Mental disorder, sexual risk behaviour, sexual violence and HIV in Uganda

Aim The overall aim of this thesis was to investigate the association between mental disorder and risk of sexual HIV transmission in a low-income country with a generalized HIV epidemic. Specific objectives were to investigate in Uganda, (1) the association between common mental disorder and sexual risk behaviour, (2) how severe mental disorder could influence sexual risk behaviour, (3) the prevalence of HIV in persons with severe mental disorder, and (4) the association of severe mental disorder with sexual risk behaviour and sexual violence exposure. Methods (1) Population-based household survey of 646 Ugandans. Depression, psychological distress and alcohol use were assessed, and questions asked about sexual risk behaviour. (2) Facility-based qualitative semi-structured interview study of 20 Ugandans, exploring sexual risk behaviour and violence exposure. (3) Facility-based study of HIV prevalence among 602 persons with severe mental disorder. (4) Facility-based study of prevalence of sexual risk behaviour and sexual violence among 602 persons with severe mental disorder, with nationally representative comparison data. Results (1) Depression, psychological distress and alcohol use were all associated with sexual risk behaviour, with stronger associations found in women than in men. (2) Severe mental disorder can influence sexual risks by contributing to casual sex during episodes, to rape by non-partners, to exploitation by partners, to non-monogamy in partners, and to sexual inactivity. (3) HIV prevalence was higher in women with severe mental disorder than in women in the general population, but no similar difference was found in men. (4) Severe mental disorder was associated with sexual risk behaviour in women, but not men. In women, severe mental disorder was associated with exposure to sexual violence by a non-partner. The above associations were not confounded by basic socio-demographic variables. Conclusions Mental disorder is associated with risk of sexual HIV transmission in a low-income country with a generalized HIV epidemic. Associations were found across levels of mental disorder severity and in relationship to several indicators of sexual risk. Stronger associations were found in women. By design we were not able to show that mental disorder preceded the development of sexual risk behaviour, or first sexual violence exposure. However, qualitative and quantitative findings were consistent. Our findings suggest that women with mental disorder in Uganda may be at higher risk of HIV, and at higher risk of sexual violence, than women in the general population

Crime, re-offence, and substance abuse of patients with severe mental disorder

Scientific research has shown that there is a causal association between crime, re-offence, and severe mental disorder. Numerous authors have found that psychosis, particularly schizophrenic psychosis, personality disorders, namely antisocial personality disorder, and substance abuse are disorders, which considerably increase the criminal risk. The patients’ decompensation and the associated comorbidity, in this regard, can never be neglected. Therefore, in this paper a review of literature was performed whose goals demonstrate: 1) the relationship between severe mental disorder and crime; 2) the relationship between severe mental disorder and re-offence; 3) the relationship between substance use and crime; 4) the relationship between substance use in individuals with severe mental disorder and crime and re-offence. Promoting the independence and well-being of these patients contributing to the maintenance of social peace, which requires timely monitoring and evaluation of the clinical condition and functionality of the individual, through articulation in a network, which would allow to assess and foster the skills of the individual as a social being.info:eu-repo/semantics/publishedVersio

Hubungan Antara Dukungan Keluarga Dan Kepatuhan Minum Obat Dengan Kekambuhan Klien Gangguan Jiwa Berat

ABSTRAC National prevalence of severe mental disorder is 1,7 per mil meaning 1-2 person in 1000 resident suffered from severe mental disorder. The highest prevalence is in Daerah Istimewa Yogyakarta and Aceh (0,27%). Prevalence of severe mental disorder in West Sumatera is (0,19%). This study was aimed to get an overview of relationship between family support and medication compliance with clients recurrence in severe mental disorder. Analytical design with cross sectional with the number of respondents 184 clients of severe mental disorder and family in Mental Care Unit A RSJ. Prof. Dr. HB. Saanin Padang. Samples in this study were taken with purposive sampling technique. Data were collected through questionnaires of family support and medication compliance. Research shows that there are significant difference between family support with high recurrence and low recurrence (p <0.05), no significant difference between medication compliance with high recurrence and low recurrence (p <0.05), Results of this study are expected to be contribution for nurses and related institutions in order to advise the family to oversee the client to take medication on a regular basis so that recurrence can be prevented, providing related penkes on taking medication and home settings visite. Keywords: family support, medication compliance, reccurence clients of severe mental disorder   ABSTRAK Prevalensi gangguan jiwa berat secara Nasional 1,7 per mil yang berarti 1-2 orang dalam 1000 penduduk mengalami gangguan jiwa berat. Prevalensi gangguan jiwa berat tertinggi di Daerah Istimewa Jogjakarta dan Aceh (0.27 %), sedangkan prevalensi gangguan jiwa berat di Sumatera Barat mencapai (0.19%) . Penelitian ini  bertujuan untuk mendapatkan  gambaran  tentang hubungan antara dukungan keluarga dan kepatuhan minum obat dengan kekambuhan pada klien gangguan jiwa berat. Desain Analitik dengan pendekatan potong lintang (Cross sectional) dengan jumlah responden 184 orang klien gangguan jiwa berat dan keluarga di Unit Pelayanan Jiwa A RSJ. Prof. Dr. HB. Saanin Padang. Pengambilan sampel dalam penelitian ini dengan teknik purposive sampling. Pengumpulan data dilakukan menggunakan kuesioner dukungan keluarga dan kepatuhan minum obat. Hasil Penelitian menunjukkan bahwa ada perbedaan yang signifikan antara dukungan keluarga dengan kekambuhan tinggi dan kekambuhan rendah dengan nilai (p<0,05), ada perbedaan yang signifikan antara kepatuhan minum obat dengan kekambuhan tinggi dan kekambuhan rendah dengan nilai (p<0,05). Hasil penelitian ini diharapkan menjadi masukkkan bagi perawat dan intansi terkait agar menganjurkan kepada keluarga untuk mengawasi klien untuk minum obat secara teratur agar kekambuhan dapat di cegah,memberikan penkes terkait pengaturan minum obat dan home visite.   Kata kunci        :  dukungan keluarga, kepatuhan minum obat, kekambuhan klien gangguan jiwa berat.   &nbsp

The right to smoke and the right to smoke-free surroundings: international comparison of smoke-free psychiatric clinic implementation experiences

In Scandinavia, people with a severe mental disorder have a reduced life expectancy of 15-20 years compared with the general public. Smoking is a major contributor, and smoke-free policies are increasingly adopted in psychiatric clinics around the world. We compared potential facilitators and barriers among staff and management, for the implementation of smoke-free psychiatric clinics

Violent Behavior During Psychiatric Inpatient Treatment in a German Prison Hospital

Violent behavior in correctional facilities is common and differs substantially in type, target, implication, and trigger. Research on frequency and characteristics of violent behavior in correctional facilities and psychiatric hospitals is limited. Results from recent research suggest that comorbidity of severe mental disorder, personality disorder, and diagnosis of substance abuse is related to a higher risk of violent behavior. In the Berlin prison hospital, a database was created to collect data from all violent incidences (n=210) between 1997 and 2006 and between 2010 and 2016. In a retrospective, case-control study, we analyzed specific socioeconomic data and psychiatric diagnosis and compared the group of prisoners with violent behavior with randomly selected prisoners of the same department without violent behavior (n = 210). Diagnosis of schizophrenia, non-German nationality, no use of an interpreter, no children, and no previous sentence remained significantly associated with the dependent variable violent behavior. There were no significant differences regarding age and legal statuses. Practical implications for clinical work are discussed

The dangers of using diagnoses outside of established psychiatric nosology in the courtroom: Analysis and discussion of current Swiss legal precedent from a medical perspective.

Akin to many jurisdictions, Switzerland has a dual system of sanctions comprising sentences and measures. To order a therapeutic measure per Article 59 or 63 of the Swiss Criminal Code, the presence of a "severe mental disorder" must be determined. Before the new legal precedent, this required a medical diagnosis according to recognised classification systems like the ICD or DSM. The court then decided if a disorder was "severe" in the legal sense, thereby requiring such a therapeutic measure. However, in two 2019 rulings, the Swiss Federal Supreme Court concluded that a severe mental disorder could legally exist without a diagnosis according to the ICD or DSM, if it is based on offence- and risk-relevant personality-related factors amenable to risk-reducing therapy. We examine the details and context of the rulings, alongside their wider dangers. Specifically, we outline how undue influence could be exerted by non-ICD/DSM diagnostic systems, which were developed within individual theoretical schools of thought and lack empirical validation, like in these two court cases. Such non-manual diagnoses could make the presence of a severe mental disorder dependent upon whether an expert witness employs a particular diagnostic system, which would undermine principles of legality. Moreover, the Court's requirement that the disorder is based on personality-related risk factors amenable to risk-reducing therapy is problematic because research has highlighted the low effectiveness of treatment provided independently of a psychiatric disorder. Finally, broadening entry criteria may increase the number of offenders who require psychiatric treatment, thus endangering the quality of care for those with ICD/DSM-based diagnoses that are known to respond well to treatment (e.g. schizophrenia). In short, fulfilling the Court's request that any non-manual diagnoses are based on personality-related risk factors that are amenable to risk-reducing therapy is not possible for such non-manual diagnoses. Using unvalidated diagnoses could also render the system susceptible to ethical issues and hypothetical misuse, which may adversely affect society's most vulnerable people. To counter these dangers, we suggest that in order to be admissible in court, any diagnostic system must mandatorily fulfil sufficient scientific standards

Health surveillance and workers with severe mental disorder

El caso del accidente aéreo de la compañía aérea Germanwins ocurrido en marzo de 2015 en el que el copiloto que estrelló el aparato con 150 personas a bordo padecía un problema de salud mental puso en evidencia un problema social y jurídico de primera magnitud: la importancia de realizar una adecuada seguridad y salud para los trabajadores con trastornos mentales graves. Este es uno de los colectivos a los que más le cuesta entrar en el mundo laboral pese a que está científicamente demostrado que ésta atesora beneficios comprobados para las personas que sufren una enfermedad mental grave y puede servir para reducir el gasto en protección social para este grupo de población que actualmente ronda en torno al 3% del Producto Interior Bruto. El presente trabajo se encarga de estudiar la Vigilancia de la Salud para la inclusión laboral de este colectivo y, en concreto, analiza el conocimiento por la empresa de la discapacidad mental del nuevo trabajador; la consideración de estas personas como Trabajadores Especialmente Sensibles; la comprobación inicial de su estado de salud y, en fin, los exámenes de salud para trabajadores con discapacidad mental y su periodicidad.In March 2015, a Germanwings aircraft crashed resulting in 150 people passing away. It was later discovered that its copilot suffered from a mental health problem. This issue highlights a first-order social and legal problem -- the relevance of an adequate safety and health plan for employees with serious mental disorders. This collective faces big entry barriers to employment, although it has already been scientifically proven that working brings remarkable benefits for this group. Moreover, this can serve to reduce the spending in social protection for this collective, which currently amounts to around 3% of the Spanish gross domestic product. The present work focuses on the health monitoring towards the labour inclusion of this collective. In particular, this work analyzes the company’s need-to-know regarding the mental disability of the new employee, the consideration of these people as Especially Sensitive Workers, their initial health check, and the particular matters that must be considered to carry out appropriate health checks with a proper periodicity.INTRODUCCIÓN 1. VIGILANCIA DE LA SALUD DE LOS TRABAJADORES CON DISCAPACIDAD MENTAL: 1.1. El conocimiento por la empresa de la discapacidad mental del nuevo trabajador. 1.2. La consideración de las personas con discapacidad mental como Trabajadores Especialmente Sensibles. 2. LA COMPROBACIÓN INICIAL DEL ESTADO DE SALUD DE LA PERSONA CON DISCAPACIDAD MENTAL. 3. LOS EXÁMENES DE SALUD PARA TRABAJADORES CON DISCAPACIDAD MENTAL Y SU PERIODICIDAD. BIBLIOGRAFÍA

Benefits and Barriers of Physical Activity in Social Inclusion and Quality of Life in People with Serious Mental Disorders

This book chapter presents a review of the main benefits that the practice of physical activity brings to people with severe mental disorder (SMD), as well as highlighting the most significant barriers that hinder their adherence. In this regard, it should be noted that this is a population sector in which sedentary lifestyle habits predominate, showing that physical activity is not only beneficial for physical health but also for mental and social health. However, people with severe mental disorder face barriers in which personal, social, and intervention program factors play a role, what makes regular practice difficult for them and, therefore, to access the numerous benefits it brings