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A Rare Case of Wilsons Disease with Zoophilia
Prakash Barman,
Madhurima Khasnobis,
Kamal Nath
Issue:
Volume 7, Issue 4, December 2019
Pages:
78-82
Received:
19 August 2019
Accepted:
4 October 2019
Published:
17 October 2019
Abstract: Wilsons Disease also known as hepatolenticular degeneration is a autosomal recessive disorder, characterized by abnormal copper deposition in the liver, brain, and other tissues caused by mutation in the copper transporting gene ATP7B. Patients presents with neurological and hepatic disorder. Psychiatric manifestation are common along with movement disorder but its association with paraphilic disorders like zoophilia is very rare and there is practically no literature regarding this in North-Eatern India. In this article we report the unique case of a 21 year old boy from rural Assam suffering from Wilson’s disease with multiple neuropsychiatric manifestations among which zoophilia was noteworthy. This case report highlights a rare and atypical association between an adolescent patient of Wilson disease & zoophilia--- a relatively rare paraphilic disorder. A 21 year old boy presented in the Psychiatry emergency department in a tertiary care hospital with aggressive, disorganized behavior with reported sexual act with a cow. Examination of the patient also revealed massive organomegaly and K-F ring which on further investigation confirmed the diagnosis of Wilsons Disease. The occurrence of zoophilic behavior in Wilsons disease is very rare and we have not come across any such report regarding this. To conclude, the association between copper deposition in specific brain areas due to Wilsons disease and zoophilic behaviour we need further studies with better investigative modalities, which will in turn help in drawing an individualise treatment plan.
Abstract: Wilsons Disease also known as hepatolenticular degeneration is a autosomal recessive disorder, characterized by abnormal copper deposition in the liver, brain, and other tissues caused by mutation in the copper transporting gene ATP7B. Patients presents with neurological and hepatic disorder. Psychiatric manifestation are common along with movement...
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Neuroleptic Malignant Syndrome, a Sequalae of Multiple Administration of Antipsychotics: A Case Report
Nervana Abdelfattah Hafez Elbakary,
Mohamed Adil Shah Khoodoruth
Issue:
Volume 7, Issue 4, December 2019
Pages:
83-87
Received:
21 September 2019
Accepted:
9 October 2019
Published:
5 November 2019
Abstract: Neuroleptic malignant syndrome (NMS) is a lethal adverse drug reaction (ADR) that is often attributed to the administration of dopamine blockers, antiemetic agents as well as anti-parkinsonism medication withdrawal. We describe a challenging case of NMS, with malignant catatonia as a differential diagnosis, who was difficult to respond to treatment. The patient developed severe complications following her exposure to rapid titration using high doses of olanzapine, which was abruptly converted to chlorpromazine due to lack of efficacy, in addition to administering multiple as needed (PRN) medications for agitation. Hyperthermia, muscle rigidity, dysautonomia, mental status changes, catatonia, and some laboratory derangement were reported in this case. It is possible that factors such as naïve patients, high doses of neuroleptics, a switch from one agent to another, rapid escalation, and the increased use of parenteral therapy for managing of agitation acted collectively or individually as risk factors for developing NMS. Health care professionals should be cautious about the cumulative dose of antipsychotics used per day, including PRN medications. The delay in recognizing the early symptoms of NMS could put patients at higher risk of mortality. Lastly, it is pivotal to exclude other infectious or autoimmune etiologies before treating as NMS case.
Abstract: Neuroleptic malignant syndrome (NMS) is a lethal adverse drug reaction (ADR) that is often attributed to the administration of dopamine blockers, antiemetic agents as well as anti-parkinsonism medication withdrawal. We describe a challenging case of NMS, with malignant catatonia as a differential diagnosis, who was difficult to respond to treatment...
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Novel Insights into the Psychopathology of War
Issue:
Volume 7, Issue 4, December 2019
Pages:
88-99
Received:
9 October 2019
Accepted:
6 November 2019
Published:
12 November 2019
Abstract: Background: To grasp the terrible nature and enormity of nuclear weapons is a painful exercise of the imagination. Recent political developments between different nuclear countries are quite alarming. A nuclear war would be an absolute disrespect and cruelty toward humanity and nature. Religion is simply made a scapegoat in times of wars. The psychopathology of war is “the elephant in the room.” Aim: To evaluate the different psychological, psychopathological views and para-psychodynamics of global conflicts as well as some of the future directions in peace research. Method: A selective survey of the literature, including previous reviews, to collect different understandings to help inspire and form a framework for future peace research. Results: The medical profession has a major burden in the form of physical and emotional rehabilitation after war; therefore, prevention is better than cure and rehabilitation. Psychological, political, religious, and economic factors may be at the root of war. Even though the psychopathology of war is being studied, the para-psychodynamics of global conflicts are poorly understood. Peace research without identifying the causative factors would be like treating an infection without recognizing the infecting agent. Marian apparitions offer some insight into this important aspect of peace research. In each credible, worldwide religion, there is a strong longing for peace and harmony, and mental health workers should get enlightenment from the wisdom of world religions. Both religious leaders and mental health professionals must take the helm in peace-making. The new insights gained through research into the psychopathology of global conflicts can inspire the international mental health professionals to support the existing peace campaigns to create a world without war, crimes and poverty.
Abstract: Background: To grasp the terrible nature and enormity of nuclear weapons is a painful exercise of the imagination. Recent political developments between different nuclear countries are quite alarming. A nuclear war would be an absolute disrespect and cruelty toward humanity and nature. Religion is simply made a scapegoat in times of wars. The psych...
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In Differential Diagnosis of Dementia Application of Easy Z-score Imaging System in Single Photon Emission Computed Tomography Brain Perfusion Scan
Nasreen Sultana,
Hiroshi Matsuda,
Azmal Kabir Sarker,
Jasmine Ara Haque,
Rafiqul Islam
Issue:
Volume 7, Issue 4, December 2019
Pages:
100-107
Received:
20 October 2019
Accepted:
6 November 2019
Published:
12 November 2019
Abstract: Application of easy Z score imaging system (eZIS) on brain perfusion SPECT images for quantitative evaluation of rCBF has attempted to explore the differential diagnosis of dementia with various degenerative diseases and to evaluate discrimination of early Alzheimer’s disease (AD) from other types of dementia. This retrospective study was done with various degenerative diseases that underwent brain perfusion SPECT using 99mTc ethyl cysteinate dimer were included. Brain perfusion SPECT was performed in 58 patients (M/F = 48/10) with mean age of 61.2±10.4 years (41-90). Decreased rCBF was observed in the area suspected early AD in 20 cases (34%) and in the frontal gyrus and insula in 10 cases (17%). And decreased rCBF was observed in occipital lobe and, precuneus, gyrus and posterior cingulate cortex in 8 cases (14%). Discrete areas of decreased rCBF were seen in 14 cases (24%) and the rest of 6 cases (11%) showed normal rCBF. Clinically suspected AD patients were divided into two groups on basis of MMSE score (group A, mild stage of AD, MMSE =20-26 and group B, moderate to severe stage of AD, MMSE=10-19). Mean MMSE and mean Z scores were 22.9±1.11 and 1.01±0.35 in group A (n = 12) while 17.56±0.96 and 2.62±0.59 in group B (n= 8). There was negative correlation between MMSE and eZIS score; r = - 0.69 in group A (p = 0.002); r = - 0.58 in group B (p = 0.019) and r = - 0.93 overall (p = 0.000). Quantification of rCBF with eZIS score was well associated with clinical MMSE scoring in this study group with clinical likelihood of having AD. In rest of the cases, SPECT findings and surface view analysis by eZIS, the affected area of decreased rCBF were consistent with clinically suspected different types of degenerative disease manifesting dementia.
Abstract: Application of easy Z score imaging system (eZIS) on brain perfusion SPECT images for quantitative evaluation of rCBF has attempted to explore the differential diagnosis of dementia with various degenerative diseases and to evaluate discrimination of early Alzheimer’s disease (AD) from other types of dementia. This retrospective study was done with...
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A Review of Psychosocial Interventions in Patients with Advanced Cancer in Latin America and the Value of CALM Therapy in This Setting
Paulina Troncoso,
Anne Rydall,
Sarah Hales,
Gary Rodin
Issue:
Volume 7, Issue 4, December 2019
Pages:
108-118
Received:
13 May 2019
Accepted:
6 November 2019
Published:
21 November 2019
Abstract: Background: Advanced cancer is associated with multiple profound and practical challenges, including physical suffering and support needs. Depressive symptoms and other manifestations of distress are common in this population. At present, little professional support is available to help to alleviate the psychological distress of patients and families living with the burden of advanced cancer. Effective interventions and their integration into local health systems are needed to meet this challenge. Managing Cancer and Living Meaningfully (CALM), a brief psychotherapy intervention for patients with advanced cancer. Research conducted in Canada has demonstrated its feasibility, acceptability and effectiveness in reducing and preventing depressive symptoms, in managing distress related to death and dying, and in preparing for the end of life. Research is needed to demonstrate the feasibility and acceptability of CALM in Latin America, a developing region comprised of 35 different low- and middle-income countries in South and Central America, where more than one million people are presently in need of end-of-life care. Aim: Review evidence for psychosocial oncology interventions in Latin America and the potential applicability and implementation of CALM therapy in patients with advanced Cancer in this setting. Methods: We used an iterative search process to locate information about psychological interventions for patients with advanced cancer in South/Central/Latin America. Multiple searches were performed in Medline, Google Scholar, National Guidelines Clearinghouse, Trip Database, Redalyc, Scielo, and Latindex for terminology describing cancer, end-of-life, psychology, and psychological interventions. In the larger resources, we added either limits or search terms for Latin America. Results: The literature identified describes psychological interventions for patients with cancer, including psychoeducation, support therapies, group therapies, cognitive behavior therapy, spirituality and hypnosis. However, very few of these interventions were specifically designed for patients with advanced cancer. The majority of articles describe psychological/ psychotherapeutic interventions being implemented in Europe, North America, and Australian settings and we could identify only two papers describing psychological interventions being applied in an advanced cancer setting in Latin America. Conclusion: The availability and practice of psychological interventions in advanced cancer in Latin America are scarce. However, interest in applying such interventions appears to be growing. The application of the CALM intervention in multiple cultures and international settings suggests that it may be feasible and acceptable and effective in Latin America. Research is needed to demonstrate this and to support advocacy for its implementation in this region.
Abstract: Background: Advanced cancer is associated with multiple profound and practical challenges, including physical suffering and support needs. Depressive symptoms and other manifestations of distress are common in this population. At present, little professional support is available to help to alleviate the psychological distress of patients and famili...
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To Assess the Compliance of Monitoring Metabolic Symptoms Associated with Antipsychotics in an Inpatient Setting in a Tertiary Care Hospital in Karachi, Pakistan
Humera Saeed,
Maheen Batool,
Muhammad Shameel Khan,
Rabeeka Aftab,
Mohammad Zaman
Issue:
Volume 7, Issue 4, December 2019
Pages:
119-125
Received:
19 October 2019
Accepted:
12 November 2019
Published:
26 November 2019
Abstract: Mental health problems like schizophrenia, bipolar affective disorder and use of second generation antipsychotics (SGA) are linked to the risk of developing metabolic syndrome. The purpose of our study was to determine the level of compliance to monitoring metabolic symptoms associated with second generation antipsychotics according to the standards of NICE guidelines. Secondly, we aim to develop a workable standardized protocol. A total of 385 patients admitted to psychiatric ward from February 2015-January 2016 were included in the study. Case files were reviewed to obtain relevant clinical information. Assessment of height, weight, pulse, blood pressure, movement disorders, level of physical activity and nutritional status were measured in all patients. Fasting blood glucose was measured in 99 (26.5%), glycosylated hemoglobin (HbA1c) in 39 (10.4%), blood lipid profile in 44 (11.8%) and prolactin in 3 (0.8%) patients. Less than half of the patients (118, 31.6%) underwent ECG investigation. Slow titration of medication (331, 88.5%) and a trial at optimum dosage (343, 81.7%) were routinely seen. Overall physical health and patient well-being was recorded in the majority of subjects (310, 82. 9%). A significant number of physical and biochemical parameters were not routinely monitored. Our study reports findings consistent with previous literature. With this we hope to highlight important concerns and make recommendations, especially in country like Pakistan where these monitoring systems are non-existing. This will not only reduce the risk of a number of complications secondary to antipsychotic medications, but will also improve patient adherence and compliance to the pharmacological treatment.
Abstract: Mental health problems like schizophrenia, bipolar affective disorder and use of second generation antipsychotics (SGA) are linked to the risk of developing metabolic syndrome. The purpose of our study was to determine the level of compliance to monitoring metabolic symptoms associated with second generation antipsychotics according to the standard...
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Understanding Medjugorje Apparitional Experiences: Medical and Parapsychological Perspectives
Issue:
Volume 7, Issue 4, December 2019
Pages:
126-141
Received:
16 November 2019
Accepted:
5 December 2019
Published:
11 December 2019
Abstract: Background. The continuing apparitional events at Medjugorje in Bosnia offer an opportunity for sceptics to gain fresh insight into an alleged mystical-cum-paranormal phenomenon. Initially, the apparitional experiences occurred in a collective manner ruling out the possibilities of psychological and spiritual artefacts. Ostensibly, according to the percipients, an active apparition—that has inserted itself harmoniously into our three-dimensional world—is manifesting itself at Medjugorje. In this respect, science is hindered by the lack of both theoretical tools and the vocabulary to handle mystical and paranormal events. Apparitional occurrences involve apparitional experience, the apparition and social events. The apparition is beyond the parameters of science and only apparitional experience can be scientifically studied; social events are more important to social sciences and theology. Aim. To test the postulation that visionary experiences involving RSPK, or RSPK-like activity may be instances of apparitions at the physical site and find the results applying this criterion along with other distinguishable features specific to Marian apparitional experiences. To evaluate the different psychological, parapsychological, psychopathological views usually held against true apparitional experiences. Method. Observational and quantitative studies attempted accepting the limitations. Selective survey of the scientific and journalistic literature including previous reviews has been carried out to collect different interpretations which also help to form a framework for an informed conclusion. Results. The voice extinction and sensory disconnection exhibited by the Medjugorje witnesses could probably be explained as a manifestation of psychokinetic-like activity of the apparition. Unlike other generic apparitional experiences reported in the scientific literature on parapsychology, the percipients and the apparition at Medjugorje partake in back and forth communication for extended periods of time. It is obvious that these are not self-generated. Medical studies indicate that there are dual modes of perception proving an inward cum outward apparitional experience. These apparitional experiences have the same pattern as those the officially authenticated Marian apparitions of the past. Additionally, the terrestrial memories revealed to the percipients prove the identity of the apparition as the Mother of Jesus. Apart from the spiritual and religious implications, Medjugorje is thought to be at the forefront of a revolutionary paradigm shift in the field of consciousness studies that may be unprecedented in scope. Psychiatry is currently founded on medical reduction and will have to make many adjustments according to the paradigmatic shifts in cognitive sciences; mental health professionals should be tuned to these on-going mystical happenings.
Abstract: Background. The continuing apparitional events at Medjugorje in Bosnia offer an opportunity for sceptics to gain fresh insight into an alleged mystical-cum-paranormal phenomenon. Initially, the apparitional experiences occurred in a collective manner ruling out the possibilities of psychological and spiritual artefacts. Ostensibly, according to the...
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Mental State of the Workers of the Ministry of Higher Education and Scientific Research (MESRS) in Benin in 2018
Gansou Grégoire Magloire,
Eganhoui Denis,
Klikpo Elvyre,
Gnansounnou Glele Alda Lidwine Ekoundayo,
Houessou Patrick Yélindo Dossou
Issue:
Volume 7, Issue 4, December 2019
Pages:
142-146
Received:
20 November 2019
Accepted:
12 December 2019
Published:
23 December 2019
Abstract: The work environment is an environment at risk for the psychological well-being of workers. This research is conducted on a population of 348 workers from the Ministry of Higher Education and Scientific Research (MESRS) in Benin. It was a cross, descriptive study, with an analytical goal, with non-probabilistic sampling, and by convenience. The research tools were documentation, SATIN scales, interview and observation. The results processed and analyzed by the Excel software, and R show that the general health is poor in 14.7% of workers, average in 27.9%, and good in 57.5%. Psychological health is poor in 10.3%, average in 18.1%, and good in 71.6%. Physical health is poor in 6.1% of workers, average in 24.4%, and good in 69.6%. Similarly, stress is bad for 13.5% of workers, average for 37.7%, and good for 48.8%. Psychosomatic symptoms are poor in 19.6% of workers, average in 21.1% and 59.2%. The symptoms are poor in 31.0% of workers, average in 16.5%, and good in 52.5%. The well-being of this population is attributable to several factors, the predominant element of which is the organizational environment and its conditions. Better consideration of the factors that strengthen human capital is essential for the physical and psychological well-being of MESRS workers.
Abstract: The work environment is an environment at risk for the psychological well-being of workers. This research is conducted on a population of 348 workers from the Ministry of Higher Education and Scientific Research (MESRS) in Benin. It was a cross, descriptive study, with an analytical goal, with non-probabilistic sampling, and by convenience. The res...
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Prevalence of Radiological Abnormalities Among Psychiatric Inpatients: A Study from the United Arab Emirates
Amir Mufaddel,
Ghanem Al Hassani,
Shakhboot Al Bedwawi,
Ossama Osman
Issue:
Volume 7, Issue 4, December 2019
Pages:
147-152
Received:
5 December 2019
Accepted:
18 December 2019
Published:
30 December 2019
Abstract: Background: This is a cross sectional retrospective study aimed to estimate the prevalence of brain aberrations visible on computed tomography (CT) scan or magnetic resonance imaging (MRI) in psychiatric patients admitted to the main tertiary hospital of Alain city in the United Arab Emirates. Methods: Between January 2011 and December 2013, 1,586 patients were admitted study of patients admitted to the psychiatric ward in Al Ain Hospital. Head CT or brain MRI was requested for 295 (19%) patients. Results: Ninety-four (31.8%) of the 295 patients had abnormalities on the CT or MRI. The most common finding was calcification, detected in 21 (22.3%) patients. The most common site of calcification was the basal ganglia (15 patients, or 16%). Multiple site involvements were also common (16 patients, or 17%). Other types of brain abnormalities included evolutionary changes (dilated ventricles, atrophy and prominent sulci) reported in 13 patients which represent 4.4% of the total sample and 13.8% of those with positive findings. Similar number was reported for patients with findings of vascular lesions (ischemic changes / infarction). Basal ganglia was the most common site of reported involvement occurring in 19 subjects and representing 6.4% of the total sample and 20.2% of those with positive findings. Common age at presentation with positive findings was 30-39y. Conclusions: Radiological abnormalities are common among psychiatric inpatients. Future studies are needed to identify the potential significance of these findings and correlate them with patient’s psychopathology.
Abstract: Background: This is a cross sectional retrospective study aimed to estimate the prevalence of brain aberrations visible on computed tomography (CT) scan or magnetic resonance imaging (MRI) in psychiatric patients admitted to the main tertiary hospital of Alain city in the United Arab Emirates. Methods: Between January 2011 and December 2013, 1,586 ...
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Controversies on the Repercussions of Cannabis Use on Mental Health: Critical Clarifications
José Manuel Bertolín-Guillén
Issue:
Volume 7, Issue 4, December 2019
Pages:
153-157
Received:
1 December 2019
Accepted:
19 December 2019
Published:
31 December 2019
Abstract: Background. It is scientifically undeniable that there is a relationship between cannabis use, psychoses of different types and other mental disorders. Frequent use of cannabis as well as high potency synthetic cannabis has special clinical significance for public health. Method. A review of the best and most current specialized literature published in order to clarify possible controversies that still persist. The aim is to resolve certain doubts so that scientifically supported criteria on the risks and dangers of cannabis use for mental health can be issued without any prejudices. Result. Cannabis is the most used illegal drug in the US and worldwide over the past year. Some authors hypothesize about interaction bias and confounding that could annul the internal validity of many studies reporting on the dangers of cannabis for mental health. They also emphasize that cannabis use should not be criminalized. This is, however, a merely speculative or unrealistic hope that disregards the wealth of scientific data that reject the authors’ aspiration according to the available evidence consulted. Conclusion. The most qualified scientific journals, in line with the main professional institutions, have been rigorously and accurately informing their readers ˗and must continue doing it˗ of the dangers and harm caused by substance use, including cannabis. In short, the issue is to try to decrease the incidence of the related mental disorders which are sufficiently acknowledged. Mental health professionals cannot and must not be neutral or ambiguous regarding cannabis use, its collective spreading and the health risks that it entails.
Abstract: Background. It is scientifically undeniable that there is a relationship between cannabis use, psychoses of different types and other mental disorders. Frequent use of cannabis as well as high potency synthetic cannabis has special clinical significance for public health. Method. A review of the best and most current specialized literature publishe...
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