Mariamma Philip

Suicidal risk and childhood adversity: a study of Indian college students.

BACKGROUND The study was undertaken in response to reported increase in deaths due to suicide and suicidal behaviors in the youth. AIM The objectives of the study were to assess childhood adversity and suicidal risk and to study the relationship between adverse childhood experiences and suicidal risk, in Indian students. METHOD A cross sectional study design was conducted with 436 undergraduate students in the age range of 18-25. Suicidal risk was assessed using Scale for Suicidal Ideation and Becks Hopelessness Scale. Parental Bonding Instrument and Early Trauma Inventory-Self Report (Short Form) were used to assess adverse childhood experiences. RESULTS Suicidal risk in terms of suicidal ideation and hopelessness was reported by 15% and 9%, respectively. Physical abuse is the most common form of early trauma, experienced in both males and females. Males experienced significantly more traumatic experiences in all domains. Affectionless control, which is considered as the pathogenic form of parent child bonding, is widely reported. A moderate degree of association exists between suicidal risk and early exposure to trauma. Higher suicidal ideation, hopelessness and trauma are reported in respondents with affectionless parental control and neglectful parenting. CONCLUSION The study provides evidence of correlation between suicidal risk and childhood adversity in the Indian setting.

Asymmetric dimethylarginine as a risk marker for early-onset ischemic stroke in Indian population.

BACKGROUND Asymmetric dimethylarginine (ADMA), a circulating endogenous inhibitor of nitric oxide synthase, has been associated with the pathogenesis of atherosclerosis. The present study was initiated to investigate the role of ADMA as a biomarker of risk for early-onset ischemic stroke. METHODS Plasma ADMA levels were measured in 201 ischemic stroke patients aged between 15 and 50 years and 217, age and gender-matched healthy controls, by high performance liquid chromatography using pre-column derivatization with O-phthaldialdehyde. RESULTS Patients with ischemic stroke had significantly higher plasma ADMA compared with the controls (1.49 vs. 0.97 μmol/l, p < 0.001). After adjustment for vascular risk factors, increased ADMA was associated with stroke (OR=1.55, 95% CI 1.25-1.92, p < 0.001). Univariate analysis showed that ADMA was significantly associated with age, alcohol, smoking, hypertension, diabetes mellitus, low serum HDL-cholesterol and homocysteine. By multiple stepwise linear regression analysis, diabetes, HDL-cholesterol and homocysteine were found to be independent determinants of plasma ADMA. CONCLUSIONS Increased plasma ADMA is associated with increased risk for ischemic stroke in the young. Diabetes mellitus, HDL-cholesterol and homocysteine are independent predictors of elevation in plasma ADMA concentration.

Cognitive deficits and its relation with psychopathology and global functioning in first episode schizophrenia

AIM The aim was to examine the cognitive deficits profile in first episode schizophrenia patients as well as examine the correlation between cognitive deficits, psychopathology and global functioning. Better understanding of these various facets of this debilitating illness is imperative in planning treatment, thereby limiting decline in global functioning. METHODS Forty-nine schizophrenia patients with illness duration less than two years comprised the sample. A comprehensive battery of neuropsychological tests, the Positive and Negative Syndrome Scale and WHO Disability Assessment schedule were administered to assess cognitive functions, psychopathology and global functioning respectively. RESULTS Cognitive deficit quotient for each patient was calculated. In this cohort 16.3% of patients had less than 25% of cognitive deficits, 38.8% had 25-50% of cognitive deficits, 36.7% had 50-75% of cognitive deficits and 8.2% of patients had more than 75% cognitive deficits. More than 50% of the patients in the present cohort showed deficits in the domains of attention, executive functions and learning and memory. Psychopathology significantly correlated with global functioning. Negative symptoms significantly correlated with cognitive functions of motor speed, attention and executive functions. Step wise linear regression analysis showed that duration of illness, attention (sustained attention), executive function (response inhibition), negative and positive psychopathology predicted level of global functioning at varied levels. CONCLUSIONS Cognitive deficits in multiple domains were observed in the present cohort. Attention and executive functions predicted global functioning. There is a need for longitudinal studies with larger sample to examine the course of the cognitive deficits with progress in illness.

Do newspaper reports of suicides comply with standard suicide reporting guidelines? A study from Bangalore, India

Background: Several countries have prescribed standard guidelines for media professionals on suicide reporting. However, the implementation of these guidelines has been varied. Suicide rates in South Asia are one of the highest in the world, and it is known that media guidelines for suicide reporting are not followed adequately. However, there are no published reports available from this region. Aim: This study aimed at assessing newspaper reports of suicide for quality of reporting based on standard reporting guidelines and to study differences between English and vernacular (Kannada) newspapers in Bangalore, South India. Methods: A total of 341 newspaper reports of suicide from 550 newspapers (3 English and 3 Kannada) over 3 months were systematically assessed for compliance with reporting guidelines. Each report was evaluated on 2 domains and 36 parameters. Data were analyzed for frequency of inappropriate reporting and patterns compared between vernacular and English newspapers. Results: In all, 87% of the reports were those of completed suicide. Non-compliant reporting – method of suicide was reported in 89% and 32% of reports were in prominent pages of the newspaper, 95% mentioned gender, 90% reported the name, 80% reported age and suicide location, 75% reported life events related to suicide, 70% reported occupation, 69% had headline explicity on suicide and 61% reported monocausality. Only 16% reported mental disorder related to suicide, and less than 3% included information on suicide prevention and helplines. Vernacular papers showed significantly better compliance in 16 of the 20 areas. However, protective characteristics were better reported in English newspapers. Conclusion: Majority of reports on suicides in newspapers from Bangalore did not comply with standard guidelines of reporting. There is a strong need to evolve local guidelines and mechanisms for ensuring responsible reporting which have important implications in prevention of suicide.

Growing up with a parent having schizophrenia: Experiences and resilience in the offsprings

Background: Parental mental illness has been found to have an impact on offsprings in their emotional, social, and behavioral aspects of life. Aims: To examine the experiences of offsprings of a parent having schizophrenia and to study their resilience. Materials and Methods: A sample of 45 adults with one parent diagnosed with schizophrenia was selected using purposive sampling. Subjects were assessed using socio-demographic data sheet, semi-structured interview schedule, and Connor–Davidson Resilience Scale. Results: The experiences perceived by them as different from children of healthy parents included negative experiences in social (49%) and emotional aspects (40%), lack of support from the parent who is ill (40%), and burden (66%) in various areas. Majority of the offsprings were satisfied with the parenting received (70%). About 60% of them reported medium resilience, and 24% and 15% reported high and low resilience, respectively. Majority of those with medium and high resilience had supportive relationship with other family members. Social support was the most frequently reported factor that helped them to cope with difficulties. Conclusions: Growing up with a parent having mental illness can have negative impact on offsprings. However, it can also have positive effects in terms of developing resilience in the presence of good support system.

Role of yoga for patients with type II diabetes mellitus: A systematic review and meta-analysis☆

To understand the role and efficacy of yoga in the management of type 2 diabetes mellitus, this meta-analysis was conducted. Electronic data bases searched were PubMed/Medline, ProQuest, PsycINFO, IndMED, CENTRAL, Cochrane library, CamQuest and CamBase till December 17, 2014. Eligible outcomes were fasting blood sugar (FBS), post prandial blood sugar (PPBS) and glycosylated haemoglobin (HBA1C). Randomized controlled trials and controlled trials were eligible. Studies focussing only on relaxation or meditation or multimodal intervention were not included. A total of 17 RCTs were included for review. Data from research articles on patients, methods, interventions- control and results were extracted. Mean and standard deviations were utilized for calculating standardized mean difference with 95% confidence interval. Heterogeneity was assessed with the help of I(2) statistics. χ(2) was used to rule out the effects of heterogeneity due to chance alone. Beneficial effects of yoga as an add-on intervention to standard treatment in comparison to standard treatment were observed for FBS [Standardized Mean Difference (SMD) -1.40, 95%CI -1.90 to -0.90, p˂0.00001]; PPBS [SMD -0.91, 95%CI -1.34 to -0.48, p˂0.0001] as well as HBA1C [SMD -0.64, 95%CI -0.97 to -0.30, p˂0.0002]. But risk of bias was overall high for included studies. With this available evidence, yoga can be considered as add-on intervention for management of diabetes.

Alterations in Polysomnographic (PSG) profile in drug-naïve Parkinson's disease

Objective: We studied the changes in Polysomnographic (PSG) profile in drug-naïve patients of Parkinsons disease (PD) who underwent evaluation with sleep overnight PSG. Materials and Methods: This prospective study included 30 with newly diagnosed levodopa-naïve patients with PD, fulfilling the UK-PD society brain bank clinical diagnostic criteria (M:F = 25:5; age: 57.2 ± 10.7 years). The disease severity scales and sleep related questionnaires were administered, and then patients were subjected to overnight PSG. Results: The mean duration of illness was 9.7 ± 9.5 months. The mean Hoehn and Yahr stage was 1.8 ± 0.4. The mean Unified Parkinsons Disease Rating Scale (UPDRS) motor score improved from 27.7 ± 9.2 to 17.5 ± 8.9 with sustained usage of levodopa. Nocturnal sleep as assessed by Pittsburgh Sleep Quality Index (PSQI) was impaired in 10 (33.3%) patients (mean PSQI score: 5.1 ± 3.1). Excessive day time somnolence was recorded in three patients with Epworth Sleepiness Scale (ESS) score ≥ 10 (mean ESS score: 4.0 ± 3.4). PSG analysis revealed that poor sleep efficiency of <85% was present in 86.7% of patients (mean: 68.3 ± 21.3%). The latencies to sleep onset (mean: 49.8 ± 67.0 minutes) and stage 2 sleep (36.5 ± 13.1%) were prolonged while slow wave sleep was shortened. Respiration during sleep was significantly impaired in which 43.3% had impaired apnoea hyperpnoea index (AHI) ≥5, mean AHI: 8.3 ± 12.1). Apnoeic episodes were predominantly obstructive (obstructive sleep apnea, OSA index = 2.2 ± 5.1). These patients had periodic leg movement (PLM) disorder (56.7% had PLM index of 5 or more, mean PLMI: 27.53 ± 4 9.05) that resulted in excessive daytime somnolence. Conclusions: To conclude, sleep macro-architecture is altered in frequently and variably in levodopa-naïve patients of PD and the alterations are possibly due to disease process per se.

The effect of blood transfusion on central venous oxygen saturation in critically ill patients admitted to a neurointensive care unit

Literature suggests poorer outcomes during anaemia as well as following red blood cell transfusion (BT) in brain injured patients. Recently, central venous oxygen saturation (ScvO2) has been proposed as a physiological trigger to guide red BT. In this study, we looked at ScvO2 changes following BT in patients admitted to a neurointensive care unit (NICU).

Proinflammatory chemokines are major mediators of exuberant immune response associated with Influenza A (H1N1) pdm09 virus infection

In India, the case fatality ratio of the pandemic A (H1N1) pdm09 influenza was relatively higher when compared to seasonal Influenza A infection. Hypercytokinemia or “cytokine storm” has been previously implicated in the pathogenesis of other influenza viruses. The present study was undertaken to compare the cytokine profiles of A (H1N1) pdm09 influenza and seasonal H3 infection in Indian population and to correlate the findings with disease severity. Plasma levels of 18 cytokines/chemokines were measured by flow‐cytometry using a bead based assay in patients infected with A (H1N1) pdm09 virus (n = 96) and Influenza A seasonal H3 virus (n = 30) categorised into mild, moderate, and severe groups along with healthy controls (n = 36). There was an overall trend indicating an exuberant cytokine/chemokine response in A (H1N1) pdm09 as compared to seasonal H3 influenza, which was more evident in severe cases, suggesting a role for these cytokines/chemokines in the pathogenesis of A(H1N1) pdm09. Increased levels of CXCL‐8/IL‐8, IL‐10, IL‐6, and IL‐17A were seen in both A(H1N1) pdm09 influenza and seasonal H3 cases when compared to healthy controls. However, dysregulated production of proinflammatory chemokines was seen more pronounced in A (H1N1) pdm09 influenza cases as compared to seasonal H3 cases. This study has brought forth the potential role of chemokines as prognostic indicators of disease severity and outcome. Further research on modulating the host immune response to limit severity of the disease could help in the treatment and management of influenza.

Effect of Atropine Premedication on Cardiac Autonomic Function During Electroconvulsive Therapy: A Randomized Crossover Study

Objectives Electroconvulsive therapy (ECT) results in significant cardiovascular changes. The acute cardiac autonomic changes during ECT remain unexplored. The primary objective of this study was to compare autonomic dysfunction with and without atropine premedication during ECT and secondarily to evaluate dysautonomia across psychiatric diagnoses before and after ECT. Methods In this crossover study, 41 psychiatric patients were monitored during 82 ECT sessions. Patients were randomized either to receive atropine or not to receive atropine during their second ECT session and were crossed over during their third session. Heart rate, blood pressure, and oxygen saturation were continuously monitored from stimulus application until 300 seconds after ECT. Demographic characteristics and ANSiscope indices derived pre- and post-ECT were collected. Results Autonomic dysfunction (%) before ECT was similar between atropine and no-atropine sessions (32.4 ± 15.7 vs 32.8 ± 16.7; 95% confidence interval, −7.6 to 6.7; P = 0.90) but increased significantly after ECT to 60.9 ± 16.3 and to 47.0 ± 17.3, respectively, and this difference was significant (95% confidence interval, 6.5–21.3; P < 0.001). There was no difference in the autonomic function across psychiatric diagnoses both before (P = 0.07) and after ECT (P = 0.12). Conclusions Cardiac autonomic dysfunction worsens after ECT in patients with psychiatric illnesses and to a significantly greater extent with atropine premedication. The degree of dysautonomia is similar across various psychiatric diagnoses both before and after ECT. Atropine premedication during ECT should be restricted to select patients susceptible to bradyarrhythmia and could be avoided in others.