Stigma towards mental illness in Asian nations and low-and-middle-income countries, and comparison with high-income countries: A literature review and practice implications.

Background: Stigma related to mental illness (and its treatment) is prevalent worldwide. This stigma could be at the structural or organizational level, societal level (interpersonal stigma), and the individual level (internalized stigma). Vulnerable populations, for example, gender minorities, children, adolescents, and geriatric populations, are more prone to stigma. The magnitude of stigma and its negative influence is determined by socio-cultural factors and macro (mental health policies, programs) or micro-level factors (societal views, health sectors, or individuals' attitudes towards mentally ill persons). Mental health stigma is associated with more serious psychological problems among the victims, reduced access to mental health care, poor adherence to treatment, and unfavorable outcomes. Although various nationwide and well-established anti-stigma interventions/campaigns exist in high-income countries (HICs) with favorable outcomes, a comprehensive synthesis of literature from the Low- and Middle-Income Countries (LMICs), more so from the Asian continent is lacking. The lack of such literature impedes growth in stigma-related research, including developing anti-stigma interventions. Aim: To synthesize the available mental health stigma literature from Asia and LMICs and compare them on the mental health stigma, anti-stigma interventions, and the effectiveness of such interventions from HICs. Materials and Methods: PubMed and Google Scholar databases were screened using the following search terms: stigma, prejudice, discrimination, stereotype, perceived stigma, associate stigma (for Stigma), mental health, mental illness, mental disorder psychiatric* (for mental health), and low-and-middle-income countries, LMICs, High-income countries, and Asia, South Asian Association for Regional Cooperation/SAARC (for countries of interest). Bibliographic and grey literature were also performed to obtain the relevant records. Results: The anti-stigma interventions in Asia nations and LMICs are generalized (vs. disorder specific), population-based (vs. specific groups, such as patients, caregivers, and health professionals), mostly educative (vs. contact-based or attitude and behavioral-based programs), and lacking in long-term effectiveness data. Government, international/national bodies, professional organizations, and mental health professionals can play a crucial in addressing mental health stigma. Conclusion: There is a need for a multi-modal intervention and multi-sectoral coordination to mitigate the mental health stigma. Greater research (nationwide surveys, cultural determinants of stigma, culture-specific anti-stigma interventions) in this area is required.

[Working conditions among Mental Healthcare workers at the beginning of COVID-19 pandemic in Argentina]. / Condiciones laborales del personal de salud mental al comienzo de la pandemia por COVID-19 en Argentina.

INTRODUCTION: The current COVID-19 pandemic highlights the different difficulties that healthcare workers have to face in this context. In order to quantify some aspects of the current working situation, the Asociación de Psiquiatras Argentinos (APSA) designed a survey for Mental Healthcare workers. The goal was to: measure and know what are the working conditions of those working in Mental Health in Argentina, in this pandemic context. METHODS: Cross sectional descriptive study. Convenience sample. The survey was designed and sent in a digital format, thru APSA means of communication. The survey had 27 questions and one comments option. Questions explored sociodemographic variables, worked related aspects and discrimination suffered by participants. RESULTS: The survey, in its digital format, was answered by 710 participants. 32% of those in the public sector pointed out that people needed to bring their own personal protective equipment, compared to 56% in the private sector. For protocols in place, nearly 82% of public sector responses said there is a protocol for COVID-19 compatible symptoms in patients, compared to 58% in the private sector. And for new patients in an inpatient facility, responses showed that more than 50% had a protocol in the public sector, vs less than half in the private setting. CONCLUSIONS: This survey and the results allows to know and have evidence on which were the working conditions at the beginning of the pandemic. Having a plan considering what is known and what is available, allows a more appropriate approach, for both the workers and those who depend on them for care.

[Psychotic major depressive episode: target symptoms in males and females]. / Episodio Depresivo Mayor psicótico: síntomas distintivos en hombres y mujeres.

Frequently Major Depressive Episodes in patients with psychotic features are not obvious as in other patients with psychotic disorders, such as schizophrenia, that makes difficult to carry out the diagnosis. The results (n= 48) show bigger occurrence of depressed mood, somatic symptoms and decreased motor activity (HAM-D), and show differences in depression when the corporal disorder take characteristic predominant. Psychotic symptoms was suspiciousness and unusual thought content (BPRS). Both gender had characteristic symptoms, women: depression and somatic symptoms, male: (retardation) slow in work and activities, that take to the slowness. It is convenient to have present the consigned symptoms, that could collaborate in the differential diagnosis.