Naveen Jayaram

Effect of yoga therapy on plasma oxytocin and facial emotion recognition deficits in patients of schizophrenia

Context: Yoga therapy has been demonstrated to be useful in treatment of negative symptoms and improving the socio-occupational functioning and emotion recognition deficits in antipsychotic-stabilized schizophrenia patients. Oxytocin has been recently implicated in social cognition deficits in schizophrenia. The effect of yoga therapy on oxytocin levels in schizophrenia has not been studied. Aims: This study aimed to assess the effect of yoga therapy on symptoms, socio-occupational functioning, facial emotion recognition deficits and plasma oxytocin levels in antipsychotic stabilized schizophrenia patients. Settings and Design: Randomized controlled study on 43 consenting, medication stabilized patients with schizophrenia in a tertiary psychiatric center using yoga intervention and waitlisted groups. Materials and Methods: A total of 43 schizophrenia patients were randomized to yoga group (n=15) or waitlist group (n=28). Patients in the yoga group received training in a specific yoga therapy module for schizophrenia. Patients in both groups were continued on stable antipsychotic medication. Assessments included scale for assessment of positive symptoms, scale for assessment of negative symptoms, socio-occupational functioning scale and tool for recognition of emotions in neuropsychiatric disorders (TRENDS) and plasma oxytocin levels; performed at baseline and at the end of 1 month. Results: A total of 15 patients in the yoga group and 12 in waitlist group completed the study. The yoga therapy group showed a significant improvement in socio-occupational functioning, performance on TRENDS (P<0.001) and plasma increase in oxytocin levels (P=0.01) as compared with the waitlist group. Conclusion: The study supported the role of add-on yoga therapy in management of schizophrenia and demonstrated an improvement in endogenous plasma oxytocin levels in schizophrenia patients receiving yoga therapy.

Beneficial effects of add-on raloxifene in schizophrenia

The role of estrogens in schizophrenia has been proposed from the observation of schizophrenia occurring later and with symptom severity being lesser in women. Utility of estrogens in treatment of psychoses, though seen to be useful, comes with inherent risks of neoplasias, given its agonistic action on breast and endometrium. This risk can be overcome with use of selective estrogen receptor modulators, like raloxifene. Raloxifene has been used in schizophrenia, with improvement in symptoms and cognitive functions. We report the use of raloxifene as an adjunctive treatment, with risperidone, in treatment-resistant form of schizophrenia. The patient, a 29-year-old woman, over a 7-month follow-up period, showed significant improvement in socio-occupational functioning, with reduction in symptom severity.

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.

Vitamin B12 Levels and Psychiatric Symptomatology: A Case Series

Cobalamin (Vitamin B₁₂) has been implicated in the pathogenesis of various neuropsychiatric disorders. A review of 19 patients (14 vegetarians) with demonstrable vitamin B₁₂ deficiency showed varied psychiatric symptomatology, with the majority not having significant hematological or neurological manifestations.

Acyclovir in bipolar disorder: A mismatched combination?

Acyclovir, a commonly used antiviral drug can rarely result in neuropsychiatric complications especially in elderly. We for the first time report acyclovir associated hypomania in an elderly woman. Our report suggests that acyclovir is a risk factor for mood episode in vulnerable individual and one need to be cautious while using antiviral agents in patients with psychiatric disorders.

Baclofen as an anti-craving agent for adolescent inhalant dependence syndrome

Inhalant abuse and dependence are important public health problem worldwide, especially among adolescent age group. Approximately 18.8% of school children were noted to use inhalants in Northeast India [1]. A school-based survey in the USA showed that it is the second most common substance abused after cannabis by the school children [2]. In the past two decades, there is a trend of increased use of inhalants among adolescents [3]. The main reasons for such an increase are that inhalants are cheap, easily available and give an immediate high. Because of non-specific withdrawal symptoms and lack of knowledge of the exact mechanism by which inhalants exert their effects, the treatment of inhalant abuse and dependence has been a major concern. Baclofen, a selective GABA B receptor agonist, has been shown to be an effective and safer anti-craving agent in alcohol dependence [4–7]. Baclofen has been used for treating withdrawal symptoms in inhalant dependence [8]. However, there are no studies about long-term use of baclofen as an anticraving agent in adolescents. We report a case of inhalant dependence syndrome in an adolescent where baclofen was in the long-term prophylaxis. Mr M, a 14-year-old boy from low socioeconomic background, studying in eighth grade, presented to us with a 1-year history of inhalant dependence syndrome (DSM IV). He was sniffing around two 50 mL tubes of a toluene-based adhesive per day. He reported that he initiated the solvent use because of peer pressure. He would feel uncomfortable and irritable whenever he tried to abstain from inhalants. Family history was positive for alcohol dependence in a first-degree relative. He was not attending his school for around 1 year. There was no history of abuse of any other substances except nicotine. All the routine investigations (haemogram, liver function test, renal function test) were normal. After obtaining consent from the patient and his family members, he was initiated on 10 mg of baclofen (plain preparation), which was titrated up to 40 mg (Baclofen XL extended release tablets, 20 mg) per day in two divided doses over a period of 1 week. He reported significant improvement in craving after 1 week. He was adherent on medication and was under regular follow up for 10 months. He was completely abstinent from inhalant use during this period. He had stopped baclofen for 3 weeks, during which he had lapsed to inhalant use for a period of 4–5 days. After the drug was restarted, he maintained abstinence for the next 6 months. He also received psychosocial support during the follow-up visits. Both patient and family members felt there is a qualitative difference in his ability to resist drug-related cues from the environment while on baclofen therapy. Compliance to treatment and the response were corroborated by the patient’s mother.We also confirmed his abstinence from inhalant by screening his urine samples (gas chromatography/mass spectrometry technique) for volatile solvents randomly.This case report highlights the use of baclofen as an anticraving agent for long-term management of inhalant dependence. Management of solvent abuse has been a major concern, because of lack of specific agents. Few authors claim that pharmacotherapy is not an option for inhalant use management [8]. Baclofen enhances the inhibitory GABAergic tone on dopaminergic neurons of the reward pathway resulting in reduced reinforcements from substances of abuse. It also suppresses the neuronal hyper-excitability during withdrawal phase by acting on preand post-synaptic GABAergic receptors [9]. Many studies had shown that baclofen is useful as anti-craving agent for various substances including alcohol, cocaine and cannabis [6,10,11]. Most of the inhalants are higher molecular weight alcohols. GABArelated changes have been noted in animal studies. Decreased levels and decreased firing rate of GABAergic neurons have been demonstrated following toluene exposure in animal studies [12]. Baclofen has been found to be useful in adults and adolescents to reduce withdrawal symptoms and craving associated with inhalant use [8]; however, literature is limited about the long-term use of the drug. Baclofen was tolerated well by our patient. Except for mild dizziness immediately after taking the drug, no other major side effects like seizures and other neuropsychiatric symptoms were noted. In this case, Mr M had good adherence to medication and had regular follow ups for 10 months. He reported that his desire to take inhalants reduced significantly after bs_bs_banner

Successful Use of Add - On Topiramate for Antipsychotic - Induced Weight Gain

Antipsychotic induced weight gain is the most common and distressing side effect. This also affects the compliance toward the treatment and hence the prognosis. Non - pharmacological interventions such as exercise and diet modifications alone might not be sufficient most of the times; also ensuring compliance toward this is difficult in patients with psychiatric illness. So, the role of weight - reducing drugs become important. In this case report, we describe the use of low - dose topiramate as a weight - reducing agent, in a patient with a bipolar affective disorder - mania with psychotic symptoms, who had significant risperidone - induced weight gain.