N Janakiramaiah

National Institute of Mental Health and Neuro Sciences, Bengalore, State of Karnataka, India

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Publications (81)256.72 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Although electroconvulsive therapy (ECT) causes no structural brain damage, recent studies reported altered brain perfusion acutely following ECT. This is in keeping with brain edema which was noted in animal experiments following electroconvulsive shock. This study examined alteration in magnetic resonance imaging (MRI) T(2) relaxation time, a measure of brain edema, and its relation to therapeutic efficacy, orientation and memory impairment with ECT. Fifteen drug-naive consenting patients of major depressive disorder with melancholia (DSM-IV) received ECT as first-line treatment. MRI scans were done before the first ECT and at 2 hours after the second ECT. T(2) relaxation time was measured bilaterally in thalamus, hippocampus, medial temporal lobes and dorsolateral frontal cortex by a blind rater. Depression scores and memory scores were reduced significantly both after the second and fifth ECT. There was no change in T(2) relaxation time after second ECT. The finding suggests that ECT does not produce demonstrable change acutely in brain parenchyma detectable by MRI scans.
    Indian Journal of Psychiatry 07/2007; 49(3):195-9.
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    ABSTRACT: Cerebellar neurological abnormalities in schizophrenia have been associated with severe negative symptoms, cognitive deficits, and smaller cerebellar volume. This study assessed the comparative discriminant validity between Cerebellar Soft Signs (CSS) vs. other neurological soft signs (ONSS) [in discriminating between schizophrenia patients and healthy controls] as well as the relationship between the soft signs and psychopathology. Antipsychotic-naïve schizophrenia patients (n = 32) and healthy subjects (n = 32) were examined using International Co-Operative Ataxia Rating Scale and Neurological Evaluation Scale. Mean CSS scores, ONSS total score, and Sensory Integration Signs sub-score were significantly higher in patients. Discriminant analysis revealed two CSS sub-scores (but none of the ONSS scores) to be significant (P < 0.0001) accounting for 78% of classification. CSS total score, Posture sub-score, and Oculomotor sub-score had significant positive correlation with negative syndrome score. Findings support intrinsic cerebellar dysfunction in schizophrenia. The observations are discussed in relationship with cognitive dysmetria.
    Acta Psychiatrica Scandinavica 11/2006; 114(5):352-6. · 5.55 Impact Factor
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    ABSTRACT: Sudarshana Kriya Yoga (SKY) has demonstrable antidepressant effects. SKY was tested for this effect in inpatients of alcohol dependence. Following a week of detoxification management consenting subjects (n=60) were equally randomized to receive SKY therapy or not (controls) for a two-week study. SKY therapy included alternate day practice of specified breathing exercise under supervision of a trained therapist. Subjects completed the Beck Depression Inventory (BDI) before and after the two weeks of this intervention. Morning plasma cortisol, ACTH and prolactin too were measured before and at the end of two weeks. In both groups reductions in BDI scores occurred but significantly more so in SKY group. Likewise, in both groups plasma cortisol as well as ACTH fell after two weeks but significantly more so in SKY group. Reduction in BDI scores correlated with that in cortisol in SKY but not in control group. Antidepressant effects of SKY were demonstrated in early abstinence that also had substantial spontaneous improvement. It is not known if this effect contributes to sustained abstinence. Results extend the antidepressant effects of SKY in alcohol dependence subjects. Reduction in stress-hormone levels (cortisol and ACTH) along with BDI reductions possibly support a biological mechanism of SKY in producing beneficial effects.
    Journal of Affective Disorders 09/2006; 94(1-3):249-53. · 3.71 Impact Factor
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    ABSTRACT: The study examined the high energy-phosphate metabolism of basal ganglia in antipsychotic-naive schizophrenia patients with and without developmental reflexes in comparison to healthy subjects. Nineteen antipsychotic-naive schizophrenics of whom 11 had developmental reflexes and 26 age-sex-matched healthy subjects without developmental reflexes underwent in-vivo 2-D 31P Magnetic Resonance Spectroscopy of basal ganglia on a 1.5-T scanner. Mean age-at-onset of psychosis was significantly lower in patients with developmental reflexes. Mean PCr/Total ATP ratio in bilateral basal ganglia was lower in patients than healthy subjects. The ratio was the least in patients with developmental reflexes (F=10.7; df=2, 42; p<0.001). Schizophrenia patients with developmental reflexes had the lowest PCr/Total ATP ratio in basal ganglia indicating more severe metabolic abnormality. These patients had younger age-at-onset of psychosis. Together, this suggests neurodevelopmental etiopathogenesis in schizophrenia.
    Progress in Neuro-Psychopharmacology and Biological Psychiatry 07/2006; 30(5):910-3. · 4.03 Impact Factor
  • Journal of Affective Disorders,. 01/2006;
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    ABSTRACT: This study examined gray matter (GM) volume abnormalities in first-episode, antipsychotic-naïve Indian schizophrenia patients. Magnetic resonance images of 18 schizophrenia patients and 18 matched healthy comparison subjects were analyzed by optimized voxel-based morphometry. Schizophrenia patients had significantly smaller global GM and greater global CSF volumes and smaller regional GM volume in superior frontal, inferior frontal, cingulate, post-central, superior temporal and parahippocampal gyri, inferior parietal lobule, insula, caudate nuclei, thalamus and cerebellum. Findings suggest limbic, heteromodal cortical, striatal, thalamic and cerebellar abnormalities in schizophrenia.
    Progress in Neuro-Psychopharmacology and Biological Psychiatry 06/2005; 29(4):587-91. · 4.03 Impact Factor
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    ABSTRACT: This study used 31-phosphorus magnetic resonance spectroscopy ((31)P MRS) to investigate basal ganglia abnormalities in neuroleptic-naive patients with schizophrenia. Nineteen schizophrenia patients and 31 age- and sex-matched healthy comparison subjects underwent (31)P MRS. The phosphocreatine/total phosphorus and phosphocreatine/total ATP ratios in both basal ganglia were significantly lower in patients. Schizophrenia patients showed features of increased metabolism in the basal ganglia consistent with impaired activity of the frontostriatal pathways.
    American Journal of Psychiatry 08/2004; 161(7):1304-6. · 13.56 Impact Factor
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    ABSTRACT: This study examined the effect of low- and high-pulse frequency stimulus electroconvulsive therapy on seizure physiology and therapeutic outcome. Forty depressed patients randomly received either low (n = 19) or high (n = 21) pulse frequency stimulus during a course of right unilateral electroconvulsive therapy. The current and pulse width were kept constant whereas the duration was proportionately varied. The two groups were compared for seizure parameters and therapeutic outcome. Low frequency stimulus group had lower threshold and less subconvulsive stimulation. There were no differences in seizure durations, ictal cardiovascular responses and therapeutic outcome between the two groups. Low frequency stimulus produced seizure at lower stimulus dose without affecting seizure parameters and therapeutic effects.
    Journal of Ect 04/2004; 20(1):10-2. · 1.39 Impact Factor
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    ABSTRACT: Stimulus parameters, such as pulse width, frequency, and stimulus train duration, affect seizure threshold in electroconvulsive therapy (ECT), although variably. This study examined the effect of low- and high-pulse frequencies of stimulus on seizure threshold and physiological responses to ECT. Twenty-four consenting inpatients prescribed ECT by the treating psychiatrist received bilateral ECT. Threshold was reassessed at second and third ECT sessions in a crossover design. In the second ECT the pulse frequency was randomly either 50 pulses per second (PPS; n=13) or 200 PPS (n=11). In the third ECT, the same was reversed. The seizure threshold and number of subconvulsive stimulations were significantly lower with 50 PPS compared with 200 PPS. There was no significant difference in the cardiovascular responses between the two groups. Lower stimulus frequency is more efficient in inducing a seizure (smaller threshold) without compromising the physiological responses to ECT. Clinical effects of different doses of ECT stimulus must also consider the role of charge rate (frequency of pulses).
    Journal of Ect 10/2003; 19(3):133-5. · 1.39 Impact Factor
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    ABSTRACT: Studies of Neurological Soft Signs (NSS) in schizophrenia are confounded by handedness, inconsistent methodology, and prior treatment with neuroleptics. The study objective is to examine NSS in never-treated schizophrenia. We examined the NSS in treatment-naïve schizophrenia patients (n = 21) and age, sex, education, and handedness matched normal controls (n = 21) using the modified Neurological Evaluation Scale with good inter-rater reliability. Schizophrenia patients had significantly more NSS than normals. No significant correlation was found between illness duration and NSS. Higher neurological signs in never-treated patients and their lack of association with illness duration suggest neurodevelopmental etiopathogenesis of schizophrenia.
    Acta Psychiatrica Scandinavica 09/2003; 108(2):144-6. · 5.55 Impact Factor
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    ABSTRACT: Studies in schizophrenia using in vivo (31)P magnetic resonance spectroscopy (MRS) have mostly focused on the association cortices, including the frontal and temporal lobes. Striatum has also been implicated in schizophrenia, although neuroleptic exposure in the patients is a potential confound limiting interpretation of earlier studies. We examined membrane phospholipid abnormality in the basal ganglia using (31)P MRS in neuroleptic-naive schizophrenia patients. Never-treated, DSM-IV schizophrenia patients (n=20) and age- and gender-matched healthy control subjects (n=30) underwent in vivo 1-D 31P MRS of both basal ganglia using an image-selected technique on a 1.5-T magnetic resonance imaging scanner. A neuroradiologist blind to clinical data measured the phosphomonoester (PME) and phosphodiester (PDE) from the spectra. The schizophrenia patients showed significantly and bilaterally elevated levels of PME/PDE ratios in basal ganglia as compared with control subjects. There were no significant differences in the ratios between the two sides in either patient or control groups. Phosphomonoester/phosphodiester ratio did not correlate with illness duration. Lower Positive and Negative Syndrome Scale scores were associated with lower PME/PDE ratio. The basal ganglia of never-treated schizophrenia patients show features suggestive of reduced breakdown and/or increased synthesis of membrane phospholipids. Lack of correlation between illness duration and the membrane phosphorus moiety ratio may be consistent with a nonprogressive, possibly neurodevelopmental etiopathogenesis.
    Biological Psychiatry 09/2003; 54(4):491-4. · 9.47 Impact Factor
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    ABSTRACT: Corpus Callosum (CC) abnormalities have been described in schizophrenia. Review of CC measurement methods in schizophrenia reveals inconsistency and lack of neuroanatomical basis. The aims of the study are to describe a new CC measurement method with valid a neuroanatomical and cytoarchitectural basis and to demonstrate inter-rater reliability for the same. The study was performed in the National Institute of Mental Health & Neurosciences, Bangalore, India. Ours is a cross-sectional study in which both the first author and senior neuroradiologist were blind to clinical details. We report a reliable, semi-automated CC measuring technique with a neuroanatomical and cytoarchitectural basis tested in a group of 16 never-treated schizophrenia patients using 1-mm thick, objectively defined midsagittal MRI section. Measurement on coded slices using scion image software ensured elimination of rater bias. The statistical analysis used for assessing inter-rater reliability is intraclass correlation coefficient analysis. The intraclass correlation coefficients for the CC measurements were as follows: CC Area = 0.93; Anterior CC area = 0.84; Area of body of the CC = 0.83; Area of CC isthmus = 0.65; Area of CC splenium = 0.88; maximum antero-posterior distance of CC = 0.96. Measurements showed good inter-rater reliability. The methodology demonstrated in our study is simple, relevant, reliable and can be used for future schizophrenia research.
    Neurology India 06/2003; 51(2):189-92. · 1.08 Impact Factor
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    ABSTRACT: Evidence suggests that caudate nucleus abnormalities have a role in schizophrenia. Structural brain imaging studies on caudate size in schizophrenia are inconclusive due to confounding factors. In this study, caudate volume was measured on coronal Magnetic Resonance Images (I -mm) in consenting 15 never-treated schizophrenia (DSM-IV) patients and 15 age, sex, handedness, education and socioeconomic status matched controls using semi-automated Scion image software. Multivariate analysis revealed significantly smaller caudate volume in patients than controls after controlling for intracranial area (df = 2,27; F = 5.4; p = 0.028). Separate univariate analysis showed that right (df = 2,27; F = 5.4; p = 0.028) and left (df = 2,27; F = 5.2; p = 0.031) caudate were significantly smaller in patients than controls after controlling for intracranial area. Illness duration did not correlate significantly with either right (r = - 0.13; p = 0.65) or left (r = - 0.10; p = 0.7) caudate volume. Significantly smaller caudate nucleus in patients with never-treated schizophrenia suggests that some aspect of the disease process of schizophrenia influences the caudate nucleus. In conclusion, smaller caudate volume in never treated schizophrenia with lack of correlation between illness duration and caudate size supports neuro developmental etiopathogenesis in schizophrenia.
    Indian Journal of Psychiatry 04/2003; 45(2):20-6.
  • Schizophrenia Research 03/2003; 60(1):211-211. · 4.43 Impact Factor
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    ABSTRACT: This study examined the concurrent use of psychotropic drugs on seizure duration during Electroconvulsive therapy (ECT). Consecutive consenting patients prescribed bilateral ECT (n=182) by the treating psychiatrist were considered for the study. The concurrent psychotropic medication (antipsychotic, antidepressant, benzodiazepine and lithium) was recorded. Motor and EEG seizure durations were recorded at threshold ECT session. The seizure durations were compared between the co-administered drug and control groups for each of the psychotropic drug independently using students′ t-test. Concurrent antipsychotic or antidepressant drugs had no influence on seizure duration. However, the seizure duration was longer in patients on lithium (n=30) and shorter in patients on benzodiazepines (n=67). Prolonged seizures occurred more often in the former (26.6%) but less often in the later (12%). Polypharmacy in these patients precludes firm conclusions. Findings however, point to the need for discontinuing concurrent administration of lithium and benzodiazepines during ECT.
    Annals of Indian Academy of Neurology. 01/2003;
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    ABSTRACT: Background: Preliminary evidence suggests abnormal basal ganglia and cerebellar loops in schizophrenia. Few studies have examined the striatocerebellar system in never-treated schizophrenia. Objective: The study objec- tive was to examine the striato-cerebellar system using Magnetic Resonance Imaging (MRI) in never-treated schizophrenia. Methods: MRI was done in never treated, right-handed, schizophrenia (DSM-IV) patients (n=15) and age-, sex-, education- and handedness-matched healthy controls (n=15). Right and left caudate volumes as well as cerebellar vermis area were measured using Scion Image software. Psychopathology was as- sessed using Positive and Negative Syndrome Scale. Results: Patients had significantly smaller right (df=2, 27; F =4.5; p=0.042) and left (df=2, 27; F=4.3; p=0.048) caudate volumes as well as smaller cerebellar vermis area (df=2, 27; F=6.5; p=0.017) were significantly smaller in patients than controls after controlling for in- tracranial area. Cerebellar vermis area correlated significantly with right caudate volume (r=0.6; p=0.04) in patients but not in controls. Conclusions: Smaller caudate nuclei and cerebellar vermis in never-treated schizo- phrenia supports neurodevelopmental etiopathogenesis. Significant correlation between right caudate and cere- bellar vermis in patients suggests related striato-cerebellar abnormality in schizophrenia (German J Psychiatry 2003; 6: 1-7).
    01/2003;
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    K Girish, B N Gangadhar, N Janakiramaiah
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    ABSTRACT: It is a myth that electroconvulsive therapy (ECT) produces greater side effects and worsens the neurological condition when used in neurologically ill patients. With the advancement and sophistication in ECT practice standards and modification procedures, it can be safely administered either to treat selected neurological conditions or the co-morbid psychiatric illnesses without additional risks. However ECT should be administered only after thorough evaluation of risks and benefits in such individuals.
    Indian Journal of Psychiatry 07/2002; 44(3):228-39.
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    ABSTRACT: Effects of diencephalic seizure generalization during ECT, e.g., cardiovascular response, may be relevant in indexing its therapeutic potency. A trend for greater rate pressure product (RPP=heart rate x systolic blood pressure) response to modified ECT in responders than in nonresponders is reported. Atropine used in modified ECT is known to increase RPP. This study examined if cardiovascular response during ECT with or without atropine predicts antidepressant effect. Twenty nine consenting, major depressive disorder patients received ECTs. Atropine premedication was randomly withheld in the second or third ECT session. RPP was recorded during ECT. Severity of depression was measured at twice weekly intervals. Fifteen patients remitted at the end of 2 weeks. These early remitters had significantly higher poststimulus RPP than the rest in the ECT session without atropine but not so in the session with atropine. Cumulative poststimulus RPP predicted the early antidepressant response. Corresponding motor or EEG seizure durations were not associated with antidepressant effect. Most patients continued to receive antidepressants. ECT stimulus laterality was not controlled. The study focussed on only short term antidepressant effects. RPP response to ECT recorded under no-atropine condition may reflect its physiological effects relevant to therapeusis and may have the potential to index seizure adequacy.
    Journal of Affective Disorders 06/2002; 69(1-3):101-8. · 3.71 Impact Factor
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    ABSTRACT: This study seeks an explanation for reversed gender effect on age-at-onset (AAO) in schizophrenia. The hypothesis is older AAO in males would be detected in a sample where higher infant mortality (IMR) prevailed. Case records of International Classification of Diseases-10 (ICD-10) schizophrenia patients from two states (n=70 each) with an IMR of 13 and 67 per thousand were reviewed and AAO was obtained by using the recorded age and duration of illness. In the sample from the state with lower IMR, AAO did not differ between the two sexes. However, men had older AAO than women in the state with fivefold higher IMR. Gender differences in AAO may be a function of perinatal complications. In places where infants with perinatal complications are less likely to survive, hence high IMR, a small group of potentially youngest AAO schizophrenic males may be eliminated thus changing the gender effect on AAO.
    Acta Psychiatrica Scandinavica 05/2002; 105(4):317-9. · 5.55 Impact Factor
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    K Girish, B N Gangadhar, N Janakiramaiah
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    ABSTRACT: Eliciting cerebral seizure during electroconvulsive therapy (ECT) is essential for therapeutic purposes. When it exceeds beyond 120 seconds (Freeman, 1995) i.e., prolonged, it adds to adverse effects of ECT. Estimating seizure duration using 'cuff method' alone has limitations. This study examined the merits of electroencephalographic (EEG) monitoring in routine ECT practice on a large representative sample. Modified ECT either unilateral or bilateral electrode placement, was administered to 485 patients under EEG monitoring at first ECT session. Ninety one (18.8%) patients had prolonged seizures of which only 59 would have been detected if 'cuff method' alone was used. Twenty nine (6%) patients had inadequate motor seizures but had adequate EEG seizure duration. Twenty five (5.2%) of them had no motor seizure and two such patients even had prolonged seizures. The prolonged seizure was unpredictable in majority. In conclusion, EEG monitoring during ECT is essential to detect both adequacy of cerebral seizure in patients having no or inadequate motor seizures and a/so to detect prolonged seizures.
    Indian Journal of Psychiatry 01/2002; 44(1):24-8.