Mental Pathology Research Articles

Clinical case of senesto-hypochondrical form of schizophrenia with implementation of pathological bodily sensations mainly in the orofacial area: problems of differential diagnosis at the early stages

The article presents a clinical case of the senesto-hypochondriacal form of schizophrenia, the implementation of violations of bodily perception within which for a long time was limited to the orofacial space against the background of orthodontic pathology. Prosopalgia is a transnosological syndrome characteristic of a heterogeneous group of disorders, the differential diagnosis of which, due to the peculiarities of the innervation of the facial area, can be difficult and requires special attention for the timely determination of their nosological affiliation and the initiation of adequate therapy. Interest in the clinical case is due to longlasting senestoalgic syndrome, similar in clinical picture to established pathology of the temporomandibular joint, which complicated the timely assessment of the patient’s condition and led to exacerbation of the mental disorder in the absence of psychopharmacological therapy. The article provides an analysis of the place of mental pathology in the formation and development of orofacial pain, both of a somatogenic nature and in the context of somatopsychic disorders, emphasizing the need for a comprehensive assessment of both the dental and mental status of such patients in order to formulate optimal approaches to treatment.

Modern approaches to psychoterapy of somatoform disorders

The scientific review focuses on the relevant for modern medicine problem of psychotherapy of somatoform disorders (SFD). It is based on the analysis of 106 publications on this topic (46 of them in Russian and 60 in English). The search for publications was carried out in the RSCI and Medline bibliographic databases. The purpose of the review was to form ideas about the current state of the psychotherapy of SFD with the highlighting and comparison of the main current approaches in this area. The review analyzes the overall effectiveness of psychotherapy of SFD and considers the following modern its directions: cognitive behavioral therapy, mindfulness-based psychotherapy, dynamic psychotherapy, group psychotherapy, other (rarely mentioned) psychotherapeutic methods, as well as polymodal and remote approaches to psychotherapy of SFD.The summary of the literary information presented in the review allows to conclude that psychotherapy today is considered by most authors as an important, possibly even leading component of the treatment of the considered mental pathology type. At the same time, data on its clinical effectiveness, especially in isolated use, remains ambiguous, in addition, among researchers there is still no unity of views on the main targets of psychotherapeutic impacts in SFD, as well as on the most suitable forms and methods of psychotherapy for the treatment of this pathology. Information on the clinical effectiveness of specific psychotherapeutic methods currently used for the treatment of SFD is either ambiguous or incomplete, and the polymodal approaches to psychotherapy of SFD proposed by some authors have insufficient scientific justification for the methodological combinations used in them. The future of psychotherapy of SFD is seen by the authors of this review in the development of integrative psychotherapeutic programs that combine elements of several multidirectional methods of psychotherapy, but that are based on knowledge of the general personal and psychological characteristics of patients suffering from SFD.

Effects of Anxiety and Chronotype on Sleep Quality: Advantages of Evening Chronotype in the Post-Pandemic Era

Objective: Prior to the pandemic, all scientific evidence suggested that the evening chronotype is a risk factor for mental pathologies, while the morning chronotype is a protective factor. However, by exploring the effects of anxiety and chronotype on sleep quality in a post-pandemic, segmented by age, new evidence is presented that contradicts the traditional ones.Methods: This quantitative, exploratory, cross-sectional study included 2,253 participants, segmented into three age categories: <18 years, 18–23 years, and >23 years. Linear regression coefficients were calculated using weighted least squares, with a confidence level of 95% or greater (p<0.05) applied in all cases.Results: The highest levels of anxiety were found in men. In all cases, significant correlation and variance were found in sleep quality with respect to age and anxiety. The increase in poor sleep quality is explained by between 1.8% and 1.9% in subjects with anxiety and morning chronotype as age advances in post-pandemic.Conclusion: Anxiety, chronotype, and age significantly affect sleep quality. In the context of a pandemic, older subjects with a morning chronotype experience worse sleep quality. Specifically, under conditions of confinement and social isolation during a pandemic, morning chronotypes tend to have worse sleep quality compared to evening chronotypes, who may have an adaptive evolutionary advantage in such circumstances.

HEAR set: A ligHtwEight acoustic paRameters set to assess mental health from voice analysis

BackgroundVoice analysis has significant potential in aiding healthcare professionals with detecting, diagnosing, and personalising treatment. It represents an objective and non-intrusive tool for supporting the detection and monitoring of specific pathologies. By calculating various acoustic features, voice analysis extracts valuable information to assess voice quality. The choice of these parameters is crucial for an accurate assessment. MethodIn this paper, we propose a lightweight acoustic parameter set, named HEAR, able to evaluate voice quality to assess mental health. In detail, this consists of jitter, spectral centroid, Mel-frequency cepstral coefficients, and their derivates. The choice of parameters for the proposed set was influenced by the explainable significance of each acoustic parameter in the voice production process. ResultsThe reliability of the proposed acoustic set to detect the early symptoms of mental disorders was evaluated in an experimental phase. Voices of subjects suffering from different mental pathologies, selected from available databases, were analysed. The performance obtained from the HEAR features was compared with that obtained by analysing features selected from toolkits widely used in the literature, as with those obtained using learned procedures. The best performance in terms of MAE and RMSE was achieved for the detection of depression (5.32 and 6.24 respectively). For the detection of psychogenic dysphonia and anxiety, the highest accuracy rates were about 75 % and 97 %, respectively. ConclusionsThe comparative evaluation was carried out to assess the performance of the proposed approach, demonstrating a reliable capability to highlight affective physiological alterations of voice quality due to the considered mental disorders.

Anxiety and Depression after Spinal Cord Injury: A Cross-Sectional Study.

Spinal cord injury (SCI) is a life-changing event that often results in chronic physical damage and challenges in maintaining a good quality of life as it affects every aspect of life. These situations require adjustment, increasing vulnerability to psychological disorders. The objective of this study was to evaluate the impact of SCI on psychological morbidity in individuals with subacute and chronic SCI. The present investigation was designed to determine the presence and extent of psychological complications following SCI. We used two reliable questionnaires and validated psychological assessments to study depression (BDI) and anxiety (STAI), a broad range of factors derived from SCI that may be predictors of certain psychological problems. The psychological assessment revealed alterations in depression and anxiety, although the data do not exceed those of previous investigations. No clear predisposing factors leading to certain psychological pathologies were found. In addition, individuals in the subacute and chronic stages differed in their scores. In individuals with SCI, identifying predictors of psychological problems is difficult, but premature assessment of mental state is essential. This early diagnosis of possible problems or changes at the mental level is fundamental and necessary to avoid possible alterations at the cognitive level and, of course, more serious mental complications.

Fracturing the affordance space: an account of digitalized alienation.

This paper investigates the lived experience of alienation as a form of mental strife or pathology as it is connected to the digitalization of modern life. To do so, I deploy the concept of affordances from ecological psychology, phenomenology, and embodied cognition. I propose an affordance-based model for understanding digitalized alienation. First, I argue that the lived sense of alienation is best understood as a fracturing of the affordance space, where possibilities for action are lived as disconnected from one another and therefore from one's personal development and search for meaning. Using this model, I show how the process of digitalization can lead to a lived sense of alienation for modern subjects. On this model, digitalization is alienating insofar as it fractures the affordance space into disconnected fields that invite determinate, separate, and repeatable tasks-swiping, clicking, scrolling, etc.-rather than offering opportunities for the development of new cognitive and bodily skills that are mutually informing and enriching across different affordance fields.

Preventive treatment of latent tuberculosis infection in persons living in social welfare homes due to mental pathology

Preventive treatment of latent tuberculosis infection in persons living in social welfare homes due to mental pathology

Discussion of “The Possible Profession: Joe Lichtenberg and the Restoration of the Bodily Self”

ABSTRACT This discussion of Daniel Posner’s paper has two purposes. First, it affirms Joe Lichtenberg’s lifelong forward thinking contributions to the theory and practice of psychoanalysis. In “The Psychoanalytic Situation of Infancy” he redefined infant and subsequent development in terms of the non-dynamic unconscious and the bodily self. At the end of his life, these two components of his contributions led to a redefinition of some mental pathologies making psychoanalysis applicable to those previously considered unsuitable for psychoanalytic clinical work such as the neuroatypical. Second, this discussion suggests additional possibilities for integrating and using the concepts of embodiment and subsymbolic memory in psychoanalytic theory and practice. They provide an additional language to understand and communicate with patients: brief clinical moments are illustrative.

The Possible Profession: Joe Lichtenberg and the Restoration of the Bodily Self

ABSTRACT Beginning with “The Psychoanalytic Situation and Infancy,” I consider Joe Lichtenberg’s legacy of creating an experience-near holistic psychology of the self in terms of a larger attempt to make psychoanalysis a more possible profession. By grounding developmental theory in an empirical-phenomenological science of subjectivity, Lichtenberg not only helped give self psychology a more “clinically relevant baby” (Stern) – he also widened the scope of analytic theory to include both the non-dynamic unconscious and the bodily subject, which Freud had abandoned in his search for a purely psychological science of subjectivity. In this sense, “The Psychoanalytic Situation and Infancy” represents the first major installment in Lichtenberg’s decades-long project toward what we might call, the restoration of the bodily self. Furthermore, by freeing psychoanalysis from its pathomorphic developmental theory – which construed adult psychopathology in disembodied terms, as evidence of the fragmented, conflicted nature of infant experience – Lichtenberg helped catalyze an “enactive” turn in psychoanalysis, opening the way for re-conceptualizing mental pathology in adaptive terms as “varieties of self-disorder” (Sass) – ensuring psychoanalysis’ relevance to the understanding and treatment of conditions long considered outside of its purview.

Poster 182: Pain and Quality of Life Scores Following Hip Arthroscopy for Femoroacetabular Impingement are More Related to Mental Health Than Hip Pathology

Objectives: Symptom severity in patients with femoroacetabular impingement (FAI) has been demonstrated to have a stronger association with mental health status than pathology. However, there is limited data on the relationship between mental health status and postoperative outcomes in FAI patients. This study aims to evaluate the relationship of mental health status and structural hip pathology to pain and quality of life. Methods: This was a retrospective review of patients from a single surgeon’s hip outcomes registry. Mental health status was evaluated using the Patient-Reported Outcomes Measurement Information System (PROMIS)-Anxiety and PROMIS-Depression scores. Pain was evaluated with Single Assessment Numerical Evaluation Score for Activities of Daily Living (SANE ADL) while quality of life (QOL) was evaluated with the International Hip Outcome Tool (iHOT-12). Repeated measures mixed modeling was used to evaluate the association between hip pathology (size of labral tear, grade of chondral damage, preoperative alpha angle), pain, QOL, anxiety, and depression pre- and postoperatively. Results: A total of 337 patients were included in this study. The degree of preoperative alpha angle, intra-operative cartilage damage and size of labral tear did not influence postoperative improvements in pain or QOL (p>0.05). However, higher levels of anxiety and depression were significantly associated with lower SANE-ADL scores (anxiety estimate: -0.608, SE (0.079), p<0.0001), (depression estimate: -0.677, SE (0.086), p<0.0001), and lower iHOT-12 scores (anxiety estimate: -0.709, SE (0.069), p<0.0001), (depression estimate: -0.706, SE (0.077), p<0.0001). These associations were seen both preoperatively and up to 2 years postoperatively. Furthermore, anxiety and depression do not appear to moderate the relationship between hip pathology and patient outcomes. Conclusions: All patients had similar improvements in pain scores and QOL following hip arthroscopy for FAI suggesting this surgery is beneficial for varying degrees of hip pathology. Additionally, preoperative anxiety and depression are associated with greater pain and decreased QOL both pre- and postoperatively regardless of the degree of hip pathology. This may suggest a need for pre- and postoperative psychological interventions in patients with anxiety and depression, and clinicians should prioritize mental health treatment at or above the level of the hip pathology itself.

Mental pathology in the field of personality and psychotic disorders, systematic review of its relationship with the commission of homicide and violent acts

AbstractMental pathology and violence have been studied by the scientific community, a topic that is sometimes perceived as controversial, partly due to the prevailing stigma around psychiatric disorders. In this project, all those factors concomitant with psychotic pathologies and ‘Cluster B’ antisocial disorders, which could interfere with the commission of violent actions, and their maximum expression, the homicide, are addressed from a comprehensive psychological perspective. To this end, a rigorous methodological selection of 15 high‐impact articles has been carried out, from which the results have been extracted and compared in this systematic review. The findings obtained revolve around the importance of adherence to treatment, the therapeutic alliance, the absence of toxic consumption, and concomitance with other mental pathologies, taking into account the idiosyncratic differences of the subjects, as well as between the pathologies and diagnoses described, always maintaining the comparison between said disorders, and with the population in absence of pathology.

From the Microbiome to the Electrome: Implications for the Microbiota-Gut-Brain Axis.

The gut microbiome plays a fundamental role in metabolism, as well as the immune and nervous systems. Microbial imbalance (dysbiosis) can contribute to subsequent physical and mental pathologies. As such, interest has been growing in the microbiota-gut-brain brain axis and the bioelectrical communication that could exist between bacterial and nervous cells. The aim of this study was to investigate the bioelectrical profile (electrome) of two bacterial species characteristic of the gut microbiome: a Proteobacteria Gram-negative bacillus Escherichia coli (E. coli), and a Firmicutes Gram-positive coccus Enterococcus faecalis (E. faecalis). We analyzed both bacterial strains to (i) validate the fluorescent probe bis-(1,3-dibutylbarbituric acid) trimethine oxonol, DiBAC4(3), as a reliable reporter of the changes in membrane potential (Vmem) for both bacteria; (ii) assess the evolution of the bioelectric profile throughout the growth of both strains; (iii) investigate the effects of two neural-type stimuli on Vmem changes: the excitatory neurotransmitter glutamate (Glu) and the inhibitory neurotransmitter γ-aminobutyric acid (GABA); (iv) examine the impact of the bioelectrical changes induced by neurotransmitters on bacterial growth, viability, and cultivability using absorbance, live/dead fluorescent probes, and viable counts, respectively. Our findings reveal distinct bioelectrical profiles characteristic of each bacterial species and growth phase. Importantly, neural-type stimuli induce Vmem changes without affecting bacterial growth, viability, or cultivability, suggesting a specific bioelectrical response in bacterial cells to neurotransmitter cues. These results contribute to understanding the bacterial response to external stimuli, with potential implications for modulating bacterial bioelectricity as a novel therapeutic target.

Some aspects of non-medical use of narcotic substances

The article presents foreign data on the non-medical use of certain combinations of narcotic drugs, the range of their effects on the body of patients, as well as the development of state response measures and propaganda of the rejection of the use of narcotic drugs among populations at risk. It is noted that the use of narcotic drugs without medical indications is a global public health problem. In addition to the negative impact on health, the use of narcotic drugs aggravates existing mental illnesses, and on the other hand, the presence of mental pathology accelerates the formation of drug addiction.

Evolution of Child and Youth Mental Health in the Context of the COVID-19 Pandemic: A Longitudinal Analysis.

The COVID-19 pandemic generated uncertainty and disruption among the child and adolescent population. Multiple studies have documented a worsening of mental health following the pandemic. The main objective of this longitudinal study is to analyze the short-, medium-, and long-term evolution of the overall functioning of children and adolescents treated by a child and adolescent mental health team in the context of the COVID-19 pandemic. 420 patients aged 3 to 18 were assessed using the Global Assessment of Functioning (GAF) scale at three time points: during the lockdown, three months later, and three years later. Differences based on gender, diagnosis, and time were analyzed. A significant improvement was observed in the short-term (three months) and long-term (three years) compared to the lockdown period. This improvement was maintained in all diagnostic subgroups except for mixed cases (severe mental pathology), which showed the least improvement. No significant differences were found between males and females. The child and adolescent population showed a greater capacity for adaptation to the lockdown than expected. Family support, decreased stress, and therapeutic intervention appear to have played an important role in improving mental health.

Preclinical Online Sсreening for Stress-Associated Disorders in Combatants

Background: the need to improve standards, organizational methods and practical scientific approaches to the prevention and treatment of mental pathology and the restoration of mental health of military personnel involved in combat operations determines the importance of developing and implementing effective strategies for correcting the mental state of combatants. The aim: to analyze the results of preclinical online screening of stress-associated disorders in combatants to assess its effectiveness in conducting routine psychoprophylactic examinations of military personnel after returning from the combat zone. Subjects and methods: 176 male employees of the Russian Guard who returned after a business trip of up to 90 days in the combat zone were examined. All combatants underwent preclinical online screening for the detection of stress-associated mental disorders, including methods regulated by the Ministry of Health of the Russian Federation. After testing, the obtained data were processed using cluster analysis by the K-means method. Clinical and psychopathological examination and laboratory studies were conducted, including: the content of carbohydrate-deficient transferrin (CDT), testosterone and cortisol levels, processing of the data obtained using statistical methods. Results: the combination of high levels of evening cortisol and CDT in combatants may indicate a complex interaction of physical stress, psychological trauma and possible alcohol abuse, which may be the result of both specific conditions of military service and a way to cope with post-war stress and trauma. Conclusions: it was found that the data of preclinical screening testing are consistent with clinical and laboratory results. Online screening testing for the detection of stress-associated disorders in combatants, combined with the determination of testosterone, evening cortisol and CDT levels, can serve as markers of the presence of stress-associated disorders.

Association Between Symptoms of Anxiety and Depression, Hip Pathology, and Patient-Reported Outcomes After Hip Arthroscopy for Femoroacetabular Impingement

Background: In patients with femoroacetabular impingement (FAI), mental health has been implicated in both symptom severity and postoperative outcomes. However, there are limited data regarding the independent influences of baseline mental health and hip pathology on patient-reported outcomes over time after hip arthroscopy. Purpose: To evaluate the association between mental health and structural hip pathology with pain, hip function, and quality of life (QOL). Study Design: Cohort study; Level of evidence, 3. Methods: Patient records from a single surgeon’s hip outcomes registry were retrospectively reviewed. Mental health was evaluated using the Patient-Reported Outcomes Measurement Information System Anxiety and Depression scores. Pain was evaluated with the Single Assessment Numeric Evaluation score for Activities of Daily Living (SANE-ADL), while hip-related QOL was evaluated with the 12-item International Hip Outcome Tool (iHOT-12). Hip function was assessed with the Hip Outcome Score (HOS) Sport-Specific (SS) and ADL subscales. Separate mixed models were used to predict pain, QOL, and hip function, including hip pathology measures (size of labral tear, grade of chondral damage, preoperative alpha angle), anxiety, depression, and time as fixed effects and individuals as a random effect. Results: A total of 312 patients were included in this study. The preoperative alpha angle, degree of intraoperative cartilage damage, and size of the labral tear were not associated with pain or QOL (P > .05 for all). However, higher levels of anxiety and depression were significantly associated with lower SANE-ADL scores (estimate ± SE) (anxiety: –0.59 ± 0.07, P < .0001; depression: –0.64 ± 0.08, P < .0001), iHOT-12 scores (anxiety: –0.72 ± 0.07, P < .0001; depression: –0.72 ± 0.08, P < .0001), HOS-SS scores (anxiety: –0.68 ± 0.09, P < .0001; depression: –0.57 ± 0.10, P < .0001), and HOS-ADL scores (anxiety: –0.43 ± 0.05, P < .0001; depression: –0.43 ± 0.06, P < .0001). Conclusion: Patients had similar improvements in pain scores, QOL, and hip function after hip arthroscopy for FAI irrespective of their degree of hip pathology. Additionally, preoperative symptoms of anxiety and depression symptoms were associated with greater pain, decreased QOL, and worse hip function both pre- and postoperatively, independent of the degree of hip pathology. This suggests that efforts to directly address symptoms of anxiety and depression may improve outcomes after hip arthroscopy.

Early Images of Trauma in George Eliot’s The Lifted Veil

This paper explores George Eliot’s The Lifted Veil (1859) as an early portrayal of traumatic neurosis, providing a fresh perspective to enhance the existing scholarly attention on trauma in Eliot’s Daniel Deronda. To illustrate potential contemporary diagnoses for Latimer, I examine other prevalent mid-nineteenth-century models of mental pathology, including phrenology, mesmerism, and hemispheric brain disunity. Drawing on Pierre Janet’s trauma theories from the late nineteenth century, I argue that Eliot presents an early portrayal of dissociative trauma through Latimer’s psychological experiences. Latimer’s visions, complex dream-like interactions, and involuntary consciousness splitting provide a framework for understanding dissociation in response to his emotionally traumatic loss of his mother. Eliot’s exploration of dissociation anticipates Pierre Janet’s theories, which underpin contemporary understandings of trauma, revealing a remarkable modernity in Eliot’s approach.

Resting-state functional magnetic resonance imaging: features of statistical processing of ROI-analysis data

BACKGROUND: In many works, to study intra- and inter-network connections, a method for constructing networks is used — ROI-analysis (region of interest analysis). The conflicting results obtained when assessing brain connectivity using ROI-analysis can be explained by methodological differences associated with the statistical processing of fMRI data. In this regard, it is relevant to conduct a study with a comparative assessment of various statistical methods of ROI-analysis in processing resting state fMRI data.&#x0D; AIM: to assess the functional connectivity of the main resting state networks of the brain using ROI-analysis using various statistical approaches.&#x0D; MATERIALS AND METHODS: We analyzed data from 15 resting-state fMRI studies of the brain of patients without neurological and mental pathology. fMRI scanning was performed on a Phillips Ingenia 1.5 T scanner using a gradient echo-planar imaging (EPI-BOLD) sequence. ROI-analysis was used to build networks. Statistical data processing was performed using methods: functional network connectivity, randomization/permutation spatial pairwise clustering statistics, and threshold-free cluster enhancement.&#x0D; RESULTS: The number of connections between the structures of brain networks recorded using the method of functional network connectivity is 280, spatial pairwise clustering — 186, threshold-free cluster enhancement — 182. An interesting fact is that negative connections were identified only when using parametric statistics.&#x0D; CONCLUSION: A comparative assessment of methods for statistical processing of fMRI data during ROI-analysis was carried out. The functional network connectivity method based on multivariate parametric statistics turned out to be more informative than randomization/permutation spatial pairwise clustering statistics and the method based on threshold-free cluster enhancement. Despite the growing popularity in recent years of resting-state fMRI in the study of functional activity and connectivity of the brain, there are no standardized algorithms for constructing networks of the brain.

Mental health and social vulnerability. The case of women living on the street at Buenos Aires, Argentine

The purpose of this research is to investigate the possible relationship between homelessness and mental pathology in a population of women housed in a Social Inclusion Center of the Autonomous City of Buenos Aires, Argentina. There could be a clinical bias that characterizes homelessness as a consequence of a mental illness. A group of women between 18 and 65 years of age, socially assisted in the Social Inclusion Center for women alone or with minor children “Azucena Villaflor” of the City of Buenos Aires, who in turn consult or have consulted in the past about their mental health before or after being homeless. An observational, descriptive and cross-sectional quantitative study was carried out, collecting primary data through semi-structured interviews, complementing the research with a qualitative approach using the narrative method through in-depth interviews. There is no unicausal relationship between having a mental illness and being homeless. The job search, a form of re-entry into the productive system, is extremely difficult, due to the market itself, not due to the psychological state of the users. However, the fruitless search generates situations of frustration that, given the context of vulnerability in which they find themselves, can lead to mental health consultations.

A spark of genius and a flash of madness: Nikola Tesla and his struggles with mental illness

IntroductionAn example of the unification of the contrast between artistic creativity and discipline of science, Nikola Tesla engineer and physicist, was also a prolific inventor that contributed to the transformation of modern society. Having resurfaced in the mainstream culture as a mythical figure, he appears to be enjoying a renaissance of posthumous recognition and praise. Throughaccounts available directly from his autobiography and descriptions offered by those who worked with him, the existence of the inventor´s eccentricities appear to reveal the existence of mental health disorder.ObjectivesThe authors explore Tesla and the psychopathology that accompanied him throughout his periods of brilliance and as well as hardship.MethodsThe authors conducted a brief non-structured narrative literature review. The keywords used during the research, alone or in combination, included: Nikola Tesla, psychopathology and mental illness. The works consulted included: news articles, autobiographies and biographies. Of these, those that were written in the English language and deemed most pertinent to the explored theme were chosen for review in this work.ResultsThe popular image of the mad scientist, which describes a brilliant but solitary and eccentric individual focused on their work is one that could be applied to Tesla. Documents reveal that he suffered a nervous breakdown, as well as having symptoms that point to a probably presence of obsessive-compulsive disorder, of which included counting and cleanliness rituals, exacerbated by chronic insomnia.ConclusionsThere appears to be anecdotal evidence pointing to an eventual relationship between creative genius and mental pathology. Although not formally evidenced through the scientific literature, exploring the life and accomplishments of Tesla serve as a significant example of a spark of genius perhaps ignited by mental illness. Tesla demonstrated suffering associated with his symptoms especially when considering the end of his life. At the time, adequate mental health interventions and treatments were not widely available, with his diagnosis probably being considered the quirks of genius and not the symptoms of disease.Disclosure of InterestNone Declared