Forms Of Psychiatric Disorders Research Articles

Burden of Care of Family Caregivers for People Diagnosed with Serious Mental Disorders in a Rural Health District in Kwa-Zulu-Natal, South Africa.

An estimated 6% of the world population has serious mental illness, with one in four families having a member with some form of psychiatric disorder, who is mostly cared for by their relatives within a family setting. Although care-giving in a home setting is reported to be associated with significant mental distress, the burden of such distress is rarely measured. The purpose of this study was to quantify the burden of care among family caregivers of relatives with serious mental disorders, as well as to explore possible associations between the caregiver burden of care and a range of caregiver and Mental Health Care User (MHCU) variables in a rural district in Kwa-Zulu Natal, South Africa. The Zarit Burden Interview (ZBI) scale was used to collect data from 357 caregivers, and STATA 14 was used to analyze data. The ages of the sample ranged from 18 to 65 years, with a mean of 50.29, and the majority (86%) were female and unemployed (83%). The ZBI scores ranged from 8 to 85, with a mean of 41.59. The majority (91%) were found to be affected by family caregiver burden, which ranged from mild to severe. Using the Pearson Chi-square test of association (p = 0.05), variables that were significantly associated with the burden of care were clinically related (caregiver self-reported depression, MHCU diagnosis, recent relapse of the MHCU), socio-economic (caregiver family monthly income, MHCU disability grant status and MHCU employment status) and socio-demographic (MHCU gender and MHCU level of education). The prevalence of the burden of care is high and severe, and the scarcity of resources in families and communities contributes to the high burden of care in these rural communities.

Shift from black swan to brown swan approach during the COVID pandemic

The pandemic of COVID-19 and the lockdown imposed which took the entire world by storm has not only tested our physical health but also impacted our mental health in ways no one had envisaged! It led to a situation of socioeconomic crisis and mental anguish among the general population. It was indeed a black swan event as the response to the pandemic with worldwide lockdown was highly unpredictable having a colossal impact on the world and its functioning, however, several explanations have now come into view that has made the event explainable and predictable. The outbreak of a novel virus unknown to the medical fraternity and its explosive spread every day, conflicting messages from the government, lack of infrastructure for treatment, the spread of misinformation on media platforms, and an incessant quarantine have led to a sense of fear, apprehension, stress, desolation, weariness, frustration, and depression among the masses. The imposition of lockdown in the nation not only undermined personal freedom but also lead to huge financial losses, unemployment, work, and school closure, uncertainty, boredom, and stigma which had been major stressors leading to widespread emotional affliction and an increased risk of developing psychiatric illness during the time of the pandemic. People who were already suffering from some form of psychiatric disorder had been prone to exacerbations due to the pandemic. Individuals living with confirmed or suspected COVID-19 cases, frontline workers, unemployed people, and people in quarantine were at a higher risk of developing some form of mental illness such as anxiety, insomnia, and depression. Resilience and good social support are the protective factors against this mental health epidemic that has begun. In this article, we reflect upon the impact of the COVID-19 pandemic and lockdown on the mental health of people in India.

Natural Products: Ray of Hope for Anxiety Disorders

Background:Anxiety, a familiar form of psychiatric disorder, influences numerous persons throughout the world. These psychological disorders frequently need an enduring regime of recommended medicines and impose huge costs on human societies. For the last few decenniums, discovery in the field of natural neurophysiology garnered a lot of recognition because of its least side effects.Objective:Many people find it helpful to discover an effective herbal remedy for anxiety with fewer detrimental repercussions. The purpose of the present article is to report medicinal plant species used as anti-anxiety agents, which in turn, are helpful to develop new anti-anxiety herbal formulations.Method:An unlimited, semantic electronic and manual exploration of PubMed, Cumulative Index of Nursing and Allied Health Literature, ISI, Google Scholar, Elsevier's abstract and citation database, and the database libraries was carried using keywords such as medicinal plants, herbal drugs, traditional medicine, and anxiety for recognizing natural medications in the management of anxiety disorders.Results:Literary review collected the information of potential anti-anxiety plants. Data support the effectiveness of some popular herbal remedies by indicating high-quality scientific studies and support several clinically efficacious natural plants as anxiolytics.Conclusion:Evidence-based studies indicate that natural plant treatment is an efficient way to manage anxiety disorders; the benefits outweigh the risks.

Psychiatric evaluation in patients with central serous chorioretinopathy in Asian Indians.

Purpose:This study aimed at psychiatric evaluation of patients with central serous chorioretinopathy (CSCR) and its association.Material:Consecutive patients diagnosed to have CSCR were included in the study. The participants underwent a routine eye examination. After informed consent, participants were subjected to psychiatric evaluation by a qualified psychiatrist. Details of evaluation and psychiatric disorders were documented and if treatment required were given by the psychiatrist. The outcome measure was the incidence of psychological disorder.Results:Cross-sectional observational data analysis of 40 patients diagnosed to have treatment-naive CSCR who agreed to undergo psychiatric evaluation were included in the study. The ethnic origin of the patients was Asian Indian. The mean age was 39.55 ± 8.33 years with a male to female ratio of 33:7. After a thorough psychiatric evaluation, 31 individuals (77.5%) diagnosed to have mixed anxiety disorders, 4 (10%) had the major depressive disorder, and 5 (12.5%) had adjustment disorder. All 40 patients had stressed personality. All 40 patients had treatment with anti-anxiolytics and advised lifestyle modification. Of these 40 patients, one patient (2.5%) underwent treatment additionally with an antidepressant.Conclusion:All patients with acute CSCR had some form of psychiatric disorder. Psychiatric evaluation in acute treatment naïve CSCR may contribute to the management besides other factors known in the management.

A Latent Class Approach for Classifying the Problem and Disordered Gamers in a Group of Adolescence.

Gaming disorder is not yet recognized as a formal psychiatric disorder, and consensus is still lacking in the field concerning the definition of gaming disorder and what methods should be used to measure it. In order to deal with methodological challenges related to previously suggested approaches, the aim of the present study was to develop an alternative assessment procedure for gaming disorder using a latent class cluster approach, and to compare the criterion validity of this procedure with existing assessment procedures. A representative sample of 3,000 adolescents (n = 1,500 female) aged 17.5 years was drawn from the National Registry, and 2,055 participants responded (yielding a response rate of 70.3%). The Gaming Addiction Scale for Adolescents was used to measure gaming disorder and measures of loneliness, anxiety, depression, and aggression were used to test criterion validity. A model with five Latent Class Clusters represented the best fit [BIC(LL) = 21,253,7; L2 = 3,881,204; df = 1,978; Class. Err. = 0.1239]. The five different groups were labeled never symptoms (46.2%), rarely symptoms (22.3%), occasionally symptoms (23.5%), problem gamers (6.9%), and disordered gamers (1.2%). The groups displayed different probabilities of responses (never/rarely/sometimes/often/very often) to the seven Gaming Addiction Scale items. Regarding criterion validity, MANOVA revealed a significant overall main effect of latent classes [F(20, 6359) = 13.50, p < 0.001; Wilks Lambda = 0.871]. All dependent variables (loneliness, depression, anxiety, verbal, and physical aggression) reached statistical significance when results from the dependent variables were considered separately. Comparing the present approach with previous suggested classifications of gaming addiction offered by Lemmens et al. and Charlton and Danforth, the present approach showed greater specificity in terms of number of classes identified. We conclude that the Latent Class approach identifying five different groups of gamers offers a more refined view on addiction compared to previous assessment procedures.

P.3.008 - N-acetyl cysteine does not modify cognitive markers of compulsivity and impulsivity in an ‘at-risk’ eating-disorder group

N-acetyl cysteine (NAC) is a dietary supplement and glutathione precursor which has shown benefit in the treatment of psychiatric disorders that feature prominent compulsive behaviours such as excoriation and trichotillomania [1]. Eating disorders such as anorexia nervosa and bulimia nervosa also possess compulsive features: both in terms of observed symptoms (binge eating, compulsive exercise, compulsive body-checking), as well as their profile on psychological tasks assessing compulsivity [2]. The aim of this study was to investigate whether performance on cognitive tasks measuring compulsivity, or the related construct of impulsivity [3], could be altered using sub-acute dosing of N-acetyl cysteine in a non-clinical participant group enriched for eating disorder symptomatology. We used a randomised, placebo-controlled, cross-over design with 23 participants (females aged 18-40), who were selected to score between 9 and 19 on the EAT-26 questionnaire [3]. All participants had a BMI of over 18.5, were not taking any psychotropic medication and did not have any formal current psychiatric disorders. Participants received 9 days of either NAC or placebo in randomised order, with a seven-day wash-out period in between. The dose was 1200mg for the first two days, followed by 2400mg for the remaining 7 days. At the end of each 9 day drug/placebo administration period participants completed questionnaires and a number of cognitive tasks. Data were analysed using mixed models, with condition (NAC/Placebo) and order (NAC first or Placebo first) as fixed effects, and participant as a random effect. This was specified in R syntax as lmer(y~order*condition + (1| participants)). Task outcome measures were z-scored. There was no significant main effect of condition on the primary task outcome measure, which was defined as perseverative errors on the WCST: F(1,20) = 1.05, p=0.317. Additionally, there was no significant main effect of condition in the MANOVA of key task outcome measures: F(6,35) = 0.599, p=0.729, see table 1 for data.

Behavioral responses to surveys about nicotine dependence

Behavioral responses to surveys can significantly affect inferences about population prevalence unless correctly modeled statistically. An important case study is the prevalence of nicotine dependence, a formal psychiatric disorder satisfying clinical criteria. Data from the National Epidemiologic Survey on Alcohol and Related Conditions in the United States are used, along with a flexible semi-nonparametric sample selection model. Corrections for sample selection responses to "gateway" survey questions lead to significantly higher estimates of the prevalence of nicotine dependence among current daily smokers. These corrections also imply even higher levels of the decades-long and lifetime-long persistence of nicotine dependence after the onset of smoking.

Borderline intellectual functioning: an update.

Borderline intellectual functioning (BIF) is a descriptive v-code that is often used, especially in forensic settings, as if it were a full-fledged disorder. Various historical and other aspects of this classification are reviewed, and commentary is made on the question of whether to upgrade BIF to a regular psychiatric category, or to eliminate it by folding it into an already recently expanded category of intellectual developmental disorder (IDD). Full-scale intelligence quotient (IQ) is an outmoded concept that is decreasingly being used. For example, DSM-5 states that measures of 'executive functioning' (reasoning, planning, consequential thinking, attention, self-regulation, and so on) are often more meaningful that full-scale IQ as diagnostic indicators of IDD. Even the definition of BIF in DSM-5 no longer specifies an IQ score range. BIF is a descriptive v-code (rather than a typical psychiatric category), which started out as a sub-type of IDD (formerly mental retardation or intellectual disability) but morphed into its current status when the IQ ceiling for IDD was changed from minus one standard deviation (85) to minus two standard deviations (70). It has been suggested that, as people with BIF often have adjustment problems, the BIF category be elevated to the status of a formal psychiatric disorder. In this article, a contrary opinion is expressed, namely that the BIF category be dropped.

Electroconvulsive therapy and nursing support

Electroconvulsive therapy is a therapeutic option offered as part of the global treatment of certain severe forms of psychiatric disorders. Carried out under general anaesthesia, this treatment is subject to specific clinical monitoring and support in which the nurse plays an active role.

Formal Psychiatric Disorders are not Overrepresented in Behavioral Variant Frontotemporal Dementia.

While psychiatric misdiagnosis is well-known in behavioral variant frontotemporal dementia (bvFTD), a systematic evaluation of standardized criteria for psychiatric disorders in bvFTD is still missing. Our aim was to define frequency and character of DSM-IV psychiatric disorders among patients with probable and definite bvFTD compared to possible bvFTD, other neurodegenerative diseases, and psychiatric diagnoses, using MINI-International Neuropsychiatric Interview. We additionally compared psychiatric prodromes between these groups. Subjects were participants of the late-onset frontal lobe (LOF) study, a longitudinal multicenter study. In each patient, after baseline diagnostic procedure, a neurologist and geriatric psychiatrist made a joint clinical diagnosis. Independently, a structured diagnostic interview according to DSM-IV and ICD-10 criteria (MINI-Plus) was performed by a trained professional blinded to clinical diagnosis. Out of 91 patients, 23 with probable and definite bvFTD, 3 with possible bvFTD, 25 with a non bvFTD neurodegenerative disease, and 40 with a clinical psychiatric diagnosis were included. Overall frequency of formal current and past psychiatric disorders in probable and definite bvFTD (21.7% current, 8.7% past) did not differ from other neurodegenerative diseases (12.0% current, 16.0% past) or possible bvFTD (66.7% current, 66.7% past), but was less than in patients with a clinical psychiatric diagnosis (57.5% current, 62.5% past; p < 0.01). In probable and definite bvFTD unipolar mood disorders were most common. Formally diagnosed psychiatric disorders are not overrepresented in probable bvFTD, suggesting that psychiatric misdiagnosis in bvFTD can be reduced by strictly applying diagnostic criteria. In suspected bvFTD close collaboration between neurologists and psychiatrists will advance diagnostics and subsequent treatment.

“A deluge of shrieking unreason”: Supernaturalism and Settlement in New Zealand Gothic Fiction

“A deluge of shrieking unreason”: Supernaturalism and Settlement in New Zealand Gothic Fiction

Patterns of psychiatric emergency at tertiary referral psychiatric hospital

Background Psychiatric emergency has been extensively studied over years with different transcultural presentations. Objective The aim of the study was to assess sociodemographic aspects and clinical diagnoses of psychiatric emergency cases attending emergency room (ER) at tertiary referral mental hospital and to study some of the clinical contributions of admitted patients through ER. Patients and methods During 3-month period, 3666 attendants to psychiatric ER were submitted for this cohort study. Patients were submitted to medical assessment and psychiatric evaluation by semistructured clinical interview. Of them, 283 were admitted and further submitted to Mini–Mental State Examination, Brief Psychiatric Rating Scale, and Crisis Triage Rating Scale at ward. Results A total of 3666 patients (2352 male and 1314 female) who were aged 33.44±11.5 years, age range of 8–70 years, with psychiatric emergency attended Al Taif Psychiatric Hospital ER, KSA. The most prevalent psychiatric diagnoses were schizophrenia-related disorders in 30.4%, mood disorders in 28.8%, substance-related disorders in 21.4%, anxiety in 9.6%, developmental disorders (MR) in 3.2%, personality disorders in 0.6%, somatoform disorders in 0.14%, and neurological disorders in 2.2%, whereas 3.3% of ER attendants had no formal psychiatric disorder. The main cause for attending ER was refill of medicine in 31%, followed by natural exacerbation of illness in 26%, then familial conflict in 16%, and finally social problem in 15% of patients. The hospitalization rate was found to be 7.7%; most admitted patients were alert. Hospitalized male patients were found to be more severe and had less social support with little cooperativeness from their families than female patients. Conclusion Psychiatric emergency constitutes a significant route for providing service for mentally ill patients. Family education and early detection of psychiatric disorders minimize the burden of psychiatric illness.

Effects of Depressive and Other Psychiatric Disorders on Anticoagulation Control in a Pharmacist-Managed Anticoagulation Clinic

The impact of psychiatric disorders on International Normalized Ratio (INR) control and adverse events for patients receiving warfarin has not been fully elucidated. To determine the effect of depressive and other psychiatric disorders on anticoagulation control in a pharmacist-managed anticoagulation clinic. A retrospective chart review evaluated outcomes of patients with no history of psychiatric disorders and compare it with that of patients with either a history of depression or any form of psychiatric disorder. Data was obtained from patient medical records over a 24-month period. The primary outcome was a comparison of time in therapeutic range, calculated using 3 separate methods (percentage of INRs in therapeutic range, a modified Rosendaal's linear interpolation, and mean INR in goal). A total of 151 patients met the inclusion criteria (control = 79, psychiatric disorders = 72 patients). Control patients had a significantly greater proportion of INRs in the goal range compared with either the depression or psychiatric disorders groups (control, 55.7%; depression, 43.5%; psychiatric, 45.8%). Utilizing the Rosendaal's method, patients with psychiatric disorders were in the goal range significantly less often than those in the control group (53.0% vs 61.3%). No differences were seen when adjusting for multiple comparisons or when comparing the control and depression groups (54.5% vs 61.3%). There was no difference between the groups when comparing percentages of patients with a mean INR in their goal range. Patients with psychiatric disorders who take warfarin may spend less time in the therapeutic range.

Psychiatric Disorders in Huntington's Disease: A 2-Year Follow-up Study

This study investigates the presence and course of formal psychiatric disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) in 142 Huntington's disease (HD) mutation carriers in a two-year follow-up design. Of the 142 mutation carriers, 106 (75%) participated in the second measurement of an ongoing cohort study on psychopathology in HD. Presence of psychiatric disorders was assessed using the Composite International Diagnostic Interview. Of the 91 patients without a formal psychiatric disorder at baseline, 14 (15%) had a psychiatric disorder after 2 years, mostly a major depressive disorder (MDD) (64%). The baseline characteristics of lower education, having no children, a lower level of global daily functioning, a lifetime psychiatric diagnosis, and the use of psychotropic medication were predictive of incident psychiatric disorders after 2 years. Of the 15 patients with a psychiatric diagnosis at baseline, eight (53%) no longer had a psychiatric disorder at follow-up. All seven patients (47%) with a persistent psychiatric disorder were female and their most prevalent diagnosis was generalized anxiety disorder. This cohort study confirms that psychiatric disorders, in particular MDD, frequently occur in patients with HD. Professionals working with HD patients should therefore be aware of the high risk of psychopathology in HD because early diagnosis and treatment of psychiatric disorders may improve the quality of life of patients and their caregivers.

P02-82 - Depressive disorder among the breast cancer patients in outpatient department of a tertiary care hospital in Pakistan

ObjectivesTo determine the frequency of Depressive Disorder among patients with breast cancer in an outpatient department of a tertiary care hospital in Pakistan.BackgroundCancer not only affects body physically but can also affect the mind in the form of psychiatric disorder. Proper identification and treatment of these conditions can be beneficial and cost-effective.MethodologyThis cross-sectional descriptive study was conducted on patients of breast cancer attending OPD of oncology department of Civil Hospital Karachi. The sample consisted of ninety three diagnosed patients of breast cancer who were screened for psychiatric morbidity through Hospital Anxiety and Depression Scale (HAD Scale). Screened patients were interviewed and diagnosed as depressive disorder according to ICD criteria. The level of depression in these diagnosed patients was quantified through ZUNG'S Depression Rating Scale.ResultsEighty two percent (n = 76) of the sample (n = 93) were found to have psychiatric morbidity on HAD scale. Out of these screened sample sixty percent (n = 46) were found to be depressed on Zung self rating depression scale. Majority of these patients were suffering from mild to moderate depression. Half of the female in this sample were undergone mastectomy that was not found to have any statistically significant impact on psychiatric morbidity of the patient.ConclusionThis study shows high prevalence of depression in patients with breast cancer. The health professional involve in care of breast cancer should screen routinely their patients for symptoms of depression.

General medicine and surgery for dental practitioners. Part 5 – psychiatry

There are a significant number of patients in society who have some form of psychiatric disorder. It is important that dental practitioners have an awareness of the more common psychiatric disorders and their potential implications as they are likely to encounter them in clinical practice.

Measurement of Psychopathology in Huntington's Disease

Assessment of psychopathology in Huntington's disease (HD) using formal DSM-IV criteria is complex because of comorbid somatic and cognitive disturbances and diminished disease awareness. Using dimensional tests in 152 HD mutation carriers, both the total score of the Problem Behaviors Assessment (PBA) scale and the behavioral section of the Unified Huntington's Disease Rating Scale (UHDRS-b) corresponded with presence of DSM-IV diagnoses. Receiver operating characteristic curves showed an area under the curve of 0.87 for the PBA and 0.91 for the UHDRS-b, demonstrating moderate to strong discriminatory power. Using caregiver information, subjects who were too cognitively impaired for composite international diagnostic interview assessment showed similar high PBA and UHDRS-b scores, with both a negative predictive value of 96% and a positive predictive value of 40% and 44%, respectively, for the presence of formal psychiatric disorders, indicating that dimensional rating scales and caregiver information allow for the assessment of psychopathology in advanced-stage HD.

Why the Rush to Create Dubious New Sexual Disorders?

The sevenpublished critiques to Blanchardetal.’s (2009) study justifying‘‘hebephilia’’ as a mental disorder identified numerous scientific flaws. These flaws demonstrate the scientifically suspect nature of the construct. My critique (Franklin, 2009) also addressed the broader implications of creating a formal psychiatric disorder that will be used to justify the civil commitment of sex offenders. In his latest salvo in this debate, Blanchard (2010) sidesteps any engagement with the substantive arguments, instead presenting a misshapen little straw man thathe then easilydemolishes through smoke-and-mirrors statistical machinations. In Franklin (2009), I mentioned that heterosexual men’s sexual attraction to pubescent girls was‘‘evolutionarily adaptive.’’ As Blanchard (2010) rightly notes, that term refers to adaptations that enable a species to better survive across time. Scientists regard heterosexual men’s preference for younger female partners as one potential reproductive strategy under harsh environmental conditions, such as those of Neanderthal cave dwellers (Kenrick & Keefe, 1992; see also Heaton, Lichter, & Amoateng, 1989). My argument here is not with Blanchard’s definition of evolutionary adaptation, but rather with both his logic and methods in attempting to rebut my previous critique. As all students of Darwin know, evolutionary success strategies must be understood on a population-wide basis, not an individual level. Moreover, social scientists generally agree that biological evolution is rarely sufficient to understand human behavior in modern, complex social systems. Thus, to say that a trait may have emerged as evolutionarily adaptive in prehistoric times implies nothing of its presence or function on an individual level in contemporary society. More to the point: Blanchard’s (2010) new study is far from a scientifically valid debunking of any evolutionary component. One cannot test the theory that consumption of chili pepper—eaten daily by more than one billion people— is evolutionarily adaptive simply by locating a convenience sample at a random diet clinic, dividing the patients into groups based on their liking for the spice, and then measuring some putatively related outcome variable such as bouts of food poisoning, presence of ulcers, or level of thrill-seeking temperament (Rozin, 2000). Ergo, one cannot test whether men’s attraction to younger females was at one point evolutionarily adaptive by asking a group of white male patients in 21st-century Canada how many children they have fathered. Since the foundational study is yet unpublished, we know little about Blanchard’s subject pool or methods. However, from his letter, it appears that—with the exception of race and sexual orientation—the study did not control for any of the myriad co-variables that contribute in complex ways to number of offspring. These include (just to name a few) economic status, urbanicity, culture, fertility, women-controlled birth control strategies, periods of incarceration (particularly relevant here, given that sexual contact with young minors is illegal in Canada), and even gender of first-born child. Plunging birth rates in developed nations alone create a low ceiling effect for this outcome variable; without reported population norms, we cannot properly interpret the findings. Ultimately, the fertility of so-called hebephiles is a red herring that has no relevance to either the possible evolutionary basis for the attraction or to the broader scientific

Apoyo psicológico en desastres: Propuesta de un modelo de atención basado en revisiones sistemáticas y metaanálisis

A search for meta analyses and systematic reviews on psychological support to disaster victims was carried out to devise a local support model. Based on 36 meta analyses and systematic reviews, the support should be carried out in five echelon levels: diffusion, social support, general medical care, general psychiatric care and psychiatric care carried out by experts. Only victims with well-established formal psychiatric disorders should receive psychotherapy or psychotropic medication. The rest should only receive psychological first aid. According to the best evidence available, a model for psychological care is proposed.

Psychological support for disaster victims: an evidence-based care model

A search for meta analyses and systematic reviews on psychological support to disaster victims was carried out to devise a local support model. Based on 36 meta analyses and systematic reviews, the support should be carried out in five echelon levels: diffusion, social support, general medical care, general psychiatric care and psychiatric care carried out by experts. Only victims with well-established formal psychiatric disorders should receive psychotherapy or psychotropic medication. The rest should only receive psychological first aid. According to the best evidence available, a model for psychological care is proposed.