Psychiatry Notes- Childhood Schizophrenia

CHILDHOOD ONSET SCHIZOPHRENIA

CLASSIFICATION:
Very early onset- before 13 yrs of age, Insidious Onset
Early onset , -before 18 years.Acute to subacute onset, i.e within one year

SYMPTOMS
Hallucinations, There are more of hallucinations, both visual and auditory. Misreprentation of normal intrapsychic experience, imagination, dissociative experiences or plainly not understanding the examiner’s question.
Thought Disorder- Commonly seen, Rule out developmental delays or Language disorders.
Flattened affect – common

Generally when evaluating a child for Schizophrenia the child’s age has to be taken into account. The child at the earlier years before age of 7 – 8 may have fantasy friends, this may generally not be of concern to the parents.
If the child demonstrates strange experiences after that age, especially voices passing derogatory remarks, or conversing with each other or seeing scary visual images as well as a decline in their social interaction, esp. staying away from friends, then this may be suggestive of signs of schizophrenia. Remember that since the child’s cognitive framework has not developed well it is very rare that you find them having well systematized delusions. They generally comprise childhood themes.
Incidence: 1 in 40,000, compared to 1 in 100 in adults.

Differential Diagnosis:
Mood Disorders: 50% bipolar chlldren originally diagnosed as schizophrenia
Increased family history of depression in young schizophrenics

Schizoaffective Disorder

Nonpsychotic Behavioural Disorders- they have lower rrates of delusions & thought
disorder. Children who have been victims of abuse may sometimes claim to hear voices of or see visions of the abuser.

Pervasive Developmental Disorder:Earlier age of Onset (Schiz- age of onset 7 years or older) Autism is usually diagnosed by age 3yrs
No normal period of development
Generally lack of hallucinations and delusions
Deviant language patterns
Problems with social relating

Language and Speech Disorders: May mimic thought disorders
Organicity: R/O Seizure Disorder
CNS Lesions- head trauma, tumors
Delirium
Neurodegenerative Disorders- Huntington’s, Lipid Storage, etc

Medications: Amphetamines, Anticholinergics

Metabolic- Wilson’s

Prognosis is poor as compared to adult onset schizophrenia.

The newer generation "atypical" antipsychotics, such as olanzapine and clozapine, may also help improve motivation and emotional expressiveness in some patients. They also have a lower likelihood of producing disorders of movement, including tardive dyskinesia, than the other antipsychotic drugs such as haloperidol. However, even with these newer medications, there are side effects, including excess weight gain that can increase risk of other health problems.
Families can also benefit from supportive counseling, psychotherapies and social skills training aimed at helping them cope with the illness. They likely require special education and/or other accommodations to succeed in the classroom.

Psychiatry notes - schizophrenia questionnaire

PRIME questionnaire for Schizophrenia

Actually I owe this Questionnaire to Schizophrenia.com. This free and anonymous screening test for early symptoms of schizophrenia is part of a research study being performed by Yale University Medical School. The PRIME screening test was developed by Dr. Tom McGlashan, Dr. Tandy Miller, Dr. Scott Woods and the PRIME group in the psychiatry dept. of Yale Medical School. I feel it is a very useful tool for the common man who is terrified if they’re going crazy. The site can be accessed and ratings can be done immediately. There is no worry because this site keeps all information anonymous and there is no need to reveal identities.

The following questions are posed and the person is rated on various levels of agreement(definitely disagree to definitely agree at the ends of the spectrum).

1. I think that I have felt that there are odd or unusual things going on that I can’t
explain.

2. I think that I might be able to predict the future.

3. I may have felt that there could possibly be something interrupting or controlling my thoughts, feelings, or actions.

4. I have had the experience of doing something differently because of my superstitions.

5. I think that I may get confused at times whether something I experience or perceive may be real or may be just part of my imagination or dreams.

6. I have thought that it might be possible that other people can read my mind, or that I can read other’s minds.

7. I wonder if people may be planning to hurt me or even may be about to hurt me.

8. I believe that I have special natural or supernatural gifts beyond my talents and natural strengths.

9. I think I might feel like my mind is “playing tricks” on me.

10. I have had the experience of hearing faint or clear sounds of people or a person mumbling or talking when there is no one near me.

11. I think that I may hear my own thoughts being said out loud.

12. I have been concerned that I might be “going crazy”.

another count of faces.

People have given me various ranges for this one between 9 and 15, but many happen to be contorted to the extent of being scary. Maybe you could find more than the maximum till now, that's 15.

Is anyone able to find 9 faces- none of my friends have- Maybe you could!

I have never been able to find the 9 faces which have been claimed to be hidden within this general's photograph unless i count the face of a Dog and the Bird??? If any of you manage to catch the 9 human faces do share it with me.I would love not to spend time on this one again.

How many faces are you able to see in this illusion.

Sorry, these faces seem to be mostly unhappy, morbid ones, though i was reminded of Don Quixote immediately among the few valorous faces I was able to catch.

I guess this was always on Freud,s Mind- Can you see the not so obvious???

Psychiatry notes - handwriting analysis

Graphology is a term used for all types of handwriting analysis.On the other hand Graphoanalysis specifically deals with handwriting analysis that can produce sny scintific validation data. Taught by the International Graphonanlysis society its practitioners go by a Code of Ethics.This Society society has over 55,000 graduates and it mainly performs research in the field of Handwriting analysis.Graphoanalysis, therefore, is truly a nonbiased assessment. Analysis of handwriting can neither predict future behavior nor diagnose disease.Graphoanlysis is considered a branch of applied psychology. The analyst deals with a series of personality traits and character that is reflected through various strokes in the Handwriting.

Psychiatry Notes-graphology in Psychiatry

Alcohol intoxication produces abnormal handwriting with manifestations that are thoroughly described in the literature of forensic science. A less known phenomenon is the peculiar handwriting changes found in alcoholics, especially individuals in the later stages of the disease. In addition to the two handwriting states of non-alcoholic drinkers (normal/sober and intoxicated) the alcoholic writer has a third state, handwriting done in withdrawal. Withdrawal is a state of tension resulting in handwriting characterized by irregularity, ataxia and tremor. This type of abnormal handwriting creates special problems of authentication requiring detailed background history and appropriate comparison specimens, but it can also be used to judge the writer's state of sobriety.
In psychopathology, an interesting approach consists of observing the essential characteristics of already recorded entities. Very few works have been devoted to the rapport existing between graphological productions, personality structure and mental illness. This work concerns the handwritings observed in hysteric patients, diagnosed as such after taking into account case history and clinical interview. Our aim is to show the essential points which characterize this particular pathological structure. The stable features of hysteria are verified in graphic items. From, movement and ordonnance of such handwritings serve as useful aides in identifying the stages of maturation of the Ego. The graphological expressions observed in patients presenting with obsessional neurosis significantly contrast, however, with those encountered in the preceding personality structure (Hy). A comparison of these two different series demonstrate the utility of this work in clinical psychiatry.
(source)

Psychiatry notes-Choice theory

Choice THeory, Dr.WIlliam Glasser

Choice theory is a new psychology developed by Dr.William Glasser. Dr. Glasser has described how by 1996, he realized that all his psychiatric work was based on people choosing what they do. Hence he decided to give this form of practice a new concept, which he described in Counseling With Choice Theory. The following text is from an abstract by Dr. Glasser. I found the concept very interesting and thought why not share it with everyone…..

“By learning to put choice theory to work in your life, you can improve your relationships with all the people who are important to you. You can also teach choice theory to someone else who then can use it to improve his or her important relationships. Since we are social beings, the need for satisfying relationships is encoded into our genetic structure. The more our genes are satisfied, the healthier we are. Therefore, improving our relationships is improving our mental health.

What I call a psychology is a usual way of dealing with other people in certain situations. For example a car sales person will use a sales psychology when approaching people who come into the showroom. A mother will use a bedtime psychology when she has difficulty putting her children to bed.

Right now all over the world, people rich or poor, of all races, religions and political persuasion use an ancient world psychology which I call external control when they have difficulty getting along with other people, especially people they want to get along well with, usually spouses, family, friends, teachers, fellow students, fellow workers and bosses. This occurs because we live in an external control world. Almost all of what is now wrongly called mental illness can easily be traced back to too much external control.

Even though people who use external control believe it will help them to get along better with the people they use it with, it actually does the opposite. External control will always increase the difficulty between the disagreeing parties. If it is continued it can destroy the relationship it was intended to help. Almost all people who divorce have no idea where their initial, strong, positive feeling for each other has gone. Choice theory teaches this early love was destroyed by one or usually both using external control as the marriage progressed.

External control is destructive because one or both parties will attempt to control the other so the other does what the controlling person wants. If it is used in a marriage, the partners use it on each and other and as they do the marriage goes rapidly downhill. If one partner gets control he or she may be happy but the other will be more miserable and increase his or her resistance. The actual resistance usually starts with anger but most often the anger is changed into depression, anxiety or any of the four hundred plus symptoms that are wrongly diagnosed as mental illness in a book called the DSM-IV. A better title for that book is the big red book of unhappiness. These unhappy people need each other but don’t know how to get along.

Choice theory is the opposite of external control: It is a self- control psychology. Those who practice it have learned that they choose everything they do. They learn they can control their own choices but they can’t control what anyone else chooses. Basically, choice theory explains that whenever we deal with any person we want to get along well with, we should be careful to replace any external control with choice theory.

Specifically, external control leads all who use it to practice the Seven Deadly Habits that destroy relationships. These are criticizing, blaming, complaining, nagging, threatening, punishing or bribing or rewarding to control. Remember once the sentence is out of you mouth you can’t reach out and put it back in. Nor can you erase a look on your face or an upward out-ward roll of your eyes. Choice theory urges all of us to replace the deadly habits with the Seven Caring Habits: supporting, encouraging, listening, accepting, trusting, respecting and negotiating differences.

Keep in mind that the unhappiness caused by our not being able to get along with the people we want to get along with is the basic problem. But unhappiness is not mental illness. Our normal brains are perfectly capable of using external control to the point of suffering any symptom in the DSM-IV. While we may not be mentally healthy, we are not mentally ill. There is nothing wrong with the structure or chemistry of our brains. Learning to put choice theory to work in our lives can bring back happiness or mental health.”

Psychiatry Notes - Autoscopy/Doppleganger

Many famous poets and writers have described autoscopy, sometimes based on their own experiences, like the German poet Goethe. While out in the woods, he thought he recognized himself in someone coming toward him. He perceived himself not through his real, physical eyes, but through the eyes of his soul. Goethe's account is probably the origin of descriptions of autoscopy as having some detached insight (Vondrýcek and Holub, 1968). This factor supports the idea that an extreme narcissism is a specific psychogenic factor here. Patients see themselves either in their contemporary aspect or sometimes older or younger.
Autoskopie, autoscopic hallucinations aussersichsein (to be outside oneself) and doppelsehen (seeing double) are the various terms which describe the experience of an individual seeing themselves.In the past, the term deuteroskopie was sometimes used. The phenomenon is more common in males (Arieti and Bemporad, 1974). Menninger-Lerchenthal, who coined the term heautoskopie, considered this phenomenon to exist primarily as a result of right parietal lobe impairment (Leischner, 1961). He observed one case in the right frontoparietal astrocytoma, and reported on several cases of autoscopy associated with right and left hemisphere damage due to shell injury

Causes: Autoscopic phenomena were described in cases of exhaustion, infection (especially Typhus exanthematicus), epilepsy, migraine, substance abuse or intoxication, and postpartum psychosis (Leischner, 1961).Deep prosopagnosia (impaired facial recognition) could also be a reason for autoscopy. Tranel wrote (1992).

German and Scottish superstitions maintain that seeing one's double is an omen that one will soon die.

Capgras had a female patient in 1923 with the delusion that she was of high noble origin but that, as an infant, she had been switched to another family. She believed that the members of her family had all been gradually replaced by doubles. All of her surroundings and all of her acquaintances were doubles. The patient believed her daughter had 2,000 doubles. The patient believed that in the Parisian underground, 28 million people were kept prisoner, while on the surface only their doubles existed. The patient feared that she herself could be considered to be her own double, and therefore she kept all of her documents on her body (Leischner, 1961).
(source)

Amazing numbers

• One in five children have a diagnosable mental, emotional or behavioral disorder. And up to one in 10 may suffer from a serious emotional disturbance. Seventy percent of children, however, do not receive mental health services (SGRMH, 1999).
• Attention deficit hyperactivity disorder is one of the most common mental disorders in children, affecting 3 to 5 percent of school-age children (NIMH, 1999).
• As many as one in every 33 children and one in eight adolescents may have depression (CMHS, 1998).
• Once a child experiences an episode of depression, he or she is at risk of having another episode within the next five years (CMHS, 1998).
• Teenage girls are more likely to develop depression than teenage boys (NIMH, 2000).
• Children and teens who have a chronic illness, endure abuse or neglect, or experience other trauma have an increased risk of depression (NIMH, 2000).
• Suicide is the third leading cause of death for 15- to 24-year-olds and the sixth leading cause of death for 5- to 14-year-olds. The number of attempted suicides is even higher (AACAP, 1997).
• Studies have confirmed the short-term efficacy and safety of treatments for depression in youth (NIMH, 2000).
• Alcohol, marijuana, inhalants and club drugs are the most frequently used drugs among middle- and high-school youth (SAMHSA, 2000)
• Research has shown that use of club drugs such as Ecstasy and GHB can cause serious health problems and, in some cases, death. Used in combination with alcohol, these drugs pose even more danger (NIDA, 1999).
• Children and adolescents increasingly believe that regular alcohol and drug use is not dangerous (SAMHSA, 2000).
• Among middle- and high-school students, less than 20 percent of young people between the ages of 12 and 17 report using alcohol in the previous month, and less than 4 percent report drinking heavily in the previous month (SAMHSA, 2000).
• Young people are beginning to drink at younger ages. This is troubling particularly because young people who begin drinking or using drugs before age 15 are four times more likely to become addicted than those who begin at age 21 (SAMHSA, 2000).
• Children of alcohol- and drug-addicted parents are up to four times more likely to develop substance abuse and mental health problems than other children. (NACOA, 1998)
• Twenty percent of youths in juvenile justice facilities have a serious emotional disturbance and most have a diagnosable mental disorder. Up to an additional 30 percent of youth in these facilities have substance abuse disorders or co-occurring substance abuse disorders (OJJDP, 2000).

Treating depression in tigers!

In a zoo in California, a mother tiger gave birth to a rare set of triplet tiger cubs. Unfortunately, due to complications in the pregnancy, the cubs were born prematurely and due to their tiny size, died shortly after birth. The mother tiger after recovering from the delivery, suddenly started to decline in health, although physically she was fine. The veterinarians felt that the loss of her litter had caused the tigress to fall into a depression. The doctors decided that if the tigress could surrogate another mother's cubs, perhaps she would improve. After checking with many other zoos across the country, the depressing news was that there were no tiger cubs of the right age to introduce to the mourning mother. The veterinarians decided to try something that had never been tried in a zoo environment. Sometimes a mother of one species will take on the care of a different species. The only "orphans" that could be found quickly, were a litter of wiener pigs. The zoo keepers and vets wrapped the piglets in tiger skin and placed the babies around the mother tiger.
(source)

Chocolate-the reasons behind consumption!!!

I found an interesting article examining the reasons behind eating Chocolate, one of my favorite pastimes. I realised i was being categorised into one of 2 kinds of consumers- the cravers and the emotional eaters. Cravers are those who eat chocolate as an indulgent pleasure and emotional eaters are those who use chocolate in a bid to alleviate depression.What more, they even dissected the reason behind wishing for a bite of that brown treat in that anticipating and eating the treat releases 'feel good' neurotransmitters.Chocolate craving, (for the cravers), as an indulgent pleasure seems to stimulate the dopamine system in the brain, and provides an enjoyable experience.However the emotional eaters eat chocolate to relieve boredom, stress or clinical depression and are actually looking for an opioid effect to improve their mood, which is only a temporary relief which is quickly followed by a return to or a worsening of their earlier negative state.

Premenstrual Syndrome

PMS looks more at physical symptoms such as bloating, weight gain, breast tenderness, swelling of hands and feet, aches and pains, poor concentration, sleep disturbance, appetite change, and psychologic discomfort. Premenstrual dysphoric disorder has as part of its definition, symptoms such as depressed mood or dysphoria, anxiety or tension, emotional lability, irritability, decreased interest in usual activities, concentration difficulties, marked lack of energy, marked change in appetite, overeating or food cravings, sleepiness or insomnia, and feeling overwhelmed.The simplest treatments are really simple.First and foremost change in diet can help dramatically. Discontinuance of all caffeine containing products, drinks and over-the-counter medications. A low carbohydrate diet, especially avoiding any simple sugars and only sparingly having complex carbohydrates is beneficial. Calcium supplements (1200 mg/day) also have been shown to help. Vitamin B6 (pyridoxine) has contradictory evidence of its efficacy and progesterone treatment used in the past has been shown to be no better than placebo.

THe Paradox about Tristam Shandy

The Paradox of Tristram Shandy
This paradox, formulated by Bertrand Russell, is based on the 18th century novel TheLife and Opinions of Tristram Shandy, Gentleman, by Laurence Sterne. Here is Russell's statement of the paradox:

"Tristram Shandy, as we know, took two years writing the history of the first two days of his life, and lamented that, at this rate, material would accumulate faster than he could deal with it, so that he could never come to an end. Now I maintain that, if he had lived for ever, and not wearied of his task, then, even if his life had continued as eventfully as it began, no part of his biography would have remained unwritten."

Suppose Tristram Shandy continued at the painfully slow rate at which he started, so that he took a full year to write about each day of his life. In spite of this, there is a one-to-one correspondence between each year that he writes in and each day he writes about. Therefore, no matter what day of his life you care to consider, there will eventually come a year in which he will be able to write about it. There is no part of his life that can never be written down. Nevertheless, he gets further and further behind!

It's interesting to reverse this paradox and consider what would happen if Tristram had already been writing for an infinite amount of time. It at first may seem that the two temporal directions might be mirror images of one another. In that case, just as he might begin to write at time t in the original paradox, in the reversed version it would seem he might have finished his task at t. But a little reflection shows that that is impossible. If he had just finished writing his autobiography, then he would have just written about the most recent day of his life. But since it takes him a year to write about each day, he would have had to start writing about this most recent day 364 days before the day started! Thus, unless Tristram can foretell the future, he cannot have finished writing yet, even though he has already spent an infinite amount of time on the task.

Suppose Tristram has in fact been writing forever and has just finished describing another day. When might have been the day he just finished writing about? As we've just seen, he could not have been writing about today, for he would have had to start writing about it a year ago. So it seems that the most recent day he could have been writing about is a year ago today. But then what was he writing about in the previous year? He would have been writing about a year ago yesterday. But that too is impossible, for he would once again have had to start 364 days too soon. Repeated application of this argument shows that, no matter what date in the past one chooses, Tristram could not already have written about it. He therefore can only have finished writing about a day that lies in the infinitely remote past!
(Source)

Who's the tallest of the 3 figures?

Well, well,......they're all the same size. I know it is hard to believe, but its true. I actually measured them.

How the tables have turned now in three years

I read an article while surfing thru the net, which featured in The Times Of India, Saturday 1 November 2003,

But fortunately or unfortunately it’s a whole different situation now as in 2006, 3 years later. Britain seems to have got smart and changed so many rules that many doctors from the UK have packed their bags and come back for good.

After teachers and nurses it’s the psychiatrist’s turn to get lured by the Queen’s own country, UK.Along with Mumbai, Bangalore and Hyderabad the trend is taking Pune in its wings with doctors saying the English want more. Britain ’s National Health Service has been openly accused of indulging in the “Great Brain robbery”.

According to statistics from the London School of Hygiene and Tropical Medicine, India has one psychiatrist per 30,0000 population in comparison to one per 90,000 population in UK . From which, Maharashtra has approximately 500 psychiatrists, while the number of psychiatrists in Pune stands at about 80, who according to the latest reports have been bitten by the UK bug. When there is an excess of manpower in any particular field, a foreign Government can take permission from the domestic Government to advertise for jobs. That’s what the British Government has been doing for the last couple of years. The brain drain could be attributed to this. Moreover, applicants can now also do the procedure on-line through the department of Health UK .But the process is anything but easy, and involves years of experience, several credentials, a good amount of research and various levels of screening to then finally be UK bound.

Psychiatry Notes - First Psychaitric Hospital In India

It is worthwhile to trace the beginning of general hospital psychiatry in India, my country.
During the early decades of the 20th century a movement was initiated, first in the USA and then in the UK to improve the quality of care for mental illness and to disseminate knowledge about mental health amongst the masses. In order to organize this movement a National Committee for Mental Hygiene was established in the USA in 1909. This was followed by the formation of a Mental Hygiene Council in the UK in 1923. The educated and the enlightened people of all walks of life were enrolled as members of these organizations. The impact of their activities was felt on the shores of India very soon. On active encouragement from the Mental Hygiene Council (UK), the Indian Association for Mental Hygiene came into being at Simla on 23rd August 1928. The membership of the association was open to all who subscribed to its aims and objectives and participated in all activities towards their implementation. Lt. Col. Owen Berkeley – Hill, Superintendent of the then European Lunatic Asylum, Ranchi (now known as Central Institute of Psychiatry) was elected as its first President. The aims and objectives of the association, as attributed by its President, were as follows –

To disseminate the knowledge about mental hygiene amongst masses

To organize meetings, seminars and popular lectures on mental health and mental illnesses

To establish a library for storing and distributing books on mental health and allied disciplines

Publication of a quarterly Bulletin of the Association

Establishment of treatment centers for mental illnesses.

The Calcutta Chapter of the Association was opened sometime in late 1929. Dr. Girindra Sekhar Bose, who was the Founder President of Indian Psychoanalytical Society (established in 1922) and the then head of Department of Psychology, Calcutta University was a leading member of the Association at Kolkata. The Calcutta Chapter, under the leadership of Dr. Bose, took an active part in implementing the rather ambitious plan of the Association. From a small beginning (with five founder members) this subcommittee of the Association grew in size rapidly. In course of less than four years, by the beginning of 1933, its membership rose to 264.

The Calcutta Chapter arranged a monthly popular lecture on mental health delivered by a leading scholar of the city. It became so popular and attractive that, on public demand, the monthly event soon became a weekly event.

Emboldened by this favorable public response, the Association decide to establish a home for the Mentally Retarded for their custody, care, and training. Support in the form of money, land and voluntary expert service came readily and the Home was established on 24th April, 1932. The name of the Home – BODHANA NIKETAN – was coined by none other than the Nobel Laureate poet Rabindranath Tagore.

The next step taken by the Association was the opening of a psychiatric outpatient clinic in a general hospital. The far-reaching impact of this act outlived the association itself. The State Government was approached for assistance in this endeavor. It was proposed by the Association that adequate room be made available in the Calcutta Medical College (a state-run institution) for the Clinic. The initial response was positive, but very soon it was made clear by the Government that the time was not yet ripe for it. Thereupon, the Association, under the leadership of Dr. Girindra Sekhar Bose, persuaded the authority of Carmichael Medical College, Calcutta – then run by a non-profit-making private organization – to allow it to open a psychiatric outpatient clinic in the college premises (this private college was taken over by the State Government in free India). It was agreed that the Association would pay for the expenses of the clinic. The College authority, however, lent some furniture and arranged for supply of free electricity. Dr. Bose made an advance of Rs. 867.50/- to defray the cost of furnishing the Clinic and purchasing some essential instruments. Thus the stage was set for opening the doors of the first psychiatric OPD clinic in a general hospital in India.
The first department of psychiatry with outpatient facility in a general hospital in India was opened on 1st May 1933 at the then Carmichael Medical College (now known as R. G. Kar Medical College). Kolkata. In 1938, the outpatient facility of Department of Psychiatry of J.J. Hospital, Mumbai was opened.A department of Neurology and Psychiatry was established in the Calcutta Medical College in 1939 by an order of the Government of Bengal.

A few interesting details about this Clinic-

The working hours of the Clinic was between 8-00 AM and 10-00 AM on every Tuesday and Thursday. The MO-in-Charge was Dr. Girindra Sekhar Bose. He had two other M.O.’s to assist him. They were Dr. Bhupati Mohan Ghosh and Dr. Kamakhya Charan Mukherjee. All the members of the staff worked on honorary basis. The sole exception was a part-time bearer who received a monthly pay of Rs. 2/- (Rupees Two only).

Though the OPD clinic was opened on 1st May, 1933 the first patient was registered on the following day i.e. 2nd May, 1933. The original case record of this patient is still preserved and displayed on the wall of the chamber of the Head of the Dept. of Psychiatry of R.G. Kar Medical College.

It is on record that 174 new cases attended the clinic during the first year of its existence. It is gratifying to note that this clinic is not only the first of its kind but is still one of the most thriving centers of service, teaching and research in Psychiatry in Kolkata.

Napolean???Haemorrhoids

I read this funny article citing that one of the problems at Waterloo may have been Napoleon's haemorroids.Allegedly he did suffer from very painful hemorrhoids which troubled him riding a horse in the battlefield.If you are a type A individual, you frequently develop hemorrhoids.

Van Gogh

There is speculation rife if Van Gogh, suffered from some form of "madness". Many have drawn attention to the large amount of green and yellows in his last paintings.The most common doubt is that he was bipolar (manic-depressive). There's very interesting literature on the fact that he drank a liquor called absinthe, which when taken in a large dose, does cause xanthopsia, or yellow vision(due to a component in it called Thujone). That's one speculation. The other interesting speculation is that he was being overdosed with digitalis which is the medication for heart failure. So why was Van Gogh, who wasn't in heart failure, getting digitalis? He was known to be an epileptic, which could have been caused by the absinthe. It can cause epilepsy if too much is taken. That was recently discovered by a group at the University of California in Berkley. It affects the GABA (gamma-aminobutyric acid) receptor on the brain cells, and they fire at will when you are getting overdosed, which could cause convulsions. The speculation about digitalis comes forth because of the famous painting, The Starry Night. When you are overdosing on digitalis, you develop yellow vision. In The Starry Night, there are yellow circles around the stars which is also a complaint of the overdose. Van Gogh's last physician was Dr. Gachet. He used digitalis to treat his epilepsy. Why did he do this? Maybe it didn't. It's interesting in the portrait, Dr. Gachet is holding the digitalis flower. It's called Digitalis Purpura. That's another speculation. The last speculation is that Van Gogh just liked the color yellow, trying to dismiss all of the absinthe story and the story of digitalis. A chemistry lab could have been very effective in determining whether he was getting poisoned.
There was a history of suicide in the family, and he committed suicide.Manic-Depressive Illness does lead to increased creativity because the brain cells are firing at will. When you are in a manic state, you are very creative, but once you get depressed, you create nothing.

The Starry Night was completed near the mental asylum of Saint-Remy, 13 months before Van Gogh's death at the age of 37 in June 1889.
Van Gogh painted furiously and The Starry Night vibrates with rockets of burning yellow while planets gyrate like cartwheels. The hills quake and heave, yet the cosmic gold fireworks that swirl against the blue sky are somehow restful.
This painting is probably the most popular of Vincent's works.

did you know

Some of the physical features of famous individuals are highly suggestive of certain illnesses.Beethoven had a bulging forehead and became deaf at the age of 28. He thought that his deafness was due to trauma from his alcoholic father beating him but when he died, one of the most famous pathologists, Dr. Rokitansky, discovered that he had Paget's disease of the bone. A common symptom of this disease is deafness, so that's the most likely cause of his deafness

problems!!!!

Hi , finally got things in order

hello

i'll be back. trying to put things in order

Vagus Nerve Stimulation in Bipolar Disorder

Vagus nerve stimulation (VNS), approved in 2005 for the management of treatment-resistant depression, uses mild electronic pulses to intermittently stimulate the left vagus nerve. A recent study evaluating VNS + treatment as usual (TAU) to a similar group of treatment-resistant patients who received only TAU indicated similar efficacy for the subset of bipolar depressed patients and the unipolar depressed patients.

transcranial magnetic stimulation in bipolar affective disorder

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation paradigm that uses a strong and rapidly alternating magnetic field to stimulate brain tissue via a coil placed on the scalp. While stimulating the brain in a manner theoretically similar to that used in electroconvulsive therapy (ECT), rTMS stimulates a focal region of cortex, thereby avoiding the cognitive side effects that are often associated with ECT. It is important to note that rTMS does not produce a seizure. A few pilot studies have evaluated the efficacy of rTMS for bipolar depression, one showing positive results and another indicating a trend toward improvement in the treatment group.

quietapine in bipolar depression

Bolder I and Bolder II (BipOLar DEpRession) are 8-week, multicenter, double-blind, randomized, fixed-dose, placebo-controlled studies for quetiapine monotherapy in the treatment of bipolar depression. Data from Bolder I, published last year, have indicated a robust effect of quetiapine monotherapy in the treatment of bipolar depression as measured by decreases in the Montgomery Asberg Depression Rating Scale (MADRS). Data from Bolder II show strikingly similar results and further support a role for quetiapine as a first-line treatment for depression in bipolar patients.For quetiapine, sedation or somnolence, mostly within the first week of treatment, is the most common adverse event, leading to treatment dropout.This side effect may be used clinically for specific patient populations, such as in the treatment of patients with anxiety or agitation

olanzapine: Bipolar disorder

Olanzapine was the first of the atypical antipsychotics to be approved for the treatment of bipolar disorder.But weight gain is the main problem faced by patients.The American Psychiatric Association/American Diabetes Association Consensus Statement on Diabetes Care suggests monitoring patient weight at baseline, once a month for 3 months, and then quarterly. A fasting blood sugar should be taken at baseline, 3 months, and annually, and a fasting lipid profile should be taken at baseline, 3 months, and every 5 years afterwards

Binswangers disease

Otto Binswanger was born in Münsterlingen, Switzerland, on October 14, 1852. Otto Binswanger studied medicine in Heidelberg, Strasbourg, and Zurich. At the age of 30, Dr Binswanger was appointed professor of psychiatry and director of the mental asylum in Jena, a position he held for 37 years between 1882 and 1919.
In 1894, Binswanger first described a form of dementia called encephalitis subcorticalis chronica progressiva, separate from neurosyphilis and other forms of dementia in the elderly. He characterized the disease as being associated with lesions of the subcortical white matter with "severe atheromatosis of the arteries," enlarged ventricles and normal cortex.
1902 Use of the term "Binswanger's disease" by Alzheimer to identify this form of senile dementia.
1962: The term "subcortical arteriosclerotic encephalopathy" was first used
1974: The term "multi-infarct dementia" began to be used Multi-infarct dementia is a broader term for vascular dementia and includes both Binswanger's dementia and the dementia resulting from repeated thrombotic and embolic cerebral infarcts.
1987: The term "senile dementia of the Binswanger's type" was recommended

Affective disorders,alterations in mood and behavior are predominant features of senile dementia of the Binswanger's type. These mental status changes are typically found early in the course of the disease and may not accompany the neurologic findings. The changes vary in onset and severity but are present in most cases.

hyperkinetic disorders

Types of Hyperkinetic Movements Chorea: refers to involuntary, irregular, purposeless, non-rhythmic, rapid, unsustained movements that seem to flow from one body part to another. They are unpredictable in timing, direction and distribution. Chorea involve random group of muscles.They can be partially suppressed and the patient can often camouflage some of the movements by incorporating them into semi-purposeful(quasipurposive) movements (termed ‘parakinesias’). Huntington's disease presents with chorea.

Athetosis: Here the involuntary movements are slow, writhing, continuous.

Ballismus :this constitutes large amplitude choreic movements of the proximal parts of the limbs causing flinging and flailing limb movements. Most frequently unilateral,The lesion is most likely in the contralateral subthalamic nucleus.

Athetosis, chorea, and ballism may represent a continuum of one type of hyperkinetic movement disorder and are sometimes combined (‘choreoathetosis’ or ‘chorea-ballism’).

Dystonia: refers to twisting movements, they are sustained at the peak of the movement;many a time progress to prolonged abnormal postures. Both agonist and antagonist muscles contract simultaneously to produce the twisted posture of the limb, neck or trunk. Dystonic movements repeatedly involve the same group of muscles.

Focal dystonia - a single body part is affect. Examples of focal dystonia include: blepharospasmspasmodic torticollis (cervical or neck dystonia), writer’s cramp (hand dystonia).
Segmental Dystonia: Involvement of 2 or more contiguous regions of the body .
Generalized dystonia: Involvement of the trunk, legs and other body parts.
Idiopathic torsional dystonia:Common among Ashkenazi Jews, autosomal dominant disorder (with reduced penetrance) that begins in childhood as a focal or segmental dystonia that later generalizes to the entire body. (dystonia of the eyelids), Focal dystonia can be treated by injecting the involved muscles with botulinum toxin.
Generalized dystonia can be treated by anticholinergic agents (benztropine, trihexyphenidyl), or muscle relaxants (clonazepam, baclofen).

Myoclonus: is a sudden, brief, shock-like jerk caused by a muscle contraction (positive myoclonus) or inhibition (negative myoclonus). The causes of myoclonus are quite diverse from epileptic syndromes, to drug side effects, metabolic disturbances, and CNS lesions. Unless the cause is readily identifiable, it often requires a laborious work-up.
Regardless of its etiology, mainstay symptomatic treatments are benzodiazepines (such as clonazepam) and valproic acid.

Restless legs syndrome: refers to the phenomenon of restless legs, where the patient describes an unpleasant, crawling sensation in the legs, particularly when sitting and relaxing in the evening which then disappear on walking. It is quite common, found in 10% of the general population in one study. It is mostly “idiopathic” but is found in increased frequency among parkinsonian patients and in patients with iron deficiency anemia. Sometimes, simply replacing with iron will provide relief. Otherwise, dopaminergic agents (such as dopamine agonists and levodopa) are the mainstay treatments of RLS. In refractory RLS, anti-epileptic agents (such as gabapentin), benzodiazepines and opiates can be used.

Tics: consist of abnormal movements (motor tics) or abnormal sounds (phonic tics). When both types of tics are present, and occurring under the age of 15, accompanied by obsessive compulsive features, the designation of Tourette syndrome is commonly applied. Tics frequently vary in severity over time and can have remissions and exacerbations. Motor and phonic tics can be simple or complex. Most of the time tics are repetitive. They can be suppressed temporarily but will need to be “released” at some point providing internal ‘relief’ to the patient until the next ‘urge’ is felt. Examples include: shoulder shrug, head jerk, blink, twitch of the nose, touching other people, head shaking with shoulder shrugging, kicking of the legs, obscene gesturing, grunting, throat clearing, etc. Dopamine receptor blocking agents (such as conventional antipsychotic agents), dopamine depleting agents (such as reserpine), clonazepam, and clonidine are used to symptomatically control tics.

Tremor: is an oscillatory, usually rhythmical and regular movement affecting one or more body parts, such as limbs, neck, tongue, chin or vocal cords. The rate, location, amplitude and constancy varies depending on the specific type of tremor. It is always helpful to determine whether a tremor is present at rest (resting tremor), with posture holding (postural tremor) or with action such as writing or pouring water (intention or kinetic tremor). Resting tremor, for example, while on its own is a hyperkinetic movement, is often part of a hypokinetic movement disorder: parkinsonism. When tremor occurs mostly with action or intention, the most common cause is Benign Essential Tremor—a non-progressive disorder which can either be hereditary (usually autosomal dominant) or sporadic. The tremor can sometimes be relieved by beta blockers (propranolol), primidone (an old anti-epileptic drug) or clonazepam.
When the tremor frequency is rapid and most prominent with posture holding, it can be a manifestation of “enhanced physiologic tremor”.
Remember the conditions that ‘enhance’ the silent tremor that is in all of us include: hyperthyroidism, anxiety, hypoglycemia, medications such as steroids and anti asthma agents such as terbutaline, albuterol, etc.

parkinsonism

Almost half of all movement disorders is Parkinsonism. This is manifested by any combination of 4 cardinal features: resting tremor, bradykinesia (slowness in movement), rigidity (stiffness) and gait/postural instability. At least 2 of these features need to be present with one being resting tremor or bradykinesia before the diagnosis of parkinsonism is made.

There are several causes of parkinsonism: primary, secondary, parkinson-plus, and heredo-degenerative disorders. Primary parkinsonism (Parkinson’s disease) refers to a progressive disorder of unclear etiology and the diagnosis is often made by excluding other causes of parkinsonism. For this reason, it is also called “idiopathic” PD. It is probably the most common type of parkinsonism encountered by a neurologist.

Secondary parkinsonism refers to disorders with an identifiable cause such as drug-induced parkinsonism (from intake of dopamine receptor blocking agents such as antipsychotic and anti-emetic drugs), or parkinsonism resulting from a stroke, infection, or tumor in and area of the basal ganglia.
Parkinson-plus syndromes are also progressive neurodegenerative disorders with parkinsonism as their main but not the only feature. Examples of parkinson-plus disorders are: progressive supranuclear palsy (with early dementia, vertical gaze palsy and early, frequent falls), multiple systems atrophy (with lack of tremor, more prominent cerebellar features such as ataxia and incoordination, significant autonomic dysfunction such as urinary incontinence, erectile dysfunction or orthostatic hypotension) and cortico-basal-ganglionic degeneration or cortico-basal-degeneration (presenting with early dementia, limb dystonia and “alien limb phenomenon”—where the limb performs autonomous movements). Finally, other neurodegenerative disorders can also present with parkinsonism. The main difference between this group (compared to the parkinson-plus) of disorders is that parkinsonism is not their most prominent feature. For example, Alzheimer’s disease is primarily a neurodegenerative disorder of memory dysfunction but parkinsonism can occur at the later stages of the illness.

movement disorders

Movement Disorders can be defined as neurological syndromes in which there is either an excess of movement (termed “hyperkinetic movements”) or a paucity of voluntary or automatic movements (termed “hypokinetic movements”) these are unrelated to weakness or spasticity.

Hyperkinesias have also been called dyskinesias or abnormal involuntary movements. The six major categories of hyperkinetic movement disorders are: restless legs, tremor, chorea, dystonia, myoclonus and tics. However, there are other ‘minor’ or less common hyperkinetic movement disorders such as akathisia, hemifacial spasms, hyperekplexia, myokimia, myorhythmia, and stereotypy.

These hyperkinetic disorders can be, involuntary, automatic (i.e. learned motor behaviors performed without conscious effort such as the act of walking or swinging of arms during walking), voluntary (planned or self-initiated), semi-voluntary (induced by an inner sensory stimulus such as a need to scratch an itch; or an unwanted feeling or compulsion such as those seen in restless legs or akathisia).

Hypokinesia (decreased amplitude of movement) is sometimes used alternatively with bradykinesia (slowness of movement), and akinesia (loss of movement). Parkinsonism is the most common cause of hypokinetic movements but there are other less common causes of hypokinetic movements such as: cataplexy and drop attacks, catatonia, hypothyroid slowness, rigidity, and stiff muscles.

Most, but not all, movement disorders are a result of basal ganglia dysfunction—what we term as “extrapyramidal disorders”. Movement disorders can also come from injury of the cerebral cortex, cerebellum, brainstem, spinal cord, peripheral nerve, and other areas.

ICMR GUIDELINES, AN INTERVIEW WITH DR. MUTHUSWAMY

Dr Vasantha Muthuswamy, called the Queen of Bioethics. head of basic medical sciences at the Indian Council of Medical Research, was responsible for coordinating the ICMR’s guidelines for biomedical research, finalised in 2000. Dr Muthuswamy was a keynote speaker at Indian Journal of Medical Ethics’ National Bioethics Conference held in Mumbai in the last week of November. Excerpts from the interview:

ICMR is a research organisation and have issued guidelines: Ethical guidelines for biomedical research on human subjects, 2000. But ICMR is not a policing authority and have no legal authority to take any action against anybody. Even if the guidelines become law, there has to be someone to implement the law, and this authority may or may not be the ICMR.

But there are laws governing research in India. Under the Drugs and Cosmetics Act all trials in India should follow the ICMR guidelines of 2000. The Medical Council of India (MCI) Act, amended in 2002, states that all research in India carried out by physicians has to follow the ICMR guidelines. So there is indirect power to enforce our guidelines.

The Drugs Controller General is the regulatory authority for clinical trials. Schedule Y of the Drugs and Cosmetics Act applies to trials of new drugs, but permission must be sought from the DCGI for other trials as well, of drugs which have received approval in other countries but have to be marketed in India.

icmr interview with dr muthuswamy

Which agencies have control over different aspects of supervision of a trial?

Every doctor is governed by the MCI Act. Any doctor doing wrong in a trial or in practice can be prosecuted. The hospital can be closed. The MCI Act is very strong, the MCI has the power to take punitive measures. Whether they are using the power or not, we cannot say.

The Drugs Controller has authority over any clinical trial for which DCGI permission has been sought and functions under the Drugs and Cosmetics Act. (Trials of recombinant or biotechnology products come under the Environmental Protection Act and the Department of Biotechnology and the Ministry of Environment have a regulatory role.)

But if someone did a trial without asking the Drugs Controller because it is an approved drug and something goes wrong then the Drug Controller will not come to know.

What do you fear?

The fear is that India is being projected as a global hub for clinical trials. Will the ethics committees of each institution be strong enough? For example, will they understand the implications of post-trial benefits? Now the pharmaceutical industry will have its strategies, like selecting 30 centres with 10 cases each to arrive at the statistically valid sample of 300, but it is invalid per centre. Will the local institutional ethics committee have the power to ask the right questions?

Should such responsibility be left to local institutional committees? They may give in to pressures which the ICMR would have the power to withstand.

That’s the only way of controlling research at the moment. We think that ethics committees have certain powers, you have to empower them to ask questions.

The second concern is that all these new contract research organisations are coming up to get their clinical trials done fast. Now some of them may be good, some may not be that good. Their intentions or ulterior motives may be different. And they get paid for the trials…

DRUG ABUSE IN SCHIZOPHRENIA

The Clinician Alcohol Abuse Scale and Clinician Drug Use Scale are short, reliable, and valid measures that are suitable for use by clinicians. Comorbid substance abuse occurs in up to 50% of people with schizophrenia. However, there is evidence that the use of clozapine reduces suicidality and persistent suicidal ideation in patients with schizophrenia. Evidence for this comes from an innovative randomized controlled study in which increased suicidality was the primary outcome (3-fold overall reduction in risk of suicidal behaviors).

suicide in schizophrenia

Lifetime rate of risk for suicide in schizophrenia, which for many years was considered to be 10%, is actually much lower than previously thought. A computer study suggested a lower lifetime risk of around 4% The lower lifetime risk occurs because many follow-up studies are of relatively short duration and the risk of suicide is higher earlier in the course of the disorder. However, the lower estimate still translates into an overall mean risk of suicide 8.5 times that expected in the general population

A recent systematic review indicates that there are a number of reliable individual risk factors for schizophrenia and suicide as well as attempted suicide.Furthermore, people with schizophrenia do communicate their potential for suicide. A systematic review identified 8 strategies that were promising.

In addition, clinical practice guidelines have identified a number of evidence-based treatments related to reducing suicidality in schizophrenia.

In a Swedish 10-year longitudinal cohort study mortality was double that of the general population rate, with suicide being the leading cause of death

In a study following a Danish cohort of 9156 patients with schizophrenia admitted to the hospital for the first time, there were increasing rates of suicide in 3 successive 5-year cohorts after patients were discharged. There was a particularly high risk in the first year.

The suicide attempts by patients with schizophrenia were, on average, more medically dangerous than attempts made by patients with other diagnoses.

A recent systematic review of risk factors for schizophrenia and suicide identified 7 robust risk factors.

Table 1. Robust Risk Factors for Suicide in Schizophrenia

Risk Factors

Previous depressive disorder

Drug misuse

Previous suicide attempts

Fear of mental disintegration

Agitation or motor restlessness

Recent loss

Poor treatment adherence

Reduced risk was associated with hallucinations. This finding is consistent with a study that found that command auditory hallucinations were not more common in those who had attempted suicide. Overall, suicide was less associated with the core symptoms of psychosis and more with affective symptoms, agitation, and awareness that illness was affecting mental function. In a relatively small sample, those who had both suicide attempts and command hallucinations made more suicide attempts than those who did not. The authors hypothesized that command hallucinations were not an independent risk factor, but they increased the risk in those already predisposed to attempted suicide.

Suicide Prevention Strategies: A Systematic Review

Education and awareness

1. General public

2. Primary care providers

3. Other gatekeepers

Screening for individuals at high risk

Treatment

1. Pharmacotherapy

2. Psychotherapy

3. Continuity of care after suicide attempts

Restricting access to lethal methods

Media reporting guidelines

APA-Recommended Components for the Assessment of the Suicidal Patient

Current presentation of suicidality

A. Mental disorder

B. History

C. Psychosocial situation

D. Individual strengths and vulnerability

Estimation of risk

Treatment plan

The Calgary Depression Scale for Schizophrenia (CDSS) is specifically developed for schizophrenia, has been found to be reliable and valid and can be used to predict future suicidality in the context of a randomized clinical trial. It includes items that rate hopelessness and suicidality, which may have more specific predictive validity for suicidality than the total depression score.

In international survey of clinical experts in schizophrenia care identified 3 key questions that clinicians can use to screen for depression in schizophrenia:

1. Have you been feeling down or depressed?
2. Have you been feeling hopeless?
3. Did you ever think of ending your life?

Clinical practice guidelines suggest that there is evidence to support both antidepressant pharmacotherapy and cognitive therapy for depression in schizophrenia. There is also evidence that second-generation antipsychotics are more effective than first-generation ones in reducing the level of depression in patients with schizophrenia

the group

Sigmund Freud started the movement of Psychoanalysis. Since its inception Freud started being surrounded by collaborators, but there were disagreements at every corner. Many of his ardent supporters later objected to psychoanalytical theories he had established and they even set up their own schools – Alfred Adler (individual psychology) and C.G.Jung (analytical psychology).

Sandor Ferenczi ,Ernest Jones, Otto Rank, Sachs and Karl Abraham, Etington were the other members. The group was dissolved 20 years after its creation.

The Defense Mechanisms

THE DEFENSE MECHANISMS

Whenever anxiety becomes overwhelming, the ego, which has to deal with reality, the id, and the superego to its fullest. has to protect itself. So it tries to block out all impulses or change them into more acceptable forms which are less anxiety provoking. These techniques are called the ego defense mechanisms.

Denial involves blocking external events from awareness. If some situation is just too much to handle, the person just refuses to experience it. Anna Freud also talks of denial in fantasy. Eg: Your’e fuming angry with your friend, but you completely reject the thought or feeling."I'm not angry with him!"

Repression, which Anna Freud also called "motivated forgetting," is just that: not being able to recall a threatening situation, person, or event. That is your unconscious chooses not to remember an event which produces anxiety and threaten the ego.

Asceticism, or the renunciation of needs. An example of this can be seen with the new age disease of anorexia. Preadolescents, when threatened by their emerging sexual desires, unconsciously try to protect themselves by denying all their desires.

Isolation (sometimes called intellectualization) involves stripping the emotion from a difficult memory or threatening impulse. A person may, in a very cavalier manner, acknowledge that they had been abused as a child, or may show a purely intellectual curiosity in their newly discovered sexual orientation. Something that should be a big deal is treated as if it were not. Many times in event of death you are able to continue with social obligations and you crumble with the knowledge of the loss later after the storm ceases. Your mad at your friend, you "think" the feeling but don't really feel it. "I guess I'm angry with him, sort of."

Displacement is the redirection of an impulse onto a substitute target. If the impulse, the desire, is okay with you, but the person you direct that desire towards is too threatening, you can displace to someone or something that can serve as a symbolic substitute. You are angry with your best friend, but you can’t hit him, you go out and kick the dog.

Turning against the self is a very special form of displacement, where the person becomes their own substitute target. It is normally used in reference to hatred, anger, and aggression, rather than more positive impulses, and it is the Freudian explanation for many of our feelings of inferiority, guilt, and depression. The idea that depression is often the result of the anger we refuse to acknowledge is accepted by many people, Freudians and non-Freudians alike.

Projection, which Anna Freud also called displacement outward, is almost the complete opposite of turning against the self. It involves the tendency to see your own unacceptable desires in other people. In other words, the desires are still there, but they're not your desires anymore. I confess that whenever I hear someone going on and on about how aggressive everybody is, or how perverted they all are, I tend to wonder if this person doesn't have an aggressive or sexual streak in themselves that they'd rather not acknowledge. You’re angry this time with you’re teacher, but you project that feeling as "That professor hates me."

Let me give you a couple of examples: A husband, a good and faithful one, finds himself terribly attracted to the charming and flirtatious lady next door. But rather than acknowledge his own, hardly abnormal, lusts, he becomes increasingly jealous of his wife, constantly worried about her faithfulness, and so on. Or a woman finds herself having vaguely sexual feelings about her girlfriends. Instead of acknowledging those feelings as quite normal, she becomes increasingly concerned with the presence of lesbians in her community.

Altruistic surrender is a form of projection that at first glance looks like its opposite: Here, the person attempts to fulfill his or her own needs vicariously, through other people.

A common example of this is the friend (we've all had one) who, while not seeking any relationship himself, is constantly pushing other people into them, and is particularly curious as to "what happened last night" and "how are things going?" The extreme example of altruistic surrender is the person who lives their whole life for and through another.

Reaction formation, which Anna Freud called "believing the opposite," is changing an unacceptable impulse into its opposite. So a child, angry at his or her mother, may become overly concerned with her and rather dramatically shower her with affection. An abused child may run to the abusing parent. Or someone who can't accept a homosexual impulse may claim to despise homosexuals. You don’t like a friend but you turn the feeling into its opposite. "I think he's really great!"

Undoing involves "magical" gestures or rituals that are meant to cancel out unpleasant thoughts or feelings after they've already occurred. Anna Freud mentions, for example, a boy who would recite the alphabet backwards whenever he had a sexual thought, or turn around and spit whenever meeting another boy who shared his passion for masturbation. Generally seen with Obsessive Compulsive Disorders. When your angry maybe a sorry may be your way to defuse the situation or even "I think I'll give that professor an apple."

Introjection, sometimes called identification, involves taking into your own personality characteristics of someone else, because doing so solves some emotional difficulty. For example, a child who is left alone frequently, may in some way try to become "mom" in order to lessen his or her fears. You can sometimes catch them telling their dolls or animals not to be afraid. And we find the older child or teenager imitating his or her favorite star, musician, or sports hero in an effort to establish an identity.

I must add here that identification is very important to Freudian theory as the mechanism by which we develop our superegos.

Identification with the aggressor is a version of introjection that focuses on the adoption, not of general or positive traits, but of negative or feared traits. If you are afraid of someone, you can partially conquer that fear by becoming more like them.

eg: Stockholm Syndrome. After a hostage crisis in Stockholm, psychologists were surprised to find that the hostages were not only not terribly angry at their captors, but often downright sympathetic. A more recent case involved a young woman named Patty Hearst, of the wealthy and influential Hearst family. She was captured by a very small group of self-proclaimed revolutionaries called the Symbionese Liberation Army. She was kept in closets, raped, and otherwise mistreated. Yet she apparently decided to join them, making little propaganda videos for them and even waving a machine gun around during a bank robbery. When she was later tried, psychologists strongly suggested she was a victim, not a criminal. She was nevertheless convicted of bank robbery and sentenced to 7 years in prison

Regression is a movement back in psychological time when one is faced with stress. When we are troubled or frightened, our behaviors often become more childish or primitive. A child may begin to suck their thumb again or wet the bed when they need to spend some time in the hospital. Where do we retreat when faced with stress? To the last time in life when we felt safe and secure, according to Freudian theory. When your angry with your buddy, you revert to an old, usually immature behavior to ventilate your feeling."Let's shoot spitballs at people!"

Rationalization : A better way of making excuses i.e. the cognitive distortion of "the facts" to make an event or an impulse less threatening.. But for many people, with sensitive egos, making excuses comes so easy that they never are truly aware of itA useful way of understanding the defenses is to see them as a combination of denial or repression with various kinds of rationalizations.

And yet Freud saw defenses as necessary. You can hardly expect a person, especially a child, to take the pain and sorrow of life full on! While some of his followers suggested that all of the defenses could be used positively, Freud himself suggested that there was one positive defense, which he called sublimation.

eg This time your’e angry, you come up with various explanations to justify the situation (while denying your feelings) "He's so critical because he's trying to help us do our best."

Sublimation is the transforming of an unacceptable impulse into a socially acceptable, even productive form. In case of the situation where youre angry with your friend, you redirect the feeling into a socially productive activity. "I'm going to write a poem about anger."

Anna O, alias Bertha Pappenheim, Germany's first social worker

THE FAMOUS CASE OF ANNA O:

Anna O,21 yrs old, was Joseph Breuer's patient from 1880 through 1882., Anna spent most of her time nursing her ailing father. She developed a bad cough, then she developed some speech difficulties, then became mute, and then began speaking only in English, rather than her usual German. All these difficulties seemed to have no physical basis.

After the death of her father she started to refuse food, and developed an unusual set of problems. She lost the feeling in her hands and feet, developed some paralysis, began to have involuntary spasms, visual hallucinations and tunnel vision. Specialists could find no physical causes for these problems.

If all this weren't enough, she had fairy-tale fantasies, dramatic mood swings, and made several suicide attempts. Breuer's diagnosis was that she was suffering from what was then called hysteria (now called conversion disorder), which meant she had symptoms that appeared to be physical, but were not.

In the evenings, Anna would sink into states of what Breuer called "spontaneous hypnosis,"she could explain her day-time fantasies and other experiences, and she felt better afterwards. Anna called these episodes "chimney sweeping" and "the talking cure." Here some emotional event was recalled that gave meaning to some particular symptom. The first example came soon after she had refused to drink for a while: She recalled seeing a woman drink from a glass that a dog had just drunk from. While recalling this, she experienced strong feelings of disgust...and then had a drink of water! In other words, her symptom -- an avoidance of water -- disappeared as soon as she remembered its root event, and experienced the strong emotion that would be appropriate to that event. BREUER CALLED THIS CATHARSIS, from the Greek word for cleansing. or what Anna herself called "clouds." Breuer found that, during these trance-like states,

Breuer and Freud, 11 years later, wrote a book on hysteria. In it they explained their theory: Every hysteria is the result of a traumatic experience, one that cannot be integrated into the person's understanding of the world. The emotions appropriate to the trauma are not expressed in any direct fashion, but do not simply evaporate: They express themselves in behaviors that in a weak, vague way offer a response to the trauma. These symptoms are, in other words, meaningful. When the client can be made aware of the meanings of his or her symptoms (through hypnosis, for example) then the unexpressed emotions are released and so no longer need to express themselves as symptoms.

In this way, Anna got rid of symptom after symptom. But it must be noted that she needed Breuer to do this: Whenever she was in one of her hypnotic states, she had to feel his hands to make sure it was him before talking! And sadly, new problems continued to arise.

According to Freud, Breuer recognized that she had fallen in love with him, and that he was falling in love with her. Plus, she was telling everyone she was pregnant with his child. You might say she wanted it so badly that her mind told her body it was true, and she developed an hysterical pregnancy. Breuer, a married man in a Victorian era, abruptly ended their sessions together, and lost all interest in hysteria.

It was Freud who would later add what Breuer did not acknowledge publicly -- that secret sexual desires lay at the bottom of all these hysterical neuroses.

TO FINISH HER STORY, ANNA SPENT TIME IN A SANATORIUM. LATER, SHE BECAME A WELL-RESPECTED AND ACTIVE FIGURE -- THE FIRST SOCIAL WORKER IN GERMANY -- UNDER HER TRUE NAME, BERTHA PAPPENHEIM. She died in 1936. She will be remembered, not only for her own accomplishments, but as the inspiration for the most influential personality theory we have ever had.