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Eating disorders, risk and management: a personal journey and a South African and African perspective

Abstract

Eating disorders are amongst the most, disabling and lethal of psychiatric conditions. These conditions affect predominantly adolescent and young adult females, but not exclusively so. Whilst stereotypically diagnosed in western, urban societies their emergence in a range of population groups beyond the aforementioned has challenged the stereotype – no more so than in South Africa where eating disorders had not been diagnosed in black, female South Africans until the 1990s. Creating awareness of the changing demographic profile and thus risk was critical in ensuring appropriate diagnosis and management. Whilst this was a key feature of my personal journey there were numerous other aspects of risk explored for the development of eating disorders, as well as management, which will be highlighted and discussed in the paper. This has been especially relevant within the South African context.

Open access
Association of severity of depressive symptoms with sleep quality, social support and stress among Pakistani medical and dental students: A cross-sectional study

Abstract

Objectives

This study has been designed to elucidate the prevalence of stress, depression and poor sleep among medical students in a Pakistani medical school. There is a paucity of data on social support among medical students in Pakistan; an important predictor of depressive symptoms. Therefore, this study was also aimed to demonstrate the direct and indirect impact of social support in alleviating depressive symptoms in the study sample.

Methods

This observational cross-sectional study was conducted in Lahore, Pakistan, where a total of 400 students at a medical school were approached between 1st January to 31st March 2018 to participate in the study. The study sample comprised of medical and dental students enrolled at a privately financed Pakistani medical and dental school. The participants responded to a self-administered survey comprising of five parts: a) demographics, b) Pittsburgh Sleep Quality Index (PSQI), c) Patient Health Questionnaire-9 (PHQ-9), d) Multidimensional Scale of Perceived Social Support (MSPSS) and e) Perceived Stress Scale-4 (PSS-4). All data were analysed using SPSS v. 20. Linear regression analysis was used to reveal the predictors of depression.

Results

In total, 353 medical students participated, yielding a response rate of 88.25%. Overall, poor sleep quality was experienced by 205 (58.1%) students. Mild to severe depression was reported by 83% of the respondents: mild depression by 104 (29.5%), moderate depression by 104 (29.5%), moderately severe depression by 54 (15.3%) and severe depression by 31 (8.8%) respondents. Subjective sleep quality, sleep latency, daytime dysfunction and stress levels were significantly associated with depression symptoms. Social support was not significantly associated with depressive symptoms in the regression model (Beta = -0.08, P < 0.09); however, it acted as a significant mediator, reducing the strength of the relationship between depressive symptoms and sleep quality and stress.

Conclusions

According to our study, a large proportion of healthcare (medical and dental) students were found to be suffering from mild to moderate depression and experienced poor sleep quality. It is concluded that social support is an important variable in predicting depressive symptomatology by ameliorating the effects of poor sleep quality and high stress levels.

Open access
Barriers and facilitators to conducting research by early career psychiatrists: a literature review

Abstract

Objectives

To understand and identify factors that promote and prevent research participation among early career psychiatrists (ECPs), in order to understand what would encourage more ECPs to pursue a research career.

Methods

We conducted an electronic search of databases (PubMed and the Cochrane library) using the keywords ‘doctors’, ‘trainees’, ‘residents’, ‘physicians’ and ‘psychiatric trainees’ as well as ‘research’ (MeSH) and ‘publishing’ (MeSH). This search was complemented by a secondary hand search.

Results

We identified 524 articles, of which 16 fulfilled inclusion criteria for this review. The main barriers included lack of dedicated time for research, lack of mentoring and lack of funding. The main facilitators were opportunities to receive mentorship and access to research funding.

Conclusions

Action is needed to counteract the lack of ECPs interested in a career in research. Specific programs encouraging ECPs to pursue research careers and having access to mentors could help increase the current numbers of researching clinicians in the field.

Open access
The effects of Guarana (Paullinia cupana) supplementation on the cognitive performance of young healthy adults – a Systematic Review

Abstract

Objectives

Guarana (Paullinia cupana) from the Sapindaceae family, native to the Amazon basin, is a natural stimulant herb that can be found in popular energy drinks, pharmaceutical shops or local herb shops. With the use of natural health products increasing, guarana has gained a fair amount of popularity in the past years. In this systematic review, we examined the effects of guarana supplementation on cognitive performance. A secondary objective was to compare guarana with caffeine on cognitive performance.

Methods

Searches were made in PubMed using the terms ‘Guarana’ or ‘Paullinia cupana’. Filters focused on Controlled Clinical trials. Inclusion criteria were met by studies using interventions with guarana, while focusing on guarana’s effects on cognition. Participants needed to be young, healthy adults. Studies not published in English or Greek were excluded. The last date of our search was March 7, 2019.

Results

A total of 29 studies were identified and screened. After screening, 17 studies were excluded. The remaining 12 studies were found eligible for data extraction. After reading the full text of the 12 studies, 3 studies were excluded. In the end, 9 studies were found eligible for our systematic review (n = 369 participants). In these studies, guarana showed to improve reaction time and accuracy of performance at cognitive tasks. No significant differences were found when comparing guarana with caffeine.

Conclusion

Guarana seems to improve reaction time and accuracy of performance at tasks, but no significant effects were found when compared with caffeine. High quality randomized controlled clinical trials with a low risk of bias are needed to further study the herb.

Open access
Anxiety In A Dental And Maxillofacial Surgery Consulting Room: Does Previous Experience Matter?

Abstract

Objectives

To explore the associations between previous dental visits and dental anxiety among patients presenting at the dental and maxillofacial surgery clinic of Department of Dental and Maxillofacial Surgery, Federal Medical Centre, Birnin Kebbi, Nigeria.

Materials and methods

This study was a cross-sectional study conducted among 172 patients. Study instrument was a 9-item structured questionnaire, which obtained information about the participants regarding their: demographic profile; previous dental experience; and dental anxiety status in a dental and maxillofacial surgery consulting room. Data collected were analyzed using the SPSS Version 20 Software. Associations between variables were evaluated using Chi-square statistics using a p < 0.05 to determine the level of statistical significance.

Results

Roughly, six-tenth (57.6%) of the participants were males. The observed prevalence of dental anxiety among the participants was 47.7%. A history of pain experience during past dental treatment as well as a history of past dental visit were found to have statistically significant relationships with participants’ dental anxiety status (p-values < 0.05). However, the frequency of previous dental visits, a history of past dental treatment, and a history of use of intraoral injections in the course of past dental treatment were found to have no statistically significant relationship with participants’ status of dental anxiety (p-values > 0.05). Finally, the prevalence of dental anxiety among the groups of female folks with “a history of previous visit to a dentist” and “a history of pain experience in the past dental treatment” were found to be significantly higher than that observed among similar groups among the male folks (p-values < 0.05).

Conclusion

Previous experience of pain plays a major role of influence over dental anxiety experience among patients. Hence, dental practitioners need to pay more attention towards dental anxiety management among patients, especially women.

Open access
Psychometric properties of the Bangla version of the Kessler Psychological Distress Scale (K6)

Abstract

Objective

The 6 item Kessler Psychological Distress Scale (K6) is a screening tool for psychological distress with robust psychometric properties; however, information is lacking on such properties of the scale on its Bangla version. The aim of this study was to evaluate the psychometric properties of the Bangla version of the K6 scale in young people.

Method

A self-administered questionnaire survey was conducted between August 2017 and April 2018 among 718 students aged 13-24 years (45% females) from Dhaka, Bangladesh. Psychological distress was assessed using the Bangla K6. The survey was repeated in a week. Statistical software AMOS 25 and Stata SE 14 were used to conduct the analyses.

Results

The Bangla K6 scale demonstrated an acceptable internal consistency with high Cronbach alpha. Principal component analysis confirmed a single-factor structure of the scale. Confirmatory factor analysis supported the one-factor structure of the scale with adequate fit to the survey data. Test-retest reliability was acceptable with good reliability coefficients. Receiver operating characteristic analyses showed good prediction of depressive symptoms by the Bangla K6 scores.

Discussion

This study provides an initial support for the Bangla K6 scale as an acceptable instrument to assess psychological distress of Bangla-speaking young people. More research is needed to understand our ability to identify vulnerable individuals, whose native language is Bangla and who are in need of mental health support.

Open access
Adherence to Mediterranean diet and risk of depression later in life. A cross sectional study in East Attica, Greece

Abstract

Objectives

The purpose of the present study was to estimate the prevalence of depression later in life in an urban area and to investigate the associations between possible risk and protective factors including adherence to a Mediterranean diet.

Methods

A cross-sectional study was conducted among the active members of the open day-care centres for older people, in East-Attica, Greece. An anonymous questionnaire was developed to collect basic demographic and medical data, the Geriatric Depression Scale (GDS-15) was applied to screen the elderly for depressive symptoms, the Athens Insomnia Scale (AIS) was used to quantify sleep disturbances and adherence to the Mediterranean diet was evaluated using the Mediterranean Diet Score (MDS). Statistics was processed with SPSS 24.0.

Results

154 older adults took part in the study. According to GDS-15, 24.7% (21.4% moderate and 3.2% severe type) screened positive for depressive symptoms. 29.9% of the participants reported inadequate sleep, based on AIS. Depression and insomnia in older participants were more frequent in women than in men, in lower educated, in participants with lower monthly income and in older people with comorbidity (p < 0.05).

MDS revealed that adherence to a Mediterranean diet was moderate for 64.3% of the participants, and it was high for 34.4%. Depression diagnosed by a physician, was strongly associated with MDS (p = 0.035) and AIS (p = 0.001). Logistic regression analysis results revealed a diet higher in vegetables and lower in poultry and alcohol was associated with decreased likelihood of developing symptoms of depression later in life.

Conclusions

Our results support that depression in older adults is common and strongly associated with several risk factors. Adherence to a Mediterranean diet may protect against the development of depressive symptoms in older age. Moreover, not only diet but also sleep-deficiency might contribute to the depression later in life.

Open access
Positive impact of clinical pharmacist interventions on antipsychotic use in patients on excessive polypharmacy evidenced in a retrospective cohort study

Abstract

Objectives

Although antipsychotic prescribing in elderly patients using polypharmacy has not been studied in well-designed clinical trials and meta-analyses, there is an urgent need to monitor prescribing practice in this population. One of the possible approaches to optimize pharmacotherapy may be the involvement of clinical pharmacists (CPs). The aim of this research was to examine whether the involvement of a CP can improve treatment guidelines adherence and change the total number of medications per patient in older patients who are treated with excessive polypharmacy that includes antipsychotics.

Methods

This cohort retrospective study included older patients (65 years or older) treated with at least one antipsychotic and excessive polypharmacy (10 or more medications concurrently) between 2012 and 2014 in primary care. The main outcome measures were antipsychotic treatment guidelines’ adherence and the total number of medications per patient after the CP’s interventions. Only interventions including antipsychotics were studied in detail (i.e., discontinuation, switching, initiation, dose adjustment, change of another medication because of a drug-related problem). Data on diagnoses, patient pharmacotherapy and the CP’s interventions were obtained from clinical records and medical reviews. Age and acceptance of the CP’s interventions were used as predictive factors for antipsychotic treatment guidelines’ adherence.

Results

Forty-nine patients were included. The CP suggested 21 different interventions of which nine (42.8%) were accepted by the general practitioners. The number of medications that patients received decreased after the CP’s interventions (N of medications before: 15.4; N of medications after: 12.0, p < 0.05). The acceptance of the CP’s recommendations, but not age, improved antipsychotic treatment guidelines’ adherence (p = 0.041).

Conclusions

These results show that a collaborative care approach including a CP in primary care significantly improved the adherence to treatment guidelines. The results also support the implementation of this service in the Slovenian healthcare system, although more studies are needed.

Open access
Cognitive entrainment to isochronous rhythms is independent of both sensory modality and top-down attention

Abstract

The anisochrony of a stimulus sequence was manipulated parametrically to investigate whether rhythmic entrainment is stronger in the auditory modality than in the visual modality (Experiment 1), and whether it relies on top-down attention (Experiment 2). In Experiment 1, participants had to respond as quickly as possible to a target presented after a sequence of either visual or auditory stimuli. The anisochrony of this sequence was manipulated parametrically, rather than in an all or none fashion; that is, it could range from smaller to larger deviations of the isochrony (0, 10, 20, 50, 100, 150 and 200 ms). We compared rhythmic entrainment patterns for auditory and visual modalities. Results showed a peak of entrainment for both isochrony and deviations of isochrony up to 50 ms (i.e., participants were equally fast both after the isochronous sequences and after 10, 20 and 50 ms deviations), suggesting that anisochronous sequences can also produce entrainment. Beyond this entrainment window, the reaction times became progressively slower. Surprisingly, no differences were found between the entrainment patterns for auditory and visual rhythms. In Experiment 2, we used a dual-task methodology by adding a working memory n-back task to the procedure of Experiment 1. Results did not show interference of the secondary task in either auditory or visual modalities, with participants showing the same entrainment pattern as in Experiment 1. These results suggest that rhythmic entrainment constitutes a cognitive process that occurs by default (automatically), regardless of the modality in which the stimuli are presented, and independent of top-down attention, to generate behavioural benefits.

Open access
Context dependency as a Function of Prediction Error-Based Attention

Abstract

Context dependence of information has been shown to be based, at least in part, on the attention contexts received at the time of training. Recent research suggests that attention to irrelevant contexts may be a byproduct of the activation of a general exploratory attentional mechanism prompted by high prediction errors associated with situations of uncertainty. Alternatively, low prediction errors may engage an attentional mechanism of exploitation in situations in which contexts play a relevant role. A selective review discusses the potential of this approach to explain context switch effects from an attentional perspective.

Open access