Attention Deficits in a Comorbidity-Free Sample of Euthymic Pediatric Bipolar Disorder.

Attention deficits are considered one of the potential endophenotypic markers of Bipolar Disorder (BD). Pediatric bipolar disorder (PBD) likely has stronger genetic underpinnings than adult onset BD; therefore, demonstrating attention deficits in PBD can be both strategic and convincing in attesting their status as one of the potential endophenotypic markers of BD. However, unlike adult literature, uncertainty exists regarding the magnitude of attention deficits in PBD. In this regard, one key unresolved question is the potential impact of attention deficit hyperactivity disorder (ADHD). The main goal of the study was to examine attention deficits in a comorbidity-free sample of euthymic PBD patients. Thirty (21 boys, 9 girls) remitted PBD patients without co-morbidity and thirty age (<17 years), sex, handedness, and Full-Scale IQ matched control subjects were compared on performance on attention tasks. Working memory (WM), which might potentially confound with the attention task performances, was also examined. Compared to controls, PBD patients performed poorly on various tests of attention, but not on any WM tasks. Further, it was found that observed attention deficits were independent of residual mood symptoms, medication effect or illness characteristics. Such attention deficits in this comorbidity-free PBD sample further endorses its status as an endophenotypic marker of bipolar disorders and establishes continuity with deficits found in adult bipolar patients.

National Mental Health Survey of India, 2016 - Rationale, design and methods.

Understanding the burden and pattern of mental disorders as well as mapping the existing resources for delivery of mental health services in India, has been a felt need over decades. Recognizing this necessity, the Ministry of Health and Family Welfare, Government of India, commissioned the National Mental Health Survey (NMHS) in the year 2014-15. The NMHS aimed to estimate the prevalence and burden of mental health disorders in India and identify current treatment gaps, existing patterns of health-care seeking, service utilization patterns, along with an understanding of the impact and disability due to these disorders. This paper describes the design, steps and the methodology adopted for phase 1 of the NMHS conducted in India. The NMHS phase 1 covered a representative population of 39,532 from 12 states across 6 regions of India, namely, the states of Punjab and Uttar Pradesh (North); Tamil Nadu and Kerala (South); Jharkhand and West Bengal (East); Rajasthan and Gujarat (West); Madhya Pradesh and Chhattisgarh (Central) and Assam and Manipur (North East). The NMHS of India (2015-16) is a unique representative survey which adopted a uniform and standardized methodology which sought to overcome limitations of previous surveys. It employed a multi-stage, stratified, random cluster sampling technique, with random selection of clusters based on Probability Proportionate to Size. It was expected that the findings from the NMHS 2015-16 would reveal the burden of mental disorders, the magnitude of the treatment gap, existing challenges and prevailing barriers in the mental-health delivery systems in the country at a single point in time. It is hoped that the results of NMHS will provide the evidence to strengthen and implement mental health policies and programs in the near future and provide the rationale to enhance investment in mental health care in India. It is also hoped that the NMHS will provide a framework for conducting similar population based surveys on mental health and other public health problems in low and middle-income countries.

Gender differences in obsessive-compulsive disorder: Findings from a multicentric study from India.

Obsessive-compulsive disorder (OCD) is phenotypically heterogeneous. Gender is an important factor mediating this heterogeneity. We examined gender differences in a large sample (n = 945) of OCD patients under a multi-centric study in India. Cross-sectional assessments were done on consecutive adult (>18 years) treatment-seeking patients with a DSM-5 diagnosis of OCD. Subjects were assessed on Structured Clinical Interview for DSM-5-Research Version for comorbid psychiatric illnesses, Yale Brown Obsessive Compulsive Scale for OCD phenomenology and symptom severity, Brown Assessment of Beliefs Scale for insight, Beck's Depression Inventory for severity of depressive symptoms, and the Obsessive Beliefs Questionnaire. On multivariate backward Wald logistic regression analysis, males (59.7%) had more years of education, had a higher rate of checking compulsions and comorbid substance use disorders. Women were more likely to be married, more commonly reported precipitating factors, had a higher rate of hoarding compulsions and comorbid agoraphobia. Findings from this large study validate gender as an important mediator of phenotypic heterogeneity in OCD. The mechanistic basis for these differences might involve complex interactions between biological, cultural and environmental factors.

Role of mindfulness in dissociative disorders among adolescents.

CONTEXT: Dissociation is understood as maladaptive coping and is common in children and adolescents. Treatment outcome studies show improvement in comorbid conditions suggesting the need to implement programs that target dissociative pathology. AIM: To study the effect of practicing mindfulness among adolescents diagnosed with dissociative disorders. SETTINGS AND DESIGN: It was a hospital-based repeated measures design. MATERIALS AND METHODS: 7 adolescents participated in a mindfulness-based therapeutic program for 6 weeks. STATISTICAL ANALYSIS: Scores were expressed as mean ± standard deviation. Friedman test was used to assess significance of the difference in scores at various assessment phases. Wilcoxon signed rank test was used for post hoc analysis. RESULTS: Participants were mostly female adolescents from rural, Eastern India. There was a significant reduction in dissociative experiences and significant improvement in mindfulness. CONCLUSIONS: Incorporating mindfulness in clinical practice may prove effective in reducing dissociation and promoting adaptive functioning.

Bereitschaftspotential in remitted paediatric bipolar disorder.

Bereitschaftspotential (BP) is an anticipatory slow wave in the brain that typically precedes a voluntary motor act and its deficit reflects abnormal motor preparatory processes in the brain. Although BP deficits have been consistently noticed in schizophrenia, similar research in depression has yielded contradictory results; therefore, it is unclear if motor anticipatory processes are actually abnormal in mood disorder. We compared both early and late BP between thirty remitted paediatric bipolar patients (PBD) and thirty matched healthy control group subjects. We did not find any evidence of BP abnormality in PBD, indicating normal motor preparatory processes in this condition. This finding is in agreement with our previous research reporting normal anticipatory slow waves in bipolar subjects. Future research needs to address the specificity of normal anticipatory slow waves in bipolar disorder, compared to other major Psychoses.

The contingent negative variation in remitted paediatric bipolar patients: no evidence of abnormality.

Although the Contingent Negative Variation (CNV) paradigm has been useful in schizophrenia, limited research involving such paradigm in subjects with Bipolar Disorder (BD) has produced contradictory findings. To the best of our knowledge, no study has investigated CNV in Paediatric Bipolar Disorder (PBD) subjects. Thirty remitted PBD patients and thirty matched healthy control group subjects participated in the study. No significant between group main effect could be found for either CNV latency or amplitude. We propose that CNV is unlikely to be a true endophenotype of BD. However, absence of CNV finding during euthymic phase in BD may help us in advancing our understanding of BD and such finding may, in fact, have some specificity with regard to differentiating BD from schizophrenia.

Current social functioning in adult-onset schizophrenia and its relation with positive symptoms.

BACKGROUND: In schizophrenia, relation exists between psychopathology and social functioning. AIM AND OBJECTIVES: Determining relationship of positive symptoms with current social functioning in adult-onset (≥19 years) schizophrenia. MATERIALS AND METHODS: Eighty schizophrenia patients [ICD-10-DCR], of both sexes (18-60 years), on follow-up for ≥6 months, with no change of diagnosis and without co-morbidities, having onset of illness ≥19 years of age, accompanied by informants having contact with the patient for a period of >12 months prior the first psychiatric contact or symptom onset were assessed with SCARF- Social Functioning Index and SAPS. RESULTS: Family role, occupational role, and other social role have negative correlation with all positive symptoms. CONCLUSION: Current social functioning has significant negative correlation with concurrent positive symptoms.

Euthanasia: An Indian perspective.

In our society, the palliative care and quality of life issues in patients with terminal illnesses like advanced cancer and AIDS have become an important concern for clinicians. Parallel to this concern has arisen another controversial issue-euthanasia or "mercy -killing" of terminally ill patients. Proponents of physician-assisted suicide (PAS) feel that an individual's right to autonomy automatically entitles him to choose a painless death. The opponents feel that a physician's role in the death of an individual violates the central tenet of the medical profession. Moreover, undiagnosed depression and possibility of social 'coercion' in people asking for euthanasia put a further question mark on the ethical principles underlying such an act. These concerns have led to strict guidelines for implementing PAS. Assessment of the mental state of the person consenting to PAS becomes mandatory and here, the role of the psychiatrist becomes pivotal. Although considered illegal in our country, PAS has several advocates in the form of voluntary organizations like "death with dignity" foundation. This has got a fillip in the recent Honourable Supreme Court Judgment in the Aruna Shaunbag case. What remains to be seen is how long it takes before this sensitive issue rattles the Indian legislature.

Theta-patterned, frequency-modulated priming stimulation enhances low-frequency, right prefrontal cortex repetitive transcranial magnetic stimulation (rTMS) in depression: a randomized, sham-controlled study.

Efficacy of repetitive, transcranial magnetic stimulation (rTMS) has been found in depression; however, doubt still remains about its effectiveness in clinical practice. In this context, results are being explored. The authors, describing new techniques to improve response rates to rTMS treatment, compared the efficacy of adjuvant, frequency-modulated, active-priming rTMS with sham-priming stimulation in the theta range in patients with moderate-to-severe depression receiving low-frequency rTMS. Forty patients with moderate-to-severe depression (ICD-10 DCR) were alternately assigned to receive add-on, active-priming rTMS (4-8 Hz; 400 pulses, at 90% of motor threshold [MT]) or sham-priming stimulation followed by low-frequency rTMS (1-Hz; 900 pulses at 110% of MT) over the right dorsolateral prefrontal cortex. They were rated with the Structured Interview Guide for the Hamilton Depression Rating Scale (SIGH-D), the Brief Psychiatric Rating Scale (BPRS), and the Clinical Global Impression-Severity of Illness (CGI-S) scale at baseline, after the 5th and 10th rTMS, and 2 weeks post-rTMS. For SIGH-D scores, there was significant improvement in the active group over time. Stepwise linear-regression analysis showed that age at onset significantly predicted SIGH-D scores after the 5th rTMS session in the active-priming group. Pre-stimulation with frequency-modulated priming stimulation in the theta range has greater antidepressant effect than low-frequency stimulation alone.

Auditory P300 study in remittent bipolar child and adolescent population.

OBJECTIVES: Previous studies have revealed P300 abnormality in adult bipolar population, both in acute and euthymic phases and also in their first-degree relatives. To the best of our knowledge there are limited data in the child and adolescent bipolar population. In this study we attempt to record P300 amplitudes and latencies of remittent child and adolescent bipolar patients and compare them with normal controls. METHOD: 25 remittent child and adolescent bipolar patients and 25 age, sex matched controls were recruited. P300 was recorded using the auditory oddball paradigm. RESULTS: There was significant increase in latency of P300 at midline, parietal leads, and the frontal and central leads decreased significantly at the parietal and frontal leads in the patient population. Amplitude was more in the patient group as compared to controls. CONCLUSION: The present findings of prolonged latency and reduced amplitude of P300 in the remission and the phase of bipolar illness indicate that cognitive processing deficits persist beyond illness and P300 could be a promising candidate endophenotype for future research.

Chloroquine-induced recurrent psychosis.

Chloroquine is a commonly prescribed antimalarial drug that is widely used for the presumptive treatment of malaria in India. It has rarely been reported to cause psychosis, and to the best of our knowledge, recurrent psychosis due to chloroquine use has been reported only once, in 1996. We are reporting the second case of chloroquine-induced recurrent psychosis. We also discuss some of the possible neurobiological mechanisms leading to this neurotoxic adverse effect and our recommendations for future use of this drug.

Duloxetine for childhood depression with pain and dissociative symptoms.

Over two thirds of people suffering from depression complain of pain with or without reporting psychological symptoms. Physical symptoms are more prevalent among the women, the elderly, the poor, and in children population. Successful treatment of depression in children complicated by pain symptoms constitutes a great clinical challenge. Duloxetine has already emerged as a safe and effective treatment option for adult depressed patients with painful physical symptoms. However, no data exist in literature which suggests use of duloxetine in childhood and adolescent population for the same clinical indication. We report a case documenting successful use of duloxetine in a depressed girl child who also had severe pain and dissociative symptoms.

Intravenous valproate in acute adolescent mania: a preliminary report.

This study evaluated the efficacy and tolerability of intravenous valproate in acute mania in adolescents. Five consecutive patients, meeting the study criteria, were treated with intravenous valproate. Of them, three significantly improved and one had no appreciable improvement. Two out of five patients experienced gastrointestinal and neurological side effects. This preliminary study suggests intravenous valproate is useful and safe to treat acute juvenile mania.

Demographic and clinical correlates of substance abuse comorbidity in schizophrenia.

Seventy patients of schizophrenia were divided into two groups based on the presence or absence of substance abusing history in them. Two groups were compared on various socio-demographic and clinical variables. Thirty-eight (54.3%) patients could be diagnosed as having comorbid alcohol/substance abuse/dependence. Seventeen (24.3%) of them were poly-substance abusers. Comorbid substance abusers were predominantly represented by positive syndrome while non-abusers by negative syndrome. In contrast to the report by the most western researchers, most patients in the present study with a diagnosis of substance abusing schizophrenia were married. Similar study from a developing country is rare in the existing literature.