K S Jacob

Christian Medical College Vellore, Velluru, Tamil Nadu, India

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Publications (168)539.1 Total impact

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    ABSTRACT: Background: While western studies have focused on the importance of psychiatric illnesses in the complex pathways leading to suicides, several Indian studies have highlighted the important contributions by economic, social, and cultural factors. Hence, we tested the hypothesis that annual national suicide rates and suicide rates of the different states in India were associated with macroeconomic indices. Materials and Methods: Data from the National crime records bureau, Ministry of finance, labour bureau, Government of India, population commission, and planning commission official portals, World Bank and the United Nations were accessed. We assessed the correlations of annual national and state-wise suicide rates with macroeconomic, health, and other indices using ecological study design for India, and for its different states and union territories. Results: We documented statistically significant associations between the suicide rates and per capita gross domestic product, consumer price index, foreign exchange, trade balance, total health expenditure as well as literacy rates. Conclusions: As recent economic growth in India is associated with increasing suicide rates, macroeconomic policies emphasizing equitable distribution of resources may help curtailing the population suicide rates in India.
    Indian Journal of Psychological Medicine 07/2015; 37(3):277-281.
  • K S Jacob
    Indian Journal of Psychological Medicine 04/2015; 37(2):117. DOI:10.4103/0253-7176.155605
  • International Journal of Gynecology & Obstetrics 02/2015; 129(3). DOI:10.1016/j.ijgo.2014.12.006 · 1.56 Impact Factor
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    ABSTRACT: Background: Variable responses to clozapine in patients with schizophrenia are complex and poorly understood phenomena. The findings of pharmacogenetic studies on the use of this drug are poorly replicated. Effects of individual polymorphisms have rarely proved explanatory. One possible explanation may be multi-factorial involvement of genetic and environmental influences. Aim: To evaluate the role of possible second and third order genetic interactions (epistasis) between polymorphisms in CYP1A2 (*1F, *1D, *1E, *1C), HTR3A (rs1062613 and rs2276302), DRD4 (120-bp duplication) and COMT (Val158Met) genes in clinical response, serum levels and adverse effects of clozapine in patients with treatment-resistant schizophrenia (TRS). Methods: The model-based multidimensionality reduction (MB-MDR) method has recently been shown to be superior to traditional parametric regression methods in detecting higher order gene-gene interactions. We used this approach in a sample of 93 patients with TRS to explore the epistatic effects of the polymorphisms of interest on clinical phenotypes of clozapine. Data on genotypes and phenotypes of the patients that was available from a previous pharmacogenetic study was used for the analysis. Results: The MB-MDR analysis showed a significant interaction between Val158Met, CYP1A2*1D and rs1062613 polymorphisms and clinical response to clozapine (p=0.002). In addition, multiple significant second and third order interactions were observed with regard to the adverse effects of clozapine (p<0.05). No significant interactions were observed between the polymorphisms and serum levels of clozapine. All the reported interactions were found to be significant after 1000 permutations. Conclusion: Epistatic analysis showed significant associations of several polymorphisms with clinical phenotypes of clozapine that were not previously found on isolated analysis. This emphasizes the importance of epistatic analysis in pharmacogenetic studies of clozapine. Such an approach may be useful in predicting a patient’s response to clozapine therapy.
    World Congress of Psychiatric Genetics, Copenhagen, Denmark; 10/2014
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    ABSTRACT: The use of clozapine, an effective antipsychotic drug used in treatment-resistant schizophrenia, is associated with adverse effects. Sialorrhea is one such effect, which can be distressing for many patients. Studies on the pharmacogenetics of the adverse effects of clozapine are limited. The aim of the present study was to determine whether clozapine-induced sialorrhea is associated with a 120 base-pairs (bp) tandem duplication polymorphism in the dopamine receptor subtype D4 (DRD4) gene. Ninety-five patients, mean age 35.43±9.43 years, with treatment-resistant schizophrenia and on clozapine were included in the study. Development of sialorrhea in response to the drug, as manifested by drooling of saliva, was documented in 45 (47.4%) patients. Genotyping of the patients was carried out to detect the presence of the polymorphism of interest. Clozapine-induced sialorrhea was found to be associated significantly with the 120-bp duplication in DRD4. The association was found to fit a log-additive model with an odds ratio of 2.95 (95% confidence interval 1.51-5.75; P=0.0006). Thus, the presence of the 120-bp duplication in DRD4 appears to confer a risk for sialorrhea in response to clozapine therapy. The underlying pathophysiology and clinical significance of this phenomenon warrant further investigation.
    Psychiatric Genetics 10/2014; 24(6). DOI:10.1097/YPG.0000000000000058 · 2.27 Impact Factor
  • P Thangadurai · K S Jacob
    Indian Journal of Psychological Medicine 10/2014; 36(4):351-4. DOI:10.4103/0253-7176.140698
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    ABSTRACT: Background: Genetic factors explaining phenotypes in psychiatric genetics were always characterised by significant heterogeneity and non-reproducibility. Even understanding genetic basis of highly heritable diseases such as schizophrenia, was challenging. Contribution of environmental factors in terms of its interaction with genetic factors were recently implicated in addressing the unexplained heterogeneity of schizophrenia genetics. Aims and Objectives: The present study explored the possible associations of polymorphisms in genes: DRD4 (120-bp duplication) and COMT (Val158Met), with clinical response to clozapine in patients with treatment resistant schizophrenia (TRS). We tried to identify the associations of gene-gene interaction( DRD4XCOMT) and gene-environmental interactions with clinical phenotypes of c!lozapine. Methodology: A cohort of 95 participants with diagnosis of TRS was studied. The patients, were genotyped for the polymorphisms of interest using polymerase chain reaction and restriction fragment polymorphism (RFLP) method. Clozapine response were defined a priori. Appropriate statistical analysis were employed. Results: The polymorphisms were not found to associate statistically with clozapine response when analysed individually. However, interestingly we found a statistically significant DRD4XCOMT interaction over clozapine response. We also found significant gene-environmental interactions over clozapine response. A logistic regression model (Response ~ (COMTXDRD4)+age+smoking habit + maximum dose of clozapine + Abnormal involuntary movements scale + Adden’s cognitive examination scale) that proved most explanatory was derived. ! Conclusion: Gene-gene interaction between DRD4 and COMT and their gene-environment interactions play a significant role in predicting clinical response to clozapine therapy. Future studies were suggested to replicate our findings before it could be translated to clinical practice.
    International Conference on Schizophreni(ICONS) VI, Hyatt hotel, Chennai, TN, India; 08/2014
  • Sauradeep Sarkar · Mazda K Turel · Kuruthukulangara S Jacob · Ari G Chacko
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    ABSTRACT: Object T2-weighted intramedullary increased signal intensity (ISI) on MRI in patients with cervical spondylotic myelopathy (CSM) appears to represent a wide spectrum of pathological changes that determine reversibility of cord damage. Although sharp T2-weighted ISI on preoperative imaging may correlate with poorer surgical outcomes, there are limited data on how these changes progress following surgery. In this study, the authors characterized pre-and postoperative ISI changes in patients undergoing surgery for CSM and studied their postoperative evolution in an attempt to quantify their clinical significance. Methods The preoperative and postoperative MR images obtained in 56 patients who underwent oblique cervical corpectomy for CSM were reviewed, and the ISI was classified into 4 subtypes based on margins and intensity: Type 0 (none), Type 1 ("fuzzy"), Type 2 ("sharp"), and Type 3 ("mixed"). The locations of the ISI were further classified as focal if they represented single discrete lesions, multifocal if there were multiple lesions with intervening normal cord, and multisegmental if the lesions were continuous over more than 1 segment. The maximum craniocaudal length of the ISI was measured on each midsagittal MR image. The Nurick grade and Japanese Orthopaedic Association (JOA) score were used to assess clinical status. The mean duration of follow-up was 28 months. Results T2-weighted ISI changes were noted preoperatively in 54 patients (96%). Most preoperative ISI changes were Type 1 (41%) or Type 3 (34%), with a significant trend toward Type 2 (71%) changes at follow-up. Multi-segmental and Type 3 lesions tended to regress significantly after surgery (p = 0.000), reducing to Type 2 changes at follow-up. Clinical outcomes did not correlate with ISI subtype; however, there was a statistically significant trend toward improvement in postoperative Nurick Grade in patients with a > 50% regression in ISI size. In addition, patients with more than 18 months of follow-up showed significant regression in ISI size compared with patients imaged earlier. On logistic regression analysis, preoperative Nurick grade and duration of follow-up were the only significant predictors of postoperative improvement in functional status (OR 4.136, p = 0.003, 95% CI 1.623-10.539 and OR 6.402, p = 0.033, 95% CI 1.165-35.176, respectively). Conclusions There is a distinct group of patients with multisegmental Type 3 intramedullary changes who show remarkable radiological regression after surgery but demonstrate a residual sharp focal ISI at follow-up. A regression of the ISI by > 50% predicts better functional outcomes. Patients with a good preoperative functional status remain the most likely to show improvement, and the improvement continues to occur even at remote follow-up. The clinical relevance of the quality of the T2-weighted ISI changes in patients with CSM remains uncertain; however, postoperative regression of the ISI change is possibly a more important correlate of patient outcome than the quality of the ISI change alone.
    Journal of Neurosurgery Spine 07/2014; 21(4):1-9. DOI:10.3171/2014.6.SPINE13727 · 2.36 Impact Factor
  • Neil Jeyasingam · Kuruthukulangara S Jacob · Henry Brodaty
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    ABSTRACT: Objective: To assess the prevalence of personality disorders in general medical geriatric admissions. Methods: Forty of 508 general medical geriatric admissions screened at a large tertiary hospital, who were eligible as defined by a Mini-Mental State Examination score of over 23 and capable of informed consent, were assessed by direct interview and discussion with the patient's family or close contact to determine personality traits. Results: Eight (20%) of these patients were found to satisfy DSM-IV criteria for a personality disorder. They were found to have significantly lower global assessments of functioning, impaired overall functioning and lower quality of life compared with non-personality disordered patients. None of their personality disorders had been recognised by their treating teams. Conclusions: This study supports the need for systematic research into the area and the need for increased clinical awareness of the issues.
    Australasian Psychiatry 07/2014; 22(5). DOI:10.1177/1039856214541688 · 0.56 Impact Factor
  • K S Jacob
    The National medical journal of India 07/2014; 27(4):189-91. · 0.91 Impact Factor
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    ABSTRACT: Background. Sexual dysfunction, common in general medical practice, is under-recognized and inadequately managed resulting in significant morbidity and reduction in quality of life. We examined the nature, prevalence, clinical features and explanatory models of illness among men with sexual dysfunction in a general healthcare setting. Methods. We recruited 270 consecutive men attending a general health clinic. Participants were evaluated using a structured interview. The International Index of Erectile Function-5, the Chinese Index of Premature Ejaculation-5, Short Explanatory Model Interview and the Revised Clinical Interview Schedule were used to assess sexual dysfunction, explanatory models and psychiatric morbidity. Results. Premature ejaculation and erectile dysfunction were reported by 43.0% and 47.8% of men, respectively. The most common perceived causes were loss of semen due to masturbation and nocturnal emission. Popular treatments were herbal remedies and resources used were traditional healers. The factors associated with erectile dysfunction were diabetes mellitus, financial stress, past history of psychiatric treatment and common mental disorders such as depression and anxiety; those associated with premature ejaculation were common mental disorders, older age and financial debt. Sexual dysfunctions and concerns were under-diagnosed by physicians when compared to the research interview. Conclusion. There is a need to recognize sexual problems and effectively manage them in general medical settings. The need for sex education in schools and through the mass media, to remove sexual misconceptions, cannot be under-emphasized. Copyright 2014, NMJI.
    The National medical journal of India 07/2014; 27(4):198-201. · 0.91 Impact Factor
  • Rajesh Gopalakrishnan · Packirisamy Thangadurai · Anju Kuruvilla · Kuruthukulangara Sebastian Jacob
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    ABSTRACT: Anejaculation is an uncommon clinical entity that may result from a variety of causes, both organic and psychological. Psychogenic anejaculation is influenced by relationship, behavioral, and psychological factors. We present a clinical case of situational anejaculation, which was managed with a combination of techniques that addressed these factors including changes in masturbatory technique, improved marital communication and quality, and reduction of anxiety using cognitive behavioral techniques. It is suggested that the standard techniques of sex therapy be modified and tailored to manage the specific problems of the individual patient.
    Indian Journal of Psychological Medicine 07/2014; 36(3):329-31. DOI:10.4103/0253-7176.135393
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    ABSTRACT: Background There is a dearth of information about the predictors of disability in schizophrenia from low and middle-income countries. This study attempted to investigate the impact of socio-demographic and clinical variables on disability in a cohort of first episode schizophrenia. Method Patients diagnosed to have DSM IV schizophrenia (n = 131) were assessed prospectively for psychopathology, functioning, insight and explanatory models of illness at baseline, 6, 12 and 60 months using standard instruments. Disability was assessed at 5 years. Multiple linear regression was employed to adjust for common confounders. Results We could follow up 95 (72.5%) patients. Sixty-five of these patients (68.4%) achieved remission. Disability scores at 5 years were associated negatively with episodic nature of illness at baseline, functional assessments at 6 and 12 months and return to pre-morbid level function. Disability correlated positively with psychopathology at 6 and 12 months and time spent in psychotic episodes. It was also associated with psychopathology, remission, insight and patient perspectives at the 5th year cross-sectional evaluation. While employment status at recruitment was not associated with disability, it was associated with unemployment at follow up. Conclusions Disability at 5 years was associated with illness variables- episodic nature of illness at baseline, psychopathology and functioning, duration in psychotic episode and return to pre-morbid function. Patient perspectives about their illness (insight and patient explanatory models) were only associated cross-sectionally at 60 months but not earlier and are more suggestive of a coping response rather than being predictive of outcome. The relationship between unemployment and disability suggests that they are products of the same disease process.
    Asian Journal of Psychiatry 06/2014; 9. DOI:10.1016/j.ajp.2014.01.003
  • K.S. Jacob
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    ABSTRACT: While the traditional view within psychiatry is that insight is independent of psychopathology and predicts the course and outcome of psychosis, recent data from India argues that insight is secondary to interaction between progression of illness on one hand and local culture and social environment on the other. The findings suggest that “insight” is an Explanatory Model (EM) and may reflect attempts at coping with the devastating effects of mental disorders. Most societies are pluralistic and offer multiple, divergent and contradictory explanations for illnesses. These beliefs systems interact with the trajectory of the person's illness to produce a unique personal understanding, often based on a set of complex and contradictory EMs. Like all EMs, insight provides meaning to explain and overcome challenges including disabling symptoms, persistent deficits, impaired social relations and difficult livelihood issues. The persistence of distress, impairment, disability and handicap, despite regular and optimal treatment, call for explanations, which go beyond the simplistic concept of disease. People tend to choose EMs, which are non-stigmatizing and which seem to help explain and rationalize their individual concerns. The frequent presence of multiple and often contradictory EMs, held simultaneously, suggest that they are pragmatic responses at coping. The results advocate a non-judgmental approach and broad based assessment of EMs of illness and their comparison with culturally appropriate beliefs, attributions and actions. The biomedical model of illness should be presented without dismissing patient beliefs or belittling local cultural explanations for illness. Clinical practice demands a negotiation of shared model of care and treatment plan between patient and physician perspectives. The diversity of patients, problems, beliefs and cultures mandates the need to educate, match, negotiate and integrate psychiatric and psychological frameworks and interventions. It calls for multifaceted and nuanced understanding of “insight” and explanatory models of illness.
    Asian Journal of Psychiatry 06/2014; 11. DOI:10.1016/j.ajp.2014.06.001
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    ABSTRACT: Early detection of residual disease may benefit management strategies in patients undergoing transsphenoidal surgery for acromegaly. This requires establishing objective thresholds for early postoperative growth hormone (GH) assays, and incorporating these parameters into a scale for outcome prediction. We analyzed a database containing the records of 86 patients who had undergone gross total transsphenoidal resection of GH-secreting pituitary adenomas. Early postoperative biochemical testing included a morning fasting basal GH assay on the first postoperative day (POD1) and a second GH assay following suppression with 100 g of oral glucose on the seventh postoperative day (POD7). Remission was defined as a normal IGF-1 with either a GH nadir <0.4 ng/ml following suppression with oral glucose or a basal fasting GH <1 ng/ml on follow-up dated >3 months after surgery. Receiver operator characteristic (ROC) curves identified optimal thresholds for all biochemical parameters. Logistic regression analysis assessed the statistical significance of factors associated with cure. A point system was developed, employing regression coefficients obtained from the multivariate statistical model to quantify the impact of each predictor on cure. Remission was achieved in 34.6 % of patients and was associated with smaller, non-invasive tumors with lower preoperative, POD1 and POD7 GH levels. Optimal thresholds obtained from the ROC analysis suggested that lower POD1 and POD7 GH values provided good sensitivity and specificity for cure, despite modest predictive values. The model with the best ability to predict outcome included size, POD1 GH and POD7 GH levels, with a score of ≥95 demonstrating high specificity for prediction of remission. Early postoperative GH assays are highly sensitivity and specific. The scoring system that we propose provided excellent predictive value and requires further validation in larger cohorts and in different populations. The model may help guide the intensity of follow-up and enable early identification of residual disease.
    Acta Neurochirurgica 04/2014; 156(7). DOI:10.1007/s00701-014-2098-5 · 1.79 Impact Factor
  • K S Jacob
    Indian Journal of Psychiatry 04/2014; 56(2):117-20. DOI:10.4103/0019-5545.130478
  • Rida Nongrum · Elsy Thomas · Jessie Lionel · Kuruthukulangara S Jacob
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    ABSTRACT: Objectives: This study attempted to follow up a cohort of women who presented to a tertiary hospital to investigate the effect of domestic violence on maternal and neonatal outcomes. Materials and Methods: Women, between 26-34 weeks of gestation, attending the obstetrics outpatient department, were recruited and followed up until delivery. They were assessed at recruitment and after delivery using the Edinburgh Postnatal Depression Scale, the Abuse Assessment Screen, and a pro forma to assess socio-demographic and clinical characteristics. Bivariate and multivariate statistics were employed to assess statistical significance. Results: One hundred and fifty women were recruited, 132 delivered in the hospital and were followed up. Domestic violence was associated with antenatal and postnatal depression, spouse's insistence of a boy baby, medical complications during pregnancy, preterm delivery, and lower birth-weight. Conclusion: Domestic violence has a significant impact on maternal and neonatal outcomes. Screening for domestic violence and interventions should be part of all antenatal programs. India should also employ public health approaches to change its patriarchal culture.
    Indian Journal of Psychological Medicine 04/2014; 36(2):179-81. DOI:10.4103/0253-7176.130989
  • K S Jacob
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    ABSTRACT: Some recent studies from Vellore, Tamil Nadu, on dementia have been published in international journals as part of international data, analysis and interpretation. They have also been published separately employing local perspectives and analysis. The different results and interpretations of these two approaches to the same data suggest the need for independent work and study of the local reality to inform national public health policies.
    The National medical journal of India 03/2014; 27(2):95-8. · 0.91 Impact Factor
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    ABSTRACT: Background. We examined the nature, prevalence and explanatory models of sexual concerns and dysfunction among women in rural Tamil Nadu. Methods. Married women between 18 and 65 years of age, from randomly selected villages in Kaniyambadi block, Vellore district, Tamil Nadu, were chosen by stratified sampling technique. Sexual functioning was assessed using the Female Sexual Function Index (FSFI). The modified Short Explanatory Model Interview (SEMI) was used to assess beliefs about sexual concerns and the General Health Questionnaire-12 (GHQ-12) was used to screen for common mental disorders. Sociodemographic variables and other risk factors were also assessed. Results. Most of the women (277; 98.2%) contacted agreed to participate in the study. The prevalence of sexual dysfunction, based on the cut-off score on the FSFI, was 64.3%. However, only a minority of women considered it a problem (4.7%), expressed dissatisfaction (5.8%) or sought medical help (2.5%). The most common explanatory models offered for sexual problems included an unhappy marriage,stress and physical problems. Factors associated with lower FSFI included older age, illiteracy, as well as medical illness and sexual and marital factors such as menopause, poor quality of marital relationship, history of physical abuse and lack of privacy. Conclusion. The diagnosis of female sexual dysfunction needs to be nuanced and based on the broader personal and social context. Our findings argue that there is a need to use models that employ personal, local and contextual standards in assessing complex behaviours such as sexual function. Copyright 2014, NMJI.
    The National medical journal of India 01/2014; 27(1):4-8. · 0.91 Impact Factor
  • T S Sathyanarayana Rao · K S Jacob
    Indian Journal of Psychiatry 01/2014; 56(1):1-2. DOI:10.4103/0019-5545.124706

Publication Stats

2k Citations
539.10 Total Impact Points

Institutions

  • 1999–2015
    • Christian Medical College Vellore
      • Department of Psychiatry
      Velluru, Tamil Nadu, India
  • 2003–2014
    • Christian Medical College & Hospital
      Ludhiana, Punjab, India
  • 2012
    • Aarhus University
      • Department of Biomedicine
      Aarhus, Central Jutland, Denmark
  • 2007
    • University of Pittsburgh
      Pittsburgh, Pennsylvania, United States
    • King's College London
      • Institute of Psychiatry
      London, ENG, United Kingdom