Showing papers in "Asian Journal of Psychiatry in 2011"

Mental health in Vietnam: Burden of disease and availability of services

Abstract: Purpose: Despite the accomplishments, the economic and social reform program of Vietnam has had negative effects, such as limited access to health care services for those disadvantaged in the new market economy. Among this group are persons with mental disorders. This paper aims to understand the burden of mental disorders and availability of mental health services (MHS) in Vietnam. Methods: We reviewed both national as well as the international literature about the burden of mental disorders and MHS in Vietnam. This included academic literature (Medline, Pubmed), national (government) reports, World Health Organization (WHO) reports, and grey literature. Results: The burden of mental disorders in Vietnam is similar to that of other Asian countries and occurs across all population groups. MHS have been made one of the national health priorities and more efforts are being made to promote equity of access by integrating MHS into other health care programs and by increasing MHS capacity. However, it is not yet sufficient to meet the care demand of persons with mental disorders. Challenges remain in various areas of MHS, including: lack of mental health legislation, human resources, hospital beds, shortage and diversification of MHS. Conclusion: Although MHS in Vietnam have considerably improved over the last decade, mainly in terms of accessibility, the care demand and the illness burden remain high. Therefore, more emphasis should be put on increasing MHS capacity and on human resource development. In that process, more representative epidemiological data and intervention research is needed.

Validation of Social Cognition Rating Tools in Indian Setting (SOCRATIS): A new test-battery to assess social cognition.

Abstract: Social cognition is a cognitive domain that is under substantial cultural influence. There are no culturally appropriate standardized tools in India to comprehensively test social cognition. This study describes validation of tools for three social cognition constructs: theory of mind, social perception and attributional bias. Theory of mind tests included adaptations of, (a) two first order tasks [Sally-Anne and Smarties task], (b) two second order tasks [Ice cream van and Missing cookies story], (c) two metaphor-irony tasks and (d) the faux pas recognition test. Internal, Personal, and Situational Attributions Questionnaire (IPSAQ) and Social Cue Recognition Test were adapted to assess attributional bias and social perception, respectively. These tests were first modified to suit the Indian cultural context without changing the constructs to be tested. A panel of experts then rated the tests on likert scales as to (1) whether the modified tasks tested the same construct as in the original and (2) whether they were culturally appropriate. The modified tests were then administered to groups of actively symptomatic and remitted schizophrenia patients as well as healthy comparison subjects. All tests of the Social Cognition Rating Tools in Indian Setting had good content validity and known groups validity. In addition, the social cure recognition test in Indian setting had good internal consistency and concurrent validity.

What is the relationship between alexithymia and ego defense styles? A correlational study with Iranian students.

Abstract: The relationship between alexithymia and ego defense styles was investigated in a sample of Iranian students. The association between the components of alexithymia including difficulty in identifying and describing feelings and externally oriented thinking with ego defense styles including mature, neurotic, and immature defense styles was investigated in two hundred and eighty six students in the University of Tehran. All participants were asked to complete the Farsi version of the Toronto Alexithymia Scale (FTAS-20) and Defense Styles Questionnaire (DSQ). Results showed that there was a significant negative correlation between alexithymia and mature defense style as well as a significant positive association with neurotic and immature defense styles. It is concluded that alexithymia is associated with ego defense mechanisms. Results are discussed in terms of the implications of the present results in terms of designing possible modification and intervention programmes as well as answering important theoretical questions.

The effect of a brief family intervention on primary carer's functioning and their schizophrenic relatives levels of psychopathology in India.

Abstract: A B S T R A C T This study examined the short term effects of a brief familial intervention on schizophrenic the patient’s levels of psychopathology and their primary caregiver’s functioning in India. Caregiver functioning was measured by the caregiver’s levels of burden and coping along with the patient’s perceived level of expressed emotion (EE). The participants were 18 schizophrenic patients and their related primary carer from a medical facility in India. The patients’ levels of psychopathology and EE were assessed at baseline and at completion of the study with the Positive and Negative Syndrome Scale (PANSS; Kay et al., 1987) and the Family Emotional Involvement And Criticism Scale (FEICS; Shields et al., 1992), respectively. The primary caregiver’s levels of burden and coping were also measured at baseline and upon completion of the study by the Burden Assessment Scale (BAS; Thara et al., 1998) and the Family Crisis Oriented Personal Evaluation Scale (F-COPES; McCubbin et al., 1981), respectively. The brief intervention was comprised of 3 one hour sessions aimed at educating the primary caregiver and patient about schizophrenia; along with improving their communication, problem solving skills and expression of emotions. A significant improvement was found between baseline and the final 3-month follow-up on measures of psychopathology for the patients, as well as family functioning for both the caregivers and patients. The implications of the findings are discussed, along with future research directions.

Global mental health: Global strengths and strategies: Task-shifting in a shifting health economy

Abstract: Global mental health challenges sit at the frontiers of health care worldwide The frequency of mental health disorders is increasing, and represents a large portion of the global burden of human disease (DALYs) There are many impeding forces in delivering mental health care globally The knowledge of what mental health and its diseased states are limits the ability to seek appropriate care Limited training and experience among primary providers dilutes the capacity of systems for adequate care, support, and intervention There are limited numbers of medical personnel worldwide to attend to individuals afflicted by mental health disorders The challenges of global mental health are the capacity of the global systems to enhance knowledge and literacy surrounding mental health disorders, enhance and expand ways of identifying and treating mental health disorders effectively at an early stage in its course Much has been written about the epidemiology of mental health disorders globally followed by discussions of the need for improvements in programs that will improve the lot of the mentally ill Task shifting involves the engaging of human resources, generally nonprofessional, in the care of mental health disorders Engaging traditional healers and community health workers in the identification and management of mental health disorders is a very strong potential opportunity for task shifting care in mental health In doing so it will be necessary to study the concept of mental health literacy of traditional healers and health workers in a process of mutual alignment of purpose founded on evidence based research

Differential actions of antidepressant treatments on cardiac autonomic alterations in depression: A prospective comparison.

Abstract: Background Patients with depression have higher rates of cardiac morbidity and mortality. Alterations of cardiac autonomic functions associated with depression may partly explain this. Prospective studies comparing the effects of antidepressants on these abnormalities are limited due to confounding factors and co-morbidities. Methods Cardiac autonomic functions were studied in antidepressant naive patients with major depression (without co-morbid medical or psychiatric disorders) before and after treatment with repetitive transcranial magnetic stimulation (rTMS; n = 30), specific serotonin reuptake inhibitors (SSRIs; n = 32) and tricyclic antidepressants (TCAs; n = 32). Conventional autonomic function tests and time- and frequency-domain measures of heart rate variability (HRV) were measured using standard procedures. Changes in autonomic functions were compared across the three treatment groups using repeated measures analysis of variance (ANOVA) using sex and age as covariates. Results Depression improved by comparable extent across patients treated with the three treatments. Overall, there was no change in cardiac autonomic functions. However, significant group × occasion interactions were noted for HRV measures. Both time- and frequency-domain HRV measures showed increase with rTMS and decrease with TCAs; they remained virtually unchanged with SSRIs. Limitations One of the major limitations of our work being we could not randomize the treatment groups. Conclusions The effects of antidepressant treatments on cardiac autonomic function abnormalities found in depression vary with the mode of treatment used. Long-term clinical implications of these effects on cardiac health of patients with depression need further studies.

Attitude Toward Own Aging and Mental Health in Post-menopausal Women.

Abstract: INTRODUCTION: Attitudes toward own aging (ATOA) refers to expectations about the personal experience of aging. As of now, there is limited literature that addresses the impact of ATOA on indicators of psychological, physical, and social health. In this study, we examine associations between ATOA and several measures associated with successful aging. METHODS: A detailed cross-sectional survey questionnaire on successful aging was completed by 1,973 older women enrolled in the San Diego site of the Women's Health Initiative study. ATOA was measured using the Philadelphia Geriatric Morale Scale (PGMS) RESULTS: The final sample consisted of 1151 women. The mean ATOA score was 3.8 indicating generally positive ATOA. Positive ATOA score was significantly associated with younger age, lower income, being married, higher SF-36 Physical Composite scores, higher SF-36 Mental composite scores, lower depression scores, and higher resilience scores. Approximately 40% of variance in ATOA scores was explained by successful aging-related domain scores. CONCLUSIONS: Better physical and emotional functioning, greater resilience and lower depression are associated with more positive ATOA. Associations with sociodemographic traits are complex. Modifying ATOA may have potential to impact a broad range of health and successful aging related outcomes.

Quality of life in patients with obsessive compulsive disorder: A longitudinal study from India.

Abstract: Obsessive Compulsive Disorder (OCD) is one of most frequently diagnosed psychiatric illness, tends to run a chronic course and severely affects the patient's quality of life (QoL). The aim of this study was to assess QoL in patients with OCD and compare it with QoL of patients with major depressive disorder (MDD) and healthy controls. Forty-five patients with OCD, fifty patients with the diagnosis of MDD and one hundred and fifty healthy controls were evaluated using WHOQoL-BREF, Hindi version and their QoL scores were compared. Symptom severity of the OCD group was measured using Yale Brown Obsessive Compulsive Scale (YBOCS) and was charted longitudinally over a period of 6 months. The QoL of patients with OCD was found to be significantly lower in the domains of physical, psychological well-being and social domains as compared to the healthy controls. When compared with patients with MDD, the pre-treatment QoL of patients with OCD was found to be significantly higher. Six months follow up found Psychological health domains of QoL better in the MDD group than the OCD group. Between MDD and OCD groups, statistically significant differences were noted in the environment domains, though overall improvement in QoL scores was noted in both the groups in all domains. YBOCS scores significantly improved with treatment in OCD patients, as did the scores on WHOQoL-BREF. Minimal correlation was found between changes in YBOCS scores and QoL scores in OCD subjects at 6 months follow up. These findings indicate that all aspects of QoL are markedly affected in individuals with OCD, QoL scores improve with treatment and the changes in QoL scores over a period of 6 months are not necessarily correlated with corresponding changes in YBOCS scores (indicative of symptom severity in OCD subjects).

Association of depression with social support and self-esteem among HIV positives

Abstract: Background Depression in Human Immunodeficiency Virus (HIV) positives has implications such as poor drug compliance, lower quality of life, faster progression to full blown Acquired Immunodeficiency Syndrome (AIDS) and higher mortality. Aims To assess depression, social support and self-esteem in HIV positives and to find out the association of depression with social support and self-esteem among HIV positive patients. Setting and design Kasturba Medical College (KMC) Hospital, a tertiary care hospital, Mangalore, India and cross-sectional design. Methods and materials Study constituted of 105 HIV positive subjects; depression was assessed using BDI (Beck depression inventory), social support was assessed using Lubben social network scale and self-esteem was assessed using Rosenberg self-esteem scale. Statistical analysis Kappa statistics was used to measure the agreement of depression assessed by BDI with clinical diagnosis of depression. Logistic regression analyses were done to find out predictors of depression among HIV positives. All analyses were conducted using Statistical Package for Social Sciences (SPSS) version 11.5. Results Depression was found to be present in 43.8% of HIV positives. Among the study subjects, 10.5% had high risk for isolation and low self-esteem was found only among 5.7%. In univariate analysis both gender and self-esteem were significantly associated with depression whereas in multivariate analysis only self-esteem was found to be significantly associated with depression. Conclusion The present study shows a high prevalence of depression in HIV positive patients along with the importance of self-esteem.

Discordance in diagnoses and treatment of psychiatric disorders in children and adolescents with 22q11.2 deletion syndrome

Abstract: This study examines the rate of utilization of mental health services in children and adolescents with 22q11.2DS relative to their remarkably high rate of psychiatric disorders and behavior problems. Seventy-two children and adolescents with 22q11.2DS were participants; their parents completed the Diagnostic Interview Schedule for Children (DISC) and the Child Behavior Checklist (CBCL). The results indicated that 22q11.2DS children and adolescents have higher rates of psychopathology than the general pediatric population, with ADHD and anxiety disorders being the most common. However, among youth with 22q11.2DS, those with psychopathology are often no more likely to receive either pharmacological or non-pharmacological mental health care than those without a given psychiatric diagnosis. Thus, although psychopathology is fairly common in this sample, many children with 22q11.2DS may not be receiving needed psychiatric care. These results have significant implications for these children and their families, as well as for the health care providers who treat them. In particular, the results may suggest a need for careful screening of psychiatric disorders that are likely to affect this population, as well as making appropriate treatment recommendations to remedy childhood mental health problems. Since these children face an extraordinarily high risk of psychoses in late adolescence/adulthood, treatment of childhood psychopathology could be crucial in mitigating the risk/consequences of major psychiatric illnesses in later life.

Longitudinal treatment outcome of African American and Caucasian patients with first episode psychosis.

Abstract: The purpose of our analyses to examine the outcome differences between African American and Caucasian first-episode psychotic patients over the course of one year, to explore the interactive effects of gender, diagnosis, and race on treatment outcome. A consecutive series of patients (N=199) were recruited into our study from the inpatient and outpatient services at a psychiatric clinic. Global functioning, positive, negative, affective, and depression symptoms and treatment adherence were assessed at baseline prior to treatment and during follow-up up to one year. African American patients (N=62) were found to experience significantly less improvement in symptoms, bizarre behavior, avolition, anhedonia, and functional performance, and affective symptoms than their Caucasian counterparts (N=137). In addition, African American female patients experienced less improvement in affective flattening. While both groups of patients have experienced significant improvement during the one-year treatment, that of the African American patients was less optimal.

Spontaneous gamma coherence as a possible trait marker of schizophrenia—An explorative study

Abstract: Objectives Integration of sensory information by cortical network binding appears to be crucially involved in sensory processing activity. Studies in schizophrenia using functional neuroimaging, event-related potentials and EEG coherence indicate an impairment of cortical network coupling in this disorder. Previous electrophysiological investigations in animals and humans suggested that gamma activity (oscillations at around 30–100 Hz) is essential for cortical network binding. This is the first investigation of spontaneous gamma activity in schizophrenics and their first degree relatives as compared to normal controls. Method Resting EEG was recorded in 20 drug naive/drug free male schizophrenic patients, their pair matched male first degree relatives and 20 age-, sex-, education- and handedness-matched normal controls. Power spectrum and coherence of gamma band activity was analysed using MATLAB 6.5. Results Schizophrenic patients had significantly less interhemispheric spontaneous gamma coherence and increased gamma power compared to normal controls. But there was no significant difference in gamma coherence between patients and their first degree relatives. Spontaneous gamma coherence had significant correlation with few PANSS subscale scores. Conclusions There is cortical hyperactivation and a reduced spontaneous and induced gamma coherence abnormality in schizophrenia. The abnormal gamma coherence appears explaining the psychopathology and poor performance on cognitive task in schizophrenia. This study has also generated hypotheses that the gamma band abnormality may be a trait abnormality in schizophrenics as seen by the similarity between the patient and their clinically asymptomatic first degree relatives.

Sleep Disturbances in Pediatric Depression.

Abstract: Depressive illness beginning early in life can have serious developmental and functional consequences. Therefore, understanding its etiology and pathophysiology during this developmental stage is critical for developing effective prevention and intervention strategies. There is considerable evidence of sleep alterations in adult major depressive disorder. However, studies in children and adolescents have not found consistent changes in sleep architecture paralleling adult depression. This review article summarizes sleep polysomnography research in early-onset depression, highlighting the factors associated with variable findings across studies. In addition, potential avenues for future research will be suggested in order to develop more comprehensive theoretical models and interventions for pediatric depression.

Prevalence and factors associated with Ecstasy use among college undergraduates in north of Iran-2005.

Abstract: We conducted a cross sectional study of 3958 college students in north of Iran in 2005 with an anonymous questionnaire that was adapted from the questionnaires used in “Monitoring the future”. Three thousand seven hundred students responded (93.5%). Lifetime prevalence use of ecstasy, opium and cannabis was 4.3%, 2.7% and 2.4% respectively. The prevalence of current cigarette smoking was 19.5%. After the logistic regression, the factors influencing ecstasy use were use of other illicit drugs, alcohol and cigarette smoking ( P ρ = 0.007) and higher educational background of mother ( ρ = 0.019).

Determinants of depression and insomnia among institutionalized elderly people in Malaysia

Abstract: Depression and insomnia are common psychiatric disorders among elderly people and reported to be related to several social and health factors. However, their occurrences in relation to food intake have rarely been investigated. Therefore, this study was to identify determinants of depression and insomnia, with emphasised on food intake among 71 elderly people residing in a government funded institution in Malaysia. An interview based questionnaire was used to obtain information on socio-demography, health and functional status, depression, insomnia and food intake. A total of 71.8% subjects had depression and 53% had insomnia. Subjects who had insomnia [Adjusted Odds Ratio (AOR) 19.55, 95% CI = 4.04–94.64], needed help/unable to perform >4 items of IADL (AOR = 16.65, 95% CI = 3.95–70.22), had hypertension (AOR = 7.66, 95% CI = 1.37–42.76), had >50% wastage of poultry or fish (AOR = 3.66, 95% CI = 1.06–12.60) and wastage of vegetables (AOR 3.31, 95% CI = 1.03–10.60) were more likely to have depression. Subjects who had depression (AOR 19.55, 95% CI = 4.04–94.64), needed help/unable to perform >4 items of IADL (AOR 2.97, 95% CI = 1.12–7.84), needed help/unable to handle financial matters (AOR 5.01, 95% CI = 1.37–18.27) and had >50% wastage of vegetables (AOR 3.91, 95% CI = 1.42–10.82) were at a higher risk to develop insomnia. Depression and insomnia affected more than half of the subjects, interrelated, and associated with functional inability, socioeconomic factor and high food wastage of specific foods.

Mental health literacy survey among Sri Lankan carers of patients with schizophrenia and depression

Abstract: Introduction Mental health literacy has been defined as knowledge and beliefs about mental disorders which aid their recognition, management or prevention. Aim Preliminary investigation on mental health literacy among Sri Lankan carers of patients with Schizophrenia and Depression. Method Cross sectional descriptive study investigated a convenience sample of 119 carers of a person with Depression or Schizophrenia attending a community clinic using vignettes adapted from an existing mental health literacy survey. Results The Schizophrenia vignette was reported as a crisis by 28% and 35.6% reported the Depression vignette as a crisis. Schizophrenia and Depression were identified as mental illnesses by 72% and 64% respectively. Persons with Schizophrenia and Depression were reported to be more violent than a member of the community by 61% and 60%. Psychiatrist's help was preferred as the therapeutic intervention in Schizophrenia (86.7%) and Depression (91.5%), whereas only 21.7% preferred traditional healers. Carers of persons with Schizophrenia (72%) and Depression (61%) held the attitude that the problem is a sign of personal weakness. Sixteen percent of carers wanted to avoid people with similar problems. Discussion Carers had stigmatising attitudes such as persons with mental illness were violent and the illness was a sign of personal weakness. A minority wanted to avoid persons with similar problems, indicating that maintaining social distance was not a major issue. Carers had good knowledge of help seeking locations with a majority identifying psychiatrists and psychiatric wards in general hospitals. Conclusion The mental health literacy amongst the carers are lacking in certain areas. They have stigmatising attitudes towards people with mental illness.

Bhagavadgita and psychotherapy.

Abstract: This paper attempts to summarize the main postulates of Bhagavadgita, a sacred book of Hindus, with reference to their implications in psychotherapeutic context in the Indian sociocultural set up. The Bhagavadgita's concept of a mentally healthy person is discussed and finally the relevance of the Bhagavadgita's teaching to current psychological medicine is explained.

Thyroid function and lipid profile in bipolar I patients.

Abstract: Objective This study aims to evaluate the prevalence of thyroid dysfunctions and to explore their association with perturbations in lipid profile in bipolar I patients. Patients and methods Our study included 130 bipolar I patients diagnosed according to the DSM IV, and 124 control subjects aged respectively 37.9 ± 12.1 and 37.6 ± 13.2 years. TSH and FT4 were determined using electrochemiluminescence. Total cholesterol, triglycerides, c-LDL and c-HDL were determined by enzymatic colorimetric methods and ApoA1, ApoB and Lp(a) by immunoturbidimetric techniques on Konelab 30™. Results Patients had significantly higher TSH values than controls and had perturbations in lipid profile. 0.7% and 28.5% of patients had respectively hyperthyroidism and hypothyroidism. Hypothyroidism was associated with obesity and perturbations in lipid profile particularly increase in total cholesterol, c-LDL, ApoB, ApoB/ApoA1 and Lp(a) and decrease in ApoA1 and c-HDL. Moreover, it was associated with lithium and valproic acid treatment. Conclusions Hypothyroidism was frequent in bipolar patients. It was significantly associated with obesity and perturbations in lipid profile. Therefore, bipolar patients require specific care, particularly for thyroid, lipid profile and weight; the effectiveness of this care will be evaluated during follow-up period.

Personality factors and psychopathy, alexithymia and stress.

Abstract: The present study investigated the relations between the Five-Factor Model of personality, psychopathy, alexithymia and stress in 205 technology students. Students completed four tests: the NEO Personality Inventory Revised, the Levinson Self-report Psychopathy Scale, the Toronto Alexithymia Scale and the Recognize Sign of Stress. Multiple regression analyses revealed that Agreeableness and Conscientiousness were significant predictors of total scores of psychopathy, and Openness was a significant predictor of alexithymia. Path analyses indicated that apart from Openness, all personality traits were significant to the model, and stress acted as a mediator between Neuroticism and alexithymia.

Neurobiology of adult and teenage suicide

Abstract: Suicide is a major public health concern worldwide (Botsis et al 1997). About 30,000 people die of suicide in the USA and about 1 million worldwide (Botsis et al 1997; Goldsmith et al 2002). In the United States, suicide is the third leading cause of death in teenagers (Singh et al 1996). There are several risk factors for suicide, including the presence of depression (Lonqvist 2000) and other mental disorders (Caldwell and Gottesman 1992; Harris and Barraclough 1998; Lonqvist 2000; Moscicki 1997; Weissman et al 1989) and substance and alcohol abuse (Hlady and Middaugh 1988). Hopelessness (Beck et al 1993), stress (Westrin 2000), and impulsive-aggressive traits are among other risk factors (Brent et al 1999; Brent et al 1993; Linnoila and Virkkunen 1992). Recent studies also suggest that a family history of suicide and genetic and abnormal neurobiology may also be important risk factors for suicide (Ernst et al 2009; Mann 2003). There is evidence to suggest that some factors associated with adolescent suicide may be different from adult suicide (Brent et al 1999; Zalsman et al 2008). Although impulsive-aggressive behavior is a common risk factor for both adult and teenage suicide, aggression and impulsivity are traits highly related to suicidal behavior in adolescents (Apter et al 1995). Higher levels of impulsive aggressiveness play a greater role in suicide among younger individuals with importance decreasing with age (Brent et al 1993). Brent et al.(1993) have also shown that adolescents with aggression and conduct disorders may be suicidal even in the absence of depression. Psychosocial factors associated with adolescent suicide, such as stress and contagion, bullying and peer victimization (Brunstein et al 2008; Bursztein and Apter 2009; Klomek et al 2008) may also be different from adults. Alcohol and drug abuse contribute significantly to the risk of suicide in teenagers (Apter et al 1990; Apter et al 1995). Additional potential contributors to suicidal behavior in depressed adolescents are early defined traits such as temperament and emotional regulation. One study suggests (Tamas et al 2007) that suicidal youth are characterized by highly maladaptive regulatory responses and low adaptive emotional regulation responses to dysphoria. In the USA, as in many countries of the world, older adults are at greater risk for suicide; of the 35,000 people who died by suicide in the USA, more than 5,000 are among people older than 65 years (CDCPrevention 2007). Based on psychological autopsy (PA) studies it is estimated that mood disorder was the most common disorder among these cases (Conwell et al 1996). Hopelessness, stress (relationship and financial problems) are other risk factors. Biology of elderly suicide is not well studied. For suicidal behavior in elderly see review by Conwell and Thompson (2008). Neurobiological studies in suicide have been performed either in patients with suicidal behavior or in the postmortem brain of suicide victims. In this chapter, we will primarily focus on the major neurobiological findings in suicide related to serotonin and noradrenergic mechanism, signal transduction pathways, hypothalamic adrenal pituitary axis (HPA) dysfunction, and inflammatory markers (cytokines in the postmortem brain). We will also briefly discuss the evidence from studies of suicidal patients, specifically the 5HT system leading to these studies in postmortem brain.

Next generation of psychiatrists: What is needed in training?

Abstract: Populations can be divided into generations. Each generation has its own characteristics and even though not every member of the same generation will share characteristics with other members of that generation, it is possible to identify generational differences. Generations frequently have different values and varying styles of functioning and learning. Since the Second World War, the generations can be divided into four cohorts: the Veterans, the Baby Boomers, Generation X, and the Millennials. Each generation has a collective identity and, in addition to understanding cultural and ethnic differences, these generational differences should also be taken into account in the teaching arena. Values and beliefs about work-life balance, learning styles, comfort with technology, methods of communication, and approaches to leadership are the types of parameters which vary across generations. As a result, medical educators would benefit from appreciating these differences in order to enhance the learning of medical students and residents and to better prepare them for delivering patient care in the twenty-first century. In this paper, the authors highlight some of the challenges and issues related to these generational divides.

DSM-IV ADHD: Prevalence based on parent and teacher ratings of Malaysian primary school children

Abstract: Based on Malaysian parent and teacher agreement for ratings of their primary school-aged children on a scale comprising the Diagnostic and Statistical Manual of Mental Disorders- IV Attention-Deficit/Hyperactivity Disorder symptoms, this study examined the prevalence rates of the three ADHD types. The prevalence rates for the Inattentive, Hyperactive–Impulsive, and Combined types were 0.96%, 0.32%, and 0.32%, respectively. For all types together, the male to female ratio was 4:1.

Pharmaceutical industry and the market: The case of Prozac and other antidepressants.

Abstract: Objective This article attempts to critically evaluate the role of the pharmaceutical industry in health care from the theoretical standpoint of ‘medical–industrial complex’. Methods The historical context of the expansion of the pharmaceutical industry is summarized followed by a critical evaluation of the methods of studying effectiveness of pharmaceutical agents and the aspects involved in reporting, publication and marketing. Further issues are elaborated with a case study of the antidepressants. Results The establishment of pharmaceutical industry is premised on various ethical principles and moral norms yet such guiding values are forsaken resulting in a contradictory stance where human life and suffering are devalued rather than saved and ameliorated in a bid to maximize profits. Conclusion The conventional response of more stringent regulation and the broader reason of economic model of unequal power need to be reevaluated.

Lunar phase cycle and psychiatric hospital emergency visits, inpatient admissions and aggressive behavior.

Abstract: Introduction We examined the correlation between lunar cycles and the number of psychiatric emergency visits, patients’ gender, aggressive behavior, need for inpatient admission, legal referral and need for involuntary chemical restraint in a period of one calendar year. Method Charts of all psychiatric emergency room patients were reviewed retrospectively. Arabic calendar lunar months were divided based on three different models: Two 15 days sections, three 10 days, and six 5 days parts in the third model. Results 5431 patients were seen in the psychiatric emergency service (PES) during a one year period. We did not find a relationship between the visit time (day or night), gender, and legal referral in relation to moon cycles. A higher number of visits during full moon period which was not statistically significant (P > 0.05) was found. Highest frequency of inpatient admissions was discovered in the first and last parts of the three part model and in the first and last segments of the six part model followed by second and fifth parts (P-values: 0.000). Conclusion This study revealed a slight increase in number of visits to psychiatric emergency room during full moon periods. In addition a highly significant increase in the severity of illness and aggressive behaviors and agitation in the beginning and end of the moon cycles were noticed. Some of the underlying possible causes such as changes in intra/extracellular fluids, neural and endocrine cell functions, hemodynamic and biological responses and changes in social dynamics and support are discussed.

Stress and coping behaviors among smokers

Abstract: Positive association has been seen between stress and smoking behavior. This relationship has not been explored in relation to one's coping behavior and desire to quit smoking. The present study examined stress, coping and readiness to change among smokers. 50 smokers were selected using a cross sectional design. Assessment Proforma, Fagerstrom test for Nicotine Dependency, General Health Questionnaire, Perceived Stress Scale, Coping Checklist and Readiness to Change Questionnaire were administered on them. Stress was related to smoking behavior as well as initiation and maintenance of smoking. Individuals in the early adulthood stage were using maladaptive coping strategies. Perceived stress was higher among the middle age group. Stress and maladaptive coping behaviors were found to be associated with initiation and maintenance of smoking. It has implications for psychosocial interventions in tobacco cessation.

Neurobiology of self-awareness deficits in schizophrenia: A hypothetical model

Abstract: Self-awareness (SA) is a cognitive ability to differentiate between self and non-self cues and is pivotal to understand the behavior of other human beings. For this reason, there has been a significant interest to investigate the neurobiology of SA in human subjects. So far the majority of such research has been conducted in healthy subjects but a significant relationship between impaired SA and poor psychosocial outcome in schizophrenia has stimulated neuroimaging research in this patient population. The results from small number of neuroimaging studies in schizophrenia suggest that impaired SA may be mediated by a dysfunction of cortical midline structures. This paper is an attempt to review emerging functional magnetic resonance imaging (fMRI) data in schizophrenia and to propose a hypothetical model of deficits in SA in schizophrenia that can be tested in future research. The model is refined from the available literature and proposes that self-referential activity appears to reflect a shift from activation of anterior to posterior cortical midline structures in schizophrenia subjects, which may be related to lack of functional connectivity between different cortical midline regions.

Personality and chronic fatigue syndrome: The role of the five-factor model

Abstract: The aim of this study was to examine the relationships between personality factors and the symptomatology of fatigue among people with chronic fatigue syndrome (CFS), and compare them to people from the general population. Seventy-seven CFS patients (47 women, 30 men) were compared with 72 healthy individuals (44 women, 28 men) to investigate whether personality factors are related to the symptomatology of fatigue. All participants were asked to complete the NEO Five Factor Inventory (NEO-FFI), the Modified Fatigue Impact Scale (MFIS), the Fatigue Severity Scale (FSC), and the Mental Health Inventory (MHI). The results revealed that the CFS group reported higher levels of neuroticism and conscientiousness than the control group. These two personality factors were significantly related to fatigue symptoms, impact, and severity in both groups. These findings suggest that personality factors of neuroticism and conscientiousness may play an important role in the development and perpetuation of fatigue symptoms.

Coping with stress and quality of life in schizophrenic patients.

Abstract: Objective Explore the patterns of coping among schizophrenic patients employed in the face of general day-to-day stressors and its correlates, study the effect of schizophrenic illness on quality of life, its relation to psychiatric symptoms. Patients and methods 70 patients with chronic stable schizophrenia were enrolled. Data on sociodemographic and clinical variables were recorded. The following scales were utilized: scale for assessment of positive symptoms (SAPS), scale for assessment of negative symptoms (SANS), Brief Cope scale, Self report Quality of life for schizophrenia (SQLS), three subtest short form of WAIS. Results On average, each patient used 12 coping strategies. Acceptance and distraction coping strategies were most commonly employed. No correlations were found between different sociodemographic variables, family history of illness, duration of illness or diagnostic subtype and total number of coping strategies used. SAPS score was correlated with acceptance ( r = .580, p = .000), less self blame ( r = −.305, p = .010), while SANS score was correlated with venting ( r = .258, p = .031). Participants with higher IQ estimates reported more active coping ( r = .298, p = .012) and religion ( r = .235, p = .050). Most scales for Quality of life were impaired. SAPS was correlated only with Psychosocial scale, SANS was correlated with all scales of SQLS, while it showed no correlation with the total number of coping strategies. Conclusions Patients with schizophrenia used numerous coping strategies to deal with stress. Lack of correlation with coping strategies suggests that coping efforts are determined by the individual's personality and coping resources, rather than by illness characteristic. Schizophrenic symptoms, especially negative symptoms, had a major impact on SQOL.

Overcoming cultural barriers to deliver comprehensive rural community mental health care in Southern India.

Abstract: Aim To describe obstacles overcome in establishing and implementing a comprehensive community psychiatry program in rural India. Background Studies in low income countries point to a significant association of common mental disorders with female gender, low education, poverty, lack of access to running water in the home, and experiencing hunger. Gynecological complaints are associated with an increased risk of mental disorders. Suicide is a major public health problem with women outnumbering men in completed suicides in India. Among barriers to care are low value given to mental health by individuals in society, high prevalence of mental and neurological problems, apathy toward psychosocial aspects of health and development, and chronic lack of resources. Design/methods We developed and implemented a program of care delivery thus (a) targeting the indigent women in the region; (b) integrating mental health care with primary care; (c) making care affordable and accessible; and (d) sustaining the program long term. I also review pertinent articles to demonstrate our success. Results We provided mental healthcare for the indigent using a successful and vibrant model that overcame hurdles to treat patients from 187 villages in Southern India. Of note are low resource use, and the lack of accessibility, comprehensive care, the use of indigenous case workers and primary care professionals. Conclusions Rural mental health care must be culturally congruent, integrate primary care and local community workers for success.