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  Mens Sana Monographs
A Monograph Series Devoted To The Understanding Of Medicine, Mental Health, Man, Mind, Music And Their Matrix
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   2012| January-December  | Volume 10 | Issue 1  
    Online since April 28, 2012

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Stigma of Mental Illness-1: Clinical reflections
Amresh Shrivastava, Megan Johnston, Yves Bureau
January-December 2012, 10(1):70-84
DOI:10.4103/0973-1229.90181  PMID:22654383
Although the quality and effectiveness of mental health treatments and services have improved greatly over the past 50 years, therapeutic revolutions in psychiatry have not yet been able to reduce stigma. Stigma is a risk factor leading to negative mental health outcomes. It is responsible for treatment seeking delays and reduces the likelihood that a mentally ill patient will receive adequate care. It is evident that delay due to stigma can have devastating consequences. This review will discuss the causes and consequences of stigma related to mental illness.
  9 9,429 134
Treatment-resistant schizophrenia: Evidence-based strategies
Susanne Englisch, Mathias Zink
January-December 2012, 10(1):20-32
DOI:10.4103/0973-1229.91588  PMID:22654380
Treatment-resistant symptoms complicate the clinical course of schizophrenia, and a large proportion of patients do not reach functional recovery. In consequence, polypharmacy is frequently used in treatment-refractory cases, addressing psychotic positive, negative and cognitive symptoms, treatment-emergent side effects caused by antipsychotics and comorbid depressive or obsessive-compulsive symptoms. To a large extent, such strategies are not covered by pharmacological guidelines which strongly suggest antipsychotic monotherapy. Add-on strategies comprise combinations of several antipsychotic agents and augmentations with mood stabilizers; moreover, antidepressants and experimental substances are applied. Based on the accumulated evidence of clinical trials and meta-analyses, combinations of clozapine with certain second-generation antipsychotic agents and the augmentation of antipsychotics with antidepressants seem recommendable, while the augmentation with mood stabilizers cannot be considered superior to placebo. Forthcoming investigations will have to focus on innovative pharmacological agents, the clinical spectrum of cognitive deficits and the implementation of cognitive behavioral therapy.
  6 10,015 274
The Foetal 'Mind' as a Reflection of its Inner Self: Evidence from Colour Doppler Ultrasound of Foetal MCA
Sushil Ghanshyam Kachewar, Siddappa Gurubalappa Gandage
January-December 2012, 10(1):98-108
DOI:10.4103/0973-1229.85495  PMID:22654385
The unborn healthy foetus is looked upon as a blessing by one and all. A plethora of thoughts arise in the brains of expectant parents. But what goes on in the brain of the yet unborn still remains a mystery. 'Foetal mind' is a reflection of functions of its organs of sense, an instrument of knowledge that may even be reduced to machine to demonstrate the effect of sense organs and brain contact. Testimony to this fact are the various waveform patterns obtained non-invasively from the foetal Middle Cerebral Artery (MCA) by using Colour Doppler Ultrasound. Our study, conducted for evaluating the foetal MCA in a rural obstetric population in Maharashtra, India, explains how the MCA - a major artery supplying foetal brain, can give abundant information about foetal heart and foetal stress. When only the foetal heart is stressed by the presence of arrhythmias or ectopic beats, these changes are manifest in the foetal MCA velocity waveform pattern as seen on Colour Doppler study. When the entire foetus is under stress, as in cases of intra uterine growth retardation (IUGR), changes again manifest in the foetal MCA velocity waveform pattern and are designated as the foetal Brain Sparing Effect. Thus scientific evaluation of foetal MCA waveform can objectively demonstrate that the overtly non-communicating foetal brain indeed remains an internal organ of sense and a vital instrument of knowledge to clarify the various effects of sense organs and brain contact. Although the brain parenchyma or cerebral metabolism has not been studied here, cerebral vessels serve as a window to cerebral metabolism, as auto regulatory function of brain leads to changes in haemodynamics of cerebral vessels. Also, like other vessels, MCA mirrors foetal distress and IUGR; but unlike other vessels, e.g. the umbilical or uterine artery, which show these changes in the form of reduction or even reversal of diastolic flow, MCA shows an increase in diastolic component due to brain sparing effect. The unique connection between physical changes in the foetal heart, brain and mental operations are thus critically clarified to some extent, and this helps untangle and comprehend the lattice of mental operations. Although this preliminary study has its limitations, it still carries forward the present corpus of knowledge on the strength of its evidential and critical enquiry and helps unravel the concept of foetal consciousness.
  4 7,007 466
Psychopharmacology of schizophrenia: The future looks bleak
Chittaranjan Andrade, Rajiv Radhakrishnan, Praveen P Fernandes
January-December 2012, 10(1):4-12
DOI:10.4103/0973-1229.91293  PMID:22654378
Introduction: More than half a century after the introduction of effective pharmacotherapy for the illness, in most patients schizophrenia remains a chronic, relapsing condition with poor long-term outcomes. Methods: We examine the pharmacological treatment of schizophrenia from different perspectives to understand why there have not been significant advances, and to consider what the future might hold in store. Results: We argue that the treatment of schizophrenia addresses the phenotype and not the cause; that the causes may not be treatable even if identifiable; that secondary prevention approaches involving treating the phenotype before full-fledged illness develops have, so far, not yielded promising results; and that shifting the focus of treatment from dopamine to other neurotransmitter systems is merely a tertiary prevention approach which will not reverse the extensive structural and functional pathology of schizophrenia. Conclusions: We believe that, given the current state of our knowledge of the illness, the future of the pharmacotherapy of schizophrenia looks bleak.
  3 6,994 164
The future of schizophrenia pharmacotherapeutics: Not so bleak
William T Carpenter
January-December 2012, 10(1):13-19
DOI:10.4103/0973-1229.91298  PMID:22654379
Chlorpromazine efficacy in schizophrenia was observed 60 years ago. Advances in pharmacotherapy of this disorder have been modest with effectiveness still limited to the psychosis psychopathology and mechanism still dependent on dopamine antagonism. While a look backward may generate pessimism, future discovery may be far more robust. The near future will see significant changes in paradigms applied in discovery. Rather than viewing schizophrenia as a disease entity represented by psychosis, the construct will be deconstructed into component psychopathology domains. Each domain will represent a clinical target for aetiologic and therapeutic discovery. Research on pathophysiology will shift to the neural circuit level in relation to specific behavioural constructs. Progress at the molecular, genetic, cellular and network levels will be more robust. The behavioural paradigm will map on to the deconstructed clinical paradigm and in the process discovery will cut across current classification boundaries.
  2 4,275 124
On being the Editor of the Medical Journal of Australia: Living dangerously
Martin B Van Der Weyden
January-December 2012, 10(1):150-157
DOI:10.4103/0973-1229.91295  PMID:22654390
Editorial independence is crucial for the viability of a journal and editors have many masters - the public, the readers, the authors and the owners. Negotiating the resultant minefield requires a purposeful and independent stance. This is particularly so in instances of a relatively modern phenomenon: concerted attempts by clinical groups to influence, or even abort, publication of articles, which may threaten their practice. Moreover, modern social media facilitates this manipulation.
  2 3,617 49
Drug therapy of attention deficit hyperactivity disorder: Current trends
Avinash De Sousa, Gurvinder Kalra
January-December 2012, 10(1):45-69
DOI:10.4103/0973-1229.87261  PMID:22654382
Attention deficit hyperactivity disorder is a developmental disorder with an age onset prior to 7 years. Children with ADHD have significantly lower ability to focus and sustain attention and also score higher on impulsivity and hyperactivity. Stimulants, such as methylphenidate, have remained the mainstay of ADHD treatment for decades with evidence supporting their use. However, recent years have seen emergence of newer drugs and drug delivery systems, like osmotic release oral systems and transdermal patches, to mention a few. The use of nonstimulant drugs like atomoxetine and various other drugs, such as a-agonists, and a few antidepressants, being used in an off-label manner, have added to the pharmacotherapy of ADHD. This review discusses current trends in drug therapy of ADHD and highlights the promise pharmacogenomics may hold in the future.
  2 7,942 177
Medicalization: Current concept and future directions in a Bionic Society
Antonio Maturo
January-December 2012, 10(1):122-133
DOI:10.4103/0973-1229.91587  PMID:22654387
The article illustrates the main features of the concept of medicalization, starting from its theoretical roots. Although it is the process of extending the medical gaze on human conditions, it appears that medicalization cannot be strictly connected to medical imperialism anymore. Other "engines" of medicalization are influential: consumers, biotechnology and managed care. The growth of research and theoretical reflections on medicalization has led to the proposal of other parallel concepts like pharmaceuticalization, genetization and biomedicalization. These new theoretical tools could be useful in the analysis of human enhancement. Human enhancement can be considered as the use of biomedical technology to improve performance on a human being who is not in need of a cure: a practice that is increasingly spreading in what might be defined as a "bionic society".
  2 9,872 91
Criminals in the citadel and deceit all along the watchtower: Irresponsibility, fraud, and complicity in the search for scientific truth
Prathap Tharyan
January-December 2012, 10(1):158-180
DOI:10.4103/0973-1229.91426  PMID:22654391
Scientific research aims to use reliable methods to produce generalizable new knowledge in order to understand the human condition and maximize human potential. The sanctity accorded to scientific research has been violated by numerous instances of research fraud, as well as deceptive and conflicted research that have seriously harmed people, subverted the evidence-base, wasted valuable resources, and undermined public trust. This deception by individuals has been fostered by the unrealistic expectations of society; facilitated by the complicity of institutions and organisations; and sanctioned by the inaction of supposed gate-keepers. Re-defining misconduct as occurring on a continuum from irresponsible to fraudulent is the first step in confronting this inconvenient truth. Implementing and evaluating multiple strategies targeting systems and individuals that promote the responsible conduct of research, rather than merely exposing serious instances of misconduct by individuals, is urgently required to restore faith in the aspirations, integrity, and results of scientific research.
  1 4,216 80
Stigma of Mental Illness-2: Non-compliance and Intervention
Amresh Shrivastava, Megan Johnston, Yves Bureau
January-December 2012, 10(1):85-97
DOI:10.4103/0973-1229.90276  PMID:22654384
The consequences of stigma are preventable. We argue that individual attention should be provided to patients when dealing with stigma. Also, in order to deal with the impact of stigma on an individual basis, it needs to be assessed during routine clinical examinations, quantified and followed up to observe whether or not treatment can reduce its impact. A patient-centric anti-stigma programme that delivers the above is urgently needed. To this end, this review explores the experiences, treatment barriers and consequences due to stigma. We also offer putative solutions to this problem.
  1 5,840 105
Proposal about scientific names giving**
Ajai R Singh
January-December 2012, 10(1):181-183
DOI:10.4103/0973-1229.92395  PMID:22654392
  - 2,192 55
Referencing modification in Mens Sana Monographs from 2012
Ajai R Singh
January-December 2012, 10(1):184-188
DOI:10.4103/0973-1229.95426  PMID:22654393
  - 2,292 54
Mind and Consciousness as per J. Krishnamurti
Avinash De Sousa
January-December 2012, 10(1):198-207
The present article looks at mind and consciousness from the perspective of the eminent Indian philosopher, Jiddu Krishnamurti. He believed in total awareness as being essential for a free mind. Human beings always learned from their past, and it was important that they looked inwards and freed themselves from self-perpetuated torment. It was also necessary that they avoided repression. The society in which we live should be organic, where, although individuals had no choice but to dwell in that society, it was one where the interests of the individual and society were the same. He also maintained that religion was always the result of past conditioning. A mind should be investigative and scientific. One could not get pleasure without difficulty, for which living in totality, not in segments, was a must. We often dwell on one part of the consciousness and miss its holistic aspect. One must uncover the mind layer by layer to achieve complete growth. Deeper delving into it and a study of J. Krishnamurti's philosophy is a must for the understanding of human consciousness, in a manner that is simple, yet abstract and deep.
  - 4,666 49
Ajai R Singh
January-December 2012, 10(1):194-194
DOI:10.4103/0973-1229.95427  PMID:22654395
  - 2,091 52
And Bombay* became a Village**

January-December 2012, 10(1):195-196
  - 1,630 44
Happy New Year!
Ajai R Singh
January-December 2012, 10(1):197-197
  - 1,779 52
A Slice of a Postgraduate Medical Resident's Life
Dilip Gude
January-December 2012, 10(1):189-193
DOI:10.4103/0973-1229.87288  PMID:22654394
  - 4,796 66
Preface, MSM 2012

January-December 2012, 10(1):1-3
  - 2,158 61
Science of the Mind*
C Shamasundar
January-December 2012, 10(1):109-121
DOI:10.4103/0973-1229.86137  PMID:22654386
The popular concept and practice of science as an exclusively objective exercise ignores the study of rich and unavoidable subjective phenomena relating to mind. This article proposes that as a process of generating knowledge from perceptual experiences, science-skill is innate to man, which demands precision and effective management of bias, and relies on faith for communication. It manifests in man along two dimensions, one of precision and the other of need and interest. Two more dimensions influence its practice and communicability. This dimensionality accommodates scientific study of diverse human experiences, including religion and spirituality. Evolution of scientific study of mind requires complementing the existing objective techniques with development of techniques for investigating subjective and intuitive experiences. It would also benefit by borrowing concepts and methodologies from ancient Indian philosophies and spiritual practices. Swami Vivekananda's observations are presented in this connection.
  - 3,486 102
Suicide and antidepressants: What current evidence indicates
Anil Nischal, Adarsh Tripathi, Anuradha Nischal, JK Trivedi
January-December 2012, 10(1):33-44
DOI:10.4103/0973-1229.87287  PMID:22654381
The documented efficacy and long-term benefit of antidepressants in patients with recurrent forms of severe anxiety or depressive disorders support their use in those individuals with these disorders, who experience suicidal thoughts or behavior. In general, it is assumed that antidepressants are beneficial for all symptoms of depression, including suicidality. However, some evidence suggests that Selective Serotonin Reuptake Inhibitors [SSRIs] may cause worsening of suicidal ideas in vulnerable patients. Systematic reviews and pooled analysis of experimental, observational, and epidemiological studies have investigated the use of SSRIs and their association with suicidality. Taking account of the methodological limitations of these studies, the current evidence fails to provide a clear relationship between their use and risk of suicidality in adults. However, in children and adolescents, there appears to be a bit of increased risk of suicidal ideations and attempts, but not of completed suicides. This risk can be anticipated and managed clinically. Clinicians are, therefore, advised to maintain a close follow-up during the initial treatment periods and remain vigilant of this risk. This advisory, however, should not deter clinicians from the use of effective dosages of antidepressants for a sufficient period of time, in every age group of patients, when clinically needed, and if found suitable otherwise.
  - 4,963 110
Democracy, human rights and women's health
Jalil Safaei
January-December 2012, 10(1):134-142
DOI:10.4103/0973-1229.91303  PMID:22654388
Significant improvements in human rights and democracy have been made since the adoption of the Universal Declaration of Human Rights by the United Nations in 1948. Yet, human rights, especially women's rights, are still being violated in many parts of the developing world. The adverse effects of such violations on women's and children's health are well known, but they are rarely measured. This study uses cross-national data from over 145 countries to estimate the impact of democracy and respect for human rights on various measures of women's health while controlling for confounding socio-economic factors such as income, education, fertility and healthcare. It finds that democracy and regards for human rights contribute positively to women's health outcomes, as do socio-economic variables.
  - 3,350 87
Of money and trust in medical care redux
Joel Lexchin
January-December 2012, 10(1):143-149
DOI:10.4103/0973-1229.91294  PMID:22654389
Should we be concerned about financial conflicts of interest (COI) between doctors and the pharmaceutical industry? Some people will say no as there are clearly doctors who celebrate the relationship. Others say that it does not matter to patients, but the evidence says otherwise. Financial COI is different from other types of conflicts because it is voluntary and can be refused. Finally, it is not just the large gifts that are a problem, the small ones also create a "gift relationship." Drug companies know about this and spend billions on promotion with good effect from their point of view. Companies also woo doctors who honestly hold pro-industry points of view to speak on behalf of the companies. There are still multiple examples of financial COI, and although there are isolated examples of improvement, this is still an area of deep concern.
  - 2,824 61
Revised Template for MSM Submissions 2012
Ajai R Singh
January-December 2012, 10(1):208-213
  - 5,095 48
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