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ABSTRACT: Inferior parietal lobule (IPL) is implicated in the pathogenesis of first rank symptoms (FRS) in schizophrenia by functional neuroimaging studies. However, the relationship between IPL cortical thickness and FRS is yet to be explored. In this study, cortical thickness of IPL was analyzed in antipsychotic-naïve schizophrenia patients (total number = 51) with [FRS(+); N = 25] and those without FRS [FRS(-); N = 26] in comparison with group-matched healthy controls (N = 47). FRS(+) patients showed significant cortical thickness deficit in right IPL (specifically angular gyrus) in comparison with both FRS(-) patients (p = 0.005) and healthy controls (p = 0.0002); lack of difference on the left side might possibly be related to larger variance in healthy controls. Deficient cortical thickness involving IPL in FRS(+) schizophrenia patients adds further support to the role of internal monitoring system in the pathogenesis of FRS in schizophrenia.
Progress in Neuro-Psychopharmacology and Biological Psychiatry 01/2011; 35(1):40-6. · 3.25 Impact Factor
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The primary care companion to CNS disorders. 01/2011; 13(3).
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ABSTRACT: 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.
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).
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.
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.
International Journal of Yoga 01/2011; 4(1):3-6.
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The primary care companion to CNS disorders. 01/2011; 13(4).
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ABSTRACT: Psychogenic polydipsia with associated hyponatremia is a potentially fatal condition observed in patients with chronic psychiatric illness, especially schizophrenia. Recognition and management of this condition are difficult, as patients are uncooperative and secretive about their water intake, but are important in terms of the associated complications. Different strategies, including involuntary fluid restriction and use of various pharmacological agents, such as demeclocycline, propranolol, captopril, and naloxone, have been used for the treatment of this condition with inconsistent results. Antipsychotics have also been used in the treatment of polydipsia; however, their role is not clear as there are reports of antipsychotics both improving and causing polydipsia. Typical antipsychotics have been associated with exacerbation of polydipsia, whereas clozapine has been associated with its improvement. The efficacy of risperidone in the treatment of this condition is controversial, as negative results have been reported. Herein we present a schizophrenia case with polydipsia and hyponatremia that was successfully treated with risperidone.
Turk psikiyatri dergisi = Turkish journal of psychiatry 01/2011; 22(2):123-5. · 0.43 Impact Factor
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The primary care companion to CNS disorders. 01/2011; 13(5).
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ABSTRACT: The corpus callosum (CC), has been hypothesized to be implicated in the pathogenesis of schizophrenia; however, the findings from magnetic resonance imaging studies are conflicting. Moreover, the relationship between first-rank-symptoms (FRS) and CC abnormalities in schizophrenia is yet to be examined. The authors examined CC morphometry, based on Witelson's method, in antipsychotic-naïve-schizophrenia patients in comparison with matched healthy-control subjects. Patients had significantly smaller CC, splenium, and isthmus areas than control subjects. A novel finding of the study is that only those without FRS differed from control subjects, but not those with FRS. Study findings support a neuro-developmental hypothesis and possible connectivity abnormalities in symptom-genesis.
The Journal of neuropsychiatry and clinical neurosciences 01/2011; 23(2):155-62. · 2.34 Impact Factor
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ABSTRACT: Contents related to threat and associated cognitive processes are proposed to be the central characteristic of obsessive-compulsive disorder (OCD) according to 'threat-relatedness hypothesis'. However, evidence for attention bias toward emotionally salient stimuli using the emotional Stroop test is equivocal. This discrepancy could be due to methodological issues, mainly differences in the lexical characters of words. Fifty Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) OCD patients (23 washers and 27 checkers) and 50 age-, handedness- and sex-matched healthy controls were examined with an optimized version of the emotional Stroop test (i.e., with lexically matched words) and color-Stroop test. Twenty-four patients were clinically symptomatic and 26 were remitted. OCD patients had significantly higher attention bias only for negative OCD stimuli as calculated by negatively valenced OCD interference score but not for neutral or non-OCD emotional stimuli. Symptomatic patients had significantly higher bias, but not the remitted patients. There were no significant correlations between other illness-related variables (age at onset, illness duration, and medication dose) and Stroop test performance. Study findings suggest the presence of selective emotional bias for OCD relevant stimuli in these patients and this bias is potentially related to symptomatic status. These observations are in tune with the threat-relatedness hypothesis.
Psychiatry Research 12/2010; 180(2-3):99-104. · 2.52 Impact Factor
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ABSTRACT: Multiple sclerosis (MS) has both neurological and psychiatric manifestations. Though depression, bipolar disorder and la belle indifference are commonly described, schizophrenia-like-psychosis is not widely reported with MS. Drug interactions and side effects make treatment, in such scenario, challenging. We, for the first time, report a patient with MS and paranoid schizophrenia successfully treated with concurrent use of clozapine and risperidone with interferon-beta-1a.
Asian journal of psychiatry. 12/2010; 3(4):235-6.
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ABSTRACT: Schneiderian first rank symptoms (FRS) in schizophrenia have been hypothesised to be secondary to aberrant cerebral lateralisation over the course of human evolution. The ratio of length of second digit to fourth digit (2D:4D) has been put forward as a potential indicator of cerebral lateralisation. This study examined 2D:4D and its asymmetry in antipsychotic-naïve schizophrenia patients (N=79) in comparison with healthy controls (N=75). Psychopathology was assessed using Scales for Assessment of Positive and Negative Symptoms. FRS assessment was performed as per established descriptions. The digit lengths (2D & 4D) were measured using a digital vernier caliper with good inter-rater reliability. Female schizophrenia patients showed significantly lower 2D:4D than female healthy controls. Mean 2D:4D asymmetry index was significantly lower in male schizophrenia patients than male healthy controls. FRS status had significant effect on left 2D:4D as well as 2D:4D asymmetry index, the patients with FRS having the lowest values. Our study findings support association between schneiderian FRS and low 2D:4D as well as low 2D:4D asymmetry index. Since 2D:4D is linked with limbic asymmetry, our study findings offer further support to the cerebral lateralisation theories of schizophrenia.
Laterality 12/2010; 16(4):499-512. · 1.13 Impact Factor
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ABSTRACT: Delirious mania also known as Bell mania is a syndrome of excitement, delirium, and psychosis, of acute onset. We report 2 patients who presented with acute onset of disorientation, aggressive behavior, double incontinence, grandiose ideas, and auditory hallucinations. Results of investigations to rule out organic etiology such as computed tomographic scan of brain, cerebrospinal fluid examination, and biochemical parameters were normal. Creatine kinase levels were only moderately elevated. A provisional diagnosis of delirious mania was made, and patients were empirically started on electroconvulsive therapy (ECT) session. Delirium resolved by the second ECT session, unmasking manic symptoms, and recovered completely at the end of sixth ECT session. Prophylactic lithium was started, and both patients continue to be in remission after 1 year. Differential diagnosis of the above clinical presentation includes neuroleptic malignant syndrome and malignant catatonia. Delirious mania is clinically important owing to the potential for diagnostic confusion and good response to ECTs.
The journal of ECT 12/2010; 26(4):278-9. · 1.19 Impact Factor
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ABSTRACT: The study objective was to explore the biological basis for link between antipsychotic-induced weight gain and therapeutic response in schizophrenia by examining longitudinal changes in serum leptin level after antipsychotic treatment.
We examined serum leptin in schizophrenia patients at antipsychotic-naive baseline status as well as after 3 months of antipsychotic treatment. For baseline analyses, the patients were compared with healthy controls matched for anthropometric measures and physical activity.
At baseline, schizophrenia patients had significantly lower levels of leptin in comparison with controls. After treatment, body mass index and levels of leptin increased significantly in patients. The magnitude of increase in leptin had a significant positive correlation with magnitude of increase in body mass index; the magnitude of reduction in SANS total score showed significant positive correlation with the magnitude of increase in leptin level.
The study findings suggest a potential role for leptin to mediate the link between antipsychotic-induced weight gain and beneficial therapeutic response in schizophrenia.
Clinical neuropharmacology 11/2010; 33(6):288-92. · 2.35 Impact Factor
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ABSTRACT: 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.
The journal of ECT 10/2010; 27(1):e37-8. · 1.19 Impact Factor
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ABSTRACT: Emotion processing abnormalities are considered among the core deficits in schizophrenia. Subjects at high risk (HR) for schizophrenia also show these deficits. Structural neuroimaging studies examining unaffected relatives at high risk for schizophrenia have demonstrated neuroanatomical abnormalities involving neo-cortical and sub-cortical brain regions related to emotion processing. The brain functional correlates of emotion processing in these HR subjects in the context of ecologically valid, real-life dynamic images using functional Magnetic Resonance Imaging (fMRI) has not been examined previously.
To examine the neurohemodynamic abnormalities during emotion processing in unaffected subjects at high risk for schizophrenia in comparison with age-, sex-, handedness- and education-matched healthy controls, using fMRI.
HR subjects for schizophrenia (n=17) and matched healthy controls (n=16) were examined. The emotion processing of fearful facial expression was examined using a culturally appropriate and valid tool for Indian subjects. The fMRI was performed in a 1.5-T scanner during an implicit emotion processing paradigm. The fMRI analyses were performed using the Statistical Parametric Mapping 2 (SPM2) software.
HR subjects had significantly reduced brain activations in left insula, left medial frontal gyrus, left inferior frontal gyrus, right cingulate gyrus, right precentral gyrus and right inferior parietal lobule. Hypothesis-driven region-of-interest analysis revealed hypoactivation of right amygdala in HR subjects.
Study findings suggest that neurohemodynamic abnormalities involving limbic and frontal cortices could be potential indicators for increased vulnerability toward schizophrenia. The clinical utility of these novel findings in predicting the development of psychosis needs to be evaluated.
Indian Journal of Psychiatry 10/2010; 52(4):308-15.
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Indian Journal of Psychiatry 07/2010; 52(3):282.
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ABSTRACT: Thalamus, the sensory and motor gateway to the cortex, plays an important role in cognitive and perceptual disturbances in schizophrenia. Studies examining the volume of the thalamus in schizophrenia have reported conflicting findings due to the presence of potential confounding factors such as low-resolution imaging and anti-psychotics. The thalamus volume in anti-psychotic-naïve patients determined using high-resolution 3-Tesla magnetic resonance imaging (MRI) has not yet been examined.
Using 3-Tesla MRI, this study for the first time examined anti-psychotic-naïve schizophrenia patients (n=18; M:F:11:7) in comparison with healthy controls (n=19;M:F:9:10) group-matched for age, sex, handedness, education, and socioeconomic status. The volume of the thalamus was measured using a three-dimensional, interactive, semi-automated analysis with good inter-rater and intra-rater reliability. Psychopathology was assessed using the Scale for Assessment of Negative Symptoms (SANS) and the Scale for Assessment of Positive Symptoms (SAPS).
Right, left, and total thalamus volumes of patients were significantly smaller than those of controls after controlling for the potential confounding effect of intracranial volume. Thalamus volumes had significant positive correlation with positive symptoms score (SAPS) and significant negative correlation with negative symptoms score (SANS).
Thalamus volume deficits in anti-psychotic-naïve schizophrenia patients support a neurodevelopmental pathogenesis. The contrasting correlation of thalamus volume deficits with psychopathology scores suggests that contrasting pruning aberrations underlie symptom genesis in schizophrenia.
Indian Journal of Psychiatry 07/2010; 52(3):229-35.
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Clinical Chemistry and Laboratory Medicine 06/2010; 48(6):895-6. · 2.15 Impact Factor
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ABSTRACT: The corpus callosum (CC), the largest inter-hemispheric tract connecting the association cortices, has been shown to be affected in disorders with aberrant neurodevelopment. Previous studies that investigated CC abnormalities in schizophrenia have reported mixed findings potentially due to various confounding factors. In this study, we used magnetic resonance imaging to examine a large sample of antipsychotic-naïve schizophrenia patients (n=66) in comparison with age-, sex-, and handedness-matched (as a group) healthy comparison subjects (n=46). Mid-sagittal areas of CC sub-regions--namely, the genu, body, isthmus and splenium--were measured based on Witelson's method with good inter- and intra-rater reliability. The genu and body of the CC were significantly smaller in schizophrenia patients in comparison to healthy subjects after controlling for the potential confounding effects of age, sex and intracranial area. In male schizophrenia patients, there was a significant positive correlation between the age at onset of psychosis and the area of the genu. Together, these findings suggest neurodevelopmentally mediated hypoconnectivity in schizophrenia.
Psychiatry Research 05/2010; 182(2):141-5. · 2.52 Impact Factor
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ABSTRACT: Evolutionary theories link the pathogenesis of psychosis with anomalous brain asymmetry. Research shows that aberrant lateralization is linked to schizophrenia with elevated rates of left-handedness and reversal of normal cerebral asymmetries. However, lateralization is underexamined in bipolar affective disorder (BPAD) and the available literature suggests the possibility of greater lateralization, which is diametrically opposite to what is observed in schizophrenia. For the first time, we report concurrent analyses of asymmetry in BPAD and schizophrenia using a line bisection task.
We examined 164 subjects (31 patients with BPAD in remission, 30 patients with schizophrenia, and 103 healthy controls) using a two-hand line bisection task with established methodology. Raters with good inter-rater reliability (intraclass correlation coefficient > 0.8) measured deviation from the center. Task performance was compared using analysis of covariance with age, sex, and education as covariates.
Study groups did not differ significantly on age, sex, and handedness (p > 0.06). Patients (both schizophrenia and BPAD) had significantly more errors in identifying the center than controls (p < 0.001). Patients with schizophrenia bisected fewer lines at center than controls and BPAD subjects (p < 0.001). Using their right hand, schizophrenia patients had significant rightward deviation and BPAD patients had leftward deviation (p = 0.001). A significant interaction between diagnosis and direction of deviation (p = 0.01) was noted, with significant rightward deviation in schizophrenia and a trend toward leftward deviation in BPAD.
Study findings suggest attenuation of normal pseudoneglect in schizophrenia and accentuation of normal pseudoneglect in BPAD, indicating lesser lateralization in schizophrenia and possibly greater lateralization in BPAD. From an evolutionary perspective, schizophrenia and BPAD might have antithetical origins.
Bipolar Disorders 05/2010; 12(3):221-9. · 5.29 Impact Factor
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ABSTRACT: Neurodevelopmental pathogenesis of schizophrenia might be mediated by abnormalities in Insulin-like Growth Factor-1 (IGF-1). Developmental disturbances like obstetric complications, by themselves, as well as through the resultant hypercortisolemia due to hypothalamic-pituitary-adrenal (HPA) axis hyperactivity, can lead to deficient IGF-1 level. The relevance of IGF-1-Cortisol interactions in schizophrenia, especially in the context of antipsychotic treatment, is yet to be explored. In this study, thirty-three antipsychotic-naïve schizophrenia patients (13-men) were examined for serum IGF-1 and cortisol levels at baseline and after 3months of antipsychotic treatment. For baseline analyses, the patients were compared with 33 healthy controls matched for age, sex, socio-economic status, and physical activity. Symptoms were assessed using Scale for Assessment of Positive Symptoms (SAPS) and Scale for Assessment of Negative Symptoms (SANS). At baseline, schizophrenia patients had significantly lower levels of IGF-1 [t=4.6; p<0.0001] and higher levels of cortisol [t=3.9; p=0.0002] in comparison with healthy controls. Following treatment, IGF-1 level increased significantly [t=4.5; p<0.0001] whereas cortisol decreased significantly [t=2.5; p=0.02] in patients. There was a significant positive correlation between magnitude of increase in IGF-1 level and the magnitude of reduction in cortisol level [r=0.52; p=0.002]. Also, the greater the increase in IGF-1 the greater was the reduction in SAPS score [r=0.39; p=0.02]. Our study findings demonstrate that antipsychotic treatment can result in significant elevation of serum IGF-1 possibly mediated by reduction in cortisol levels. These observations suggest a possible link between HPA axis abnormalities and IGF-1 deficits in the neurodevelopmental pathogenesis of schizophrenia.
Biological Psychiatry 03/2010; 119(1-3):131-7. · 8.28 Impact Factor
