Symptoms Of Psychiatric Illness Research Articles

Cognitive inhibition deficit in long COVID-19: An exploratory study.

An increasing number of research studies point toward the importance and prevalence of long-term neurocognitive symptoms following infection with COVID-19. Our objectives were to capture the prevalence of cognitive impairments from 1 to 16 months post-COVID-19 infection, assess the changes in neuropsychological functions over time, and identify factors that can predict long-term deficits in cognition. A cross-sectional research design was adopted to compare four sub-samples recruited over a 16-month timeframe (1-4, 5-8, 9-12, and 13-16 months). Phone interviews were conducted at least 6 weeks after being infected by COVID-19. Sociodemographic and clinical questionnaires were administered followed by standardized neurocognitive and psychological tests and health questionnaires screening cognitive symptoms, anxiety, depression, fatigue, and autonomy. Regarding general health questionnaires, 55.2% of the 134 participants had symptoms of psychiatric illness, while 21.6% of patients had moderate-to-severe anxiety or depression. Cognitive efficiency was diminished in 19.4% of our population. Executive dysfunction was screened in 56% of patients, and an impairment of cognitive flexibility and inhibition was revealed in 38.8%. Depression, hospital or intensive care unit (ICU) admission, and the duration of hospital or ICU stay were associated with an inhibition deficit. The duration elapsed from the initial infection, and the neurocognitive assessment was not associated with a decrease in inhibition deficit. The prevalence of cognitive impairments, other than inhibition deficit, tended to decrease during the study period. This study supports the extensive literature on the cognitive and neuropsychiatric sequelae of COVID-19 and highlights long-lasting inhibition deficits, while other cognitive functions seemed to improve over time. The severity of infection could interact as a catalyst in the complex interplay between depression and executive functions. The absence of a relation between inhibition deficits and sociodemographic or medical factors reinforces the need for cognitive screening in all COVID-19 patients. Future research should focus on inhibition deficits longitudinally to assess the progression of this impairment.

MENTAL HEALTH IMPLICATIONS OF COVID-19: A NARRATIVE REVIEW OF THE LITERATURE

Introduction: The novel coronavirus disease, which the World Health Organization (WHO) officially designated as COVID-19, originated in Wuhan, China, as a cluster of unexplained pneumonia cases. It has affected countries worldwide and has been classified as a pandemic. To deal with this global health crisis and to curtail the spread of the virus, stringent public health measures have been implemented. There is evidence of a positive correlation between widespread outbreaks of contagious diseases, symptoms of psychiatric illness, and psychological distress. Aim: Considering the need to develop a deeper understanding of COVID-19 to devise strategies to deal with and prevent impact of COVID-19 on mental health thereby present review is undertaken. Method: A narrative review was conducted in May 2020. Result: Findings are suggestive that healthcare workers engaged in providing care to patients affected by COVID-19 are at a risk of developing psychological issues such as vicarious traumatization. With regards to the public, certain populations, including individuals with preexisting mental health issues, are more vulnerable to adverse psychological impacts from COVID-19. To conclude it, the review findings highlight the hidden mental health impact of COVID-19 and allows health care workers in all specialty to watch for vulnerable patients, their family members, and colleagues who may adversely psychologically affected by COVID-19.

Mental Activity as the Bridge between Neural Biomarkers and Symptoms of Psychiatric Illness.

The Research Domain Criteria (RDoC) initiative challenges researchers to build neurobehavioral models of psychiatric illness with the hope that such models identify better targets that will yield more effective treatment. However, a guide for building such models was not provided and symptom heterogeneity within Diagnostic Statistical Manual categories has hampered progress in identifying endophenotypes that underlie mental illness. We propose that the best chance to discover viable biomarkers and treatment targets for psychiatric illness is to investigate a triangle of relationships: severity of a specific psychiatric symptom that correlates to mental activity that correlates to a neural activity signature. We propose that this is the minimal model complexity required to advance the field of psychiatry. With an understanding of how neural activity relates to the experience of the patient, a genuine understanding for how treatment imparts its therapeutic effect is possible. After the discovery of this three-fold relationship, causal testing is required in which the neural activity pattern is directly enhanced or suppressed to provide causal, instead of just correlational, evidence for the biomarker. We suggest using non-invasive brain stimulation (NIBS) as these techniques provide tools to precisely manipulate spatial and temporal activity patterns. We detail how this approach enabled the discovery of two orthogonal electroencephalography (EEG) activity patterns associated with anhedonia and anxiosomatic symptoms in depression that can serve as future treatment targets. Altogether, we propose a systematic approach for building neurobehavioral models for dimensional psychiatry.

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Background and objectivesAggression is a most common symptom shared by various mental disorders but is often neglected when not associated with overt signs and symptoms of psychiatric illnesses. When in excess aggression can prove destructive and results in social maladjustment. Aggression is considered to be a normal reaction of humans and can be provoked by any type of stressful situation like COVID-19. During COVID-19 Pandemic, and lockdown implemented to curtail the spread of infection, people were restricted to their houses. Prolonged stay at home, financial problems, closure of schools and recreational parks increased frustration in all. The present study was aimed to investigate the levels of aggression and its impact on the quality of life (QoL) of healthy adults during times of Pandemic.Material and methodsTo examine the hypothesis, an online survey was conducted during the lockdown period of the COVID-19 Pandemic April to August 2020. A Google form of 65 questions (9 questions asking about socio-demographic variables, 29 questions enquiring about aggression and 27 questions about quality of life) was created with a starting question asking for consent to participate in the survey. The hypothesis of the study was mentioned at the top of the survey page. The inclusion criteria for the participants were age between 18 to 55 years with minimum qualification of high school so that they can easily understand the questionnaire without any history of psychiatric illness or use of psychotropic medication for the same at the time of survey or in past. The Google form was shared on social media to reach the maximum number of participants. After fulfilling the inclusion criteria, the participants filled the questions about sociodemographic variables, the Buss-Perry aggression questionnaire and the WHO-BREF Quality of life questionnaire.Statistical AnalysisThe data were entered in SPSS.21 a software package of a comprehensive system for analysing data. The descriptive statistics, average mean score and standard deviation of different variables have been calculated followed by the t-test and ANOVA to check the significance. The multiple regression analysis was performed to find the correlation across subscales of aggression and quality of life.ResultsA total of 192 healthy adults voluntarily participated in the online survey. The average age of the participants was 32.03±6.09 years. Out of 192, 60.41% (n=116) were males and 39.58% (n=76) were females, 51.56% (n=99) were married and 48.43% (n=93) were unmarried. The majority 85.41% (n=164) of the participants were graduates and postgraduates. The total aggression score was found more in males than females with a mean of 77.78±20.35, 71.0±20.26. The males also scored higher in physical and verbal aggression. Physical aggression was found more in the married group with a Mean±SD of 20.68±8.4. The participants from urban backgrounds scored higher in Anger (20.68±8.4), verbal (15.55±4.7) and total aggression (77.98±20.35) than rural group (18.30±7.1, 13.55±3.8, 71.00±20.26, respectively) and the difference was statistically significant (S=.036, .003, .021, respectively). The psychological quality of life was found less in joint families with a Mean±SD of 19.10±2.9 than nuclear families (20.38±3.0) and the difference was statistically significant (S=.004). the social quality of life was found less in the unmarried group with a Mean±SD of 10.10±1.9. From this study, a positive and significant correlation between subscales of aggression and subscales of quality of life was found. The results also showed a negative and significant correlation between the aggression scale and the quality of life scale.ConclusionAccording to this study, the physical and verbal aggression levels were found to be more prevalent than hostility and anger. It was revealed that as the level of aggression increases, all the subscales of quality of life were negatively affected. More impact was found on psychological and social quality of life which indicates COVID-19 had a direct impact on psychosocial wellbeing of people.

Mental Activity as the Bridge between Neural Biomarkers and Symptoms of Psychiatric Illness

Mental Activity as the Bridge between Neural Biomarkers and Symptoms of Psychiatric Illness

Functionality and Neurocognition in Patients With Bipolar Disorder After a Physical-Exercise Program (FINEXT-BD Study): Protocol of a Randomized Interventionist Program.

Introduction: Recent studies have shown that symptoms of psychiatric illness, functionality, and cognitive function improve with exercise. The aim of this study will be to investigate whether the implementation of an individualized exercise program will improve the functional status of patients with bipolar disorder (BD).Methods: This longitudinal, interventional, randomized, controlled, simple-blind clinical trial will include 80 patients aged 18–65 years, all of them with BD diagnosis. Patients will be randomly assigned to a physical exercise intervention + Treatment-As-Usual (TAU) group and a non-intervention + TAU group. Patients will be assessed by an extensive battery of clinical tests, physical parameters (e.g., brain structure changes measured by optical coherence tomography, cardiorespiratory fitness) and biological parameters (inflammation, oxidative stress and neurotrophic factors) at baseline, after a 4-month intervention period, and 6-month follow-up.Discussion: This is an innovative study aimed at gaining a deeper understanding of the physiopathology of BD and determining whether the prognosis and evolution of the disease can be improved through modifiable areas of the patient's lifestyle.Clinical Trial Registration: NCT04400630. NCT clinicaltrials.gov. Date of registration in primary registry 22 May 2020. clinicaltrials.gov.

Psychiatric Illness in Indian Bone Marrow Transplant Patients.

Introduction: Bone marrow transplantation is the main stay treatment for various disorders. Psychosocial morbidity associated with Bone Marrow Transplant are due to the diagnosis of a deadly disease, curative option with its associated risk of death. Several psychosocial factors influence the long-term outcome in patients.Objective: To identify Psychiatric illnesses in Indian patients undergoing hematopoietic stem cell transplantation.Materials and Methods: This cross-sectional study was conducted during the period of July 2015 to March 2017 at Institute of Haematology and Bone Marrow Transplantation, MIOT INTERNATIONAL, Chennai, India. All consecutive patients, aged 15 years and above, who fulfilled inclusion and exclusion criteria and underwent transplantation, were enrolled in this study. Psychiatric assessment comprised of a semi-structured interview based on Present Status Examination (PSE).Results: Out of 72 enrolled patients, twenty-six (36.1%) patients met the psychiatric diagnostic criteria. Adjustment disorder (43%) was more frequently encountered among the affected individuals followed by depressive illnesses (24%).Discussion:We had 36% of patients with symptoms of psychiatric illnesses. Interestingly higher percentage (54% and 41%) of psychiatric morbidity was observed in studies carried out by Leigh et al. and Sasaki respectively. Regarding diagnostic breakup among transplant patients, adjustment disorders (with symptoms of anxiety and depression) was the most frequent diagnosis (43%) in our study, which is similar to research of Sasaki.While on the other hand study done by Jenkin et al.observed higher prevalence (40%) of depression, which was the second highest psychiatric morbidity in our research. Majority of patients appeared to be mentally prepared and tolerant during transplantation and very few patients observed psychological problems. So, any sort of psychological issues encountered during transplantation has no relation with the diagnosis or the therapy per se but rather is more intricately related to the personality and personal history of the patients.Post-transplantation period seems to be highly stressful mainly due to the isolation, high vigilance, expectations, apprehension of the future and reverse barrier nursing. Therefore, most of psychiatric symptoms were observed within first week after transplantation procedure in 69% (n=18) of patients in our study. Other studies by Illescas - Rico et al. and Sasaki also noted that psychiatric disorders mainly developed after transplantation in majority of cases (68.75%). 76%(n=20) required psychotropic medicines in addition to counselling and psychotherapy Psychiatric symptoms settled in 62% (n=16) of cases during their stay in BMT unit.In this study, patients of the age group 24-45 years, were mostly affected comprising of 54% of all the individuals having psychological problems. Another study carried out by Prieto et al.on 220 patients who had recieved stem cell transplantation had however observed that younger age is one of the risk factor associated with psychiatric disorder in BMT. This clearly reflects the more stress observed in younger population secondary to transplantation. Regarding gender, it is believed that psychiatric disorders are significantly more common in females than males. However in this study, the number of males (58%) were more than the number females amongst the affected patients.There are few limitations of our study like the relatively small sample size, single centre study and limited time period. A multi-centric study is mandated to establish the findings more strongly to bring about a comprehensive care for the patients.Conclusion: Significant psychiatric morbidity (>1/3 - 36%) associated with bone marrow transplantation was observed. This study indicates the importance of psychiatric intervention during the transplant procedure as well as pre-transplant psychiatric assessment and counselling regarding transplant procedure.Keywords: Psychiatric disorder, Adjustment disorder, Hematopoietic stem cell transplantation.ReferencesAndrykowski MA.Psychological factors in bone marrow transplantation: a review and recommendation. Bone Marrow Transplant 1994; 13: 357-375,PrietoJM, BlanchJ, AtalaJ, CarrerasE, RoviraM, CireraE, et.al. Stem cell transplantation: risk factors for psychiatric morbidity. Eur J Cancer 2006; 42:514-20. DisclosuresNo relevant conflicts of interest to declare.

Help-seeking behavior among patients and their relatives presenting to psychiatric unit in southern Sri Lanka

BackgroundEarly recognition of the signs and symptoms of psychiatric illnesses is important as the delay would predict worse prognosis.AimsTo study the help-seeking behavior and sociodemographic factors of psychiatric patients presenting to Psychiatric Unit Teaching Hospital, Karapitiya.MethodsA descriptive cross sectional study. Sample drawn from patients presenting for the first time to Psychiatric Unit Teaching Hospital, Karapitiya. An interviewer administered questionnaire was used to collect data.ResultsAge ranged from 13 to 76 years (n = 50). Males 34 (68%). Duration from onset of symptoms to first presentation ranged from 2 days to nine years, mean 2 years. Twenty-five (50%) had symptoms for more than one year. Sixteen (32%) stated to have attributed illness to supernatural courses as the reason to delay seeking medical help. None gave difficulty in accessing a psychiatric unit as reason for the delay. Twenty-six (52%) referred by nonpsychiatric medical professionals. Regarding alternative treatment engaged in prior to presentation to a psychiatric unit, eighteen (36%) tried to dispose of evil spirits with the help of yakaduru or kattadi, seven (14%) sought help from indigenous medical practitioners and twenty (40%) engaged in religious rituals. Thirteen (26%) sought nonpsychiatric medical treatment.ConclusionsA substantial number of patients suffering from psychiatric disorders present to psychiatric units delayed. As the majority were referred by nonpsychiatric medical professionals, alerting them regarding importance of early identification of psychiatric illnesses could help in reducing the delay.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Abstract TMP52: Psychiatric Hospitalization Increases Short-Term Risk of Stroke: A Case-Crossover Analysis

Introduction: Recent evidence suggests that psychological distress, including symptoms of psychiatric illness, may acutely increase the risk of stroke. However, current studies are limited by small sample sizes, inherent recall bias, and poorly defined criteria for what constitutes psychological distress. Methods: We used a case-crossover design, where each patient serves as his/her own control, to assess the relationship between the diagnosis of a psychiatric condition (defined by ICD-9 codes) and stroke (combined hemorrhagic and ischemic events) in adults over the age of 18. Data were utilized from the Healthcare Cost and Utilization Project (HCUP) for the state of California from 2007 - 2009. Cases in which both stroke and psychiatric diagnoses were present on arrival were excluded from the analysis. The relationship between psychiatric hospitalization and stroke was assessed through conditional logistic regression, with separate analyses conducted for 15, 30, 90, 180, and 365-days pre-stroke. Results: A total of 52,068 strokes were identified. Psychiatric conditions diagnosed within 1 year of stroke were found in 3,337 (6.4%) patients. Compared to patients without (n = 48,731), patients with a recent psychiatric hospitalization had a higher proportion of women (59.67% vs. 50.11%) and longer hospital course (8.9 days vs. 6.9). The presence of a psychiatric condition leading to hospitalization was associated with increased odds of stroke within all five pre-defined time periods (Table 1), with the highest odds of stroke occurring in those who most recently experienced a psychiatric visit (15 day OR = 3.48, 95% CI; 2.68-4.52). Conclusions: Psychiatric hospitalization increases the short-term risk of stroke, particularly within the 15-day period following the diagnosis. This risk decreases but persists for at least 1 year.

The Dsm-v Classification From the Perspective of Neurochemical Model of Temperament

Temperament is viewed here as biologically based individual differences. These differences are consistent through situations and are observable not only in humans, but also in animals and very young children, i.e. in pre-cultural individuals. Temperament therefore cannot be called 'personality”, contrary to common beliefs since 'personality” refers to culturally based phenomena. Temperament and mental illnesses are considered to be varying degrees along the same continuum of imbalance in the neurophysiological regulation of behavior. Temperament traits are linked to specific patterns in the relationships between neurotransmitters and activation of certain brain structures. Similar links were found between neurotransmitters, brain structures, and mental disorders. To describe the neurochemical systems underlying adult temperament traits and mental disorders. Findings in neurochemistry, neuropsychology, differential psychology and psychopathology will be compared to the traits described as temperament within the perspective of the neurochemical Functional Ensembleof Temperament (FET) model. Neurochemical correlates for each trait are reviewed and compared against symptoms of psychiatric illnesses. The role of biogenic amine systems (serotonin, dopamine, noradrenalin), GABA/glutamate, neuropeptide and opioid receptor systems are linked to regulation of specific dynamical properties of behavior. Several insights for the structure of the classification of mental disorders from the perspective of the FET model are proposed. An integration of research in neurochemistry and psychopathology of behavior with differential psychology based on healthy samples can bring new insights for classification of mental disorders.

Treating patients with schizophrenia deficit with erythropoietin?

This systematic review summarizes and critically appraises the literature on the effect of erythropoietin (EPO) in schizophrenia patients and the pathophysiological mechanisms that may explain the potential of its use in this disease. EPO is mainly known for its regulatory activity in the synthesis of erythrocytes and is frequently used in treatment of chronic anemia. This cytokine, however, has many other properties, some of which may improve the symptoms of psychiatric illness. The review follows the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement guidelines. Three databases (Medline, Web of Science, and Cochrane) were searched combining the search terms 'erythropoietin AND (psychotic disorders OR schizophrenia)'. Seventy-eight studies were included in qualitative synthesis, a meta-analytic approach being prohibited. The findings suggest that several EPO cerebral potential properties may be relevant for schizophrenia treatment, such as neurotransmission regulation, neuroprotection, modulation of inflammation, effects on blood-brain barrier permeability, effects on oxidative stress and neurogenesis. Several potentially detrimental side-effects of EPO therapy, such as increased risk of thrombosis, cancer, increased metabolic rate and mean arterial blood pressure leading to cerebral ischemia could severely limit or halt the use of EPO. Overall, because the available data are inconclusive, further efforts in this field are warranted.

Common psychotic symptoms can be explained by the theory of ecological perception

The symptoms of psychiatric illness are diverse, as are the causes of the conditions that cause them. Yet, regardless of the heterogeneity of cause and presentation, a great deal of symptoms can be explained by the failure of a single perceptual function – the reprocessing of ecological perception.It is a central tenet of the ecological theory of perception that we perceive opportunities to act. It has also been found that perception automatically causes actions and thoughts to occur unless this primary action pathway is inhibited. Inhibition allows perceptions to be reprocessed into more appropriate alternative actions and thoughts. Reprocessing of this kind takes place over the entire frontal lobe and it renders action optional. Choice about what action to take (if any) is the basis for the feeling of autonomy and ultimately for the sense-of-self. When thoughts and actions occur automatically (without choice) they appear to originate outside of the self, thereby providing prima facie evidence for some of the bizarre delusions that define schizophrenia such as delusional misidentification, delusions of control and Cotard’s delusion.Automatic actions and thoughts are triggered by residual stimulation whenever reprocessing is insufficient to balance automatic excitatory cues (for whatever reason). These may not be noticed if they are neutral and therefore unimportant or where actions and thoughts have a positive bias and are desirable. Responses to negative stimulus, on the other hand, are always unwelcome, because the actions that are triggered will carry the negative bias.Automatic thoughts may include spontaneous positive feelings of love and joy, but automatic negative thoughts and visualisations are experienced as hallucinations. Not only do these feel like they emerge from elsewhere but they carry a negative bias (they are most commonly critical, rude and are irrationally paranoid).Automatic positive actions may include laughter and smiling and these are welcome. Automatic behaviours that carry a negative bias, however, are unwelcome and like hallucinations, occur without a sense of choice. These include crying, stereotypies, perseveration, ataxia, utilization and imitation behaviours and catatonia.

Relationship between aggression, interpersonal style, and therapeutic alliance during short‐term psychiatric hospitalization

Aggression during psychiatric hospitalization is frequent, problematic, and a major challenge for nurses and mental health services more generally. The strength of the therapeutic alliance between nursing staff and patients has been posited as an important protective factor that can limit the likelihood of aggression. This study examined the relationship between interpersonal style, perceived coercion, and psychiatric symptoms on the therapeutic alliance between patients and staff, and how each, in turn, is related to aggression. Participants in this study were 79 patients admitted to an acute psychiatric hospital. Each participant was interviewed to determine perceived coercion, symptoms of psychiatric illness, interpersonal style, and therapeutic alliance. Incidents of aggression were recorded at discharge through a review of incident forms, file review, and interviews with unit nursing staff. The results showed that a hostile-dominant interpersonal style and symptoms of paranoia predicted poor therapeutic alliance, contributing 14% of the variance in therapeutic alliance scores. A dominant interpersonal style predicted aggression towards staff. Therapeutic alliance, perceived coercion, and symptoms of psychiatric illness did not predict aggression. Implications for engagement in treatment and the prevention of aggression are discussed.

Medication Errors in Psychiatry

Medication errors are among the most common medical errors and cause significant morbidity and in some cases mortality. The objective of this article is to review the literature on medication errors in psychiatry. We completed a comprehensive search of both peer- and non-peer-reviewed articles that investigated medication errors in psychiatry. Our primary focus was to examine patient-, provider- and system-related factors that contributed to medication errors. Due to differences in research design and denominators used to determine error rates, the reported prevalence rates of medication errors in psychiatry vary widely. Patient-related factors identified as contributing to medication errors included non-adherence to medication, failure of patients to inform their various care providers about the medications they are taking and symptoms of psychiatric illnesses. Provider-related factors identified as contributing to medication errors were also identified and included clinical practices associated with prescribing, transcription, dispensing, administration and monitoring. Finally, the healthcare system also has a major role to play in reducing medication errors by ensuring seamless continuity of care, mandating medication reconciliation programmes, ensuring adequate clinical pharmacy services and supporting a nonpunitive medication error reporting system. Although the literature raises awareness of these specific contributing factors, there is still a great need for more systematic evaluations of the problem including root cause analysis. Medication errors in psychiatry have been studied almost exclusively in the inpatient setting and thus little is known about the incidence and significance in outpatient and community settings.

Improving Psychological and Psychiatric Aspects of Palliative Care: The National Consensus Project and the National Quality Forum Preferred Practices for Palliative and Hospice Care

As patients with terminal disease enter into the final stage of their illness, psychiatric symptoms and psychological responses to the disease contribute to overall suffering of both patient and family. Until recently, no nationally accepted guidelines or practices had been established to support assessment and management of this type of suffering. In 2007, the National Quality Forum published A National Framework and Preferred Practices for Palliative and Hospice Care Quality that included a list of preferred practices for assessing and treating symptoms of psychiatric illness, anticipatory grief and psychologic distress prior to death, and bereavement after the death, of the patient. While specialized care may be provided to patient and families in the context of advanced disease, all clinicians involved in palliative and end-of-life care are responsible for having a basic understanding of effectively managing psychologic and psychiatric aspects of this care. Evidence from current literature supports these best practices.

Appropriate treatment targets or products of a demanding environment? The relationship between aggression in a forensic psychiatric hospital with aggressive behaviour preceding admission and violent recidivism

Effective treatment of aggressive behaviour and accurate release decision making are necessary components of adequate clinical practice in forensic psychiatric units. Unfortunately, methods to identify treatment targets and ameliorate aggressive behaviour have developed at a slower pace than risk assessment technologies. Recent progress on the identification of offence paralleling or functionally equivalent behaviour offers a framework for individually tailored treatment and idiographic release decision making, although empirical scrutiny of this approach is inadequate. This paper describes an examination of the relationship between aggressive behaviour prior to admission with aggression during inpatient psychiatric treatment, and reconviction for violent offending following discharge. Results showed a relationship between pre- and post-admission aggression but no relationship between aggression during inpatient psychiatric treatment with either pre-admission aggressive behaviour or violent recidivism. These findings indicate the importance of state psychological variables, specifically those states affected by symptoms of psychiatric illness, as well as environmental activators and inhibitors of violence that operate within the hospital. These require inclusion in an adequate functional analysis of aggressive behaviour for forensic psychiatric patients.

Neurobiological bases of aggression, violence, and cruelty

Aggression, violence, and cruelty are symptoms of psychiatric illness. They reflect abnormalities in the regulation of the stress and emotion circuitries. The functioning of these circuitries depends upon the interaction between genetics and environment. Abuse and neglect during infancy, as well as maternal stress and poor quality of maternal care, are some of the causes that produce these types of abnormal behavior. Research on the neurobiological bases of emotion regulation will allow the detection of the population at risk.

On Being Insane in Medico-Legal Places: The Importance of Taking a Complete History in Forensic Mental Health Assessment

Rosenhan's experiment (1973) showed that it is not difficult to simulate symptoms of psychiatric illness. A Parliamentary Committee in New South Wales and research from overseas have shown that, in the medicolegal context, such practices continue to exist. To illustrate the argument, there will be a discussion of Post Traumatic Stress Disorder. It is argued that such practices not only bring the area of mental health into disrepute, they also have the effect of distorting negatively the outcomes of litigation and raise ethical questions about the misuse of mental illness for personal benefit. It remains the case that expert mental health practitioners have an ethical duty to educate both the practitioners who employ them and the courts in general as to the reality of what constitutes mental illness. They can begin this action by taking thorough histories from plaintiffs. The term 'mental injury' or variations thereon, used in most criminal injuries compensation legislation, provides an opportunity to appreciate that being a victim of crime is often likely to result in distress that is more than transient and hence compensable, but not necessarily something that has to become pathological. That does not mean that some people will not develop psychopathology or have pre-existing psychopathology exacerbated. To adopt such an approach for personal injury matters in general may resolve some of the tensions experienced by mental health practitioners when they enter the forensic arena.

Detecting early signs of psychosis. Vignettes presented to professionals in primary healthcare and psychiatry

Among personnel in primary healthcare and psychiatric care, the ability to detect early signs of psychosis was examined and compared. Differences due to sex, age, profession or time in the profession were explored. Three different vignettes concerning patients with mental illness were presented to the respondents, and every respondent was to mark what they thought were early signs of psychosis in the vignettes. The findings were compared with a pre-set standard of symptoms and signs. Healthcare personnel from two different administrative districts, Umeå and Örnsköldsvik in northern Sweden, participated in the study. The response rate was 77%, but for district nurses in the administrative district of Umeå it was only 25%, so therefore complementary interviews with nine district nurses in that district, representing the drop-outs, were performed. There was no difference whatsoever in ability to detect early signs of psychosis between personnel in primary healthcare and psychiatric care; nor were there any significant differences due to sex, age, profession or time in their profession. Detecting early signs of psychosis requires training and the ability to communicate with patients, as well as a special sensitivity to psychiatric conditions. This can be achieved by enhancing accessibility and continuity of primary healthcare for these patients. Furthermore, a greater sensitivity to early signs of psychosis must be created among all healthcare personnel. The co-operation between primary healthcare and psychiatric care must increase. Primary care physicians need opportunities to see patients over time in order to correctly interpret early signs and symptoms of psychiatric illness.

Anomie and Egoism in Relation to Contemporary Psychiatry

With increasing numbers of people in western society engaging in deliberate self-harm behaviours, psychiatric practitioners should reconsider some of the implications. 1. Psychiatry as a branch of medicine has a medical bias in assessing people who have engaged in deliberate self-harm behaviours and tends to view these behaviours as symptoms of psychiatric illness rather than sociological disorder. 2. The increasing number of these distressed people is causing an increasing psychiatric workload to the disadvantage of other patients, research activity and teaching. 3. The psychiatric profession should focus its attention on patients with formal psychiatric illness and encourage the involvement and participation of professionals from other agencies and services who are now trained and willing to become involved. Psychiatry cannot replace the enfeebled phenomena of collective sentiment or the regulatory function of a simpler, more cohesive society (as described by Durkheim) but many of the established self-help groups can help and links could be established with these agencies. To do this will require changes to established professional role boundaries and the loosening of medico-legal constraints which currently prevent relinquishing of responsibility when there is an obvious absence of psychiatric illness.