Biomedical subjects

D K Subbakrishna

Publications and source records attributed to D K Subbakrishna.

At least 37 records · Page 2Linked to original sources

PubMed2003

The index manic episode in juvenile-onset bipolar disorder: the pattern of recovery.

OBJECTIVE: Recent studies of patients with juvenile bipolar disorder report low rates of recovery and high rates of chronicity. However, we lack data on the short-term outcome. This study examines the pattern of recovery from the index episode in an aggressively treated juvenile sample. METHOD: We assessed 25 subjects (< 16 years) with a diagnosis of mania, using the Diagnostic Interview for Children and Adolescents-Revised) (DICA-R), Young Mania Rating Scale (YMRS), and Children's Global Assessment Scale (CGAS) at intake and at 3 and 6 months. We studied the time taken to recover from the index episode, the level of functioning, and the factors predicting them. RESULTS: After 6 months, 24 (96%) subjects had recovered from the index manic episode. The median time to recovery was 27 days. Total episode length was significantly longer among those with previous affective episodes. CONCLUSIONS: The findings suggest that juvenile-onset mania has high rates of recovery and low rates of chronicity. These differences from the existing literature need further exploration.

Adolescent↗

PubMed2003

Measuring the corpus callosum in schizophrenia: a technique with neuroanatomical and cytoarchtectural basis.

BACKGROUND: Corpus Callosum (CC) abnormalities have been described in schizophrenia. Review of CC measurement methods in schizophrenia reveals inconsistency and lack of neuroanatomical basis. AIMS: The aims of the study are to describe a new CC measurement method with valid a neuroanatomical and cytoarchitectural basis and to demonstrate inter-rater reliability for the same. SETTINGS AND DESIGN: The study was performed in the National Institute of Mental Health & Neurosciences, Bangalore, India. Ours is a cross-sectional study in which both the first author and senior neuroradiologist were blind to clinical details. MATERIAL AND METHODS: We report a reliable, semi-automated CC measuring technique with a neuroanatomical and cytoarchitectural basis tested in a group of 16 never-treated schizophrenia patients using 1-mm thick, objectively defined midsagittal MRI section. Measurement on coded slices using scion image software ensured elimination of rater bias. STATISTICAL ANALYSIS USED: The statistical analysis used for assessing inter-rater reliability is intraclass correlation coefficient analysis. RESULTS: The intraclass correlation coefficients for the CC measurements were as follows: CC Area = 0.93; Anterior CC area = 0.84; Area of body of the CC = 0.83; Area of CC isthmus = 0.65; Area of CC splenium = 0.88; maximum antero-posterior distance of CC = 0.96. CONCLUSION: Measurements showed good inter-rater reliability. The methodology demonstrated in our study is simple, relevant, reliable and can be used for future schizophrenia research.

Brain↗

PubMed2002

Does higher cardiovascular response to ECT predict early antidepressant effect?

BACKGROUND: Effects of diencephalic seizure generalization during ECT, e.g., cardiovascular response, may be relevant in indexing its therapeutic potency. A trend for greater rate pressure product (RPP=heart rate x systolic blood pressure) response to modified ECT in responders than in nonresponders is reported. Atropine used in modified ECT is known to increase RPP. This study examined if cardiovascular response during ECT with or without atropine predicts antidepressant effect. METHODS: Twenty nine consenting, major depressive disorder patients received ECTs. Atropine premedication was randomly withheld in the second or third ECT session. RPP was recorded during ECT. Severity of depression was measured at twice weekly intervals. RESULTS: Fifteen patients remitted at the end of 2 weeks. These early remitters had significantly higher poststimulus RPP than the rest in the ECT session without atropine but not so in the session with atropine. Cumulative poststimulus RPP predicted the early antidepressant response. Corresponding motor or EEG seizure durations were not associated with antidepressant effect. LIMITATIONS: Most patients continued to receive antidepressants. ECT stimulus laterality was not controlled. The study focussed on only short term antidepressant effects. CONCLUSIONS: RPP response to ECT recorded under no-atropine condition may reflect its physiological effects relevant to therapeusis and may have the potential to index seizure adequacy.

Adult↗

PubMed2002

Age-at-onset and schizophrenia: reversed gender effect.

OBJECTIVE: This study seeks an explanation for reversed gender effect on age-at-onset (AAO) in schizophrenia. The hypothesis is older AAO in males would be detected in a sample where higher infant mortality (IMR) prevailed. METHOD: Case records of International Classification of Diseases-10 (ICD-10) schizophrenia patients from two states (n=70 each) with an IMR of 13 and 67 per thousand were reviewed and AAO was obtained by using the recorded age and duration of illness. RESULTS: In the sample from the state with lower IMR, AAO did not differ between the two sexes. However, men had older AAO than women in the state with fivefold higher IMR. CONCLUSION: Gender differences in AAO may be a function of perinatal complications. In places where infants with perinatal complications are less likely to survive, hence high IMR, a small group of potentially youngest AAO schizophrenic males may be eliminated thus changing the gender effect on AAO.

Adult↗

PubMed2002

Religious coping and psychological wellbeing in carers of relatives with schizophrenia.

OBJECTIVE: To examine the use of religious coping and its relation to psychological wellbeing in carers of relatives with schizophrenia. METHOD: Sixty carers of patients with an ICD-10 diagnosis of schizophrenia, were assessed on strength of religious belief, perceived burden, religious and other coping strategies and psychological wellbeing. RESULTS: Coping strategies of denial and problem solving, strength of religious belief and perceived burden were significant predictors of wellbeing. CONCLUSION: Strength of religious belief plays an important role in helping family members to cope with the stress of caring for a mentally ill relative. In addition to psychoeducation and problem solving coping, the role of religious coping in enhancing wellbeing of carers needs to be considered in family intervention programmes.

Adaptation, Psychological↗

PubMed2001

Epilepsy control with phenobarbital or phenytoin in rural south India: the Yelandur study.

BACKGROUND: Epilepsy is a controllable disorder if detected and treated early. For most families in rural areas of less developed countries, however, treatment can be delayed because of the inaccessibility of specialist neurological assessment facilities. We aimed to find a practical solution to rural epilepsy control by doing a non-randomised trial in south India. METHODS: 135 patients with partial or generalised tonic-clonic seizures agreed to long-term treatment with phenobarbital (n=68), phenytoin (n=60), or both (n=7). Drugs were given once daily, and at the lowest effective dose, by trained primary-care physicians and health workers. All management was entirely clinical. The main outcome measure was absence of seizures of any type for at least 2 years (terminal remission). Analysis was by intention to treat. FINDINGS: The proportion with terminal remission at each of 4 successive years of follow-up ranged from 58% to 66% for patients who were drug compliant and who had a lifetime total of 30 or fewer generalised tonic-clonic seizures. The corresponding range for patients who were not compliant and who had ever had more than 30 such seizures was 6-16%. Multivariate logistic regression analysis confirmed that strict drug compliance and early treatment were important predictors of a 2-year terminal remission. Clinical adverse effects were noted in three (4%) patients on phenobarbital and 67 (43%) of those on phenytoin (mainly in the form of gingival hyperplasia). INTERPRETATION: In rural areas of less developed countries, epilepsy control in its early stages can be practical and effective with existing resources. The key to success is a combination of trained primary-care physicians, health workers, inexpensive phenobarbital, drug compliance, health education, and follow-up.

Adult↗

PubMed2000

Discontinuation of antidepressant drugs during electroconvulsive therapy: a controlled study.

BACKGROUND: The concurrent use of antidepressant drugs with ECT is recommended by a recent ECT guideline. The study aimed to examine differential therapeutic and side effect responses when antidepressants are discontinued or not during ECT. METHODS: This study compared the effectiveness and side effect profile of unilateral ECT with antidepressant drugs (Group-1) or unilateral ECT with drug placebo (Group-2) in 30 major depressive disorder (DSM-IV) patients on antidepressants using a prospective randomised trial. Hamilton Rating Scale for Depression (HRSD), Montgomery Asberg Depression Rating Scale (MADRS), UKU scale, Columbia ECT side effect check list were used. The assessments were carried out before starting ECTs and at fixed intervals thereafter for four weeks. In addition, at six weeks a follow-up assessment was carried out using HRSD. ECTs were stopped after four weeks or earlier if patient obtained HRSD scores <8 and remained so for one week. RESULTS: Continuation of antidepressant drugs with ECT conferred no therapeutic advantage. Barring tricyclic antidepressant induced anticholinergic side effects, no differential side effect profile was noted. At follow-up none relapsed in Group-2 and the mean HRSD scores between the groups did not differ. LIMITATION: The antidepressant treatment prior to ECT was uncontrolled. In addition, the design was not strictly double-blind. CONCLUSION: The study failed to support an advantage with antidepressant continuation during an ECT course in major depressive disorder.

Adult↗

PubMed2000

Cardiovascular response during ECT: a cross-over study across stimulus conditions.

This study examined the effect of stimulus conditions on rate pressure product (RPP) during ECT. Seizure duration as well as baseline, ictal, and postictal RPP were recorded in 28 patients who received ECT under four stimulus conditions (unilateral threshold, unilateral suprathreshold, bilateral threshold, and bilateral suprathreshold). Seizure duration did not differ between the stimulus conditions. RPP significantly rose from baseline under every stimulus condition. Both ictal and postictal RPP values were different between stimulus conditions (one-way repeated-measure analysis of variance). Pair-wise comparisons showed that unilateral threshold ECT produced significantly lower RPP than unilateral suprathreshold and bilateral suprathreshold ECT conditions. The selective differences in RPP during ECT as well as their correspondence with the known therapeutic potency of ECT under these stimulus conditions suggest that RPP may be a potential index of ECT's therapeutic potency.

Adult↗

PubMed2000

Seizure threshold estimation by formula method: a prospective study in unilateral ECT.

Formula methods of estimating seizure threshold in bilateral electroconvulsive therapy (ECT) have been successful in 75% (at the first ECT) and 80% (at the sixth ECT) of treatments (Gangadhar et al., 1998). This study showed the same results for unilateral (UL) ECT patients. Its aim was to compare formula and titration methods for threshold determination. The seizure threshold (dependent variable) was determined by the titration method used at the first ECT in consecutive consenting patients (n = 80) prescribed UL ECT under general anesthesia. The independent variables were age, gender, diagnosis, illness severity, concurrent drugs, head circumference, and inion-nasion distance. Forward, step-wise, linear regression analysis showed age as the only significant predictor of seizure threshold (15% of variance). A formula based on regression analysis was prospectively applied in an independent sample (n = 30) of patients receiving UL ECT using the titration method for threshold determination. The results calculated a higher threshold than the actual threshold used in 14 patients, a threshold level in 8 patients, and below threshold in 8 patients. Formula-based estimates would have been successful in 22 (73%) patients, but the majority of them would have received higher than the recommended stimulus dose. Titration is the method preferred for clinical use. However, if a patient's doctor wishes to use the formula-based method, he or she should do so with specific considerations.

Adult↗

PubMed2000

Factor structure of the Mental Health Professionals Stress Scale (MHPSS) among clinical psychologists in India.

This study examined the factor structure of the Mental Health Professionals Stress Scale (MHPSS) and its reliability and validity in a sample of 116 clinical psychologists in India. Principal component analysis of the MHPSS identified four factors that accounted for 42.2% of the total variance. These 4 factors reflected 6 of the 7 original subscales. The subscale 'Client-related difficulties' did not emerge as a distinct factor. The authors attribute this to cultural differences in the therapist-patient relationship. The MHPSS correlated negatively with measures of professional role satisfaction and subjective well being. It was concluded that the MHPSS is a reliable and valid tool to measure sources of occupational stress experienced by mental health professionals.

Adult↗

PubMed1999

Motor seizure monitoring during electroconvulsive therapy.

BACKGROUND: The occurrence of a seizure during electroconvulsive therapy (ECT) should be confirmed. Most clinicians use motor seizure monitoring alone and recent guidelines have not considered electroencephalogram (EEG) monitoring mandatory. AIMS: To examine the potential pitfalls of motor seizure monitoring. METHOD: Consenting consecutive patients (n = 232) were prospectively studied at the first ECT session using both motor and EEG seizure monitoring. It was ensured (by titration) that all the patients had an adequate EEG seizure. Adequate and prolonged seizures were defined according to the latest recommendations of the Royal College of Psychiatrists. RESULTS: Motor seizure was inadequate in 15 (7%) of patients. EEG seizure was prolonged in 38 (16%) of patients. Fifteen patients (39%) did not have a prolonged motor seizure. Motor seizure correlated well (r = 0.8, P < 0.001) with EEG seizure when the latter was adequate, but not when prolonged (r = 0.12, P > 0.5). CONCLUSIONS: Motor seizure monitoring without EEG is undependable. The study provides a rational basis for the Royal College of Psychiatrists' definition of prolonged EEG seizure.

Adolescent↗

PubMed1999

An intrasubject comparison of two doses of succinylcholine in modified electroconvulsive therapy.

UNLABELLED: The electroconvulsive therapy (ECT) guideline of the Royal College of Psychiatrists recommends a 0.5 mg/kg of succinylcholine for ECT modification. Our clinical experience suggests that this dose is insufficient for Indian patients. The dose recommended by the Royal College of Psychiatrists (0.5 mg/kg) and a larger dose (1 mg/kg) were compared in 50 patients referred for ECT. In one ECT session, patients were equally randomized to receive one of the two doses and in the next session they were switched to the other dose. The extent of motor seizure modification was rated on a five-point scale by two independent raters who were blinded to the succinylcholine dose. The interrater reliability was good (K = 0.85). "Poor" seizure modification occurred in 48% and 12% of patients with the 0.5 and 1 mg/kg doses, respectively. Of the 24 patients who had poor modification with 0.5 mg/kg, 20 had "good" modification in the session with 1 mg/kg (P < 0.001). A small delay (mean = 55 s) occurred in time to recover from the respiratory paralysis with the 1 mg/kg dose of succinylcholine. No patient, however, had prolonged apnea requiring special measures. We recommend 1 mg/kg of succinylcholine dose be used in the first ECT session. For subsequent sessions, the dose may be altered, depending on the response for optimal motor seizure modification. IMPLICATIONS: The dose of muscle relaxant (succinylcholine) recommended in modified electroconvulsive therapy is not based on empirical research. In the same patients (n = 50), two doses-0.5 mg/kg and 1 mg/kg-were compared during different electroconvulsive therapy sessions. The larger dose was more effective in modifying the peripheral convulsion.

Adult↗

PubMed1998

Awareness of diagnosis and psychiatric morbidity among cancer patients--a study from South India.

Awareness regarding cancer diagnosis and its relationship to psychiatric morbidity was studied in 294 newly admitted cancer patients at an oncology center in South India. Fifty-four percent of patients were aware that they had cancer and were able to discuss their diagnosis; 46% of patients reported nonawareness of diagnosis. Discriminant function analysis revealed that oral cancers and relatives' awareness of the cancer was more prevalent in the group aware of diagnosis. More patients in the "unaware" group refused treatment for psychological distress. There was no difference between the two groups in patterns and prevalence of psychiatric morbidity. The study emphasizes the complexities in assessing awareness in cancer patients and a need to study its various components and relationship to psychological distress.

Adaptation, Psychological↗

PubMed1998

Anxiety and depression among HIV-infected heterosexuals--a report from India.

The aim of the study was to study factors related to anxiety, depression, and suicidal ideation among HIV-seropositive heterosexuals soon after being tested for their HIV status for the first time. Anxiety, depression, and suicidal ideation were assessed among 51 HIV-seropositive heterosexual men and women with various stages of HIV infection. All assessments were done between 4 and 6 weeks after revelation of positive serostatus. Psychosocial variables such as quality of family relationships and substance use and sociodemographic details such as gender, income, education, and residence were studied for their association with psychiatric morbidity. Illness details studied for their association with psychiatric morbidity included stage of HIV infection, spouse's HIV status, presence of physical illness, and pain. Depression was present in 40% and anxiety in 36% of the sample. Serious suicidal intent was seen in 14%. Multiple regression analysis indicated that presence of pain, concurrent alcohol abuse, poor family relations, and presence of AIDS in the spouse were significant factors associated with depression, anxiety, and suicidal ideation.

Adult↗

PubMed1998

P300 amplitude and antidepressant response to Sudarshan Kriya Yoga (SKY).

BACKGROUND: There is evidence that Sudarshan Kriya Yoga (SKY) has significant antidepressant effects. OBJECTIVE: The present study examined whether pretreatment P300 ERP amplitude predicts antidepressant response to SKY. METHODS: Consenting, drug-free depressed patients (n = 30; dysthymics, 15, melancholics, 15) who received SKY as the sole treatment were assessed clinically at pretreatment, 1 month and 3 months. Auditory P300 was recorded before treatment. RESULTS: Twenty-two patients responded favourably to SKY. The pretreatment P300 amplitude neither distinguished responders and non-responders nor was associated with differential rates of response. DISCUSSION: It is concluded that SKY therapy is uniformly effective regardless of the pretreatment P300 amplitude.

Adult↗

PubMed1998

Atropine premedication and the cardiovascular response to electroconvulsive therapy.

A report by the Royal College of Psychiatrists recommended avoiding atropine premedication during electroconvulsive therapy (ECT). We have examined the cardiovascular effects of ECT with or without atropine premedication. Consenting patients (n = 30) were allocated randomly before their third ECT session to receive atropine or no premedication. The rate pressure product (RPP) was recorded before anaesthesia, before ECT stimulus and at 1-min intervals thereafter for 5 min. Patients who did not receive atropine had significantly lower RPP values after all stimulus recordings. Administration of atropine or not explained 32% of the variance of summated RPP after the stimulus. There was no clinically significant bradyarrhythmia in those who did not receive atropine. Our findings support the recommendation of the Royal College of Psychiatrists. The study suggests that when threshold determination is not needed, avoiding atropine effectively contains potentially harmful cardiovascular responses.

Adjuvants, Anesthesia↗

PubMed1998

Sex difference in age at onset of schizophrenia: discrepant findings from India.

Consecutive male (n=100) and female (n=100) DSM-IV schizophrenics newly registered for treatment in a large psychiatric hospital were examined with regard to age at onset of the first psychotic symptom. Age at onset of the first psychotic symptom did not differ between the sexes regardless of whether schizophrenia was diagnosed by DSM-IV or by several alternative systems. Age at onset defined by other criteria, namely age at first contact with a physician, and age at first admission for psychiatric care, also did not show any differences between the sexes. Survival analysis of subjects having a documented date of birth revealed a female preponderance at younger ages. A higher positive symptom score predicted older age at onset of the first psychotic symptom in the total sample. These findings call into question the universality of the traditional view of a younger age at onset of schizophrenia among males. Tentative neurodevelopmental and cultural explanations are presented to explain why there is no sex difference in age at onset of schizophrenia in India.

Adolescent↗

PubMed1998

Once vs. three times weekly ECT in melancholia: a randomized controlled trial.

Once weekly and three times weekly schedules of ECT, each at two stimulus dose levels (high and low), were compared for therapeutic efficacy in melancholia. Three times weekly ECTs were more efficacious than once weekly ECTs. A high stimulus dose did not enhance the efficacy of once weekly ECTs. However, the patients who remitted did so over a comparable time-course regardless of the ECT schedule. Although three times weekly ECTs are superior, 55% of patients responded to once weekly ECTs. There is therefore a need for research to identify the patients for whom once weekly ECT may be sufficient.

Adult↗