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Papers by Srinivasan Tirupati

Indian Journal Of Mental Health And Neurosciences, Jul 14, 2018

People with severe mental disorders experience difficulty in functioning in several domains of li... more People with severe mental disorders experience difficulty in functioning in several domains of life that are all not related to the illness and the symptoms. Medical management for severe mental disorders leads to improvement in symptoms and distress that may not always correlate with functional improvement. A comprehensive rehabilitative care is necessary to reengage the person in life activities and full participation in mainstream life. The Rehabilitation interventions are to be person centered with supports from the environment and removal of barriers to progress recovery. Rehabilitative care should be enhanced by integrated recovery-orientated practices that sustain hope, promote self-agency. This paper discusses the definition of psychiatric rehabilitation and a model of the processes involved.

Journal of Psychosocial Rehabilitation and Mental Health

Australasian Psychiatry

Objectives To elicit mental health clinicians’ views on the reasons for delayed initiation of clo... more Objectives To elicit mental health clinicians’ views on the reasons for delayed initiation of clozapine treatment. Method Thematic analysis of transcripts from a semi-structured interview of 15 mental health clinicians. Results Four major themes emerged from data analysis: Patient and Carer Factors, Medication factors, Protocol factors, and Prescriber factors. Patient and carer anxiety over side effects and experience of stigma, difficulties in implementing the monitoring protocol, problems with community managing of treatment, prescriber preferences and practices, and gaps in mental health services were some of the reasons identified. Conclusion Education and support to patients and carers, a modified monitoring protocol, establishing clozapine clinics, improved early intervention services, and upskilling of clinicians can promote early clozapine initiation.

Journal of Clinical Psychopharmacology, 2021

Background Clozapine is the most effective in treatment-resistant schizophrenia. Neutropenia is a... more Background Clozapine is the most effective in treatment-resistant schizophrenia. Neutropenia is an adverse effect of the drug requiring treatment discontinuation. This study related treatment continuation with little or no interruption after a neutropenia episode. The study contrasted from rechallenge studies after an extended treatment interruption. Methods This retrospective chart audit examined 37 patients with an episode of neutropenia. It described characteristics of patients continuing treatment with minimal interruption. Findings Thirty-one patients continued treatment after an initial treatment interruption for less than 3 days. A probable cause for neutropenia other than clozapine was identified in 14 patients. Twelve patients continued treatment with a change in the absolute neutrophil counts threshold to 1000/μL to determine treatment cessation. Most patients recovered from the index episode of neutropenia within 2 days. They also frequently presented with recurring benig...

Twin Research and Human Genetics, 2006

Journal of Clinical Psychopharmacology

Indian Journal of Social Psychiatry

Journal of Psychosocial Rehabilitation and Mental Health, 2021

The Intermediate Stay Mental Health Unit - Establishment, Service Context, Staffing and Training ... more The Intermediate Stay Mental Health Unit - Establishment, Service Context, Staffing and Training Strategy. (DOCX 45 kb)

Psychological Medicine, 1998

Background. A significant number of patients with severe psychiatric disorders remain untreated i... more Background. A significant number of patients with severe psychiatric disorders remain untreated in the community although health services are available. The factors related to non-treatment are not well understood.Method. A door-to-door survey was conducted on an Indian urban population of 100 000 using standardized screening and clinical instruments as a part of a larger epidemiological study. Treatment status was determined from multiple sources of information.Results. Nearly one-third of 261 schizophrenia patients were found never to have received treatment. They were older in age and ill for a longer duration than those who had been treated and were more symptomatic and severely disabled. They were more often uneducated and divorced and lived with larger extended/joint families. This last factor was considered as being the important factor in determining whether the patient received treatment.Conclusion. The larger extended/joint family, which was able to compensate and cope wit...

Early Intervention in Psychiatry, 2014

Australian & New Zealand Journal of Psychiatry, 2008

Objective: This paper reports findings from a multicentre service evaluation project conducted in... more Objective: This paper reports findings from a multicentre service evaluation project conducted in acute psychiatric inpatient units in NSW, Australia. Overall rates of aggression, absconding and early readmission are reported, as well as length-of-stay profiles and associations between these outcomes and selected sociodemographic and clinical characteristics routinely collected by health services. Method: Data from the 11 participating units were collected for a 12month period from multiple sources, including electronic medical records, routine clinical modules, incident forms, and shift based project-specific logs. For the current analyses, two admission-level datasets were used, comprising aggregated patient-level events (n=3242 admissions) and basic sociodemographic, clinical, admission and discharge information (n=5546 admissions by 3877 patients). Results: The participating units were under considerable strain: 23.3% of admissions were high acuity; 60.4% had previous hospital s...

American Journal of Psychiatry, 2009

The study of ethnically homogeneous populations may help to identify schizophrenia risk loci. The... more The study of ethnically homogeneous populations may help to identify schizophrenia risk loci. The authors conducted a genomewide linkage scan for schizophrenia in an Indian population. Method: Participants were 441 individuals (262 affected probands and siblings) who were recruited primarily from one ethnically homogeneous group, the Tamil Brahmin caste, although individuals from other geographically proximal castes also participated. Genotyping of 124 affected sibling pair pedigrees was performed with 402 short tandem repeat polymorphisms. Linkage analyses were conducted using nonparametric exponential LOD (logarithm of the odds ratio for linkage) scores and parametric heterogeneity LOD scores. Parametric heterogeneity scores were calculated using simple dominant and recessive models, correcting for multiple statistics. The data were examined for evidence of consanguinity. Genomewide significance levels were determined using 10,000 gene dropping simulations. Results: These findings revealed genomewide significant linkage to chromosome 1p31.1, through the use of both exponential and heterogeneity LOD scores, incorporating correction for multiple statistics and mild consanguinity. The estimated sibling recurrence risk associated with this putative locus was 1.95. Analysis for heterogeneity LOD scores also detected suggestive linkage to chromosomes 13q22.1 and 16q12.2. Using 117 tag single nucleotide polymorphisms (SNPs), familybased association analyses of phosphodiesterase 4B (PDE4B), the closest schizophrenia candidate gene, detected no convincing evidence of association, suggesting that the chromosome 1 peak represents a novel risk locus. Conclusions: This is the first study-to the authors' knowledge-to report significant linkage of schizophrenia to chromosome 1p31.1. Further investigation of this chromosome region in diverse populations is warranted to identify underlying sequence variants.

Australian Social Work, 2021

Mandatory restrictions on social activities and access to services during the COVID-19 pandemic p... more Mandatory restrictions on social activities and access to services during the COVID-19 pandemic prevented discharge into the community of consumers from an extended-stay, hospital-based rehabilitat...

Indian Journal of Psychiatry, 2004

Definition of culture is difficult. Nevertheless, culturecontrols our lives (Pedersen & Ivey, 199... more Definition of culture is difficult. Nevertheless, culturecontrols our lives (Pedersen & Ivey, 1993). Cross-culturalpsychiatry classically deals with the interaction betweenculture and the experience and expression ofpsychopathology. It discusses the role of culture in the courseand outcome of psychiatric disorders. The concepts ofculture-bound and culture-free syndromes are commonknowledge now. Cross-cultural themes also coverexplanatory models of illness and traditional models oftreatment followed in different cultures.The society is becoming more diverse with the evolution ofa “global village” environment. The geographical boundariesthat defined cultures have become porous. Multiethnic andmulticultural societies are becoming commonplace. Apsychiatrist from India caring for a patient of Greek originliving in Australia does not raise any eyebrow nowadays.For the purpose of this article, I thought it would beinteresting to look at issues that may arise in such a multi-cultural scenar...

Australasian Psychiatry

Background: Sudden cardiac death (SCD) is a significant cause for increased mortality in people w... more Background: Sudden cardiac death (SCD) is a significant cause for increased mortality in people with schizophrenia and schizoaffective disorders. Cardiac arrhythmia is one cause of SCD. Electrocardiographic (ECG) abnormalities predictive of arrhythmias are associated with antipsychotic drug use. Method: This chart audit examined the types and frequency of ECG abnormalities (ECG-Abs) in 169 patients with schizophrenia and schizoaffective disorder in a long-stay inpatient unit. We examined the association of ECG-Abs with demographic details and psychotropic drug prescription using chi-square test, Fisher’s Exact test, independent two-sample t-test, Pearson’s correlation, and one-way ANOVA. Results: Eighty-eight patients (52.1%) recorded at least one ECG-Ab, and 20.7% had two or more ECG-Abs. The use of multiple antipsychotics, with or without other psychotropic drugs, did not associate significantly with the presence or number of ECG-Abs. Conclusion: A significant proportion of patien...

A systematic review of literature was conducted to determine the association between serum lipids... more A systematic review of literature was conducted to determine the association between serum lipids and suicidality in people with schizophrenia spectrum disorders.

People with severe mental disorders experience difficulty in functioning in several domains of li... more People with severe mental disorders experience difficulty in functioning in several domains of life that are all not related to the illness and the symptoms. Medical management for severe mental disorders leads to improvement in symptoms and distress that may not always correlate with functional improvement. A comprehensive rehabilitative care is necessary to reengage the person in life activities and full participation in mainstream life. The Rehabilitation interventions are to be person centered with supports from the environment and removal of barriers to progress recovery. Rehabilitative care should be enhanced by integrated recovery-orientated practices that sustain hope, promote self-agency. This paper discusses the definition of psychiatric rehabilitation and a model of the processes involved.

Indian Journal Of Mental Health And Neurosciences, Jul 14, 2018

People with severe mental disorders experience difficulty in functioning in several domains of li... more People with severe mental disorders experience difficulty in functioning in several domains of life that are all not related to the illness and the symptoms. Medical management for severe mental disorders leads to improvement in symptoms and distress that may not always correlate with functional improvement. A comprehensive rehabilitative care is necessary to reengage the person in life activities and full participation in mainstream life. The Rehabilitation interventions are to be person centered with supports from the environment and removal of barriers to progress recovery. Rehabilitative care should be enhanced by integrated recovery-orientated practices that sustain hope, promote self-agency. This paper discusses the definition of psychiatric rehabilitation and a model of the processes involved.

Journal of Psychosocial Rehabilitation and Mental Health

Australasian Psychiatry

Objectives To elicit mental health clinicians’ views on the reasons for delayed initiation of clo... more Objectives To elicit mental health clinicians’ views on the reasons for delayed initiation of clozapine treatment. Method Thematic analysis of transcripts from a semi-structured interview of 15 mental health clinicians. Results Four major themes emerged from data analysis: Patient and Carer Factors, Medication factors, Protocol factors, and Prescriber factors. Patient and carer anxiety over side effects and experience of stigma, difficulties in implementing the monitoring protocol, problems with community managing of treatment, prescriber preferences and practices, and gaps in mental health services were some of the reasons identified. Conclusion Education and support to patients and carers, a modified monitoring protocol, establishing clozapine clinics, improved early intervention services, and upskilling of clinicians can promote early clozapine initiation.

Journal of Clinical Psychopharmacology, 2021

Background Clozapine is the most effective in treatment-resistant schizophrenia. Neutropenia is a... more Background Clozapine is the most effective in treatment-resistant schizophrenia. Neutropenia is an adverse effect of the drug requiring treatment discontinuation. This study related treatment continuation with little or no interruption after a neutropenia episode. The study contrasted from rechallenge studies after an extended treatment interruption. Methods This retrospective chart audit examined 37 patients with an episode of neutropenia. It described characteristics of patients continuing treatment with minimal interruption. Findings Thirty-one patients continued treatment after an initial treatment interruption for less than 3 days. A probable cause for neutropenia other than clozapine was identified in 14 patients. Twelve patients continued treatment with a change in the absolute neutrophil counts threshold to 1000/μL to determine treatment cessation. Most patients recovered from the index episode of neutropenia within 2 days. They also frequently presented with recurring benig...

Twin Research and Human Genetics, 2006

Journal of Clinical Psychopharmacology

Indian Journal of Social Psychiatry

Journal of Psychosocial Rehabilitation and Mental Health, 2021

The Intermediate Stay Mental Health Unit - Establishment, Service Context, Staffing and Training ... more The Intermediate Stay Mental Health Unit - Establishment, Service Context, Staffing and Training Strategy. (DOCX 45 kb)

Psychological Medicine, 1998

Background. A significant number of patients with severe psychiatric disorders remain untreated i... more Background. A significant number of patients with severe psychiatric disorders remain untreated in the community although health services are available. The factors related to non-treatment are not well understood.Method. A door-to-door survey was conducted on an Indian urban population of 100 000 using standardized screening and clinical instruments as a part of a larger epidemiological study. Treatment status was determined from multiple sources of information.Results. Nearly one-third of 261 schizophrenia patients were found never to have received treatment. They were older in age and ill for a longer duration than those who had been treated and were more symptomatic and severely disabled. They were more often uneducated and divorced and lived with larger extended/joint families. This last factor was considered as being the important factor in determining whether the patient received treatment.Conclusion. The larger extended/joint family, which was able to compensate and cope wit...

Early Intervention in Psychiatry, 2014

Australian & New Zealand Journal of Psychiatry, 2008

Objective: This paper reports findings from a multicentre service evaluation project conducted in... more Objective: This paper reports findings from a multicentre service evaluation project conducted in acute psychiatric inpatient units in NSW, Australia. Overall rates of aggression, absconding and early readmission are reported, as well as length-of-stay profiles and associations between these outcomes and selected sociodemographic and clinical characteristics routinely collected by health services. Method: Data from the 11 participating units were collected for a 12month period from multiple sources, including electronic medical records, routine clinical modules, incident forms, and shift based project-specific logs. For the current analyses, two admission-level datasets were used, comprising aggregated patient-level events (n=3242 admissions) and basic sociodemographic, clinical, admission and discharge information (n=5546 admissions by 3877 patients). Results: The participating units were under considerable strain: 23.3% of admissions were high acuity; 60.4% had previous hospital s...

American Journal of Psychiatry, 2009

The study of ethnically homogeneous populations may help to identify schizophrenia risk loci. The... more The study of ethnically homogeneous populations may help to identify schizophrenia risk loci. The authors conducted a genomewide linkage scan for schizophrenia in an Indian population. Method: Participants were 441 individuals (262 affected probands and siblings) who were recruited primarily from one ethnically homogeneous group, the Tamil Brahmin caste, although individuals from other geographically proximal castes also participated. Genotyping of 124 affected sibling pair pedigrees was performed with 402 short tandem repeat polymorphisms. Linkage analyses were conducted using nonparametric exponential LOD (logarithm of the odds ratio for linkage) scores and parametric heterogeneity LOD scores. Parametric heterogeneity scores were calculated using simple dominant and recessive models, correcting for multiple statistics. The data were examined for evidence of consanguinity. Genomewide significance levels were determined using 10,000 gene dropping simulations. Results: These findings revealed genomewide significant linkage to chromosome 1p31.1, through the use of both exponential and heterogeneity LOD scores, incorporating correction for multiple statistics and mild consanguinity. The estimated sibling recurrence risk associated with this putative locus was 1.95. Analysis for heterogeneity LOD scores also detected suggestive linkage to chromosomes 13q22.1 and 16q12.2. Using 117 tag single nucleotide polymorphisms (SNPs), familybased association analyses of phosphodiesterase 4B (PDE4B), the closest schizophrenia candidate gene, detected no convincing evidence of association, suggesting that the chromosome 1 peak represents a novel risk locus. Conclusions: This is the first study-to the authors' knowledge-to report significant linkage of schizophrenia to chromosome 1p31.1. Further investigation of this chromosome region in diverse populations is warranted to identify underlying sequence variants.

Australian Social Work, 2021

Mandatory restrictions on social activities and access to services during the COVID-19 pandemic p... more Mandatory restrictions on social activities and access to services during the COVID-19 pandemic prevented discharge into the community of consumers from an extended-stay, hospital-based rehabilitat...

Indian Journal of Psychiatry, 2004

Definition of culture is difficult. Nevertheless, culturecontrols our lives (Pedersen & Ivey, 199... more Definition of culture is difficult. Nevertheless, culturecontrols our lives (Pedersen & Ivey, 1993). Cross-culturalpsychiatry classically deals with the interaction betweenculture and the experience and expression ofpsychopathology. It discusses the role of culture in the courseand outcome of psychiatric disorders. The concepts ofculture-bound and culture-free syndromes are commonknowledge now. Cross-cultural themes also coverexplanatory models of illness and traditional models oftreatment followed in different cultures.The society is becoming more diverse with the evolution ofa “global village” environment. The geographical boundariesthat defined cultures have become porous. Multiethnic andmulticultural societies are becoming commonplace. Apsychiatrist from India caring for a patient of Greek originliving in Australia does not raise any eyebrow nowadays.For the purpose of this article, I thought it would beinteresting to look at issues that may arise in such a multi-cultural scenar...

Australasian Psychiatry

Background: Sudden cardiac death (SCD) is a significant cause for increased mortality in people w... more Background: Sudden cardiac death (SCD) is a significant cause for increased mortality in people with schizophrenia and schizoaffective disorders. Cardiac arrhythmia is one cause of SCD. Electrocardiographic (ECG) abnormalities predictive of arrhythmias are associated with antipsychotic drug use. Method: This chart audit examined the types and frequency of ECG abnormalities (ECG-Abs) in 169 patients with schizophrenia and schizoaffective disorder in a long-stay inpatient unit. We examined the association of ECG-Abs with demographic details and psychotropic drug prescription using chi-square test, Fisher’s Exact test, independent two-sample t-test, Pearson’s correlation, and one-way ANOVA. Results: Eighty-eight patients (52.1%) recorded at least one ECG-Ab, and 20.7% had two or more ECG-Abs. The use of multiple antipsychotics, with or without other psychotropic drugs, did not associate significantly with the presence or number of ECG-Abs. Conclusion: A significant proportion of patien...

A systematic review of literature was conducted to determine the association between serum lipids... more A systematic review of literature was conducted to determine the association between serum lipids and suicidality in people with schizophrenia spectrum disorders.

People with severe mental disorders experience difficulty in functioning in several domains of li... more People with severe mental disorders experience difficulty in functioning in several domains of life that are all not related to the illness and the symptoms. Medical management for severe mental disorders leads to improvement in symptoms and distress that may not always correlate with functional improvement. A comprehensive rehabilitative care is necessary to reengage the person in life activities and full participation in mainstream life. The Rehabilitation interventions are to be person centered with supports from the environment and removal of barriers to progress recovery. Rehabilitative care should be enhanced by integrated recovery-orientated practices that sustain hope, promote self-agency. This paper discusses the definition of psychiatric rehabilitation and a model of the processes involved.