Comparison of NLR (neutrophil/lymphocyte ratio) and PLR (platelet/lymphocyte ratio) as inflammatory markers in 1st episode mania and bipolar mania: A preliminary study.

Background: There are various factors including inflammation that have been studied in bipolar disorder. NLR (Neutrophil to lymphocyte ratio) and PLR (platelet to lymphocyte ratio) are one of them. Various psychotropic drugs can affect the inflammatory state. Aim: This study was planned to find NLR and PLR in bipolar disorder (mania) and psychotropic drug naïve 1st episode mania. Materials and Methods: Total of 120 subjects were chosen including, 40 bipolar mania, 40 drugs naïve 1st episode mania, and 40 healthy controls. The severity of mania was assessed by the Young Mania Rating Scale. Blood samples were collected in the morning hours in order to get blood counts. Results: A significantly higher values of neutrophil counts and NLR, while the significant lower values of lymphocyte counts in both 1st episode and bipolar mania compared to healthy control were observed. The first episode mania group had significantly higher neutrophil counts and NLR in comparison to bipolar mania. Conclusion: Results suggest a possible inflammatory pathophysiology of mania. Psychotropic medicines may have an anti-inflammatory effect, signified by the fact that 1st episode mania group has a greater level of inflammation in comparison to bipolar mania.

Blood pressure is associated with cognitive impairment in young hypertensives.

AIMS: The present study was conducted to assess the effects of duration of hypertension, systolic hypertension, diastolic hypertension, drug compliance and class-of-drug on cognitive functions. METHODS AND RESULTS: A cohort of young hypertensive subjects was recruited after obtaining informed consent. Subjects with confounding factors, e.g., substance use, neurological disorders, endocrinopathies, inflammatory conditions, psychiatric illnesses, etc., were excluded. Their average systolic and diastolic blood pressure since onset of illness and prescribed drugs were noted from the records. Compliance was assessed with the help of information from subjects as well as the close relatives. MMSE and a battery of neuropsychological tests (Digit Span Test, Trail Making Test Form B, Stroop Test, Visuospatial Working Memory Matrix and Word Fluency Test) was applied to all the participants. Multivariate regression analysis was used for the assessment of associations and one-way ANOVA was performed to assess differences in the mean. Analysis showed that mean age of study subject was 52 years and average duration of hypertension was 9 years. Fourteen percent subjects had obvious cognitive impairment as suggested by MMSE score less than 23. However, when cut-off score was lowered to 20, only 6% subjects fell into this category. Diastolic blood pressure had significant negative association with all of the cognitive measures except Trail Making Test, which was, on the contrary, significantly and negatively associated with systolic blood pressure. Duration of hypertension did not influence cognitive performance in this study. Effect of drug compliance was somewhat variable, but in general good compliance was associated with better cognitive performance. Beta-Blocker therapy hampered cognitive performance, whereas the best performance, especially on tests of semantic memory and pre-frontal functions was seen in subjects taking calcium channel blockers. CONCLUSIONS: Diastolic hypertension was associated with significant impairment of cognitive functions in younger subjects. On the other hand good compliance and calcium channel blockers had protective effect on hypertension induced cognitive impairment, especially on the prefrontal functions.

Clozapine: Current perspective.

The author conducted a review of studies that compared the efficacy, tolerability and indication for the use of clozapine in current perspectives for the treatment of resistant schizophrenia/ partial responders.

Association of hypertension and its treatment with dementia and cognitive functioning.

AIM: Hypertension is known to induce many pathological changes in the body, including cardiac hypertrophy, atherosclerosis, micro-aneurisms and stroke. Besides these conspicuous pathologies, it also has subtle effects on the functioning of the brain. These cognitive changes have received little attention despite the fact that they make a large impact on the daily functioning of affected persons. The present study was conducted to assess the effect of hypertension and related factors on cognitive functions in an Indian population. METHODS AND RESULTS: A cohort of young hypertensive subjects was recruited after obtaining informed consent. Subjects with confounding factors, such as substance use, neurological disorders, endocrinopathies, inflammatory conditions and psychiatric illnesses, were excluded. The average systolic and diastolic blood pressure of the subjects since the onset of illness and prescription of drugs were noted from the records. Compliance was assessed with the help of information given by the subjects and their close relatives. The mini-mental state examination and a battery of neuropsychological tests (digit span test, trail making test, Stroop test, visuospatial working memory matrix and word fluency test) were applied to all participants. Univariate regression analysis was used for the assessment of association and a one-way analysis of variance was performed on categorical variables. The mean age of the subjects was 52 years, and the average duration of hypertension 9 years. Twelve subjects had dementia which could be attributed to the subtle effects of hypertension only. Blood pressure (both systolic and diastolic) had a significant negative association with the cognitive tests. Cognitive impairment was also seen in subjects who reported poor drug compliance and those using beta blockers, while calcium channel blockers played a protective role. CONCLUSIONS: Hypertension was associated with a significant decline in cognitive functioning in younger subjects. Good compliance with drugs and the use of calcium channel blockers had a protective effect on hypertension-induced cognitive decline.