Archive for March 2010

Not too far from being a sport psychologists and scientists, Azuar and I collaborated with Dr Jolly (she is a sport psychologist) coming up with some interesting work in mapping up individual’s zone of optimal functioning among footballers. As a result of frequent association with footballers, Azuar came out fit as never before. Unfortunately, in the year 2007, Kelantan football team wasn’t as famous as in 2009 when the team enter the final league in the Malaysia Cup. I wonder whether Halim Napi was then (2007) the temperamental goalkeeper as in 2009 when he was found guilty of started the clash against Kedahan at Stadium Sultan Mohd IV. To the contrary, this study has shown that this particular goalkeeper (whoever he was) in the Kelantan football team didn’t show statistically significant different in term of his emotional intensity within group compared to striker, defender and midfielder (Slide 16). So, if he was Halim Napi, his name to some extent has been cleared, so to speak.

Believe me or not, in most instances as shown by this study there is not much different between what position you play and emotional intensity. It is your individual’s subjective experiences proved to contribute to the unique characteristic of your emotional content.

Last but not least, you got to believe me, negative emotions are also good and functional in competitive sport as what I’d watched in Discovery channel some time ago. In 1974 fight in Zaire, a 32-year old former world boxing champion Muhammad Ali fought the younger undefeated heavyweight champion, George Foreman who was heavily favored to win the fight. Ali used an unusual strategy he called “rope-a-dope” to tire Foreman. He then proceeded to knock Foreman out and win the championship. In this head-to-head competition, Ali used deception and anger, which are the negative emotion to get Foreman to overextend himself. The loss to Ali so demoralized Foreman that he retired from boxing at age 28.

Interventional cardiologists created an alternative to open heart surgery by developing a mitral valve clip. To alleviate mitral valve regurgitation–a condition where the heart’s mitral valve does not close properly, allowing blood to leak back into the heart–cardiologists insert a catheter into the patient’s groin that travels up into the mitral valve.

The clip is fed through this catheter, where it finally grasps and tightens the valves’ leaflets–effectively preventing blood from leaking. The clip remains in place while the catheter is removed, the entire procedure taking approximately two hours and recovery a few weeks. The procedure is good for those with weaker hearts, when traditional surgery is more dangerous.

Chances are you know someone who has had heart problems. In fact, one in five people over the age of 55 has a problem with their mitral valve. A new alternative to open heart surgery can get their blood flowing again.
Nothing keeps 77-year-old Josephine Herndon from shopping, but her hobby was slowed down by a heart problem called mitral regurgitation.

“In the store, I sat down, and I was breathing pretty heavily,” said Herndon. “I could barely make it back to the car.”
Mitral regurgitation is a condition in which the heart’s mitral valve doesn’t close tightly, allowing blood to flow backward into the heart.
“I had a leaky valve and didn’t even know it,” Herndon said.

A lot of these patients have shortness of breath,” said George Hanzel, M.D., an interventional cardiologist at William Beaumont Hospital in Royal Oak, Mich. “The main thing they have is fatigue, exercise intolerance, shortness of breath and swelling.”

Herndon was one of the first patients in the United States to have the mitral clip procedure. First, interventional cardiologists inserted a catheter into her groin up into the mitral valve. Next, a clip was fed through. The clip grasped and tightened the valves’ leaflets, preventing blood from leaking. “By pulling them together and approximating them, it reduces the leakiness,” Dr. Hanzel said.

The clip stays and keeps blood from leaking, and the catheter is removed. The procedure takes two hours, the same as for open-heart surgery. The difference is in the recovery — down from months to just weeks.
“Patients typically say they feel better,” Dr. Hanzel said. “They can breathe better. They can do more without having to stop and rest.”

Herndon’s mitral regurgitation was reduced from severe to trivial, and she’s back looking for bargains again. “I always did love to go shopping,” Herdon said.

The mitral clip procedure is good for patients who have a weak heart and may not make it through traditional surgery.

The procedure is being investigated in clinical trials in 38 hospitals across USA.

The ability to speak a second language isn’t the only thing that distinguishes bilingual people from their monolingual counterparts—their brains work differently, too. Research has shown, for instance, that children who know two languages more easily solve problems that involve misleading cues. A new study published in Psychological Science reveals that knowledge of a second language—even one learned in adolescence—affects how people read in their native tongue. The findings suggest that after learning a second language, people never look at words the same way again.

Eva Van Assche, a bilingual psychologist at the Univer sity of Ghent in Belgium, and her colleagues recruited 45 native Dutch-speaking students from their university who had learned English at age 14 or 15. The researchers asked the participants to read a collection of Dutch sentences, some of which included cognates—words that look similar and have equivalent meanings in both lan guages (such as “sport,” which means the same thing in both Dutch and English). They also read other sen tences containing only noncognate words in Dutch.

Van Assche and her colleagues recorded the participants’ eye move ments as they read. They found that the subjects spent, on average, eight fewer milliseconds gazing at cognate words than control words, which suggests that their brains processed the dual-language words more quickly than words found only in their native language.

“The most important implication of the study is that even when a per son is reading in his or her native language, there is an influence of knowledge of the nondominant second language,” Van Assche notes. “Becoming a bilingual changes one of people’s most automatic skills.” She plans to investigate next whether people who are bilingual also process auditory language information differently. “Many questions remain,” she says.

Seminar on Learning Difficulties (LD) in Primary Care, organized by USM Family Medicine Association (FAMOUS) held on the March, 20; under auspices of Dr Azidah Abdul Kadir was a good platform to review commitment by multidisciplinary agencies involved in the management of children with LD.

The doctors were reminded (i) to differentiate LD from Mental Retardation (MR), (ii) to remember in clinical practice, poly-diagnoses and co-morbidities are common (iii) to assess patients in a holistic manner which involve OT & psychological assessment (using various scales and assessment tools), (iv) to do proper placement for these pupils; in order not to jeopardize their future education.

Cases were discussed and the dispute regarding new Orang Kelainan Upaya form were thrashed out despite the fact that many believed the form needs further improvisation for the sake of clarity and simplicity. I congratulate FAMOUS for the hard work.

I am dysphasic when looking for some right words to use at the right time. This evening I was looking for the word, ‘frozen watchfulness’ while teaching on special character or marker of children with physical abuse. It simply means a situation in which the child is extremely tense, hypervigilent and watchful of the adult’s every move and expression.

This term was first described by Ounsted at. al. (1974) to describe symptoms like lack of initiative, hypervigilance and pseudoadult behavior where basic trust and secure environment have not been established.

Older children may become extremely passive and withdrawn, show little initiative, avoid attracting attention to themselves and typically do not act until they are fairly certain of the adult reaction. The child may become hypervigilant, acutely sensitive to adult mood changes and concentrate all resources on his or her caregivers in order to please them and avoid further harm.

Since abuse children are only appreciated when they meet adult needs, they only take on pseudoadult behaviors. In other word, they tend to become too matured, role-playing as the adult in order to please those who abuse them.

Because so much have been invested emotionally in this relationship and also because to do so may be hazardous, the child play little, does not explore the environment and does not develop peer relationship outside the family.

It is difficult to demonstrate clinically how it looks like but those who have seen these children would remember for life.

In a condition called reactive attachment disorder when the abused child minimally turn to their mum or attachment figure for comfort, support, protection and nurturance, frozen watchfulness is one of the signs to watch for. It does happen in foster-care, abuse children even at home with foreign maids as well as traumatized victim of natural disaster and war.

I am lucky to use information technology to correct my dysphasia or may be I’m too ancient to show off my talent in teaching as the correct word did not deliver at the correct time.

The new module for diagnosing mental illness, DSM-V has reach its final stage i.e for public viewing vis-a-vis scrutinizing. Here is the comment from chairman of the DSM-IV task force, Prof Allen Frances.

As chairman of the task force that created the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which came out in 1994, I learned from painful experience how small changes in the definition of mental disorders can create huge, unintended consequences.

Our panel tried hard to be conservative and careful but inadvertently contributed to three false “epidemics” – attention deficit disorder, autism and childhood bipolar disorder. Clearly, our net was cast too wide and captured many “patients” who might have been far better off never entering the mental health system.

The first draft of the next edition of the DSM, posted for comment with much fanfare last month, is filled with suggestions that would multiply our mistakes and extend the reach of psychiatry dramatically deeper into the ever-shrinking domain of the normal. This wholesale medical imperialization of normality could potentially create tens of millions of innocent bystanders who would be mislabeled as having a mental disorder. The pharmaceutical industry would have a field day – despite the lack of solid evidence of any effective treatments for these newly proposed diagnoses.

The manual, prepared by the American Psychiatric Association, is psychiatry’s only official way of deciding who has a “mental disorder” and who is “normal.” The quotes are necessary because this distinction is very hard to make at the fuzzy boundary between the two. If requirements for diagnosing a mental disorder are too stringent, some who need help will be left out; but if they are too loose, normal people will receive unnecessary, expensive and sometimes quite harmful treatment.

Where the DSM-versus-normality boundary is drawn also influences insurance coverage, eligibility for disability and services, and legal status – to say nothing of stigma and the individual’s sense of personal control and responsibility.

What are some of the most egregious invasions of normality suggested for DSM-V? “Binge eating disorder” is defined as one eating binge per week for three months. (Full disclosure: I, along with more than 6% of the population, would qualify.) “Minor neurocognitive disorder” would capture many people with no more than the expected memory problems of aging. Grieving after the loss of a loved one could frequently be misread as “major depression.” “Mixed anxiety depression” is defined by commonplace symptoms difficult to distinguish from the emotional pains of everyday life.

The recklessly expansive suggestions go on and on. “Attention deficit disorder” would become much more prevalent in adults, encouraging the already rampant use of stimulants for performance enhancement. The “psychosis risk syndrome” would use the presence of strange thinking to predict who would later have a full-blown psychotic episode. But the prediction would be wrong at least three or four times for every time it is correct-and many misidentified teenagers would receive medications that can cause enormous weight gain, diabetes and shortened life expectancy.

A new category for temper problems could wind up capturing kids with normal tantrums. “Autistic spectrum disorder” probably would expand to encompass every eccentricity. Binge drinkers would be labeled addicts and “behavioral addiction” would be recognized. (If we have “pathological gambling,” can addiction to the Internet be far behind?)

The sexual disorders section is particularly adventurous. “Hypersexuality disorder” would bring great comfort to philanderers wishing to hide the motivation for their exploits behind a psychiatric excuse. “Paraphilic coercive disorder” introduces the novel and dangerous idea that rapists merit a diagnosis of mental disorder if they get special sexual excitement from raping.

Defining the elusive line between mental disorder and normality is not simply a scientific question that can be left in the hands of the experts. The scientific literature is usually limited, never easy to generalize to the real world and always subject to differing interpretations.

Experts have an almost universal tendency to expand their own favorite disorders: Not, as alleged, because of conflicts of interest-for example, to help drug companies, create new customers or increase research funding-but rather from a genuine desire to avoid missing suitable patients who might benefit. Unfortunately, this therapeutic zeal creates an enormous blind spot to the great risks that come with overdiagnosis and unnecessary treatment.

This is a societal issue that transcends psychiatry. It is not too late to save normality from DSM-V if the greater public interest is factored into the necessary risk/benefit analyses.

Allen Frances is professor emeritus and former chairman of the department of psychiatry at Duke University. He wrote this for the Los Angeles Times. (c) 2010, Los Angeles Times. Distributed by McClatchy-Tribune Information Services.

My wife and I were talking to our son on the need to organize. Indeed, that was the gist of my talk to Master students last week. I had to present him a diary in order to familiarize him to self-organization and multi-tasking. But then why my daughter is quite different? That questions popped up suddenly in my head. Perhaps one size does not fit all. Individuals differ.

Genetic diversity? Well, they are from the same parents. Culture and experience? More or less the same. But my daughter went to a religious school. May be, somehow, religious school shapes the student differently. I guess, I have no complaint about character building since religious schools are doing a very good job. Minor complaint lies with relatively less sociability and poor communication skill in a small number of students.

I have complimented my son on some good characters that he has and he has been reminded that our comments are made for improvement, not just a dire criticism to kill his creativity and initiative. After all, raising children is a duty to be accomplished during our life time as a parent.

The question that I have next in mind is what is he going to do with the diary, since he never write any notes in any diary. They are all in his head.

After all he is a man and will forever be a man.