All Psych Buzz: March 2013

Monday 18 March 2013

Paranoia Revisited

Paranoia is derived from the Greek word ‘para’ (besides) and ‘nous’(mind) and was used in ancient Greek literature to mean ‘out of mind’, i.e. of unsound mind or insane. This broad usage was revived in the eighteenth century. The word Paranoia, from which the modern adjective paranoid derived, has a long and chequered history as old as the term Psychiatry is.
The first stage in the development of its use in modern psychiatry can best be dated to 1818 when Heinroth described delusional states as ‘disorders of intellect’ (Verrucktheit) not fundamentally involving the other faculties of the mind, feeling and will, although they recognized that some admixture was usually present...

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Tuesday 12 March 2013

OPIOIDS

Opium , derived from the ripe seed capsule of the opium poppy (Papaver somniferum), has been used for its analgesic and euphoriant effects since antiquity, with Sumerian ideograms of about 4000 BC referring to the poppy as the ‘plant of joy'.
In the developed countries the opioid drug most frequently associated with abuse and dependence is heroin. Virtually all the opioid dependence and abuse seen clinically is associated with prototypical m-agonist opioids.

Ms A, a 34-year old, single white woman presented with a chief complaint of “I’m obsessed, and I have lots of compulsive behaviors.” Since age 15, she had been preoccupied with her nose, which she thought was huge, hideous, and horrendous looking.” Because of this concern, she sometimes missed school, avoided friends, and felt suicidal. She stated at times, she realized that her view of her appearance was “probably distorted,” but at other times, especially when she was around other people, she was “absolutely, 100% convinced” that her belief was correct. Ms A was also excessively concerned about germs. She washed her hands up to 50 times a day and avoided activities that she thought might lead to contamination. In addition, she reported a history of hair pulling, which in her 20’s had resulted in noticeable hair loss. The patient’s family history was notable for Tourette’s disorder in a brother.

Dementia is a common neurodegenerative disorder involving as many as 10% of those over age 65 and substantially shortens life expectancy. The prevalence of dementia in developed countries under the age of 60 years is very low (0.3–0.7%) and increases almost exponentially with age to 42-68% in those older than 95 years (Fratiglioni et al., 2000). The incidence of dementia is about 0.1% in persons aged 60-65 years and increases to 9% in the population older than 95 years (Fratiglioni et al., 2000). Although Alzheimer’s disease (AD) is the commonest type of dementia, several other types of dementias have been described which are collectively referred to as non-Alzheimer’s disease (non-AD) dementias (Table 1). AD, because of its prevalence, has become the prototypical dementia to which all other dementias are compared. However, in the past two decades, remarkable progress in the fields of molecular genetics, biochemistry, and biophysics have permitted better distinction of the ‘other’ dementias from AD and more refined discrimination among these non-AD dementias.

In many patients with epilepsy, seizures can be controlled with the established antiepilepstic drugs (Brodie et al., 1996) but 25-30% of patients continue to have seizures despite optional therapy, and other have unacceptable side effects. Thus there is clearly a need for additional drugs as well as formant. Strategies for preventing epilepsy. Mechanisms is that underline seizure processes constitute potential target areas for the development of new AEDS. New antiepileptics drugs (AEDS) are being developed using two complimentary strategies. Animal models that roughly mania human used to serene new compounds for antiseizure activity. Alternatively, new drugs are being developed with specific cellular or molecular targets believed to be important in seizure generation.

Depressive disorders afflict at least 20% of women and 12% of men at some time during their lives. By the year 2020 the global burden of depression is projected to rank second only to that of ischaemic heart disease (Murray et al. 1997). However, When correctly diagnosed and aggressively managed, depression is a highly treatable disease (Angst, 1992; Burvill, 1995; Cohen & Guthrie, 1997). Pharmacotherapy represents a first line option in the management of major depressive illness (Evais et al. 1997; Brugha & Bebbington, 1992. Hence, antidepressant drugs have become an indispensable tool in modem medicine.

Neuroleptic malignant syndrome (NMS) is a life threatening condition. A drop in its incidence as well as mortality has been attributed to increased awareness among the clinicians, early diagnosis and prompt treatment. Central dopamine blockade is considered to play the major role in pathogenesis, though a primary role of sympathoadrenal hyperactivity has also been described, along with various other theories including genetic theories. Apart from conventional neuroleptics, atypical antipsychotics, few antidepressants and many other medications have been considered to be the risk factors for NMS. Hyperthermia, altered mental status, rigidity and autonomic instability are the main clinical symptoms. It is often complicated by renal and respiratory failure. Supportive care is of utmost importance in its management, but bromocriptine, amantadine and dantrolene have been seen to hasten recovery.

Sustained Attention and Executive Functioning in remitted Adolescents with Bipolar Disorder

The concept of bipolar disorder grew out of Emil Kraepelin‘s classification of Manic depressive insanity, when differentiated it from Dementia Precocox. Kraepelin described manic depressive insanity as a cyclic illness that leads to dysfunction only during the illness period and has relatively better prognosis (Kraepelin, 1904). However, bipolar illness has been known since ancient times as description of mania like state can be found in the writings of Hippocrates...

Neurobiology of Obsessive Compulsive Disorder

Once considered a rare condition, Obsessive Compulsive Disorder (OCD) is now recognized as a severe and often chronically disabling illness affecting 1% to 3%of the world's population (1) Apart from the initially dominant psychodynamic and behavioural understanding, biological understanding of the disabling condition got impetus after the advent of successful clinical trials of OCD with clomipramine. In the past two decades, there has been a considerable advance in understanding the biological underpinnings of OCD with emergence of various hypothetical models. Some of the views have raised questions over existing beliefs, too. Thus, to have an insight into the risk, phenomenology, pathophysiology and treatment implications of OCD, there is a need to know the neurobiological mechanism mediating it.

Nonconvulsive Status Epilepticus

For most clinicians, status epilepticus brings to mind a state of ongoing convulsions, often with marked morbidity and mortality. Less well recognized are ongoing epileptic seizures with little or no evidence of convulsion. Such states, often with mild or minimal obtundation, are some of the more difficult conditions to diagnose, especially early in their course. In January, 1888, Charcot in France made a connection between epileptic states and ongoing confusion In 1901, Gowers stated, that after epileptic fits, the patient may pass into a condition of mental automatism, in which various acts are performed in an apparently conscious manner, but of which no recollection is retained afterwards. It was not until the advent of EEG and Lennox's description in 1938 of his cousin who had continuous spike-wave activity that non-convulsive status epilepticus (NCSE) was demonstrated.

Multiple personality disorder (MPD) or Dissociative Identity Disorder (DID) is one of the most amazing and unusual mental conditions known. It is the ultimate dissociative disorder, chronic in nature and without proper treatment may become a lifelong process, though it may manifest itself differently over the lifetime of an individual (Kluft, 1985). The existence of apparently separate and autonomous alter personalities, exchanging control over an individual’s behaviour, elicits intense fascination in some and protests and disbelief form others. The existence of these entities raises questions about fundamental assumptions of the unity of personality and the structure of consciousness. The wide variety of symptoms commonly found in MPD includes most of the types of symptoms found in all of the psychiatric disorders combined. Thus, to find out what is MPD a fact or fiction we will discuss various aspects of MPD/DID in some detail.

Mild cognitive impairment (MCI) refers to a specific type of recent memory loss characterizing trouble remembering recently learned information or knowledge, forget appointments, difficulty in identifying familiar faces, may frequently misplace items and repeating the same questions. People who are experiencing forgetfulness and are concerned about MCI should undergo a medical evaluation. To an extent it will help us to rule out and treat potentially reversible conditions like disorders of the thyroid or parathyroid gland, intracranial space occupying processes, vitamin deficiencies, kidney and liver disorders, and emotional problems such as depression, which can also cause forgetfulness like MCI.

Researchers have long been interested in understanding how individuals and environments affect each other, primarily so as to describe and explain age – related behaviour and individual differences. One focus has been to study life events. A life event is indicative of or requires a significant change in the ongoing life patterns of the individual. According to Settersten and Mayer (1997), "A life event is a significant occurrence involving a relatively abrupt change that may produce serious and long lasting effects". It refers to the happening itself and not to the transitions that will occur because of the happenings.

Personal Values Questionnaire

The PVQ measures the importance individuals attach to three social values or conscious drivers of behaviour: Achievement, Affiliation and Power. A PVQ profile will describe the extent to which test-takers consciously rate these values. It offers illuminating information on what matters to an individual; where they are likely to invest their energies; whether they fir their chosen job role, and how then can improve this fit.

Kentucky Inventory of Mindfulness Skills (KIMS)

The Kentucky Inventory of Mindfulness Skills (KIMS) is a 39-item self-report measuring Mindfulness on four scales: i.Observing, ii.Describing, iii.Act With Awareness, and iv.Accept Without Judgment. It was developed at Kentucky University by Baer, Smith, & Allen in 2004. A short, 20-item version of it (KIMS-Short) was developed in Germany in 2011 and enables researchers to replicate the basic factor structure. However KIMS-Short shows the Observing subscale as comprising two different but strongly correlated factors depending on whether the observed stimuli are internal or external. Good support has been found for the model of four correlated factors, and the scales have been found to be both highly internally consistent and sensitive to change through Mindfulness-Based Cognitive Therapy.

Dialectical Behavior Therapy-Ways of Coping Checklist (DBT-WCCL)

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Distress Tolerance Scale

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Beck's Depression Inventory

The Beck Depression Inventory (BDI, BDI-II), created by Dr. Aaron T. Beck, is a 21-question multiple-choice self-report inventory, one of the most widely used instruments for measuring the severity of depression. Its development marked a shift among health care professionals, who had until then viewed depression from a psychodynamic perspective, instead of it being rooted in the patient's own thoughts.

The Rorschach test (German pronunciation; also known as the Rorschach inkblot test, the Rorschach technique, or simply the inkblot test) is a psychological test in which subjects' perceptions of inkblots are recorded and then analyzed using psychological interpretation, complex algorithms, or both. Some psychologists use this test to examine a person's personality characteristics and emotional functioning. It has been employed to detect underlying thought disorder, especially in cases where patients are reluctant to describe their thinking processes openly. The test is named after its creator, Swiss psychologist Hermann Rorschach.

Yale Brown Obsessive Compulsive Scale (Y-BOCS)

The Yale–Brown Obsessive Compulsive Scale, sometimes referred to as Y-BOCS, is a test to rate the severity of obsessive–compulsive disorder (OCD) symptoms.
The scale, which was designed by Dr. Wayne Goodman and his colleagues, is used extensively in research and clinical practice to both determine severity of OCD and to monitor improvement during treatment. This scale, which measures obsessions separately from compulsions, specifically measures the severity of symptoms of obsessive–compulsive disorder without being biased towards the type of content of obsessions or compulsions present.

Acceptance and Action Questionnaire

The Acceptance and Action Questionnaire (AAQ) was the first self-report measure explicitly designed to measure EA, but has since been re-conceptualized as a measure of "psychological flexibility". The Multidimensional Experiential Avoidance Questionnaire (MEAQ)[22] was developed to measure different aspects of EA.

State Trait Anxiety Inventory (STAI)

The State-Trait Anxiety Inventory (STAI) is a psychological inventory based on a 4-point Likert scale. The STAI measures two types of anxiety-state anxiety, or anxiety about an event, and trait anxiety. Higher scores are positively correlated with higher levels of anxiety. Its most current revision is Form Y.

Handbook of Autism and Pervasive Developmental Disorders

Handbook of Autism and Pervasive Developmental Disorders, Two Volume Set

Authors:Fred R. Volkmar, Rhea Paul, Ami Klin, Donald Cohen

History of Indian Psychiatry

Mental disorders take enormous toll in all societies, cultures, in human suffering, disability and loss of community resources. As per the World Mental Health Report 2001, 12% of the total burden of disease and 30.8 % of all Years Lived with Disability (YLD’s) are due to neuropsychiatric illness (WHO, 2001). This field has fascinated intellectuals since antiquity. It has evolved through different phases before arriving to the present scenario. Acquaintance with the evolution of psychiatry is a prerequisite for a better understanding the past and for a clear concept of the present and to plan any future activity.
In India, Mental illness has received importance since antiquity, dating back to the prehistoric period and preceding the Indus Valley civilization. The Indian indigenous science and philosophy have significantly influence the present Indian psychiatry. These contributions come from the Ayurveda, Unani, Siddha, Vedas, Upanishads, tantra (alchemical), the great epics like the Ramayana and Mahabharata, and other folklore (Bilimoria, 2003).

Schizophrenia, like other common diseases poses challenges to the geneticist because it results from the action of both genetic and environmental factors. Moreover, the genetic component probably consists of the combined action of several, and possibly many, genes, each of which results in only a modest increase or decrease in liability. However, in psychiatry genetic complexity is compounded by phenotypic complexity and this is specially true for schizophrenia. Despite these methodological difficulties, genetic research of schizophrenia has been gathering speed with improvements in molecular genetic techniques. This seminar aims to give an overview on the current status of genetics of schizophrenia

According to World Health Organization, three to eight percent of married couples world wide are at high risk of producing an offspring with severe genetic disorder which is inherited in a Mendelian pattern. These disorders need careful attention through genetic services. However, it is a fact that in various parts of world, especially, in under-developed and developing countries where malnutrition and infection are still important problems; genetic services are an unaffordable luxury (WHO, 2006).
Gregor Mendel (1822-1884) for the first time demonstrated the particular nature of inheritance. Although, Mendelian thinking contributed importantly to the general concepts in medicine, it was in the late 1950s when genetics involved significantly in clinical medicine. Medical genetics is the science of human biological variation as it relates to health and disease; while clinical genetic is that part of medical genetic which is concerned with the health of individual human and their families (McKusick, 2002).

Acute psychosis is dangerous to a person's safety, hampers capacity to function, life and reputation, and if present consistently for prolonged period can negatively affect prognosis. In contrast, early interventions may result in a significant reduction in morbidity and better quality of life for patients and families.
Proper management of the first episode of psychosis (FEP) is crucial with the following reasons to justify focus on this phase of psychotic disorders (International Early Psychosis Association Writing Group, 2005).

Economics of Mental Health

Economic Evaluation is concerned with the best use of limited resources, and occurs in a decision specific context of identifying the most efficient way of meeting a stated objective.
Its main function is to allow policy makers, managers and clinicians to make choices by assessing the costs and benefits of achieving objectives by different methods. Health care budgets are limited. However there is no limit to expenditure if all existing demands are to be met.
Finite resources and this discrepancy between the demand and the available supply suggest that a formula for allocating resources among the various competing sectors is necessary. Thus choices have to be made between differing treatments, treatment settings and illnesses to allow judicious use of scarce resources.

Violence is the violation or invasion of territory or the act of holding people captive within territory, and is true on an individual level. Directly or indirectly, violent crime touches every one. Megargee (1982) defined it as “the overtly threatened or overtly accomplished application of force which results in the injury or destruction of persons or their reputation”. Domestic violence occurs within a fundamental social institution of the family. The institution has emotional bonds; it has history and has future. Domestic violence can be understood within that context.

Mental disorders have profound implications on the health and well-being not only of individuals but also of families and entire communities.The global burden of disease attributable to mental/neurological disorders and substance abuse is projected to rise from 11.5% in 1998 to 15.5% by the year 2020. India, constituting 1/6th of the world population, will have to share its burden of mentally ill. There is a huge gulf between the existing mental health care resources and the need for psychiatric services in the community. This calls for the development of a comprehensive policy that defines a vision for the future that helps to establish a blueprint for the prevention and treatment of mental illness, the rehabilitation of people with mental disorders, and the promotion of mental health in the community.

Psychotic states with acute onset and short duration have long been recognized as clinical entities, and several researchers have attempted to classify them under terms such as cycloid psychosis, bouffee delirante, and reactive psychosis. However, descriptive and predictive validities of the diagnostic categories have not been fully established. In the last decade, there has been a renewed interest in studying these groups of psychoses. It is reflected in the tenth revision of the International Classification of Diseases and Related Health Problems (ICD-10) that has introduced a group entitled 'acute and transient psychotic disorder' (ATPD). Susser and Wanderling in 1994 introduced a group of non-affective psychoses that are characterized by very acute onset and full remission under the rubric of 'Non affective Acute Remitting Psychosis' (NARP). Studies have suggested that acute brief psychoses, may exhibit distinctive biological associates, temporal stability, duration criterion, and excellent long term course and outcome, especially in developing countries.

The first act of suicide probably occurred before the beginning of written records. Historically society’s attitude towards suicide reveals a wide range between a rational one of acceptance, an irrational one of superstition and a hostile one of punishment. Pythagoras argued that since humans were slaves and soldiers of God, they had no right to leave the world without his permission. Socrates felt that in some circumstances it would be permissible and even a necessary for a man to end his own life, Plato supported the general philosophy against the suicide act, with the exception of suicide ordered by state and in extreme cases of poverty and sorrow. Aristotle considered suicide as a cowardly act and an offence against the state.

Atypical Anti-Psychotics

Originally, atypical antipsychotics were drugs that did not produce catalepsy (Immobility) in animal models. Unlike typical antipsychotics (neuroleptics), atypical antipsychotics decreased amphetamine induced hyperactivity in rats in doses that did not produce catalepsy.
Classically, an antipsychotic is said to be atypical when it improves both positive and negative symptoms of schizophrenia but

Produces minimal or no EPS
Causes minimal or no sustained prolactin elevation

Many researchers have proposed greater efficacy in treating negative symptoms, mood changes and cognitive deficits, giving rise to broader definitions of atypicality.

Anti-Psychotics Metabolic Effects

Old is the existence of psychosis and varied are its presentations. Efforts to understand this enigma, as well as to treat the sufferer have been puzzling humanity since time as old as the problem itself. So far, trials have been done with innumerable options including a number of pharmacological agents starting from those of ancient days through typical antipsychotics to atypical ones in later times. But problems came hand-in-glove with each of these options. As extrapyramidal side effects of typical antipsychotics compelled clinicians to move towards the atypical ones, these newer, so-called novel agents have brought with them a gamut of adversities, the various metabolic side effects.

ISAA is an individually administered instrument which encompasses six domains measuring the characteristic triad of impairments in social relationship, communication and behavior patterns of persons with autism. The test items of the tool were constructed from the range of activities generally performed by the persons with autism. Comparison group of normal and individuals with mental retardation & other psychiatric illnesses were tested to determine the uneven development characteristic of this type of disability.

The Scale for the Assessment of Negative Symptoms (SANS)

The Scale for the Assessment of Negative Symptoms (SANS) is a rating scale to measure negative symptoms in schizophrenia. The scale was developed by Nancy Andreasen and was first published in 1984. SANS is split into 5 domains, and within each domain separate symptoms are rated from 0 (absent) to 5 (severe). The scale is closely linked to the Scale for the Assessment of Positive Symptoms (SAPS) which was published a few years later.

Neuroplasticity in Neurology and Psychiatry

The word plasticity has been derived from the word ‗plastos‘ meaning ‗capable of being molded‘. Basically, it is the ability of the brain and nervous system to change in response to experience or stimuli. Neuroplasticity is the capacity of the nervous system to modify its organization. It encompasses concepts such as learning, sensitization, and habituation, and implies changes in the way information is encoded or processed (Das et al 2000). A central dogma of early neuroscience was that the neurons of the adult brain do not change. However, modern neuroscience now recognizes that the brain can reorganize (this reorganization is called ―neuroplasticity‖) throughout life, not only in early childhood. Our brains rewire to create new connections, set out on new path, and assume new roles. (Schwartz,2003).One outcome of the discovery of neuroplasticity was a reasonable explanation for the puzzling ―phantom limb― syndrome. From the mid 19th century onwards, physicians have written very cautiously, to be sure about the fact that amputees sometimes feel pain in a limb that no longer exists. The conventional suspicion was that either doctor misinterpreted the symptoms or the amputee was seeking attention. However, neuroscientist V.S.Ramachandran showed that neurons that once received input from a vanished hand could rewire themselves to report input from the face. If an amputee‘s brain has not changed its mental map of the body after the amputation, she will experience those feelings as if they came from her vanished hand. (Schwartz,2003).

Molecular Genetics in Mental Health

The Greek term ‗Pangenesis‘ means ‗traits inherited and blended in blood‘. (Hamer, 2002) Genetics is the science of inheritance. Human genetics describes the study of inheritance as it occurs in human beings. Study of human genetics can be useful as it can answer questions about human nature, understand the diseases and development of effective disease treatment, and understand genetics of human life.

Recovery From Schizophrenia: What It Means?

A prominent, popular and age-old accepted myth about Schizophrenia is that, it is a chronic, incurable progressive mental illness with genetic defects of the brain. This view has been promoted not only by mainstream media and pharmaceutical companies, but also by psychiatric professionals and even the governments (Breeding, 2008).Since the time of Emil Kraepelin, Schizophrenia has been viewed as a chronic, debilitating disorder with a downhill course and little or no hope for sustained recovery. Many researchers have considered it as a chronic biological illness and focussed mainly on the medical model of this particular disorder.

Since 4th Century BC ,when Hippocrates theorized ,that physiological abnormalities may be the root cause of mental disorders to present times when in US on 4th October 2008 Mental Health Parity legislation was signed , there has been a paradigm shift in the way humanity sees a mental illness or a person with mental illness. Although still far behind the developed world, India is one of the more progressive Asian nations in terms of its perspective on mental health and actions it has taken in mental health care. The history of mental health care in India has seen some dramatic changes, and the factors affecting Asia have been important determinants in shaping the state of its mental health care attitudes and services.

The ability to store and recall information is one of the most amazing capacities of higher organisms. As human adults, we can remember events that happened in our earliest childhood. We can recall skills learned far in the past. Our memories encapsulate our sense of personal identity, our cultural identities, and the meaning of our lives. We can even be influenced by memories that we cannot explicitly remember. However, we all remember—of that there can be no doubt. Whether we remember accurately or inaccurately, in detail or in abstract, are questions that researchers have investigated for many years.