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Open access

Dinesh Bhugra

Abstract

In the past 40 years, the practice of psychiatry has changed dramatically from asylums to community care to personalized home-based treatments. The personal history of working in various settings and changing NHS indicates that an ability to change one’s clinical practice is a critical skill. Being a migrant and an International Medical Graduate brings with it certain specific challenges. Personal histories provide a very specific account that is inherently incomplete and perhaps biased, but personal accounts also give history a tinge that academic accounts cannot. In this account, changes in the NHS have been discussed with regards to changes in clinical care of patients with psychiatric disorders as well as research and training.

Open access

S.M. Yasir Arafat, M A Al Mamun and Md. Saleh Uddin

Abstract

Objectives

Early detection of depression has been assumed to lead to its earlier and better care. Increased depression literacy among the general population might play a vital role in the early and successful detection and treatment. We aimed to investigate depression literacy among the first year university students, to be able to compare their depression literacy with those of other previously investigated groups, we hypothesized that depression literacy might be different from other groups such as patients and other subjects from the general population. Knowledge about depression might also be different in female and male students.

Methods

This cross-sectional study was conducted among the first-year students of Jahangirnagar University, Bangladesh between January and May 2018. A convenience sample of 306 students was randomly identified from a list of students obtained from the authority. Relevant sociodemographic variables were collected. Students were interviewed using the Bangla Depression Literacy scale (D-Lit Bangla). This was a semi structured interview asking for the knowledge on 20 different characteristics of depression. Collected data were analysed to estimate the mean score and 95% confidence intervals of D-Lit Bangla scores.

Results

The mean score of the correctly identified characteristics of depression was 6.55 (95% CI = 6.31 to 6.89). Only five characteristics of depression were correctly identified by more than 50% participants, that is, sleep change (76.7%), feeling of guilt (75.2%), low self-esteem (81.8%), psychomotor changes (64.6%) and identification of famous people suffering from depression (66.7%). Only a very small portion of the participants correctly knew about psychotic symptoms and different options for the treatment of depression. There were no significant differences between male and female students in the amount and pattern of knowledge of depression.

Conclusions

The study revealed poor literacy status among the first-year university students of Bangladesh. Both male and female gender have similar amount of depression literacy.

Open access

S.M. Yasir Arafat

Abstract

Objectives

Bangladesh is a densely populated country in south-east Asia with paucity of research in suicide. This systematic review was aimed at critical appraising various aspects of suicide in Bangladesh based on available literature and systematic search.

Methods

Extensive literature search was conducted in Scopus, PubMed, PubMed Central, Google, Google Scholar and BanglaJOL with searching key words without any date boundary and without any basis of types of studies, that is, all types of studies were scrutinised. The author focused on sources of suicide data along with epidemiological variables of suicides in Bangladesh such as suicide rate, gender of victims, methods of suicides, risk factors and prevention activities and role of media in suicide.

Results

After exclusion of repetitions, screening was performed, and finally, 35 articles were selected for review. Amongst the 35 articles, 16 articles were original contributions, 2 systematic reviews, 6 narrative reviews, 2 scoping reviews, 3 editorials, 3 case reports and rest correspondence article. The review revealed that the actual rate of suicide in Bangladesh is yet to come out and quality data is a real challenge. Women are dying more than the men, and early adulthood is the most vulnerable time of life.

Discussion

Suicide is a under attended problem in Bangladesh, as the country yet to reveal the actual rate of suicide along with the challenge of quality data. Prevention activities have been started but yet to be visualised. Decriminalisation of suicide in the legal criteria and establishment of suicide surveillance can be the top priorities in the country.

Open access

S. M. Yasir Arafat

Abstract

Objectives

There has been a plethora of studies conducted on different aspects of parenting and how it affects children. However, assessment of parenting style and dimension is untouched in Bangladesh. The Parenting Style and Dimension Questionnaire (PSDQ) is a self-reporting questionnaire responded by parents regarding their parenting practices, which assesses the three categories of parenting styles, namely, authoritative, authoritarian, and permissive. It was aimed to adapt and validate PSDQ in Bangla which is the mother tongue of the people of Bangladesh.

Methods

The validation study was conducted from January 2017 to June 2018 in three schools of Dhaka city with the self-reporting semi-structured Bangla version of PSDQ. The adaptation of PSDQ to Bangla was performed according to the state-of-the-art procedure of forward–backward translation. Parents having children aged 6–16 years were approached through schools to participate in the study. Data were collected from 349 parents and analyzed using Statistical Package for the Social Science version 16.0 software.

Results

Cronbach’s alpha of PSDQ Bangla was 0.84, which signifies a good internal consistency. Cronbach’s alpha of authoritative domain was 0.95, authoritarian domain 0.88, and permissive domain 0.78. A total of three factors were extracted using exploratory factor analysis with varimax rotation after discarding four items that had poor correlation and factor loading values. The three extracted factors were authoritative, authoritarian, and permissive; these are similar with the initial three dimensions of PSDQ.

Conclusions

Current study resulted in PSDQ Bangla, which retains 35 items in 3 domains with distribution of 20 items in authoritative domain, 9 items in authoritarian domain, and 6 items in permissive domain. The 35-item PSDQ Bangla can be a psychometrically reliable and valid tool to use in clinical setting of psychiatric practices in Bangladesh, especially to deal with child psychiatric disorders.

Open access

Jenny Hufenreuter, Josephine Otto and Michael Linden

Abstract

Objectives

Training, treatment and quality assurance in occupational therapy need guidelines and manuals. Two manuals and corresponding manual adherence checklists were developed for resistance- and regeneration-oriented treatment strategies, which are standard in occupational therapy. The hypothesis is that occupational therapists can apply different treatments and that this can be measured.

Methods

In a psychiatric-psychosomatic rehabilitation hospital, 108 patients were randomly assigned to the regeneration group and 113 to the resistance group. Patients were asked to indicate on a manual adherence checklist which interventions they had experienced during treatment. Additionally, a convenience sample of 124 patients who had not participated in the special groups but only in routine occupational therapy was interviewed at the end of the hospital stay.

Results

Resistance-oriented interventions were significantly more often reported in the resistance group and regeneration-oriented intervention was reported in the regeneration group.

Conclusions

The study demonstrates that the occupational therapy can be standardised according to treatment manuals and that protocol adherence can be ascertained, similar to that in other psychotherapies. This is important for training, practice, research and quality control, as manual guided and monitored treatment allows transparency in regard to what should and what has been done in therapy.

Open access

Niku Dhillon and Reinhard Heun

Abstract

Objectives

Clozapine is an effective antipsychotic medication licenced for the management of treatment resistant schizophrenia. Due to its non-selective pharmacology, it has a broad range of side effects. Nocturnal enuresis secondary to the use of clozapine has been documented in the literature but may be overlooked, the link between drug and symptom being clinically unnoticed. Patients may not mention urinary symptoms due to supervening psychosis, co-existing symptomatology, embarrassment or shame. By raising awareness of the phenomenon, early recognition and patient support may improve compliance with clozapine medication, and consecutively, overall mental health. Consequently, this systematic review investigates the prevalence of nocturnal enuresis secondary to clozapine use.

Methods

A literature search on clozapine and nocturnal enuresis was used to identify the relevant papers. Papers providing the prevalence data on Clozapine associated nocturnal enuresis were selected for data extraction.

Results

47 papers were initially identified. Eight papers focused on the prevalence of clozapine associated nocturnal enuresis (CANE). Point prevalence (nocturnal enuresis at the time of assessment), 1-month prevalence and episode prevalence (nocturnal enuresis since beginning of clozapine) were given. Papers included patients with schizophrenia, schizoaffective disorder, bipolar affective disorder and psychotic depression, taking clozapine medication. The prevalence of CANE ranged from 10–42%. Point prevalence was 21–27%, 1-month prevalence was 10–39% and episode prevalence was 15–42%. Clozapine was more likely to cause nocturnal enuresis compared to other psychotropic medication.

Conclusion

The prevalence of CANE may be greater than previously thought. However, in order to determine an accurate prevalence of clozapine associated nocturnal enuresis, larger studies with strict inclusion criteria, common definition of diagnosis and prevalence are required. By establishing an accurate prevalence, physician awareness can be improved, and patients can becounselled on the risk of developing the side effect, thus improving early identification and reducing discontinuation rates.

Open access

Reinhard Heun

Abstract

Obsessive compulsive disorder (OCD) is a severe, often long-term mental disorder. It may be independent from, or comorbid with other mental disorders, especially depression and anxiety disorders. Suicidal thoughts, ideations and ruminations are prevalent in subjects with OCD, but it is not yet clear if the incidences of attempted and completed suicides have increased in comparison with the general population and with other psychiatric disorders.

Methods

We conducted a systematic literature search on the incidence of suicide attempts and completed suicides in subjects with OCD. Search terms for Pubmed and Medline were OCD and suicide. We selected papers providing follow-up data on the incidence of attempted and completed suicide in OCD.

Results

404 papers were initially identified. Only 8 papers covering six studies provided prospective data on attempted or completed suicide over a defined period in subjects with OCD, four studies included control subjects. Two studies providing follow-up data were limited to high-risk samples and did not provide enough data on the incidence of suicide in comparison with the general population. The conclusion that there is an increased risk of attempted and completed suicides in OCD can only be based on one large Swedish National Registry sample with an up to 44 year follow up. Psychiatric comorbidity is the most relevant risk factor for suicide.

Conclusions

Even though some studies report an increased incidence of attempted and completed suicides in OCD patients from selected high risk samples, the evidence from population based studies is mostly based on one large Swedish study. More long-term studies in the general population with a reduced risk of subject attrition are needed. Using a clear definition and assessment of suicidal behaviour and a common time-frame would improve the comparability of future studies.

Open access

Giuseppe Carrà, Giulia Brambilla, Manuela Caslini, Francesca Parma, Alessandro Chinello, Francesco Bartoli, Cristina Crocamo, Luigi Zappa and Costanza Papagno

Abstract

Objectives

Since evidence on executive control among women with Anorexia or Bulimia Nervosa (AN/BN) are somehow inconclusive, we aimed to explore whether performance in set-shifting in AN/BN might be influenced by Facial Emotion Recognition (FER).

Methods

We randomly recruited women with a diagnosis of AN or BN, from an Eating Disorders Outpatient Clinic in Italy, as well as healthy controls (HCs). We evaluated with established tools: diagnosis (Eating Disorder Examination- EDE-17.0), executive control (Intra-Extra Dimensional Set Shift-IED) and FER (Ekman 60 Faces Test-EK-60F). Univariate distributions by diagnostic subgroups were assessed on sociodemographic and clinical variables, which were selected for subsequent multiple linear regression analyses.

Results

Women with AN performed significantly worse than HCs on IED adjusted total errors. HCs scored significantly better than AN and BN on EK-60F fear subscale. Although IED set shifting was associated (p = 0.008) with AN, after controlling for age, EK-60F fear subscale, alexithymia and depression (i.e., clinically relevant covariates identified a priori from the literature, or associated with AN/BN at univariate level), this association could not be confirmed.

Conclusions

Impaired executive control may not be a distinctive feature in women with AN, since several clinical characteristics, including fear recognition ability, are likely to have an important role. This has significant implications for relevant interventions in AN, which should aim at also improving socio-emotional processing.

Open access

Eleanor Mari Holzapfel and Christopher Paul Szabo

Abstract

Objectives

To describe the range and frequency of psychotropics used in the management of bipolar disorder in a specific setting as well as describe the nature and frequency of monotherapy versus polypharmacy use. Specifically to determine congruence with recommended standard of care that might inform a review and refinement of prescribing within this context.

Methods

The study was a retrospective file review for patients with bipolar disorder (ICD 10 and or DSM IV TR diagnostic criteria) attending the outpatient clinic of a specialised psychiatric hospital (Tara Hospital) affiliated to the Department of Psychiatry (University of the Witwatersrand) in Johannesburg, South Africa. Data were presented both descriptively (continuous, discrete and categorical data) and with a range of appropriate statistical tests used for associations between categorical data (Chi Square; Fisher’s exact test; Cramer’s V and the phi coefficient).

Results

The majority of patients (93.8%) were prescribed polypharmacy, with 3.2 as the mean number of psychotropic medications prescribed per patient (as determined from the last prescription written during the period of review, i.e. one year). There was a notable variety in the combinations used with no particular combination being prescribed in the majority of patients, noting, however, that 47% of the combinations used included a standard mood stabiliser prescribed together with an antipsychotic.

Conclusions

The current study provides data on the prescribing patterns for bipolar disorder in a specialist psychiatric clinic within an academic complex in South Africa. The findings reflect international studies and highlight polypharmacy and combination treatment as common in such settings. Where polypharmacy is prescribed, the variation in combinations prescribed indicate that whilst treatment guidelines may provide a best practice approach, studies determining the most useful combinations are few and ultimately clinical requirements for individual patients will dictate treatment.

Open access

Matej Stuhec and Jordi Serra-Mestres

Abstract

Objectives

There is almost no data on antidepressant prescribing in older adults treated with polypharmacy, although this population represents approximately 50% of older patients. These patients are frequently excluded from double-blind randomized controlled trials, meta-analyses and existing treatment guidelines. The main aim of this paper was to identify data on antidepressant prescribing in depressed older adults on polypharmacy using a systematic review.

Methods

Randomized controlled clinical trials (RCTs) and other clinical trials in Medline/PubMed without language limitation (-2017) were searched to identify those with older depressed patients on polypharmacy. Only elderly patients (>65 years as mean) were included. Only approved antidepressants were included.

Results

The systematic search identified 26 different clinical trials, although only one clinical open label trial with sertraline met the final inclusion criteria. This sertraline trial indicated the absence of clinically important drug-drug interactions and confirmed the effectiveness and safety of sertraline in routine clinical practice. Heterogeneity in this trial was high in almost all the categories except attrition and reporting bias.

Conclusions

Sertraline has the highest evidence level in older adults with depression on polypharmacy. According to the results of this review and due to a low number of appropriate trials, a basic understanding of psychopharmacology is the possible approach to avoid serious problematic drug combinations in these patients. Newer RCTs are also urgently needed. This is the first systematic review including patients treated with polypharmacy, and therefore, its results are important in the field of evidence-based medicine.