Vinod Kumar Sinha

Event-related potential: An overview.

Electroencephalography (EEG) provides an excellent medium to understand neurobiological dysregulation, with the potential to evaluate neurotransmission. Time-locked EEG activity or event-related potential (ERP) helps capture neural activity related to both sensory and cognitive processes. In this article, we attempt to present an overview of the different waveforms of ERP and the major findings in various psychiatric conditions.

Adjunctive high-frequency right prefrontal repetitive transcranial magnetic stimulation (rTMS) was not effective in obsessive–compulsive disorder but improved secondary depression

BACKGROUND There is preliminary evidence that repetitive transcranial magnetic stimulation (rTMS) may be useful in obsessive-compulsive disorder (OCD) patients. METHODS Our objective was to examine efficacy of adjunctive right prefrontal high-frequency (rapid) rTMS treatment in OCD patients. 42 patients with OCD were randomly assigned to 10 sessions of add-on high-frequency right prefrontal active rTMS (10Hz, 110% of motor threshold, 4s per train, 20 trains per session) or sham stimulation. They were rated on Yale Brown Obsessive Compulsive Scale (YBOCS), Hamilton Rating Scale for Depression (HAM-D), Hamilton Rating Scale for Anxiety (HAM-A) and Clinical Global Impression-Severity of Illness (CGI-S) at baseline, day 14 and day 28. The dose of antiobsessive drug was kept constant throughout the period of assessment. RESULTS For YBOCS scores, repeated measures ANOVA showed significant main effect of treatment, but no effect of treatment over time (Pillais Trace F=1.39, p=.262). However, significant effect of treatment over time as shown by interaction effect for both HAM-D (Pillais Trace F=3.67, p=.035, eta(2)=.158) and HAM-A scores (Pillais Trace F=5.22, p=.01, eta(2)=.211) were seen. CONCLUSION Adjunctive high-frequency right prefrontal rTMS does not have any significant effect in the treatment of OCD. However, it is modestly effective in the treatment of comorbid depressive symptoms in patients with OCD.

Metformin for olanzapine‐induced weight gain: a systematic review and meta‐analysis

Olanzapine is an atypical antipsychotic that is useful in schizophrenia and bipolar affective disorder, but its use is associated with troublesome weight gain and metabolic syndrome. A variety of pharmacological agents has been studied in the efforts to reverse weight gain induced by olanzapine, but current evidence is insufficient to support any particular pharmacological approach. We conducted a systematic review and meta-analysis of randomized controlled trials of metformin for the treatment of olanzapine-induced weight gain. Systematic review of the literature revealed 12 studies that had assessed metformin for antipsychotic-induced weight gain. Of these, four studies (n= 105) met the review inclusion criteria and were included in the final analysis. Meta-analysis was performed to see the effect size of the treatment on body weight, waist circumference and body-mass index (BMI). Weighted mean difference (WMD) for body weight was 5.02 (95% CI 3.93, 6.10) kg lower with metformin as compared with placebo at 12 weeks. For waist circumference, the test for heterogeneity was significant (P= 0.00002, I(2) = 85.1%). Therefore, a random effects model was used to calculate WMD, which was 1.42 (95% CI 0.29, 3.13) cm lower with metformin as compared with placebo at 12 weeks. For BMI, WMD was 1.82 (95% CI 1.44, 2.19) kg m(-2) lower with metformin as compared with placebo at 12 weeks. Existing data suggest that short term modest weight loss is possible with metformin in patients with olanzapine-induced weight gain.

Incidence of Catatonia in Children and Adolescents in a Paediatric Psychiatric Clinic

Objective: To investigate the incidence and phenomenology of catatonia in a child and adolescent population. Method: Children and adolescents who had attended a paediatric psychiatric outpatient clinic between April and July 2001 were examined for catatonic signs with a formal catatonia rating scale, and patients who had at least two catatonic signs were included. Results: Eleven patients met the criteria (5.5% of the entire sample and 17.7% of the patients with affective and nonaffective psychotic disorder); of them eight had an affective disorder and three a nonaffective disorder. The mean catatonic scores were significantly high for males and patients with mental retardation. Conclusion: This study shows that catatonia occurs in children and adolescents. Further studies are essential to clarify the distribution of catatonia across various diagnoses and the outcome of paediatric catatonia.

Subcortical functioning in obsessive-compulsive disorder: an exploratory EEG coherence study.

Background. Given the paucity of quantitative EEG studies using coherence measures to understand the electrophysiological functional integrity of sub-cortical structures in obsessive-compulsive disorder, the current study was carried out. Methods. We obtained EEG coherence values for 20 adult OCD patients (10 males; 10 females) and 19 appropriately matched healthy controls across delta (0.5–3.5 Hz), theta (4–7.5 Hz), alpha (8–12 Hz), beta1 (12.5–20 Hz) and beta2 (20.5–30 Hz) bands. As coherence between distant brain regions reflects physiological activities at sub-cortical neural networks, we chose EEG channels at four distant brain regions – anterior interhemispheric, posterior interhemispheric, fronto-temporal and fronto-occipital. Results. In comparison to controls we found significant increase of theta band EEG coherence in the fronto-occipital region in OCD patients (P = 0.045) which did not correlate significantly with either medication status or disease severity. Conclusion. This EEG coherence study that suggests hyperactivity at subcortical circuitry in OCD patients is in agreement with existing neuro-imaging findings. Furthermore, this finding provides external validity for sub-cortical dysfunction hypothesis of OCD.

Musical obsession or pseudohallucination : Electrophysiological standpoint

Reported herein is a case of obsessive–compulsive disorder with persistent and distressing musical obsessions along with other symptoms. Advanced source analysis of electroencephalographic data indicated high spectral power over the bifrontal region. The musical symptoms were resistant to pharmacotherapy but there was some reduction in frequency and duration of musical obsessions with thought‐stopping technique.

Marriage Consummated After 22 Years: A Case Report

This case report discusses a couple who presented with a 22-year unconsummated marriage, due to penetration phobia in the female partner. The couple did well with sex education and therapy. The case is discussed in its various aspects and with a cultural background.

Asperger disorder in adults.

Asperger disorder was first described in 1944 by the Austrian pediatrician, Hans Asperger. It was introduced as a separate diagnostic category from autistic disorder in DSM-IV and ICD-10. The pattern of comorbidity in Asperger disorder is different from autistic disorder, with a higher level of psychosis, violent behavior, anxiety, and mood disorders. We present three cases of Asperger disorder diagnosed for the first time in adulthood, with psychosis being the predominant reason for the referral. In each case, the psychosis improved with antipsychotic treatment, although core autistic symptoms remained the same.

Factor structure of manic symptoms

Objective: The purpose of the present study was to identify the factor structure of manic symptoms as assessed by the Scale for Manic States (SMS). Method: The pattern of symptoms in a group of 225 adults with an ICD-10-DCR diagnosis of manic episode was studied. A factor analysis was conducted of the broad range of psychiatric symptoms covered by SMS. A principal component analysis followed by oblimin rotation was performed. Results: Six eigenvalues were greater than unity and parallel analysis indicated four factors. After observing the scree plot a f ve-factor solution seemed appropriate. Nevertheless, a six-factor solution was chosen that described the data appropriately and was clinically relevant. The six factors (psychosis, irritability aggression, dysphoria, accelerated thought stream, hedonia, and hyperactivity) captured 59.29%% of the total variance. Conclusion: A six-factor solution explains the clinical dimensions of mania in the present sample and dysphoria appeared as a separate factor.

Duloxetine for childhood depression with pain and dissociative symptoms

Over two thirds of people suffering from depression complain of pain with or without reporting psychological symptoms. Physical symptoms are more prevalent among the women, the elderly, the poor, and in children population. Successful treatment of depression in children complicated by pain symptoms constitutes a great clinical challenge. Duloxetine has already emerged as a safe and effective treatment option for adult depressed patients with painful physical symptoms. However, no data exist in literature which suggests use of duloxetine in childhood and adolescent population for the same clinical indication. We report a case documenting successful use of duloxetine in a depressed girl child who also had severe pain and dissociative symptoms.