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IS07 Mental Health Delivery System: A Cross-cultural Perspective
Oral presentations / Asian Journal of Psychiatry 4S1 (2011) S1–S39
The results of a recent study concerning deaths that occurred with the use of seclusion and restraints will be presented and the implications for the development of guidelines for the use of seclusion and restraints will be discussed. IS05 Schizo-obsessive Disorder: Clinical Characteristics, Neurobiology and Treatment A. Weizman1,2 . 1 Geha Mental Health Center, Tel Aviv University, Tel Aviv, 2 Felsenstein Medical Research Center, Petah Tikva, Israel There is a considerable overlap of schizophrenia and obsessivecompulsive disorder (OCD) in the structural and functional brain abnormalities involved, role of the dopamine/serotonin neurotransmitter systems, and some demographic and clinical characteristics. Although OCD co-occurs in a substantial proportion of schizophrenia patients, a systematic evaluation of the clinical features, neurobiology, genetics and treatment of this population is lacking. Preferential aggregation of OCD spectrum disorders was observed in schizo-obsessive patients compared to schizophrenia patients without OCD, supports the unique clinical association. Whether a schizo-obsessive interface represents co-morbidity or a specific subtype of schizophrenia warrants further investigation. In the absence of evidence-based data, tentative therapeutic approaches in this difficult-to-treat patient subgroup, like combination of atypical antipsychotics and SSRIs, are suggested. Future directions of research in schizophrenia-OCD co-morbidity relevant to clinical practice should include brain-imaging studies, cognitive assessment and pharmacological trials. IS06 Enhancing Plasticity of the Ageing Brain P. Sachdev1,2 . 1 School of Psychiatry, Faculty of Medicine, University of New South Wales, 2 Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia Recent research has shown that the brain is an exceedingly plastic organ, but many of the mechanisms of plasticity are attenuated with age. There is good evidence that neuronal numbers do not decline with age, but there is a reduction in dendritic length, number and efficiency of synapses and neurogenesis. The mechanisms behind this are beginning to be understood. The relationship of brain plasticity with neurodegenerative disorders is complex. Even though brain plasticity delays the onset of symptoms of neurodegenerative disorders, brain degeneration produces a rapid decline in plasticity. Understanding the processes involved in brain plasticity, such as synaptogenesis, neurogenesis and multicellular adaptation as we age, will open up new avenues of intervention to prevent the onset and/or delay the progression of neurodegenerative disorders such as Alzheimer’s and Parkinson’s disease, as well as neurodevelopmental disorders of adulthood such as Schizophrenia. The possibilities include growth factors for synaptogenesis, exploiting endogenous neurogenic factors, the use of embryonic and adult stem cells, and cognitive and physical exercise. The objective is to maintain brain fitness well into old age. IS07 Mental Health Delivery System: A Cross-cultural Perspective E.H. Pi. Psychiatry, University of Southern California, School of Medicine, Los Angeles, CA, USA During the past four decades, great progress in the diagnosis and treatment of mental disorders has been made. The discovery and use of effective psychotropic medications, advancement in neuroscience, establishment of community mental health system and mental health laws, and utilization of psychosocial rehabilitation have significantly impacted the treatment outcome of mental disorders. Currently, many countries are experiencing a variety of rapid changes in the mental health system of care.
S5
Recognizing these changes it is essential for mental health professionals to understand the dynamics of the interrelationship between individual, family, society, culture and values that comes to planning for a mental health system. There is a need to look at ways of developing culturally sensitive mental health delivery systems that are appropriate to the particular culture and society. As the process of “globalization” is swiftly moving forward, constant exchange and circumspect analysis of the information and experience regarding mental health delivery systems between regions/countries can be mutually beneficial particularly in not only how to deliver cost-efficient care without compromising the quality of care but also to avoid reinventing the wheel and falling into the past pitfalls when developing and implementing a mental health delivery system. A cross-cultural aspect on issues pertaining to mental health delivery system will be presented and discussed. IS08 Culture and Psychiatry: An Indian Perspective A. Avasthi. Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India Culture is a set of shared attitudes, values, goals and practices that characterizes an institution or a nation. Despite advances in molecular biology, psychiatry continues to be influenced by cultural norms and beliefs. What is normal for one culture may be abnormal in other. Initially, phenomena occurring infrequently in the Western world were called culture bound syndromes, but further insight into this, led to a branch of psychiatry known as “cultural psychiatry”. Indian culture promotes collectivism and dependency. It encourages individuals to have a wider circle of intimacy which involve his close relatives. Families also play a considerable role in caring for the mentally ill and consider that to be their duty to care for their relatives. Moreover, they place a considerable degree of trust in god and fatalism. The greater role of religion is reflected in the phenomenology of various psychiatric disorders, with predominance in the trance and possession disorders. In depressive disorders also, there is predominance of somatic symptoms. Greater care and affection shown by the family members have probably resulted in better outcome in patients with schizophrenia as shown by cross cultural studies. Treatment seeking is also influenced by religious beliefs. Patients and family members seek help of magico-religious healers in addition to the medical treatment. Therapist is considered to be superior by the patients and they are expected to provide guidance to the patients. Thus, in understanding of psychiatric syndromes it is very important to understand the role, culture is playing. IS10 Development of Psychotherapy Training for Trainee Psychiatrists in Hong Kong R.M.K. Ng. Department of Psychiatry, Kowloon Hospital, Hong Kong, Hong Kong S.A.R. Psychotherapy is a evidence-based psychological intervention for various psychiatric disorders. Training of psychiatrists in Asia has been focusing on pharmacological interventions with relative neglect of psychological intervention. However, with the increased demand from patients for psychological intervention, increasing complexity of needs of patients in psychiatric setting, and limited effectiveness of pharmacological interventions for a variety of psychiatric disorders, there has been rising demand from trainee psychiatrists for training in psychological interventions. With the demand for increasing access to psychological treatments in the community, there is also a pressing need to train other mental health professionals in their competence in delivery of psychological interventions. The speaker will share his experience of developing a territory wide psychotherapy training curriculum in
The results of a recent study concerning deaths that occurred with the use of seclusion and restraints will be presented and the implications for the development of guidelines for the use of seclusion and restraints will be discussed. IS05 Schizo-obsessive Disorder: Clinical Characteristics, Neurobiology and Treatment A. Weizman1,2 . 1 Geha Mental Health Center, Tel Aviv University, Tel Aviv, 2 Felsenstein Medical Research Center, Petah Tikva, Israel There is a considerable overlap of schizophrenia and obsessivecompulsive disorder (OCD) in the structural and functional brain abnormalities involved, role of the dopamine/serotonin neurotransmitter systems, and some demographic and clinical characteristics. Although OCD co-occurs in a substantial proportion of schizophrenia patients, a systematic evaluation of the clinical features, neurobiology, genetics and treatment of this population is lacking. Preferential aggregation of OCD spectrum disorders was observed in schizo-obsessive patients compared to schizophrenia patients without OCD, supports the unique clinical association. Whether a schizo-obsessive interface represents co-morbidity or a specific subtype of schizophrenia warrants further investigation. In the absence of evidence-based data, tentative therapeutic approaches in this difficult-to-treat patient subgroup, like combination of atypical antipsychotics and SSRIs, are suggested. Future directions of research in schizophrenia-OCD co-morbidity relevant to clinical practice should include brain-imaging studies, cognitive assessment and pharmacological trials. IS06 Enhancing Plasticity of the Ageing Brain P. Sachdev1,2 . 1 School of Psychiatry, Faculty of Medicine, University of New South Wales, 2 Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia Recent research has shown that the brain is an exceedingly plastic organ, but many of the mechanisms of plasticity are attenuated with age. There is good evidence that neuronal numbers do not decline with age, but there is a reduction in dendritic length, number and efficiency of synapses and neurogenesis. The mechanisms behind this are beginning to be understood. The relationship of brain plasticity with neurodegenerative disorders is complex. Even though brain plasticity delays the onset of symptoms of neurodegenerative disorders, brain degeneration produces a rapid decline in plasticity. Understanding the processes involved in brain plasticity, such as synaptogenesis, neurogenesis and multicellular adaptation as we age, will open up new avenues of intervention to prevent the onset and/or delay the progression of neurodegenerative disorders such as Alzheimer’s and Parkinson’s disease, as well as neurodevelopmental disorders of adulthood such as Schizophrenia. The possibilities include growth factors for synaptogenesis, exploiting endogenous neurogenic factors, the use of embryonic and adult stem cells, and cognitive and physical exercise. The objective is to maintain brain fitness well into old age. IS07 Mental Health Delivery System: A Cross-cultural Perspective E.H. Pi. Psychiatry, University of Southern California, School of Medicine, Los Angeles, CA, USA During the past four decades, great progress in the diagnosis and treatment of mental disorders has been made. The discovery and use of effective psychotropic medications, advancement in neuroscience, establishment of community mental health system and mental health laws, and utilization of psychosocial rehabilitation have significantly impacted the treatment outcome of mental disorders. Currently, many countries are experiencing a variety of rapid changes in the mental health system of care.
S5
Recognizing these changes it is essential for mental health professionals to understand the dynamics of the interrelationship between individual, family, society, culture and values that comes to planning for a mental health system. There is a need to look at ways of developing culturally sensitive mental health delivery systems that are appropriate to the particular culture and society. As the process of “globalization” is swiftly moving forward, constant exchange and circumspect analysis of the information and experience regarding mental health delivery systems between regions/countries can be mutually beneficial particularly in not only how to deliver cost-efficient care without compromising the quality of care but also to avoid reinventing the wheel and falling into the past pitfalls when developing and implementing a mental health delivery system. A cross-cultural aspect on issues pertaining to mental health delivery system will be presented and discussed. IS08 Culture and Psychiatry: An Indian Perspective A. Avasthi. Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India Culture is a set of shared attitudes, values, goals and practices that characterizes an institution or a nation. Despite advances in molecular biology, psychiatry continues to be influenced by cultural norms and beliefs. What is normal for one culture may be abnormal in other. Initially, phenomena occurring infrequently in the Western world were called culture bound syndromes, but further insight into this, led to a branch of psychiatry known as “cultural psychiatry”. Indian culture promotes collectivism and dependency. It encourages individuals to have a wider circle of intimacy which involve his close relatives. Families also play a considerable role in caring for the mentally ill and consider that to be their duty to care for their relatives. Moreover, they place a considerable degree of trust in god and fatalism. The greater role of religion is reflected in the phenomenology of various psychiatric disorders, with predominance in the trance and possession disorders. In depressive disorders also, there is predominance of somatic symptoms. Greater care and affection shown by the family members have probably resulted in better outcome in patients with schizophrenia as shown by cross cultural studies. Treatment seeking is also influenced by religious beliefs. Patients and family members seek help of magico-religious healers in addition to the medical treatment. Therapist is considered to be superior by the patients and they are expected to provide guidance to the patients. Thus, in understanding of psychiatric syndromes it is very important to understand the role, culture is playing. IS10 Development of Psychotherapy Training for Trainee Psychiatrists in Hong Kong R.M.K. Ng. Department of Psychiatry, Kowloon Hospital, Hong Kong, Hong Kong S.A.R. Psychotherapy is a evidence-based psychological intervention for various psychiatric disorders. Training of psychiatrists in Asia has been focusing on pharmacological interventions with relative neglect of psychological intervention. However, with the increased demand from patients for psychological intervention, increasing complexity of needs of patients in psychiatric setting, and limited effectiveness of pharmacological interventions for a variety of psychiatric disorders, there has been rising demand from trainee psychiatrists for training in psychological interventions. With the demand for increasing access to psychological treatments in the community, there is also a pressing need to train other mental health professionals in their competence in delivery of psychological interventions. The speaker will share his experience of developing a territory wide psychotherapy training curriculum in