Showing papers in "Asian Journal of Psychiatry in 2012"

Assessing social support among South Asians: The multidimensional scale of perceived social support

Abstract: The psychometric properties of the Multidimensional Scale of Perceived Social Support (MSPSS) of the Urdu (MSPSS-U) and Nepali (MSPSS-N) versions were investigated among Pakistani (n=148) and Nepalese (n=153) respondents living in Hong Kong. The factor analysis of the MSPSS-N conducted in this study confirmed the three factors of the original MSPSS, namely, Family, Friend, and Significant Others, while only two factors were extracted from the MSPSS-U (i.e., the Family and Friends subscales). With regard to construct validity, both the MSPSS-U and MSPSS-N were inversely correlated with depression, anxiety and stress as assessed by the Depression Anxiety Stress Scale (DASS-21). The internal reliability and construct validity of the MSPSS-U and MSPSS-N were also established and provided support for the validity of both versions as tools for measuring perceived social support among South Asian migrants.

Religion, spirituality and mental health in the West and the Middle East

Abstract: Research on religion, spirituality and mental health has been rapidly accumulating from Western countries and now increasingly from the Middle East. We review here the latest research on this topic from these two areas of the world, one largely Christian and the other largely Muslim, after discussing similarities and differences in these faith traditions. Contrary to popular thought, there is considerable overlap between these religious groups in beliefs, practices of worship, moral beliefs and values, and emphasis on family life (although also some distinct differences). Because of the similarity in belief and practice, it is not surprising that research on mental health and devout religious involvement in both these religious traditions has tended to produce similar results. Religious psychotherapies within these faith traditions have been developed and are now being refined and used in clinical trials to determine if integrating patients' religious resources into therapy is more or less effective than conventional therapies in relieving the symptoms of depression and anxiety.

Brain structural abnormalities in obsessive-compulsive disorder: converging evidence from white matter and grey matter.

Abstract: Introduction Specific cortico-striato-thalamic circuits are hypothesised to underlie the aetiology of obsessive-compulsive disorder (OCD). However, findings from neuroimaging studies have been inconsistent. In the current study, we attempted to provide a complete overview of structural alterations in OCD by conducting signed differential mapping (SDM) meta-analysis on grey matter and white matter studies of patients with OCD based on voxel-based morphometry (VBM) studies and diffusion tensor imaging (DTI) studies. Methods Fifteen VBM and seven DTI case–control studies were included in this meta-analysis. SDM meta-analyses were performed to assess grey matter volume and white matter integrity changes in OCD patients and healthy controls. Results We found that OCD patients had smaller grey matter volume than health controls in the frontal eye fields, medial frontal gyrus and anterior cingulate cortex. However, we showed that there was an increase in the grey matter volume in the lenticular nucleus, caudate nucleus and a small region in the right superior parietal lobule. OCD patients also had a lower fractional anisotropy (FA) in the cingulum bundles, inferior fronto-occipital fasciculus, and superior longitudinal fasciculus, while increased FA in the left uncinate fasciculus. Conclusions The current findings confirm the structural abnormalities of cortico-striato-thalamic circuits in OCD.

Applying mobile technologies to mental health service delivery in South Asia.

Abstract: Mobile phones have increasingly assumed an important role in the treatment of mental disorders in high-income countries. This paper considers such possibilities in the South Asian context. First, a brief review of mobile phone use in mental disorders is provided. Next, data on the market penetration and dissemination of mobile phones in South Asia is presented. Finally, common barriers to treatment for mental disorders in South Asia are evaluated against solutions that could be derived from mobile technologies. Though not without their risks, mobile phones have the potential to increase engagement, treatment, and retention of South Asian patients with mental disorders in unprecedented ways.

Yoga: a spiritual practice with therapeutic value in psychiatry.

Abstract: Yoga is one of the spiritual practices derived from the orthodox school of Hindu philosophy. The practices were codified by Patanjali under the title of Ashtanga Yoga. Although Yoga was traditionally seen as a practice meant for achieving self-realization, in recent years there has been significant attention given to the effects of yoga practices on physical and mental health. Yoga as a therapy has proven to be effective as a sole or additional intervention in several psychiatric disorders. Conclusions The literature suggests that yoga can lead to significant symptomatic improvements in psychiatric disorders, along with neurobiological effects which may underlie these changes. This suggests that mental health professionals should be open to the potential benefits of spiritual practices for their patients, either as complementary interventions to modern treatments or as sole treatment in some disorders.

Pathway to psychiatric care in a tertiary mental health facility in Jaipur, India.

Abstract: Purpose This study was planned to evaluate the pathway to care of mentally ill patients attending a tertiary mental health facility in Jaipur to highlight the difficulties of mentally ill and their relatives in accessing appropriate care. Methods Seventy-six patients, who attended the Out Patient Department of Psychiatry of a tertiary care hospital in Jaipur, India for the first time, were enrolled in this study. The family members of the patients were interviewed to evaluate the pathway to care using the Encounter form developed by the WHO. Results The patients were predominantly young adults, male, from rural, agrarian but educated background and a majority of them presented with psychotic illnesses. It was seen that there were five major gateways to care of the mentally ill in the region, Faith healers being the most popular portal of care. The median duration of untreated illness (DUI) was 6 months, and subjects had already visited, 2 carers before visiting any mental health professional. The median monetary cost of the pathway was Rs. 3565. Patients suffering from psychotic illnesses presented earlier. Those who used psychiatric services as first portal of care had different socio-demographic variables as compared to clients who used other services. Conclusion This pathway to psychiatric care study in Jaipur, India demonstrated that referral pathway heavily relies on faith healers. The study indicates possible fields and gives indications, underlining the importance of improving awareness campaigns that will facilitate the recognition of psychiatric disorders.

Suicidal risk and childhood adversity: A study of Indian college students

Abstract: Background The study was undertaken in response to reported increase in deaths due to suicide and suicidal behaviors in the youth. Aim The objectives of the study were to assess childhood adversity and suicidal risk and to study the relationship between adverse childhood experiences and suicidal risk, in Indian students. Method A cross sectional study design was conducted with 436 undergraduate students in the age range of 18–25. Suicidal risk was assessed using Scale for Suicidal Ideation and Beck's Hopelessness Scale. Parental Bonding Instrument and Early Trauma Inventory-Self Report (Short Form) were used to assess adverse childhood experiences. Results Suicidal risk in terms of suicidal ideation and hopelessness was reported by 15% and 9%, respectively. Physical abuse is the most common form of early trauma, experienced in both males and females. Males experienced significantly more traumatic experiences in all domains. Affectionless control, which is considered as the pathogenic form of parent child bonding, is widely reported. A moderate degree of association exists between suicidal risk and early exposure to trauma. Higher suicidal ideation, hopelessness and trauma are reported in respondents with affectionless parental control and neglectful parenting. Conclusion The study provides evidence of correlation between suicidal risk and childhood adversity in the Indian setting.

Outcomes that matter: A qualitative study with persons with schizophrenia and their primary caregivers in India

Abstract: Background Involving persons with schizophrenia and their families in designing, implementing and evaluating mental health services is increasingly emphasised. However, there is little information on desired outcomes from the perspectives of these stakeholders from low and middle income countries (LMIC). Aims To explore and define outcomes desired by persons with schizophrenia and their primary caregivers from their perspectives. Method In-depth interviews were held with 32 persons with schizophrenia and 38 primary caregivers presenting for care at one rural and one semi-urban site in India. Participants were asked what changes they desired in the lives of persons affected by the illness and benefits they expected from treatment. Data was analysed using thematic and content analysis. Results Eleven outcomes were desired by both groups: symptom control; employment/education; social functioning; activity; fulfilment of duties and responsibilities; independent functioning; cognitive ability; management without medication; reduced side-effects; self-care; and self-determination. Social functioning, employment/education and activity were the most important outcomes for both groups; symptom control and cognitive ability were more important to persons with schizophrenia while independent functioning and fulfilment of duties were more important to caregivers. Conclusions Interventions for schizophrenia in India should target both clinical and functional outcomes, addressing the priorities of both affected persons and their caregivers. Their effectiveness needs to be evaluated independently from both perspectives.

Early intervention in psychosis: Insights from Korea.

Abstract: Subjects at clinical high risk (CHR) for psychosis have been the focus of clinical attention in psychiatry for the last 15 years, leading to the development of valid and reliable diagnostic instruments to detect these individuals early in the course of their illness. These efforts have resulted in research into optimal preventive measures. Our experiences at and data from the Seoul Youth Clinic support the validity of the CHR concept and its underlying neurobiological basis and provide valuable information related to the determination of appropriate clinical interventions. The limitations of the current criteria for CHR, such as the relatively low transition rates to psychosis and the "false-positive" problem, are also common critical issues in Korea. Additionally, concerns about social stigmatization and the potential side effects of pharmacotherapy render individuals at CHR reluctant to visit clinical settings. Therefore, further investigations using a combination of predictive markers based on clinical and neurobiological studies of those at CHR are needed to refine the diagnostic criteria, overcome their current limitations including ethical issues, and develop phase-specific and individualized therapeutic interventions.

Relational mindfulness, spirituality, and the therapeutic bond.

Abstract: Mindfulness training, which emphasizes deliberate non-judgmental attention to present moment experiences, has become increasingly mainstream over the past several decades. With accumulating evidence for the physical and mental health benefits of mindfulness, it has been integrated into medical and psychological treatments and is increasingly accepted in the fields of psychology and psychiatry. However, several elements of mindfulness practice which potentially contribute to its benefits have been largely neglected. These include the connections between mindfulness, interpersonal relationships, spirituality, and the psychotherapeutic alliance. The emerging concept of "relational mindfulness" focuses attention on the oft-neglected interpersonal aspects of mindfulness practices. Relational mindfulness is potentially relevant to the psychotherapeutic process, due to its cultivation of the types of qualities that enhance the therapeutic relationship, including warmth, empathy, curiosity, acceptance, self-attunement, and emotional intelligence. In addition, mindfulness practices, especially relational ones, can contribute to the development of spiritual qualities, such as transcendence, boundlessness, ultimacy, and interconnectedness. Several recent studies suggest that meditation/mindfulness interventions may be explained and or enhanced by an emphasis on spiritual components. In this paper, we suggest that focusing on the oft-neglected relational and spiritual aspects of mindfulness practice has the potential to deepen its benefits, especially within the context of the psychotherapeutic relationship.

The Singapore Early Psychosis Intervention Programme (EPIP): A programme evaluation.

Abstract: The alarmingly long duration of untreated psychosis (DUP) in Singapore and probable severe consequences were the impetus for establishing the Early Psychosis Intervention Programme (EPIP) in 2001. In 2007, EPIP became a part of the National Mental Health Blueprint. Here, we report some of the programme's outcomes. Method Consecutive patients accepted into EPIP from April 2007 to March 2011 were included. Programme inclusion criteria were: (1) age between 15 and 41 years, (2) first-episode psychotic disorder with no prior or minimal treatment, (3) no current history of substance abuse, and (4) no history of major medical or neurological illness. EPIP has incorporated an evaluation component to the clinical programme by administering regular structured assessments and generating operational statistics from our hospital's data systems. Results Between April 2007 to March 2011, 815 patients had been accepted and 795 had baseline data. 50.8% (404/795) were males, with mean age of 27 years (±6.5 years). Mean DUP (SD) was 14.6 (±25.2) months and median was 6 months. At the end of two years, 71.1% (202/284) achieved symptomatic remission as defined by the Schizophrenia Working Group, 84.9% (241/284) scored 61 or more on Global Assessment of Functioning (GAF) disability and 76.5% (274/358) had returned back to school or were gainfully employed. Conclusion Being a national programme, EPIP had articulated process and outcome indicators to our stakeholders, and a periodic report card on these outcomes makes us accountable to our funders, our patients and their families.

Association between MTHFR C677T and A1298C, and MTRR A66G polymorphisms and susceptibility to schizophrenia in a Syrian study cohort.

Abstract: The folate–homocystiene metabolic pathway has been shown to be involved in the susceptibility for developing schizophrenia by several studies. In the present study we investigated the role of three common polymorphisms of the folate–homocysteine metabolic pathway in an Arab population from Syria consisting of 85 schizophrenic patients and 126 healthy controls. The studied polymorphisms included the MTHFR C677T and A1298C, and MTRR A66G, all of which result into amino acid changes, and were previously shown to yield decreased enzymatic activity and alter plasma homocysteine concentration. While MTHFR C677T and A1298C polymorphisms were not previously studied in an Arab population with respect to the susceptibility for developing schizophrenia, the MTRR A66G was not previously investigated in any population around the world. Our results indicated a strong association between MTHFR A1298C and schizophrenia. The variant C allele frequency was significantly higher in the patients group (40% vs 29.4%, OR = 1.6, 95% CI (1.06–2.41), p = 0.023). A statistically significant association was found for MTHFR 677TT genotype under the recessive model in the male patients subgroup (OR = 2.6, 95% CI (1.04–6.5), p = 0.036), and MTHFR 677CT genotype under the overdominant model in the total patients group (OR = 0.52 95% CI (0.29–0.92), p = 0.024). No statistically significant association was found for MTRR A66G polymorphism on an individual basis. However, a borderline association was found for the CC/GG (C677T/A66G) compound genotype (OR = 2.24, 95% CI (0.97–5.15), p = 0.053). Our results support the hypothesis of association between schizophrenia and folate–homocystiene metabolic pathway genes.

Are there different neural mechanisms responsible for three stages of weight gain development in anti-psychotic therapy: Temporally based hypothesis

Abstract: Weight gain as a result of atypical anti-psychotic treatment is a common issue with different atypical anti-psychotic treatments causing differing magnitudes of weight gain. Although differing amounts of weight gain result from different atypical agents little is known about the temporal course of weight gain in anti-psychotic treatment. Specifically is the time course of weight gain comparable across different agents. Therefore this article reviews the temporal course of weight gain for three common atypical anti-psychotics namely; clozapine, olanzapine and risperidone. It is evident that all three of these agents exhibit similar although at distinct magnitudes temporal courses of weight gain. That is an initial rapid increase from baseline to 3 months (stage 1), a steady increase from 3 months to 18 months (stage 2) and a plateau after this point (stage 3) with continued anti-psychotic treatment. It is postulated that each of these stages of weight gain result from distinct neural mechanisms. The hypothesized neural correlates for each stage of weight gain are reviewed and discussed. The article concludes with recommendations for future research.

Talking about stigma towards mental health professionals with psychiatry trainees: A movie club approach

Abstract: Psychiatry as a discipline is often perceived as ‘different’ by other medical professionals as much as by a common man. This perception of ‘difference’ may give rise to stigma both towards mental illness and to mental health professionals. Mental health professionals are thus both recipients of stigma and agents who can de-stigmatize psychiatry. A psychiatry movie club approach can be a very useful learning experience to understand various aspects of this stigmatization process. This paper presents a brief account of such an endeavour in which the film Gothika (2003) was used to help psychiatry trainees talk about their experiences with stigma towards mental illness as well as their profession.

A preliminary study on the influence of glutathione S transferase T1 (GSTT1) as a risk factor for late onset Alzheimer's disease in North Indian population

Abstract: Introduction Oxidative stress plays key role in pathogenesis of Alzheimer's disease Glutathione S-transferases (GSTs), a family of phase-II isoenzymes, play a critical role in providing protection against electrophiles and products of oxidative stress Among different classes of GSTs, GSTM1 (Mu) and GSTT1 (theta) are found to be genetically deleted which results in decreased expression of the concerned enzyme This study aims at preliminary analysis of the frequency of deletion of GSTM1 and GSTT1 and their association with late-onset Alzheimer's disease Material and methods In this study, association of the deletion type polymorphism of GST M1 and T1 as possible risk factors for dementia of Alzheimer's type was studied in 50 patients and 100 controls Dementia was diagnosed by Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria, Mini Mental State Examination (MMSE) and Clinical Dementia Rating (CDR) scale Genotyping was done by multiplex Polymerase Chain Reaction (PCR) Associations between null genotype of either GSTM1 and GSTT1 or both with Alzheimer's disease were analyzed by Chi-Square test Results Deletion of GSTT1 was found significantly associated with Alzheimer's disease ( χ 2 = 508, p = 002*) Conclusions The odds of Alzheimer's disease in null GSTT1 is found to be increased by 247 times in comparison to positive GSTT1

Substance-induced psychotic disorders: 13-year data from a de-addiction centre and their clinical implications.

Abstract: The relationship between substance use and psychotic disorder has been complex. Alcohol, cannabis, amphetamines, hallucinogens, and phencyclidine have been implicated as a causative factor for psychotic disorders. It is important to differentiate substance induced psychotic disorders (SIPDs) from primary psychotic disorders as management of the two conditions is different. There is paucity of research in the area of SIPD particularly from Asia. The present study was a retrospective study and it determines retrospectively the incidence rate and clinical characteristics of the SIPDs over a period of 13 years. The incidence of SIPDs was found to be 1.4% and all the subjects were males. In the present study, only alcohol and cannabis were implicated as causative agents for SIPDs. The most common type of psychosis was schizophrenia like psychosis, being more common in the cannabis group. The other forms of psychosis included delusional type, hallucinatory type and affective psychosis. 20% of the subjects had a change in diagnosis to either schizophrenia or affective psychosis on follow-up. The present study showed that the presentation of SIPDs is similar to the primary psychotic disorder and this has management implication.

Public knowledge and beliefs about depression among urban and rural Chinese in Malaysia

Abstract: The study compared knowledge and beliefs about depression among urban and rural Chinese in a Malaysian sample. A total of 409 participants were asked to identify cases of depression varying in intensity from two vignettes and rate their beliefs regarding a list of possible causes and treatments for depression. The urban Chinese were more likely to identify depression as the problem in the vignette. Beliefs about causes of depression were factored into five components, whereas beliefs about treatment for depression factored into four components. The results indicated that the causes most strongly endorsed were stress and pressure, and standard treatments rated the highest as treatments for depression. Overall, depression literacy was moderate for Chinese Malaysians. The results are discussed in relation to Chinese cultural beliefs about depression. Limitations of this preliminary study were acknowledged.

Comparison of symptoms in African-American, Asian-American, Mexican-American and Non-Hispanic White patients with major depressive disorder.

Abstract: The study compared depressive and associated psychopathological symptoms in 17 African-American, 19 Asian-American, 22 Mexican-American and 41 Non-Hispanic White patients with unipolar major depressive disorder. Overall, severity of depression was comparable among the groups both on clinician-rated and subject-rated measures. However, ethnic-minority groups were more likely to experience diurnal variation of mood, with worsening in the evening. Furthermore, Asian-Americans and Mexican-Americans reported greater severity of anxiety and somatic symptoms. The findings suggest that clinicians should be aware of potential differences in symptom presentation when assessing and treating depressed patients from different ethnic groups.

Quality of life in anxiety disorders: Its relation to work and social functioning and dysfunctional cognitions: An exploratory study from India

Abstract: The aim of the study was to examine quality of life, functioning, disability, work and social adjustment, depression, anxiety and dysfunctional cognitions in patients with anxiety disorders. One hundred patients with anxiety disorders and 98 non-clinical participants were recruited for the study. A cross sectional design was adopted. The participants were assessed on the WHOQoL-BREF, Global Assessment of Functioning (GAF), Sheehan Disability Scale (SDS), the Work and Social Adjustment Scale (WSAS) and Dysfunctional Attitudes Scale (DAS). Data was analyzed using descriptive statistics, Mann-Whitney test, Spearman's Rho and regression analysis. Patients with anxiety disorders reported significantly lower quality of life than the community sample (df=98, p<.001). A shorter duration of illness was associated with lower quality of life. QoL was significantly correlated with severity of anxiety, depression and stress as well as with measures of disability and adjustment. Partial correlations indicated that depression did not significantly impact the relationship between work and social adjustment and QoL. Work and social adjustment, depression and dysfunctional cognitions emerged as significant predictors of QoL. The findings of the study are discussed in the light of existing research and the implications for future interventions are highlighted.

Early psychosis in Asia: Insights from Japan.

Abstract: The largest task for psychiatry in Japan today is the deinstitutionalization of patients with psychiatric disorders. In Japan, all citizens are covered by a national health plan, and about 70% of the total cost is covered by the national health insurance scheme. At present, however, there is still no category for early intervention in the national health reimbursement schedule. Recent research has shown that the mean duration of untreated psychosis (DUP) at seven university hospitals in Japan was 17.6 months. We present data using case vignettes suggesting that pharmacotherapy might be overused in prodromal cases. The concept of an At-Risk Mental State (ARMS)/prodromal state might not yet be widely recognized among Japanese psychiatrists. We outline early intervention initiatives in Japan; The Japanese Society for Prevention and Early Intervention in Psychiatry (JSEIP), and a representative early intervention facility for young people is the "Il Bosco" in Tokyo. There are several leading centers for early intervention research and practice in Japan. Most of them are driven by university departments of psychiatry with respect to both research and clinical activities. The development of services for early intervention is expected to reduce stigmatization, prevent suicide among young persons, and promote general knowledge about mental health. There are several common or similar issues among Asian countries, including service systems, community attitudes to psychiatric illness including stigma, and dependence on pharmacotherapy.

A comparison between acupuncture versus zolpidem in the treatment of primary insomnia

Abstract: Background To determine the relative efficacy of acupuncture and zolpidem in the treatment of primary insomnia, we administered a sleep quality scale to thirty-three patients with primary insomnia randomly chosen to receive one of the two therapies at a psychosomatic clinic. Methods A study in the psychosomatic clinic at a teaching hospital in southern Taiwan from November 2007 to November 2008. The 19 patients in acupuncture group underwent one acupuncture session a week. The 14 patients in the control group took zolpidem 1# (10 mg) every night. Members of both groups returned to our clinic once a week for four weeks. The main outcome measure was the Pittsburgh Sleep Quality Index (PSQI). Results Both groups were found to have improved significantly. Using generalized estimating equation analysis to test the variance with group and time as factors, we found both groups improved over time at a similar rate ( p = 0.79). In regression analysis, setting the fourth total PSQI score to zero, the baseline PSQI score was 4.13 ( p p = 0.005), and the third 1.49 ( p = 0.03); men had a higher PSQI score 1.56 than women ( p = 0.02); the increasing age of one year would have lower PSQI score 0.08 ( p p = 0.007). Conclusions Acupuncture might be used as an alternative strategy compared to zolpidem for the treatment of primary insomnia.

Electroconvulsive therapy (ECT) in bipolar disorder: A narrative review of literature.

Abstract: In many countries including India electroconvulsive therapy (ECT) is frequently used to treat different phases of bipolar disorder. The response to ECT is impressive in mania, depression and in mixed affective states. Preliminary evidence also suggests benefit from maintenance ECT in bipolar disorder. However, most of the literature on efficacy and adverse effects comes from case series, retrospective reports and open trials - controlled trials have been few and far between. Official guidelines recommend the use of ECT only when there is a dire emergency or when all other options have been exhausted. Concurrent use of lithium and antiepileptic drugs along with ECT is common in clinical practice. While such practice appears to be largely safe, one should be mindful about dose of lithium and possible interference of antiepileptic drugs with efficacy of ECT. The use of suprathreshold bilateral ECT and bifrontal placement of electrodes may confer some advantage over other methods.

Holistic health and well-being: a psycho-spiritual/religious and theological perspective.

Abstract: Neuro-biological studies have established the perennial teaching of all the world's religious traditions that human persons are primarily religious/spiritual beings. They confirm that religion and spirituality are hardwired into the human brain and into human nature. The transcendental dimension of human nature demands that progress in man's ethical formation and inner growth is the most essential aspect of holistic health. Their experience of the divine led the Hindu sages to commit themselves to establish peace, happiness and well-being for all the human family and the universe. Judeo-Christian theology advocates that human beings created in the image of God have potential for theocentric-transcendence. Catholic theologians like St. Augustine propose that God has made humans for himself and that their hearts are restless until they rest in him. With the revolutionary shift in recent years from attacking faith and religion to the exploration of the benefits of spirituality and religion for human flourishing, the outstanding themes of Christian theology and other religious traditions became topics of research in health sciences. Interdisciplinary interaction will result in attaining a profound understanding of the human person and help him/her to achieve lasting fulfilment by adequately paying attention to the transcendental, religious and spiritual needs.

Sibling care, school performance, and depression among adolescent caretakers in Cambodia.

Abstract: In many resource-poor countries, home-based care for young children is crucial. Yet little has been known about the negative impacts of sibling caretaking on mental health conditions of adolescent student caretakers. This study explored associations between sibling caretaking, school performance, and depression among 1943 students randomly selected from 11 junior high and high schools in Cambodia. The Asian Adolescent Depression Scale was used to measure depressive symptoms. In bivariate analyses, we used χ2 test or Fisher's exact test for categorical variables and t-test or one-way analysis of variance for continuous variables. Multiple linear regression models were then constructed. Of total, 60.1% of our participants took care of their younger sibling(s) regularly during the past one year. The number of siblings under their care ranged from one to nine, and the time they spent for sibling care ranged from one to 10 h per day. After adjustment, increased levels of depressive symptoms remained significantly associated among boys with sibling caretaking (p

Early intervention for psychotic disorders: Real-life implementation in Hong Kong

Abstract: Hong Kong is among the first few cities in Asia to have implemented early intervention for psychosis in 2001. Substantial changes in psychosis service have since taken place. We reviewed available outcome data in Hong Kong, with reference to the philosophy of early intervention in psychosis, discussing experience and lessons learned from the implementation process, and future opportunities and challenges. Data accumulated in the past decade provided evidence for the benefits and significance of early intervention programmes: patients under the care of early intervention service showed improved functioning, milder symptoms, and fewer hospitalizations and suicides. Early intervention is more cost-effective compared with standard care. Stigma and misconception remains an issue, and public awareness campaigns are underway. In recent years, a critical mass is being formed, and Hong Kong has witnessed the unfolding of public service extension, new projects and organizations, and increasing interest from the community. Several major platforms are in place for coherent efforts, including the public Early Assessment Service for Young people with psychosis (EASY) programme, the Psychosis Studies and Intervention (PSI) research unit, the independent Hong Kong Early Psychosis Intervention Society (EPISO), the Jockey Club Early Psychosis (JCEP) project, and the postgraduate Psychological Medicine (Psychosis Studies) programme. The first decade of early intervention work has been promising; consolidation and further development is needed on many fronts of research, service and education.

Family violence influences mental health of school girls in Iran: Results of a preliminary study

Abstract: Introduction The family plays the first and may be the most important role in the development of individuals’ personality, health and function. The current study aimed to evaluate different aspects of violence against a sample of school girls of Iranian population and its effect on their mental health. Methods A cluster, randomized sample consisting of 399 school girls was selected from all of the high schools in Tabriz city, northwest of Iran. Students were asked to participate in this study anonymously. Signs and symptoms of depression and anxiety were assessed by the General health questionnaire-28 (GHQ-28) measuring their social function and physical situation as well. Another inquiry form involving questions about different kinds of violence and neglect gathered information about their situation during the recent year. Results The mean (SD) age of the students was 14.9 (0.8) and all were under 18. The mean (SD) total score of GHQ-28 was 24.18(13.61). The sub-threshold score in GHQ-28 (under 23) was observed in 44.1% of students which indicates considerable problems in mental health status. The type of reported violence was not significantly associated with an abnormal score of GHQ-28. A higher score of somatic symptoms was related to verbal violence at home by parents and the educational level of mother. High score on social dysfunction was predicted by lower educational level of mother. The depression scale was related to humility, neglect and discrimination at home. The factors were not predicting the score of anxiety or insomnia subscales. Discussion The current study observed a noticeable amount of problems in the mental health of teenage girls in a sample of the Iranian population. The educational level of the mother plays an important role in the mental health of school girls.

Pain symptoms in Malay patients with major depression.

Abstract: Objectives There is a strong association between depression and pain, which is influenced by various biological and psychological mechanisms. The objectives of this study were to assess the prevalence and severity of pain symptoms among patients with major depression; and to determine the correlation between pain with clinical variables, neurotic pathology and severity of depression. Methods Fifty-one Malay patients with major depressive disorder without psychotic feature enrolled for the study. They were assessed with the Hamilton Rating Scale for Depression (HAM-D), Brief Pain Inventory (BPI) and Crown Crisp Experiential Index (CCEI). Results The majority (80.4%) of the subjects had experienced pain, but overall severity of the pain was mild (33.3%). There were no statistically significant differences in socio-demographic variables with the status of pain. The prevalence of pain was significantly higher in patients who were still depressed ( p p p Conclusions The somatising patients were heterogeneous group. The pain symptoms were common in severe mixed anxiety–depression, predisposed by the underlying neurotic pathology. Neuroticism and high scores on SOM, DEP and FFA subscales of the CCEI contributed significantly to the pathogenesis of depressed Malay patients with pain symptoms.

Mental health literacy, stigma, and early intervention.

Abstract: Growing evidence suggests that early detection and intervention in people with mental illness may ameliorate, if not prevent, associated distress, reduce patient symptoms and improve quality of life of patients and their caregivers (Addington, 2007; Hetrick et al., 2008; Tang et al., 2010). However, patients and their families often encounter different challenges in seeking mental health services. What’s more, mental health professionals may also experience obstacles in serving these patients and families (Kalra, 2012). This is particularly true for individuals from Asian cultures (Li and Seidman, 2010; Kalra, 2012; Yang et al., 2010; Yeh, 2003). Individuals from Asian cultures, regardless of their gender, age, and location, tend to have lower rates of utilization of mental health services across the world (Loo and Furnham, 2012; US Department of Health and Human Services, 2001a). When they actually enter services, their conditions are more of great severity, ‘‘suggesting that they delay using services until problems become very serious’’ (US Department of Health and Human Services, 2001b). Lack of mental health literacy stands out among the variety of challenges that patients and families from Asian cultures face in seeking care. Individuals who have poor mental health literacy tend to have higher rates of hospitalization and emergency care use. Lack of knowledge about mental illness was in fact one of the most common reasons given by patients from Chinese cultural backgrounds and their parents for their delay in seeking psychiatric help (Chiang et al., 2005). Mental health literacy enhances early recognition and treatment of mental disorders and improves long-term outcomes. Few studies yet have looked at cultural factors associated with mental health literacy. Loo and Furnham (2012) take on the challenge. Using vignettes and questionnaires, they conducted a welldesigned study to examine mental health literacy—public knowledge and beliefs—about depression, in particular, in Malaysian Chinese. The authors reported that the Chinese translation of ‘‘depression’’ is a culturally acceptable term and the literacy level of depression is moderate. However, the participants do not attribute those symptoms to depression, rather to issues with relationship. Stigma and shame have been regarded as ‘‘major deterrents’’ to utilization of services among individuals from Asian cultures (US Department of Health and Human Services, 2001a,b). It is manifested by bias, distrust, stereotyping, fear, embarrassment, anger, shame, and avoidance (Li and Seidman, 2010). Most studies up to now have investigated stigma as experienced by patients and their family members. Mental health professionals in Asian countries like India are ‘‘both recipients of stigma and agents who can destigmatize psychiatry (Kalra, 2012). On the one hand, they are called the ‘‘madmen-treatment doctors,’’ on the other

Intervention for first episode psychosis in India - The SCARF experience

Abstract: Introduction There have been very few studies or programs in India on early intervention for first episode psychoses. This paper reports the findings of a pilot program, part of a collaboration with the Prevention and Early Intervention Program for Psychoses, Montreal. Methodology A sample of 47 patients with first episode psychosis were followed up for 2 years. Complete data was available on 39 subjects at 2 years. This data was analyzed for socio-demographic and clinical variables and its relationship with outcomes and DUP. Those who had a PANSS score 80 were categorized to be in remission ( N = 28) and others as continually ill ( N = 10). Results There was significant improvement from baseline to 1st year with maximal improvement seen at 3 months after intake. However, improvement between 1 and 2 years was not significant. More women relapsed and more men dropped out. 25 out of 28 subjects with shorter DUP ( 2 years DUP. Three different patterns of course of the disorder were found. Single episode followed by total remission for 2 years ( N = 20; 52.6%) was the commonest. The others were relapses followed by remissions ( N = 8; 21.1%), and continuous illness ( N = 10; 26.3%). Conclusion Early intervention is effective and more so if DUP is shorter. PANSS scores and GAF at baseline are not predictive of later outcomes. Medication adherence in therapeutic engagement and psychosocial needs should be considered in the implementation of early intervention programs in our cultural context.