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Line 374: − • Presence of disturbances in thinking & behavior, interfering with meaningful communication+ − • Need for information from significant others (informers)+ − • More important to obtain information regarding personal history & premorbid personality+ − • More need for astute observation of the patient+ − • Difficulty in establishing rapport may be encountered often + − • The patient may lack illness & have poor judgment+ − • More important to elicit information regarding stressors.+ − Mental status examination: + + + + + + + + + + − 1. General appearance & behavior − • General appearance − • Attitude towards examiner − • Comprehension − • Gait & Posture − • Motor Activity − • Social Manner − • Rapport − 2. Speech − • Rate & Quantity − • Volume & Tone − • Flow & Rhythm − 3. Mood & Affect − • Mood is internal feeling & affect is outward emotional display. − 4. Thought − • Stream & Form − • Content − 5. Perception − 6. Cognition (Higher Mental Functions) − • Consciousness − • Orientation − • Attention − • Concentration − • Memory − • Intelligence − • Abstract thinking − + − + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + − Inference of mental status (Manasa bhava pariksha): − The mental status can be examined and inferred by an assessment of mental factors. (Ch. Vi. 4/8) The 22 mental factors are divided into two groups like positive & negative emotions. This description is as follow: - − I. Beneficial or positive factors (manasa bhava) − 1) Assessment of functions of mind by concentration and absence of deviation from objects (manasa artheshu avyabhicharanena) − + + + + − + + + + + + + − + + + + − + + + + − + + + + − + + + − + − + + + + + + + + + + + + + + + + + + + + + + + + − Sr.+ − No. Perversion − Impairment of mental factor − Clinical condition − 1) Mano vibhrama (perversion of mind) Thought form & content Schizophrenia, Delusional disorder, O.C.D. − 2) Buddhi vibhrama − (perversion of intellect) Thought form & content, Decisive power, Intelligence Schizophrenia, Delusional disorder, Anxiety, O.C.D., M.R. − 3) Sajna vibhrama − (perversion of attention) Attention, Consciousness, Orientation, − Concentration Extreme psychosis, − Coma, ADHD − 4) Smruti vibhrama − (perversion of memory) Memory, recall, registration Dementia, Alzheimer's Disease − 5) Bhakti vibhrama − (perversion of interest) Desires, Hobbies, Interest, Mood Mood & Affective disorders, Depression − 6) Shila vibhrama − (perversion of character) Thought form & content, Perception Schizophrenia, Delusional disorder, Anxiety Disorder, Stress disorder − 7) Cheshta vibhrama − (perversion of motor movements) Motor activity, Behavior Psychosis, Mania, personality disorder − 8) Aachara vibhrama(perversion of behavior) Behavior, Mood Dementia, Personality Disorder, Mania − Psychological investigations+ − 1) Objective tests − • Objective Personality Test − • Intelligence Test − 2) Neuro psychological tests − • Wechsler Memory Scale − • PGI Memory Scale − 3) Rating scales − • Brief Psychiatry Rating Scale − • Hamilton’s Anxiety Rating Scale − • Hamilton’s Depression Rating Scale − 4) Diagnostic standardized interviews − • PSE (Present State Examination) − • SCAN (Schedules for Clinical Assessment in Neuro-Psychiatry) − General categories of psychiatric illness: − The psychiatric illness is broadly categorized into − • Mood disorders − • Psychotic disorders − • Eating disorders − • Developmental disorders − • Personality disorders − • Others − + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + − + − + − + − + − + − + − + − + − + + + + + + + + + − + − + + + − + − + − + − +
→Diagnosis:
====The psychiatric interview====
====The psychiatric interview====
It differs from a medical interview by many aspects such as:
It differs from a medical interview by many aspects such as:
*Presence of disturbances in thinking & behavior, interfering with meaningful communication
*Need for information from significant others (informers)
*More important to obtain information regarding personal history & premorbid personality
*More need for astute observation of the patient
*Difficulty in establishing rapport may be encountered often
*The patient may lack illness & have poor judgment
*More important to elicit information regarding stressors.
====Mental status examination:====
A comprehensive mental status examination is the key to an accurate diagnosis. The following points should be taken into consideration while examining the mental status.
A comprehensive mental status examination is the key to an accurate diagnosis. The following points should be taken into consideration while examining the mental status.
7. Insight
'''1. General appearance & behavior'''
8. Judgement
*General appearance
*Attitude towards examiner
*Comprehension
*Gait & Posture
*Motor Activity
*Social Manner
*Rapport
'''2. Speech'''
*Rate & Quantity
*Volume & Tone
*Flow & Rhythm
'''3. Mood & Affect'''
*Mood is internal feeling & affect is outward emotional display.
'''4. Thought'''
*Stream & Form
*Content
'''5. Perception'''
'''6. Cognition (Higher Mental Functions)'''
*Consciousness
*Orientation
*Attention
*Concentration
*Memory
*Intelligence
*Abstract thinking
'''7. Insight'''
'''8. Judgement'''
===Inference of mental status (Manasa bhava pariksha):===
The mental status can be examined and inferred by an assessment of mental factors. (Cha. sa. [[Vimana Sthana]] 4/8].
The 22 mental factors are divided into two groups like positive & negative emotions.
This description is as follow:
'''I. Beneficial or positive factors (manasa bhava)
'''
1) Assessment of functions of mind by concentration and absence of deviation from objects (manasa artheshu avyabhicharanena)
2) Assessment of knowledge by indulgence in productive activities (vijnanam – vyavasayena )
2) Assessment of knowledge by indulgence in productive activities (vijnanam – vyavasayena )
3) Assessment of happiness by cheerful state or celebrating occasions (harsha amodena)
3) Assessment of happiness by cheerful state or celebrating occasions (harsha amodena)
4) Assessment of love by content state of mind (priti – toshena)
4) Assessment of love by content state of mind (priti – toshena)
5) Assessment of courage by absence of fear or sorrow (dhairyam-avishadena) 6) Assessment of enthusiasm by initiation of activities (viryam – utthanena)
5) Assessment of courage by absence of fear or sorrow (dhairyam-avishadena) 6) Assessment of enthusiasm by initiation of activities (viryam – utthanena)
7) Assessment of mental stability by absence of distractions or perversions (avasthanam avibhramena)
7) Assessment of mental stability by absence of distractions or perversions (avasthanam avibhramena)
8) Assessment of attitude by interest in activities (shraddha abhiprayena)
8) Assessment of attitude by interest in activities (shraddha abhiprayena)
9) Assessment of grasping power by grasping capacity (medha – grahanena)
9) Assessment of grasping power by grasping capacity (medha – grahanena)
10) Assessment of attention by calling name (samjna – namagrahanena)
10) Assessment of attention by calling name (samjna – namagrahanena)
11) Assessment of memory by recall and remembrance capacity (smriti – smaranena)
11) Assessment of memory by recall and remembrance capacity (smriti – smaranena)
12) Assessment of shyness by withdrawal (hriya – apatrapanena)
12) Assessment of shyness by withdrawal (hriya – apatrapanena)
13) Assessment of character by behavior and conduct (shila–anushilanena)
13) Assessment of character by behavior and conduct (shila–anushilanena)
14) Assessment of restraining power by absence of greed (dhriti – alaulyena)
14) Assessment of restraining power by absence of greed (dhriti – alaulyena)
15) Assessment of obedience by obeying commands (vashyata – videyataya)
15) Assessment of obedience by obeying commands (vashyata – videyataya)
II. Non-beneficial or negative factors (manasa bhava)
'''II. Non-beneficial or negative factors (manasa bhava)'''
1) Assessment of affection by indulgence in activities (rajah–sangena)
1) Assessment of affection by indulgence in activities (rajah–sangena)
2) Assessment of confused state by lack of knowledge (moha – avijnanena)
2) Assessment of confused state by lack of knowledge (moha – avijnanena)
3) Assessment of anger by violent and harmful tendencies to others (krodha – abhidrohena)
3) Assessment of anger by violent and harmful tendencies to others (krodha – abhidrohena)
4) Assessment of grief by crying and sorrowful spells (shoka dainyena)
4) Assessment of grief by crying and sorrowful spells (shoka dainyena)
5) Assessment of fear by depressed mood (bhayam – vishadena)
5) Assessment of fear by depressed mood (bhayam – vishadena)
6) Assessment of hatred by revenging tendency (dvesha – pratishedhena)
6) Assessment of hatred by revenging tendency (dvesha – pratishedhena)
7) Assessment of impact by outcome after doing activity (upadhi – anubandhanena)
7) Assessment of impact by outcome after doing activity (upadhi – anubandhanena)
Diagnosis of perverted mental state:
===Diagnosis of perverted mental state:===
The perverted states of mind (vibhrama) are observed as clinical features of psychosis. [Cha. Sa. Nidana Sthana 7/5] The features are used to assess the severity of disease and prognosis. These indicate impaired mental status. The symptomatology commented by Chakrapani can be observed in various psychiatric conditions as below:
The perverted states of mind (vibhrama) are observed as clinical features of psychosis. [Cha. Sa.[[Nidana Sthana]] 7/5] The features are used to assess the severity of disease and prognosis. These indicate impaired mental status. The symptomatology commented by Chakrapani can be observed in various psychiatric conditions as below:
{ |class="wikitable"
|-
!Sr.No.!!Perversion !!Impairment of mental factor !! Clinical condition
|-
|1)|| Mano vibhrama (perversion of mind)||Thought form & content||Schizophrenia, Delusional disorder, O.C.D.
|-
|2)||Buddhi vibhrama (perversion of intellect)||Thought form & content, Decisive power, Intelligence||Schizophrenia, Delusional disorder, Anxiety, O.C.D., M.R.
|-
|3) || Sajna vibhrama(perversion of attention)||Attention, Consciousness, Orientation,Concentration||Extreme psychosis,Coma, ADHD
|-
|4)||Smruti vibhrama(perversion of memory)|| Memory, recall, registration || Dementia, Alzheimer's Disease
|-
|5)|| Bhakti vibhrama (perversion of interest)||Desires, Hobbies, Interest, Mood||Mood & Affective disorders, Depression
|-
|6)|| Shila vibhrama(perversion of character) ||Thought form & content, Perception || Schizophrenia, Delusional disorder, Anxiety Disorder, Stress disorder
|-
|7)||Cheshta vibhrama(perversion of motor movements)|| Motor activity, Behavior|| Psychosis, Mania, personality disorder
|-
|8)|| Aachara vibhrama(perversion of behavior)|| Behavior, Mood|| Dementia, Personality Disorder, Mania
|}
===Psychological investigations===
'''1) Objective tests'''
*Objective Personality Test
*Intelligence Test
Management of preserving and protecting mental health:
'''2) Neuro psychological tests'''
*Wechsler Memory Scale
*PGI Memory Scale
'''3) Rating scales'''
*Brief Psychiatry Rating Scale
*Hamilton’s Anxiety Rating Scale
*Hamilton’s Depression Rating Scal
'''4) Diagnostic standardized interviews'''
*PSE (Present State Examination)
*SCAN (Schedules for Clinical Assessment in Neuro-Psychiatry)
==General categories of psychiatric illness:==
The psychiatric illness is broadly categorized into
* Mood disorders
* Psychotic disorders
* Eating disorders
* Developmental disorders
* Personality disorders
* Others
==Management of preserving and protecting mental health:==
This depends upon two things:
This depends upon two things:
1. Growth and development of mind as a whole by proper nutrition of body and mind
1. Growth and development of mind as a whole by proper nutrition of body and mind
2. Preservation of harmony of all factors mentioned in journey of life
2. Preservation of harmony of all factors mentioned in journey of life
These objectives can be achieved by following the principles of prevention and management of mental disorders as below: [ Cha.Su.1/58, Vol.I pg.43], [ A.Hr.Su.1/26]
These objectives can be achieved by following the principles of prevention and management of mental disorders as below: [ Cha.Sa.[[Sutra Sthana]]1/58], [A.Hr.Sutra Sthana 1/26]
1. Jnana (spiritual knowledge)
2.Vijnana (scriptural or scientific knowledge)
'''1. Jnana (spiritual knowledge)'''
3.Dhairya (courage or patience)
4.Smriti (memory)
'''2.Vijnana (scriptural or scientific knowledge)'''
5.Samadhi (meditation). These are various measures for controlling and regulating mental mechanisms.
Three types of treatments:
'''3.Dhairya (courage or patience)'''
In a broad-based classification of ayurvedic treatments, three crucial types of therapies are followed:
I. Daivavyapashraya (spiritual therapy):
'''4.Smriti (memory)'''
'''5.Samadhi (meditation).'''
These are various measures for controlling and regulating mental mechanisms.
==Three types of treatments:==
In a broad-based classification of Ayurvedic treatments, three crucial types of therapies are followed:
===I. Daivavyapashraya (spiritual therapy):===
Spiritual therapy comprises nono-pharmacological measures in management of certain conditions. It includes incantation of mantras, aushadhi (talisman) , mani (wearing of gems), bali (auspicious offerings), upahara (gifts), homa (oblations), niyama (observance of scriptural rules), prayaschitta (atonement), upavasa (fasting), svastyayana (chanting of auspicious hymns), obeisance of God, pranipatagamana (pilgrimage) etc.
Spiritual therapy comprises nono-pharmacological measures in management of certain conditions. It includes incantation of mantras, aushadhi (talisman) , mani (wearing of gems), bali (auspicious offerings), upahara (gifts), homa (oblations), niyama (observance of scriptural rules), prayaschitta (atonement), upavasa (fasting), svastyayana (chanting of auspicious hymns), obeisance of God, pranipatagamana (pilgrimage) etc.
II. Yuktivyapashraya (rational therapy): It includes the rationale of medicines, therapies, and diet protocols.
===II. Yuktivyapashraya (rational therapy):===
III. Sattvavajaya therapy: It includes therapies to controlling the mind from harmful objects. [ Cha.Su.11/54]
It includes the rationale of medicines, therapies, and diet protocols.
===III. Sattvavajaya therapy:===
It includes therapies to controlling the mind from harmful objects. [ Cha.Su.11/54]
Following measures are followed to prevent diseases and promote mental health. These can be broadly categorized as materialistic (dravyabhuta) and immaterialistic (adravyabhuta) treatment measures.
Following measures are followed to prevent diseases and promote mental health. These can be broadly categorized as materialistic (dravyabhuta) and immaterialistic (adravyabhuta) treatment measures.
I. Materialistic measures (dravyabhuta chikitsa)
===I. Materialistic measures (dravyabhuta chikitsa)===
1. Proper nutrition for growth and development of mind:
====1. Proper nutrition for growth and development of mind:====
Besides providing nutrition to body, diet has a great impact on mind as well. Many recently published research indicate effect of diet on mental health. Most of the research focus upon the antioxidants, nutraceuticals and their effect on functions of brain. Though, this is important at physical plane, nourishment of soul and mind are equally important with body. The effect of diet in nourishing five sheaths/coverings of body is observed in yogic texts. Any food first nourishes the sheath of nutrition, material, physical covering (annamaya kosha). Then it nourishes the sheath of life and energy covering (pranamaya kosha). After that, sheath or covering of mind (manomaya kosha), intellect (vijnanamaya kosha) and bliss (anandamaya kosha) are nourished in sequence resulting in blissful state of atman i.e. spiritual self. A subtler part of food is nourishing subtlest part of mind. Thereafter from that part, thoughts and emotions are evoked at a superficial level presenting behavior of that person. The purest (prasad) part of food nurtures soul finally. If this does not happen, it leads to psychiatric illness.
Besides providing nutrition to body, diet has a great impact on mind as well. Many recently published research indicate effect of diet on mental health. Most of the research focus upon the antioxidants, nutraceuticals and their effect on functions of brain. Though, this is important at physical plane, nourishment of soul and mind are equally important with body. The effect of diet in nourishing five sheaths/coverings of body is observed in yogic texts. Any food first nourishes the sheath of nutrition, material, physical covering (annamaya kosha). Then it nourishes the sheath of life and energy covering (pranamaya kosha). After that, sheath or covering of mind (manomaya kosha), intellect (vijnanamaya kosha) and bliss (anandamaya kosha) are nourished in sequence resulting in blissful state of atman i.e. spiritual self. A subtler part of food is nourishing subtlest part of mind. Thereafter from that part, thoughts and emotions are evoked at a superficial level presenting behavior of that person. The purest (prasad) part of food nurtures soul finally. If this does not happen, it leads to psychiatric illness.
Diet as etiological factor:
Diet as etiological factor: