Capgras syndrome presenting in an adolescent girl in the Caribbean.

The case of a 16-year old Jamaican girl who presented to the psychiatric service of a general hospital with features of Capgras syndrome is presented. Her history, treatment, progress and relevant psychodynamic and neurocognitive issues are explored. This is the first known published case of an adolescent with Capgras syndrome from the Caribbean. The case highlights that the syndrome may occur in different cultural contexts and that clinicians should be sensitive to its existence in order to avert under-diagnosis or misdiagnosis.

Validation of the Beck Depression Inventory II in HIV-positive patients.

OBJECTIVE: Research on depression among HIV-positive patients has been limited by the lack of a valid and reliable measure of depression. This project addresses this problem by exploring the internal consistency reliability and the concurrent and discriminant validity of the Beck Depression Inventory-II (BDI-II) using HIV-positive patients in Jamaica. METHOD: Patients from three HIV clinics in Jamaica (n = 191 patients; 61% female, 39% male, mean age 40.5-10 years) were administered the BDI-II along with the Centre for Epidemiological Studies -Depression Scale (CES-D) and the Social Provisions Scale. RESULTS: Overall, the BDI-II was found to have a high degree of reliability (alpha = 0.89). The scale also had good concurrent validity as evidenced by a high correlation with scores on the CES-D (r = 0.74) and acceptable discriminant validity as demonstrated through a moderate correlation with the Social Provisions Scale (r = -0.42). This pattern of scores suggests that the majority of the variance underlying the BDI-II assesses depression (55%) while a smaller degree of the variability (18%) measures a conceptually similar but distinct concept. CONCLUSION: The BDI-II is a sufficiently reliable and valid measure for assessing depression in HIV-positive patients.

Patterns of depressive symptoms among patients with HIV infection.

OBJECTIVE: To identify the level of depressive symptoms among patients with HIV infection and to examine the reported patterns of depressive symptoms not confounded by the physical manifestations of HIV-infection. METHOD: A total of 191 patients with HIV infection (75 males (39%) and 116 females (61%), mean age 40.48 +/- 10 years), from three HIV clinics were administered the Beck Depression Inventory-II as well as a demographic questionnaire as part of a larger study. RESULTS: Moderate to severe depressive symptoms were reported by 17.3% of the HIV-infected patients with females reporting significantly higher levels of depressive symptoms than males. A principal components analysis identified three clusters of depressive symptoms: cognitive-affective, negative cognitions and somatic symptoms. The HIV-infected patients were found to display mainly cognitive-affective symptoms of depression. CONCLUSION: HIV-infected patients, especially female patients, may be at an increased risk of experiencing high levels of depressive symptoms. It is recommended that HIV-infected patients be routinely screened for depression, particularly cognitive-affective symptoms of depression.

Factors associated with depression in students at The University of the West Indies, Mona, Jamaica.

OBJECTIVE: This project examines the factors associated with depression in students attending the University of the West Indies, Mona Campus. METHOD: Students enrolled in the Foundation courses during the first and second semesters of the 2005/2006 academic year were administered the Brief Screen for Depression as well as a demographic questionnaire as part of a larger study. RESULTS: A wide cross-section of the university population was sampled (n = 690; 252 from semester one, 438 from semester two; 77% females, 23% males; age 16-62 years, median = 20 years, mean = 23.4 years +/- 7.4). Nearly 40% of students scored in the clinically depressed range. Students in the December wave of data collection had higher depression scores than those in the January wave. Consistent with international research, females reported significantly higher levels of depressive symptoms. Married students reported significantly lower depression scores than students in visiting relationships. Students who were combining employment and school reported lower depression scores than those who were not employed. Maternal education significantly influenced students' levels of depression such that students whose mothers had university or other tertiary education had lower depression scores while those whose mothers had primary or lower education had the highest depression scores. Students with a chronic condition or a disability scored higher than those without such problems on all three measures of depression. CONCLUSION: Depression may be a significant problem in students at The University of the West Indies, Mona campus.

HIV infection, sexual abuse and social support in Jamaican adolescents referred to a psychiatric service.

BACKGROUND: Children and adolescents with HIV/AIDS often have psychological/psychiatric issues that require specialist intervention. We explored whether HIV infection acquired through sexual abuse led to particularly negative psychiatric outcomes and whether good social support is a protective factor in the development of undesirable psychiatric sequelae. METHODS: This study consists of a case series of five persons referred from the Paediatric Infectious Diseases Clinic to the Child Psychiatry Clinic, both at the University Hospital of the West Indies (UHWI) in Jamaica, during July 1 to November 30, 2005. The patients were clinically assessed and diagnosed by a psychiatrist using the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM IV) criteria. Cases were compared according to gender, age, likely route of HIV infection, level offamily/social support and nature of psychiatric outcome. RESULTS: Adolescents who acquired HIV infection through sexual abuse reported more intense feelings of sadness and suicidal ideations. Those with good social support reported less intense feelings of sadness with no suicidal ideations and were more optimistic about their future regardless of the route of acquisition. Two of three adolescents who acquired HIV infection through sexual abuse and one of two who was perinatally infected required ongoing supportive psychotherapy to augment their social support, the characteristic most associated with favourable outcome. CONCLUSION: Both sexual abuse and HIV/AIDS are likely to have negative psychological consequences in children and adolescents. This psychological impact may be intensified when HIV infection results from sexual assault as opposed to other methods of transmission. The findings support the practice of providing HIV prophylaxis to all sexual assault victims of known or suspected HIV-positive perpetrators and of encouraging utilization of existing social support networks.

Validation of the beck depression inventory-II in a Jamaican university student cohort / Validación del inventario de depresión de beck II en una cohorte de estudiantes universitarios jamaicanos

OBJECTIVE: This project explores the internal consistency reliability and the concurrent and discriminant validity of the Beck Depression Inventory-II (BDI-II) using a wide cross-section of the student population attending the University of the West Indies, Kingston, Jamaica. SUBJECTS AND METHODS: Students enrolled in UWI Foundation courses during the first and second semesters of the 2005/2006 academic year (n = 690; 77% females, 23% males; mean age = 23.4 +/- 7.4 years) were administered the BDI-II along with the Brief Screen for Depression (BSD), the Centre for Epidemiological Studies--Depression Scale (CES-D) and the UCLA Loneliness Scale--Revised. RESULTS: Overall, the BDI-II was found to have an acceptable degree of reliability (alpha = 0.90). The scale also had reasonably good concurrent validity as evidenced by high correlations with scores on the BSD (r = 0.74) and the CES-D (r = 0.71) and acceptable discriminant validity as demonstrated through moderate correlations with the UCLA Loneliness Scale (r = 0.50). This pattern of scores suggests that the majority of the variance underlying the BDI-II assesses depression (50% to 55%) while a smaller degree of the variability (25%) measures a conceptually similar but distinct concept. CONCLUSION: The BDI-II is a reliable and valid measure for assessing depression within the Jamaican population.

OBJETIVO: Este proyecto explora la fiabilidad de la consistencia interna y la validez discriminante y concurrente del inventario de depresión de Beck II (IDB - II) usando una amplia sección transversal de la población estudiantil que asiste a la Universidad de West Indies, Kingston, Jamaica. SUJETOS Y MÉTODOS: A los estudiantes matriculados en los cursos de Fundación de UWI durante el primer y segundo semestres del año académico 2005/2006 (n = 690; 77% hembras 23% varones; edad promedio = 23.4 años B1 7.4) se les aplicó el IDB - II junto con la Prueba Breve para la Detección de la Depresión (BSD), la Escala de Depresión del Centro de Estudios Epidemiológicos (CES-D), y la Escala Revisada de Soledad de la Universidad de los Ángeles de California. RESULTADOS: En general, se halló que el IDB - II tenía un grado aceptable de fiabilidad (a = 0.90). La escala también tenía una validez concurrente razonablemente tal como lo evidencian las altas correlaciones con las puntuaciones del BSD (r = 0.74) y el CES-D (r = 0.71), y una validez discriminante aceptable como quedó demostrado mediante las correlaciones moderadas con la Escala de Soledad de UCLA (r = 0.50). Este patrón de puntuaciones sugiere que la mayor parte de la varianza que subyace en el IDB - II evalúa la depresión (50% a 55%) mientras que un grado menor de variabilidad (25%) mide un concepto conceptualmente similar pero distinto. CONCLUSIÓN: El IDB - II constituye un instrumento de medición fiable y válido para evaluar la depresión en la población jamaicana.

Validation of the beck depression inventory-II in a Jamaican university student cohort.

OBJECTIVE: This project explores the internal consistency reliability and the concurrent and discriminant validity of the Beck Depression Inventory-II (BDI-II) using a wide cross-section of the student population attending the University of the West Indies, Kingston, Jamaica. SUBJECTS AND METHODS: Students enrolled in UWI Foundation courses during the first and second semesters of the 2005/2006 academic year (n = 690; 77% females, 23% males; mean age = 23.4 +/- 7.4 years) were administered the BDI-II along with the Brief Screen for Depression (BSD), the Centre for Epidemiological Studies--Depression Scale (CES-D) and the UCLA Loneliness Scale--Revised. RESULTS: Overall, the BDI-II was found to have an acceptable degree of reliability (alpha = 0.90). The scale also had reasonably good concurrent validity as evidenced by high correlations with scores on the BSD (r = 0.74) and the CES-D (r = 0.71) and acceptable discriminant validity as demonstrated through moderate correlations with the UCLA Loneliness Scale (r = 0.50). This pattern of scores suggests that the majority of the variance underlying the BDI-II assesses depression (50% to 55%) while a smaller degree of the variability (25%) measures a conceptually similar but distinct concept. CONCLUSION: The BDI-II is a reliable and valid measure for assessing depression within the Jamaican population.

Screening for postpartum depression

Postpartum depression, a potentially serious public health problem can be effectively treated. With the implementation of universal screening with a standardized, self-administered screening tool, in conjunction with appropriate education and training of health care providers to increase awareness of this problem and to impart greater diagnostic suspicion, identification of and early intervention for PPD can be facilitated. There is need for increased collaboration between Obstetric and Consultation Liaison Psychiatric Services, with particular emphasis on the prevention of psychiatric morbidity associated with pregnancy, thereby improving the quality of life for and interaction between mother and child. The establishment of a true Liaison Psychiatric Service dedicated to pregnancy and the postpartum period, with a Psychiatrist employed by the Obstetric Services, may be of great value.

Validation of the Brief Screen for Depression in a Jamaican cohort.

Research on depression in Jamaicans has been limited by the absence of a psychometrically sound measure of depression. This project attempts to rectify this problem by exploring the concurrent and discriminant validity of the Brief Screen for Depression (BSD) using a sample of 244 students attending the University of the West Indies, Mona, Jamaica. Participants were administered the BSD along with the Beck Depression Inventory (BDI), the Center for Epidemiologic Studies Depression scale (CES-D) the University of California at Los Angeles (UCLA) Loneliness Scale - Revised, (UCLA-R) and the Responding Desirably on Attitudes and Opinions scale (RD16). Overall, the BSD was found to have an acceptable level of concurrent validity as evidenced by high correlations with scores on the BDI (0.64) and the CES-D (0.62), and an acceptable level of discriminant validity as demonstrated through moderate correlations with the UCLA Loneliness Scale (0.40). In addition, the BSD was found to possess a moderate degree of sensitivity in identifying individuals who may be experiencing clinically significant symptoms of depression.

Screening for postpartum depression.

Postpartum depression, a potentially serious public health problem can be effectively treated. With the implementation of universal screening with a standardized, self-administered screening tool, in conjunction with appropriate education and training of health care providers to increase awareness of this problem and to impart greater diagnostic suspicion, identification of and early intervention for PPD can be facilitated. There is need for increased collaboration between Obstetric and Consultation Liaison Psychiatric Services, with particular emphasis on the prevention of psychiatric morbidity associated with pregnancy, thereby improving the quality of life for and interaction between mother and child. The establishment of a true Liaison Psychiatric Service dedicated to pregnancy and the postpartum period, with a Psychiatrist employed by the Obstetric Services, may be of great value.

Depression in adolescence: new developments / La depresión en la adolescencia: nuevos desarrollos

Depression in adolescence is under-recognized although its associated burden of illness is very high. Some frequent associations with depression in this age group are under-achievement, poor lifestyle choices including substance abuse, and a high risk of the persistence of the illness into adulthood There is also an increased risk of mortality related to suicide and harmful lifestyles. For depression in adolescents to be reduced, there needs to be strong collaboration among health professions, adolescents and their caregivers. Non-mental health clinicians must expand their role and become better prepared to recognize, prevent and treat depression in this age-group. Greater public awareness must also be achieved so that adolescents and their caregivers can seek help early.

La depresión en la adolescencia es subreconocida, a pesar de que la carga de padecimientos asociada con ella es muy alta. Algunas de las asociaciones frecuentes de la depresión en este grupo de edad son el bajo rendimiento académico, opciones de vida pobre – incluyendo el abuso de sustancias –, y un alto riesgo de que la enfermedad persista y continúe en la adultez. Existe también un riesgo elevado de mortalidad relacionado con el suicidio y los estilos de vida nocivos. A fin de reducir la depresión en los adolescentes, es necesaria una sólida cooperación entre los profesionales de la salud, los adolescentes y sus cuidadores. Inclusive los clínicos que no se ocupan directamente de la salud mental deben ampliar su función y prepararse mejor para reconocer, prevenir y tratar la depresión en este grupo de edad. También es necesaria una mayor concientización del público con el propósito de que los adolescentes y sus cuidadores puedan buscar ayuda temprano.

Depression in adolescence: new developments.

Depression in adolescence is under-recognized although its associated burden of illness is very high. Some frequent associations with depression in this age group are under-achievement, poor lifestyle choices including substance abuse, and a high risk of the persistence of the illness into adulthood There is also an increased risk of mortality related to suicide and harmful lifestyles. For depression in adolescents to be reduced, there needs to be strong collaboration among health professions, adolescents and their caregivers. Non-mental health clinicians must expand their role and become better prepared to recognize, prevent and treat depression in this age-group. Greater public awareness must also be achieved so that adolescents and their caregivers can seek help early.