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Treatment of mental and physical problems using holy quran (between illusion and reality)

Author(s): Gamal Elfeky / Language(s): English Issue: 1/2015

The wide spreading practice of what is named spiritual healers and treatment with Quran (the Holy Book of Islamic religion) among Muslim nations now-a-days, to the extent that a lot of satellite channels are specialized in presenting such claimer therapists stimulated me to search and research, investigate, experiment and attend many sessions of that type of treatment being a Muslim physician. What stimulated me more (as a psychiatrist) for more activity was the fact that almost all candidates for such healers were proved to me to be psychiatric patients who have a straight forward diagnosable psychiatric illness and a high percentage of them appeared to be treatable and curable if advised to visit a psychiatrist for their problems. I had to review all my academic and clinical knowledge not only in medicine and psychiatry but in Islam as well (as a Muslim). Based on the scientific religious knowledge from Islamic academic sources it has been found that Islamic psychiatric way of management and treatment of diseases does not mean the using/ relating the texts of Quran.

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Sensitive dependence of mental function on prefrontal cortex

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

This study offers evidence to suggest that both normalcy and psychiatric illness are sensitively dependent upon prefrontal cortex function. In general, the emergence of psychiatric symptoms coincide with diminished influence of prefrontal cortex function. The mediating influence of prefrontal cortex may be independent of molecular and regional brain dysfunctions contributory to psychiatric illness.

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A review of the verbal memory profile of individuals with autism spectrum disorder

Author(s): Nicolson Yat Fan Siu,Jacqueline Jiaying LE / Language(s): English Issue: 1/2015

Behavioral studies concerning the memory of individuals with Autism Spectrum Disorder (ASD) have yielded inconsistent results over the past few decades. Some have found impairment where as others have reported an intact memory profile in ASD. Therefore, in the present review, we will examine the verbal memory profile of ASD. A systematic search has located 18 articles for review and analysis. It is suggested that ASDs mainly have an intact verbal recognition performance but impaired verbal recall ability. The conflicting memory performance found in ASD may probably be due to confounding factors, including differences in the experimental designs of research studies, the intellectual functioning levels of ASD and their developmental trajectories. In general, the memory processing of ASD is implicated by the frontal lobe function, and the memory problem is primarily caused by the poor utilization of organizational strategies during information encoding. A failure to encode the information properly will directly hinder their later retrieval performance. Finally, priorities for future research in the memory functions of ASD are suggested, and the need for more rigorous research paradigms is highlighted. With a more comprehensive understanding of the underlying mechanism of the memory functions of those with ASD, it is believed that better intervention programs can be developed to aid their memory deficits and to improve their daily-life performances.

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Screening pattern of carbamazepine level on admission to the psychiatric unit in patients receiving the medication: quality improvement project

Author(s): Adel Zaraa,Nahid M. Elhassan,Ahmed Abd Alkarim Yousif / Language(s): English Issue: 1/2016

Accurate monitoring of psychotropic drugs blood level is imperative for proper clinical practice, to prevent side effects or relapse, to optimize treatment and ensure compliance. in 1995, Schoenenberger RA et al tried to develop explicit reliable criteria to decrease routine daily monitoring for anti-epileptic drugs in efforts to substantially reduce cost without missing clinical results,1 so did Affolter N et al in 2003.2 Both studies found that 27% and 48% -respectively- of all AED measurements had appropriate indications.

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Anxiety: friend or foe?

Author(s): Natasha Shapiro / Language(s): English Issue: 1/2015

Lately I’ve been noticing a theme in which many people suffering from anxiety do not really want to let it go. You may ask why anyone would want to continue dealing with the litany of distressing thoughts and panic-like sensations in their bodies for a moment longer than necessary. Well the truth is that sometimes worry convinces people that it is helpful. To understand why anxiety is so challenging to let go, it may be useful to explore possible causes of its existence.

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Mild Traumatic Brain Injury – Case Report

Author(s): Urša Čižman Štaba,Karmen Resnik / Language(s): English Issue: 1/2015

A mild traumatic brain injury or a concussion represents the majority of all traumatic brain injuries. The consequences show on physical, cognitive, and emotional functioning and even though the injury classifies as mild, it can have a significant effect on a patient, patient’s family and their quality of life. Defects are often overlooked as objective clinical methods are lacking. Neuropsychological evaluation can aid in appraisal of the defect magnitude and determine factors that influence the outcome of the injured. The following case report addresses the importance of neuropsychological evaluation in treating cognitive defects along with the Cognitive Behavioral therapy approach toward emotional and behavioral disorders treatment in mild traumatic brain injury. It has been shown how important it is to find possible causes for slow recovery. The annuity tendencies have been noted as an important factor for prolongation of the post-concussion syndrome. We can detect the symptom simulation with appropriate psychological instruments. Described is a case of 38-year-old man who suffered a mild traumatic brain injury.

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Prefrontal cortex governs normalcy and psychiatric illness: neuroimaging evidence

Author(s): Alen J Salerian / Language(s): English Issue: 2/2015

Objective: We reviewed neuroimaging evidence to determine whether prefrontal cortex is endowed with unique properties that mediate both normalcy and psychiatric illness. Method: Evidence based upon clinical observations and neuroimaging studies were reviewed. Results: The cumulative evidence -based upon clinical and neuro imaging evidencesuggest that prefrontal cortex is endowed to mediate normalcy and psychiatric dysfunction. The mediating influence of prefrontal cortex may be independent of molecular and regional brain dysfunction contributory to psychiatric illness. Conclusion: There seems to be compelling evidence to suggest that prefrontal cortex is endowed to mediate normalcy and psychiatric illness.

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Dissociative depression is resistant to treatment-asusual

Author(s): Vedat Şar / Language(s): English Issue: 2/2015

A new concept introduced by the author, the dissociative depression differs from primary depression in symptomatology, course and treatment response. Being related to traumatization in childhood, dissociative depression tends to be chronic and is usually classified as treatment-resistant due to its limited response to biological interventions. Trauma-focused psychotherapy targeting dissociative psychopathology leads to positive results. However, such patients are usually undertreated in terms of effective psychotherapy and become recipients of long-term antidepressant prescription. Introduction of the concept of dissociative depression is proposed to facilitate the identification of this large group of patients who suffer from their “no name” condition from the angle of official psychiatric classifications.

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Differences in impulsivity between females diagnosed with eating disorders and healthy subjects

Author(s): M Langer,A. Bord,M Golan / Language(s): English Issue: 3/2015

Objectives: This cross-sectional study investigates the tendencies toward impulsivity and self-control over the entire spectrum of the different eating disorders in comparison to healthy and recovered subjects. Methods: The study included 116 women, aged 18-35. Participants filled seven self-report questionnaires to assess eating disorders features and tendencies toward impulsivity and self-control and two computerized tasks (Go/No Go and Cognitive Delay Discounting) to examine motoric impulsivity. Results: There was a hierarchy of occurrence of impulsivity in the different categories of eating disorders. Cognitive impulsivity as well as motor impulsivity and global score of impulsivity were most prominent in the anorexia nervosa binging type. This hierarchy was correlated with the eating disorders symptoms. The lowest score in motor impulsivity was observed among restrictive patients with anorexia and the highest among patients with binging-purging anorexia, while all other groups were in between. Those with bingingpurging anorexia demonstrated significantly different behavior in short term delays: they were less willing to delay gratification in comparison to other participants who demonstrated preference for the higher delayed reward. The impulse regulation and the ineffectiveness scores of both anorextic groups were higher in comparison to the other groups. These two variables were highly correlated with attentional impulsiveness. Conclusion: These findings suggest that bingeing and restricting behaviors may be seen as lying on opposite ends of a spectrum of impulsive behaviors. Individuals with AN-BP appear to have more in common with BN individuals as they share the tendency to display greater response Disinhibition and produce more impulsive behaviors. Since at this stage only a small sample size was analyzed these results are considered preliminary.

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Treatment of depression following a traumatic brain injury

Author(s): Robert Perna,Hana Perkey / Language(s): English Issue: 2/2015

Depression following a brain injury constitutes a threat to an optimal recovery. Depressed individuals who have suffered a brain injury are likely to experience poorer outcomes; have lower level of psychosocial functioning; and potentially decline or stagnate in their recovery. In addition, they may be at higher risk for suicide than their non-depressed peers. Timely, effective treatment is essential to maintain functional gains. This article aims to provide an overview of clinical issues that can allow for an early identification of depression and lead to more effective interventions. Moreover, the available treatment strategies which have already garnered a degree of empirical support are discussed. There is some evidence for effective depression treatment utilizing sertraline and other antidepressants. Also there is growing empirical support for many non-medication therapeutic options, such as Cognitive Behavioral Therapies, and mindfulness-based protocols. The importance of an integrated, systematic framework to serve as a guide to the treating mental health professionals is highlighted.

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Chronic psychosis and its prevention

Author(s): Adonis Sfera / Language(s): English Issue: 3/2015

Nothing is more challenging in psychiatry than the management of chronic psychosis. Indeed, this issue may shape the future of psychiatry in the long run. Today there is excessive pessimism in the field about our ability to influence the outcome of chronic schizophrenia. In my opinion we need a long term vision with emphasis on prevention, early detection and a good dose of optimism. Winston Churchill once said: “for my self I am an optimist – it does not seem to be much use in being anything else.”

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Prevalence of antipsychotic polypharmacy: prescribing practices at the psychiatry department at HMC (hamad medical corporation, Doha, Qatar)

Author(s): Adel Sleiman Zaraa,Majid Al-Abdulla,Waseem Abdallah,Mahmoud Aborabeh,Soha Mahmoud / Language(s): English Issue: 4/2015

Combining antipsychotics in the treatment of schizophrenia and other psychotic disorders is relatively common. Rates in the literature have varied with an average ranging from 10% to 40%.1 A recently published systematic review that summarized 173 studies reporting on rates and correlates of antipsychotic polypharmacy from the 1970s to today in over 1.5million patients found that the overall mean antipsychotic polypharmacy rate was 26%.2 Concerns about antipsychotic polypharmacy include the possibility of higher than necessary numbers of medications, greater than necessary total dosages, increased acute and long-term adverse effects, drug-drug interactions, increased non-adherence, difficulties in determining the effect of each treatment, substantially higher cost, a risk for increased mortality, and the general lack of evidence for the effectiveness and safety of antipsychotic polypharmacy.3‒8 It is our observation that despite the lack of clinical evidence, the anti-psychotic prescribing practices are very prevalent in our department. So far there was no quantitative or qualitative study that looked into this important issue. But there is little literature evidences found regarding the benefits of adding another antipsychotic. We are set to review the prescribing practices at the department of Psychiatry, HMC, in regard to the Antipsychotic polypharmacy, and see how it compares to the international general psychiatric practice then compare it to the existing guidelines. The results are discussed, recommendations are drafted and we plan on follow up in a separate yet later study the progress we would made in bringing about any change in the prescribing behavior after a remedial one year of educational intervention.

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A physical mind but not just organic

Author(s): Joan Torello / Language(s): English Issue: 4/2015

Throughout history, in different times and in different areas of thought, mind was very differently conceived than we do today. Here is shown an unconventional design to modern science, which is the idea of soul as something, material, in one hand, yet not totally contained within the physical limits of the body or located in any specific part of the body, in the other. This idea, that can be shocking, is that of an ‘extensive’ soul, a material element that acts on the body. This soul would be ‘made’ of a non-solid, much more subtle than the body, almost imperceptible, like air or breath, but also physical.

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Opiates may have neuroprotective properties against neurodegeneration and premature death

Author(s): Alen J Salerian / Language(s): English Issue: 4/2015

Endorphins and endorphin agonists play a crucial role in the neuromodulation of mood, anxiety, pain and addiction. Review of clinical studies seem to elucidate possible protective role of opiates against neurodegeneration and premature death. The historical, biological, experimental, clinical and neuroimaging data strongly support the potential properties of opiates as neuro protectors.

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The possible threats of labeling in a psychiatric context

Author(s): Marcel van Delft / Language(s): English Issue: 4/2015

Labeling is a form of categorization which can have profound effects on individuals. In psychiatric contexts, in which a form of categorization is utilized to discriminate and identify mental disorders, this could lead to stigma and other negative consequences. In this article I am identifying a relationship with the analytical viewpoints applied in medical science and demonstrating the incongruence with psychiatric and psychological perspectives. Most notably, I am stressing the negative effects these viewpoints may well have on mental healthcare clients. But I am also pointing out some positive changes already set in motion.

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Case study: how the use and abuse of cannabis is related with organic brain damage and psychotic symptoms

Author(s): Victoria Dolia / Language(s): English Issue: 6/2015

Background: Many studies have been done in order to show that the use of Cannabis can cause psychotic symptoms and brain damage. The aim of this study is to investigate closely what symptoms are presented in chronic users of cannabis. Also, demonstrate with a clinical investigation that chronic use of cannabis (and withdrawal syndrome too) can cause organic brain damage and psychotic symptoms. Case presentation: Mr. K is a 31 years old man. He is from Nigeria. He graduated from college at Nigeria. Since 2009 he lives in Greece. He has a story of abuse of cannabis lasting 11 years, since his early 20s. He smokes cannabis daily, two (2) “trifoliate” cigarettes without adding tobacco with nicotine. The two (2) “trifoliate” cigarettes correspond to one (1 gr) gram of cannabis approximately. Methodology and results: During the interview his behavior did not give any information relating to psychiatric/psychological disorder or cerebral dysfunction. He answered openly and honestly all the questions. Through the appropriate questions for detecting clinical symptoms of psychopathology were observed some elements of psychological dysfunction. Also, he performed a set of neuropsychological tests to investigate, if he presents cerebral dysfunction. The tests showed that there were some elements of organic brain damage. With the help of the interview and tests, that are valid and reliable tools, we were able to identify and find the presence of psychotic symptoms and panic attacks which were directly related to the use of cannabis, as these occur under the influence of cannabis. Moreover, the chronic use of cannabis has caused him brain dysfunction.

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Sleep management protocol to improve screening and management of sleep disorders among HIV population

Author(s): Serah Muigai,Kimberly Williams,Kisani Ogwaro / Language(s): English Issue: 1/2016

Background: Sleep problems among individuals living with HIV is a major challenge that needs to be addressed. Objectives: To implement a quality improvement project and develop an evidence based clinic-specific protocol to improve management of sleep disorders among individuals living with HIV served at a local Community Health center. Methods: Using Pittsburg Sleep Quality Indicator (PSQI) and Insomnia Sleep Index (ISI) questionnaires, individuals living with HIV were assessed for presence of insomnia at baseline and one month after implementation of sleep habit teaching. Results: A total of 13 individuals living with HIV agreed to participate in the project. The participants in this quality improvement project suffered from sleep disorder as indicated by a mean of 16.40 in the initial ISI and a PSQI score of 9.53 which signified poor sleep quality. A paired-samples t test was calculated to compare the mean initial ISI/PSQI scores to the mean final ISI/PSQI scores. A significant decrease from the initial to final PSQI was found (t (12) = 3.454, p = .005), indicating improvement to sleep symptoms. Discussion: One month of clinical interventions among HIV patients indicated that the insomnia was a significant problem as demonstrated by the ISI and PSQI measurements. The results demonstrated unequivocally success. The results are attributable to the patient’s motivation to get better, their increased compliance to care, and the staff dedication in educating the patients on sleeping hygiene.

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Can haloperidol cause serious neutropenia?

Author(s): Adel Zaraa,Nahid M. Elhassan,Ahmed Abd Alkarim Yousif / Language(s): English Issue: 1/2016

According to literature; clozapine and remoxipride carry the highest risks of haemopoietic reactions appeared to be associated with the aliphatic phenothiazine derivatives thioridazine and chlorpromazine. There is therefore no evidence of any increased risk with high-potency drugs such as haloperidol or pimozide or with the newer drugs such as sulpiride or risperidone. However, this case report revealed that haloperidol can cause serious neutropenia.

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Beta blocker induced notorious psychiatric combination: psychosis, depression, and suicide

Author(s): Adel Zarra,Rana El Maghraby,Ahmed AL Hassan / Language(s): English Issue: 1/2016

The literature review shows that the most common psychiatric manifestation of beta adrenoreceptor blockers is depression, fatigue, and erectile dysfunction. There was one case reported in the 1970s about psychosis-induced by beta adrenoreceptor blocker. This case report is the only one of its kind reporting an association between psychosis and beta adrenoreceptor blockers uses. The case we would like to report is unique in its kind because it can be considered to be the second in literature to convey the rare, but detrimental, side effect profile of beta adrenoreceptor blockers: psychosis. Furthermore, our case report is demonstrating evidence of psychosis co-existing with worsening depressive symptoms, and emerging suicidal thoughts. Another large cohort study was conducted in the 1990s that assessed the risk of suicide in 58, 529 users of B-adrenoceptor blockers, calcium channel blockers, and angiotensin converting enzyme inhibitors (ACEIs). One hundred and forty suicide cases were reported in this study, and it was significant in users of B-adrenoceptor blockers. This study and further literature concluded that b-adrenoreceptor blockers were associated with increased risk of suicide. However, calcium channel blockers and ACEIs were not associated with increased suicide risk.

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Executive functioning and dysfunctional schema modes in individuals with frontal lobe lesion and temporal lobe epilepsy; mega case analysis

Author(s): Sabir Zaman,Muhammad Tahir Khalily / Language(s): English Issue: 1/2016

The present study was to investigate the executive functioning like selective attention, cognitive flexibility, processing speed and executive processing abilities in individuals with frontal lobe lesion and temporal lobe epilepsy by using a tool Stroop Neuropsychological Screening Test.1 The study also tried to explore emotional problems, cognitive state, specific behavioral responses and coping strategies of individuals with frontal lobe lesion and temporal lobe epilepsy. The present study was also designed to develop the reflective understanding of dysfunctional and healthy modes of individuals of frontal lobe lesion and temporal lobe epilepsy measure through Schema Mode Inventory Urdu version.2 The sample of the present study consisted of 08 cases 04 cases related to frontal lobe lesion and 04 cases of temporal lobe epilepsy. Our finding indicated that the individuals of frontal lobe lesion and temporal lobe epilepsy were found significantly engaged in dysfunctional modes, such as Child Modes, Maladaptive and Punitive Parents Modes. On Stroop Test the Standard Deviation of individuals with frontal lobe lesion (74.18) and temporal lobe epilepsy (59.25) both the values are below the standard value (98) which shows the significant level. The Stroop Test measure executive functioning like selective attention executive processing, cognitive flexibility and inhibition control all these qualities are low and poor in individuals with frontal lobe lesion and temporal lobe epilepsy. The individuals with frontal lobe lesion and temporal lobe epilepsy were engaged in dysfunctional modes such as Child Modes, Maladaptive and Punitive Parent Modes are positively associated with executive functioning. Individuals with dysfunctional schema modes are lower score on Stroop test.

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