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It is difficult for a single investigator to study the psychosocial changes that occur over the life span of an individual affected with a chronic illness like β-thalassaemia major. Therefore, a developmental epidemiological perspective is required to understand the chain of events and problems of psychological nature.
Aim and objectives
We aimed to construct the picture of developmental epidemiology for psychosocial aspects in families of β-thalassaemia major patients attending a tertiary care hospital in north India.
The accelerated longitudinal design was used. The sample consisted of 100 children with β-thalassaemia and their 150 parents, both groups were subdivided further so that each group represented the continuum of longitudinal course.
Overall 54 per cent of children had significant psychopathology. Within the parents groups, 10 per cent had adjustment disorder, 33.3 per cent depressive disorder, and 10 per cent had anxiety disorder and 11 per cent somatoform disorder. There was significant difference only in the domain of psychological health in all the three groups of parents with respect to the quality of life. Among children, quality of life improved with their progression of illness.
Growing up with β-thalassaemic family was analyzed. Such a design can test the hypothesized aetiological or developmental function of a targeted risk factor within a developmental path and may be used in studying the psychological impact of even other chronic illnesses over the life span of an individual for conceptual and holistic understanding.
Culture forms a part of one's identity. Cultural beliefs are intricately interwoven not only in conflicts and psychopathology but also in conflict resolution. With classificatory systems, now understanding and emphasizing on a ‘person-centred’ approach, the need to integrate cultural beliefs and attitudes can not be understated. With globalization, awareness and understanding of cultural beliefs, values, scriptures, practices, rituals and festivities, can help in personal growth, understanding psychopathology, establishing trust and rapport, aid in the help-seeking process, holistic management of the patient in a more acceptable, sensitive and compliant manner. Revisiting scriptures and trying to understand the insights gained in the past era can add on to the knowledge and skills used in the practice of Psychotherapy. Models of cultural integration that can be utilized in the teaching and practice of psychiatry, in understanding preventive psychiatry and stress-management shall be presented. Such integration shall be a definite step forward to a ‘person-centred’ approach and in addressing the soul of science.
In today’s age of globalization, growing materialism-unhealthy competition and distress, there is a felt need to explore the dimension of spirituality (Spiritual Intelligence). Spirituality and values can work as a soul for the science. In this regard, mythology and cultural heritage have a lot to offer. Revisiting scriptures and trying to understand the insights gained in the past era can add on to the knowledge and skills used in the practice of Psychotherapy. In todays fast pace life and age of globalization, utilizing such knowledge, insights and skills shall indeed be quite useful, both for personal growth and that of the patient. Today the challenge lies in inclusion, merging the cultural knowledge with current psychotherapeutic skills.
The paper shall focus on values derived from ‘Geetopdesha’ (’Geeta’, the Holy Book of the Hindus that incl. the preachings and guidance of Lord Krishna, an incarnation of the Administrator God Vishnu, to Arjun on the battlefield). It incorporates the philosophy of life and death, the never ending soul, cognitive psychotherapy, ‘Karm’ philosophy emphasizing on one’s duties and responsibilities.
Patients from different parts of the world can benefit from such insights and concepts that help in conflict resolution, enhancing motivation, self realization, increasing tolerance and acceptance thus aiding in reducing human suffering. It is of practical use in managing anxieties, phobias, fear of death, care of terminally ill and grief work. Combining relevant traditional approaches with the newer techniques is indeed a challenge in todays clinical practice of mental health professionals.
Data related to brain function may have the potential to improve the reliability and validity of assessments for the aetiologically and clinically heterogeneous syndrome of attention-deficit/hyperactivity disorder (ADHD). This study investigated associations between questionnaire assessments of behavioural features of adults with ADHD and an aspect of neurocognitive performance which has been reported to be impaired in adults with ADHD.
Fifty-nine adult patients with a DSM-IV diagnosis of ADHD, and their informants, completed questionnaires related to aspects of severity of ADHD. Associations were examined between questionnaire ratings and performance on a computer-administered task of spatial working memory (SWM).
Correlations between ratings of ADHD and SWM indicated moderate but significant correlations for patients' ratings, but not for informants' ratings. Also, patients who reported a past history of ‘self-harm’ (N = 33) had a significantly worse mean performance on both measures of SWM (p = 0.004, 0.003).
The results indicate that aspects of impulsivity, i.e. self-ratings of ‘emotive’ behaviour (involving rapid response to stimuli and marked reactivity of mood) and of past ‘self-harm’, show relatively strong associations with SWM performance in adults selected on the basis of an ADHD diagnosis. A profile of neurocognitive performances may have a role in the assessment of ADHD.
To assess changes in body mass and metabolic profiles in patients with first-episode schizophrenia receiving standardised, assured treatment and to identify predictors and moderators of the effects.
We investigated the changes in body mass, fasting blood glucose and lipids in 107 largely antipsychotic naïve, first-episode schizophrenia patients who were treated according to a standard algorithm with long-acting injectable flupenthixol decanoate over 12 months.
Eighty-three (78%) participants completed the 12 months of treatment, and 104 (97%) received 100% of the prescribed injections during their participation. There were significant increases in BMI (P < .0001), waist circumference (P = 0.0006) and triglycerides (P = 0.03) and decrease in HDL (P = 0.005), while systolic (P = 0.7) and diastolic blood pressure (P = 0.8), LDL (P = 0.1), cholesterol (P = 0.3), and glucose (P = 0.9) values did not change over time. The triglyceride: HDL ratio increased by 91%. Change in BMI was only correlated with change in triglycerides (P = .008). The only significant predictor of BMI increase was non-substance abuse (P = .002).
The risks of weight gain and metabolic syndrome associated with antipsychotic treatment in first-episode schizophrenia are not restricted to second generation antipsychotics. This is a global problem, and developing communities may be particularly susceptible.
The Adolescent Day Treatment Program (ADTP) established in Summer 2000 in Calgary, Alberta, Canada provides multi-disciplinary non-residential day treatment for mentally disturbed youth aged 13 to 18 years who suffer from moderate to severe forms of mental health disorders that do not to require hospitalization or as a step-down from hospitalization. the treatment approach includes pharmaco-therapy, psychiatric consultation, psycho-educational groups, individual, group and family therapy, occupational and recreational therapy and school board-operated educational programming.
Data descriptions and repeated measure analyses included variables representing demographics, length of stay, diagnoses, admission and discharge problem severity, goal achievement ratings, and Children's Global Assessment Scale (CGAS).
Significant improvement was observed over the course of treatment in the majority of patients in outcome measures (problem severity and goal achievement) and CGAS. Follow-up of a sub-sample of those served indicates that function at the time of discharge best predicts adaptation at the time of follow-up.
Day treatment appears to be effective and clinical effects persists at the time of follow-up and are predicted primarily by discharge function.
Considerable data support phenomenological and temporal continuity between psychotic disorders and subclinical psychotic-like experiences (PLE's). Although numerous studies have found similar personality correlates for schizophrenia and schizotypal personality disorder patients, their unaffected first-degree relatives, and healthy adults characterized for schizotypal traits, no study has yet investigated personality correlates of PLE's measured by the Community Assessment of Psychic Experiences (CAPE). Our study sought to examine personality correlates of PLE's using the CAPE in healthy adults.
The CAPE and temperament and character inventory (TCI) were administered to 415 healthy adults. Regressions examined links between TCI traits and overall PLE levels as well as positive and negative PLE's separately.
Consistent with past studies, lower self-directedness (SD) and reward dependence (RD) and higher self-transcendence (ST) and harm avoidance (HA) significantly predicted overall PLE levels. Higher ST and persistence (P) and lower SD significantly predicted higher levels of positive PLE's while lower SD and RD and higher HA, ST, and cooperativeness (C) predicted higher levels of negative PLE's.
Associations between TCI and PLE's using the CAPE are strikingly similar to past work in non-clinical and patient samples and provide additional support for phenomenological continuity between psychotic disorders and sub-syndromal psychotic symptoms.
Prior work by our group identified personality profiles associated with psychotic-like experiences (PLE's) in healthy adults that were strikingly similar to those found in schizophrenia patients, with the exception of two key differences. Specifically, higher levels of PLE's were linked to higher persistence and cooperativeness, suggesting that these characteristics might represent personality-based resilience factors. Notably, age and personality were significantly correlated in these data, raising questions about whether healthy children and adolescents would show similar results. To date, no study has examined personality profiles associated with both positive and negative PLE's in healthy children and adolescents using Cloninger's Temperament and Character Inventory (TCI). Thus, this study examined the relationship between TCI dimensions and PLE's in healthy children and adolescents.
The TCI and the Community Assessment of Psychic Experiences (CAPE) were administered to 123 healthy children and adolescents aged 8–18. Multiple regression models were used to examine personality dimensions associated with overall severity of PLE's as well as severity of positive and negative PLE's separately.
Positive, negative, and overall PLE severity were all associated with a personality pattern of higher harm avoidance and lower self-directedness. Negative PLE severity was also associated with lower persistence.
Personality correlates of PLE's in healthy children and adolescents were largely consistent with our past work on PLE's in healthy adults. However, our previously identified resilience factors were notably absent in this sample. These findings may suggest that these personality characteristics have not yet crystallized or emerged to aid in coping with PLE's.
Resistance to colistin, a last resort antibiotic, has emerged in India. We investigated colistin-resistant Klebsiella pneumoniae(ColR-KP) in a hospital in India to describe infections, characterize resistance of isolates, compare concordance of detection methods, and identify transmission events.
Retrospective observational study.
Case-patients were defined as individuals from whom ColR-KP was isolated from a clinical specimen between January 2016 and October 2017. Isolates resistant to colistin by Vitek 2 were confirmed by broth microdilution (BMD). Isolates underwent colistin susceptibility testing by disk diffusion and whole-genome sequencing. Medical records were reviewed.
Of 846 K. pneumoniae isolates, 34 (4%) were colistin resistant. In total, 22 case-patients were identified. Most (90%) were male; their median age was 33 years. Half were transferred from another hospital; 45% died. Case-patients were admitted for a median of 14 days before detection of ColR-KP. Also, 7 case-patients (32%) received colistin before detection of ColR-KP. All isolates were resistant to carbapenems and susceptible to tigecycline. Isolates resistant to colistin by Vitek 2 were also resistant by BMD; 2 ColR-KP isolates were resistant by disk diffusion. Moreover, 8 multilocus sequence types were identified. Isolates were negative for mobile colistin resistance (mcr) genes. Based on sequencing analysis, in-hospital transmission may have occurred with 8 case-patients (38%).
Multiple infections caused by highly resistant, mcr-negative ColR-KP with substantial mortality were identified. Disk diffusion correlated poorly with Vitek 2 and BMD for detection of ColR-KP. Sequencing indicated multiple importation and in-hospital transmission events. Enhanced detection for ColR-KP may be warranted in India.
Organizational, economic, and technology forces are encouraging organizations to experiment with new ways to develop their strategic priorities (Chesbrough & Appleyard, 2007). One such new approach is Open Strategy (OS), an approach that increasingly relies on the use of online digital platforms. OS refers to the process by which an organization’s strategy for the future is developed in a planned or inadvertent manner with more transparency for all stakeholders and/or inclusion of different stakeholders compared to conventional strategy-making processes (Hautz et al., 2017; Mack & Szulanski, 2017; Whittington et al., 2011). Rather than limiting strategy to an exclusive group of “elite” strategy planners, OS engages a broader set of stakeholders in the process (Dobusch & Kapeller, 2013; Palmisano, 2004; Steiger et al., 2012). Among those included in OS are external stakeholders, defined as individuals not currently employed by the organization, including current or future potential customers, investors, general public, suppliers, universities, or other as-yet unaffiliated institutions and individuals.