ABSTRACT
The recent advancements in the field of stem cell (SC) biology have increased the hope of achieving the definitive treatments for the diseases which are now considered incurable such as diabetes, Parkinson's disease and other chronic long standing conditions. To achieve this possibility, it is necessary to understand the basic concepts of SC biology to utilize in various advanced techniques of regenerative medicine including tissue engineering and gene therapy. This article highlights the types of SCs available and their therapeutic capacity in regenerative medical and dental fields.
ABSTRACT
BACKGROUND: Transcultural studies have found lack of insight to be an almost invariable feature of acute and chronic schizophrenia, but its influence on prognosis is unclear. AIMS: To investigate the relationship between insight, psychopathology and outcome of first-episode schizophrenia in Vellore, India. METHOD: Patients with a DSM-IV diagnosis of schizophrenia (n = 131) were assessed prospectively at baseline and at 6-month and 12-month follow-up. Demographic and clinical measures included insight, psychopathology, duration of untreated psychosis (DUP) and social functioning. Linear and logistic regression was used to measure predictors of outcome. RESULTS: Follow-up data were available for 115 patients at 1 year. All achieved remission, half of them with and half without residual symptoms. Changes in psychopathology and insight during the first 6 months and DUP strongly predicted outcome (relapse or functional impairment), controlling for baseline measures. CONCLUSIONS: Outcome of schizophrenia in this setting is driven by early symptomatic improvement and is relatively favourable, in line with other studies from low- and middle-income countries. Early improvement in insight might be a useful clinical guide to future outcome. Reduction of DUP should be a target for intervention.
Subject(s)
Awareness , Psychotic Disorders/drug therapy , Psychotic Disorders/psychology , Schizophrenia/drug therapy , Schizophrenic Psychology , Adolescent , Adult , Aged , Antipsychotic Agents/therapeutic use , Epidemiologic Methods , Female , Humans , India , Male , Middle Aged , Time Factors , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: Existing evidence indicates that dissonance between patients' and professionals' explanatory models affects engagement of patients with psychiatric services in Western and non-Western countries. AIMS: To assess qualitatively the explanatory models (EMs) of psychosis and their association with clinical variables in a representative sample of first episode patients with schizophrenia in South India. METHOD: One hundred and thirty one patients with schizophrenia presenting consecutively were assessed. Measures included the patient's explanatory models, and clinician ratings of insight, symptoms of psychosis, and functioning on standard scales. RESULTS: The majority of patients (70%) considered spiritual and mystical factors as the cause of their predicament; 22% held multiple models of illness. Patients who held a biomedical concept of disease had significantly higher scores on the insight scale compared to those who held non-medical beliefs. Multivariate analyses identified three factors associated with holding of spiritual/mystical models (female sex, low education and visits to traditional healers); and a single factor (high level of insight) for the endorsement of biological model. CONCLUSIONS: Patients with schizophrenia in this region of India hold a variety of non-medical belief models, which influence patterns of health seeking. Those holding non-medical explanatory models are likey to be rated as having less insight.
Subject(s)
Attitude to Health/ethnology , Brief Psychiatric Rating Scale , Mental Health Services/statistics & numerical data , Schizophrenia/diagnosis , Schizophrenic Psychology , Adult , Cross-Sectional Studies , Diagnostic and Statistical Manual of Mental Disorders , Episode of Care , Female , Humans , India/epidemiology , Interview, Psychological , Magic/psychology , Male , Models, Biological , Models, Psychological , Multivariate Analysis , Rural Health , Schizophrenia/epidemiology , Socioeconomic FactorsABSTRACT
BACKGROUND: Lack of insight has been observed in people with schizophrenia across cultures but assessment of insight must take into account prevailing illness models. AIMS: To determine whether culturally specific and Western biomedical interpretations of insight and psychosis can be reconciled. METHOD: Patients with schizophrenia (n=131) were assessed during their first contact with psychiatric services in Vellore, South India. Patients' explanatory models, psychopathology and insight were investigated using a standard schedule translated into Tamil. RESULTS: Supernatural explanations of symptoms were frequent. Some insight dimensions were weakly associated (inversely) with severity of symptoms whereas preserved insight was associated with anxiety, help-seeking and perception of change. Willingness to attribute symptoms to disease, in others and in one's self, but not to supernatural forces was strongly associated with insight. CONCLUSIONS: The relationship between insight, awareness of illness and other clinical variables is similar in South India to elsewhere. However, the assessment of insight might have failed to capture locally accepted explanatory frameworks. An inclusive conceptual model which emphasises help-seeking is recommended.
