ABSTRACT
Culture plays an important role in the presentation, help seeking, treatment and outcomes of psychiatric illnesses like schizophrenia. We report a case of paranoid schizophrenia in a 35-year-old lady, from South India, whose clinical presentation was influenced by various sociocultural factors. These cultural constructs were taken into consideration to formulate an acceptable and effective management plan. A detailed case description using a cultural formulation to highlight the etic and emic perspectives and challenges in treatment and management are discussed.
Subject(s)
Schizophrenia, Paranoid/ethnology , Adult , Culturally Competent Care , Female , Humans , India/ethnology , Schizophrenia, Paranoid/diagnosis , Schizophrenia, Paranoid/therapyABSTRACT
BACKGROUND: Acute and Transient Psychotic Disorder (ATPD) is a psychotic disorder of brief duration with acute onset and uncertain diagnostic stability. AIM: To study the diagnostic stability of ATPD during the index episode. METHOD: 140 patients diagnosed with ATPD as per ICD-10, attending a tertiary care hospital in North India were evaluated at follow ups. RESULTS: Other acute and transient psychotic disorder (ICD10: F23.8) was the most common (69.3%) subtype of ATPD. In 14.28% patients, there was a past episode of ATPD. In our study, 66.3% patient's episodes resolved as ATPD, 32.7% patients converted into either a mood disorder or schizophrenia spectrum disorders. CONCLUSION: The diagnostic stability of ATPD during the index episode was 66.3% during three months follow up period. Nearly two third of patients with ATPD evolve to either, schizophrenia or mood disorders during the index episode.
Subject(s)
Outcome Assessment, Health Care , Psychotic Disorders , Acute Disease , Adolescent , Adult , Disease Progression , Female , Follow-Up Studies , Humans , India/epidemiology , Male , Psychotic Disorders/diagnosis , Psychotic Disorders/epidemiology , Psychotic Disorders/therapy , Tertiary Care Centers , Young AdultABSTRACT
Systemic Lupus Erythematosus (SLE) is an autoimmune rheumatic disease which predominantly affects women of reproductive age. Despite significant progress in recent years to elucidate many potential mechanisms involved in the generation of autoimmunity the factors behind the high incidence among women, the relapsing-remitting clinical course and pregnancy-related complications in SLE remain unclear. In this review, we hypothesize a potential role for uterine endometrium through its production of relaxin, a peptide hormone, as a "missing-link" to explain this female predominance, variable clinical course and obstetric complications operating in SLE.
Subject(s)
Endometrium/metabolism , Lupus Erythematosus, Systemic/etiology , Relaxin/metabolism , Autoimmunity , Female , Humans , Lupus Erythematosus, Systemic/metabolism , Male , Pregnancy , Pregnancy Complications/metabolism , Sex FactorsABSTRACT
Preventive psychiatry is a branch of psychiatry that aims at health promotion, protection from specific mental illnesses, early diagnosis, effective treatment, disability limitation and rehabilitation. Prevention of neuropsychiatric illnesses as compared to other illnesses is particularly important as they run a chronic course and cause substantial disability. Preventive measures have been found to be effective in reducing incidence and disability in a wide range of mental illnesses such as depression, psychosis, anxiety and conduct disorders. The need of the hour is to translate advances in our understanding of mental illness into effective intervention programmes for the prevention of mental illness and the promotion of positive mental health.
Subject(s)
Concept Formation , Mental Disorders/prevention & control , Psychiatry/methods , Evidence-Based Medicine , Humans , Psychiatry/trendsABSTRACT
HIV associated dementia (HAD), is a neuronal complication of HIV infection and causes cognitive and motor impairment. The cognitive decline in HAD is due to widespread synaptic loss than neuronal loss. The neurotoxicity in HAD is caused by activation of NMDA receptors by HIV-proteins but the exact mechanism of the synaptic loss is yet to be determined. This article explores a novel pathomechanism for the observed synaptic loss. The HIV-proteins augment NMDA mediated increase of intracellular Ca(2+) in neurons which activates nNOs for Nitric Oxide (NO) synthesis. The NO activates MAPK and phosphorylates Microtubule-associated protein-2(MAP2) at specific sites causing conformational changes, microtubular disassembly and promote MAP2 degradation by the ubiquitin-proteosome pathway. Under physiological conditions Ca(2+) signaling increases cholesterol transport into mitochondria for steroidogenesis by the CYP11A1. The neurosteroid pregnenolone binds to MAP2 and causes inhibition of phosphorylation, increase in microtubule assembly and decrease MAP2 degradation. The NO can inhibits CYP11A1 in a concentration dependent manner and reduces steroidogeneisis. There is a upregulation of NO production in HAD from HIV infected microglia and astrocytes which cross neuronal membrane and increase intracellular NO. This can cause profound inhibition of steroidogenesis in the brain, increase MAP2 degradation and synaptic loss in presence of HIV-proteins.
