Surgical Treatment for Refractory Aggression after Bacterial Meningitis Complicated by Stroke: Case Report

Bacterial meningitis remains a public health problem. One of the complications of this group of diseases is cerebral ischemia, an important indicator of severity and an independent predictor of poor prognosis. It is already known that, in many cases, pathological aggressiveness is the result of brain abnormalities in individuals with mental illnesses. The indication of neurosurgeries for psychiatric disorders (NPDs) relies on numerous studies based on scientific evidence that correlate psychiatric illnesses with the limbic system and the pathophysiology of emotions. The development of sophisticated stereotactic target localization techniques, brain atlases, and imaging methods made stereotaxis possible, a procedure that increased the precision of neurosurgery and reduced brain damage. Nowadays, multiple targets can be treated during NPD, according to the particular characteristics of the patient. Moreover, the combination of lesions leads to more significant improvements compared with isolated procedures. The present study aimed to report the rare case of a patient with a history of bacterial meningitis who developed stroke and chronic pathological aggressiveness refractory to clinical treatment and underwent ablation using the multitarget stereotactic technique.

Impaired endogenous neurosteroid signaling contributes to behavioral deficits associated with chronic stress

Chronic stress is a major risk factor for psychiatric illnesses, including depression; however, the pathophysiological mechanisms whereby stress leads to mood disorders remain unclear. The recent FDA approval of antidepressants with novel mechanisms of action, like Zulresso®, a synthetic neuroactive steroid analog with molecular pharmacology similar to allopregnanolone, has spurred interest in new therapeutic targets and, potentially, novel pathophysiological mechanisms for depression. Allopregnanolone acts as a positive allosteric modulator of GABAA receptors (GABAARs), acting preferentially at δ subunit-containing receptors (δ-GABAARs). Accumulating clinical and preclinical evidence supports the antidepressant effects of exogenous administration of allopregnanolone and allopregnanolone analogs; however, the role of endogenous neurosteroids in the pathophysiology of depression remains unknown. Here, we examine whether altered neurosteroid signaling may contribute to behavioral deficits following chronic unpredictable stress (CUS) in mice. We first identified reductions in expression of δ-GABAARs, the predominant site of action of 5a-reduced neuroactive steroids, following CUS. Additionally, utilizing LC-MS/MS we discovered a decrease in levels of allopregnanolone in the BLA, but not plasma of mice following CUS, an indication of impaired neurosteroid synthesis. CRISPR knockdown the rate-limiting enzymes involved in allopregnanolone synthesis, 5α-reductase type 1 and 2, in the BLA mimicked the behavioral deficits associated with CUS in mice. Furthermore, overexpression expression of 5α-reductase type 1 and 2 in the BLA improved behavioral outcomes. Collectively, this suggests chronic stress impairs endogenous neurosteroid signaling in the BLA which is sufficient to induce behavioral deficits similar to those observed following CUS. Further, these studies suggest that the therapeutic efficacy of allopregnanolone-based treatments may be due to their ability to directly target the underlying pathophysiology of mood disorders. Therefore, targeting endogenous neurosteroidogenesis may offer a novel therapeutic strategy for the treatment of mood disorders.

A study on referral of patients in Department of Psychiatry at Lumbini Medical College and Teaching Hospital

Introduction: In a developing country like Nepal, where there is inadequate awareness but more social stigma towards psychiatric illnesses among people, there is an important role of referral psychiatry. Referral psychiatry has been considered to be an interface between psychiatric and non-psychiatric medicines as practiced in general hospital settings. This study analyses the psychiatric problems among patient referred to psychiatry department from other outpatient departments and emergency department in a tertiary care centre. Methods: This was a descriptive hospital-based study conducted among patients who were referred to psychiatry department from different outpatient departments of Lumbini Medical College and Teaching Hospital from November 1, 2019 to April 30, 2020. Ethical issues were considered strictly. Data were entered into Statistical Package for the Social Sciences version 21.0 and descriptive analysis was done. Results: A total of 781 patients were referred out of which more than half (n=487, 62.35%) were females and the most common age group was 41 to 50 years (n=175, 22.4%). Majority of patients (n=284, 36.4%) were referred from medicine department. The most common psychiatric illness diagnosed were those included under International Classification of Diseases 10th Revision F40-48 (Anxiety, Dissociative, Stress-related, Somatoform and other Non-Psychotic Mental Disorders). Conclusions: Referral psychiatry plays an important role to diagnose the undiagnosed psychiatric illnesses earlier and better and manage accordingly so it should be prioritized and practiced in health centers.

Glutamate Elicits Therapeutic Responses in Light-Induced Sleep-Deprived Zebrafish, Danio rerio

Sleep deprivation disrupts most neurotransmitters, which can lead to adverse behavioural changes and other psychiatric illnesses. Many neurotransmitter systems, including dopamine (DA), serotonin (5-HT), norepinephrine (N.E.) and GABA, have been implicated in the pathophysiology of mood disorders. The precise significance of sleep deprivation (S.D.) changes in the neurotransmitter levels and the mechanism underlying behavioural alterations is unknown. According to research, sleep deprivation (S.D.) has a major effect on an individual’s quality of life and ability to perform essential physiological functions. As a result, we wanted to confirm the levels of neurotransmitters and behavioural modifications in zebrafish after 24, 48, and 72 hours of sleep deprivation and glutamate treatment on the sleep-deprived groups. The T-maze test was used to assess learning and memory alterations in zebrafish. We used the Novel Tank Test (NTT) and Light and Dark Test (LDT) to examine the anxiety-like behaviour. The spectrofluorimetric method was used to determine the quantities of DA, 5-HT, N.E. and GABA. From this study, it is evident that 72h sleep-deprived fish had a loss of learning and memory via T-maze test and also the anxiety levels were very high in the sleep-deprived group than the other groups. The groups that received glutamate after sleep deprivation showed betterment in the behavioural response. Also, the levels of neurotransmitters were increased in the glutamate treated groups than the sleep-deprived groups. Our findings indicate that sleep loss dramatically impairs behavioural responses and disrupts most neurotransmitter concentrations. When sleep-deprived fish were given glutamate, their behaviour and neurotransmitter levels were nearly identical to those of the control group. This study will have a greater impact on sleep deprivation therapy and pave the way for using the neurotransmitters as external therapeutic agents in treating sleep deprivation and other behavioural changes related to sleep deprivation.It has been suggested that zebrafish is an excellent testing subject for loss of sleep on cognition and that it may also be an efficient model for unravelling the pathways that underpin learning and memory formation.

Psychological Stress Due to Covid-19 on Pregnant Women in Post Partal Period

There is no indication that covid-19 has a long-term effect on pregnancy, the mother's psychiatric condition, or the infant's developmental delay. Between May 1st and July 31st 2020, 72 pregnant patients with covid-19 took part in a study that took place in different locations. Since giving birth these woman patients engaged in three-month follow-up surveys. The data was collected from Covid-19 medical history, maternal reports, quarantine questionnaires, mother-baby feeding separation, and assessing the mothers psychiatric illnesses. While there is no conclusive evidence of vertical transmission of SARS-COV-2, in order to reduce the risk of infection, healthcare professionals and researchers must focus more on the mental health of pregnant women, infant feeding, and closeness to the parents. This will aid in the early development of the new born, reducing stress on the mother.

Treating Depression and other Serotonin Deficiency Brain Disorders with Tryptophan

: Deficits of brain serotonin (5-hydroxytryptamine; 5-HT) are implicated in a number of psychiatric illnesses including depression. Treatment efficacy of this highly prevalent brain disorder is not adequate largely because serotonin stores are depleted. Tryptophan an essential amino acid is the sole precursor of serotonin; its systemic or oral administration increases serotonin synthesis because tryptophan hydroxylase, the rate limiting enzyme of 5-HT biosynthesis, is physiologically unsaturated with its substrate. The present article targets importance of tryptophan supplementation in treating serotonin deficiency and improving therapeutic intervention in depression and other serotonin deficiency brain disorders.

Contemporary Supportive Therapy: A Review of History, Theory, and Evidence

Supportive psychotherapy interventions were developed as a part of psychodynamic psychotherapy work, and supportive psychotherapy was historically considered to be the default form of therapy only for lower-functioning patients. These roots unfortunately have resulted in supportive psychotherapy being viewed as an inferior form of treatment. In reality, supportive psychotherapy is a practical and flexible form of psychotherapy that helps patients with a wide range of psychiatric illnesses, including mood disorders, anxiety disorders, posttraumatic stress disorder, schizophrenia, personality disorders, eating disorders, body dysmorphic disorder, and substance use disorders. In addition, supportive psychotherapy can be well-suited to higher-functioning patients, as well as to patients who are chronically lower-functioning. There is also evidence to support the use of supportive psychotherapy in patients with certain medical illnesses, including coronary artery disease, some gastrointestinal illnesses, HIV infection, and certain types of cancer. The goals of supportive psychotherapy include helping patients to understand emotional experiences, improving affective regulation and reality-testing, making use of their most effective coping strategies, and engaging in collaborative problem solving to reduce stressors and increase effective engagement with support systems.

An Unusual Presentation of Catatonia-Like Behavior: Differentiating Malingering from Catatonia

Malingering involves the intentional production of physical or psychological behaviors due to motivation from external incentives, posing unique challenges to healthcare. Although malingering as an entity has been well studied, the current literature does not explore the intentional production of catatonia-like behavior or how to differentiate malingering from catatonia. Here, we describe a 45-year-old female who was admitted to an acute psychiatric hospital with a complex presentation of catatonia-like signs that was ultimately thought to be volitional behavior, resulting in a diagnosis of malingering. We highlight the important factors considered in her presentation, the differences between her behaviors and true catatonia, and other important differential diagnoses to consider. Although a diagnosis of malingering is difficult to make, we underscore the importance of reaching this conclusion in order to avoid unnecessary and potentially harmful medical interventions. We stress the importance of shifting focus from medical management to more appropriate patient goals such as providing social services and treatment of other underlying psychiatric illnesses.

Simulating Psychedelic Therapy Through Mediated Reality

<p>Due to the illegality of psychedelic substances, and despite proven efficiency, people suffering from various psychiatric illnesses and disorders are unable to receive potentially life-changing psychedelic therapy. With the recent technological development of computer-mediated realities, designers and developers now have the opportunity to digitally recreate such treatments. Through practical application along with the review of literature and conferences, this study aims to analyse the potential of mediated realities to convincingly simulate psychedelic therapy. Augmented reality (AR) and modulated realities (ModR) such as modified and diminished reality show insufficient evidence for practical use in simulated psychedelic therapy. Augmented virtuality (AV), mixed reality (MR), virtual reality (VR) and modulated virtuality (ModV) contain a range of characteristics fundamental to potentially simulating mind manifesting psychedelic therapy. However, mediated reality in general appears to be extraneous for practical use in mind loosening psychedelic therapy. Currently, virtual reality (VR) shows the greatest potential for healing, trauma release, personal growth and exploration of the psyche by simulating closed-eye psychedelic experiences through adding virtual information via an HMD. Accordingly, the author of this study has proposed a proof of concept (POF) for a neurofeedback driven VR experience which simulates aspects of both mind loosening and mind manifesting psychotherapy. This POF is intended to simulate the transformation of phosphenes into complex geometric pattern based hallucinations. With further development in this field, one day people suffering from various mental conditions might be able to receive safe, accessible and legal forms of simulated psychedelic therapy.</p>

Simulating Psychedelic Therapy Through Mediated Reality

<p>Due to the illegality of psychedelic substances, and despite proven efficiency, people suffering from various psychiatric illnesses and disorders are unable to receive potentially life-changing psychedelic therapy. With the recent technological development of computer-mediated realities, designers and developers now have the opportunity to digitally recreate such treatments. Through practical application along with the review of literature and conferences, this study aims to analyse the potential of mediated realities to convincingly simulate psychedelic therapy. Augmented reality (AR) and modulated realities (ModR) such as modified and diminished reality show insufficient evidence for practical use in simulated psychedelic therapy. Augmented virtuality (AV), mixed reality (MR), virtual reality (VR) and modulated virtuality (ModV) contain a range of characteristics fundamental to potentially simulating mind manifesting psychedelic therapy. However, mediated reality in general appears to be extraneous for practical use in mind loosening psychedelic therapy. Currently, virtual reality (VR) shows the greatest potential for healing, trauma release, personal growth and exploration of the psyche by simulating closed-eye psychedelic experiences through adding virtual information via an HMD. Accordingly, the author of this study has proposed a proof of concept (POF) for a neurofeedback driven VR experience which simulates aspects of both mind loosening and mind manifesting psychotherapy. This POF is intended to simulate the transformation of phosphenes into complex geometric pattern based hallucinations. With further development in this field, one day people suffering from various mental conditions might be able to receive safe, accessible and legal forms of simulated psychedelic therapy.</p>