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Mental status examination of borderline personality disorder

Author(s): Shalini Choudhary / Language(s): English Issue: 2/2017

The study aimed to identify characteristics of Borderline Personality Disorder (BPD) patients using case study method and mental status examination (MSE). Five cases of BPD (3 males, 2 females; aged 17-23years) identified using semi-structured interview schedule including case history, MSE and DSM-IV-TR criteria were taken from a Psychiatric Centre in India. The themes and characteristics were identified from in-depth clinical interviews and direct observation of the patients. Evaluation of the emotional and cognitive functioning was done. General appearance of patients was appropriate. Males appeared dull, sad and reclusive while females were elated. Psychomotor activity was slow, increased in some cases. Speech was slow; they spoke in muffled voices and sometimes were loud. Emotional state indicated feelings of anger, hurt, boredom, and depression. Affect was not compatible with the idea and content of thoughts and situations. Thought processes involved loose associations, fears and somatic trends in males. Suicidal ideation was common in all patients. Sensorium and mental capacity revealed that their remote memory was adequate, recent memory was impaired while immediate memory was poor. They had poor attention and concentration with average general awareness. Insight and judgement capacity showed that patients were aware of their mental problem. They wanted their problems to be shared, heard and understood. A characteristic profile for evaluating emotional and cognitive functioning of BPD was developed in the study using case study.

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Semiological bridge between psychiatry and epilepsy

Author(s): Ahmed Gaber / Language(s): English Issue: 1/2017

Epilepsy is a paroxysmal disturbance of brain function that presents as behavioral phenomena involving four spheres; sensory, motor, autonomic and consciousness. These behavioural disturbances though transient but may be confused with psychiatric disorders. Thus representing a diagnostic problem for neurophyschiatrists. Here we review the grey zone between psychiatry and epilepsy on three levels. The first level is the semiology itself, that the behavioral phenomenon at a time can be the presentation of an epileptic disorder and at another time a representation of a psychiatric disorder. The second level is the comorbidity between epilepsy and psychiatric disorders namely epileptic psychosis. The third level is the disorders of the brain that can present by both epileptic and/or psychiatric disorders. We reviewed the current literature in both epilepsy and Psychiatry including the main presentations that might be confusing. Conclusion:Epilepsy, schizophrenia like psychosis, intellectual disability, autism are different disorders that may share same semiological presentation, comorbidity or even etiology. A stepwise mental approach and decision making is needed excluding seizure disorder first before diagnosing a psychiatric one.

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Frequency of subtypes of irritable bowel syndrome in subtypes of schizophrenia

Author(s): Shoaib Ahmed Kashani,Muhammad Umer Mari,Muhammad Ilyas,Ghulam Rasool,Jalaluddin Rumi,Hazrat Ali,Abdul Nasir,Zainullah Kakar,Ramesh Chand / Language(s): English Issue: 6/2017

Objective: The aim of the study was to determine the frequency of subtypes of irritable bowel syndrome in predominant positive and negative subtypes of schizophrenia. Methods: 143 drug naïve hospitalized and outdoor patients between 18 and 50years with first episode of predominant positive and negative symptoms of schizophrenia based on DSM IV-TR completed this study. A semi-structured clinical interview was used to assess the patients with predominant positive and negative symptoms of schizophrenia. Clinical data were obtained; routine lab investigations and ultrasonography of abdomen were done in all subjects to exclude any related abdominal pathology. Rome III Urdu language version scale (cross validation obtained) for irritable bowel syndrome (IBS) were administered to assess the symptoms of subtypes of irritable bowel Syndrome, i.e. IBS Constipation (IBS-C), IBS Diarrhoea (IBS-D) and IBS Mix (IBS-M) in both male and female patients with type 1 and type 2 of schizophrenia. Results: 134 patients (81 male and 53 female) had predominant positive and negative symptoms of schizophrenia. Out of 134 patients, 64 (48.8%) had IBS vs 70 (52.2%) of non IBS. Patients with type 1 of schizophrenia had higher rate of IBS-C 33.3% (n=14) and IBS-M 9.5% (n=4) versus type 2 of schizophrenia IBS-C 17.4% (n=16) and IBS-M 5.4% (n=5). In type 1, IBS-D was 21.7% (n=20) more frequent than IBS-D 11.9% (n=5) in type 2 of schizophrenia. Female patients 49.1% (n=26) had more frequent of IBS compared to 46.9% (n=38) male patients with schizophrenia (OR= 0.91; 95% CI: 0.46-1.84). Conclusion: Irritable bowel syndrome is more frequent in patients with schizophrenia than in general population. This functional gastrointestinal disorder associated with predominant positive and negative symptoms of schizophrenia requires attention and management while managing patients with subtypes of schizophrenia.Objective: The aim of the study was to determine the frequency of subtypes of irritable bowel syndrome in predominant positive and negative subtypes of schizophrenia. Methods: 143 drug naïve hospitalized and outdoor patients between 18 and 50years with first episode of predominant positive and negative symptoms of schizophrenia based on DSM IV-TR completed this study. A semi-structured clinical interview was used to assess the patients with predominant positive and negative symptoms of schizophrenia. Clinical data were obtained; routine lab investigations and ultrasonography of abdomen were done in all subjects to exclude any related abdominal pathology. Rome III Urdu language version scale (cross validation obtained) for irritable bowel syndrome (IBS) were administered to assess the symptoms of subtypes of irritable bowel Syndrome, i.e. IBS Constipation (IBS-C), IBS Diarrhoea (IBS-D) and IBS Mix (IBS-M) in both male and female patients with type 1 and type 2 of schizophrenia. Results: 134 patients (81 male and 53 female) had predominant positive and negative symptoms of schizophrenia. Out of 134 patients, 64 (48.8%) had IBS vs 70 (52.2%) of non IBS. Patients with type 1 of schizophrenia had higher rate of IBS-C 33.3% (n=14) and IBS-M 9.5% (n=4) versus type 2 of schizophrenia IBS-C 17.4% (n=16) and IBS-M 5.4% (n=5). In type 1, IBS-D was 21.7% (n=20) more frequent than IBS-D 11.9% (n=5) in type 2 of schizophrenia. Female patients 49.1% (n=26) had more frequent of IBS compared to 46.9% (n=38) male patients with schizophrenia (OR= 0.91; 95% CI: 0.46-1.84). Conclusion: Irritable bowel syndrome is more frequent in patients with schizophrenia than in general population. This functional gastrointestinal disorder associated with predominant positive and negative symptoms of schizophrenia requires attention and management while managing patients with subtypes of schizophrenia.

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Anger management in young children

Author(s): Steven Richfield / Language(s): English Issue: 5/2017

Early childhood is generally marked by behaviors that leave parents brimming with pride and wonder, not shuddering with worry and confusion. But sometimes immature impulse control and fierce anger combine with such intensity that young children aggressively attack and react to people and events. The results are disastrous for peer relations, school placement, and family relationships. Parents are hard pressed to assess causation and find answers to helping their child. Consider the following coaching points to help your young child learn to manage his anger.

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Forgiveness: as attaining mental health among depressed patients

Author(s): Momina Abid / Language(s): English Issue: 4/2017

Forgiveness plays a vital role from the recovery of mental and physical health issues. The main purpose of the study was to determine the importance of male and females’ forgiveness in mental health and further find out the correlation between forgiveness and mental health among depressed patients. 120 diagnosed depressed patients randomly approached from Nishtar hospital Multan. Level of Forgiveness was measured through Heartland Forgiveness Scale1 and mental health of depressed patients was evaluated by Mental Health Inventory.2 Statistical Package of Social Sciences (SPSS) 22 version utilized to get the results. Correlation analysis indicated that forgiveness was positively and strongly correlated with mental health. The presence of forgiveness in depressed patient’s life was found to attain mental health. Results revealed that female scored higher on forgiveness and mental health as compare to their male counterparts. Future implications for helping depressed patient’s perceive presence of forgiveness in their lives are Forgiveness practice on daily basis is very helpful to increase the mental health and by embracing forgiveness, individuals can also embrace peace, hope, gratitude, happiness and joy these are path that lead to mental health.

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Mother’s health directly impacts the recovery timeline of the autistic child

Author(s): Rajalakshmi Kandaswamy / Language(s): English Issue: 1/2017

The recent studies and a document publication by the NHF (Neurological Health Foundation) has revealed that the health condition of the Mother of a child with Autism DIRECTLY affects the ability of the autistic child to recover fully from the limiting symptoms of autism and other co-morbid conditions. Today, cutting-edge treatment modalities in autism based on the emerging science of Epigenetics and Applied Intentional Epigenetics are helping the autistic child to thrive free from the limiting symptoms of autism. This healing in the child is greatly accelerated once the mother’s health challenges, including and especially the psychological challenges are addressed and healed. This article draws attention to the largely ignored connection between the health - spiritual, mental and emotional well being of women and mothers dealing with children with autism and their direct impact on the thriving or the absence of thriving of the autistic child under their care.

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Mental health stigma and subjective happiness

Author(s): Ahmed Shahbaz / Language(s): English Issue: 1/2017

The present study is aimed at examining the association between Mental Health Stigma and Subjective Happiness. Self-Stigma of Seeking Help scale1 was used to measure the degree of threat perceived by the participants to their self esteem in seeking psychological help, where as Subjective Happiness Scale2 was used to measure the level of happiness among individuals. 264 students (130 Males and 134 Females) of University of Karachi participated in the study; they were asked to rate the items present on SSOSH and SES scales. This study was aimed to investigate that their exist a relationship between Mental Health Stigma and Subjective happiness. Findings of the study revealed that no relationship exist among the two variables hence disapproving the hypothsis.

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Positive psychology and spirituality

Author(s): Leslie Dawn Culpepper / Language(s): English Issue: 7/2016

Since Psychology became a healing profession, multitudes of historical revelations from theorists who devoted their lives to the study of human behavior made the science of mental illness very effective as well as transferable. The field of psychology has come up with valid and reliable ways to measure indistinct concepts such as anger, schizophrenia, and depression, while simultaneously earning recognition for the development of both experimental and longitudinal methods necessary ingaining insight as to the causal pathways that result in undesirable consequences for the client/ patient.

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A psychological aspect of malnutrition: hitting psychological distress among patients with depression

Author(s): Momina Abid / Language(s): English Issue: 7/2016

Nutrition plays a vital role in mental health; malnutrition kills the mental health of individuals and psychological distress is a sign of poor mental health. The purpose of current research to explore the association between malnutrition and psychological distress and it was also aimed to determine the gender differences on malnutrition and psychological distress among adults. Randomly 100 diagnosed patients aged between 25-35years were taken from different hospitals of Multan. Malnutrition was assessed by Malnutrition Screening Tool1 and psychological distress was measured by Kessler Psychological Distress Scale.2 Statistical analysis explored that malnutrition has positive relationship with psychological distress and malnutrition has impact on psychological distress. Findings of present research also depict that malnutrition and psychological distress has significant gender differences among adults. Female patients scored high on malnutrition and male patients showed high level of psychological distress. The implication of current research that food intake must be healthy because healthy food is key path to good health and mental health. Seminars and workshops on healthy nutrition plans must be conducted to overcome the side effects of malnutrition in individuals.

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They’re only memories

Author(s): Merrill C. Hubbard / Language(s): English Issue: 7/2016

pinion To be alive is to have a past. Our only choice is whether we will repress or re-create the past. Childhood may be distant, but it is never quite lost; as full grown men and women we carry tiny laughing and whimpering children around inside us. We both repress the past and continue to fight its wars with new personnel or we invite it into awareness so that we may see how it has shaped the present.

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Teaching pain psychology and neuropsychology: what do medical trainees want to learn?

Author(s): Amir Ramezani / Language(s): English Issue: 7/2016

Pain psychology and neuropsychology education helps medical trainees learn how to better treat pain. There is no existing standard education curriculum for pain psychology and neuropsychology medical education. This makes it challenging for educators to teach the most clinically relevant topics to medical trainees. To take the first step in advancing our understanding of high-yield education topics for medical trainees, this article reports on the author’s view of high yield education topics to teach as a result of two focus groups and teaching experience feedback, aimed at identifying clinically relevant education topics. The focus groups and feedback led to the development of two lists: trainee-instructor generated topics and trainee-generated topics. Trainees believe that these topics represent the most need-to-know information for their day-to-day clinical practice. The implementation of high-yield topics appeared to enhance class engagement and participation. Educators may consider implementing focus groups and the two lists of topics as a starting point to develop pain psychology and neuropsychology education curriculum for medical trainees.

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Dissociative experiences in psychiatric inpatients

Author(s): Ali Firoozabadi,Soroush Pakniyat Jahromi,Nooshin Reza Alizadeh / Language(s): English Issue: 6/2016

Dissociative disorders are conditions that involve disruptions of memory, awareness, identity, or perception. Data collected in diverse geographic locations underline the consistency in clinical symptoms of dissociative disorders. In this cross-sectional descriptive study, prevalence of dissociative experiences has been screened in hospitalized patients in psychiatric wards of Shiraz University of Medical Sciences in Iran. One hundred and sixty patients in two hospitals entered the study. Our tool to screen the prevalence of dissociative experiences was Dissociative Experience Scale (DES). Linear regression analysis shows that gender and age are predictors of high DES scores to some extent while psychiatric disorders are not good predictors. Age, gender and psychiatric disorders are poor predictors (almost 7%) of high DES scores in this study (R square=0.69). In this study, patients with Borderline Personality Disorder had higher dissociative experiences based on DES score (Mean: 56.44), followed by Schizophrenic patients (Mean: 28.22) and patients with Bipolar Personality Disorder (Mean: 25.18). This study showed that we might be able to create a new category in psychological disorders based on dissociative experiences. As age, gender and psychological disorders were poor predictors of dissociative experiences, stronger predictors such as positive childhood psychological traumas could be responsible for dissociative disorders.

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Formation and functions of alter personalities in dissociative identity disorder: a theoretical and clinical elaboration

Author(s): Erdinc Ozturk,Vedat Şar / Language(s): English Issue: 6/2016

Dissociative identity disorder DID is a chronic complex psychiatric condition related to cumulative psychological traumatization in childhood. It is characterized by a marked disturbance of identity due to the presence of distinct personality states and repetitive dissociative amnesias which interfere with the continuity of the affected person’s autobiography. These personality states alter personalities recurrently take control of or influence the individual undermining one’s sense of self and agency. Although working with alter personalities is the hallmark of psychotherapy in DID, a detailed and specific clinical and theoretical psychopathology of alter personalities do not exist yet. Hence, the present paper addresses the formation and functions of alter personalities in DID. The hypotheses, proposals, and assumptions developed in this paper have been derived from experiences inintensive treatment of a very large number of patients with DID over more than two decades. The authors propose that the reconciliation between diverse perspectives about one’s internal world and external reality carried by various personalities is necessary for successful treatment of DID. The hallmark of dealing with alter and host personalities constitutes of the elimination of misperceptions of them about each other personality state and even about themselves.This requires an analysis of the missions and functions of alter personalities which are usually different than the perceived conceptualizations. This recognition usually increases the therapeutic alliance and even consent between the therapist, and alter and host personalities and decreases the duration of treatment. The present paper is a preliminary one on this subject and may serve as a basis both for further theoretical elaborations as well as for development of hypotheses in empirical research devoted to understanding the operations of human mind when exposed to stress in particular as well as the mechanisms of effective therapeutic interventions in those conditions.

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Neurocognitive processing steps during remembrance

Author(s): CR Mukundan / Language(s): English Issue: 6/2016

A method of recording several of the electrophysiological changes seen during remembrance of experiential components of autobiographic episodes has been developed for use in forensic investigations of suspects and accused persons. The technique has called Brain Electrical Oscillations Signature BEOS profiling and has been successfully used in several hundreds of cases as aid for investigation. The two important facilitating aspects of the test are that1 remembrance can be automatically cued by presenting short verbal statements referring to various components of an experience, and remembrance is automatic and mandatory when a cue is presented, in normal individuals.2 There is also no need for any response from the subject while receiving the cueing information. Knowing the occurrence of an activity in the past does not trigger any remembrance of own participation. Remembrance of participation in an activity occurs only if the person has participated in the activity referred by the probe. Remembrance has several neurocognitive components, which are reflected in the scalp EEG of a person. Sets of verbal probes representing different formulations of the episode and the different roles of individuals, as they are essentially possibilities arrived at by an investigating team, when more than one person is suspected to be involved in the activity are presented to the suspected persons. Each multichannel epoch of EEG time locked to each probe, acquired with its pre-probe baseline, is acquired and analyzed to determine the statistical significance of the differences in the different components across the EEG channels of each epoch, related to each probe, is analyzed and statistically compared. Presence of Experiential Knowledge is arrived at if all the changes indicating multiple neurocognitive processing components are significantly present.

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Brief cognitive behaviour therapy in a case of depression in India

Author(s): K. Chhibber,S. Parikh / Language(s): English Issue: 5/2016

Beck’s model of Cognitive Behaviour Therapy (CBT) has been successfully used for the treatment of depression. Brief versions of CBT are now being increasingly applied in the treatment of depressive disorders. The case of Ms. A is presented to highlight the effectiveness of a brief intervention conducted across 7 sessions to ameliorate the debilitating effects of the disorder which was diagnosed post the traumatic loss of her brother 2 years ago to suicide. The rationale for the choice of a brief intervention, its application and a session wise discussion of the treatment and its planning are discussed to provide an insight into the varied applicability and utility of brief interventions.

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The stress of prejudice

Author(s): Arthur P. Ciaramicoli / Language(s): English Issue: 3/2016

Whenever we encounter someone who we have an inherent prejudice against, whether conscious or unconscious, we begin to experience a degree of stress. When we are stressed we release the stress hormone cortisol, which limits our capacity for empathy while also causing repetitive negative thinking. If you have prejudices against several types of people it is likely that your cortisol levels will be consistently high. In addition to causing negative thinking excess cortisol also causes weight gain, inflammation, hair loss, breaks down muscle tissue, causes flabbiness, depression, anxiety and memory loss.

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Consult liaison psychiatry in the emergency department

Author(s): Adel Zaraa / Language(s): English Issue: 3/2016

Boarding of psychiatric patients, (defined as a length of stay greater than four hours after medical clearance), is ubiquitous throughout emergency departments nationwide (USA). The limited number of inpatient psychiatric beds combined with the increase in mental health related visits to emergency department has amplified the number of patients boarding in the accidents and emergency. Thus, the primary goal of most emergency departments is to keep the patients safe until they can be moved into a mental health unit or further stabilized and discharged home with an appropriate outpatient care plan; in this retrospective data review we set to examine the impact of adding a full time consult liaison psychiatric service to the general emergency department. For that purpose, we compared the data of the same trimester of two different years of all psychiatric presentations to the emergency department and calculating the boarding time and the admission rate to the psychiatric hospital in the before and after the inception of the service. We discussed the results and analyze contributing factors to quality improvement.

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Why did it take so long to see the light?

Author(s): Michael Ellenbogen / Language(s): English Issue: 2/2016

Going down the path of Alzheimer’s is a very terrible role for the person who must take care of them. It’s a road no one wants to take willingly. But when you do it does something to you; you go to a point where there is no return from it. If you have been there you know what I am talking about. The only good news is that there are many others like you who are in the same leaking boat that you can relate to and tap into resource as needed. They are there to cheer you on or to pick you up from the gutter when the day seems hopeless. Those caregivers form a unique bond. When it’s all said and done they are able to pick themselves up again.

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A search of the origins of anorexia nervosa in adolescence. a new treatment approach

Author(s): Matt Lacoste / Language(s): English Issue: 1/2016

Anorexia nervosa is an eating disorder, which affects particularly adolescents. The media coverage of feminine thinness is demonstrated as a token of beauty, with diet food as means to achieve this. However, diet foods are not enough to explain the numerous cases. This disease is the symptom of a psychological disorder and research for the origin must follow-up the psychotherapeutic treatment. Multi-factorial explanations seem dominate in the various case of this article. Family problems and sexual assaults can also explain this transition to anorexia. In the first case, anorexia nervosa is used as a tool for identification and of personalization in the assumption of autonomy and independence. In the second, the anorexia becomes a means of defense in response to aggression. We give a clinical confirmation of the multivariate origins of anorexia nervosa and of the impact of sexual abuse. This paper proposes a new approach of the anorexia nervosa treatment.

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Are some DSM5 diagnosis complications of other psychiatric disorders?

Author(s): Alen J Salerian / Language(s): English Issue: 1/2015

This article offers evidence supported by clinical observations to propose that many DSM 5 psychiatric disorders may represent complications of other psychiatric disorders. Evidence is presented to suggest that DSM 5’s linear architecture is inadequate to measure the dynamic complexity of brain function. Of significance is the butterfly effect of sensitive dependence on initial errors to trigger major delayed complications that may render DSM 5 a potentially harmful diagnostic tool. It seems that DSM’s inherent deficit not to distinguish a disease from a disease complication is a major handicap for psychiatry

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