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Practical Management of Attention Deficit Hyperactivity Disorder (ADHD) 注意缺陷多动障碍(ADHD)的实用管理
Pub Date : 2021-10-13 DOI: 10.5005/ejp-12-1--2-60
R. Banhatti, K. Dwivedi
Children who fulfil the diagnostic criteria for ADHD are found in almost all cultures that have been studied so far· The rates differ to some extent often reflecting the different instruments of assessment used. Cultural environment may affect a child's behaviour, but the differing attitudes of parents, teachers, clinicians and the society towards acceptable behaviour will also influence diagnosis • Some European countries (e.g. Italy, Spain) and India and other Southeast Asian countries can be more accepting of boisterous, noisy behaviour and hence more 'child friendly' and more accepting and absorbing of the 'ADHD' like behaviour as 'normal'. At present there is a pressing need and scope for research looking into culture /ethnicity sensitive research instruments to explore this area further. Issues in diagnosis Attention Deficit Hyperactivity Disorder is the diagnostic category in DSM-IV (American Psychiatric Association
到目前为止,几乎在所有的文化中都发现了符合ADHD诊断标准的儿童。比率在某种程度上有所不同,通常反映了所使用的评估工具的不同。文化环境可能会影响儿童的行为,但父母、教师、临床医生和社会对可接受行为的不同态度也会影响诊断•一些欧洲国家(如意大利、西班牙)、印度和其他东南亚国家可能更能接受吵闹、吵闹的行为,因此更“儿童友好”,更能接受和吸收“多动症”类行为为“正常”。目前,迫切需要研究文化/种族敏感的研究工具,以进一步探索这一领域。注意缺陷多动障碍的诊断问题是美国精神病学协会DSM-IV的诊断范畴
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引用次数: 0
Folie Simultanee: A Case Report 同时Folie: 1例报告
Pub Date : 2021-10-13 DOI: 10.5005/ejp-12-1--2-64
C. Narayan, M. Narayan
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引用次数: 0
Suicidal Behavior in Drug Abused Patients 药物滥用患者的自杀行为
Pub Date : 2021-10-13 DOI: 10.5005/ejp-12-1--2-71
A. Brahma
Drug addiction is one of the most burning problems of the whole world. A number of studies have shown that drug abuse is associated with a high risk for suicidal behavior, which is likely to reflect common contributing factors as well as the effects of drugs on mood. Alcohol and other drug use and abuse occur more frequently among youth and adults. Depression and drug abuse appear to be more lethal in combination than either factor is alone. Alcohol and other drugs abuse problems contribute to suicidal behavior in several ways. In addition to being depressed, they are also likely to have social and financial problems. Drug abuse can be common among persons who are impulsive, and among persons who engage in many types of high risk behaviors. There are a number of effective prevention efforts that reduce the risk for drug abuse. Future Research may direct treatments specifically for persons with drug abuse problems who also have suicidal ideations.
吸毒成瘾是全世界最紧迫的问题之一。许多研究表明,药物滥用与自杀行为的高风险有关,这可能反映了常见的影响因素以及药物对情绪的影响。酒精和其他药物的使用和滥用在青年和成年人中更为常见。抑郁症和药物滥用加在一起似乎比单独使用任何一个因素更致命。酒精和其他药物滥用问题在几个方面会导致自杀行为。除了抑郁之外,他们还可能出现社会和经济问题。药物滥用在冲动的人和从事多种高风险行为的人中很常见。有一些有效的预防工作可以减少药物滥用的风险。未来的研究可能会指导专门针对有药物滥用问题并有自杀念头的人的治疗。
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引用次数: 0
The Quest for an Ideal Mental Health Act 寻求一个理想的精神健康法案
Pub Date : 2021-10-13 DOI: 10.5005/ejp-14-1--2-50
C. Narayan, R. Jaiswal
: Legislation in the field of mental health is required to protect human rights of the patients, and to provide for legislative procedures for admission into mental health facilities. After a long and protracted course, the Mental Health Act (MHA) – 1987 was enacted by the Government of India (GOI). Though it contained many progressive features of advancement over the previous India Lunacy Act (ILA) – 1912, it failed to come up to expectation due to various inherent drawbacks and other factors. After ratification of the UNCRPD by India, it became imperative to amend the existing MHA – 1987. The drafting team, which has been assigned duty to prepare the new and amended proposal of the MHA by the Ministry of Health & FW, GOI, issued a draft of a new Act, the Mental Health Care Act on 06.12.10. This proposed draft gives special stress to human rights of persons with mental illness, and makes it obligatory for the government to establish a mental health care delivery system which can be accessed by all. It also proposes to establish Mental Health Review Commission (MHRC) to review admissions to mental health facilities and to ensure human rights of persons of mental illness and State Mental Health Authority (SMHA) to perform various functions like registration and supervision of mental health facilities and other functions related to mental health services. All stake holders are being consulted in the process. But the professionals have reservations on some of its provisions. Stands of the professionals in mental health and those of the human right activists are frequently at variance with each other. Activist groups are pressing for stiff control on psychiatric institutions and practically a ban on involuntary admissions to mental health facilities. Suggestions for improvement in the proposed draft are given.
*需要在精神卫生领域立法,以保护病人的人权,并规定进入精神卫生设施的立法程序。经过漫长的过程,印度政府颁布了《1987年精神卫生法》。尽管它比之前的《1912年印度疯子法案》(ILA)有许多进步的特点,但由于各种内在缺陷和其他因素,它未能达到预期。在印度批准《联合国儿童权利公约》之后,必须修订现有的《1987年妇女权利公约》。起草小组受命编写卫生部的新提案和经修订的卫生部提案,于2010年12月6日发布了一项新法案草案,即《精神保健法》。这项拟议的草案特别强调精神病患者的人权,并规定政府有义务建立一个人人都能获得的精神保健服务体系。它还建议设立精神卫生审查委员会,审查精神卫生设施的入院情况,确保精神病患者的人权,并建议设立国家精神卫生管理局,履行各种职能,如登记和监督精神卫生设施以及与精神卫生服务有关的其他职能。在这个过程中,所有的利益相关者都被征求了意见。但专业人士对其中一些条款持保留意见。精神卫生专业人员的立场与人权活动人士的立场经常不一致。活动团体正在施压,要求严格控制精神病院,并实际上禁止非自愿进入精神卫生机构。对建议草案提出了改进意见。
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引用次数: 0
Culture and Somatization: A Psycho Social Perspective 文化与躯体化:心理社会视角
Pub Date : 2021-10-13 DOI: 10.5005/ejp-12-1--2-28
Arif Ali, S. Deuri, A. Baruah, S. K. Deuri
Culture shapes the perception and expression of distress .The occurrence of somatization varies across socio cultural groups and seems to be influenced by psychosocial factors. The study was conducted on somatization patients selected from outpatient unit of LGB Regional Institute of Mental Health, Tezpur, Assam. The data was collected in a period of three months from September to November, 2008. Subjects fulfilling the criteria of the study were evaluated for socio demographic variables and clinical presentation on semi structured proforma and thereafter the Bradford Somatic Inventory 1, Satisfaction with Life Scale 2 , Multidimensional Scale of Perceived Social Support 3 ,WHO Wellbeing Index (1998) 4 and Perceived Stress Scale 5 were administered. Women have consistently been shown to report more somatic symptoms than men. Perceived social supports and perceived stress was found to have a significant positive correlation with life satisfaction. Wellbeing was found to be poor in the most of the patients and was found to have a significant positive correlation with perceived stress. Somatization is common in all ethno cultural groups and societies studied to date. The importance of demographics, psychosocial functioning, perceived stress, availability of social support was emphasized in the explanation of somatization tendencies among the subjects in the present study.
文化塑造了痛苦的感知和表达。躯体化的发生在不同的社会文化群体中是不同的,并且似乎受到心理社会因素的影响。该研究是在阿萨姆邦提斯普尔LGB地区精神卫生研究所门诊部选择躯体化患者进行的。数据收集时间为2008年9月至11月三个月。对符合研究标准的受试者进行社会人口学变量和半结构化形式的临床表现评估,然后进行布拉德福德躯体量表1、生活满意度量表2、感知社会支持多维量表3、世界卫生组织幸福指数(1998)4和感知压力量表5。一直以来,女性报告的躯体症状都比男性多。感知社会支持、感知压力与生活满意度呈显著正相关。研究发现,大多数患者的幸福感都很差,而且幸福感与感知压力呈显著正相关。躯体化在迄今为止所研究的所有民族文化群体和社会中都很常见。在本研究中,在解释被试的躯体化倾向时,强调了人口统计学、心理社会功能、感知压力、社会支持的可得性等因素的重要性。
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引用次数: 0
Cognitive Dysfunctions in Depressive Patients 抑郁症患者的认知功能障碍
Pub Date : 2021-10-13 DOI: 10.5005/ejp-14-1--2-24
Pushpa Lnu, D. Prasad, Smita Hemrom, K. S. Sengar, P. Singh, A. Singh
: Cognition is the word often used to describe the fundamental capacity to think. Its disturbance in depression is probably what most bothers patients and their families and not the symptoms, they are usually used to measure and diagnose the condition. It has also become clear that depression has an enduring impact on memory function, attention and other domains of cognition with major implication for neurological explanation of depression. Cognitive functions have thus become an increasingly central target for emergent interest and relevance. These developments have also reignited interest in patient experience and the possibility that may be blunted in depression, but also as a consequence of its treatment. Past studies on depression have documented cognitive dysfunctions significantly. Aim - In this study an attempt was made to assess and compare the cognitive impairment in depressive patients and normal subjects. Methodology- The sample was selected from Ranchi Institute of Neuro-Psychiatry and Allied Sciences (RINPAS). Hindi adaptation of Cognitive Symptoms Checklist and Beck Depression Inventory were administered on 50 depressive patients and 50 normal controls. Results of the study suggest significant difference in cognitive functions between depressive patients and normal subjects. Depressive patients showed more deficits in Attention, Memory and Executive Functioning on Cognitive Symptoms Checklist (CSC) than normal controls.
认知这个词经常被用来描述思考的基本能力。它在抑郁症中的干扰可能是最困扰患者及其家人的,而不是症状,它们通常用于测量和诊断病情。同样清楚的是,抑郁症对记忆功能、注意力和其他认知领域有持久的影响,这对抑郁症的神经学解释具有重要意义。因此,认知功能日益成为新兴兴趣和相关性的中心目标。这些发展也重新点燃了人们对患者经历的兴趣,以及抑郁症可能会减弱的可能性,但这也是治疗的结果。过去对抑郁症的研究已经记录了显著的认知功能障碍。目的:在本研究中,试图评估和比较抑郁症患者和正常人的认知障碍。方法:样本选自兰契神经精神病学和相关科学研究所(RINPAS)。对50例抑郁症患者和50例正常对照者进行认知症状量表和贝克抑郁量表的印度语改编。研究结果表明,抑郁症患者的认知功能与正常人有显著差异。在认知症状检查表(CSC)中,抑郁症患者在注意、记忆和执行功能方面表现出比正常人更多的缺陷。
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引用次数: 0
Psychopathology among Primary Caregivers of Major Psychiatric Patients 主要精神病人主要照顾者的精神病理
Pub Date : 2021-10-13 DOI: 10.5005/ejp-13-1--2-54
A. Singh, Sanjay Kumar Nayak, S. Kumari, M. Jahan
Background:Perceived stigma and experiencing different kinds of burden for long time by primary caregivers during caring family member suffering from major psychiatric illness may affects their mental health. Present study was conducted to find out the nature of psychopathology experienced by primary caregivers of major psychiatric patients. Material & Method: Forty-four caregivers of major psychiatric patients were selected from outdoor psychiatric unit of Ranchi Institute of Neuro-Psychiatry and Allied Sciences, Ranchi and forty-one normal controls were selected from different location of Ranchi district. They were assessed on Symptoms Checklist–90–Revised (SCL-90) and General Health Questionnaire – 28 (GHQ-28). Statistical analysis was done using SPSS (13.0 ver.). Result: The result suggests that primary caregivers experience psychopathology, namely, somatization, obsessive compulsive symptoms, interpersonal sensitivity, depression, anxiety, anger hostility, phobic anxiety, paranoid ideation and social dysfunction while caring someone family member suffering from major psychiatric illness and the number of caregivers in family definitely has an impact on severity of the caregivers’ psychopathology. Total duration of patient’s treatment and total duration of patient’s illness also affect caregiver’s phobic anxiety and number of patient’s hospitalization affects caregivers’ social dysfunction as well. Conclusion:Findings suggest that mental health issues of caregivers should also be addressed while formulating management plan for patients suffering from major psychiatric disorders.
背景:主要照顾者在照顾患有重大精神疾病的家庭成员时所感受到的耻辱感和长期承受的各种负担可能影响其心理健康。本研究旨在了解主要精神病人的主要照顾者所经历的精神病理性质。材料与方法:选取兰契市兰契神经精神病学与联合科学研究所户外精神科的44名重症精神病人护理人员和来自兰契地区不同地点的41名正常对照。采用症状检查表-90 -修订版(SCL-90)和一般健康问卷-28 (GHQ-28)进行评估。采用SPSS (13.0 ver.)进行统计学分析。结果:主要照顾者在照顾患有重大精神疾病的家庭成员时,会出现躯体化、强迫症状、人际敏感、抑郁、焦虑、愤怒敌意、恐惧焦虑、偏执妄想和社交功能障碍等精神病理症状,而家庭中照顾者的人数对照顾者的精神病理严重程度有一定影响。患者总治疗时间和患者总患病时间也会影响照顾者的恐惧焦虑,患者住院次数也会影响照顾者的社交功能障碍。结论:研究结果提示,在制定重大精神障碍患者的管理方案时,护理人员的心理健康问题也应得到重视。
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引用次数: 0
Anxiety Disorders in Children and Adolescents 儿童和青少年焦虑症
Pub Date : 2021-10-13 DOI: 10.5005/ejp-16-1--2-50
Satyakam Mohapatra, V. Agarwal
The first section covers historical and conceptual issues, including cognitive and developmental processes, clinical and theoretical models, phenomenology and classification, and evidence-based assessment. Subsequent sections cover the biology of child and adolescent anxiety, and environmental influences including traumatic events, parenting and the impact of the peer group. The final section addresses prevention and treatment of anxiety. All chapters incorporate new advances in the field, explicitly differentiate between children and adolescents, and incorporate a developmental perspective. Written and edited by an international team of leading experts in the field, this is a key text for researchers, practitioners, students and clinical trainees with interests in child and adolescent anxiety.
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引用次数: 0
Treatment Resistant Depression 难治性抑郁症
Pub Date : 2021-10-13 DOI: 10.5005/ejp-13-1--2-77
Mahesh Hembram, Suprakash Chaudhury
Most of the literature on Treatment Resistant Depression (TRD) has based its definition of resistance on the failure to respond to antidepressant drug treatment of adequate dose and duration. The prevalence of TRD is lowest in primary care settings and progressively increases in outpatient psychiatry settings, inpatient psychiatric settings, and academic/tertiary care settings. Strategies available for the treatment of TRD include optimization, substitution or switching, combination, and augmentation therapies. Currently there are no clear guidelines on when to substitute, combine, or augment therapies in the treatment of patients with TRD. Some new and novel therapies that show promise for the future include addition of an atypical antipsychotic to the initial antidepressant; newer pharmacologic interventions; and non-pharmacologic therapies such as vagus nerve stimulation (VNS), repetitive transcranial magnetic stimulation (rTMS), and deep brain stimulation (DBS). The newer models of interpersonal, cognitive, and behavioral therapies offer structured, pragmatic methods to work with such difficult patients. Guidelines for psychotherapeutic intervention for TRD suggested that the therapy should be collaborative and centered on the goal of teaching new skills to improve coping with a chronic illness. A better understanding of the many facets of the etiology of TRD as well as the availability of new and effective therapies hopefully will decrease the morbidity and mortality associated with this condition.
大多数关于治疗难治性抑郁症(TRD)的文献都将耐药性的定义建立在对适当剂量和持续时间的抗抑郁药物治疗无效的基础上。TRD的患病率在初级保健机构中最低,在门诊精神病学机构、住院精神病学机构和学术/三级保健机构中逐渐增加。可用于治疗TRD的策略包括优化、替代或转换、联合和增强治疗。目前,在TRD患者的治疗中,没有关于何时替代、联合或加强治疗的明确指南。一些新的和新颖的治疗方法显示出未来的希望,包括在最初的抗抑郁药中加入非典型抗精神病药;更新的药物干预;以及非药物治疗,如迷走神经刺激(VNS)、重复经颅磁刺激(rTMS)和深部脑刺激(DBS)。人际关系、认知和行为治疗的新模式提供了结构化的、实用的方法来治疗这些困难的病人。TRD的心理治疗干预指南建议,治疗应该是协作的,并以教授新技能为中心,以提高应对慢性疾病的能力。更好地了解TRD病因的许多方面,以及新的有效治疗方法的可用性,有望降低与该疾病相关的发病率和死亡率。
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引用次数: 0
Co-Morbid Personality Disorders among Alcohol Dependent Patients 酒精依赖患者的共病型人格障碍
Pub Date : 2021-10-13 DOI: 10.5005/ejp-14-1--2-11
O. Prakash, M. Jahan, A. Singh, J. Ranjan
The aim of the present research investigation was to describe the co-morbid personality disorder among alcohol dependent patients and to compare it with those of the normal population. Based on purposive sampling technique, 50 alcohol dependent patients were selected from psychiatric inpatient of RINPAS and 50 normal participants were selected from the general population. Both the groups were matched for age,gender and socioeconomic level. All participants were assessed with Millon Clinical Multi-axial Inventory (MCMI)-III. The obtained responses were scored by using standard scoring procedure and subsequently statistically analyzed by using of x 2 test and step wise discriminant analysis. Results revealed that alcohol dependent patients have more co-morbid pathological personality traits and disorders in comparison to normal control group. Of the alcohol-dependent patients, dependent personality disorder was most prevalent followed by antisocial, negativistic and compulsive personality disorders.
本研究的目的是描述酒精依赖患者的共病型人格障碍,并将其与正常人群的共病型人格障碍进行比较。采用目的抽样方法,从RINPAS精神科住院患者中选取50例酒精依赖患者,从普通人群中选取50例正常受试者。这两组人的年龄、性别和社会经济水平都是匹配的。所有参与者均采用百万临床多轴量表(MCMI)-III进行评估。采用标准评分程序对所得问卷进行评分,随后采用x2检验和逐步判别分析进行统计分析。结果显示,酒精依赖患者与正常对照组相比有更多的共病性病理人格特征和障碍。在酒精依赖患者中,依赖型人格障碍最为普遍,其次是反社会、消极和强迫性人格障碍。
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引用次数: 0
期刊
Eastern Journal of Psychiatry
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