Nilesh M Naphade

Reduced folic acid, vitamin B12 and docosahexaenoic acid and increased homocysteine and cortisol in never-medicated schizophrenia patients: Implications for altered one-carbon metabolism

Abnormal one-carbon metabolism has long been suggested as one of the mechanisms for neuropathology and psychopathology of schizophrenia. Variable levels of components of one-carbon metabolism (folic acid and vitamin B12) and consequent altered levels of homocysteine and phospholipid docosahexaenoic acid (DHA) have been independently reported, mostly in medicated patients. This study examined the simultaneous levels of these key components of one-carbon metabolism and its consequences in unique, medication-naïve first-episode psychotic patients (FEP, n=31) and healthy controls (HC, n=48) matched for confounds such as race, diet and lifestyle to reduce the variability. Significantly lower levels of folate and vitamin B12 in plasma and folate in red blood cells were observed in FEP compared to HC. These reductions paralleled the significant increase in plasma homocysteine and cortisol levels. Significantly reduced levels of membrane DHA were also observed in FEP compared to HC. This study, using a unique cohort, provided a broader mechanism (disturbed folic acid-vitamin B12-DHA balance) of altered one-carbon metabolism and one of its key consequential components, an increased homocysteine level that together with cortisol, can contribute to the neuropathology of psychosis. These data may have important implications for the amelioration of psychopathology in schizophrenia.

Decreased BDNF levels in CSF of drug-naive first-episode psychotic subjects: Correlation with plasma BDNF and psychopathology

Brain-derived neurotrophic factor (BDNF), which plays an important role in neurodevelopmental plasticity and cognitive performance, has been implicated in neuropsychopathology of schizophrenia. We examined the levels of both cerebrospinal fluid (CSF) and plasma BDNF concomitantly in drug-naive first-episode psychotic (FEP) subjects with ELISA to determine if these levels were different from control values and if any correlation exists between CSF and plasma BDNF levels. A significant reduction in BDNF protein levels was observed in both plasma and CSF of FEP subjects compared to controls. BDNF levels showed significant negative correlation with the scores of baseline PANSS positive symptom subscales. In addition, there was a significant positive correlation between plasma and CSF BDNF levels in FEP subjects. The parallel changes in BDNF levels in plasma and CSF indicate that plasma BDNF levels reflect the brain changes in BDNF levels in schizophrenia.

Opposite changes in predominantly docosahexaenoic acid (DHA) in cerebrospinal fluid and red blood cells from never-medicated first-episode psychotic patients.

Variable levels of essential polyunsaturated fatty acids (EPUFAs) reported in schizophrenia are likely due to differences in age, sex, ethnicity, diet, life style and treatments. The present study examined the EPUFAs levels in plasma, RBC and CSF in never-medicated first-episode psychotic patients and normal controls matched for ethnicity, diet and life style. The plasma EPUFAs levels were similar in both groups. Among the EPUFAs enriched in the brain, predominantly docosahexaenoic acid (DHA) levels were lower in RBC (p=<0.01) whereas higher in CSF (p=<0.01) in male>female patients. This altered DHA metabolism may provide clues for neuropathology and treatment of schizophrenia.

Reduced cerebrospinal fluid and plasma nerve growth factor in drug-naïve psychotic patients

Impaired expression and function of several major neurotrophic factors such as nerve growth factor (NGF) has been proposed to contribute to the neurodevelopmental pathology of schizophrenia. However, the evidence in the majority of studies is based on variable and inconsistent levels of plasma NGF in diverse populations of early psychosis or medicated patients with chronic schizophrenia. We report here the first study comparing NGF levels in cerebrospinal fluid (CSF) and plasma from a unique patient cohort (unmedicated, early psychotic patients with similar racial and dietary patterns) and matched healthy controls. Significantly lower levels of NGF in both CSF (p=0.038) and plasma (p=0.002) were observed in drug-naïve first-episode psychosis patients as compared to controls. The levels of NGF in the CSF correlated (p=0.05) to the plasma values in controls. The data on plasma NGF confirm the reported deficits of NGF in drug-naïve first-episode psychosis. The reduced levels first time observed here may have important implications to repeatedly reported neurobiological and clinical deficits which are discussed.

Neuropsychiatric manifestations of Fahr's disease pathogenesis and potential for treatment

Fahrs disease (FD) is a rare neuropsychiatric disease consisting of bilateral basal ganglia calcification with neurological, cognitive, and psychiatric manifestations. We report here a sporadic case of FDs with its neuropsychology.

Very late-onset schizophrenia like psychosis: Case series and future directions

The quest to unravel the mysteries of schizophrenia has led to immense research in this area over the years. Previously schizophrenia was considered to strictly be an early onset disorder. However, the heralding of baby boomers, with a subsequent surge in the elderly population, has led to growing curiosity in the geriatric age group with schizophrenia. The nosology of late-onset and very late-onset schizophrenia like psychosis (VLOSLP) has remained contentious. The international late-onset schizophrenia (LOS) group has proposed that schizophrenia with an onset between ages 40 and 60 be termed LOS and above 60 years termed VLOSLP. We present two case reports of VLOSLP and its relevance to the present day context.

Stress and coping styles in postgraduate medical students: A medical college-based study

Background: Medical education is inherently stressful. Postgraduate medical students, in particular are vulnerable to experience stress. Considering the paucity of research on stress in postgraduate medical students, this study was conducted to assess their perceived stress and coping strategies. The study intends to provide inputs for future interventions to manage their stress. Objective: To study perceived stress, coping styles and psychological morbidity in postgraduate medical students Material & methods: This was a cross sectional study conducted on all postgraduate students willing to participate in the study, studying at this medical college and hospital. They were asked to fill a structured proforma to assess socio-demographic details and domains of stress. Stress was assessed by Perceived stress scale (PSS-10), coping strategies using BRIEF COPE and psychological morbidity screened by Self reporting questionnaire (SRQ). Descriptive analysis &Pearson correlation was done between stress levels, psychological morbidity and various coping strategies. Results: Postgraduate medical students had mean PSS-10 score of 17.96. Pearson correlation revealed positive correlation between stress levels measured by PSS-10 and psychological morbidity measured by SRQ (Correlation coefficient 0.639). There was also positive correlation independently between higher stress score and psychological morbidity with higher use of dysfunctional coping strategies (Correlation coefficient 0.44 & 0.421 respectively). Conclusion: Postgraduate students using dysfunctional coping strategies had higher stress and psychological morbidity, whereas those using healthy emotion focused coping strategies had lower stress levels and lower psychological morbidity.

Hypersexuality – a cause of concern: A case report highlighting the need for psychodermatology liaison

Sexual addictions are behavioral addictions. Hypersexuality is used to describe non-paraphilic “excesses” of sexual behavior. Hypersexual disorder (HSD) can be accompanied by clinically significant social, personal distress, and medical morbidity. Common medical comorbidities seen with HSD are the sexually transmitted diseases (STDs). We present one such case with management. A psychodermatology liaison clinic would be the ideal one-stop for screening patients with STDs for HSD.

Electroconvulsive Therapy in Severe Depression: Is Amnesia a Problem?

Introduction: Depression is the leading global cause of disability and approximately, 350 million people suffer from depression worldwide. Despite the availability of numerous psychopharmacological treatments, evidence indicates that only 60–70% of persons who tolerate antidepressants will respond to first-line drug therapy for major depressive disorder. Resistance to the antidepressant medication is the main indication for ECT. However, the use of ECT remains controversial due to concerns about memory impairment in persons with depression who receive acute ECT. The present study was planned toevaluate the effectiveness of ECT in severe depression and its effect on retrograde and anterograde amnesia or any change in their level due to ECT. Materials & Methods: A total of 30 consecutive patients diagnosed with Severe Depressive Episode as per International Classification of Diseases (ICD-10) Diagnostic Criteria for Research and satisfying the eligibility criteria were taken in the study after informed consent. ECT was administered as per prevailing guidelines by means of a medical model BPE – 2000 giving bidirectional square wave pulse at a frequency of 20-90Hz. Baseline evaluation by Hamilton Rating Scale for Depressionwhile Autobiographical Memory Interview (AMI) and Wechsler Memory Scale (WMS) – Third India Edition was used for assessment of retrograde and anterograde amnesia following ECT. Post-treatment evaluation was carried out at the end of ECT treatment and at one month after ECT treatment. Results: The mean age of the study subjects was 38.53 years with 66.7% females and 33.3% males. Significant improvement was seen in depressive symptoms after ECT treatment (p<0.05). Mean Hamilton score at baseline, immediately after ECT and at 1 month follow up were 40.03, 14.32 and 14.89 respectively (p<0.01 and p-0.19). AMI scores were significantly lower at post-treatment (79.32 ± 17.93) and follow-up (76.76 ± 20.88) when compared to pre-treatment AMI scores (100 ± 0.00). A repeated measures ANOVA which compared mean scores for the immediate and delayed Logical Memory Test (WMS) across treatment did not demonstrate any significant effect for ECT. Conclusion: The observation made in present study strongly suggest the benefits of ECT in reducing and providing sustained relief from the acute symptoms of depression while no changes were observed in participants anterograde memory. However persistent problems with retrograde amnesia can be a cause of concern. The study findings may assist health care providers and potential patients to take a more informed decisions about their care.

The impact of parental alcohol dependence on the development and behavior outcome of children in a tertiary care hospital

Parents play a pivotal role in upbringing a child and shaping their future. However, children of alcoholics (COAs) suffer due to their parents dependence pattern. The various domains affected encompass cognitive, behavioural, psychological, emotional and social spheres. This study was designed to assess the impact of alcohol dependence in the parent on the development and behavior of their children, so that further steps could be taken to minimize the negative influences. Aims: To study the impact of parental alcohol dependence on the development and behaviour outcome of children in various domains, alongwith the effect of the family environment. Materials and Methods: The study was a cross-sectional observational study conducted at a tertiary care teaching hospital on 25 children between 6 and 18 years of age, whose atleast one parent was diagnosed as alcohol dependant. The other parent was assessed using a general health questionnaire-28. Child behaviour checklist and family evaluation scale (FES) were then applied. Statistical Analysis Used: The analysis was done according the manuals provided with the respective scales to calculate the score. Results: Both male and female COAs had high externalizing and internalizing scores. The girls have higher internalizing scores while the boys of such parents have higher externalizing scores. The FES showed dysfunction in all the three dimensions, namely the relationship, personal growth and the system maintenance. Conclusions: Our study corroborates the findings of the studies done in the past on COAs. The COAs face various affective, anxiety, somatic, attention deficit/hyperactivity, oppositional defiant conduct problems.