Psychiatry Disorders and Sociodemographic Profile of the Victims of Assault Attending the Teaching Hospital—Cross-Sectional Study

Background: According to World Health Organization, proportion of women experiencing either physical or sexual violence ranges between 15% and 17%. In India, one-third of women population in 15 to 49 age group experiences sexual assault at least once in their life, predisposing them to develop psychiatric disorders. Aims and Objectives: To assess prevalence of psychiatry disorders among victims of assault attending tertiary care center. Methodology: It is a retrospective, record-based study which was conducted among 216 victims of assault attending one-stop center. Study was started after obtaining Institutional Ethical Committee clearance and permissions from concerned authorities and confidentiality was maintained throughout the study. Data was analyzed by frequency, proportion, and chi-square tests using SPSS version 16. Results: Out of 216 victims, 50% were physically assaulted and 50% were sexually assaulted. Among 108 sexual assault cases, 81.5% victims were raped, 2.7% were sexually harassed, 1.9% was sexually abused, and 13.9% children were sexually abused. A total of 30.1% had adjustment disorder, 11.6% had dysthymia, 8.3% had mild depression, 5.6% had moderate depression, 0.5% had obsessive-compulsive disorder, 0.5% had psychosis, and 43.5% did not have any psychiatry disorder. Conclusion: Majority of the sexually assaulted victims belonged to age group 16 to 20 years and had adjustment disorder, whereas physically assaulted victims belonged to age group above 36 years and had dysthymia and depression. Special services like medical care, counseling, legal aid, and so on should be provided to victims free of charge. Awareness and sensitization programs should be done through active community participation for the welfare of children and women.

AN AYURVEDA CONCEPTUAL STUDY ON EIGHT DOMAINS IN THE ASSESSMENT OF MIND

History taking, clinical examinations play a major role in confirming the diagnosis and predicting the prognosis of the illness. This is applicable in psychiatric as well as psychosomatic disorders. Sometimes organic diseases may simulate the presentation of psychiatric disorders and vice versa. Many types of examination techniques are ex- plained in Ayurveda which help directly or indirectly to elicit and diagnose psychiatry disorders. Astavibhrama, impairment in eight domains of mental faculties - thinking process (Mano vibhrama), intellect (Buddhi vibhrama), consciousness and orientation (Sanjnajnana vibhrama), memory (smriti vibhrama), desire or interest (Bhakti vibhrama), temperaments (sheela vibhrama), behaviour (chesta vibhrama), conduct (achara vibhrama); a concept adopted for the diagnosis of unmada (insanity). These eight domains can be generalised for eliciting the mental status of an individual. Keywords: Astavibhrama, Mental status examination, Psychiatric disorder

Risk of cardiovascular disease after a diagnosis of common psychiatric disorders: a matched cohort study of disease susceptibility and progression trajectory in the UK Biobank

Background: Whether associations between psychiatric disorders and cardiovascular diseases (CVDs) can be modified by disease susceptibility and the temporal pattern of these associated CVDs remain unknown. Methods: We conducted a matched cohort study of UK Biobank including 35,227 patients with common psychiatry disorders (anxiety, depression, and stress-related disorders) between 1997 and 2019, together with 176,135 sex- and birth year- individually matched unexposed individuals.Results: The mean age at the index date was 51.76 years, and 66.0% of participants were females. During a mean follow-up of 11.94 years, we observed an elevated risk of CVD among patients with studied psychiatry disorders, compared with matched unexposed individuals (hazard ratios [HRs]=1.16, 95% confidence interval [CI]: 1.14-1.19), especially during the first six months of follow-up (HR=1.59 [1.42-1.79]). To assess the modification role of disease susceptibility, we stratified analyses by family history of CVD and by CVD PRS, which obtained similar estimates between subgroups with different susceptibilities to CVD. We conducted trajectory analysis to visualize the temporal pattern of CVDs after common psychiatry disorders, identifying primary hypertension, acute myocardial infarction, and stroke as three main intermediate steps leading to further increased risk of other CVDs.Conclusions: The association between common psychiatry disorders and subsequent CVD is not modified by predisposition to CVD. Hypertension, acute myocardial infarction, and stroke are three initial CVDs linking psychiatric disorders to other CVD squeals, highlighting a need of timely intervention on these targets to prevent further CVD squeals among all individuals with common psychiatric disorders.Funding: This work is supported by the National Natural Science Foundation of China (No. 81971262 to HS), 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (No. ZYYC21005 to HS), EU Horizon2020 Research and Innovation Action Grant (847776 to UV and FF).

A Complicated Case of Stroke, Epilepsy, and Mood Disorder: Hyperhomocysteinemia or Medication Cascade

Introduction: Hyperhomocysteinemia is a risk factor for atherosclerosis and vascular disease, which is correlated with cerebral problems and various neurological disorders. Case presentation: We report a 20-year-old lady with a history of hyperhomocysteinemia affected with stroke, seizure, and mood disorder. By initiating medication for these illnesses, different complications appeared. During the hospital stay, drugs for treating a disease deteriorated the other. We encountered a complex patient and numerous ambiguities in her management. Conclusions: For patients with elevated serum homocysteine and psychiatry disorders, it is important to consider MTHFR gene mutation. A challenge in these patients is to select the medication that does not deteriorate hyperhomocysteinemia. In this complex case, we used carbamazepine that was accompanied by clinical improvement.

The Use of Bioinformatics and Big Data for the In Silico Study of Psychiatric Disorders

Mental and behavioral disorders are becoming the leading cause of disability across the world. Along with the ongoing development of biomedical and computational technologies, more and more data are being constantly produced, including genomic, transcriptomic, metabolomic, proteomic, clinical, and imaging resources. As a consequence, scientists in the psychiatric field are actively changing their research ways from studies focused on individual investigators to large international consortia, which accelerate the data accumulation and increase its size. This chapter discusses the current publicly available data sets on psychiatry disorders and neuroscience, as well as their integrated analysis. The authors also list some studies using novel types of data, which will further extent the potential of big data in the study of psychiatric disorders.

Tobacco Use and Dependence among Psychiatry Out-Patients of a Health Institute in Eastern Nepal

Background: Assessment of nicotine dependence among tobacco users is essential as highly dependent individuals have greater risk of developing tobacco related physical and psychiatric problems. There is little information about the tobacco use and nicotine dependence among psychiatric patients in developing countries, including Nepal. Objectives: To estimate the prevalence of tobacco use, the level of nicotine dependence and the psychiatric disorder specific prevalence among tobacco users visiting a psychiatry out-patient department. Materials and methods: A cross-sectional study was conducted in Out-patient setting of Department of Psychiatry, B. P. Koirala Institute of Health Sciences (BPKIHS). Ninety cases (calculated sample size) were enrolled. The Fagerström Test for Nicotine Dependence (FTND) was applied to assess the level of nicotine dependence and the Mini International Neuropsychiatric Interview (MINI) for diagnosis of Psychiatric disorders. Results: The prevalence of tobacco use was 55.6%. Tobacco use was more common among males (pvalue < 0.05). Smokeless form was the common form of tobacco. Majority of them had started their consumption in their adolescence. Most users had moderate nicotine dependence. Major depressive disorder and Alcohol dependence were the most common diagnoses among tobacco users. Conclusion: More than half of the psychiatry out-patients consumed tobacco. Future studies that help to understand the relationship and possible mechanism of increased tobacco use in patients with psychiatry disorders are required. Tobacco control and prevention strategies should be initiated targeting vulnerable populations such as male gender and adolescent.

Is Schizophrenia A Brain Disorder?

In the language of psychiatry, disorders that change the functioning of psy­chological processes or emotion are called either ‘symptomatic’ or ‘idiopathic’. Symptomatic disorders are those for which there is a known physical cause. For example, temporal lobe epilepsy, strokes, and brain tumours can change mental functioning and emotional expression. In these cases, the physical cause can be found by using electroencephalograms (which measure the electrical activity of the brain), X- rays, or similar, but more sophisticated, methods of assessment. In contrast, we say a disorder is idiopathic if it has no known phys­ical cause. We emphasize the word ‘known’ because most scientists expect that physical causes of schizophrenia will some day be found when we can look moreclosely at the molecular level. The term ‘idiopathic’ originally reflected the be­lief that these disorders were due to psychological and social events that had no physical effects on the brain.When the first edition of this book was published, psychiatry was undergoing a revolution in its approach to mental illness, especially schizophrenia. Many scientists and clinicians were starting to question the idea that schizophrenia was rooted in psychological and family conflict. Instead, they thought that the massive alterations in thought and emotion in people with schizophrenia were due to a disease of the brain.This chapter reviews evidence showing that biological processes are altered in the brains of individuals with schizophrenia. During the past century, scien­tists have created many methods for studying the brain. As each of these new neuroimaging technologies emerged, they were swiftly applied to the study of schizophrenia. As we shall see, most of these measurements led to the same con­clusion: that the structure and function of the brains of some individuals with schizophrenia were not normal. We are, however, still uncertain about many of the details of the aetiology and pathophysiology of the disorder. Aetiology re­fers to the causes of brain dysfunction (e.g., defective genes, environmental risk factors); pathophysiology denotes the specific modifications of the brain that lead to illness (e.g., brain atrophy, too much dopamine).