Cheryl M. Paradis

TRIVIAL OR TERRIBLE? THE PSYCHOSOCIAL IMPACT OF PSORIASIS

Background. Psoriasis remains a chronic disease with lesions that are often extensive and disfiguring. While the potential for psychosocial morbidity and impairment are recognized, the literature remains equivocal with regard to the prevalence and degree of this impairment.

Sleep Paralysis in African Americans with Panic Disorder

Studies have reported a wide range in lifetime prevalence of sleep paralysis (SP). This variation may stem from cultural factors, stressful life events and genetic differences in studied populations. We found that recurrent SP was more common among African-American participants, especially those with panic disorder. Recurrent SP was reported by 59% of African Americans with panic disorder, 7% of whites with panic disorder, 23% of African-American community volunteers and 6% of white community volunteers. Significantly more early life stressors were reported by African Americans than whites. Higher levels of psychosocial stressors, including poverty, racism and acculturation, may contribute to the higher rates of SP experienced by African Americans.

Behavioral treatment of obsessive-compulsive disorder in African Americans

This paper reviews some important features in the presentation, diagnosis, and treatment of obsessive-compulsive disorder (OCD) in African Americans. Some adaptations to the behavioral treatment of OCD in African Americans are illustrated through the use of case examples. The growing awareness in psychology that cultural and ethnic issues are important factors in effective treatment planning forms the basis for the present paper. African Americans with OCD in particular have tended not to seek help in mental health settings, and there is little published research in this area. Thus, many clinicians and researchers may be unfamiliar with issues relevant to treatment issues of OCD in this population.

Obsessive-compulsive disorder in a multi-ethnic urban outpatient clinic: Initial presentation and treatment outcome with exposure and ritual prevention

There are no naturalistic treatment outcome studies in the literature investigating the effectiveness of exposure and ritual prevention across diverse ethnic groups for OCD. We present data on the naturalistic treatment of 62 outpatients with OCD who presented at an anxiety disorders clinic in an inner-city area. More of our African American and Caribbean American patients, compared to Caucasians with OCD, were female and were more likely to be initially diagnosed with panic disorder only. On initial assessment both groups were similar on psychometric measures as well as reporting similar types of obsessive-compulsive symptoms. Both groups showed moderate improvement with treatment, although significant residual symptoms remained. Our results are discussed within the need for further cross-cultural clinical research and outreach.

The assessment of the phenomenology of sleep paralysis: the Unusual Sleep Experiences Questionnaire (USEQ).

Previous research has found a relationship between sleep paralysis (SP) and anxiety states and higher rates have been reported among certain ethnic groups. To advance the cross‐cultural study of SP, we developed a brief assessment instrument (which can be self‐administered), the Unusual Sleep Experiences Questionnaire (USEQ). In this article, we report on a pilot study with the USEQ in a sample of 208 college students. The instrument was easily understood by the participants, with one quarter reporting at least one lifetime episode of SP. As in previous studies, SP was associated with anxiety (in particular, panic attacks).

Mentally Ill Elderly Jail Detainees: Psychiatric, Psychosocial and Legal Factors

Abstract Relatively little research has focused specifically on elderly offenders with severe mental illness. This study assessed psychosocial and legal issues in 83 male detainees, age 62 and above, who were hospitalized on a psychiatric forensic unit. This group included 38 Non-Hispanic whites, 31 blacks, 12 Hispanics, and 2 from other groups. Forty percent were diagnosed with a psychotic disorder. A series of chi-square tests found that patients charged with nonviolent crimes were more likely to report experiencing delusions. The victims of these alleged violent acts were primarily family members. There was no significant association between ethnic background and severity of legal charge or having a competency evaluation ordered. Suicidal ideation and thought disorders were more prevalent in nonwhite mentally ill elderly jail detainees.

Competency to stand trial evaluations in a multicultural population: Associations between psychiatric, demographic, and legal factors

Data were examined from an archival sample of Competency to Stand Trial (CST) reports of 200 consecutive New York City pre-trial defendants evaluated over a five-month period. Approximately a fourth of defendants in the present study were immigrants; many required the assistance of interpreters. The examiners conducting the CST evaluation diagnosed approximately half of the defendants with a primary diagnosis of a psychotic disorder and deemed over half not competent. Examiners reached the same conclusion about competency in 96% of cases, about the presence of a psychotic disorder in 91% of cases, and affective disorder in 85% of cases. No significant differences between psychologists and psychiatrists were found for rates of competency/incompetency opinions. Compared to those deemed competent, defendants deemed not competent had significantly higher rates of prior psychiatric hospitalization and diagnosis of psychotic illness at the time of the CST evaluation but lower rates of reported substance abuse.

Evaluations of Urban Sovereign Citizens' Competency to Stand Trial

There are few studies of sovereign citizens undergoing competency-to-stand-trial evaluations and little has been written about African-American or urban sovereign citizens. In this study, we examined competency-to-stand-trial reports of 36 New York City defendants who declared themselves to be sovereign citizens during their evaluations. All were men and 33 were African American. The majority denied recent or remote histories of psychiatric hospitalizations or substance use. Sixty-nine percent were deemed competent. Compared with those deemed competent, those deemed not competent were significantly more likely to have diagnosed psychotic disorders and to have reported histories of psychiatric hospitalizations. The 36 who declared themselves sovereign citizens were compared with 200 who did not, from a study conducted in the same forensic clinic. The sovereign citizens were significantly more likely to be male, African American, and high school graduates and were significantly less likely to report a history of psychiatric hospitalization or substance use. Compared with the nonsovereign citizens, they were less likely to receive a diagnosis of psychotic or mood disorders during the competency evaluation and were more likely to be deemed competent. Included are suggestions to assist forensic examiners conducting evaluations of these difficult cases.

Asian American Defendants: A Study of Psychiatric, Psychosocial and Legal Factors

There is little empirical research on the association between mental illness and violent behavior in the Asian American (AA) community. The present study gathered information, through a retrospective review of approximately 3,500 charts from a 25-year period, on 51 AA defendants referred for competency to proceed evaluations. A comparison group of 127 defendants of other ethnic backgrounds (non-AAs) was selected randomly. The present study found many demographic, psychiatric and legal differences between AA and non-AA defendants. The AA group included significantly more women and older defendants. Only one AA was born in the United States and was fluent in English. Eighty percent had immigrated within the previous 15 years. The AAs were significantly more likely to be diagnosed with a severe psychiatric illness and charged with rape. The non-AAs were significantly more likely to be diagnosed with a personality disorder and to be charged with robbery and criminal sale of a controlled substance. The low number of AAs identified from psychiatric-court records suggests that court personnel are overlooking serious mental illness in AA defendants with less obvious psychiatric symptoms. This is likely due to a language barrier and possibly to AAs reporting primarily somatic symptoms. The high number of older and female AA defendants may be due to a variety of factors. They might have received more attention from court personnel or experienced more stress secondary to incarceration.