Gunnar Kullgren

SCID II interviews and the SCID Screen questionnaire as diagnostic tools for personality disorders in DSM-III-R

A modified version of the SCID Screen questionnaire covering 103 criteria by means of 124 questions was compared with SCID II interviews in 69 psychiatric patients. The correlation between the number of criteria fulfilled in the SCID II interviews or the questionnaires was 0.84. In the SCID interviews, 54% of the patients had a personality disorder. When the SCID Screen questionnaire was used, 73% had a personality disorder. When the cut‐off level for diagnosis was adjusted, the frequency found by means of the SCID screen questionnaire or the interviews was roughly the same, 58% and 54%, respectively. The overall kappa for agreement between the SCID II interviews and questionnaire with adjusted cut‐off was 0.78.

Perception of stigma among family members of individuals with schizophrenia and major affective disorders in rural Ethiopia.

Background: Many studies from the Western world have reported on stigmatisation of people with mental illnesses and its negative consequences, but few studies have addressed the issue in traditional rural societies. The present study aimed to estimate the extent and socio-demographic distribution of stigma as perceived by relatives of mentally ill individuals in rural Ethiopia. Method: A total of 178 relatives of individuals who were diagnosed as suffering from schizophrenia or major affective disorders in a community-based survey were interviewed using the Family Interview Schedule. Results: About 75 % of the respondents perceived that they were stigmatised or had experienced some sort of stigma due to the presence of mental illness in the family, 42 % were worried about being treated differently and 37 % wanted to conceal the fact that a relative was ill. Those from the older age group (45+) and urban residents were more likely to perceive stigma as a major problem, but otherwise differences were few between socio-demographic groups. The illness was attributed to supernatural forces by 27 % and praying was suggested as a preferred method to deal with the problem by 65 %. Conclusion: Stigma was found to be a common problem, with few differences between socio-demographic groups or between types of mental disorder. Beliefs about causes differ from those held by professionals. Popular beliefs and attitudes must be taken into account when planning for intervention.

The prevalence and socio‐demographic correlates of khat chewing in Butajira, Ethiopia

A house‐to‐house survey was carried out in a rural Ethiopian community to determine the prevalence and socio‐demographic correlates of khat use. A total of 10 468 adults were interviewed. Of these, 58% were female, and 740/0 were Muslim. More than half of the study population (55.7%) reported lifetime khat chewing experience and the prevalence of current use was 50%. Among current chewers, 17.40/0 reported taking khat on a daily basis; 16.1% of these were male and 3.4% were female. Various reasons were given for chewing khat; 80% of the chewers used it to gain a good level of concentration for prayer. Muslim religion, smoking and high educational level showed strong association with daily khat chewing.

Clinical characteristics of patients with motor disability due to conversion disorder : a prospective control group study

OBJECTIVES Previous studies have suggested associations between conversion and many different clinical characteristics. This study investigates these findings in a prospective design including a control group. METHODS Thirty consecutive patients with a recent onset of motor disability due to a conversion disorder were compared with a control group of patients with corresponding motor symptoms due to a definite organic lesion. Both groups had a similar duration of symptoms and a comparable age and sex profile and were assessed on a prospective basis. Background information about previous somatic and psychiatric disease was collected and all patients were assessed by means of a structured clinical interview linked to the diagnostic system DSM III-R, the Hamilton rating depression scale, and a special life events inventory. RESULTS The conversion group had a higher degree of psychopathology with 33% of the patients fulfilling the criteria for psychiatric syndromes according to DSM-III-R axis I, whereas 50% had axis II personality disorders compared with 10% and 17% respectively in the control group. Conversion patients also had significantly higher scores according to the Hamilton rating depression scale. Although patients with known neurological disease were not included in the conversion group, a concomitant somatic disorder was found in 33% of the patients and 50% complained of benign pain. The educational background in conversion patients was poor with only 13% having dropped out of high school compared with 67% in the control group. Self reported global assessment of functioning according to the axis V on DSM IV was significantly lower in conversion patients, who also registered significantly more negative life events before the onset of symptoms than controls. Logistic regression analysis showed that low education, presence of a personality disorder, and high Hamilton depression score were significantly associated with conversion disorder. CONCLUSION The importance of several previously reported predisposing and precipitating factors in conversion disorder is confirmed. The results support the notion that conversion should be treated as a symptom rather than a diagnosis and that efforts should be made in diagnosing and treating possible underlying somatic and psychiatric conditions.

Psychological impact of the hurricane Mitch in Nicaragua in a one-year perspective.

Abstract  Background Whereas natural disasters more commonly occur in low-income countries, almost all studies on psychological consequences have been conducted in the Western world. In countries where resources are poor it is of importance to know which groups should be targeted for early intervention after a disaster. The study aims at assessing the prevalence of post-traumatic stress disorder PTSD and of post-traumatic symptoms among people afflicted by hurricane Mitch in Nicaragua and at identifying risk factors for PTSD symptoms 6 months following a disaster. Method: At four primary health care centres, 496 consecutive adult patients were interviewed 6 months after hurricane Mitch regarding PTSD symptoms (Harvard Trauma Questionnaire, HTQ), disaster experiences and post-disaster help-seeking. Results: All individuals resident in the area during Mitch were judged to have experienced a trauma fulfilling A criteria for PTSD. Regarding more specific traumas, 39% reported a close relative to be dead or seriously injured and 72% had their house partly or completely destroyed. Prevalence of PTSD ranged from 9.0% in the worst afflicted area to 4.5% in a less damaged area. From a dimensional perspective, PTSD symptoms according to HTQ 6 months after the disaster were significantly associated with the death of a relative (β-coefficient 0.257, P=0.000), a house destroyed (β-coefficient 0.148, P=0.001), female sex (β-coefficient 0.139, P=0.001), previous mental health problems (β-coefficient 0.109, P=0.009) and illiteracy (β-coefficient 0.110, P=0.009). Those with previous mental health problems (OR=4.84; 95% CI=3.04–7.66) were more likely than others to seek from help, any source whereas the opposite was true for illiterate people (OR=0.38; 95% CI=0.21–0.69). Of all respondents, 8.5% reported that they had thought of taking their lives, and illiterates (OR 2.84; 95% CI=1.12–4.37) and those with previous mental health problems (OR 2.84; 95% CI=1.12–4.57) were at particular risk for suicidal problems. One year after Mitch, half of those identified as PTSD cases at 6 months still fulfilled the criteria for a PTSD diagnosis. Conclusion: PTSD represents a serious mental health problem after a disaster. Those with illiteracy, females and those with previous mental health problems should be targets for early post-disaster intervention.

DOMESTIC VIOLENCE AND EMOTIONAL DISTRESS AMONG NICARAGUAN WOMEN: RESULTS FROM A POPULATION-BASED STUDY

This study aimed to measure the prevalence of emotional distress among women in Leon Nicaragua and to identify risk factors for emotional distress with special reference to wife abuse. A survey was performed among a representative sample of women aged 15-49. Among ever-married women 20% were classified as experiencing emotional distress at the time of the interview and 52% reported physical partner abuse at some point in their lives. Women reporting abuse were six times more likely to experience emotional distress. An estimated 70% of all cases of emotional distress found among ever-married women were attributable to wife abuse. The study underscores the need to improve screening and care for battered women within mental health services in Nicaragua. (authors)

Axis V--Global Assessment of Functioning Scale. Evaluation of a self-report version.

The present study examines a self‐report version of the Global Assessment of Functioning Scale according to Axis V (GAF self‐report). The sample (n= 73) was a psychiatric outpatient population from a catchment area clinic. Patients with psychotic and organic mental disorders were not included. The diagnostic distribution on Axis I was similar to the findings from previous studies. Axis II disorders were identified among 47%, of whom a majority also had a concomitant Axis I disorder. The mean GAF expert score was 66.5 (range: 48–86). High complexity and severity of disorders and a high number of fulfilled Axis II criteria were significantly associated with low GAF scores. Independent expert ratings on GAF were correlated with the GAF self‐report overall at r= 0.62, varying from 0.45 to 0.91 between different diagnostic groups. In general, the patients scored themselves lower (mean: ‐ 4.4 units) than expert ratings. Patients with depressive symptoms from an adjustment disorder or mood disorder were most prone to underestimation. Women also tended to score themselves lower than experts did. Conclusively, the GAF self‐report turned out to be a valid and reliable unidimensional instrument measuring psychological, social and occupational functioning. The GAF is easy to handle, and with a self‐report version as a complement, Axis V could be more frequently used in future clinical practice and research.

SCHIZOPHRENIA AND CRIMINAL OFFENDING The Role of Psychopathy and Substance Use Disorders

This study investigated the associations of psychopathy and substance use disorders (SUDs) with criminal offending among 202 men with schizophrenia and 78 men with a primary diagnosis of psychopathy. Comparisons among six groups of offenders indicated that non–mentally ill offenders diagnosed with psychopathy committed the highest numbers of offenses per year at risk. Among offenders with schizophrenia, those with high psychopathy scores committed more crimes than those with low psychopathy scores. Among non–mentally ill offenders with psychopathy and schizophrenic offenders with high psychopathy scores, those with and without SUDs committed, on average, similar numbers of offenses. These findings suggest that among offenders with psychopathic traits, the traits, not substance abuse, are associated with criminal offending.

The prevalence and socio-demographic correlates of mental distress in Butajira, Ethiopia.

A cross‐sectional survey was conducted on 10468 rural and semi‐urban adults in an Ethiopian district using the Self Reporting Questionnaire (SRQ) to detect the prevalence of mental distress and its association with socio‐demographic risk factors. Fifty‐eight per cent of the study population were women, 74% were Muslim, 79% were illiterate. Those experiencing 11 or more symptoms out of the 20 SRQ items were considered as having mental distress. Accordingly, the prevalence of mental distress was 17%, which is comparable with the previous hospital‐based studies in Ethiopia and elsewhere. However, it was higher than the previous community‐based studies in Ethiopia. Mental distress was more prevalent among women. Part of the explanation was that women in the study population were older and that they were more often widowed or divorced, which were factors associated with mental distress. Illiteracy, which was more common among women and older individuals, was also independently associated with mental distress.

Transsexualism--general outcome and prognostic factors : a five-year follow-up study of nineteen transsexuals in the process of changing sex.

Ninetten transsexuals, approved for sex reassignment, were followed-up after 5 years. Outcome was evaluated as changes in seven areas of social, psychological, and psychiatric functioning. At baseline the patients were evaluated according to axis I, II, V (DSM-III-R), SCID screen, SASB (Structural Analysis of Social Behavior), and DMT (Defense Mechanism Test). At follow-up all but 1 were treated with contrary sex hormones, 12 had completed sex reassignment surgery, and 3 females were waiting for phalloplasty. One male transsexual regretted the decision to change sex and had quit the process. Two transsexuals had still not had any surgery due to older age or ambivalence. Overall, 68% (n=13) had improved in at least two areas of functioning. In 3 cases (16%) outcome were judged as unsatisfactory and one of those regarded sex change as a failure. Another 3 patients were mainly unchanged after 5 years. Female transsexuals had a slightly better outcome, especially concerning establishing and maintaining partnerships and improvement in socioeconomic status compared to male transsexuals. Baseline factors associated with negative outcome (unchanged or worsened) were presence of a personality disorder and high number of fulfilled axis II criteria. SCID screen assessments had high prognostic power. Negative self-image, according to SASB, predicted a negative outcome, whereas DMT variables were not correlated to outcome.