The trail making test in India

The trail making test (TMT) is a short and convenient estimate of cognitive functions, principally attention and working memory. Like most neuropsychological tests, it is derived from and primarily applicable to English-speaking individuals. Norms for other ethnic minorities may differ significantly. The application of majority or mixed norms to specific ethnic subcultures may introduce systematic bias. To examine the impact of an English test on primarily nonEnglish-speaking individuals, outpatients attending the dermatology department of a large Indian hospital (n = 120) were asked to complete the English version of the TMT. The time taken to complete the TRAILS was unexpectedly long, although all the subjects scored within normal limits on the modified mini mental status examination and a test for general knowledge. Possible reasons for the delayed completion times are discussed below

Knowledge & attitudes of mental health professionals regarding psychiatric research

Background & objectives: Mental health professionals have varied attitudes and views regarding informed consent and confidentiality protections in psychiatric research and clinical care. The present study was designed to understand the knowledge and views of mental health professionals (MHPs) regarding informed consent and confidentiality protection practices. Methods: Mental health professionals (n=121) who were members of the Delhi Psychiatric Society, were invited to participate in this questionnaire-based study of their knowledge and attitudes regarding informed consent and confidentiality. Half of them expressed willingness to discuss participation and gave initial oral consent (n=62); of these, 31 gave written informed consent to participate and completed the questionnaires. The questionnaires included both forced choice (yes / no / do not know) and open-ended questions. Questionnaires content reflected prominent guidelines on informed consent and confidentiality protection. Results: Attitudes of the majority of the participants towards informed consent and confidentiality were in line with ethical principles and guidelines. All expressed the opinion that confidentiality should generally be respected and that if confidentiality was breached, there could be mistrust of the professional by the patient/participant. The mean knowledge scores regarding informed consent and confidentiality were 8.55 ± 1.46 and 8.16 ± 1.29, respectively. Interpretation & conclusions: The participating mental health professionals appeared to have adequate knowledge of basic ethical guidelines concerning informed consent and confidentiality. Most respondents were aware of ethical issues in research. Given the small sample size and low response rate, the significance of the quantitative analysis must be regarded with modesty, and qualitative analysis of open-ended questions may be more valuable for development of future research. Increased efforts to involve mental health professionals in research on ethical concerns pertinent to their work must be made, and the actual practices of these professionals with regard to ethical guidelines need to be studied

Association of common and rare genetic variants with cognition in schizophrenia

Cognitive dysfunction is one of the core features in schizophrenia (SZ), which is a common neuro-psychiatric disorder affecting ~1% of the population globally. Cognitive impairment is related to social deficits with severity and breadth of these impairments varying across patients. Further, different cognitive domains seem to be dysfunctional in different patients. Severity of cognitive decline depends on the age of onset of SZ, with higher severity in early onset cases and generally manifests before the actual onset of psychosis. Though estimated heritability of cognition is ~50-70% little is known about its genetic basis. Of note, contemporary antipsychotic medication is also not effective in addressing this endophenotype. In this study we recruited SZ patients (n=158) from Dr. RML hospital, New Delhi and assessment of cognition was performed using Hindi version of University of Pennsylvania Computerized Neurocognitive Battery (Penn CNB). Eight selected cognitive domains namely abstraction and mental flexibility, attention, face memory, spatial memory, working memory, spatial ability, sensorimotor and emotional processing known to be impaired among patients with SZ were measured. Whole exome sequencing of the study cohort was performed and data were processed using standard tools and software.  To identify variants/genes associated with cognitive domains, we performed two different levels of association testing: 1) linear regression analysis using the common variants (MAF>0.01) and eight different domains of cognition; and 2) gene-level tests for rare variant (MAF<0.01) association using burden tests (CMC, CMC-Wald & Zeggini). We identified 11 common variants associated (P<10-7) with different cognitive domains, which withstood Bonferroni corrections and rare variant burden analysis identified four genes associated (P<10-7).  Genes identified by these two approaches and their implications for cognitive deficits will be presented

Genetic susceptibility to tardive dyskinesia in chronic schizophrenia subjects: III. Lack of association of CYP3A4 and CYP2D6 gene polymorphisms

Tardive dyskinesia is a severe debilitating movement disorder characterized by choreoathetotic movements developing in one-fifth of the patients with schizophrenia. In this study we have investigated the significance of CYP3A4*1B and CYP2D6*4 polymorphisms in TD susceptibility among chronic schizophrenia patients (n=335) from north India. Tardive dyskinesia was diagnosed in ~29% (96/335) of these patients. No significant association of either of the two SNPs with TD (CYP3A4*1B χ2=0. 308, df=1, p=0.579; CYP2D64χ 2=0.006, df=1, p=0.935) was observed. However a trend towards increased severity of TD in patients heterozygous for the CYP2D64 mutation was observed