Prevalence of depersonalization and derealization experiences in a rural population.

BACKGROUND: Dissociative symptoms are common psychiatric symptoms whose prevalence in rural (agricultural) populations is unknown. The present study examines the prevalence of depersonalization and derealization experiences in a southern rural US population as well as socio-demographic and emotional factors associated with these experiences. METHOD: A random sample of 1008 adults in rural eastern North Carolina completed a survey by telephone, which included questions about experiences of depersonalization or derealization in the past year. Demographic information was gathered on all respondents; for those reporting these dissociative experiences, information on their frequency, duration, and whether they occurred during conditions of danger, severe stress, upsetting memories, nervousness or depression, or for no apparent reason was also elicited. RESULTS: The reported prevalence rates were 19.1% for depersonalization, 14.4% for derealization, and 23.4% for either dissociative experience. Logistic regression showed that women reported a significantly higher rate of dissociative experiences (26.5%) than men (19.5%), (Odds Ratio = 1.93, 95% CI = 1.37-2.74), particularly African-American women (29.9%). Experiencing chronic pain (OR = 2.96, 95% CI = 2.05-4.28) and irregular church attendance (OR = 1.18, 95% CI = 1.07-1.31) were also associated with increased frequency of dissociation. Increasing age (OR = 0.73, 95% CI = 0.65-0.81) and being employed (OR = 0.58, 95% CI = 0.39-0.86) were associated with reduced frequency of dissociation. Pain, gender, and age were related to both depersonalization and derealization experiences. Employment and church attendance were related to depersonalization experiences, while ethnic minorities experienced more derealization. CONCLUSIONS: A predominantly southern rural population reported a high 1-year prevalence of depersonalization and derealization experiences. The prevalence of dissociation experiences was common in this southern sample, as was found by Ross and colleagues (1990) in an urban population in Canada. Risk factors for depersonalization and derealization experiences had considerable overlap, but differed on several variables suggesting different underlying mechanisms.

Dementia praecox to schizophrenia: the first 100 years.

The historical roots of dementia praecox and schizophrenia are described in the context of current nosology and continuing controversies surrounding this nosology. Relevant books and journal articles were reviewed. The information was obtained through computer searches and cross-references from previously published papers. If English translations of foreign language articles were available, they were used; if not, the cross-references were consulted. The psychoses have existed as diagnostic categories from ancient times although their names have changed. Initially, these disorders were considered diseases of the brain, a concept that was swept aside in the United States, influenced by European-derived psychodynamic theories. American clinicians and investigators simply accepted these theories, showing little interest in testing their underlying principles. In contrast, a narrower Kraepelinian approach was adopted outside the United States, and attempts were made to refine its nosology. Because current data supports a central nervous system aetiology for schizophrenia, the concept of dementia praecox warrants resurrection. The authors suggest abandoning the term schizophrenia in favour of the more broad and generic term dementia praecox. Replacing 'schizophrenia' with 'dementia praecox' in the 21st century will facilitate further research and help clarify the nosology of various brain disorders currently included in the schizophrenias.

Epidemiology of neuroleptic malignant syndrome.

The authors reviewed the trends in the incidence of neuroleptic malignant syndrome (NMS) in studies recently reported in various countries. Possible reasons for the differences in reported incidences were considered. The authors identified publications in English (and their cross-references) that estimated the incidence of NMS with a retrospective or prospective design. They compared the incidence in studies from the United States with those from other countries. The initial retrospective studies from the United States reported higher incidence rates of NMS than did similar studies from elsewhere. More recent prospective studies from the United States report a much lower incidence. Neuroleptic malignant syndrome remains a rare complication of psychotropic treatment if the syndrome is defined stringently. The high incidence reported in earlier studies in the United States can be explained by retrospective study design, loose diagnostic criteria, adherence to an amorphous "spectrum concept," and clinical practices in vogue.

The current status of tardive dystonia.

Tardive dystonia (TDt), a persistent dystonia associated with exposure to neuroleptic drugs, is an uncommon disorder. It differs from tardive dyskinesia (TDk) in epidemiology, clinical features, risk factors, pathophysiology, course, prognosis, and treatment outcome. TDt seems to develop faster and is more painful, distressing, and disabling than tardive dyskinesia. In this article, evidence is reviewed on the face, descriptive, construct, and predictive validity of this iatrogenic complication of antipsychotic drugs. It is suggested that TDt should not be lumped together with TDk. It deserves a separate nosological status as an independent diagnostic category. The subclassification of TDt into various subtypes based on coexistence of other movement disorders is suggested.

Violence in America: a survey of suicide linked to homicides.

This paper describes murder-suicide in the United States from 1990 through 1995, using the cases reported in six major newspapers. Spousal murder-suicide was the predominant type with a range of 42%-57%; familicide-suicide was the second predominant type with a range of 22%-47%. The perpetrators were predominantly males; the victims were female sexual partners or consanguineous relatives. Firearms (guns) were used in 90% of the cases. The author concludes that a national surveillance system that specifically identifies and codes this phenomenon, and multi disciplinary studies are necessary to hinder this phenomenon.

Deinstitutionalization and criminalization: tinkering in the interstices.

The mental health service system has undergone continuous change for more than three decades. Undoubtedly, some of its problems are related to economic, social and political factors. This contribution discusses problems of deinstitutionalization, homelessness and criminalization of the mentally ill persons. To conclude, it proposes a number of ways by which better services could be rendered to the mentally disordered persons, particularly in areas that interface with the criminal justice system.

Factor structure of the 28-item general health questionnaire in a sample of antenatal women.

OBJECTIVE: The factor structure of responses to the twenty-eight-item General Health Questionnaire (GHQ-28) in a sample of 277 Nigerian antenatal women was examined. METHOD: Principal Component Analysis (PCA) and Varimax rotation were used. RESULTS: A four factor structure interpretable as social dysfunction, somatic-anxiety, depression-anxiety, and severe depression was obtained. CONCLUSION: Although the factor structure in this sample is similar to that previously reported with this instrument, the factor loadings particularly for the anxiety subscale differed. Thus, the factor structures of the GHQ may differ depending on the cultural background of the sample.

PIP: A study was undertaken to determine the factor structure of the 28-item General Health Questionnaire (which has four subscales measuring somatic symptoms, anxiety and insomnia, social dysfunction, and severe depression) in a sample of 277 Nigerian women receiving prenatal care. After the women completed the questionnaire, additional data were gathered from semistructured interviews with 106 of the subjects. Principal component analysis and varimax rotation were used to determine whether the psychopathological subsets could be identified in this sample. It was found that the factor structure of the questionnaire was similar to that found in other samples but had important differences, especially in the clustering of the somatic and anxiety symptoms into a "somatization" factor. In this study, anxiety loaded with depression items define a depression-anxiety factor. Thus, the factor structure in this population was social dysfunction, somatic-anxious, depression-anxiety, and severe depression. Based on these results and on findings reported in a Mexican study, it may prove necessary to consider alternative factor scales for use with different cultures and groups.

Symptom dimensions of schizophrenia: a selective integration of neurophysiological and neuropsychological correlates.

Schizophrenia is a heterogeneous and multidimensional disorder. The different syndromes or dimensions of this disorder represent distinct pathophysiological processes. Evidence is growing that each of the composite syndromes or dimensions of this disorder is associated with specific validators. This article reviewed neurophysiological and neuropsychological studies in schizophrenia in order to determine the external validators of its syndromes. The review reveals compelling findings in some instances and contradictory findings in other instances.

Three syndromes in schizophrenia: validity in young patients with recent onset of illness.

The heterogeneity of schizophrenia constitutes an impediment in the identification of reliable biological markers of the illness and aetiological factors. The two syndrome concept of the illness has proved a powerful stimulus in this endeavour. There is however evidence now to regard this construct as inadequate and in need of refinement. Using a sample of young patients with early onset of illness who fulfilled the Research Diagnostic Criteria for schizophrenia, we have shown that three rather than two dimensions better describe the pathology of the illness. The results of factor analysis showed these syndromes, termed disorganization, positive, and negative syndromes, to account for 65% of the total variance of the psychopathology of the disorder. The negative syndrome was associated with disturbed pre-morbid functioning while the disorganization syndrome bore significant association with early onset of illness, poorer socio-educational attainment, and impairment on neuropsychological tests, especially those designed to evaluate frontal lobe functioning. The positive syndrome was not associated with any of the assessed variables. These results provide strong support for the validity of the three-syndrome construct even among a sample of non-institutionalized patients.

Psychiatric epidemiology in cross-cultural perspective: a review.

Advances in psychiatric research have reestablished the importance of psychiatric community epidemiological studies. Psychiatric epidemiological surveys that used the same standardized diagnostic interview and classification system in different parts of the world were reviewed. The lifetime prevalence for any psychiatric morbidity ranged from 21 to 65%. The prevalence of psychiatric disorders was higher than that in the first- and second-generation community surveys. The relevance of these findings to clinical practice, public health, and the directions for future epidemiological research are discussed.

Tardive dyskinesia in non-western countries: a review.

Tardive dyskinesia (TD) is a well-described adverse effect of treatment with neuroleptics. Studies from non-western countries are sparse and those that exist are not well publicized. We analyzed prevalence data on TD, published in English or French, and carried out in countries in Africa and Asia through December 1993. The estimated prevalence of TD among African subjects was 24% and among Asian subjects 17.2091. Both rates are in the middle range when compared with the western prevalence rates of 10-50%. Long-term hospitalization and older age were risk factors associated with TD. Female gender did not emerge as a risk factor. Also, several Asian studies showed that subjects with TD were taking lower doses of neuroleptics than subjects without TD. Prospective and controlled cross-cultural studies of TD are recommended for better understanding of associated risk factors and primary prevention.

Comment: the neglect of culture in psychiatric nosology: the case of culture bound syndromes.

Descriptive psychopathology and clinical phenomenology inform contemporary psychiatric diagnosis and nosology. The process of psychiatric diagnosis and classification is intricate and subject to continuous revision. This paper attempts to illustrate the effect of culture on psychopathology, with special emphasis on the diagnosis and classification of culture bound syndromes. There is a need for more clarity and specificity about the diagnosis and classification of culture bound syndromes. The paper suggests some questions that need to be addressed for the better integration of these syndromes into the main body of international classificatory systems. It is presumed that answers to these questions will provide a better nosological framework for culture bound syndromes.

Premorbid functioning in schizophrenia: a controlled study of Nigerian patients.

We compared the premorbid social adjustment of 38 schizophrenic patients with that of 20 manic patients. Even though the small sample size affected the number of significant differences obtained, schizophrenic patients consistently showed evidence of poorer premorbid functioning than manics at various stages of social development. Schizophrenic men also tended to have functioned more poorly than women. Poor premorbid functioning was associated with negative syndrome, but not with positive or disorganization syndromes. Our findings suggest that poor premorbid adjustment is an early sign of schizophrenic illness even among patient populations who may be characterized by good short-term outcome.

Heritability of schizophrenia. A controlled family history investigation in Nigeria.

Thirty-six consecutively admitted patients with schizophrenia and 20 with mania were studied for the morbid risk of psychosis in their first-degree relatives. Using the family history method of ascertainment, the morbid risk for schizophrenia in the relatives of schizophrenic probands was 4.12% compared with 1.42% in the relatives of manic probands. While this difference was not statistically significant, that between the morbid risk for affective psychoses in the relatives of manic patients (7.81%) was significantly higher than for the relatives of schizophrenic patients (0%).

Postnatal emotional disorders in Nigerian women. A study of antecedents and associations.

One hundred and sixty-two women were evaluated for psychiatric morbidity in the second trimester of pregnancy and also six to eight weeks postnatally. A sizeable proportion of the women also had a second prenatal assessment in their third trimester and in the lying-in ward shortly after giving birth. Assessments were conducted with the 28-item GHQ. This was initially validated using a subsample of 106 women, taken from the original group, who were interviewed with the PAS. Thirty per cent of the women were 'cases' at the first prenatal assessment, while only 14% were 'cases' six to eight weeks postnatally. Thus, even though there was an overlap between prenatal and postnatal morbidity, there was also substantial difference between the groups that were symptomatic at both periods. This observation was reinforced by the low correlation between the mean GHQ scores at both periods. Both prenatal and postnatal morbidities were associated with recent adverse life events, with the latter more likely to be associated with marital and family events. This observation is in support of the view that neurotic problems, prenatally or postnatally, are caused mainly by psychosocial factors.

The validity of the 28-item General Health Questionnaire in a Nigerian antenatal clinic.

The 28-item General Health Questionnaire (GHQ-28) was validated against the Psychiatric Assessment Schedule (PAS) using data collected during a prospective study of psychiatric disorders associated with childbirth among 277 Nigerian women attending an antenatal clinic. Using the results of correlational analyses of the total scores on the GHQ and on the PAS and the traditional validity coefficients of sensitivity, specificity, and misclassification rate, the instrument was shown to be a valid tool for the detection of psychiatric morbidity in this population. With a sensitivity of 82% and a specificity of 85%, the revised scoring method devised by Goodchild and Duncan-Jones performed better in discriminating 'cases' from 'non-cases' than the conventional scoring method, which values respectively, of 75% and 83%. In a discriminant function analysis, only three of the four subscales of the instrument contributed to its discriminating power.