Objective: Clozapine is seen as a gold standard for treatment refractory schizophrenia; however, it is not recommended for the treatment of first-episode psychosis mainly due to concerns of severe side effects. An indicator for response holds tremendous clinical value to select patients who can benefit from clozapine, safely. EEG abnormality has been reported to be one such parameter, yet the definite conclusion of the nature of EEG changes and its predictive value remains undetermined. The present study was undertaken to examine electroencephalographic (EEG) abnormalities and clinical response subsequent to clozapine therapy in schizophrenia. Methods: A total of 80 first-episode patients were recruited for a 12 week study, from a tertiary care centre in Mumbai, India. First episode was defined as an illness of less than 2 years duration and first hospitalization since illness. EEG abnormalities, psychopathology, and positive and negative symptoms were examined at baseline and again after 12 weeks of clozapine treatment. Results: There were some types of EEG abnormalities found in pretreatment state in at least two-thirds of patients. The number of patients showing EEG abnormality at the end of the 12 weeks of treatment increased significantly, which included theta (θ) frequency, slow waves, and sharp waves. Symptomatically, significant improvement was seen in both positive as well as negative symptoms scores. However, there was no significant correlation between EEG changes and clinical outcome. Conclusion: There was significant abnormality in the number of patients exhibiting EEG abnormalities. Baseline pretreatment EEG abnormalities were present in a considerable number of patients, and these EEG abnormalities did not significantly correlate with clinical improvement, except suggesting a trend towards such correlation.
Electroencephalography

Objective: We report a rare case of musical hallucination in a male who had a history of alcohol consumption for 25 years. Methods: We present a 47-year-male with a history of alcohol consumption since 25 years presented with fearfulness, hearing voices and decreased sleep for 8 days. The last drink was 12 days prior to presentation. Results: The patient was diagnosed to have alcohol withdrawal syndrome and had musical hallucination whereby he heard voices reading a poem in a rhyming manner. These voices threatened him in these musical rhyming ways that they would make him go mad, would not allow him to sleep and would kill him and his family members. Conclusion: Musical hallucination has heterogeneous clinical and pathophysiological etiology, and has been reported in the elderly and in those with hearing impairment, central nervous system disorders and psychiatric disorders. Musical hallucination is very rare in alcohol withdrawal syndrome. The treatment of musical hallucination includes carbamazepine, clomipramine and Electroconvulsive therapy (ECT).

Acquired hand trauma is a significant event that often affects an individuals’ life in diverse manners. The present paper aims to review the psychological issues in hand trauma along with factors that affect recovery from the same. Method: A relevant search for literature on psychological issues in hand trauma was made across search engines like Google Scholar, Medline and Pubmed and relevant studies were selected for this review. The studies include those on symptomatology, course as well as treatment. The studies were analyzed critically along with inputs of personal clinical experience of the authors. Results: Psychological symptoms that occur after hand trauma together with the treatment methods that provide relief from psychological symptoms are discussed. Symptoms of post-traumatic stress disorder (PTSD), flashbacks, concerns with personal appearance, avoidance of reminders of the trauma and physiological arousal along with sleep issues have been discussed. The article also looks at the psychosocial effects of hand trauma including marital and sexual issues that may arise. Treatment interventions commonly used in the form of imagery and in vivo exposure with and without cognitive restructuring are explained along with psychoeducation approaches that may benefit these patients. Conclusions: It is important that surgeons and professionals dealing with hand trauma are aware of the psychological issues in hand trauma and to take appropriate steps to deal with any such problems that ensue.

The objective of this study was to compare the safety and efficacy of mirtazapine and escitalopram in HIV patients for the treatment of depression. Methods: In this trial, 70 adult HIV patients with major depression were randomized and assigned to receive 8 weeks of daily open label mirtazapine (5-30mg) or escitalopram (7.5-20 mg). The primary outcome variables were endpoint response in Hamilton Rating Scale for Depression (HAM-D) score and change of HAM-D score from baseline to endpoint. Patients having improvement of > 50% on the HAM-D total scores during treatment were considered to have responded. A final 17-item HAM-D total score of 8 or less defined remission. Results: The response rate was 91.4 % (32/35) in Mirtazapine group and 85.7 % (30/35) in Escitalopram group (p= 0.71). The remission rate was more in escitalopram group (48.6 %, 17/35) compared to Mirtazapine group (34.3 %, 12/35); however it was not statistically significant (Chi square (1, N = 70) = 2.1, p = 0.22). After controlling for baseline score, the median HAMD score at 8 weeks was significantly lower in the Mirtazapine group (Median (Mdn)=4, Interquartile range (IQR)= 11) compared to Escitalopram group (Mdn=13, IQR= 12) (p < 0.001). The number of adverse events reported was more in Escitalopram group (110) than Mirtazapine group (85); however this was not statistically significant (p= 0.34). Conclusions: Both these drugs are useful in the management of depression in HIV patients and need further study.