Comparison of Treatment Response before and after Antiobsessivae Therapy among Psychiatric Patients with Obsessive Compulsive Disorder

Introduction: Obsessive compulsive disorder is a common, chronic and disabling disorder marked by obsessions and/or compulsions. This study tries to find the demographic profiles, severity and response of antiobsessive drugs in young and adult patients with obsessive compulsive disorder. Aims: To study the socio-demographic profile, severity and treatment response to commonly used antiobsessive medications in male and female, and young and adults. Methods: This is a hospital based experimental study done in patients attending to psychiatry out-patient department over one year from February 2020 to January 2021. Diagnosis of obsessive compulsive disorder was made based on International Classification of Disease- 10 criteria for research. Yale-Brown obsessive compulsive scale check list (adult and children) was applied in those patients and recorded accordingly on baseline (week 0) and patients were treated with specific serotonin reuptake inhibitors or tricyclic antidepressants in therapeutic doses for 6 weeks. On follow up at week 6, they were again reassessed and the scores were recorded and analyzed. Results: Among the total study subject (N-52), 26(50 %) were male and 26(50 %) were females. Patients in age bracket 20-29 is the most common age group representing 18(34.6 %). Mean age of patients is 30.36±11.93 years (28.65±9.80 in male and 32.04±13.73 in female). Severe form of obsessive compulsive disorder was the most common type that represent 33(63.5%) followed by moderate 16(30.8%) and extreme 3(5.7%). There is a difference of treatment response of antiobsessive therapy in male and female with statistical significance (p= 0.039). Conclusion: This study shows that obsessive compulsive disorder is most commonly found in 20-29 age group and the severe type is the most common. There is a significant difference in treatment response of antiobsessive therapy in male and female.

The Frequency and Factors Related to Aggressive Behavior in Psychiatric Patients Controlled by a Variety of Restraint Methods

Background: Aggressive behavior of patients in psychiatric wards is one of the main challenges faced by healthcare workers. Despite the abundance of research on the frequency of aggressive behavior, not enough attention has been paid to its severity. Furthermore, limited studies have evaluated the restraint methods used to manage aggressive behaviors. Objectives: The current descriptive study aimed to compare the relationship between demographic characteristics, diagnosis of psychiatric illness, medical illness, and hospitalization characteristics with features of aggressive behavior in patients experiencing different types of restraint during hospitalization. Methods: We evaluated subjects admitted to the adult psychiatric wards of Imam Hossein and Taleghani hospitals in Tehran, Iran, in 2018. The patients were controlled by various restraint methods during hospitalization. All the patients were evaluated for the severity of aggression, which was determined utilizing the Persian version of the Modified Overt Aggression Scale (MOAS). All the data along with demographic and clinical characteristics obtained from medical records were analyzed using the Mann-Whitney and Kruskal-Wallis nonparametric test (P-value = 0.05) and Spearman correlation coefficient to describe the factors affecting the aggressive behavior of patients. Results: In this study, the prevalence of aggressive behavior was 11.7%. Among the demographic variables, gender (P-value = 0.003), education level (P-value = 0.05), and the history of aggressive behavior (P-value = 0.001) were significantly associated with the MOAS. Furthermore, as the hospitalization duration increased, the frequency of aggressive behavior decreased, and its severity intensified. Moreover, there was a significant relationship between aggression severity with admission type (P-value = 0.00), concurrent medical illness (P-value = 0.026), and substance abuse (P-value = 0.025). Conclusions: According to the obtained results, the factors affecting the aggression and early identification of patients with the potential of aggressive behavior is an effective management strategy for controlling these patients.

The Construction of Self-Identity in the Chronically Mentally Ill: A Focus on Autobiographic Narratives of Mentally Ill Patients in South Korea

A systematic policy for treatment and management of chronic psychiatric patients in South Korea was begun with the passage of the Mental Health Act in 1995. The mentally ill patients who were previously separated from the society now have opportunities to live in local communities under medication with the help of rehabilitation facilities. This study aims to understand how mentally ill patients deal with their new medical environment. An autobiographic narrative analysis is methodically applied in order to link the social and the individual levels. Autobiographic narratives of illness show how the patient’s self-identity is formed and further developed according to the chronic conditions of his illness and the continual learning from experiences. In regard to the construction of selfidentity, two aspects should be taken into consideration: First, medication is absolutely necessary before patients can leave the hospital and participate in rehabilitation programs. Secondly, social integration is usually evaluated by the return of the patient into a normal biographical stage. It turns out that medication deprives the patients of control over their emotions, their bodies. Furthermore, their social environments – including family, friends and the labor market – work against them. Under these circumstances, mentally ill patients are liable to adhere to their own interpretation of mental illness, and what they experience is far different from the expectations of experts in the field. The new mental health environment also contributes to the formation of patient communities. As a result, chronic psychiatric patients are able to build their own subculture and to see themselves through their own eyes. Further studies are needed to explore whether and to what extent the ongoing improvement of social conditions for mentally ill patients has an impact on autobiographic narratives and self-identity construction.

Volition and “free will”

Philosophers have debated the “free will” for centuries, yet it is only in recent years that voluntary actions have become an object of investigation for cognitive neuroscience. This review begins by attempting a definition of volition (i.e., the mental state associated specifically with voluntary actions) that could be relevant for cognitive neuroscience. We then review the neuropsychology of volition. Alterations in voluntary behaviour in neurological and psychiatric patients first suggested the possibility that specific cognitive processes of volition have specific bases in the brain. These findings counter traditional dogmas that human volition is somehow ineffable, and instead suggest that voluntary actions depend on specific brain circuitry that is accessible to scientific investigation.The second part of the review focuses on the experimental psychology of volition. A number of studies have combined a systematic manipulation of experimental conditions, and recording of brain processes associated with voluntary action. We argue that this combination is most likely to identify the brain processes specifically associated with volition, and we therefore review these studies systematically. For example, several studies link the Readiness Potential of the EEG to preparatory conscious preplanning of actions. Further, a meta-analysis of neuroimaging studies (PET/ fMRI) reveals a distinctive pattern of activations for choosing one among many possible actions - a key element of volition. The medial frontal cortex appears to make a key contribution to both these biomarkers of volition.

O cão como coterapeuta e os cuidados para a sua atuação em ambiente hospitalar

Este estudo teve por objetivo abordar a cinoterapia como modalidade terapêutica capaz de promover uma maior humanização do atendimento ao doente, atuando como ferramenta efetiva no tratamento do assistido, dando ênfase aos cuidados necessários para o emprego do cão no ambiente hospitalar. A humanização da saúde, hoje já bem discutida, apoia iniciativas que visem à transformação do ambiente hospitalar. Acredita-se que, através de pequenas ações, podemos amenizar a dor de muitos, contribuir para o sucesso dos tratamentos e para a diminuição do tempo de hospitalização. A Cinoterapia, apoiada por uma equipe multidisciplinar, tem assistido crianças e adultos hospitalizados por diferentes patologias, pacientes cardíacos, psiquiátricos, portadores de Alzheimer, Parkinson, AIDS, paralisia cerebral, acidente vascular cerebral, câncer entre outras. Mesmo diante da tendência mundial e do reconhecimento da importância da terapia, a implantação de projetos ainda tem sido dificultada pela carência de estudos que demonstrem o impacto do cão no ambiente hospitalar. O desconhecimento dos riscos inerentes à terapia, principalmente no que diz respeito à transmissão de doenças, assim como a falta de protocolos com normas específicas para a sua implantação, são alguns dos entraves para uma maior disseminação da técnica. The aim of this study was to approach Pet therapy as a therapeutic modality capable of promoting a greater humanization of patient care, acting as an effective tool in the treatment of the assisted, emphasizing the necessary care for the use of the dog in the hospital environment. The humanization of health, now well discussed, supports initiatives aimed at transforming the hospital environment. It is believed that, through small actions, we can ease the pain of many, contribute to the success of the treatments and decrease the length of hospitalization. Pet therapy, supported by a multidisciplinary team, has assisted children and adults hospitalized for different pathologies, cardiac patients, psychiatric patients with Alzheimer's, Parkinson's, AIDS, cerebral palsy, stroke, cancer, among others. Even in the face of the worldwide trend and recognition of the importance of therapy, the implementation of projects has still been hampered by the lack of studies that demonstrate the impact of the dog in the hospital environment. The lack of knowledge about the risks inherent to the therapy, especially regarding the transmission of diseases, as well as the lack of protocols with specific norms for its implantation, are some of the obstacles for a greater dissemination of the technique.

Implementation of the DSM-5 and ICD-11 Dimensional Models of Maladaptive Personality Traits Into Pre-bariatric Assessment

Background: Personality pathology does not have to be a contraindication to a bariatric surgery if a proper pre-surgical assessment is done. Indicating subgroups of patients with their specific needs could help tailor interventions and improve surgical treatment outcomes.Objectives: Using the Alternative DSM-5 model for personality disorders (AMPD) and the ICD-11 model for PDs to detect subgroups of patients with obesity based on a specific constellation of maladaptive personality traits and the level of overall personality impairment.Methods: 272 consecutively consented patients who underwent a standard pre-surgical psychological assessment. The majority were women (58.0%), age range was 22–79 years (M = 48.06, SD = 10.70). Patients’ average body mass index (BMI) was 43.95 kg/m2. All participants were administered the Personality Inventory for DSM-5 (PID-5) from which Level of Personality Functioning Scale-Self Report (LPFS-SR) and Standardized Assessment of Severity of Personality Disorder (SASPD) scores were gained using the “crosswalk” for common metric for self-reported severity of personality disorder. The k-means clustering method was used to define specific subgroups of patients with obesity and replicated for equality testing to the samples of non-clinical respondents and psychiatric patients.Results: The cluster analysis detected specific groups in the sample of patients with obesity, which differed quantitatively from the samples of non-clinical respondents and psychiatric patients. A vast majority of patients with obesity showed above-average values in most of the PID-5 facets compared to the United States representative general community sample. In two out of the three clusters defined, patients demonstrated moderate (> M + 1.5 × SD) to severe (> M + 2.0 × SD) personality psychopathology within the Detachment and Negative Affectivity domains according to PID-5, which in one of the clusters corresponded to the mild overall impairment in both, LPFS-SR (M = 2.18, SD = 0.27) and SASPD (M = 8.44, SD = 2.38). Moreover, higher levels of psychopathology prove to be associated with higher age and use of psychiatric medication.Conclusions: The dimensional DSM-5 and ICD-11 trait models are suitable procedures for defining specific “characters” of patients in a pre-bariatric setting. As such, they help to identify subgroups of patients with obesity who are different from general population and psychiatric patients. Implications for clinical practice and further research are discussed.

The Relationship Between and Correlates of Problematic Sexual Behavior and Major Mental Illness

While research has consistently found that general distress and psychopathology are not predictive of sexual recidivism, examination of specific syndromes and their relationship to offending has revealed a potentially more complicated relationship. One proposed mechanism for the mixed findings with respect to major mental illness and sexual offending may be the confound of neurological injury. As identified in Mann et al. (2010) work on psychologically meaningful risk factors, mental illness represents an area in need of more study given the indirect influence it may exert on risk. To this end, the current paper summarizes the study of the relationship between neurological injury, psychosis and problematic sexual behavior among two Canadian samples of forensic and civil psychiatric patients. In the first study we observed higher than expected rates of sexually-themed psychotic symptoms (45%) and problematic sexual behavior (PSB; 40%) among a combined group of forensic and civil psychiatric patients (n = 109). Indeed 70 percent of those individuals who engaged in PSB endorsed sexually-themed psychotic symptoms. While comorbidity is common amongst this group, brain injury appeared to represent a specific liability. Compared to those who did not engage in PSB, those who did were almost 4x (OR = 3.83) more likely to have a documented history of brain injury (e.g., traumatic and acquired brain injury, including fetal alcohol syndrome). In the second study we sought to replicate this finding in a larger forensic sample of 1,240. However, the recorded rates of brain injury were significantly less, such that no relationship to PSB was observed. Based on the mixed findings to date, including our own data, questions remain about the nature of a potential shared vulnerability for psychosis and PSB previously postulated. Among psychiatrically complex individuals who engage in PSB, understanding etiology and links to risk are helpful, but perhaps more importantly is attention to the mechanisms through which symptoms confer risk (e.g., problem solving, sexual disinhibition, social/intimacy deficits) and how best to treat and manage them.

Alysis Reliability Study: Rearranging Phenomenology into Etiology in Mental Disorders

‘Alysis’ )abbreviation of Neuroanalysis(, - is the chosen definition for the rearrangement of psychiatric phenomology to approximate the hypothesized etiology of mental disorders. Currently the relevant scales such as Positive and Negative Symptoms Scale (PANSS) for schizophrenia and the Hamilton scales for depression and anxiety, and Mania Rating Scale have no specific guiding principle in the order of items. ‘Alysis’ is a reorganization of multiple known scales to fit a future brain-related diagnostic approach to mental disorders. Due to the regrouping of items from different scales and reorganizing them according to a brain-related hypothetic order, it is necessary to reassess the reliability of the new ‘Alysis’ rearrangement. In this work the new ‘Alysis’ format is described and then using t-scores analysis, compared to the widely-used Brief Psychiatric Rating Scale (BPRS) scale for mental disorders. It is shown that ‘Alysis’ is reliable thus can be a good diagnostic platform to go ahead and generate personalized testable-predictions about brain-related diagnostics for psychiatric patients.

Psychiatric Morbidity in Elderly Patients attending OPD of Lumbini Medical College and Teaching Hospital

INTRODUCTION: Geriatric psychiatry patients are increasing but enough work has not been done in this area of Nepal. We conducted this study to find out the prevalence of different psychiatric morbidities in elderly population and to find out if there are any age and gender specific differences. MATERIAL AND METHODS: Medical records of psychiatric patients above 65 years of age visiting outpatient department of Lumbini Medical College and Teaching Hospitalfrom April 1, 2018 to March 31, 2019 were reviewed. Risks of having different psychiatric disorders was estimated using odds ratio. RESULTS: A total of 300 cases were enrolled in the study. Mean age of the study group was 71.49(SD=6.99). There were more females. Depressive disorderwas the most common diagnosis followed by somatoform disorder, anxiety disorder, dementia and others. Depressive disorder was higher in females and in younger subgroup of the elderly patient.The risk of having dementia was higher in older group. CONCLUSION: Depressive disorder was the most common psychiatric disorderfollowed by somatoform disorder in elderly patients above 65 years of age. Male patients were more likely to suffer psychiatric disorder as compared to females in this age.