Adopting the UNESCO Ethics Model to Critique Disease Mongering

The question this dissertation seeks to address is if the process of disease mongering can be ethically assessed. Chapter one provides a broad scope of the ethical challenge of disease mongering, UNESCO model framework, ADHD and PMDD. Chapter two examines disease mongering and its driving forces in detail. Chapter three provides an overview of the UNESCO model framework. Chapter four ethically examines disease mongering in conjunction with Attention Deficit Hyperactivity Disorder (ADHD). Chapter five examines disease mongering in association with Premenstrual Dysphoric Disorder (PMDD). Chapter six concludes that examined through the UNESCO model ethical framework disease mongering is occurring for both ADHD and PMDD, and provides remarks for the addressing this in the future

Genetics of premenstrual syndrome: investigation of specific serotonin receptor polymorphisms

Premenstrual dysphoric disorder (PMDD) is a distressing and disabling syndrome causing a significant degree of impairment on daily functioning and interpersonal relationships in 3-8% of the women. With the convincing evidence that PMS is inheritable and that serotonin is important in the pathogenesis of PMS, and failure of initial studies to demonstrate significant associations between key genes controlling the synthesis, reuptake and catabolism of serotonin and PMDD, the main aim of this thesis was to target the functional polymorphisms of serotonin receptors

A Family Systems Approach to Addressing Depression in Children

Children of all ages and around the globe can experience depressive symptoms. However, certain symptoms of depression can be expressed in distinct ways from depression in adulthood. While many individualistic approaches are utilized to treat depression in childhood, family systems modalities can be utilized with effectiveness since family factors can contribute to depressive symptoms (Ghandour et al., 2019). Family systems theories often examine and address the interactions between family members and the context in which the interactions occur. Specifically, structural family therapy has been demonstrated to be effective in reducing childhood depression symptomology (Jiménez et al., 2019). Structural family therapy focuses on boundaries, hierarchies, and subsystems within a cultural context. The purpose of this literature review is to propose that structural family therapy is appropriate for addressing depression in childhood. Additional discussion includes structural family therapy being appropriate for various cultures around the globe. Major depressive disorder is a common mental disorder affecting children of all ages (James et al., 2018) and becomes higher in prevalence for children who have entered puberty (Costello et al., 2006). Mental health problems in childhood, such as depression, have been shown to have a more negative effect (e.g., a reduction in work resulting in a lower SES outcome) in the person’sadult life when compared to the effect of physical health issues (Delaney & Smith, 2012). Furthermore, depressive disorders were found to be one of the leading causes for disability in 2017 (James et al., 2018). Individuals who experienced depressive symptoms at an early onset typically had poorer quality of life, more depressive episodes, greater medical psychiatric comorbidity, more suicide attempts, and more significant symptoms severity than those with later ages of onset of major depressive disorder (Zisook et al., 2007). Given the research demonstrating the negative effect that early onset of depression has on an individual, it is imperative to consider interventions. Family systems therapy has been demonstrated to be an effective approach for addressing depression in childhood (Jiménez et al., 2019; Tompson et al., 2017; Trowell et al., 2007). Due to the reliance of children on their caregivers, it is prudent to involve the family in addressing mental health concerns (Steinberg, 2001). While many approaches operate from an individualist approach (see Bernaras et al., 2019), consideration of the family is significant since children with a primary caregiver who rated their own mental health as fair or poor in mental or emotional health had an increased rate of depression at 13% (Ghandour et al., 2019). The purpose of thisliterature review is to propose structural family therapy as an effective modality for treating children with depressive symptoms

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142934/1/bdi12609.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142934/2/bdi12609_am.pd

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder.

The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third- line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment-emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second- line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence-based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first-line treatments for acute mania. First-line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first-line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third- line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment-emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second- line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence-based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first-line treatments for acute mania. First-line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first-line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe

A study of childhood attention deficit hyperactivity disorder symptoms in adult bipolar affective disorder patients and their outcome

INTRODUCTION: BPAD is responsible for the loss of more DALYs (Disability – Adjusted Life years) than all forms of cancer or major neurologic disorders due to its onset early in life and chronicity throughout the life. Various studies performed to assess the association of adult Attention Deficit Hyperactivity Disorder with BPAD. In a study done by Tamam et al., they found at the rate of 27% BPAD had been in associated with adulthood Attention Deficit Hyperactivity Disorder in 16%. Sitholey et al. in India conducted a study in 2009 and found that 8% had BPAD in a sample of Adult Attention Deficit Hyperactivity Disorder subjects. There are only very few studies on childhood Attention Deficit Hyperactivity Disorder symptoms and bipolar disorder. Sach et al. did a study and found that bipolar patients with Attention Deficit Hyperactivity Disorder history had onset of disease earlier than those without Attention Deficit Hyperactivity Disorder. AIM OF THE STUDY: To assess the childhood attention deficit hyperactivity disorder symptoms in the adult bipolar patients and their outcome. OBJECTIVES: 1. To study the relationship between clinical characteristics of bipolar affective disorder with childhood externalizing factors. 2. To study the correlation between bipolar affective disorders severity & attention deficit hyperactivity disorder symptoms. 3. To assess the symptoms severity of the bipolar affective disorder patients & quality of life in with (or) without ADHD symptoms. DESIGN: Case control study. SETTING: This study conducted at the Institute of Mental Health, Chennai. STUDY POPULATION: A total of 150 sample size with 120 BPAD patients under remission and age, sex, socio economic status matched 30 healthy controls was collected. SCALES USED: MINI-Plus structured clinical interview, Semi- structured questionnaire for sociodemographic profile, VADPRS parent informant scale, Semi –structured questionnaire for aggression, psychotic episodes, suicidal attempts and WHO – BREF quality of life RESULTS: The mean age of presentation was 31.59years with standard deviation of 7.570years. The mean age of onset of illness was 22.88years with standard deviation of 6.102years. The mean number of episodes was 4.08 with standard deviation 2.544. The average numbers of manic and depressive episodes were 3.50 and 0.49. 16 out of 120 sample of BPAD patients had ADHD in their childhood. This accounts for 13.3%. The physical, psychological, social and environmental health was 56.83, 53.53, 37.47 and 47.98 respectively. CONCLUSION: The prevalence of diagnosable ADHD during the childhood period of patients with bipolar affective disorder was found to be 13.3% in our study. The prevalence of ADHD features but not fulfilling the criteria was found to be 35.83%. This prevalence of ADHD was significantly higher among cases than controls. When compared BPAD subjects with and without ADHD has statistically significant increased frequency of episodes and more number of manic episodes. Quality of life was found to be lower among BPAD subjects. On comparing quality of life with and without ADHD by WHO-QOL BREF scale, we found that there was statistically significant reduction in environmental domain rather than physical, psychological and social domains

Social workers' knowledge of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD): implications for assessment practices with mothers

Some women experience premenstrual syndrome (PMS), and its more severe presentation as premenstrual dysphoric disorder (PMDD), which seriously limits their coping ability in daily life, including their parenting ability. Social workers routinely assess parenting ability, giving rise to the question, “How does the premenstrual knowledge of social workers influence whether and what they ask in their assessment practices with mothers?” The heavily debated premenstrual literature rests on four approaches. After these perspectives, an enhanced biopsychosocial framework (BPS-E) is used to examine the premenstrual knowledge of social workers and their conversations about PMS/PMDD as they assess women’s parenting. This exploratory study used a triangulated convergence design, generating data from both quantitative and qualitative methodologies. In the first phase, 521 social workers completed a Premenstrual Experience Knowledge Questionnaire (PEKQ) created for this research. In the qualitative phase, inspired by an interpretative phenomenological approach, 16 social workers described in interviews their premenstrual knowledge and its impact, if any, on their assessment practices with mothers. Most social workers had limited knowledge of PMS/PMDD, most crucially a) the PMDD DSM-V classification, b) increased suicide attempts during the premenstruum, and c) the effectiveness of SSRI anti-depressants in moderating the symptoms of PMDD. Also, the greater the interference of social workers’ own premenstrual symptoms on their daily living and the more premenstrual training they had received, the higher their premenstrual knowledge scores. Very few social workers in this study (5.1%) addressed premenstrual symptoms with their female clients. However, a statistically significant relationship existed in this sample between asking female clients about PMS/PMDD and social workers’ (a) age, (b) premenstrual knowledge scores, (c) premenstrual training, and (d) the degree to which the premenstrual symptoms of female social workers interfered in their own daily living. These results can direct social work education and practice. Not asking about PMS/PMDD symptoms could have negative outcomes, particularly in child protection, where the safety needs of children could remain unaddressed. Conversely, women who tell uninformed or disapproving social workers about their premenstrual symptoms might be further subjected to mother-blame, stigmatization, or punitive interventions