Introduction Fifty percent of people living with schizophrenia do not receive proper treatments, and adherence level has been reported as low as 65%. Furthermore, the level of satisfaction has been reported to be very low in this population. Objective The purpose of this study was to evaluate treatment satisfaction, adherence, and the prevalence of drug therapy problems (DTPs). Methods A hospital-based cross-sectional study was carried out on 118 patients with schizophrenia. DTPs, adherence, and treatment satisfaction were determined using the Cipolle, Morisky, Green, and Levine, and Treatment Satisfaction with Medicines Questionnaire tools. The data were then entered using Epi-Info™ version 7.2.1 and SPSS version 22 was used for analysis. Descriptive statistics were used to summarize patients’ characteristics. Univariate and bivariate logistic regressions, with a significance threshold of P < .05, were used to analyze the associations. Results DTPs were found in 52.5% ( P < .001) of the participants. The most often detected DTPs were ‘adverse drug reaction', (26.1%); ‘dose-too-low', (20.5%); and ‘ineffective-medicine therapy', (20.5%). Risperidone was the most prevalent medication (79, 47%) found in DTPs. DTPs were associated with age ≥ 65 years [AOR = .044, 95% CI (.003-.741); P < .030], drug-source [AOR = .774, 95% CI (.070-.826); P = .241], treatment duration [AOR = 5.820, 95% CI (1.451-23.342), P = .013], and the number of drugs taken [AOR = 5.936, 95% CI (1.623-21.71), P = .007]. Adherence status revealed that 69 (58.5%) of the participants were poorly adherent to their treatment. Overall, 68.8% of those who took part in the study were satisfied according to satisfaction ratings. Conclusions There is a high burden of DTPs in the study setting in the form of Adverse drug reactions, low dose schedules, and ineffective treatment associated with poor medication adherence; even though two-third of the participants were found to be satisfied with the clinical services given at the clinic.
Introduction Schizophrenia spectrum disorders are characterised by notable deficits in executive function, working memory, attention and social cognition. Previous studies in cognitive remediation therapies, of various dose and duration, have shown behavioural and neurobiological improvements. The current pilot study will be the first to test the Cogmed Working Memory Training (CWMT) program in schizophrenia spectrum disorder. Methods This pilot study was conducted using purposive sampling of consumers with schizophrenia spectrum disorders from a forensic mental health inpatient unit in Australia was used. Eleven participants completed 30 sessions of CWMT over a 2-month period. One participant completed 28 sessions. The primary outcome measure was the CogState Schizophrenia Battery (CSB). Secondary measures included the Brock Adaptive Functioning Questionnaire (BAFQ) and the Allen Cognitive Level Screen (ACLS). Measures were taken before and after the intervention, and at 6-months follow-up to detect maintenance of improvements. Results Significant improvements were seen in social cognition and emotionality. Trends toward improvement in executive function and working memory were observed in younger participants, but were not significant. Conclusion Findings indicate that the CWMT may be a beneficial tool for improving social cognition in patients with schizophrenia. CWMT interventions of longer than 2 months may be required to see measurable improvements in other cognitive functions. Age-related cognitive impairment should be controlled for in future studies. Larger studies should be conducted to confirm these findings.
Background Somatic complaints play a central role in the posttraumatic psychological symptom presentation among people within many cultural contexts. One theory about the function of somatic symptoms suggests that diffuse bodily complaints serve as idioms of distress. However, few studies have examined the effect of culturally adapted trauma interventions on reducing somatic symptoms specifically implemented in a low-income country. Methods We examined the effects of Islamic Trauma Healing – a brief, group- and mosque-based, lay-led intervention – on somatic symptom reduction in a pre-post feasibility study conducted in Somaliland. Inclusion criteria were DSM-5 trauma exposure and DSM-5 re-experiencing or avoidance. Participants (N = 26; 12 men, 14 women) reported large intervention effects for somatic symptoms ( g = 2.74, SSS-8). Higher pre-intervention somatic symptoms showed moderate to large associations with higher overall PTSD symptoms ( r = .43, P = .03). At post-intervention, somatic symptoms were only significantly associated with higher PTSD avoidance symptoms ( r = .41, P = .04) and lower well-being ( r = -.49, P = .01). No gender effects on total somatic symptom scores were observed. Discussion Results of this feasibility trial bring into focus overlap between mental health symptom reporting and somatic concerns as conceptualized within the context of cultural idioms of distress. Moreover, these findings suggest that diffuse transdiagnostic somatic symptoms could offer opportunity to learn about the intersections among culture, posttraumatic stress, and idioms of distress as mechanisms in global mental health intervention development.
The primary aim of suicidology is to understand the phenomenon of suicide by increasing its predictability and prevention to reduce the suicide rate. However, the rate of suicide remained obstinately high. This phenomenological study explored the different perspectives of 5 suicide attempt survivors and 7 mental health professionals on suicide recovery and its process. Phenomenological methods were used to analyze the participants' lived experiences through reduction, description, and finding the essence. Four essential emergent elements elucidate these perspectives, implying the general status of the current suicide healthcare system, vital in understanding suicide and suicide recovery, namely: (1) contextual elements: factors that describe how the participants view suicidality and suicide recovery; (2) facilitative elements: elements that lead to and affect the youths' suicide recovery; (3) impeding elements: factors that hinder suicide recovery; and (4) procedural elements: conditions that pertain to the steps in suicide management and intervention program. By integrating the findings of this current phenomenological study with the Inflorescence Model of Suicide Recovery, a suicide recovery-focused paradigm for suicide care and management was conceptualized. Exploring suicide recovery and its process found that there are different perspectives on suicide among suicide attempt survivors and mental health professionals; thereby, showing the gaps or cracks that exist in the health care system. This fragmentation results in deaths of suicide despite psychological and psychiatric treatments. Thus, the findings were used to conceptualize the Inflorescence Suicide Management Program (ISMP) that hopes to contribute to establishing a structured, systemic, and collaborative health care system.
Background DiGeorge syndrome (DGS) is a rare genetic illness characterised by the abnormal development of the pharyngeal pouch system. It is known to have a high association with intellectual disability and psychiatric disorders. Purpose This case report details a unique 22-year journey of a 49-year-old female with an established diagnosis Intellectual disability, Schizophrenia and Borderline Personality Disorder associated with DGS. This report demonstrates the challenges faced for a patient with 22q11.2DS in the 3 intersecting domains of physical, psychiatric and psychological illness. Results The report draws attention to the limitations in follow up care, risk management and discharge settings in the face of the treatment refractory nature of her underlying health conditions. Conclusions The case highlights the lack of specific treatment guidelines and psychosocial supports for the neuropsychiatric phenotypes associated with 22q11.2DS. More research is needed to inform guidelines and considerations of care for the`-se patients.
Introduction The outbreak of COVID-19 has heightened mental health challenges among adolescents worldwide, while also hindering the development of effective emotion regulation strategies. Nevertheless, there exists a pertinent requirement to further investigate the psychological ramifications of COVID-19 on adolescents, as well as to discern disparities in these impacts across various nations. In order to address this gap in research, this study compares the prevalence of NSSI (characterized by purposefully injuring one's own body tissues without suicidal intention or engaging in behaviors that are not socially approved or sanctioned.), emotion regulation strategies, and psychopathology (internalization and externalization) among Belgian and Iranian adolescents pre- and during the COVID-19 pandemic. Method Adolescents between the ages of 13-21 from Iran and Belgium participated in a two-wave longitudinal design. In Iran, the sample consisted of 117 adolescents in wave 1 (April 2019) and 142 adolescents in wave 2 (Nov 2020). The Belgian sample consisted of 376 participants in wave 1 and 356 adolescents in wave 2. NSSI was assessed using the Self-Harm Inventory (SHI). Emotion Regulation was examined via the Emotion Regulation Inventory (ERI). The S trengths and Difficulties Questionnaire for Youth (SDQ) was used to assess psychological symptoms. Result Across the whole sample, lifetime NSSI prevalence was 35% in the first wave and 43.8% in the second wave. Longitudinal analysis across waves and counties did not show an increase in the prevalence of NSSI but did find that emotion dysregulation and internalizing symptoms are important risk factors for NSSI across countries. Emotional suppression and emotional dysregulation were the most prevalent emotion regulation strategies in Iran, whereas emotional integration was most prevalent in the Belgian sample. Conclusion Our study highlights cultural differences on the impact of COVID-19 on adolescent mental health. But it also indicates the importance of certain universal risk factors, for example, emotional dysregulation. These findings can inform developers to tailor programs for (early) intervention culturally.
Background Adverse childhood experiences (ACEs) are pernicious events (e.g., physical abuse) that occur before 18 years of age within the household. Mothers’ ACEs are associated intergenerationally with their preschool children’s (two-to-five-year-old) behavioural problems, impacting lifelong mental health trajectories. Mediators (e.g., mental health) may explain how mothers’ ACEs exert their influence on children's behavioural development whereas moderators (e.g., child sex) may affect the strength and direction of the association, revealing potential points of intervention. Therefore, this study aimed to: (1) identify mediators and moderators of this association; and (2) describe and compare moderation and mediation outcomes. Methods This review (#CRD42022307214) extracted data from peer-reviewed literature formally analyzing at least one moderating or mediating variable of the association between maternal ACEs and preschool children’s behavioural problems using MEDLINE, Embase, APA PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL, SCOPUS, and Web of Science databases (n = 7). Validity was assessed using the Joanna Briggs Institute checklists. Results Thirteen full-text studies with moderate-to-high validity were identified. Most studies examined mediating variables, with unanimous support for mediation through maternal depression. The mediating roles of adult attachment styles and anxiety were conflicting. No studies examined environmental factors (e.g., neurotoxins). Conclusions Mothers’ depression is a significant contributor to children’s behavioural problems in the context of ACEs and should be a target of early intervention to prevent lifelong challenges. Future research should focus on examining more moderating variables and consider the roles of environmental factors. More research is needed on the moderating and mediating roles of genes.
Background Suicidal behavior in adolescents is a public health problem. Although it has been reported that there is a link between suicidal behavior and Quality of life (QoL), this relationship has not been explored in pregnant adolescents, nor have depressive symptoms been examined as mediators and social support as a moderator in a moderated mediation model. Methods In 2021, 143 pregnant adolescents between 13 and 19 years old from different states in Mexico were evaluated. The KIDSCREEN-52 instrument was applied to evaluate the Health-Related Quality of Life, the scale of expectation of living and dying of Okasha, the Edinburgh Postpartum Depression Scale, the family and partner support scale (AFA-R) and sociodemographic information. Moderated mediation analyses were completed. Results A relationship between QoL and suicidal behavior was found, and that relationship was mediated by depressive symptoms on all eighteen models. In addition, social support from the family moderated the mediation of depressive symptoms in 4 of 9 QoL dimensions, and social support from the partner moderated the mediating effect of depressive symptoms in 8 of 9 QoL dimensions. Conclusion The relationship between QoL and suicidal behavior was consistent with previous studies. The moderating role of social support and the mediation of depressive symptoms on the relationship between QoL and suicidal behavior were also consistent with the literature. Professionals who work with pregnant adolescents should consider both depressive symptoms and social support as important factors that influence QoL and suicidal behaviors.
Background Provider loneliness in healthcare can have devastating consequences. The causes of loneliness are not well known and workplace changes during the COVID-19 pandemic likely cause fewer opportunities for socialization. Objective We sought to explore the relationships between healthcare worker loneliness and isolation among various specialties and work environments. We evaluated factors that may contribute to increased loneliness/isolation, such as job satisfaction, time with peers, and work-related changes during COVID-19. Design An email containing an 18-item survey was sent out to Hartford Hospital’s medical staff. Setting Hartford Hospital Participants Hartford Hospital’s medical staff including physicians, psychologists, physician assistants, and APRNs Measurements Our survey included demographic information, questions regarding frequency of meaningful interactions with colleagues, isolation behaviors, as well as the UCLA 3-Item Loneliness Scale, Patient Health Questionnaire-2, Single-Item Burnout Scale, and Single-Item Measure of Job Satisfaction Results Of 1,015 respondents, almost half (48%) reported feeling lonely. Staff in procedure areas had significantly higher loneliness scores, while hospital-based floor/unit staff reported the lowest scores. Isolation was attributed to exhaustion from clinical work (36.1%), being too busy (39.6%), and being cautious due to COVID-19 (39.2%). Those who reported burnout, depression, and having few meaningful interactions all had increased loneliness scores. Those with higher job satisfaction reported lower loneliness. Limitations While our study had a 51% response rate, this rate is equivalent or higher than the response rate the organization receives to obligatory engagement surveys. It is likely that the ongoing pandemic affected these results. Conclusion We found significant levels of loneliness among our medical staff that appeared strongly related to work setting and environment. Social isolation behaviors were associated with higher loneliness scores. Future research should examine the efficacy of tailored strategies/interventions to reduce loneliness. Primary Funding Source None
Background This study describes adaptation and modification of World Health Organization (WHO) recommended group interpersonal psychotherapy (IPT-G) for depressed peripartum adolescents. The adaptation process includes accommodating contextual factors and strategies to address intervention implementation barriers, such as engagement problems with adolescents, caregivers, and providers, and stigma and dearth of mental health specialists. The modifications include and adolescent relevant iterations to the therapy format and content. Methods A multi-stakeholder led two-stage intervention adaptation and modification process integrating mixed qualitative methods were used with pregnant and parenting adolescents, their partners, and health care workers. In-depth interviews focusing on personal, relationship, social, and cultural barriers experienced by adolescents were carried out modeled on the Consolidated Framework for Implementation Research. Focus group discussions with depressed adolescents on their experiences, feedback from caregivers, partners, health workers inform focused modifications. An IPT expert committee of three practitioners, along with UNICEF adolescent officer, and mental health policy expert from Ministry of Health and representative community advisory body reviewed the adaptations and modifications made to the WHO IPT-G manual. Discussion Integration of mental health needs of peripartum adolescents as demonstrated in the stakeholder engagement process, adaptation of key terms into locally relevant language, determination of number of sessions, and user-centric design modifications to digitize a brief version of group interpersonal psychotherapy are presented.
Background Specific phobia (SP) is one of the most common mental disorders among general population. In this national survey in Iran, we aimed to identify the lifetime prevalence, predictors, and co-morbidities of SP among children and adolescents. Methods A face-to-face household interview was applied by 250 skilled clinical psychologists using the Persian version of the kiddie schedule for affective disorders and schizophrenia for school-age children/present and lifetime version (K-SADS-PL) to determine the prevalence of SP and its co-morbid conditions. Results About 30 000 individuals participated in this study. We identified 923 individuals (378 boys and 545 girls) with SP. The lifetime prevalence rate of SP was 4.8%. This condition was related to gender, age, and type of settlement. Female gender and living in urban areas were the main positive predictors of developing SP. We showed that parental educations and their history of psychiatric hospitalization were not predictors of SP occurrence. Anxiety and behavioral disorders were the most common reported co-morbidities in our included children and adolescents. Conclusions The findings of this study indicate that SP is a prevalent disorder among pediatric population with different co-morbidities and should not be underestimated.
Introduction Intensive case management is an essential component of community mental health care system for people with severe mental illness. We examined the association of service types with previous and future functioning and hospital admissions using a longitudinal data, to clarify the case managers’ activity. Methods The study included baseline assessment, recording and analysis of services, and follow-up assessment. At the baseline and follow-up assessments, we examined functioning (ie, Personal and Social Performance Scale: PSP) and hospital admission of users for past periods. For recording and analysis of services, we recorded services provided by case managers over 2 months, and five core services were used for the analyses: regular face-to-face contact, outreach services, hospital-based (outpatient) services, and easy contacts and coordination. Results Outreach services were significantly associated with hospital admissions at baseline and follow-up assessments. Hospital-based services were significantly associated with lower PSP scores and hospital admission at follow-up assessment. Easy contacts and coordination were associated with lower PSP scores at follow-up assessment. Conclusion In Japan, most services are provided in the outpatient department of hospital, and outreach services are relatively time consuming for case managers; thus, the indications for providing outreach services need to be carefully considered. Therefore, we suggest that case managers provide flexible services to users according to the circumstances in Japan.
Background COVID-19 has globally increased psychological distress. Although research has shown a clear link between neuroticism and psychopathology, pandemic fears—manifesting as fear of death and coronavirus anxiety, have not been examined as mediating factors for explaining this connection during the pandemic. Methods Therefore, to fill this void in the literature, this study examined 259 U.S. MTurk adult workers in May 2020 using an online questionnaire. The study used the Patient Health Questionnaire, the 8-item Big Five Inventory neuroticism subscale, a single-item fear of death measure, and the Coronavirus Anxiety Scale as well as collected demographic information to perform correlational and meditation analyses. Results The results showed that both coronavirus anxiety and fear of death partially mediated the relationship between neuroticism and symptoms of depression and generalized anxiety. The results also found that those high in trait neuroticism who were fearful of death or had coronavirus anxiety showed heightened levels of depression and general anxiety. Conclusion This study’s findings were consistent with previous research and current work on pandemic-related distress. In addition, the results of these findings can help bring to light the connectedness of these psychopathological constructs with fears surrounding the pandemic—which can be useful to both researchers and mental health professionals alike.
Background: Cognitive interviewing is a well-recognised methodology to identify clinical and commonsensical relevance of mental health questionnaire items by our research participants. Depression is amongst the most common condition impacting pregnant and parenting adolescents in sub-Saharan Africa (SSA). In Kenya, studies have reported depression prevalence estimates of 12-50% in peripartum adolescents. While young people prefer using English, there has not been enough data to point to how well they respond to Kiswahili translations of the commonly used tools. Method: Thirty-two participants between ages 14-18 years were approached and through informed consent for them to participate. We used Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire-9 (PHQ-9) in English and Kiswahili versions to carry out the interviews and were coded along with 4 domains of comprehension, retrieval, judgement, and patient response. The interviews were discussed within the team and tables were shared between 3 raters for further consensus. The interview transcripts were analyzed manually using thematic analysis. We used the findings from the interviews to make modifications to the existing English versions of EPDS and PHQ-9 and to modify Kiswahili versions too. Discussion: We found that adolescents had challenges in fully understanding items in both sets of tools however, EPDS was better received than PHQ-9. Psychometrically, the EPDS English version and Kiswahili versions fared better than the PHQ-9 English and Kiswahili versions. PHQ-9 presented considerable issues with regards to semantic clarity however had simpler response options in comparison to EPDS which was more experientially appropriate, but response options were not simple. On our thematic analysis, we felt that the adolescents were significantly challenged by the new, unanticipated pregnancy or motherhood experience. Poverty, poor partner support, discord with parents and distress in the family, and traumatic end of supportive and helpful relationships were the notable problems. We believe the cultural and linguistic modifications made on these tools would make them more suitable to be validated with a sample of pregnant adolescents. Conclusion: While sensitive cross-cultural translations for the commonly used open access depression tools is critical, it is also pertinent to understand whether these are developmentally appropriate. Our participants had multiple psychosocial and material challenges that necessitate measures sensitive to their age, social context, and health experiences. Additionally, we felt that both the tools may not be suitable for self-administration and may need the involvement of a case worker or community health worker.
Background:Substance use disorders are more common among people with mental illness than in the general population. It makes recovery from mental illness more difficult, leads to frequent thoughts of suicide and re-hospitalization.Objective:Aimed to assess the prevalence of substance use disorders and associated factors among adult psychiatric patients in Jimma Town, Southwest, Ethiopia, 2017.Methods:A community-based cross-sectional study was conducted on a total of 300 patients with mental illness using the case tracing method. Participants were interviewed using the alcohol use disorder identification test questionnaire to assess Alcohol Use Disorder (AUD). Fagerstrom test tool for nicotine dependence and structured questionnaires were utilized to assess the socio-demographic characteristics of participants. Data were analyzed using SPSS version 20. The variable that showed association with AUD and nicotine dependence at P < .25 in the bivariate analysis was entered into multivariable logistic regressions to control confounders for both outcome variables independently. The significance of association was determined by P < .05 and strength was described using an adjusted odds ratio at a 95% confidence level.Results:The prevalence of alcohol use disorder and nicotine dependence was 14.3% and 23.3%, respectively. Female gender (AOR 0.15, 95% CI = 0.04-0.57), starting treatment within the first month of the onset of the illness (AOR 0.20, 95% CI = 0.05-0.82) and nicotine dependence(AOR 4.84, 95% CI = 1.85-12.67) associated with AUD. Additionally, being female (AOR 0.04, 95% CI = 0.01-0.25), joblessness (AOR 3.05, 95% CI = 1.30-7.16), absence of relapse of illness (AOR 0.18, 95% CI = 0.065-0.503), no improvement in illness (AOR 5.3, 95% CI = 1.70-16.50), and current khat use (AOR 3.09, 95% CI = 1.21-7.90) were associated with nicotine dependence.Conclusion:This study revealed a high prevalence of substance use disorders among psychiatric patients in the community. Being female, experiencing a shorter duration of illness before initiating treatment, and nicotine-dependence were significantly associated with AUD. On the other hand, female sex and absence of relapse of illness were negatively associated with nicotine dependence whereas, joblessness, less improvement of illness, and khat chewing were positively associated with it. Therefore, services on substance use disorders have to be extended to the community level with wide-scale training for the town’s health care providers, including health extension workers who have direct contact with these individuals. Accordingly, comprehensive and suitable interventions were advised to be provided on factors contributing to substance use disorders in general.
Background: Symptoms of pseudobulbar affect (PBA) often are misinterpreted as those of a mood disorder. Symptoms seen in patients with PBA can be influenced by a mood disorder and vice versa. Our aim in this study was to determine the occurrence rate of PBA symptoms and comorbid depressive symptoms in a cohort of nursing home patients with different subtypes of neurocognitive disorders (NCD)/dementia. Methods: Eighty patients were screened and 61 met the inclusion criteria. These individuals were divided into 5 groups according to NCD subtypes: Alzheimer’s disease, vascular, HIV, unspecified, or combined types. The Center for Neurologic Study–Lability Scale (CNS-LS) and the Geriatric Depression Scale–Short Form (GDS-SF) were used to screen for PBA and depressive symptoms, respectively. The Mini-Mental Status Exam (MMSE) was used to determine patients’ baseline functioning. Fifty-nine patients successfully completed the CNS-LS and 42 completed the GDS. Results: Forty-four percent of individuals screened positive for PBA symptoms. Depressive symptoms were found among 23% of these patients. Not only were PBA-symptoms positive patients common among this nursing home residents, the PBA-symptoms positive patients were found to cluster mostly among those with NCD due to HIV (66.0%). PBA symptom-positive patients often received psychotropics. Conclusion: Better awareness, screening tools, and treatment approaches for patients with NCD expressing PBA-symptoms—especially those with NCD due to HIV Infection—are needed.
Objectives: Lasting, unexplained and high levels of pain may cause anxiety in patients with chronic fatigue syndrome. The objectives of the current study were to test assumptions of the association between pain and anxiety in patients diagnosed with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and to clarify the role of depression in this relationship. Methods: Data were collected from 664 participants (age 18-65 years) with 133 ME/CFS patients and 201 healthy controls from Norway and 330 CFS patients from Spain. Binary logistic regression model was applied to test relationships between the included variables in the samples. Results: Both pain and depression made significant direct contributions to the level of anxiety. The strongest risk for higher levels of anxiety was the combination of high levels of depression and high levels of pain in the overall sample (OR = 49.70; P < 0.001), not so much in the Spanish cohort (OR = 11.99; P < 0.0001) and most of all in the Norwegian cohort (OR = 88.21; P < 0.001) sample. Conclusions: It was the combination of high pain levels and high levels of depression that to the greatest extent increased the risk of anxiety in patients with CFS/ME. Whatever diagnostic criterion that is applied, anxiety and depression should be mandatory to assess in the clinical assessments performed for diagnosing the ME/CFS. Approaches addressing anxiety-related pain and treatment of depression should be warranted.
Aims: This study examines factors potentially contributing to unattended mental health needs among primary care patients in Lebanon’s Shatila Palestinian Refugee Camp in order to understand the prevalence of such needs and improve clinical practice with refugees and other vulnerable groups. Methods: Data collection (2012-13) involved researcher administered structured surveys of primary healthcare-clinic patients (n = 254) using the K6, the PC-PTSD, and the Modified-MINI mental illness screens. Chi. Sq., ANOVA and Principal Component analysis evaluate associations and differences in sample characteristics; Logistic regression evaluates factors associated with unattended-positive-mental-health-screens. Results: The sample (n = 254) included 55% females and 45% males; aged 18 to 89, M = 40.4 (±13). About 51.6% (n = 132) screened positive for mental illness, for these individuals only 11.4% (15 of 132) spoke to their physician about mental illness or had an acknowledged record of psychological problems. Thus 88.6% (n = 117) of those who screened positive, had unattended positive-screens. Univariate tests indicated that patients with “negative-screens,” those with “attended positive-screens,” and those with “unattended positive-screens” differed in their social and psychological characteristics as well as their relationship with the primary care setting. Overall multivariable Logistic results indicated that patients with unattended positive-screens were 34% less likely to have higher SES scores for each step up in status [OR = 0.66; CI: 0.48-0.89] and 58% less likely to have access to a provider for advice or assistance [OR = 0.42; CI: 0.20-0.88]. They were 2.2 times more likely to be females [OR = 2.20; CI: 1.22-3.95], and 5.26 times more likely to attribute their mental illness to a physical illness [OR = 5.26; CI: 2.36-11.74]. Conclusion: Large numbers of patients screen positive for mental illness who do not have their mental health need addressed during their primary care visit. This seems an issue rooted in a lack of psychoeducation about what is mental versus physical illness, female specific access to care, stigma toward mental illness, and cross-SES-communication. Improved communication in primary care, especially as it serves vulnerable refugee populations might significantly reduce the prevalence of untreated mental illness.
We report the case of a 23-year-old woman who presented to our Psychiatry Unit with a complex psychiatric symptomatology, 6 years after suffering from a form of encephalopathy which was retrospectively and hypothetically labeled as autoimmune limbic encephalitis. Over the years, several psychopharmacological therapies had been initiated, but none of them led to substantial remission of symptomatology. During the first visit, symptoms were characterized by dysphoric mood with suicidal ideation, anxiety, delusional thoughts. Self-harm and psychogenic seizures with daily frequency were also reported. A therapy with slow-release lithium sulfate, lurasidone, and lorazepam was prescribed. After 6 months of treatment, psychopathological manifestations significantly improved.
