Donepezil-induced bradycardia in a schizophrenic patient with comorbid neurocognitive disorder: a case report and review of the literature.

BACKGROUND: Trials of cholinergic and glutamatergic agents have improved cognition and memory for the geriatric schizophrenic population. Donepezil is an acetylcholinesterase inhibitor that improves cognition by preventing postsynaptic degradation of hippocampal acetylcholine in patients with mild-to-moderate dementia. Donepezil has been attributed to some adverse effects, especially gastrointestinal symptoms. However, cardiovascular adverse effects are not common as there remains a dearth of literature regarding donepezil-induced bradycardia. CASE REPORT: Hence, we present the case of a 70-year-old Hispanic female with past psychiatry history of schizophrenia who developed bradycardia and syncope following the commencement of low-dose donepezil in the inpatient unit and subsequent resolution with cessation. She had no prior cardiovascular symptoms or diagnosis. DISCUSSION: Considering there is no baseline cardiac monitoring requirement guideline for patients on Donepezil treatment, pre-assessment electrocardiogram is advised before the commencement of acetylcholinesterase inhibitors. Finally, routine monitoring of vital signs for at least the first 72 hours following the start of donepezil might be good proactive practice for all psychiatrists. Extending this practice to inpatient and outpatient service settings will be worthwhile.

Adverse childhood experiences, mental distress, self-harm and suicidality, and cumulative HIV risk by sex in Lesotho.

BACKGROUND: Adverse childhood experiences (ACEs) have been understudied in low- and middle-income countries, especially in sub-Saharan Africa. OBJECTIVES, PARTICIPANTS, SETTING: We explored associations between mental distress, self-harm or suicidality, and HIV risk and individual and cumulative ACEs (sexual, emotional, and physical violence; witnessing community and interparental violence; orphanhood) among youth aged 13-24 in Lesotho. METHODS: Multivariable logistic regressions stratified by sex using nationally representative 2018 Lesotho Violence Against Children and Youth Survey (nfemale = 7101; nmale = 1467) data. RESULTS: Over 75 % of males and females experienced at least 1 ACE. Among males, physical and community violence were significantly associated with mental distress; orphan status and emotional violence was associated with self-harm/suicidality. Males who witnessed interparental violence had higher odds of disclosing 2 types and 3 or more types of HIV risk versus none. Among females, being a double orphan and having experienced sexual, emotional, physical, community, and interparental violence were significantly associated with mental distress and any self-harm/suicidality in both models. Females who experienced physical violence had higher odds of disclosing 3 or more risk types versus no risk. Statistically significant associations emerged between cumulative ACEs and mental distress, self-harm/suicidality, and higher levels of HIV risk for both males and females. CONCLUSIONS: Differential patterns of associations between ACEs and mental health problems and HIV risk emerged by sex. Scalable, integrated individual and community efforts to prevent ACEs, provide mental health supports, and encourage safer sexual behaviors among those exposed are needed and could benefit youth in Lesotho.

Pre-intervention child maltreatment risks, intervention engagement, and effects on child maltreatment risk within an RCT of MHealth and parenting intervention.

Introduction: Evidence-based mental health and parenting support services for mothers postpartum can reduce risk for child maltreatment. However, women suffering economic and cultural stressors disproportionately shoulder the burden of infant caregiving while experiencing profound barriers to accessing mental health and parenting services. This article reports on an MHealth and parenting intervention targeting maternal mood and positive parent practices within a randomized controlled trial, which provided a unique opportunity to view pre-intervention child maltreatment risk, its relationship to subsequent intervention engagement, and intervention engagement effects on pre-post child maltreatment risk reduction. Method: Principal component factor analysis was conducted to identify a modifiable pre-intervention child maltreatment risk construct within a combined MHealth and parenting intervention sample of 184 primarily Black mothers and their infants. An independent t-test was conducted to compare pre-intervention child maltreatment risk levels between mothers who went on to complete at least two-thirds of the intervention and those who did not. A GLM repeated measures analysis of variance was conducted to determine effects of intervention engagement on child maltreatment risk reduction. Results: Pre-intervention child maltreatment risk did not differentiate subsequent maternal intervention completion patterns. Mothers who completed two-thirds of the intervention, compared to those who did not, demonstrated significant reductions in pre-post child maltreatment risk. Discussion: Findings underscore the potential of MHealth parenting interventions to reduce substantial child maltreatment risk through service delivery addressing a range of positive parenting and behavioral health needs postpartum, a particularly vulnerable developmental period for maternal depression and child maltreatment risk.

Prevalence and associated factor of postpartum depression among mothers living with HIV at an urban postnatal clinic in Uganda.

BACKGROUND: Postpartum depression among mothers living with HIV is a significant public health problem due to its effects on engagement in care, HIV disease progression, and an increased risk of mother-to-child transmission of HIV. OBJECTIVE: The objective of this study was to determine the prevalence and factors associated with postpartum depression among mothers living with HIV. DESIGN: The study employed a cross-sectional quantitative research design. METHODS: In this cross-sectional survey, we consecutively recruited 290 participants among mothers attending postnatal, immunization, and family planning clinics at an urban clinic in Uganda. Using an interviewer-administered questionnaire, we collected data on socio-demographics, obstetric, and HIV-related characteristics. Postpartum depression was assessed using the Patient Health Questionnaire version 9. We classified participants with Patient Health Questionnaire version 9 scores of ⩾10 as having postpartum depression. We conducted logistic regression to examine the association between postpartum depression and independent variables. RESULTS: The prevalence of postpartum depression was 15.9%. After controlling for other variables, participants who reported poor male partner support were more likely to experience postpartum depression compared to those who had good partner support (adjusted odds ratio = 4.52, confidence interval = 2.31-8.84, p value < 0.001). CONCLUSION: Mothers living with HIV should be routinely assessed for the presence of depression and male partner support. Health care providers of HIV-infected women should design strategies to promote male partner support for better maternal, infant, and HIV treatment outcomes.

Cervical cancer screening among HIV-positive women in urban Uganda: a cross sectional study.

BACKGROUND: Women living with Human Immunodeficiency Virus (HIV) are at a high risk for early development of cervical cancer. Adherence to cervical cancer prevention strategies in this population is vital for the early detection and treatment of cervical cancer. This study aimed to determine the prevalence and factors associated with cervical cancer screening among HIV-positive women attending an urban HIV care center in Uganda. METHODS: This cross-sectional study included 205 HIV-positive women receiving care at an urban HIV care center. An interviewer-administered questionnaire was used to capture sociodemographic information, history of screening for cervical cancer, and reproductive health characteristics. Logistic regression analysis was used to determine the factors associated with cervical cancer screening. RESULTS: Of the 205 HIV-positive women with a mean age of 37.5 ± 8.87 that participated in the study, majority (n = 201, 98%) were aware of cervical cancer screening. Ninety participants (44%) had ever been screened for cervical cancer and only 33 (16.1%) had been screened in the past year. Obtaining information about cancer of the cervix and cervical cancer screening from health care professionals was significantly associated with higher levels of cervical cancer screening (adjusted odds ratio = 5.61, 95% confidence interval: 2.50-12.61, p value < 0.001). CONCLUSION: This study highlights the low prevalence of cervical cancer screening among HIV-positive women and underscores the role of health professionals as an effective source of information on cervical cancer and cervical cancer screening. Patient education programs in HIV prevention and care facilities should emphasize cervical cancer screening messages to enhance the uptake of screening services.

Comorbid Substance Use and Mental Health Disorders: Prior Treatment/Admission as a Predictor of Criminal Arrest Among American Youths.

BACKGROUND: There is a dearth of literature with regards to substance use disorder (SUD) treatment outcomes and criminal arrest relationships. AIM: We aimed to examine the association between criminal arrest within a month prior to SUD treatment admissions among 12- to 24-year-old Americans and the role of recurrent or prior SUD treatment. METHODS: The 2017 United States Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Episode Data Set - Admissions (TEDS-A; N = 333,322) was used for this analysis. Prevalence odds ratios from the multivariate logistic regression analyses were used to determine associations between recurrent or prior SUD treatment and criminal arrest one month before admission, adjusting for selected independent variables. RESULTS: Prior history of SUD treatment remained associated with past criminal arrest (adjusted OR = 0.972; 95% CI: 0.954-0.991; P = 0.004) after adjusting for gender, marital status, employment status, and source of income. Comorbid SUD-mental disorder was associated with past criminal arrest (adjusted OR = 1.046; 95% CI: 1.010-1.083; P = 0.012) after adjusting for gender, marital status, employment status, education, and source of income. CONCLUSION: Our study shows that there is a protective association between history of previous substance treatment re-admissions and its relationship with criminal arrest one month before admission.

Suicidal tendencies and its association with psychoactive use predictors among university students in Uganda: a cross-sectional study.

BACKGROUND: Globally, suicide is one of the leading causes of death, and approximately 80% of all suicides occur in lowand middle-income countries. Younger people in Africa are at a higher risk of suicide than others. OBJECTIVE: To describe the prevalence and factors associated with suicidal tendencies among undergraduate university students using alcohol and other psychoactive substances. METHODS: Convenient sampling was used to identify 400 students who participated in the study. Socio-demographic and Mini-International Neuropsychiatric Interview tools were used to obtain information. Data were analyzed using SAS 9.4 and presented in descriptive and inferential statistics. RESULTS: Among the respondents, 80% were male, and 85% were using marijuana. 6.3% had suicidal tendencies. Respondents from the northern region had more suicidal tendencies than other regions, and unemployed students had more suicidal tendencies than those employed. After multivariate analysis, being abusive and dependent on other psychoactive substances was associated with suicidality. And having dependence on both alcohol and other psychoactive substances was associated with suicidality. CONCLUSION: Suicidality screening and psychosocial support should be provided to this vulnerable population. Efforts There is a need to strengthen, implement more effective preventive strategies to reduce the use of alcohol and other psychoactive substances.

Existence, triggers, and coping with chronic sorrow: a qualitative study of caretakers of children with sickle cell disease in a National Referral Hospital in Kampala, Uganda.

BACKGROUND: Worldwide, sickle cell disease is recognized as one of the major causes of morbidity and mortality. Caregivers and patients with such chronic illnesses experience economic, physical, social and psychological distresses which may lead to chronic sorrow. Chronic sorrow is viewed as a normal reaction to loss, however it can progress to a pathological state such as depression if the coping styles are ineffective. Therefore, the aim of this study was to explore the existence of chronic sorrow, triggers and coping with grief related feelings among caretakers of children with sickle cell disease. METHODS: A descriptive qualitative study was conducted. Twelve in-depth interviews were conducted with eligible participants who were purposively selected. Deductive thematic analysis methods were used for data analysis. RESULTS: Many (9 out of 12) of the caretakers experienced chronic sorrow. The grief related feelings were triggered by health worker related, disease related and support related factors. Caretakers used both external and internal coping strategies. External support was derived from community, family and health facility. Internal coping strategies were behavioral and cognitive. CONCLUSION: Caretakers of children with sickle cell disease experienced chronic sorrow and employed both internal and external coping strategies to deal with it, which could be either effective or ineffective. This study recommends that health workers should routinely screen for chronic sorrow among caretakers of children with sickle cell disease and assist caretakers to strengthen effective coping strategies to ameliorate the negative effects of chronic sorrow.

Quality of life of caregivers of patients diagnosed with severe mental illness at the national referral hospitals in Uganda.

BACKGROUND: Worldwide, 450 million people suffer from mental and behavioral disorders. In Uganda, it is estimated that 35% of the population that is 9,574,915 people suffer from some form of mental illness. Caregivers are increasingly bearing the responsibility of taking care of these patients, which can influence their QoL due to the social and economic costs they incur. The aim of the study was to assess the QoL of caregivers for patients diagnosed with severe mental illness attending the National Referral Hospitals in Uganda. METHOD: This was a cross sectional study. A pretested tool with two parts; a sociodemographic part and a validated WHOQOL-BREF, was used to collect data from 300 consecutive eligible participants. SPSS (Statistical Package for Social Sciences) Version 22 and Stata Version 14 were used in data entry and analysis. RESULTS: Of the 300 participants, 57.3% of the caregivers had a poor QoL. The statistically significant factors associated with QoL were environment (Adjusted coefficient = 0.016, 95% CI = 0.009-0.023), caregiver satisfaction with their health (Adjusted coefficient = 0.405, 95% CI = 0.33-0.487), psychological wellbeing (Adjusted coefficient = 0.007, 95% CI = 0.0002-0.013), and education level (Adjusted coefficient = 0.148, 95% CI = 0.072-0.225). CONCLUSION: QoL of caregivers for patients diagnosed with mental illness is generally poor due to the added responsibilities and occupation of their time, energy and attention. This additional responsibility results in high levels of stress and caregivers may fail to have appropriate coping mechanisms. Interventions like support groups or counseling should be put in place to aid caregivers in their role and therefore improve QoL. This study adds to the international database of QoL literature and calls for more attention to be placed on caregivers in supporting their role and improving their QoL so as to lead to better patient outcomes among those diagnosed with mental illness.

Chronic sorrow: lived experiences of caregivers of patients diagnosed with schizophrenia in Butabika Mental Hospital, Kampala, Uganda.

During the experience of chronic sorrow, people feel emotional discomfort, and hopelessness. It may progress to pathological grief, depression or trigger some of the psychiatric disorders in individuals who are vulnerable. The study explored the experience of chronic sorrow among caregivers of patients diagnosed with schizophrenia. A descriptive qualitative design using focus groups and indepth interviews was used. Most caregivers experienced chronic sorrow and identified trigger factors and coping strategies. The findings may enlighten psychiatric nurses in the care of mentally ill patients, caregivers and family members. The results may also help policy makers to prioritize mental health in the country.