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Lal A, Tharyan A, Tharyan P. The prevalence, determinants and the role of empathy and religious or spiritual beliefs on job stress, job satisfaction, coping, burnout, and mental health in medical and surgical faculty of a teaching hospital: A cross-sectional survey. Rev Med Interne 2020; 41:232-240. [PMID: 31924391 DOI: 10.1016/j.revmed.2019.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/26/2019] [Accepted: 12/08/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Systematically ascertained data on job stress and burnout and their antecedents and mediators in health professionals from low- and middle-income countries are scant. METHODS This cross sectional survey, conducted from July 2007 to August 2008, of consenting medical and surgical faculty of a large, charitable, teaching hospital aimed to evaluate: 1) the prevalence and sources of job stress and job satisfaction, and the ways used to cope with stress; 2) the prevalence of burnout and mental distress; and 3) the influence of age, gender, empathy and religious or spiritual beliefs on job stress, satisfaction, mental health and burnout. RESULTS Of 345 respondents, high job stress on the Physician Stress and Satisfaction questionnaire were reported by 23%. However, 98% of faculty reported high levels of job satisfaction with deriving intellectual stimulation from teaching and a high level of responsibility identified as important contributory sources. Significantly more respondents aged<45 years compared to older faculty achieved moderate or high scores on Emotional Exhaustion and Depersonalization. General Health Questionnaire-12 scores suggested psychiatric morbidity in 21%, particularly in younger faculty. High job stress was associated with high scores for Emotional Exhaustion and Depersonalization. High scores on the Jefferson Scale of Physician Empathy correlated with high scores of Emotional Exhaustion. Religious or spiritual beliefs strongly influencing attitudes to work were significantly associated with high levels of Personal Accomplishment. CONCLUSIONS This study provides data that will inform the design and implementation of interventions to reduce job stress and burnout and improve retention of faculty.
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Affiliation(s)
- A Lal
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 55902 Rochester, MN, USA.
| | - A Tharyan
- Department of Psychiatry, Christian Medical College, 632002 Vellore, Tamil Nadu, India
| | - P Tharyan
- Department of Psychiatry, Christian Medical College, 632002 Vellore, Tamil Nadu, India
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Chichra A, Abhijnhan A, Tharyan P. Job stress and satisfaction in faculty of a teaching hospital in south India: A cross-sectional survey. J Postgrad Med 2019; 65:201-206. [PMID: 31204727 PMCID: PMC6813678 DOI: 10.4103/jpgm.jpgm_489_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/27/2018] [Accepted: 01/22/2019] [Indexed: 11/04/2022] Open
Abstract
Background There are multiple economic, psychological, and physical consequences of high job stress, low job satisfaction and burnout in faculty of a teaching hospital in South India. Data from developing countries on these domains are sparse. Materials and Methods In a cross-sectional study we assessed the prevalence and sources of perceived job stress, job satisfaction and burnout in faculty, as well as ways of coping with stress among consenting faculty of a large, private, charitable, teaching hospital in India using standardized, self-rated questionnaires. Results A total of 304 respondents, 156 (51.3%) were Assistant Professors; 71 (23.4%) were Associate Professors, and 77 (25.3%) were Professors. The majority (175; 58%) were male, younger than 45 years (235; 76%) and from clinical departments (248; 81.5%) A third (96; 31%) reported high overall levels of perceived job stress. In multivariate analyses, age less than 45 years, designation as Assistant or Associate Professor, and working in a clinical department were associated with perceived high job stress; reporting high perceived job satisfaction was protective. Nearly two-thirds (217; 71.4%) of faculty reported high levels of job satisfaction. In multivariate analysis, age less than 45 years and reporting high job stress were associated with low perceived job satisfaction. Causes of stress and satisfaction differed by age, gender and designation. On the Maslach Burnout Inventory (MBI), 88 (29%) had high scores on the emotional exhaustion subscale, 63 (20.8%) had high scores on the depersonalization subscale, and 90 (29.7%) had low scores on the personal achievement subscales. High job stress and low job satisfaction were significantly associated with burnout on the three domains. Conclusions High job stress and low job satisfaction were inversely related in this survey of medical faculty and were significantly associated with levels of burnout. The sources of job stress and job satisfaction identified provide insights that could inform formal institutional mechanisms to prevent burnout in doctors.
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Affiliation(s)
- A Chichra
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
| | - A Abhijnhan
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
| | - P Tharyan
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
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Asokan GV, Fedorowicz Z, Tharyan P, Vanitha A. Authors'response. East Mediterr Health J 2013; 19:581. [PMID: 24983123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Rajkumar AP, Mohan TSP, Tharyan P. Lessons from the 2004 Asian tsunami: epidemiological and nosological debates in the diagnosis of post-traumatic stress disorder in non-Western post-disaster communities. Int J Soc Psychiatry 2013; 59:123-9. [PMID: 21997766 DOI: 10.1177/0020764011423468] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The nosological validity of post-traumatic stress disorder (PTSD) remains controversial in non-Western communities. After natural disasters, epidemiological studies often overlook these conceptual debates and assess post-traumatic stress symptoms (PTSS) by short screening instruments. Such PTSS estimates are reported as inflated prevalence rates of PTSD in post-disaster settings. AIMS To discuss the prevalence and determinants of PTSS within the context of pertinent epidemiological and nosological debates. METHODS We assessed PTSS and grief symptoms of 643 survivors from five Indian villages struck by the Asian tsunami using the Impact of Events Scale - Revised and Complicated Grief Assessment Scale. We adopted a case control design and employed complex sample multiple logistic regression statistics to study the determinants of PTSS. RESULTS The prevalence of PTSS was 15.1% (95% CI 12.3%-17.9%). PTSS was significantly associated with traumatic grief, female gender, physical injury, death of children and financial losses, but not with functional disability (p = .91). CONCLUSIONS Although PTSS were common in this population, elevating them to a psychiatric construct of PTSD is questionable, when functional impairment and avoidance behaviours were absent. Grief reactions, socio-economic burden, and poor support systems contribute towards PTSS. We highlight the important issues regarding the nosological validity and epidemiology of PTSD in non-Western communities.
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Affiliation(s)
- A P Rajkumar
- Department of Psychiatry, Christian Medical College, Vellore, India
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Asokan GV, Fedorowicz Z, Tharyan P, Vanitha A. One health: perspectives on ethical issues and evidence from animal experiments. East Mediterr Health J 2013; 18:1170-3. [PMID: 23301381 DOI: 10.26719/2012.18.11.1170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Zoonoses constitute more than 60% of all known infectious diseases and 75% of emerging infectious diseases. Their impact is not monitored, prevented and treated in an integrated way. The efficacy of therapeutic interventions for zoonotic diseases is deemed to be comparable across species with scientifically valid results originating from a range of animal experiments. Ethical obligations limit the number of animals used in experiments as well as reduce repetition of studies. The evidence based on randomized controlled trails and systematic reviews for the effectiveness of health care interventions is often inconclusive. Subjecting human volunteers to risk in the absence of scientifically valid results from animal experiments is unethical. The One Health concept is a comparative, clinical approach directed towards zoonoses which present challenges to research workers and clinicians. Optimal health for all--One Health--should be underpinned by ethically conducted research in animals or humans and the results should be complementary to both.
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Affiliation(s)
- G V Asokan
- Public Health Programme, College of Health Sciences, University of Bahrain, Manama.
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Andrade C, Shah N, Tharyan P, Reddy MS, Thirunavukarasu M, Kallivayalil RA, Nagpal R, Bohra NK, Sharma A, Mohandas E. Position statement and guidelines on unmodified electroconvulsive therapy. Indian J Psychiatry 2012; 54:119-33. [PMID: 22988318 PMCID: PMC3440905 DOI: 10.4103/0019-5545.99530] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In modern day psychiatric practice, it is assumed as a matter of fact that when electroconvulsive therapy (ECT) is administered, it will be administered under anesthesia and with succinylcholine (or its equivalent) modification. Yet, as surveys indicate, there is considerable practice of unmodified ECT in developing countries and, to a small extent, in the developed world, as well. MATERIALS AND METHODS This document examines historical and recent literature on the geographical practice, physiology, efficacy, and adverse effects of unmodified ECT. Particular attention is paid to musculoskeletal risks. RESULTS Although almost all the research is of poor methodological quality, there is a good reason to accept that unmodified ECT is associated with a wide range of adverse consequences, important among which are musculoskeletal complications, pre-ECT anxiety, and post-ECT confusion. However, it appears from recent data that these risks are not as large as historically portrayed. Possibly explanations are suggested, with seizure modification using parenteral benzodiazepines as a special possibility. CONCLUSIONS Under exceptional circumstances, if ECT is strongly indicated and seizure modification with succinylcholine is not feasible, unmodified ECT, especially benzodiazepine-modified ECT, may be a viable option. A detailed set of recommendations for such use of unmodified ECT is proposed along with necessary checks and balances. This document has been approved by the Indian Psychatric Society, the Indian Association of Biological Psychiatry, and the Indian Association of Private Psychiatry (which commissioned the preparation of the document).
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Singh JC, Tharyan P, Kekre NS, Singh G, Gopalakrishnan G. Prevalence and risk factors for female sexual dysfunction in women attending a medical clinic in south India. J Postgrad Med 2009; 55:113-20. [PMID: 19550056 DOI: 10.4103/0022-3859.52842] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tharyan P. Tranquilising agitated mentally ill patients: intramuscular haloperidol plus promethazine reduces need for additional medication or medical attention compared to olanzapine. Evid Based Ment Health 2008; 11:87. [PMID: 18669689 DOI: 10.1136/ebmh.11.3.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- P Tharyan
- Department of Psychiatry, Christian Medical College, Vellore and BV Moses Centre for Clinical Trials and Evidence Based Medicine, Christian Medical College, Vellore 632002, Tamil Nadu, India.
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George K, Nair R, Tharyan P. Ovulation triggers in anovulatory women undergoing ovulation induction. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2008. [DOI: 10.1002/14651858.cd006900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
BACKGROUND Meningococcal disease begins suddenly and death can follow within hours. Pre-admission antibiotic therapy aims to prevent delay in starting therapy that occurs if bacterial confirmation is sought before instituting therapy. OBJECTIVES To study the effectiveness and safety of pre-admission antibiotics versus no pre-admission antibiotics or placebo and of different pre-admission antibiotic regimens in decreasing mortality and morbidity in people suspected of meningococcal disease. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2007, Issue 1), MEDLINE (1966 to February 2007) and EMBASE (1980 to February 2007). SELECTION CRITERIA We selected randomised controlled trials (RCTs) or quasi-RCTs, of all people with suspected meningococcal infection. We compared antibiotic treatment versus placebo or no intervention, or different antibiotic treatments administered before admission to hospital or confirmation of the diagnosis. DATA COLLECTION AND ANALYSIS Two author authors independently assessed quality and extracted data from included trials. We calculated the relative risk (RR) and 95% confidence interval (CI) for dichotomous data. As only one trial fulfilled inclusion criteria, data synthesis was not performed. MAIN RESULTS No RCTs were found that compared pre-admission antibiotics versus no pre-admission antibiotics or placebo. One open-label RCT evaluated a single dose of intramuscular ceftriaxone versus a single dose of intramuscular long acting (oily) chloramphenicol. Interventions did not differ significantly in mortality (RR 1.2, 95% CI 0.5 to 2.6; N = 510; 349 confirmed meningococcal meningitis; 26 deaths), nor in proportions of survivors who developed neurological sequelae (RR 1.2, 95% CI 0.6 to 2.2; N = 488; 36 with neurological sequelae), or that were classified as clinical failures (RR 0.8, 95% CI 0.4 to 1.8; N = 488, 25 clinical failures). No adverse effects of treatment were seen. No data were available for our secondary outcomes. AUTHORS' CONCLUSIONS We found no reliable evidence to support or refute the use of pre-admission antibiotics for suspected cases of meningococcal disease. Evidence from one RCT-during an epidemic of meningococcal meningitis, indicated that single intramuscular injections of ceftriaxone and long-acting chloramphenicol were equally effective and safe in preventing mortality and morbidity. The choice between these antibiotics would be based on affordability, availability, and patterns of antibiotic resistance.Further RCTs comparing different pre-admission antibiotics, including penicillin, including participants with severe illness are ethically justifiable and are needed to provide reliable evidence to clinicians in differing clinical settings.
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Affiliation(s)
- T Sudarsanam
- Christian Medical College, Medicine Unit 2, Vellore, Tamil Nadu, India, 632 004.
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Kurien M, Thomas K, Ahuja RC, Patel A, Shyla PR, Wig N, Mangalani M, Kasthuri A, Vyas B, Brogen A, Brojen A, Sudarsanam TD, Chaturvedi A, Abraham OC, Tharyan P, Selvaraj KG, Mathew J. Screening for HIV infection by health professionals in India. Natl Med J India 2007; 20:59-66. [PMID: 17802983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Stigma and discrimination, particularly in access to healthcare, remains a major problem for people Infected with HIV in most parts of India. METHODS We did a multicentre study (n = 10) with a cross-sectional survey design using a standardized, interviewer-administered questionnaire. RESULTS A total of 2200 healthcare providers participated. The knowledge, attitude and practice (KAP) related to HIV service delivery were very poor with a mean overall KAP score of only 49.7% (CI: 49.1-50.3). Only 5%, 5% and 1% of the participants scored more than 75% separately for the dimensions of knowledge, attitude and practice, respectively. Only 24.4% and 36.7% of responders knew that HIV screening was not recommended prior to surgery and pre-employment check-up. Many doctors (19.4%) had refused treatment to people living with HIV/AIDS (PLHA) at least some of the time and nearly half (47.2%) identified and labelled them; 23.9% isolated them in separate care areas and 13.3% postponed or changed treatment based on the patient's HIV status. Screening for HIV prior to elective surgery was done by 67% of providers. While 64.7% of responders were aware of the existence of national guidelines on and recommendations for HIV testing, only 38.4% had read the policy document. CONCLUSION There is a growing need to provide care, support and treatment to a large number of PLHA. The capacity of healthcare providers must be urgently built up so as to improve their knowledge of and attitude to HIV to enable them to deliver evidence-based and compassionate care to PLHA in various healthcare settings.
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Affiliation(s)
- M Kurien
- Coordinating Centre, Christian Medical College, Vellore 632004, Tamil Nadu, India
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Rajkumar AP, Jebaraj P, Tharyan P. Multi-drug overdose risperidone, ziprasidone, valproate, trihexyphenidyl, and clonazepam. J Assoc Physicians India 2007; 55:146-8. [PMID: 17571746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Risperidone and ziprasidone are commonly used as first line drugs for the treatment of psychotic disorders and overdose with these agents is increasingly being reported. Relatively few of these reports have involved co-ingestion of multiple psychotropic agents. We report a case of overdose with risperidone, ziprasidone, valproate, trihexyphenidyl and clonazepam in a 25 years female, who recovered uneventfully with supportive management. Notwithstanding the benign outcome in this instance, age, co-ingested drugs, active metabolites and medical co-morbidity are critical issues in overdose with atypical antipsychotics. As prescription of these drugs continues to increase in developing countries, systematic studies evaluating their clinical toxicity and management are necessary. The issues associated with overdose of multiple psychotropic agents and appropriate management policies are highlighted.
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Affiliation(s)
- A P Rajkumar
- Department of Psychiatry, Christian Medical College, Vellore 632002, Tamil Nadu, India
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Abstract
BACKGROUND Plasmodium vivax infections contribute to a significant proportion of the malaria infections in many countries. Primaquine is the most widely used drug for treating the dormant liver stage. Different primaquine dosing regimens are in use. OBJECTIVES To compare primaquine regimens for preventing relapses in people with P. vivax malaria. SEARCH STRATEGY In 2006, we searched the Cochrane Infectious Diseases Group's Specialized Register (January), CENTRAL (The Cochrane Library 2006, Issue 3), MEDLINE (October), EMBASE (January), LILACS (January). We also checked conference proceedings and reference lists, and contacted researchers, the World Health Organization (WHO), malaria mailing lists, and pharmaceutical companies. SELECTION CRITERIA Randomized and quasi-randomized controlled trials comparing primaquine plus chloroquine with chloroquine alone, and the standard primaquine regimen (15 mg/day for 14 days) with other primaquine-containing regimens in people with vivax malaria. DATA COLLECTION AND ANALYSIS All authors independently assessed trial eligibility and quality, and extracted data. We calculated odds ratios (OR) with 95% confidence intervals (CI) for dichotomous data, and used the random-effects model if there was significant heterogeneity. MAIN RESULTS Nine trials (3423 participants) met the inclusion criteria. Compared with chloroquine alone, five-day primaquine plus chloroquine was no better at preventing relapses (OR 1.04, 95% CI 0.64 to 1.69, random-effects model; 2104 participants; 3 trials), while 14-day primaquine plus chloroquine was significantly better (OR 0.24, 95% CI 0.12 to 0.45, random-effects model; 1071 participants, 6 trials). Limited data suggest the advantage for the 14-day primaquine regimen persisted for over six months (OR 0.41, 95% CI 0.29 to 0.60; 585 participants, 2 trials). Direct comparisons of the 14-day and five-day primaquine plus chloroquine regimens also confirm the superiority of the longer course (OR 13.33, 95% CI 3.45 to 51.44; 186 participants, 2 trials). Adverse effects were poorly reported, with three trials reporting skin rash, vertigo, headache, abdominal pain and/or nausea, and two trials reporting that primaquine was well tolerated. AUTHORS' CONCLUSIONS Primaquine (15 mg/kg/day for 14 days) plus chloroquine is more effective than chloroquine alone or primaquine (15 mg/kg for 5 days) plus chloroquine in preventing relapses of vivax malaria. Primaquine (five days) plus chloroquine appears no better than chloroquine. Countries should follow the WHO's recommendation for 14-day primaquine plus chloroquine regimen. Alternative regimens need to be evaluated in randomized controlled trials, which should also consider variations in regional P. vivax strains and the possibility of primaquine resistance, reinfection, and adherence in those who relapse.
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Affiliation(s)
- G N L Galappaththy
- Ministry of Health, Anti Malaria Campaign, 45/2C Auburn Side, Dehiwala, Colombo, Sri Lanka.
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Affiliation(s)
- S Kurian
- Reader, Department of Psychiatry, Christian Medical College, Vellore
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Abstract
BACKGROUND Electroconvulsive therapy (ECT) involves the induction of a seizure for therapeutic purposes by the administration of a variable frequency electrical stimulus shock via electrodes applied to the scalp. The effects of its use in people with schizophrenia are unclear. OBJECTIVES To determine whether electroconvulsive therapy (ECT) results in clinically meaningful benefit with regard to global improvement, hospitalisation, changes in mental state, behaviour and functioning for people with schizophrenia, and to determine whether variations in the practical administration of ECT influences outcome. SEARCH STRATEGY We undertook electronic searches of Biological Abstracts (1982-1996), EMBASE (1980-1996), MEDLINE (1966-2004), PsycLIT (1974-1996),SCISEARCH (1996) and the Cochrane Schizophrenia Group's Register (July 2004). We also inspected the references of all identified studies and contacted relevant authors. SELECTION CRITERIA We included all randomised controlled clinical trials that compared ECT with placebo, 'sham ECT', non-pharmacological interventions and antipsychotics and different schedules and methods of administration of ECT for people with schizophrenia, schizoaffective disorder or chronic mental disorder. DATA COLLECTION AND ANALYSIS Working independently, we selected and critically appraised studies, extracted data and analysed on an intention-to-treat basis. Where possible and appropriate we calculated risk ratios (RR) and their 95% confidence intervals (CI) with the number needed to treat (NNT). For continuous data Weighted Mean Differences (WMD) were calculated. We presented scale data for only those tools that had attained pre-specified levels of quality. We also undertook tests for heterogeneity and publication bias. MAIN RESULTS This review includes 26 trials with 50 reports. When ECT is compared with placebo or sham ECT, more people improved in the real ECT group (n=392, 10 RCTs, RR 0.76 random CI 0.59 to 0.98, NNT 6 CI 4 to 12) and though data were heterogeneous (chi-square 17.49 df=9 P=0.04), its impact on variability of data was not substantial (I-squared 48.5%). There was a suggestion that ECT resulted in less relapses in the short term than sham ECT (n=47, 2 RCTs, RR fixed 0.26 CI 0.03 to 2.2), and a greater likelihood of being discharged from hospital (n=98, 1 RCT, RR fixed 0.59, CI 0.34 to 1.01). There is no evidence that this early advantage for ECT is maintained over the medium to long term. People treated with ECT did not drop out of treatment earlier than those treated with sham ECT (n=495, 14 RCTs, RR fixed 0.71 CI 0.33 to 1.52, I-squared 0%). Very limited data indicated that visual memory might decline after ECT compared with sham ECT (n=24, 1 RCT, WMD -14.0 CI -23 to -5); the results of verbal memory tests were equivocal. When ECT is directly compared with antipsychotic drug treatments (total n=443, 10 RCTs) results favour the medication group (n=175, 3 RCTs, RR fixed 'not improved at the end of ECT course' 2.18 CI 1.31 to 3.63). Limited evidence suggests that ECT combined with antipsychotic drugs results in greater improvement in mental state (n= 40, 1 RCT, WMD, Brief Psychiatric Rating Scale -3.9 CI - 2.28 to -5.52) than with antipsychotic drugs alone. One small study suggested more memory impairment after a course of ECT combined with antipsychotics than with antipsychotics alone (n=20, MD serial numbers and picture recall -4.90 CI -0.78 to -9.02), though this proved transient. When continuation ECT was added to antipsychotic drugs, the combination was superior to the use of antipsychotics alone (n=30, WMD Global Assessment of Functioning 19.06 CI 9.65 to 28.47), or CECT alone (n=30, WMD -20.30 CI -11.48 to -29.12). Unilateral and bilateral ECT were equally effective in terms of global improvement (n=78, 2 RCTs, RR fixed 'not improved at end of course of ECT' 0.79 CI 0.45 to 1.39). One trial showed a significant advantage for 20 treatments over 12 treatments for numbers globally improved at the end of the ECT course (n=43, RR fixed 2.53 CI 1.13 to 5.66). AUTHORS' CONCLUSIONS The evidence in this review suggests that ECT, combined with treatment with antipsychotic drugs, may be considered an option for people with schizophrenia, particularly when rapid global improvement and reduction of symptoms is desired. This is also the case for those with schizophrenia who show limited response to medication alone. Even though this initial beneficial effect may not last beyond the short term, there is no clear evidence to refute its use for people with schizophrenia. The research base for the use of ECT in people with schizophrenia continues to expand, but even after more than five decades of clinical use, there remain many unanswered questions regarding its role in the management of people with schizophrenia.
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Affiliation(s)
- P Tharyan
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India, 632001.
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Tharyan P, Ramalingam S, Kannangai R, Sridharan G, Muliyil J, Tharyan A. Prevalence of HIV infection in psychiatric patients attending a general hospital in Tamil Nadu, south India. AIDS Care 2003; 15:197-205. [PMID: 12856341 DOI: 10.1080/0954012031000068344] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
An anonymous, unlinked study was conducted to detect antibodies to HIV-1 or HIV-2 infections in 1,160 consecutive, newly registered, adult psychiatric outpatients at a general hospital in South India to determine whether psychiatric patients presenting to general hospitals are a population at high risk for HIV infection and should be routinely screened. The seroprevalence of HIV infection (12/1160; 1.03%; 95% CI = 0.4-1.6%) did not approximate rates expected of a high-risk group compared to the national (0.7%) or regional community (1.8%) prevalence. It did not differ significantly from HIV seroprevalence in non-psychiatric patients (233/35450; 0.7%; 95% CI = 0.57-0.74%) who were systematically screened (relative risk = 1.57; 95% CI = 0.88-2.80) during the same period, but was greater than the seroprevalence in healthy blood donors (0.5%; p = 0.02; relative risk = 2.15 95% CI = 1.17-3.95). Non-psychiatric patients were also more likely to be HIV infected than blood donors (p = 0.02; relative risk = 1.37; 95% CI = 1.05-1.78). These findings have implications for HIV testing policies among psychiatric and non-psychiatric patients presenting to general hospitals in India.
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Affiliation(s)
- P Tharyan
- Christian Medical College, Vellore, Tamil Nadu 632002, India.
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Russell PS, Tharyan P, Arun Kumar K, Cherian A. Electro convulsive therapy in a pre-pubertal child with severe depression. J Postgrad Med 2002; 48:290-1. [PMID: 12571387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
Electro Convulsive Therapy (ECT) in pre-pubertal children is a controversial and underreported treatment. Even though the effectiveness and side effects of ECT in adolescents are comparable with those in adults, there is a pervasive reluctance to use ECT in children and adolescents. We report the case of a pre-pubertal child in an episode of severe depression with catatonic features, where a protracted course of ECT proved life-saving in spite of prolonged duration of seizures and delayed response to treatment. The case illustrates the safety and efficacy of ECT in children. Relevant literature is also reviewed along with the case report.
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Affiliation(s)
- P S Russell
- Department of Psychiatry, Christian Medical College, Vellore - 632 002, India.
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Abstract
BACKGROUND Electroconvulsive therapy (ECT) involves the induction of a seizure (fit) for therapeutic purposes by the administration of a variable frequency electrical stimulus shock via electrodes applied to the scalp. The effects of its use in people with schizophrenia are unclear. OBJECTIVES To determine whether electroconvulsive therapy (ECT) results in clinically meaningful benefit with regard to global improvement, hospitalisation, changes in mental state, behaviour and functioning for people with schizophrenia, and whether variations in the practical administration of ECT influences outcome. SEARCH STRATEGY Electronic searches of Biological Abstracts (1982-1996), EMBASE (1980-1996), MEDLINE (1966-2001), PsycLIT (1974-1996),SCISEARCH (1996) and the Cochrane Schizophrenia Group's Register (July 2001) were undertaken. The references of all identified studies were also inspected and authors contacted. SELECTION CRITERIA All randomised controlled clinical trials that compared ECT with placebo, 'sham ECT', non-pharmacological interventions and antipsychotics, and different schedules and methods of administration of ECT for people with schizophrenia, schizoaffective disorder or chronic mental disorder. DATA COLLECTION AND ANALYSIS Studies were reliably selected, quality rated and data extracted. For dichotomous data, relative risks (RR) were estimated, with the 95% confidence intervals (CI). Where possible, the number needed to treat statistic (NNT) was calculated. Analysis was by intention-to-treat. Normal continuous data was summated using the weighted mean difference (WMD). Scale data was presented for only those tools that had attained pre-specified levels of quality. Tests of heterogeneity and for publication bias were undertaken. MAIN RESULTS This review includes 24 trials with 46 reports. When ECT is compared with placebo or sham ECT, fewer people remain unimproved in the real ECT group (n=400, RR fixed 'not globally improved in the short term' 0.77 CI 0.6 to 0.9, chi-square 13.46 df=8 p=0.1). Removal of the one study with clearly heterogeneous results causes a change in the findings (n=380, 8 RCTs, RR fixed 0.83 CI 0.7 to 1.01), as does removal of a clinically heterogeneous trial (n=370, 8 RCTs, RR fixed 0.74 CI 0.6 to 0.9, chi-square 10.97 df=7 p=0.14). There was a suggestion that ECT resulted in less relapses than sham ECT (n=47, 2 RCTs, RR fixed 0.26 CI 0.03 to 2.2), and a greater likelihood of being discharged from hospital (n=98, 1 RCT, RR fixed 0.59, CI 0.34 to 1.01). There is no evidence that this early advantage for ECT is maintained over the medium to long term. People treated with ECT did not drop out of treatment earlier than those treated with sham ECT (n=495, 14 RCTs, RR fixed 0.71 CI 0.33 to 1.52). Very limited data indicated that visual memory might decline after ECT compared with sham ECT (n=24, 1 RCT, WMD -14.0 CI -23 to -5); the results of verbal memory tests were equivocal. When ECT is directly compared with antipsychotic drug treatment (total n=419, 8 RCTs), results favour the medication group (n=175, 3 RCTs, RR fixed 'not improved at the end of ECT course' 2.18 CI 1.3 to 3.6). One small study suggested more memory impairment after a course of ECT combined with antipsychotics than with antipsychotics alone (n=20, MD serial numbers and picture recall -4.90 CI -0. 8 to -9), though this proved transient. When continuation ECT was added to antipsychotic drugs, the combination was superior to the use of antipsychotics alone (n=30, WMD Global Assessment of Functioning 19.1 CI 9.7 to 28.5), or CECT alone (n=30, WMD -20.3 CI -11.5 to -29.1). Unilateral and bilateral ECT were equally effective in terms of global improvement (n=78, 2 RCTs, RR fixed 'not improved at end of course of ECT' 0.79 CI 0.5 to 1.4). One trial showed a significant advantage for 20 treatments over 12 treatments for numbers globally improved at the end of the ECT course (n=43, RR fixed 2.53 CI 1.1 to 5.7). REVIEWER'S CONCLUSIONS There is no evidence to clearly refute the use of ECT for people with schizophrenia. There is some limited evidence to support its use, particularly combined with antipsychotic drugs for those with schizophrenia who show limited response to medication alone. The research base for the use of ECT in people with schizophrenia is growing but, even after more than five decades of clinical use, is still inadequate.
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Affiliation(s)
- P Tharyan
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India, 632001.
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Tharyan P, John T, Tharyan A, Braganza D. Attitudes of 'tomorrow's doctors' towards psychiatry and mental illness. Natl Med J India 2001; 14:355-9. [PMID: 11804368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Attitudes to psychiatry and mental illness among medical undergraduates are key factors in determining their choice of psychiatry as a career and willingness to deal with psychiatric disorders in general practice. METHODS The responses of 108 medical students from the first and fourth year batches not exposed to psychiatry were compared with those of 139 final year students and interns who had completed varying components of psychiatric training using validated questionnaires that assessed their attitudes to psychiatry and mental illness, and their interest in psychiatry as a career choice. RESULTS A greater proportion of students exposed to psychiatric training endorsed positive attitudes to mental illness than those not exposed (odds ratio=0.4; 95% confidence intervals: 0.21-0.71; p=0.002). The overall attitude towards psychiatry did not differ between students before or after psychiatric education. Women students were more likely to consider a career in psychiatry (odds ratio=2.9; 95% confidence intervals: 1.36-6.21; p = 0.004), but the proportion of students of either gender wishing to pursue psychiatry as a career option did not differ significantly with psychiatric training. CONCLUSION Psychiatric education positively influences the attitudes of medical students towards mental illness and some aspects of psychiatry but does not increase the number of students wishing to pursue psychiatry as a career. Urgent and radical changes in psychiatric education for undergraduate medical students are required to meet current and future requirements of medical personnel trained to deal with psychiatric disorders.
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Affiliation(s)
- P Tharyan
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India.
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Tharyan P. Diagnostic stability was higher in schizophrenia than other psychoses. Evidence-Based Mental Health 2001. [DOI: 10.1136/ebmh.4.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Tharyan P. Is monitoring of platelets necessary during clozapine therapy ? Indian J Psychiatry 1999; 41:263-4. [PMID: 21455401 PMCID: PMC2963003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- P Tharyan
- Professor of Psychiatry, Christian Medical College, Vellore-632 002
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Tharyan P. The relevance to meta-analysis, systematic reviews and the cochrane collaboration to clinical psychiatry. Indian J Psychiatry 1998; 40:135-48. [PMID: 21494461 PMCID: PMC2965837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Traditional review articles provide clinicians with syntheses of the medical literature but are criticised as being haphazard in their methodology and biased in their conclusions. Systematic reviews use rigorous methods to minimise bias and statistical methods to synthesise results (meta-analysis) that increase power and precision. They permit investigation of generalisability and consistency, improve transparency of methodology, and enhance reproducibility. This article examines the science of systematic reviews and meta-analysis and their relevance to clinical psychiatry. It evaluates the potential errors and sources of bias of meta-analysis, and offers guidelines for evaluation of systematic reviews. It highlights the efforts of the Cochrane Collaboration which is an international organisation involved in preparing, maintaining and disseminating highly structured, frequently updated, and good quality systematic reviews of the effects of interventions in all aspects of health care.
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Affiliation(s)
- P Tharyan
- M.D., MRCPsych., Professor of Psychiatry, Christian Medical College, Vellore - 6320O2
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Sheehan BD, Tharyan P, McTavish SF, Campling GM, Cowen PJ. Use of a dietary manipulation to deplete plasma tyrosine and phenylalanine in healthy subjects. J Psychopharmacol 1996; 10:231-4. [PMID: 22302950 DOI: 10.1177/026988119601000309] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the present study was to lower plasma concentrations of tyrosine, the amino acid precursor of noradrenaline and to determine whether this manipulation impaired noradrenergic function as measured by the evening rise in concentrations of plasma melatonin. Eight healthy volunteers received three drinks: (i) an essential amino acid load with tyrosine, (ii) the same load without tyrosine and its precursor, phenylalanine and (iii) tap water. The tyrosine- and phenylalanine-deficient drink lowered plasma tyrosine by approximately 50% over 5 h. However, this did not alter the evening plasma melatonin levels compared to the other two drinks. The results suggest that amino acid loading produces a modest decline in plasma tyrosine levels but this does not lower noradrenergic neurotransmission in the pineal gland.
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Affiliation(s)
- B D Sheehan
- University Department of Psychiatry, Littlemore Hospital, Oxford OX4 4XN, UK
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Tharyan P. Tharyan et al's reply. Indian J Psychiatry 1995; 37:100. [PMID: 21743727 PMCID: PMC2971466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- P Tharyan
- MD., Department of Psychiatry, Christian Medical College, Vellore 632 002
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Tharyan P, Saju PJ, Datta S, John JK, Kuruvilla K. Tharyan et Al reply. Indian J Psychiatry 1994; 36:97-8. [PMID: 21743682 PMCID: PMC2972473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- P Tharyan
- Prathap Tharyan, Department of Psychiatry, Christian Medical College, Vellore-632 002
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Tharyan P, Saju PJ, Datta S, John JK, Kuruvilla K. Physical morbidity with unmodified ect - a decade of experience. Indian J Psychiatry 1993; 35:211-4. [PMID: 21743648 PMCID: PMC2980643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Recent recommendations for the routine use of modified ECT prompted an audit to be undertaken to determine the incidence of musculoskeletal complications occurring in patients who received ECT at our centre from 1980 to 1990. Of the 13,597 treatments given, 98% were unmodified, due to the lack of availability of anesthetists. Musculoskeletal complications occurred in less than 1% of treatments and were of little clinical significance. However, modified ECT was associated with significantly greater frequency of potentially fatal complications such as cardiac arrest. The findings of this audit indicate that unmodified ECT administered by a trained team does not result in significant musculoskeletal morbidity and may be preferable to modified ECT in the absence of trained anaesthetic personnel. The decision to routinely recommend modified ECT in developing countries should await scientific debate with due consideration of the complications, resources, ethics, practicality and cost as well as the consequences of such a recommendation on clinical practice.
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Affiliation(s)
- P Tharyan
- Prathap Tharyan, MD, Reader, Department of Psychiatry, Christian Medical College, Vellore - 632 002
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Tharyan P. Postictal hyperprolactinaemia. Natl Med J India 1992; 5:40. [PMID: 1304253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Tharyan P, Kuruvilla K, Prabhakar S. Prolactin in the diagnosis of epilepsy. Natl Med J India 1991; 4:225-230. [PMID: 29783610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The clinical differentiation of epileptic seizures from hysterical pseudo-epileptic seizures is sometimes difficult. The routine inter-ictal electroencephalogram is of limited use in such instances and prolonged electrophysiological monitoring for the detection of ictal changes may not always be feasible, especially in many centres in developing countries. This article focuses on hyperprolactinaemia as a biochemical marker of a recent ictus. It reviews studies that have explored the possibility of utilizing transient post-ictal elevations in serum prolactin as a diagnostic test in aiding the differentiation of epilepsy from hysterical pseudo-epilepticseizures, In the past decade many reports have documented post-ictal elevations in serum prolactin after tonic-clonic and complex partial seizures. Peak prolactin levels were observed 15 to 20 minutes after the ictus and values fell towards baseline within the hour. Evidence from these studies indicates that post-ictal hyperprolactinaemia is caused by involvement of medial temporal structures, especially the amygdala and hippocampus, by ictal discharges and the resultant disruption of tonic dopaminergic inhibition of prolactin release and/or stimulation of serotonin, rather than due to non-specific influences. The factors that affect the specificity, sensitivity and predictive value of post-ictal hyperprolactinaemia as a diagnostic test are discussed and a standard test procedure and definition of test result proposed that would improve its clinical utility. The test is recommended as a simple, relatively inexpensive, highly specific and fairly sensitive aid to diagnosis.
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Affiliation(s)
- P Tharyan
- Department of Psychiatry, Christian Medical College, Vellore 632004, Tamilnadu, India
| | - K Kuruvilla
- Department of Psychiatry, Christian Medical College, Vellore 632004, Tamilnadu, India
| | - S Prabhakar
- Department of Neurology, Christian Medical College, Vellore 632004, Tamilnadu, India
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Tharyan P. Prolactin levels in epilepsy. J Assoc Physicians India 1991; 39:505-6. [PMID: 1938864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Tharyan P, Kuruvilla K, Prabhakar S. Serum prolactin changes in epilepsy and hysteria. Indian J Psychiatry 1988; 30:145-52. [PMID: 21927300 PMCID: PMC3010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The usefulness of post-ictal serum prolactin changes, as an adjunct, in the differentiation of generalized tonic-clonic seizures and complex partial seizures from hysterical pseudoepileptic seizures, was investigated in a double blind study designed to control for variables known to alter prolactin levels. Significant post-ictal hyper-prolactinemia, with a peak at 20 minutes and a fall towards baseline by 1 hour, was found after complex partial seizures, generalized tonic-clonic seizures and after bilateral, unmodified ECT, but not after hysterical pseudoepileptic seizures or in stressed, non-epileptic controls. A proportionate increase in peak prolactin levels of at least thrice baseline values was found to best differentiate genuine seizures from pseudoepileptic seizures. Postictal hyperprolactinemia is a sensitive biochemical marker of a genuine seizure and of potential use in the differentiation of epileptic from hysterical pseudoepileptic seizures.
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Affiliation(s)
- P Tharyan
- Department of Psychiatry, Christian Medical College & Hospital, Vellore - 632 004, Tamil Nadu
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