Health Disorders In People Research Articles

Prevalence of Mental Health Disorders Among Individuals Experiencing Homelessness

Several factors may place people with mental health disorders, including substance use disorders, at increased risk of experiencing homelessness and experiencing homelessness may also increase the risk of developing mental health disorders. Meta-analyses examining the prevalence of mental health disorders among people experiencing homelessness globally are lacking. To determine the current and lifetime prevalence of mental health disorders among people experiencing homelessness and identify associated factors. A systematic search of electronic databases (PubMed, MEDLINE, PsycInfo, Embase, Cochrane, CINAHL, and AMED) was conducted from inception to May 1, 2021. Studies investigating the prevalence of mental health disorders among people experiencing homelessness aged 18 years and older were included. Data extraction was completed using standardized forms in Covidence. All extracted data were reviewed for accuracy by consensus between 2 independent reviewers. Random-effects meta-analysis was used to estimate the prevalence (with 95% CIs) of mental health disorders in people experiencing homelessness. Subgroup analyses were performed by sex, study year, age group, region, risk of bias, and measurement method. Meta-regression was conducted to examine the association between mental health disorders and age, risk of bias, and study year. Current and lifetime prevalence of mental health disorders among people experiencing homelessness. A total of 7729 citations were retrieved, with 291 undergoing full-text review and 85 included in the final review (N = 48 414 participants, 11 154 [23%] female and 37 260 [77%] male). The current prevalence of mental health disorders among people experiencing homelessness was 67% (95% CI, 55-77), and the lifetime prevalence was 77% (95% CI, 61-88). Male individuals exhibited a significantly higher lifetime prevalence of mental health disorders (86%; 95% CI, 74-92) compared to female individuals (69%; 95% CI, 48-84). The prevalence of several specific disorders were estimated, including any substance use disorder (44%), antisocial personality disorder (26%), major depression (19%), schizophrenia (7%), and bipolar disorder (8%). The findings demonstrate that most people experiencing homelessness have mental health disorders, with higher prevalences than those observed in general community samples. Specific interventions are needed to support the mental health needs of this population, including close coordination of mental health, social, and housing services and policies to support people experiencing homelessness with mental disorders.

The Correlation Between Stigma and Mental Health Disorders in People Living with HIV/AIDS

Stigma remains a significant challenge for people living with HIV/AIDS(PLWHA) despite the advances that have been made in HIV care and treatment. It is known to affect health care outcomes including care seeking habits and medication adherence. In addition to contributing to poor health outcomes, stigma is known to increase the risk of developing mental health disorders. Various researchers have found a correlation between stigma and mental health disorders including depression, anxiety, mental distress, stress, post-traumatic stress disorder (PTSD), and suicidal ideation. The aim of this review is to explore the association between stigma and mental health disorders in PLWHA. It identifies common mental health disorders found in people living with HIV and how these disorders are linked to stigma. The review also identifies how stigma and mental health disorders affect healthcare outcomes of PLWHA. The review concludes by providing a number of measures that can help to end stigma and improve overall health outcomes of PLWHA.
 Keywords: stigma, HIV-related stigma, HIV/AIDS, mental health disorders, people living with HIV/AIDS

Age- and sex-specific hospital bed-day rates in people with and without type 2 diabetes: A territory-wide population-based cohort study of 1.5 million people in Hong Kong.

Type 2 diabetes affects multiple systems. We aimed to compare age- and sex-specific rates of all-cause and cause-specific hospital bed-days between people with and without type 2 diabetes. Data were provided by the Hong Kong Hospital Authority. We included 1,516,508 one-to-one matched people with incident type 2 diabetes (n = 758,254) and those without diabetes during the entire follow-up period (n = 758,254) between 2002 and 2018, followed until 2019. People with type 2 diabetes and controls were matched for age at index date (±2 years), sex, and index year (±2 years). We defined hospital bed-day rate as total inpatient bed-days divided by follow-up time. We constructed negative binominal regression models to estimate hospital bed-day rate ratios (RRs) by age at diabetes diagnosis and sex. All RRs were stratified by sex and adjusted for age and index year. During a median of 7.8 years of follow-up, 60.5% (n = 459,440) of people with type 2 diabetes and 56.5% (n = 428,296) of controls had a hospital admission for any cause, with a hospital bed-day rate of 3,359 bed-days and 2,350 bed-days per 1,000 person-years, respectively. All-cause hospital bed-day rate increased with increasing age in controls, but showed a J-shaped relationship with age in people with type 2 diabetes, with 38.4% of bed-days in those diagnosed <40 years caused by mental health disorders. Type 2 diabetes was associated with increased risks for a wide range of medical conditions, with an RR of 1.75 (95% CI [confidence interval] [1.73, 1.76]; p < 0.001) for all-cause hospital bed-days in men and 1.87 (95% CI [1.85, 1.89]; p < 0.001) in women. The RRs were greater in people with diabetes diagnosed at a younger than older age and varied by sex according to medical conditions. Sex differences were most notable for a higher RR for urinary tract infection and peptic ulcer, and a lower RR for chronic kidney disease and pancreatic disease in women than men. The main limitation of the study was that young people without diabetes in the database were unlikely to be representative of those in the Hong Kong general population with potential selection bias due to inclusion of individuals in need of medical care. In this study, we observed that type 2 diabetes was associated with increased risks of hospital bed-days for a wide range of medical conditions, with an excess burden of mental health disorders in people diagnosed at a young age. Age and sex differences should be considered in planning preventive and therapeutic strategies for type 2 diabetes. Effective control of risk factors with a focus on mental health disorders are urgently needed in young people with type 2 diabetes. Healthcare systems and policymakers should consider allocating adequate resources and developing strategies to meet the mental health needs of young people with type 2 diabetes, including integrating mental health services into diabetes care.

Глутатион как прогностический фактор риска нарушения здоровья работающих лиц

Redox balance plays the key role in maintaining health. Optimizing glutathione levels has been proposed as a strategy for health promotion and disease prevention, although cause-effect relationships between glutathione status and disease risk or treatment have not been fully clarified. This study aims to estimate glutathione as a non-specific prognostic risk factor of health disorders in people exposed to industrial aerosols at their workplaces. Our observation covered the following occupational groups: workers employed at a metallurgic plant who contacted industrial aerosols (welding and silicon-containing aerosols with predominantly fibrogenic effects); patients with non-obstructive chronic industrial bronchitis (NCIB) without exacerbation; patients suffering from occupational chronic obstructive pulmonary disease (oCOPD) who were in a post-exposure period; workers who were not exposed to industrial aerosols at their workplaces. Total glutathione (TG), reduced glutathione (GSH) and oxidized glutathione (GSSG) were identified in whole blood by the Ellman method. Elevated GSSG levels (higher than 100 µmol/l) and low values of the GSH/GSSG ratio (less than 10 units) were identified in more than 50 % of the workers exposed to industrial aerosols. These markers were established to have diagnostic sensitivity of more than 50 %, diagnostic specificity of more than 85 % and prognostic significance of more than 80 % for the examined groups. The GSSG level and GSH/GSSG ratio can be used as a prognostic indicator of health disorders in workers exposed to industrial aerosols and a possibility of chronic bronchopulmonary pathology developing in future.

Glutathione as a prognostic factor of health risk in working population

Redox balance plays the key role in maintaining health. Optimizing glutathione levels has been proposed as a strategy for health promotion and disease prevention, although cause-effect relationships between glutathione status and disease risk or treatment have not been fully clarified. This study aims to estimate glutathione as a non-specific prognostic risk factor of health disorders in people exposed to industrial aerosols at their workplaces. Our observation covered the following occupational groups: workers employed at a metallurgic plant who contacted industrial aerosols (welding and silicon-containing aerosols with predominantly fibrogenic effects); patients with non-obstructive chronic industrial bronchitis (NCIB) without exacerbation; patients suffering from occupational chronic obstructive pulmonary disease (oCOPD) who were in a post-exposure period; workers who were not exposed to industrial aerosols at their workplaces. Total glutathione (TG), reduced glutathione (GSH) and oxidized glutathione (GSSG) were identified in whole blood by the Ellman method. Elevated GSSG levels (higher than 100 µmol/l) and low values of the GSH/GSSG ratio (less than 10 units) were identified in more than 50 % of the workers exposed to industrial aerosols. These markers were established to have diagnostic sensitivity of more than 50 %, diagnostic specificity of more than 85 % and prognostic significance of more than 80 % for the examined groups. The GSSG level and GSH/GSSG ratio can be used as a prognostic indicator of health disorders in workers exposed to industrial aerosols and a possibility of chronic bronchopulmonary pathology developing in future.

Hospitalisation for mental health disorders in Australians with type 1 or type 2 diabetes

AimsTo determine the burden and leading reasons for mental health hospitalisation among Australians with diabetes. MethodsWe determined the incidence of hospitalisation for all mental health disorders in people with type 1 or type 2 diabetes of all ages by linking the National Diabetes Services Scheme to hospital admission datasets from 2010 to 2017. We compared those with type 2 diabetes aged 15 and above to the general population using excess hospitalisations per 100,000 person-years associated with diabetes. ResultsDepressive disorders were the leading reason for mental health admission in Australians with diabetes, responsible for 6.09 (95% CI 5.78–6.42) and 7.05 (6.95–7.14) admissions per 1,000 person-years in those with type 1 and type 2 diabetes, respectively. When considering only one admission per person, mental health admission rates were up to 90% lower. Among males with type 2 diabetes, stress and adjustment disorders were the leading cause of excess admissions compared to the general population, while depressive disorders were the leading cause in females. ConclusionsWe found a substantial burden of psychiatric hospitalisations among Australians with diabetes, reinforcing the importance of mental health awareness among diabetes clinicians, and support by psychiatric teams for those with diabetes to prevent readmission.

Nonadherence to systemic immune-modifying therapy in people with psoriasis during the COVID-19 pandemic: findings from a global cross-sectional survey.

Nonadherence to immune-modifying therapy is a complex behaviour which, before the COVID-19 pandemic, was shown to be associated with mental health disorders in people with immune-mediated diseases. The COVID-19 pandemic has led to a rise in the global prevalence of anxiety and depression, and limited data exist on the association between mental health and nonadherence to immune-modifying therapy during the pandemic. To assess the extent of and reasons underlying nonadherence to systemic immune-modifying therapy during the COVID-19 pandemic in individuals with psoriasis, and the association between mental health and nonadherence. Online self-report surveys (PsoProtectMe), including validated screens for anxiety and depression, were completed globally during the first year of the pandemic. We assessed the association between anxiety or depression and nonadherence to systemic immune-modifying therapy using binomial logistic regression, adjusting for potential cofounders (age, sex, ethnicity, comorbidity) and country of residence. Of 3980 participants from 77 countries, 1611 (40.5%) were prescribed a systemic immune-modifying therapy. Of these, 408 (25.3%) reported nonadherence during the pandemic, most commonly due to concerns about their immunity. In the unadjusted model, a positive anxiety screen was associated with nonadherence to systemic immune-modifying therapy [odds ratio (OR) 1.37, 95% confidence interval (CI) 1.07-1.76]. Specifically, anxiety was associated with nonadherence to targeted therapy (OR 1.41, 95% CI 1.01-1.96) but not standard systemic therapy (OR 1.16, 95% CI 0.81-1.67). In the adjusted model, although the directions of the effects remained, anxiety was not significantly associated with nonadherence to overall systemic (OR 1.20, 95% CI 0.92-1.56) or targeted (OR 1.33, 95% CI 0.94-1.89) immune-modifying therapy. A positive depression screen was not strongly associated with nonadherence to systemic immune-modifying therapy in the unadjusted (OR 1.22, 95% CI 0.94-1.57) or adjusted models (OR 1.14, 95% CI 0.87-1.49). These data indicate substantial nonadherence to immune-modifying therapy in people with psoriasis during the pandemic, with attenuation of the association with mental health after adjusting for confounders. Future research in larger populations should further explore pandemic-specific drivers of treatment nonadherence. Clear communication of the reassuring findings from population-based research regarding immune-modifying therapy-associated adverse COVID-19 risks to people with psoriasis is essential, to optimize adherence and disease outcomes.

Mental health disorders in patients with end-stage renal failure

Renal failure is commonly accompanied by psychological distress compounding to mental health conditions such as anxiety and depression. Common risk factors towards the development of mental health disorders in people with renal failure include the need to attend regular hemodialysis session and the burden of related complications. A growing body of evidence has elucidated the biochemical and immunological underpinnings of mental health disorders in the context of renal failure. This knowledge calls for strengthening the existing mental health support frameworks and conducting research with the reported molecular pathways as potential therapeutic targets

Bangladeshi Health Practitioner Knowledge, Confidence in Diagnosis, and Treatment of Mental Health Disorders in People with Intellectual Disabilities

ABSTRACT Background Intellectual disability and mental health disorders constitute a major health problem globally with higher economic burden in low- and middle-income countries such as Bangladesh. In 2017, the World Bank estimated that 85% of the global population lived in low-middle-income countries. Limited research has explored health practitioner knowledge and/or confidence in the diagnosis and treatment of mental health issues in persons with intellectual disabilities (IDs) in low-income countries such as Bangladesh. Method One hundred and ninety-seven Bangladeshi-based health practitioners were grouped into 7 main professional groups according the current Bangladeshi health hierarchy (psychiatrists; traditional healers and community workers; medical doctors; nurses; psychologists; allied health: speech therapists, occupational therapists, social workers; and others: teachers physiotherapists, administration staff). A 34-item online survey was completed, which included questions measuring symptoms of common mental health disorders with reference to the Psychiatric Assessment Schedule for Adults with Developmental Disabilities, and questions measuring confidence working with persons with IDs from the Therapy Confidence Scale-Intellectual Disabilities. Results Participants demonstrated low knowledge of symptomology but were “confident” working with people with IDs. Kruskal–Wallis H tests indicated a significant effect of professional group on both overall knowledge and confidence levels, respectively. Traditional healers and community health workers had significantly more knowledge of symptoms than all other practitioners for obsessive-compulsive disorder, depression, psychosis, and hypomania. Conclusion Participants demonstrated confidence, but low knowledge, in treating individuals with IDs. The development of training programs to address specific deficits in knowledge of mental health symptoms, and confidence in using assessment and assessment-based communication, is recommended.

Modified body - symbol of risk or resources?

Tattooing and body piercing are becoming more and more popular. The psychological approach to body modifications remains heterogeneous. The purpose of this replication was to assess the level of life satisfaction and self-esteem, as well as to reveal subjectively experienced symptoms of mental health disorders in people who reported having a tattoo and/or piercing during the coronavirus epidemic. Method. The research was conducted in the period from April to June 2020 in an on-line form. Participants (N = 557) were 15-68 years old. There were no significant differences in perceived life satisfaction, self-esteem and mental health assessment between people with and without body modifications. The revealed differences in the dimensions of self-esteem and the number of subjective depressive symptoms turned out to be accidental. All participants in the study (regardless of having body modification) were aware of having and the ability to use personal resources to deal with the COVID-19 pandemic. Body modifications should not be considered a risk factor. Especially among tattooed people, the self-assessment of psychological functioning increased with the increase in life satisfaction.

ОТДАЛЕННЫЙ СЛЕД ЭКОЛОГИЧЕСКИХ КАТАСТРОФ НА ГЕНЕТИКО-РЕПРОДУКТИВНЫЙ ПОТЕНЦИАЛ ПОКОЛЕНИЙ

The paper discusses and highlights the promising modern environmental problems that affect pollution and environmental destruction, affecting the health status of the population. The deterioration of the situation cannot be justified and compensated for by the positive results of the progress of civilization - today the decaying environment is gaining more and more weight even in comparison with the well-being and economic prosperity of developed countries, affecting the dynamics of the state of health. The studies carried out to determine the relationship between the development of psycho-somatic morbidity and environmental factors of environmental pollution are confirmed by a direct correlation dependence. Studies of the evolution of populations and species are described in detail under the increased pressure of mutations caused by pollution of the biosphere of an atomic and nuclear agent. However, until now, these studies have not been carried out with the required depth and scope. The proposed human genetic monitoring sets itself the task of determining the volume and dynamics of the hereditary health disorders in people caused by the influence of the genetic load. It has been proved that the main, methodologically, when working on genetic monitoring of a person is that an increase in the number of genetic pathologies in the population can be established only when reliable quantitative data are obtained. Thus, an absolutely acceptable solution to the contradictions between the quality of health and the state of the ecological situation has not yet been proposed.

Examining common mental health disorders in people living with HIV on methadone maintenance therapy in Hanoi, Vietnam

BackgroundInjection drug use drives HIV transmission in Southeast Asia, where around a quarter of users are living with HIV. Vietnam developed Methadone Maintenance Therapy (MMT) programs to reduce unsafe drug abuse. Common mental health disorders (CMD), including depression, anxiety and post-traumatic stress disorder (PTSD), can worsen MMT outcomes and are highly prevalent among people living with HIV (PLH). We aimed to characterize HIV and CMD among MMT patients and assess the impact of HIV and CMD on MMT engagement outcomes in Hanoi, Vietnam.MethodsThis cross-sectional study was conducted at an urban MMT clinic in Hanoi. Participants were screened for CMD with the relevant sections of the Mini International Neuropsychiatric Interview (MINI). Tabular comparisons and regression models were used to understand the association of HIV and CMD with substance use and methadone compliance.ResultsOf the 400 MMT participants, 22% were living with HIV, 11% a CMD, 27% reported injection drug use, and 27% reported methadone noncompliance. Around 17% of those with HIV also had a CMD. Reporting non injection and injection drug use were each higher among those with CMD regardless of HIV status. In addition, reporting any drug use was much higher among those with both HIV and CMD than among those with neither (73% vs 31%, p value 0.001). While methadone noncompliance was lower among PLH than among those without HIV (16.3% vs 30.1%, p value 0.010), noncompliance was higher among those with CMD than among those without (40.5% vs 25.6%, p value 0.045). Among those without HIV, noncompliance was higher among those with CMD than among those without, but among those with HIV, the opposite relationship was observed.ConclusionThere is complex overlap between substance use and methadone noncompliance among MMT patients living with HIV, CMD or both. In this population, we found a high prevalence of CMD and substance use among PLH, and a high prevalence of substance use and methadone noncompliance among those with CMD. Prioritizing provision of mental health care services to MMT patients living with HIV can help improve engagement with substance use disorder treatment and reduce the risk of HIV transmission.

“Investigating the Diagnostic Overshadowing Bias in Bangladeshi Health Professionals”

ABSTRACT Introduction: Intellectual disability (ID) and co-morbid mental health problems are more common in developing countries such as Bangladesh. However, little is known about how Bangladeshi health practitioners diagnose mental health disorders in people with an ID. Studies in developed countries have explored the impact of the diagnostic overshadowing bias (DOB): the tendency for health practitioners to misattribute mental health symptomology to a client’s ID, rather than a separate mental health disorder. To date, no study has investigated the presence of the DOB in Bangladesh. Method: A range of Bangladeshi health practitioners (N = 243) were randomly assigned a clinical vignette describing a client displaying symptoms of a mental health disorder. Vignette 1 described a client with an IQ of 105 who graduated from secondary school. Vignette 2 described a client with an IQ of 55 who attended special education. All other details were identical. Participants rated the likelihood of seven mental health diagnoses on a 5-point Likert scale. Results: Practitioners were more likely to diagnose schizophrenia, drug problems and being bullied in people with a typical IQ compared to those with an ID. Doctors, psychiatrists, and psychologists appeared to be more affected by the DOB than community health workers, traditional healers, and allied health practitioners. Conclusion: Findings indicate that the bias may be present in Bangladesh healthcare professionals. The development and implementation of specific training programs to meet the differing needs of practitioners, across the health fields are recommended.

Psychiatric care organization and mental health disorders in people of countries affected by the COVID-19 pandemic 2020 (Review)

In the context of the COVID-19 pandemic, 50 patients and 30 medical personnel were infected in a psychiatric hospital in Wuhan (Hubei Province, China), which required the Ministry of Health of China to urgently analyze the situation and develop a set of measures aimed at containing the spread of the virus and organizing a full and safe psychiatric care.&#x0D; The reasons for this situation could be the lack of reserve beds for psychiatric patients, low awareness of psychiatrists in diagnosing and treating infectious diseases, the separation of the psychiatric care system between the two departments, and the cramped living conditions of patients in psychiatric hospitals.&#x0D; More than 500 psychiatrists from across the country were sent to Wuhan to fill staff. Psychiatric patients with mild to moderate COVID-19 were transferred to temporary psychiatric hospitals organized in gymnasiums and exhibition centers. Severely ill psychiatric patients COVID-19 were transferred to hospital infectious diseases. A single patient routing system was organized, a shift schedule for doctors was introduced. To reduce the burden on public transport, the outpatient unit of psychiatric care was taken to regional hospitals, which had previously dealt only with forensic psychiatry and the control of patients with addictive disorders.&#x0D; Based on the experience of Wuhan, psychiatric communities from different countries proposed a list of practical recommendations designed to reduce the risks of spreading the infection and optimize the work of psychiatric care.&#x0D; All hospitals should have a reserve bed capacity, which can be used for the rehabilitation and socialization of patients in quiet times. Hospitals must be provided with a sufficient number of tests, drugs, and personal protective equipment. Outpatients need to be fully provided with access to medical and psychotherapeutic therapy using telemedicine technologies to minimize the risk of infection. It is crucial to restructure the appointment of doctors by introducing work on a shift schedule: two weeks in two weeks, which will not only ensure a good rest but also allow doctors to be quarantined after each shift.

A Socio-Statistical Survey Conducted to Draw a Direct Proportionalitybetween COVID-19 and Psychological Disorders

It’s been decades that the world has seen a pandemic like the one we are in today. COVID-19 is one such global pandemic where all of the nightmares are coming true for mankind, to maintain order and stay safe, the only thing that we can do is stay at home. But enclosing ourselves also means that our work is paused; our lives seem to be punctuated. Moreover, the everyday myths and fake news on the media and internet are eating away the remaining self-confidence in human beings. Everyone is in panic; people don’t know what to do; it’s a rush situation where each day is bringing a new horror with it. With the virus spreading like locust storm and unemployment rate soaring high, survival is becoming difficult with normalcy. Governments are reporting new numbers each day, which doesn’t help much to common men, but confirms their probable risk. With fear lurking around, people are getting diseased with hypertension. When the doors to Nature and outside world are closed, slowly, anxiety, depression and other such psychic disorders are affecting people. Psychological problems are on forever high when you have to secure your physical health from Corona virus. The paper attempts to study the proportionate relationship between Corona Virus and mental health disorders in people.

A Socio-Statistical Survey Conducted to Draw a Direct Proportionality Between COVID-19 and Psychological Disorders

It’s been decades that the world has seen a pandemic like the one we are in today. COVID-19 is one such global pandemic where all of the nightmares are coming true for mankind, to maintain order and stay safe, the only thing that we can do is stay at home. But enclosing ourselves also means that our work is paused; our lives seem to be punctuated. Moreover, the everyday myths and fake news on the media and internet are eating away the remaining self-confidence in human beings. Everyone is in panic; people don’t know what to do; it’s a rush situation where each day is bringing a new horror with it. With the virus spreading like locust storm and unemployment rate soaring high, survival is becoming difficult with normalcy. Governments are reporting new numbers each day, which doesn’t help much to common men, but confirms their probable risk. With fear lurking around, people are getting diseased with hypertension. When the doors to Nature and outside world are closed, slowly, anxiety, depression and other such psychic disorders are affecting people. Psychological problems are on forever high when you have to secure your physical health from Corona virus. The paper attempts to study the proportionate relationship between Corona Virus and mental health disorders in people.

Health practitioner knowledge and confidence in diagnosis and treatment of mental health issues in people with intellectual disabilities

ABSTRACT Background: There is limited Australian research investigating health practitioner knowledge and/or confidence in the diagnosis and treatment of mental health disorders in people with intellectual disabilities (IDs). Method: Ninety-three health practitioners from four professional groups (primary health practitioners, psychologists, mental health practitioners, and alternative therapies) completed a 34-item online survey comprising questions designed to identify participant knowledge of disorders described in the Psychiatric Assessment Schedule for Adults with Developmental Disabilities and the Therapy Confidence Scale-Intellectual Disabilities. Results: Participants demonstrated low knowledge of symptomology and were “moderately confident” to “confident” working with people with IDs. Whilst professional group showed a significant main effect on confidence levels, post-hoc analysis did not detect significant differences between the individual professional groups. Conclusions: Australian participants demonstrated confidence, but low knowledge, in treating individuals with IDs. The development of training to address deficits in practitioner knowledge of symptomology, assessment, and assessment-based communication is recommended.

Simple or complex? A case study of physical and mental health co-morbidity

AbstractPeople with epilepsy are significantly more likely to have a mental health disorder than those without a chronic illness. The reasons for this are multiple but may include the mental health difficulties being perceived as complex due to the presence of a chronic illness. In part due to the apparent complexity of the co-occurring physical and mental illness, many are not offered evidence-based treatment (EBT) for the mental health disorder. There is little guidance to inform clinicians about the interventions to use to treat mental health disorders in people with epilepsy. The present paper reports a case of treatment for depression using a standard EBT in a young person with epilepsy. The patient also had clinically significant symptoms of anxiety and an eating disorder and would be considered ‘complex’ according to standard criteria. The intervention, however, was relatively simple and was delivered as guided self-help via 10 weekly telephone calls of approximately 30 minutes duration, and two follow-up calls at one month and three months post-intervention. Self-report and parent-report questionnaire measures were completed before and after the intervention, and at both follow-up time points. A blind-rated online diagnostic interview measure was also completed before and after the intervention. The young person and her family also completed a qualitative interview of their experiences of the intervention. This simple intervention was effective in working towards the client's goals, although pre–post measurement on standard measures was variable. This interesting case raises questions about whether patients with mental and physical comorbidities are complex, or just perceived as complex.

A preliminary controlled trial of a trans-diagnostic programme for cognitive behaviour therapy with adults with intellectual disability.

Several studies have found a heightened prevalence of mental health disorders in people with intellectual disabilities (ID). There have been a number of successful case series and two promising controlled treatment trials of cognitive behaviour therapy (CBT) for emotional disorders (excluding anger) for people with ID. Several authors have promoted the development of trans-diagnostic approaches to cognitive treatment. The present study extends this work with the development and evaluation of a trans-diagnostic treatment manual for CBT in people with ID. A controlled treatment trial was conducted with 12 participants in treatment and waiting list control data. Each treatment participant was matched to a control on age, IQ, presenting problem, and Brief Symptom Inventory (BSI) global severity index (GSI) score. The treatment group was also evaluated on the Glasgow anxiety and depression scales and was followed up for 3 to 6 months after treatment. There were no significant differences between groups at baseline. Following treatment, the CBT group was significantly improved when compared with the control group on the GSI scale of the BSI. The ancovas for all other measures were not significant but there were significant improvements for the treatment group on all scaled except BSI depression from pre to post-CBT. Gains were maintained to follow up, and changes were associated with large effect sizes. It was possible to treat a range of symptoms and psychiatric diagnoses with a general trans-diagnostic CBT manual. The effects of therapy were promising, suggesting that the participants could respond to treatment in a meaningful and helpful manner and supporting the case for further evaluation of the trans-diagnostic approach in ID.

When dual diagnosis means no diagnosis: co-occurring mental illness and problematic drug use in clients of alcohol and drug services in eastern metropolitan Melbourne

Background: Most previous studies examining the prevalence of co-occurring psychiatric illness and problematic substance use in Australia have been population studies or focused on clients of psychiatric services. There is little literature on the prevalence of psychiatric disorders in persons attending Alcohol and Drug Services (ADS). Aims: This study attempted to estimate the incidence of mental health disorders in people treated at two ADS in Melbourne and to describe the mental disorders with which they present. Method: 165 client records from two ADS were reviewed to determine the incidence and characteristics of psychiatric problems in people presenting for management of substance use. Results: Psychiatric diagnoses were recorded in 42% of client records but rarely substantiated by further documentation. The most common diagnoses were mood disorders (31.5%). Only 4.9% clients were diagnosed with drug-induced psychosis. Personality disorders were not recorded. While 52.7% of clients were documented a...