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Siamisang K, Phologolo T, Mukuhwa T, Schafrick N, Mhaladi B, Phuthego B, Mmati M, Masupe T. Predictors of mass psychogenic illness in a junior secondary school in rural Botswana: A case control study. S Afr J Psychiatr 2022; 28:1671. [PMID: 35747341 PMCID: PMC9210177 DOI: 10.4102/sajpsychiatry.v28i0.1671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/31/2022] [Indexed: 11/17/2022] Open
Abstract
Background In March 2019, students at Lempu Secondary School in Kweneng District, Botswana displayed symptoms including headache, abnormal leg movements and difficulty walking. Within days, 133 students were admitted to Scottish Livingstone Hospital where mass psychogenic illness (MPI) was diagnosed. Aim To identify predictors of this illness. Setting Kweneng West District, Botswana. Methods This was a case control study using interviewer-administered questionnaires. Cases were students who displayed MPI symptoms from the 2nd of March to the time of the interviews or who were admitted with MPI diagnosis. Analysis was restricted to female students. Logistic regression was used to generate odds ratios. A p value of < 0.05 was considered to demonstrate significant association between variables. Results Interviews were conducted with 142 cases and 202 controls. The median age was 15 years. Most of the cases (95.8%) were boarding girls. Residence in school campus (AOR 13.2), history of evaluation by psychologist and/or social worker (AOR 2.6), history of traumatic events (AOR 1.8), contact with sick peers (AOR 2.3) and contact with spiritual healer (AOR 2.0) were independent predictors of MPI. Additionally, perception of adequate security in the dormitories (AOR 0.3) and perception of poor lighting (AOR 6.8) were significant predictors of MPI amongst boarding girls. Conclusion The outbreak in Lempu Community Junior Secondary School (CJSS) was typical of mass psychogenic illness affecting mainly boarding girls and was associated with psychological and environmental risk factors. Changing the boarding environment and continuous psychological support are key to preventing future outbreaks. Interventions should also target the identified risk factors.
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Affiliation(s)
- Keatlaretse Siamisang
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Health Services Management, Ministry of Health and Wellness, Gaborone, Botswana
| | - Thabo Phologolo
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Terrence Mukuhwa
- Department of Health Services Management, Ministry of Health and Wellness, Gaborone, Botswana
| | - Nathaniel Schafrick
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Vermont, Vermont, United States of America
| | - Bonolo Mhaladi
- Department of Health Services Management, Ministry of Health and Wellness, Gaborone, Botswana
| | - Boang Phuthego
- Department of Health Services Management, Ministry of Health and Wellness, Gaborone, Botswana
| | - Monica Mmati
- Department of Health Services Management, Ministry of Health and Wellness, Gaborone, Botswana
| | - Tiny Masupe
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
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Barnett C, Mitchell C, Tyson S. The management of patients with functional stroke: speech and language therapists’ views and experiences. Disabil Rehabil 2021; 44:3547-3558. [DOI: 10.1080/09638288.2020.1867910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Caroline Barnett
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Claire Mitchell
- Division of Human Communication, Development & Hearing, University of Manchester, Manchester, UK
| | - Sarah Tyson
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
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Read J, Jordan H, Perdue I, Purnell J, Murray J, Chalder T, Reuber M, Stone J, Goldstein LH. The experience of trial participation, treatment approaches and perceptions of change among participants with dissociative seizures within the CODES randomized controlled trial: A qualitative study. Epilepsy Behav 2020; 111:107230. [PMID: 32640411 PMCID: PMC7581898 DOI: 10.1016/j.yebeh.2020.107230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/17/2020] [Accepted: 06/05/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nested within a large, multicenter randomized controlled trial (RCT) for people with dissociative seizures (DS), the study used purposive sampling to explore participants' experience of participating in an RCT, their experience of DS-specific cognitive behavioral therapy (CBT) and another component of the RCT, Standardized Medical Care (SMC) and their perceptions of and reflections on seizure management and change. METHODS A qualitative study using semistructured interviews was conducted with 30 participants in an RCT (the COgnitive behavioral therapy vs standardized medical care for adults with Dissociative non-Epileptic Seizures (CODES) Trial) investigating the effectiveness of two treatments for DS. Key themes and subthemes were identified using thematic framework analysis (TFA). RESULTS Analysis yielded three overarching themes: taking part in a treatment trial - "the only thing out there", the experience of treatment techniques that were perceived to help with seizure management, and reflections on an "unpredictable recovery". CONCLUSIONS People with DS are amenable to participating in a psychotherapy RCT and described a largely positive experience. They also described the applicability of aspects of DS-specific CBT and SMC in the management of their DS, received within the confines of the CODES trial. Factors that appeared to account for the variability in response to treatment delivery included individual preferences for the nature of sessions, the nature of therapeutic relationships, readiness to discuss trauma, other aspects of emotional avoidance, and whether therapy provided something new.
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Affiliation(s)
- Julie Read
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Harriet Jordan
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Iain Perdue
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - James Purnell
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Joanna Murray
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Trudie Chalder
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Jon Stone
- Department of Clinical Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Laura H Goldstein
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
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Wilkinson M, Day E, Purnell J, Pilecka I, Perdue I, Murray J, Hunter EM, Goldstein LH. The experiences of therapists providing cognitive behavioral therapy (CBT) for dissociative seizures in the CODES randomized controlled trial: A qualitative study. Epilepsy Behav 2020; 105:106943. [PMID: 32078929 PMCID: PMC7156910 DOI: 10.1016/j.yebeh.2020.106943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/08/2020] [Accepted: 01/22/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Little is known about the experiences of therapists delivering psychotherapy for patients with dissociative seizures (DS), a complex disorder associated with a range of comorbid psychosocial and mental health difficulties. This study set out to explore therapists' experiences of delivering DS-specific, manualized cognitive behavioral therapy (CBT) to adults with DS within the context of a randomized control trial. METHODS Interviews were conducted with 12 therapists involved in the COgnitive behavioral therapy vs standardized medical care for adults with Dissociative non-Epileptic Seizures (CODES) trial and were analyzed using thematic framework analysis (TFA). RESULTS Six main themes emerged, namely 1) aspects of the intervention that were favored, while others were not always considered applicable; 2) multiple and complex difficulties faced by patients; 3) working effectively within the protocol; 4) limitations of the protocol; 5) significance of formulation; and 6) quality of standardized medical care (SMC) and difficulties of diagnosis delivery. These addressed valued aspects of the intervention, complexities of the patient group, and experiences working within a structured treatment protocol. Family involvement and psychoeducation were highlighted as important components; the applicability of graded exposure techniques, however, was restricted by patients' apparent emotional avoidance. The structure provided by the treatment protocol was valued, but flexibility was important to individualize treatment in complex cases. A comprehensive formulation was fundamental to this. The initial diagnostic explanation provided by neurologists and psychiatrists was generally considered beneficial, with patients often perceived to enter therapy with a better understanding of their condition. CONCLUSIONS This study demonstrated that the DS-specific CBT intervention met with general approval from therapists who also highlighted some practical challenges. Because of the nature of the condition, the need for experience of working with complex patients should be considered when applying the intervention to individual cases. Setting the CBT intervention in the context of a structured care pathway involving neurology and psychiatry may facilitate the therapeutic process.
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Affiliation(s)
- Matthew Wilkinson
- Canterbury Christ Church University, Salomons Institute for Applied Psychology, Tunbridge Wells, UK,South London and Maudsley NHS Foundation Trust, London, UK
| | - Elana Day
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James Purnell
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Izabela Pilecka
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iain Perdue
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joanna Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Edyta Monika Hunter
- Canterbury Christ Church University, Salomons Institute for Applied Psychology, Tunbridge Wells, UK
| | - Laura H. Goldstein
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK,Corresponding author at: Department of Psychology, PO77, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London SE5 8AF, UK.
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Baitha U, Deb KS, Ranjan P, Mukherjee A, Bauddh NK, Kaloiya GS, Kumar A, Jadon RS. Estimated prevalence of medically unexplained physical symptoms in the medicine outpatient department of a tertiary care hospital in India. Gen Hosp Psychiatry 2019; 61:47-52. [PMID: 31710858 DOI: 10.1016/j.genhosppsych.2019.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE There is a paucity of scientific evidence from the Indian subcontinent regarding the magnitude and burden of Medically Unexplained Physical Symptoms (MUPS). This study aims to fill the evidence gap by assessing the prevalence and pattern of MUPS amongst patients attending the Medicine Out-Patient Department (OPD). METHODOLOGY The study assessed all consecutive new patients, presenting to the Medicine OPD of a tertiary care center in India over a period of nine months. All consenting patients, between 18 and 60 years of age, irrespective of their reason for consultation were included for the study. The diagnosis in subjects was established by a combination of clinical history, physical examination, and relevant investigations. A diagnosis of MUPS was made in cases with no demonstrable organic cause, and after agreement in the opinion of two independent physicians. All recruited patients with MUPS were subsequently evaluated on a pre-validated symptom checklist of 23 symptoms. RESULTS Out of 976 subjects included, a diagnosis of MUPS was established in 24.6% [95% CI = 21.9-27.3] of the sample. An additional 20.6% met the criteria of persistent MUPS (symptoms >2 months), and 19.7% of subjects had symptom duration of more than three months, meeting the stricter definition for 'persistent MUPS'. Prevalence was significantly higher in females (p = 0.02), and patients of MUPS were significantly younger (p = 0.004) than patients with other diagnoses. MUPS patients on average complained of 13 ± 5 symptoms and sought multiple medical consultations [Median (IQR) = 3 (2 - 6)] in the last one year. Non-specific, general symptoms (94.6%) and various types of pain (93.7%) were the most frequent complaints. Pain symptoms, genitourinary symptoms, palpitation, and nausea were more frequent in females as compared to males. DISCUSSION Medically unexplained symptoms are as common in India as in the west and therefore pose a significant burden on the healthcare delivery systems. There is a need to sensitize the medical fraternity and policymakers for this condition to develop effective services.
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Affiliation(s)
| | | | | | - Aparna Mukherjee
- Wellcome Trust- India Alliance, Department of Pediatrics, AIIMS, New Delhi, India
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