Vascular age, cardiovascular disease risk factors, and hematological parameters in patients with Schizophrenia: An exploratory study

Objectives

Patients with schizophrenia have shortened life expectancy due to greater cardiovascular disease (CVD) risk. Due to sparse data, index study was planned to assess the CVD risk factors, vascular age (VA), and hematological parameters in patients with schizophrenia and the concordance between Framingham Risk Score (FRS) for lipids and body mass index (BMI) (FRSLIPIDS and FRSBMI).

Materials and Methods

Patients with schizophrenia (n = 53) were evaluated for the presence of metabolic syndrome (MS) using the modified NCEP ATP III criteria, along with their functionality, illness severity, physical activity and nutritional score, FRSLIPIDS and FRSBMI, and hematological parameters.

Results

Prevalence of MS was 39.6%; in addition, 47% of patients were at risk for developing MS as they fulfilled one or two components of MS criteria and 56% of patients were obese. BMI, obesity, and RBC count were found as significant correlates for MS. CVD risk (FRS) median score (3.10) was comparable for BMI and lipid criteria along with significant correlation for FRSLIPIDS and FRSBMI (r = 0.555, P < 0.001).

Conclusion

VA and 10-year CVD risk (FRS for BMI and lipid criteria) represent easier way to communicate with the patients and caregivers and also to guide for comprehensive treatment plan, appropriate nutrition, physical activity, and cardiometabolic screening.

Correlates of Metabolic Syndrome in Patients with Schizophrenia: An Exploratory Study

Metabolic syndrome (MS) is commonly reported in patients with severe mental illness including schizophrenia, but data is sparse from north-western India. The study was aimed to assess the metabolic profile in patients with schizophrenia. Patients with schizophrenia and healthy controls (N = 55 in each group) were recruited from psychiatric outpatient clinic and evaluated for the presence of metabolic syndrome using the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria. Prevalence of MS was significantly greater in patient group (34.5%), compared to healthy controls (14.5%). Other 31 patients (56.4%) had one or two metabolic abnormalities. Most common metabolic abnormality was higher waist circumference in both the groups. Nearly half of the patients (56%) were obese. Greater age, weight, body mass index, and obesity were significantly associated with MS and similar variables were significant predictors of MS. MS was not associated with duration and severity of schizophrenia (PANSS score), attitude towards psychotropics (DAI-10 score), functionality (GAF score) and demographic variables. Metabolic abnormalities were significantly greater in patients with schizophrenia. It calls for comprehensive evaluation of the patients with schizophrenia, with timely management and effective prevention of metabolic problems.

Emotional distress among health professionals involved in care of inpatients with COVID-19: a survey based cross-sectional study

INTRODUCTION

Health care workers (HCWs) are directly involved in processes linked with diagnosis, management, and assistance of coronavirus disease-19 (COVID-19) patients which could have direct implications on their physical and emotional health. Emotional aspects of working in an infectious pandemic situation is often neglected in favour of the more obvious physical ramifications. This single point assessment study aimed to explore the factors related to stress, anxiety and depression among HCWs consequent to working in a pandemic.

MATERIAL AND METHODS

This was a cross-sectional study involving healthcare workers who were working in COVID-19 inpatient ward, COVID-19 screening area, suspect ward, suspect intensive care unit (ICU) and COVID-19 ICU across four hospitals in India. A web-based survey questionnaire was designed to elicit responses to daily challenges faced by HCWs. The questionnaire was regressed using machine-learning algorithm (Cat Boost) against the standardized Depression, Anxiety and Stress Scale - 21 (DASS 21) which was used to quantify emotional distress experienced by them.

RESULTS

A total of 156 participants were included in this study. As per DASS-21 scoring, severe stress was seen in ∼17% of respondents. We could achieve an R² of 0.28 using our machine-learning model. The major factors responsible for stress were decreased time available for personal needs, increasing age, being posted out of core area of expertise, setting of COVID-19 care, increasing duty hours, increasing duty days, marital status and being a resident physician.

CONCLUSIONS

Factors elicited in this study that are associated with stress in HCWs need to be addressed to provide wholesome emotional support to HCWs battling the pandemic. Targeted interventions may result in increased emotional resilience of the health-care system.

Catastrophic Presentation of COVID-19 with Solitary Large Denovo Tumefactive Demyelination

Background

The ongoing Coronavirus disease-19 (COVID-19) pandemic has revealed a plethora of extrapulmonary manifestations including neurological presentations. To date, nervous system demyelination has been relatively infrequently reported in this setting. Also, while most data point toward immune activation as a causative process, few studies propound a direct effect.

Case Description

A 35-year-old man presented with severe new-onset headache, hemiparesis, and focal seizures culminating in deeply altered sensorium. Radiological evaluation showed a large expansile demyelinating lesion in the right cerebral hemisphere. Nasopharyngeal swab COVID reverse transcription-polymerase chain reaction (RT-PCR) was positive. After initial non-response to steroids, the patient responded well to plasma exchange leading to complete recovery.

Conclusions

This report highlights a case of active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection presenting with tumefactive demyelination and subsequent response to therapy. It is important to recognize atypical presentations at this juncture as it may be crucial for planning treatment strategies.

Relapse in bipolar disorder in hospitalized patients with COVID-19: A case series and key recommendations

COVID-19 has adversely affected the lives of people with bipolar disorder (BD). We have reported three patients with BD, who suffered from relapse after being diagnosed with COVID-19. Patient X is a 54-year-old man who developed manic episode, while Y is a 63-year-old man and Z is a 52-year-old woman who developed severe depression after being hospitalized for COVID-19. In this case series, three patients with BD who developed manic or depressive episodes during COVID-19 infection have been described. Adequate liaison between consultation-liaison psychiatrist and primary medical team was done. Rational pharmacotherapy along with psychosocial interventions led to favorable outcomes in all three cases.

Spotlight on Oculogyric Crisis: A Review

BACKGROUND

Oculogyric crisis (OGC) is a form of acute dystonia characterized by sustained dystonic, conjugate, and upward deviation of the eyes. It was initially reported in patients with postencephalitic parkinsonism. But later, other factors such as medications, movement disorders, metabolic disorders, and focal brain lesions were also found to be associated with OGC.

METHODS

The literature regarding OGC was searched via PubMed, Google Scholar, and through citations in relevant articles till December 2019, with keywords including OGC, oculogyric eye movements, tonic eye movement, neuroleptics and OGC, antipsychotics and OGC, and all combinations of these. Only original articles (abstract or full text) that were published in the English language were reviewed.

RESULTS

Hypodopaminergic state is implicated in the pathogenesis of OGC. Common risk factors are younger age, male sex, severe illness, high neuroleptic dose, parenteral administration of neuroleptics, high potency of neuroleptic drugs, abrupt discontinuation of anticholinergic medication, and family history of dystonia.

CONCLUSION

OGC is an acute dystonic reaction leading to tonic upward deviation of eyes. It is associated with various neurometabolic, neurodegenerative, and movement disorders and medications such as antipsychotics, antiemetics, antidepressants, antiepileptics, and antimalarials. OGC can adversely impact the compliance and prognosis of the primary illness. Hence, it needs to be managed at earlier stages with appropriate medication, primarily anticholinergics.

Correlates of metabolic syndrome in patients with depression: A study from north-western India

BACKGROUND AND AIMS

Metabolic syndrome (MS) is found to be prevalent in patients with mental illness including depression. Data is sparse on the role of lifestyle factors on MS in depression.

METHODS

This study was aimed to assess correlates of MS in patients with depression.

METHODOLOGY

Three hundred eighty-two patients with depressive disorders were assessed for the prevalence of MS by using modified National Cholesterol Education Program- Adult Treatment Panel-III criteria (NCEP ATP-III). Their illness severity, functionality, physical activity and nutritional habits were also assessed.

CONCLUSIONS

Majority of patients with depression (82.2%) were drug naive. One-fourth of the patients had metabolic syndrome (27.7%). Additionally, other 59% of patients had one or two metabolic abnormalities and one-third of patients were obese. Lower high density lipoprotein cholesterol level was the most common abnormality (65%), while abnormal blood pressure was the least common abnormality (18%). Significant correlates of MS were greater age, and age at onset of depression, greater illness duration, lesser physical activity and lower nutritional score.

CONCLUSION

Nearly one-fourth of patients with depression had MS; another three-fifth of patients had one or two metabolic abnormalities. MS was more commonly seen with sedentary lifestyle and poor nutritional habits. It calls for comprehensive assessment and timely management of cardiovascular risk factors as well as lifestyle factors in depression.

Vitamin D and Depression: A Critical Appraisal of the Evidence and Future Directions

BACKGROUND

Growing evidence points to the role of vitamin D in the pathobiology and treatment of depression. However, the evidence is inconsistent in many aspects. The objectives of this narrative review were to evaluate the state of the evidence, synthesize the knowledge gaps, and formulate recommendations for more enhanced research in this growing area.

METHODS

Electronic searches of MEDLINE via PubMed, Cochrane Library, and Google Scholar databases were carried out from inception till February 2019 to identify relevant English language peer-reviewed articles. Abstracts generated were systematically screened for eligibility. Included articles were grouped under three broad themes: The association between vitamin D and depression, its biological underpinnings, and trials evaluating the efficacy of vitamin D supplementation in depression. Relevant data were extracted as per a structured proforma.

RESULTS

A total of 61 articles were included in the present review. Overall findings were that there is a relationship between vitamin D and depression, though the directionality of this association remains unclear. The association appears to be driven by the homeostatic, trophic, and immunomodulatory effects of vitamin D. Evidence from supplementation trials suggest a more robust therapeutic effect on subjects with major depression and concurrent vitamin D deficiency.

CONCLUSION

Serum vitamin D levels inversely correlate with clinical depression, but the evidence is not strong enough to recommend universal supplementation in depression. Enriching depression treatment trials with subjects having concurrent vitamin D deficiency appears to be a potential step forward in identifying subgroups who may maximally benefit from this approach.

Association of Inflammatory and Liver Markers with Cardiometabolic Risk Factors in Patients with Depression

Metabolic syndrome (MS) is found to be more prevalent in patients with psychiatric disorders including depression. This study aimed to assess the association of inflammatory and liver markers with cardiometabolic risk factors in patients with Depressive disorders. Prevalence of MS by using Modified NCEP ATP-III Criteria and liver enzymes and CRP were assessed in 382 patients with depressive disorders. MS prevalence was 27.7% and lower HDL level was the commonest metabolic abnormality. ALT, GGT, and CRP levels were positively correlated with weight and BMI. ALT, GGT, and CRP levels were significantly greater in patients with abnormal waist circumference, triglyceride levels and raised blood pressure, compared to patients with normal indices. Such association was not found with abnormal HDL cholesterol and hyperglycemia. Levels of GGT and CRP were significantly greater in patients with MS compared to patients without MS and CRP was significant predictor for MS. To conclude, one-fourth of depressed patients had MS. MS and metabolic abnormalities were associated with inflammatory marker and liver enzymes. Patients with depression should be regularly evaluated for cardiovascular risk factors, liver enzymes, and inflammatory markers.

Galactorrhea with antidepressants: A case series

Galactorrhoea is a rare but distressing, and often embarrassing adverse effects of selective serotonin reuptake inhibitors (SSRIs) treatment. Here we report three cases that developed galactorrhoea with combination of SSRIs or combination of SSRI and SNRI/TCA and also review the literature of galactorrhoea with SSRIs.

Oculogyric crisis with atypical antipsychotics: A case series

Oculogyric crisis (OGC) is an acute dystonic reaction, commonly seen with the administration of typical antipsychotics, and rarely reported with atypical antipsychotics. Here, we report five cases of oculogyric crisis, developed after administration of atypical antipsychotics. The first case developed OGC on quetiapine 800 mg/day and the second case on olanzapine 20 mg/day. Both the patients did not improve on adding anticholinergic agents and finally stabilized by switching to clozapine. The third case developed OGC on amisulpride 400 mg and lurasidone 40 mg/day and improved by reducing amisulpride dose to 200 mg and stopping lurasidone. The fourth case developed OGC on aripiprazole 30 mg/day and improved by dose reduction. The fifth case developed OGC on amisulpride 400 mg/day and improved by switching to risperidone and anticholinergic combination. Oculogyric crisis is a potential side effect of antipsychotic medications (mostly with typical and rarely with atypical) and generally respond to oral anticholinergics, but in some cases, dose reduction or discontinuation of antipsychotic agent and switching to safer alternatives or clozapine is required.

Sleeping Beauty Syndrome: A Case Report and Review of Female Cases Reported from India

Kleine-Levin syndrome (KLS), also called "Sleeping beauty syndrome" is a rare, disorder predominantly reported in adolescent males, characterized by recurrent episodes of hypersomnia and to various degrees, hyperphagia, cognitive disturbances, and hypersexuality. Here, we are reporting a case of a middle-aged female, with 16 years delay in diagnosing KLS, poor response to most of the psychotropics, except good response to a combination of lithium, sertraline, and modafinil for last 12 months and also reviewing other female cases with KLS reported from India.

Frequency and pattern of radiological and laboratory investigations in patients with mental illnesses: A study from North Rajasthan

BACKGROUND

There are widespread perceptions that excessive and unnecessary investigations are done in many patients with mental illnesses. There are no studies from India looking into this issue.

AIMS

(i) To study the frequency and pattern of various investigations such as electroencephalography (EEG), computerized tomography (CT) scan of head, magnetic resolution imaging (MRI) scan of brain, and blood investigations carried out by the previous doctors on patients seeking treatment in three different settings. (ii) To study the socio-demographic and clinical correlates of investigations carried out on these patients.

STUDY DESIGN AND SETTINGS

A cross-sectional study in a community outreach clinic, a district level psychiatric hospital, and psychiatry outpatient clinic of a medical college.

MATERIALS AND METHODS

160 newly registered patients seeking treatment at these settings were assessed using a semi-structured pro forma regarding various investigations that they had undergone before seeking the current consultation. Frequency of investigations was analyzed.

RESULTS

About 47.5% of patients had at least one of the three brain investigations done. EEG, CT head, and MRI brain had been done in 37.5%, 20.0%, and 8.8% of the patients, respectively. Only 1.8% of the patients had blood tests done before current consultation.

CONCLUSION

This study results raise question whether certain investigations such as EEG and CT head were carried out excessively and blood investigations were done infrequently. Further studies on larger samples with prospective study design to evaluate the appropriateness of current practices of carrying out investigations in patients presenting with psychiatric symptoms are required.