National Institute of Mental Health and Neuro Sciences

nimhans.ac.in/nimhans/
Bangalore, India

The National Institute of Mental Health and Neuroscience - Deemed University located in Bangalore, is a Medical institute of National importance. Wikipedia.

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Ghosh S.,National Center for Biological science | Rao Laxmi T.,National Institute of Mental Health and Neuro Sciences | Chattarji S.,National Center for Biological science
Journal of Neuroscience | Year: 2013

The cellular and molecular effects of stress on the amygdala are strikingly different compared with those in the hippocampus. Previous findings on stress-induced plasticity were based primarily on postmortem analysis within individual areas. However, little is known about how stress affects dynamic changes and interactions in neuronal activity between the two areas. Hence, we simultaneously monitored in vivo activity of neuronal populations located in hippocampal areas CA1 and CA3 and the lateral amygdala (LA) in rats during and after chronic immobilization stress. The amplitude of auditory-evoked potentials (AEPs) in the hippocampus increased transiently only after a single 2 h stress but not when it was repeated for 10 d. In contrast, both acute and chronic stress caused a persistent increase in AEPs in the LA. Chronic stress also elicited a sustained increase in the LA but a decrease in the hippocampus in the evoked power of gamma and beta frequencies. Moreover, beta and gamma synchrony was reduced between areas CA1 and CA3 but enhanced between the LA and hippocampus after chronic stress. Granger causality spectra revealed a strong directional influence from the LA to area CA1 that persisted throughout and even 10 d after chronic stress. However, directional coupling from hippocampal area CA3 to CA1 became weaker at the end of chronic stress. Thus, our findings suggest that the growing dominance of amygdalar activity over the hippocampus during and even after chronic stress may contribute to the enhanced emotional symptoms, alongside impaired cognitive function, seen in stress-related psychiatric disorders. © 2013 the authors.


Andrade C.,National Institute of Mental Health and Neuro Sciences
Journal of Clinical Psychiatry | Year: 2017

Background: Ketamine, administered in subanesthetic doses, is an effective off-label treatment for severe and even treatmentrefractory depression; however, despite dozens of studies across nearly 2 decades of research, there is no definitive guidance on matters related to core practice issues. Methods: This article presents a qualitative review and summary about what is known about ketamine dosing, rate of administration, route of administration, duration of treatment, and frequency of sessions. Results: Ketamine is most commonly administered in the dose of 0.5 mg/kg, but some patients may respond to doses as low as 0.1 mg/kg, and others may require up to 0.75 mg/kg. The ketamine dose is conventionally administered across 40 minutes; however, safety and efficacy have been demonstrated in sessions ranging between 2 and 100 minutes in duration. Bolus administration is safe and effective when the drug is administered intramuscularly or subcutaneously. Whereas the intravenous route is the most commonly employed, safety and efficacy have been described with other routes of administration, as well; these include oral, sublingual, transmucosal, intranasal, intramuscular, and subcutaneous routes. Patients may receive a single session of treatment or a course of treatment during the acute phase, and treatment may rarely be continued for weeks to years to extend and maintain treatment gains in refractory cases. When so extended, the ideal frequency is perhaps best individualized wherein ketamine is dosed a little before the effect of the previous session is expected to wear off. Conclusions: There is likely to be a complex interaction between ketamine dose, session duration, route of administration, frequency of administration, and related practice. Until definitive studies comparing different doses, rates of administration, routes of administration, and other considerations are conducted, firm recommendations are not possible. From the point of view of clinical practicability, subcutaneous, intranasal, and oral ketamine warrant further study. If domiciliary treatment is considered, the risk of abuse must be kept in mind. © 2017 Physicians Postgraduate Press, Inc.


Andrade C.,National Institute of Mental Health and Neuro Sciences
Journal of Clinical Psychiatry | Year: 2015

Research papers and research summaries frequently present results in the form of data accompanied by 95% confidence intervals (CIs). Not all students and clinicians know how to interpret CIs. This article provides a nontechnical, nonmathematical discussion on how to understand and glean information from CIs; all explanations are accompanied by simple examples. A statistically accurate explanation about CIs is also provided. CIs are differentiated from standard deviations, standard errors, and confidence levels. The interpretation of narrow and wide CIs is discussed. Factors that influence the width of a CI are listed. Explanations are provided for how CIs can be used to assess statistical significance. The significance of overlapping and nonoverlapping CIs is considered. It is concluded that CIs are far more informative than, say, mere P values when drawing conclusions about a result. © Copyright 2015 Physicians Postgraduate Press, Inc.


Andrade C.,National Institute of Mental Health and Neuro Sciences
Journal of Clinical Psychiatry | Year: 2013

Some patients with schizophrenia may suffer from continuous or severe auditory hallucinations that are refractory to antipsychotic drugs, including clozapine. Such patients may benefit from a short trial of once- to twice-daily transcranial direct current stimulation (tDCS) with the cathode placed over the left temporoparietal cortex and the anode over the left dorsolateral prefrontal cortex; negative, cognitive, and other symptoms, if present, may also improve. At present, the case for tDCS treatment of refractory auditory for tDCS treatment of refractory auditory hallucinations rests on 1 well-conducted randomized, sham tDCS-controlled trial and several carefully documented and instructive case reports. Benefits with up to 3 years of maintenance tDCS have also been described. In patients with refractory auditory hallucinations, tDCS has been delivered at 1- to 3-mA current intensity during 20-30 minutes in once- to twicedaily sessions for up to 3 years with no apparent adverse effects. Transcranial direct current stimulation therefore appears to be a promising noninvasive brain stimulation technique for patients with antipsychotic- refractory auditory hallucinations. © Copyright 2013 Physicians Postgraduate Press, Inc.


Andrade C.,National Institute of Mental Health and Neuro Sciences
Bipolar Disorders | Year: 2013

Objectives: To examine the need for and the possible benefits and risks of statin therapy in patients with major mental illness. Methods: Patients with psychiatric conditions, especially those with major mental illnesses such as schizophrenia and bipolar disorder, are at increased risk of overweight, obesity, dyslipidemia, diabetes mellitus, and the metabolic syndrome, all of which increase the risk of cardiovascular disease, cerebrovascular disease, and mortality. The literature on the subject was qualitatively reviewed. Results: Primary prevention benefits with statins are well known in the general population of high-risk patients; recent evidence suggests that statins also carry primary prevention benefits in low-risk subjects. Regrettably, the primary prevention of cardiovascular and cerebrovascular events in psychiatry is a neglected area in clinical practice as well as in interventional research, whether in high- or in low-risk patients. Initial concerns notwithstanding, psychiatric complications do not appear to be important among the adverse effects of statins. Although statins are associated with an increased risk of incident diabetes mellitus, myopathy, and other untoward consequences, the risk-benefit ratio appears to favor statin use. The advisability of using statins in low-risk or medically healthy subjects remains debatable. Conclusions: Overweight, obesity, dyslipidemia, diabetes mellitus, and the metabolic syndrome are common in patients with major mental illness, and these increase the risk of medical morbidity and mortality. Statin use should therefore be considered for the primary prevention of cardiovascular and cerebrovascular events in psychiatric patients, especially in those at high risk. © 2013 John Wiley & Sons A/S.


BACKGROUND: Some patients with schizophrenia suffer from continuous auditory hallucinations that are refractory to antipsychotic medications. METHODS: Transcranial direct current stimulation (tDCS) was used to treat a 24-year-old female schizophrenia patient who had severe, clozapine-refractory, continuous, psychosocially and cognitively disabling auditory hallucinations. The tDCS cathode was placed midway between T3 and P3, and the anode over F3, in the 10-20 electroencephalogram electrode positioning system. RESULTS: Once daily, 20-minute tDCS sessions at 1-mA intensity produced noticeable improvement within a week: cognitive and psychosocial functioning improved, followed by attenuation in the experience of hallucinations. There was greater than 90% self-reported improvement within 2 months. Benefits accelerated when the current was raised to 3 mA; treatment duration was increased to 30-minute sessions, and session frequency was increased to twice daily. The patient improved from a psychosocially vegetative state to near-normal functioning. Once- to twice-daily domiciliary tDCS was continued across nearly 3 years and is still ongoing. Benefits attenuated or were even lost when alternate day session spacing was attempted, or when electrode positioning was changed; benefits were regained when the original stimulation protocol was reintroduced. There was confirmation of benefit in 2 separate on-off-on situations, which occurred inadvertently and under blinded conditions. There were no adverse events attributable to tDCS. CONCLUSIONS: This is the first report in literature of the safe and effective use of daily to twice-daily, domiciliary, 30-min, 1- to 3-mA tDCS sessions across nearly 3 years for the treatment of continuous, disabling, clozapine-refractory auditory hallucinations in schizophrenia. Key learning points emerging from this case are presented and discussed. Copyright © 2012 by Lippincott Williams & Wilkins.


Andrade C.,National Institute of Mental Health and Neuro Sciences
Journal of Clinical Psychiatry | Year: 2014

Elderly patients commonly receive statin drugs for the primary or secondary prevention of cardiovascular and cerebrovascular events. Elderly patients also commonly receive antidepressant drugs, usually selective serotonin reuptake inhibitors (SSRIs), for the treatment of depression, anxiety, or other conditions. SSRIs are associated with many pharmacokinetic drug interactions related to the inhibition of the cytochrome P450 (CYP) metabolic pathways. There is concern that drugs that inhibit statin metabolism can trigger statin adverse effects, especially myopathy (which can be potentially serious, if rhabdomyolysis occurs). However, a detailed literature review of statin metabolism and of SSRI effects on CYP enzymes suggests that escitalopram, citalopram, and paroxetine are almost certain to be safe with all statins, and rosuvastatin, pitavastatin, and pravastatin are almost certain to be safe with all SSRIs. Even though other SSRI-statin combinations may theoretically be associated with risks, the magnitude of the pharmacokinetic interaction is likely to be below the threshold for clinical significance. Risk, if at all, lies in combining fluvoxamine with atorvastatin, simvastatin, or lovastatin, and even this risk can be minimized by using lower statin doses and monitoring the patient. © Copyright 2014 Physicians Postgraduate Press, Inc.


Andrade C.,National Institute of Mental Health and Neuro Sciences
Journal of Clinical Psychiatry | Year: 2015

Research papers and research summaries frequently present information in the form of derived statistics such as the number needed to treat (NNT) and the number needed to harm (NNH). These statistics are not always correctly understood by the reader. This article explains what NNT and NNH mean; presents a simple, nontechnical explanation for the calculation of the NNT; addresses the interpretation of the NNT; considers applications of the NNT; and discusses the limitations of this statistic. The NNH is also briefly considered. © Copyright 2015 Physicians Postgraduate Press, Inc.


Andrade C.,National Institute of Mental Health and Neuro Sciences
Journal of Clinical Psychiatry | Year: 2014

Curcumin, an ingredient of turmeric, is widely available as a nutritional supplement. Curcumin has biological properties that suggest its use for a large number of health-related conditions, including depression. Curcumin is effective in animal models of depression. However, controlled clinical trials provide no convincing evidence that patients with major depressive illness fare better with different extracts of curcumin (dosed at 500-1,000 mg/d) than with placebo (or no treatment) after 5-8 weeks of monotherapy or antidepressant-augmentation therapy. At present, therefore, there is insufficient evidence to encourage depressed patients to consider curcumin as a possible alternative to standard antidepressant therapy. © Copyright 2014 Physicians Postgraduate Press, Inc.


Andrade C.,National Institute of Mental Health and Neuro Sciences
Journal of Clinical Psychiatry | Year: 2015

Intranasal drug delivery (INDD) systems offer a route to the brain that bypasses problems related to gastrointestinal absorption, first-pass metabolism, and the blood-brain barrier; onset of therapeutic action is rapid, and the inconvenience and discomfort of parenteral administration are avoided. INDD has found several applications in neuropsychiatry, such as to treat migraine, acute and chronic pain, Parkinson disease, disorders of cognition, autism, schizophrenia, social phobia, and depression. INDD has also been used to test experimental drugs, such as peptides, for neuropsychiatric indications; these drugs cannot easily be administered by other routes. This article examines the advantages and applications of INDD in neuropsychiatry; provides examples of test, experimental, and approved INDD treatments; and focuses especially on the potential of intranasal ketamine for the acute and maintenance therapy of refractory depression. © Copyright 2015 Physicians Postgraduate Press, Inc.

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