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Modern faces of hysteria, or some of the dissociative disorders

Abstract

The concept of “hysteria” comes from the Greek word “hystera” (uterus) and dates back to the time of Hippocrates, at least. Modern classifications differ regarding the area encompassed by the concepts of dissociation and conversion differ. Mental health professionals in the United States (DSM-5) use a standard classification of mental disorders codifying dissociative disorders as a distinct class of disorders, but subsumes conversion disorders under “somatoform disorders”. The history of hysteria is as long as the history of mankind. Apparently, both the essence and mechanisms of dissociative disorders remain unchanged despite the fact that many years have passed. According to Owczarek et al., dissociative symptoms are caused by the malfunctioning of defence mechanisms and anxiety. This article provides an overview of the available literature on the etiology and pathogenesis of dissociative disorders as well as disorders such as amnesia, dissociative fugue, trance and possession.

Open access
Omega – 3 fatty acids in schizophrenia – part I: importance in the pathophysiology of schizophrenia

Abstract

Despite the increasing offer of antipsychotic drugs, the effectiveness of pharmacotherapy in schizophrenia is still unsatisfactory. Drug resistance, lack of complete remission and the increasing risk of metabolic complications are the reasons why the new forms of therapy in schizophrenia among which unsaturated essential fatty acids omega 3 (EFAs ω-3) affecting the proper functioning of nervous system, are mentioned, are being looked for.

Fatty acids represent 50-60% of the dry weight of the brain and diet is one of the factors that influence the value of each of the fat fractions in the neuron membranes. Patients with schizophrenia tend to have irregular nutritional status concerning essential fatty acids ω-3, which might result from metabolic disorders or irregular consumption of fatty acids.

Apart from being a review of the literature on this subject, this very paper characterizes essential fatty acids ω-3, their metabolism, the most important sources in the diet and the opinions of experts in the field about the recommended intake. It pays attention to the role of essential fatty acids in both the structure and functioning of the central nervous system is, as well as their role in the pathophysiology of schizophrenia, with particular emphasis on the membrane concept by David Horrobin. The assessment of the errors in consumption and metabolism of essential fatty acids are described as well.

The evidence was found both in epidemiological and modeling studies. It supports the participation of EFAs in etiopathogenesis and pathophysiology of schizophrenia. Further research is needed, both observational and interventional, as to the role of essential fatty acids ω-3 in the functioning of the CNS as well as the development and course of schizophrenia.

Open access
On the border of deep spirituality and psychosis… A case study

Abstract

This article is a case study of a 28-year-old patient diagnosed with F23. The report is preceded by an extensive literature review describing the situation of the mentally ill, in which psychiatry intermingles with spirituality and the sacrum.

The aim of the study was to investigate the relationship between religion/spirituality and schizophrenia as well as to draw attention to the complex problem of differential diagnosis of religious and spiritual problems. When is psychiatric treatment enough and when is intervention of a priest really essential?

The authors discuss the problem of mental disorders in connection with religion and spirituality in the clinical context. The article shows that it is very important that the processes of diagnosis and treatment take into account the patients’ individual traits, beliefs, values and spirituality.

Open access
Psychopathological symptoms in children and adolescents diagnosed with autism spectrum disorders with comorbid epilepsy - case report

Abstract

The number of diagnoses of Autism Spectrum Disorders (ASD) is on the rise, which encourages the search for their causes spurs researchers to study co-occurrence of ASD with other diseases and disorders. This study aims at highlighting the importance of the clinical problem of autism spectrum disorders and its comorbidity with epilepsy. This is one of the most common co-morbidities happening to children.

Regarding the psychopathological symptoms, it needs emphasizing that both in case of an isolated ASD and epilepsy itself, the accompanying psychiatric symptoms are confirmed. The research conducted so far also shows that in the course of epilepsy in the child / youth, mental health problems are often revealed, particularly depression and anxiety disorders. Episodes of depression and anxiety disorders are also mentioned as the most common comorbid psychopathological symptoms associated with ASD. An accurate and rapid diagnosis of epilepsy can improve the functioning of the child in the family environment and can improve communication skills. It is also important for the overall intellectual and psychological development. Making a correct diagnosis of the problem is equally crucial as choosing the right methods of medical and psychological care. Moreover,, it determines the early use of adequate, safe and effective forms of treatment.

Open access
Risk behaviors at late childhood and early adolescence as predictors of depression symptoms

Abstract

The study aims to answer following questions: (1) What are the risk behaviors among children at late childhood and early stage of adolescence? (2) What are the differences between boys and girls concerning problem behaviors? (3) Do risk behaviors predict symptoms of depression? Participants fulfilled the set of three tools: (1) Children Depression Inventory authored by M. Kovacs (1992); (2) List of experienced risk behaviors and (3) List of open questions concerning the knowledge and experience with smart drugs. The study group consisted of 130 boys and girls attending the fifth and sixth grade of primary school. The study shows differences between boys’ and girls’ risk behaviors, as well as the similarities. The findings indicate that gender-related disparities in problem behaviors exist even at the early stages of puberty. Boys under one parent custody declare significantly more risk behaviors than girls under one parent custody. Finally, the symptoms of depression were predicted by cumulative number of risk behaviors and – on tendency level – by type of parental custody.

Open access
Stolen motherhood-case study of postpartum depression

Abstract

Aim: The objective was to analyze the case of postpartum depression complicated with extended suicide attempt.

Method: The analysis of clinical case and medical history.

Results: In 25-year-old patient, two weeks after childbirth, postpartum depression episode occurred. In the further course of illness psychotic symptoms (delusions, mood disorders), suicidal and infanticide thoughts emerged. Four weeks after childbirth, the patient killed her baby and took an unsuccessful suicidal attempt. Based on medical records, several risk factors of postpartum depression were identified: 1. obstetric and child-related risk factors: Caesarean section, premature birth, obstetric complications during pregnancy, infant’s difficult temper, difficulties related to breastfeeding; 2. psychological risk factors: baby blues, high anxiety level during pregnancy, high level of stress related to child care.

Conclusions: Psychoeducation of women during pregnancy, including their families, is an extremely crucial element of postpartum depression prevention. It is also necessary to raise awareness among healthcare professionals who have frequent contact with mothers after childbirth: midwives, gynaecologists and paediatricians.

Open access
Anti-fibrinolytic agents in bleeding disorders – A clinical perspective

Abstract

Tranexamic acid (TXA) is a synthetic antifibrinolytic drug used widely used to control bleeding complications in a wide variety of clinical situations. Soon after its development in the 1960s it found use in treatment of women with menorrhagia, and in inherited bleeding disorders. Subsequently it was used in surgery and with proven efficacy to reduce transfusion requirements and bleeding complications. Recent meta-analysis have provided further evidence of efficacy and safety. Tranexamic acid is now on the World Health Organization’s (WHO) list of essential drugs, and is the focus of ongoing worldwide trials. Similarly, there is increasing evidence base in both congenital and acquired bleeding disorders. We present a clinical narrative of the antifibrinolytic system and associated drugs to accompany the pharmacy review by Chaplin et al, with the aim of highlighting the evolution of TXA use in bleeding disorders over recent decades.

Open access
Diagnosis and education for a better future in Uganda

Abstract

Since 2005, the Novo Nordisk Haemophilia Foundation (NNHF; www.nnhf.org) has worked in collaboration with local partners and internationally renowned experts to improve access to haemophilia care. The NNHF has identified three areas on which to focus its activities in order to create impact where it is most needed: capacity building, diagnosis and registry, and education and empowerment. Underpinning these focus areas are targeted awareness creation activities and the development of strategic partnerships, which enable and facilitate local impact creation through empowered community advocates and authority engagement. NNHF supports fellowships, local development projects, and recognises extraordinary achievements via the annual ‘NNHF Project of the Year Award’ and the ‘NNHF Community Award’. Raising awareness of haemophilia in Uganda was the NNHF global fundraiser in 2015. This article summarises how the donations raised were used to establish diagnosis and education for a better future for Uganda’s haemophilia patients.

Open access
Does a patient’s personality style impact health outcomes?

Abstract

This case describes a young man with severe haemophilia B who uses the “avoiding” mode of behaviour, leading to isolation and reduced ambulation. Health care providers promoting health change behaviour were able to empower the patient to direct his care toward his desired outcomes. As his self-awareness increases, he begins to use another mode of behaviour: compromising. Thomas- Kilmann’s conflict management framework is a novel approach to bringing two sides together in a working partnership. This challenging case shows the balance between a patient’s self-care and symbiotic interaction with HCPs to achieve successful health outcomes.

Open access
Does sickle cell trait reduce the frequency of spontaneous bleeds in severe haemophilia?

Abstract

Haemophilia A is an X-linked recessive disorder associated with deficiency of coagulation factor VIII and lifelong bleeding diathesis. Sickle cell trait (SCT) is the heterozygous state for the sickle β-globin gene. The frequency of SCT is up to 30% in Africa, wherein it confers survival advantage by providing resistance against severe malaria. SCT does not cause vaso-occlusive crisis, but is associated with high risk of venous thromboembolism as variously reported in the literature. We consider SCT as a hypercoagulable prothrombotic state and hypothesise that coinheritance of SCT may ameliorate the clinical phenotype of severe haemophilia. We conducted a retrospective analysis of frequencies of spontaneous bleeding among severe haemophiliacs with SCT (Hb AS phenotype) and their counterparts with normal Hb phenotype (Hb AA phenotype) in order to determine the possible ameliorating effect of SCT on spontaneous bleeding rates in severe haemophilia A. If our hypothesis is correct, severe haemophiliacs with SCT will have lower frequencies of spontaneous bleeding than their counterparts with normal Hb phenotype. Our results revealed that severe haemophiliacs with normal Hb phenotype had significantly higher mean annual bleeding episodes per patient in comparison with their counterparts with SCT (45±7 vs 31±5, p=0.033), suggesting that severe haemophiliacs with SCT had lower frequencies of spontaneous bleeding episodes. The result of this study indicates that coinheritance of SCT in patients with severe haemophilia may be associated with reduced frequency of spontaneous bleeding, which may imply better overall prognosis. However, the study has important limitations, which include its retrospective nature and the very low number of subjects. The findings should therefore be validated by a larger and prospective study.

Open access