Publications by authors named "Mariamma Philip"

54 Publications

Development of "My Experiences Scale" for Children and Adolescents in India.

Indian J Psychol Med 2021 Mar 25;43(2):106-112. Epub 2020 Aug 25.

Dept of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India.

Background: Experiences that a child or adolescent goes through play a critical role in their development as an individual. To understand the world of adolescents and their mental health and well-being, it would be important to be able to access their experiences. Therefore, an objective measure to assess experiences is necessary. The study aimed to develop a scale to assess experiences and establish their psychometric properties.

Materials And Methods: My Experiences Scale (MES) is a newly developed 50-item, multiple-choice, self-report measure. Various steps involved in developing the MES and establishing its psychometric properties have been elaborated. The study was carried out across four phases, and the sample consisted of 1,260 school-going children and adolescents. The participants were representative of both genders, a wide age range, and diverse socioeconomic backgrounds.

Results: MES was found to have good internal consistency (Alpha 0.85) and test-retest reliability (0.96). MES was found to have significant correlations with Strengths and Difficulties Questionnaire and global self-worth.

Conclusions: The newly developed experiences scale shows promising psychometric properties and a wide scope for application.
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http://dx.doi.org/10.1177/0253717620939266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313444PMC
March 2021

Efficacy of a Brief Self-management Intervention in Type 2 Diabetes Mellitus: A Randomized Controlled Trial from India.

Indian J Psychol Med 2020 Nov 10;42(6):540-548. Epub 2020 Aug 10.

Dept. of Endocrinology, St. John's Medical College and Teaching Hospital, Bengaluru, Karnataka, India.

Background: Diabetes mellitus places a considerable burden on the individual and the family with respect to lifestyle changes. There is a paucity of systematic studies in India examining the efficacy of self-management programs for diabetes. The study examined the impact of a brief self-management intervention (SMI) on primary outcome of HbA1c and secondary outcomes of quality of life (QOL), self-care, perceived barriers to self-care (BSC), perceptions regarding illness and mood in patients with type 2 diabetes mellitus.

Methods And Materials: Eighty patients with type 2 diabetes mellitus were randomly allocated to either a 4-session SMI or treatment as usual (TAU) and were assessed on HbA1c levels, QOL, self-care, BSC, illness perceptions, anxiety, and depression at baseline, postintervention , and at three-month postintervention follow-up.

Results: Repeated measures analysis of variance indicated significant improvement in the SMI group from baseline to follow-up on HbA1c (P = 0.001), impact of diabetes on QOL (P = 0.006), self-care with respect to diet and exercise (Ps = 0.001), perceived barriers in adherence to diet, exercise, (P = 0.001), medication (P < 0.01), glucose testing (P = 0.04), general BSC (P = 0.001), total barriers (P = 0.001), illness perceptions-timeline or chronicity of illness (P = 0.002), personal control over illness, (P = 0.001), belief in effectiveness of treatment (P = 0.002), understanding of one's illness (P = 0.001), and emotional representations regarding illness (P =0.001), depression, (P = 0.001), and anxiety (P = 0.001). In the SMI group, large effect sizes were obtained at the postintervention assessment and the three-month follow-up on most outcome measures.

Conclusions: Brief psychological intervention is efficacious in patients with type 2 diabetes.
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http://dx.doi.org/10.1177/0253717620932250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735239PMC
November 2020

Chitotriosidase, a biomarker of amyotrophic lateral sclerosis, accentuates neurodegeneration in spinal motor neurons through neuroinflammation.

J Neuroinflammation 2020 Aug 6;17(1):232. Epub 2020 Aug 6.

Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru, 560 029, India.

Background: Cerebrospinal fluid from amyotrophic lateral sclerosis patients (ALS-CSF) induces neurodegenerative changes in motor neurons and gliosis in sporadic ALS models. Search for identification of toxic factor(s) in CSF revealed an enhancement in the level and enzyme activity of chitotriosidase (CHIT-1). Here, we have investigated its upregulation in a large cohort of samples and more importantly its role in ALS pathogenesis in a rat model.

Methods: CHIT-1 level in CSF samples from ALS (n = 158), non-ALS (n = 12) and normal (n = 48) subjects were measured using ELISA. Enzyme activity was also assessed (ALS, n = 56; non-ALS, n = 10 and normal-CSF, n = 45). Recombinant CHIT-1 was intrathecally injected into Wistar rat neonates. Lumbar spinal cord sections were stained for Iba1, glial fibrillary acidic protein and choline acetyl transferase to identify microglia, astrocytes and motor neurons respectively after 48 h of injection. Levels of tumour necrosis factor-α and interleukin-6 were measured by ELISA.

Findings: CHIT-1 level in ALS-CSF samples was increased by 20-fold and it can distinguish ALS patients with a sensitivity of 87% and specificity of 83.3% at a cut off level of 1405.43 pg/ml. Enzyme activity of CHIT-1 was also 15-fold higher in ALS-CSF and has a sensitivity of 80.4% and specificity of 80% at cut off value of 0.1077989 μmol/μl/min. Combining CHIT-1 level and activity together gave a positive predictive value of 97.78% and negative predictive value of 100%. Administration of CHIT-1 increased microglial numbers and astrogliosis in the ventral horn with a concomitant increase in the levels of pro-inflammatory cytokines. Amoeboid-shaped microglial and astroglial cells were also present around the central canal. CHIT-1 administration also resulted in the reduction of motor neurons.

Conclusions: CHIT-1, an early diagnostic biomarker of sporadic ALS, activates glia priming them to attain a toxic phenotype resulting in neuroinflammation leading to motor neuronal death.
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http://dx.doi.org/10.1186/s12974-020-01909-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7412641PMC
August 2020

Effect of music listening on P300 event-related potential in patients with schizophrenia: A pilot study.

Schizophr Res 2020 02 7;216:85-96. Epub 2020 Jan 7.

Clinical Neuropsychology & Cognitive Neuroscience Centre and Music Cognition Laboratory, Department of Clinical Psychology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, KA, India. Electronic address:

Reduced amplitude and increased latency of P300 auditory event-related potential (ERP) in patients with schizophrenia (SZ) indicate impairment in attention. Overall arousal level can determine the amount of processing capacity required for attention allocation. Music evokes strong emotions and regulates arousability. Music has been used to modulate P300, especially in normals. This exploratory study examined the effect of music listening on the amplitude and latency of P300 in SZ patients. EEG/ERP was recorded (32-channels) while SZ patients (n = 20; 18-45 years) performed an auditory oddball P300 task after the eyes-closed rest condition (Condition-A) and ten-minute music listening condition (Condition-B) as per the complete counterbalancing design (AB-BA). Patients listened to the researcher chosen, instrumental presentation of raag-Bhoopali in the North-Indian-Classical-Music, for ten-minutes. All patients rated the music excerpt as a relaxing and positively valenced. A significant increase in accuracy score and reaction time during the oddball task after music listening was noted. There was an increase in amplitude at TP7. A trend of increased amplitude was noted across all electrodes in the music condition compared to the rest condition. Mean amplitude in an apriori defined time window of interest (250 to 750 ms) showed significant changes in the frontal and central electrode sites. Power spectral analysis indicated a slight increase in frontal and central alpha and theta activity during music listening. However, this was not statistically significant. Findings add further impetus to examine the effect of music in chronic psychiatric conditions. Need for systematic studies on a larger cohort is underscored.
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http://dx.doi.org/10.1016/j.schres.2019.12.026DOI Listing
February 2020

Yoga and schizophrenia-a comprehensive assessment of neuroplasticity: Protocol for a single blind randomized controlled study of yoga in schizophrenia.

Medicine (Baltimore) 2019 Oct;98(43):e17399

Department of Psychiatry.

Introduction: Schizophrenia is one of the most severe mental disorders with a prevalence of about 1% and a leading cause of disability among young adults. Pharmacotherapy is the mainstay in the management of schizophrenia. However, even with the best of medication, several problems like refractoriness, negative symptoms, frequent relapses, and cognitive impairments persist.

Methods: This is a randomized-controlled clinical study including patients from an urban tertiary hospital and a semi-urban community center, with a between-group, repeated-measures, longitudinal design. This study will recruit 160 patients with DSM 5 diagnosis of schizophrenia who are on stable medication for a minimum of 6 weeks; they will be randomly assigned into 2 arms viz., yoga therapy (YT), and treatment-as-usual (TAU) with 80 patients in each arm. Participants will undergo Clinical, Laboratory, and Radiological assessments at baseline and at intervals of 1 month, 3 months, and 6 months from the baseline. It is hypothesized that yoga will improve psychopathology and emotion processing, increase serum brain derived neurotrophic factor (BDNF) and plasma oxytocin levels and effect changes in cerebral activation in areas of the brain associated with schizophrenia.

Discussion: This study aims to measure the efficacy of a Yoga-based intervention as an adjunct in patients with schizophrenia as well as the mechanisms of these effects.

Trial Registration: Registered retrospectively with Clinical Trial Registry - India (CTRI) with registration number CTRI/2017/08/009219.
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http://dx.doi.org/10.1097/MD.0000000000017399DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824782PMC
October 2019

Concurrent Validity and Interrater Reliability of the "Clinical Schedules for Primary Care Psychiatry".

J Neurosci Rural Pract 2019 Jul 23;10(3):483-488. Epub 2019 Sep 23.

Primary Care Psychiatry Program, Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.

 There is limited access to specialized mental health care in countries such as India with a wide treatment gap for psychiatric illnesses. Integrating mental health delivery with primary health-care services is vital. The clinical schedules for primary care psychiatry (CSP) was designed for training primary care doctors (PCDs) to identify and diagnose psychiatric illness in patients presenting to primary care settings. This study aims to study the validity and reliability of the CSP and its hypothesis is that the CSP would help PCDs to identify psychiatric caseness.  The study was conducted at three primary health centers of Karnataka. Consented PCDs were briefly trained in the use of CSP and screened patients who were later interviewed by a psychiatrist using a semistructured interview and confirmed by International Statistical Classification of Diseases and Related Health Problems 10th edition (ICD-10) symptom checklist. The appropriate statistical analysis was performed.  A total of 180 patients were included. Agreement was found between diagnoses made by PCDs and psychiatrist for 142 (78. 9%) patients with a Cohen's kappsychiatry pa (K) = 0. 57. The sensitivity was 91. 1% and specificity was 68. 3%. The interrater reliability showed = 0. 7.  The CSP helps PCDs to make psychiatric diagnoses. It has a relatively high sensitivity with reasonably high specificity but mayneed clinical training.
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http://dx.doi.org/10.1055/s-0039-1697878DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6779541PMC
July 2019

Cultural differences and neural correlates of cognitive insight in schizophrenia.

Schizophr Res 2019 07 14;209:98-104. Epub 2019 May 14.

Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India. Electronic address:

Cognitive insight refers to a person's ability to examine their psychotic experiences and the inferences they draw from these experiences. Several studies suggest that cultural factors influence cognitive insight and the processes involved therein; a few studies have suggested differences between Western and Asian societies. However, there are no studies on cognitive insight and its neural correlates in non-Western populations. Hence, we examined factor structure of Beck's cognitive insight scale (BCIS) in a large sample of patients with schizophrenia (SCZ) and healthy volunteers (HV) from India and assessed the relationship between cortical thickness and cognitive insight. We recruited 240 participants (SCZ-140; HV-100). Of these, 58 participants (SCZ-33; HV-25) underwent magnetic resonance imaging. We found a three-factor structure for BCIS which is different from the original two factor structure; self-reflection (SR) of original two-factor structure was sub-divided into- SR1, introspection and SR2, openness to feedback. There was a significant difference between HV and SCZ in the new factors, SR1 and SR2 but not in the original SR factor. Difference was also seen on MRI analysis; while there was a significant positive correlation between original SR factor and thickness of right posterior cingulate cortex, SR2 was positively correlated with thickness of left ventrolateral prefrontal cortex. The difference in factor structure in Indian participants and their distinct neural correlates point to cultural differences in cognitive insight. While in western societies the constructs of introspection and openness to feedback might integrate, they might be separate entities in Asian population.
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http://dx.doi.org/10.1016/j.schres.2019.05.010DOI Listing
July 2019

Eye movement tracking in pediatric obsessive compulsive disorder.

Asian J Psychiatr 2019 Jun 24;43:9-16. Epub 2019 Apr 24.

Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore Hosur Road, Bangalore, Pin: 560029.

Till date researchers have elucidated the neurobiological substrates in OCD using methods like neuroimaging. However, a potential biomarker is still elusive. The present study is an attempt to identify a potential biomarker in pediatric OCD using eye tracking. The present study measured pro-saccade and anti-saccade parameters in 36 cases of pediatric OCD and 31 healthy controls. There was no significant difference between cases and controls in the error rate, peak velocity, position gain and latency measures in both pro-saccade and anti-saccade eye tracking tasks. With age, anti-saccades become slower in velocity, faster in response and more accurate irrespective of disorder status of the child. Pro-saccades also show a similar effect that is less prominent than anti-saccades. Gain measures more significantly vary with age in children with OCD than the controls, whereas latency measures positively correlated with age in children with OCD as opposed to being negatively correlated in the controls. Findings of this study do not support any of the eye tracking measures as putative diagnostic bio-markers in OCD. However, latency and gain parameters across different age groups in anti-saccade tasks need to be explored in future studies.
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http://dx.doi.org/10.1016/j.ajp.2019.04.003DOI Listing
June 2019

Incidence of Deep Vein Thrombosis in Neurointensive Care Unit Patients-Does Prophylaxis Modality Make Any Difference?

Indian J Crit Care Med 2019 Jan;23(1):43-46

Department of Biostatistics, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, Karnataka, India.

Background And Aims: To determine the incidence of upper and lower limb deep vein thrombosis (DVT) using ultrasonography (USG) in adult patients admitted to neuro-medical and neurosurgical intensive care unit (ICU).

Materials And Methods: In this prospective observational study, patients admitted to the medical and surgical neuro-ICU and remained in the ICU for more than 48 hours were recruited. All patients were clinically examined for DVT. Basilic and axillary veins in the upper limbs and popliteal and femoral veins in the lower limbs were screened for DVT using USG. USG examination was performed on the day of admission to ICU and thereafter every 3rd day till discharge from ICU or death. Intermittent pneumatic compression (IPC) stockings were applied to the lower limbs to all the patients in both ICUs. Unfractionated heparin (UFH) was given subcutaneously to neuromedical ICU patients, while in surgical ICU, it was left to the discretion of the neurosurgeons.

Results: A total of 130 adult patients were admitted to the ICU during the 8 month study period. Thirty patients were excluded and the remaining 98 patients' (38 in medical and 60 in surgical ICU) data were analyzed. None of the 38 medical ICU patients developed DVT, while in neurosurgical ICU, 4 out of 60 patients developed DVT.

Conclusion: A combination of UFH and IPC stockings were effective in minimizing the DVT in neuromedical ICU patients. In surgical patients, through IPC stockings were effective, UFH can be considered for patients with intracranial malignancy.

How To Cite This Article: Behera SS, Krishnakumar M, Muthuchellappan R, Philip M. Incidence of Deep Vein Thrombosis in Neurointensive Care Unit Patients-Does Prophylaxis Modality Make Any Difference? Indian Journal of Critical Care Medicine, January 2019;23(1):43-46.
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http://dx.doi.org/10.5005/jp-journals-10071-23111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481265PMC
January 2019

Cytokine alterations in first-onset postpartum psychosis-clues for underlying immune dysregulation.

Asian J Psychiatr 2019 Apr 26;42:74-78. Epub 2019 Mar 26.

National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, 560029, Bengaluru, Karnataka, India.

Background: Emerging evidence suggests a possible role for immune system dysregulation in the pathogenesis of postpartum psychosis (PP) but the evidence is limited. The current study sought to determine the serum cytokines/ chemokine changes associated with first-onset PP.

Methods: Women with first onset PP were recruited as cases and the cytokines/ chemokine changes were compared against healthy postpartum (HP) and healthy non-postpartum (HNP) women.There were 20 subjects in each of the three groups. Levels of serum cytokines and Monocyte Chemoattractant Protein-1 (MCP-1) were estimated with a cytometric beadarray assay.

Results: HP group showed significantly elevated levels of interleukin (IL)-6 as compared to HNP group. Whereas, the first onset PP group showed significantly elevated levels of both IL-6 and IL-8 as compared to HNP group.

Conclusion: Postpartum period appears to be a state of altered immune functioning considering the elevated level of IL-6 in both HP and PP group. Additionally, IL-8 appears to play a role in the manifestation of PP. Our study highlights the immune alterations associated with first-onset PP.
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http://dx.doi.org/10.1016/j.ajp.2019.03.012DOI Listing
April 2019

A clinical TRIAD for early suspicion of autoimmune encephalitis as a possibility in patients presenting with progressive cognitive decline.

Asian J Psychiatr 2019 Mar 22;41:5-12. Epub 2019 Feb 22.

Associate Professor of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru - 560029, Karnataka, India. Electronic address:

Patients with progressive cognitive decline mostly suffer from degenerative disease and carry a relatively poor prognosis. But small groups among these patients have a potentially treatable cause of illness and therefore every patient with dementia needs to be considered treatable unless proved otherwise. This group can be identified only by high degree of suspicion based on clinical clues. We have evaluated the validity of some simple clinical clues which we noticed in our patients with immune mediated dementias. The Panic score, Epsworth sleepiness score, catatonic symptoms and history of seizures were compared between 23 and 11 patients with serologically confirmed anti-NMDA antibody and anti-VGKC antibody associated encephalitis respectively. They were compared with 20 patients with probable behavioral variant of Frontotemporal dementia (bvFTD) and 20 patients with probable Alzheimer's disease (AD). Chi-square test was used to compare across the groups and there was significant difference (P < 0.05) across the 4 groups comprising anti NMDA encephalitis, anti VGKC encephalitis, FTD and AD among the four variables (Panic scores, Catatonic symptoms, Epsworth sleepiness score and seizures) studied. Our study revealed that panic and sleepiness is highly significant when tested across all groups and catatonia showed a trend towards NMDA and when compared with degenerative dementia versus immune mediated syndromes all the 4 parameters were highly significant This simple bedside TRIAD of panic, sleepiness with either of catatonia or seizures if found in patients it is appropriate to order antibody assessment before anything else is planned. This needs to be evaluated in a larger sample.
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http://dx.doi.org/10.1016/j.ajp.2019.02.013DOI Listing
March 2019

Aging mildly affects dendritic arborisation and synaptic protein expression in human substantia nigra pars compacta.

J Chem Neuroanat 2019 04 8;97:57-65. Epub 2019 Feb 8.

Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, 560029, India. Electronic address:

The protein α-synuclein, a major component of Lewy bodies in nigral neurons of aged and Parkinson's disease (PD) patients, normally co-localizes with synaptophysin and regulates the pool of synaptic vesicles. Our earlier study on substantia nigra pars compacta (SNpc) in an Asian-Indian population, demonstrated an age-associated linear but non-logarithmic increase in soluble α-synuclein without any loss of nigral neurons. Another distinctive finding was the presence of activated microglia in the ventrolateral region of the aged nigra, suggesting sub-threshold neurodegeneration. Since microglia prune dendrites, we evaluated the alterations in dendritic arborisation in the SNpc from autopsied midbrains of Asian-Indians through aging, using Golgi-Kopsch protocol. Further, we evaluated the expression of synaptic proteins, synaptophysin and synaptotagmin-11 as parallel markers of synaptic transmission anomalies. The dendritic arborization pattern was typical of large multipolar neurons. A subtle but non-significant decline in parameters like dendritic length and number of intersections was noted. Thus, the alterations were milder than those reported in PD. In the neurons of the young (till 10 years), faint cytoplasmic immunoreactivity of synaptic proteins was noted. In the adults and elderly, it was membrane-bound or appeared as punctae within neuropil. Both proteins showed a slight age-related decline, suggesting a mild decrease in the synaptic vesicular traffic, affecting the dopamine transmission with age that may manifest as minor motor disabilities in the elderly. Mapping the differences in synaptic profiles in differentially susceptible ethnic populations, could reveal interesting insights. Thus, nigra of aged individuals and PD patients share pathogenic features that differ in magnitude.
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http://dx.doi.org/10.1016/j.jchemneu.2019.02.001DOI Listing
April 2019

Aging mildly affects dendritic arborisation and synaptic protein expression in human substantia nigra pars compacta.

J Chem Neuroanat 2019 04 8;97:57-65. Epub 2019 Feb 8.

Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, 560029, India. Electronic address:

The protein α-synuclein, a major component of Lewy bodies in nigral neurons of aged and Parkinson's disease (PD) patients, normally co-localizes with synaptophysin and regulates the pool of synaptic vesicles. Our earlier study on substantia nigra pars compacta (SNpc) in an Asian-Indian population, demonstrated an age-associated linear but non-logarithmic increase in soluble α-synuclein without any loss of nigral neurons. Another distinctive finding was the presence of activated microglia in the ventrolateral region of the aged nigra, suggesting sub-threshold neurodegeneration. Since microglia prune dendrites, we evaluated the alterations in dendritic arborisation in the SNpc from autopsied midbrains of Asian-Indians through aging, using Golgi-Kopsch protocol. Further, we evaluated the expression of synaptic proteins, synaptophysin and synaptotagmin-11 as parallel markers of synaptic transmission anomalies. The dendritic arborization pattern was typical of large multipolar neurons. A subtle but non-significant decline in parameters like dendritic length and number of intersections was noted. Thus, the alterations were milder than those reported in PD. In the neurons of the young (till 10 years), faint cytoplasmic immunoreactivity of synaptic proteins was noted. In the adults and elderly, it was membrane-bound or appeared as punctae within neuropil. Both proteins showed a slight age-related decline, suggesting a mild decrease in the synaptic vesicular traffic, affecting the dopamine transmission with age that may manifest as minor motor disabilities in the elderly. Mapping the differences in synaptic profiles in differentially susceptible ethnic populations, could reveal interesting insights. Thus, nigra of aged individuals and PD patients share pathogenic features that differ in magnitude.
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http://dx.doi.org/10.1016/j.jchemneu.2019.02.001DOI Listing
April 2019

Prognostic Value of Tissue Oxygen Monitoring and Regional Cerebral Oxygen Saturation Monitoring and Their Correlation in Neurological Patients with Sepsis: A Preliminary, Prospective, Observational Study.

J Neurosurg Anesthesiol 2020 Jan;32(1):77-81

Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.

Background: There is paucity of literature on the prognostic value of tissue oxygen saturation (StO2) and regional cerebral oxygen saturation (rSO2) in neurological patients with sepsis. In this preliminary study, we investigated the prognostic value of StO2 and rSO2 in a group of neurological patients and correlated StO2 and rSO2 with hemodynamic and metabolic parameters.

Materials And Methods: This preliminary, prospective observational study was conducted in 45 adult neurological patients admitted to intensive care unit. Once a diagnosis of sepsis or septic shock was established, parameters of oxygenation (StO2, rSO2, central venous oxygen saturation [ScvO2]), serum lactate, illness severity scores (Acute Physiology and Chronic Health Evaluation score, Sequential Organ Failure Assessment score, Glasgow Coma Scale) were recorded at 0, 6, 12, 24, 36, and 48 hours, and once daily thereafter. Outcomes were in-hospital mortality attributable to sepsis and the Glasgow outcome score at hospital discharge.

Results: There was a moderately positive correlation between StO2 and rSO2 at baseline (r=0.599; P=0.001). StO2, illness severity scores and serum lactate, but not rSO2, were significantly different between survivors (n=29) and nonsurvivors (n=16) at baseline and during the first 48 hours. An rSO2 of 62.5% had a sensitivity of 83% and specificity of 67% to differentiate survivors and nonsurvivors of septic shock at 48 hours. StO2 had a higher correlation with ScvO2 and serum lactate than rSO2.

Conclusions: StO2 prognosticates survival and favorable/unfavorable outcomes in neurological patients with sepsis. The role of rSO2 in predicting survival in milder form of sepsis is doubtful.
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http://dx.doi.org/10.1097/ANA.0000000000000563DOI Listing
January 2020

Anatomical Variations of the Temporomesial Structures in Normal Adult Brain - A Cadaveric Study.

J Neurosci Rural Pract 2018 Jul-Sep;9(3):317-325

Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.

Background: Despite significant evolutional, functional, and clinical interest, the anatomical variations of the temporomesial structures in cadaveric samples have received little attention. This study was undertaken to document the anatomical variations observed in the temporal lobe of human brain with emphasis on the structures present in temporomesial region.

Materials And Methods: Using 26 postmortem cadaveric cerebral hemispheres (13 right and 13 left hemispheres), several neurosurgically significant mesial structures were studied by blunt dissection under the operating microscope. The observed surface-based qualitative variations and right-left asymmetries were tabulated under well-defined, moderately defined, and ill-defined classification.

Results: Among the areas, uncus (100%), limen insulae (88.4%), rhinal sulcus and hippocampus (81%), intralimbic gyrus (77%), Heschl's gyrus (73%), gyrus ambiens, semilunar gyrus, sulcus semiannularis, and calcar avis (69.2%) were well defined, and band of Giacomini (38.4%) was found to be distinctly ill-defined areas in the list. Further, our analysis confirmed the presence of consistent left-greater-than-right asymmetry in all the areas of interest in temporal region under well-defined category. Rightward asymmetry was noticed in moderately defined and ill-defined classification. However, no asymmetry was detected in the uncal region. value for all the obtained results was >0.05.

Conclusion: Our study offers a preliminary anatomic foundation toward the better understanding of temporal lobe structures. These variations may prove valuable to neurosurgeons when designing the appropriate and least traumatic surgical approaches in operating the temporomesial lesions.
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http://dx.doi.org/10.4103/jnrp.jnrp_73_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6050764PMC
August 2018

Quality of abstracts of randomized control trials in five top pain journals: A systematic survey.

Contemp Clin Trials Commun 2017 Sep 9;7:64-68. Epub 2017 Jun 9.

Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.

Background: The reporting quality of abstracts of randomized control trials (RCTs) is inadequate despite the publication of consolidated standards of reporting trials extension for abstracts (CONSORT-A). We compared the reporting quality of abstracts in pain journals before and after the publication of CONSORT-A.

Methods: We searched MEDLINE in April-2016 for RCTs published in five pain journals: Pain, Pain Physician, European Journal of Pain, Clinical Journal of Pain and Pain Practice for pre- and post-CONSORT-A period (2005-2007 and 2013-2015). Data were extracted in duplicate from 250 abstracts for compliance with CONSORT-A, and for items known to affect reporting quality: journal endorsement of CONSORT, number of trial centers, sample-size, type of intervention, industry-sponsorship and significance of results. The primary outcome was mean number of items reported and the secondary outcome was the reporting of each item. We used logistic regression and Poisson regression for analyses.

Results: Most trials were single centric (76%), had sample size <100 (63%), involved pharmacological intervention (59%) and were non-industry funded (70%). The mean number of items reported was better for 2013-2015 (mean difference 0.94; 95% confidence-interval [CI]: 0.50-1.38, p < 0.001). Post-CONSORT-A, trials were more likely to report as randomized in the title (odds ratio (OR) 2.69; 95% CI 1.61-4.49), describe eligibility criteria and settings (OR 2.47; 95% CI 1.35-4.54), provide effect size and precision for primary outcome (OR 2.47; 95% CI 1.19-5.16), inform harms (OR 1.80; 95% CI 1.05-3.07) and report trial registration (OR 5.13; 95% CI 1.44-18.32). Post-CONSORT-A period (incident rate ratio (IRR) 1.15; 95% CI 1.07-1.24), endorsement of CONSORT statement by the journal (IRR 1.08; 95% CI 1.02-1.14), multi-centric studies (IRR 1.14; 95% CI 1.08-1.20), and studies with pharmacological interventions (IRR 1.07; 95% CI 1.02-1.13) were significantly associated with reporting of more items.

Conclusions: Abstract reporting for trials in pain literature was better in the post-CONSORT-A period, but there is room for improvement.
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http://dx.doi.org/10.1016/j.conctc.2017.06.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5898559PMC
September 2017

Duration of Pupillary Unresponsiveness to Light: A Physiological Adjunct to Electroencephalography and Motor Seizure Duration Monitoring During Electroconvulsive Therapy.

J ECT 2018 Dec;34(4):e61-e64

Psychiatry, and.

Background: During electroconvulsive therapy (ECT) sessions, we observed that the time taken for the return of pupillary response to light (ROPL) outlasted both the electroencephalography (EEG) and the motor seizure duration after the delivery of the electrical stimulus to produce convulsions.

Objective: The objective of this study was to investigate whether ROPL can be used as a marker of cessation of seizure activity in the brain after ECT and also to study the effect of atropine premedication on seizure activity during ECT.

Methods: Forty-one patients underwent 82 sessions of ECT in a cross-over design study. The duration of motor seizure, EEG seizure, and time for ROPL was observed and compared.

Results: The ROPL consistently outlasted EEG and motor seizures; the difference in their mean durations was statistically significant P < 0.05. There was good correlation among the 3 parameters. Atropine premedication did not alter the seizure activity and ROPL after ECT.

Conclusions: The ROPL after ECT stimulus is a good bedside monitor for termination of seizure activity and can be a valuable adjunct to surface EEG in monitoring the duration of epileptic activity after delivery of ECT.
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http://dx.doi.org/10.1097/YCT.0000000000000491DOI Listing
December 2018

Efficacy of an indicated intervention program for Indian adolescents with subclinical depression.

Asian J Psychiatr 2018 Mar 11;33:99-104. Epub 2018 Mar 11.

NIMHANS, Bangalore, India.

Subclinical depressive symptoms in adolescents are associated with a host of impairments and constitute a risk factor for future depression. The aim of the present study was to study the efficacy of a school-based group coping skills program for Indian adolescents with subclinical depression. Adolescents (n = 120) across two schools comprised the intervention and control groups and were assessed at baseline, post-intervention, and 3 months no-contact follow-up. The intervention group adolescents received the 8-weekly Coping Skills program in same-gender groups of 4-8 adolescents each, and the control group adolescents received one interactive psycho-educatory session. The intervention group evidenced clinically significant reductions in depressive symptoms, negative cognitions, and academic stress, and increased social problem solving and coping skills, at both post-intervention and follow-up. With regard to moderators, initial levels of depressive symptoms and homework compliance were found to partially moderate the effect of intervention. No effects were found for parental depression, gender, and age. The present study calls for future development and implementation of programs to address subclinical psychopathology among adolescents in Indian schools.
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http://dx.doi.org/10.1016/j.ajp.2018.03.007DOI Listing
March 2018

Treatment-related Fluctuations in Guillain Barre Syndrome and the Conundrum of Additional Cycles of Plasmapheresis.

Ann Indian Acad Neurol 2017 Oct-Dec;20(4):372-377

Department of Transfusion Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.

Introduction: In Guillain Barre syndrome (GBS), worsening of weakness or disability after initial period of recovery or stabilization is described as treatment-related fluctuations (TRF).

Aim: This study aims to describe the clinical characteristics and outcome of six patients with GBS and TRF.

Patients And Methods: Six patients with GBS fulfilling NINCDS criteria, evaluated at a tertiary care university hospital during 2008-2017, were diagnosed to have TRF. They form the basis of this report.

Results: All patients were men and their mean age was 40 years. At presentation, mean duration of illness was 15 days; the illness had plateaued in three and progressive in other three patients. Two of the four patients had variant GBS. Initially, five patients were treated with large volume plasmapheresis (LVPP) and one patient with methyl prednisolone. At 17-28 days after disease onset, three patients developed new neurologic deficits (bilateral facial paresis in two; paralytic ileus in one). Other three patients with worsening of limb weakness (medical research council sum score of >5) and disability (Hughes disability grade by ≥1) fulfilled Kleyweg's criteria for TRF. All the six patients were treated with the completion of five cycles or additional cycles of LVPP.

Conclusion: Awareness about TRF is essential for correct diagnosis and management of patients with GBS.
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http://dx.doi.org/10.4103/aian.AIAN_242_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5682741PMC
November 2017

Hydroxyethyl starch and kidney function: A retrospective study in patients undergoing therapeutic plasma exchange.

J Clin Apher 2018 Jun 30;33(3):278-282. Epub 2017 Oct 30.

Department of Transfusion medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka 560029, India.

Purpose: Hydroxyethyl starch (HES) and albumin are used as replacement fluids during therapeutic plasma exchange (TPE). HES solutions are no longer recommended in critically ill patients due to its effect on kidneys and coagulation. In this retrospective study, we tried to look at the association between cumulative HES administration and kidney function in patients undergoing TPE.

Methods: Transfusion medicine department register was scrutinized to identify adult patients who had completed at least 5 cycles of TPE during the period June 2014-May 2015. Patient demographics, indication for TPE, amount of plasma removed, amount of colloid administered, adverse events and vascular access details were collected. Electronic hospital database was scrutinized to retrieve lab parameters, including blood urea and serum creatinine (before and after 5 cycles of TPE) and platelet count. Baseline renal parameters were compared with post TPE values using Wilcoxon signed rank test. A p value <0.05 was kept as significant.

Results: Of the 593 patients who received TPE during the study period, 104 patients fulfilled the inclusion criteria. Forty-five patients out of 104 received TPE in the intensive care unit. All patients received 2500 ml of HES during the study period. Blood urea and serum creatinine values, when compared to baseline, significantly decreased after 5 cycles of TPE (p = 0.004, p = 0.001, respectively).

Conclusion: Blood urea and serum creatinine, used as markers of renal function, improved in patients requiring multiple doses of HES solutions during TPE. Further studies using novel renal biomarkers are required to examine whether HES induces any structural damage to kidneys.
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http://dx.doi.org/10.1002/jca.21598DOI Listing
June 2018

Effectiveness of a structured teaching program (STP) on cessation of tobacco chewing, on knowledge and attitude among female hospital housekeeping personnel - a pilot study.

Asian J Psychiatr 2017 Oct 28;29:73-76. Epub 2017 Apr 28.

Department of Psychiatry, NIMHANS (INI), Hosur Road, Bengaluru, Karnataka, India. Electronic address:

Aim: To evaluate the effectiveness of a structured teaching program (STP) on: a) improving knowledge of female hospital housekeeping personnel regarding harmful impact of tobacco chewing and how to quit, and b) fostering an unfavorable attitude toward tobacco chewing.

Methods: The STP focused on adverse health effects of tobacco chewing, myths and facts, and tobacco cessation. It was administered in regional language to female hospital housekeeping personnel (N=35) over three days. Post-assessments were conducted at 4 weeks following the last session of the STP.

Results: Current tobacco use was reported by 26% of the sample. Tobacco chewers (vs. non-chewers) were more likely to be significantly older, have elementary education, belong to nuclear family, have lesser knowledge regarding harmful effects, and have a more favorable attitude toward the practice of tobacco chewing. At the end of 4 weeks following the STP, participants significantly improved their knowledge regarding the harmful health impact of tobacco chewing and how to quit (p=0.001), and showed a significantly less favorable attitude toward tobacco chewing (p=0.001). Change in participants' knowledge scores was found to be negatively correlated with change in attitude scores, implying that increase in knowledge was associated with less favorable attitude toward tobacco chewing (r=-0.427, p=0.011).

Conclusion: Findings provide preliminary evidence for the effectiveness of health education on harmful impact of tobacco chewing and how to quit, delivered through a STP, in improving knowledge and fostering an unfavorable attitude toward tobacco chewing, among female hospital housekeeping personnel.
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http://dx.doi.org/10.1016/j.ajp.2017.04.021DOI Listing
October 2017

Elevated serum adenosine deaminase levels in neuroleptic-naïve patients with recent-onset schizophrenia.

Asian J Psychiatr 2017 Oct 27;29:13-15. Epub 2017 Mar 27.

Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India.

The present study examined serum levels of adenosine deaminase (ADA), an adenosine metabolizing enzyme, in neuroleptic-naive patients with recent-onset schizophrenia and age-matched healthy comparison subjects. ADA levels were found to be higher among patients, and revealed a possible link between evening rise and severity of auditory hallucinations as well as morning rise and severity of avolition-apathy in patients with schizophrenia. These findings suggest the potential utility of serum ADA as a peripheral biomarker of schizophrenia.
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http://dx.doi.org/10.1016/j.ajp.2017.03.034DOI Listing
October 2017

Cerebral Oxygen Saturation During Electroconvulsive Therapy: A Secondary Analysis of a Randomized Crossover Trial.

J Neurosurg Anesthesiol 2018 Oct;30(4):314-318

Departments of Neuroanesthesia.

Background: Electroconvulsive therapy (ECT) causes acute changes in cerebral perfusion and oxygenation. Near-infrared spectroscopy is a novel, noninvasive technique to assess cerebral oxygen saturation (cSO2). We hypothesized that cSO2 increases during ECT and more so with atropine premedication and decreases when systemic desaturation (peripheral oxygen saturation <90%) occurs during ECT.

Methods: We performed a secondary analysis of a randomized trial of patients undergoing ECT for psychiatric illness during a 6-month period. During the second ECT session, patients were randomly assigned to receive either 0.01 mg/kg IV atropine or no atropine. During the third ECT session, patients were crossed over. Standard anesthetic management was performed. Data with regard to heart rate, blood pressure, peripheral oxygen saturation, and cSO2 were collected at baseline and continuously examined for 5 minutes from delivery of ECT stimulus.

Results: Forty-one patients underwent 82 ECT sessions. ECT resulted in significant increase in cSO2 during both the atropine and the no-atropine sessions (P<0.001 for both) but no between-session difference was observed (mean difference, 1.9±2.0; 95% confidence interval, -2.0, 5.9; P=0.337). The cSO2 values were lower in patients who developed systemic desaturation when compared with the cSO2 values in those who did not (mean difference, 5.0±2.6; 95% confidence interval -0.1, 10.2; P=0.054). However, the mean cSO2 was >60% at any measured time point, even in those with systemic desaturation.

Conclusions: ECT increased cSO2 irrespective of atropine premedication. cSO2 was lower when systemic desaturation occurred. Future studies should explore the effect of cerebral oxygenation changes during ECT on outcome of psychiatric conditions.
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http://dx.doi.org/10.1097/ANA.0000000000000456DOI Listing
October 2018

Estrogen pathway related genes and their association with risk of postpartum psychosis: A case control study.

Asian J Psychiatr 2017 Apr 19;26:82-85. Epub 2017 Jan 19.

Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, India. Electronic address:

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http://dx.doi.org/10.1016/j.ajp.2017.01.014DOI Listing
April 2017

Effect of Atropine Premedication on Cardiac Autonomic Function During Electroconvulsive Therapy: A Randomized Crossover Study.

J ECT 2017 Sep;33(3):176-180

From the Departments of *Neuroanaesthesia, †Psychiatry, and ‡Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore, India.

Objectives: Electroconvulsive therapy (ECT) results in significant cardiovascular changes. The acute cardiac autonomic changes during ECT remain unexplored. The primary objective of this study was to compare autonomic dysfunction with and without atropine premedication during ECT and secondarily to evaluate dysautonomia across psychiatric diagnoses before and after ECT.

Methods: In this crossover study, 41 psychiatric patients were monitored during 82 ECT sessions. Patients were randomized either to receive atropine or not to receive atropine during their second ECT session and were crossed over during their third session. Heart rate, blood pressure, and oxygen saturation were continuously monitored from stimulus application until 300 seconds after ECT. Demographic characteristics and ANSiscope indices derived pre- and post-ECT were collected.

Results: Autonomic dysfunction (%) before ECT was similar between atropine and no-atropine sessions (32.4 ± 15.7 vs 32.8 ± 16.7; 95% confidence interval, -7.6 to 6.7; P = 0.90) but increased significantly after ECT to 60.9 ± 16.3 and to 47.0 ± 17.3, respectively, and this difference was significant (95% confidence interval, 6.5-21.3; P < 0.001). There was no difference in the autonomic function across psychiatric diagnoses both before (P = 0.07) and after ECT (P = 0.12).

Conclusions: Cardiac autonomic dysfunction worsens after ECT in patients with psychiatric illnesses and to a significantly greater extent with atropine premedication. The degree of dysautonomia is similar across various psychiatric diagnoses both before and after ECT. Atropine premedication during ECT should be restricted to select patients susceptible to bradyarrhythmia and could be avoided in others.
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http://dx.doi.org/10.1097/YCT.0000000000000417DOI Listing
September 2017

Risperidone versus olanzapine in the acute treatment of Persistent Delusional Disorder: A retrospective analysis.

Psychiatry Res 2017 07 9;253:270-273. Epub 2017 Apr 9.

Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bangalore-560029, Karnataka, India. Electronic address:

There is a dearth of prospective trials studying treatment response in Persistent Delusional Disorder (PDD) to guide clinical practice. Available retrospective data indicate good response to second-generation antipsychotics (SGAs). We selected the data of patients prescribed either olanzapine or risperidone from a retrospective chart review of PDD (n=455) at our centre. We compared the two groups olanzapine (n =86) versus risperidone (n =280) on dose, drug adherence, response and adverse effects. The two groups were comparable on socio-demographic and clinical characteristics of PDD. There was no statistically significant difference between the two groups on adherence (>80%) and response to treatment (>52% good response). Olanzapine was effective at lower mean chlorpromazine equivalents than risperidone. Logistic regression analysis identified shorter mean duration of illness, good adherence and absence of substance dependence as predictors of good response to both drugs. Our study indicates that acute PDD responds well to treatment with both risperidone and olanzapine, provided adherence can be ensured. In the absence of specific treatment guidelines and randomized controlled trials for PDD, our analysis reaffirms the efficacy of SGAs.
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http://dx.doi.org/10.1016/j.psychres.2017.02.066DOI Listing
July 2017

Personality Traits in the Siblings and Children of Patients with Frontotemporal Dementia: A Questionnaire-based Study.

Indian J Psychol Med 2017 Jan-Feb;39(1):28-31

Department of Statistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.

Introduction: Frontotemporal dementias (FLD) form a group of relatively young onset, male dominant dementias with significant behavioral abnormalities early in the course of the disease. Routine assessment suggested preexisting traits such as lack of empathy, self-directedness, and persistence in most of these persons even before the onset of disease. Hence, we decided the study, the siblings and children of patients for any specific traits and correlation with hexanucleotide expansion repeats if any traits were identified.

Patients And Methods: A total of 35 age- and gender-matched cases and controls were included for the study as per criteria. They were screened for mental illness and cognitive dysfunction using Hindi Mental State Examination and Mini-mental State Examination. Eligible persons were given temperament and character inventory (TCI) scores for the recommended parameters. Hexanucleotide expansion was also studied in the patients, cases and controls.

Results: No specific personality trait was found to have an increased correlation with siblings and children of patients with FLD in this small group using TCI scores.

Conclusions: 7% of cases showed Hexanucleotide expansion suggesting a possible risk. The role of self reporting bias resulting in normal personality trait needs to be addressed in future studies.
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http://dx.doi.org/10.4103/0253-7176.198943DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5329987PMC
March 2017
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