Biomedical subjects
P Sachdev
Publications and source records attributed to P Sachdev.
Egas Moniz: a commemoration.
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Tardive blepharospasm.
I report on five patients with tardive blepharospasm seen in a movement disorders clinic, out of 25 tardive dystonia patients. They were young (aged 25-50 yrs); four were men and three had a schizophrenic disorder. The onset was gradual while on maintenance neuroleptics in four and on withdrawal in the fifth. There were no significant antecedent events precipitating the disorder. The disorder was bilateral but asymmetric in two cases. Dyskinetic blinking was often an initial feature and tended to persist after the resolution of the blepharospasm. Orolingual dyskinesia was present in one case and tardive akathisia in two other cases. The symptoms fluctuated in severity with a number of exacerbating and relieving factors. Reduction of neuroleptic dose led to improvement with complete reversal in one of two patients who could be withdrawn off neuroleptic medication. These reports suggest that TB, although uncommon, can be a disabling disorder that may improve considerably with the cessation or dose reduction of the neuroleptic drugs. Its treatment and longitudinal course should be further examined.
Sex on campus: a preliminary study of knowledge, attitudes and behaviour of university students in Delhi, India.
Eight hundred and eighty-seven students from two major universities in Delhi, India, were surveyed, using a self-administered questionnaire, about their sexual knowledge, attitudes and behaviour. The data show that female students seem to be rejecting traditional Indian repressive sexual standards of premarital and non-procreative sex and the gender differences are beginning to narrow. Despite their sexual awareness, the students were highly ignorant of the facts of life. Being male and married did not make them more knowledgeable.
Schizophrenia-like psychosis and epilepsy: the status of the association.
OBJECTIVE: Current knowledge of the relationship between epilepsy and schizophrenia-like psychosis is examined, and the proposed pathogenetic mechanisms are evaluated. METHOD: The author provides an overview of the published literature on epilepsy and schizophrenia-like psychosis. RESULTS: The schizophrenia-like psychoses of epilepsy are inadequately categorized by the current classifications. Their categorization into ictal, postictal, and interictal psychoses is clinically useful, but it does not imply distinct pathophysiology for each. The recent interest in postictal psychoses has opened an important avenue for research. Brief interictal psychoses, involving alternation between epilepsy and psychosis and accompanied by forced normalization, are uncommon. Many aspects of the relationship with chronic interictal psychosis remain controversial. The majority of investigators support a special but not exclusive relationship with mediobasal temporal lobe epilepsy, and left temporal bias receives only limited support. The chronic psychosis resembles schizophrenia phenomenologically. Some suggested risk factors are severe and intractable epilepsy, epilepsy of early onset, secondary generalization of seizures, certain anticonvulsant drugs, and temporal lobectomy. Different neuropathological studies suggest the presence of cortical dysgenesis or diffuse brain damage. CONCLUSIONS: There are many mechanisms by which epilepsy may be associated with schizophrenia-like psychosis. It is likely that structural brain abnormalities, e.g., cortical dysgenesis or diffuse brain lesions, underlie both epilepsy and psychosis, and that the seizures modify the presentation of the psychosis, and vice versa, thus producing a clinical picture of both an affinity and an antagonism between the two disorders.
AIDS/HIV and university students in Delhi, India: knowledge, beliefs, attitudes and behaviors.
Eight hundred eighty-seven students in social work, nursing, and humanities from two major universities in Delhi were compared regarding their knowledge about AIDS/HIV and attitudes toward PWAs and homosexuals. Their scores on the 20-item knowledge test indicate fair degree of knowledge; however, they lacked information in crucial areas of AIDS prevention and human sexual anatomy. Unmarried, female and older students and those in social work and nursing disciplines scored significantly higher on correct answers. Social work students were likely to be more positive in their attitudes toward AIDS victims than those in nursing or humanities. Knowledge was positively related to attitudes and perception of risk. Despite their awareness of personal risks only four in ten used condoms sometimes during intercourse. Educational strategies to increase cognitive and affective understanding of AIDS and its victims are discussed.
Is Tourette's syndrome triggered by streptococcal infections?
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Regional cerebral blood flow in late-onset schizophrenia: a SPECT study using 99mTc-HMPAO.
Functional neuroimaging studies have been performed in many young patients with schizophrenia, but late-onset schizophrenia (LOS) remains largely unexamined by these techniques. We predicted that LOS would demonstrate regional cerebral blood flow (rCBF) abnormalities similar to those seen in early-onset schizophrenia (EOS), but with a basis in demonstrable coarse brain disease. The subjects were 15 LOS and 7 EOS patients and 27 healthy controls. Each was given a detailed clinical and neuropsychological assessment and underwent MRI and Tc99m-HMPAO single photon emission computed tomography (SPECT) scans. The LOS subjects had a significantly lower cerebral hemispheric perfusion than controls, with a lower perfusion in the frontal and temporal lobes bilaterally. The LOS group also had significantly lower left-to-right hemisphere blood flow ratios. EOS subjects had a lower frontal perfusion than the controls, which was significant in the left frontal region. The temporal perfusion in the EOS subjects was greater than in the LOS group, and not different from the control subjects. Left temporal perfusion was the most discriminating variable between LOS and control subjects on logistic regression. Correlations of perfusion with MRI were generally low with the exception that the asymmetry indices were significantly correlated, and basal ganglia perfusion correlated with basal ganglia hyperintensities on MRI. The total cerebral perfusion index correlated significantly with the mini-mental state examination (MMSE) score, and the temporal lobe perfusion correlated with MMSE scores and some verbal memory measures. In the schizophrenic groups, perfusion correlated nonsignificantly with symptom profiles. We conclude that our findings of temporal and frontal rCBF abnormalities, especially on the left side, in LOS are similar to those reported in schizophrenia in general. The results do not provide evidence for coarse brain disease underlying the rCBF abnormalities in LOS, or support the specificity of these abnormalities for particular subsyndromes of schizophrenia.
Longitudinal study of cerebral blood flow in Alzheimer's disease using single photon emission tomography.
Ten patients with probable Alzheimer's disease were assessed at baseline and a mean 2 years later using a battery of neuropsychological tests, CT scans and Tc99m-HMPAO SPECT scans. The subjects had declined significantly in their functional indices. Cerebral perfusion measures declined in the parietal lobes, left hemisphere and whole brain, but the overall decline did not reach statistical significance. The decline in brain perfusion did not correlate significantly with the decline in various indices of neuropsychological function, either globally or for specific brain regions. The index of cerebral perfusion correlated significantly with global indices of neuropsychological function at baseline but not at follow-up. No single perfusion index was a significant predictor of clinical progression of dementia.
A controlled study of sensory tics in Gilles de 1a Tourette syndrome and obsessive-compulsive disorder using a structured interview.
OBJECTIVE: To determine the prevalence and characteristics of sensory tics in the Gilles de la Tourette syndrome (GTS), and a matched population of patients with obsessive-compulsive disorder (OCD) using a structured assessment. METHODS: 50 subjects each of GTS, OCD, and healthy controls were studied to determine the prevalence and phenomenology of sensory tics, and diagnose tic disorders, OCD, and affective disorders according to DSM-III-R criteria. The severity of tics and obsessive-compulsive symptoms were quantified using the Tourette syndrome global scale (TSGS) and Yale-Brown obsessive-compulsive scale (Y-BOCS) respectively. RESULTS: The GTS group (28%) had significantly-greater life-time prevalence of sensory tics than the OCD (10%) and healthy (8%) groups (P < 0.05). The sensory tics in both the GTS and OCD groups were predominantly located in rostral anatomical sites. Multiple sensory tics occurred in some patients with GTS or OCD, but not in healthy subjects. Within the OCD group, those who had sensory tics had significantly higher TSGS scores (P < 0.0001), and a higher prevalence of GTS (P < 0.005). CONCLUSIONS: Sensory tics seem to be a common and distinctive feature of GTS and that subpopulation of patients with OCD predisposed to tic disorders. Neurophysiologically, a possible explanation for sensory tics is that they represent the subjectively experienced component of neural dysfunction below the threshold for motor and vocal tic production.
Case-control study of neuroleptic malignant syndrome.
OBJECTIVE: The authors performed a case-control study of neuroleptic malignant syndrome to identify potential risk factors. METHOD: Twenty-five patients with neuroleptic malignant syndrome were matched with 50 comparison subjects on age, sex, primary psychiatric diagnosis, and time of admission to the hospital. The records of all subjects were reviewed independently by two researchers for information on postulated risk factors. Exploratory direct comparisons of the two groups were followed by a conditional logistic regression analysis. RESULTS: Patients with neuroleptic malignant syndrome were more likely to be agitated or dehydrated before the development of neuroleptic malignant syndrome, often needed restraint or seclusion, and received larger doses of neuroleptics soon after hospitalization. Previous treatment with ECT increased vulnerability. CONCLUSIONS: The prevalence of neuroleptic malignant syndrome may be reduced by avoiding large doses of neuroleptics over short periods in the management of acute psychosis and by paying adequate attention to the patient's hydration and electrolyte status.
Sixty years of psychosurgery: its present status and its future.
After its introduction 60 years ago, psychosurgery witnessed a remarkable rise followed by a decline. In the 1990s, it is a marginal treatment practised by a few psychiatrists in some specialised centres around the world. The psychiatric profession, however, continues to support it, and there is some evidence for a recent renewal of interest in the procedure. In this paper, the reasons for this reluctant acceptance of psychosurgery are examined, and the factors that are likely to determine its future are identified. The profession is urged to keep the interest in psychosurgery alive until further theoretical and empirical developments can either announce its death or lead to a resurgence of psychiatric neurosurgery in its present or modified form.
Site and size of lesion and psychosurgical outcome in obsessive-compulsive disorder: a magnetic resonance imaging study.
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Negative symptoms, cognitive dysfunction, tardive akathisia and tardive dyskinesia.
This study examined the relationship of neuropsychological deficits and negative symptoms with tardive akathisia in chronic schizophrenic patients. Consecutive volunteers (n = 100) were recruited from Community Health Centres with a DSM-III-R diagnosis of schizophrenic disorder, chronic and on stable medication. Subjects were subgrouped into tardive akathisia (TA), tardive dyskinesia (TD) and control groups using four sets of criteria. Detailed single examinations were performed using the following measures: sociodemographic, illness-related and treatment-related variables, Negative Symptom Rating Scale (NSRS), Abnormal Involuntary Movement Scale (AIMS), Rating Scale for Extrapyramidal Side-Effects (EPSE), Akathisia Rating Scale, Barnes Akathisia Rating Scale, and a brief neuropsychological test battery. Group comparisons and logistic regression analyses were performed in order to test the significance of findings. TA ratings showed a significant association with NSRS subscale scores, and with some neuropsychological test scores (Symbol Digits Modalities Test, and to a lesser extent Trail Making Test and Finger Tapping Test). TD scores showed a consistent association with age, and a less consistent association with gender, and their association with NSRS subscale scores and neuropsychological dysfunction was positive but less significant. Higher EPSE scores predicted TA and limb truncal (LT) dyskinesia. In conclusion, TA showed a more significant association with some clinical indices of organic brain dysfunction than the oral-lingual-buccal-facial dyskinetic syndrome. Prospective studies are necessary to determine whether organicity is a vulnerability factor for TA. Both our data and the published literature suggest that the movement disorder seen in TA and TD is but one feature of complex syndromes that include motor and cognitive features.
Tics status.
OBJECTIVES: To describe two patients with tics status, propose a definition of this syndrome and draw attention to its clinical significance. METHOD: Two patients suffering from Tourette's Syndrome who had developed episodes of continual motor tics that lasted from minutes to hours, were non-suppressible and intruded into normal functioning, were treated with an increase in the dose of haloperidol, in one case with the addition of clonazepam. RESULTS: The offset of the episodes was gradual and the tic disorder was worse after the episodes. One patient had further spontaneous episodes of tics status. CONCLUSIONS: The recognition of tics status has implications for the management as well as our understanding of the pathobiology of tics and Tourette's Syndrome. The definition of tics status should be standardised.
Restlessness: the anatomy of a neuropsychiatric symptom.
OBJECTIVE: The aim of this paper is to review the literature on restlessness and related syndromes in order to examine the different causes and clinical descriptions, and to present a pathogenetic model that would incorporate its diverse aetiology. METHOD: A literature search was undertaken with restlessness, agitation, akathisia, hyperactivity, fidgetiness and jitteriness as key words. RESULTS: Causes of restlessness are diverse, and its distinction from other descriptions, such as agitation and hyperactivity, is poorly defined in the literature. Detailed descriptions of the syndromes are therefore lacking. The neuroanatomical basis of restlessness may consist of abnormalities in the cortico-subcortical neuronal circuits, the complex regulation of which may explain why different causes often lead to a common end result. CONCLUSIONS: The terms used to describe restlessness and related disorders should be standardised, and the clinical manifestations investigated pedantically. Human and animal studies should investigate the pathophysiology so that intervention can be based on the underlying mechanisms.
A critique of 'organic' and its proposed alternatives.
OBJECTIVE: A critical examination of the term 'organic' in psychiatry and its proposed alternatives. METHOD: An examination of the published literature on the concepts of 'organicity' in mental syndromes, and of the mind-brain problem. RESULTS: The term 'organic' presents a number of problems, some of which can be described as those of historical schism, duality, method, practice, scholasticism and semantics. The currently available alternatives are not without their difficulties, and examples are provided. CONCLUSION: Whether the term 'organic' is retained or replaced, we are condemned to an unsatisfactory position while we await a radically new paradigm to understand the role of neurobiological and psychosocial factors in psychiatric disorders.
The diagnosis of neuroleptic malignant syndrome revisited.
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