The estimated prevalence of alcohol misuse among Indian women is less than 5%. Misuse has been as... more The estimated prevalence of alcohol misuse among Indian women is less than 5%. Misuse has been associated with the upper socio-economic classes, primitive tribal cultures and certain rural traditions. The problem of substance misuse in India has been underdiagnosed and underreported, but various health agencies and media reports suggest it is increasing.
In a side-by-side comparison, we found that the voices of patients who met the criteria for schiz... more In a side-by-side comparison, we found that the voices of patients who met the criteria for schizophrenia in Chennai, Tamil Nadu, India and in San Mateo, CA, United States were different. Both groups heard commands. In San Mateo, those commands were often violent, but in Chennai, commands often seemed more to do with everyday activities. Both groups heard voices that spoke about sexual activities. In Chennai, participants reported more voices that talked about sex, and they often experienced intense shame and guilt around these sexual voices. In San Mateo, sexual voices seemed to have less shaming content and were more often described with enjoyment. In San Mateo, voices were also more violent in general. We suggest that the content of voices may reflect local cultural ideas about voices and local cultural responses to specific features of the voice-hearing experience.
This review chronicles the origin of telepsychiatry services started by the Schizophrenia Researc... more This review chronicles the origin of telepsychiatry services started by the Schizophrenia Research Foundation (SCARF) in the community and traces the birth of the Scarf Telepsychiatry in Pudukkottai (STEP) program at Pudukkottai in Tamil Nadu. This paper also examines the trajectory of STEP and highlights other relevant models existing in the country in the last decade.
Studies involving astrology and psychiatry have mostly found confl icting results, with astrology... more Studies involving astrology and psychiatry have mostly found confl icting results, with astrology being criticized as unscientifi c and also lacking an objective assessment method for being scientifi cally tested. We tested the predictive ability of astrology using the Indian system in identifying mental illness on 150 subjects (75 having mental illness and 75 without).Four astrologers blind to the subjects interpreted the computer-generated birth chart data derived from subject’s gender, and date, time, and place of birth. Predictions were matched with the clinical details at fi rst assessment.Kappa coeffi cients suggested a moderate agreement in the astrological prediction of lifetime mental illness (k = 0.560, p = .001) and a substantial agreement in predicting current state of mental illness (k = 0.626, p = .001),but with good inter- strologer agreement only for lifetime mental illness.Viewed as a diagnostic test, astrology showed a good sensitivity and specifi city for identifying mental illness of more than 75% for lifetime mental illness and more than 80% for the current mental illness. However, the study showed a poor match in predicting the symptom cluster and time of onset of symptoms. Overall, the evidence seemed to point toward Indian astrology (Vārāhamihira system) as practiced in the study modestly predicting the presence of mental illness. Caveats included diff erences in diagnostic concepts in the allopathic and astrological systems and the lack of a predefi ned level of astrological analysis which resulted in a poor match for symptom cluster and timing of illness. The fi ndings in this study hence are at best tentative and need more extensive enquiry.
Abnormal metabolism of dopamine and glutamate in schizophrenia induces oxidative stress that is e... more Abnormal metabolism of dopamine and glutamate in schizophrenia induces oxidative stress that is exacerbated by brain glutathione (GSH) deficiency. N-acetyl cysteine (NAC) increases brain GSH levels and is being used as an adjunctive agent in patients with schizophrenia. This open-label exploratory study in a naturalistic setting was conceived to examine the efficacy of NAC augmentation in treating negative syndrome in schizophrenia. To examine the efficacy of add-on NAC (1200 mg) in treating negative symptoms measured using Scale for the Assessment of Negative Symptoms (SANS) and clinical global impression (CGI) at baseline and 24 weeks. In a 24-week feasibility study with open-label design, thirty patients with the International Classification of Diseases-Tenth Edition diagnosis of schizophrenia were recruited. Eligible patients were required to have been treated with stable dose of clozapine or amisulpride for negative symptoms for a minimum period of 8 weeks were selected for the...
Background: Abnormal metabolism of dopamine and glutamate in schizophrenia induces oxidative stre... more Background: Abnormal metabolism of dopamine and glutamate in schizophrenia induces oxidative stress that is exacerbated by brain glutathione (GSH) deficiency. N-acetyl cysteine (NAC) increases brain GSH levels and is being used as an adjunctive agent in patients with schizophrenia. This open-label exploratory study in a naturalistic setting was conceived to examine the efficacy of NAC augmentation in treating negative syndrome in schizophrenia. Aims: To examine the efficacy of add-on NAC (1200 mg) in treating negative symptoms measured using Scale for the Assessment of Negative Symptoms (SANS) and clinical global impression (CGI) at baseline and 24 weeks. Subjects and Methods: In a 24-week feasibility study with open-label design, thirty patients with the International Classification of Diseases-Tenth Edition diagnosis of schizophrenia were recruited. Eligible patients were required to have been treated with stable dose of clozapine or amisulpride for negative symptoms for a minimum period of 8 weeks were selected for the study. The subjects were assigned to receive NAC (1.2 g/day) as an add-on treatment. Severity of negative symptoms was measured using SANS and CGI-severity at baseline and improvement with NAC measured using CGI-improvement at 24 weeks. Serum interleukin-6 was assessed before NAC initiation at baseline. Results: NAC augmentation showed a significantly greater improvement in negative symptoms on total SANS and CGI scores at 24 weeks. Conclusions: NAC may be effective as an adjunct for the treatment of negative symptoms in schizophrenia.
This study compares 20 subjects, in each of three different settings, with serious psychotic diso... more This study compares 20 subjects, in each of three different settings, with serious psychotic disorder (they meet inclusion criteria for schizophrenia) who hear voices, and compares their voice-hearing experience. We find that while there is much that is similar, there are notable differences in the kinds of voices that people seem to experience. In a California sample, people were more likely to describe their voices as intrusive unreal thoughts; in the South Indian sample, they were more likely to describe them as providing useful guidance; and in our West African sample, they were more likely to describe them as morally good and causally powerful. What we think we may be observing is that people who fall ill with serious psychotic disorder pay selective attention to a constant stream of many different auditory and quasi-auditory events because of different "cultural invitations"-variations in ways of thinking about minds, persons, spirits and so forth. Such a process is consistent with processes described in the cognitive psychology and psychiatric anthropology literature, but not yet described or understood with respect to cultural variations in auditory hallucinations. We call this process "social kindling."
Raloxifene augmentation in postmenopausal women with schizophrenia has shown promising results. Y... more Raloxifene augmentation in postmenopausal women with schizophrenia has shown promising results. Younger patients diagnosed as treatment-resistant schizophrenia and treated with raloxifene (120 mg/day) have reported significant improvement in symptoms. This case highlights how raloxifene, a selective estrogen receptor modulator (SERM), can play a major role in alleviating positive and negative symptoms in postmenopausal women with treatment-resistant schizophrenia.
A 46-year old lady presenting with drinking excessive quantities of milk is highlighted. The disc... more A 46-year old lady presenting with drinking excessive quantities of milk is highlighted. The discussion focuses on whether this behavior is pathological (German J Psychiatry 2006;9:120-122).
Background Alcohol Dependence exists in different spectrums at different settings and associated ... more Background Alcohol Dependence exists in different spectrums at different settings and associated with various medical morbidities, disability and health care utilization costs. Objectives To study the drinking patterns, alcohol use disorders and alcohol related medical morbidities in patients diagnosed with Alcohol Dependence Syndrome (ADS) and attending out / in-patient psychiatry services at secondary and tertiary care centre. Methods A cross-sectional comparative study was done among the patients diagnosed with ADS attending psychiatry services at District hospital, Udupi and Kasturba Hospital, Manipal. Serial sampling was done. Patients having any other psychiatric illnesses were excluded. The two groups were compared in relation to socio-demographic variables, drinking related variables, patterns of drinking and alcohol related medical morbidities identified. Results Significant differences in some socio-demographic parameters among the patients from the two different treatment...
ABSTRACT Background: Schizophrenia is considered to be a Neurodevelopmental disorder with its pat... more ABSTRACT Background: Schizophrenia is considered to be a Neurodevelopmental disorder with its pathogenesis going back to gestation and early childhood. New mutations secondary to advanced paternal age may operate to increase the risk of this disorder by adversely affecting the brain development. Objectives: To study the association between the paternal age at conception and development of Schizophrenia among the patients attending the psychiatry services in a tertiary care hospital. Materials and methods: Retrospective file review of the patients diagnosed with Schizophrenia was carried out and compared with equal number of patients with non-psychotic illness (excluding organic mental illness & substance abuse) in relation to the maternal and paternal age and duration of marriage of the parents at delivery. Results: Logistic regression analysis among the patients with Schizophrenia and Non-schizophrenic illness in relation to paternal age above 40 years , maternal age above 40 years...
The estimated prevalence of alcohol misuse among Indian women is less than 5%. Misuse has been as... more The estimated prevalence of alcohol misuse among Indian women is less than 5%. Misuse has been associated with the upper socio-economic classes, primitive tribal cultures and certain rural traditions. The problem of substance misuse in India has been underdiagnosed and underreported, but various health agencies and media reports suggest it is increasing.
In a side-by-side comparison, we found that the voices of patients who met the criteria for schiz... more In a side-by-side comparison, we found that the voices of patients who met the criteria for schizophrenia in Chennai, Tamil Nadu, India and in San Mateo, CA, United States were different. Both groups heard commands. In San Mateo, those commands were often violent, but in Chennai, commands often seemed more to do with everyday activities. Both groups heard voices that spoke about sexual activities. In Chennai, participants reported more voices that talked about sex, and they often experienced intense shame and guilt around these sexual voices. In San Mateo, sexual voices seemed to have less shaming content and were more often described with enjoyment. In San Mateo, voices were also more violent in general. We suggest that the content of voices may reflect local cultural ideas about voices and local cultural responses to specific features of the voice-hearing experience.
This review chronicles the origin of telepsychiatry services started by the Schizophrenia Researc... more This review chronicles the origin of telepsychiatry services started by the Schizophrenia Research Foundation (SCARF) in the community and traces the birth of the Scarf Telepsychiatry in Pudukkottai (STEP) program at Pudukkottai in Tamil Nadu. This paper also examines the trajectory of STEP and highlights other relevant models existing in the country in the last decade.
Studies involving astrology and psychiatry have mostly found confl icting results, with astrology... more Studies involving astrology and psychiatry have mostly found confl icting results, with astrology being criticized as unscientifi c and also lacking an objective assessment method for being scientifi cally tested. We tested the predictive ability of astrology using the Indian system in identifying mental illness on 150 subjects (75 having mental illness and 75 without).Four astrologers blind to the subjects interpreted the computer-generated birth chart data derived from subject’s gender, and date, time, and place of birth. Predictions were matched with the clinical details at fi rst assessment.Kappa coeffi cients suggested a moderate agreement in the astrological prediction of lifetime mental illness (k = 0.560, p = .001) and a substantial agreement in predicting current state of mental illness (k = 0.626, p = .001),but with good inter- strologer agreement only for lifetime mental illness.Viewed as a diagnostic test, astrology showed a good sensitivity and specifi city for identifying mental illness of more than 75% for lifetime mental illness and more than 80% for the current mental illness. However, the study showed a poor match in predicting the symptom cluster and time of onset of symptoms. Overall, the evidence seemed to point toward Indian astrology (Vārāhamihira system) as practiced in the study modestly predicting the presence of mental illness. Caveats included diff erences in diagnostic concepts in the allopathic and astrological systems and the lack of a predefi ned level of astrological analysis which resulted in a poor match for symptom cluster and timing of illness. The fi ndings in this study hence are at best tentative and need more extensive enquiry.
Abnormal metabolism of dopamine and glutamate in schizophrenia induces oxidative stress that is e... more Abnormal metabolism of dopamine and glutamate in schizophrenia induces oxidative stress that is exacerbated by brain glutathione (GSH) deficiency. N-acetyl cysteine (NAC) increases brain GSH levels and is being used as an adjunctive agent in patients with schizophrenia. This open-label exploratory study in a naturalistic setting was conceived to examine the efficacy of NAC augmentation in treating negative syndrome in schizophrenia. To examine the efficacy of add-on NAC (1200 mg) in treating negative symptoms measured using Scale for the Assessment of Negative Symptoms (SANS) and clinical global impression (CGI) at baseline and 24 weeks. In a 24-week feasibility study with open-label design, thirty patients with the International Classification of Diseases-Tenth Edition diagnosis of schizophrenia were recruited. Eligible patients were required to have been treated with stable dose of clozapine or amisulpride for negative symptoms for a minimum period of 8 weeks were selected for the...
Background: Abnormal metabolism of dopamine and glutamate in schizophrenia induces oxidative stre... more Background: Abnormal metabolism of dopamine and glutamate in schizophrenia induces oxidative stress that is exacerbated by brain glutathione (GSH) deficiency. N-acetyl cysteine (NAC) increases brain GSH levels and is being used as an adjunctive agent in patients with schizophrenia. This open-label exploratory study in a naturalistic setting was conceived to examine the efficacy of NAC augmentation in treating negative syndrome in schizophrenia. Aims: To examine the efficacy of add-on NAC (1200 mg) in treating negative symptoms measured using Scale for the Assessment of Negative Symptoms (SANS) and clinical global impression (CGI) at baseline and 24 weeks. Subjects and Methods: In a 24-week feasibility study with open-label design, thirty patients with the International Classification of Diseases-Tenth Edition diagnosis of schizophrenia were recruited. Eligible patients were required to have been treated with stable dose of clozapine or amisulpride for negative symptoms for a minimum period of 8 weeks were selected for the study. The subjects were assigned to receive NAC (1.2 g/day) as an add-on treatment. Severity of negative symptoms was measured using SANS and CGI-severity at baseline and improvement with NAC measured using CGI-improvement at 24 weeks. Serum interleukin-6 was assessed before NAC initiation at baseline. Results: NAC augmentation showed a significantly greater improvement in negative symptoms on total SANS and CGI scores at 24 weeks. Conclusions: NAC may be effective as an adjunct for the treatment of negative symptoms in schizophrenia.
This study compares 20 subjects, in each of three different settings, with serious psychotic diso... more This study compares 20 subjects, in each of three different settings, with serious psychotic disorder (they meet inclusion criteria for schizophrenia) who hear voices, and compares their voice-hearing experience. We find that while there is much that is similar, there are notable differences in the kinds of voices that people seem to experience. In a California sample, people were more likely to describe their voices as intrusive unreal thoughts; in the South Indian sample, they were more likely to describe them as providing useful guidance; and in our West African sample, they were more likely to describe them as morally good and causally powerful. What we think we may be observing is that people who fall ill with serious psychotic disorder pay selective attention to a constant stream of many different auditory and quasi-auditory events because of different "cultural invitations"-variations in ways of thinking about minds, persons, spirits and so forth. Such a process is consistent with processes described in the cognitive psychology and psychiatric anthropology literature, but not yet described or understood with respect to cultural variations in auditory hallucinations. We call this process "social kindling."
Raloxifene augmentation in postmenopausal women with schizophrenia has shown promising results. Y... more Raloxifene augmentation in postmenopausal women with schizophrenia has shown promising results. Younger patients diagnosed as treatment-resistant schizophrenia and treated with raloxifene (120 mg/day) have reported significant improvement in symptoms. This case highlights how raloxifene, a selective estrogen receptor modulator (SERM), can play a major role in alleviating positive and negative symptoms in postmenopausal women with treatment-resistant schizophrenia.
A 46-year old lady presenting with drinking excessive quantities of milk is highlighted. The disc... more A 46-year old lady presenting with drinking excessive quantities of milk is highlighted. The discussion focuses on whether this behavior is pathological (German J Psychiatry 2006;9:120-122).
Background Alcohol Dependence exists in different spectrums at different settings and associated ... more Background Alcohol Dependence exists in different spectrums at different settings and associated with various medical morbidities, disability and health care utilization costs. Objectives To study the drinking patterns, alcohol use disorders and alcohol related medical morbidities in patients diagnosed with Alcohol Dependence Syndrome (ADS) and attending out / in-patient psychiatry services at secondary and tertiary care centre. Methods A cross-sectional comparative study was done among the patients diagnosed with ADS attending psychiatry services at District hospital, Udupi and Kasturba Hospital, Manipal. Serial sampling was done. Patients having any other psychiatric illnesses were excluded. The two groups were compared in relation to socio-demographic variables, drinking related variables, patterns of drinking and alcohol related medical morbidities identified. Results Significant differences in some socio-demographic parameters among the patients from the two different treatment...
ABSTRACT Background: Schizophrenia is considered to be a Neurodevelopmental disorder with its pat... more ABSTRACT Background: Schizophrenia is considered to be a Neurodevelopmental disorder with its pathogenesis going back to gestation and early childhood. New mutations secondary to advanced paternal age may operate to increase the risk of this disorder by adversely affecting the brain development. Objectives: To study the association between the paternal age at conception and development of Schizophrenia among the patients attending the psychiatry services in a tertiary care hospital. Materials and methods: Retrospective file review of the patients diagnosed with Schizophrenia was carried out and compared with equal number of patients with non-psychotic illness (excluding organic mental illness & substance abuse) in relation to the maternal and paternal age and duration of marriage of the parents at delivery. Results: Logistic regression analysis among the patients with Schizophrenia and Non-schizophrenic illness in relation to paternal age above 40 years , maternal age above 40 years...
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