NUTRITION ASPECT IN PSYCHIATRIC CONDITION Dr. Dimyati Burhannudin M.

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Mental Illnes Axis I Disorders Primarily biologic in origin Resulting from : Alteration in brain structure (result of stress, trauma, nutrition status, illness) Biochemistry Environmental expossure

Alteration in brain or nervous system function : altered perception and response can be degenerative and permanently destructive disorders include; depression, anxiety, obsessive convulssive, bipolar, deficit or hyper activity attention, schizophremia and postraumatic stress disorders (PTSD) Eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder) behavioral and organic issues need chemotherapy, nutrition, pharmacotherapy in addition to psychotherapy. The diagnose of axis I, despite of their strong physiologic component are primarily through behavioral criteria and pschological testing. Because ; no definitive diagnostic testing ( blood or brain ). So, difficult to convince the treatment in attempting to willfully change behavior that result the frustrations, shame and destructive behavior will not respond without intensive biologic intervention.

Food behaviors are often the first indication exist in axis I. Obsessive convulssive person need help to choose a kind of food A bipolar disorder, in period of mania consumes a lot of sugar, but not eat at all in the period of severe depression.

Nutrition :

-not to diagnose -not to treat But ; to recognized behavior indicative of their existance food recommendation.

Axis II Disorders : A personality disorders. It is include : antisocial, narcissistic, histrionic schizoid, avoidant, dependent, et all. Psychoterapy is required Not respond to medication But : ion borderline personality disorder, suggest to give fish oil supplementation in helping to reduce rapid mood swings and impulsive behaviors.

Axis I and Axis II disorders are often comorbid conditions. When an individual impairs to interact to the environtment, axis II developes as a copying mechanism. Example ; PTSD person easily over stimulated, pluctuate between period of intense anxiety and depression. Borderline personality comorbid to PTSD. Therapy for behavioral issues is primarily the responsibility of the psychotherapy team, but should be consider to nutrition counseling.

The long term outcome of healthy food and life style changes is most certainly possitive. In Brain and Nervous System Maintenance : Structure and function of the neurons and brain centers coordinating communication (within the body, body vs environment). 60% of dry brain (weight) is fat. 25% of that fat is docosahexanoic acid (DHA), an omega 3 (n-3) fatty acid, a unique substance, important to brain and nervous system functioning ; important for infant nutrition. ALA ( Linolenic Acid ) an unsaturated fatty acid from several varieties of nuts oil found to have many health benefits Especially ; -inhibition of inflamatory processes, assosiated with cardiovascular disease diabetes bowel disease

-function as a precursor for n-3 f.a. eicosapentanoic acid (EPA) and DHA ; but the conversion is low EPA and DHA are found in fish. In saturated condition of DHA can reconvert to EPA. DHA cannot synthesized in fishtissue, it is obtaining from marine algae. Adequate DHA is important for maintaining healthy neurotransmitter function. Antidepressants, are not effective for promoting recovery in patient with anorexia Who is often depleted in fat, but effective to relaps when the diet and tissues have more fat.

Recommendation of Nutrition. 1. Consumption of dietary DHA and EPA. The omega-3 fatty acids needed daily to sustain the function of healthy brain and nervous system. International Society for the Study of Fatty Acid and Lipid (ISSFAL) recommends a dailly minimum of 220 mg each of both DHA and EPA (however maybe much higher) Fishes and seafoods are beneficial wioth regard to omega-3 content. These foods may help to reduce the need for medications used to manage mental health disorders. 2. Maintenance low total dailly omega-6 to omega-3 ratio. Keep ratio 2:1 instead of the common effect in the brain and mental illness (17:1). High ratio founds in : People war on saturated fat (omega-6 f.a. increase) Vegetarian (lower tissue DHA consentration). Mental illness, need supplements of marine algae (omega-3). 3. Avoid resctrictive diet. During period of calorie restriction in rapid lowering body weight, cannot specify which type of fat is loss Fatty acids are being liberated and oxidized through calorie restriction. It is need to replace n-3 fatty acid with the supplementation of omega-3 ALA during the weight loss diet. 4. Increased antioxidant intake. Maintenance of fatty acid level ; Increase the level of dietary food choices

Prevent their oxidation (dietary food choices).

The important strategy is a diet rich in fruits and vegetables ; contain vitamins, minerals, and antioxidants for brain nervous system healths. Etiology, Pathophysiology and Management of Psychiatric Disorders. Etiology : 1. Genetic predisposition 2. Nutritional intake (poor) 3. High ratio omega-6 : omega-3 f.a. 4. Triggers ; marijuana, drugs e.t.c. Pathophysiology : 1. Clinical Findings. 2. Neurochemical changes - production of fewer neurotransmitters. - altered neurotransmitter levels. - changes in neurotransmitter receptor density. 3. Nutrition assessment : - evaluation of BMI - Dietary : fatty acids antioxidant carbohydrate (weight changes) Management : - Medical : -antipsychotics -antidepressants -cardiac medications -Nutrition : -low lipid (?) -DASH (dietary approach to stop hypertension) -weight reduction (?) -fat (omega-3) supplement -antioxidant (high fruits and vegetables)

Food Sources of ALA ( -linolenic acid). Brocolli, cooked Cabbage Flaxeed, flaxeed oil Pumpkin seeds Soybean oil Spinach Walnut, walnut oil Condition for which Fish Oils are beneficial. Anciety disorder Attention deficit/hyperactivity disorder Autism Borderline personality disorder Eating disorder Epilepsy and bipolar disorder Pospartum depression Schizophrenia