The Phenomenon Of Dissociation, Depression And Borderline Personality In A Young Woman

Early life adversities like parental loss during childhood, physical abuse, sexual abuse and emotional harassment may have deleterious consequences in an individual’s life, which can manifest under the form of various externalizing or internalizing behaviors. This case study aimed to highlight the impact of unusual early life adversities in a young woman’s mental health and related management issues. Methods: We reported a case of a young lady presenting with anxiety, low mood, disturbed sleep and appetite for more than six months. She also had episodes of dissociative stupor following any stressful event for approximately 13 years. She was hospitalized, evaluated clinically as well as by psychometric assessment. Relevant pharmacological and psychological interventions were performed. Results: She was diagnosed with Major depressive disorder with dissociative disorder and borderline personality disorder. The patient had multiple stressors during childhood like - loss of parents, emotional & physical abuse, which had an impact on her mental wellbeing. Conclusion: Early life adversities are detrimental to the mental health of an individual. The clinical outcome depended upon on the nature of trauma to the mental well-being, mode of intervention done and available psychosocial supports. ASEAN Journal of Psychiatry, Vol. 17 (2): July – December 2016: XX XX.

Assessing protein energy malnutrition in children: biochemical markers serum total protein, serum albumin and serum protein electrophoresis

Protein Energy Malnutrition [PEM] is a global problem among children. Worldwide 27% under five children are malnourished. PEM is more prevalent in India where almost half [47%] the children are underweight. Assessment of PEM has traditionally been clinical which is time consuming and skill dependent, with considerable inter-observer variability. Hence, biochemical markers like serum protein and albumin measurements may be used for the assessment of nutritional status. At the same time, there is a controversy, whether edema can be considered as a reliable clinical marker of hypoalbuminemia. Readily available and reliable tests and can often detect nutritional deficiencies before they have an adverse effect on biological functions and certainly before deficiencies can be detected by physical examination. The study was designed to assess PEM in children using biochemical markers like serum protein, albumin and protein electrophoresis and establishing a correlation between edema and hypoalbuminemia. This analytical case control study was done in the Narayana Medical College and Hospital from September 2007 to September 2009. The material for the study consisted of 50 cases of PEM and 20 normal healthy children. In PEM cases, total protein and serum albumin were found to be significantly lower in comparison to normal healthy controls. Thus total protein and serum albumin may become useful indicators of the nutritional status of the malnourished children and good markers of PEM. Albumin and beta fractions of Serum Protein Electrophoresis were significantly lower while alpha 1, alpha 2 and gamma globulin fractions were significantly higher in malnourished children in comparison to controls

Inhibitory control test, critical flicker frequency, and psychometric tests in the diagnosis of minimal hepatic encephalopathy in cirrhosis

Minimal hepatic encephalopathy [MHE] impairs health-related quality of life and driving ability of the patient. We assessed the utility of the inhibitory control test [ICT], critical flicker frequency [CFF], and psychometry in the diagnosis of MHE. Consecutive patients with cirrhosis underwent number connection tests A and B [NCT-A, B], digit symbol test [DST], line tracing test [LTT], serial dot test [SDT], CFF, and ICT at baseline and after four hours. Fifty healthy subjects served as controls for the ICT test. Fifty patients with cirrhosis [43.4 +/- 10.2 yrs, M: F 42:8] underwent psychometric tests [NCT-A [48.3 +/- 17.7 vs. 42.6 +/- 17.3 sec, P = 0.001], NCT-B [85.7 +/- 40.1 vs. 90.2 +/- 37.0 sec, P = 0.18], DST [23.5 +/- 9.3 vs. 23.0 +/- 8.7, P = 0.45], LTT [96.6 +/- 48.2 vs. 96.8 +/- 46.8 sec, P = 0.92], SDT [88.0 +/- 39.5 vs. 83.4 +/- 37.2 sec, P = 0.02]] at baseline and after four hours. Target accuracy of ICT was lower in patients with cirrhosis compared with controls [88.4 +/- 5.6 vs. 95.6 +/- 2.1, P = 0.01], whereas ICT lures were higher [18.3 +/- 4.2 vs. 10.2 +/- 2.8, P = 0.01]. Patients with cirrhosis showed a reduction in lures in the second evaluation compared with the first [18.3 +/- 4.2 vs. 17.1 +/- 4.3, P = 0.003] but no change in target accuracy [88.4 +/- 5.6 vs. 88.4 +/- 5.3, P = 0.97]. Control subjects did not show any change either in lures [10.2 +/- 2.8 vs. 10.3 +/- 2.1, P = 0.65] or target accuracy [95.6 +/- 2.1 vs. 95.5 +/- 2.2, P = 0.82]. The sensitivity and specificity of ICT test for the diagnosis of MHE at lure rate >16.5 was 88.5 and 56%, respectively. CFF in patients with MHE [38.4 +/- 1.8 vs. 38.6 +/- 1.5, P = 0.3] and non MHE [40.6 +/- 2.2 vs. 40.8 +/- 2.2, P = 0.6] did not show any difference after four hours as in controls [41.9 +/- 2.4 vs. 42.1 +/- 2.0, P = 0.3]. Thirty one [31%] patients preferred psychometric tests, 57 [57%] preferred CFF and only 12 [12%] preferred ICT [P = 0.001]. ICT, CFF, and psychometric tests are useful tools to assess MHE, and CFF was preferred by this study cohort