Sayantanava Mitra

“I Do Not Exist”—Cotard Syndrome in Insular Cortex Atrophy

Cotard syndrome is a fascinating entity, in which the patient lingers under extreme nihilistic delusions. While its etiology is still unclear, modern imaging techniques have revealed interesting possibilities regarding the role of insular cortex in mediating interoception and selfperception. Our paper reports development of Cotard syndrome in a 65-years old female suffering from symptoms of dementia and depression, who’s subsequent MRI revealed atrophy of bilateral insular cortices. We propose that etiology of Cotard syndrome in this case may be a reduction in her ability to validate internal perception against external information and subsequent coloring of anomalous perceptions by depressive cognitions.

Prevalence of restless legs syndrome in somatoform pain disorder and its effect on quality of life

Background: Persistent somatoform pain disorder (SPD) is a condition in which the patient suffers from persistent, severe and distressing pain; and from associated physical and psychological distress. While presence of restless leg syndrome (RLS) in SPD is understudied, their association might have an impact on general well-being and quality of life (QoL) in SPD. Aims and Objectives: Present study aimed at evaluating the prevalence of RLS in SPD patients attending outpatient department services at a tertiary care institute in eastern India. Materials and Methods: Two hundred and forty consecutive patients with SPD were screened initially and after applying appropriate inclusion and exclusion criteria, 192 subjects (male = 85, female = 107) were included in the study. Severity of RLS was assessed using a questionnaire of the International Restless Legs Syndrome Study Group and QoL was measured on QoL Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF). Results: Revealed a 28% prevalence of RLS is in patients with SPD, which is much higher than its estimated population prevalence. A larger proportion of those with RLS had continuous course of SPD, longer duration of SPD, and higher daytime sleepiness. They also had poorer scores on Q-LES-Q-SF, indicating a poorer QoL overall. Discussion and Conclusion: This is the first report, to the best of our knowledge, on this aspect from India. While this association between RLS and SPD may have biological explanation based on abnormal monoaminergic neurotransmission system, the findings call for more vigilant approach to SPD patients in order to improve their QoL and add to their well-being.

Emerging Hyperprolactinemic Galactorrhea in Obsessive Compulsive Disorder with a Stable Dose of Fluoxetine

While fluoxetine (FXT) is a frequently prescribed selective serotonin reuptake inhibitor (SSRI), with few major side-effects; altered serotonergic transmissions in hypothalamic pathways might lead to a distressing, and often embarrassing, manifestation of galactorrhea by altering prolactin release in those on FXT. We report here a case of FXT-induced hyperprolactinemic galactorrhea developing late into treatment on a stable regimen, who responded well to subsequent replacement with sertraline. Based on present finding, we suggest that while SSRIs may share similar mechanisms of action, there exist individual differences in their effects on prolactin secretion pathways.

Event related desynchronisation of mu-wave over right sensorimotor cortex at baseline may predict subsequent response to antipsychotics in Schizophrenia

Mirror neuron system (MNS) has been demonstrated to be defective in patients with schizophrenia. This paper report findings from a high resolution (192-channel) EEG study conducted on 15 drug free/naïve consenting schizophrenia patients, in which the specific role of right hemispheric MNS has been explored over 4 weeks of antipsychotic treatment. The authors used mu wave suppression paradigm, and found that baseline right MNS mu suppression correlated negatively with and predicted relative improvement in thought disturbance cluster score of PANSS during first 4 weeks of drug treatment.

Psychiatry at undergraduate level in India: What is needed?

Present day health-care philosophy strongly favors an increased attention to mental health related issues. However, the lack of an adequate number of trained specialists in India in this field makes it imperative that the burden is shared by general practitioners at large. But our current medical education system may not be equipped enough to prepare them for the task.

Primary Prevention of Alzheimer’s Disease in Developing Countries

TO THE EDITOR The “use it or lose it” theory of brain proposes that an enriched environment, a cognitively active life-style, and an exploratory rather than “indoor” exercise schedule can prevent or postpone dementia, much like with a muscle. Enhancement of hippocampal volume; continued cellular proliferation, differentiation, survival and integration into circuits involving the hippocampus have all been reported with adoption of these methods. Recently, it has been reported that low educational achievement has the highest estimated population-attributable risk (PAR; 19.1%, 95% confidence interval 12.3-25.6) worldwide in terms of developing Alzheimer’s dementia (AD); while physical inactivity contributed highest in this regard in developed world. PAR, in this report, has been calculated through meta-analysis of existing data for seven modifiable factors. As PAR measures the proportion of cases that would not occur in a population if concerned factor was eliminated, this revelation is of seminal importance. It is, therefore, implied that improving access to education and physical exercise could help the world avoid an epidemic of AD. “Developing nations” like India face certain unique problems in this regard. They have to deal with widely prevalent poverty, which ensures that the population maintains dismal rates of adult literacy and conditions of general deprivation at-large. In India, for example, adult literacy rate was 62.8% during 2008-2012. Since education is one of the cheapest and most generalizable methods for cognitive stimulation, approximately 37% of the adult population in this country might therefore be denied of their chances at stimulating their brains through cognitive exercises. At the same time, a fast incursion of sedentary lifestyle into traditional Indian society and associated physical inactivity might propagate obesity, increase metabolic risk factors and expose the population to chances of developing AD. Thus, with these two socio-economically opposing but physiologically complementary ultra-high PAR clusters at work; what are the chances that an AD epidemic could be avoided in the developing world in near future? India, in 2030, is expected to have its older population share more than 45% of the healthcare-related burden; and by 2045, proportion of adults above 60 years might exceed those between 0-14. In this age-group, associated urbanization is also expected to increase physical inactivity, while unequal distribution of wealth might still maintain poverty and keep cognitive stimulations at bay. Therefore, while a reduction in prevalence of these risk factors could predictably reduce the prevalence of AD; it would require massive undertakings by all stakeholders (governments and private players) in order to realize this dream. We believe that a concerted effort at alleviating poverty, improving access to quality education and lifestyle modification might enable us in achieving a better old age for the rapidly aging population of the developing world.

Psychological interventions in pervasive developmental disorder: An overview

Pervasive developmental disorders (PDDs) are characterized by several impairments in the domains of social communication, social interaction and expression of social attachment, and other aspects of development like symbolic play. As the role of drugs in treating these impairments is extremely limited, a variety of psychological interventions have been developed to deal with them. Some of these have strong empirical support, while others are relatively new and hence controversial. Though it may prove to be a daunting task to begin with, the final reward of being able to improve the life of a child with PDD is enormous and hugely satisfying. Therefore, knowledge of these psychological interventions is important for a mental health professional, in order to be effective in the profession. Present paper presents an overview of these techniques in the management of PDD.

Comparing mirror neuron system activity between sporadic and familial cases of schizophrenia

Schizophrenia is a heterogenous disorder, and has often been subtyped on the basis of family history of psychotic disorders. Compared to those without, a positive family history is associated with an earlier age of onset, greater structural brain abnormalities and poorer clinical course. Given recent emphasis on mirror neuron system (MNS) in attempting to explain psychopathology in schizophrenia; present analysis tried to tease out differences in MNS functioning between these two groups. With ethical approval, 10 consenting right-handed patients with schizophrenia (ICD-10-DCR; M=8; Drug-naïve=2) were recruited and divided into two groups of five each (M=4, F=1): those with (age 29.40±5.85 years, duration of illness 50.80±30.84 months) and without (age 29.60±5.77 years, duration of illness 43.20±43.76 months) family history of schizophrenic illness (group difference p>0.05). MNS activity was assessed using event-related desynchronization of EEG Mu waves in response to biological motion on 192-channel EEG Neurofax EEG-1100K. On comparison, while patients had significantly lower mu suppression compared to controls (p<0.001); two schizophrenia groups did not differ between themselves, neither on MNS activity nor on psychopathology (p>0.05). Present study replicates finding of a dysfunctional MNS in schizophrenia patients, and represents a preliminary attempt at comparing two groups of symptomatic schizophrenia patients. In both these groups, MNS dysfunctions were comparable, and commensurate with respect to psychopathology. Thus, MNS dysfunction in schizophrenia might either be inherited or acquired. However, this abnormality forms a common base, and ultimate vulnerability marker, for development of psychopathology during active disease states.

Paper eating: An unusual obsessive-compulsive disorder dimension.

There is a lot of diversity in the medical realm; where unspecified sign and symptoms might confuse and force even experienced clinicians to commit mistakes. Paper eating is presently included in pica, but certain rare compulsions may mimic this and cause confusion for unsuspecting observers. We report a case of paper eating as a manifestation of compulsion in a 15-year-old girl, and reiterate that missing on rare presentations might cause the patient sufferings from inadvertent pharmacological treatment efforts.

Mirror Neuron System Activity Does Not Differ Between Sporadic and Familial Cases of Schizophrenia: Preliminary Report

Background Schizophrenia is a heterogenous disorder, and has often been subtyped on the basis of family history of psychotic disorders. Compared to those without, a positive family history is associated with an earlier age of onset, greater structural brain abnormalities and poorer clinical course. Given recent emphasis on mirror neuron system (MNS) in attempting to explain psychopathology in schizophrenia; present analysis tried to tease out differences in MNS functioning between these two groups. Method With ethical approval, ten consenting right-handed patients with schizophrenia (ICD-10-DCR; M=8; Drug-naive=2) were recruited and divided into two groups of five each (M=4,F=1): those with (age 29.40±5.85 years, duration of illness 50.80±30.84 months) and without (age 29.60±5.77 years, duration of illness 43.20±43.76 months) family history of schizophrenic illness (group difference p>0.05). MNS activity was assessed using event-related desynchronization of EEG Mu waves in response to biological motion on 192-channel EEG Neurofax EEG-1100K. Results On comparison, while patients had significantly lower mu suppression compared to controls (p 0.05). Conclusion Present study replicates finding of a dysfunctional MNS in schizophrenia patients, and represents a preliminary attempt at comparing two groups of symptomatic schizophrenia patients. In both these groups, MNS dysfunctions were comparable, and commensurate with respect to psychopathology. Thus, MNS dysfunction in schizophrenia might either be inherited or acquired. However, this abnormality forms a common base, and ultimate vulnerability marker, for development of psychopathology during active disease states.