Psychotic-like experiences in a conflict-affected population: a cross-sectional study in South Sudan

Course of psychotic experiences and disorders among apprentice traditional health practitioners in rural South Africa: 3-year follow-up study

Background

Culture is inevitably linked with the experience, interpretation and course of what modern biomedicine understands to be psychotic symptoms. However, data on psychoses in low- and middle-income countries are sparse. Our previous study showed that psychotic and mood-related experiences, symptoms and disorders are common among individuals who had received the ancestral calling to become a traditional health practitioner (THP) in rural KwaZulu-Natal, South Africa. Our related ethnographic study suggested that ukuthwasa (the training to become a THP) may positively moderate these calling-related symptoms. As far as we know, no research has been conducted into the course of psychiatric symptoms among apprentice THPs.

Objective

We studied the course of psychotic experiences, symptoms and disorders among apprentice THPs. We also assessed their level of functioning and expanded our knowledge on ukuthwasa.

Materials and methods

We performed a 3-year follow-up of a baseline sample of apprentice THPs (n = 48). Psychiatric assessments (CAPE, SCAN), assessment of functioning (WHODAS) and a semi-structured qualitative questionnaire were completed for 42 individuals.

Results

At 3-year follow-up, psychotic experiences were associated with significantly less distress and there was a reduction in frequency of psychotic symptoms compared to baseline. The number of participants with psychotic disorders had decreased from 7 (17%) to 4 (10%). Six out of seven participants (86%) with a psychotic disorder at baseline no longer had a psychiatric diagnosis at follow-up. Although the mean level of disability among the (apprentice) THPs corresponded with the 78th percentile found in the general population, 37 participants (88%) reported no or mild disability. Forty-one participants (98%) reported that ukuthwasa had positively influenced their psychiatric symptoms.

Conclusion

In rural KwaZulu-Natal, psychotic experiences, symptoms and disorders have a benign course in most individuals who are undergoing the process of becoming a THP. Ukuthwasa may be an effective, culturally sanctioned, healing intervention for some selected individuals, potentially because it reframes distressing experiences into positive and highly valued experiences, reduces stigma, and enhances social empowerment and identity construction. This implies that cultural and spiritual interventions can have a positive influence on the course of psychosis.

Epidemiology of psychotic-like experiences by subtypes and their relationship with emotional regulation and affective lability among Chinese college students

Although psychotic-like experiences (PLEs) are transient and not pathognomonic for psychiatric disorders, they may increase the risk of concurrent and future psychiatric disorders. However, the prevalence of PLEs and the different effects of PLE subtypes on mood outcomes are still unclear. Thus, this study seeks to investigate the prevalence of PLE subtypes and explore their relationship with the use of specific emotion regulation strategies and the level of affective lability among college students. The history of PLEs, the level of affective lability, and the use of specific emotion regulation strategies were assessed via self-reported questionnaires, and 1905 college students and 1812 college students were included in separate analyses. This study found that 14.44% of college students reported ever experiencing any of the five PLEs, with males reporting more PLE symptoms and a higher number of PLEs than females. Different PLE subtypes had different effects on the use of specific emotion regulation strategies (cognitive reappraisal or suppression) and the level of affective lability and also showed gender differences. Cognitive reappraisal and suppression differently predicted affective lability in males and females, and cognitive reappraisal mediated the relationship between hearing voices in PLEs and affective lability in males. In conclusion, PLEs were common in Chinese college students and gender differences were revealed in the prevalence of PLE subtypes. PLEs were associated with the use of specific emotion regulation strategies and the level of affective lability. Cognitive reappraisal may be a promising target for intervention aimed at relieving the effect of PLEs in non-clinical individuals.

Prevalence of Mental Disorders in the WHO Eastern Mediterranean Region: A Systematic Review and Meta-Analysis

Objectives: To synthesize the prevalence of mental and substance use disorders in countries of the Eastern Mediterranean Region (EMR) of the World Health Organization. Methods: The literature search was conducted across several databases in two phases. First, we searched for systematic reviews and/or meta-analyses published before 2014, reporting prevalence estimates for mental disorders in the EMR. Then, we identified new primary cross-sectional or longitudinal studies published between 2014 and 2020. Studies were included if they had a sample size of ≥ 450 and were conducted among the general adult population. Current, period and lifetime prevalence estimates for each disorder were pooled using random-effects meta-analyses, and subgroup analyses and meta-regressions were conducted. Findings: Prevalence estimates were extracted from 54 cross-sectional studies across 15 countries within the EMR. Pooled analyses of current, period and lifetime prevalence showed the highest prevalence for depression (14.8%, 95% confidence interval, CI: 10.7-20.1%), followed by generalized anxiety disorder (GAD) (10.4%, 95% CI: 7.1-14.7%), post-traumatic stress disorder (7.2%, 95% CI: 2.9-16.6%), substance use (4.0%, 95% CI: 3.1-5.2%), obsessive compulsive disorder (2.8%, 95% CI: 1.6-4.9%), phobic disorders (1.8%, 95% CI: 1.1-2.8%), panic disorders (1.1%, 95% CI: 0.6-2.2%), bipolar disorders (0.7%, 95% CI: 0.3-1.6%), and psychosis (0.5%, 95% CI: 0.3-0.9%). Populations exposed to adverse events had higher prevalence of mental disorders than the general population. Period and lifetime prevalence showed little difference across mental disorders. More pronounced differences in prevalence were seen for depression and GAD, specifically between current and lifetime prevalence (depression: current prevalence 20.5% (95% CI: 14.9-27.4%), vs. lifetime prevalence: 4.2% (95%CI: 1.8-9.6%); GAD: current prevalence 10.3% (95% CI: 6.1-17.0), vs. lifetime prevalence: 4.5% (95% CI: 2.4-8.3%). Differences between current and lifetime prevalence of mental disorders may be due to the use of different screening instruments and thresholds being applied. Conclusion: The prevalence of mental and substance use disorders in the EMR is high. Despite substantial inter-survey heterogeneity, our estimates align with previous global and regional data on mental disorders. Our meta-review provides new evidence on the burden of mental health problems in the EMR. Systematic Review Registration: PROSPERO, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020187388.

The lived experience of psychosis in Nicaragua: a qualitative examination of the views of service users

BACKGROUND

The experience of psychosis is individual and influenced by a complex intersection of identity, thought processes, perceptions and culture. Little is known about the lived experience of psychosis in Nicaragua.

AIM

To explore the subjective experience of psychosis in Nicaragua from the perspectives of service users.

METHODS

Focus groups with 28 service users with experience of psychosis. A qualitative analysis using both inductive and deductive approaches was used to analyse these data.

RESULTS

Participants mostly attributed the onset of psychosis to external factors such as physical or psychological trauma and highlighted the impact of long-term conflict in the area. Whilst medication was generally viewed positively where this was available participants foregrounded lay and community support networks and engagement in valued activities in their narratives about the management of psychosis. Religious and magical forces were salient in participants' accounts of causal pathways, wider Nicaraguan culture and management practices. Stigma, social exclusion and limited access to formal health services and psychological interventions in particular were the major barriers reported to recovery from psychosis.

CONCLUSION

Our findings point to the potential utility of culturally adapted psychological interventions in Nicaragua as well as the value of lay and community workforces in delivering such interventions.

Pre-migration traumatic experiences, post-migration perceived discrimination and substance use among Russian and Kurdish migrants-a population-based study

BACKGROUND AND AIMS

The associations between traumatic events, substance use and perceived discrimination have been rarely studied among migrants in host countries. We examined whether pre-migration potentially traumatic experiences (PTEs) or perceived discrimination (PD) are associated with substance use among migrants with voluntary (Russians) and forced (Kurds) migration backgrounds.

DESIGN

Cross-sectional interview and health examination data from the Finnish Migrant Health and Wellbeing Study were used. The target sample (n = 1000 for each group) was drawn from the national population register using stratified random sampling by participants' country of birth and native language.

SETTING

Population-based data were collected from six cities in Finland during 2010-12.

PARTICIPANTS

The participation rates were 68% (Russians) and 59% (Kurds). The analytical sample size varied (Russians n = 442-687, Kurds n = 459-613), as some participants completed only interview, health examination or short interview. The majority of Kurds had a refugee background (75%) while Russians had mainly migrated for other reasons (99%).

MEASUREMENTS

The three main outcomes were self-reported binge drinking, daily smoking and life-time cannabis use. PTEs and PD were self-reported in the interview. Socio-demographic background, migration-related factors and current affective symptoms were adjusted for.

FINDINGS

Among Kurds, PTEs were associated with binge drinking [adjusted odds ratio (aOR) = 2.65, 95% confidence interval (CI) = 1.30-5.42] and PD was associated with life-time cannabis use (aOR = 3.89, 95% CI = 1.38-10.97) after adjusting for contextual factors. Among Russians, PTEs were associated with life-time cannabis use adjusting for contextual factors (aOR = 2.17, 95% CI = 1.12-4.18).

CONCLUSIONS

In Finland, pre-migration traumatic experiences appear to be associated with life-time cannabis use among the Russian migrant population (voluntary migration) and binge drinking among the Kurdish migrant population (forced migration). Perceived discrimination in Finland appears to be associated with life-time cannabis use among Kurdish migrants.

Lifetime prevalence and potential determinants of psychotic experiences in the general population of Qatar

BACKGROUND

To estimate the lifetime prevalence and potential determinants of psychotic experience(s) (PEs) in the general population of Qatar - a small non-war afflicted, conservative, high-income, middle-eastern country with recent rapid urbanization including an influx of migrants.

METHODS

A probability-based sample (n = 1353) of non-migrants and migrants were interviewed face-to-face and administered a 7-item psychosis screener adapted from the Composite International Diagnostic Interview, the Kessler 6-item psychological distress scale, and the 5 items assessing odd (paranormal) beliefs and magical thinking (OBMT) from the Schizotypal Personality Questionnaire. Using bivariate and logistic regression analyses, lifetime prevalence rates of PEs were estimated then compared before and after adjustment for socio-demographics, Arab ethnicity, psychological distress, and OBMT.

RESULTS

Prevalence of PEs was 27.9%. Visual hallucinations were most common (12.8%), followed by persecutory delusions (6.7%) and auditory hallucinations (6.9%). Ideas of reference (3.6%) were least prevalent. PEs were significantly higher in Arabs (34.7%) compared with non-Arabs (16.4%, p < 0.001) with the exception of ideas of reference and paranoid delusions. Female gender was associated with a higher prevalence of PEs in the Arab group only (p < 0.001). Prevalence of PEs was significantly higher among Arabs (48.8% v. 15.8%, p < 0.001) and non-Arabs (35.2% v. 7.3%, p < 0.001) with OBMT. Arab ethnicity (OR = 2.10, p = 0.015), psychological distress (OR = 2.29 p = 0.003), and OBMT (OR = 6.25, p < 0.001) were independently associated with PEs after adjustment for all variables.

CONCLUSIONS

Ethnicity, but not migration was independently associated with PEs. Evidence linking Arab ethnicity, female gender, and psychological distress to PEs through associations with OBMT was identified for future prospective investigations.

Posttraumatic stress disorder with secondary psychotic features (PTSD-SP): Diagnostic and treatment challenges

Trauma exposure leads to various psychiatric disorders including depression, anxiety, bipolar disorders, personality disorders, psychotic disorders, and trauma related disorders, especially posttraumatic stress disorder (PTSD). There are some overlapping symptoms of both PTSD and psychosis that make diagnosis challenging. Despite this overlap, the evidence of PTSD with comorbid psychosis as a distinct entity lies in the research showing biologic, genetic and treatment management differences between psychotic PTSD, non-psychotic PTSD, psychotic disorders and healthy controls. There is emerging evidence that PTSD with secondary psychotic features (PTSD-SP) might be a discrete entity of PTSD with known risk factors that increase its prevalence. This review has presented evidence for individuals with PTSD-SP being distinct in genetics and neurobiological factors. Individuals with PTSD and comorbid psychosis can benefit from evidence based psychotherapy (EBT). There is not enough evidence to recommend second generation antipsychotics (SGA) for PTSD-SP given that risperidone and quetiapine are the only SGAs studied in randomized controlled trials. Hence, developing an operational diagnostic criteria and treatment framework for clinical and research use is critical.

Prevalence of psychotic-like experiences and their correlations with internalizing problems: A study of early adolescents in rural area in Karawang, Indonesia

INTRODUCTION

Adolescents who live in rural areas have been found to experience more mental health problems than those who live in urban areas. In Indonesia, adolescents who live in rural areas have limited facilities to access mental health services. On the other hand, there is still a strong belief in the rural communities that mental health problems are the consequence of demonic possession, having committed a sin, lack of faith, etc. Rural communities tend to seek traditional remedies such as advice from traditional healers or witchdoctors. Unfortunately, previous studies have indicated that the onset of most mental health problems is during adolescence, and this includes psychotic symptoms that are often manifested as psychotic-like experiences (PLEs).

METHODS

The Strength and Difficulties Questionnaire was used to examine internalizing problems. PLEs were used to examine psychotic symptoms. Data were collected in 3 junior high schools in Karawang. A total of 270 adolescents (aged between 11 and 16 years old) who live in the rural area in Karawang participated in this research.

RESULTS

The study found that the prevalence of adolescents with at least 2 symptoms of PLEs was 7%. The result of the study indicated that there is no significant correlation between psychotic-like experiences and internalizing problems (r = .075, P = .22).

DISCUSSION

PLEs significantly correlated with peer-relationship problems rather than with internalizing problems. Further investigation is needed to examine the factors that contribute to PLEs in rural settings.

The contemporary refugee crisis: an overview of mental health challenges

There has been an unprecedented upsurge in the number of refugees worldwide, the majority being located in low-income countries with limited resources in mental health care. This paper considers contemporary issues in the refugee mental health field, including developments in research, conceptual models, social and psychological interventions, and policy. Prevalence data yielded by cross-sectional epidemiological studies do not allow a clear distinction to be made between situational forms of distress and frank mental disorder, a shortcoming that may be addressed by longitudinal studies. An evolving ecological model of research focuses on the dynamic inter-relationship of past traumatic experiences, ongoing daily stressors and the background disruptions of core psychosocial systems, the scope extending beyond the individual to the conjugal couple and the family. Although brief, structured psychotherapies administered by lay counsellors have been shown to be effective in the short term for a range of traumatic stress responses, questions remain whether these interventions can be sustained in low-resource settings and whether they meet the needs of complex cases. In the ideal circumstance, a comprehensive array of programs should be provided, including social and psychotherapeutic interventions, generic mental health services, rehabilitation, and special programs for vulnerable groups. Sustainability of services, ensuring best practice, evidence-based approaches, and promoting equity of access must remain the goals of future developments, a daunting challenge given that most refugees reside in settings where skills and resources in mental health care are in shortest supply.