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Mahal P, Deep R, Kumaran SS, Khandelwal SK. Elevated choline in dorsolateral prefrontal cortex of lithium responders with bipolar I disorder. Asian J Psychiatr 2023; 79:103318. [PMID: 36402079 DOI: 10.1016/j.ajp.2022.103318] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/05/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Response to lithium maintenance varies widely across patients with bipolar disorder (BD). The studies on neurochemical correlates of long-term lithium response in BD remain scant. AIM To assess the neurochemical profile in DLPFC based on lithium response status among subjects with bipolar I disorder (BD-I) using in vivo MRS. MATERIALS AND METHOD This was an observational study of 40 right-handed, euthymic adult participants with DSM-5 BD-I on long-term lithium maintenance with no psychiatric comorbidities (MINI 7.0). Using Alda Lithium Response Scale (LRS), a cut-off ≥ 7 for excellent lithium response, the sample was grouped into study group I for responders and group II for non-responders. All participants were assessed using NIMH Life Chart Method and IGSLI typical/atypical features scale. 1H-MRS was carried out on a 3 T MR scanner (Achieva, Phillips) using a 32-channel head coil, with a voxel placed at the left DLPFC. LC model was used to measure absolute concentrations of neurochemicals and their ratios in relation to creatine. RESULTS Group I (n = 20) was comparable to Group II (n = 20) with respect to demographic and illness profile. The GPC/Cr+PCr ratio was significantly higher (p = 0.028) among excellent lithium responders (0.32 ± 0.20 mmol/l) compared to sub-optimal responders (0.25 ± 0.05 mmol/l). Choline-containing compounds reflect alterations in cell membrane synthesis or myelin turnover, and are a marker of overall cell density. No significant alterations were detected in NAA, glutamate, glutamine, myo-inositol and creatine. CONCLUSION The lithium responders exhibited elevated choline (GPC) in the left DLPFC compared to non-responders.
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Affiliation(s)
- Pankaj Mahal
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Raman Deep
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - S Senthil Kumaran
- Department of Nuclear Magnetic Resonance (NMR), All India Institute of Medical Sciences, New Delhi 110029, India.
| | - S K Khandelwal
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India.
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Swami MK, Mahal P, Arora IK, Mishra VC, Panda TK, Nebhinani N, Kumar D, Banerjee M, Garg MK. Psychiatric morbidity among patients attending the post-COVID clinic and its association with hematological inflammatory markers. Asian J Psychiatr 2022; 78:103293. [PMID: 36279816 PMCID: PMC9547390 DOI: 10.1016/j.ajp.2022.103293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Mukesh Kumar Swami
- Department of Psychiatry, All India Institute of Medical Sciences, Basni Industrial Area, MIA 2nd Phase, Basni, Jodhpur, Rajasthan 342005, India.
| | - Pankaj Mahal
- Department of Psychiatry, All India Institute of Medical Sciences, Basni Industrial Area, MIA 2nd Phase, Basni, Jodhpur, Rajasthan 342005, India.
| | - Isha Kaur Arora
- Department of Psychiatry, All India Institute of Medical Sciences, Basni Industrial Area, MIA 2nd Phase, Basni, Jodhpur, Rajasthan 342005, India.
| | - Vikash Chandra Mishra
- Department of Psychiatry, All India Institute of Medical Sciences, Basni Industrial Area, MIA 2nd Phase, Basni, Jodhpur, Rajasthan 342005, India.
| | - Tushar Kanta Panda
- Department of Psychiatry, All India Institute of Medical Sciences, Basni Industrial Area, MIA 2nd Phase, Basni, Jodhpur, Rajasthan 342005, India.
| | - Naresh Nebhinani
- Department of Psychiatry, All India Institute of Medical Sciences, Basni Industrial Area, MIA 2nd Phase, Basni, Jodhpur, Rajasthan 342005, India.
| | - Deepak Kumar
- Department of General Medicine, All India Institute of Medical Sciences, Basni Industrial Area, MIA 2nd Phase, Basni, Jodhpur, Rajasthan 342005, India.
| | - Mithu Banerjee
- Department of Biochemistry, All India Institute of Medical Sciences, Basni Industrial Area, MIA 2nd Phase, Basni, Jodhpur, Rajasthan 342005, India.
| | - Mahendra Kumar Garg
- Department of General Medicine, All India Institute of Medical Sciences, Basni Industrial Area, MIA 2nd Phase, Basni, Jodhpur, Rajasthan 342005, India.
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Abstract
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.
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Affiliation(s)
- Pankaj Mahal
- Dept. of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Navratan Suthar
- Dept. of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Naresh Nebhinani
- Dept. of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Kumar S, Singh S, Mahal P, Vishwakarma A, Deep R. Assessment of lithium-related knowledge and attitudes among patients with bipolar disorder on long-term lithium maintenance treatment. Indian J Psychiatry 2020; 62:577-581. [PMID: 33678841 PMCID: PMC7909029 DOI: 10.4103/psychiatry.indianjpsychiatry_339_19] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/25/2019] [Accepted: 06/16/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Gaps in lithium-related knowledge among bipolar disorder (BD) patients on lithium prophylaxis may pose safety concerns and could adversely influence attitudes to lithium. OBJECTIVE To assess the lithium-related knowledge and attitudes among patients with BD. MATERIALS AND METHODS This was a cross-sectional, observational study assessing euthymic, adult outpatients with BD on lithium prophylaxis (≥1 year) using a semi-structured pro forma, lithium questionnaire for knowledge, lithium attitude questionnaire (LAQ), and medication adherence rating scale (MARS). RESULTS Descriptive analysis revealed several deficits in knowledge, including lack of critical safety information or need for periodic blood tests. Lower knowledge group had significantly more negative attitudes. Favorable attitude toward lithium (lower LAQ score) was significantly associated with the number of psychiatric follow-ups in the last year and MARS score. CONCLUSION There were critical deficits in lithium-related knowledge among the patients. Lower lithium knowledge was associated with negative lithium attitudes. Educative interventions should be delivered periodically to regular lithium users.
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Affiliation(s)
- Saurabh Kumar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Swarndeep Singh
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Mahal
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | | | - Raman Deep
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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Nebhinani N, Panda T, Saini V, Mahal P, Gupta T. Diagnostic dilemma and management difficulties in a case of chronic mania. J Mental Health Hum Behav 2020. [DOI: 10.4103/jmhhb.jmhhb_148_20] [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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Gehlawat P, Mahal P, Gupta T. Atypical presentation of bipolar disorder in adolescent. Arch Ment Health 2020. [DOI: 10.4103/amh.amh_40_20] [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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Singh S, Kumar S, Mahal P, Vishwakarma A, Deep R. Self-reported medication adherence and its correlates in a lithium-maintained cohort with bipolar disorder at a tertiary care centre in India. Asian J Psychiatr 2019; 46:34-40. [PMID: 31590007 DOI: 10.1016/j.ajp.2019.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Received: 07/11/2019] [Revised: 09/21/2019] [Accepted: 09/21/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Lithium remains a cornerstone of prophylaxis in bipolar disorder (BD), but adherence continues to be a major clinical challenge and merits a closer attention. There is scant literature available in Indian as well as Asian context. METHODS This study was conducted at Department of Psychiatry, AIIMS, New Delhi with an aim to assess the self-reported medication adherence and its correlates among a naturalistic, lithium-maintained cohort (n = 76) with bipolar disorder. Subjects were included if they were on lithium therapy ≥1 year, met DSM-5 diagnosis of bipolar disorder and were in clinical remission (≥1 month). Besides sociodemographic and clinical performa, participants were assessed on medication adherence rating scale (MARS), lithium questionnaire for knowledge and lithium attitude questionnaire (LAQ). RESULTS Mean age was 35.7 ± 10.6 years (males: 59.2%); median duration of illness and lithium therapy was 84 months and 24.5 months, respectively. Mean MARS score was 6.95 ± 2.81. Regression analysis (with MARS total as dependent variable) found LAQ score to be the single most significant predictor variable (β=-0.681, p < 0.0001), explaining over 75% of the total variance. In regression model with MARS factor-1 score as dependent variable, the 'LAQ score' (β=-0.601, p < 0.0001) and 'being accompanied by family during psychiatric visits (always/mostly) in the past year' (β = 0.193, p = 0.010) emerged as significant predictor variables. CONCLUSION Adherence in lithium-maintained treatment-seeking cohort of patients with BD remains far from ideal as observed in this naturalistic setting. Lithium-related attitudes and being accompanied by family during psychiatric visits were found to be significant predictors for adherence.
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Affiliation(s)
- Swarndeep Singh
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Saurabh Kumar
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Pankaj Mahal
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Anuranjan Vishwakarma
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Raman Deep
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
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Abstract
Trihexyphenidyl is an anticholinergic medication that is routinely used for the management of extrapyramidal symptoms in patients who receive antipsychotic medications. Trihexyphenidyl has been reported to be abused by some patients, who start to take it in increasing doses and tend to report a sensation of relaxation or pleasure with this medication. Hence, whether trihexyphenidyl should be considered a psychoactive substance and whether nonprescription misuse of this medication should be considered under the purview of substance use disorders need further clarity. We present here two cases of trihexyphenidyl misuse which developed in the context of persistent delusional disorders and highlight the challenges in diagnosis in such a situation.
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Affiliation(s)
- Pankaj Mahal
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - K N Nishanth
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Ananya Mahapatra
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
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Aneja J, Mahal P, Sudhakar G, Panda S, Tiwari S. Steroid-responsive Encephalopathy as a Semblance of Neuroleptic Malignant Syndrome in a Patient with Schizophrenia. Indian J Psychol Med 2019; 41:487-491. [PMID: 31548776 PMCID: PMC6753705 DOI: 10.4103/ijpsym.ijpsym_307_19] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jitender Aneja
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pankaj Mahal
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Gautam Sudhakar
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Samhita Panda
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sarbesh Tiwari
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Garg H, Verma R, Balhara Y, Sarkar S, Kumar S, Kumar N, Mahal P. Effect of targeted prefrontal cortex modulation with bilateral transcranial direct current stimulation (tDCS) in reducing craving in patients with opioid dependence: a case controlled trial. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.315] [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: 10/27/2022] Open
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