Suchergebnisse

For the past decade, overt unrest and danger have typified daily life for many families in Iraq and Afghanistan, while in Egypt under the former regime a superficial appearance of political stability lay over a sense of deep discontentment. What impact does living in those circumstances have on mental health? We asked psychiatrists with personal knowledge of events in three countries that have recently been riven by war and revolution to discuss their experiences. Because so few objective data are available on the impact of stress in any of the three regions reviewed, the authors have inevitably relied in large part upon anecdote and upon news reports from the internet.

Back in April 2006 (vol. 3, no. 2) we published papers on the theme of misuse of alcohol by young people, 3 years after the UK government had introduced the option of 24-hour drinking. The British Medical Association (BMA) subsequently recommended that there should be a programme of research to examine the consequences of this change to our drinking culture. In 2008, it reported on current trends in alcohol misuse (BMA Board of Science, 2008). An appendix to that report summarises the different alcohol control strategies pursued by the governments of England, Wales, Scotland and Northern Ireland in the past few years. These are outlined in the document Safe. Sensible. Social. The Next Steps in the National Alcohol Strategy (HM Government, 2007).

On 3 November 2008, new powers which allowed supervised community treatment, implemented by community treatment orders, came into effect in England. These orders were presaged by the Mental Health Act 2007 and contain specific conditions with which a patient must comply. The thinking behind the new orders was that patients in the community who are likely to be non-adherent to treatment could be treated under compulsion at an early stage in a relapsing phase of their illness, in order to prevent further relapse into serious illness, which could lead to their recurrent and compulsory admission to hospital. If patients who are to be treated in the community refuse to comply, they can be held in hospital against their will for up to 72 hours and forcibly treated. They cannot be forcibly compelled to accept treatment in the community. The legislation was controversial and was by no means universally supported. Some have argued that the motivation behind the introduction of new powers to allow 'compulsory treatment in the community' was more to assuage public anxiety about the potential threat to them caused by some people with mental health problems, a threat that is arguably in the public mind far greater than reality, than to provide a more liberal regime for the management of seriously ill psychiatric patients.

Since the collapse of the Soviet Union in 1990/91, there have been major changes in the political landscape of the former Soviet states. These have been mirrored in less publicised reforms of the way in which healthcare has been delivered. Here we focus on the way in which psychiatric services have developed in Ukraine and Moldova.

Within the continent of Africa, mental health services are relatively undeveloped. In the sub-Saharan countries of Malawi, Kenya and Nigeria, similar problems are faced by dedicated psychiatrists who are struggling to create and sustain an educational, management and political structure for psychiatry.

With the extraordinarily large movements of populations from some of the former Soviet Union states into Western Europe, since their recent membership of the European Union, attention has been focused in recent years on how easy or otherwise it has been for these people to adjust to life in very different economic and social circumstances. It has been estimated that the UK has absorbed up to a million immigrants from Eastern European states since 2004, and an equivalent picture is seen elsewhere; for example, in Switzerland immigrants now comprise nearly a quarter of the population. We consider here the mental health issues faced by those moving to work in other countries, some of whom aim to become citizens, others to gain temporary economic advantage, and yet others to escape persecution and threats to their personal safety in their countries of origin.

The chronic trauma endured by the people of Iraq, Darfur and Zimbabwe is a subject regularly brought to our attention in the UK by the news media. The mental health risk attributable to living in a situation in which each day brings the threat of more disruption, another risk to life and limb, the loss of people you love, perhaps of your home, is great. Less attention is now paid to isolated incidents that came in an instant but then passed by, leaving in their wake terrible destruction. Initial concern has not exactly turned into indifference, but in the aftermath of acute events it is hard to sustain great interest for months on end. Yet, for those who inhabit the rim of land in the Indian Ocean affected by the tsunami of December 2004, one single event did bring about unimaginable destruction and loss of life. In Kashmir in October 2005, an earthquake destroyed communities within a huge geographical area, one that was far more isolated, and hence less accessible to reporters, than the beaches of Phuket. From time to time we may wonder what happened to the survivors of these disasters – how are they coping, what help has been made available to them since, and to what extent have political complexities in Indonesia, Sri Lanka and Kashmir influenced the availability of aid and assistance?

Recently, the UK government expressed concern about the rising tide of antisocial behaviour among young people who, in certain areas of the country, were habitually engaging in acts of minor delinquency – often fuelled by drink. On the other hand, legislation was introduced to make it legal for premises that sell alcohol to remain open longer, up to 24 hours a day. This latter arrangement has courted considerable controversy. For example, the British Medical Association commented that any extension to licensing hours requires a programme of research, after its introduction, to look at its health consequences – both acute and chronic.

Depression, child abuse histories, and current attributions were investigated for 80 mothers of boys in three abuse referral groups (victimized perpetrators, nonvictimized perpetrators, and victim only) in comparison with a group of boys showing externalizing behaviors. During semistructured interviews with mothers, child abuse histories were elicited and the Beck Depression Inventory (BDI) was administered. The Leeds Attributional Coding System (LACS) was used to code spoken attributions from verbatim interview transcripts. Sexual victimization in their own childhood was reported by 55% of mothers of perpetrators and 30% of mothers of victims; high rates of domestic violence were reported by both mothers of perpetrators (72%) and mothers of victims (50%). There were no significant group differences on BDI scores. Mothers of the externalizing comparison group showed "low perceived control" in their attributions for negative events and blamed their sons for negative events significantly more than those of the three case groups (p < .05). The findings are discussed in terms of their implications for clinical interventions and research.

We aimed to construct and validate a shortened form of the developmental, diagnostic and dimensional interview (3Di), a parent report interview for assessing and diagnosing autistic spectrum disorders (ASDs). Data from 879 children and young people were used. In half of the sample (n = 440) reliability analysis was used to identify 3Di items that best measured each dimension of the autism triad. This informed the construction of a shortened (53 item) 3Di, which was then validated on subjects not used in the reliability analysis (n = 439). This involved comparison with scores from the original 3Di algorithm and, in a subsample (n = 29), with the autism diagnostic interview-revised (ADI-R). Agreement of the new shortened 3Di with the 3Di's original algorithm was excellent in both dimensional and categorical terms. Agreement on caseness (27 out of 29) with the ADI-R was also strong. The new 3Di short version is less than half as long as the original version and outputs very similar scores. It will be useful to clinicians and researchers for obtaining a dimensional autism assessment in less than 45 minutes.