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Singh U, Das B, Khanra S, Roy C. Resting state and activated brain glutamate-glutamine, brain lactate, cognition, and psychopathology among males with schizophrenia: A 3 Tesla proton magnetic resonance spectroscopic (1H-MRS) study. Indian J Psychiatry 2024; 66:82-89. [PMID: 38419937 PMCID: PMC10898519 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_621_23] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/09/2023] [Accepted: 12/25/2023] [Indexed: 03/02/2024] Open
Abstract
Background Research on glutamate (Glu) in schizophrenia has so far been inconclusive. Based on preclinical studies on Glu lactate interaction, researchers have now focused on brain lactate level as a sign of major pathology, including cognitive dysfunctions in the brain. Our study aimed to examine changes at resting and activated states in brain lactate and Glu-glutamine (Glx) at the anterior cingulate cortex (ACC) in schizophrenia. Methods A hospital-based prospective study was conducted with twenty-two male cases of schizophrenia and matched healthy controls (HCs). Positive and Negative Syndrome Scale (PANSS), Montreal Cognitive Assessment (MoCA), and Stroop tasks were administered among patients. Brain lactate and Glx at ACC were measured at resting state and during the Stroop test with proton magnetic resonance spectroscopy (1H-MRS) both at baseline and at remission and once among HC. Result Though MoCA scores improved significantly (P < 0.001) at remission from baseline among cases, repeated-measures analysis of variance (RM-ANOVA) did not find a significant time effect for Glx (P = 0.82) and lactate (P = 0.30) among cases from baseline to remission. Glx and lactate changed differently from baseline to remission. Conclusion Our study did not find significant differences in Glx and lactate between schizophrenia patients and HC. No significant time effect on Glx and lactate was observed from baseline to remission among schizophrenia cases. Different changes observed in Glx and lactate from baseline to remission require replication in future studies with larger sample size, longer follow-up period, and multivoxel MR assessment.
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Affiliation(s)
- Ujjwal Singh
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Basudeb Das
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Sourav Khanra
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Chandramouli Roy
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
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Khanra S, Reddy P, Giménez-Palomo A, Park CHJ, Panizzutti B, McCallum M, Arumugham SS, Umesh S, Debnath M, Das B, Venkatasubramanian G, Ashton M, Turner A, Dean OM, Walder K, Vieta E, Yatham LN, Pacchiarotti I, Reddy YCJ, Goyal N, Kesavan M, Colomer L, Berk M, Kim JH. Metabolic regulation to treat bipolar depression: mechanisms and targeting by trimetazidine. Mol Psychiatry 2023; 28:3231-3242. [PMID: 37386057 PMCID: PMC10618096 DOI: 10.1038/s41380-023-02134-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/14/2023] [Accepted: 06/13/2023] [Indexed: 07/01/2023]
Abstract
Bipolar disorder's core feature is the pathological disturbances in mood, often accompanied by disrupted thinking and behavior. Its complex and heterogeneous etiology implies that a range of inherited and environmental factors are involved. This heterogeneity and poorly understood neurobiology pose significant challenges to existing drug development paradigms, resulting in scarce treatment options, especially for bipolar depression. Therefore, novel approaches are needed to discover new treatment options. In this review, we first highlight the main molecular mechanisms known to be associated with bipolar depression-mitochondrial dysfunction, inflammation and oxidative stress. We then examine the available literature for the effects of trimetazidine in said alterations. Trimetazidine was identified without a priori hypothesis using a gene-expression signature for the effects of a combination of drugs used to treat bipolar disorder and screening a library of off-patent drugs in cultured human neuronal-like cells. Trimetazidine is used to treat angina pectoris for its cytoprotective and metabolic effects (improved glucose utilization for energy production). The preclinical and clinical literature strongly support trimetazidine's potential to treat bipolar depression, having anti-inflammatory and antioxidant properties while normalizing mitochondrial function only when it is compromised. Further, trimetazidine's demonstrated safety and tolerability provide a strong rationale for clinical trials to test its efficacy to treat bipolar depression that could fast-track its repurposing to address such an unmet need as bipolar depression.
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Affiliation(s)
- Sourav Khanra
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Preethi Reddy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Anna Giménez-Palomo
- Bipolar and Depressive Disorders Unit, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Mental Health Biomedical Research Networking Center (CIBERSAM), Madrid, Spain
| | - Chun Hui J Park
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Bruna Panizzutti
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Madeleine McCallum
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Shreekantiah Umesh
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Monojit Debnath
- Department of Human Genetics, NIMHANS, Bengaluru, Karnataka, India
| | - Basudeb Das
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Melanie Ashton
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Alyna Turner
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Olivia M Dean
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Ken Walder
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Mental Health Biomedical Research Networking Center (CIBERSAM), Madrid, Spain
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Mental Health Biomedical Research Networking Center (CIBERSAM), Madrid, Spain
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Nishant Goyal
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Muralidharan Kesavan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Lluc Colomer
- Bipolar and Depressive Disorders Unit, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Mental Health Biomedical Research Networking Center (CIBERSAM), Madrid, Spain
| | - Michael Berk
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia.
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.
| | - Jee Hyun Kim
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia.
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.
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Balan A, Kannekanti P, Khanra S. Pathways to care for substance use treatment among tribal patients at a psychiatric hospital: A comparative study. J Neurosci Rural Pract 2023; 14:432-439. [PMID: 37692827 PMCID: PMC10483211 DOI: 10.25259/jnrp_30_2023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/04/2023] [Indexed: 09/12/2023] Open
Abstract
Objectives According to the national mental health survey, substance use disorders (SUDs) are prevalent in 22.4% of the population above 18 years, whereas the same is 26% among the tribal population. The treatment gap is also high in substance-addictive disorders. Our study aimed to compare the severity of substance use, pathways to psychiatric care, and treatment-seeking behavior among the tribal and non-tribal populations. Materials and Methods The study was conducted at a tertiary psychiatric teaching institute in India. It was a cross-sectional comparative study. Patients fulfilling the International Classification of Disease 10 diagnostic criteria of mental and behavioral disorders due to substance use, with active dependence, were taken without comorbidity. Forty patients in tribal and non-tribal groups were recruited with consecutive sampling. The samples were assessed with a semi-structured interview schedule, addiction severity index, attitudes toward help-seeking, and pathways-to-care. Results Excessive substance use median was for 7.00 (± 5.00) years in tribal and 6.00 (± 4.00) years in non-tribal; in tribal, substance intake was younger than non-tribal (P = 0.167), and general health-care system more distance than the non-tribal (P < 0.001). Around 65% of the persons with SUD never consulted their general practitioner and primary health-care facilities. Alcohol severity was higher in the tribal population than in the non-tribal population. The cannabis and opioid severity was high in the non-tribal population. Help-seeking behavior was deficient in both groups. Conclusion Most of the substance abuse tribal and non-tribal populations reach healthcare very late and do not consider it as a health issue initially. The major reason for the delayed pathway is a lack of awareness about mental health care facilities and stigma in both populations. The stigma is high in non-tribal communities compared to the tribal community. There is a need to improve the identification and treatment of alcohol morbidity in primary care.
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Affiliation(s)
- Arathi Balan
- Department of Psychiatric Social Work, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Prasad Kannekanti
- Department of Psychiatric Social Work, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Sourav Khanra
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
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Khanra S, Mukherjee A, Munda SK. Sex Differences in Profiles and Treatment-Seeking Among Patients Visiting the Drug Dependence Treatment Center at a Psychiatric Hospital in India. Indian J Psychol Med 2023; 45:201-204. [PMID: 36925486 PMCID: PMC10011850 DOI: 10.1177/02537176221078431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sourav Khanra
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Aniruddha Mukherjee
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Sanjay Kumar Munda
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
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Saha S, Bhattacharjee D, Kannnekanti P, Pachori H, Khanra S. A comparison of stress, coping, empathy, and personality factors among post-graduate students of behavioural science and engineering courses. Indian J Psychiatry 2023; 65:113-114. [PMID: 36874518 PMCID: PMC9983451 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_698_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/08/2021] [Accepted: 12/17/2022] [Indexed: 01/13/2023] Open
Affiliation(s)
- Soma Saha
- Department of Psychiatric Social Work, Institute of Psychiatry, Kolkata, West Bengal, India
| | - Dipanjan Bhattacharjee
- Department of Psychiatric Social Work, Central Institute of Psychiatry, Ranchi, Jharkhand, India E-mail:
| | - Prasad Kannnekanti
- Department of Psychiatric Social Work, Central Institute of Psychiatry, Ranchi, Jharkhand, India E-mail:
| | - Hariom Pachori
- Statistician, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Sourav Khanra
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
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Mukherjee A, Kumre PK, Goyal N, Khanra S. Adjunctive neuronavigated accelerated continuous theta-burst stimulation in obsessive-compulsive disorder: a randomized sham-controlled study. CNS Spectr 2022; 28:1-10. [PMID: 36059099 DOI: 10.1017/s1092852922000980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/06/2022]
Abstract
BACKGROUND Approximately 40% of patients treated for obsessive-compulsive disorder (OCD) do not respond to standard and second-line augmentation treatments leading to the exploration of alternate biological treatments. Continuous theta burst stimulation (cTBS) is a form of repetitive transcranial magnetic stimulation inducing more rapid and longer-lasting effects on synaptic plasticity than the latter. To the best of our knowledge, only one recent study and a case report investigated the effect of cTBS at the supplementary motor area (SMA) in OCD. OBJECTIVE This study aimed to examine the effect of accelerated robotized neuronavigated cTBS over SMA in patients with OCD. METHODS A total of 32 patients with OCD were enrolled and randomized into active and sham cTBS groups. For active cTBS stimulation, an accelerated protocol was used. Bursts of three stimuli at 50 Hz, at 80% of MT, repeated at 5 Hz were used. Daily 2 sessions of 900 pulses each, for a total of 30 sessions over 3 wk (weekly 10 sessions), were given. Yale-Brown Obsessive-Compulsive Rating Scale (YBOCS), Clinical Global Impressions scale (CGI), Hamilton Depression Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A) were administered at baseline and at end of weeks 3 and 8. RESULTS A total of 26 patients completed the study. Active cTBS group showed significant group × time effect in YBOCS obsession (P < .001, η2 = 0.288), compulsion (P = .004, η2 = 0.207), YBOCS total (P < .001, η2 = 0.288), CGI-S (P = .010, η2 = 0.248), CGI-C (P = .010, η2 = 0.248), HAM-D (P = .014, η2 = 0.224) than sham cTBS group. CONCLUSIONS Findings from our study suggest that adjunctive accelerated cTBS significantly improves psychopathology, severity of illness, and depression among patients with OCD. Future studies with larger sample sizes will add to our knowledge.
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Affiliation(s)
- Aniruddha Mukherjee
- Centre for Cognitive Neuroscience, Central Institute of Psychiatry, Ranchi, India
| | - Pramod Kumar Kumre
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, India
| | - Nishant Goyal
- Centre for Cognitive Neuroscience, Central Institute of Psychiatry, Ranchi, India
| | - Sourav Khanra
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, India
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Kumar AS, Khanra S, Goyal N, Dharani R, Roy C. Adjunctive High-Definition Transcranial Direct Current Stimulation in Brain Glutamate-Glutamine and γ-Aminobutyric Acid, Withdrawal and Craving During Early Abstinence Among Patients With Opioid Use Disorder on Buprenorphine-Naloxone: A Proton Magnetic Resonance Spectroscopy-Based Pilot Study. J ECT 2022; 38:124-132. [PMID: 35537121 DOI: 10.1097/yct.0000000000000820] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our study aimed to (1) examine the effect of adjunctive high-definition transcranial direct current stimulation (HD-tDCS) in craving and withdrawal among patients with opioid use disorder on buprenorphine-naloxone, and (2) examine effect of HD-tDCS changes in glutamate-glutamine and γ-aminobutyric acid (GABA) at the left dorsolateral prefrontal cortex (DLPFC) among patients with opioid use disorder on buprenorphine-naloxone. METHODS This was a pilot randomized double-blind, sham-controlled parallel-group study. A total of 28 patients on buprenorphine-naloxone (6/1.5 mg/d) were randomly allocated into 2 groups for active and sham HD-tDCS stimulation. High-definition transcranial direct current stimulation was administered twice daily for consecutive 5 days, from days 2 to 6. The Clinical Opiate Withdrawal Scale (COWS), the Desire for Drug Questionnaire (DDQ), the Obsessive-Compulsive Drug Use Scale (OCDUS), and glutamate-glutamine and GABA at DLPFC via proton magnetic resonance spectroscopy were measured at baseline and on day 7. RESULTS Both active and sham groups had comparable changes in DDQ, OCDUS (except 2 subcomponents), COWS, and glutamate-glutamine and GABA at DLPFC. In the active HD-tDCS group, statistically significant reductions were observed in DDQ, OCDUS, and COWS but not in glutamate-glutamine and GABA. CONCLUSIONS The adjunctive active HD-tDCS group showed comparable changes in craving and withdrawal, and glutamate-glutamine and GABA at DLPFC compared with sham HD-tDCS. Craving and withdrawal but not glutamate-glutamine and GABA at DLPFC decreased significantly with adjunctive HD-tDCS. Future studies with larger sample size and online assessment of glutamate-glutamine and GABA would enhance our knowledge.
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Affiliation(s)
| | | | - Nishant Goyal
- Cognitive Neuroscience, Central Institute of Psychiatry, Ranchi, India
| | | | - Chandramouli Roy
- Cognitive Neuroscience, Central Institute of Psychiatry, Ranchi, India
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Khanra S, Singh U, Munda SK, Das B. Demographic and clinical profile of women receiving inpatient treatment at a deaddiction unit of a psychiatric hospital in India: Five years' observation. Ind Psychiatry J 2022; 31:177-180. [PMID: 35800856 PMCID: PMC9255629 DOI: 10.4103/ipj.ipj_84_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/17/2021] [Accepted: 06/26/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
- Sourav Khanra
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Ujjwal Singh
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Sanjay Kumar Munda
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Basudeb Das
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
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Dey A, Khanra S, Kshitiz KK. Serum calcium, parathormone, calcitonin, vitamin D and their relationships with craving during early abstinence in alcohol use disorder: A hospital based prospective study. Asian J Psychiatr 2021; 66:102898. [PMID: 34740124 DOI: 10.1016/j.ajp.2021.102898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Aheli Dey
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi 834006, India.
| | - Sourav Khanra
- Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi 834006, India.
| | - K K Kshitiz
- Department of Biochemistry, Central Institute of Psychiatry, Ranchi 834006, India.
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Khanra S, Mukherjee A, Goyal N, Das B, Munda SK. Service utilization and saved travel cost in telepsychiatry consultation by outpatients at a psychiatric hospital in India during COVID-19 pandemic. Asian J Psychiatr 2021; 57:102568. [PMID: 33535135 PMCID: PMC7840431 DOI: 10.1016/j.ajp.2021.102568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Sourav Khanra
- Central Institute of Psychiatry, Ranchi, 834006, Jharkhand, India.
| | | | - Nishant Goyal
- Central Institute of Psychiatry, Ranchi, 834006, Jharkhand, India.
| | - Basudeb Das
- Central Institute of Psychiatry, Ranchi, 834006, Jharkhand, India.
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Verma DK, Khanra S, Goyal N, Das B, Khess CRJ, Munda SK, Ram D. Absconding During Inpatient Care from a Tertiary Psychiatric Hospital: A Comparative Study. Indian J Psychol Med 2020; 42:456-463. [PMID: 33414593 PMCID: PMC7750842 DOI: 10.1177/0253717620929182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/05/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Absconding from psychiatric hospitals is of great concern for patients and caregivers. Absconding affects not only the treatment and safety of these patients but also patient's caregivers and the community. Further investigation is needed to examine the pattern of this event and the characteristics of patients who abscond. Hence, our study was aimed to examine the sociodemographic and clinical profiles of inpatients who absconded from a psychiatric hospital in five years and to compare them with matched controls. METHODS A retrospective chart review of inpatients who absconded and matched control inpatients during the specified period of five years from January 2014 to December 2018 was done at a psychiatric hospital. Each control was matched with a corresponding absconding case on the following order: (a) admission ward, (b) admission period, (c) diagnosis, and (d) age. Results: Among 20,052 adult admissions during the specified period, 38 patients absconded, with a rate of 1.8 per 1,000 admissions. Most of them were male, from a younger age group, diagnosed with schizophrenia or mood disorder, and having comorbid substance use disorder, irritable affect, impaired judgment, and absent insight. Most of the events occurred within the first two weeks of admission. About 11% of them had a history of prior absconding from the hospital. CONCLUSION Knowledge about the associated sociodemographic and clinical profile would help clinicians and mental health care professionals to prevent absconding. Further risk assessment using a patient's profile would help to reduce absconding events from psychiatric hospitals in the future.
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Affiliation(s)
| | - Sourav Khanra
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Nishant Goyal
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Basudeb Das
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | | | | | - Daya Ram
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
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Vats P, Das B, Khanra S. Responses to the Comments on "Serum Lipids Among Drug Naïve or Drug-Free Patients with Obsessive Compulsive Disorder and Their Association with Impulsivity: A Comparative Study". Indian J Psychol Med 2020; 42:486. [PMID: 33414601 PMCID: PMC7750854 DOI: 10.1177/0253717620944612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Purvi Vats
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Basudeb Das
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Sourav Khanra
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
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Khanra S, Goyal N, Khess CRJ. Comments on "Psychological impact of COVID-19 pandemic on general population in West Bengal: A cross-sectional study". Indian J Psychiatry 2020; 62:447-448. [PMID: 33165352 PMCID: PMC7597716 DOI: 10.4103/psychiatry.indianjpsychiatry_607_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/20/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sourav Khanra
- Deaprtment of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India. E-mail:
| | - Nishant Goyal
- Deaprtment of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India. E-mail:
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Vats P, Das B, Khanra S. Serum Lipids among Drug Naïve or Drug-Free Patients with Obsessive Compulsive Disorder and their Association with Impulsivity: A Comparative Study. Indian J Psychol Med 2020; 42:281-289. [PMID: 32612334 PMCID: PMC7320738 DOI: 10.4103/ijpsym.ijpsym_299_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/27/2019] [Accepted: 03/16/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The derangement of serum lipids is well documented in psychiatric disorders like schizophrenia, mania, and depression but not in obsessive compulsive disorder (OCD), where it has been inadequately examined. Also, serum lipid abnormalities are increasingly found in "impulsivity," an important sub-construct of OCD. Our study aimed to examine serum lipid profile among patients with OCD and its association with clinical profile and impulsivity among them. METHODS Forty drug naïve or drug-free (four weeks for oral and eight weeks for any depot psychotropics) patients with OCD according to International Classification of Disease -10th version (ICD-10): Diagnostic Criteria for Research (DCR) by the World Health Organization (WHO), from outpatient and inpatient departments of a tertiary care psychiatric hospital were recruited. Measures like Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamliton Rating Scale for Depression (HAM-D), Barratt's Impulsivity Scale (BIS-11), and Hamilton Rating Scale for Anxiety (HAM-A) were administered. Forty age and sex-matched healthy controls (HC) were recruited after screening with General Health Questionnaire 12 (GHQ-12). Serum lipids were assessed in both the groups. RESULTS Serum high density lipoproteins (HDL) (P < 0.001; partial η2 = 0.176) and apolipoprotein B (P < 0.001; partial η2 = 0.531) were significantly higher in OCD group than age- and sex-matched HC. A trend toward lower serum HDL (P = 0.06; partial η2 = 0.060) was observed among patients of OCD with high impulsivity. Serum HDL was negatively correlated with BIS attention (rs =-0.32; p = 0.03), BIS motor (rs = 0.40; P = 0.01), BIS non-planning (rs = - 0.36; P = 0.02), and BIS total (rs = - 0.36; P = 0.01) scores. Serum triglycerides (TG) (rs = 0.34; P = 0.03) and apolipoprotein B (rs = -0.32; P = 0.04) were negatively correlated with Y-BOCS compulsion score. Serum TG (rs = -0.45, P < 0.01) and serum very low density lipoprotein (VLDL) was negatively (rs = -0.39; P = 0.01) correlated with Y-BOCS total scores. Serum VLDL was positively (rs = 0.34; P = 0.03) correlated with BIS motor scores. CONCLUSIONS Serum lipid fractions are deranged among patients with OCD. Different lipid fractions have different associations with clinical profiles of OCD. Impulsivity among patients with OCD may have a specific association with serum lipids. A small sample size, use of self-report measure without adaptation for impulsivity, a lack of metabolic profile assessment among participants, and a lack of assessment of impulsivity among HC were the limitations of our tudy.
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Affiliation(s)
- Purvi Vats
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Basudeb Das
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Sourav Khanra
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
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Khanra S, Sahu AK, Khess CRJ. Intravenous Use of Lemon Juice with Brown Sugar: A Potentially Fatal Cook-Up Technique? J Neurosci Rural Pract 2019; 10:386-388. [PMID: 31001047 PMCID: PMC6454969 DOI: 10.4103/jnrp.jnrp_333_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sourav Khanra
- S. S. Raju Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Amiya Krushna Sahu
- S. S. Raju Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
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Affiliation(s)
- Sourav Khanra
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India. E-mail:
| | - Christoday R J Khess
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India. E-mail:
| | - Sanjay K Munda
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India. E-mail:
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Affiliation(s)
- Sourav Khanra
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Basudeb Das
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
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Abstract
Clinical signs and symptoms of posterior cerebral artery (PCA) stroke are varied and can be challenging to diagnose at early stage. A case of bilateral PCA infarct presenting with marked behavioral symptoms and minimal neurological symptoms is presented here. A 34 years old female had presented with marked behavioral symptoms, blurring of vision and tingling sensation in left half of body. Though the latter complaints resolved following day, her behavioral complaints persisted. Magnetic Resonance Imaging (MRI) of brain revealed acute non-hemorrhagic infarct in bilateral PCA territory. Psychotropics were beneficial for her behavioral symptoms. Isolated behavioral symptoms in PCA stroke led to speculate anatomical substrate for those symptoms. We discussed possible anatomical substrates for behavioral symptoms. Our case adds to the existing literature on a range of disguising presentations in PCA stroke and also emphasizes those distinctions between 'neurological' or 'psychological' or 'psychiatric' disorders are often sketchy.
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Affiliation(s)
- Sourav Khanra
- Department of Psychiatry, ICARE Institute of Medical Sciences and Research, Haldia, West Bengal, India
| | - Neelanjana Paul
- Department of Psychiatry, ICARE Institute of Medical Sciences and Research, Haldia, West Bengal, India
| | - Swapan Mukherjee
- Department of Pediatric Neurology, Institute of Child Health, Kolkata, West Bengal, India
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Khanra S, Munda SK, Khess CRJ, Maity M. New psychoactive substances: Can there be any effective legal enforcement? Asian J Psychiatr 2017; 30:165-166. [PMID: 29073586 DOI: 10.1016/j.ajp.2017.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 10/13/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Sourav Khanra
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi 834006, India.
| | - Sanjay Kumar Munda
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi 834006, India.
| | | | - Manosij Maity
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi 834006, India.
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Affiliation(s)
- Sourav Khanra
- Department of Psychiatry, ICARE Institute of Medical Sciences & Research, Haldia 721645, India.
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Khanra S, Das S. Mirtazapine Is Effective in Steroid Withdrawal Syndrome Related Depression: A Case Report. Clin Psychopharmacol Neurosci 2017; 15:73-75. [PMID: 28138116 PMCID: PMC5290723 DOI: 10.9758/cpn.2017.15.1.73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/18/2016] [Accepted: 03/08/2016] [Indexed: 11/24/2022]
Abstract
Steroid withdrawal syndrome (SWS) following steroid dependence is becoming a common clinical condition. It may be associated with body image disorder. Though selective serotonin reuptake inhibitors (SSRIs) are found to be effective SWS associated depression, data for this clinical condition is limited. We present a case of SWS associated with body image disorder which improved with mirtazapine. Mirtazapine might be better option than SSRIs in this subgroup of patients for its noradrenergic property and better gastrointestinal profile. More research should explore its efficacy in this clinical condition.
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Affiliation(s)
- Sourav Khanra
- Department of Psychiatry, ICARE Institute of Medical Sciences and Research, Haldia, India
| | - Sourav Das
- Department of Psychiatry, ICARE Institute of Medical Sciences and Research, Haldia, India
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Khanra S, Srivastava N, Khess CJ, Munda S. Does opioid and ketamine “codependence” exist? Indian J Soc Psychiatry 2017. [DOI: 10.4103/0971-9962.200097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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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Abstract
OBJECTIVE Risk factors for inpatient suicide are different from those in the general population. We examined sociodemographic and clinical variables of patients who committed suicide as an inpatient in a psychiatric hospital in India. METHODS Matched retrospective nested case-control design was adopted. Ten patients who died by suicide as inpatients between 2000 and 2013 were included, along with fifty controls, matched with respect to age, sex, diagnosis, and period of admission. RESULTS Suicide completers were mostly unskilled in occupation (P = 0.03), had a history of past suicide attempts (P < 0.001), shorter duration of hospital stay (P = 0.001), poorer improvement on psychopathology (P = 0.02), and were having more suicidal ideation (P = 0.02). Significantly more completers were receiving antidepressants (P = 0.04). CONCLUSION This study adds to the existing sparse literature on inpatient suicides from Asia. Strength of the study was close matching between case and controls and blindedness. Limitations were retrospective design, and variations in prescription behavior and treatment decisions.
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Affiliation(s)
- Sourav Khanra
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | | | - Swarnali Bose
- Department of Clinical Psychology, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | | | - Shreekantiah Umesh
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Daya Ram
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
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Abstract
OBJECTIVE Several significant midline abnormalities including cavum septum pellucidum (CSP) have been reported in schizophrenia. However, not all studies were able to replicate similar findings. Furthermore, very few of them were conducted with large samples. METHODS CSP was identified and graded with 16 slice computed tomography (CT) machine in 138 patients of schizophrenia and 64 controls. RESULTS We found 21.0% of patients in schizophrenia group had abnormal CSP compared to only 9.4% in control group (P = 0.047). Grade III was most frequent type (19.6%) in schizophrenia group. CONCLUSIONS Our study adds to the existing literature suggesting abnormal CSP may reflect neurodevelopmental process in schizophrenia. The strength of our study was larger sample size. Limitations were use of CT, male predominance in schizophrenia group, the inclusion of nonpsychiatric patients in control group.
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Affiliation(s)
- Sourav Khanra
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | | | - Vivek Chail
- Center for Neuroimaging and Radio Diagnosis, Central Institute of Psychiatry, Ranchi, Jharkhand, India
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Khanra S, Sen S. Pharmacoterrorism: We should be worried. Asian J Psychiatr 2016; 22:83. [PMID: 27520902 DOI: 10.1016/j.ajp.2016.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 05/14/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Sourav Khanra
- Department of Psychiatry, ICARE Institute of Medical Sciences & Research, Haldia 721645, India.
| | - Sukanta Sen
- Department of Pharmacology, ICARE Institute of Medical Sciences & Research, Haldia 721645, India.
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Bose S, Khanra S, Umesh S, Khess CRJ, Ram D. Inpatient suicide in a psychiatric hospital: Fourteen years' observation. Asian J Psychiatr 2016; 19:56-8. [PMID: 26957339 DOI: 10.1016/j.ajp.2015.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 12/06/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Swarnali Bose
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi 834006, India.
| | - Sourav Khanra
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi 834006, India.
| | - Shreekantiah Umesh
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi 834006, India.
| | - Christoday R J Khess
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi 834006, India.
| | - Daya Ram
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi 834006, India.
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Khanra S, Sethy RR, Munda SK, Khess CRJ. An Unusual Case of Delirium after Restarting Clozapine. Clin Psychopharmacol Neurosci 2016; 14:107-8. [PMID: 26792049 PMCID: PMC4730934 DOI: 10.9758/cpn.2016.14.1.107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/02/2015] [Accepted: 07/27/2015] [Indexed: 12/24/2022]
Abstract
Clozapine is a gold standard medication and drug of choice in refractory schizophrenia. Among many of its fatal side effects, delirium is less reported and inconsistently recognized by clinicians. We here present a case of delirium which emerged during retreatment with clozapine in a patient of paranoid schizophrenia. A patient diagnosed with paranoid schizophrenia, was restarted on clozapine after he left medications and became symptomatic. He was delirious on 22nd day after clozapine was restarted. Clozapine was stopped and the patient was managed with standard treatment for delirium. After one week interval, clozapine was restarted. Delirium was not noted till 6 weeks of his hospital stay. Clozapine induced central anticholinergic toxicity or clozapine induced seizure might cause delirium in index case. Limited literature exist delirium with clozapine. Clinicians must have high index of suspicion to detect delirium during clozapine therapy. More researches should focus to explore the association between delirium and clozapine.
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Affiliation(s)
- Sourav Khanra
- Department of Psychiatry, ICARE Institute of Medical Sciences and Research, Haldia, India
| | - Rati Ranjan Sethy
- Department of Psychiatry, Institute of Medical Sciences & SUM Hospital, Bhubaneswar, India
| | - Sanjay Kumar Munda
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, India
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Mitra S, Khanra S, Mondal SK, Kavoor AR, Das B. Carbamazepine in Treatment of Visual Hallucinations: A Case of Chronic Hallucinatory Psychosis. Indian J Psychol Med 2015; 37:449-51. [PMID: 26702181 PMCID: PMC4676215 DOI: 10.4103/0253-7176.168594] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Visual hallucinations are commonly present in various neurological and psychiatric conditions such as schizophrenia and other hallucinatory psychosis. Current conceptualization of hallucinations assume pattern completion model of thalamus to be responsible for the origin of this type of the perceptual abnormality and proposes that central inhibition of such circuits may treat hallucinations. We present a case of chronic hallucinatory psychosis with significantly distressing visual hallucinations, resistant to antipsychotics, which successfully responded to carbamazepine. This case illustrates the novel use of an antiepileptic in the treatment of resistant visual hallucinations. Targeted therapy of this kind can be considered in the future, although more evidence is required in this field.
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Affiliation(s)
- Sayantanava Mitra
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Sourav Khanra
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Supriya Kumar Mondal
- Department of Psychiatry, Murshidabad Medical College, Murshidabad, West Bengal, India
| | - Anjana Rao Kavoor
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Basudeb Das
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
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Khanra S, Khess C, Srivastava N. Chronic non-fatal Datura abuse in a patient of paranoid schizophrenia: a case report. Addict Behav 2015; 43:39-41. [PMID: 25544354 DOI: 10.1016/j.addbeh.2014.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 12/03/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A range of psychoactive substances used by patients suffering from schizophrenia varies and may include those which are fatal and may cause serious toxicity leading to death. We here present a case report of a patient suffering from paranoid schizophrenia, who was abusing Datura stramonium over a prolonged period. CASE SUMMARY A 32 year old male presented with aggressive behaviour, irritability for 6 years and regular intake of Datura seeds for 3 years. After taking detailed history and mental status examination (MSE), diagnoses of paranoid schizophrenia and mental and behavioral disorder due to use of hallucinogen were made. He had shown improvement on standard treatment with antipsychotics. CONCLUSION D. stramonium is recognized among emerging new psychoactive substances being used across the world. Among various theories we discuss self-medication hypothesis as a mediating factor for this case. Though D. stramonium is notorious for its life threatening sequelae, clinicians should be aware of its chronic abuse as self-medication.
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Khanra S, Mahintamani T, Khess CRJ. Does withdrawal seizure occur in opioid dependence syndrome? A case series. Psychiatry Clin Neurosci 2015; 69:238-9. [PMID: 25163508 DOI: 10.1111/pcn.12234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/07/2014] [Accepted: 08/20/2014] [Indexed: 11/28/2022]
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Abstract
Cavum septum pellucidum (CSP) is a neurodevelopmental anomaly, which is commonly reported in schizophrenia patients. Various symptoms of schizophrenia, including thought disturbances have been associated with CSP. We present a rare case of undifferentiated schizophrenia with CSP who presented with self-mutilating behaviors.
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Affiliation(s)
- Shreekantiah Umesh
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, India
| | - Swarnali Bose
- Training Co-ordinator Project HIFAZAT Central Institute of Psychiatry, Ranchi, India
| | - Sourav Khanra
- Department of Psychiatry, ICARE Institute of Medical Sciences and Research, Haldia, West Bengal, India
| | - Basudeb Das
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, India
| | - S Haque Nizamie
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, India
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Carpenter CC, Mitra PP, Biern RC, Dans PE, Wells SA, Khanra S. Electrocardiographic findings during treatment of acute cholera patients. Bull Calcutta Sch Trop Med 1965; 13:38-40. [PMID: 5827190] [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: 01/16/2023]
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