Shreekantiah Umesh

Aberrant gamma band cortical sources and functional connectivity in adolescents with psychogenic non-epileptic seizures: A preliminary report

Psychogenic non-epileptic seizures (PNES) resemble epileptic seizures, but lack clinically evident abnormal electrical activity in the brain. We aimed to assess resting gamma spectral power, current source distribution and functional connectivity in adolescents with PNES. Interictal, 32 channels electroencephalographic recording of 15 adolescents with PNES was compared with 10 matched healthy controls. Spectral power, current source distribution and lagged linear coherence were assessed. Statistically significant gamma spectral power, cortical sources and connectivity pattern was found in some brain areas. Region specific aberrant gamma activity and its relationship to psychopathology are discussed.

Social anhedonia and gamma band abnormalities as a composite/multivariate endophenotype for schizophrenia: a dense array EEG study

Social anhedonia and gamma band oscillations are proposed as a promising endophenotype for schizophrenia (SZ). The aim was to assess whether social anhedonia and spontaneous gamma band oscillations could be used as multivariate/composite endophenotypic measures for SZ.

Juvenile myoclonic epilepsy: Clinical characteristics, standard and quantitative electroencephalography analyses

Objectives: Most studies comparing inter-ictal background quantitative electroencephalography (EEG) measures in generalized epilepsies with normal controls do not specifically determine patients with juvenile myoclonic epilepsy (JME) as a separate group. The study aims at comparing absolute spectral power and global field coherence in various frequency bands between patients diagnosed exclusively with JME and 10 healthy controls, and correlating significantly different quantitative EEG measures with various clinical characteristics and standard EEG abnormalities. Materials and Methods: Clinical and EEG data were collected from 10 patients with JME and 10 healthy controls. Spectral power and global field spectral coherence were calculated using Welchs averaged periodogram method. The data was analyzed using descriptive statistics, Fishers exact test and t-test. Results: Statistically significant (or trend level) higher power (global α and θ, frontal α and θ, left temporal θ, right occipital α, δ and γ1, and central δ, θ, α, β, and γ2) and coherence (global α and γ1) was found in JME patients when compared to controls. Significant correlation of left frontal and central θ-power with presence of absence seizures (negative), central δ-, and θ-power with the presence of psychiatric comorbidity and central θ-power with frequency of myoclonic seizures was found. Conclusion: Findings on global–frontal and temporal–occipital power support mild diffuse epileptogenic state and θ-activity as an endophenotype concepts in JME patients, respectively; findings suggest future studies on JME to include psychiatric comorbidity while selecting the sample; some spectral measures (e.g., central θ-power) do relate to progression of JME while some do not.

Neurobiology of eating disorders - an overview

• Neurobiology of eating disorders and its overlap with other psychiatric illnesses is reviewed.

Inpatient suicide in a psychiatric hospital: A nested case–control study

Objective: Risk factors for inpatient suicide are different from those in the general population. We examined sociodemographic and clinical variables of patients who committed suicide as an inpatient in a psychiatric hospital in India. Methods: Matched retrospective nested case–control design was adopted. Ten patients who died by suicide as inpatients between 2000 and 2013 were included, along with fifty controls, matched with respect to age, sex, diagnosis, and period of admission. Results: Suicide completers were mostly unskilled in occupation (P = 0.03), had a history of past suicide attempts (P < 0.001), shorter duration of hospital stay (P = 0.001), poorer improvement on psychopathology (P = 0.02), and were having more suicidal ideation (P = 0.02). Significantly more completers were receiving antidepressants (P = 0.04). Conclusion: This study adds to the existing sparse literature on inpatient suicides from Asia. Strength of the study was close matching between case and controls and blindedness. Limitations were retrospective design, and variations in prescription behavior and treatment decisions.

Inpatient suicide in a psychiatric hospital: fourteen years' observation

Inpatient suicide is an important issue all over the world. Patients admitted to psychiatric hospitals have increased rates of suicide in comparison to the rate in general population (Appleby et al., 2006; Hunt et al., 2007). The risk factors for suicide among inpatients are not essentially the same as the risk factors for suicide in other population groups (Powell et al., 2000). In comparison to the abundant information on inpatient suicide in Western countries, there is a paucity of data on inpatient suicide in Asia. Thus, the goal of the present study was to describe the sociodemographic and clinical factors for completed in-patient suicide and to compare those with matched living controls. This is a retrospective 1:1 matched case-control study which was undertaken at Central Institute of Psychiatry, Ranchi, India. This study pertains to 10 suicide cases that occurred at Central Institute of psychiatry, Ranchi, Jharkhand, India between the years from 2000 to 2013. For this study, each suicide case was matched with a living control based on the following criteria (in descending order of importance): (1) sex; (2) diagnoses; (3) age; and (4) admission period, from the inpatient population of the institute. Thus, a living control group consisting of 10 patients was selected. After obtaining ethical permission, data were extracted from medical case notes by one researcher and recorded. To ensure blindedness as to the case-control status of the case notes, the senior researcher obtained the medical case notes medical records section. The records were copied and to minimize information bias and to maintain blindness, information regarding the period after the censoring date (the date of death of the case) was also removed from the control’s record. Method of chart review was followed for data collection. Data were analyzed using Statistical Package of Social Sciences (SPSS) 20th version for Windows. Table 1 summarizes sociodemographic and clinical variables of patients of two groups. In parallel with other studies on inpatient suicides, schizophrenia and affective disorders were the most common diagnoses in our study (Cassells et al., 2005; Dong et al., 2005; Neuner et al., 2008; Bowers et al., 2010). In the present study a trend toward significance was observed in terms of family type and religion in line with earlier studies (Bansal et al., 2011; Ramdurg et al., 2011). All suicide completers belonged to Hindu religion whereas in control group 30% belonged to Islamic religion. In Hinduism, life is seen as a cycle and reincarnation is seen as part of this cycle. Thus, attitudes to suicide in Hinduism are more liberal and less

Acute high dose lithium-induced exacerbation of obsessive compulsive symptoms.

Obsessive compulsive disorder (OCD) is a chronic neuropsychiatric disorder whose pathophysiology is linked to serotonergic dysfunction. More recently, the role of glutamate has also been posited. Lithium is used as an adjunctive for the treatment of OCD which is found to enhance serotonergic transmission. We present a case of OCD who was on stable dose of sertraline developed exacerbation of obsessive compulsive symptoms with acute high dose of lithium but improved after dose reduction.

Cavum septum pellucidum in a case of schizophrenia presenting with self-mutilating behavior

Cavum septum pellucidum (CSP) is a neurodevelopmental anomaly, which is commonly reported in schizophrenia patients. Various symptoms of schizophrenia, including thought disturbances have been associated with CSP. We present a rare case of undifferentiated schizophrenia with CSP who presented with self-mutilating behaviors.

Factors for poor follow-up in early intervention programme for children with developmental delay: A comparative study

Background: Estimates of services used by children with developmental delay and disability are quite limited. Research studies indicate that factors such as specific race, gender, poverty and nonavailability of health services and insurance are associated with lower rates of participation in early intervention services. Therefore, assessment of risk factors is considered nodal for nonparticipation in early intervention programmes. The aim of the present study was to compare the factors for poor follow-up in early intervention programme for children with developmental delay. Methods: Nine children aged 0-3 years with developmental delay attending early intervention programme and nine age-matched children irregular in this programme were included using purposive sampling technique. Sociodemographic and clinical characteristics were compared. Identifiable factors for poor follow-up were assessed and compared between both groups. Results: We found significantly higher rates of poor follow-up in children who belonged to lower socioeconomic classes. Moreover, misconception about delay in development and medical morbidity of child were other reasons for poor follow-ups. Interestingly, we also found delay in the use of hand by the child to be a reason for poor follow-up. Conclusion: We conclude that some factors responsible for poor follow-ups must be addressed at the beginning of enrollment in early intervention programmes in order to sustain them for long, thereby getting benefits out of it.

Genetics in psychiatry.

Today, psychiatrists are focusing on genetics aspects of various psychiatric disorders not only for a future classification of psychiatric disorders but also a notion that genetics would aid in the development of new medications to treat these disabling illnesses. This review therefore emphasizes on the basics of genetics in psychiatry as well as focuses on the emerging picture of genetics in psychiatry and their future implications.