Late onset psychosis in a case of 15q11.2 BP1-BP2 microdeletion (Burnside-Butler) syndrome: A case report and literature review.

Burnside-Butler syndrome is an inheritable genetic condition characterized by the partial deletion of specific genetic material located on chromosome 15q11. Individuals diagnosed with this particular medical condition display a variety of neuropsychiatric disorders, including psychosis, aggression, mood disorders, anxiety disorders, developmental disorders involving learning difficulties, language delays, autism spectrum disorders, and attention-deficit/hyperactivity disorder. The authors discuss the case of a 51-year-old Caucasian female diagnosed with Burnside-Butler syndrome at 8 years. The article highlights the importance of raising awareness regarding the complex nature and delayed onset of neuropsychiatric symptoms associated with this syndrome. It also emphasizes the need for comprehensive evaluation and multidisciplinary care for individuals affected by this uncommon condition.

Different climate sensitivity for radial growth, but uniform for tree-ring stable isotopes along an aridity gradient in Polylepis tarapacana, the world's highest elevation tree species.

Tree growth is generally considered to be temperature limited at upper elevation treelines, yet climate factors controlling tree growth at semiarid treelines are poorly understood. We explored the influence of climate on stem growth and stable isotopes for Polylepis tarapacana Philipi, the world's highest elevation tree species, which is found only in the South American Altiplano. We developed tree-ring width index (RWI), oxygen (δ18O) and carbon (δ13C) chronologies for the last 60 years at four P. tarapacana stands located above 4400 m in elevation, along a 500 km latitude aridity gradient. Total annual precipitation decreased from 300 to 200 mm from the northern to the southern sites. We used RWI as a proxy of wood formation (carbon sink) and isotopic tree-ring signatures as proxies of leaf-level gas exchange processes (carbon source). We found distinct climatic conditions regulating carbon sink processes along the gradient. Current growing-season temperature regulated RWI at northern-wetter sites, while prior growing-season precipitation determined RWI at arid southern sites. This suggests that the relative importance of temperature to precipitation in regulating tree growth is driven by site water availability. By contrast, warm and dry growing seasons resulted in enriched tree-ring δ13C and δ18O at all study sites, suggesting that similar climate conditions control carbon-source processes along the gradient. Site-level δ13C and δ18O chronologies were significantly and positively related at all sites, with the strongest relationships among the southern drier stands. This indicates an overall regulation of intercellular carbon dioxide via stomatal conductance for the entire P. tarapacana network, with greater stomatal control when aridity increases. This manuscript also highlights a coupling (decoupling) between physiological processes at leaf level and wood formation as a function of similarities (differences) in their climatic sensitivity. This study contributes to a better understanding and prediction of the response of high-elevation Polylepis woodlands to rapid climate changes and projected drying in the Altiplano.

Seven centuries of reconstructed Brahmaputra River discharge demonstrate underestimated high discharge and flood hazard frequency.

The lower Brahmaputra River in Bangladesh and Northeast India often floods during the monsoon season, with catastrophic consequences for people throughout the region. While most climate models predict an intensified monsoon and increase in flood risk with warming, robust baseline estimates of natural climate variability in the basin are limited by the short observational record. Here we use a new seven-century (1309-2004 C.E) tree-ring reconstruction of monsoon season Brahmaputra discharge to demonstrate that the early instrumental period (1956-1986 C.E.) ranks amongst the driest of the past seven centuries (13th percentile). Further, flood hazard inferred from the recurrence frequency of high discharge years is severely underestimated by 24-38% in the instrumental record compared to previous centuries and climate model projections. A focus on only recent observations will therefore be insufficient to accurately characterise flood hazard risk in the region, both in the context of natural variability and climate change.

Improvement in neurocognitive functions and serum brain-derived neurotrophic factor levels in patients with depression treated with antidepressants and yoga.

CONTEXT AND AIMS: Impairment in cognition is well-known in patients with major depressive disorder. This study examined the effect of yoga therapy with or without antidepressants and antidepressants alone on certain neuropsychological functions in patients with depression. Correlation between changes in neuropsychological test performance and serum brain-derived neurotrophic factor (BDNF) levels was also explored. MATERIALS AND METHODS: Antidepressant-naïve/antidepressant-free outpatients with depression received antidepressant medication alone (n = 23) or yoga therapy with (n = 26) or without (n = 16) antidepressants. Depression was assessed using the Hamilton Depression Rating Scale. Neuropsychological tests included digit-span forward and backward, Rey Auditory Verbal Learning Test, and Trail Making Tests (TMT-A and B). These tests were administered before and 3 months after the treatment in patients, and once in healthy comparison subjects (n = 19). STATISTICAL ANALYSIS: Baseline differences were analyzed using independent sample t-test, Chi-square, and one-way ANOVA. Paired t-test was used to analyze the change from baseline to follow-up. Pearson's correlation was used to explore the association of change between 2 variables. RESULTS: Patients had impaired performance on most neuropsychological tests. After 3 months, there was significant improvement - patients' performance was comparable to that of healthy controls on majority of the tests. Significant inverse correlation was observed between increase in BDNF levels and improvement in TMT "A" duration in Yoga-alone group (r = -0.647; P = 0.009). CONCLUSIONS: To conclude that, Yoga therapy, alone or in combination with medications, is associated with improved neuropsychological functions and neuroplastic effects in patients with depression.

Add-on Aripiprazole for Atypical Antipsychotic-induced, Clinically Significant Hyperprolactinemia.

BACKGROUND: Antipsychotic treatment-induced hyperprolactinemia is a highly distressing and disabling side effect for patients. The use of add-on aripiprazole has been identified as a possible treatment strategy in this situation. However, data on prolactin changes with add-on aripiprazole in a real-world naturalistic clinical setting from India are sparse. MATERIALS AND METHODS: The retrospective chart review was conducted at the specialty metabolic clinic at the National Institute of Mental Health and Neurosciences, Bengaluru, India. Sixteen patients (female: male = 13:3) who were on a stable dose of antipsychotic medications, complaining of either sexual dysfunction or menstrual irregularities, were prescribed add-on aripiprazole. The serum prolactin values were obtained before the initiation of aripiprazole and during the follow-up. RESULTS: Patients were on treatment with risperidone, amisulpride, and olanzapine and had a prolactin level of 87.1 ± 60.7 ng/ml. Add-on aripiprazole treatment was given with a mean dose of 13.8 ± 7.4 mg/day. Patients had a significant reduction in prolactin level (35.6 ± 29.1 ng/ml) following treatment with aripiprazole (P = 0.004). CONCLUSIONS: Add-on aripiprazole could be a clinically useful strategy in patients who develop antipsychotic-induced hyperprolactinemia.

Investigating the causes of increased 20th-century fall precipitation over the southeastern United States.

Much of the eastern United States (US) experienced increased precipitation over the 20th century. Characterizing these trends and their causes is critical for assessing future hydroclimate risks. Here, US precipitation trends are analyzed during 1895-2016, revealing that fall precipitation in the southeastern region north of the Gulf of Mexico (SE-Gulf) increased by nearly 40%, primarily increasing after the mid-1900s. As fall is the climatological dry season in the SE-Gulf and precipitation in other seasons changed insignificantly, the seasonal precipitation cycle diminished substantially. The increase in SE-Gulf fall precipitation was caused by increased southerly moisture transport from the Gulf of Mexico, which was almost entirely driven by stronger winds associated with enhanced anticyclonic circulation west of the North Atlantic Subtropical High (NASH) and not by increases in specific humidity. Atmospheric models forced by observed SSTs and fully-coupled models forced by historical anthropogenic forcing do not robustly simulate 20th-century fall wetting in the SE-Gulf. SST-forced atmospheric models do simulate an intensified anticyclonic low-level circulation around the NASH, but the modeled intensification occurred farther west than observed. CMIP5 analyses suggest an increased likelihood of positive SE-Gulf fall precipitation trends given historical and future GHG forcing. Nevertheless, individual model simulations (both SST-forced and fully-coupled) only very rarely produce the observed magnitude of the SE-Gulf fall precipitation trend. Further research into model representation of the western ridge of the fall NASH is needed, which will help us better predict whether 20th-century increases in SE-Gulf fall precipitation will persist into the future.

Six centuries of Upper Indus Basin streamflow variability and its climatic drivers.

Our understanding of the full range of natural variability in streamflow, including how modern flow compares to the past, is poorly understood for the Upper Indus Basin (UIB) because of short instrumental gauge records. To help address this challenge, we use Hierarchical Bayesian Regression (HBR) with partial pooling to develop six centuries long (1394-2008 C.E.) streamflow reconstructions at three UIB gauges (Doyian, Gilgit, and Kachora), concurrently demonstrating that HBR can be used to reconstruct short records with interspersed missing data. At one gauge (Partab Bridge), with a longer instrumental record (47 years), we develop reconstructions using both Bayesian Regression (BR) and the more conventionally used Principal Components Regression (PCR). The reconstructions produced by PCR and BR at Partab Bridge are nearly identical and yield comparable reconstruction skill statistics, highlighting that the resulting tree-ring reconstruction of streamflow is not dependent on the choice of statistical method. Reconstructions at all four reconstructions indicate flow levels in the 1990s were higher than mean flow for the past six centuries. While streamflow appears most sensitive to accumulated winter (January-March) precipitation and summer (MJJAS) temperature, with warm summers contributing to high flow through increased melt of snow and glaciers, shifts in winter precipitation and summer temperatures cannot explain the anomalously high flow during the 1990s. Regardless, the sensitivity of streamflow to summer temperatures suggests that projected warming may increase streamflow in coming decades, though long-term water risk will additionally depend on changes in snowfall and glacial mass balance.

Serum cortisol and BDNF in patients with major depression-effect of yoga.

Depression is associated with low serum Brain Derived Neurotrophic Factor (BDNF) and elevated levels of serum cortisol. Yoga practices have been associated with antidepressant effects, increase in serum BDNF, and reduction in serum cortisol. This study examined the association between serum BDNF and cortisol levels in drug-naïve patients with depression treated with antidepressants, yoga therapy, and both. Fifty-four drug-naïve consenting adult outpatients with Major Depression (32 males) received antidepressants only (n = 16), yoga therapy only (n = 19), or yoga with antidepressants (n = 19). Serum BDNF andcortisol levels were obtained before and after 3 months using a sandwich ELISA method. One-way ANOVA, Chi-square test, and Pearson's correlation tests were used for analysis. The groups were comparable at baseline on most parameters. Significant improvement in depression scores and serum BDNF levels, and reduction in serum cortisol in the yoga groups, have been described in previous reports. A significant negative correlation was observed between change in BDNF (pre-post) and cortisol (pre-post) levels in the yoga-only group (r = -0.59, p = 0.008). In conclusion, yoga may facilitate neuroplasticity through stress reduction in depressed patients. Further studies are needed to confirm the findings and delineate the pathways for these effects.

Hazards of antihistamine dependence in psychiatric patients: a case report.

Excessive use of over-the-counter (OTC) medications has been a growing public health problem. We present the case of a patient with avoidant personality disorder, social phobia, and dull normal intelligence, with dependence to pheniramine maleate. His anxiety symptoms, initially unresponsive to conventional treatment, reduced only after stopping pheniramine during inpatient care. This case emphasizes the need for awareness and regular monitoring of the use of OTC medications in vulnerable patient populations.

Auditory Neuropathy Spectrum Disorder Masquerading as Social Anxiety.

The authors report a case of a 47-year-old man who presented with treatment-resistant anxiety disorder. Behavioral observation raised clinical suspicion of auditory neuropathy spectrum disorder. The presence of auditory neuropathy spectrum disorder was confirmed on audiological investigations. The patient was experiencing extreme symptoms of anxiety, which initially masked the underlying diagnosis of auditory neuropathy spectrum disorder. Challenges in diagnosis and treatment of auditory neuropathy spectrum disorder are discussed.

Metacognitive training for delusion in treatment-resistant schizophrenia.

Metacognitive training for patients with schizophrenia (MCT) is a novel form of psychotherapy that aims to promote insight into the relationship between metacognitive deficits and psychotic symptoms, especially delusions. MCT has been found to be effective in reducing the delusional conviction and other positive symptoms in patients with schizophrenia. However, we are not aware of any research in which MCT has been used specifically to manage treatment-resistant schizophrenia patients. We report the case of a patient with treatment-resistant schizophrenia who responded to MCT. Her persecutory and referential delusions improved with a course of twelve sessions of therapy. Further, the improvement in delusions had a positive impact on her psychosocial functioning. A follow-up after two months of therapy revealed sustained improvement.

Vitamin B12 levels and psychiatric symptomatology: a case series.

Cobalamin (Vitamin B12) has been implicated in the pathogenesis of various neuropsychiatric disorders. A review of 19 patients (14 vegetarians) with demonstrable vitamin B12 deficiency showed varied psychiatric symptomatology, with the majority not having significant hematological or neurological manifestations.

Piracetam treatment in patients with cognitive impairment.

Piracetam is a cognitive-enhancing agent that is used for the treatment of cognitive impairments of various etiologies. Little is known about its side effect profile, especially in those with psychiatric illness. We herewith present two cases with cognitive impairment who had contrasting responses to piracetam. One of them with organic amnestic syndrome had significant improvement, whereas the other who had an organic personality change as well as a family history of mental illness had significant worsening of behavioral problems after piracetam was introduced. This report highlights the need for caution in the use of piracetam, especially in those with past or family history of psychiatric illness.

Late-onset clozapine-induced agranulocytosis in a patient with comorbid multiple sclerosis.

The risk of clozapine-induced agranulocytosis is highest in the initial 6 months after onset of treatment. There have been very few reports of neutropenia and agranulocytosis after this period. We report a unique case of delayed clozapine-induced agranulocytosis in a patient with preexisting multiple sclerosis (MS) which was treated with granulocyte colony-stimulating factor. Both MS and clozapine-induced agranulocytosis have an underlying autoimmune immune mechanism. This case highlights the need for frequent blood count monitoring on clozapine even after the initial 6 months of starting treatment especially in patients with a past history of drop in white blood cell counts as well as with a comorbid autoimmune disorder.

Obsessive compulsive disorder masquerading as psychosis.

Obsessive compulsive disorder (OCD) is commonly regarded as a disorder with good insight. However, it has now been recognized that insight varies in these patients. Pathological beliefs seem to lie on a continuum of insight, with full insight at one end and delusion at the other. This can indeed pose a considerable challenge, especially in a scenario where the phenomenon is difficult to discern. We report a case of OCD, which was initially diagnosed as psychosis.

Hyperthyroidism presenting as mixed affective state: a case report.

Thyroid disorders have long been associated with psychiatric illness, commonly mood disorders. In bipolar disorder, hypothyroidism is quite a common abnormality. Little is known about the association of thyroid disorders and mixed affective states. We present a case of hyperthyroidism presenting as a mixed affective state and the successful resolution of psychiatric symptoms with antithyroid medication along with a mood-stabilizing agent.