High Psychiatric Morbidity Research Articles

Clinical segmentation in 22q11.2 deletion syndrome: Cognitive impairments and additional genetic load

The 22q11.2 deletion syndrome (22q11.2DS) is associated with high psychiatric morbidity. However, large phenotypic heterogeneity hampers early detection of 22q11.2DS individuals at highest risk. Here, we investigated whether individuals with 22q11.2DS can be subdivided into clinically relevant subgroups based on their severity of cognitive impairments and whether such subgroups differ in polygenic risk. Using a cross-sectional design, we examined the number of lifetime psychiatric diagnoses and polygenic risk scores for schizophrenia in an unselected nationwide biobank cohort of individuals with 22q11.2DS (n = 183). Approximately 35% of this sample, aged 10–30 years, had a history with one or more psychiatric diagnosis. In a representative nested subgroup of 28 children and youth, we performed additional comprehensive cognitive evaluation and assessed psychiatric symptoms. Unsupervised hierarchical cluster analysis was performed to divide the subgroup of 22q11.2DS individuals, based on their performance on the cognitive testing battery. This produced two groups that did not differ in mean age or gender composition, but were characterized by low cognitive (LF) and high cognitive (HF) functional levels. The LF group, which had significantly lower global cognitive functioning scores, also displayed higher negative symptom scores; whereas, the HF group displayed lower rate of current psychiatric disorders than the LF group and the reminder of the biobank cohort. The polygenic risk score for schizophrenia was insignificantly lower for the low functioning group than for the high functioning group, after adjustment. Cognitive functioning may provide useful information on psychiatric risk.

Neurobiology of Attention Deficit Hyperactivity Disorder (ADHD): A brief review

Attention deficit hyperactivity disorder (ADHD) is a common condition associated with long-lasting psychosocial functioning difficulties and high psychiatric morbidity. ADHD is a heterogeneous syndrome in its clinical presentation and probably in its aetiology. Nevertheless, it can be understood as a spectrum of multifactorial cognitive, emotional, and behavioural dysfunctions under the influence of genetic and environmental factors, mainly perinatal. For several decades, the dopaminergic dysfunction hypothesis has been one of the possible pathways in the origin of ADHD. Still, other neurotransmission systems also appear to play a role, as evidenced by the recent therapeutic development of noradrenergic agonists in this indication.

An exploratory study of psychosis risk factors in individuals who are referred but do not meet criteria for an early intervention in psychosis service.

The 'at-risk mental state' (ARMS) for psychosis has been critiqued for its limited prognostic ability and identification of a limited proportion of those who will develop a first episode of psychosis (FEP). Broadening the search for high-risk groups is key to improving population-level ascertainment of psychosis risk. To explore risk enrichment in diagnostic, demographic and socio-functional domains among individuals referred to an early intervention in psychosis (EIP) service not meeting ARMS or FEP criteria. A retrospective file review of 16 years of referrals to a tertiary EIP service in Ireland was undertaken. Diagnostic outcomes from standardised assessments (Structured Clinical Interview for DSM), demographic (age, gender, family history, nationality) and socio-occupational (relationship status, living status, working status) variables were compiled for those not meeting criteria. These were compared with individuals diagnosed with an FEP in the same period. From 2005 to 2021 inclusive, of 2025 index assessments, 27.6% (n = 558) did not meet either FEP or ARMS criteria, which is notably higher than the 5.4% (n = 110) meeting ARMS criteria. This group had high psychiatric morbidity, with 65.4% meeting criteria for at least one DSM Axis I disorder. Depressive, anxiety and substance use disorders predominated. Their functional markers were poor, and comparable to the FEP cohort. This group is enriched for psychosis risk factors. They are a larger group than those meeting ARMS criteria, a finding that may reflect EIP service configuration. They may be an important focus for further study in the search for at-risk populations beyond the current ARMS model.

Female doping: observations from a data lake study in the Hospital District of Helsinki and Uusimaa, Finland

BackgroundDoping is a well-recognized risk factor for several potentially severe health effects. Scientific literature concerning the need for medical treatment for such adversities is still sparse. This is especially true for women, due to lower doping use prevalence compared to men. Our study explored the nature of medical contacts and deviance in red blood cell parameters of female patients with doping use in Finnish specialized health care.MethodsThis was a retrospective register study. The study sample was gathered from the Hospital District of Helsinki and Uusimaa, Finland (HUS) Datalake. An exhaustive search for doping related terms was performed to find patients with doping use documentation within free-text patient records. Medical record data was supplemented with laboratory data and medical diagnoses covering a total observation time of two decades. Statistical analysis included Fisher's Exact Test and one-way ANOVA.ResultsWe found 39 female patients with history of doping use and specialized health care contacts in the HUS-area between 2002–2020. At initial contact (i.e., the first documentation of doping use), the mean age of these patients was 33.6 years (min 18.1, max 63.5, SD 10.6). The most frequently used doping agents were anabolic androgenic steroids (AAS). The initial contacts were significantly more often acute in nature among patients with active doping use than among patients with only previous use (no use within one year; p = 0.002). Psychiatric and substance use disorder (SUD) morbidity was high (46.2% and 30.8%, respectively). Eight patients (20.5%) had received specialized health care for acute poisoning with alcohol or drugs, and nine (23.1%) for bacterial skin infections. Less than 45% of patients with active AAS use presented with off-range red blood cell parameters.ConclusionsOur findings suggest that female patients with a history of doping use encountered in specialized health care may exhibit high psychiatric and SUD related morbidity. Also, majority of patients with AAS use had red blood cell parameters within-range. Further studies are required to assess the generalizability of these findings to patients within primary health care services, and to determine the usefulness of hematological parameters as indicators of AAS use in female patients.

Psychiatric Morbidity, Utilization and Quality of Mental Health Care in Long-Term Unemployed People.

Research has shown complex interactions between unemployment and mental health. However, the prevalence of specific mental disorders, utilization of mental health care services and influences on help-seeking behavior have been investigated surprisingly little in the past. In this study, we investigated a sample of long-term unemployed people in a cooperation program of the local unemployment agency and a psychiatric university hospital in a larger city in Germany. Mental disorders, treatment history, accordance of treatment to national treatment guidelines and factors influencing previous treatment were assessed. Participants (n = 879; male 56%, female 44%, mean age 43.9 years) showed a high psychiatric morbidity, mostly with diagnoses from the ICD-10 categories F1 (22%), F3 (61%) and F4 (68%). Currently, 18% were in psychiatric treatment, 6% were in psychotherapeutic treatment, and 28% received psychopharmacological treatment. Mostly young men underutilized the psychiatric-psychotherapeutic system, with middle-aged men and women being most frequently in psychopharmacological treatment. Of those treated, only about 10% of the subjects currently received a treatment according to national guidelines. The utilization of psychotherapeutic treatment was strikingly poor. This study identified high psychiatric morbidity and severe treatment gaps in unemployed people. These results can help to target subjects with specific needs for interventions and to modify counseling programs.

Psychiatric morbidity and quality of life in infertile females: a cross-sectional, case-controlled hospital-based study

BackgroundInfertility is a huge global problem with a significant mental health burden. Infertility could become a source of continuous stress leading to psychosocial issues including stress, anxiety, depression, and low self-esteem in these women. A cross-sectional, case-controlled study was conducted between January 2021 and November 2021 to study the effect of infertility on mental health and quality of life. A semi-structured questionnaire was used for sociodemographic and clinical variables. The Oslo Social Support Scale-3 and FertiQol were used to study social support and quality of life respectively. Psychiatric morbidity was assessed using ICD-10 symptom checklist. A total of 56 cases and 102 controls were studied.ResultsThe mean age of cases and controls was 30.4 ± 3.5 years and 31.9 ± 2.9 years, respectively. Young infertile females, primary infertility, and female factor for infertility were associated with higher psychiatric morbidity. Psychiatric morbidity was seen in 46.4% of infertile women. FertiQoL score for the infertile group was 64.61 ± 5 with the lowest score in the emotional domain (45.10) and mind-body domain (54.86) (p < 0.0001). The scores in the relational domain and social domain were higher (85.2 and 73.3, respectively). The scores in the mind-body domain and emotional domain were poor among the infertile women regardless of the presence of psychiatric morbidity (48.27 vs 59.80 and 43.57 vs 46.57) (p < 0.0001–0.04).ConclusionsOur study emphasizes the role of more qualitative instruments like FertiQoL in studying the well-being of infertile women. Even in the absence of psychiatric morbidity, the QoL score could still predict mental well-being in fertility-related issues.

Why mental health service delivery needs to align alongside mainstream medical services.

There is significant individual human suffering and economic burden because of untreated mental health and substance use disorders. There is high psychiatric morbidity in primary and secondary medical care. At least one-fifth of patients attending primary care services in western countries pertain to mental health and one-third of patients attending general hospitals have a comorbid mental disorder. Patients with mental disorders have lower life expectancy than the general population due to various medical conditions and reduced access to physical healthcare. There is a suicide every 40 seconds and the vast majority of those who die by suicide have a diagnosable mental disorder. Despite this, most countries spend less than 2% of their health budgets on mental health. Effective treatments exist for mental disorders, however underfunding, poor integration of services, lack of trained health care professionals and stigma often prevent access to effective treatments. Stigma is a significant barrier to seeking help and receiving treatment. Geographical separation of mental health services from general hospital settings may be perpetuating the stigma of mental illness among the population. In this article, we review the key reasons why mental health services globally need to align with mainstream healthcare services and the longstanding reasons that necessitate the need to make mental health a public health priority.

A STUDY OF SOCIODEMOGRAPHIC CHARACTERISTICS AND PSYCHIATRIC MORBIDITY IN WOMEN RESIDING IN A SHELTER HOME IN KOTA,RAJASTHAN

Background-The women shelter home is supportive institutional framework of women victim of difcult circumstances. High psychiatric morbidity has been reported in such women in various studies. Aims &amp;Objectives-To nd out socio-demographic characteristics, psychiatric morbidity, factor responsible for stay in shelter home &amp; its association with psychiatric morbidity.Material &amp; methods-40 women above 18 years residing in shelter home of district headquarter of Rajasthan were the subjects of study. They were evaluated on a specially designed proforma.GHQ-12 was administered to all women &amp; GHQ positive subjects were assigned a psychiatric diagnosis as per ICD-10 criteria &amp; conrmed by a consulted psychiatrist. Results-Results of the study showed that 70% of women belonged to age group 19-40 years,65% were illiterate,50% were housewives &amp; 42.5% unemployed.55% of women were staying in shelter home for a period of 2-10 years. Most of the family members(77.5%) did not come to meet them.77% women had psychiatric morbidity, of which 35% were schizophrenic,22.5%mentally retarded,10% were suffering from BPAD &amp; 10% from depression. Most common reason for admission of women in shelter home was found wandering(62.5%),followed by lack of nancial affordability. Schizophrenia was most commonly found associated with wandering(57.1%) followed by nancial affordability. The most common cause of depression was rape(50%),other reason were divorce (25%) and breakdown of family(25%).Conclusion-Shelter home women had psychiatric morbidity as high as 77% which mainly included schizophrenia(35%) and mental retardation(22.5%).Most of them(62.5%) were found wandering. Schizophrenia was most commonly associated with wandering (57.5%) and depression with rape(50%).

Sensory Deprivation and Psychiatric Disorders: Association, Assessment and Management Strategies.

Background:Sensory deprivation (SD) is a widely prevalent condition that leads to various health-related consequences and is also an important cause of disability worldwide. Earlier, SD experiments were used as research modalities to alter human behavior. In recent years, the focus has shifted to understand how SD can affect the mental health of individuals (with congenital or acquired sensory impairments). This narrative review focuses on the current understanding about the association of SD and psychiatric disorders.Methods:A comprehensive literature search was done PubMed, Scopus, PsycINFO, and Google Scholar and in the cross-references of relevant articles. Keywords included “sensory deprivation,” “blindness,” “deafness,” “mental illness,” “psychiatric disorders,” “prevalence,” “assessment,” and “management” in various combinations. Only original articles (abstract and full text) published in English till October 2020 were included.Results:The prevalence of anxiety, depression, dementia, suicidality, and psychosis in persons with SD is higher than the general population (highest being in persons with dementia with comorbid SD). Several mechanisms/hypotheses have been proposed to explain these associations. Assessment of SD includes a thorough history taking, with adequate awareness about the difficulties faced during a psychiatric interview in this population. Modifications in the psychometric assessment procedures are warranted. Management depends on a multi-disciplinary approach that includes proper referral to specialties, pharmacological management (depending on diagnosis as well as taking care of ototoxic/ocular side-effect profile of the drugs), and nonpharmacological supportive measures.Conclusions:SD is a complex condition, and evidence suggests that persons with SD have higher psychiatric morbidity. A comprehensive assessment, along with holistic management approach is warranted.

English

BACKGROUND With recent advancement in health facility, both in urban and rural population, ratio of elderly people has increased and due to this apart from physical illness, mental health is also emerged as an important public health challenge. Psychiatric disorders such as depression, anxiety, cognitive disorders and substance use disorders were commonly found in elderly specially living alone and in care homes. The primary purpose of this study was to compare mental health of elderly people living in care homes with those living with family in Kota (Hadoti region, Rajasthan). METHODS This is a cross-sectional comparative study that was carried out in 50 elderly people living in care homes and 50 elderly people living with family. Both groups were screened for psychiatric disorders using general health questionnaire (GHQ – 12). Comparison was made under various headings between these groups including severity. Obtained data were analysed by using proportion, mean, standard deviation, chi-square, and Pearson correlation. RESULTS No statistically significant difference was found in having psychiatric disorders on screening with GHQ - 12. Difference in these groups for prevalence and severity was not statistically significant for depression and anxiety although significant higher mean of total geriatric depression score (GDS) score in control (10.74 ± 2.56) than in cases (9.38 ± 2.36) and total Hamilton’s anxiety rating scale (HAM – A) score was seen in case group (24.53 ± 3.50) than in controls (23.15 ± 2.34). CONCLUSIONS In this study, it was found out that psychiatry morbidity was higher among elderly population living in old age home when compared to elders living with family in community. Possible reason for higher psychiatric morbidity in old age home group in our study appears to be because of lack of family support, pain of being separated from their children whom they cared and nurtured for their whole life. In psychiatric morbidity we found that depression was the most common disorder in elderly population in both groups. KEYWORDS Old Age Home, Mental Disorders, Depression, Anxiety

A Study on Psychiatric Morbidity and It’s Correletes Among Mothers of Children with Intellectual Disability Disorder in Northern Karnataka

BACKGROUND: Worldwide, the prevalence of intellectual disability disorder (IDD) is as high as 2.3%. IDD produces psychological, social and financial distress to the whole family, particularly parents, as they are usually the constant caretakers. Mothers of these children, being the primary caregivers undergo more psychological distress than other members in their families. OBJECTIVES: To study the prevalence of psychiatric morbidity and it’s correlates among mothers of children with IDD. MATERIALS AND METHOD: A cross- sectional study was conducted among 133 mothers of children with IDD consulting tertiary care psychiatry unit in northern Karnataka. Mothers, who fulfilled the inclusion and exclusion criteria of the study were interviewed. Socio- demographic data was collected using semi structured pro forma and psychiatric morbidity was assessed using M.I.N.I. Plus 5.0.0 scale. RESULTS: Mean age of mothers is found to be 33.48 years and majority of them have completed their primary education (45.11%), (71.4%) hail from rural background (67.67%). Majority of children were diagnosed with mild mental retardation (46.62%). Study results showed that 52 ( 39.1%) of them had psychiatric morbidity. The most common morbidity being somatization disorder 22(16.54%) followed by Dysthymia 10.53% (14), MDD 11(8.27%), GAD 5(3.76%). Majority of psychiatric morbidity was seen among mothers of children with mild IDD. INTERPRETATION AND CONCLUSION: The study shows high psychiatric morbidity in mothers of children with intellectual disability, and psychiatric screening should be considered among mothers of children with intellectual disability and help them to develop effective coping strategies to handle the burden of care giving and improve their quality of life.

English

BACKGROUND Chronic kidney disease (CKD) is a major health issue to be discussed in this current era due to its increasing prevalence. The burden due to chronic kidney disease is very high especially in low and middle income countries. The prevalence of psychiatric morbidity is high in patients undergoing haemodialysis. The presence of psychiatric illness increases the risk of hospitalisation and mortality in patients with end stage renal disease. This study was conducted to assess the psychiatric morbidity of patients with chronic kidney disease on maintenance haemodialysis. METHODS Descriptive research design was used for the study. The sample of the study consisted of 180 patients above the age of 18 years with chronic kidney disease undergoing maintenance haemodialysis. A specially designed pro-forma, ICD 10 symptoms check list, and ICD 10 diagnostic criteria for research are the tools used for the study. RESULTS Most of the patients were from 41 - 50 years age group (27.8 %) with a mean age of 47.43 and majority were males (74.4 %). 45.6 % patients had plan for renal transplant and 62.2 % patients were on twice weekly haemodialysis. The primary diagnosis was chronic glomerulonephritis in 33.9 % and diabetic nephropathy in 32.8 % of study participants. 11.7 % of study participants had IgA nephropathy and 9.4 % of study participants had ischemic renal failure. 23.9% of participants were found to have psychiatric morbidity. The most common psychiatric illness was depression which was reported in 15.0 % of study population. 6.1 % of participants had adjustment disorder, 2.2 % had anxiety disorder and 0.6 % had psychosis. The mean duration of dialysis was 2 years in patients with psychiatric illness. CONCLUSIONS A male preponderance was found in the study population. High psychiatric morbidity is found among patients undergoing haemodialysis and depression is the most common psychiatric disorder identified. KEYWORDS Psychiatric Morbidity, Haemodialysis

Psychiatric morbidity of patients with keratoconus: A cross-sectional study

BackgroundThis study aimed to determine the prevalence of psychiatric disorders in patients with keratoconus and the effect of clinical parameters and psychiatric morbidity on quality of life in this patient group. Materials and methodsThis cross-sectional study enrolled 94 patients with keratoconus. All patients underwent a complete ophthalmic and psychiatric examination and completed the The National Eye Institute Refractive Error Quality of Life Instrument-42 (NEI-RQL-42), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) questionnaires. The current diagnosis of psychiatric disorders was determined using the Structured Clinical Interview for DSM-IV (SCID). The impact of disease severity (binocular BCVA ≥0.4 logMAR, steep K reading ≥52, and Amsler-Krumeich grades) on vision-related quality of life was also analyzed. ResultsThe patients' mean age was 23.9 ± 4.8 (range, 18–40) years. Of the 94 participants 35 (37.2%) had a psychiatric diagnosis, 13 (13.8%) had moderate-severe depression and 20 (21.2%) had moderate-severe anxiety according to the BDI and BAI, respectively. The probability of having a psychiatric disorder was higher if the keratoconus was more severe. Patients with a psychiatric diagnosis scored lower on physical functioning, role limitations due to emotional problems, energy/fatigue; emotional well-being, social functioning and pain subscales of the Short Form-36 (SF-36). Having a SCID-1 psychiatric diagnosis and the presence of a psychiatric disorder did not significantly affect NEI-RQL-42 questionnaire scores. ConclusionsThere was high psychiatric morbidity among patients with keratoconus. Having a psychiatric disorder was associated with lower QoL as measured using the SF-36.

Psychiatric morbidity in absentees in industry.

Background:Absenteeism refers to a worker's unscheduled absence from the workplace. Around the world, a large share of mental disorders can be attributed to work productivity losses. Despite industries working on improvement in employees' wages, better work environment and improved health care to improve their mental health. Absenteeism continues to be a global burden.Aim:The aim of the study was to explore the factors influencing absenteeism.Materials and Methods:A sample size of 100 workers was selected and standardized, and reliable research tools were employed. Factors influencing absenteeism such as the sociodemographic factors, personality traits, psychiatric morbidity, family typology, and interactions were studied using relevant scales, i.e., Eysenck's Personality Inventory and Family Typology by Batti and Channabasavanna.Results:Study found that absentees were more emotionally stable, whereas regulars were found to be emotionally unstable. Factors were found to be associated with absenteeism such as low income, 11–20 years of service, low mean neuroticism score, chronic physical disease, high psychiatric morbidity among the workers, egoistic and anomic family typology. This study reveals that a significantly higher proportion of absentees had a low pay scale. Paradoxically, a high proportion of absenteeism had a longer duration service, indicating that the low pay scales could have resulted from disciplinary actions against absentees, like loss of increments, etc.Conclusion:Psychosis, alcoholism, and chronic physical illnesses are among the illnesses which contribute to absenteeism.

A Cross-sectional Study to Assess Psychiatric Co-morbidity among Patients of Migraine and Other Headaches

Introduction: Migraine is the most common cause of vascular headache with a one-year prevalence as high as 6-14.3%. Having various pathophysiological theories, it occurs in much co-morbidity with several medical as well as psychiatric disorders like mood disorders, phobia, anxiety spectrum, etc. Migraine, especially when co-morbid with psychiatric illness stands markedly burdensome economically, diagnostically, therapeutically and prognostically. Hence, needs even further research. Aim: To study patients with migraine versus other types of headache and to study psychiatric co-morbidity among patients with migraine. Materials and Methods: This cross-sectional study was conducted on total 100 patients presenting with headache, meeting the criteria were taken up for the study and divided into two groups. Patients meeting International Headache Society (IHS) criteria for migraine were enrolled under group A and patients suffering from headache other than migraine under group B. Having subjected to detailed history and evaluation, patients were subjected to Symptom checklist-80, Hamilton’s Anxiety Rating Scale (HARS) and Montgomery Asberg Depression Rating Scale (MADRS), International Classification of Diseases (ICD)-10 criteria. The data so collected was subjected to statistical analysis and association of psychiatric morbidity with migraine patients was assessed. Results: Patients with migraine (group A) and among those too, patients having psychiatric morbidity had significantly (p&lt;0.01) longer duration of illness (≥8 years), more frequent attacks ≥5 attacks per month and had longer duration of each attack &gt;24 hours compared to the other groups. Patients having migraine had significantly (p&lt;0.01) higher psychiatric morbidity, more SCL-80 symptoms (mean score 83.05); more depressive symptoms (mean MADRS score was 31.9±9.2) and more anxiety with the mean Hamilton Anxiety score was 23.3 than in patients without psychiatric morbidity. Conclusion: A thorough evaluation of psychiatric disorders in migraine is important so as to propose a non segregated model of care to direct the burden and deterioration associated with psychiatric co-morbidity in migraine.

Addressing Postpandemic Clinician Mental Health : A Narrative Review and Conceptual Framework.

Previous pandemics have seen high psychiatric morbidity among health care workers. Protecting clinician mental health in the aftermath of coronavirus disease 2019 (COVID-19) requires an evidence-based approach to developing and deploying comprehensive clinician mental health support. In a narrative review of 96 articles addressing clinician mental health in COVID-19 and prior pandemics, 7 themes emerged: 1) the need for resilience and stress reduction training; 2) providing for clinicians' basic needs (food, drink, adequate rest, quarantine-appropriate housing, transportation, child care, personal protective equipment); 3) the importance of specialized training for pandemic-induced changes in job roles; 4) recognition and clear communication from leadership; 5) acknowledgment of and strategies for addressing moral injury; 6) the need for peer and social support interventions; and 7) normalization and provision of mental health support programs. In addition to the literature review, in collaboration with the Collaborative for Healing and Renewal in Medicine (CHARM) network, the authors gathered practice guidelines and resources from health care organizations and professional societies worldwide to synthesize a list of resources deemed high-yield by well-being leaders. Studies of previous pandemics demonstrate heightened distress in health care workers years after the event. The COVID-19 pandemic presents unique challenges that surpass those of previous pandemics, suggesting a significant mental health toll on clinicians. Long-term, proactive individual, organizational, and societal infrastructures for clinician mental health support are needed to mitigate the psychological costs of providing care during the COVID-19 pandemic.

Self-inflicted upper limb injuries in a tertiary care rural Plastic Surgery unit - A psychiatric evaluation

Background: Deliberate self-harm patients (DSH) with upper limb injuries are commonly admitted in the plastic surgery units. Psychiatric comorbidities are risk factors for these patients with self-inflicted injuries. A multidisciplinary team approach is needed. Methods: Patients who presented with self-inflicted upper limb injuries in the plastic surgery department were referred for psychiatric liaison services. Socio-demographic data, mode of injury, plastic surgical procedures, and psychiatry diagnosis were noted. Results and discussion: Out of 48 patients, 20 (41.6%) belong to the 21-30 age group, 30 (62.5%) were males. 43 (89.6%) patients needed major plastic surgery procedures. The major psychiatric comorbidities were depressive disorder (27.1%), adjustment disorder (16.6%), alcohol dependence syndrome (14.6%), and bipolar mood disorder (12.5%). High psychiatric morbidity among self-inflicted hand injuries suggests the need for a multidisciplinary approach and long term follow-up. Conclusion: Psychiatric liaison services are important in the treatment of self-inflicted upper limb injuries.

High Psychiatric Morbidity and Comorbidity Among Female Prisoners in Hunan, China.

BackgroundHigh prevalence of mental disorders has been found among female prisoners in Western countries, however, little is known about the epidemiology of mental disorders in such populations in China. This study aims to investigate psychiatric morbidity and comorbidity among sentenced prisoners in a female prison in China.MethodsA cluster sample of 2,703 female adult prisoners from Hunan Provincial Female Prison were interviewed with the Mini International Neuropsychiatric Interview, a semi-structured Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) mental disorder diagnostic tool. The rates of psychotic disorders, affective disorders, anxiety disorders, and substance use disorders were reported.ResultsNearly 2/3 (66.2%, N=1,790) of the sample fulfilled the criteria for at least one lifetime DSM-IV disorder 36.5% had major depression, 22.2% had post-traumatic stress disorder (PTSD), and 16.5% had drug use disorder. Drug use disorders were the major comorbid disorders. 60.8% of people with alcohol use disorder and 37.0% of those with psychotic disorders also had a drug use disorder. More than one-quarter (26.1%) of the population met criteria for a current diagnosis of any mental disorder, of which major depression was the most common (14.7%), followed by PTSD (6.4%) and psychotic disorder (1.8%).ConclusionThe high levels of psychiatric morbidity and comorbidity in a representative sample of female prisoners in China indicate unmet needs that require identification and therapeutic intervention in prisons.

A study on prevalence of psychiatric morbidity and substance abuse among prisoners

Background: Studying the psychiatric morbidity among prisoners is important to plan the correctional measures and to understand many related factors. Aim and objectives: 1. To determine the sociodemographic profile. 2. To assess the prevalence of psychiatric morbidity and substance abuse among prisoners. Methodology: It was an observational study. Two hundred prisoners were included in to the study randomly. Study instrument were the Mini-International Neuropsychiatric Interview (M.I.N.I.)-Plus and personality disorders according to the American Psychiatric Association's text revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Results: Mean age of prisoners was 36.45±11.2 years. Most of the sentenced prisoners were Hindu, males, illiterates, and from rural area. Majority (83%) belonged to lower socioeconomic status. 33.5% had a history of substance abuse before entering into prison. Majority of them (83.5%) were diagnosed with psychiatric illness. Predominant type found was mood disorder. Conclusions: High psychiatric morbidity was revealed in the study and there should be screening programme at the point of entry to reveal the undiagnosed psychiatric illness. Training of prison staff is needed to respond and support the prisoners with psychiatric illness.

School refusal - Psychosocial distress or Psychiatric disorder?

Background: School refusal is not a diagnosis by itself but a behavior described when a child frequently refuses to go to school or remain in school. It is often associated with several psychiatric disorders. A prevalence rate of 5-10% is described in most studies. Several psychosocial factors, individual, familial, societal, school and medical are also known to play an important role. The study intends to explore the association of school refusal to either psychiatric disorder or to distress due to psychosocial factors. Aim: To explore the psychosocial factors and psychopathology in children presented with school refusal. Materials and Method: A descriptive study conducted on children attending Child and Adolescent Psychiatry OPD at ASHA Hospital with primary complaint of school refusal, from January 2018 to December 2018. Data pertaining to 33 new cases of school going children between 6 years and 18 years, with school refusal as main symptom were collected using a semi structured proforma. Various psychosocial factors which were broadly classified as individual, family, school, societal factors and other medical disorders were analyzed. Psychiatric diagnosis made using ICD 10 criteria was assessed. Data analyzed using SPSS software. Results: About 6.6% of total new child cases in the year of 2018 were with primary complaint of School Refusal. Out of these 33 subjects, 30 (91%) had a psychiatric diagnosis at baseline. Depressive disorder (36.4%) was commonest followed by anxiety disorder (18.2%), conduct disorders (15.1%) and remaining Hyperkinetic disorder, mental retardation and bipolar disorders. Psycho-social factors influenced school refusal contributing to the psychiatric disorder. Conclusion: The study highlights school refusal as a symptom of one or two psychiatric disorder rather than psychosocial distress alone, indicating high psychiatric morbidity. Further it emphasizes that the symptom need to be taken as an emergency and intervened. This would e