Effect of integrated yoga on anti-psychotic induced side effects and cognitive functions in patients suffering from schizophrenia

Abstract Background Twenty one (12 females) subjects, diagnosed with schizophrenia by a psychiatrist using ICD-10, in the ages 52.87 + 9.5 years and suffering since 24.0 ± 3.05 years were recruited into the study from a schizophrenia rehabilitation center in Bengaluru. Methods All subjects were taking anti-psychotic medications and were in stable state for more than a month. Psychiatric medications were kept constant during the study period. Assessments were done at three points of time: (1) baseline, (2) after one month of usual routine (pre) and (3) after five months of validated Integrated Yoga (IY) intervention (post). Validated 1 h Yoga module (consisting of asanas, pranayama, relaxation techniques and chantings) was practiced for 5 months, five sessions per week. Antipsychotic-induced side effects were assessed using Simpson Angus Scale (SAS) and Udvalg for Kliniske Undersogelser (UKU) side effect rating scale. Cognitive functions (using Trail making Test A and B), clinical symptoms and anthropometry were assessed as secondary variables. Comparisons between “pre” and “post” data was done using paired samples t-tests after subtracting baseline scores from them respectively. Results At the end of five months, significant reduction in drug-induced Parkinsonian symptoms (SAS score; p=0.001) and 38 items of UKU scale was observed along with significant improvement in processing speed, executive functions and negative symptoms of schizophrenia patients. No side effects of Yoga were reported. Conclusions The present study provides preliminary evidence for usefulness of Integrated Yoga intervention in managing anti-psychotic-induced side effects.

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Antimicrobial-induced cognitive side effects

Mental Health Clinician ◽

10.9740/mhc.2016.07.207 ◽

2016 ◽

Vol 6 (4) ◽

pp. 207-214 ◽

Cited By ~ 7

Author(s):

Amanda Warstler ◽

Jennifer Bean

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Side Effects ◽

Clinical Symptoms ◽

Case Reports ◽

Time Frame ◽

Drug Induced ◽

Pubmed Search ◽

Neuropsychiatric Side Effects ◽

Cognitive Side Effects

Abstract Introduction: Antimicrobial-induced cognitive side effects are often overlooked or underreported. Literature often reports symptoms of antimicrobial-induced cognitive impairment under more general blanket terms, such as neuropsychiatric side effects, neurotoxicity, or drug-induced delirium or encephalopathy. Methods: A PubMed search using terms including antibiotics, antifungals, antivirals, antimalarials, side effects, cognitive, neurotoxicity, encephalopathy, and delirium was conducted. Respectively, symptoms of cognitive impairment were teased out of the multiple neurologic complications presented for each case and reported based on antimicrobial class. Articles were excluded if they focused solely on neuropsychiatric side effects such as seizures, psychosis, hallucinations, or mood disturbances, were conducted in animals, or involved antiretroviral medication therapies. Results: Of over 50 case reviews, case reports, retrospective chart reviews, and prospective cohort studies analyzed, 25 were deemed appropriate for purposes of this review. Common antimicrobial-induced cognitive side effects for all antimicrobial classes included confusion, delirium, encephalopathy, and impaired concentration or attention. Recurring risk factors included, but were not limited to, older age and renal impairment. Mechanisms of cognitive impairment were relatively specific to each antimicrobial class. Discussion: Awareness of the potential for antimicrobial-induced cognitive side effects, including the general time frame of symptom onset and symptom presentation, is critical in challenging patient cases. This review article aims to summarize the risk factors, clinical symptoms, mechanisms, and management of antimicrobial-induced cognitive side effects. Pharmacists can play a key role in prevention through adjustment of medications for renal or hepatic dysfunction, avoidance of polypharmacy, and knowledge of critical drug interactions that may precipitate cognitive decline.

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Tropicamide eye drops reduce clozapine-induced hypersalivation: A case report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2009 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S543-S544 ◽

Cited By ~ 1

Author(s):

O. Kilic ◽

H.M. Ozturk ◽

E. Ata

Keyword(s):

Case Report ◽

Side Effects ◽

Side Effect ◽

Negative Symptoms ◽

Rating Scale ◽

Short Form ◽

Eye Drops ◽

Oral Application ◽

Competing Interest ◽

Pressure Changes

IntroductionClozapine-induced sialorrhea (CIS) is a common, treatment-limiting and stigmatizing side effect. All systemic agents that are used for hypersalivation may increase clozapine side effects such as blood pressure changes, constipation, or arrythmias. Oral application of topical anti-muscarinic agents may be a low side effect option for treatment of CIS.ObjectiveThe aim of this case report was to propose an off-label treatment of tropicamide drops to CIS and to stimulate further investigation.Case reportA 33-year-old male inpatient with schizophrenia has been on clozapine 800 mg and amisulpride 600 mg/day. His drooling was occasional and severe as drool drips off his chin during the day and night. Wet area over the pillow, visual analog scale (VAS), the short form of health survey (SF-36), UKU side effect rating scale, scale for the assessment of negative symptoms (SANS), scale for the assessment of positive symptoms (SAPS) were applied at baseline and in one-week intervals. Oral application of one drop of tropicamide % 0.5 (5 mg/mL) to left and one drop to right side before going to bed in the first week and two drops to each side were administered subsequently. Informed consent was given by the patient.ResultsNo psychological, neurological, autonomic and other side effects were observed associated with tropicamide. On VAS, the patient rated hypersalivation 5/7 at baseline, 4/7 after one drop each, 3/7 after two drops each.ConclusionsThe reduction of CIS by oral use of tropicamide eye drops is promising and should be explored with randomized controlled trials.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Limbic and Motor Function Comparison of Deep Brain Stimulation of the Zona Incerta and Subthalamic Nucleus

Operative Neurosurgery ◽

10.1227/neu.0b013e318232fdac ◽

2011 ◽

Vol 70 (suppl_1) ◽

pp. ons125-ons131 ◽

Cited By ~ 8

Author(s):

Anthony M. Burrows ◽

Paula D. Ravin ◽

Peter Novak ◽

Mary Linton B. Peters ◽

Brian Dessureau ◽

...

Keyword(s):

Side Effects ◽

Subthalamic Nucleus ◽

Motor Function ◽

Repeated Measures ◽

Rating Scale ◽

Preliminary Evidence ◽

Zona Incerta ◽

Psychiatric Side Effects ◽

Stn Dbs ◽

Stimulation Of

Abstract BACKGROUND: Psychiatric and neuropsychological side effects of subthalamic nucleus (STN) stimulation have been increasingly recognized. Most programming regimens focus on contacts 0 and 1, whereas contact 3, which often is located near or in the zona incerta (ZI), is usually not used. The question of whether ZI stimulation may limit limbic effects has not been answered. OBJECTIVE: To examine the effects of short-term stimulation near or in the ZI (contact 3) compared with stimulation of the STN using standard trajectories and targeting as measured by limbic and motor functions. METHODS: Motor and limbic functions of 11 patients with STN DBS were assessed with the Unified Parkinson Disease Rating Scale-3, structured gait video analysis, Visual Analog Scale mood scales, task testing of impulsivity, and facial recognition under routine STN programming and under stimulation in or near the ZI. Postoperative magnetic resonance imaging confirmed the location of contact 3 near or in the ZI. RESULTS: Data analysis with repeated-measures analysis of variance revealed that motor scores remained stable with both stimulation settings, with specific improvements in finger taps (P = .02) and rapid alternating movements (P = .03) in ZI stimulation. Stimulation near or in the ZI led to a decrease in self- reported anxiety and depression (P = .03 for both) and an improvement in fear recognition (P = .02). CONCLUSION: We provide preliminary evidence that stimulation in or near the ZI results in maintained motor function while improving self-reported depression and anxiety in patients with bilateral STN DBS. Stimulation in or near the ZI may provide a useful programming setting for patients prone to psychiatric side effects.

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Aspects of dysphoria and symptoms of schizophrenia

Psychological Medicine ◽

10.1017/s003329179800751x ◽

1998 ◽

Vol 28 (6) ◽

pp. 1433-1441 ◽

Cited By ~ 37

Author(s):

R. M. G. NORMAN ◽

A. K. MALLA ◽

L. CORTESE ◽

F. DIAZ

Keyword(s):

Side Effects ◽

Negative Symptoms ◽

Self Report ◽

Anxiety And Depression ◽

Depression And Anxiety ◽

Extrapyramidal Side Effects ◽

Psychomotor Slowing ◽

Drug Induced ◽

Observer Ratings ◽

Reality Distortion

Background. In the past it has been postulated that dysphoric emotions may be related to positive and/or negative symptoms in schizophrenia. The results of several recent studies have suggested that composite dysphoria indices are more strongly related to positive than negative symptoms. In the current study we use part correlation techniques to examine the possible unique contributions of two aspects of dysphoria – depression and anxiety – to three syndromes of symptoms (reality distortion, disorganization and psychomotor poverty) within schizophrenia.Methods. Data were obtained from 60 patients with a DSM-III-R diagnosis of schizophrenia. Symptoms of schizophrenia were assessed using the SAPS and SANS and dysphoria was assessed using both self-report (BDI and BAI) and observer ratings (HRSD and HARS). Assessment of schizophrenia symptoms and ratings of depression and anxiety were completed by different observers. In addition, drug induced extrapyramidal side effects were rated.Results. Part correlations showed that unique aspects of anxiety (particularly physiological arousal) were correlated with reality distortion while unique aspects of depression (including psychomotor slowing and loss of social interest) were related to psychomotor poverty. At least part of the latter relationship may be due to extrapyramidal side effects of neuroleptic medication.Conclusions. Although there is considerable overlap between anxiety and depression, it appears that the unique arousing or activating aspects of anxiety are related to the experience of reality distortion symptoms in schizophrenia and the unique slowing and withdrawal aspects of depression are particularly related to psychomotor poverty. Possible reasons for these relationships are discussed.

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Drug-Drug-Induced Akathisia: Two Case Reports

Case Reports in Psychiatry ◽

10.1155/2020/9649483 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Grace Owusu Aboagye ◽

Daniel Ankrah

Keyword(s):

Side Effects ◽

Rating Scale ◽

Beta Blockers ◽

Case Reports ◽

First Episode ◽

Extrapyramidal Side Effects ◽

Drug Induced ◽

Fluphenazine Decanoate ◽

Probable Case ◽

Psychotropic Medicines

Extrapyramidal side effects of psychotropic medicines are usually experienced by patients in the first few weeks of initiating therapy. Patients stabilized on these medications who present with distressing complaints akin to akathisia may be triggered by other factors. This report presents two cases of drug-drug-induced akathisia. Case A is a patient with schizophrenia who was being managed with risperidone 2 mg tablet daily for the past 3 years. She fell ill and reported to a nearby clinic where she was prescribed ciprofloxacin and artemether/lumefantrine tablets for the treatment of an infection and malaria. She presented 7 days later to her psychiatrist with complaints of restlessness, tremor, palpitations, insomnia, and resurgence of obsessive thoughts. Case B is a patient who was diagnosed with first-episode psychotic depression and admitted for 10 days. Her medications on admission were fluphenazine decanoate 25 mg depot injection once, olanzapine 10 mg tablet daily, and fluoxetine 20 mg capsule daily. On discharge, ciprofloxacin 500 mg tablet every 12 hours for 5 days and fluconazole 150 mg capsule once were added to her medications for the treatment of a urinary tract infection. She reported back to the hospital a day after discharge with complaints of restlessness, “seizures,” tremor, abdominal discomfort, and weight gain. Both patients were diagnosed with akathisia using ICD-10 classification and the Barnes akathisia rating scale and managed with anticholinergics, benzodiazepines, and beta blockers. Other measures employed in managing the akathisia included reducing the dose of the antipsychotic and/or switching antipsychotics. Despite these management measures, the symptoms of akathisia persisted and only resolved after 4weeks. Upon the resolution of symptoms, Case A continued treatment on olanzapine 5 mg tablet daily and fluoxetine 20 mg capsule daily while Case B continued treatment on risperidone 2 mg tablet daily and fluoxetine 20 mg capsule daily. Using Naranjo’s adverse drug reaction causality assessment scale, Medscape drug interaction checker, and literature review, a possible and probable case of drug-drug-induced akathisia was made for Case A and Case B. This report is to create more awareness about psychotropic-antimicrobial-induced akathisia. The information underpins the need for health professionals to consider adverse drug-drug interactions as the probable cause of extrapyramidal side effects experienced by patients on antipsychotics.

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Side effects of treatment and quality of life among patients with schizophrenia

European Psychiatry ◽

10.1016/s0924-9338(11)73155-8 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1450-1450

Author(s):

J. Ben Thabet ◽

I. Feki ◽

R. Sallemi ◽

J. Masmoudi ◽

L. Zouari ◽

...

Keyword(s):

Quality Of Life ◽

Side Effects ◽

Negative Symptoms ◽

Rating Scale ◽

Treatment Compliance ◽

University Hospital ◽

Average Score ◽

Treatment Side Effects ◽

Impaired Quality

The aim of our study was to assess the treatment side effects and their implications on quality of life in a population of schizophrenic patients.We included 50 patients with schizophrenia treated at Hthe psychiatry department of the university hospital in Sfax (Tunisia). We used the PANSS, the UKU side effect rating scale and the SF-36 to assess, respectively, the severity of disease, the treatment side effects and the quality of life. The statistical analysis was carried out by software SPSS.The assessment of quality of life revealed a global average score of 59.11 and an alteration in 54% of patients. Impaired quality of life was significantly correlated with irregular follow-up (p = 0.02), bad treatment compliance (p = 0.016) and polytherapy (p = 0.024). The presence of side effects which affect either moderately or severely daily activity was significantly correlated with impaired quality of life (p = 0.007). The presence of side effects was correlated in a significant way with altered quality of life (p = 0,007).Our study showed a relatively high frequency of side effects of treatment in patients with schizophrenia. They were correlated with impaired quality of life. They are also factors of bad compliance. Reduction and prevention of side effects requires the use of atypical antipsychotics which are better tolerated and more active on negative symptoms. However, they pose the problem of high costs. But it must be noted here that the overall cost of disease is higher with conventional antipsychotics than with atypical ones.

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The Effect of Neuroleptics on Cognitive and Psychomotor Function

The British Journal of Psychiatry ◽

10.1192/bjp.157.6.799 ◽

1990 ◽

Vol 157 (6) ◽

pp. 799-811 ◽

Cited By ~ 117

Author(s):

David J. King

Keyword(s):

Cognitive Functions ◽

Negative Symptoms ◽

Drug Effects ◽

Neuroleptic Drug ◽

Psychomotor Function ◽

Neuroleptic Treatment ◽

Drug Induced ◽

Attentional Processing ◽

Beneficial Effects ◽

Schizophrenic Patients

There has been great variability and inconsistency in the reported effects of neuroleptic drugs on cognitive and psychomotor function in both patients and normal controls. Experimental design rather than any particular cognitive or psychomotor test appears to have determined the sensitivity of detection of neuroleptic drug effects. In general, sedative phenothiazines have been found to depress psychomotor function and sustained attention, but higher cognitive functions are relatively unaffected. In the majority of studies of schizophrenic patients, both cognitive function and attention improve with neuroleptic treatment, in parallel with clinical recovery. Negative symptoms are not increased and usually show slight improvement with neuroleptic treatment. Controls are more sensitive than schizophrenic patients to neuroleptic drug-induced impairments. Tolerance has been seen in patients but has not been demonstrated in normal volunteers. The way in which neuroleptics produce their beneficial effects in patients remains unknown. Three main hypotheses to replace early arousal theories are proposed: normalisation of attention, facilitated indirectly by suppression of ‘released’ limbic dopamine hyperactivity; normalisation of asymmetrical temporohippocampal function; or direct improvement of attentional processing. Studies of the effects of new antipsychotic drugs with selective actions and the development of more reliable and selective tests of psychomotor and cognitive functions are required.

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Effects of High-Frequency rTMS on Negative Symptoms and Cognitive Function in Hospitalized Patients With Chronic Schizophrenia: A Double-Blind, Sham-Controlled Pilot Trial

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.736094 ◽

2021 ◽

Vol 12 ◽

Author(s):

Na Wen ◽

Lei Chen ◽

Xuemeng Miao ◽

Min Zhang ◽

Yaoyao Zhang ◽

...

Keyword(s):

Cognitive Functions ◽

High Frequency ◽

Negative Symptoms ◽

Clinical Symptoms ◽

Repetitive Transcranial Magnetic Stimulation ◽

Pilot Trial ◽

Chronic Schizophrenia ◽

Double Blind ◽

Immediate Memory ◽

Left Dlpfc

This study aimed to evaluate the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) over left dorsolateral pre-frontal cortex (DLPFC) in ameliorating negative symptoms and cognitive impairments in patients with chronic schizophrenia. Fifty-two patients with chronic schizophrenia were randomly assigned to two groups: active rTMS group and sham rTMS group, with existing antipsychotic drugs combined 20 sessions of 10 Hz active/sham rTMS over DLPFC (20 min/session, 5 times/week). The PANSS, RBANS, and SCWT were used to evaluate the clinical symptoms and cognitive functions of the patients. Our results indicated significant improvements in clinical symptoms (PANSS total and subscale scores) and cognitive functions (RBANS total and subscale scores, card 1 and card 3 of the SCWT test) (All p <0.05) after 4-week intervention both in active and sham rTMS group. Moreover, the active rTMS group showed more effective on ameliorating negative symptoms (p = 0.002), immediate memory (p = 0.016) and delayed memory (p = 0.047) compared to the sham group. Interestingly, PANSS negative symptom scores was negatively correlated with RBANS language scores in the real stimulation group (p = 0.046). The study found that the high frequency rTMS stimulation over left DLPFC as a supplement to antipsychotics may have potential benefits in improving clinical symptoms and cognitive functions in patients with chronic schizophrenia.

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MTHFD1 1958 G>A Genetic Polymorphism (rs2236225) Dichotomy in Schizophrenia: Lower Manifestation Risks, but More Severe Negative Symptoms

10.20944/preprints202111.0121.v1 ◽

2021 ◽

Author(s):

Tatiana Zhilyaeva ◽

Oksana Chekanina ◽

Grigory Rukavishnikov ◽

Anna Blagonravova ◽

Galina Elevna Mazo

Keyword(s):

Side Effects ◽

Biochemical Markers ◽

Negative Symptoms ◽

Clinical Symptoms ◽

Folate Metabolism ◽

Serum Folate ◽

Extrapyramidal Side Effects ◽

Serum Folate Level ◽

One Carbon Metabolism

Despite a large amount of data on the association of folate metabolism disturbances with different aspects of schizophrenia, the role of the MTHFD1 1958 G>A polymorphism in this disorder is barely studied. The aim of this study was to assess the distribution of alleles and genotypes frequencies of MTHFD1 1958 G>A in patients with schizophrenia and healthy controls and to study the association of allele/genotype carriage of this SNP with biochemical markers of one-carbon metabolism and with the severity of schizophrenia symptoms. Methods: In 57 patients with schizophrenia and 37 healthy volunteers the carriage of alleles/genotypes of the MTHFD1 1958 G>A and biochemical markers of folate metabolism disturbances were evaluated. Clinical symptoms of schizophrenia and the severity of extrapyramidal side effects of therapy were assessed in patients. Results: an association of the wild GG genotype with schizophrenia was shown (GG versus AG / AA: χ2 = 7.31; p = 0.007). The serum folate level in carriers of the wild genotype GG is lower (in all participants p = 0.024, in patients p = 0.10), and the level of cobalamin in this subgroup is higher (in all participants p = 0.047, in patients p = 0.091) than in carriers of other genotypes. Patients carrying the G allele had less severe negative symptoms (p = 0.0041) and extrapyramidal side effects of antipsychotics (p = 0.054), than patients with AA genotype. The age of psychosis manifestation is the later, the more wild alleles G are present in the genotype (p = 0.00195).

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The Effect of Risperidone on Cognitive and Psychopathological Manifestations of Schizophrenia

CNS Spectrums ◽

10.1017/s1092852900006660 ◽

1998 ◽

Vol 3 (10) ◽

pp. 55-69 ◽

Cited By ~ 2

Author(s):

Isabelle Lussier ◽

Emmanuel Stip

Keyword(s):

Negative Symptoms ◽

Rating Scale ◽

Clinical Symptoms ◽

Extrapyramidal Symptoms ◽

Control Group ◽

Long Term Memory ◽

Cognitive Evaluation ◽

Schizophrenic Patients ◽

Psychiatric Rating ◽

Psychiatric Rating Scale

AbstractThe purpose of this study was to evaluate the effect of risperidone on the cognitive functioning of patients with schizophrenia and how it relates to the alleviation of psychopathological symptoms usually observed in patients receiving treatment. Twelve schizophrenic patients were evaluated while being treated with a traditional neuroleptic, and again approximately 8 and 24 weeks after initiation of risperidone. Patients were compared with a group of normal controls (n=24) who underwent the same cognitive evaluation across time. The normal control group was included to evaluate the level of impairments in patients, but also to test for practice effects. The cognitive evaluation included measures of short-term and long-term memory; attention (alertness, sustained and selective); and executive functioning (verbal and category fluency). Clinical symptoms were rated on the Positive and Negative Symptoms Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS). Extrapyramidal symptoms were rated with the Extrapyramidal Symptoms Rating Scale.During treatment with risperidone, schizophrenic patients improved their BPRS and PANSS scores, their performance level on tests of alertness, and both sustained and selective attention.

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