Neuropsychiatric Disorders And Cardiometabolic Risks Evidence And Controversies

Neuropsychiatric Disorders And Cardiometabolic Risks: Evidence And Controversies

By

MANDY CHUNG

COURSE: GENERAL ENDOCRINOLOGY AND METABOLISM

A DISSERTATION SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE………………….

DECEMBER 2010

INTRODUCTION

1.1 General background

The prevalence of cardio-metabolic syndrome (CMS) is increasing worldwide with many studies indicating higher prevalence of the syndrome among people of the African origin. According to national cholesterol education program expert panel of UK on detection, evaluation and treatment of mental related disorders, ethnic alienations influence the prevalence of cardio metabolic syndrome. Mendelso notes that the highest prevalence of cardio metabolic syndrome is recorded in Mexico for both genders while African and American women have higher incidences than their men counterparts. Aaron and Brad predicted the value of increased body mass because it can be used to ascertain the development of cardio metabolic risks.

CMS has many symptoms but the most common and adverse characteristics of CMS are physical and biochemical abnormalities which increases the risks of an individual to contact cardiovascular ailments, diabetes mellitus and other related diseases as highlighted by Yudofsky and Hale in 2002. The antipodal distinction between the brain and the mind which identifies them as two separate entities has complicated the identification of the illness that affects the brain and the mind. This mind-brain monism has been adopted as opposed to mind-brain dualism because mentality is believed to be biological which has formed a common research work for the treatment of neuropsychiatric disorders.

1.2 Problem statement

Despite numerous studies that have done to the effort of establishing the association of mental disorders and the risks that accompany them, no concrete conclusion has been reached to clear the controversies that surround the relationship between the causes of mental disorders and the risks involved. This research paper is therefore concerned about finding a conclusion to the said controversies that surround causes and effects of mental disorders with a great reference to depression as an effect of mental disorders.

2.0 LITERATURE REVIEW

There have been differences in the research concerning the prevalence of neuropsychiatric disorders with the biological cause being the main focal point as noted by Berrios and Markova in 2002. Price, Adams and Coyle agree that mental disorders are not only caused by brain constituents and genetics but also factors outside the skin of an individual. This is true because many diseases that affect human beings are caused by internal factors, external or a combination of the two factors. Mental disorders are no exception and with the distinction between the mind and brain the causing factors of the metal disorders are said to veridical.

2.1 MENTAL DISORDERS AND CARDIOMETABOLIC RISKS

Martin notes that the previous researches have shown that cardio metallic metabolism is associated with functions of the mind and neuropsychiatric disorders. Oestrogen has been indicated as a major factor in maturation and functioning of many parts of the brain and other neurochemical systems involved in neuropsychiatric disorders. Oestrogen usually affects the microstructure of brain regions that support the cognitive functions. Kendler in his 2002 article claims that mental disorders are wholly responsible for all risks that lead to development of mental related ailments such as depression. However, Bell, Halligan and Ellis, 2006 contradict this by noting that mental illnesses can be a result of many other reasons especially fatal accidents and drug abuse.

Epidemiological evidence has been documented to the effect of pathophysiology of many neuropsychiatric disorders. Homocysteine acid has been implicated as a risk factor in some of the evident neuropsychiatric disorders discussed below:

Stoke

Ferenczi indicate that Homocysteine is an independent risk factor in most ailments that come with stoke with a summary odd ratio of 2:0 increment in plasma Homocysteine. Thus, there is good epidemiological evidence that suggest that Homocysteine is a significant risk factor for stoke.

Cognitive impairment

The evidence that planted Homocysteine as a significant risk factor for cognitive functioning is still controversial. An initial study in 2001 by Green indicated that Homocysteine contributed to approximately nine per cent difference in mental performance of adults. However a consequent study indicated that there was no association between Homocysteine and cognitive impairment and failure. Another study indicated that there was an association between Homocysteine and cognitive impairement but the former caused no decline to cognitive development.

Depression

The relationship between Homocysteine and depression has not been fully documented. However, the available literature show some evidence that Homocysteine status dictates the rate of depression on an individual and how antidepressants will perform on the individual. Other studies have indicated that Homocysteine may play a crucial role in elevated rates and cardiovascular mortality in depression.

Alcoholism

Brain atrophy that has been reported in many alcoholics may be related to high levels of Homocysteine. Though alcohol is not a source of Homocysteine acid, it reacts with the acid to increase body and blood pressure which may result to mental disorders.

2.2 DEPRESSION

Depression is a felling that occurs to everyone especially when stressed or sad as documented by Kaye in 2005. Kendler notes that depression is a condition that interferes with daily life and normal function of the individual. Depression just like other ailments needs medical attention for the victims to get better although many individuals never get any medication causing the disorder to be recurrent. While many people with depressive related illness do not seek medical advice, there has been a notable extensive research that has resulted to development of therapies and medications to treat people diagnosed with depressive disorders.

2.2.1 Forms of depression

Depression has many forms but the most common and frequent types of depression that are believed to be caused by mental disorders include:

Major depression

This is a combination of main depression symptoms and can fully interfere with the normal function of an individual such as working, sleeping, eating, and learning among other related functionalities. This form of depression may occur once in a life time or recur if an individual is subjected to too much brain work and stress. Koch and Laurent agree that the main cause of major depression is mental disturbance and can lead to severe mental risks.

Dysthymic disorder

Lerner and Whitehouse say that Dysthymic depression is a long term but has lesser severe symptoms that can’t prevent a person from doing the normal bodily functioning but usually causes the individual to be less active. Similarly, this kind of depression is risk result of mental disorders.

Psychotic depression

Psychotic depression is a severe depressive illness accompanied by hallucination and break from the real world and requires immediate attention because it can cause brain malfunctioning. Linden claims that this type of depression is the most dangerous and can lead to complete mental failure.

2.2.2 Symptoms of depression

Depression occurs in co-existence with other illnesses that precede it, cause it or be a consequence of depression. Thus depression has many signs and symptoms that may be stand alone or caused by other related illnesses. Some of these symptoms include:

Prevalence of sad, hopeless and empty feelings

Loss of interest in treasured activities

Decreased body energy resulting to fatigue

Thought of suicide and suicidal attempts

Troubled thinking patterns because depression affects the memory and the way people think about themselves

2.2.3 Causes of depression

Marr, 2003 argues that there is no one established cause of depression but a combination of environmental, genetic and psychological factors are believed to cause or trigger the causes of depression. Mayberg , 1997 noted that many depressive disorders are caused by the disturbance of the brain functions especially on the parts of the brain that control moods, feelings, thinking and normal body functions. Genetically, many depression disorders are believed to run through family lines though it can affect individuals with no history of depression disorders, Price 2000. Robertson states that the genetic link in causing depression disorders down the line is triggered by multiple genes that act together with other factors believed to cause depression such as psychological factors.

2.2.3.1 Depression in women

In 2006, Ross wrote that depression is much prevalence in women than in men because of their psychological, life cycle and biological differences with men. He further indicated that, women usually get depression after birth when hormonal and physical changes coupled with the added responsibility of the newborns. Additionally, women get stress from their places of work, house hold duties, caring for their children, spouses and parents and other factors such as relationship strains, abuse and poverty

2.2.3.2 Depression in men

Both Sabshin and Sachdev agree that depression is less effective to men that it is in women. Many neuropsychiatric specialists have revealed that men have different ways of experiencing depression and similarly have different ways of coping with the disorders. However, just like women, men experience fatigue, loss of interest and motivation among other symptoms of depression. Contrastingly, men turn to alcohol when depressed or become irritable, frustrated, discouraged and some extend very abusive.

2.2.4 Diagnosis and treatment of depression

Saxena, 1998 claims that irrespective of its degree of prevalence, depression is a treatable illness. Just like other disorders, the earlier the disorder is intervened the better to treat it and prevent future occurrence of the same or related disorder. Schiffer et al. state that oonce a victim visits a medical centre for medication; the doctor usually conducts physical examinations, interviews and lab tests. If nothing is diagnosed at this stage, the doctor can conduct a psychological evaluation or refer the individual to a mental health specialist. The specialist usually focus on depression because it the core result of many mental disorders and conducts an interview to establish the family history in relation to depression so as to get the historical symptoms of the depressive disorder. Once a person is diagnosed with depression, medication is prescribed, psychotherapy applied or Electroconvulsive therapy if the first two fails.

2.2.4.1 Medication

Antidepressants have been used to normalize the activities of the brain by cooling the two common neurotransmitters; serotonin and norepinephrine, Shapiro et al 2001. However, antidepressants have been criticized because they have side effects to individuals who continually use them especially causing short term mildness on the body.

2.2.4.2 Psychotherapy

A talk-therapy has been very successfully to counter depressive disorders. Shergill notes that regimens range from 10 to 20 weeks depending on the degree of disorder and the needs of the individual. Cognitive Behavior Therapy (CBT) and Interpersonal Therapy (IPT) have been successfully applied in treating depression. CBT teaches affected individuals new ways of thinking and behavior thus help individuals change from behavior that has been a cause of their depressive states and adopt positive thinking and behavioral methods. IPT is usually tailored towards addressing depression caused by relation conflicts and it advocates for understanding and working through troubled relationships

2.2.4.3. Electroconvulsive therapy

As Uher and Treasure write in their 2005 article, Electroconvulsive therapy is an intervention for depression that is only applied where both medication and psychotherapy have failed. This is a more physical treatment and patients are put under anesthesia for their body to relax. However, this method has some known side effects such as confusion and memory loss.

3.0 METHODOLOGY

3.1 Study population

In most communities in the United Kingdom (UK), many young people have migrated to cities leaving the elderly at semi urban areas. This population in semi urban and rural areas doesn’t have access to much sophisticated medical care that is needed for such diseases such as mental disorders. Additionally, medical facilities that could be used in diagnosis for these orders are costly and far away in developed areas. Therefore, the study population will be drawn from patients from both semi urban and rural areas.

3.2 Data Resources

3.2.1 Primary Resources

For the purposes of this research, the main sources of primary information were the information accrued from the primary data collection instruments- in depth interviews and questionnaires. The informants were mainly persons who have suffered or are suffering from neuropsychiatric disorder such as depression, stoke or stress. The age bracket for the informants was between 25 and 45 years.

3.2.2 Secondary Resources

The relevant articles, journals, seminar papers, books, online web pages, medical reports and online books formed the basis for the study especially for the literature review which needed more scrutiny because the area of this study faces many controversies and incomplete theories.

3.3 Sampling Methods

Stratified sampling was used for the survey questionnaire to come up with the appropriate sample. Stratified sampling is whereby a stratum is a subset of populations that have common characteristics. The researchers categorize the appropriate stratums then enough subjects from each stratum are chosen through random sampling. It is the best probability method since it lowers sampling error (Galloway, 1997). A minimum target size population size of 2000 adults aged between 25 and 45 was stratified by sex and 10-year group ranges. For the in- depth interviews, judgment sampling was used. This is where samples are chosen on the basis of judgment and are often chosen from one “representative” area (Galloway, 1997).

3.4 Research Design

The proposed study was based on an inductive as opposed to deductive approach. This is mainly due to the fact that this research is to a large extent qualitative in nature. Inductive reasoning, as compared to deductive reasoning, is prevalent in qualitative studies because it is theory generating. The focus of inductive researchers is to search for a theory that provides an explanation for the data while deductive researchers search for data that matches a particular theory they may have. In terms of the approach or strategy, exclusively inductive researches begin with data collection, measurements of some kind or empirical observations. Such an approach is appropriate for this study since the attempt is to generate data concerning association and relationship between neuropsychiatric disorders and the risks that such disorder pose to patients. Since the available data is scanty, an inductive research is important to fill this knowledge gap by generating data (Cooper & Schindler, 2008).

The study was also exploratory in nature and the approach used was the mixed design approach- a combined qualitative and quantitative approach defined by Creswell (2007) as a “Sequential Exploratory Strategy”. In order to meet the research objectives, such an exploratory study is crucial in benefiting from the strengths of both approaches. It is also known as the triangulation approach and is geared towards capturing a more holistic, complete and contextual depiction of the respondents under research while at the same time reducing the effect of bias in any approach used. Moreover, researchers can attain high levels of data validity, verifiability and generalizability by making use of triangulation approaches that provide justification and replication of data results across all methods. In addition, the combination of both research approaches within one research project releases tremendous opportunities for mutual advantage because the weaknesses of one strategy can be neutralized through the incorporation of other methods (Simon and Vosseberg, 2001).

3.5 Research methods

3.5.1 Qualitative Methods

In depth interviews were one of the preferred methods for collecting data from the identified patients. This form of one-on-one interviews is the most appropriate when trying to uncover the thoughts of each respondent without the hitches of group dynamics (The Centre for Strategy Research, 1997). There is more depth in the interviews plus more statistics are obtained (The Centre for Strategy Research, 1997). Statistically, more statistics are obtained from all the participants thus making it impossible to reliably and accurately measure the responses through the content analysis of individual responses. In fact, there has been a growing tendency in the modern world to utilize focus groups to merely provide statistically relevant as opposed to statistically accurate data Therefore, since this particular study was interested in obtaining accurate data, in depth interviews were preferred for their statistical accuracy.

3.5.2 Quantitative Methods

With regards to quantitative methods, the use of questionnaires is proposed for the collection of data from patients who preferred confidentiality; they are viewed as the most suitable for their privacy and anonymity. In addition, a questionnaire is a simple tool that has several questions related to the particular research objectives thus obtaining specific answers for specific questions is easier (Learning Technology Dissemination Initiative, 1999).

4.0 DATA ANALYSIS

For the this research, the SPSS software statistical analysis tool was used to analyze the collected data. The SPSS software is simple to use and also helps generate conclusions and recommendations necessary for the research.

4.1 Clinical evaluation and collection of samples

Screening centers convenient for the study participants were set up in many social and religious institutions such as churches, schools, social centers, heath centers, market places and town halls. The data of the participants was taken such as weight, height and waist circumference. Blood pressure measurements were also taken three times in their arms with Accusons, mercury sphygmomanometer. Blood sugar was also measured using the accuchek glucometer. All the results were measured and analyzed by the UK medical research centre.

4.2 Results of specificity and sensitivity of a diagnostic test

A total of 1342 participants were analyzed out of the 2000 people screened. The rest were not analyzed because some of their data was found to be incomplete. Out of the screened participants, 300 female participants were removed from the list to balance the participation gender wise leaving 1042 participants. Female participants who were listed to participate in the study towards its end were removed.

Figure 1: Mapped causes of Neuropsychiatric disorders (Depression)

The figure indicates the results obtained from the tests that was conducted on the participants. Its clear that mental disorders do not have a specific cause because many cases are caused by a combination of several factors.

4.3 Risks in assessing prognosis and causation of mental disorders

The study also identified several risks that are associated with diagnosis the causes of mental disorders. First, assessing the neuropsychiatric disorders in individuals requires great caution and qualification because a mistake in diagnosis can lead to prescription of a different medication which can have adverse effects on the individual. The fact that people come from different areas and live different lives dictates that each individual must have a personal diagnosis to the cause of the disorder. The number of cases where people have been treated for wrong mental illnesses is increasing all over the world thus there has been increased number of persons who are mentally disturbed and increased deaths resulting to severe mental disorders.

4.4 Intervention for neuropsychiatric disorders

As indicated earlier, there are three main treatments for mental disorders namely medication, psychotherapy and Electroconvulsive therapy. However, in using any of the methods, reduction of risk that may accompany the use of the methods must be addressed. This is done by having the right number of patients for a given treatment program with enough resources regarding the personnel and drugs. Straining the available resources will only reduce the effects of the disorder but leave a great chance of reoccurrence.

This study found out that many patients who know that they have mental related disorders do not seek medical attention while those who seek medication do not use it. This is due to the reason that many people believe that mental triggered disorders such as stoke, depression and stress are caused by overworking the brain and resting could eliminate the disorder. While many specialists of mental disorders have advocated for immediate medical address once an individual feels stressed or depressed, many individuals prescribe medication for themselves by taking simple pain relievers or sleep inducers.

The type I and II statistical errors have played a crucial role in the treatment of mental disorders. In Type I one error, medical specialists indicate that a patient has no mental illness while in real sense the patient is affected while in Type II statistical error, the specialists indicate that a patient is affected by a given mental disorder while in reality the patient in not ill. Such errors have resulted to prescription of medication to the wrong patients and not prescribing medication to the affected individuals.

CONCLUSIONS

This dissertation aimed to clear understanding that most mental risks result from Neuropsychiatric related disorders. However from the study, risks that result from mental disorders may be caused by number factors and neuropsychiatric is just one of the causes of risks associated to mental disorders. The study has focused on depression as one the risks that have been believed to be purely caused by neuropsychiatric disorders. Studies have also indicated that most of the illnesses related to mental disorders are unknown because many people never seek medical advice once they are stressed or depressed thus there is no concrete relation between the neuropsychiatric disorders and the consequent risks that occur after an individual is mentally disturbed.

Conclusively, there has been epidemiological association between mental disorders andmetabolic risks through Homocysteine acid which has been dictating the performance of the brain in the body. The metabolic risk factors have been said to be causes of other severe body diseases such as heart, cancer diseases and hypertension. The cluster of disorders referred to metabolic disorders which include high blood pressure, high insulin levels, increased body weight and abnormal cholesterol levels are risk factors for other diseases that affect human body. Age, race, obesity, other diseases and family history are some of the risk factors that are believed to cause a metabolic syndrome that could consequently result to brain related disorders.

REFERENCES

Mendelso D. Metabolic syndrome and psychiatric interactions. New York: Elsevier Inc; 2008

Aaron T, Brad A. Depression; causes and treatment. Penisslavia: University of Pennislavia Press; 2009

Yudofsky C, Hales H. Neuropsychiatry and the Future of Psychiatry and Neurology. American Journal of Psychiatry. 2002; 159(8): 1261–1264.

Berrios E, Marková S. The concept of neuropsychiatry. A historical overview. Journal of Psychosomatic Research. 2002; 53: 629–638.

Price H., Adams D, Coyle T. Neurology and psychiatry: closing the great divide. Neurology, 2000; 54(1): 8–14.

Martin, B. The Integration of Neurology, Psychiatry, and Neuroscience in the 21st Century. American Journal of Psychiatry. 2002; 159(5) :695–704.

Kendler K. Toward a Philosophical Structure for Psychiatry. American Journal of Psychiatry. 2005; 162: 433–440.

Bell V, Halligan, W., Ellis D. Explaining delusions: a cognitive perspective. HYPERLINK “file:///E:\wiki\Trends_in_Cognitive_Science” o “Trends in Cognitive Science” Trends in Cognitive Science. 2006; 10(5): 219-26.

Ferenczi, S. Psychoanalytical observations on tic. International Journal of Psychoanalysis. 1999 2: 1-30.

Green F. Schizophrenia Revealed: From Neurons to Social Interactions. New York: W.W. Norton. 2001

Kaye, W. et al. Brain imaging of serotonin after recovery from anorexia and bulimia nervosa. Physiology & Behaviour, 2005; 86(1-2), 15-7

Kendler K. Toward a Philosophical Structure for Psychiatry. American Journal of Psychiatry. 2005; 162, 433-440.

Koch C, Laurent G. Complexity and the nervous system. Science. 1999; 284(5411), 96-8.

Lerner A, Whitehouse J. Neuropsychiatric aspects of dementias associated with motor dysfunction. Washington, DC: American Psychiatric. 2002

Linden J. How psychotherapy changes the brain – the contribution of functional neuro imaging. Molecular Psychiatry. 2006; 11, 528-38.

Marr D. Vision: A Computational Approach. San Francisco: Freeman & Co. 2003

Martin J. The Integration of Neurology, Psychiatry, and Neuroscience in the 21st Century. American Journal of Psychiatry, 2002; 159(5), 695 – 704.

Mayberg, H. Limbic-cortical deregulation: a proposed model of depression. Journal of Neuropsychiatry and Clinical Neurosciences, 1997; 9, 471–481.

Price B. et al Neurology and psychiatry: closing the great divide. Neurology. 2000; 54(1), 8-14.

Robertson .M. Tourette syndrome, associated conditions and the complexities of treatment. Brain, 2000; 123(3), 425–462.

Ross C. et al. Neurobiology of Schizophrenia. Neuron. 2006; 52, 139–153.

Sabshin, M. Turning points in twentieth-century American psychiatry. American Journal of Psychiatry, 1990; 147(10),1267-1274.

Sachdev S. Whither Neuropsychiatry? Journal of Neuropsychiatry and Clinical Neurosciences, 2005; 17,140-141.

Saxena S et al. Neuroimaging and frontal-subcortical circuitry in obsessive-compulsive disorder. HYPERLINK “file:///E:\wiki\British_Journal_of_Psychiatry” o “British Journal of Psychiatry” British Journal of Psychiatry, 1998; 173(35), 26–37.

Schiffer R. et al. Neuropsychiatry: A Management Model for Academic Medicine. Journal of Neuropsychiatry and Clinical Neurosciences. 2004; 16, 336-341.

Shapiro A. et al. Organic factors in Gilles de la Tourette’s syndrome. HYPERLINK “file:///E:\wiki\British_Journal_of_Psychiatry” o “British Journal of Psychiatry” British Journal of Psychiatry, 2001; 122, 659-664.

Shergill S. et al. Mapping auditory hallucinations in schizophrenia using functional magnetic resonance imaging. Archives of General Psychiatry. 2000; 57, 1033 -1038.

Singer H. Neurobiology of Tourette syndrome. Neurologic Clinics, 1997; 15, 357–379.

Uher R, Treasure J. Brain lesions and eating disorders. Journal of Neurology, Neurosurgery & Psychiatry, 2005; 76, 852-7.

Vawter P, Freed J, Kleinman E. Neuropathology of bipolar disorder. Biological Psychiatry. 2000; 48, 486-504.

Yudofsky C, Hales H. Neuropsychiatry and the Future of Psychiatry and Neurology. American Journal of Psychiatry. 2002; 159(8), 1261-1264.

Eckel R, Grundy S, Zimmet P. The metabolic syndrome. Lancet 2005, 365:1415-1428.

Prussian H, Barksdale J, Dieckman J. Racial and ethnic differences in the presentation of metabolic syndrome. J Nurse Pract 2007, 3:229-239.

Ford S, Giles H, Dietz H. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002, 287:356-359.

Gibbs C, Beever D, Lip G. The management of hypertensive diseases in black patients. QJM 1999, 92:187.

Cooper D, Schindler S. Business Research Methods. Boston: Irwin/McGraw-Hill; 1998.

Galloway, K. Probability and Non-Probability Sampling. HYPERLINK “http://www.tardis.ed.ac.uk/~kate/qmcweb/s2.htm” http://www.tardis.ed.ac.uk/~kate/qmcweb/s2.htm. 1997.

Creswell W. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. London: Sage Publications; 2003.

Learning Technology Dissemination Initiative. Questionnaires: Advantages and Disadvantages. HYPERLINK “http://www.icbl.hw.ac.uk/ltdi/cookbook/info_questionnaires/index.html” http://www.icbl.hw.ac.uk/ltdi/cookbook/info_questionnaires/index.html. 1999

Myers M. Qualitative research and the generalizability question: Standing firm With Proteus. The Qualitative Report.20004; (3/4). 

The Centre for Strategy Research.. Advantages of In-depth Interviews (IDIs).

HYPERLINK “http://www.csr-bos.com/approach/focusgroups.html. 1997” http://www.csr-bos.com/approach/focusgroups.html. 1997.