Awareness Of Illness Research Articles

Appropriateness and timeliness of care-seeking for complications of pregnancy and childbirth in rural Ethiopia: a case study of the Maternal and Newborn Health in Ethiopia Partnership

BackgroundIn 2014, USAID and University Research Co., LLC, initiated a new project under the broader Translating Research into Action portfolio of projects. This new project was entitled Systematic Documentation of Illness Recognition and Appropriate Care Seeking for Maternal and Newborn Complications. This project used a common protocol involving descriptive mixed-methods case studies of community projects in six low- and middle-income countries, including Ethiopia. In this paper, we present the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) case study.MethodsMethods included secondary analysis of data from MaNHEP’s 2010 baseline and 2012 end line surveys, health program inventory and facility mapping to contextualize care-seeking, and illness narratives to identify factors influencing illness recognition and care-seeking. Analyses used descriptive statistics, bivariate tests, multivariate logistic regression, and thematic content analysis.ResultsMaternal illness awareness increased between 2010 and 2012 for major obstetric complications. In 2012, 45% of women who experienced a major complication sought biomedical care. Factors associated with care-seeking were MaNHEP CMNH Family Meetings, health facility birth, birth with a skilled provider, or health extension worker. Between 2012 and 2014, the Ministry of Health introduced nationwide initiatives including performance review, ambulance service, increased posting of midwives, pregnant women’s conferences, user-friendly services, and maternal death surveillance. By 2014, most facilities were able to provide emergency obstetric and newborn care. Yet in 2014, biomedical care-seeking for perceived maternal illness occurred more often compared with care-seeking for newborn illness—a difference notable in cases in which the mother or newborn died. Most families sought care within 1 day of illness recognition. Facilitating factors were health extension worker advice and ability to refer upward, and health facility proximity; impeding factors were time of day, weather, road conditions, distance, poor cell phone connectivity (to call for an ambulance), lack of transportation or money for transport, perceived spiritual or physical vulnerability of the mother and newborn and associated culturally determined postnatal restrictions on the mother or newborn’s movement outside of the home, and preference for traditional care. Some families sought care despite disrespectful, poor quality care.ConclusionsImprovements in illness recognition and care-seeking observed during MaNHEP have been reinforced since that time and appear to be successful. There is still need for a concerted effort focusing on reducing identified barriers, improve quality of care and provider counseling, and contextualize messaging behavior change communications and provider counseling.

Mental illness in Bwindi, Uganda: Understanding stakeholder perceptions of benefits and barriers to developing a community-based mental health programme.

BackgroundMental illness has been increasingly recognised as a source of morbidity in low- and middle-income countries and significant treatment gaps exist worldwide. Studies have demonstrated the effectiveness of task sharing through community-based treatment models for addressing international mental health issues.AimThis paper aims to evaluate the perceptions of a wide range of mental health stakeholders in a Ugandan community regarding the benefits and barriers to developing a community-based mental health programme.SettingBwindi Community Hospital (BCH) in south-west Uganda provides services through a team of community health workers to people in the Kanungu District.MethodsThematic analysis of 13 semi-structured interviews and 6 focus group discussions involving 54 community members and 13 mental health stakeholders within the BCH catchment area.ResultsStakeholders perceived benefits to a community-based compared to a hospital-based programme, including improved patient care, lower costs to patients and improved community understanding of mental illness. They also cited barriers including cost, insufficient workforce and a lack of community readiness.ConclusionsStakeholders express interest in developing community-based mental health programmes, as they feel that it will address mental health needs in the community and improve community awareness of mental illness. However, they also report that cost is a significant barrier to programme development that will have to be addressed prior to being able to successfully establish such programming. Additionally, many community members expressed unique sociocultural beliefs regarding the nature of mental illness and those suffering from a psychiatric disease.

Assessing Teachers’ Attitudes Towards Students with Mental Health Disorders in 16 Postsecondary Institutions in Quebec

The number of students with mental health disorders (MHDs) in postsecondary institutions is increasing. Teachers’ attitudes are among the main factors that influence these students’ academic success. Unfortunately, their attitudes are little studied, in part because of lack of validated scales. Therefore, this article has two purposes: (1) analyse the construct validity of new scales assessing teachers’ attitudes, as well as existing scales without an established construct validity; and (2) report the correlations between the variables assessed in these scales, with a special focus on two variables: (a) teachers’ negative attitudes; and (b) the measures offered to students by teachers. The participants are 232 teachers from 16 French and English CEGEPS in Quebec, Canada. The questionnaire includes three scales created by the research team and three scales from the Mental Illness Awareness Survey. Correlational and factor analyses were conducted. The scales present good construct validity. Four variables were associated with the two variables of interest: confidence in one’s ability to convince a student to seek help; familiarity with MHDs; knowledge and understanding of MHDs; favourable perception of the accommodations offered by adapted and psychosocial services. Based on these results, strategies are proposed to improve teachers’ attitudes.

Social Distance and Community Attitudes Towards People with Psycho-Social Disabilities in Uttarakhand, India.

Stigma is an important contributor to the large treatment gap for people with mental and psycho-social disabilities (PPSD) in India. Social distance as assessed by willingness to engage in relationships with PPSD is a proxy measure of stigma and potential discrimination. In North India, investigations of community attitudes towards PPSD have been limited. To describe attitudes towards people with depression and psychosis, acommunity sample of 960 adults in Dehradun district, India from 30 randomised clusters, was surveyed using a validated tool to assess social distance, beliefs and attitudes related to mental illness. Participants preferred greater social distance from a person with psychosis than a person with depression. Beliefs and attitudes around mental illness were diverse reflecting a wide spread of belief frameworks. After controlling for confounding, there was increased social distance among people who believed PPSD were dangerous. Factors that reduced social distance included familiarity with PPSD, and belief that PPSD can recover. Attitudes to PPSD, stigma and social distance are complex and likely to require complex responses that include promoting awareness of mental health and illness, direct contact with PPSD and increasing access to care for PPSD.

Insights on insight

This study examined the reliability, validity and internal structure of the newly developed, interview-based Schedule for the Assessment of Insight in Eating Disorders (SAI-ED) and the relationships of insight with demographic and clinical characteristics in EDs. Ninety-four female patients – 44 with anorexia nervosa (AN) and 50 with bulimia nervosa (BN) – were assessed with SAI-ED. The Brown Assessment of Beliefs Scale was used to evaluate convergent validity of SAI-ED. Hierarchical cluster analysis and multidimensional scaling were used to identify insight components and assess their inter-relationships. The final 8-item SAI-ED demonstrated good psychometric properties. Inter-rater and test-retest reliabilities were high. Three subscales of SAI-ED were identified which measure major insight components: awareness of illness, awareness of symptoms, and treatment engagement. Patients with AN had significant lower score on SAI-ED than patients with BN. Impaired insight was associated with: (a) lower current and lowest lifetime BMI and more severe dietary restrain in AN, (b) illness duration, severity of overall ED symptoms, body-related concerns and obsessionality in BN. Insight is a multidimensional construct in EDs associated with different clinical aspects in AN and BN. The SAI-ED is a valid and reliable tool for the assessment of insight in EDs patients.

"Even Heroes Get Depressed": Sponsorship and Self-Stigma in Canada's Mental Illness Awareness Week.

In 1992, the Canadian Psychiatric Association launched Canada's first national campaign against mental illness, Mental Illness Awareness Week (MIAW). I stress that pharmaceutical sponsorship of the first five years of MIAW (1992-1997) was integral to shaping the trajectory of the campaign and marks a shift in the way stigma is conceived and resisted in Canada: what was an interpersonal process based on social norms becomes refigured as "self-stigma," or an individualized process in which lack of information, education, and self-assessment contribute to an inability to consider oneself as at-risk for a disease, condition, or disorder.

Vitamin and trace element deficiencies in the pediatric dialysis patient.

Pediatric dialysis patients are at risk of nutritional illness secondary to deficiencies in water-soluble vitamins and trace elements. Unlike 25-OH vitamin D, most other vitamins and trace elements are not routinely monitored in the blood and, consequently, the detection of any deficiency may not occur until significant complications develop. Causes of vitamin and trace element deficiency in patients on maintenance dialysis patient are multifactorial, ranging from diminished nutritional intake to altered metabolism as well as dialysate-driven losses of water-soluble vitamins and select trace elements. In this review we summarize the nutritional sources of key water-soluble vitamins and trace elements with a focus on the biological roles and clinical manifestations of their respective deficiency to augment awareness of potential nutritional illness in pediatric patients receiving maintenance dialysis. The limited pediatric data on the topic of clearance of water-soluble vitamins and trace elements by individual dialysis modality are reviewed, including a brief discussion on clearance of water-soluble vitamins and trace elements with continuous renal replacement therapy.

“That proves you mad, because you know it not”: impaired insight and the dilemma of governing psychiatric patients as legal subjects

This article investigates “impaired insight,” a controversial psychiatric category describing a mad person unable to know his or her madness. Like “moral insanity” and other concepts before it, impaired insight offers a way to link the disparate logics of human responsibility in psychiatry and the law. I attribute its development to changes wrought by deinstitutionalization, the rise of antipsychotic medication, and patient incarceration in penal settings. In a system that aims to govern psychiatric patients through their freedom, the logic of impaired insight introduces a wrinkle: can a person make an informed choice to refuse treatment if madness itself impairs awareness of illness? Drawing on tools from the sociology of science, I trace the process by which researchers recast psychodynamic “denial” as a neurological and therefore non-volitional “impairment” in the 1990s. I then show how social movement actors mobilized the materialized form in the legal and policy fields in the 2000s, bringing insight science to bear upon the very questions of custodial management and patient rights that gave birth to it. At stake is this dilemma: how can societies that simultaneously privilege individual responsibility and somatic accounts of behavior govern those at the border of legal capacity, and with what justification?

Kenneth Fung, M.D., Brings Culturally Sensitive Psychiatry to Toronto’s Asian Community

Kenneth Fung, M.D., Brings Culturally Sensitive Psychiatry to Toronto’s Asian Community

397. TDCS Modulates Brain Regions Associated with Impaired Illness Awareness in Schizophrenia Spectrum Disorders

397. TDCS Modulates Brain Regions Associated with Impaired Illness Awareness in Schizophrenia Spectrum Disorders

The predictive role of insight for the evolution of the disease in Romanian patients diagnosed with schizophrenia

IntroductionSchizophrenia is a serious disorder that influences all life aspects of the patients. The most important goals in schizophrenia are remission, recovery, improving psychosocial functioning and quality of life, which can be influenced by different factors, especially insight.ObjectivesTo evaluate the awareness of illness in Romanian patients diagnosed with schizophrenia and to determine the predictive role of insight.AimsThis study wants to highlight the importance of the evaluation of insight in psychotic patients, taking into account that awareness leads to compliance with treatment, decreased rate of relapses and rehospitalization and a better prognosis.Material and methodsOverall, 80 patients (44 males and 36 females) recruited from first and second psychiatric clinic Cluj-Napoca, diagnosed according to ICD-10 and DSM-V criteria with schizophrenia and acute psychotic disorder participated in this study. A semi-structured interview collected demographical data. Psychotic symptoms were evaluated using PANSS, severity of the disease using CGI and insight using SUMD.ResultsOur results showed that the most important predictive factors for the evolution were: level of insight (r = −0.41 P < 0.01), presence of family history (r = 0.24 P < 0.05) and belonging to urban areas (r = 0.23 P < 0.05). The level of insight explained 16% of variance of improving psychotic symptoms during hospitalization.ConclusionsThe awareness of illness is one of the predictive factors for long-term schizophrenia and the best predictive model of disease progression is composed of variables SUMD total and PANSS total on admission.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Comparison of insight in bipolar disorder with and without co-morbid substance use disorders

AimsCompare the level of insight in bipolar disorder (BD) with and without substance use disorders (SUD).MethodsCase-control study during a period of six months from July 2015 to December 2015. One hundred euthymic patients with BD (type I, II or unspecified) were recruited in the department of psychiatry C Razi Hospital, during their follow-up. Two groups were individualized by the presence or not of SUD co-morbidity. We evaluated and compared insight with Birchwood IS scale (with its three sub-scales),ResultsThe mean age was 40.6 years (±16.4). The sex ratio was 2. Sixty-six percent of patients were diagnosed with bipolar disorder type 1 and type 2 bipolar disorder remains.There is no statistically significant difference between bipolar with and without SUD in terms of quality of insight.As for the subscales, bipolar patients with comorbid SUD had lower scores of awareness of any symptoms, whereas there was no significant difference regarding the awareness of illness and the need for treatment between the two populations.ConclusionsCo-morbid SUD can affect the quality of insight in individuals with BD. Patients with this co-morbidity should be targeted for intensive psycho-educational measures and psychotherapeutic interventions focused on the improvement of insight.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Somatic-type delusional disorder and comorbidity mood disorder

Chronic delusional disorder encompasses what classical termed as paranoia and paraphrenia. This disorder is characterized by the presence of one or more non-bizarre, permanent and systematized delusions. Cognitive functions of the patient not affected, judgment and reason are not affected if the subject is not addressed delirious. Delusional theme includes life-like experiences, including: persecution – persecutory type –, suffering from a disease – somatic type –, to be loved by someone famous – erotomaniac type –, the partner is unfaithful – jealous type – or having a special quality or gift – megalomaniac type –. Usually, patients lack awareness of mental illness and often prior to contact with mental health, made a pilgrimage by different specialists looking for an organic explanation.The description of a case report of a 47-year-old male who has a delusional belief body deformity secondary to manipulation by a physiotherapist suffering a muscular pain in the lumbar region is performed. Prior to psychiatric diagnosis, begins a long journey by different specialists.As a consequence, somatic-type delusional disorder is a challenge in the diagnosis and treatment in the medical field because it is required a multidisciplinary approach for these patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Ekbom syndrome in a visually impaired patient with alcohol abuse and OCD: A case report

This is a case report of a 63-year-old patient with no previous attentions in mental health. He is referred by his general practitioner because he presents wounds all over his body. He reports that there is a plague of bugs at his place that bite him everywhere. Therefore, he scratches continuously, trying to remove the stingers, and injuring himself all over. The family ensures there are no bugs at all, but the patient threatens to set fire to the house in order to extinguish the plague or even kill himself. An OCD with cleaning compulsive behavior was also present since many years, as well as an alcohol abuse. The patient required hospitalization in the psychiatry service. Organic cause for the disorder was discarded. Long-acting injectable aripiprazol was introduced and the patient stopped drinking. Progressively, the delusional symptoms began to subside. Now he maintains no awareness of illness but he says the bugs are disappearing and, at least, they do not bite him anymore.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Cancer and serious mental illness: A qualitative exploration–findings

IntroductionSerious mental illness (SMI) is associated with poorer cancer outcomes. Reasons for such inequalities are unclear; those with this comorbidity receive fewer specialist interventions and die earlier than the general population. Further exploratory work is required.ObjectivesExploring the experience of SMI and cancer from the perspective of those affected by this comorbidity and those caring for them professionally or informally.MethodsSemi-structured interviews were conducted with ‘key patients’ living with SMI who had received a cancer diagnosis (n = 7), significant others who had supported key patients (n = 4) and healthcare professionals who had worked with at least one KP (n = 17). A panel of patients and professionals ratified interview guides. Interviews were analysed thematically.ResultsMental health professionals were more confident in their knowledge of the needs of this population than oncology professionals, but were challenged by working with patients with major physical health needs. Key patients’ mental health appeared to remain stable after cancer diagnosis, and they expressed altruism towards others with comorbid cancer and SMI. Significant others and healthcare professionals were more likely to critique systemic aspects of care than were key patients.ConclusionsProfessionals feel challenged when working outside of their usual job role. Training needs include mental illness awareness in an oncology setting. Improved coordination and communication is required, encompassing significant others as well as professional groups. SMI may protect against the psychological impact of cancer. Key patients were keen to provide advice and support to others in similar situations. Further research is needed into these areas.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Public information officers’ social media monitoring during the Zika virus crisis, a global health threat surrounded by public uncertainty

As Zika virus emerged as a global health concern in 2016, it was surrounded in public uncertainty regarding its transmission and health consequences. Health communicators were tasked with managing their own uncertainties and with incomplete information on the virus. Given the misinformation, rumors, and even conspiracy theories surrounding Zika virus, monitoring public awareness and understanding of the mysterious illness on social media could offer critical insight to crisis management. A survey (n=226) was conducted with public information officers (PIOs) at local public health departments across the United States to reveal how they utilize and listen to social media during public health crises. In addition to an overall low rate of social media monitoring reported by PIOs, troublesome disparities exist based on community size served. However, there were positive relationships between social media monitoring and satisfaction with overall departmental crisis management as well as preparedness for Zika. These and many other monitoring trends are explored.

M90. Associations of Cortical Thickness With Awareness of Illness in Enduring Schizophrenia

M90. Associations of Cortical Thickness With Awareness of Illness in Enduring Schizophrenia

SU56. Impaired Illness Awareness and Leftward Visuospatial Inattention in Schizophrenia Are Attributable to a Common Neural Deficit—Posterior Parietal Hemispheric Imbalance

SU56. Impaired Illness Awareness and Leftward Visuospatial Inattention in Schizophrenia Are Attributable to a Common Neural Deficit—Posterior Parietal Hemispheric Imbalance

Poster Number: EI 14 - Impaired Illness Awareness is an Independent Predictor of Conversion From Mild Cognitive Impairment to Alzheimer's Disease and a Function of Reduced Brain Metabolism: An ADNI Study

Poster Number: EI 14 - Impaired Illness Awareness is an Independent Predictor of Conversion From Mild Cognitive Impairment to Alzheimer's Disease and a Function of Reduced Brain Metabolism: An ADNI Study

Insight and suicidality in psychosis: A cross-sectional study

AimsWe aimed to test whether specific insight dimensions are associated with suicidality in patients with psychotic disorders. Methods143 patients with schizophrenia spectrum disorders were recruited. Suicidality was assessed by item 8 of the Calgary Depression Scale for Schizophrenia (CDSS). Insight was measured by the Scale of Unawareness of Mental Disorder (SUMD) and the Markova and Berrios Insight Scale. Bivariate analyses and multivariable logistic regression models were conducted. ResultsThose subjects aware of having a mental illness and its social consequences had higher scores on suicidality than those with poor insight. Awareness of the need for treatment was not linked with suicidality. The Markova and Berrios Insight scale total score and two specific domains (awareness of “disturbed thinking and loss of control over the situation” and “having a vague feeling that something is wrong”) were related to suicidality. However, no insight dimensions survived the multivariable regression model, which found depression and previous suicidal behaviour to predict suicidality. ConclusionsSuicidality in psychosis was linked with some insight dimensions: awareness of mental illness and awareness of social consequences, but not compliance. Depression and previous suicidal behaviour mediated the associations with insight; thus, predicting suicidality.