An Unusual Occurrence of Trifluoperazine-Induced Nystagmus in Persistent Hallucinatory Disorder-A Case Report.

Trifluoperazine is a conventional antipsychotic whose use has been limited with the arrival of relatively new atypical antipsychotics. However, conventional antipsychotics are utilized in the management of psychiatric illnesses comorbid with metabolic disorders such as diabetes or dyslipidemia. Though trifluoperazine has been known to cause extrapyramidal symptoms, rarely ophthalmic symptoms manifest. Here, we discuss the rare occurrence of newly-emergent nystagmus in an individual with persistent hallucinatory disorder and comorbid diabetes mellitus treated with trifluoperazine.

Duration of suicide process among suicide attempters and characteristics of those providing window of opportunity for intervention.

BACKGROUND: There is limited cross-cultural literature on the duration of suicide process among attempters. AIMS: The primary aim was to assess the duration of suicide process among suicide attempters attending the Crisis Intervention Clinic. We also aimed to identify the characteristics of those who reported a longer duration for this process. METHODS: In this retrospective record-based study, we collected the duration of the suicidal process from the records of all the suicide attempters evaluated over a 3-year period (n = 319). Attempters were divided into four groups based on the quartile value of the duration of the suicidal process. For analysis, the characteristics of those in the last quartile with suicide process time of >120 min (n = 75) were compared with those in the first three (n = 244). Those in the last quartile were considered to provide a window of opportunity for intervention. RESULTS: The median time for the suicidal process was 30 min (interquartile range of 5 min to 120 min). Seventy-five (23.5%) subjects belonged to the fourth quartile (duration of suicide process >120 min). A significant proportion of them came from urban areas (P = 0.011), had a diagnosis of mood disorder (P = 0.028), had visited a health professional in the recent past (P = 0.015), and had lower rates of attempt under intoxication (P = 0.005). A lesser proportion of them showed problem-focused disengagement style of coping strategy (P = 0.015). CONCLUSIONS: The suicide process time among Indian suicide attempters is short. However, a quarter of them has suicide process duration of 2 h which provides some scope for intervention. Individual and community level interventions need further evaluation for their potential efficacy in preventing the progress of the suicidal process.

Is Depression an Inflammatory Disease? Findings from a Cross-Sectional Study at a Tertiary Care Center.

BACKGROUND: Evidence linking inflammation and depression is marred by several methodological inconsistencies. Further, varying information is present on the role of gender as a potential confounder in this association. AIMS: To assess systemic inflammation in drug naοve depression by measuring selected pro-inflammatory (tumor necrosis factor-alpha [TNF-α], interleukin-6 [IL-6]) and anti-inflammatory cytokines (transforming growth factor-beta [TGF-ß]) and comparing them with a matched control group. We also aimed at exploring the differences in these markers between genders. SETTING AND DESIGN: The study was a cross-sectional one carried out a teaching cum Tertiary Care Hospital. MATERIALS AND METHODS: We recruited 55 drug naοve cases diagnosed with major depression and compared them for inflammatory markers with a matched apparently healthy control group (n = 42) at baseline. The inflammatory markers were also compared between the genders. Baseline depression and stress levels were assessed using standard measures. STATISTICAL ANALYSIS USED: Mann-Whitney U-test. RESULTS: In comparison with healthy controls, drug naοve depressed individuals demonstrated significantly raised baseline levels of TNF-α and IL-6 (P < 0.001 for both) but no difference in levels of TGF-ß (P = 0.433). Neither the baseline depression nor the stress scores correlated with any of the inflammatory markers (P = 0.955 and 0.816 for TNF-α respectively). Males and females were comparable on the levels of markers studied (P = 0.986, 0.415, and 0.430 for TNF-α, IL-6 and TGF-ß respectively). CONCLUSION: There is evidence for higher baseline inflammation in depression prior to starting anti-depressant therapy. Gender does not mediate this observed link between inflammation and depression.

Evaluation of interleukin-6 and serotonin as biomarkers to predict response to fluoxetine.

OBJECTIVE: Only 30% of major depressive disorder (MDD) patients achieve complete remission with a serotonergic antidepressant (selective serotonin reuptake inhibitor). We investigated the potential of serotonin (5-HT) and interleukin-6 (IL-6) to serve as functional biomarkers of fluoxetine response. METHODS: Serum IL-6 and 5-HT were measured in 73 MDD patients (39 responders and 34 non-responders) pre- and 6 weeks post-treatment and in 44 normal controls with ELISA. Fluoxetine and norfluoxetine were measured using LC MS/MS. RESULTS: IL-6 levels were significantly higher in MDD patients when compared with controls (p < 0.01), and 5-HT levels were significantly lower in non-responders compared with controls (p = 0.0131). Pre- and post-treatment levels of both biomarkers individually and in combination did not significantly differ between responders and non-responders. Area under the receiver operating characteristics curve for the biomarkers was 0.5. Significant correlation was seen between the percentage change in IL-6 and percentage change in Hamilton Rating Scale for Depression score in responders. Fluoxetine and norfluoxetine concentrations were not significantly different in responders and non-responders, and there was no correlation between fluoxetine concentrations and percentage reduction in 5-HT from week 0 to 6. CONCLUSION: 5-HT and IL-6 may not serve as useful markers of response to fluoxetine because of inconsistent results across different studies. Copyright © 2016 John Wiley & Sons, Ltd.

Gender differences among suicide attempters attending a Crisis Intervention Clinic in South India.

BACKGROUND AND OBJECTIVES: Studying gender differences among suicide attempters is important for identifying gender-specific risk factors and for planning management and prevention. Our objective was to delineate gender differences among a well-defined group of suicide attempters. MATERIALS AND METHODS: This record-based study was conducted among patients presenting to a Crisis Intervention Clinic in a Tertiary Care Hospital in South India. Information was gathered regarding sociodemographic and clinical characteristics. Hopelessness was measured using Beck Hopelessness Scale (BHS), and stress was evaluated using Presumptive Stressful Life Events Scale (PSLES). RESULTS: The sample comprised of 162 males and 137 females. Males were significantly older and were more likely to be employed as compared to females. Alcohol use was significantly more in males and number of men who attempted suicide under intoxication was significantly higher. Females had a greater proportion of attempts with the use of plant poisons and medication overdose. There was no significant difference between two genders on BHS though differences were noted on types of stresses reported on PSLES. CONCLUSION: Gender-specific differences were noted with regard to substance use, mode of attempt and types of stressors experienced. Identifying these factors might help us to design targeted interventions to prevent further attempts.