N. Janakiramaiah

Antidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia: a randomized comparison with electroconvulsive therapy (ECT) and imipramine

BACKGROUND Sudarshan Kriya Yoga (SKY) is a procedure that involves essentially rhythmic hyperventilation at different rates of breathing. The antidepressant efficacy of SKY was demonstrated in dysthymia in a prospective, open clinical trial. This study compared the relative antidepressant efficacy of SKY in melancholia with two of the current standard treatments, electroconvulsive therapy (ECT) and imipramine (IMN). METHODS Consenting, untreated melancholic depressives (n=45) were hospitalized and randomized equally into three treatment groups. They were assessed at recruitment and weekly thereafter for four weeks. RESULTS Significant reductions in the total scores on Beck Depression Inventory (BDI) and Hamilton Rating Scale for Depression (HRSD) occurred on successive occasions in all three groups. The groups, however, did not differ. Significant interaction between the groups and occasion of assessment occurred. At week three, the SKY group had higher scores than the ECT group but was not different from the IMN group. Remission (total HRSD score of seven or less) rates at the end of the trial were 93, 73 and 67% in the ECT, IMN and SKY groups, respectively. No clinically significant side effects were observed. DISCUSSION Within the limitations of the design (lack of double blind conditions), it can be concluded that, although inferior to ECT, SKY can be a potential alternative to drugs in melancholia as a first line treatment.

Neurological soft signs in never-treated schizophrenia

Objective: Studies of Neurological Soft Signs (NSS) in schizophrenia are confounded by handedness, inconsistent methodology, and prior treatment with neuroleptics. The study objective is to examine NSS in never‐treated schizophrenia.

P300 amplitude and antidepressant response to Sudarshan Kriya Yoga (SKY)

BACKGROUND There is evidence that Sudarshan Kriya Yoga (SKY) has significant antidepressant effects. OBJECTIVE The present study examined whether pretreatment P300 ERP amplitude predicts antidepressant response to SKY. METHODS Consenting, drug-free depressed patients (n = 30; dysthymics, 15, melancholics, 15) who received SKY as the sole treatment were assessed clinically at pretreatment, 1 month and 3 months. Auditory P300 was recorded before treatment. RESULTS Twenty-two patients responded favourably to SKY. The pretreatment P300 amplitude neither distinguished responders and non-responders nor was associated with differential rates of response. DISCUSSION It is concluded that SKY therapy is uniformly effective regardless of the pretreatment P300 amplitude.

Sex difference in age at onset of schizophrenia: discrepant findings from India.

Consecutive male (n=100) and female (n= 100) DSM‐IV schizophrenics newly registered for treatment in a large psychiatric hospital were examined with regard to age at onset of the first psychotic symptom. Age at onset of the first psychotic symptom did not differ between the sexes regardless of whether schizophrenia was diagnosed by DSM‐IV or by several alternative systems. Age at onset defined by other criteria, namely age at first contact with a physician, and age at first admission for psychiatric care, also did not show any differences between the sexes. Survival analysis of subjects having a documented date of birth revealed a female preponderance at younger ages. A higher positive symptom score predicted older age at onset of the first psychotic symptom in the total sample. These findings call into question the universality of the traditional view of a younger age at onset of schizophrenia among males. Tentative neurodevelopmental and cultural explanations are presented to explain why there is no sex difference in age at onset of schizophrenia in India.

Heart rate variability as an index of cue reactivity in alcoholics

BACKGROUND Autonomic responses follow exposure to conditioned stimuli such as contextual factors associated with alcohol ingestion. Heart rate variability is under autonomic control and may be a measure of such response. METHODS Twenty alcoholics and 23 matched social drinkers (all male) were exposed to a neutral cue and then an alcohol cue in identical settings, during which the electrocardiogram of these subjects was recorded. Time and frequency domain parameters of heart rate variability (HRV) were computed by a blind rater. RESULTS Coefficient of variation of R-R intervals and absolute powers of HRV spectrum (in frequency bands 0.05-0.15 Hz and 0.01-0.05 Hz) following alcohol cue were significantly higher in alcoholics than social drinkers. The mean heart rate (MHR) failed to reflect this difference. CONCLUSIONS HRV paradigm appears more sensitive than MHR to measure cue reactivity.

ECT/chlorpromazine combination versus chlorpromazine alone in acutely schizophrenic patients.

The response to ECT or no ECT at two levels of chlorpromazine was studied in a 2 × 2 factorial experiment on 60 acutely schizophrenic patients hospitalized for a period of 6 weeks. ECT enhanced the therapeutic response at the 300 mg level of chlorpromazine but neither of the ECT chlorpromazine combinations offered any significant therapeutic advantage over 500 mg of chlorpromazine.

Cerebellar and other neurological soft signs in antipsychotic-naïve schizophrenia

Objective:  Cerebellar neurological abnormalities in schizophrenia have been associated with severe negative symptoms, cognitive deficits, and smaller cerebellar volume. This study assessed the comparative discriminant validity between Cerebellar Soft Signs (CSS) vs. other neurological soft signs (ONSS) [in discriminating between schizophrenia patients and healthy controls] as well as the relationship between the soft signs and psychopathology.

Post-seizure EEG fractal dimension of first ECT predicts antidepressant response at two weeks

BACKGROUND Duration of seizure by itself is an insufficient criterion for a therapeutically adequate seizure in ECT. Therefore, measures of seizure EEG other than its duration need to be explored as indices of seizure adequacy and predictors of treatment response. We measured the EEG seizure using a geometrical method-fractal dimension (FD) and examined if this measure predicted remission. METHODS Data from an efficacy study on melancholic depressives (n = 40) is used for the present exploration. They received thrice or once weekly ECTs, each schedule at two energy levels - high or low energy level. FD was computed for early-, mid- and post-seizure phases of the ictal EEG. Average of the two channels was used for analysis. RESULTS Two-thirds of the patients (n = 25) were remitted at the end of 2 weeks. As expected, a significantly higher proportion of patients receiving thrice weekly ECT remitted than in patients receiving once weekly ECT. Smaller post-seizure FD at first ECT is the only variable which predicted remission status after six ECTs. Within the once weekly ECT group too, smaller post-seizure FD was associated with remission status. CONCLUSIONS Post-seizure FD is proposed as a novel measure of seizure adequacy and predictor of treatment response. CLINICAL IMPLICATIONS Seizure measures at first ECT may guide selection of ECT schedule to optimize ECT. LIMITATIONS The study examined short term antidepressant effects only. The results may not be generalized to medication-resistant depressives.

Twice versus thrice weekly ECT in melancholia: a double-blind prospective comparison

Thirty patients with major depressive disorder of melancholic subtype were randomly allocated to receive ECT either twice or thrice a week. Double-blind ratings on the Hamilton Scale for Depression and Clinical Global impression showed no differences in the outcome through 4 weeks of trial as well as at 6-month follow-up. Cumulative seizure duration was higher in the thrice weekly group but not significantly so in spite of having received a significantly greater number of ECTs. The results indicate that ECT given thrice a week conferred no advantage over ECT given twice a week.

Age‐at‐onset and schizophrenia: reversed gender effect

Objective: This study seeks an explanation for reversed gender effect on age‐at‐onset (AAO) in schizophrenia. The hypothesis is older AAO in males would be detected in a sample where higher infant mortality (IMR) prevailed.