Declarations

The World Medical Association has established global ethical standards through various declarations. These include:

Declaration of Geneva: This declaration was created as a revision of the Hippocratic Oath after the atrocities committed in Nazi Germany.

Declaration of Helsinki: This statement outlines ethical principles for medical research involving human subjects.

Declaration of Tokyo: This declaration states that doctors should not participate in, condone, of allow torture, degradation, of cruel treatment of prisoners of detainees.

Declaration of Malta: This declaration provides guidance to doctors treating individuals on hunger strike.

Declaration of Lisbon: This international statement outlines the rights of patients.

Declaration of Ottawa: This declaration sets out the principles necessary for optimal child health.

Each of these declarations serves as a guide for medical professionals to uphold ethical standards in their practice.

Lyonization: The Process of X-Inactivation

The X chromosome is crucial for proper development and cell viability, containing over 1,000 essential genes. However, females carry two copies of the X chromosome, which can result in a potentially toxic double dose of X-linked genes. To address this imbalance, females undergo a process called Lyonization, of X-inactivation, where one of their two X chromosomes is transcriptionally silenced. The silenced X chromosome then condenses into a compact structure known as a Barr body, which remains in a silent state.

X-inactivation occurs randomly, with no preference for the paternal or maternal X chromosome. It takes place early in embryogenesis, soon after fertilization when the dividing conceptus is about 16-32 cells big. This process occurs in all somatic cells of women, but not in germ cells involved in forming gametes. X-inactivation affects most, but not all, genes on the X chromosome. If a cell has more than two X chromosomes, the extra Xs are also inactivated.

In the given scenario, the individual is exhibiting projective identification by attributing their negative response to another person’s perceived attitudes. This is different from projection, where one attributes their own unacceptable thoughts of impulses to someone else.

The individual is not engaging in acting out, which involves impulsively acting on unconscious impulses to avoid conscious awareness of their effects. Instead, they are unable to gratify their impulse.

Suppression, a mature defense mechanism where one postpones attention to conscious impulses, is not being utilized in this situation. The individual is unable to avoid their unconscious impulse.

Repression involves the unconscious forgetting of painful memories of unacceptable impulses. However, in this scenario, the individual is expressing their unacceptable impulses rather than repressing them.

Understanding Endophenotypes in Psychiatry

Endophenotypes are measurable components that are not visible to the naked eye, but are present along the pathway between disease and distal genotype. These components may be neurophysiological, biochemical, endocrinological, neuroanatomical, cognitive, of neuropsychological. They provide simpler clues to genetic underpinnings than the disease syndrome itself, making genetic analysis more straightforward and successful.

Endophenotypes are important in biological psychiatry research as they specifically require heritability and state independence. They must segregate with illness in the general population, be heritable, manifest whether illness is present of in remission, cosegregate with the disorder within families, be present at a higher rate within affected families than in the general population, and be a characteristic that can be measured reliably and is specific to the illness of interest.

Understanding endophenotypes is crucial in delineating the pathophysiology of mental illness, as genes are the biological bedrock of these disorders. By identifying and measuring endophenotypes, researchers can gain insight into the underlying genetic causes of mental illness and develop more effective treatments.

If serum clozapine levels remain elevated, it is recommended to add anticonvulsant cover due to the increased risk of seizures and EEG changes. While some clinicians may advocate for higher clozapine levels, there is limited evidence to support this practice. Amisulpride can be used to augment clozapine, but it is not necessary in this situation. Beta-blockers are used to treat persistent tachycardia caused by clozapine, while hyoscine hydrobromide is used to manage clozapine-associated hypersalivation. Loperamide is unlikely to be needed as clozapine is known to cause constipation.

The psychosocial theory of development, as described by Erikson, involves eight stages that continue into adulthood and require the resolution of a crisis at each stage. Bowlby is known for attachment theory and maternal deprivation, while Freud focused on psychosexual development. Kohlberg studied moral development, and Piaget developed the cognitive model of development.

This is an instance of a primary delusion known as delusional perception. Delusional misidentification syndrome refers to a cluster of conditions, such as Capgras syndrome, Fregoli syndrome, Intermetamorphosis, and Subjective doubles, where individuals hold a belief that the identity of a person, object, of location has been modified of transformed in some way.

Borderline Learning Disability

Borderline learning disability is a term used to describe individuals with an IQ between 70-85. This category is not officially recognized as a diagnosis by the ICD-11. It is estimated that approximately 15% of the population falls within this range (Chaplin, 2005). Unlike mild learning disability, borderline learning disability is not typically associated with deficits in adaptive functioning, such as grooming, dressing, safety, of money management.

There are several types of defence mechanisms, including mature, primitive, and intermediate. Mature defence mechanisms are considered healthy and effective ways of coping with emotional stressors. Examples of mature defence mechanisms include humour, suppression, anticipation, altruism, sublimation, and asceticism.

Sublimation is a particularly important mature defence mechanism, as it involves transforming instinctual energies into socially acceptable goals. This can lead to humanitarian and altruistic activities.

On the other hand, primitive defence mechanisms, such as denial, involve ignoring of disavowing that which the conscious cannot tolerate. Intermediate defence mechanisms, such as projection and splitting, involve attributing one’s own undesirable impulses of separating off intolerable aspects of the self.

It’s important to note that not all defence mechanisms are created equal. While mature defence mechanisms can be helpful, primitive and intermediate defence mechanisms can be harmful and may indicate underlying psychological issues.

Splicing of mRNA

After the transcription of DNA into mRNA, the mRNA undergoes a crucial process known as splicing. This process involves the removal of certain portions of the mRNA, called introns, leaving behind the remaining portions known as exons. The exons are then translated into proteins. The resulting spliced form of RNA is referred to as mature mRNA. This process of splicing is essential for the proper functioning of genes and the production of functional proteins.

The four moral principles are a useful tool in clinical practice. For instance, if a patient arrives in critical condition after a car accident and is unable to provide informed consent, the principle of beneficence requires healthcare professionals to prioritize treatment for the patient. The principle of justice may also be considered if there are many patients in need of care of if the treatment is expensive of scarce, potentially depriving others of medical attention. Non-maleficence is relevant if the treatment is likely to cause more harm than good. Respect for autonomy is important if the patient has previously expressed a desire to decline treatment in such circumstances.

Overview of Cranial Nerves and Their Functions

The cranial nerves are a complex system of nerves that originate from the brain and control various functions of the head and neck. There are twelve cranial nerves, each with a specific function and origin. The following table provides a simplified overview of the cranial nerves, including their origin, skull exit, modality, and functions.

The first cranial nerve, the olfactory nerve, originates from the telencephalon and exits through the cribriform plate. It is a sensory nerve that controls the sense of smell. The second cranial nerve, the optic nerve, originates from the diencephalon and exits through the optic foramen. It is a sensory nerve that controls vision.

The third cranial nerve, the oculomotor nerve, originates from the midbrain and exits through the superior orbital fissure. It is a motor nerve that controls eye movement, pupillary constriction, and lens accommodation. The fourth cranial nerve, the trochlear nerve, also originates from the midbrain and exits through the superior orbital fissure. It is a motor nerve that controls eye movement.

The fifth cranial nerve, the trigeminal nerve, originates from the pons and exits through different foramina depending on the division. It is a mixed nerve that controls chewing and sensation of the anterior 2/3 of the scalp. It also tenses the tympanic membrane to dampen loud noises.

The sixth cranial nerve, the abducens nerve, originates from the pons and exits through the superior orbital fissure. It is a motor nerve that controls eye movement. The seventh cranial nerve, the facial nerve, also originates from the pons and exits through the internal auditory canal. It is a mixed nerve that controls facial expression, taste of the anterior 2/3 of the tongue, and tension on the stapes to dampen loud noises.

The eighth cranial nerve, the vestibulocochlear nerve, originates from the pons and exits through the internal auditory canal. It is a sensory nerve that controls hearing. The ninth cranial nerve, the glossopharyngeal nerve, originates from the medulla and exits through the jugular foramen. It is a mixed nerve that controls taste of the posterior 1/3 of the tongue, elevation of the larynx and pharynx, and swallowing.

The tenth cranial nerve, the vagus nerve, also originates from the medulla and exits through the jugular foramen. It is a mixed nerve that controls swallowing, voice production, and parasympathetic supply to nearly all thoracic and abdominal viscera. The eleventh cranial nerve, the accessory nerve, originates from the medulla and exits through the jugular foramen. It is a motor nerve that controls shoulder shrugging and head turning.

The twelfth cranial nerve, the hypoglossal nerve, originates from the medulla and exits through the hypoglossal canal. It is a motor nerve that controls tongue movement. Overall, the cranial nerves play a crucial role in controlling various functions of the head and neck, and any damage of dysfunction can have significant consequences.

Trait Theory: Understanding Personality Traits

Trait theory is a psychological approach that seeks to understand personality by identifying and categorizing specific traits. The theory was first introduced by Gordon Allport, who classified personality traits into three levels.

At the highest level, we have cardinal traits. These are traits that are so pervasive that they dominate a person’s behavior and activities. Only a few people possess cardinal traits, but for those who do, these traits are the ruling force of their personality. Cardinal traits are usually evident to most people who know the individual.

The second level of traits is central traits. These are easily detected characteristics within a person, traits that all people have a certain number of, usually around five to ten on average. Central traits are the building blocks of personality and help to define a person’s overall character.

Finally, we have secondary traits. These are less evident and only manifest in select circumstances. They are not as important as central of cardinal traits, but they still play a role in shaping a person’s behavior and personality.

Overall, trait theory provides a useful framework for understanding personality and how it develops over time. By identifying and categorizing specific traits, psychologists can gain insights into why people behave the way they do and how they can change their behavior to achieve their goals.

It is advisable to avoid agents with longer half lives as they have a tendency to induce drowsiness in patients.

Benzodiazepines are a class of drugs commonly used to treat anxiety and sleep disorders. It is important to have a working knowledge of the more common benzodiazepines and their half-life. Half-life refers to the amount of time it takes for half of the drug to be eliminated from the body.

Some of the more common benzodiazepines and their half-life include diazepam with a half-life of 20-100 hours, clonazepam with a half-life of 18-50 hours, chlordiazepoxide with a half-life of 5-30 hours, nitrazepam with a half-life of 15-38 hours, temazepam with a half-life of 8-22 hours, lorazepam with a half-life of 10-20 hours, alprazolam with a half-life of 10-15 hours, oxazepam with a half-life of 6-10 hours, zopiclone with a half-life of 5-6 hours, zolpidem with a half-life of 2 hours, and zaleplon with a half-life of 2 hours. Understanding the half-life of these drugs is important for determining dosages and timing of administration.

The recommended treatment for emotionally unstable personality disorder (borderline type) does not involve a single psychological therapy of drug treatment as a first line of defense. However, for women who prioritize reducing self-harm, DBT is recommended. Drug treatments may be considered for comorbid conditions. According to NICE guidelines on Borderline personality disorder (BPD) (CG78), a comprehensive dialectical behaviour therapy programme should be considered for women with borderline personality disorder who prioritize reducing recurrent self-harm. Brief psychological interventions of less than 3 months’ duration should not be used specifically for borderline personality disorder of for the individual symptoms of the disorder. Drug treatment should not be used specifically for borderline personality disorder of for the individual symptoms of behavior associated with the disorder, such as repeated self-harm, marked emotional instability, risk-taking behavior, and transient psychotic symptoms. If sedatives are used for crisis intervention in a patient with EUPD, they should be prescribed for a maximum period of one week.

Concordance rates are used in twin studies to investigate the genetic contribution to a trait of condition. Concordance refers to the presence of the same trait of condition in both members of a twin pair. There are two main methods of calculating twin concordance rates: pairwise and probandwise. These methods produce different results and are calculated differently. The probandwise method is generally preferred as it provides more meaningful information in a genetic counseling setting.

The table below shows an example of a population of 100,000 MZ twin pairs, and the pairwise and probandwise concordance rates calculated from this population. Pairwise concordance is the probability that both twins in a pair are affected by the trait of condition. Probandwise concordance is the probability that a twin is affected given that their co-twin is affected. Both methods are conditional probabilities, but pairwise applies to twin pairs, while probandwise applies to individual twins. This is why probandwise is preferred, as it helps predict the risk at the individual level.

– Kurt Cobain, Amy Winehouse, Jeff Buckley, Jimi Hendrix, and Marilyn Monroe are all celebrities who died prematurely.
– Kurt Cobain’s mother referred to them as that stupid club.
– Amy Winehouse died from alcohol consumption at age 27.
– Jeff Buckley drowned accidentally at age 30.
– Jimi Hendrix died from barbiturate-related asphyxia at age 27.
– Marilyn Monroe died from a barbiturate overdose at age 36.

Harry Harlow conducted controversial experiments with rhesus macaque monkeys and surrogate ‘mothers’ made of inanimate objects, revealing that the infants preferred comfort and warmth over food.
Mary Ainsworth created the Strange Situation classification to categorize infants’ attachment behaviors.
John Bowlby coined the term ‘attachment’ to describe a child’s bond with their mother.
Konrad Lorenz studied imprinting in geese that were hatched in incubators.
Mary Main played a role in the development of the Adult Attachment Interview, which evaluates an individual’s early attachment experiences.

Inheritance of knight’s move pattern is observed in disorders that are caused by recessive X-linked genes, rather than dominant X-linked genes.

Modes of Inheritance

Genetic disorders can be passed down from one generation to the next in various ways. There are four main modes of inheritance: autosomal dominant, autosomal recessive, X-linked (sex-linked), and multifactorial.

Autosomal Dominant Inheritance

Autosomal dominant inheritance occurs when one faulty gene causes a problem despite the presence of a normal one. This type of inheritance shows vertical transmission, meaning it is based on the appearance of the family pedigree. If only one parent is affected, there is a 50% chance of each child expressing the condition. Autosomal dominant conditions often show pleiotropy, where a single gene influences several characteristics.

Autosomal Recessive Inheritance

In autosomal recessive conditions, a person requires two faulty copies of a gene to manifest a disease. A person with one healthy and one faulty gene will generally not manifest a disease and is labelled a carrier. Autosomal recessive conditions demonstrate horizontal transmission.

X-linked (Sex-linked) Inheritance

In X-linked conditions, the problem gene lies on the X chromosome. This means that all males are affected. Like autosomal conditions, they can be dominant of recessive. Affected males are unable to pass the condition on to their sons. In X-linked recessive conditions, the inheritance pattern is characterised by transmission from affected males to male grandchildren via affected carrier daughters.

Multifactorial Inheritance

Multifactorial conditions result from the interaction between genes from both parents and the environment.

Glutamate is the precursor for the synthesis of GABA.

Neurotransmitters are substances used by neurons to communicate with each other and with target tissues. They are synthesized and released from nerve endings into the synaptic cleft, where they bind to receptor proteins in the cellular membrane of the target tissue. Neurotransmitters can be classified into different types, including small molecules (such as acetylcholine, dopamine, norepinephrine, serotonin, and GABA) and large molecules (such as neuropeptides). They can also be classified as excitatory or inhibitory. Receptors can be ionotropic or metabotropic, and the effects of neurotransmitters can be fast of slow. Some important neurotransmitters include acetylcholine, dopamine, GABA, norepinephrine, and serotonin. Each neurotransmitter has a specific synthesis, breakdown, and receptor type. Understanding neurotransmitters is important for understanding the function of the nervous system and for developing treatments for neurological and psychiatric disorders.

The Significance of 5-HIAA in Depression and Aggression

During the 1980s, there was a brief period of interest in 5-hydroxyindoleacetic acid (5-HIAA), a serotonin metabolite. Studies found that up to a third of people with depression had low concentrations of 5-HIAA in their cerebrospinal fluid (CSF), while very few normal controls did. This suggests that 5-HIAA may play a role in depression.

Furthermore, individuals with low CSF levels of 5-HIAA have been found to respond less effectively to antidepressants and are more likely to commit suicide. This finding has been replicated in multiple studies, indicating the significance of 5-HIAA in depression.

Low levels of 5-HIAA are also associated with increased levels of aggression. This suggests that 5-HIAA may play a role in regulating aggressive behavior. Overall, the research on 5-HIAA highlights its potential importance in understanding and treating depression and aggression.

Lithium – Pharmacology

Pharmacokinetics:
Lithium salts are rapidly absorbed following oral administration and are almost exclusively excreted by the kidneys unchanged. Blood samples for lithium should be taken 12 hours post-dose.

Ebstein’s:
Ebstein’s anomaly is a congenital malformation consisting of a prolapse of the tricuspid valve into the right ventricle. It occurs in 1:20,000 of the general population. Initial data suggested it was more common in those using lithium but this had not held to be true.

Contraindications:
Addison’s disease, Brugada syndrome, cardiac disease associated with rhythm disorders, clinically significant renal impairment, untreated of untreatable hypothyroidism, low sodium levels.

Side-effects:
Common side effects include nausea, tremor, polyuria/polydipsia, rash/dermatitis, blurred vision, dizziness, decreased appetite, drowsiness, metallic taste, and diarrhea. Side-effects are often dose-related.

Long-term use is associated with hypothyroidism, hyperthyroidism, hypercalcemia/hyperparathyroidism, irreversible nephrogenic diabetes insipidus, and reduced GFR.

Lithium-induced diabetes insipidus:
Treatment options include stopping lithium (if feasible), keeping levels within 0.4-0.8 mmol/L, once-daily dose of the drug taken at bedtime, amiloride, thiazide diuretics, indomethacin, and desmopressin.

Toxicity:
Lithium salts have a narrow therapeutic/toxic ratio. Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI symptoms and neuro symptoms.

Pre-prescribing:
Before prescribing lithium, renal function, cardiac function, thyroid function, FBC, and BMI should be checked. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.

Monitoring:
Lithium blood levels should be checked weekly until stable, and then every 3-6 months once stable. Thyroid and renal function should be checked every 6 months. Patients should be issued with an information booklet, alert card, and record book.

Inheritance Patterns and Examples

Autosomal Dominant:
Neurofibromatosis type 1 and 2, tuberous sclerosis, achondroplasia, Huntington disease, and Noonan’s syndrome are all examples of conditions that follow an autosomal dominant inheritance pattern. This means that only one copy of the mutated gene is needed to cause the condition.

Autosomal Recessive:
Phenylketonuria, homocystinuria, Hurler’s syndrome, galactosaemia, Tay-Sach’s disease, Friedreich’s ataxia, Wilson’s disease, and cystic fibrosis are all examples of conditions that follow an autosomal recessive inheritance pattern. This means that two copies of the mutated gene are needed to cause the condition.

X-Linked Dominant:
Vitamin D resistant rickets and Rett syndrome are examples of conditions that follow an X-linked dominant inheritance pattern. This means that the mutated gene is located on the X chromosome and only one copy of the gene is needed to cause the condition.

X-Linked Recessive:
Cerebellar ataxia, Hunter’s syndrome, and Lesch-Nyhan are examples of conditions that follow an X-linked recessive inheritance pattern. This means that the mutated gene is located on the X chromosome and two copies of the gene are needed to cause the condition.

Mitochondrial:
Leber’s hereditary optic neuropathy and Kearns-Sayre syndrome are examples of conditions that follow a mitochondrial inheritance pattern. This means that the mutated gene is located in the mitochondria and is passed down from the mother to her offspring.

Declarations

The World Medical Association has established global ethical standards through various declarations. These include:

Declaration of Geneva: This declaration was created as a revision of the Hippocratic Oath after the atrocities committed in Nazi Germany.

Declaration of Helsinki: This statement outlines ethical principles for medical research involving human subjects.

Declaration of Tokyo: This declaration states that doctors should not participate in, condone, of allow torture, degradation, of cruel treatment of prisoners of detainees.

Declaration of Malta: This declaration provides guidance to doctors treating individuals on hunger strike.

Declaration of Lisbon: This international statement outlines the rights of patients.

Declaration of Ottawa: This declaration sets out the principles necessary for optimal child health.

Each of these declarations serves as a guide for medical professionals to uphold ethical standards in their practice.

It is not recommended to combine MAOIs with SSRIs, clomipramine, of ephedrine.

MAOIs: A Guide to Mechanism of Action, Adverse Effects, and Dietary Restrictions

First introduced in the 1950s, MAOIs were the first antidepressants introduced. However, they are not the first choice in treating mental health disorders due to several dietary restrictions and safety concerns. They are only a treatment option when all other medications are unsuccessful. MAOIs may be particularly useful in atypical depression (over eating / over sleeping, mood reactivity).

MAOIs block the monoamine oxidase enzyme, which breaks down different types of neurotransmitters from the brain: norepinephrine, serotonin, dopamine, as well as tyramine. There are two types of monoamine oxidase, A and B. The MOA A are mostly distributed in the placenta, gut, and liver, but MOA B is present in the brain, liver, and platelets. Selegiline and rasagiline are irreversible and selective inhibitors of MAO type B, but safinamide is a reversible and selective MAO B inhibitor.

The most common adverse effects of MAOIs occurring early in treatment are orthostatic hypotension, daytime sleepiness, insomnia, and nausea; later common effects include weight gain, muscle pain, myoclonus, paraesthesia, and sexual dysfunction.

Pharmacodynamic interactions with MAOIs can cause two types of problem: serotonin syndrome (mainly due to SSRIs) and elevated blood pressure (caused by indirectly acting sympathomimetic amines releasers, like pseudoephedrine and phenylephrine). The combination of MAOIs and some TCAs appears safe. Only those TCAs with significant serotonin reuptake inhibition (clomipramine and imipramine) are likely to increase the risk of serotonin syndrome.

Tyramine is a monoamine found in various foods, and is an indirect sympathomimetic that can cause a hypertensive reaction in patients receiving MAOI therapy. For this reason, dietary restrictions are required for patients receiving MAOIs. These restrictions include avoiding matured/aged cheese, fermented sausage, improperly stored meat, fava of broad bean pods, and certain drinks such as on-tap beer. Allowed foods include fresh cottage cheese, processed cheese slices, fresh packaged of processed meat, and other alcohol (no more than two bottled or canned beers of two standard glasses of wine, per day).

Neurotransmitters are substances used by neurons to communicate with each other and with target tissues. They are synthesized and released from nerve endings into the synaptic cleft, where they bind to receptor proteins in the cellular membrane of the target tissue. Neurotransmitters can be classified into different types, including small molecules (such as acetylcholine, dopamine, norepinephrine, serotonin, and GABA) and large molecules (such as neuropeptides). They can also be classified as excitatory or inhibitory. Receptors can be ionotropic or metabotropic, and the effects of neurotransmitters can be fast of slow. Some important neurotransmitters include acetylcholine, dopamine, GABA, norepinephrine, and serotonin. Each neurotransmitter has a specific synthesis, breakdown, and receptor type. Understanding neurotransmitters is important for understanding the function of the nervous system and for developing treatments for neurological and psychiatric disorders.

Interview Techniques: Open and Closed Questions

When conducting an interview, it is important to use the appropriate types of questions. Open questions are designed to encourage a detailed response and can help to open up the conversation. In contrast, closed questions typically result in a yes of no answer and are useful for clarifying specific details. By using a combination of open and closed questions, interviewers can gather more information and gain a better understanding of the interviewee’s perspective. It is important to use these techniques effectively to ensure a successful interview.

Antidepressants (Licensed Indications)

The following table outlines the specific licensed indications for antidepressants in adults, as per the Maudsley Guidelines and the British National Formulary. It is important to note that all antidepressants are indicated for depression.

– Nocturnal enuresis in children: Amitriptyline, Imipramine, Nortriptyline
– Phobic and obsessional states: Clomipramine
– Adjunctive treatment of cataplexy associated with narcolepsy: Clomipramine
– Panic disorder and agoraphobia: Citalopram, Escitalopram, Sertraline, Paroxetine, Venlafaxine
– Social anxiety/phobia: Escitalopram, Paroxetine, Sertraline, Moclobemide, Venlafaxine
– Generalised anxiety disorder: Escitalopram, Paroxetine, Duloxetine, Venlafaxine
– OCD: Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Clomipramine
– Bulimia nervosa: Fluoxetine
– PTSD: Paroxetine, Sertraline

Vigabatrin is an anticonvulsant drug that has been associated with irreversible concentric visual field loss in 30-50% of patients with long-term exposure. This visual field loss can vary in severity and is often asymptomatic, making regular visual field testing essential for patients taking this medication. It is important for healthcare providers to monitor patients closely for any signs of visual field loss and to consider alternative treatment options if necessary. For more information on anticonvulsant drugs, please refer to GP Notebook.

Culture-bound syndromes are conditions that are specific to certain cultures and are often accompanied by culturally accepted beliefs and practices for treatment. These syndromes may not fit into the diagnostic criteria of Western medicine and are often unique to certain regions of ethnic groups. Examples of culture-bound syndromes include Taijin-jikoshu-kyofu in Japan, Piblokto in the Arctic, Koro in Malaysia, Locura among Latinos in the United States and Latin America, and Susto among Latinos in the United States and in Mexico, Central America, and South America. These syndromes are often associated with social and cultural factors and may require culturally sensitive approaches to treatment.

The concept of recovery in mental disorder goes beyond symptom resolution and focuses on developing a rewarding and meaningful life while accepting the impact of mental distress on the self. Clinical remission, on the other hand, refers to the cessation of symptoms and is often measured through clinical outcome scales. Chronic psychosis is the ongoing experience of psychotic symptoms. Recovery in mental disorder is a rephrasing of the conventional medical definition of remission and recognizes the need for a holistic approach to treatment while still involving clinicians and allied professionals. For further reading, Anthony’s Recovery From Mental Illness and Davidson and Roe’s Recovery from versus recovery in serious mental illness offer valuable insights.