Soma Ganesan

Catastrophic stress and factors affecting its consequences among Southeast Asian refugees

Effects on mental health of the stress of being interned in a refugee camp were assessed in a community survey of 1348 Southeast Asians. The impact on depressive mood proved significant but short-lived. Social support derived from the ethnic community and from an intact marriage moderated the risk of developing depressive symptoms, apparently by enhancing a sense of identity and belongingness. A psychological coping mechanism--avoidance of the past--buffered the impact of camp stress on depressive symptoms. While refugees brought into the country under private sponsorship were expected to have a mental health advantage compared to those admitted under government sponsorship, this hypothesis was not confirmed. Private sponsorship, carried out by individuals or groups whose religion differed from the refugees they were supporting, acted as a source of stress.

Spirituality and Religion in Canadian Psychiatric Residency Training

Objective: Mental health professionals are increasingly aware of the need to incorporate a patients religious and spiritual beliefs into mental health assessments and treatment plans. Recent changes in assessment and treatment guidelines in the US have resulted in corresponding curricular changes, with at least 16 US psychiatric residency programs now offering formal training in religious and spiritual issues. We present a survey of training currently available to Canadian residents in psychiatry and propose a lecture series to enhance existing training. Methods: We surveyed all 16 psychiatry residency programs in Canada to determine the extent of currently available training in religion and spirituality as they pertain to psychiatry. Results: We received responses from 14 programs. Of these, 4 had no formal training in this area. Another 4 had mandatory academic lectures dedicated to the interface of religion, spirituality, and psychiatry. Nine programs offered some degree of elective, case-based supervision. Conclusion: Currently, most Canadian programs offer minimal instruction on issues pertaining to the interface of religion, spirituality, and psychiatry. A lecture series focusing on religious and spiritual issues is needed to address this apparent gap in curricula across the country. Therefore, we propose a 10-session lecture series and outline its content. Including this lecture series in core curricula will introduce residents in psychiatry to religious and spiritual issues as they pertain to clinical practice.

Spirituality and treatment choices by South and East Asian women with serious mental illness.

The purpose of this qualitative study is to investigate how South and East Asian immigrant women who have diagnoses of serious mental illness make treatment choices in relation to spirituality and to explore how gender, cultural beliefs, and spirituality intersect with the process of choice. The findings reveal that the process of spiritual choice includes three interrelated phases: (1) identifying contributing factors, (2) exploring spiritual resources and strategies, and (3) living with the choices. Variations among health beliefs and health care decisions are explained and services that women see as being helpful are identified.

Overview of Culturally-Based Mental Health Care in Vancouver

This article is a description of how cross-cultural services in mental health have evolved in Vancouver. With 49% of Vancouver’s total population described as a ‘visible minority’ by Statistics Canada, it has been essential for the city, in its efforts to provide health care that is accessible, available and acceptable to all, to develop health care that acknowledges racial and cultural diversities. Vancouver’s Cross Cultural Mental Health Services had their beginnings over 25 years ago. The services encompass both formal and informal sectors of the healthcare system, are provided at primary, secondary and tertiary levels of healthcare delivery and are available through hospital- and community-based services. With recent regionalization of British Columbia’s health services, the cross-cultural mental health service has experienced increased coordination under the administration of the Vancouver Coastal Health Authority (one of six British Columbia health regions). The initial elements of a cross-cultural mental health service consisted of the Vancouver Association for the Survivors of Torture, the Cross-Cultural Clinic at Vancouver General Hospital, and the Multicultural Liaison Workers Program of the Vancouver Community Mental Health Service. Collaboration and partnerships between the formal and informal sectors support each other, bridge gaps in services and provide a milieu for growth and development.

Perception of mental illness: preliminary exploratory research at a cross-cultural outpatient psychiatric clinic.

This descriptive study presented an overview of culturally sensitive mental health services and potential barriers for immigrant Canadians. A semi-structured questionnaire was developed and administered to 173 patients who attended a large cross-cultural psychiatry outpatient clinic in Vancouver, British Columbia, Canada. Results indicated that only 21% of patients were able to state their diagnosis or were able to describe the symptoms of their diagnosis that met the DSM-IV criteria given by a psychiatrist. Examination of patient ethnicity showed that more South Asian (25%) or Southeast Asian (24%) patients had more diagnoses of anxiety disorder in comparison to other ethnic groups. Refugees characterized mental illness in terms of stress or stress-related factors (30%) in comparison to non-refugees (13%). There was a greater preference in women, when compared to men, to prefer the term ‘client’ versus ‘patient’. These results elucidate the importance of cultural and systemic barriers for immigrant Canadians. The need for appropriate service delivery is discussed.

Pilot study of the prevalence of alcohol, substance use and mental disorders in a cohort of Iraqi, Afghani, and Iranian refugees in Vancouver

This study investigated the prevalence rate of current alcohol, substance use, post‐traumatic stress disorder (PTSD) and depression in a cohort of Middle‐Eastern government‐assisted refugees (GAR) to British Columbia.Introduction This study investigated the prevalence rate of current alcohol, substance use, post-traumatic stress disorder (PTSD) and depression in a cohort of Middle-Eastern government-assisted refugees (GAR) to British Columbia. Methods A group of GARs (32 men and 36 women) were interviewed and assessed using four clinical assessments (AUDIT, DUDIT, IES-R, PHQ-9) at an intake facility in Metro Vancouver. Results Men had a higher prevalence of alcohol use compared to women (15.6% versus 0%, P < .05). Substance use was low for both men and women (3.1% and 2.8%) and consisted of Tylenol 3 use. Approximately the same proportion of male and female GARs had PTSD as a clinical concern (21.8% and 22.2%). GARs that were Iraqi, Muslim, had attended university, or had children had higher IES-R scores compared to other GARs. Depression as a clinical concern was found in female and male GARs (16.7% and 21.9%). Total PHQ-9 scores were higher for GARs who were unmarried. Discussion It would be beneficial for mental health care providers who treat Middle-Eastern GARs to review screening methods for PTSD, depression, and substance use. This may also include additional training in the screening of GARs for appropriate mental health services. Mental health services must be linguistically and culturally matched to the recipient for optimal therapeutic benefit.

Overview of psychiatric scales used in Nepal: their reliability, validity and cultural appropriateness.

A review of the Western mental health scales that have been utilized in Nepal was conducted. Academic search engines (PubMed, MEDLINE, PsychLIT, Social Sciences Citation Index, and Anthropology Plus) were searched using relevant terms for the years 1990–2011. Search results indicated a limited number of mental health scales had been used and/or developed in Nepal with mixed emphasis on reliability and validity, as well as cultural considerations. These scales, methods and limitations are discussed within the cultural and social background of Nepal.

Long-acting injectable risperidone in treatment refractory patients: a 14-week open-label pilot study.

A paucity of studies exists in evaluating long acting risperidone injectable (LAR) in treatment refractory patients. The objective of this pilot study (NCT00272597 http://www. clinicaltrials.gov) was to determine if LAR is effective and well tolerated in this patient group. Thirteen treatment refractory inpatients diagnosed with schizophrenia or schizoaffective disorder were recruited. Treatment refractory status was defined as having persistent illness for at least 5 years and: 1) treated previously with clozapine or 2) failed at least two adequate trials with antipsychotics alongwith a history of multiple hospitalizations in the previous year. Consenting patients entered a two-week run-in phase, in which they received oral risperidone, as monotherapy (maximum 6 mg/day), for at least 5 days before entering the open-label treatment phase. If the patient was treated with an antipsychotic other than risperidone, the dosage was tapered gradually while simultaneously starting oral risperidone. LAR was administered intramuscularly (IM) every 2 weeks. For the first three doses, all patients received 25 mg. At the time of the fourth injection, the dosage could be increased to 37.5 mg. A further increase to 50 mg was allowed if the patient had been on 37.5 mg for at least 4 weeks (2 injection intervals). To accommodate the latency period (time for risperidone to be released from the microspheres of the long-acting formulation), patients took oral risperidone for a three-week period beginning with the first IM dose of LAR. Oral risperidone supplementation was also permitted anytime to treat worsening or exacerbation of psychosis. Apart from adding a second antipsychotic, physicians were not restricted from using other medications for patient management. The primary outcome was severity of symptoms as measured using the total Positive and Negative Syndrome Scale (PANSS) scores (Kay et al., 1987). Secondary measures of effectiveness included the PANSS subscales, and the Clinical Global Impressions-Severity (CGI-S) scale (1976). Adverse events were evaluated using the Extrapyramidal Symptom Rating Scale (Chouinard et al., 1980) and the Barnes Akathisia Scale (Barnes, 1989).Metabolicmonitoringwas alsoperformed.

Risperidone long-acting injection in the treatment of schizophrenia spectrum illnesses: A retrospective chart review of 19 patients in the Vancouver Community Mental Health Organization (Vancouver, Canada)

BACKGROUND Schizophrenia is a chronic debilitating disease that affects ~110,000 Canadians (0.55% lifetime prevalence). Risperidone long-acting injection (RLAI) is the first injectable, long-acting, atypical antipsychotic drug marketed in Canada. OBJECTIVE The aim of this study was to assess the clinical effectiveness and hospitalization rates of patients with schizophrenia, schizoaffective disorder, or schizophreniform disorder treated with RLAI in a community mental health care setting. METHODS Data were collected between August 1, 2006 and September 30, 2006 via a retrospective chart review of outpatients diagnosed with schizophrenia, schizoaffective disorder, or schizophreniform disorder who received treatment from 1 of the 8 mental health teams within the Vancouver Community Mental Health Organization (VCMHO) in Vancouver, British Columbia, Canada. Collected data included: frequency and duration of institutional care, discharge and relapse rates, demographic variables, diagnosis history, RLAI medication history, and history of other medications. The overall severity of symptoms before and after RLAI treatment and the improvement in symptoms during treatment were evaluated using the Clinical Global Impression Scales for severity (CGI-S)(1 = not ill to 7 = extremely ill) and improvement (CGI-I)(1 = very much improved to 7 = very much worse). RESULTS Forty-four patients were identified as having received RLAI. The charts of 19 patients (10 men, 9 women; mean [SD] age at time of chart audit, 36.7 [11.7] years; mean [SD] age at primary diagnosis, 23.6 [7.4] years; race: white, 10 [52.6%]; Asian, 6 [31.6%]; American Indian, 1 [5.3%]; black, 1 [5.3%]; other, 1 [5.3%]) were included in the analysis. The majority of patients (78%) had been treated with another antipsychotic drug prior to treatment with RLAI: risperidone (77%), quetiapine (47%), zuclopenthixol (43%), olanzapine (43%), and loxapine (17%). Mean (SD) CGI-S Scale score declined significantly from 5.29 (1.3) before treatment initiation to 3.05 (1.0) posttreatment (P < 0.001). Mean (SD) CGI-I Scale score was 2.58 (0.71) (P < 0.001); 94% of patients had a CGI-I score ≤3. Mean (SD) duration of hospitalization decreased significantly from 15.7 (19.7) days before treatment to 2.4 (6.0) days after treatment (P < 0.05). Mean (SD) number of hospializations also decreased significantly from 2.0 (1.8) before treatment to 0.5 (1.3) after treatment (P < 0.01). CONCLUSIONS The results of this pilot study suggest that use of the atypical-antipsychotic medication RLAI significantly decreased duration and rates of hospitalization, compared with baseline, in these VCMHO patients with schizophrenia spectrum illnesses.

Expression of depressed mood: a comparative study among Japanese and Canadian aged people.

Objective: To investigate differences of expression regarding depressed mood between Japanese and Canadian aged people. Method: The Zung Self-Rating Depression Scale (SDS) was applied to people aged 65 and over in Ohira, Japan, and Steveston, British Columbia, Canada. Results: The number of subjects who filled out the SDS completely was 2180 for the Japanese sample and 183 for the Canadian sample. The mean SDS indexes of the Japanese and the Canadian samples were 44.03 and 44.34, respectively. The Canadian sample showed a higher average score in 11 items out of 20, whereas the Japanese sample showed a higher score on only 4 items. The factor analysis of those samples showed only small differences. Conclusions: The Canadian sample showed a higher average score in more items compared with the Japanese sample. This indicates that Canadian aged people express their depressed moods more clearly and spontaneously than Japanese aged people.