Biomedical subjects
Publications and source records attributed to P S Sachdev.
Two patients with the acquired immunodeficiency syndrome (AIDS), who had no past psychiatric history, developed a mania-like illness soon after commencing treatment with zidovudine. The neurotoxic effects of zidovudine have been described previously, but to our knowledge no reports of a psychiatric disorder that is related to the drug have appeared. Our report emphasizes the need to monitor patients with AIDS for neuropsychiatric problems.
A patient is described who developed frequent blinking and blepharospasm after long-term treatment with trifluoperazine, whose condition improved dramatically after the cessation of the drug. The implications of this for our understanding of the manifestations and natural course of the late-onset side-effects of neuroleptic drugs are discussed. This case further supports the role of dopaminergic mechanisms in the aetiology of Meige's syndrome, which has blepharospasm and oromandibular dystonia as its main manifestations.
This paper discusses three concepts, mana, tapu and noa, that lie at the heart of Maori culture. These concepts are inter-related and concern power and influence, with political (or secular) authority implicit in mana and ritual (or religious) authority determined by tapu and noa. The paper explores their importance for the understanding of the ethnic views on aetiology and management of illness, the mechanisms of social organization and control, and the behaviour of individuals. Although the belief in these concepts exists in only an attenuated form in modern Maori society, their importance becomes obvious to any psychiatrist or physician working with Maori patients.
This paper examines the dynamics of teh psychotherapeutic relationship between a Maori Elder and Maori psychiatric patients. The functioning of an Elder was examined over a period of 9 months in a psychiatric unit. A content analysis was performed on audiovisual records of 10 interviews conducted by the Elder on five psychiatric patients. The results of this analysis were used to construct a theoretical paradigm of the Elder-Patient Transaction and to contrast it with psychodynamic psychotherapy and pastoral counseling. Distinctive features of relationship, content of the sessions and the issues of dominance and dependence are discussed, and possible mechanisms of change are mentioned.
A middle-aged woman with a recurrent depressive illness showed worsening of her tardive dyskinesia during the depressive phases, with improvement on remission.
This paper compares psychiatric illness in the contemporary Maori with that in the non-Maori New Zealander. The ethnic data available are all from secondary sources. The limitations of this and the problems of achieving a satisfactory definition of "a Maori" are discussed. The data suggest that the Maori have a slightly greater risk of psychiatric hospitalization than the non-Maori. First admission rates for schizophrenia are higher for the Maori, as are the readmission rates. First admission rates for major affective illness are roughly comparable in the two groups, and those for neuroses and neurotic depression are lower in the Maori. Rates of admission for alcohol abuse, alcohol dependence and personality disorders are much higher for the Maori male aged 20-40 years and this group is at greatest risk of psychiatric hospitalization. A larger proportion of Maori are admitted involuntarily, especially under the Criminal Justice Act. The median stay in hospital is not longer for the Maori but their re-admissions are more frequent. The Maori have shown an increase in first psychiatric admission rates since the 1950s, with rapid increases in the early 60s and the 80s. The rates for psychotic disorders have been relatively constant and the most significant changes have been for alcohol abuse, alcohol dependence and personality disorders. The author relates this historical change to socioeconomic and politico-cultural factors, particularly the stress of rapid urbanization.
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Koro is an unusual psychogenic syndrome reported, until recently, predominantly in men of the Chinese race who live in southern China and south-east Asia. Issues concerning its phenomenology, diagnosis and nosology are still controversial. This paper describes an epidemic of koro in north-east India. A psychiatric analysis of thirty-one cases is presented. Probable reasons for the rapid spread of the illness are discussed. The majority of the individuals affected were from the lower socio-economic strata, were poorly educated and in the age group of 20-40 years. Many women were affected. There was no evidence of significant premorbid or sexual psychopathology in most cases. Some patients had a number of episodes but with only minor residual symptoms. The author compares these findings with earlier reports and discusses the implications for its nosology and psychodynamics.
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Dementia is common among patients with cerebrovascular disease, particularly in a setting of one or more clinically evident strokes. Prior cohort and case studies have suggested that the cognitive syndrome of vascular dementia is characterized by predominant executive dysfunction, in contrast to the deficits in memory and language function that are typical of patients with Alzheimer disease. The course of cognitive decline may also differ between those dementia subtypes, with many, but not all, patients with vascular dementia exhibiting a stepwise course of decline caused by recurrent stroke and most patients with Alzheimer disease exhibiting a gradually progressive course of decline. The findings of prior studies of the cognitive syndrome of vascular dementia must be interpreted with caution, however, because of (1) possible inaccuracies in the determination of the dementia subtype and the loss of precision that might result from pooling heterogeneous subgroups of patients with vascular dementia, (2) difficulties inherent in identifying a pattern of strengths and weaknesses in patients who are required to have memory impairment and other deficits to meet operationalized criteria for dementia, and (3) the use of limited test batteries whose psychometric properties are incompletely understood. Specific questions that should be addressed by future studies are discussed.
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Startle reflex responses were studied in 15 normal human subjects using weak (88 dB) and strong (114 dB) auditory stimuli in the orbicularis oculi, masseter, sternocleidomastoid, trapezius, deltoid, biceps, forearm flexors and quadriceps muscles. With the subjects in the relaxed state, no consistent responses were seen with the weak stimuli, and with the strong stimuli responses were only present in orbicularis oculi muscles. When the above muscles were in a state of voluntary contraction, the strong stimuli produced complex responses which were not always excitatory in nature, with muscle relaxation being noted in a number of stimulation sequences. Repetitive weak and strong stimuli were used to study habituation effects in the orbicularis oculi muscles. The repetitive strong stimuli produced a wide range of response patterns, indicating a high inter-individual variability in habituation. In two subjects, no habituation effects were present. Our study supports the high intra-individual variability of the startle response, and suggests that this response is affected by the state of muscle contraction at the time of stimulation. Startle response is more easily elicited in a state of muscular contraction. Future studies of startle reflex should take this into consideration.