Suchergebnisse

Israel has become a destination for asylum seekers. Asylum seekers often experience emotional distress, but have limited access to health services and rarely use psychiatric services. This study sought to understand and characterize the use of psychiatric versus medical services by asylum seekers in Israel. We compared the emotional distress, stressful life events and previous treatment consultations of 21 psychiatric service users (PSU) and 55 medical service users (MSU) at the Open Clinic of Physicians for Human Rights in Tel-Aviv. Participants completed a socio-demographic questionnaire, the General Health Questionnaire (GHQ-12), the Stressful Life Events Scale and the Health Care Utilization Questionnaire. PSU and MSU did not have significantly different levels of emotional distress. PSU reported significantly more stressful life events during the past year than MSU ( M = 5.81, SD 3.47 vs. M = 3.8, SD 2.35, p < 0.01). In comparison to MSU, PSU utilized more medical ( M = 4.33, SD 2.28) and non-medical ( M = 2.38, SD 1.92) services ( p < 0.001) than MSU. Asylum seekers who consulted multiple treatment agencies in the last year were 1.55 times more likely to seek psychiatric treatment than those who had consulted only a few treatment agencies. Emotional distress in asylum seekers appears to be under-diagnosed in the Open Clinic and under-treated by mental health professionals. To better detect this distress, a thorough screening is recommended at assessment. Collaboration with mental health professionals and community and religious leaders consulted in the past is important and can contribute to good health care outcomes in this population.

(1) Background: Psychiatrists are increasingly required to treat minimally verbal (MV) individuals with autism spectrum disorder (ASD), intellectual disability (ID) and behavior problems without much published guidance. (2) Methods: We reviewed 80 charts of MV patients managed strategically for challenging behaviors, following IRB approval. Data extracted included demographics, ASD/ID level, diagnoses, epilepsy and medications. In this descriptive study, we examined the course of assessment and treatment and made recommendations for a strategic, person-centered approach. (3) Results: Of 53 males and 27 females, mean age 34 years (range 7–76), all had ID; 75 had ASD (94%). Diagnoses included seizures in 40/80 (50%), frequent aggression (89%), self-injury (80%), attention-deficit hyperactivity disorder (ADHD) (64%) and obsessive compulsive disorder (OCD) (34%). The commonest medication classes adjusted were antiseizure medications, antipsychotics, and non-stimulant ADHD medications. (4) Conclusions: Clinical impressions suggested that this strategic psychiatric approach was beneficial, notably a review of antiseizure and all other medications for polypharmacy, behavioral and other side effects, followed by a review of possible childhood/current ADHD and a trial of low-dose non-stimulant ADHD medications if warranted. Low-dose risperidone was often effective and tolerable for irritability and self-injury.

Schizophrenia often follows a chronic or recurrent course, placing an immense burden on patients and their families. Mental health services in Cambodia are still highly limited, thus there is a major treatment gap. It is common that people consult traditional healers ( Kru Khmer) and monks. In this culture, people who receive psychiatric medical treatment are expected to exhibit higher mental health literacy, but little is known about this factor. In this study, we interviewed 59 patients with schizophrenia and 59 family caregivers attending psychiatric clinics in Cambodia. Through qualitative analysis using a thematic analysis approach, we extracted eight themes of causal beliefs regarding schizophrenia: (1) spiritual beliefs, (2) cultural symptoms, (3) physical problems, (4) heredity, (5) substance abuse, (6) traumatic events, (7) stress in human relationships or in one's social environment, and (8) socioeconomic position. We found that "thinking too much" ( kit chroeun) and "worrying too much" ( prouy / barom chroeun), cultural idioms of distress, were recognized as causal factors of schizophrenia by both parents and family caregivers. Some participants were aware of the possible causal factors in light of the latest psychiatry findings, such as genetic factors and childhood trauma. Our data show that causal beliefs are not a decisive factor in shortening the duration of untreated psychosis (DUP). In Cambodia, where the treatment for schizophrenia is pluralistic, we suggest that it is crucial to embed the meaning of psychiatric treatment into local meaning worlds for better help-seeking behaviors.

OBJECTIVE: School refusal (SR) in adolescence represents an important risk factor associated with adverse consequences. Although many clinical features of adolescents presenting with SR have been studied, the relationship between SR and personality styles—specifically in the help-seeking population—remains unclear. The present study aimed at investigating differences in personality style, adaptive functioning, and symptomology between Italian help-seeking adolescents who refused (SRa) and did not refuse (non-SRa) to attend school, to provide preliminary evidence of personality patterns in adolescent help-seekers presenting with SR. METHOD: The study sample was comprised of 103 help-seeking adolescents (54 female, 49 male) aged 14–18 years. Participants were recruited during their first clinical visit and evaluated using the Shedler and Westen Assessment Procedure – Adolescent version (SWAP-A), the Hamilton Rating Scale for Depression (HAM-D), the Hamilton Rating Scale for Anxiety (HAM-A), the Maniac Rating Scale (MRS), the Global Assessment of Functioning (GAF), the Global Functioning Social Scale (GFSS), and the Global Functioning Role Scale (GFRS). Differences in the studied variables between SRa and non-SRa were measured and a multivariable logistic regression analysis was performed to identify possible predictive factors of SR. RESULTS: SRa presented with more anxious and depressive symptomatology and worse social functioning compared to non-SRa. With respect to personality, SRa displayed more schizoid and schizotypal characteristics and fewer adaptive and healthy personality features. Irrespective of any differences between groups, SRa were largely characterized by inhibited–self-constricted and emotionally dysregulated personality styles. CONCLUSIONS: The results suggest that personality styles are clinical features that may contribute to broadening our knowledge of SR behavior and aid in the detection of SRa, also in the help-seeking population. The findings have clinical, social, and political ...

Psychiatric discourse works by redefining behaviors and relational practices in nosological categories with effects of subjectification. Genders and sexualities overflow the field of action and are translated into continuous and unitary identities that signify the person as a whole, and convert the body in an isolable and objectifiable terrain. When the body does not locate the stabilizers coordinates of sex, gender and desires in a coherent way (accord-ing to the normative regulations), it is translated into a mismatch in need of intervention, by a chain of enunciations that deform the required confessions of their life experiences. Through discourse analysis of a brief psychiatric narration about transsexuality, this paper reviews the "what" and the "how" of its pathologization, exploring its politics of recogni-tion and dualistic fictions ; El discurso psiquiátrico funciona redefiniendo comportamientos y prácticas relacionales en categorías nosológicas individuales con efectos de subjetivación. Los géneros y las sexuali-dades desbordan el campo de la acción y son traducidos en identidades unitarias y continuas que significan a la persona en su totalidad, y convierten el cuerpo en terreno aislable y ob-jetivable. Cuando este no localiza de modo coherente las coordenadas estabilizadoras de sexo, género y deseos (siempre según las regulaciones normativas), es traducido en un des-ajuste necesitado de intervención, a través de una cadena de enunciaciones que deforman las confesiones exigidas de sus experiencias de vida. Por medio del análisis del discurso de una breve narración psiquiátrica en torno a la transexualidad, reviso el qué y el cómo de su patologización, transitando por sus políticas de reconocimiento y sus ficciones dualistas

Background. The steady increase in prevalence of mental disorders resulting from various dependence forms and high criminogenicity of such disorders led to a number of legislative changes in the field of jurisprudence, medicine and expertise. This problem became particularly relevant after the ratification of the agreement on the association of Ukraine with the European Union. European partners drew attention to the ineffectiveness of crime prevention measures committed by persons with addictions. Obtaining a visa-free regime between the EU and Ukraine has made it obligatory for the latter to take effective measures to solve this problem. Objective. To analyze and scientifically substantiate the relevance of legislative changes in forensic psychiatric examination and provision of psychiatric care to people with psychoactive substances dependence status who committed criminal offenses. Materials. For the scientific substantiation results of the forensic psychiatric examination of 368 sub-experts with the dependence on SAR were used. The sample was presented by a group with alcohol and narcotic addiction, 156 and 212 cases respectively. Analytical, clinical-anamnestic, clinical-psychopathological, statistical methods and the method of forensic psychiatric analysis were used for analysis and data processing. Results of researches indicate a high proportion of drug addicts in penitentiary institutions due to the low threshold for their prosecution. This demonstrates the ineffectiveness of harsh criminal approaches to people who are dependent and points to the need to humanize the state policy towards them. Conclusions. Legislation of Ukraine needs urgent changes in the issues of introducing alternative punishment for treatment of people with dependence status, formation of a network of specialized medical and rehabilitation centers, implementation of differentiated expert approaches in choosing medical measures of compulsory or alternative character. Forensic psychiatric examination is the first stage of the practical implementation of the declared legislative changes. Given current realities, experts themselves need social guarantees of their professional independence. ; Актуальність. Неухильно зростаючі показники поширеності психічних розладів внаслідок різних форм залежностей та висока криміногенність таких осіб обумовили низку законодавчих змін у сфері юриспруденції (права), медицини та експертизи. Особливої актуальності ця проблема набула після ратифікації договору про асоціацію України з Європейським союзом. Європейські партнери звернули увагу на неефективність заходів профілактики злочинів, які вчиняються особами зі станами залежності. Отримання безвізового режиму між Євросоюзом та Україною поклало зобов'язання на останню вжити дієвих заходів з метою вирішення цієї проблеми. Мета - проаналізувати та науково обґрунтувати актуальність законодавчих змін щодо судово-психіатричної експертизи та надання психіатричної допомоги особам із станами залежності від психоактивних речовин, які вчинили кримінальні правопорушення. Матеріали та методи. Для наукового обґрунтування використовувались результати судово-психіатричного обстеження 368 підекспертних із залежністю від ПАР. Вибірка була представлена групою з алкогольною (АЗ) та наркотичною залежністю (НЗ) (відповідно 156 і 212 випадків). Для аналізу і обробки даних застосовувались аналітичний, клініко-анамнестичний, клініко-психопатологічний, статистичний методи і метод судово-психіатричного аналізу. Результати наукових досліджень свідчать про високі показники наркозахворюваності та рецидивності злочинів, велику частку наркозалежних осіб в установах відбування покарань внаслідок низького порогу притягнення їх до кримінальної відповідальності. Це демонструє неефективність жорстких кримінальних підходів стосовно осіб, залежних від ПАР і свідчить про необхідність гуманізації державної політики щодо них. Висновки. Законодавство України потребує нагальних змін у питаннях запровадження альтернативних покаранню заходів лікування осіб із станами залежності, формування мережі спеціалізованих медико-реабілітаційних центрів, впровадження диференційованих експертних підходів при виборі медичних заходів примусового чи альтернативного характеру. Судово-психіатрична експертиза виступає першим етапом практичної реалізації задекларованих законодавчих змін. Однак, з урахуванням сьогоденних реалій, самі експерти потребують соціальних гарантій своєї професійної незалежності.

The present article concept the psycho-social trauma and its evolution in Mental Health to make reference to a experience of group with women who have lived experiences on extreme traumatization because of the political repression in Chile.It raises the work of Occupational Therapy in the formation of self-help groups that allow to alleviate chronic sintomatologhy and to harness successful strategies of psycho-social reintegration by means of the enrichment of the social networks of support. It raises the alternative of formation of long terms groups as alternative forehead to associated chronic damage to the lived traumatic experiences As well create the difficulties associated to this process as much at personal, group and social level. ; El presente artículo conceptualiza el trauma psicosocial y su evolución en Salud Mental para hacer referencia a una experiencia de grupo con mujeres que han vivido experiencias de traumatizacion extrema a causa de la represión política en Chile. Se plantea la labor de Terapia Ocupacional en la formación de grupos de autoayuda que permitan aliviar sintomatología crónica y potenciar estrategias exitosas de reinserción psicosocial por medio del enriquecimiento de las redes sociales de apoyo. Se plantea la alternativa de formación de grupos de largo aliento como alternativa frente a daño crónico asociado a las experiencias traumáticas vividas. A su vez se plantean las dificultades asociadas a este proceso tanto a nivel personal, grupal y social.

This book describes and analyses two dialogic network practices: 'Open Dialogues' - developed for use in psychiatric crisis situations - and 'Anticipation Dialogues' - used in less acute situations such as multi-agency muddles where the helper systems are stuck. The book is both theoretical and detailed enough for practitioners who wish to apply the approaches to their work. It is meant for professionals in the fields of psycho-social work - including therapists to day care personnel, social workers to school teachers, - researchers, and academics. As the book touches upon dialogues with and w

Background: The issue of hikikomori (prolonged social withdrawal) among Japanese youth has attracted attention from international experts. In previous research, the unique cultural and social factors of Japanese society have been the focus; however, in order to resolve the problem of hikikomori, individual mental health problems must be included. Aim: We examined the psychiatric background of individuals with hikikomori. Methods: We recruited 337 individuals with hikikomori; 183 subjects who utilized the centres were designated as the help-seeking group. We examined the multi-axial psychiatric diagnosis based on the DSM-IV-TR, treatment policies and treatment outcomes. We also examined 154 subjects who did not utilize the centers (non-help-seeking group). Results: Most of the subjects in the utilization group were classified into one of the diagnostic categories. Forty-nine (33.3%) subjects were diagnosed with schizophrenia, mood disorders or anxiety disorders, and this group needed pharmacotherapy. Other subjects were diagnosed with personality disorders or pervasive developmental disorders, and they mainly needed psycho-social support. The Global Assessment of Functioning (GAF) scores of the non-help-seeking group were significantly lower than the GAF scores of those who used treatments. Conclusion: Most hikikomori cases can be diagnosed using current diagnostic criteria. Individuals with hikikomori are much worse if they do not seek help.