On patients who explode: surviving petrifying psychotherapeutic experiences

Although most of our patients will enter the consulting room quite quietly, often in a depressive state, having contained their sadistic impulses, a tiny fraction of those with whom we work will attack us in a variety of chilling ways. In this article, the author describes in detail two particularly terrifying clinical experiences in which a patient either threatened to kill him or actually sullied his consulting room with bodily fluids. Drawing upon his psychotherapeutic encounters not only with intellectually disabled patients and forensic patients but, also, with those who presented as ordinary “normal-neurotics”, the author considers the phenomenology of these “bomb”-like explosions and explains how he attempted to maintain a classical psychoanalytical focus of understanding, which consisted of a careful scrutiny of the countertransference and a firm commitment to the interpretation of unconscious material, whilst under attack. Furthermore, he examines the essential role of speaking with experienced colleagues who will provide essential supervision or assistance during these challenging chapters of clinical practice. The author also considers the many ways in which “bombs” can be hurled not only by the more obviously dangerous or disturbed individuals but, also, with surprising frequency, by those with no criminal history whatsoever, who, upon first encounter, often present as reasonably healthy.

Identification of three novel pathogenic mutations in cystathionine beta-synthase gene of Pakistani intellectually disabled patients

Background Classical homocystinuria (HCU) is an autosomal recessive inborn error of metabolism, which is caused by the cystathionine-β-synthase (CBS: encoded by CBS) deficiency. Symptoms of untreated classical HCU patients include intellectual disability (ID), ectopia lentis and long limbs, along with elevated plasma methionine, and homocysteine. Methods A total of 429 ID patients (age range: 1.6–23 years) were sampled from Northern areas of Punjab, Pakistan. Biochemical and genetic analyses were performed to find classical HCU disease in ID patients. Results Biochemically, nine patients from seven unrelated families were identified with high levels of plasma methionine and homocysteine. Targeted exonic analysis of CBS confirmed seven causative homozygous mutations; of which three were novel missense mutations (c.451G>T; p.Gly151Trp, c.975G>C; p.Lys325Asn and c.1039 + 1G>T splicing), and four were recurrent variants (c.451 + 1G>A; IVS4 + 1 splicing, c.770C>T; p.Thr257Met, c.808_810del GAG; p.Glu270del and c.752T>C; p.Leu251Pro). Treatment of patients was initiated without further delay with pyridoxine, folic acid, cobalamin, and betaine as well as dietary protein restriction. The immediate impact was noticed in behavioral improvement, decreased irritability, improved black hair color, and socialization. Overall, health outcomes in this disorder depend on the age and symptomatology at the time of treatment initiation. Conclusions With personalized treatment and care, such patients can reach their full potential of living as healthy a life as possible. This screening study is one of the pioneering initiatives in Pakistan which would help to minimize the burden of such treatable inborn errors of metabolism in the intellectually disabled patients.

A Wearable Low-cost Muscle Activated Switch for Wireless Control for the Physically Challenged Patients

BackgroundTo control the environmental conditions of the living place and to use the electrical appliances and computers etc. are one of the major challenges for the physically disabled persons and elderly people. The surface electro myography (sEMG) is employed to detect the muscle movement and used for games therapy and various others applications. This paper presents a low-cost wearable muscle switch designed to acquire sEMG signal and process it to provides the control, gaming therapy and mode of communication to the physically disabled patients.ResultsThis paper proposes a wearable low-cost muscle activated switch to assist the physically challenged members of the society. The designed muscle activated switch consists of Myoware muscle sensors that is used for data acquisition and to detect the muscle activity from the target muscle using Electromyography (EMG) signals. The Arduino board provides the human-computer interface and control to the devices based on the muscle signal. The Bluesmirf bluetooth is used for the wireless connectivity to our designed system that assists the physically disabled persons to use the computer and to control the home appliances via commercially available Grid 3 software and wifi switches. The novelty of this muscle sensor switch is that it can be connected to any bluetooth compatible devices that can be controlled from any targeted muscle. The system was tested with Grid 3 software on laptop for environmental control and text to speech conversion.ConclusionsA low cost muscle sensor based Bluetooth switch system for the physically disabled patients has been presented in this paper. The designed switch can be connected to any Bluetooth enabled device as demonstrated in this paper. The physically disable persons can select any module from the Grid 3 software such as the environmental control (to control the environment via electrical appliances), text to speech converter (for Aphasia patients), gaming therapy etc. The designed system can also be utilized to use the Bluetooth enabled electric gadgets such as Mobile Phones, Ipad and android Tablets etc. in accessibility mode.

IMPACT OF COLOUR ON DEPRESSION, ANXIETY AND STRESS LEVELS OF PHYSICALLY DISABLED PATIENTS IN HEALTH CARE FACILITIES

Physically disabled community in Sri Lanka is not receiving sufficient attention with reference to the conduciveness of their living environments. The patients who are harrowed with mobility impairments should be supported to overcome challenges which hinder the smooth functioning of day today physical activities while maintaining their psychological health by incorporating disabled-friendly, optimum healing design interventions. In view of this, an attempt was made to determine the impact of interior colours to reduce depression, anxiety and stress levels of disabled individuals. The investigation was executed with reference to wall colour of patient’s (n=15) bedrooms of a selected rehabilitation centre, at Ragama. The impact of three selected hues (blue, yellow and green) were tested by installing colour panels on the sidewall of the beds, allowing the participants to be exposed to each colour for three consecutive days. Depression, anxiety and stress levels of participants were measured using DASS-21. Impact of green colour was found to be more favourable to reduce depression, anxiety and stress levels of participants over blue and yellow. It is recommended to extend this study further to test different hues, shades and intensities of green colour with long-term exposure, to enhance psychological health and well-being of disabled patients in health care facilities.

Communication barriers that affect medication adherence in patients with learning disabilities

Having a disability that affects communication can cause particular problems in primary care as inadequate communication can lead to the wrong diagnosis, poor assessments and inadequate health care ( Murphy, 2006 ). All patients are entitled to accessible and appropriate information on prescribed medication to facilitate a deeper understanding of the benefits and harms of treatment ( Grime et al, 2007 ). Reasonable adjustments should be made for learning difficultly patients and this can be in the form of easy reads guides that incorporate larger text, simple information and pictural explanations. Communication passports are a tool used by learning disabled patients, these provide both a practical and person-centred approach to passing on key information about people with complex communication difficulties ( Nursing Times, 2018 ). They provide information about the communication needs and health needs of a patient which is useful to assist in bridging the communication gap between nurse practitioner and patient. In a time of technological advancements, a move towards digital passports would be more beneficial with regular updates from the multidisciplinary team. This in turn can be shared across numerous health platforms the patient might come into contact with, allowing the nurse practitioner to better prepare for the patient prior to their consultation. Education on learning disabilities is an area of training that is lacking in general practice, there have been no provisions made to make the training mandatory. Incorporating mandatory yearly staff training will ensure nurse practitioners have the tools and knowledge to adapt communication techniques during a consultation.

Értelmi sérültek fogászati állapotának felmérése

Összefoglaló. Bevezetés: Magyarországon 100 000 olyan értelmi sérült él, akik speciális ellátásra szorulnak. Előzőleg beszámoltunk az akut fogászati ellátás eredményeiről és problémáiról. Ahhoz azonban, hogy a teljes fogászati rehabilitáció felé lépéseket lehessen tenni, ismerni kell az ilyen betegek fogászati állapotát. Célkitűzés: Statisztikailag releváns, nagyobb beteganyagon felmérni az értelmi sérült betegek fogászati állapotát, összehasonlítva mind az orvosi rehabilitációs kezelésben részesülő betegek (főleg testi fogyatékosok), mind az általános populáció adataival. Módszer: A fogászati állapot felmérésére két betegcsoport állt rendelkezésünkre. Összesen 325 beteg statusát rögzítettük. A vizsgáltakat 3 csoportba osztottuk: enyhe (36), közepes (247) és súlyos (42) értelmi sérültek. Az értelmi sérült betegek fogászati állapotát DMF-T-indexszel mértük, és összehasonlítottuk az orvosi rehabilitációs kezelésben részesülő betegek és az általános populáció adataival is. Eredmények: A 325 szellemi sérült össz-DMF-T-indexének átlaga ± szórás: 11,04 ± 7,35; a carieses fogak számának átlaga: D = 3,66 ± 4,61; a hiányzó fogak számának átlaga: M = 5,22 ± 5,74. A fogmegtartó kezelés minimális volt: átlag F = 2,16 ± 3,12. Azoknak az értelmi sérülteknek, akik intézetben élnek, rosszabb a fogazati állapotuk, mint azoknak, akik családban vannak. Következtetések: Az eredményekből látszik, hogy az értelmi sérültek fogai elhanyagoltabbak, mint a normálpopuláció esetében. A DMF-T-index önmagában nem tükrözi ezeket a magállapításokat, csak akkor, ha szétbontva vizsgáljuk az adatokat. Orv Hetil. 2021; 162(42): 1698–1702. Summary. Introduction: There are 100,000 mentally disabled individuals in Hungary requiring special care. Previously, we reported the results and problems of acute dental care. However, in order to take the appropriate measures toward holistic dental rehabilitation, clarity regarding the condition of those mentally disabled individuals is necessary. Objective: To measure the dental health of mentally disabled individuals based on a large sample of patients, to compare the results with both differently-abled (i.e., primarily physically disabled) individuals and the general population. Methods: There were two available patient cohorts for the measurement of dental health. With the two cohorts combined, we recorded data about 325 patients. We split the patients into three groups: mild (36), medium (247), and severe (42) mental disability. We used DMF-T index to measure dental health status, and compared the results with those of physically disabled and the general population. Results: The mean ± deviation of DMF-T index of the disabled patients was 11.04 ± 7.35; the mean of decayed teeth: D = 3.66 ± 4.61; the missing teeth: M = 5.22 ± 5.74; the filled teeth: F = 2.16 ± 3.12. Mentally disabled patients living in institutions showed worse dental health than those living with families. Conclusions: The results show that the teeth of mentally disabled patients are more neglected than those of the general population. The DMF-T index does not mirror these conclusions unless we examine each data set separately. Orv Hetil. 2021; 162(42): 1698–1702.

Electrical Appliance Switching Controller by Brain Wave Spectrum Evaluation Using a Wireless EEG Headset

Disabled people are usually unable to interact with their surroundings efficiently, and performing tasks like switching an appliance on or off can be troublesome if the user is bedridden, for example. This article discusses an electrical appliance switching controller using a wireless EEG headset that is aimed to aid elderly people and the disabled. The system comprises of a MindLink EEG headset that is Bluetooth-connected to an Arduino microcontroller board. The system permits the user to separately switch on and off the 4 electrical devices connected to the power socket. The EEG signal is obtained to investigate the brain activity throughout the experiments done. Based on the brain wave signals read, attention and meditation are determined to be the most suitable for this project and is used to trigger the relay switching of the power socket. It is found that the response time to trigger the switching is slow as some users require practice or training to control their brain wave signals effectively. The work performed provides a rudimentary insight of a BCI system functionalities and presents a brainwave-controlled hardware switching for the bedridden or disabled patients.