Mental Health Sciences Research Articles

Goserelin-Induced Depression in a Man With Prostate Cancer

Received November 5, 2013; revised December 11, 2013; accepted December 12, 2013. From University of South Florida College of Medicine, Tampa, FL; Acute Recovery Center, James A Haley VA Hospital, Tampa, FL. Send correspondence and reprint requests to Jonathan T. Stewart, MD, Mental Health and Behavioral Sciences Service (116A), James A Haley VA Hospital, 13000 Bruce B Downs Blvd, Tampa, FL 33612; e-mail: jonathan.stewart1@va.gov Published by Elsevier Inc. on behalf of The Academy of Psychosomatic Medicine. None of the authors have any financial or other potential conflict of interest pertinent to this work. All authors contributed to the conceptualization, data collection, literature review, manuscript preparation and final approval of this work. There was no source of funding or other sponsorship or support for this work. This work was presented as a poster at the Academy of Psychosomatic Medicine Annual Meeting, Atlanta, Georgia, November 2012. Introduction

The Importance of Thalamic Connections: Cognition, Arousal, and Behavior in Thalamic Stroke

Back to table of contents Previous article Next article LettersFull AccessThe Importance of Thalamic Connections: Cognition, Arousal, and Behavior in Thalamic StrokeAnil Srivastava, M.D., David McNeill, M.D., and Rosa Ip, Ph.D.Anil SrivastavaSearch for more papers by this author, M.D., David McNeillSearch for more papers by this author, M.D., and Rosa IpSearch for more papers by this author, Ph.D.Published Online:1 Jul 2013https://doi.org/10.1176/appi.neuropsych.12080206AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: The thalamus is a midline, paired, brain structure broadly composed of anterior, medial, and lateral nuclei.1 Appreciation of thalamic connections is important for the clinician presented with thalamic injury. We explore manifestations of thalamic stroke in a man admitted to a neuropsychiatric unit for aggression. Functional anatomy as it pertains to cognition, arousal, and behavior is explored and management is discussed.The patient is a man in his 40s, with community college education and no medical history, who developed vasculitis of unknown etiology involving the thalamoperforating vessels. Infarction largely involved the right thalamus (Figure 1).FIGURE 1. Right Thalamic Infarction: MRI Brain, T2-Weighted Axial Image Without ContrastPhysical aggression was of new onset. The anterior nucleus is the principal relay nucleus for the limbic system, thought to play a role in emotion; it receives the mammilothalamic tract, which, in turn, projects to the cingulate gyrus.2 The dorsomedial nucleus (DM) similarly retains interconnections with the prefrontal cortex, which helps regulate affect and planning. Inputs to the DM include not only the prefrontal cortex but also elements of the limbic system, e.g., the amygdala. Successful treatment of aggression included divalproex sodium 1,000 mg p.o. od, citalopram 20 mg p.o. od, and olanzapine 5 mg p.o. od.Previously unrecognized periods of diminished arousal were observed. These seemed to be of two types: In one, preceding verbal automatisms with focal motor activity were present. Despite a normal waking EEG, consideration to partial complex seizures was given. Seizures secondary to subcortical involvement have been reported,3 and the thalamus, including the reticular nucleus2 and the anterior nucleus,4 may play a role. Gabapentin was initiated at 300 mg p.o. tid, adjunctive to valproic acid. Residual periods of prolonged somnolence, often of quick onset, remained. Ascending projections from the reticular formation, which collects information from multiple sensory modalities, terminate in the thalamus, especially the intralaminar nuclei, and are involved in arousal.1 Modafinil 100 mg p.o. bid was started. A sleep study was conducted and detection of significant central apnea prompted use of continuous positive airway pressure (CPAP). Significantly greater alertness resulted with the above measures.Cognitive changes were noted post-stroke. In particular, neuropsychological deficits were obvious in delayed memory (Repeatable Battery for the Assessment of Neuropsychological Status [RBANS] subtests List Learning and Story Memory), executive functioning (Stroop Color Word Test, Trails B), and visuospatial ability (RBANS subtest Figure Copy). Visuospatial deficits may be especially prominent in right-sided thalamic lesions,2 such as with this patient. The anterior nucleus of the thalamus maintains direct and indirect connections with the hippocampus, thought to subserve memory. Executive function is mediated in part by prefrontal cortex, as above, connected with the dorsomedial nucleus. Interestingly, although not explored in this case, there is a report of improvement in executive functioning in thalamic infarction with the use of donepezil.5Damage to thalamic circuits results in wide-ranging effects, including arousal, cognition, and behavior. Knowledge of functional anatomy is important in the recognition and understanding of such impairment. Successful management may involve use of antiepileptics, antidepressants, antipsychotics, continuous positive airway pressure (CPAP), and stimulants.Ontario Shores Centre for Mental Health Sciences Whitby, Ontario, CanadaCorrespondence: Dr. Anil Srivastava; e-mail: [email protected]comReferences1 Nolte J: The Human Brain: An Introduction to Its Functional Anatomy, 4th Edition. Maryland Hgts., MO, Mosby, 1999Google Scholar2 Schmahmann JD: Vascular syndromes of the thalamus. Stroke 2003; 34:2264–2278Crossref, Medline, Google Scholar3 Norden AD, Blumenfeld H: The role of subcortical structures in human epilepsy. Epilepsy Behav 2002; 3:219–231Crossref, Medline, Google Scholar4 Fisher R, Salanova V, Witt T, et al.: SANTE Study Group: Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy. Epilepsia 2010; 51:899–908Crossref, Medline, Google Scholar5 Riveros R, Chabriat H, Flores R, et al.. Effects of donepezil on behavioral manifestations of thalamic infarction: a single-case observation. Front Neurol 2:16Medline, Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 25Issue 3 Summer 2013Pages E63-E64 Metrics PDF download History Published online 1 July 2013 Published in print 1 July 2013

Dexmedetomidine for a patient with Hallervorden–Spatz syndrome during magnetic resonance imaging: a case report

To the Editor: A 17-year-old boy of 160 cm height and 30 kg weight, diagnosed with Hallervorden–Spatz syndrome (HSS), also known as pantothenate kinase-associated neurodegeneration (PKAN), presented as severe opisthotonus, retrocollis, deteriorating intelligence level, thoracolumbar spine scoliosis, and tongue dystonia and was scheduled for brain magnetic resonance imaging (MRI) under general anesthesia. On preanesthesia examination, his heart rate was 127 bpm, respiratory rate 16/min, blood pressure 80/45 mm Hg, and oxygen saturation 95 % on room air. A loading dose of 1 lg/kg dexmedetomidine (Dexem; Themis Medicals, India) was infused over 15 min. With this, posturing and rigidity disappeared and the Ramsay sedation score (RSS) reached 5. Dexmedetomidine infusion was continued at a rate of 0.5 lg/kg/h using an MRIcompatible infusion pump (Perfusor; Space B/Braun, Germany) during MR imaging that lasted 1 h. Oxygen was administered through a face mask. He was hemodynamically stable throughout the procedure. An RSS of 2 was reached and opisthotonus posturing and rigidity reappeared 2 h after stopping the infusion. This case report highlights successful use of dexmedetomidine as a sole sedative agent for MRI in a patient with HSS. HSS is a rare autosomal recessive disorder caused by pantothenate kinase-associated neurodegeneration 2 (PKAN2) gene mutations resulting in accumulation of iron in the brain. The disease is also called neurodegeneration with brain iron accumulation (NBIA) [1]. Presenting features of HSS include progressive generalized dystonia involving the oromandibular muscles, rigidity, and choreoathetoid movement [1]. Airway management is critical during anesthesia in these patients. Oromandibular dystonia results in impaired swallowing, malnourishment, and high risk for pulmonary aspiration. Involvement of the pharyngeal muscles results in breathing difficulty and dynamic airway obstruction. These patients develop contractures and joint stiffness, including the jaw and cervical spine, leading to difficult airway. Associated mental retardation renders preoperative airway assessment difficult. Airway problems necessitate careful postoperative monitoring. MRI studies demand a quiet patient for better image quality. Severe dystonia necessitated sedation/general anesthesia in our patient. In a previous case report, volatile anesthetic was used to sedate a child with HSS, but postoperatively the patient developed airway obstruction requiring emergency intubation [2]. In our patient, we chose dexmedetomidine to provide sedation without respiratory depression [3]. As dystonia completely disappeared and an RSS of 5 was achieved after a bolus infusion of dexmedetomidine, we continued dexmedetomidine infusion during the MR imaging. Dexmedetomidine, by alpha-2 adrenergic modulation, induces prolonged nonREM sleep. As muscle atonia has been described during non-REM sleep, patients receiving dexmedetomidine infusion tend to be in a relaxed state with reduced muscle tone [4]. This mechanism could have suppressed the dystonia in our patient. Although propofol has been used in such patients, we avoided propofol as it causes dystonic reactions and opisthotonus [5]. Dystonia suppression by B. Madhusudhana Rao M. Radhakrishnan (&) Department of Neuroanesthesia, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, Karnataka, India e-mail: mrks1974@gmail.com

Should mental disorders be regarded as brain disorders? 21st century mental health sciences and implications for research and training

Should mental disorders be regarded as brain disorders? 21st century mental health sciences and implications for research and training

Habilitation, health, and agency: a framework for basic justice

Introduction Part One: Habilitation and Basic Justice Preface to Part One 1. Basic Justice and Habilitation: Concept and Conception 1. Basic Justice 2. Habilitation: Concept and Conception 3. Normative Theories with a Close Connection to Habilitation 4. Habilitation: Conception and Framework 2. The Circumstances of Habilitation for Basic Justice 1. Functional Abilities in a Given Range of Environments 2. Summary of the Circumstances of Habilitation 3. The Centrality of Health and Agency Part Two: Health, Healthy Agency, and the Health Metric Preface to Part Two 3. Eudaimonistic Health: Complete Health, Moral Development, Well-Being, and Happiness 1. Health, Well-Being, and Virtue 2. A Unified Conception of Health, Positive and Negative 3. The Science of Mental Health, Happiness, and Virtue 4. Health, Happiness, and Basic Justice 4. Good Health as Reliably Competent Functioning 1. Basic health: An Integrated, Limited General Concept 2. Habilitation, Coping Abilities, and Agency 3. Good (basic) Health as Reliably Competent Functioning 5. Robustly Healthy Agency 1. The Health Metric 2. Health Science: Limited and Unified 3. Habilitation into Robustly Healthy Agency 6. Healthy Agency as the Representative Good for Basic Justice 1. Healthy Agency versus Wealth and Income 2. Healthy Agency versus Pluralism 3. The Representativeness of Habilitation into Healthy Agency 4. Theory All the Way Down: A Public Policy Objection Part Three: Healthy Agency and the Norms of Basic Justice Preface to Part Three 7. Healthy Agency and Its Behavioral Tendencies 1. Dispositions Toward Health and Habilitation 2. Dispositions About the Subject Matter of Justice 8. Healthy Agency and the Norms of Basic Justice 1. Habilitative Necessities and Justice 2. Habilitative Stability, Strength, and Efficiency 3. Second-Order Norms, 4. Moving Beyond Basic Justice Part Four: Relevance, Influence, and Prejudice Revisited Preface to Part Four 9. Relevance, Influence, and Prejudice 1. Exclusionary Reminders 2. Comprehensiveness and Representativeness 10. Conclusion and Extrication 1. Health, Individual Liberty, and Social Stability: A Fantasy 2. Approximations to Health 3. Pseudo-Problems and Elusive Targets: Sensible Replies to the Foole 4. Hope Rather than Fantasy Acknowledgments Bibliography

Interleukin-1� micro-environment promotes viability and proliferation of malignant glioma cell U87MG

Event Abstract Back to Event Interleukin-1β micro-environment promotes viability and proliferation of malignant glioma cell U87MG Nandakumar DN1*, Hurmath F. K1 and Palaniswamy R1 1 National Institute of Mental Health and Neuro Sciences (NIMHANS), Department of Neurochemistry, India Glioma is one of the most common and Glioblastoma (GBM) is most malignant tumours of the central nervous system. It is notorious for its highly proliferative, infiltrative and invasive behaviour. Despite substantial progress in early diagnosis and combined modality therapy including surgical therapy, radiotherapy and chemotherapy have failed to drastically change survival. Due to the invasive phenotype and diffuse penetration of glioblastoma cells into normal regions of the brain, patients diagnosed with GBM have mean survival of 10 to 12 months even with combined modality therapy. Their exceptional ability to proliferate and infiltrate normal brain makes complete radical surgical resection virtually impossible and leading in almost all cases to tumor recurrence. In human glioblastomas, pro-inflammatory cytokine IL-1β is expressed and secreted at high concentration. Objective of the current study was to study the role of IL1β on the glioma proliferation and cell viability. The human glioma cell line U87MG was cultured in 5% CO2 and 95% humidified atmosphere air at 37°C in Dulbecco's modified Eagle's medium (DMEM), supplemented with 10% foetal bovine serum (FBS). Cells were trypsinized and 100000 cells were incubated with 1 ng/mL IL-1β for 24 hours in serum free media for cell viability assay. Cell viability was measured by Trypan blue dye exclusion assay. Viable cells were plated at a density of 5000 cells per well in 96-well plates and proliferation was demonstrated by 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. We observed significant increase in viability of cells and proliferation of glioma cells in the micro-environment of IL-1β. Inflammation is a critical component of tumour progression. This study indicates that pro-inflammatory cytokine IL-1β, enhances cell viability and proliferation of U87MG glioma cells. Acknowledgements This work was supported by NIMHANS research grant, and research grant form Neurotaskforce, Department of Bio Technology (DBT), India. Keywords: Glioma, IL-1beta, viability, proliferation, proinflammatory cytokines Conference: 15th International Congress of Immunology (ICI), Milan, Italy, 22 Aug - 27 Aug, 2013. Presentation Type: Abstract Topic: Immune-mediated disease pathogenesis Citation: DN N, K HF and R P (2013). Interleukin-1β micro-environment promotes viability and proliferation of malignant glioma cell U87MG. Front. Immunol. Conference Abstract: 15th International Congress of Immunology (ICI). doi: 10.3389/conf.fimmu.2013.02.00263 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 12 Mar 2013; Published Online: 22 Aug 2013. * Correspondence: Dr. Nandakumar DN, National Institute of Mental Health and Neuro Sciences (NIMHANS), Department of Neurochemistry, Bangalore, Karnataka, 560029, India, drnandn@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Nandakumar DN Hurmath F K Palaniswamy R Google Nandakumar DN Hurmath F K Palaniswamy R Google Scholar Nandakumar DN Hurmath F K Palaniswamy R PubMed Nandakumar DN Hurmath F K Palaniswamy R Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Yoga and Neurobehavioral Sciences: Indian Perspective

The issue carries a series of research reports by the team from Advanced Center of Yoga in collaboration with Morarji Desai National Institute of Yoga. I wish to congratulate the team for making this possible. I also thank the editors, Dr. M. S. Keshavan, Dr. T. S. S. Rao and Dr. Naren for their effort in bringing out this supplement. National Institute of Mental Health and Neuro Sciences (NIMHANS) has identified yoga as an important area for service as well as research and the word yoga itself figures in the logo of NIMHANS. This is researched in both clinical and preclinical departments over the four decades or longer. The advanced center was set up with a memorandum of understanding and collaboration with the “Morarji Desai National Institute of Yoga” in 2007. This led to opening of a regular yoga service for the patients. Every day nearly 40 patients and some of their caregivers receive yoga intervention in this center. Yoga is also given as an add-on intervention in the children's ward. The team has trained the nurses in other wards too to provide yoga-based physical activity. In the past 5 years, the team conducted several seminars and symposia to popularize yoga in relation to mental health and neurosciences. The populations included doctors, teachers, special groups like the elderly and caregivers. The group also released a booklet on yoga in depression. Interdisciplinary research was undertaken as part of this collaboration in important areas. Students were guided in these researches to complete their PhD and MD degrees successfully. Some of these research papers are being published as a compilation in this special issue of the Indian Journal of Psychiatry. Yoga approaches used in these studies include postures (Asanas), breathing techniques (Pranayamas) and chanting (OM). These procedures were chosen from traditional texts and the modules were validated by experts in the field of Yoga. Such validated modules were used in these studies. The studies demonstrate the efficacy of these modules in select conditions, but with some limitations. That many of the measurements are objective suggests that there was no bias in these results. There is also evidence that the yoga intervention produced predictable biological changes. These biological changes too were relevant to the therapeutic effects. Yoga also was found beneficial in certain divergent groups, caregivers and children and acutely ill in-patients. Persons with difficult-to-treat epilepsy attending out-patient care too expressed a need for yoga as an add-on intervention. This is only a modest attempt to project evidences in favor of yoga. I am also aware that some studies are not published here as they are yet incomplete, have not shown such positive results in the preliminary analyses. More careful documentation/verification of yoga's adverse effects, if any, deserves to be brought to the notice of clinicians. The team should also extend its work to include other clinical populations in whom the allopathic interventions have limitations. Examples include dementias, degenerative muscle disorders, acquired brain damage-related deficits, childhood/developmental disorders and substance use disorders. There is a need to develop strategies that help to overcome barriers in reaching yoga to the patients living in the community. Demonstrating the effectiveness of such strategies will go a long way in introducing comprehensive/integrated approaches for the care of chronically ill. There could also be potential to include these in public health programs. Given the presence at NIMHANS of advanced and cutting edge research facilities in basic science, the team must explore the research with reference to the basic mechanisms of yoga as a composite module as well as its independent components. Demonstration of such biological evidence in correcting the underlying disease by yoga helps to motivate modern practitioners to recommend yoga as a treatment in certain conditions. The quantum of evidence in favor of yoga could well prompt in the days to come inclusion of a yoga specialist in the mental health Team. I wish the yoga research team all success in meeting these objectives in the near future. I also wish all the readers a productive reading and I hope they will be the individuals who will speak for yoga in the modern medicine clinics.

2754 – Title: a study to assess the stress, coping strategies and domestic violence in wives of alcohol dependent individuals

Divorce rates are high among wives of alcoholics and the most frequently identified cause is domestic strife in the form of harassment, torture or beating from the husband and or in-laws. However, there is only limited literature in this regard. To study the stress, various coping styles and domestic violence among the wives of alcohol dependent individuals, who are admitted to the de-addiction centre of a tertiary care psychiatric centre in India. An exploratory descriptive design was adopted. Wives of 75 alcohol dependent individuals, admitted in the deaddiction centre of National Institute of Mental Health and Neuro Sciences, Bangalore were selected. Data was collected by personal interviews with all 75 wives using socio-demographic information schedule, Perceived Stress Scale, Coping with Drinking Questionnaire, and Domestic Violence Questionnaire. Wives of alcohol dependent patients had high levels of perceived stress. Avoidance, discord, fearful withdrawal and sexual withdrawal were the most common coping components identified. Domestic violence was experienced by 90% women, mostly intellectual (69%), emotional (59%), social (58%), physical (47%), economic (42%) and sexual violence (27%). Domestic violence was found to increase the stress and influences the coping styles of these women. Domestic violence is a major problem in wives of alcoholics. Routine screening for domestic violence is needed during the intake of alcoholic for substance abuse treatment so that appropriate interventions can be planned. There is a need for substance abuse treatment providers to be trained on the issue of domestic violence.

Development and feasibility of yoga therapy module for out-patients with depression in India

Context:Evidence suggests that certain yoga practices are useful in the management of depression. To the best of our knowledge, there has been no study that deals with the formulation of a yoga module for the particular clinical features of depression.Aim:The main aim of our study was to develop a comprehensive yoga therapy module targeting specific clinical features of depression.Settings and Design:Specific yoga practices were matched for clinical features of depression based on a thorough literature review. A yoga program was developed, which consisted of Sukṣmavyayāma, (loosening exercises), äsanas (postures), relaxation techniques, Prāṇāyāma (breathing exercises) and chanting meditation to be taught in a 2 week period.Materials and Methods:A structured questionnaire was developed for validation from nine experienced yoga professionals. The final version of yoga therapy module was pilot-tested on seven patients (five females) with depression recruited from outpatient service of National Institute of Mental Health and Neuro Sciences, Bangalore.Results:The final yoga therapy module had those practices that received a score of three or more (moderately/very much/extremely useful) from all responders. Six out of nine (>65%) experts suggested Sūkśmavyāyāma should be included. Five out of nine experts opined that training with 10 sessions (over 2 weeks) is rather short. All experts opined that the module is easy to teach, learn and practice. At the pilot stage, the five patients who completed the module reported more than 80% satisfaction about the yoga practices and how the yoga was taught. Severity of depression substantially reduced at both 1 and 3 months follow-up.Conclusion:The developed comprehensive yoga therapy module was validated by experts in the field and was found to be feasible and useful in patients with depression.

Maps, Models, and Narratives

Many researchers within the social sciences, medicine, and humanities have examined the ways people talk and think about depression. In their research and published literature they have attempted to determine the theoretical frameworks and appropriate language for categorizing such concepts and understandings. Drawing from mental health and broader social science scholarship, in this article we examine three approaches to developing an inclusive understanding of depression experiences: explanatory models, exploratory maps, and illness narratives. Utilizing these terms in the analysis of a single dataset, we identified multiple conceptual terms with potential analytical validity. Furthermore, we argue that variable usage and meanings of these concepts among lay people might contribute to a shared understanding of depression between lay people and experts, and ultimately have positive consequences for clinical practice.

MP 6 Dementia: perspectives from developing countries

Dr Mathew Varghese is Professor of Psychiatry at the National Institute of Mental Health and Neuro Sciences (NIMHANS) at Bangalore, India. He did his training in Medicine at the St John9s Medical College, Bangalore and specialised in Psychiatry at NIMHANS in 1984. Since then he has been a faculty at the Department of Psychiatry, NIMHANS for over 25 years. His work at NIMHANS involves clinical services, postgraduate teaching, research and administration. At present he heads an Adult Unit, the Geriatric Clinic and Services and the Family Psychiatry Center at the Department. Dr Varghese9s areas of interest are psychogeriatrics, family psychiatry and rehabilitation. He has developed family intervention manuals for WHO projects for use with caregivers of persons with dementia and schizophrenia. He has been involved with research on dementia and since 1998 is one of the founding members of the International 10/66 Dementia Research Group and a member of the World Federation of Neurology Dementia Research Group. He was an investigator on the World Mental Health survey in India. At present he has many ongoing research projects supported by international and national agencies like the Fogarty International Center, the Wellcome Trust, the Department of Science and Technology and Dept of Biotechnology, India. He has over 70 publications in journals, monographs and books. Besides work at the NIMHANS he is a visiting faculty and examiner to other postgraduate courses in mental health. He is on the governing board of the World Association for Psychosocial Rehabilitation (India), the Alzheimer9s Disease International, the ARDSI and rehabilitation centers like the Richmond Fellowship Society (RFS) and the Medico Pastoral Association. He was the President, Indian Psychiatric Society (Karnataka State Branch) and is the Vice President, ARDSI (Bangalore) and the Secretary-General of the RFS India. He has also helped organise many conferences, symposia and workshops and was the Organising Secretary of the World Association for Psychosocial Rehabilitation World Congress 2009 at Bangalore. He is the National Coordinator for the National Dementia Strategy of the ARDSI and author of the Dementia India Report 2010.

Relationship between Motor Threshold and Externalizing Symptoms in Subjects at High Risk for Alcohol Dependence: A TMS Study

The American Journal on AddictionsVolume 22, Issue 1 p. 84-85 Letter to the Editor Relationship between Motor Threshold and Externalizing Symptoms in Subjects at High Risk for Alcohol Dependence: A TMS Study Kesavan Muralidharan MD, Corresponding Author Kesavan Muralidharan MD Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, IndiaDr. Muralidharan, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T2A1. E-mail: muralidharan.kesavan@ubc.ca.Search for more papers by this authorGanesan Venkatasubramanian MD, Ganesan Venkatasubramanian MD Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, IndiaSearch for more papers by this authorPramod K. Pal DM, Pramod K. Pal DM Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore, IndiaSearch for more papers by this authorVivek Benegal DPM, MD, Vivek Benegal DPM, MD Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, IndiaSearch for more papers by this author Kesavan Muralidharan MD, Corresponding Author Kesavan Muralidharan MD Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, IndiaDr. Muralidharan, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T2A1. E-mail: muralidharan.kesavan@ubc.ca.Search for more papers by this authorGanesan Venkatasubramanian MD, Ganesan Venkatasubramanian MD Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, IndiaSearch for more papers by this authorPramod K. Pal DM, Pramod K. Pal DM Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore, IndiaSearch for more papers by this authorVivek Benegal DPM, MD, Vivek Benegal DPM, MD Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, IndiaSearch for more papers by this author First published: 07 February 2013 https://doi.org/10.1111/j.1521-0391.2013.00274.xCitations: 5Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume22, Issue1January‐February 2013Pages 84-85 RelatedInformation

La Scientologie : un délire systématisé inspiré par les Études sur l’hystérie, de Breuer et Freud

Was Lafayette-Ronald Hubbard, the famous founder of the Church of Scientology, psychotic? From this question, we have tried to rethink the analysis of this sect. We approached the scientologist doctrine in the Freudian way, that is as a “recovery attempt” – like the delirious, which enabled Hubbard to treat, through his writings, the teeming elementary psychotics phenomena, which harassed him. The study of his first “philosophical” book, Dianetics: The modern science of mental health, will show us, in a quasi-experimental way, the intense work of the delirious, which enabled him to put back together his broken-down universe, to inject sense into the sluggishness resulting from his psychotic decompensation, and finally to reintegrate the social tie. Scientology's writings will then reveal to us their hidden source: Studies on hysteria, by J. Breuer and S. Freud, which had strongly inspired Hubbard. Through a comparative analysis of these two texts, we will show how Hubbard managed to adapt hysteria's etiology into the way of his own psychotic experience, so as to include it inside his delirious system.

Positive mental health: A note of caution

Positive mental health: A note of caution

Social integration in global mental health: what is it and how can it be measured?

Purpose. Global mental health movements increasingly highlight social integration as a key outcome for mental health services. This creates a pressing need to better articulate and measure this outcome. Much of the work in social integration thus far has been in high-income countries (HIC), and is not directly applicable across diverse socio-cultural environments. We discuss promising concepts and measures of social integration with potential for global cross-cultural application. Then, we present some of the challenges of developing measures for global and cross-cultural use, and suggest ways to confront these challenges. Although we focus primarily on adults with severe mental disorders in low- and middle-income countries (LMIC), the questions we raise are also relevant to children, other mental disorders and HIC. Findings. We identify and describe four distinct conceptual frameworks for social integration that have emerged over the past decade. Then, we discuss the challenge of developing corresponding measures, and the further challenge of developing global cross-cultural measures. We suggest that a key concept shared across much previous and emerging work is active participation in community and civic life. As a platform for future development of global cross-cultural measures of this and other concepts, we propose guidelines and present examples of feasible, previously used strategies. Summary. Emerging concepts of social integration hold great promise, but as yet, there are no corresponding measures suitable for global cross-cultural use. We propose that it is feasible to develop such measures, and that their development will facilitate the advance of community mental health services and the science of global mental health.

Rebuilding the foundations: Major renovations to the mental health component of an undergraduate nursing curriculum

Concerns relating to the adequacy of nurses' preparation for the care of people with mental illness prompted significant revision of the mental health component in a Bachelor of Health Science nursing programme in New Zealand that prepares approximately 200 students per year. Working collaboratively with clinical providers, university staff developed and introduced three courses (equivalent to 450 hours of learning) specifically focused on mental health science, inpatient practice, and primary community mental health practice. This paper provides an overview of the new courses and reports the findings of an appreciative inquiry evaluation of this curriculum innovation.

Conflicting Models of Mind

Looking at the issue of child mental health and drawing on theory and methods from anthropology and cognitive linguistics, this study explores the role of cultural models in science translation. In-depth interviews with members of the American public reveal the cultural assumptions that Americans employ in thinking about child mental health, which differ dramatically from the ways scientists explain this topic. The study finds that public understandings of causation shape perceptions of effective solutions on this issue. Findings suggest strategies to translate the science of child mental health and encourage productive thinking of policy solutions to this issue.

Barriers to discharge of patients from a government-run day-care psychiatric rehabilitation center in India

ObjectiveMany psychiatric patients undergoing vocational training do not achieve successful transition to regular work. In this study, we evaluated the barriers for discharge from day care center to actual work place. Materials and methodsIn a cross-sectional study at a government-run day-care center at National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, we studied 76 patients who were undergoing vocational training for more than 1 year. We did a semi-structured interview with patients, their family members, and instructors of various occupational sections. We used a questionnaire of 17 different barriers to assess the obstacles in their discharge from day-care center to actual work place. ResultsThe majority of them had a diagnosis of mental retardation (n=47) followed by schizophrenia (n=29), and bipolar disorder (n=9). The mean (SD) age and duration of illness was 33.6 (9.7) years and 12.5 (9.3) years, respectively. Patients had more than one diagnosis. The median duration of stay in day-care center was 5.9 years. Doubts regarding performance at a new work place (n=60), fear of performance at new work place (n=65), and the fear of transition to regular work (n=64) were the most common barriers reported by patients, their family members and instructors of various occupational sections, respectively. DiscussionEducating patients and their family members, gradual exposure to new working environment, and increased community level vocational opportunities may potentially overcome above barriers. Getting them to the actual job early in their course of treatment will improve their adjustment to a new work place and overall outcome.

Expressed emotion and caregiver burden in patients with schizophrenia.

Background:Family's expressed emotion has been shown to be predictive of outcome in mental and physical illnesses in a variety of cultural settings. The relationship between caregiver burden and high level of expressed emotions has demonstrated a high level of relapse among the psychiatric patients in the West.Aim:The current study explores the relationship between caregivers’ burden and level of expressed emotions by the patients with schizophrenia in Indian setting.Materials and Methods:The sample for the study consisted of totally 70 subjects comprising 35 schizophrenic patients and 35 caregivers. The schizophrenic patients who were attending the Day Care Center run by Department of Psychiatric and Neuro Rehabilitation Unit at National Institute of Mental Health and Neuro Sciences (NIMHANS) in Bangalore, India (a tertiary care center) and their primary caregivers were included. Family emotional involvement and criticism scale and The burden assessment schedule were administered to assess the expressed emotions and caregivers’ burden. Carl Pearson Correlation test used to study the relationship between the variables.Results and Conclusion:The study highlighted the need for addressing expressed emotion in comprehensive psychosocial intervention plan. More attention should be paid to the needs of the caregivers in order to alleviate their burden in managing mentally ill patients.

Of Postures, Mirrors, and Models in Catatonia

Back to table of contents Previous article Next article LettersFull AccessOf Postures, Mirrors, and Models in CatatoniaUrvakhsh Meherwan Mehta, M.D., Narayana Manjunatha, M.D., D.P.M., and John P. John, M.D.Urvakhsh Meherwan MehtaSearch for more papers by this author, M.D., Narayana ManjunathaSearch for more papers by this author, M.D., D.P.M., and John P. JohnSearch for more papers by this author, M.D.Published Online:1 Jan 2011AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Posturing in catatonia is one of its more distinctive phenomena, the bizarreness of which has fascinated psychopathologists, clinicians, and researchers alike. Fish1 describes posturing as a disorder of goal-directed movements. Cutting2 ascribes it to a disintegration of purposeful actions and gives it a status of pseudo-purposefulness. We report a case of catatonia that presented with a wide range of posturing, involving groups of muscles from head to toe, and we highlight the relevance of a broader conceptualization of posturing and newer research forays based on fundamentals of motor cognition.Case ReportA 26-year-old man from southern India with unremarkable past, personal, and family history presented with illness lasting 8 days that had abrupt onset and polymorphic course. Symptoms appeared in the sequence of paranoid delusions and extreme psychomotor excitement, and over the next 2 days, he displayed florid catatonic features, the most dramatic of them being demonstration of an array of posturing signs from head to toe.The patient's face displayed grimacing (due to facial muscle spasm giving an appearance of a sneering grin like that of risus sardonicus) and motor stereotypies of his lower jaw with instances of spasms in his jaw muscles leading to trismus. Staring was evident, with fixed gaze and poor blink rate. Stereotyped posturing was observed in the neck and shoulder muscles as he lay supine in bed with his head a few inches off the pillow (psychological pillow) and in the extensor spinal muscles which led to episodic and recurrent opisthotonus or arc de cercle. Classical mannerist posturing involving the upper limbs was evident, with his arms spontaneously held in a prayer-like folded manner (namasthe in Indian culture). Catalepsy or perseveration of posture was observed in both upper and lower limbs when placed in a series of uncomfortable postures. The posturing display occurred in episodes lasting 1–20 minutes over a period of 36 hours. There was no historical account of being administered neuroleptics. Examination did not reveal neurological deficits. Despite extensive metabolic, imaging, and EEG investigations, no organic pathology was demonstrated. The patient improved with ECT after partial response to lorazepam.DiscussionIt has been more than a century since Kahlbaum3 described catatonia as a syndrome of motor abnormalities, yet it remains a poorly understood phenomenon. Novel methods based on fundamentals of cognitive and social neurosciences may shed some light on neurobiology of catatonia. We propose a broader conceptualization of posturing as a prototype motor dysregulation state based on recent advances in mirror neurons and motor cognition. The increasing understanding of neural circuits underlying motor cognition domains of intention (presupplementary motor area and intraparietal sulcus),4 initiation (supplementary motor area),5 termination (right posterior parietal cortex),6 implicit motor feedback for execution (anterior cingulate),7 sense of agency and gnosis of these phenomena (mirror neurons of inferior parietal lobule, pars opercularis of inferior frontal gyrus and insula)8 is an exciting development. These concepts can be utilized in formulating a composite cognitive model of catatonia which can then be empirically tested.Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India1. Casey P , Kelly B: Motor disorders, in Fish's Clinical Psychopathology: Signs and Symptoms in Psychiatry, 3rd Edition. Edited by Casey PKelly B. Cambridge, UK, Gaskell, 2007Google Scholar2. Cutting J: Principles of Psychopathology: Two Worlds, Two Minds, Two Hemispheres, 3rd Edition. Oxford, UK, Oxford Univ. Press, 1997Google Scholar3. Kahlbaum KL: Catatonia. (trans. , Levi Y , Pridon T). Baltimore, MD, Johns Hopkins Univ. Press, 1973Google Scholar4. Haggard P: Conscious intention and motor cognition. Trends Cogn Sci 2005; 9:290–295Crossref, Medline, Google Scholar5. Jahanshahi M , Jenkins IH , Brown RG, et al.: Self-initiated versus externally triggered movements. I. An investigation using measurement of regional cerebral blood flow with PET and movement-related potentials in normal and Parkinson's disease subjects. Brain 1995; 118(part 4):913–933Crossref, Medline, Google Scholar6. Northoff G: Catatonia and neuroleptic malignant syndrome: psychopathology and pathophysiology. J Neural Transm 2002; 109:1453–1467Crossref, Medline, Google Scholar7. Berns GS , Cohen JD , Mintun MA: Brain regions responsive to novelty in the absence of awareness. Science 1997; 276:1272–1275Crossref, Medline, Google Scholar8. Rizzolatti G , Fabbri-Destro M , Cattaneo L: Mirror neurons and their clinical relevance. Nat Clin Pract Neurol 2009; 5:24–34Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 23Issue 1 Winter 2011Pages E16-E16 Metrics PDF download History Published online 1 January 2011 Published in print 1 January 2011