Narayana Manjunatha

Metabolic syndrome in first episode schizophrenia — A randomized double-blind controlled, short-term prospective study

BACKGROUND Although the treatment of schizophrenia, arguably one of the most devastating diseases today, has been immensely helped by the advent of second-generation antipsychotics, they have come at a considerable cost - the metabolic syndrome (MetS). This adverse effect has been described with several antipsychotics to range between 20%-60%, at least double the prevalence in the general population. METHODS All consecutive patients with first episode schizophrenia at our referral psychiatric hospital were recruited in an extensive prospective randomized, double-blind controlled study including measures of waist circumference (WC), blood pressure (SBP/DBP), triglyceride (TGL), high-density lipoproteins (HDL) and fasting blood sugar (FBS) levels and randomized to receive either, haloperidol, olanzapine or risperidone. The prevalence of MetS was assessed based on two criteria- ATP IIIA and criteria of International Diabetes Federation (IDF). This was compared with a gender, age, exercise and diet matched healthy control group. RESULTS The analysis of 99 patients showed a prevalence of MetS as 10.1% and 18.2% as assessed by ATP IIIA and IDF criteria respectively. The prevalence of MetS in our sample of patients with schizophrenia is at least five times as high when compared to the matched healthy control group. Olanzapine had maximum prevalence of MetS at 20-25% followed by risperidone at 9-24% and haloperidol at 0-3%. DISCUSSION Metabolic syndrome is highly prevalent among treated patients with first episode schizophrenia. Early monitoring of patients on atypical antipsychotics can possibly play an important role in early detection and hence prevention of the metabolic syndrome.

Diabetes and schizophrenia – effect of disease or drug? Results from a randomized, double-blind, controlled prospective study in first-episode schizophrenia

Objective:  There have been innumerable advances in the pharmacotherapy of schizophrenia, but problems have emerged hand‐in‐glove, such as the presence of treatment‐emergent glucose intolerance and frank diabetes mellitus (DM).

Substance use and addiction research in India

Substance use patterns are notorious for their ability to change over time. Both licit and illicit substance use cause serious public health problems and evidence for the same is now available in our country. National level prevalence has been calculated for many substances of abuse, but regional variations are quite evident. Rapid assessment surveys have facilitated the understanding of changing patterns of use. Substance use among women and children are increasing causes of concern. Preliminary neurobiological research has focused on identifying individuals at high risk for alcohol dependence. Clinical research in the area has focused primarily on alcohol and substance related comorbidity. There is disappointingly little research on pharmacological and psychosocial interventions. Course and outcome studies emphasize the need for better follow-up in this group. While lack of a comprehensive policy has been repeatedly highlighted and various suggestions made to address the range of problems caused by substance use, much remains to be done on the ground to prevent and address these problems. It is anticipated that substance related research publications in the Indian Journal of Psychiatry will increase following the journal having acquired an ‘indexed’ status.

Idiopathic Recurrent Catatonia Needs Maintenance Lorazepam: Case Report and Review

Objectives: Catatonia as a phenomenon has been well described with either a schizophrenic illness, severe mood disorders or periodic catatonia disorder. We aim to report a patient who had recurrent catatonia that responded to and required lorazepam for maintenance. Methods: We describe the case of a 28 year old woman who had a history of recurrent catatonia that was unresponsive to most anti-psychotics, but who responded to high doses of lorazepam and needed long-term lorazepam for maintenance. Results and Conclusion: Our patient met the criteria for a diagnosis of idiopathic catatonic disorder. Response to lorazepam suggests that a certain group of patients may require long-term treatment with lorazepam, especially those who may have down-regulation of GABA-A receptors.

Delusion of pregnancy associated with antipsychotic induced metabolic syndrome.

Metabolic syndrome is currently the research topic of several studies. Although physical manifestations of metabolic syndrome have been described, the psychological and psychiatric impact of metabolic syndrome has not been studied to date. We report the first case of antipsychotic-induced metabolic syndrome which was associated with development of delusions of pregnancy in a post-menopausal woman.

Delayed onset, protracted delirium and aspiration pneumonitis associated with a combination of clozapine and electroconvulsive therapy

Few studies reported the efficacy and safety in combination of clozapine and electroconvulsive therapy (ECT) in schizophrenia; systematic studies are lacking. Side effects like seizure, and confusional state are reported. Authors report two cases of delayed onset/protracted delirium with ECT and clozapine in schizophrenia, one of whom developed aspiration pneumonitis possibly due to clozapine hyper-salivation. Delirium improved with stopping of ECT and clozapine. Clozapine monotherapy restarted to previous dosages in both cases without recurrence of delirium. Authors recommend for careful monitoring for delirium in ECT augmentation on high dose clozapine. Unilateral ECT may be preferred for augmenting clozapine.

Typical Aicardi syndrome in a male

Aicardi syndrome (AS), identified first by Jean Aicardi in 1965 (1), is a rare genetic disorder characterized by infantile spasm (IS), corpus callosal agenesis and chorioretinal lacunae (CRL) (2). This is an Xlinked dominant condition and occurs almost exclusively in females because of early embryonic lethality in hemizygous males (3). Because of its lethality, it has been very rarely reported in boys (4–6), with all patients having severe motor and speech disabilities, intractable epilepsy and a high mortality rate (3). Although mild cases havebeen reported (7,8), this has been exclusively in girls. We report the first case of AS inmale withmildmental retardation and normal speech development. A 21-year-old male previously thought to have infantile epilepsy was referred because of increasing aggressive outbursts and suspiciousness towards family members. On evaluation of history, he was found to have been born of nonconsanguineous marriage, of full term at the hospital. The prenatal period was eventful because of the presence of eclampsia in the mother, diagnosed in the second trimester (untreated), and he was delivered by emergency lower segment caesarean section because of prolonged labour. His weight and head circumference were normal. The Denver developmental screening scale (9) revealed delayed developmental milestones. Around the age of 3–4 months, seizures manifested themselves for the first time, mainly of a focal nature, characterised by clustering of both shoulder shrugging and salaamattacks and presence of status epilepticus.Till the ageof 20 years, these continued, although with a decreased frequency, on treatment with 60 mg phenobarbitone. At the time of evaluation, he was found to be mildly intellectually impaired and with normal speech. A complete medical examination revealed right non-paralytic squint, spastic left-sided hemiplegia and presence of a wide forehead with thoracolumbar kyphoscoliosis.His facieswasnormal.Fundal examination revealed choroidal calcification, otherwise was entirely normal. He was then investigated. Radiology revealed no evidence of costovertebral abnormality. Interictal electroencephalography revealed intermittent alpha and diffuse theta activity in the background. Rhythmical slowing (delta waves) with burst suppression was noted in the right side. Magnetic resonance imaging revealed the presence of complete callosal agenesis. An area of dysplasia was noted in the right frontal lobe with colpocephaly and convergence of lateral ventricles. He was started on 800 mg carbamazepine along with 60 mg phenobarbitone. Risperidone 3 mg was added to manage his suspicion and aggressive outbursts towards his family members. On 1-year follow-up, patient was maintaining well on the above medications, with no recurrence of seizures or aggressive outbursts.

Baclofen-induced morbiliform rashes: a case series

Baclofen is a gamma amino butyric acid (GABA) derivative that is a specific agonist at GABA‐B receptors. Initially used in the treatment of spasticity, it is now being used in the treatment of alcohol dependence. Although it has several known adverse effects, incidence of rashes developing due to baclofen is very rare, and morbiliform rashes due to baclofen, an exceedingly rare adverse effect, has been reported only once before. We report a case series of 4 patients who developed morbiliform rashes after initiation of baclofen.

Use of mobile phone technology to improve follow-up at a community mental health clinic: A randomized control trial

Background: Mobile phone technology is being used worldwide to improve follow-ups in health care. Aim: Aim of the study is to evaluate whether the use of mobile technology will improve or not the follow-up of Indian patients from a community mental health center. Materials and Methods: Patients or caregivers having mobile phones and consenting for study were enrolled, and sociodemographic and clinical details of patients were taken. Participants were randomized into two groups (short message service [SMS] vs. non-SMS group). At first intervention level, a SMS was sent to SMS group (not in non-SMS group) 1 day before their appointment. At second-level intervention (voice call level), patients from both groups who missed their first appointment were given a voice call requesting them to come for follow-up, and the reasons for first missed appointments (MA) were also elicited. The effect of these two intervention levels ( first SMS for SMS group and next voice calls for both groups) on follow-up was evaluated. Results: A total of 214 patients were enrolled in the study. At first SMS intervention level of SMS group (n = 106), 62.26% of participants reached appointment-on-time (RA), while in the non-SMS/as usual group (n = 108), 45.37% of patients RA. The difference of these groups is statistically significant. At second-level intervention (voice call), 66 of 88 (another 15 were unable to contact) were came for follow-up consultation within 2 days of MA. Distance and diagnosis of alcohol dependence were significantly associated with MA. Social reasons were most common reasons for first MA. Conclusion: The use of mobile phone technology in an outpatient community psychiatric clinic improved follow-up significantly.

Delusional Procreation Syndrome: Report from TURUVECARE Community Intervention Program.

New insights on Delusional Procreation Syndrome (DPS), a sequence of delusions in the cycle of human procreation are emerging in recent times. Till date, most of the data on DPS are reported from the clinical samples. Authors report case series of having delusions related to DPS from a rural community sample of schizophrenia patients. Delusion of having spouse, delusion of delivery, and delusion of being a parent are reported in this case-series. This evidence is a forward step towards the validity of DPS as a syndrome.