P. S. V. N. Sharma

Outcome of mood stabilizer discontinuation in bipolar disorder after 5 years of euthymia.

Objective The objective was to study the outcome of mood stabilizer discontinuation on recurrence in patients with bipolar disorder after at least 5 years of euthymia. Methods Twenty-three patients diagnosed with bipolar affective disorder according to the International Classification of Diseases, 10th Revision Diagnostic Criteria for Research, receiving mood stabilizer prophylaxis for at least 5 years, had undergone planned discontinuation, and the rates and time to recurrence were studied. Results Twenty (87%) of 23 patients had recurrence, and all of the episodes were manic. Kaplan-Meier survival analysis showed median time to recurrence following discontinuation of mood stabilizer prophylaxis was 10 months (SE, 6.06 months; 95% confidence interval, 0 to 21.89 months). Conclusion Four fifths of our patients had recurrence following discontinuation of mood stabilizer prophylaxis within 10 months.

Psychiatric Specialization as an Option for Medical Students in the Indian Context

Abstract There is a shortage of psychiatrists in India and psychiatry as a subject of specialization is not a preferred option among medical undergraduates. There is inadequate exposure to psychiatry during the medical undergraduate training in India which might contribute towards it. There are attempts to overcome the negative attitudes towards psychiatry and mental illness among medical undergraduates by changes in the curriculum. In this paper we attempt to review studies on attitudes of undergraduate students towards psychiatry and compare the results with findings from our own survey done as a part of International Study of Student Career Choice in Psychiatry (ISoSCCiP) project.

Prevalence and Factors Associated with Clozapine-Related Constipation

Background Despite being a very effective treatment for resistant schizophrenia and bipolar disorder, use of clozapine is limited by adverse effects. Constipation is a common but potentially life-threatening adverse effect of clozapine that is understudied. The objective was to study the prevalence and factors associated with constipation in those receiving clozapine compared with control subjects. Methods Fifty patients in age group of 18 to 55 years receiving clozapine were compared with 50 patients in the same age group receiving medications other than clozapine. Presence of constipation was ascertained using the World Gastroenterology Organization Practice Guidelines definition. The severity of constipation was assessed using Constipation Assessment Scale and Bristol Stool Form Scale, and anticholinergic burden was assessed using Anticholinergic Burden Scale. Results Among clozapine-treated patients, 28 (56%) had constipation as compared with 11 (22%) in the control subjects (P < 0.001); the odds of developing constipation was 4.5 (95% confidence interval, 1.9–10.8). Kaplan-Meier survival analysis showed median time to onset of constipation in clozapine-treated patients was 60 days (SE, 13.1 days; 95% confidence interval, 34.3–85.7 days) and median dose of clozapine was 300 mg/d (interquartile range, 312 mg/d). Clozapine group had high Constipation Assessment Scale scores (P = 0.005, Cohen d = 1.17) and higher prevalence of types 1 and 2 Bristol stool types (Fisher exact P = 0.005, Cramer V = 0.59). Conclusions Constipation was prevalent in more than half of patients receiving clozapine, which was severe and took longer time for recovery. Limitations include using a hospital-based sample and that dietary habits and lifestyle factors were not studied.

Newer Somatic Treatments: Indian Experience

Psychopharmacological and non-pharmacological interventions have inherent limitations in the treatment of neuropsychiatric disorders. The somatic treatment approaches such as electroconvulsive therapy (ECT) are associated with cognitive adverse effects. Therefore, there is a recent surge in interest in newer somatic treatment approaches in psychiatric disorders which are device-based, circuit-based and which have more focal actions in the key target brain regions. Several such approaches are being studied including transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS) and deep brain stimulation (DBS). We review the Indian studies using these treatment modalities for various neuropsychiatric disorders.