Actigraphy in post traumatic stress disorder

Patients with posttraumatic stress disorder [PTSD] frequently complain of sleep disturbances such as insomnia and nightmares. Evaluation of sleep disturbances is often difficult due to the subjective nature of the complaints. Polysomnography [PSG] and other sleep studies are generally not indicated in the evaluation of insomnia or nightmares associated with PTSD. Actigraphy, [electronic activity monitoring] has been used in research to evaluate sleep disturbances in patients with PTSD. We reviewed the literature on the use of actigraphy in evaluation of sleep problems in patients with PTSD. A literature search for articles on the topic was conducted on PubMed using the search algorithm [actigraphy [Title/Abstract] OR actigraphic [Title/Abstract]] AND PTSD [Title/Abstract]. Out of 11 search results, 9 studies in which application of actigraphy had relevance to the primary objective and outcome in PTSD patients with sleep problems were selected for review. We also handpicked one additional article from personal communication with our colleagues who have done some of these studies. Actigraphy has been used to evaluate circadian rhythm sleep disorders. Use of actigraphy in psychiatry clinics is uncommon. There is no data to support that there are specific actigraphic sleep related findings in PTSD patients. However, it can be a useful tool to complement the use of sleep diaries when assessing sleep and wake patterns in patients with PTSD

Educating tomorrow's doctors: a cross sectional survey of emotional intelligence and empathy in medical students of Lahore

Medical education in Pakistan traditionally emphasizes physician's biomedical knowledge with less emphasis on interpersonal skills and ability to relate to the patients. This study explored the emotional intelligence and empathy of undergraduate medical students and investigated its relationship with various factors to act as baseline for future work in this area. The Schutte Emotional Intelligence scale and Davis' Interpersonal Reactivity Index in addition to socio demographic questionnaire were administered to first year and final year medical undergraduates of two medical Institutions in Lahore, Pakistan. Data was analyzed by using SPSS 17 version. The overall mean scores for medical students both on emotional intelligence and empathy is significantly lower than that found in previous literature, highlighting that medical students do not appear to fare better than average people in EQ. Women showed statistically significant higher scores on Appraisal of emotions, Regulation of emotions, Empathic concern Scale and Personal distress scale. Comparison of EI and IRI of students according to medical college year did not show any statistical significance. Current medical curriculum and training in Pakistan does not appear to increase EI abilities which are building blocks that may allow students and residents to develop competence. Medical educators in Pakistan should look for ways to incorporate emotional intelligence in medical curriculum which will ultimately contribute towards patient centered practice, patient satisfaction as well as effective communication skills

fiery landscape of depression: a review of the inflammatory hypothesis

The purpose of this article is to review the evidence linking depression with inflammation, to examine the bi-directional relationship between the neuro-humeral circuitry of depression and the inflammatory response, and point out new treatment implications of these ideas. The evidence available is in areas of genetic links, association of depression with raised inflammatory markers such as Tumour Necrosis Factor [TNF]-alpha, Interleukin [IL]-1, IL-6, co-morbidity of depression with inflammatory medical illnesses, administration of cytokines leading to depression, and the recognition that anti-depressants have anti-inflammatory and neuro-protective properties. Inflammatory response and mood regulation constitute a system of bi-directional communication such that inflammatory cytokines can penetrate the CNS and influence behavior. Activation of the CNS cytokine network leads to a cascade of effects such as disturbed metabolism of amino acids, neurotoxicity, diminished neurotrophic support, decreased neurogenesis, impaired negative feedback regulation of HPA axis function and glucocorticoid resistance. Treatment implications include strategies to screen for patients with increased inflammatory activity, possible treatment with anti-inflammatory agents, and the recognition of new target areas for antidepressant medications. A literature search for articles published during the last ten years was conducted using various combinations of key words ['depression', 'inflammation', 'cytokines', 'immune system', 'interleukins'] utilizing the databases Google Scholar and PubMed. An outline of the most relevant aspects of the role of inflammatory processes in depression was created. Major papers, including other review articles, were identified in accordance with our outline. These articles were subsequently hand searched and reviewed individually for further references of significance. The inflammatory response leading to formation of inflammatory cytokines plays a significant role in the pathophysiology of depression, and this has important implications with regards to new and personalized treatment of depression