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 Table of Contents    
GUEST LECTURES  
Year : 2011  |  Volume : 53  |  Issue : 5  |  Page : 8-9
Guest Lectures



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Date of Web Publication3-Apr-2012
 

How to cite this article:
. Guest Lectures. Indian J Psychiatry 2011;53, Suppl S1:8-9

How to cite this URL:
. Guest Lectures. Indian J Psychiatry [serial online] 2011 [cited 2020 Sep 26];53, Suppl S1:8-9. Available from: http://www.indianjpsychiatry.org/text.asp?2011/53/5/8/94528


The changing face of medicine: The next generation of psychiatrist

Carol A. Bernstein

President APA, NYU School of Medicine

She focused on the following topics:

  1. Differences in attitudes of the four generations currently in the workplace.
  2. Strategies to improve relationships between the generations, especially in academic medical centers.
  3. How to develop an understanding for the ways in which different generational styles may influence participation in organized medicine, especially psychiatry in the years to come.
Disruptive situation disorders: Evidence from crisis and disaster psychiatry

Russell D'Souza

Disaster Psychiatry Section, World Psychiatric Association, Melbourne, Australia

Every disaster natural or human made places extreme demands on health care and mental health care in particular. Disasters affect large and diverse populations. How the psychological response to a disaster is managed may be the defining factor in the ability of a community to recover. (Holloway et al 1997) Interventions require rapid effective and sustained mobilization of resources (Ursano & Freedman) Facilitating recovery depends on the leadership's understanding of the distress, disorders responses to the event. Establishes the impact of the factual event. PTSD is often described but the issues of the PTSD we sees with disasters are there is a vague and unspecific concept, It does not differentiate between stress and trauma with high rates of comorbidity 88.3% in men and 79 % in women (Shalev) and Patients do not have good responses to pharmacological and psychotherapeutic treatments. The World Psychiatric Association section on disaster psychiatry researchers have been studying recent Crisis and disasters events attended and with this evidence have conceptualized disasters as disruptive situation and have described these disorders. A disaster or crisis situation concerns the pathogenic quality of a factual event imploding into the psyche. The radical distortion of the human environment implodes into the human psyche, confronting us with a new nosological entity. We have labeled this as anxiety by disruption (ABD). The questions we want to answer Are we in the presence of a new sustainable nosological entity? Are we facing new conditions in human environment which unleash alarm adaptive responses already known? Given the peculiarities of the alarm situation, are such responses organized in a distinctive manner? Some basic features that have been identified include Feelings of neglect. Loss of hope. Helplessness. Mistrust. Suspicion. Present and future uncertainties. Frustration. Uneasiness and guilt. Selfishness, indifference, and hostility. Freezing. Feeling trapped. Solitude. Fear and discomfort. Incapacity to make decisions. Anxiety by Disruption Symptoms include Uneasiness. Generalized and constant state of alarm. Feelings of insecurity, neglect and loneliness. Anhedonia. Sleeping Disorders. Constant pondering on the uncertainty issue. The need to share feelings and fears with others. Different somatic symptoms. Tendency to overact fear. Avoid daily pleasure activities. Irritability, aggressive attitude. This presentation will focus on this new entity of anxiety by disruption disorder and the nosology identified.

Etiological understanding of schizophrenia

Matcheri S. Keshavan

Harvard Medical School, Boston, USA

Investigating the neurobiological basis of schizophrenia is a critical step toward establishing validity of psychiatric diagnoses, delineating causative mechanisms and identifying objective targets for treatment research. Over the past two decades, there have been several advances in this field, principally related to developments in neuroimaging, electrophysiological and neuropathological approaches. Several neurobiological alterations in domains of brain structure, physiology and neurochemistry have been documented that may reflect diverse pathophysiological pathways from the "genome to the phenome". While none of the observed abnormalities are likely to qualify as diagnostic markers at this time, many can serve as potential intermediate phenotypes for elucidating etiological factors including susceptibility genes, and as therapeutic targets for novel drug discovery. Despite several challenges including the substantial phenotypic, pathophysiological and etiological heterogeneity of schizophrenia, technological limitations, and the less than ideal animal models, considerable progress has been made in characterizing the neurobiological substrate of schizophrenia. The accumulating fact-base on the neurobiology of schizophrenia calls for novel integrative model(s) that may generate new, testable predictions.

Culture, personality and migration

Dinesh Bhugra

Royal College of Psychiatrists, Institute of Psychiatry, King's College, London

Concepts of the self are very closely interlinked with cultures. Cultures themselves have personalities which are often misidentified as national characters which are stereotypes, and individuals then get stigmatized. The construction of self and individual social identity is strongly influenced by culture. Society also dictates what 'normal' behaviour is and what is seen as deviance. This leads to cultural variations in idioms of distress and patterns of help-seeking. Diagnosis of personality disorders and their classification are strongly influenced by Western cultural norms. Thus generalizations to other cultures become problematic and can lead to misdiagnosis. The challenge for psychiatry and psychiatrists is how normal and abnormal are defined and whether these are statistical anomalies or pathological variations. Cultures can be divided into two broad categories: socio-centric or collectivist cultures and ego-centric or individualistic cultures. However, not all individuals in a culture will have all the traits, though there may be some preponderance. Furthermore, there are other dimensions, including power distance and feminine/masculine cultural traits. It is possible that economic factors and development may push a culture towards less individual reliance on others and arguably increase the degree of egocentricity. The shift from socio-centric to egocentricity could itself lead to conflict within cultures. This is also bound to have an impact on individual presentation and behaviour. The rapidity of economic transition, coupled with globalization and high levels of migration, can lead to internal conflict both at societal and individual levels. With increasing globalization there is greater movement of people and goods. It has been argued that certain personality traits are more likely to lead to the likelihood of migration. Personality traits also affect mood and emotional regulation and will influence post-migration adjustment. Different personality styles will produce different levels of adjustment. Migration is not a heterogeneous phenomenon, but the post-migration settling is important both for the individuals and also for the new society.

Defining schizophrenia: From Kraepelin to DSM-5

Rajiv Tandon

College of Medicine, Gainesville, Florida

Although dementia praecox or schizophrenia has been considered a unique disease entity for the past century, its definitions and boundaries have changed considerably over this period. Conceptualizations of schizophrenia have, at any given time, been influenced by available diagnostic tools and treatments, related conditions from which it most needs to be distinguished, extant knowledge and scientific paradigms. Despite changing definitions, the construct of schizophrenia does convey useful information: (i) patients diagnosed as having schizophrenia do have some real disease- they experience both suffering and disability; (ii) a diagnosis of schizophrenia does suggest a distinctive clinical profile- a characteristic long-term course; an admixture of positive, negative, cognitive, and conative symptoms; likelihood of benefit from antipsychotic treatment; and (iii) schizophrenia satisfies criteria for a valid diagnostic entity better than almost any other psychiatric diagnosis. On the other hand, the concept of schizophrenia has very serious shortcomings. First, it is not a single disease entity- it has multiple etiological factors and pathophysiological mechanisms. Second, its clinical manifestations are so diverse that its extreme variability has been considered by some to be a core feature. Third, its boundaries are ill-defined and not clearly demarcated from other clinical entities. In DSM -5, several proposed revisions to address these limitations are being field-tested. For example, instead of current subtypes and course specifiers, the heterogeneity of schizophrenia might be significantly explained by the interplay between variations in: (a) illness dimensions and intermediate phenotypes; and (b) distinct stages of schizophrenic illness. The DSM-5 approach to providing a more useful description of schizophrenia will be summarized. The clinical and research utility of the DSM-5 approach will be discussed.

Promoting the mental health and wellbeing of communities - Can we do it?

Vimal Kumar Sharma

Visiting Prof. at Chester University

WHO's initiative on 'no health without mental health' has led the public and policy makers to give due importance to mental health in a wider context. The financial crisis in the Western world had adverse impact on people's lives, as well as on their governments' capacity to spend on public services. This has accelerated the speed and focus on to health promotion and illness prevention within their own countries. There is also an emerging emphasis onto the shift of the parameter of a nation's progress from 'GDP' to the 'Happiness Index'. Promoting mental health and improving the well-being of a population has become a fashionable slogan, as well as a serious policy implementation initiative actively pursued in a number of countries in Europe including the UK. The Royal College of Psychiatrists' October 2010 position statement on 'No health without public mental health' under Professor Bhugra's leadership highlights psychiatrists and other mental health professionals' responsibilities towards promoting public mental health. The evidence supports that simple measures in life can reduce stress, improve mental health & well-being of the population. An evidence based synthesis on the need and ways to improve a community's mental health well-being will be outlined in the lecture.

Steps to bring about changes in Asian psychiatry

M. Parameshvara Deva

Consultant Psychiatrist KPJ Selangor Specialist Hospital, Shah Alam, Malaysia

Among medical specialties in Asia psychiatry has lagged behind in the recent advances that we see in services delivery. Many countries still rely on large prison like mental hospitals to provide services for the mentally ill while modern and efficient as well as user friendly staff provide services for the physically ill. While the over emphasis on treatment of psychoses has preoccupied minds of administrators as well as psychiatrists the overwhelming numbers of anxious and depressed in our countries have remained neglected and to their own devices to suffer in silence.The move to provide health for all has sadly left mental problems far behind and out of the primary care settings that psychiatric services should be delivered in thus the training of the medical and nursing students has often continued to focus on the psychoses and severe illnesses that constitute a very small fraction of human problems of mental health care But even in that misconception the methods of diagnoses and treatments have often been archaic and ineffective. Thus interview techniques, family and social history as well as counseling and techniques of psychosocial rehabilitation of the mentally have remained unimportant in many training centres.

There also big gaps in the process of improving teaching techniques that can make psychiatry interesting to students in training and indeed the examining of students in psychiatry remains neglected or unimportant. Indeed this is worse in colleges of Nursing and medicine where psychiatric teachers and departments do not exist.

This paper outlines areas of importance in both training as well as services delivery in psychiatry that need to be emphasized if psychiatry is to change and shed its fearful and institutional image that is blocking its progress.

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