Psych Science Vol 5 No 2 - 2022

Introduction

Are we really thinking seriously about mental illness and the brain?

Prof Henry A. Nasrallah, made this profound statement in an editorial in August 2017 in the journal, Current Psychiatry: “For first-episode psychosis, psychiatrists should behave like cardiologists”. “…while cardiologists manage the first heart attack very aggressively to prevent a second myocardial infarction, we psychiatrists generally do not manage first-episode psychosis (FEP) as aggressively to prevent the more malignant second psychotic episode. Yet abundant evidence indicates that psychiatrists must behave like cardiologists at the onset of schizophrenia and other serious psychosis.” He continues, “Individuals who survive the first heart attack, which permanently destroys part of the myocardium, are at high risk for a second MI, which may lead to death or weaken the heart so much that heart transplantation becomes necessary. Only implementation of aggressive medical intervention will prevent the likelihood of death due to a second MI in a person who has already suffered a first MI. Similarly, the FEP of schizophrenia destroys brain tissue, about 10 to 12 cc containing millions of glial cells and billions of synapses. This neurotoxicity of psychosis is mediated by neuroinflammation and oxidative stress. In most FEP patients, the risk of a second psychotic episode is high, and the tissue destruction of the brain’s gray and white matter infrastructure is even more extensive, leading to clinical deterioration, treatment resistance, and functional disability. That is the grim turning point in the trajectory of schizophrenia”.

Neuromodulation is coming of age in South Africa

The evidence for neuromodulation – using electrical stimulation or chemicals to alter nerve activity in a targeted manner – to treat mood disorders is robust and growing. This article discusses the pros and cons of three neuromodulation tools that are currently available in South Africa for the management of treatment-resistant depression. Psychiatrists have been manipulating the levels of monoamines such as serotonin and dopamine in the human brain as a treatment for depression and anxiety since the 1950s. While antidepressants have alleviated suffering for many, not all patients respond in the desired way. Indeed, some patients get progressively worse. Brain atrophy may contribute to this decline. 

Bipolar spectrum disorder

The controversy regarding bipolar spectrum disorder has not yet been resolved, partly due to the fact that psychiatric diagnosis are syndromes, clusters of symptoms, disorders and not “illness” or “disease”. The distinction between major depression, bipolar disorder, schizoaffective disorder and schizophrenia are often blurred. This has led to the concept of these disorders being on a spectrum. The DSM 5 has also recognised this move and has separated mood disorders into depressive disorders and bipolar and related disorders. In patients with borderline personality disorder with severe mood shifts and emotional dysregulation or affective instability, the distinction between bipolar and borderline personality disorders are often problematic.

Mental healthcare and different platforms of services delivery: What the law and ethics say

COVID-19 has opened up the possibility to render healthcare services remotely, and even as vaccinations are ticking up, it is unlikely that the HPCSA will roll back its concession during the Covid-19 pandemic. Many businesses have now officially adopted hybrid models of working. The convenience, and in the case of mental health, the ease of accessing a mental health practitioner from the familiarity of one’s home are important considerations. For patients it is possible to access a practitioner with limited disruption to work schedules by excluding travel time and costs. It is therefore likely that practitioners will have to continue offering e-health services, in response to the needs of certain patients.