Rishikesh V. Behere

Effect of yoga therapy on facial emotion recognition deficits, symptoms and functioning in patients with schizophrenia.

Behere RV, Arasappa R, Jagannathan A, Varambally S, Venkatasubramanian G, Thirthalli J, Subbakrishna DK, Nagendra HR, Gangadhar BN. Effect of yoga therapy on facial emotion recognition deficits, symptoms and functioning in patients with schizophrenia.

Neurohemodynamic correlates of 'OM' chanting: A pilot functional magnetic resonance imaging study.

Background: A sensation of vibration is experienced during audible ‘OM’ chanting. This has the potential for vagus nerve stimulation through its auricular branches and the effects on the brain thereof. The neurohemodynamic correlates of ‘OM’ chanting are yet to be explored. Materials and Methods: Using functional Magnetic Resonance Imaging (fMRI), the neurohemodynamic correlates of audible ‘OM’ chanting were examined in right-handed healthy volunteers (n=12; nine men). The ‘OM’ chanting condition was compared with pronunciation of “ssss” as well as a rest state. fMRI analysis was done using Statistical Parametric Mapping 5 (SPM5). Results: In this study, significant deactivation was observed bilaterally during ‘OM’ chanting in comparison to the resting brain state in bilateral orbitofrontal, anterior cingulate, parahippocampal gyri, thalami and hippocampi. The right amygdala too demonstrated significant deactivation. No significant activation was observed during ‘OM’ chanting. In contrast, neither activation nor deactivation occurred in these brain regions during the comparative task – namely the ‘ssss’ pronunciation condition. Conclusion: The neurohemodynamic correlates of ‘OM’ chanting indicate limbic deactivation. As similar observations have been recorded with vagus nerve stimulation treatment used in depression and epilepsy, the study findings argue for a potential role of this ‘OM’ chanting in clinical practice.

Effect of risperidone on emotion recognition deficits in antipsychotic-naïve schizophrenia: A short-term follow-up study

BACKGROUND Facial emotion recognition deficits [FERD] have been consistently demonstrated in treated schizophrenia patients. FERD in treatment-naïve patients and the effect of antipsychotics are yet to be explored. AIMS To examine for FERD in antipsychotic-naïve schizophrenia patients and the effect of short-term atypical antipsychotic treatment on FERD. METHODS Twenty-five antipsychotic-naïve schizophrenia [DSM-IV] patients and 30 age-, sex-, and education-matched healthy control subjects were assessed for FERD using the Tool for Recognition of Emotions in Neuropsychiatric DisorderS [TRENDS] - a culturally sensitive and valid tool. Psychopathology was assessed using SAPS and SANS. Performance of patients on TRENDS and psychopathology was re-assessed after short-term exposure to risperidone. RESULTS At baseline, the patients made significantly greater errors in recognition of negative emotions of fear and disgust which improved on follow-up. This improvement was influenced by severity of baseline negative symptoms. CONCLUSION Risperidone treatment can improve disgust recognition deficits in patients with schizophrenia.

First rank symptoms & facial emotion recognition deficits in antipsychotic naïve schizophrenia: Implications for social threat perception model

Facial emotion recognition deficits (FERD) have been consistently demonstrated in schizophrenia. However the relation between psychopathology and FERD remains inconclusive. This could possibly be due to the wide heterogeneity in the psychopathology of schizophrenia. First Rank Symptoms (FRS) of schizophrenia is associated with heightened sense of paranoia and rapid processing of threatful emotional stimuli. We studied differences in patterns of FERD between homogenous sub-groups of antipsychotic naïve schizophrenia patients (n=63); namely those experiencing FRS (FRS+ group n=26) and those who did not (FRS- group n=37), in comparison to age-, sex-, education matched healthy controls (n=45). FERD was assessed using TRENDS - (Tool for Recognition of Emotions in Neuropsychiatric DisorderS), a culturally sensitive and ecologically valid (consisting of both static and dynamic emotional stimuli) tool. The total number of images of non threatful emotions (sad, happy, neutral) which were identified as any of the threatful emotions (fear, anger, disgust) and vice versa were calculated and termed TRENDS Over-identification and Under-identification score respectively. The patient group made significantly greater errors in emotion recognition as compared to healthy controls. On post hoc analysis (Tukey HSD) the patients in FRS+ group made significantly greater errors in Over-identification as compared to the FRS- group. This study supports that FERD is one of the important deficits in schizophrenia. There is a differential pattern of impairment in FERD, which supports the role of heightened threat perception in the evolution of psychopathology in schizophrenia patients.

Neuroanatomical, neurochemical, and neurodevelopmental basis of obsessive-compulsive symptoms in schizophrenia.

The prevalence of the obsessive-compulsive symptoms in schizophrenia (OCSS) appears to be higher than that expected on the basis of comorbidity rates. Review of brain abnormalities in schizophrenia and obsessive-compulsive disorder (OCD) reveals involvement of similar regions namely the frontal lobe, the basal ganglia, the thalamus, and the cerebellum, in both the disorders. Neurodevelopmental etiopathogenesis has been proposed to explain schizophrenia as well as OCD. Significant overlap in neurotransmitter dysfunction (serotonin, glutamate, and dopamine) has been documented between schizophrenia and OCD. The New-onset obsessive-compulsive (OC) symptoms have been reported with the use of atypical antipsychotics in the schizophrenia patients In this background, OCSS is an emerging area of recent interests. This article attempts to review the literature on the neurobiology of OCSS. Neuroimaging, neuropsychological, and neuromotor abnormalities in OCSS discussed in the context of neurodevelopmental etiopathogenesis suggest glutamate abnormalities in OCSS. Atypical antipsychotic induced OCSS points towards the possible roles of glutamate and serotonin. Dopamine may be responsible for the beneficial role of antipsychotics in the treatment of OCD. In summary, we propose that glutamate, serotonin, and dopamine abnormalities may be the probable basis for OCSS.

Inferior parietal lobule volume and schneiderian first-rank symptoms in Antipsychotic-Naive schizophrenia: A 3-Tesla MRI study

Background: As per Friths neuro-cognitive model, inferior parietal lobule (IPL) is implicated in the pathogenesis of Schneiderian first-rank symptoms (FRS) in schizophrenia. The specific role of IPL structural abnormalities in the pathogenesis of FRS is yet to be ascertained. Materials and Methods: Using 3-tesla MRI scanner, this first-time study examined antipsychotic-naïve schizophrenia patients ( n = 28) (patients with FRS [FRS +]: N = 14, M: F = 7:7; and patients without FRS [FRS-]: N = 14, M: F = 7:7) in comparison with sex-, handedness-, education- and socioeconomic status-matched healthy controls (n = 14, M: F = 7:7). The volume of IPL was measured using a three-dimensional, interactive, semi-automated analysis, with good inter-rater reliability. Results: FRS + patients showed significant volume deficit in right IPL in comparison with healthy controls (F = 4.0; P=.028) after controlling for the potential confounding effects of age, sex and intracranial volume. Conclusions: Right IPL volume deficit in FRS+patients adds further support to the Friths model of FRS in schizophrenia.

Comorbid Bipolar Disorder and Usher Syndrome

To the Editor: Co-occurrence of psychiatric disorder and rare syndromes with known gene loci can facilitate critical pathophysiologic insights and might have important therapeutic implications as well.1 Usher syndrome is the most common type of deaf-blindness. It is a group of genetically distinct disorders phenotypically associated with dual sensory impairments as a result of congenital sensorineural hearing loss and progressive visual impairment from retinitis pigmentosa. Rarely, Usher syndrome may be associated with mental subnormality and infertility. Twenty-three percent of these patients have a psychiatric illness, mainly schizophrenia.1,2 Pathogenic Usher protein complex is a group of proteins that are neurosensory receptors at the outer hair cells of the inner ear and the retinal photoreceptor cells and are encoded by different genes present on the chromosomes 1, 8, and 14.3,4 Mutation of any one of the multiple genes in these chromosomes leads to the symptom complex of Usher syndrome. Although co-occurrence of psychosis with Usher syndrome has been reported,5–7 co-occurrence of bipolar disorder has not been reported. For the first time, we report a patient with bipolar disorder and Usher syndrome and the treatment implications. Case report. Mr A, a 25-year-old man, presented to our hospital in December 2007 with a history of elated mood, overactivity, overtalkativeness, overfamiliarity, delusions of grandiosity, decreased need for sleep, and decreased appetite for the past 3 months. In the past, Mr A had experienced 2 episodes of mania that responded to treatment with haloperidol, with complete remission of symptoms. He also had a history of congenital hearing impairment and night blindness. There was a family history suggestive of congenital deafness and night blindness in a first-degree relative. Results of investigations, namely, hemogram, liver function tests, kidney function tests, and serum electrolytes, were normal. Magnetic resonance imaging did not reveal structural abnormalities. He was evaluated using the Mini International Neuropsychiatric Inventory8 and diagnosed as having bipolar affective disorder with psychotic symptoms (ICD-10). He had a score of 16 on the Young Mania Rating Scale (YMRS).9 Audiometry showed sensorineural hearing loss for 4–8 kHz, and ophthalmic examination revealed retinitis pigmentosa, suggestive of Usher syndrome. Mr A was started on treatment with lithium 600 mg/d for management of bipolar disorder. Subsequently, he developed hyperpigmented papular and pustular lesions involving the skin and buccal mucosa. Dermatologic opinion was sought, resulting in a diagnosis of pemphigus vulgaris, and treatment with prednisolone 30 mg/d was advised. In view of this, lithium treatment was stopped and treatment with risperidone 4 mg/d and valproate 1000 mg/d was started. He improved with this medication and at the end of 2 weeks had a score of 4 on the YMRS. Mr A had no new skin lesion, and he maintained euthymia at the end of 1 year. To the best of our knowledge, this is the first report of the co-occurrence of Usher syndrome and bipolar disorder. Our patient had high-frequency sensory neural hearing loss and atypical retinitis pigmentosa suggestive of Usher syndrome. He developed significant side effects when lithium treatment was started. One should be cautious of dermatologic side effects when starting lithium treatment in patients with comorbid Usher syndrome. This report exemplifies the need for systematic assessment of patients with bipolar disorder in liaison with other specialties for comorbid conditions whenever indicated. Interestingly, chromosomes 8 and 14 are also implicated in linkage studies of bipolar disorder.10 Further molecular biologic studies of such patients with comorbid bipolar disorder might facilitate better understanding of the pathogenesis of bipolar disorder.

Hyperprolactinemia with aripiprazole: understanding the paradox.

Aripiprazole, due to its partial agonist activity at the D2 receptors, is often recommended as the drug of choice in patients who develop antipsychotic-induced hyperprolactinemia. We report a case of a female patient who developed hyperprolactinemia while on treatment with aripiprazole. This partial D2 agonistic activity of aripiprazole could be dose related, and hence, at higher doses, aripiprazole by itself can have dopamine antagonistic properties and hence cause prolactin system abnormalities.

Has Kahlbaum syndrome disappeared or is it underdiagnosed? Reexamining the nosology of catatonia.

In contemporary psychiatric classification such as the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, and International Classification of Diseases, 10th Revision, catatonia is classified as a subtype of schizophrenia and not as an independent disorder. However, catatonia does not seem to obey nosological boundaries and is seen with both affective and nonaffective psychoses. We conducted a chart review of patients to examine the nosological status of catatonia. Our data suggest that catatonia is a syndrome of varied manifestation possibly related to both affective and nonaffective psychoses with a subgroup independent of both. Further prospective studies examining the natural course are needed, which could have significant implications on future classificatory systems.

Successful use of maintenance electroconvulsive therapy in the treatment of clozapine-associated obsessive-compulsive symptoms in schizophrenia: a case report.

Denovo obsessive-compulsive (OC) symptoms are associated with the use of atypical antipsychotics, clozapine in particular. Treatment of clozapine-associated OC symptoms is challenging and often difficult because continuation of clozapine can result in worsening of OC symptoms, whereas discontinuation may result in worsening of psychosis. We report, for the first time, the use of maintenance electroconvulsive therapy, in clozapine-associated OC symptoms, in a patient with schizophrenia.