The association of plasma acyl ghrelin level with alcohol craving in early abstinent alcohol dependent patients.

BACKGROUND: Craving plays an important role in maintenance of alcohol dependence. Earlier studies have analyzed the role of ghrelin in craving and their results have been heterogenous. Acyl ghrelin is its more active form as it crosses the blood brain barrier. Hence we aimed to examine the relationship between plasma acyl ghrelin and craving in Indian patients having alcohol dependence syndrome. METHODS: The present study was a hospital-based prospective study. A total of 60 drug-naive patients of alcohol dependence and 30 healthy controls were included. After taking informed consent fasting blood samples were collected from them on day 1 and tested for plasma acyl ghrelin level. Fasting blood samples were repeated in all cases on day 14. During this time, we also assessed the patients' cravings by obsessive compulsive drinking scale, and alcohol craving questionnaire; and withdrawal by clinical institute withdrawal assessment for alcohol scale. These scales were repeated on day 14. Data analysis was done by SPSS version 25.0. RESULTS: Plasma concentrations of acyl ghrelin increased significantly during early abstinence in patients from day 1 to day 14 (P < 0.0001). Pearson correlation test revealed a trend of positive correlation between plasma concentration of acyl ghrelin on day 14 and severity of craving on day 1. CONCLUSION: Our results suggest the plasma concentration of acyl ghrelin may be a predictor of severity of alcohol craving during early abstinence. Anti-craving drugs acting on acyl ghrelin level in brain may open an innovative avenue for optimum treatment of alcohol dependence.

Serum prolactin level and its correlation with psychopathology in drug free/drug naïve schizophrenia a case control study.

BACKGROUND: There is a discrepancy in literature regarding level of prolactin in drug free/ drug naïve patients with non-affective psychosis. Few earlier studies have found low levels of prolactin whereas recent studies have found high levels of prolactin when compared to controls. Most of these studies have not considered the possible confounding factors. Also ours is the first study that evaluated the correlation between psychopathology & prolactin levels after considering the confounding agents. METHOD: It was a cross sectional, hospital based case control study. Purposive sampling was done to identify the cases of schizophrenia. 59 cases and 59 controls fulfilling inclusion and exclusion criteria were taken for the study after taking consent. Socio-demographic and other relevant clinical data were collected. Scores of PANSS AND BPRS were collected on the day of admission. Blood samples were collected from 8 to 10 am in the morning. Samples were centrifuged and the serum was stored in sterile vials at minus 80° centigrade. Serum Prolactin, free T3, freeT4, Thyroid Stimulating Hormone & Cortisol levels were evaluated for both cases and controls and correlation between them and with psychopathology of cases was seen. RESULTS: Our study showed that prolactin level was increased in drug free/naïve cases of schizophrenia. Significant difference was found between T4 levels of cases and controls. No correlation was found between prolactin and psychopathology. CONCLUSION: Prolactin is increased in drug free/ drug naïve patients of schizophrenia and this is not related to confounding factors. There was no significant correlation between prolactin and psychopathology.

Chronic non-fatal Datura abuse in a patient of paranoid schizophrenia: a case report.

INTRODUCTION: A range of psychoactive substances used by patients suffering from schizophrenia varies and may include those which are fatal and may cause serious toxicity leading to death. We here present a case report of a patient suffering from paranoid schizophrenia, who was abusing Datura stramonium over a prolonged period. CASE SUMMARY: A 32 year old male presented with aggressive behaviour, irritability for 6 years and regular intake of Datura seeds for 3 years. After taking detailed history and mental status examination (MSE), diagnoses of paranoid schizophrenia and mental and behavioral disorder due to use of hallucinogen were made. He had shown improvement on standard treatment with antipsychotics. CONCLUSION: D. stramonium is recognized among emerging new psychoactive substances being used across the world. Among various theories we discuss self-medication hypothesis as a mediating factor for this case. Though D. stramonium is notorious for its life threatening sequelae, clinicians should be aware of its chronic abuse as self-medication.

Factor analysis of positive and negative syndrome scale in schizophrenia: An exploratory study.

BACKGROUND: Controversy persists with regard to how best we can categorize symptomatic dimension of Schizophrenia. Aim of the study was to compute factorial dimensions in Indian subset of schizophrenic patients and to compare them with five factor pentagonal model extracted in western studies. MATERIALS AND METHODS: 150 inpatients of Schizophrenia with acute exacerbation were subjected to PANSS rating within one week of admission and statistical calculation done based on exploratory factor analysis. RESULTS: Five factors namely negative, autistic, activation, positive and depression were extracted wherein negative factors showed highest percentage of total variance supporting five factor modal of western literature CONCLUSION: A consensus is gradually emerging regarding symptomatic dimensions of Schizophrenia.

Lithium-induced sinus node dysfunction at therapeutic serum levels.

Lithium-induced cardiotoxicity, though rare at therapeutic levels, has been reported frequently in overdoses. We report a patient who developed sinus bradycardia while being treated with lithium carbonate even though the serum lithium levels were within the therapeutic range. It reversed following withdrawal of lithium and did not reappear with subsequent treatment with valproate.

A study of contingent negative variation and post-imperative negative variation: search for state and trait electrophysiological markers in schizophrenia.

OBJECTIVE: To compare event-related potential measures, contingent negative variation and post-imperative negative variation in drug-naïve or drug-free schizophrenic patients and normal healthy controls, and to study the effect of antipsychotic medication on the above measures. METHODS: A hospital-based prospective study was conducted at Central Institute of Psychiatry, Ranchi, India. The sample constituted 31 drug-naïve or drug-free patients with schizophrenia and 31 normal healthy individuals, matched for age and gender. An S1-S2 paradigm was used, in which the warning stimulus (S1) was auditory and the target stimulus or imperative stimulus (S2) was visual. The early contingent negative variation was marked at 500 milliseconds after S1, and late contingent negative variation was marked as the negative wave just prior to S2. The post-imperative negative variation was measured as the continued negativity after S2. RESULTS: Drug-naïve and drug-free patients significantly differed from the controls on amplitudes of early and late contingent negative variations, as well as on latency of late contingent negative variation. The rate for correct classification in 80% of cases (Wilks' lambda = 0.76) was observed in measuring amplitude of late contingent negative variation only. After exposure to antipsychotic drugs, the late contingent negative variation amplitude was found to normalise in the patient group. CONCLUSION: The late contingent negative variation could be considered a state marker for schizophrenia.

Insight in schizophrenia and its association with executive functions.

BACKGROUND: Lack of insight or awareness of illness is most frequently observed in patients with schizophrenia, and it influences treatment compliance. It has been hypothesized that the frontal dysfunction may explain poor insight in schizophrenia. AIM: The purposes of the study were to assess the degree of insight in schizophrenia and to examine the association, if any, between the degree of insight and executive functions in patients with schizophrenia. MATERIALS AND METHODS: In this pre-post study, 30 patients of both sexes diagnosed to have schizophrenia were assessed with the Scale to Assess Unawareness of Mental Disorder and Wisconsin Card Sorting Test (WCST). They were assessed once at the time of admission and then at the time of their discharge. RESULTS: The study revealed that 70% of the subjects possessed poor awareness of mental disorder. There was significant improvement of insight over time. The degree of insight was significantly associated with the performance on WCST 2(nd) assessment. WCST scores were able to explain 42% of the variance in insight. CONCLUSION: Majority of schizophrenic patients possess poor insight. This poor insight is significantly associated with poor executive function. Hence poor insight may have a cognitive etiology.

Atypicality in presentation of neuroleptic malignant syndrome caused by olanzapine.

Neuroleptic malignant syndrome (NMS) is the most serious of acute neurological side effects produced by antipsychotic medication, characterized by hyperthermia, rigidity, altered consciousness and autonomic dysfunction, the prevalence of which varies from 0.4-1.4%. NMS is usually seen in treatment with high potency typical antipsychotics and very rarely with atypical antipsychotics. However, NMS cases have been reported with risperidone, clozapine, olanzapine and quetiapine. The presentations of NMS have often varied and we report another atypicality in presentation of NMS due to olanzapine use.

The role of Gateway drugs and psychosocial factors in substance dependence in Eastern India.

OBJECTIVE: Western studies have identified the gateway patterns of substance use which lead the way from the so called "Soft Drugs" (like nicotine, etc.) to the "Hard Drugs" (like Opioids) [the Gateway hypothesis]. Nicotine and alcohol have been implicated as the most common initiating drugs in studies from different places, however, studies are lacking from this region. This study was designed to find the drugs of initiation and to understand the factors for initiation, maintenance, and relapse of these substances in persons dependent on them in Eastern India. METHOD: Seventy subjects with ICD 10 DCR diagnosis of substance dependence admitted consecutively in Center for Addiction Psychiatry, Central Institute of Psychiatry (CIP), Ranchi, were taken up for the study after taking written informed consent. A semistructured questionnaire including the substance use part of Mini International Neuropsychiatric Inventory (MINI) was administered. RESULTS: Alcohol and opioids were the most common drugs of dependence but nicotine and alcohol were found to be the most common initiating drugs in both alcohol and opioid groups. Persons dependent on opioids presented earlier for treatment, with earlier development of withdrawal symptoms and having completed lesser years of formal education, and had higher monthly incomes as compared to those dependent on alcohol. The most common psychosocial factors determining initiation and maintenance were peer pressure or curiosity. CONCLUSIONS: If adolescents and youth can be motivated to stay away even from the "gateway drugs" by targeting common initiation factors, it may lead to delay in dependence or possibly avoidance of development of dependence.

Ganser'S syndrome : a report of two unusual presentations.

Ganser's syndrome is a rare and controversial entity in psychiatric nosology. We report two cases ofGS, one developing in a 12-year-old boy, which had their onset during an episode of mania. After recovery from Ganser's syndrome, these cases were followed-up for two and five years, respectively. Interestingly both these patients evolved into bipolar disorder with one patient showing recurrence of Ganser symptoms with each subsequent episode. The importance of following-up and relevance of affective symptoms in GS is discussed.

Genomic imprinting in bipolar affective disorder.

With recent advances in molecular genetics, a new mechanism proposed for the inheritance of Bipolar Disorder is Genomic Imprinting or Parent of Origin Affect. In this study of 79 consecutive first episode manic patients, predominantly male, we failed to establish the phenomenon of imprinting. With other proposed non-Mendelian patterns of inheritance, it may be that bipolar disorder is genetically heterogenous.

Subdural hygroma presenting as dementia with kluver-bucy symptoms.

Dementia is not an uncommon presentation in psychiatric practice. Of the various causes of reversible dementia, subdural hygroma is a lesser-known potentially reversible cause. A case of dementia with Kluver-Bucy symptoms secondary to subdural hygroma is described and implications of Kluver-Bucy symptoms in dementia are discussed.

Drug non-compliance in mania : the Indian experience.

A prominent relationship has been proposed between compliance and various factors, like the patient's individual characteristics, the illness and medication being prescribed to the patient. We compared 20 manic patients who were non compliant to medication with a control group, who were matched on the demographic variable, illness variables and the treatment prescribed. We first examined the reason for non compliance from the patient's perspective, and found out the commonest reason for non compliance to be 'side effect of the medicines' (35.0%), followed by the sense of 'feeling well' (30.0%). On assessing the patient's personality traits using 16PF, we found significant elevation on factor L, signifying characteristics like pretension, jealousy, suspiciousness etc. On the DMI, the patients got significantly lower scores on the variable PRN - indicating less use of defenses like inteilectualization and rationalization. Based on these findings we came to the conclusion that noncompiiant patients use less of mature defenses and more of primitive defenses.

Comorbidity in children with mental retardation.

This study was conducted in the child psychiatry unit of a tertiary psychiatric hospital. 60 patients diagnosed to have mental retardation according to ICD-10 (WHO, 1992) criteria constituted the study sample. A psychiatric disorder was present in 56.17% of the cases, and a medical disease was present in 35.0%. Only 13.3% cases had both a psychiatric as well as medical illness. Patients with a psychiatric illness were found to have a lesser degree of retardation. The commonest psychiatric disorder observed was behavioural and emotional disorders, while the commonest medical illness found was epilepsy. Patients with a medical illness were found to have a negative family history for a mental illness, and were much younger at the first consultation compared to the patients with a psychiatric illness. The above findings have been discussed, with emphasis on issues like dual diagnosis and diagnostic overshadowing.