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The presence of common physical comorbidities, their demographic and clinical correlates and impact on functioning was assessed in 100 patients with schizophrenia. The patients had a mean age of 35.12_10.7 yr with mean duration of illness of 8.3_0.58 years. Seventy per cent were detected to have a comorbid physical condition. Common conditions included hypertension (21%), diabetes mellitus (15%) and anaemia (12%). Increasing age, being female, being married, longer duration of illness and longer duration of treatment were associated with higher risk of having a comorbid physical illness. Further studies need to be done with a large sample to confirm these findings. [ABSTRACT FROM AUTHOR]

Gupta AK, Pokhriyal R, Das U, et al. Neuropsychiatr Dis Treat. 2019;15:2073–2085. The authors wish to advise of typographical errors in Figures 1 and 2 and Table 3, the correct unit of apolipoprotein E concentration is μg/ml, and not pg/ml. Page 2077, Figure 1A, y axis, the text “CSF apolipoprotein E (pg/ml)” should read “CSF apolipoprotein E (μg/ml)”. Page 2077, Figure 2, x axis, the text “CSF apolipoprotein E (pg/ml)” should read “CSF apolipoprotein E (µg/ml)”. Page 2079, Table 3, Cut-off values to differentiate neurological controls from the disease column, Apolipoprotein E and Apolipoprotein E or α-synuclein rows, the text “>3.4 pg (Parkinson’s disease)” should read “>3.4 µg (Parkinson’s disease)” and “ The authors apologize for these errors and any inconvenience. Read the original article

Ashish Kumar Gupta,1,* Ruchika Pokhriyal,1,* Mohd Imran Khan,1 Domada Ratna Kumar,1 Rishab Gupta,2 Rakesh Kumar Chadda,2 Rashmi Ramachandran,3 Vinay Goyal,4 Manjari Tripathi,4 Gururao Hariprasad1 1Department of Biophysics; 2Department of Psychiatry; 3Department of Anaesthesia; 4Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India*These authors contributed equally to this workCorrespondence: Gururao HariprasadDepartment of Biophysics, All India Institute of Medical Sciences, Ansari nagar, New Delhi 110029, IndiaTel +91 11 26594029Fax +91 11 26588663Email g.hariprasad@rediffmail.comAim: Parkinson’s disease and schizophrenia are clinical end points of dopaminergic deficit and excess, respectively, in the mid-brain. In accordance, current pharmacological interventions aim to restore normal dopamine levels, the overshooting of which culminates in adverse effects which results in psychotic symptoms in Parkinson’s disease and extra-pyramidal symptoms in schizophrenia. Currently, there are no laboratory assays to assist treatment decisions or help foresee these drug side-effect outcomes. Therefore, the aim was to discover a protein biomarker that had a varying linear expression across the clinical dopaminergic spectrum.Materials and methods: iTRAQ-based proteomic experiments along with mass spectrometric analysis was used for comparative proteomics using cerebrospinal fluid (CSF). CSF fluid was collected from 36 patients with Parkinson’s disease, 15 patients with urological diseases that served as neurological controls, and seven schizophrenic patients with hallucinations. Validation included ELISA and pathway analysis to highlight the varying expression and provide plausible molecular pathways for differentially expressed proteins in the three clinical phenotypes.Results: Protein profiles were delineated in CSF from Parkinson’s disease patients, neurological control and schizophrenia, respectively. Ten of the proteins that were identified had a linear relationship across the dopaminergic spectrum. α-2-Macroglobulin showed to be having high statistical significance on inter-group comparison on validation studies using ELISA.Conclusions: Non-gel-based proteomic experiments are an ideal platform to discover potential biomarkers that can be used to monitor pharmaco-therapeutic efficacy in dopamine-dictated clinical scenarios. α-2 Macroglobulin is a potential biomarker to monitor pharmacological therapy in Parkinson’s disease and schizophrenia.Keywords: Parkinson’s disease, schizophrenia, iTRAQ proteomics, dopamine, biomarkers, therapeutic efficacy, alpha-2-macroglobulin

Ashish Kumar Gupta,1 Ruchika Pokhriyal,1 Uddipan Das,1 Mohd Imran Khan,1 Domada Ratna Kumar,1 Rishab Gupta,2 Rakesh Kumar Chadda,2 Rashmi Ramachandran,3 Vinay Goyal,4 Manjari Tripathi,4 Gururao Hariprasad11Department of Biophysics; 2Department of Psychiatry; 3Department of Anaesthesia; 4Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, IndiaBackground and objective: Dopamine plays an important role in the disease pathology of Parkinson’s disease and schizophrenia. These two neuropsychiatric disorders represent disease end points of the dopaminergic spectrum where Parkinson’s disease represents dopamine deficit and schizophrenia represents dopamine hyperactivity in the mid-brain. Therefore, current treatment strategies aim to restore normal dopamine levels. However, during treatment patients develop adverse effects due to overshooting of physiological levels of dopamine leading to psychosis in Parkinson’s disease, and extrapyramidal symptoms in schizophrenia. Absence of any laboratory tests hampers modulation of pharmacotherapy. Apolipoprotein E and α-synuclein have an important role in the neuropathology of these two diseases. The objective of this study was to evaluate cerebrospinal fluid (CSF) concentrations of apolipoprotein E and α-synuclein in patients with these two diseases so that they may serve as biomarkers to monitor therapy in Parkinson’s disease and schizophrenia.Methods: Drug-naïve Parkinson’s disease patients and Parkinson’s disease patients treated with dopaminergic therapy, neurological controls, schizophrenic patients treated with antidopaminergic therapy, and drug-naïve schizophrenic patients were recruited for the study and CSF was collected. Enzyme-linked immunosorbent assays were carried out to estimate the concentrations of apolipoprotein E and α-synuclein. Pathway analysis was done to establish a possible role of these two proteins in various pathways in these two dopamine dictated diseases.Results: Apolipoprotein E and α-synuclein CSF concentrations have an inverse correlation along the entire dopaminergic clinical spectrum. Pathway analysis convincingly establishes a plausible hypothesis for their co-regulation in the pathogenesis of Parkinson’s disease and schizophrenia. Each protein by itself or as a combination has encouraging sensitivity and specificity values of more than 55%.Conclusion: The dynamic variation of these two proteins along the spectrum is ideal for them to be pursued as pharmacotherapeutic biomarkers in CSF to monitor pharmacological efficacy in Parkinson’s disease and schizophrenia.Keywords: cerebrospinal fluid, Parkinson’s disease, schizophrenia, dopamine, apolipoprotein E, α-synuclein, biomarkers, treatment monitoring

Ashish Kumar Gupta,1 Gaurav Khunger Kumar,1 Komal Rani,1 Ruchika Pokhriyal,1 Mohd Imran Khan,1 Domada Ratna Kumar,1 Vinay Goyal,2 Manjari Tripathi,2 Rishab Gupta,3 Rakesh Kumar Chadda,3 Perumal Vanamail,4 Ashok Kumar Mohanty,5 Gururao Hariprasad1 1Department of Biophysics, All India Institute of Medical Sciences, New Delhi 110029, India; 2Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; 3Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India; 4Department of Biostatistics, All India Institute of Medical Sciences, New Delhi 110029, India; 5Proteomics Facility, National Diary Research Institute, Karnal, Haryana 132001, India Objectives: Parkinson’s disease and schizophrenia are clinical scenarios that occur due to dopaminergic deficit and hyperactivity in the midbrain, respectively. Current pharmacological interventions for these two diseases therefore aim to restore normal dopamine levels in the midbrain. But during therapy, there is a overshooting of dopamine concentrations that result in hallucinations in Parkinson’s disease patients and extra-pyramidal symptoms in schizophrenic patients. This causes a lot of inconvenience to the patents and the clinicians. There are no tests currently available to monitor drug efficacy in these two neuropsychiatric diseases. Materials and methods: Parkinson’s disease and schizophrenic naïve patients were recruited. Serum proteins isolated from these two clinical phenotypes were labeled with fluorescent cyanine dyes and analyzed by two-dimensional difference in gel electrophoresis proteomic experiment. Differentially expressed spots that had consistent expression pattern across five sets of biological replicate gels were trypsin digested and subjected to mass spectrometric analysis for protein identification. Validation experiments were done for the identified proteins using antibody-based assay on a patient cohort that included naïve, treated, and those who had side effects. Results: Serum α- and β-globin chains were identified as differentially expressed proteins having threefold higher expressions in Parkinson’s patients as compared to schizophrenia. Interestingly, concentrations of these two proteins had an inverse correlation across clinical phenotypes in the dopaminergic spectrum. RBC contamination as a source for these proteins was ruled out. Conclusion: There is a clear association of free serum globin with dopaminergic clinical states. This lays a platform for protein biomarker–based monitoring of pharmacological efficacy in Parkinson’s disease and schizophrenia. Keywords: Parkinson’s disease, schizophrenia, gel-based proteomics, biomarkers, dopamine, pharmacological efficacy, difference gel electrophoresis

Background & objectives: Genetic factors have potential of predicting response to antidepressants in patients with major depressive disorder (MDD). In this study, an attempt was made to find an association between response to escitalopram in patients with MDD, and serotonin transporter (SLC6A4) and receptor (5HTR1A, 5HTR2A) polymorphisms. Methods: Fifty five patients diagnosed as suffering from MDD, were selected for the study. The patients were treated with escitalopram over a period of 6-8 wk. Severity of depression, response to treatment and side effects were assessed using standardised instruments. Genetic variations from HTR1A (rs6295), HTR2A (rs6311 andrs6313) and SLC6A4 (44 base-pair insertion/deletion at 5-HTTLPR) were genotyped. The genetic data of the responders and non-responders were compared to assess the role of genetic variants in therapeutic outcome. Results: Thirty six (65.5%) patients responded to treatment, and 19 (34.5%) had complete remission. No association was observed for genotype and allelic frequencies of single nucleotide polymorphisms (SNPs) among remitter/non-remitter and responder/non-responder groups, and six most common side-effects, except memory loss which was significantly associated with rs6311 (P=0.03). Interpretation & conclusions: No significant association was found between the SNPs analysed and response to escitalopram in patients with MDD though a significant association was seen between the side effect of memory loss and rs6311. Studies with larger sample are required to find out genetic basis of antidepressant response in Indian patients. [ABSTRACT FROM AUTHOR]

Background: General hospital psychiatric units (GHPUs) are one of the major service and training providers in the field of mental health in India. However, there has not been any systematic attempt at their contributions toward research. Aim: The present paper reports on contributions of the GHPUs toward the psychiatric research based on analysis of publications in the Indian Journal of Psychiatry (IJP). Materials and Methods: All the issues of IJP of the last 25 years (1989-2013) were manually searched for original research papers, brief reports, and case reports. A semi-structured performa was used to collect information on various parameters. Results: About two-thirds of the papers were contributed by the GHPUs, most being multi-authored and from tertiary care centers. The research covered a variety of psychiatric disorders including schizophrenia, mood disorders, and common mental disorders. Most of the research reported was self-funded. Conclusion: GHPUs have contributed significantly to psychiatric research in India in the last 25 years. [ABSTRACT FROM AUTHOR]

Forensic psychiatry is an important subspecialty of psychiatry. Forensic psychiatrists play an important role in the society in assisting the judiciary in many complicated cases. In India, forensic psychiatry work is undertaken mostly by the general psychiatrists. Forensic psychiatric assessments are often associated with an element of anxiety or fear for a young psychiatrist. The present paper aims at familiarizing the readers with forensic evaluation in various situations so that they are able to carry out the assessments in real-life situations comfortably. Various steps of forensic assessment in different situations are discussed in the background of real-life cases. Assessment areas include criminal responsibility, fitness to plead, issue of guardianship, assessment of mental status, testamentary capacity and others. The paper gives some general guidelines on forensic psychiatric assessment in practical situations in our country. The readers are advised to refer to the standard textbooks and the Indian law for further details. [ABSTRACT FROM AUTHOR]

Background: As a pilot project, Indian Psychiatric Society conducted the first multicentric study involving diverse settings from teaching institutions in public and private sectors and even privately run psychiatric clinics. Aim of the Study: To study the typology of functional somatic complaints (FSC) in patients with first episode depression. Materials and Methods: A total of 741 patients from 16 centers across the country participated in the study. They were assessed on Bradford Somatic Symptom inventory for FSC, Beck Depression Inventory for severity of depression, and Comprehensive Psychopathological Rating Scale- anxiety index (CPRS-AI) for anxiety symptoms. Results: The mean age of the study sample was 38.23 years (SD-11.52). There was equal gender distribution (male - 49.8% vs. females 50.2%). Majority of the patients were married (74.5%), Hindus (57%), and from nuclear family (68.2%). A little over half of the patients were from urban background (52.9%). The mean duration of illness at the time of assessment was 25.55 months. Most of the patients (77%) had more than 10 FSCs, with 39.7% having more than 20 FSCs as assessed on Bradford Somatic Inventory. The more common FSC as assessed on Bradford Somatic Inventory were lack of energy (weakness) much of the time (76.2%), severe headache (74%) and feeling tired when not working (71%), pain in legs (64%), aware of palpitations (59.5%), head feeling heavy (59.4%), aches and pains all over the body (55.5%), mouth or throat getting dry (55.2%), pain or tension in neck and shoulder (54%), head feeling hot or burning (54%), and darkness or mist in front of the eyes (49.1%). The prevalence and typology of FSCs is to a certain extent influenced by the sociodemographic variables and severity of depression. Conclusion: Functional somatic symptoms are highly prevalent in Indian depressed patients and hence deserve more attention while diagnosing depression in Indian setting. [ABSTRACT FROM AUTHOR]

Background: There are very few studies from India which have evaluated the prescription pattern for antidepressants by psychiatrists for treatment of depression. Aim: To study the psychotropic prescription patterns of patients with first episode depression from diverse settings including teaching institutions in public and private sectors and even privately run psychiatric clinics. Materials and Methods: Prescription data of 706 patients with first episode depression, who participated in the IPS multicentric study, were evaluated. Results: Escitalopram was the most commonly prescribed antidepressant, comprising 40% of the total prescriptions. This was followed by sertraline (17.6%) and fluoxetine (16.3%). In total, selective serotonin reuptake inhibitors (SSRIs) formed 79.2% of all the prescriptions. Tricyclic antidepressants formed a small part (15.15%) of total prescriptions, with imipramine being the most commonly used tricyclic antidepressant. Serotonin-norepinephrine reuptake inhibitors (venlafaxine, desvenlafaxine and duloxetine) were prescribed to 11.3% of patients with equal share of venlafaxine and duloxetine. About one-sixth (N=104; 14.7%) of the patients were prescribed more than one antidepressant. Nearly three-fourth of the patients (N=523; 74.1%) were prescribed a benzodiazepine, with clonazepam being the most preferred agent, prescribed to nearly half of the participants (49%) and formed nearly two-third of the total benzodiazepine prescriptions (346 out of 523). Conclusion: Escitalopram is the most commonly prescribed antidepressant and SSRIs are the most commonly prescribed class of antidepressants. Poly pharmacy in the form of concomitant use of two antidepressants is practiced infrequently. However, benzodiazepines are used quite frequently as the co-prescription. [ABSTRACT FROM AUTHOR]

In the last few decades, the number of women joining medicine has shown a marked increase all over the world. In India, similar trends are observed though exact data on a nationwide basis is not available, but most women doctors tend to join the disciplines that are less demanding. Concerns about the paucity of research in this area are highlighted in this note. [ABSTRACT FROM AUTHOR]

Long term hospitalization was considered an important factor in development of disability in patients with schizophrenia. Do short hospitalizations, as is the practice now, also lead to disability, has not been studied. The present study was conducted to compare the disability amongst two groups of patients with schizophrenia, previously hospitalized (PH) and never hospitalized (NH), and to understand the role of hospitalization in causing disability. Sixty patients with DSM-IV diagnosis of schizophrenia (30 each in PH and NH groups) attending follow up in a psychiatric outpatient service in a public funded hospital were assessed for disability, psychopathology and various clinical characteristics. The two groups of patients suffered similar levels of disability in personal and social areas as well as global disability, but the occupational disability was higher in the PH group than in the NH group. A positive correlation was observed between disability and the number of admissions, total duration of hospitalization, negative symptoms, cognitive deficit and number of exacerbations. The study concludes that short periods of hospitalization do not appear to contribute to disability in personal and social areas, but may affect occupational disability. [ABSTRACT FROM AUTHOR]

AIMS To assess the prescribing pattern and to measure some specific aspects of the behaviour of the prescribers (psychiatrists) before and after educational interventions using core drug use indicators. METHODS In the present randomized retrospective controlled pre-post intervention prescription survey of schizophrenia and depression, 100 prescriptions each for schizophrenia and depression were obtained before and after each intervention. The prescriptions were analyzed for the following prescriber-specific indicators: number of drugs prescribed, prescribing by generic names, prescriptions for essential drugs, antiparkinsonian and benzodiazepines, nature of drugs and number of combinations prescribed. Based on the results of pre-intervention data, two interactional workshops were conducted 1 and 6 months after pre-intervention data collection. The first workshop focused on the results of the prescription audit feedback and reasons thereof. The second workshop focused, in addition, on appropriate management of schizophrenia and depression using consensus treatment guidelines with the aim of evolving a consensus on the treatment in a given hospital setting. RESULTS Before intervention, the essential drugs accounted for 80.95 and 96.91% of the total number of drugs prescribed in depression and schizophrenia, respectively. Prescription for essential drugs improved further significantly in the post intervention period to 95.26% (P<0.04) for depression; whereas, in schizophrenia, prescriptions for essential drugs declined to 80.95%. The average number of drugs prescribed per encounter marginally declined in both schizophrenia (2.46±0.94 to 2.34±0.65) and depression (2.09±0.79 to 2.00±0.65) after the second intervention. The patients receiving two or more drugs from the same group together declined from 12 to 9% in schizophrenia, but increased from 5 to 10% in depression after intervention. Trihexyphenidyl, an antiparkinsonian drug, was co-prescribed (90%) with antipsychotic agents (98%) in schizophrenia; however, use of benzodiazepines declined significantly after intervention to 28% compared to 48% in the pre-intervention period. Also, benzodiazepine use was high (68%) and remained so (70%) after interventions in depression cases. CONCLUSION The present study demonstrates excessive use of antiparkinsonian agents in schizophrenia and benzodiazepines in depression. Monitoring for the use of antiparkinsonian and benzodiazepines can form an important component for measuring specific aspects of prescriber's behaviour, which can be used as an indicator for comparisons at different time intervals and between health facilities. [ABSTRACT FROM AUTHOR]

Background: A wide range of professionals including psychiatrists, psychologists, general physicians, faith-healers and religious healers cater to the needs of mentally ill patients. Psychiatric facilities are available at general hospitals, office based practice and mental hospitals. Psychiatrists are preferred the least due to stigma. The present work reports on treatment options used by a group of psychiatric patients before visiting a mental hospital. Aim: To study the help seeking behaviour of patients visiting a mental hospital. Method: Patients attending psychiatric outpatient service at a mental hospital were asked specifically about various treatment facilities utilized by them before coming to the hospital and the reasons thereof. Results: A wide range of services was used by the subjects varying from professional care to faith healers. Trust, easy availability and accessibility, recommendations by the significant others and belief in supernatural causation of illness were the important reasons for choosing a particular facility. Thus sociocultural factors appeared to influence the help seeking behaviour. Conclusion: A substantial number of patients suffering from severe mental disorders seek non-professional care. There is a need of studies in community to assess the help seeking behaviour of psychiatric patients and factors associated with it. [ABSTRACT FROM AUTHOR]

Ninety-five schizophrenic patients were assessed using the Present State Examination, the Brief Psychiatric Rating Scale and the Scale for the Assessment of Negative Symptoms. Negative and depressive symptoms were frequent, and significant relationships among negative symptom complexes and depressive syndromes were noted. Retardation, lack of energy, slowness, and other symptoms of depression were significantly associated with the negative symptoms of schizophrenia. Depressed affect per se did not have a significant correlation with negative symptoms. [ABSTRACT FROM AUTHOR]

HLA haplotypes A and B were studied in eight families with two or more schizophrenic members. All index cases and all but two sick relatives satisfied Research Diagnostic Criteria for the diagnosis of schizophrenia; 45 subjects were studied. Data were analysed by sequential tests for the detection of linkage and by the affected sib-pair method. The results do not support a linkage between HLA and schizophrenia. [ABSTRACT FROM AUTHOR]

Background: There are only a few effective treatment options currently available for treatment-refractory obsessive compulsive disorder (OCD). The supplementary motor area (SMA) has been reported to play an important role in the pathophysiology of OCD. Functional neuroimaging studies indicate that OCD is associated with increased activity in the SMA, caudate nucleus, and anterior cingulate gyrus. Novel treatment strategies like repetitive transcranial magnetic stimulation (rTMS) have been proposed for OCD refractory to standard treatments. These clinic-based data report on the efficacy of rTMS in medication-resistant OCD. Materials and Methods: Twelve right-handed persons with medication-resistant OCD were administered rTMS as an add-on treatment. Stimulation was given at 1 Hz for 10 seconds followed by 15 seconds pause and 100 trains of stimulus over the SMA per session for 5 days in a week. Assessments were done on yale brown obsessive compulsive scale (Y-BOCS) at baseline and at the end of rTMS intervention. Results: The subjects had a mean age of 33.17±12.74 years. Mean scores on Y-BOCS were 26.17 at baseline and 17.17 at the end of treatment, reflecting significant improvement. The subjects did not report any significant side effects except one person with known bipolar illness, who developed manic symptoms after the 3rd session of the rTMS. Conclusions: Low-frequency rTMS over the SMA appears a promising treatment strategy as an add-on treatment in treatment-refractory patients of OCD. [ABSTRACT FROM AUTHOR]

Dhat syndrome is a culture-bound sex neurosis of the Indian subcontinent. Fifty-two patients with a presenting complaint of passage of 'Dhat' in urine were studied. Diagnosis of neurotic depression, anxiety neurosis, hypochondriacal neurosis, and psychogenic impotence were made in 21, 19, 3, and 1 cases respectively. Seven patients received the diagnosis of pure Dhat syndrome, and one of gonorrhoea. [ABSTRACT FROM AUTHOR]