Electrical and Magnetic Stimulation of the Brain; Are These Methods Used Appropriately in Treating Depression? Part 1. Where should Transcranial Magnetic Stimulation be Placed in an Algorithm for the Treatment of Resistant Depression?

Depression is a common condition which causes serious of morbidity among the population. While treatment is often provided with pharmacological antidepressants and psychotherapy, many patients do not respond to such treatment, and therefore algorithms have been proposed to develop treatments for resistant depression. Transcranial Magnetic Stimulation is a relatively new form of treatment for depression, which appear to have a good safety profile and appear to be acceptable to patients. Other forms of Brain Stimulation, such as Electro-Convulsive therapy, have a more complex safety profile, and require anaesthesia. Still other forms of electrical stimulation of the brain, such as Vagus nerve Stimulation are invasive in nature. The position of a particular modality of treatment in the Algorithm for the treatment of Resistant Depression depends on a balance between effectiveness of treatment, side effect profile, acceptability to the patients, availability of treatment, invasiveness of treatment, and the possibility of combining it with other treatments. Here we assess the position of Transcranial Magnetic Stimulation in such an Algorithm for the treatment of Resistant Depression. Given its effectiveness and its relatively good side effect profile, we suggest that it could be used early in the treatment of depression, however its use may be limited by lack of necessary equipment. On the other hand, Electro-convulsive therapy must be reserved for much more resistant cases, because of the need for anaesthesia and muscle relaxants, as well as its side effect profile, even though it might be somewhat more effective than the other modalities. Further study of Transcranial Magnetic Stimulation and are warranted.

Electrical and Magnetic Stimulation of the Brain; Are These Methods Used Appropriately in Treating Depression? Part 2. Where should Transcranial Direct Current Stimulation be Placed in an Algorithm for the Treatment of Resistant Depression?

Depression is a common condition which causes serious of morbidity among the population. While treatment is often provided with pharmacological antidepressants and psychotherapy, many patients do not respond to such treatment, and therefore algorithms have been proposed to develop treatments for resistant depression. Transcranial Direct Current Stimulation is a relatively new form of treatment for depression, which appear to have a good safety profile and appear to be acceptable to patients. Other forms of Brain Stimulation, such as Electro-Convulsive therapy, have a more complex safety profile, and require anaesthesia. Still other forms of electrical stimulation of the brain, such as Vagus nerve Stimulation are invasive in nature. The position of a particular modality of treatment in the Algorithm for the treatment of Resistant Depression depends on a balance between effectiveness of treatment, side effect profile, acceptability to the patients, availability of treatment, invasiveness of treatment, and the possibility of combining it with other treatments. Here we assess the position of Transcranial Direct Current Stimulation in such an Algorithm for the treatment of Resistant Depression. Given its effectiveness and its relatively good side effect profile, we suggest that it could be used early in the treatment of depression, however its use may be limited by lack of necessary equipment. On the other hand, Electro-convulsive therapy must be reserved for much more resistant cases, because of the need for anaesthesia and muscle relaxants, as well as its side effect profile, even though it might be somewhat more effective than the other modalities. Further study of Transcranial Direct Current Stimulation is warranted.

The Concept of Staging in Schizophrenia; 13 Years After the 'Agius Concept of Staging' Was Published.

We review the development of clinical staging models of schizophrenia, which has developed as a logical extension of the Neuro-developmental theory of Schizophrenia. The staging approach, which involves assessing a disorder based on its severity, scope, progression, and characteristics, is gaining growing recognition in the fields of clinical psychology and psychiatry. We review the development of clinical staging models of schizophrenia, which has developed as a logical extension of the Neuro-developmental theory of Schizophrenia. The development of these clinical staging models should be based also on the neuroimaging dana, since this implies actual changes within the brain. There still are some difficulties with these models, but they are gradually providing both more logical ways of understanding the development of psychotic illness and more effective ways of treatment. The Models have contributed to research in several areas of psychiatry.

Since Exposure to Mental Trauma, Especially War Trauma, Causes Personality Changes, Should Deliberate Exposure to Mental Health Trauma of Civilians Be in Itself a War Crime?

Mental trauma is a consequence of war. Here we consider whether the inflicting of such trauma, which could cause personality changes, should be considered a war crime in its own right, especially when it is civilians who are exposed to mental trauma. We make the argument based on a review of the development of personality disorders in persons exposed to mental trauma caused by war, and we make the argument that it is possible to demonstrate both physiological and anatomical changes in the brain of such persons, which could account for the observed behavioural and personality changes. Therefore we argue that deliberate exposure to Mental Health Trauma, for example by deliberate targeting of civilian areas with artillery, should be considered a war crime in its own right irrespective of whether the civilians receive physical trauma or not.

Is Edith Stein's model of the characteristics and behaviour of woman, consonant with woman's physiology and endocrinology?

In this paper we describe the physiology and endocrinology of the women's reproductive system as this refers to the function of the brain and the functioning of Oestrogen and Progesterone Receptors within the brain. We compare this to the description of woman's nature as described by the philosopher and psychologist Edith Stein, who has described the describing specific characteristics and behaviours of women, which fit woman for contributing to the professions as well as the family. We ask whether Stein's description of the characteristics of woman, is in fact consonant with the neuroscience which we have described. We conclude that these two concepts are consonant, in other words, the neuroscience of the female reproductive system and Edith Stein's characteristics of woman are not mutually exclusive and are two concepts which potentially support each other.

How Does Present Neuroscience Support Edith Stein's View on the Appropriateness of Women's Education and the Involvement of Women in the Professions?

Edith Stein has written a great deal about the nature of women and has advocated for the place of women in society and their place in the professions. We have written a series of papers describing the relationship between the findings of neuroscience and the differences between the female and male brains. Here we summarise how our knowledge of these differences underpin Edith Stein's view of the nature of women, and therefore validate Stein's particular view of feminism.

Using Opera and the Performing Arts to Educate about Mental Health Problems - Ciklu.

For several years now, the performing arts have been used to Educate about Mental Health Problems. An important aim is to eliminate stigma, which is a multifaceted concept which has several causes including shame and which is thought to act as a barrier to successful help seeking and engagement with support services by persons with mental health problems. There have been many art forms used, from One Man Shows, to films, Plays, Dance, or Singing. Recently Opera has been added to this collections of art form initiatives . We review the publications on how performing arts have been used to destigmatise mental health problems, including those in which an attempt has been made to measure the impact quantitatively. We then review Ciklu, a new Maltese Opera production which attempts to destigmatise Mental Health Problems, to show that it fits within the worldwide attempt to use performing arts to destigmatise Mental Health Issues.

Neurological manifestations and pathogenic mechanisms of COVID-19.

Coronavirus disease (COVID-19) arising from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection has caused a worldwide pandemic, mainly owing to its highly virulent nature stemming from a very strong and highly efficacious binding to the angiotensin converting enzyme-2 (ACE2) receptor. As the pandemic developed, increasing numbers of COVID-19 patients with neurological manifestations were reported, strongly suggesting a causal relationship. Indeed, direct invasion of SARS-CoV-2 viral particles into the brain can occur through the cribriform plate via olfactory nerves, passage through a damaged blood-brain-barrier, or via haematogenic infiltration of infected leukocytes. Neurological complications range from potentially fatal encephalopathy and stroke, to the onset of headaches and dizziness, which despite their apparent innocuous presentation may still imply a more sinister pathology. Here, we summarize the most recent knowledge on the neurological presentations typically being associated with COVID-19, whilst providing potential pathophysiological mechanisms. The latter are centered upon hypoxic brain injury, generation of a cytokine storm with attendant immune-mediated damage, and a prothrombotic state. A better understanding of both the neuroinvasive properties of SARS-CoV-2 and the neurological complications of COVID-19 will be important to improve patient outcomes.

Traumatic Events, Sexual Abuse and Mental Illness.

That 'Childhood Adversity', which includes many traumatic events but in particular includes sexual abuse during childhood, can cause changes in the brain, such as the finding of a smaller hippocampus is well established by the observations of such persons as Thomas Frodl (2008, 2013). That traumatic events in adulthood can also cause both clinical symptoms such as Post Traumatic Stress Disorder, with equivalent shrinkage of the hippocampus (Smith 2005), is also well known. In this article we apply these neurological findings to the particular traumatic event of sexual abuse at any age, first to demonstrate that such abuse can indeed cause a number of mental illnesses, and hence to produce a model of how different forms of mental trauma may cause different mental illnesses. Next we describe human sexuality as a form of language, whereby feelings ranging from love to indifference to exercise of power to hatred can be expressed. We suggest that the expression of these feelings can give rise to positive feelings or to the mental illnesses we have mentioned. We emphasize how free choice is central to the 'messages' that we give to our partners through our sexuality - and therefore that we are responsible for those messages and their consequences. We point out therefore that inappropriate choices by the couple may lead to the consequent neurological changes and mental health symptoms we have mentioned. We finally analyse the act of sexual intercourse into a number of component functions (or consequences) including the Generative Function - that of producing another human person, the Choice Function - that of choosing the other person, the Language Function - that of communicating that choice to the other person and the Empowering Function- that of empowering the other person. We propose a model of human sexuality in which these four functions are linked together, so that in normal circumstances they work together in complete harmony, however, numerous circumstances of modern life can cause these four functions to operate asyncronously, thus leading to the neurological changes which we have mentioned above. These neurological changes are associated with the changes in hippocampal size which we have described above. Thus in our model, we have linked the Neurological changes of Trauma with factors relating to Choice, psychological concepts, and consequent symptomatology of illness. We do this in the context of a model of the Human Person in which mind and body are linked so that the human person can be understood as an 'Embodied Spirit', rather than the Cartesian Model. This concept goes back to the model of the Human Person of Aristotle, and was re-expressed in Medieval times by Aquinas and Augustine, and is congruent with Phenominology as expressed by Husserl and Stein. We have previously argued that such an 'Embodied Spirit' model of the Human Person is more congruent with modern neuroscience than a Cartesian Model (Agius 2017).

Anxiolytic Effects of Intraoperative Music Therapy in Adults Undergoing Local Anaesthetic Interventions.

BACKGROUND: Intra-operative anxiety is a commonly experienced feeling amongst patients undergoing surgery. Moreover, conscious patients are exposed to the multiple environmental factors triggering this emotion. Apprehension and fear are common emotions interlinked with associated intra-operative anxiety. Several concerning complications are associated with this emotion during surgery, many of which include severe cardiac related events, such as heart failure and acute myocardial infarction, extreme postoperative pain, increased requirement of analgesic, sedation and anaesthetic demand, extended hospital stay, and reduced patient satisfaction. In this review, the effect of intra-operative music therapy to alleviate anxiety in adults undergoing surgery will be studied in order to establish whether intra-operative music alleviates anxiety in adults undergoing local anaesthetic surgical interventions. METHODS: The Population studied was adults aged 18-80 years old undergoing local anaesthetic interventions. The Intervention observed was the exposure of intra-operative music therapy. The Comparison was against patients undergoing surgery without being subject to music therapy. The desired Outcome was the alleviation of intra-operative anxiety. The intention was to develop a systematic review of the available data. In orderto develop the literature search, Key elements of the question were identified and utilized to generate alternative terms. Subsequently, Boolean Operators were used to combine these terms. Search results were narrowed down by means of limiters and selected databases; EBSCO, PubMed and ScienceDirect were used to execute the search. The PRISMA 2009 framework was used as a guideline in excluding irrelevant studies. Assessment of study eligibility was done byapplying inclusion/exclusion criteria. Appraisal of literature was done by using The Critical Appraisal Skills Programme (CASP) tool as a framework. RESULTS: A total of five studies were identified. These included randomised control trials. Two of these studies demonstrated statistical significance whilst the remaining three failed to do so. The overall result of these studies was inconclusive and inconsistent in attempting to determine whether intra-operative music therapy alleviates anxiety in patients undergoing local anaesthetic interventions. CONCLUSION: The presentation of a definite conclusion is not possible. However, evidence is promising and pointing towards the likelihood of beneficial outcomes resulting from the intervention of interest. However, further research is required. IMPLICATIONS AND RECOMMENDATIONS: It is recommended that the patients be offered the choice of selecting their preferred music if they give consent to undergo surgery while being exposed to music therapy. Various cost-effective audio devices could be installed in operating theatres. The general public and healthcare professionals should be educated about the benefits of intra-operative music therapy. Future studies should use larger sample sizes, and attrition rate should be reduced through better communication with patients and thorough taking into account the demographic characteristics of the patients.