A Revisit To Paranormal Beliefs - When Is It A Psychiatric Disorder?

Objective: Beliefs in paranormal phenomena, matters beyond the ability of current science to plausibly justify, are shared by a significant number in the population. It is useful in clinical practice to be able to determine when this may have psychiatric clinical implications. This review article aims to better delineate the group of individuals with such beliefs and experiences, and go on to offer a schema of approaching a patient with paranormal beliefs. Methods: A MEDLINE search of the current literature in this field is conducted. Relevant findings are presented in the review, grouped according to appropriate subheadings. Results: Demographics of believers are reviewed, while certain psychological and physiological traits found to have associations with paranormal beliefs are also highlighted. The functional role of paranormal beliefs and the psychological rationale behind them are considered. Certain psychiatric conditions, which have to be considered when clinically evaluating an individual with paranormal beliefs and experiences, are evaluated with reference to the ICD-10. These individuals also have different attitudes towards treatment options where required for a psychiatric condition. Conclusions: Individuals with paranormal beliefs are a distinct group. Thorough evaluation is required when these individuals are assessed, to pick up a psychiatric diagnosis where present. A schema is offered towards such a cause in a clinical consultation with an individual who has paranormal beliefs. ASEAN Journal of Psychiatry, Vol.12(2): July - Dec 2011: XX XX

Future Role For Motivational Interviewing In The Treatment Of Insomnia - An Opinion

Objective: This paper aims to explore the possibility of using motivational interviewing (MI) as a therapy for insomnia patients. Methods: We reviewed the current practice guidelines for insomnia, and noted the issues pertaining to types of treatment, notably CBT-I. We also reviewed some studies which seem to suggest that MI treats insomnia. Results: MI is a proven technique for other psychiatric illnesses. There are currently not many studies done evaluating the efficacy of MI on insomnia. Of those published studies, they are either underpowered to draw any firm conclusions, or it is limited to a particular age group. Conclusion: There seems to be promise in the area of MI on insomnia. Given the paucity of data in this area, more research with bigger group of study participants are needed to fully conclude the effectiveness of this treatment. ASEAN Journal of Psychiatry, Vol. 15 (1): January – June 2014: 106-112

Genetic and Genomic Aspects of Alzheimer's Disease

Alzheimer's disease (AD) is the most common chronic neurodegenerative disease today, afflicting 35 million people worldwide. Age is the major risk factor. The heritability of AD is estimated to be around 60%. Less than 5% of AD cases are familial with early-onset of disease caused by specific gene mutations. Genetic studies over the past 2 decades have provided invaluable insights into this complex disease. Here we review AD from the latest genome-wide association studies (GWAS), and a brief review of the transcriptomics, proteomics, metabolomics and epigenetics. Ultimately, a system-wide approach is essential to integrating the diverse and complicated findings into a meaningful understanding of AD

Falls in a Psychiatric Unit

Our study in a psychiatric ward of a general hospital aims to identify acutely ill psychiatric patients who are at high risk of falls. Patient falls were identified by data collectors after they were reported by hospital staff into the Fall Reporting Risk Management System (RMS). From 2007 to 2009, there were a total of 26 patients who fell in the psychiatric ward. Falls are likely to occur while the patient is ambulating beside the bed and is unlikely to be elimination-related. Slipping or tripping was the most common fall mechanism. There were no life-threatening injuries sustained and the most common type of injury was pain, swelling, contusions and abrasions. Two main patient profiles were identified to be at risk of falls, the first being elderly patients with mood disorders and co-morbid medical conditions such as diabetes. These patients are usually deemed high risk in the fall assessment. The second group of patients is young females with eating disorders and who are not on psychotropic medications. Both groups are likely to be alert and oriented, with no muscle weakness or a history of previous falls

Making Sense of Kleptomania: Clinical Considerations

An understanding of the historical roots, clinical features and current diagnostic criteria of kleptomania would help in a better appreciation and assessment of this condition. One of the few psychiatric conditions that is defined by an illegal activity, kleptomania has been classified as one of the impulse control disorders under ICD-10 and DSM IV-TR. In terms of assessment, it is not sufficient merely to look at the operational criteria. One should take a complete history and probe for predisposing factors including childhood development and behaviour, previous relationships, losses, and habits. It is also necessary to detect current stressors and concomitant symptoms or disorders that may precipitate and perpetuate the condition. Some of the diagnostic criteria are based on subjective claim or report which may be unreliable. The use or value of the articles stolen is relative but may be easier to assess. As a guide, kleptomania should be a diagnosis by exclusion of other contributing disorders. When other contributing symptoms/disorders such as depression are present, care should be exercised before a diagnosis of kleptomania is made