Neuropsychiatry Research Articles

Awareness of Disability Certificate uses among the Caregivers of Persons with Mental Illness

Background: There are many benefits for the person with disability such as pension, reservation in various field, free education, insurance, healthcare and rehabilitation etc. the biggest obstacle to approach this benefit is the lack of awareness and poor knowledge of certificate benefits as well lack of knowledge of obtaining the certificate. Aim: To assess the awareness and uses of disability certificate among the caregivers of persons with mental illness. Methods : Purposive sampling technique was used for selecting samples. The study was carried out at Ranchi Institute of Neuro Psychiatry and Allied Sciences in Ranchi district. Total number of 160 respondents (caregivers/ family member of person with mental illness) were taken in the study. Subjects were evaluated using socio demographic datasheet and self-made questionnaire. Results: Results indicated that caregivers of the persons with mental illness were not aware about health care facility, social security, insurance facility, rehabilitation provision, reservation for that land allotment, reservation facilities available for developmental scheme, skills development program, marketing facilities. Conclusion: Finding of the present study concluded that majority of the caregivers of the persons with mental illness have not been aware of the disability certificate and its uses which isprovided by the government of India. Key Words: Disability certificate, caregivers, awareness and usefulness.

State of psychoanalytic psychotherapy in Bosnia and Herzegovina since the 1992–95 war

While individual analytic therapy is still in its early stages of development, group analytic therapy and group psychotherapy in general are considerably advanced in comparison to other talking therapies, and are often used in healthcare settings and in private practice. All forms of psychotherapy offered in healthcare institutions are covered by health insurance. Most activities related to providing psychotherapy or undergoing training in various therapeutic modalities are not regulated by adequate laws or other regulations, nor does a definitive registry of psychotherapists exist. A majority of psychotherapists in healthcare institutions are (neuro)psychiatrists, but other helping professions are also often involved in providing therapies, with psychologists usually preferring cognitive-behavioural therapy.

The association between anxiety and depression with 25(OH)D and thyroid stimulating hormone levels.

To evaluate the relationships between the serum levels of these parameters and mood disorders, including depression and anxiety. One hundred and fifty patients (77 with anxiety and 73 with depression), aged 18 to 79 years old, who were referred to the Neuro Psychiatry Clinic of Uskudar University in Istanbul, Turkey were included in this study from June 2018 to December 2018. According to the Beck Anxiety Inventory and Beck Depression Inventory II results, the anxiety patients met the mild and moderate anxiety criteria and the depression patients met the moderate and severe depression criteria, respectively. Venous blood samples were collected after overnight fasting, and the 25(OH)D and thyroid stimulating hormone (TSH) levels were measured. The data showed a significantly higher TSH level in the females when compared to their male counterparts in the severe depression subgroup (p=0.011). A serum TSH evaluation may be considered as a useful biochemical marker for more efficient depression management.

A comparative study of ketamine vs electroconvulsive therapy in the management of major depressive disorder

Objective The aim was to investigate the efficacy of ketamine vs electroconvulsive therapy (ECT) in hospitalized patients suffering from treatment-resistant major depressive disorder (MDD). Background Both propofol and ketamine are the commonly used anesthetic agents, but recent clinical studies have suggested that ketamine has rapid-acting antidepressant properties, itself, at subanesthetic doses. Patients and methods A clinical comparative randomized cross-sectional study was conducted on 20 patients suffering from treatment-resistant MDD, and receiving ketamine only (group 1) and 20 patients suffering from treatment-resistant MDD receiving ECT only (group 2), who were recruited from inpatients wards of Neuropsychiatry Department, Menoufia University and Met-Khalaf Hospital for Psychiatric Health from December 1, 2018 until March 14, 2019. All participates were subjected to full detailed general medical, neurological, and psychiatric history and examination. Results There was a statistically insignificant differences between the studied patients regarding the types of depression (P = 0.61). Bipolar depression and MDDs were represented in 57 and 54% in the ECT group and 43 and 46% in the Ketamine group, respectively. Also, catatonic depression, melancholic subtype, and seasonal affective disorder were represented by 80, 66.7, and 100% in the Ketamine group vs 20, 33.3, and 0.00% in ECT group, respectively. Conclusion There was statistically significant difference between the ketamine group and ECT, regarding the efficacy of both ketamine and ECT in favor of the ketamine group as ketamine has a more rapid effect in improving depressive symptoms in MDD patients and have more rapid antidepressant effects compared with ECT.

The association between anxiety and depression with 25(OH)D and thyroid stimulating hormone levels

Objectives:To evaluate the relationships between the serum levels of these parameters and mood disorders, including depression and anxiety.Methods:One hundred and fifty patients (77 with anxiety and 73 with depression), aged 18 to 79 years old, who were referred to the Neuro Psychiatry Clinic of Uskudar University in Istanbul, Turkey were included in this study from June 2018 to December 2018. According to the Beck Anxiety Inventory and Beck Depression Inventory II results, the anxiety patients met the mild and moderate anxiety criteria and the depression patients met the moderate and severe depression criteria, respectively. Venous blood samples were collected after overnight fasting, and the 25(OH)D and thyroid stimulating hormone (TSH) levels were measured.Results:The data showed a significantly higher TSH level in the females when compared to their male counterparts in the severe depression subgroup (p = 0.011).Conclusion:A serum TSH evaluation may be considered as a useful biochemical marker for more efficient depression management.

From Neurology and Psychiatry to NeuroPsychiatry

From Neurology and Psychiatry to NeuroPsychiatry

Efficacy of multi-sensory stimulation on psychological, behavioral symptoms and health-related quality of life in patients with Alzheimer's disease

Objective To investigate the effects of multisensory stimulation on mental behavioral symptoms and health-related quality of life in patients with Alzheimer's disease(AD). Methods From March 2018 to August 2018, 159 AD patients(65-75 years old) in neurology and psychiatric clinic of the Second Affiliated Hospital of Fujian Medical University were enrolled.Randomized grouping was performed by randomized software, experimental group (multi-sensory stimulation), 81 cases, control group(no intervention), 78 cases.The experimental group had a multi-sensory stimulation for 16 weeks, twice a week, 40 minutes each time, for a total of 32 times.At the time of enrollment and 16 weeks after the intervention, the simple neuropsychiatry scale (NPI-Q) and the health-related quality of life questionnaire (HRQLS) were filled out.The t-test and two-factor repeated measures analysis of variance were used to analyze the data. Results The NPI-Q scores of the two groups before and after intervention were compared by two-factor repeated measurement ANOVA.There was no significant difference in NPI-Q average score between the expermental group(2.20±0.22) and control group(2.17±0.35) before intervention(t=0.53, P=0.595). After intervention NPI-Q average score of the experimental group(2.17±0.46) was lower than that of the control group(1.71±0.29)(t=7.56, P<0.01). The intervention effect(F=50.77, P<0.01), the time effect(F=39.20, P<0.01) and interaction effect (F=33.89, P<0.01) were statistically significant. The HRQLS scores of the two groups before and after intervention were compared by two-factor repeated measurement ANOVA.The intervention effect(F=140.82, P<0.01), the time effect(F=56.64, P<0.01) and interaction effect (F=60.38, P<0.01) were statistically significant. Conclusion Multisensory stimulation can improve mental behavioral symptoms in patients with Alzheimer's disease and improve health-related quality of life. Key words: Behavior and psychological symptom; Health-related quality of life; Multi-sensory stimulation; Alzheimer's disease

Coded Prevalence of Mild Cognitive Impairment in General and Neuropsychiatrists Practices in Germany Between 2007 and 2017.

The diagnosis of mild cognitive impairment (MCI) is becoming increasingly important for the medical treatment of dementia. The aim of this study was to investigate whether the coded prevalence of MCI changed in the period from 2007 to 2017 compared to dementia diagnoses. This was a retrospective evaluation of diagnostic data from 432 general practitioner (GP) practices and 53 neuropsychiatrist (NP) practices in Germany based on the Disease Analyzer database (IQVIA). The frequencies with which MCI and dementia were diagnosed in these practices were determined. The frequency with which dementia was diagnosed was included to determine whether the change in the frequency of MCI diagnoses was due to the increase in dementia prevalence. It was found that the number of GP practices with patients receiving MCI diagnoses increased from 16% to 46%, while the number of NP practices with patients receiving MCI diagnoses increased from 55% to 75%. Moreover, the study found an increase in the coded prevalence of MCI from 0.4 to 1.9 patients/GP practice and from 6.5 to 11.1 patients/NP practice were observed. A growing number of GPs and NPs code MCI with increasing frequency. However, the coding frequency of MCI in 2017 corresponded to less than 10% of its true prevalence. A sharp increase in MCI diagnoses can be expected, along with the establishment of preventive and disease-modifying dementia strategies.

Using Interactive 3D Visualisations in Neuropsychiatric Education.

Obsessive compulsive disorder (OCD) is a neuropsychiatric disorder with a global prevalence of 2-3%. OCD can have an enormous impact on the lives of those with the disorder, with some studies suggesting suicidal ideation is present in over 50% of individuals with OCD, and other data showing a significant number of individuals attempt suicide. It is therefore important that individuals with OCD receive the best possible treatment. A greater understanding of the underlying pathophysiology of neuropsychiatric disorders among professionals and future clinicians can lead to improved treatment. However, data suggests that many students and clinicians experience "neurophobia", a lack of knowledge or confidence in cases involving the nervous system. In addition, research suggests that the relationship many students have with neurological conditions deteriorates over time, and can persist into practice.If individuals living with conditions such as OCD are to receive the best possible treatment, it is crucial that those administering care are equipped with a thorough understanding of such disorders. While research has shown that the use of interactive 3D models can improve anatomy education and more specifically neurology education, the efficacy of using of such models to engage with neuropsychiatric conditions, specifically OCD, has not been assessed. This study seeks to address this gap.In this study an interactive application for Android devices was designed using standardised software engineering methods in order to improve neuropsychiatry literacy by empowering self-pace learning through interactive 3D visualisations and animations of the neural circuitry involved in OCD. A pilot test and a usability assessment were conducted among five postgraduate life science students. Findings relating to user experience were promising, and pre-test vs. post-test evaluation suggested encouraging outcomes regarding the effectiveness of the application in improving the knowledge and understanding of OCD. In short, this study suggests that interactive 3D visualisations can improve neuropsychiatry education. For this reason, more efforts should be made to construct similar applications in order to ensure patients always receive the best possible care. Fig. 2.1 A diagrammatic representation of the CSTC circuit, based on a similar diagram by Robertson et al. (2017).

The Search for Meaning in Neuropsychiatry

The Search for Meaning in Neuropsychiatry

Analysis of Differences in the Value of the AUDIT-K According to the Sociological Variables the Population of Neuropsychiatry Hospital Visitor

Using the AUDIT-K (Korean versions of alcohol use disorders identification test), it was able to select a large number of potential danger drinkers who routinely live. There were no statistically significant differences in age, religion, marital status, occupation, family history of alcohol drinking, age at onset of alcohol use, smoking, and BMI (body mass index). However, only education and drinking periods were statistically significant. These results are consistent with the previous study, which suggests that alcohol consumption is higher among men who are educated. The level of education also suggests that there is a need to look at the differences depending on what you learned and how. Alcohol consumption by education also shows different results. Also, drinking at a young age will lead to a longer drinking period, which is consistent with previous studies on the age at onset of drinking. In this study, drinking period was the most important factor of alcohol use disorder and it is considered that measures and education of national government system which can delay drinking age as much as possible is needed as a method to shorten drinking period.

Evaluation of neurological outcome and quality of life after extended resection of gliomas

Objective To evaluate the neurological, neuropsychological and quality of life (QOL) alterations in patients who underwent extended resection of gliomas. Methods From January 2014 to November 2015, a total of 58 patients with gliomas were admitted to Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University, and were enrolled into this study. Extended resection was performed in all patients. Patients were assessed at 3 time points, i. e. 1 day before surgery (T1), the day of discharge (T2) and 3 months post surgery (T3). National Institutes of Health Stroke Scale (NIHSS) score, Addenbrooke cognitive examination-revised (ACE-R), Hospital Anxiety and Depression (HAD) and neuropsychological test battery (NTB) were used to assess neurological and neuropsychological profiles. QOL was ascertained through the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC-QLQ C30). Results At T1 (58 cases), T2 (50 cases) and T3 (46 cases), the patient’s overall QOL score was 67.8 (48.9, 86.7), 66.7 (47.5, 85.9) and 64.8 (41.4, 88.5), respectively. There was no significant difference between different time periods (P>0.05). At T3, 24% (11/46) of the patients showed worsened neurological functions and 28% (13/46) gained neurological improvement compared with pre-operative conditions. According to the neuropsychological test, 65% (13/50) experienced deterioration of neuropsychological functions to varying degrees. However, those functions recovered at T3 for majority of patients. Conclusions Extended resection of gliomas does not seem to result in deterioration of QOL of patients. Patients undergoing extended resection might experience deterioration of neurological and neuropsychological functions in the early postoperative period, which could recover to preoperative levels after some time in most cases. Key words: Glioma; Neuropsychiatry; Quality of life; Extended resection

Patterns of benzodiazepine prescribing by neuropsychiatrists and general practitioners for elderly patients in Germany in 2014 .

The patterns of benzodiazepine prescriptions in older adults are of general and scientific interest as they are not yet well understood. The aim of this study was to compare the prescription patterns of benzodiazepines in elderly people in Germany to determine the share or proportion treated by general practitioners (GP) and neuropsychiatrists (NP). This study included 31,268 and 6,603 patients between the ages of 65 and 100 with at least one benzodiazepine prescription in 2014 from GP and NP, respectively. Demographic data included age, gender, and type of health insurance coverage. The share of elderly people with benzodiazepine prescriptions was estimated in different age and disease groups for both GP and NP patients. The share of the six most commonly prescribed drugs was also calculated for each type of practice. The share of people taking benzodiazepines prescribed by GP increased from 3.2% in patients aged between 65 and 69 years to 8.6% in patients aged between 90 and 100 years, whereas this share increased from 5.4% to 7.1% in those seen by NP. Benzodiazepines were frequently used by patients suffering from sleep disorders (GP: 33.9%; NP: 5.5%), depression (GP: 17.9%; NP: 29.8%), and anxiety disorders (GP: 14.5%; NP: 22.8%). Lorazepam (30.3%), oxazepam (24.7%), and bromazepam (24.3%) were the three most commonly prescribed drugs for GP patients. In contrast, lorazepam (60.4%), diazepam (14.8%), and oxazepam (11.2%) were those more frequently prescribed to NP patients. Prescription patterns of benzodiazepine in the elderly varied widely between GP and NP. .

The Hunting of the Snark: a search for the history of neuropsychiatry

The Hunting of the Snark: a search for the history of neuropsychiatry

Assessment of behavior and sleep pattern in school age children with generalized epilepsy

Background Epilepsy affects 1% of the human population. Sleep disorders frequently coexist in patients with epilepsy. Whether sleep affects epilepsy or epilepsy modifies sleep has been extensively evaluated, but very little literature exists on the mutual interaction of epilepsy and sleep problems. Objective and aims To assess the sleep pattern and behavior in school age children with generalized epilepsy. Methods The current study was comparative case control study was carried on 60 school aged children 30 of them had generalized epilepsy on carbamazepine presented to neuropsychiatry department in suez canal university hospital and other 30 healthy children had no chronic illness, The Children's Sleep Habits Questionnaire and Vanderbilt assessment scale were applied on both groups. Results the current study showed that epileptic children have a statistically significant difference in breathing problem like snoring ( P =0.001), epileptic children had more common daytime sleepiness problem ( P =0.002). Behavioral problems were more common in epileptic children like ADHD ( P -value=0.001), anxiety and depression were highly frequent in epileptic children than normal children ( P -value=0.001) and schoolastic achievement was more problematic in epileptic children. Conclusions Epileptic children are more vulnerable to sleep problems, behavioral problems and poor schoolastic achievement is more common in epileptic children. Controlled fits and monotherapy decreased the effect of epilepsy in all aspects.

Training Bosnia-Herzegovina mental health workers in group analysis resulted in founding of Bosnia-Herzegovina group analysis association and continual training of new generation from local educators

Background Zagreb Institute for Group Analysis Training Programme took place in Tuzla University Clinical Centre, Department of Psychiatry, in Bosnia-Herzegovina (BH) in response to 1992–1995 war, in helping to train mental health workers in GA to enable them to treat psychological trauma symptoms of war survivors. Objectives The primary objective focused on educational process in Group Analysis (GA) in post-war BH which resulted with building capacities to continue education of new generation of Group Analysis trainees from national educators. Method Authors described realization of educational process considering the two Diploma courses and process of supervision, which was provided from the Institute for GA (IGA) Zagreb, Croatia. Results Internationally approved IGA trainers provided completed training for trainees: neuropsychiatrists, neurosurgeon, residents, nurses, psychologists, social workers, special educators, paediatrician, and gynaecologist from several different institutions from seven different cities in BH and Croatia. Training started during the war period with introduction courses and continues with two Diploma Courses. Nowadays in BH are nine graduated Group Analysts including three of them who completed training for educators of Group Analysis. They founded Bosnia-Herzegovina Association of Group Analysis, and GA educators, members of this Association started training in GA of new generation of mental health workers.

Relationship between road traffic law violation, accident and psychoactive substance use among commercial motorcycle operators in Kano, Northwestern Nigeria

Motorcycle operators who drive under the influence of psychoactive substances are at high risk for road traffic violations and accidents. Despite the high level of morbidity associated with psychoactive substance use, it is not a well-researched area in Northwestern Nigeria. The aim of the study was to determine the relationship between psychoactive substance use and road traffic violations and accidents among motorcycle operators in Kano, Northwestern Nigeria. It was a descriptive cross-sectional study. Instrument used for data collection included socio-demographic questionnaire and Schedule for Clinical Assessment in Neuropsychiatry (SCAN). Data analysis was done using Statistical Package for Social Sciences (SPSS) 17th edition. Three hundred and ninety-four subjects participated in the study. Their age ranged between 22 to 60 years, with mean age of 32.7 years ± 6.6. Motorcycle operators who used substances were more likely to violate traffic laws (P < 0.001; O.R = 1.6 (0.8 – 3.1) and to have road traffic accidents (P = 0.004; O.R = 2.6 (1.4 – 4.7) compared to those who did not use substances. Positive correlation was found between road traffic violations, road traffic accidents and substance use status at 99% confidence interval. There was also significant relationship between specific substance use, road traffic violations and accidents. Psychoactive substance use increases the risk of road traffic violations and road traffic accidents among motorcycle operators. Public health measures should be instituted to reduce the rate of substance use among motorcycle operators and cut down its associated morbidity. Key words: Psycho-active substance, road traffic accidents, road traffic violations, motorcycle operators, Schedule for Clinical Assessment in Neuropsychiatry (SCAN), Nigeria

Neuropsychiatry residents’ attitudes and perceptions regarding evidence-based medicine: a mixed-methods study

Evidence-based medicine (EBM) has dominated mainstream medicine over the last two decades. There has also been a continuous effort to establish the evidence-base of Korean medicine in various fields. The attitudes and perceptions of neuropsychiatry (NP) residents regarding EBM were investigated to ensure their ability to keep abreast of the progress in the field of medicine. We distributed a questionnaire to all of the residents in all of the Korean medical hospitals in Korea (n = 388). The questionnaire consists of both quantitative and qualitative questions. The overall response rate is 68.30 % (n = 265), while the response rate of the NP residents is 84.84 % (n = 28). The NP residents generally expressed unwelcoming attitudes toward EBM, perceiving it as less necessary compared with the residents of other specialties; the NP residents also had a poor understanding of the basic knowledge that is required to read papers. In a qualitative study, three categories and four themes were identified regarding the advantages of the application of EBM in Korean medicine, while two categories and six themes were identified regarding the barriers that hamper evidence-based practice in Korean medicine. In terms of the acceptance of new evidence, the NP residents lacked both skill and knowledge; the key underpinning factor here is a perceived uselessness. The factors that have formed this tendency should be considered during the formulation of a desirable model of NP practice.

Neuropsychiatry: More than the sum of its parts?

Neuropsychiatry: More than the sum of its parts?

Discurso del Rector de la Universidad Nacional de San Marcos

La Universidad Nacional Mayor de San Marcos, se asocia con profundo respeto en esta ocasión felizmente promovida por el distinguido Presidente de la Sociedad de Neuro Psiquiatria y Medicina Legal al homenaje universal que se dedica este año a uno de los más altos valores de nuestra raza y signo encumbrado de la grandeza del Espíritu : Santiago Ramón y Cajal.