Factors in the onset of schizophrenia: a comparison between London and Trinidad samples

Objective: Sociodemographic factors play an important role in the genesis of mental disorders. High rates of unemployment and other social factors have been reported previously among African-Caribbeans with schizophrenia in London. The aim of the present study was to compare these factors in Trinidad with London African-Caribbeans. METHOD: Using internationally-defined criteria, patients with first-onset schizophrenia were recruited in both countries, and information on the onset of symptoms, help-seeking, pathways into care, premorbid personality and educational and employment status were collected. These two samples are compared on a number of these factors. A total of 56 cases of first-onset of psychosis coming into contact with psychiatric services in Trinidad were studied. Of these, 46 cases were diagnosed as having schizophrenia using the CATEGO program. Over a period of 2 years, 38 African-Caribbean patients with schizophrenia were recruited in London. RESULTS: African-Caribbean patients with schizophrenia in London were more likely to be admitted for perceived threat to others and to have shown loss of interest and serious neglect and to have assaulted others. A lower proportion were admitted via a psychiatrist and a higher proportion by the police. The unemployment rate among the London sample of African-Caribbeans was much higher than in the general population, whereas this was not the case for the Trinidad patients. CONCLUSION: These findings are discussed in the context of culture and aetiology of schizophrenia, and suggestions with regard to future research are made. (AU)

Perceptions about mental illness among pre-clinical medical students in Trinidad and Tobago

Perceptions about mental illness among medical practitioners are likely to determine their capacity to recognise, treat appropriately and refer patients who have mental health problems. It is therefore important that training of medical students in psychiatry is undertaken with knowledge of their attitudes to mental health disorders. We determined the perceptions of 108 pre-clinical medical students (69 males, 39 females; mean age 22 years) toward mental illness in Trinidad and Tobago by analysing their responses to a questionnaire based on a case vignette of a young man with a paranoid psychotic illness. 88 percent felt that medical treatment in hospital was the best means of treating the illness and 86 percent suggested that discharge should be conditional on regular visits to a doctor. 89 percent however opposed the patient's marrying into their families and 85 percent to his teaching their children. This was associated significantly with having a personal relationship with someone having a mental illnes (p < 0.03). Surprisingly, 25 percent believed that mental illness could be caused by supernatural forces, particularly females who were almost twice as likely as males to express this belief.(AU)

Psychiatric symptoms and an anterior cranial fossa meningioma

We present a case of a patient admitted to a psychiatric hospital with psychotic symptoms and cognitive impairment but who was subsequently found to have an anterior interhemispheric falx meningioma. There must be a high index of suspicion for organic brain disease in patients over age 45 years presenting with psychotic symptoms and seizures for the first time.(AU)

Increase cholinesterase activity in psychiatric patients treated with fluphenazine, lithium and amitryptyline - Abstract

This study was planned to determine the effects of antipsychotic and antidepressant drug therapy on serum cholinesterase in an out-patient sample population in Trinidad. Inhibition of cholinesterase by dibucaine (dibucaine number) and esterase activity were measured. Mean dibucaine number (81.9 ñ 2.37) in psychiatric patients was not different from the normal population (81.9 ñ 2.55). Quantitative esterase levels were significantly higher (12.37 ñ 3.57 U/ml; p<0.05) in comparison to the normal Trinidadian population (10.05 ñ 2.67 U/mL). Cholinesterase levels were significantly higher (p<0.05) in female schizophrenics than in depressed patients. A relationship between elevated enzyme activity and pathology of the disease or drug therapy could not be determined since most patients were on long term pharmacotherapy. The evaluation of cholinesterase activities in out patients indicates that drugs such as fluphenazine, lithium carbonate and amitriptyline may be associated with increase enzyme activity.(AU)

First-contact incidence rates of schizophrenia in Trinidad and one-year follow-up

BACKGROUND: Incidence rates of schizophrenia among UK African-Caribbeans have been reported as high. Various explanations including selective migration and genetic vulnerability have been proposed. METHOD: In one calendar year, all new cases of psychosis presenting to various psychiatric services in two clearly defined geographical catchment areas in Trinidad - one in the rural south and the other an urban area - were studied. Standardised diagnostic instruments were applied and information collected using WHO screening and measurement instruments. RESULTS: A total of 56 cases were collected, giving an incidence rate of 2.2/1000 of broad schizophrenia with a rate of 1.6 for S+ schizophrenia. CONCLUSION: These rates are similar to those from the WHO study in Honolulu and Aarhus, and much lower than the rates for African-Caribbeans in London. The cases were followed up for one year and the poor outcome rate for schizophrenia was 19 percent. The findings are discussed in a cross-cultural context and suggestions for future research made.(AU)

Psychiatric disorder in systemic lupus erythematosus

The symptoms of systemic lupus erythematosus (SLE) may include altered mental function. The present study sought to examine whether the psychiatric disorders are due to the disease itself or to the stress of having a chronic disease. Forty-five SLE patients attending outpatient clinics at the Port of Spain General Hospital in Trinidad were compared with two control groups: patients with chronic debilitating diseases similar to SLE in terms of chronicity and treatment (n = 44) and non-diseased individuals (n = 48). The Structured Clinical Interview for DSM III-R was used to identify psychiatric disorders. Both the SLE and the chronic illness groups had more psychic illness (44 percent and 39 percent, respectively) when compared with the non-diseased controls (2 percent) (p<0.001). Major depression was the most common diagnosis among both diseased groups. However, the psychotic illnesses (schizophrenic-type psychosis and bipolar disorders) were more prevalent in the SLE group (11.1 percent vs 0 percent, p=0.02). These results indicate that major depression in SLE may be related more to the effects of a chronic illness than to SLE itself. However, the occurrence of psychotic symptoms may be related to SLE disease and needs further study. (AU)

A case of vivax malaria presenting with psyhosis

The first case of psychosis due to Plasmodium vivax malaria, imported from India is reported. A 44-year-old Trinidadian male presented with fever, and psychotic episodes in association with vivax malaria. The symptoms of both malaria and psychosis were resolved following the standard chloroquine-primaquine therapy (AU)

Demographic and clinical features of adolescent parasuicides

The demographic, ethnic and clinical characteristics of 102 adolescents admitted to the Port-of-Spain General Hospital over a 10-month period because of parasuicide were studied. The estimated rate of attempted suicide among adolescents was 94 per 100,000 of the hospital catchment population. Ninety per cent of the sample were females. Fifteen per cent had previously attempted suicide. Twenty-five per cent were clinically depressed, 22 per cent had adjustment reactions, and in 49 per cent no mental illness was detected. In 50 per cent of cases, no further treatment was necessary after the first psychiatric interview. Intra-family conflicts were the most frequent reasons given for the attempted suicides. Girls of East Indian origin attempted suicide more frequently than those of African origin. Adolescents of mixed racial backgrounds attempted suicide less frequently than those of either African or East Indian origins. The findings of the study suggest a need for the adolescent psychiatric services to be upgraded, and for a review of the hospital policy of admitting all parasuicides of whatever degree as this is resulting in unnecessary and costly utilization of hospital beds

Demographic and clinical features of adolescent parasuicides

The demographic, ethnic and clinical characteristics of 102 adolescents admitted to the Port-of-Spain General Hospital over a 10-month period because of parasuicide were studied. The estimated rate of attempted suicide among adolescents was 94 per 100,000 of the hospital catchment population. Ninety per cent of the sample were females. Fifteen per cent had previously attempted suicide. Twenty-five per cent were clinically depressed, 22 percent had adjustment reactions, and in 49 percent no mental illness was detected. In 50 percent of cases, no further treatment was necessary after the first psychiatric interview. Intra-family conflicts were the most frequent reasons given for the attempted suicides. Girls of East Indian origin attempted suicide more frequently than those of African origin. Adolescents of mixed racial backgrounds attempted suicide less frequently than those of either African or East Indian origins. The findings of the study suggest a need for the adolescent psychiatric services to be upgraded, and for a review of the hospital policy of admitting all parasuicides of whatever degree as this is resulting in unnecessary and costly utilization of hospital beds (AU)

The pattern of in-patient psychiatric referrals in a general hospital

All patients referred for a psychiatric consultation from the adult wards of a General Hospital over a 10-month period were examined. The referral rate was 1.4 percent. Twice as many female patients were referred as male pateints. Parasuicide accounted for 68 percent of referrals. The most common psychiatric diagnoses were adjustment reaction (41 percent), depression (23 percent), alcohol dependence (5 percent). In 30 percent of referrals, no psychiatric treatment was necessary; 26 percent were transferred to the psychiatric unit and 17 percent were discharged to the out-patients' psychiatric clinic. Explanations are offered for the "hidden" psychiatric morbidity in General Hospitals and the high percentage of referrals who did not need psychiatric follow-up. Suggestions are made for a better liaison between physicians and psychiatrists (AU)

An analysis of psychiatric inpatient admissions from a defined geographic catchment area over a one-year period

The psychiatric inpatients from a defined geographic catchment area of 100,159 were analysed for the year 1986. The inpatient treated prevalence was 5 per 1,000 the population over 15 years of age. There were 85 long-stay patients and 413 admissions during the year. Thirty-eight per cent of all admissions for 1986 had schizophrenic psychoses, 34 percent had alcohol and drug disorders, and 15 percent had affective disorders. Forty-nine per cent of first admissions had alcohol and drug disorders, and 28 per cent had schizophrenic psychoses. Schizophrenic psychosis was the diagnosis in 61 per cent of those patients who had more than 3 previous admissions. Substance abuse, acute schizophrenic psychosis and chronic schizophrenic psychosis accounted for 72 per cent of admissions for 1986. The duration of stay in hospital was longer for female patients than for male patients for each of the main diagnostic categories. The need for epidemiological and hospital utilization studies to provide essential data for the rational planning of psychiatric services in Trinidad and Tobago is emphasized (AU)

An analysis of psychiatric in-patients from a well defined geographic population over a one-year period - abstract

An analysis of psychiatric in-patients from a well-defined geographic catchment area of 100,159 persons was done for the year 1986. Four hundred and ninety-eight patients received in-patient treatment giving a crude in-treatment prevalence of 5/1,000 population over 15 years of age. There were 85 long-stay patients (mean age and duration of stay, 47 years and > 10 years, respectively), and 413 were admitted during the year. Of the latter, 81 per cent were between 20 and 40 years of age (this age range accounted for only 40 per cent of the study population), 38 per cent were schizophrenics, 34 per cent substance abusers and 16 per cent had affective disorders. The male:female ratio was 1.9:1. First admissions numbered 178 and of these, 49 per cent were substance abusers and 28 per cent schizophrenics. Schizophrenics had the highest frequency of re-admissions and accounted for 61 per cent of those with > 3 previous admissions. Substance abusers made up the largest single group (49 per cent) among first admissions. Substance abusers, schizophrenics (acute and chronic) were identified as the 3 categories of patients who form the bulk of psychiatric admissions. The majority of chronic long-stay patients were female although there were more male acute admissions. There is need for epidemiological and hospital utilisation studies to provide essential data for the rational planning of psychiatric services in Trinidad and Tobago (AU)

Tardive dyskinesia in outpatients on depot phenothiazine

Two hundred and thirty-two psychiatric outpatients on depot fluphenazine decanoate for more than six months were examined for Tardive Dskinesia (TD), using the AIMS rating scale, and the prevalence rates of TD at different criteria of severity were assessed. The prevalence rates ranged from 7 percent for patients with severe TD to 45 percent for patients with any degree of TD. The sex distribution of patients with TD showed no bias but the female patients were significantly older than the male patients. Increases in prevalence rates of TD were associated with the combination of an anticholinergic anti-Parkinsonian drug with the depot neuroleptic, and with the concommitant use of an oral neuroleptic with the depot preparation. Implication of these findings for the long-term management of schizophrenia are discussed (AU)