Psychiatric morbidity among housemaids in Kuwait. a. Prevalence of psychiatric disorders in the hospitalized group of housemaids.

OBJECTIVES: To determine the first hospital admission rates and the nature of psychiatric disorders among housemaids and compare them with the Kuwaiti female patients. SUBJECTS AND METHODS: Based on the International Classification of Diseases (10th revision; ICD-10) symptom checklist, a semi-structured interview was administered to all the housemaids and the Kuwaiti female patients hospitalized during the 2-year study period. RESULTS: The hospital admission rates were 1.86 times higher in housemaids than in the Kuwaiti female patients and the nature of psychiatric disorders was also different in the two groups. The stress-related disorders were more common among housemaids while schizophrenia was the commonest disorder among Kuwaiti patients. Duration of hospital stay was significantly shorter for housemaids, and four fifths of them were repatriated on mental health grounds. CONCLUSIONS: The psychiatric morbidity is higher among housemaids than Kuwaiti females and a substantial number of them are prematurely repatriated on health grounds. Further studies are needed to explore the possible pre-immigration risk, and post-immigration precipitating factors, to prevent this 'expatriate failure'.

The opinion of caregivers on aspects of schizophrenia and major affective disorders in a Nigerian setting.

BACKGROUND: In Nigeria the burden of caring for persons with severe mental disorders rests largely on families whose attitudes to these conditions have not been explored. OBJECTIVES: To assess the opinion of relatives of 75 schizophrenics and 20 major affective disorder cases on aspects of the disease and compare with the responses of relatives of cancer, infertility and sickle cell disease (SCD) cases. METHOD: Caregivers were assessed using a burden questionnaire that contained items on etiological beliefs and attitudes to illness. RESULTS: The responses of relatives of the two psychiatric illness groups were similar. The single most important etiological factors were that "it is Satan's work" (35.8%) and "it is a natural illness" (23.2%). Other factors were "genetic" (9.5%), "witchcraft" (10.5%) and "curse by enemies" (10.5%). This was similar to the opinion of cancer and infertility caregivers; but different from SCD where the most important causative factors were "genetic" (41.5%) and "natural" (21.5%). Psychiatric caregivers had higher frequency of anger and stigma. Over two-thirds of psychiatric caregivers felt glad caring for the patient and would not like the patient institutionalized. Most families were thought to be supportive and there was an impression that caring had made family emotional ties closer. CONCLUSIONS: These families were tolerant and would cooperate with health authorities. Causative models are influenced by available knowledge and practices in the culture. To actualize the potential of families to play useful community psychosocial roles, there is a need for public mental health literacy and welfare support.

Postpartum period: a risk factor for neuroleptic malignant syndrome.

Neuroleptic malignant syndrome (NMS) occurred in four postpartum patients treated with various psychotropic medications including depot-neuroleptics over a 5-year period. All four patients had the onset of NMS in the first few weeks of the postpartum period. Whether or not there is an increased risk for the development of NMS in the puerperium period is discussed.

Risperidone-induced increase of plasma norepinephrine is not correlated with symptom improvement in chronic schizophrenia.

BACKGROUND: Previous studies have shown an increase in plasma levels of norepinephrine (NE) after clozapine treatment of schizophrenia. This effect has been suggested to relate to improvement in symptoms. METHODS: To test whether other novel antipsychotic drugs have such an effect, the present experiment examined schizophrenic symptoms and plasma levels of NE before and after 5 weeks of treatment with risperidone or haloperidol. RESULTS: Risperidone, but not haloperidol, significantly increased plasma NE; however, there was no correlation of this effect with clinical improvement on any symptom scale. CONCLUSIONS: This finding suggests that risperidone shares similar properties with clozapine in enhancing peripheral NE, but that these changes in plasma NE may not be a consistent indicator of atypical antipsychotic drug efficacy.

Serum cholesterol concentrations in prisoners charged with violent crimes.

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Serum lipid concentrations in patients with major depressive disorder.

This study compared the serum lipid concentrations in 100 patients with major depressive disorder (MDD) with those from 100 matched healthy controls. It was found that the serum total cholesterol concentration in patients with MDD (5.27 +/- 1.18 mmol/L) was significantly lower than the value (6.63 +/- 1.32 mmol/L) in sex-, age-, and weight-matched healthy controls. This significant decrease in serum cholesterol in patients with MDD was noted in both sexes and in all age groups. Patients with MDD, however, had significantly higher HDL cholesterol than matched controls. There were no statistically significant differences in serum concentrations of triglycerides, apolipoprotein (Apo) A1, Apo B, transferrin, and albumin between patients and controls. Clinical recovery of patients with MDD was accompanied by a significant increase in serum total cholesterol from 5.27 +/- 1.18 mmol/L to 6.12 +/- 1.2 mmol/L. These results suggest an association between low serum total cholesterol and depression in both sexes and at all age groups.

Presence of psychiatric morbidity in prison population in Kuwait.

This paper surveys the prevalence of psychiatric morbidity in a Kuwaiti prison. The rate of major psychosis was considerably lower than the rate reported in other prison studies. Twenty-five percent of the sample had generalized anxiety disorder of a reactive nature which was most probably related to imprisonment itself. There was a preponderance of individuals suffering from personality disorder, alcoholism, and drug abuse problems. Prisoners with a diagnosis of major psychosis had very little exposure to psychiatrists and the large number of recidivists reflects the lack of a probation service. Financial embezzlement and drug/liquor smuggling remain the crimes of choice in Kuwait. Some underlying sociocultural factors are discussed and the need for an alternative prison-based therapeutic community service is emphasized.

Psychiatric disorders in prisoners referred for assessment: a preliminary study.

The psychiatric profile of a consecutive series of 69 men and women prisoners referred for assessment over a nine month period was examined. Thirty-six point two percent had a major psychiatric disorder and a further 53.6% had a minor psychiatric illness. One-third of the sample had a previous criminal record, and approximately one-half had past psychiatric contacts. Schizophrenic patients with active symptoms appear to be more likely to commit violent offenses. Of ten prisoners who committed murder, nine were patients with schizophrenia. Almost all the psychotic patients had active symptoms at the time that they committed their offenses. The most probable reason for the commission of their crime was psychosis. Some underlying psychosocial factors are also discussed. Ways of minimizing the vulnerability and victimization of individuals with serious mental disorders are suggested. Because this was a highly selective sample, the results should be viewed with some caution. More research is needed to determine the criminal behaviour of the mentally ill in general, and schizophrenics in particular.

Consultation liaison psychiatry in a Kuwaiti general hospital.

The authors analysed the psychiatric profile of 208 general hospital patients referred for psychiatric consultation, about half of these patients presented with parasuicidal behaviour. The diagnoses of depression and adjustment disorders predominated. Characteristics of the referred patients, source of referral and main forms of psychiatric intervention are documented. Means to promote good relationships between psychiatrists and physicians are suggested. The need for a better liaison psychiatric service is emphasised.