Understanding perceived expressed emotion in South Asians’ experiencing a first episode of Psychosis

Thesis Overview Part 1: A Systematic Review This review aims to understand the relationship between acculturation and psychosis. Findings from fourteen studies are presented through a narrative synthesis. Results indicated that the relationship between acculturation and psychosis appears to be inconsistent and that multiple confounding factors such as language, culture and ethnicity may be influencing the relationship. Clinical and research implications of findings are discussed. Part 2: An Empirical Paper This paper aims to explore perceived EE in the South Asian context for individuals with a first episode of psychosis (FEP) understand the impact of perceived EE on clinical outcomes for individuals with a FEP. A mixed methods design was used to address these aims (i.e. thematic analysis and exploratory statistical analysis). Interviews were conducted with 24 individuals for the qualitative and/or the quantitative study. Results indicate four main categories: connection and support, understanding and awareness, boundaries and independence, and context and influence. These themes are understood in relation to acculturation, gender roles, generational differences, and stigma. For the second aim, significant correlations were found between perceived EE such as the LEE and clinical symptoms such as the HADS and PSYRATS. Limitations are discussed and recommendations are made for future research Part 3: A Critical Appraisal This chapter offers a critical reflection on the process of research and follows the journey of clinical research from study design, recruitment, and interview through to analysis and writing

EPIDEMIOLOGICAL STUDY OF PREVALENCE OF ANEMIA AND ASSOCIATED RISK FACTORS IN A RURAL COMMUNITY; A HOME-BASED SCREENING

Objective: The prevalence of anemia is disproportionately high in developing countries due to poverty, inadequate diet, certain diseases, pregnancy and lactation, and poor access to health services. It is a risk factor for cardiovascular health and early death in adult.  To estimate the prevalence of anemia and its associated risk factors in a rural a community in India.Methodology: Based on inclusion and exclusion criteria, an observational house-to-house survey was conducted for a period of 6 months, by screening for anemia, using digital strip type hemoglobin meter. Result: Out of 200 people, 146 were anemic of which 77 were with mild anemia, 67 with moderate anemia and only 3 had severe anemia. There were more number of anemic patients in the group of normal and underweight (Normal=86, 58.90%; Underweight=27, 18.49%) than that of overweight and obese (Overweight=22, 15.06%; Obese=11, 7.53%). The newly diagnosed cases of anemia were 138 and previously diagnosed cases of anemia were 8. Out of 146 anemic populations, 13 were hyperlipidemics, 20 were hypertensives, 18 were diabetics, 5 were thyroid patients and 4 were cardiac patients. Conclusion: This screening program helps to diagnose anemia in a selected population and benefit avoiding further complications by offering adequate patient counseling. Study population was enriched with information on nutrition intake and importance of maintaining hemoglobin concentration at normal level in day-to-day life of an individual.Keywords: Anemia, Nutrition, Screening, Hemoglobin

Post-Transplant Outcomes in High-Risk Compared with Non-High-Risk Multiple Myeloma: A CIBMTR Analysis.

Conventional cytogenetics and interphase fluorescence in situ hybridization (FISH) identify high-risk multiple myeloma (HRM) populations characterized by poor outcomes. We analyzed these differences among HRM versus non-HRM populations after upfront autologous hematopoietic cell transplantation (autoHCT). Between 2008 and 2012, 715 patients with multiple myeloma identified by FISH and/or cytogenetic data with upfront autoHCT were identified in the Center for International Blood and Marrow Transplant Research database. HRM was defined as del17p, t(4;14), t(14;16), hypodiploidy (-Y) or chromosome 1 p and 1q abnormalities; all others were non-HRM. Among 125 HRM patients (17.5%), induction with bortezomib and immunomodulatory agents (imids) was higher compared with non-HRM (56% versus 43%, P \u3c .001) with similar pretransplant complete response (CR) rates (14% versus 16%, P .1). At day 100 post-transplant, at least a very good partial response was 59% in HRM and 61% in non-HRM (P = .6). More HRM patients received post-transplant therapy with bortezomib and imids (26% versus 12%, P = .004). Three-year post-transplant progression-free (PFS) and overall survival (OS) rates in HRM versus non-HRM were 37% versus 49% (P \u3c .001) and 72% versus 85% (P \u3c .001), respectively. At 3 years, PFS for HRM patients with and without post-transplant therapy was 46% (95% confidence interval [CI], 33 to 59) versus 14% (95% CI, 4 to 29) and in non-HRM patients with and without post-transplant therapy 55% (95% CI, 49 to 62) versus 39% (95% CI, 32 to 47); rates of OS for HRM patients with and without post-transplant therapy were 81% (95% CI, 70 to 90) versus 48% (95% CI, 30 to 65) compared with 88% (95% CI, 84 to 92) and 79% (95% CI, 73 to 85) in non-HRM patients with and without post-transplant therapy, respectively. Among patients receiving post-transplant therapy, there was no difference in OS between HRM and non-HRM (P = .08). In addition to HRM, higher stage, less than a CR pretransplant, lack of post-transplant therapy, and African American race were associated with worse OS. In conclusion, we show HRM patients achieve similar day 100 post-transplant responses compared with non-HRM patients, but these responses are not sustained. Post-transplant therapy appeared to improve the poor outcomes of HRM

Perceived expression of emotion in individuals with a first episode of psychosis from a South Asian background

Aim: To explore perceived expression of emotion in the South Asian context for individuals with a FEP (first episode of psychosis). Method: Semi-structured interviews were conducted with 16 service users (SU) experiencing a first episode of psychosis understand their experience of expression of emotion from their caregivers. Thematic analysis was used to identify the themes that emerged from the interviews. Results: Four main categories were identified: connection and support, understanding and awareness, boundaries and independence, and context and influence. Factors influencing perceived EE such as acceptance, acculturation, warmth and expressions of love, communication and family values have been identified. It also highlights that South Asian caregiving experiences and perception of EE includes warmth and connection as a strength and resource. Discussion and implications for practice: The findings shed light on a culturally specific expression of emotion within the context of FEP and can be considered when working with South Asian communities within EIP services. Findings highlight the impact of navigating and negotiating bicultural identities and generational differences in the expression of emotion in the South Asian context

Quotations illustrating “Inter-generational differences”.

Quotations illustrating “Inter-generational differences”.</p

Quotations illustrating “Acceptance”.

Background‘Expressed Emotion (EE)’ captures ways in which emotions are expressed within a family environment. Research has found that EE in families has an impact on psychiatric illness, in particular psychosis, such that it increases risk of relapse. EE was conceptualised by research conducted in the UK. Thus, behaviours defined as pathological were largely based on white samples adhering to UK norms. Cross-cultural variations have been found in EE and its relationship with clinical outcomes. A more culturally appropriate understanding of norms surrounding the EE across cultures is required.AimsThis study aims to use a bottom-up approach to provide a culturally specific understanding of family relationships and EE across ‘non-clinical’ UK-based South Asian families.MethodsSemi-structured interviews were conducted with 18 South Asian participants to explore their relationships with a significant other. Interviews were analysed using thematic analysis.ResultsFour main themes were generated: expression of love, setting boundaries, inter-generational differences and acceptance.ConclusionThe findings indicate considerable cultural variability within EE and highlight the need to interpret EE in the context of socio-cultural norms. Whilst certain domains of EE that are considered pathological in Western contexts are present in the UK-based South Asian diaspora, these are perceived as less problematic, indicative of varying cultural norms.</div

Thematic map.

Main themes: Blue; Intermediary themes: Orange; Subthemes: Yellow.</p