Niranjan S. Karnik

The Mental and Physical Health of Homeless Youth: A Literature Review.

Youth homelessness is a growing concern in the United States. Despite difficulties studying this population due to inconsistent definitions of what it means to be a youth and homeless, the current body of research indicates that abuse, family breakdown, and disruptive family relationships are common contributing factors to youth homelessness. Moreover, the experience of homelessness appears to have numerous adverse implications and to affect neurocognitive development and academics, as well as mental and physical health. Substance use, sexually transmitted infections, and psychiatric disorders are particularly prevalent in this population. Whereas some of these problems may be short-lived, the chronic stress and deprivation associated with homelessness may have long-term effects on development and functioning. Further, difficulties accessing adequate and developmentally-appropriate health care contribute to more serious health concerns. Suggestions for future research and interventions are discussed.

Mental health issues in unaccompanied refugee minors.

Previous studies about unaccompanied refugee minors (URMs) showed that they are a highly vulnerable group who have greater psychiatric morbidity than the general population. This review focuses on mental health issues among URMs. Articles in databases PsycINFO, Medline and PubMed from 1998 to 2008 addressing this topic were reviewed. The literature had a considerable emphasis on the assessment of PTSD symptoms. Results revealed higher levels of PTSD symptoms in comparison to the norm populations and accompanied refugee minors. In several studies, age and female gender predicted or influenced PTSD symptoms. The existing literature only permits limited conclusions on this very hard to reach population. Future research should include the analysis of long-term outcomes, stress management and a more thorough analysis of the whole range of psychopathology. Additionally, the development of culturally sensitive norms and standardized measures for diverse ethnic groups is of great importance.

First-year medical students' attitudes toward diversity and its teaching: an investigation at one U.S. Medical School.

Purpose. To investigate whether medical students conceptualize culture and cultural diversity best within “categorical” or “cultural sensibility” teaching models. Method. In spring 2002, first-year medical students at the University of Illinois Colleges of Medicine at Chicago and Urbana-Champaign completed a previously developed questionnaire. A self-selected subset participated in focus groups. The questionnaire collected data on attitudes toward race, culture, and diversity education and how these concepts relate to medical practice; responses to a case scenario; attitudes toward cultural tolerance; definitions of key terms and sense of cultural belonging; and feedback on the questionnaire. The focus groups discussed the two models for teaching diversity. Results. Questionnaires were returned by 111 of 153 students (72.5%). Generally, the students displayed open attitudes about the balance between cultures of origin and the culture of the wider community in which immigrants may live. However, with very personal issues there was a tendency to stay with the familiar. These students had an impression of ethnic groups as very discrete and well defined. Skin color and issues of race remained a significant barrier to dialogue regarding diversity. Students were overwhelmingly in favor of the cultural sensibility teaching model that emphasizes the fluidity and malleability of culture. Conclusions. The students in this study were not familiar with key terms on culture and race, and struggled with the issues that diversity raises in medical practice. Although students held open attitudes toward equal opportunities and multiculturalism, differences among and within groups indicated that all students would benefit from a curriculum that emphasizes self-reflection and diversity teaching.

Early maturation as a risk factor for aggression and delinquency in adolescent girls: A review.

Early physical maturation has long been considered a risk factor for the development of delinquent girls. The basis of this relationship has not been fully explored or understood. This review summarises the current literature and research on early physical maturation in adolescent females and places it within a developmental perspective. The process of early physical maturation is also placed within a biopsychosocial model so that risk and protective factors arising from the biological, social, family, education and peer environments can be ascertained. A complex model of maturation and environmental–social interaction is constructed and currently supported by research, but it is clear that a great deal of further work is necessary to fully understand this process.

Prevalence Differences of Psychiatric Disorders among Youth after Nine Months or more of Incarceration by Race/Ethnicity and Age

Despite high rates of psychiatric morbidity among young offenders, few studies look closely at prevalence rates in terms of race/ethnicity or developmental stage. Seven hundred and ninety (790) incarcerated young people with a mean age of 18±1.2 years were examined. The racial/ethnic distribution was White (17%), African American (28%), Hispanic (47%) and Other (8%). White males had greater than average levels of psychosis; African American males showed lower than average alcohol dependence rates but higher levels of marijuana dependence. White females were more likely than Hispanic and African American females to have attention deficit-hyperactivity disorder and substance and stimulant dependence. Race/ethnicity and age differences can be useful when creating culturally-informed and developmentally appropriate interventions for incarcerated young people.

Psychosocial background in incarcerated adolescents from Austria, Turkey and former Yugoslavia.

Adolescents with a migration background account for a substantial proportion of juveniles in custody. Psychosocial adversities pose a significant risk for criminal behaviour. So far, the nature of psychosocial adversities experienced by migrant youth is understudied. The aim of this study was to explore differences in psychosocial background in three ethnic groups (Turkish, former-Yugoslavian and Austrian) of detained juveniles in Austria. A semi-structured interview (Multidimensional Clinical Screening Inventory for delinquent juveniles, MCSI) was used to assess psychosocial background (e.g., trauma, family background, forensic and psychiatric family history, school history, psychiatric treatment received and criminal history) in juveniles entering an Austrian pre-trial detention facility. Of the 370 eligible participants, the final study sample consisted of 278 juveniles. The ethnic distribution was as follows: 55.4% Austrian (mean age 16.88 years, S.D.=1.52), 14% Turkish (mean age 16.28 years, S.D.=1.23), 30.6% former-Yugoslavian (mean age 16.47 years, S.D.=1.41). In the Austrian sample, family dysfunction was significantly more prevalent than in the Turkish or former-Yugoslavian samples. Mental health services were significantly less used by juveniles with migration background. Turkish juveniles had a significantly poorer school performance than Austrians. Juveniles from former-Yugoslavia had significantly less often attended schools offering secondary education. The results suggest that detained juveniles with migration background are poorly integrated into the educational and mental health system of the host society. Family systems, even if substantially dysfunctional, seem to be perceived as more stable by migrant youth than by Austrian youth.

Teaching cultural diversity to medical students.

Despite acceptance that cultural and social factors play a critical role in healthcare (General Medical Council, 1993, 2002; American Medical Association, 1999; Association of American Medical Colleges, 1999; Ludmerer 1999), the educational curricula at most medical schools have been slow to change. The preclinical years are still dominated largely by anatomy, physiology and biochemistry; as other sciences have developed further, subjects such as genetics and neurosciences have been added to the curriculum (Lowry, 1993). Sociology and psychology are often grouped under the ‘behavioural sciences’. Their place in the medical curriculum has been subject to debate over a considerable period of time (e.g. Straus, 1965; Black, 1971; Russell et al., 2002) but most medical schools today do address these disciplines in the curriculum to some extent. Benbassat et al. (2003) highlighted the difficulty in implementing courses in the behavioural and social sciences that most US medical schools now offer. They argued that medical students often fail to perceive the relevance of behavioural and social sciences in clinical practice. Second, the behavioural and social sciences are often vaguely defined and the multiplicity of topics causes confusion about priorities. Finally doctors may have received little, if any, instruction in these areas, and behavioural and social scientists often lack clinical experience. Kelly (1990) suggested that the behavioural sciences frequently fail to excite medical interest because they adopt only a humanistic and/or critical approach at the expense of more clinical and pragmatic perspectives. The evidence presented in this review provides a range of perspectives on the place of ‘cultural diversity’ in the medical curriculum. The different perspectives also highlight the lack of any structure for a coherent debate about this issue; some papers assume that there is agreement about the place of ‘cultural diversity’ and what teaching in this subject actually entails. Staff perspectives are reviewed before those of students to examine the place of ‘cultural diversity’ in medical education.

Responses to conflict, family loss and flight: posttraumatic stress disorder among unaccompanied refugee minors from Africa

ObjectiveTo investigate African unaccompanied refugee minors (URMs) living in Austria for posttraumatic stress disorder (PTSD) prevalence and related symptoms, comorbidity, demographics and coping strategies.Method“UCLA PTSD Index and inventories” and “Scales for Children Afflicted by War and Persecution (SCWP)” were used to assess 41 African URMs.ResultsThe study revealed lower PTSD rates than measured among URMs in previous studies. Girls were more likely to develop PTSD. PTSD was significantly correlated with single war-related traumatic events. The depression score for the sample was above the clinical cut-off value.ConclusionsTrauma-specific psychopathology was less severe than reported in other studies. These findings could be explained by concepts of resilience. Other implications, such as response bias, are discussed.ZusammenfassungAnliegenUnbegleitete minderjährige Flüchtlinge sind oftmals als Patienten vorstellig in kinder- und jugendpsychiatrischen Einrichtungen. Neben vorhandenen sprachlichen Barrieren existieren in der Literatur wenige Daten zu dieser heterogenen Patientenpopulation. Vorliegende Studie fokussiert die aus Afrika stammenden, unbegleiteten, minderjährigen Flüchtlinge (URMs) in Österreich und untersucht das Vorhandensein etwaiger psychischer Störungen, insbesondere jener einer posttraumatischen Belastungsstörung (PTBS) und etwaiger begleitender Symptome und Komorbiditäten. Auch werden in diesem Zusammenhang Coping-Strategien erfasst.MethodeBei den insgesamt 41 afrikanischen URMs, die innerhalb von Österreich rekrutiert werden konnten, wurden neben „UCLA PTSD Index und Inventare“ auch „Scales for Children Afflicted by War and Persecution (SCWP)“ als Untersuchungsinstrumente eingesetzt.ErgebnisseIm Vergleich mit vorhandenen Daten in der Literatur zeigten sich in vorliegender Studie niedrigere PTBS Werte. Die Vulnerabilität für PTBS war für Mädchen erhöht. Die Diagnose einer PTBS stand in einem signifikanten Zusammenhang mit einmaligen kriegsbezogenen traumatischen Ereignissen. Die Depressions-Skala für das Sample befand sich über den klinischen Cut-off Werten.SchlussfolgerungenDie traumaspezifische Psychopathologie war unterhalb der in anderen Studien aufgezeigten Werte. Diese Ergebnisse könnten durch eine mögliche erhöhte Resilienz erklärt werden. Weiterführende Erklärungsmodelle werden diskutiert.

Divalproex sodium in the treatment of pediatric psychiatric disorders

Divalproex sodium is an anticonvulsant that is used extensively in adults with indications for epilepsy, acute mania and migraine prophylaxis. It has been used in children and adolescents as a first-line agent for mania in bipolar disorder. Its efficacy as a mood stabilizer has been established, and there have been studies outlining its efficacy as an agent effective in the treatment of conduct disorder, disruptive behavior disorders, aggression and explosive disorder. Longer-acting formulations are now available that cause less gastrointestinal side effects and can also be taken once a day, thus potentially increasing adherence, an important factor in this patient population. Future directions would include developing a more potent valproic acid formulation with fewer side effects, completing randomized controlled trials to establish the efficacy of divalproex sodium in various other pediatric psychiatric disorders, establishing the relative efficacy of the compound in head-to-head comparisons with other mood stabilizers, examining systematically the value of the compound in multimodal pediatric psychiatric treatment packages, and complete effectiveness trials that demonstrate the short- and long-term effectiveness of the compound in the real world of clinicians. In this drug profile, divalproex sodium and its uses in the pediatric population for psychiatric conditions are reviewed.

Unaccompanied refugee children

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