An overview of Indian research in schizophrenia

Psychosis susceptibility zinc finger protein 804A (ZNF804A) gene polymorphism in schizophrenia patients treated with olanzapine in North Indian population

PURPOSE

The Zinc finger protein 804A (ZNF804A) is a potential schizophrenia candidate gene that has emerged from genome-wide association studies. The aim of the study is to investigate whether this gene variant influences the response of positive or negative symptoms to antipsychotic drug olanzapine in North Indian schizophrenia patients.

MATERIALS AND METHODS

Our study involved 184 unrelated schizophrenia cases (114 males and 70 females; mean age: 52.8 ± 11.6 years) and 300 normal controls (168 males and 132 females; mean age: 54.9 ± 6.9 years). At the start of treatment and after four weeks, we assessed the response of positive and negative symptoms by positive and negative syndrome scale (PANSS). Olanzapine drug level was estimated using HPLC Method and Genotyping was performed using PCR-Snap Shot technique.

RESULTS

Significant differences were observed in the genotype distribution (χ² = 6.10, d.f. = 2, p = 0.04) and allele frequencies (χ² = 5.14, d.f. = 1, p = 0.02; odds ratio = 0.57, 95% confidence interval =1.09-3.48) between schizophrenia patients and controls group. The improvement of positive and negative schizophrenia symptoms after 4 weeks of treatment with olanzapine was assessed. Patients homozygous for the ZNF804A risk allele for AA show poorer improvement of positive symptoms compared to patients with a protective allele.

CONCLUSIONS

Our findings indicate that ZNF804A gene polymorphism plays a significant role in the treatment of schizophrenia, suggesting that ZNF804A may be an effective marker for schizophrenia treatment.

Schizophrenia research in India: A scientometric assessmentof India's publications during 1990-2019

The present study examined India's publications (2803) on schizophrenia, using various bibliometric indicators during 1990-2019. The study focuses on the number of publications, and citations received by the papers on schizophrenia, published by authors affiliated to Indian institutes by using Scopus data base. Additionally, an attempt was made to evaluate the performance of India's leading organizations and authors, and inter-collaborative linkages between them. Scopus database include publications of Indian Journal of Psychiatry and Indian Journal of Psychological Medicine from 2009 and 2011. Accordingly, the publications in these journals were included after these years. Analysis of the publications showed that India is globally ranked at 13^th position in number of publications on schizophrenia with 2.04 % global share, depicting 14.21 % annual growth, with 22.8 % of publications having international collaboration. Publications from India published during the period of 1990-2019, registered a citation impact per paper (CPP) of 13.3. National Institute of Mental Health and Neurosciences, Bangalore (671 papers), Post Graduate Institute of Medical Education and Research, Chandigarh (271 papers) and Central Instittue of Psychiatry, Ranchi (136 papers) were the most productive institutes. However, the most impactful organizations in terms of citation per paper (CPP) and relative citation index (RCI), Indian Institute of Science, Bangalore (77.27 CPP and 5.78 RCI), Schizophrenia Research Foundation, Chennai (31.16 CPP and 2.55 RCI) and Banaras Hindu University, Varanasi (29.21 CPP and 2.18 RCI) were at the top. In terms of Individual authors, G. Venkatasubramanian (180 papers), and B.N. Gangadhar (162 papers) were the most productive authors and R.Thara (31.87 CPP and 2.38 RCI), B.K. Thelma (24.0 CPP and 1.8 RCI), M.S. Keshavan (23.91 CPP and 1.79 RCI) were the most impactful authors, among the top 15 authors. The journals which reported comparatively higher productivity for Indian publications included Indian Journal of Psychiatry (242 papers), followed by Asian Journal of Psychiatry (214 papers) and Indian Journal of Psychological Medicine (103 papers). In terms of most impactful Indian publications, these were published in The Lancet (97.7), Progress in Neuro Psychopharmacology & Biological Psychiatry (50) and Schizophrenia Bulletin (44.67).

Instrumental Activities of Daily Living Dysfunction among People with Schizophrenia

BACKGROUND

Life skills are the basic skills that are needed to live independently and that support meaningful, productive roles. The negative symptoms and cognitive dysfunction seen in schizophrenia may lead to deterioration in the life skills of the patient. The assessment of current life skills of the patient and subsequent intervention becomes necessary for comprehensive rehabilitation of people with mental illness. This study attempted to assess the instrumental activities of daily living among people with schizophrenia in India.

METHODS

One hundred consecutive patients with schizophrenia, between 18 and 60 years, who presented to a tertiary psychiatric facility were assessed using (i) Lawton instrumental activities of daily living scale (LIADL), (ii) positive and negative symptom scale (PANSS), (iii) pro forma for sociodemographic and clinical characteristics.

RESULTS

The majority of the patients were male, young adults, married, with secondary school education, middle socioeconomic status, from nuclear families, unemployed and were diagnosed to have paranoid schizophrenia. The reported IADL dysfunction included difficulties in handling medications (86%), preparing food (85%), shopping (78%), handling finances (61%), doing laundry (52%), housekeeping (47%), using public transport (32%), and using telephones (5%). The dysfunction documented differs from that reported in the west. Total PANSS score (P = 0.015) and its general psychopathology subscale (P = 0.005) correlated inversely with the total LIADL score; PANSS scores and sociodemographic variables were associated with some subscales of LIADL.

CONCLUSIONS

IADL dysfunction, common in people with schizophrenia, demands detailed assessment, and tailored training to ensure optimum functioning.

Cultural aspects of major mental disorders: a critical review from an Indian perspective

Major mental disorders such as schizophrenia and affective disorders are highly disabling illnesses. The cultural factors that influence the diagnosis and treatment of these disorders are of paramount clinical significance. We attempted to critically review the cultural factors in relation to the epidemiology, phenomenology, treatment, and outcome of major mental disorders from an Indian perspective, and tried to compare these with the cultural factors identified in major international studies. The clinical expression of major mental disorders was noted to vary across cultures in the review. In addition, the outcome of major mental disorders is reported to be better in developing nations than in the developed countries. Transcultural variations are also noted to exist in pharmacokinetics, pharmacodynamics, traditional healing practices, and psychotherapeutic approaches. The role of cultural factors in severe mental illnesses needs adequate attention from mental health professionals. Continued research on the cultural aspects is required to understand the interplay of all social, cultural, and biological factors. It is important to consider other cultural, traditional, and folk methods for understanding and management of mental illnesses.