The Journal of Neuropsychiatry and Clinical Neurosciences, Oct 15, 2014
Efficacy of repetitive, transcranial magnetic stimulation (rTMS) has been found in depression; ho... more Efficacy of repetitive, transcranial magnetic stimulation (rTMS) has been found in depression; however, doubt still remains about its effectiveness in clinical practice. In this context, results are being explored. The authors, describing new techniques to improve response rates to rTMS treatment, compared the efficacy of adjuvant, frequency-modulated, active-priming rTMS with sham-priming stimulation in the theta range in patients with moderate-to-severe depression receiving low-frequency rTMS. Forty patients with moderate-to-severe depression (ICD-10 DCR) were alternately assigned to receive add-on, active-priming rTMS (4-8 Hz; 400 pulses, at 90% of motor threshold [MT]) or sham-priming stimulation followed by low-frequency rTMS (1-Hz; 900 pulses at 110% of MT) over the right dorsolateral prefrontal cortex. They were rated with the Structured Interview Guide for the Hamilton Depression Rating Scale (SIGH-D), the Brief Psychiatric Rating Scale (BPRS), and the Clinical Global Impression-Severity of Illness (CGI-S) scale at baseline, after the 5th and 10th rTMS, and 2 weeks post-rTMS. For SIGH-D scores, there was significant improvement in the active group over time. Stepwise linear-regression analysis showed that age at onset significantly predicted SIGH-D scores after the 5th rTMS session in the active-priming group. Pre-stimulation with frequency-modulated priming stimulation in the theta range has greater antidepressant effect than low-frequency stimulation alone.
ABSTRACT Background Schizophrenia is a heterogenous disorder, and has often been subtyped on the ... more ABSTRACT Background Schizophrenia is a heterogenous disorder, and has often been subtyped on the basis of family history of psychotic disorders. Compared to those without, a positive family history is associated with an earlier age of onset, greater structural brain abnormalities and poorer clinical course. Given recent emphasis on mirror neuron system (MNS) in attempting to explain psychopathology in schizophrenia; present analysis tried to tease out differences in MNS functioning between these two groups. Method With ethical approval, ten consenting right-handed patients with schizophrenia (ICD-10-DCR; M=8; Drug-naïve=2) were recruited and divided into two groups of five each (M=4,F=1): those with (age 29.40±5.85 years, duration of illness 50.80±30.84 months) and without (age 29.60±5.77 years, duration of illness 43.20±43.76 months) family history of schizophrenic illness (group difference p>0.05). MNS activity was assessed using event-related desynchronization of EEG Mu waves in response to biological motion on 192-channel EEG Neurofax EEG-1100K. Results On comparison, while patients had significantly lower mu suppression compared to controls (p<0.001); two schizophrenia groups did not differ between themselves, neither on MNS activity nor on psychopathology (p>0.05). Conclusion Present study replicates finding of a dysfunctional MNS in schizophrenia patients, and represents a preliminary attempt at comparing two groups of symptomatic schizophrenia patients. In both these groups, MNS dysfunctions were comparable, and commensurate with respect to psychopathology. Thus, MNS dysfunction in schizophrenia might either be inherited or acquired. However, this abnormality forms a common base, and ultimate vulnerability marker, for development of psychopathology during active disease states.
As cerebellum and its abnormalities have been implicated in the pathophysiology of schizophrenia,... more As cerebellum and its abnormalities have been implicated in the pathophysiology of schizophrenia, repetitive transcranial magnetic stimulation (rTMS) of this alternate site has been suggested as a novel target for treating patients with this disorder. As resting state gamma activity measures functional brain connectivity, it could be used as a specific treatment marker. To investigate the effect of cerebellar-rTMS on resting state gamma activity, while studying its efficacy in recent onset schizophrenia patients. This rater-blinded prospective study was completed by 11 schizophrenia patients. They received 10 sessions of high-frequency (theta patterned) rTMS to midline cerebellum over 2 weeks. Resting state EEG was recorded using high (192-channel) resolution EEG at baseline and post rTMS. Gamma spectral power was calculated using fast Fourier transformation, Hanning window averaged over 8 scalp segments corresponding 8 lobes. Clinical improvement rated on the Positive and Negative Syndrome Scale and depressive symptoms assessed using the Calgary Depression Scale for Schizophrenia were other outcome variables. Nonparametric statistics were used. Over the treatment course, significant reduction was seen on negative syndrome and depression scores. Gamma spectral power in left frontal and temporal segments reduced significantly. Spearman correlation analysis showed that percentage reduction in psychopathology scores had significant positive correlation with percentage reduction in gamma spectral power. Cerebellar-rTMS might be an effective adjunct to treat intricate and lingering negative and affective symptoms. Resting state gamma spectral power in frontal and temporal regions might be used as a biomarker for treatment response.
Tourette syndrome and bipolar disorder are frequent comorbidities in pediatric age group. They pr... more Tourette syndrome and bipolar disorder are frequent comorbidities in pediatric age group. They provide a clinician with certain unique challenges. While on one hand the tics mask manifestation of affective symptomatology, the latter makes it difficult to elicit tics with certainty. Data suggest that they might share genetic and neurobiological basis and this is currently an area of extensive research. These clinical and biological overlaps provide grey areas in our understanding, which not only complicates the diagnosis, but also poses problems with management.
An abnormal activity in the EEG gamma band (>30 Hz) has been demonstrated in schiz... more An abnormal activity in the EEG gamma band (>30 Hz) has been demonstrated in schizophrenia and this has been suggested to be reflecting a deficit in the development and maturation of the basic cognitive functions of attention, working memory and sensory processing. Hypothesizing gamma oscillatory activity as a potential EEG biomarker to antipsychotic response in schizophrenia, the present study aimed at measuring baseline spontaneous gamma activity in schizophrenia patients, and evaluating its response to antipsychotic treatment over 8 weeks. Fifteen drug free/naïve patients were recruited, compared at baseline with 15 age-sex-education matched healthy controls, and were followed up for eight weeks treatment on antipsychotics. Resting state EEG waves were recorded using high (192-channel) resolution EEG at admission, four weeks and eight weeks. Spectral power was calculated using Fast Fourier Transformation, hanning window. The power was averaged region-wise over nine regions in 3 frequency ranges (30-50 Hz, 50-70 Hz, 70-100 Hz). Patients and controls differed significantly at intake in terms of left temporal and parietal high (70-100Hz) gamma power. Consequently, no significant differences were seen over the course of antipsychotic treatment on gamma spectral power in any of the regions. Lack of significant effect of treatment on gamma power suggests that these gamma oscillations are trait markers in schizophrenia.
In schizophrenia, novel target sites for repetitive transcranial magnetic stimulation (rTMS), suc... more In schizophrenia, novel target sites for repetitive transcranial magnetic stimulation (rTMS), such as the cerebellum, are proposed to have a putative therapeutic role in treatment-resistant cases. We present a case of treatment-resistant schizophrenia that showed worsening of auditory verbal hallucinations after receiving high-frequency cerebellar vermal rTMS. We propose that cerebellar vermal rTMS modulates neuronal networks, causing activation in temporoparietal areas, which results in worsening of auditory verbal hallucinations.
In the remitted phase of bipolar I disorder, sexual dysfunction is commonly due to drugs used in ... more In the remitted phase of bipolar I disorder, sexual dysfunction is commonly due to drugs used in the treatment rather than the disease itself. There are very few studies, especially in the Indian population, addressing the frequency of sexual dysfunction due to antipsychotics in bipolar I disorder. Hence this study was done to determine the sexual dysfunction due to antipsychotics and to compare the same among typical and atypical antipsychotics. A cross sectional study with 108 male patients of remitted bipolar I disorder (DSM-IV), chosen by purposive sampling technique was done. Psychopathology was assessed using the Brief Psychiatric Rating Scale, Structured Interview Guide for the Hamilton Depression Rating Scale and Young Mania Rating Scale. Sexual side effects due to antipsychotics were assessed using the Udvalg for Kliniske ndersogelser (UKU) side effect rating scale. The total sample size was divided into two groups of those on typical antipsychotics (n = 53) and atypical an...
The Journal of neuropsychiatry and clinical neurosciences, 2007
The potential effect of repetitive transcranial magnetic stimulation (rTMS) on core positive and ... more The potential effect of repetitive transcranial magnetic stimulation (rTMS) on core positive and negative symptoms in schizophrenia has not yet been clearly established. The aim of this study was to examine the efficacy of adjuvant 10 Hz, suprathreshold left prefrontal rTMS in negative symptoms of schizophrenia in a double-blind sham-controlled design. Additionally, our study also investigated the suitability of applying the same stimulus condition on positive symptoms. Ten right-handed schizophrenia patients received sham or active 10 Hz suprathreshold rTMS to the left dorsolateral prefrontal cortex with psychopathology, depression and global improvement ratings before and after rTMS sessions. Compared to sham, active rTMS significantly improved negative symptoms, irrespective of change in depressive symptoms.
The objective was to investigate the effect of clozapine on spontaneous gamma activity in treatme... more The objective was to investigate the effect of clozapine on spontaneous gamma activity in treatment-resistant bipolar psychotic mania. Patients with treatment-resistant (TR) bipolar psychotic mania on clozapine monotherapy and nontreatment-resistant bipolar psychotic mania patients receiving lithium were prospectively studied for 6 weeks on severity of psychopathology and 30-49 Hz gamma spectral power. Spectral power significantly increased in the lithium group and decreased in the clozapine group; no within group significant difference found. We propose a model highlighting the role of gamma spectral power and modulations of GABAergic neurotransmission in TR bipolar psychotic mania.
Mirror neuron system (MNS) has been demonstrated to be defective in patients with schizophrenia. ... more Mirror neuron system (MNS) has been demonstrated to be defective in patients with schizophrenia. This paper report findings from a high resolution (192-channel) EEG study conducted on 15 drug free/naïve consenting schizophrenia patients, in which the specific role of right hemispheric MNS has been explored over 4 weeks of antipsychotic treatment. The authors used mu wave suppression paradigm, and found that baseline right MNS mu suppression correlated negatively with and predicted relative improvement in thought disturbance cluster score of PANSS during first 4 weeks of drug treatment.
Children and adolescents with volatile solvent/inhalant dependence have neurocognitive deficits. ... more Children and adolescents with volatile solvent/inhalant dependence have neurocognitive deficits. The study aimed to explore resting state gamma activity, which is a marker of cognitive function, in children and adolescents with inhalant dependence. The study also investigated differences in gamma activity across groups differing in inhaled amounts. Clinical and electroencephalographic (EEG) data were collected from nine patients with inhalant dependence. 30-50 Hz spectral power was calculated using Welch's averaged periodogram method. The data were analyzed using descriptive statistics, bi-variate correlation, and nonparametric Mann-Whitney U-test. While significant positive correlation was found between duration of dependence and gamma spectral power in left frontal region, no significant differences were found on comparison of the groups on gamma spectral power. A complex neurobiological interaction is involved in the synaptic modulation brought about by inhalant use and this could be understood by studying changes in EEG parameters especially gamma activity.
The 'mirror-neuron system' is thought to play an important role i... more The 'mirror-neuron system' is thought to play an important role in automatic decoding of biological motions and interpretation of socially adaptive environmental stimuli. Accordingly, a dysfunction in this system in schizophrenia has been hypothesised to mediate the psychotic manifestations. As a part of an ongoing study, we evaluated the mirror neuron system using 'EEG mu-wave (8-13 Hz) suppression' paradigm in 15 drug naïve/drug free patients and compared the working to 15 age, sex and education matched controls. We also correlated the psychopathology scores on PANSS with the mu wave suppression in the schizophrenia patients, at baseline. We used high (192-channel) resolution EEG to record the mu rhythm while the subjects watched alternating sequences of a socially-relevant biological motion and white visual-noise on a custom made video-clip. We found a significant difference in the degree of mu wave suppression between the two groups. We also found that the degree of mu suppression over right sensorimotor cortex at presentation correlated significantly and negatively with thought disorder in the patient group, and had a strong linear relationship. This study replicates past findings regarding a dysfunctional mirror neuron system in schizophrenia patients, and also emphasizes the role of rMNS in schizophrenic thought disorders.
International Journal of Developmental Neuroscience, 2015
Minor physical anomalies (MPAs) and gamma oscillatory activity have been proposed as associated e... more Minor physical anomalies (MPAs) and gamma oscillatory activity have been proposed as associated endophenotypes in schizophrenia. Combining these endophenotypes to create a composite endophenotype may help identify those at risk for schizophrenia better. The present study aims to investigate MPAs and gamma oscillatory activity in schizophrenia patients, their unaffected first degree relatives and healthy controls and appreciate whether they can be used together as a composite endophenotype. This was a cross sectional family study conducted at a tertiary care mental health setup. Ninety participants including schizophrenia patients, their first degree relatives and controls (thirty each) were assessed for MPAs on the Extended Waldrop Scale. All participants underwent an awake, resting 192-channel EEG recording. Spectral power and coherence in 30-100Hz gamma bands were estimated using Welch's averaged periodogram method. One-way ANOVA, chi square test were used for comparing socio-demographic-clinical variables. MANOVA supplemented by one-way ANOVAs (post hoc Tukey HSD) were done for comparison of spectral measures. Pearson's correlation, step-by-step linear discriminant functional and intra-familial correlation analysis were subsequently performed. An endophenotype pattern of finding was found for MPAs in the craniofacial region, the total number of MPAs, spectral power in right temporal region on all bands and in the right parietal region in 50-70Hz and 70-100Hz gamma bands. The three groups were most accurately classified when MPA total score, right temporal 30-50Hz gamma power and right occipital 'intra hemispheric' 50-70Hz gamma coherence were considered together than when considered independently. Significant intra familial correlation was seen for MPA total score and right temporal gamma 30-50Hz power. Composite evaluation of two developmentally linked markers i.e. MPAs and gamma spectral measures may prove useful in categorizing schizophrenia and identifying at-risk individuals.
The Journal of Neuropsychiatry and Clinical Neurosciences, Oct 15, 2014
Efficacy of repetitive, transcranial magnetic stimulation (rTMS) has been found in depression; ho... more Efficacy of repetitive, transcranial magnetic stimulation (rTMS) has been found in depression; however, doubt still remains about its effectiveness in clinical practice. In this context, results are being explored. The authors, describing new techniques to improve response rates to rTMS treatment, compared the efficacy of adjuvant, frequency-modulated, active-priming rTMS with sham-priming stimulation in the theta range in patients with moderate-to-severe depression receiving low-frequency rTMS. Forty patients with moderate-to-severe depression (ICD-10 DCR) were alternately assigned to receive add-on, active-priming rTMS (4-8 Hz; 400 pulses, at 90% of motor threshold [MT]) or sham-priming stimulation followed by low-frequency rTMS (1-Hz; 900 pulses at 110% of MT) over the right dorsolateral prefrontal cortex. They were rated with the Structured Interview Guide for the Hamilton Depression Rating Scale (SIGH-D), the Brief Psychiatric Rating Scale (BPRS), and the Clinical Global Impression-Severity of Illness (CGI-S) scale at baseline, after the 5th and 10th rTMS, and 2 weeks post-rTMS. For SIGH-D scores, there was significant improvement in the active group over time. Stepwise linear-regression analysis showed that age at onset significantly predicted SIGH-D scores after the 5th rTMS session in the active-priming group. Pre-stimulation with frequency-modulated priming stimulation in the theta range has greater antidepressant effect than low-frequency stimulation alone.
ABSTRACT Background Schizophrenia is a heterogenous disorder, and has often been subtyped on the ... more ABSTRACT Background Schizophrenia is a heterogenous disorder, and has often been subtyped on the basis of family history of psychotic disorders. Compared to those without, a positive family history is associated with an earlier age of onset, greater structural brain abnormalities and poorer clinical course. Given recent emphasis on mirror neuron system (MNS) in attempting to explain psychopathology in schizophrenia; present analysis tried to tease out differences in MNS functioning between these two groups. Method With ethical approval, ten consenting right-handed patients with schizophrenia (ICD-10-DCR; M=8; Drug-naïve=2) were recruited and divided into two groups of five each (M=4,F=1): those with (age 29.40±5.85 years, duration of illness 50.80±30.84 months) and without (age 29.60±5.77 years, duration of illness 43.20±43.76 months) family history of schizophrenic illness (group difference p>0.05). MNS activity was assessed using event-related desynchronization of EEG Mu waves in response to biological motion on 192-channel EEG Neurofax EEG-1100K. Results On comparison, while patients had significantly lower mu suppression compared to controls (p<0.001); two schizophrenia groups did not differ between themselves, neither on MNS activity nor on psychopathology (p>0.05). Conclusion Present study replicates finding of a dysfunctional MNS in schizophrenia patients, and represents a preliminary attempt at comparing two groups of symptomatic schizophrenia patients. In both these groups, MNS dysfunctions were comparable, and commensurate with respect to psychopathology. Thus, MNS dysfunction in schizophrenia might either be inherited or acquired. However, this abnormality forms a common base, and ultimate vulnerability marker, for development of psychopathology during active disease states.
As cerebellum and its abnormalities have been implicated in the pathophysiology of schizophrenia,... more As cerebellum and its abnormalities have been implicated in the pathophysiology of schizophrenia, repetitive transcranial magnetic stimulation (rTMS) of this alternate site has been suggested as a novel target for treating patients with this disorder. As resting state gamma activity measures functional brain connectivity, it could be used as a specific treatment marker. To investigate the effect of cerebellar-rTMS on resting state gamma activity, while studying its efficacy in recent onset schizophrenia patients. This rater-blinded prospective study was completed by 11 schizophrenia patients. They received 10 sessions of high-frequency (theta patterned) rTMS to midline cerebellum over 2 weeks. Resting state EEG was recorded using high (192-channel) resolution EEG at baseline and post rTMS. Gamma spectral power was calculated using fast Fourier transformation, Hanning window averaged over 8 scalp segments corresponding 8 lobes. Clinical improvement rated on the Positive and Negative Syndrome Scale and depressive symptoms assessed using the Calgary Depression Scale for Schizophrenia were other outcome variables. Nonparametric statistics were used. Over the treatment course, significant reduction was seen on negative syndrome and depression scores. Gamma spectral power in left frontal and temporal segments reduced significantly. Spearman correlation analysis showed that percentage reduction in psychopathology scores had significant positive correlation with percentage reduction in gamma spectral power. Cerebellar-rTMS might be an effective adjunct to treat intricate and lingering negative and affective symptoms. Resting state gamma spectral power in frontal and temporal regions might be used as a biomarker for treatment response.
Tourette syndrome and bipolar disorder are frequent comorbidities in pediatric age group. They pr... more Tourette syndrome and bipolar disorder are frequent comorbidities in pediatric age group. They provide a clinician with certain unique challenges. While on one hand the tics mask manifestation of affective symptomatology, the latter makes it difficult to elicit tics with certainty. Data suggest that they might share genetic and neurobiological basis and this is currently an area of extensive research. These clinical and biological overlaps provide grey areas in our understanding, which not only complicates the diagnosis, but also poses problems with management.
An abnormal activity in the EEG gamma band (>30 Hz) has been demonstrated in schiz... more An abnormal activity in the EEG gamma band (>30 Hz) has been demonstrated in schizophrenia and this has been suggested to be reflecting a deficit in the development and maturation of the basic cognitive functions of attention, working memory and sensory processing. Hypothesizing gamma oscillatory activity as a potential EEG biomarker to antipsychotic response in schizophrenia, the present study aimed at measuring baseline spontaneous gamma activity in schizophrenia patients, and evaluating its response to antipsychotic treatment over 8 weeks. Fifteen drug free/naïve patients were recruited, compared at baseline with 15 age-sex-education matched healthy controls, and were followed up for eight weeks treatment on antipsychotics. Resting state EEG waves were recorded using high (192-channel) resolution EEG at admission, four weeks and eight weeks. Spectral power was calculated using Fast Fourier Transformation, hanning window. The power was averaged region-wise over nine regions in 3 frequency ranges (30-50 Hz, 50-70 Hz, 70-100 Hz). Patients and controls differed significantly at intake in terms of left temporal and parietal high (70-100Hz) gamma power. Consequently, no significant differences were seen over the course of antipsychotic treatment on gamma spectral power in any of the regions. Lack of significant effect of treatment on gamma power suggests that these gamma oscillations are trait markers in schizophrenia.
In schizophrenia, novel target sites for repetitive transcranial magnetic stimulation (rTMS), suc... more In schizophrenia, novel target sites for repetitive transcranial magnetic stimulation (rTMS), such as the cerebellum, are proposed to have a putative therapeutic role in treatment-resistant cases. We present a case of treatment-resistant schizophrenia that showed worsening of auditory verbal hallucinations after receiving high-frequency cerebellar vermal rTMS. We propose that cerebellar vermal rTMS modulates neuronal networks, causing activation in temporoparietal areas, which results in worsening of auditory verbal hallucinations.
In the remitted phase of bipolar I disorder, sexual dysfunction is commonly due to drugs used in ... more In the remitted phase of bipolar I disorder, sexual dysfunction is commonly due to drugs used in the treatment rather than the disease itself. There are very few studies, especially in the Indian population, addressing the frequency of sexual dysfunction due to antipsychotics in bipolar I disorder. Hence this study was done to determine the sexual dysfunction due to antipsychotics and to compare the same among typical and atypical antipsychotics. A cross sectional study with 108 male patients of remitted bipolar I disorder (DSM-IV), chosen by purposive sampling technique was done. Psychopathology was assessed using the Brief Psychiatric Rating Scale, Structured Interview Guide for the Hamilton Depression Rating Scale and Young Mania Rating Scale. Sexual side effects due to antipsychotics were assessed using the Udvalg for Kliniske ndersogelser (UKU) side effect rating scale. The total sample size was divided into two groups of those on typical antipsychotics (n = 53) and atypical an...
The Journal of neuropsychiatry and clinical neurosciences, 2007
The potential effect of repetitive transcranial magnetic stimulation (rTMS) on core positive and ... more The potential effect of repetitive transcranial magnetic stimulation (rTMS) on core positive and negative symptoms in schizophrenia has not yet been clearly established. The aim of this study was to examine the efficacy of adjuvant 10 Hz, suprathreshold left prefrontal rTMS in negative symptoms of schizophrenia in a double-blind sham-controlled design. Additionally, our study also investigated the suitability of applying the same stimulus condition on positive symptoms. Ten right-handed schizophrenia patients received sham or active 10 Hz suprathreshold rTMS to the left dorsolateral prefrontal cortex with psychopathology, depression and global improvement ratings before and after rTMS sessions. Compared to sham, active rTMS significantly improved negative symptoms, irrespective of change in depressive symptoms.
The objective was to investigate the effect of clozapine on spontaneous gamma activity in treatme... more The objective was to investigate the effect of clozapine on spontaneous gamma activity in treatment-resistant bipolar psychotic mania. Patients with treatment-resistant (TR) bipolar psychotic mania on clozapine monotherapy and nontreatment-resistant bipolar psychotic mania patients receiving lithium were prospectively studied for 6 weeks on severity of psychopathology and 30-49 Hz gamma spectral power. Spectral power significantly increased in the lithium group and decreased in the clozapine group; no within group significant difference found. We propose a model highlighting the role of gamma spectral power and modulations of GABAergic neurotransmission in TR bipolar psychotic mania.
Mirror neuron system (MNS) has been demonstrated to be defective in patients with schizophrenia. ... more Mirror neuron system (MNS) has been demonstrated to be defective in patients with schizophrenia. This paper report findings from a high resolution (192-channel) EEG study conducted on 15 drug free/naïve consenting schizophrenia patients, in which the specific role of right hemispheric MNS has been explored over 4 weeks of antipsychotic treatment. The authors used mu wave suppression paradigm, and found that baseline right MNS mu suppression correlated negatively with and predicted relative improvement in thought disturbance cluster score of PANSS during first 4 weeks of drug treatment.
Children and adolescents with volatile solvent/inhalant dependence have neurocognitive deficits. ... more Children and adolescents with volatile solvent/inhalant dependence have neurocognitive deficits. The study aimed to explore resting state gamma activity, which is a marker of cognitive function, in children and adolescents with inhalant dependence. The study also investigated differences in gamma activity across groups differing in inhaled amounts. Clinical and electroencephalographic (EEG) data were collected from nine patients with inhalant dependence. 30-50 Hz spectral power was calculated using Welch's averaged periodogram method. The data were analyzed using descriptive statistics, bi-variate correlation, and nonparametric Mann-Whitney U-test. While significant positive correlation was found between duration of dependence and gamma spectral power in left frontal region, no significant differences were found on comparison of the groups on gamma spectral power. A complex neurobiological interaction is involved in the synaptic modulation brought about by inhalant use and this could be understood by studying changes in EEG parameters especially gamma activity.
The 'mirror-neuron system' is thought to play an important role i... more The 'mirror-neuron system' is thought to play an important role in automatic decoding of biological motions and interpretation of socially adaptive environmental stimuli. Accordingly, a dysfunction in this system in schizophrenia has been hypothesised to mediate the psychotic manifestations. As a part of an ongoing study, we evaluated the mirror neuron system using 'EEG mu-wave (8-13 Hz) suppression' paradigm in 15 drug naïve/drug free patients and compared the working to 15 age, sex and education matched controls. We also correlated the psychopathology scores on PANSS with the mu wave suppression in the schizophrenia patients, at baseline. We used high (192-channel) resolution EEG to record the mu rhythm while the subjects watched alternating sequences of a socially-relevant biological motion and white visual-noise on a custom made video-clip. We found a significant difference in the degree of mu wave suppression between the two groups. We also found that the degree of mu suppression over right sensorimotor cortex at presentation correlated significantly and negatively with thought disorder in the patient group, and had a strong linear relationship. This study replicates past findings regarding a dysfunctional mirror neuron system in schizophrenia patients, and also emphasizes the role of rMNS in schizophrenic thought disorders.
International Journal of Developmental Neuroscience, 2015
Minor physical anomalies (MPAs) and gamma oscillatory activity have been proposed as associated e... more Minor physical anomalies (MPAs) and gamma oscillatory activity have been proposed as associated endophenotypes in schizophrenia. Combining these endophenotypes to create a composite endophenotype may help identify those at risk for schizophrenia better. The present study aims to investigate MPAs and gamma oscillatory activity in schizophrenia patients, their unaffected first degree relatives and healthy controls and appreciate whether they can be used together as a composite endophenotype. This was a cross sectional family study conducted at a tertiary care mental health setup. Ninety participants including schizophrenia patients, their first degree relatives and controls (thirty each) were assessed for MPAs on the Extended Waldrop Scale. All participants underwent an awake, resting 192-channel EEG recording. Spectral power and coherence in 30-100Hz gamma bands were estimated using Welch's averaged periodogram method. One-way ANOVA, chi square test were used for comparing socio-demographic-clinical variables. MANOVA supplemented by one-way ANOVAs (post hoc Tukey HSD) were done for comparison of spectral measures. Pearson's correlation, step-by-step linear discriminant functional and intra-familial correlation analysis were subsequently performed. An endophenotype pattern of finding was found for MPAs in the craniofacial region, the total number of MPAs, spectral power in right temporal region on all bands and in the right parietal region in 50-70Hz and 70-100Hz gamma bands. The three groups were most accurately classified when MPA total score, right temporal 30-50Hz gamma power and right occipital 'intra hemispheric' 50-70Hz gamma coherence were considered together than when considered independently. Significant intra familial correlation was seen for MPA total score and right temporal gamma 30-50Hz power. Composite evaluation of two developmentally linked markers i.e. MPAs and gamma spectral measures may prove useful in categorizing schizophrenia and identifying at-risk individuals.
Over two thirds of people suffering from depression complain of pain with or without reporting ps... more Over two thirds of people suffering from depression complain of pain with or without reporting psychological symptoms. Physical symptoms are more prevalent among the women, the elderly, the poor, and in children population. Successful treatment of depression in children complicated by pain symptoms constitutes a great clinical challenge. Duloxetine has already emerged as a safe and effective treatment option for adult depressed patients with painful physical symptoms. However, no data exist in literature which suggests use of duloxetine in childhood and adolescent population for the same clinical indication. We report a case documenting successful use of duloxetine in a depressed girl child who also had severe pain and dissociative symptoms.
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