The aim of the study was to compare the neurological soft signs (NSS) in schizophrenia patients with and without first rank symptoms (FRS), their first degree relatives (FDR), and normal controls. The study was conducted on 60 schizophrenia patients diagnosed according to ICD 10 DCR and categorized into groups with and without FRS using Schedules for Clinical Assessment in Neuropsychiatry, 30 FDRs of the study sample, and 30 normal controls matched for age, education, and handedness. All the subjects gave written informed consent. Scale for the Assessment of Positive Symptoms and Scale for the Assessment of Negative Symptoms were applied to have a comprehensive assessment of the symptoms. NSS were assessed using Extended Standard Neurological Assessment Instrument. The correlations between NSS and clinical symptoms were relatively modest but significant. There was a weak relation between NSS and positive symptom severity. The FDR of schizophrenia patients had significantly lower NSS scores than schizophrenia patients, but only FDR of schizophrenia patients without FRS had significantly higher scores than normal controls. Our results indicate that NSS are more prominent in schizophrenia patients with negative symptoms and support the theory of NSS being a trait marker of schizophrenia particularly in those without FRS.

Clozapine is an antipsychotic drug recommended for resistant schizophrenia, but its widespread use is limited by adverse effects. Sialorrhea is a common and troublesome adverse effect seen with clozapine which leads to poor compliance. Several treatment strategies are advocated, no single treatment is considered superior. Amitriptyline, a tricyclic antidepressant, has been found to be useful for clozapine-associated sialorrhea at 87-100 mg per day. We report the effect of very low dose amitriptyline (10 mg per day) in a patient with clozapine-associated sialorrhea. There was rapid and complete resolution of sialorrhea after three days without any emergent adverse effect.

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Substance use disorder" (SUD) is a common, chronic, remitting/relapsing group of psychiatric disorders having devastating effect not only on the individual but also impose socio-economic burden on their families and the society at large. They are often accompanied with numerous maladaptive behaviors and a persistent and compulsive, uncontrolled use of substance. Interestingly, they have moderate to high heritability and seem to be modulated by both genes and environment. Recent researches suggest that interactions of environmental and genetic factors designate the significance of epigenetic mechanisms, which have been found to occur in SUDs. This review makes an attempt to provide an overview regarding the various types of epigenetic modifications and their application in relation to SUDs.

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