Background: Older adults are likely to experience psychological and social problems due to declin... more Background: Older adults are likely to experience psychological and social problems due to decline in physical strength, increased health issues, inadequate financial resources, and family dynamics. In this context, they need psychosocial care services to handle such challenges. Particularly, inmates of old-age homes are more vulnerable to experience such challenges as they are away from the family care. In this background, knowing their views on psychosocial care needs while living in old-age homes is significant to improve old-age home-based care. The aim of this study is to explore the psychosocial care needs expressed by the inmates of old-age homes. Materials and Methods: Inmates of old-age homes were selected using purposive sampling. A total of twenty residents out of four old-age homes of Bengaluru Metropolitan City were interviewed using a semi-structured interview guide. The qualitative content analysis has been carried out to identify core psychosocial care needs out of the text data. Results: Three themes, namely “health-care needs,” “concerns regarding the behavior of the staff,” and “mental health needs,” are emerged. Conclusion: The current study findings provide insiders' views and highlight the importance of psychosocial care services to address their needs at every old-age home.
Background: Although electroconvulsive therapy (ECT) is a well-established treatment modality wor... more Background: Although electroconvulsive therapy (ECT) is a well-established treatment modality worldwide for elderly with severe psychiatric disorders, literature is sparse in India. Materials and Methods: A retrospective chart review of patients aged 60 years and above (n = 90) who received a course of ECTs between April 2003 and 2013 in National Institute of Mental Health and Neurosciences, Bengaluru, a tertiary care neuropsychiatric institute, was carried out. For each elderly person, the next consecutive nonelderly ECT patient was selected as a control (n = 85). Clinical, demographic, and ECT variables were compared. Results: Depression (n = 57; 63.3%) was the most common diagnosis for ECT among the elderly while schizophrenia (n = 28; 32.9%) was most common among controls (P < 0.01); suicidal ideas were the most common indication (n = 25; 28.4%) among the elderly while aggression was the most common indication among controls (n = 28; 33.3%) (P = 0.004). Elderly received more number of ECTs (mean [standard deviation (SD)] 8.0 [3.0] vs. 6.4 [2.8]; P ≤ 0.01), had higher seizure threshold (mean [SD] 135.3 [76.9] mc vs. 81.3 [54.2] mc; P < 0.01), and experienced lesser duration of motor seizures (mean [SD] 38.48 [9.72] s vs. 48.90 [14.66]; P < 0.01). Immediate post-ECT cognitive deficits were more in the elderly (n = 19; 21.6% vs. n = 7; 8.3%; P = 0.02). Case records showed no between-group differences both at the end of 3-month (P = 0.40) and 6-month (P = 0.50) follow-up for cognitive complaints. Mean (standard deviation) Clinical Global Impression-Improvement scores at the end of ECT course were 2.3 (0.9) versus 2.4 (0.8) (P = 0.5) among elderly and nonelderly, respectively. These scores were comparable at the end of 3 as well as 6 months' follow-up. Conclusions: This retrospective chart review showed ECT to be safe and effective for geriatric patients with severe psychiatric disorders including cognitive adverse effects. However, prospective studies would help to better establish cognitive adverse effects of ECT.
The prevalence of dementia is increasing rapidly, specifically in low and middle income countries... more The prevalence of dementia is increasing rapidly, specifically in low and middle income countries (LAMIC) due to demographic aging. Help seeking is delayed and usually sought at an advanced stage of illness and many are yet to receive a formal diagnosis. We interviewed 35 caregivers of persons with Dementia (as per ICD-10) using a semi-structured questionnaire, the Short Explanatory Model Interview (SEMI). We explored the pathways taken by caregivers of people with dementia en route to a tertiary care centre and the interactions they had with different health care providers. Qualitative data analysis was done using ATLAS.ti. We identified three major pathways: I) The Neuropsychiatric pathway II) The General Practitioner pathway and III) The Non-cohesive pathway. In general, the caregivers were poorly informed about the illness details such as diagnosis, course and outcome. Neurologists communicated the diagnosis of 'Dementia' more frequently. When information was made availa...
Objectives: Though old persons have multiple diagnoses, the illnesses are treatable. Services con... more Objectives: Though old persons have multiple diagnoses, the illnesses are treatable. Services concerned specially with elderly people who are mentally ill have formed in response to changing needs and expectations in society in developed countries. In comparison, specialty geriatric services in India are only a handful. We report findings from one of the first geriatric clinics in India. The clinic functions as a weekly referral outpatient service with referrals from other psychiatry and neurology specialists. The aim of this study was to explore the socio demographic and clinical profile of patients attending the geriatric clinic of NIMHANS. Method: Retrospective chart review. Results: 522 such patients utilized the services from October 1999 to December 2005. Mean age was 69.52 (7.91) years. Males formed 51% and females formed 49% of the sample. Diagnostic breakup was as follows: all dementias-53.3%, depressive disorders-17 %, psychotic disorders- 14 % and bipolar disorders-1.7%. ...
Alzheimer's disease (AD) is associated with widespread structural and functional brain altera... more Alzheimer's disease (AD) is associated with widespread structural and functional brain alterations. The current study examined the gray matter (GM) voxel based morphometric (VBM) correlates of cognitive and clinical severity scores in patients with AD. The study included 34 patients with AD according to NINCDS/ADRDA AD criteria and 28 matched elderly controls. All subjects were clinically evaluated using Hindi Mental Status Examination (HMSE), Everyday Abilities Scale for India (EASI) and the Clinical Dementia Rating (CDR) scale. The structural Magnetic Resonance Imaging (MRI) data were acquired using a 3 Tesla MRI scanner and VBM analysis was performed using VBM5.1 toolbox. The patients with AD had significantly lower GM volume, white matter volume and total brain volume as compared to controls. The HMSE scores were positively correlated (p=0.009) and EASI (p=0.04)…
The present study was undertaken to validate the measurement of biomarkers as a supplement to the... more The present study was undertaken to validate the measurement of biomarkers as a supplement to the latest diagnostic criteria for Alzheimer disease (AD) dementia by National Institute on Aging-Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Association (NIA-AA) work group using a sample attending a tertiary care center in Southern India. A total of 20 subjects diagnosed clinically as Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s dementia according to the NIA-AA criteria for AD were included in the study. The CSF biomarkers Aβ42, t-tau, and p-tau181 were assessed. The biomarker results were compared among mild and moderate to severe AD as defined in the NIA-AA work group guidelines. The results revealed that the amount of Aβ42 was very low in all the 20 samples (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;50pg/ml) collected from mild AD cases with CDR score of 1 (n=8), and moderate to severe AD cases with CDR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1 (n=12). t-tau and p-tau levels were in the range of 39.45±5.09pg/ml and 13.06±7.32pg/ml for CDR 1 group. t-tau and p-tau levels were in the range of 49.9±11.28pg/ml and 33.94±15.13pg/ml for moderate to severe cases. Analysis of the data revealed statistically significant differences in the p-tau/t-tau ratio and p-tau/Aβ ratio between CDR 1and CDR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1 AD cases (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) suggesting that p-tau/t-tau and p-tau/Aβ ratio are good indicators of severity of dementia with discriminative value in differentiating mild AD from moderate to severe AD.
s / Brain Stimulation 8 (2015) 360e377 369 monitor the motor potentials evoked by motor cortices.... more s / Brain Stimulation 8 (2015) 360e377 369 monitor the motor potentials evoked by motor cortices. Ultrasonic attenuation coefficients of skulls in high frequency were measured and calculated using 3D acoustic intensity measurement system (SN2010, Precision Acoustics). Our results indicate that 5MHz focused ultrasound can efficiently penetrate through skull of mouse and stimulate motor cortex to evoke motor potentials and movement responses, thus allow for more precise stimulation on brain of mouse.
Metabolic side effects of antipsychotics contribute to morbidity and non-compliance in treatment ... more Metabolic side effects of antipsychotics contribute to morbidity and non-compliance in treatment of psychosis. Multiple studies suggest that metabolic side effects correlate with response to antipsychotic treatment. However, few studies have systematically looked at this. We conducted an exploratory, naturalistic, prospective, trans-diagnostic study to examine this association. 100 patients with psychosis, initiated on antipsychotic treatment alone, were assessed on Brief Psychiatric Rating Scale (BPRS), visual analog scale for appetite, anthropometric measurements (weight, waist circumference, body mass index), and fasting serum lipid and glucose profiles at baseline, 2-4 weeks (n=71) and 8-12 weeks (n=39). Subjects who dropped out at first/second follow-ups did not differ from those who followed-up, in age, sex, illness duration and BPRS scores. On forward stepwise multiple linear regression analysis, early (2-4 weeks) increase in appetite and triglyceride levels (R(2)=0.257; p=0.003) together predicted 26% variance in treatment response (BPRS score reduction) at first follow-up. At second follow-up 16% of variance in treatment response was predicted by early (2-4 weeks) increase in triglyceride levels (R(2)=0.169; p=0.009). Early appetite and triglyceride changes predicted antipsychotic treatment response. Involvement of dopaminergic, serotonergic and histaminergic neural pathways could explain the association between appetite and treatment response. Insulin signaling pathways have been implicated in lipid changes with antipsychotics. Study findings suggest metabolic side effects may be early predictors of antipsychotic response. These findings warrant further examination to elucidate the interaction between metabolic pathways and psychotic illnesses, and possibly mechanism of action of antipsychotics beyond dopamine blockade.
ABSTRACTBackground: Cognitive and psychiatric features are important components of dementia. Earl... more ABSTRACTBackground: Cognitive and psychiatric features are important components of dementia. Early onset dementia (EOD) has been found to be associated with a greater genetic basis. If this is the case, EOD could have genetic association with psychiatric illnesses, given the presence of more behavioral disturbances in this condition. There is a definite need to explore the presence of psychiatric symptoms and disorders in families of patients with dementia.Methods: The authors compared 52 proband families of dementia and 45 control families in order to assess the familial co-aggregation of major psychiatric illnesses. The cumulative risk in first degree relatives in the two groups for major psychiatric illnesses was calculated using Kaplan Meier Survival analysis. Early onset and late onset dementia proband families were compared separately with control families for the same.Results: There was a significantly higher morbid risk for psychosis in dementia proband families (generalized...
Many psychiatric patients undergoing vocational training do not achieve successful transition to ... more Many psychiatric patients undergoing vocational training do not achieve successful transition to regular work. In this study, we evaluated the barriers for discharge from day care center to actual work place. In a cross-sectional study at a government-run day-care center at National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, we studied 76 patients who were undergoing vocational training for more than 1 year. We did a semi-structured interview with patients, their family members, and instructors of various occupational sections. We used a questionnaire of 17 different barriers to assess the obstacles in their discharge from day-care center to actual work place. The majority of them had a diagnosis of mental retardation (n=47) followed by schizophrenia (n=29), and bipolar disorder (n=9). The mean (SD) age and duration of illness was 33.6 (9.7) years and 12.5 (9.3) years, respectively. Patients had more than one diagnosis. The median duration of stay in day-care center was 5.9 years. Doubts regarding performance at a new work place (n=60), fear of performance at new work place (n=65), and the fear of transition to regular work (n=64) were the most common barriers reported by patients, their family members and instructors of various occupational sections, respectively. Educating patients and their family members, gradual exposure to new working environment, and increased community level vocational opportunities may potentially overcome above barriers. Getting them to the actual job early in their course of treatment will improve their adjustment to a new work place and overall outcome.
Background: Older adults are likely to experience psychological and social problems due to declin... more Background: Older adults are likely to experience psychological and social problems due to decline in physical strength, increased health issues, inadequate financial resources, and family dynamics. In this context, they need psychosocial care services to handle such challenges. Particularly, inmates of old-age homes are more vulnerable to experience such challenges as they are away from the family care. In this background, knowing their views on psychosocial care needs while living in old-age homes is significant to improve old-age home-based care. The aim of this study is to explore the psychosocial care needs expressed by the inmates of old-age homes. Materials and Methods: Inmates of old-age homes were selected using purposive sampling. A total of twenty residents out of four old-age homes of Bengaluru Metropolitan City were interviewed using a semi-structured interview guide. The qualitative content analysis has been carried out to identify core psychosocial care needs out of the text data. Results: Three themes, namely “health-care needs,” “concerns regarding the behavior of the staff,” and “mental health needs,” are emerged. Conclusion: The current study findings provide insiders' views and highlight the importance of psychosocial care services to address their needs at every old-age home.
Background: Although electroconvulsive therapy (ECT) is a well-established treatment modality wor... more Background: Although electroconvulsive therapy (ECT) is a well-established treatment modality worldwide for elderly with severe psychiatric disorders, literature is sparse in India. Materials and Methods: A retrospective chart review of patients aged 60 years and above (n = 90) who received a course of ECTs between April 2003 and 2013 in National Institute of Mental Health and Neurosciences, Bengaluru, a tertiary care neuropsychiatric institute, was carried out. For each elderly person, the next consecutive nonelderly ECT patient was selected as a control (n = 85). Clinical, demographic, and ECT variables were compared. Results: Depression (n = 57; 63.3%) was the most common diagnosis for ECT among the elderly while schizophrenia (n = 28; 32.9%) was most common among controls (P < 0.01); suicidal ideas were the most common indication (n = 25; 28.4%) among the elderly while aggression was the most common indication among controls (n = 28; 33.3%) (P = 0.004). Elderly received more number of ECTs (mean [standard deviation (SD)] 8.0 [3.0] vs. 6.4 [2.8]; P ≤ 0.01), had higher seizure threshold (mean [SD] 135.3 [76.9] mc vs. 81.3 [54.2] mc; P < 0.01), and experienced lesser duration of motor seizures (mean [SD] 38.48 [9.72] s vs. 48.90 [14.66]; P < 0.01). Immediate post-ECT cognitive deficits were more in the elderly (n = 19; 21.6% vs. n = 7; 8.3%; P = 0.02). Case records showed no between-group differences both at the end of 3-month (P = 0.40) and 6-month (P = 0.50) follow-up for cognitive complaints. Mean (standard deviation) Clinical Global Impression-Improvement scores at the end of ECT course were 2.3 (0.9) versus 2.4 (0.8) (P = 0.5) among elderly and nonelderly, respectively. These scores were comparable at the end of 3 as well as 6 months' follow-up. Conclusions: This retrospective chart review showed ECT to be safe and effective for geriatric patients with severe psychiatric disorders including cognitive adverse effects. However, prospective studies would help to better establish cognitive adverse effects of ECT.
The prevalence of dementia is increasing rapidly, specifically in low and middle income countries... more The prevalence of dementia is increasing rapidly, specifically in low and middle income countries (LAMIC) due to demographic aging. Help seeking is delayed and usually sought at an advanced stage of illness and many are yet to receive a formal diagnosis. We interviewed 35 caregivers of persons with Dementia (as per ICD-10) using a semi-structured questionnaire, the Short Explanatory Model Interview (SEMI). We explored the pathways taken by caregivers of people with dementia en route to a tertiary care centre and the interactions they had with different health care providers. Qualitative data analysis was done using ATLAS.ti. We identified three major pathways: I) The Neuropsychiatric pathway II) The General Practitioner pathway and III) The Non-cohesive pathway. In general, the caregivers were poorly informed about the illness details such as diagnosis, course and outcome. Neurologists communicated the diagnosis of 'Dementia' more frequently. When information was made availa...
Objectives: Though old persons have multiple diagnoses, the illnesses are treatable. Services con... more Objectives: Though old persons have multiple diagnoses, the illnesses are treatable. Services concerned specially with elderly people who are mentally ill have formed in response to changing needs and expectations in society in developed countries. In comparison, specialty geriatric services in India are only a handful. We report findings from one of the first geriatric clinics in India. The clinic functions as a weekly referral outpatient service with referrals from other psychiatry and neurology specialists. The aim of this study was to explore the socio demographic and clinical profile of patients attending the geriatric clinic of NIMHANS. Method: Retrospective chart review. Results: 522 such patients utilized the services from October 1999 to December 2005. Mean age was 69.52 (7.91) years. Males formed 51% and females formed 49% of the sample. Diagnostic breakup was as follows: all dementias-53.3%, depressive disorders-17 %, psychotic disorders- 14 % and bipolar disorders-1.7%. ...
Alzheimer's disease (AD) is associated with widespread structural and functional brain altera... more Alzheimer's disease (AD) is associated with widespread structural and functional brain alterations. The current study examined the gray matter (GM) voxel based morphometric (VBM) correlates of cognitive and clinical severity scores in patients with AD. The study included 34 patients with AD according to NINCDS/ADRDA AD criteria and 28 matched elderly controls. All subjects were clinically evaluated using Hindi Mental Status Examination (HMSE), Everyday Abilities Scale for India (EASI) and the Clinical Dementia Rating (CDR) scale. The structural Magnetic Resonance Imaging (MRI) data were acquired using a 3 Tesla MRI scanner and VBM analysis was performed using VBM5.1 toolbox. The patients with AD had significantly lower GM volume, white matter volume and total brain volume as compared to controls. The HMSE scores were positively correlated (p=0.009) and EASI (p=0.04)…
The present study was undertaken to validate the measurement of biomarkers as a supplement to the... more The present study was undertaken to validate the measurement of biomarkers as a supplement to the latest diagnostic criteria for Alzheimer disease (AD) dementia by National Institute on Aging-Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Association (NIA-AA) work group using a sample attending a tertiary care center in Southern India. A total of 20 subjects diagnosed clinically as Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s dementia according to the NIA-AA criteria for AD were included in the study. The CSF biomarkers Aβ42, t-tau, and p-tau181 were assessed. The biomarker results were compared among mild and moderate to severe AD as defined in the NIA-AA work group guidelines. The results revealed that the amount of Aβ42 was very low in all the 20 samples (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;50pg/ml) collected from mild AD cases with CDR score of 1 (n=8), and moderate to severe AD cases with CDR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1 (n=12). t-tau and p-tau levels were in the range of 39.45±5.09pg/ml and 13.06±7.32pg/ml for CDR 1 group. t-tau and p-tau levels were in the range of 49.9±11.28pg/ml and 33.94±15.13pg/ml for moderate to severe cases. Analysis of the data revealed statistically significant differences in the p-tau/t-tau ratio and p-tau/Aβ ratio between CDR 1and CDR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1 AD cases (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) suggesting that p-tau/t-tau and p-tau/Aβ ratio are good indicators of severity of dementia with discriminative value in differentiating mild AD from moderate to severe AD.
s / Brain Stimulation 8 (2015) 360e377 369 monitor the motor potentials evoked by motor cortices.... more s / Brain Stimulation 8 (2015) 360e377 369 monitor the motor potentials evoked by motor cortices. Ultrasonic attenuation coefficients of skulls in high frequency were measured and calculated using 3D acoustic intensity measurement system (SN2010, Precision Acoustics). Our results indicate that 5MHz focused ultrasound can efficiently penetrate through skull of mouse and stimulate motor cortex to evoke motor potentials and movement responses, thus allow for more precise stimulation on brain of mouse.
Metabolic side effects of antipsychotics contribute to morbidity and non-compliance in treatment ... more Metabolic side effects of antipsychotics contribute to morbidity and non-compliance in treatment of psychosis. Multiple studies suggest that metabolic side effects correlate with response to antipsychotic treatment. However, few studies have systematically looked at this. We conducted an exploratory, naturalistic, prospective, trans-diagnostic study to examine this association. 100 patients with psychosis, initiated on antipsychotic treatment alone, were assessed on Brief Psychiatric Rating Scale (BPRS), visual analog scale for appetite, anthropometric measurements (weight, waist circumference, body mass index), and fasting serum lipid and glucose profiles at baseline, 2-4 weeks (n=71) and 8-12 weeks (n=39). Subjects who dropped out at first/second follow-ups did not differ from those who followed-up, in age, sex, illness duration and BPRS scores. On forward stepwise multiple linear regression analysis, early (2-4 weeks) increase in appetite and triglyceride levels (R(2)=0.257; p=0.003) together predicted 26% variance in treatment response (BPRS score reduction) at first follow-up. At second follow-up 16% of variance in treatment response was predicted by early (2-4 weeks) increase in triglyceride levels (R(2)=0.169; p=0.009). Early appetite and triglyceride changes predicted antipsychotic treatment response. Involvement of dopaminergic, serotonergic and histaminergic neural pathways could explain the association between appetite and treatment response. Insulin signaling pathways have been implicated in lipid changes with antipsychotics. Study findings suggest metabolic side effects may be early predictors of antipsychotic response. These findings warrant further examination to elucidate the interaction between metabolic pathways and psychotic illnesses, and possibly mechanism of action of antipsychotics beyond dopamine blockade.
ABSTRACTBackground: Cognitive and psychiatric features are important components of dementia. Earl... more ABSTRACTBackground: Cognitive and psychiatric features are important components of dementia. Early onset dementia (EOD) has been found to be associated with a greater genetic basis. If this is the case, EOD could have genetic association with psychiatric illnesses, given the presence of more behavioral disturbances in this condition. There is a definite need to explore the presence of psychiatric symptoms and disorders in families of patients with dementia.Methods: The authors compared 52 proband families of dementia and 45 control families in order to assess the familial co-aggregation of major psychiatric illnesses. The cumulative risk in first degree relatives in the two groups for major psychiatric illnesses was calculated using Kaplan Meier Survival analysis. Early onset and late onset dementia proband families were compared separately with control families for the same.Results: There was a significantly higher morbid risk for psychosis in dementia proband families (generalized...
Many psychiatric patients undergoing vocational training do not achieve successful transition to ... more Many psychiatric patients undergoing vocational training do not achieve successful transition to regular work. In this study, we evaluated the barriers for discharge from day care center to actual work place. In a cross-sectional study at a government-run day-care center at National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, we studied 76 patients who were undergoing vocational training for more than 1 year. We did a semi-structured interview with patients, their family members, and instructors of various occupational sections. We used a questionnaire of 17 different barriers to assess the obstacles in their discharge from day-care center to actual work place. The majority of them had a diagnosis of mental retardation (n=47) followed by schizophrenia (n=29), and bipolar disorder (n=9). The mean (SD) age and duration of illness was 33.6 (9.7) years and 12.5 (9.3) years, respectively. Patients had more than one diagnosis. The median duration of stay in day-care center was 5.9 years. Doubts regarding performance at a new work place (n=60), fear of performance at new work place (n=65), and the fear of transition to regular work (n=64) were the most common barriers reported by patients, their family members and instructors of various occupational sections, respectively. Educating patients and their family members, gradual exposure to new working environment, and increased community level vocational opportunities may potentially overcome above barriers. Getting them to the actual job early in their course of treatment will improve their adjustment to a new work place and overall outcome.
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Papers by Sivakumar Thangaraju