Substance misuse in personality disorder and schizophrenia : findings and clinical implications from a high secure hospital

Purpose Substance misuse (SMU) is widely prevalent in mentally disordered offenders and is linked with violence and offending behaviour. There is however, a scarcity of literature dedicated to investigating SMU and its clinical correlates in relation to patients detained within high secure hospital settings. The purpose of this paper is to investigate the extent and severity of SMU and corresponding treatment needs in patients with a primary diagnosis of personality disorder (PD) in comparison with mental illness (MI) in a high secure hospital. Design/methodology/approach The responsible clinicians of all patients (n=240) detained in a high secure hospital were asked to record information using a SMU screening questionnaire over a ten-month period. Details requested included substance type, history of past use and assessment and treatment needs. Data were recorded and then analysed: descriptive statistics were conducted to report historical use of substances, cross tabulations and χ2 analysis explored the relationship between SMU and treatment status and diagnosis and offending behaviour and a means comparison analysis was employed to explore length of stay and treatment of SMU. Findings A total of 230 questionnaires were returned (95 per cent of the patient population). A history of SMU was reported in 88.6 per cent of the sample, with alcohol and cannabis misuse being the most prevalent. At least one substance had been abused by 74.3 per cent of the sample. In two-thirds of the sample, SMU was linked with the onset of mental health problems and symptom exacerbation, including violence. Interestingly, patients with a diagnosis of MI as compared with PD were more likely to have used substances (93.3 per cent compared to 81.9 per cent) and were more likely to need treatment for SMU (64.3 per cent compared to 36.8 per cent). In those with an MI diagnosis, SMU was more likely to be linked with violence and index offence (74.3 per cent compared to 59.0 per cent). Practical implications SMU is significantly prevalent in high risk mentally disordered offenders and linked to onset of mental health problems and offending. Patients with schizophrenia have a higher prevalence of SMU than PD and are likely to be more in need of treatment. Violence and offending are more likely to be related to SMU in schizophrenia than in PD. Originality/value This study substantiates existing evidence that SMU contributes to mental health problems and criminogenic behaviour. Furthermore, the study reports new findings that characterize differences of the relationship of SMU to offending in schizophrenia and PD in forensic psychiatric patients presenting to a high secure hospital. </jats:sec

Science of malaria elimination: using knowledge of bottlenecks and enablers from the Malaria Elimination Demonstration Project in Central India for eliminating malaria in the Asia Pacific region

Malaria poses a major public health challenge in the Asia Pacific. Malaria Elimination Demonstration Project was conducted as a public-private partnership initiative in Mandla between State government, ICMR, and FDEC India. The project employed controls for efficient operational and management decisions. IEC campaigns found crucial in schools and communities. Capacity building of local workers emphasized for better diagnosis and treatment. SOCH mobile app launched for complete digitalization. Better supervision for Indoor Residual Sprays and optimized Long Lasting Insecticidal Nets distribution. Significant malaria cases reduction in Mandla. Insights from MEDP crucial for malaria elimination strategies in other endemic regions of the Asia Pacific

Australian aboriginal and torres strait islanders' mental health issues: A litany of social causation

The Aboriginal and Torres Strait Islanders (ATSI) are the Indigenous people of Australia and constitute 3.3% of the Australian population, having been present in the country for more than 50,000 years before the colonization of Australia in 1788. Aboriginal culture/society is structured around the community, with strong kinship, belief systems, family ties, and networks. The colonization of Australia led to significant adversities for the ATSI population with loss of traditional way of life, land, and resources; marginalization, poverty, and being subject to racism and policies such as the “stolen generations” causing intergenerational trauma. These factors are considered as substrates for the subsequent increase in mental health and other health issues. ATSI people have poorer outcomes compared to other Australians in areas of physical health and life expectancy. They have higher rates of mental illness, suicide, alcohol/substance misuse, incarceration, and being subject to violence. Epidemiological research is lacking in ATSI population because of methodological difficulties. There are government policies/initiatives to reduce the disparity, which has been slow to bear results. The concepts of cultural safety and competence are important in the clinical management of ATSI population. Clinical presentation/management can be different in this group, and there is a need for more clinical guidelines. There have been a number of innovative strategies to improve mental illness outcomes. The paper illustrates the psychosocial impact of colonization on the ATSI population. There is an urgent need for research to understand and address the core issues that drive health inequalities in this group of disadvantaged Australians

Neural and behavioural responses to threat in men with a history of serious violence and schizophrenia or antisocial personality disorder

Background: Contemporary theories and evidence implicate defective emotion regulation in violent behaviour. The two psychiatric illnesses most implicated in violence are schizophrenia and antisocial personality disorder (APD). This study examined behavioural and brain abnormalities in violent men with schizophrenia or APD during anticipatory fear. Method: Fifty-three men [14 non-violent healthy controls, 13 with schizophrenia and a history of serious violence (VSZ), 13 with schizophrenia without a history of violence (SZ), 13 with APD and a history of serious violence] underwent blood-oxygenation-level-dependent fMRI during an experiment involving repeated presentations of ‘safe’ and ‘threat of electric shock’ conditions and provided ratings of shock anticipation and fear. Schizophrenia patients did not have co-morbid APD. Results: VSZ participants reported the highest, and APD participants the lowest, level of shock anticipation and fear, with intermediate ratings by SZ and healthy participants. The violent, relative to non-violent, groups showed altered activitymodulation in occipital and temporal regions, from early to latter parts of threat periods. Additionally, VSZ patients displayed exaggerated whereas APD patients showed attenuated thalamic-striatal activity during latter threat periods. Conclusions: Aberrant activity in occipital and temporal regions when exposed to sustained visual threat cues is associated with a predisposition to violence in both schizophrenia and APD. This common biological deficit, however, appears to arise from dissimilar behavioural mechanisms related to differences in the strength of aversive conditioning and behavioural response to sustained threat cues (enhanced in VSZ; attenuated in APD), also reflected in opposite patterns of alternations in thalamic-striatal activity, in these two disorders

Effects of Procyclidine on Eye Movements in Schizophrenia.

Smooth pursuit eye movement (SPEM) and antisaccade deficits are observed in the schizophrenia spectrum and have been used to study the pathophysiology as well as the genetic basis of this condition. The neurotransmitter acetylcholine has been implicated in a number of cognitive processes thought to underlie SPEM and antisaccade performance. This study investigates effects on eye movements of procyclidine, an anticholinergic drug often administered to schizophrenic patients. A total of 13 patients completed a double-blind placebo-controlled crossover design, receiving 15 mg procyclidine and placebo. Seven participants received procyclidine first and placebo second, six participants were tested in the reverse order. SPEM and antisaccade (as well as fixation and prosaccade) eye movements were recorded using infrared oculography. Results showed that procyclidine overall, relative to placebo, mildly worsened SPEM performance, as indicated by nonsignificantly reduced gain (p¼0.08) and increased frequency of intrusive anticipatory saccades during pursuit (p¼0.06). A significant interaction of group and order of administration indicated that procyclidine increased the rate of antisaccade reflexive errors only when administered first; the opposite pattern was observed when placebo was administered first, likely due to the operation of practice effects at second assessment. These findings indicate that acute administration of a clinically relevant dose of procyclidine leads to mild impairments in eye movement performance in schizophrenic patients, suggesting the need to consider this compound in oculomotor studies in schizophrenia. The action of this anticholinergic drug on oculomotor performance is consistent with the hypothesized role of the cholinergic system in the cognitive mechanisms of attention and working memory, processes thought to underlie SPEM and antisaccade performance. Effects of order of administration and practice on the antisaccade task suggest that these factors need to be taken into consideration in future pharmacological studies

A qualitative study on community perceptions on quality of healthcare services they received in the Malaria Elimination Demonstration Project in district Mandla, India

Abstract Background The utilization and impact of the healthcare services depend on the perceived quality, appropriateness, ease of availability, and cost of the services. This study aimed to understand the community's perception of the quality of healthcare services delivered as part of the Malaria Elimination Demonstration Project (MEDP), Mandla, Madhya Pradesh, India. Methods The study used qualitative techniques to analyze the community perceptions that emerged from the participants’ narratives during the Focus Group Discussions (FGDs) and in-depth Interviews with Key Informants (IKIs) on the promptness and quality of healthcare service delivery, the behaviour of MEDP staff, Information, Education and Communication, and Behavioural Change Communication activities, coordination with community members and other health personnel, and capacity building of healthcare workers and the community. Results 36 FGDs and 63 IKIs with 419 respondents were conducted in nine blocks of district Mandla. Overall, 97% to 100% of beneficiaries associated MEDP with regularity and prompt service delivery, availability of diagnostics and drugs, friendly behaviour, good coordination, and community mobilization to enhance treatment-seeking behaviour. Conclusions The study's findings highlighted the importance of building and maintaining the community's participation and promoting the demand for optimal utilization of healthcare services inside the village to promptly achieve the malaria elimination goal