Karishma Rupani - Academia.edu (original) (raw)
Papers by Karishma Rupani
Annals of Indian psychiatry, Apr 1, 2024
American Journal of Case Reports, Mar 13, 2023
Annals of Indian psychiatry, Apr 1, 2024
Neuro-Oncology, 2011
INTRODUCTION: Primitive neuroectodermal tumor (PNET) is the most common primary malignant childho... more INTRODUCTION: Primitive neuroectodermal tumor (PNET) is the most common primary malignant childhood brain tumor and is usually seen as an intraparenchymal lesion, typically arising in the cerebellum (as a medulloblastoma). Peripheral PNET (PPNET), a member of the Ewing's sarcoma (ES) family of tumors, is a tumor of putative parasympathetic neural histogenesis, typically developing in the soft tissue and skeletal structures of the trunk and extremities. We report here four cases of atypical primary ES/PPNET in very young children involving pericranial structures, two with significant intracranial involvement. METHODS: Following IRB approval, we compiled the clinical, imaging, and pathology records from four children with aggressive pericranial ES/PPNET. RESULTS: Ages at diagnosis were 1 day (female), 5 days (male), 12 months (male), and 13 months (female). Two patients had orbitofacial tumors with significant bony erosion but no intracranial extension, one patient had a temporal bone lesion with significant middle cranial fossa extension, and one patient had an intracranial temporal lobe-based tumor without extracranial extension. Immunohistochemical evidence of the EWS/FLI-1 chimeric protooncogene, typical of PPNET, was identified in one patient; genetic analysis in two patients revealed EWSR1 gene rearrangement in one patient and a novel t(20;22)(q11.2;q12) translocation in the other. All tumors were relatively large (for body size), measuring 3-8 cm in maximal dimension. Treatment included tumor resection and sarcoma-style combination chemotherapy. Two patients are alive and continue therapy, whereas two have died of sepsis and progressive disease at 3 and 6 months after diagnosis, respectively. CONCLUSIONS: Pericranial primary ES/PPNET is a rare tumor, heretofore typically described only in preschool and school-aged children. Our study suggests this entity can occur in very young children, in whom it has a poor prognosis. It appears to be more infiltrative and to violate the usual tissue compartments. Further awareness and reporting of this rare tumor will aid understanding of histogenesis, prognosis, and optimal therapy.
Handbook on Optimizing Patient Care in Psychiatry, Sep 29, 2022
Handbook on Optimizing Patient Care in Psychiatry, Sep 29, 2022
Epilepsy is seen in 20-40% children with attention deficit hyperactivity disorder (ADHD). Neurobi... more Epilepsy is seen in 20-40% children with attention deficit hyperactivity disorder (ADHD). Neurobiological studies point towards neuronal hyperexcitability as a putative mechanism in the pathogenesis of both ADHD and epilepsy. The management of ADHD in the presence of epilepsy needs wise clinical acumen. There is an increased risk of breakthrough seizures when methylphenidate may be used in children with epilepsy and stimulants as it is predispose children to the risk of seizures even in the absence of epilepsy. The following cases discussed here highlight the clinical complexities and treatment decisions that need to be made when ADHD and epilepsy are present in the same child.
Functional neuroimaging is any means to determine the effects of brain injury or disease on brain... more Functional neuroimaging is any means to determine the effects of brain injury or disease on brain systems and functioning related to cognition and behavior and determined how treatment changes brain systems [1]. Functional neuroimaging has improved our understanding of neurobiology and bran processes in play during various routine tasks in both normal subjects and patient populations and also has also helped elucidate the role of various brain circuits and areas in the pathogenesis and maintenance of psychiatric disorders. There have been thought of using functional neuroimaging in day to day clinical practice and making the imaging modality affordable and available to all. We've come a long way from post-mortem studies to understand the brain to structural imaging methods such as computed axial tomography (CAT) scans and magnetic resonance imaging (MRI) have allowed us to begin to visually depict the shape and size of the living brain. Structural neuroimaging technologies are u...
Indian Journal of Mental Health, 2021
Journal of Psychiatric Research, 2021
Individuals with suicidal behaviours are increasingly recognized as having impairments in brain m... more Individuals with suicidal behaviours are increasingly recognized as having impairments in brain metabolism. However, these are not well delineated. To evaluate regional cerebral glucose metabolism (rCMglu) in subjects with suicidal behaviours and assess differences in rCMglu between depressed and non-depressed suicidal subjects. Thirty-three subjects with suicidal behaviours were assessed using Columbia Suicide Severity Rating scale (CSSRS) and Beck's Depression Inventory (BDI). Brain metabolism was assessed using [18F]Fluoro,Deoxy-Glucose Positron Emission Tomography (FDG-PET). Of 33 subjects, eighteen had depression. FDG-PET findings revealed that in comparison to mean asymptomatic controls, subjects had decreased rCMglu in right inferior frontal, left Broca's, left inferiolateral andsuperiolateral temporal, right inferior parietal and left posterior cingulate cortex. Increased rCMglu was seen in bilateral superior and medial frontal, right inferiolateral and posteriomedial temporal cortex, and midbrain. CSSRS total intensity inversely correlated with rCMglu in medial frontal cortex, left Broca's and superiolateral temporal cortex and directly correlated with rCMglu in right cerebellum. There was no significant difference in rCMglu between depressed and non depressed group. Significant differences exist in rCMglu of suicidal individuals, chiefly in frontal and temporal regions. Understanding these would help us identify individuals more at risk for suicidal behaviours.
Indian Journal of Mental Health(IJMH), 2017
There are various theories that have been posited with respect to the development of schizophreni... more There are various theories that have been posited with respect to the development of schizophrenia, Much before the neurobiological and social hypotheses explaining schizophrenia, various psychoanalysts and psychodynamic oriented psychologists had proposed various theories to explain the disorder. The following paper is a review of the various schools of psychodynamics and psychoanalysis that have been used to explain the genesis of schizophrenia. All the theories are revisited and this paper provides the first of its kind collection of the various psychodynamic theories under one roof for the clinician and academic reader alike. This paper is a collection of various psychodynamic theories of schizophrenia over the years and up to the present time. These theories though old have to be viewed in the light of recent advances and clinical relevance to the modern day assessment and management of schizophrenia.
Indian Journal of Mental Health(IJMH), 2016
Background: Night Eating syndrome (NES) is characterised by morning aphagia, evening hyperphagia ... more Background: Night Eating syndrome (NES) is characterised by morning aphagia, evening hyperphagia and sleep disturbances for a period of at least three months. The exact pathophysiology of NES remains elusive in spite of behavioural and neuroendocrine studies pointing to a combination of a sleep disorder, eating disorder and/or disorder of circadian rhythm. The disorder is associated with stress, abstinence from substance or smoking and many other psychiatric manifestations, apart from significant weight gain and associated metabolic problems. The current research aimed to study the prevalence, phenomenology and demographic profile of NES in patients attending tertiary general hospital psychiatry clinic in medical college attached general hospital. Methods: 459 serial patients aged 18-59 visiting the outpatient department were screened using a standardised questionnaire for NES. A complete demographic profile of patients was recorded and a record of their height, weight, diagnosis and medication history was made. Patients diagnosed with NES were further interviewed in regards to complete phenomenology of the disease, for example duration of symptoms, number of awakenings etc. in them. The prevalence of NES in the sample was calculated and phenomenology was described. Results: In our study, prevalence of NES among patients attending psychiatric OPD was found to be 5.66% (26 patients in sample of 459). Majority of the patients were middle aged between 35-50 years of age. Majority were females. 14 out of the 26 patients were either obese (BMI>30), or overweight (BMI 25-30) and even those with normal weight had BMI in upper ranges of normal (23-25). No positive family history was noted. Complete morning anorexia was noted by all cases. Evening dysphoria, craving for snacks following dinner was found in all cases. Average number of awakenings per night was 2-3 associated with food consumption to get back to sleep. This occurred three-four times a week. Average duration of symptoms was for 1.5-2 years, ranging from 10 months to 10 years. Conclusions: The study assessed NES among a particularly vulnerable group of psychiatric patients and showed prevalence of 5.66%. It is important that we routinely enquire about NES to view of significant prevalence and apparent predisposition to weight gain in psychiatric patients. Larger studies in this direction are warranted.
Annals of Indian Psychiatry, 2017
Background: Individuals with suicidal behaviors are increasingly recognized as having impairments... more Background: Individuals with suicidal behaviors are increasingly recognized as having impairments in brain metabolism. However what differentiates those who attempt suicide while having diagnosable depression versus those who attempt suicide without depression, in terms of neurobiology is still largely unknown. Aims: Using the F-18 FDG brain positron emission tomography to: 1. To evaluate differences in resting Cerebral Glucose Metabolism (rCMglu) between depressed and non-depressed suicidal subjects. 2. To translate a suicide attempt, which is a behavioral construct (NSSI or otherwise) into neurobiological constructs. Methods: Patients with suicide attempt with diagnosable Depression and those with suicide attempt without diagnosable depression (NSSI) were included. Brain metabolism was assessed using [18F] Fluoro Deoxy-Glucose Positron Emission Tomography (FDG-PET). The brain PET scans were analyzed using the NEUROQ software. Results: Of 33 subjects, eighteen had major depressive ...
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, 2021
Background: The COVID-19 pandemic has affected people worldwide. Desperate times (SARS COV-2 bein... more Background: The COVID-19 pandemic has affected people worldwide. Desperate times (SARS COV-2 being a novel virus) called in for desperate measures in that right from its containment strategies to failed treatment trials have had various ramications affecting various spheres of our lives. It has already been established that the pandemic has taken a toll on mental health, cutting across all strata of society. However, apart from the pandemic in it itself as a causative factor, there are various other factors contributing to the increase in the mental health burden; some of which are modiable. An in-depth understanding of these modiable risk factors is the need of the hour, so that policies and guidelines can be framed accordingly to salvage what can be; of the mental health of the population at large. Understanding these modiable risk factors are lessons learned which will help us mitigate the mental health morbidity during the subsequent waves of the Pandemic. Aim: To study the ...
The Indian Journal of Pediatrics, 2013
To assess the effectiveness of integrated therapy over the past 3 y on the recipient autistic chi... more To assess the effectiveness of integrated therapy over the past 3 y on the recipient autistic children and its correlation with the following variables - age at admission, duration of therapy given and initial severity of symptoms. The index study was a retrospective study with 18 autistic children as subjects; the maximum duration of intervention was 3 y. The integrated approach consisted of special education using principles of applied behavior analysis, occupational and speech therapy. The progress records, the occupational therapy and the speech therapy progress reports were tabulated as data. The Childhood Autism Rating Scale (Schopler, Reichler and Renner, 1986) was used for evaluation of severity of symptoms at admission and in present day. The data was then compared and analyzed. The present study showed significant positive results. Only few domains requiring very high integrated cognitive and sensorimotor functioning showed non-significant results. Age at intervention correlated negatively and, duration of therapy given and initial severity of symptoms correlated positively with effectiveness of therapy. Continuous feedback and modification of the therapy is required to maintain performance and develop target interventions for problematic areas identified. Longitudinal as well as comparative studies are required to better understand the benefits of integrated approach.
Indian Journal of Mental Health, 2021
Indian Journal of Mental Health(IJMH), Jan 12, 2015
Loneliness signifies the adverse feeling resulting from social disconnectedness and the barrier b... more Loneliness signifies the adverse feeling resulting from social disconnectedness and the barrier between achieving one"s desired social relations. The present review article primarily examines the interplay between loneliness and mental health. Though the available literature is large the following paper attempts to provide an overview of the various areas where loneliness and mental health are intertwined. The paper examines the basic concept of the construct of loneliness and differentiates it from other similar constructs. Loneliness has pertinent effects on physical health that in turn affect mental health. This is reviewed in a section followed by the effects of loneliness on mental health in general. Genetic factors as well as the neurobiological underpinnings of loneliness are examined. The effects of loneliness across the life span are also discussed with loneliness and its effects across age groups being examined. The factors determining the evolution of loneliness in humans is also examined. Though the paper follows a narrative rather than a systematic review paradigm, it gives the reader an overview of the various facets of loneliness and mental health. The paper also sums up the effect of loneliness on morbidity and mortality while exhorting the need for healthy social relationships in living. Various interventions that may be carried out for the prevention of loneliness are also discussed.
Annals of Indian psychiatry, Apr 1, 2024
American Journal of Case Reports, Mar 13, 2023
Annals of Indian psychiatry, Apr 1, 2024
Neuro-Oncology, 2011
INTRODUCTION: Primitive neuroectodermal tumor (PNET) is the most common primary malignant childho... more INTRODUCTION: Primitive neuroectodermal tumor (PNET) is the most common primary malignant childhood brain tumor and is usually seen as an intraparenchymal lesion, typically arising in the cerebellum (as a medulloblastoma). Peripheral PNET (PPNET), a member of the Ewing's sarcoma (ES) family of tumors, is a tumor of putative parasympathetic neural histogenesis, typically developing in the soft tissue and skeletal structures of the trunk and extremities. We report here four cases of atypical primary ES/PPNET in very young children involving pericranial structures, two with significant intracranial involvement. METHODS: Following IRB approval, we compiled the clinical, imaging, and pathology records from four children with aggressive pericranial ES/PPNET. RESULTS: Ages at diagnosis were 1 day (female), 5 days (male), 12 months (male), and 13 months (female). Two patients had orbitofacial tumors with significant bony erosion but no intracranial extension, one patient had a temporal bone lesion with significant middle cranial fossa extension, and one patient had an intracranial temporal lobe-based tumor without extracranial extension. Immunohistochemical evidence of the EWS/FLI-1 chimeric protooncogene, typical of PPNET, was identified in one patient; genetic analysis in two patients revealed EWSR1 gene rearrangement in one patient and a novel t(20;22)(q11.2;q12) translocation in the other. All tumors were relatively large (for body size), measuring 3-8 cm in maximal dimension. Treatment included tumor resection and sarcoma-style combination chemotherapy. Two patients are alive and continue therapy, whereas two have died of sepsis and progressive disease at 3 and 6 months after diagnosis, respectively. CONCLUSIONS: Pericranial primary ES/PPNET is a rare tumor, heretofore typically described only in preschool and school-aged children. Our study suggests this entity can occur in very young children, in whom it has a poor prognosis. It appears to be more infiltrative and to violate the usual tissue compartments. Further awareness and reporting of this rare tumor will aid understanding of histogenesis, prognosis, and optimal therapy.
Handbook on Optimizing Patient Care in Psychiatry, Sep 29, 2022
Handbook on Optimizing Patient Care in Psychiatry, Sep 29, 2022
Epilepsy is seen in 20-40% children with attention deficit hyperactivity disorder (ADHD). Neurobi... more Epilepsy is seen in 20-40% children with attention deficit hyperactivity disorder (ADHD). Neurobiological studies point towards neuronal hyperexcitability as a putative mechanism in the pathogenesis of both ADHD and epilepsy. The management of ADHD in the presence of epilepsy needs wise clinical acumen. There is an increased risk of breakthrough seizures when methylphenidate may be used in children with epilepsy and stimulants as it is predispose children to the risk of seizures even in the absence of epilepsy. The following cases discussed here highlight the clinical complexities and treatment decisions that need to be made when ADHD and epilepsy are present in the same child.
Functional neuroimaging is any means to determine the effects of brain injury or disease on brain... more Functional neuroimaging is any means to determine the effects of brain injury or disease on brain systems and functioning related to cognition and behavior and determined how treatment changes brain systems [1]. Functional neuroimaging has improved our understanding of neurobiology and bran processes in play during various routine tasks in both normal subjects and patient populations and also has also helped elucidate the role of various brain circuits and areas in the pathogenesis and maintenance of psychiatric disorders. There have been thought of using functional neuroimaging in day to day clinical practice and making the imaging modality affordable and available to all. We've come a long way from post-mortem studies to understand the brain to structural imaging methods such as computed axial tomography (CAT) scans and magnetic resonance imaging (MRI) have allowed us to begin to visually depict the shape and size of the living brain. Structural neuroimaging technologies are u...
Indian Journal of Mental Health, 2021
Journal of Psychiatric Research, 2021
Individuals with suicidal behaviours are increasingly recognized as having impairments in brain m... more Individuals with suicidal behaviours are increasingly recognized as having impairments in brain metabolism. However, these are not well delineated. To evaluate regional cerebral glucose metabolism (rCMglu) in subjects with suicidal behaviours and assess differences in rCMglu between depressed and non-depressed suicidal subjects. Thirty-three subjects with suicidal behaviours were assessed using Columbia Suicide Severity Rating scale (CSSRS) and Beck's Depression Inventory (BDI). Brain metabolism was assessed using [18F]Fluoro,Deoxy-Glucose Positron Emission Tomography (FDG-PET). Of 33 subjects, eighteen had depression. FDG-PET findings revealed that in comparison to mean asymptomatic controls, subjects had decreased rCMglu in right inferior frontal, left Broca's, left inferiolateral andsuperiolateral temporal, right inferior parietal and left posterior cingulate cortex. Increased rCMglu was seen in bilateral superior and medial frontal, right inferiolateral and posteriomedial temporal cortex, and midbrain. CSSRS total intensity inversely correlated with rCMglu in medial frontal cortex, left Broca's and superiolateral temporal cortex and directly correlated with rCMglu in right cerebellum. There was no significant difference in rCMglu between depressed and non depressed group. Significant differences exist in rCMglu of suicidal individuals, chiefly in frontal and temporal regions. Understanding these would help us identify individuals more at risk for suicidal behaviours.
Indian Journal of Mental Health(IJMH), 2017
There are various theories that have been posited with respect to the development of schizophreni... more There are various theories that have been posited with respect to the development of schizophrenia, Much before the neurobiological and social hypotheses explaining schizophrenia, various psychoanalysts and psychodynamic oriented psychologists had proposed various theories to explain the disorder. The following paper is a review of the various schools of psychodynamics and psychoanalysis that have been used to explain the genesis of schizophrenia. All the theories are revisited and this paper provides the first of its kind collection of the various psychodynamic theories under one roof for the clinician and academic reader alike. This paper is a collection of various psychodynamic theories of schizophrenia over the years and up to the present time. These theories though old have to be viewed in the light of recent advances and clinical relevance to the modern day assessment and management of schizophrenia.
Indian Journal of Mental Health(IJMH), 2016
Background: Night Eating syndrome (NES) is characterised by morning aphagia, evening hyperphagia ... more Background: Night Eating syndrome (NES) is characterised by morning aphagia, evening hyperphagia and sleep disturbances for a period of at least three months. The exact pathophysiology of NES remains elusive in spite of behavioural and neuroendocrine studies pointing to a combination of a sleep disorder, eating disorder and/or disorder of circadian rhythm. The disorder is associated with stress, abstinence from substance or smoking and many other psychiatric manifestations, apart from significant weight gain and associated metabolic problems. The current research aimed to study the prevalence, phenomenology and demographic profile of NES in patients attending tertiary general hospital psychiatry clinic in medical college attached general hospital. Methods: 459 serial patients aged 18-59 visiting the outpatient department were screened using a standardised questionnaire for NES. A complete demographic profile of patients was recorded and a record of their height, weight, diagnosis and medication history was made. Patients diagnosed with NES were further interviewed in regards to complete phenomenology of the disease, for example duration of symptoms, number of awakenings etc. in them. The prevalence of NES in the sample was calculated and phenomenology was described. Results: In our study, prevalence of NES among patients attending psychiatric OPD was found to be 5.66% (26 patients in sample of 459). Majority of the patients were middle aged between 35-50 years of age. Majority were females. 14 out of the 26 patients were either obese (BMI>30), or overweight (BMI 25-30) and even those with normal weight had BMI in upper ranges of normal (23-25). No positive family history was noted. Complete morning anorexia was noted by all cases. Evening dysphoria, craving for snacks following dinner was found in all cases. Average number of awakenings per night was 2-3 associated with food consumption to get back to sleep. This occurred three-four times a week. Average duration of symptoms was for 1.5-2 years, ranging from 10 months to 10 years. Conclusions: The study assessed NES among a particularly vulnerable group of psychiatric patients and showed prevalence of 5.66%. It is important that we routinely enquire about NES to view of significant prevalence and apparent predisposition to weight gain in psychiatric patients. Larger studies in this direction are warranted.
Annals of Indian Psychiatry, 2017
Background: Individuals with suicidal behaviors are increasingly recognized as having impairments... more Background: Individuals with suicidal behaviors are increasingly recognized as having impairments in brain metabolism. However what differentiates those who attempt suicide while having diagnosable depression versus those who attempt suicide without depression, in terms of neurobiology is still largely unknown. Aims: Using the F-18 FDG brain positron emission tomography to: 1. To evaluate differences in resting Cerebral Glucose Metabolism (rCMglu) between depressed and non-depressed suicidal subjects. 2. To translate a suicide attempt, which is a behavioral construct (NSSI or otherwise) into neurobiological constructs. Methods: Patients with suicide attempt with diagnosable Depression and those with suicide attempt without diagnosable depression (NSSI) were included. Brain metabolism was assessed using [18F] Fluoro Deoxy-Glucose Positron Emission Tomography (FDG-PET). The brain PET scans were analyzed using the NEUROQ software. Results: Of 33 subjects, eighteen had major depressive ...
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, 2021
Background: The COVID-19 pandemic has affected people worldwide. Desperate times (SARS COV-2 bein... more Background: The COVID-19 pandemic has affected people worldwide. Desperate times (SARS COV-2 being a novel virus) called in for desperate measures in that right from its containment strategies to failed treatment trials have had various ramications affecting various spheres of our lives. It has already been established that the pandemic has taken a toll on mental health, cutting across all strata of society. However, apart from the pandemic in it itself as a causative factor, there are various other factors contributing to the increase in the mental health burden; some of which are modiable. An in-depth understanding of these modiable risk factors is the need of the hour, so that policies and guidelines can be framed accordingly to salvage what can be; of the mental health of the population at large. Understanding these modiable risk factors are lessons learned which will help us mitigate the mental health morbidity during the subsequent waves of the Pandemic. Aim: To study the ...
The Indian Journal of Pediatrics, 2013
To assess the effectiveness of integrated therapy over the past 3 y on the recipient autistic chi... more To assess the effectiveness of integrated therapy over the past 3 y on the recipient autistic children and its correlation with the following variables - age at admission, duration of therapy given and initial severity of symptoms. The index study was a retrospective study with 18 autistic children as subjects; the maximum duration of intervention was 3 y. The integrated approach consisted of special education using principles of applied behavior analysis, occupational and speech therapy. The progress records, the occupational therapy and the speech therapy progress reports were tabulated as data. The Childhood Autism Rating Scale (Schopler, Reichler and Renner, 1986) was used for evaluation of severity of symptoms at admission and in present day. The data was then compared and analyzed. The present study showed significant positive results. Only few domains requiring very high integrated cognitive and sensorimotor functioning showed non-significant results. Age at intervention correlated negatively and, duration of therapy given and initial severity of symptoms correlated positively with effectiveness of therapy. Continuous feedback and modification of the therapy is required to maintain performance and develop target interventions for problematic areas identified. Longitudinal as well as comparative studies are required to better understand the benefits of integrated approach.
Indian Journal of Mental Health, 2021
Indian Journal of Mental Health(IJMH), Jan 12, 2015
Loneliness signifies the adverse feeling resulting from social disconnectedness and the barrier b... more Loneliness signifies the adverse feeling resulting from social disconnectedness and the barrier between achieving one"s desired social relations. The present review article primarily examines the interplay between loneliness and mental health. Though the available literature is large the following paper attempts to provide an overview of the various areas where loneliness and mental health are intertwined. The paper examines the basic concept of the construct of loneliness and differentiates it from other similar constructs. Loneliness has pertinent effects on physical health that in turn affect mental health. This is reviewed in a section followed by the effects of loneliness on mental health in general. Genetic factors as well as the neurobiological underpinnings of loneliness are examined. The effects of loneliness across the life span are also discussed with loneliness and its effects across age groups being examined. The factors determining the evolution of loneliness in humans is also examined. Though the paper follows a narrative rather than a systematic review paradigm, it gives the reader an overview of the various facets of loneliness and mental health. The paper also sums up the effect of loneliness on morbidity and mortality while exhorting the need for healthy social relationships in living. Various interventions that may be carried out for the prevention of loneliness are also discussed.