About this journal Global Psychiatry Archives is a self-published, peer-reviewed scientific psychiatric journal that aims to advance global mental health by making relevant scientific psychiatric knowledge easily accessible to all, i.e., mental health professionals, patients, families, and relatives from countries throughout the globe. We publish in English, bi-annually (two issues per year). The journal is self-published giving independence to the editorial board to focus on the best scientific publications. We accept original papers, systematic reviews, meta-analyses, case-reports, global perspectives, and editorials in English language on general, biological, social and clinical psychiatry, clinical psychology, psychiatric epidemiology, global mental health issues, neuroscience and related fields relevant to psychiatry and global mental disorders. We particularly want to support researchers and authors from the developing economies as well as from communities that don't have robust healthcare systems or where medical funding for research is unavailable. We support and mentor new and young authors from across the globe to publish their research, especially on currently ­­­­­­neglected areas of mental health care. Some of the most downloaded papers have been written by medical students, junior doctors, and young clinical psychologists. We are also keen to document the current and recent psychiatric history for future generations. We therefore published several articles on the personal histories of psychiatry as lived and experienced by eminent and young psychiatrists and clinical psychologists. Global Psychiatry Archives was founded in 2018 by Professor Reinhard Heun and colleagues (see editorial board) as a new online open-access journal with the aim to advance global mental health by making relevant scientific knowledge easily accessible to all. We believe that all sub-specialities of psychiatry and mental healthcare have a global common ground and we can learn from each other. A journal with a global approach can benefit all readers who are mental health practitioners, professionals, carers and ultimately their patients. Publishing a first paper is not easy, but being in touch with mental health research is a characteristic and necessity of good clinical practice. We therefore endeavour to help authors from across the world to publish their research, especially on neglected areas of mental health. We help them with careful and supportive reviews of their submitted papers and if need be, with personal mentoring. Publishing in psychiatry and mental health should be affordable to all potential authors independently of where they live or come from to allow research from all countries to reach the global readership and to contribute to the relevant development of psychiatry and mental health care. We keep the article processing charge low (currently £300 for published manuscripts, no other cost) and offer generous full or partial waivers for those in need. Publication will only depend on the quality of the manuscript, not the ability to pay. The journal is a self-financed, open-access online journal. Article-processing charges are the only income of the journal to fund the editorial systems, hosting, manuscript handling, copyediting, language editing, proofreading, typesetting, plagiarism checks, indexing costs and other essential services. Global Psychiatry Archives is self-published which gives the editorial board the maximum of independence in publishing the best papers independent from the restrictions and bureaucracies of national and international organisations. Global Psychiatry Archives is owned by Reinickendorf Ltd, a company limited by shares, main shareholder Professor Reinhard Heun (registered office address is 780 Crow Road, Glasgow, UK). Reinickendorf Ltd has no influence on the governance of the journal which is self-published by the editorial board. This should allow the journal the maximum of editorial freedom. The members of the editorial board not only have an immense amount of psychiatric and mental health knowledge necessary for the editing of psychiatric papers but also have a wide knowledge of managing and running psychiatric organisations including their journals, please see the editorial board on our website.
Assessment of community needs and perception of mental health in rural Nepal
Background: Mental health disorders are a major global burden, with countries like Nepal experiencing high prevalence and significant treatment gaps. Community perceptions critically shape health-seeking behaviours, yet research in rural Nepal is limited. This study explores knowledge, perceived risk factors, care options and help-seeking attitudes related to mental illness and suicide in Saudiyar, a rural village in Dang district, Nepal, with no regular formal mental health services. It is part of a needs assessment by Health Foundation Nepal (HFN) to inform planning of community mental health interventions. Methods: This cross-sectional study was conducted in 2018 in Saudiyar, Dang. Using purposive and convenience sampling, 119 participants from 11 community groups were surveyed with a semi-structured Nepali-language questionnaire. Topics included mental health knowledge, perceptions, risk factors, suicide exposure and care preferences. Complete case analysis and descriptive statistics were used to summarise findings using the Statistical Package for the Social Sciences (SPSS) Results: A total of 95.8% of participants had heard of mental illness, with the radio as the main source of information. Stress and worry (57.1%), alcoholism (53.8%), and depression (28.6%) were identified as key mental health issues. Low self-esteem, poverty, and family problems were seen as major risk factors for mental illness and suicide. While 38.2% had known someone who died by suicide, only 4.5% reported personal experience with mental illness, and 10.2% reported a family member being affected. Doctors (75.7%) and medication (88.8%) were seen as helpful treatments, alongside yoga (78.2%) and Bhajan (religious songs – 59.7%). Nearly all participants (99.2%) supported establishing community-based mental health services. Conclusion: TOur study identified a community’s perception of stress, alcohol use, poverty-related hardship, family conflict and low self-esteem as major contributing factors for mental illnesses and suicide. While biomedical treatment was widely valued, most participants found religious and spiritual practices helpful for mental health.
Copyright (c) 2025 Global Psychiatry Archives
Cue-induced brain activation and relapse in cigarette smokers during long-term smoking cessation treatment: a prospective fMRI study
Background: Studies investigating cue-induced brain activation as markers for cigarette use relapse have yet to be examined for their relevance in long-term cessation treatment. This feasibility functional magnetic resonance imaging (fMRI) investigation compared regions of cigarette cue-induced brain activation between cigarette smokers who relapsed versus those who abstained during a six-month intervention programme. Methods: Eighteen adult cigarette smokers (>15x/day cigarette use >2 years) with tobacco use disorder completed a baseline fMRI cue exposure paradigm before undergoing treatment. Whole-brain fMRI contrasts between cue exposure conditions (cigarette, neutral) were assessed in patients who relapsed (≥1x cigarette use) compared to those who abstained during treatment. Subjective craving was assessed after each block. Results: Nine patients relapsed (38.9 ± 6.9 years old; 4F) and nine abstained (40.3 ± 7.4; 6F) from cigarette use. Relative to abstainers, patients who relapsed exhibited greater activation in parietal, fusiform, cingulate, prefrontal, orbitofrontal, and supplementary motor area regions. There were no group differences in craving. Conclusion: Cue-elicited brain activation associated with cigarette use relapse during treatment was observed in areas involved in value-driven attention. Cue-related neural activation in these areas may be potential vulnerability markers for cigarette use relapse during long-term interventions. Given the promising results in this small pilot, further investigations are warranted.
Relevance of gender in mental health in India: women are disadvantaged
When it comes to mental health, gender matters. Men and women experience psychological stress in different ways. Gender disparities are especially noticeable in mental illnesses that are more common in women. In addition to being more likely than other women to experience sexual or physical abuse, women who misuse alcohol or drugs tend to blame their drinking on stressful situations or traumatic experiences. Young married women and girls from nuclear homes are more likely to commit suicide or self-harm. Social and gender-specific variables influence the occurrence and progression of mental illnesses in female patients. The low number of hospital visits among women can be partially attributed to their lack of resources. In India, over two-thirds of married women are victims of domestic abuse. The prevalence of domestic violence from 2019 to 2021 was 31.2%. Approximately 28.5%, 13.1% and 5.7% of women reported experiences of physical, emotional and sexual violence (Mishra SK et al., 2024). Social, political, economic and legal reforms have the potential to transform Indian women’s lives and improve their mental wellbeing. To deal with the difficulties that women’s mental health presents today, it is critical to approach mental health initiatives from a gender perspective. In addition, investigating alternative approaches to service delivery, including the use of mobile phone technology, which has the potential to be efficient and increase accessibility to services, can enhance the provision of mental healthcare for women.
Blood biomarkers in suicide attempts and psychiatric disorders: a pilot study in Bangladesh
Background: Blood biomarkers showed some associations with mental health conditions. However, they remain inconclusive in predicting psychiatric disorders and suicide attempts. Identification of peripheral blood biomarkers for suicide prediction could enable early preventive measures as they are cheap and easy to measure.Objectives: We aim to compare blood biomarkers between people who have attempted suicide and who have psychiatric disorders.Methods: Data was collected for this cross-sectional study between July 2021 and November 2023 from 55 hospitalised patients categorised into two groups – suicide attempt (n=29) and psychiatric disorder (n=26). We measured the complete blood count and C-reactive protein (CRP). All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 25 and were tested using a two-sided test, and a p-value of <0.05 was considered statistically significant.Results: The mean age of the participants was 26.1 (±10.0) years which was significantly lower for people with suicide attempts than for those with psychiatric disorders. The mean CRP level (p=0.011), total leukocyte count (p=0.024), neutrophil (p=0.002), and neutrophil-to-lymphocyte ratio (NLR, p=0.002) were significantly higher among people with suicide attempts, whereas the lymphocyte (p=0.002) and monocyte (0.029) were significantly higher among psychiatric patients.Conclusion: The findings showed NLR and CRP were more prominent blood biomarkers in suicide attempts than in psychiatric patients. However, due to the small sample size, caution is required when generalising the study results.
suicide in Bangladesh, cross-sectional analysis, psychiatric disorder
Mass conversion disorder in some schools in western Nepal: a case series of fourevents
Background: Mass conversion disorder (MCD), or functional neurological symptom disorder, involves motor or sensory symptoms without medical explanation that impair functioning. When such symptoms spread within groups, it is termed MCD, which can often be seen in schools and can be shaped by cultural and social dynamics. This case series examines the presentation, shared features and health-seeking behaviours of students affected by MCD in Ghorahi municipality, Dang, Nepal.Methods: Between June and August 2022, four public schools in Ghorahi reported MCD cases to the Health Foundation Nepal (HFN). The rapid mental health team responded, conducting retrospective assessments through observation, physical examination, and also interviews with students, parents and teachers. Clinical symptoms and demographic data were compiled, standardised and descriptively analysed.Results: Between June and August 2022, 20 female students aged 8 to 16 years (mean age 11.8 ± 1.98 years), mostly from school grades 5 (30%) and 6 (30%), were affected across four public schools in Dang, Nepal. Headache (40%), weakness with loss of coordination (35%), dizziness (25%), and cold periphery with numbness (25%) were major symptoms reported. Up to 80% described experiences involving spirits, and 55% knew a family member with a similar illness. Up to 95% had previous episodes, 90% had recurrences, 35% had parents separated due to divorce, and 30% due to unemployment. None of the students’ parents had a formal education beyond grade 10. All affected students were taken to traditional healers, and 50% also to hospitals, with timing and order of visits varying by case. Most parents attributed the illness to spirit possession, and teachers noted the need for training and support to address MCD cases.Conclusions: MCD in Dang’s public schools was influenced by cultural beliefs and family stressors. There was a high female prevalence, repeated MCD episodes, low parental education and a preference for traditional healing, which suggests the need for school-based mental health programmes and further research.
Similar attitudes toward death among Muslims and Christians in Iraq
Objective: Knowing people’s attitudes towards death is useful in examining people’s level of flexibility, problem management, and self-care. The religious and related cultural background of a person may affect their attitude towards death. The current study evaluated Christian and Muslim respondents’ attitudes towards death in Iraqi society. Methods: In a cross-sectional study, 100 individuals from the two main religious groups (Muslim and Christian) were groupmatched for gender, age, marital status, and personal monthly income. The attitude towards death was measured through a death attitude profile-revised questionnaire, and findings were analysed using SPSS version 20 by applying Pearson correlation and central tendencies. Results: Findings revealed that both religions’ followers have no major fear of death and, at the same time, a reasonable approach to acceptance towards death. Overall, religion had no significant effect on participant attitudes towards death, which means both religions’ followers share the same approaches and attitudes towards death. Conclusion: From the current research work, it can be concluded that there is no significant impact of religion on individual attitudes towards death and both religions’ followers have no major death anxiety. Muslims and Christians have reasonably accepting attitudes towards death as indicated by five-dimensional attitudes toward death scores. Future studies should focus on a larger population from different cultures and religious backgrounds to generalise these findings to other populations and cultural settings.
Attitude Towards Death, Religion, Muslim, Christian, Approach Acceptance, Death Avoidance, Escape Acceptance, Fear Of Death, Natural Acceptance, Iraq.
Validation of Bangla parenting style and dimension questionnaire
Objectives: There has been a plethora of studies conducted on different aspects of parenting and how it affects children. However, assessment of parenting style and dimension is untouched in Bangladesh. The Parenting Style and Dimension Questionnaire (PSDQ) is a self-reporting questionnaire responded by parents regarding their parenting practices, which assesses the three categories of parenting styles, namely, authoritative, authoritarian, and permissive. It was aimed to adapt and validate PSDQ in Bangla which is the mother tongue of the people of Bangladesh. Methods: The validation study was conducted from January 2017 to June 2018 in three schools of Dhaka city with the selfreporting semi-structured Bangla version of PSDQ. The adaptation of PSDQ to Bangla was performed according to the state-ofthe-art procedure of forward–backward translation. Parents having children aged 6–16 years were approached through schools to participate in the study. Data were collected from 349 parents and analyzed using Statistical Package for the Social Science version 16.0 software. Results: Cronbach’s alpha of PSDQ Bangla was 0.84, which signifies a good internal consistency. Cronbach’s alpha of authoritative domain was 0.95, authoritarian domain 0.88, and permissive domain 0.78. A total of three factors were extracted using exploratory factor analysis with varimax rotation after discarding four items that had poor correlation and factor loading values. The three extracted factors were authoritative, authoritarian, and permissive; these are similar with the initial three dimensions of PSDQ. Conclusions: Current study resulted in PSDQ Bangla, which retains 35 items in 3 domains with distribution of 20 items in authoritative domain, 9 items in authoritarian domain, and 6 items in permissive domain. The 35-item PSDQ Bangla can be a psychometrically reliable and valid tool to use in clinical setting of psychiatric practices in Bangladesh, especially to deal with child psychiatric disorders.
Parenting style, PSDQ Bangla, authoritative parenting, authoritarian parenting, permissive parenting
Copyright (c) 2018 Global Psychiatry Archives
Quality Assurance in Psychiatric Occupational therapy by treatment Manuals: Patients’ Perceptions of Resistance- and Regeneration-specific Occupational therapy.
Objectives: Training, treatment and quality assurance in occupational therapy need guidelines and manuals. Two manuals and corresponding manual adherence checklists were developed for resistance- and regeneration-oriented treatment strategies, which are standard in occupational therapy. The hypothesis is that occupational therapists can apply different treatments and that this can be measured. Methods: In a psychiatric-psychosomatic rehabilitation hospital, 108 patients were randomly assigned to the regeneration group and 113 to the resistance group. Patients were asked to indicate on a manual adherence checklist which interventions they had experienced during treatment. Additionally, a convenience sample of 124 patients who had not participated in the special groups but only in routine occupational therapy was interviewed at the end of the hospital stay. Results: Resistance-oriented interventions were significantly more often reported in the resistance group and regeneration-oriented intervention was reported in the regeneration group. Conclusions: The study demonstrates that the occupational therapy can be standardised according to treatment manuals and that protocol adherence can be ascertained, similar to that in other psychotherapies. This is important for training, practice, research and quality control, as manual guided and monitored treatment allows transparency in regard to what should and what has been done in therapy
Quality assurance, manualised occupational therapy, protocol adherence, quality control, standardisation
Increased Risk of Attempted and completed Suicide in Obsessive compulsive disorder: A Systematic Review of Follow-up Studies
Obsessive compulsive disorder (OCD) is a severe, often long-term mental disorder. It may be independent from, or comorbid with other mental disorders, especially depression and anxiety disorders. Suicidal thoughts, ideations and ruminations are prevalent in subjects with OCD, but it is not yet clear if the incidences of attempted and completed suicides have increased in comparison with the general population and with other psychiatric disorders. Methods: We conducted a systematic literature search on the incidence of suicide attempts and completed suicides in subjects with OCD. Search terms for Pubmed and Medline were OCD and suicide. We selected papers providing follow-up data on the incidence of attempted and completed suicide in OCD. Results: 404 papers were initially identified. Only 8 papers covering six studies provided prospective data on attempted or completed suicide over a defined period in subjects with OCD, four studies included control subjects. Two studies providing follow-up data were limited to high-risk samples and did not provide enough data on the incidence of suicide in comparison with the general population. The conclusion that there is an increased risk of attempted and completed suicides in OCD can only be based on one large Swedish National Registry sample with an up to 44 year follow up. Psychiatric comorbidity is the most relevant risk factor for suicide. Conclusions: Even though some studies report an increased incidence of attempted and completed suicides in OCD patients from selected high risk samples, the evidence from population based studies is mostly based on one large Swedish study. More long-term studies in the general population with a reduced risk of subject attrition are needed. Using a clear definition and assessment of suicidal behaviour and a common time-frame would improve the comparability of future studies.
Obsessive-compulsive disorder, OCD, suicide, completed suicide, suicide attempt, suicidal behaviour, follow-up, incidence, epidemiology
Pharmacotherapy prescribing patterns in the treatment of bipolar disorder in a South African outpatient population
Objectives: To describe the range and frequency of psychotropics used in the management of bipolar disorder in a specific setting as well as describe the nature and frequency of monotherapy versus polypharmacy use. Specifically to determine congruence with recommended standard of care that might inform a review and refinement of prescribing within this context. Methods: The study was a retrospective file review for patients with bipolar disorder (ICD 10 and or DSM IV TR diagnostic criteria) attending the outpatient clinic of a specialised psychiatric hospital (Tara Hospital) affiliated to th e De partment of Ps ychiatry (University of the Witwatersrand) in Johannesburg, South Africa. Data were presented both descriptively (continuous, discrete and categorical data) and with a range of appropriate statistical tests used for associations between categorical data (Chi Square; Fisher’s exact test; Cramer’s V and the phi coefficient). Results: The majority of patients (93.8%) were prescribed polypharmacy, with 3.2 as the mean number of psychotropic medications prescribed per patient (as determined from the last prescription written during the period of review, i.e. one year). There was a notable variety in the combinations used with no particular combination being prescribed in the majority of patients, noting, however, that 47% of the combinations used included a standard mood stabiliser prescribed together with an antipsychotic. Conclusions: The current study provides data on the prescribing patterns for bipolar disorder in a specialist psychiatric clinic within an academic complex in South Africa. The findings reflect international studies and highlight polypharmacy and combination treatment as common in such settings. Where polypharmacy is prescribed, the variation in combinations prescribed indicate that whilst treatment guidelines may provide a best practice approach, studies determining the most useful combinations are few and ultimately clinical requirements for individual patients will dictate treatment.
Drug therapy, bipolar disorder, outpatient, South Africa.
Facial emotion recognition performance influences executive control impairment in Anorexia nervosa: an exploratory study
Objectives. Since evidence on executive control among women with Anorexia or Bulimia Nervosa (AN/BN) are somehow inconclusive, we aimed to explore whether performance in set-shifting in AN/BN might be influenced by Facial Emotion Recognition (FER). Methods. We randomly recruited women with a diagnosis of AN or BN, from an Eating Disorders Outpatient Clinic in Italy, as well as healthy controls (HCs). We evaluated with established tools: diagnosis (Eating Disorder Examination- EDE-17.0), executive control (Intra-Extra Dimensional Set Shift-IED) and FER (Ekman 60 Faces Test-EK-60F). Univariate distributions by diagnostic subgroups were assessed on sociodemographic and clinical variables, which were selected for subsequent multiple linear regression analyses. Results. Women with AN performed significantly worse than HCs on IED adjusted total errors. HCs scored significantly better than AN and BN on EK-60F fear subscale. Although IED set shifting was associated (p = 0.008) with AN, after controlling for age, EK60F fear subscale, alexithymia and depression (i.e., clinically relevant covariates identified a priori from the literature, or associated with AN/BN at univariate level), this association could not be confirmed. Conclusions. Impaired executive control may not be a distinctive feature in women with AN, since several clinical characteristics, including fear recognition ability, are likely to have an important role. This has significant implications for relevant interventions in AN, which should aim at also improving socio-emotional processing.
Executive control, facial emotion recognition, eating disorders.
How to write a scientific paper: a hypothesis-based approach
Many books and other published recommendations provide a large, sometimes excessive amount of information to be included, and of mistakes to be avoided in research papers for academic journals. However, there is a lack of simple and clear recommendations on how to write such scientific articles. To make life easier for new authors, we propose a simple hypothesis-based approach, which consistently follows the study hypothesis, section by section throughout the manuscript: The introduction section should develop the study hypothesis, by introducing and explaining the relevant concepts, connecting these concepts and by stating the study hypotheses to be tested at the end. The material and methods section must describe the sample or material, the tools, instruments, procedures and analyses used to test the study hypothesis. The results section must describe the study sample, the data collected and the data analyses that lead to the confirmation or rejection of the hypothesis. The discussion must state if the study hypothesis has been confirmed or rejected, if the study result is comparable to, and compatible with other research. It should evaluate the reliability and validity of the study outcome, clarify the limitations of the study and explore the relevance of the supported or rejected hypothesis for clinical practice and future research. If needed, an abstract at the beginning of the manuscript, usually structured in objectives, material and methods, results and conclusions, should provide summaries in two to three sentences for each section. Acknowledgements, declarations of ethical approval, of informed consent by study subjects, of interests by authors and a reference list will be needed in most scientific journals.
Psychiatry, neuroscience, publication, manuscript, hypothesis
Antidepressant drugs for older patients on polypharmacy: a systematic review reveals best evidence for sertraline
Objectives: There is almost no data on antidepressant prescribing in older adults treated with polypharmacy, although this population represents approximately 50% of older patients. These patients are frequently excluded from double-blind randomized controlled trials, meta-analyses and existing treatment guidelines. The main aim of this paper was to identify data on antidepressant prescribing in depressed older adults on polypharmacy using a systematic review. Methods: Randomized controlled clinical trials (RCTs) and other clinical trials in Medline/PubMed without language limitation (-2017) were searched to identify those with older depressed patients on polypharmacy. Only elderly patients (>65 years as mean) were included. Only approved antidepressants were included. Results: The systematic search identified 26 different clinical trials, although only one clinical open label trial with sertraline met the final inclusion criteria. This sertraline trial indicated the absence of clinically important drug-drug interactions and confirmed the effectiveness and safety of sertraline in routine clinical practice. Heterogeneity in this trial was high in almost all the categories except attrition and reporting bias. Conclusions: Sertraline has the highest evidence level in older adults with depression on polypharmacy. According to the results of this review and due to a low number of appropriate trials, a basic understanding of psychopharmacology is the possible approach to avoid serious problematic drug combinations in these patients. Newer RCTs are also urgently needed. This is the first systematic review including patients treated with polypharmacy, and therefore, its results are important in the field of evidence-based medicine
Antidepressants, older patients, medication prescribing, polypharmacy, systematic review, sertraline.
Football does not improve mental health: a systematic review on football and mental health disorders
Objective: Both football (also called association football or soccer) and mental health disorders have a global impact on the lives of billions of people. Football has been used to approach and support subjects with or at risk of mental health disorders. However, it is not clear if football itself has any beneficial effect on the mental health of players, fans or spectators. Consequently, the aim of the current systematic review was to examine if playing or watching football impacts on the frequency of mental health problems in people who are involved in playing or watching the game. Methods: We performed a systematic review on the relationship between football and mental health disorders. A total of 662 abstracts were screened initially. We identified 17 relevant papers assessing the prevalence of mental health disorders in current and previous football players, referees or spectators. Results: The prevalence and 12 months incidence of mental health problems in active and retired professional players and referees were similar to or higher than those found in the general population, possibly as response to osteoarthritis, severe injuries, career dissatisfaction, low social support and poor employment status after retirement. Studies in adolescent amateurs and spectators indicate that playing and watching football games may negatively affect subjective mental health, even though qualitative studies indicate mental health benefits of playing or watching football. Discussion: Players, referees and spectators are unlikely to present with fewer mental health problems than other members of society as a result of their involvement with football. It appears that some of the infrastructure that supports resilience in mental health such as a sense of inclusion, shared purpose and positive peer identification might be developed by playing in or supporting a team. Strategies that may use the assumed positive aspects of football need to be validated before implementation of large projects.
Football, soccer, mental health, depression, anxiety, players, referees, spectators.
a systematic review on the effect of ramadan on mental health: minor effects and no harm in general, but increased risk of relapse in schizophrenia and bipolar disorder
Objectives: Globally, Moslems are the second largest religious group. During the month of Ramadan from dawn to sundown, healthy Moslems are required to refrain from eating, drinking, smoking, sexual activity and harmful behaviour towards others and themselves. Thus Ramadan may change individual physical states and social interactions. Both might affect mental health within society. Consequently, this systematic review looks at the various effects of Ramadan on mental health. Methods: A literature search on Ramadan and mental health initially identified 294 papers. We finally selected all 22 relevant papers covering Ramadan and mental health from which study data were extracted. Results: Relevant papers focussed on the general population and healthy volunteers, on subjects practising sports, on subjects with severe physical disorders, on subjects at risk of eating disorders and on subjects with mental health disorders. The effects of Ramadan on mental well-being were mixed. Positive and negative effects were usually minor, except in subjects with schizophrenia and metabolic syndrome, and in subjects with bipolar disorder who suffered a substantial increase of relapses. Conclusion: Ramadan fasting is safe in most conditions and disorders, but caution is required in subjects with schizophrenia and bipolar disorder. The research on mental health and Ramadan would profit from larger studies with more representative samples to help understand the intra-individual and social factors that affect the mental health and well-being in patients and in society. The scientific potential of such studies may have been overlooked in the psychiatric community.
Systematic review, Ramadan, fasting, mental health, depression, anxiety, schizophrenia, bipolar disorder
scientific publishing: a developmental role for the World Psychiatric association
Association of severity of depressive symptoms with sleep quality, social support and stress among Pakistani medical and dental students: A cross-sectional study
Objectives: This study has been designed to elucidate the prevalence of stress, depression and poor sleep among medical students in a Pakistani medical school. There is a paucity of data on social support among medical students in Pakistan; an important predictor of depressive symptoms. Therefore, this study was also aimed to demonstrate the direct and indirect impact of social support in alleviating depressive symptoms in the study sample. Methods: This observational cross-sectional study was conducted in Lahore, Pakistan, where a total of 400 students at a medical school were approached between 1st January to 31 st March 2018 to participate in the study. The study sample comprised of medical and dental students enrolled at a privately financed Pakistani medical and dental school. The participants responded to a selfadministered survey comprising of five parts: a) demographics, b) Pittsburgh Sleep Quality Index (PSQI), c) Patient Health Questionnaire-9 (PHQ-9), d) Multidimensional Scale of Perceived Social Support (MSPSS) and e) Perceived Stress Scale-4 (PSS-4). All data were analysed using SPSS v. 20. Linear regression analysis was used to reveal the predictors of depression. Results: In total, 353 medical students participated, yielding a response rate of 88.25%. Overall, poor sleep quality was experienced by 205 (58.1%) students. Mild to severe depression was reported by 83% of the respondents: mild depression by 104 (29.5%), moderate depression by 104 (29.5%), moderately severe depression by 54 (15.3%) and severe depression by 31 (8.8%) respondents. Subjective sleep quality, sleep latency, daytime dysfunction and stress levels were significantly associated with depression symptoms. Social support was not significantly associated with depressive symptoms in the regression model (Beta = -0.08, P 0.09); however, it acted as a significant mediator, reducing the strength of the relationship between depressive symptoms and sleep quality and stress. Conclusions: According to our study, a large proportion of healthcare (medical and dental) students were found to be suffering from mild to moderate depression and experienced poor sleep quality. It is concluded that social support is an important variable in predicting depressive symptomatology by ameliorating the effects of poor sleep quality and high stress levels.
Sleep, Pittsburgh Sleep Quality Index, stress, depression, social support, patient health questionnaire, medical students, Pakistan
Copyright (c) 2019 Global Psychiatry Archives
The effects of Guarana (Paullinia cupana) supplementation on the cognitive performance of young healthy adults – a Systematic Review.
OBJECTIVES: Guarana (Paullinia cupana) from the Sapindaceae family, native to the Amazon basin, is a natural stimulant herb that can be found in popular energy drinks, pharmaceutical shops or local herb shops. With the use of natural health products increasing, guarana has gained a fair amount of popularity in the past years. In this systematic review, we examined the effects of guarana supplementation on cognitive performance. A secondary objective was to compare guarana with caffeine on cognitive performance. METHODS: Searches were made in PubMed using the terms ‘Guarana’ or ‘Paullinia cupana’. Filters focused on Controlled Clinical trials. Inclusion criteria were met by studies using interventions with guarana, while focusing on guarana’s effects on cognition. Participants needed to be young, healthy adults. Studies not published in English or Greek were excluded. The last date of our search was March 7, 2019. RESULTS: A total of 29 studies were identified and screened. After screening, 17 studies were excluded. The remaining 12 studies were found eligible for data extraction. After reading the full text of the 12 studies, 3 studies were excluded. In the end, 9 studies were found eligible for our systematic review (n = 369 participants). In these studies, guarana showed to improve reaction time and accuracy of performance at cognitive tasks. No significant differences were found when comparing guarana with caffeine. CONCLUSION: Guarana seems to improve reaction time and accuracy of performance at tasks, but no significant effects were found when compared with caffeine. High quality randomized controlled clinical trials with a low risk of bias are needed to further study the herb.
Guarana, Paullinia Cupana, Caffeine, Cognition, Nootropics, Herbal Medicine, Systematic Review
Impact of River Bank Erosion on Mental Health and Coping Capacity in Bangladesh
Objectives: Riverbank erosion is a regular phenomenon that displaces millions of people every year worldwide. More than 100,000 people are displaced due to river erosion every year in Bangladesh. People have to resettle in a different place leaving behind their property and familiar environment. This transformation with economic crisis acts as a major stressor for the persons and their families. However, people may adapt different strategies to adapt this difficult situation and keep themselves healthy. They might have higher coping skills due to what they had to endure. This study aimed to find out the difference in the mental health status and coping strategies among the river bank erosion affected and non-affected people in Bangladesh Methods: We interviewed 100 adult respondents, of whom 50 had been affected and 50 had never been affected by river erosion in Bangladesh. All the participants completed self-report sociodemographic questionnaires; their mental state was evaluated with the Bangla version of the General Health Questionnaire-12 (GHQ-12) and the coping was measured using the COPE scale. Result: The mental health well-being score of the affected group was significantly lower than the non-affected group. However, accounting for gender, income and age, the affected group had lower mean score in coping (55.86) then the non-affected group (64.04). However, the difference was not statistically significant. Conclusions: Riverbank erosion is a major natural disaster in Bangladesh that makes people vulnerable to mental disorder. However, it receives less attention; we hope this study will stimulate future researcher to explore mental state and coping mechanism in multiple perspectives and develop evidence-based service for them.
Riverbank erosion, mental health, coping strategy, Bangladesh, resilience
Adherence to Mediterranean diet and risk of depression later in life. A cross sectional study in East Attica, Greece
Objectives: The purpose of the present study was to estimate the prevalence of depression later in life in an urban area and to investigate the associations between possible risk and protective factors including adherence to a Mediterranean diet. Methods: A cross-sectional study was conducted among the active members of the open day-care centres for older people, in EastAttica, Greece. An anonymous questionnaire was developed to collect basic demographic and medical data, the Geriatric Depression Scale (GDS-15) was applied to screen the elderly for depressive symptoms, the Athens Insomnia Scale (AIS) was used to quantify sleep disturbances and adherence to the Mediterranean diet was evaluated using the Mediterranean Diet Score (MDS). Statistics was processed with SPSS 24.0. Results: 154 older adults took part in the study. According to GDS-15, 24.7% (21.4% moderate and 3.2% severe type) screened positive for depressive symptoms. 29.9% of the participants reported inadequate sleep, based on AIS. Depression and insomnia in older participants were more frequent in women than in men, in lower educated, in participants with lower monthly income and in older people with comorbidity (p 0.05). MDS revealed that adherence to a Mediterranean diet was moderate for 64.3% of the participants, and it was high for 34.4%. Depression diagnosed by a physician, was strongly associated with MDS (p = 0.035) and AIS (p = 0.001). Logistic regression analysis results revealed a diet higher in vegetables and lower in poultry and alcohol was associated with decreased likelihood of developing symptoms of depression later in life. Conclusions: Our results support that depression in older adults is common and strongly associated with several risk factors. Adherence to a Mediterranean diet may protect against the development of depressive symptoms in older age. Moreover, not only diet but also sleep-deficiency might contribute to the depression later in life..
Depression, older age, Mediterranean diet, insomnia, Geriatric Depression Scale 15, Athens Insomnia Scale, Mediterranean Diet Score
Psychometric properties of the Bangla version of the Kessler Psychological Distress Scale (K6)
Objective: The 6 item Kessler Psychological Distress Scale (K6) is a screening tool for psychological distress with robust psychometric properties; however, information is lacking on such properties of the scale on its Bangla version. The aim of this study was to evaluate the psychometric properties of the Bangla version of the K6 scale in young people. Method: A self-administered questionnaire survey was conducted between August 2017 and April 2018 among 718 students aged 13-24 years (45% females) from Dhaka, Bangladesh. Psychological distress was assessed using the Bangla K6. The survey was repeated in a week. Statistical software AMOS 25 and Stata SE 14 were used to conduct the analyses. Results: The Bangla K6 scale demonstrated an acceptable internal consistency with high Cronbach alpha. Principal component analysis confirmed a single-factor structure of the scale. Confirmatory factor analysis supported the one-factor structure of the scale with adequate fit to the survey data. Test-retest reliability was acceptable with good reliability coefficients. Receiver operating characteristic analyses showed good prediction of depressive symptoms by the Bangla K6 scores. Discussion: This study provides an initial support for the Bangla K6 scale as an acceptable instrument to assess psychological distress of Bangla-speaking young people. More research is needed to understand our ability to identify vulnerable individuals, whose native language is Bangla and who are in need of mental health support.
Kessler 6, psychological distress, mental health, reliability, Bengali, Bangla, Bangladesh
Eating disorders, risk and management: a personal journey and a South African and African perspective
Eating disorders are amongst the most, disabling and lethal of psychiatric conditions. These conditions affect predominantly adolescent and young adult females, but not exclusively so. Whilst stereotypically diagnosed in western, urban societies their emergence in a range of population groups beyond the aforementioned has challenged the stereotype – no more so than in South Africa where eating disorders had not been diagnosed in black, female South Africans until the 1990s. Creating awareness of the changing demographic profile and thus risk was critical in ensuring appropriate diagnosis and management. Whilst this was a key feature of my personal journey there were numerous other aspects of risk explored for the development of eating disorders, as well as management, which will be highlighted and discussed in the paper. This has been especially relevant within the South African context.
eating disorders, South Africa, post- apartheid, Africa, risk, management
Barriers and facilitators to conducting research by early career psychiatrists: a literature review
Objectives: To understand and identify factors that promote and prevent research participation among early career psychiatrists (ECPs), in order to understand what would encourage more ECPs to pursue a research career. Methods: We conducted an electronic search of databases (PubMed and the Cochrane library) using the keywords ‘doctors’, ‘trainees’, ‘residents’, ‘physicians’ and ‘psychiatric trainees’ as well as ‘research’ (MeSH) and ‘publishing’ (MeSH). This search was complemented by a secondary hand search. Results: We identified 524 articles, of which 16 fulfilled inclusion criteria for this review. The main barriers included lack of dedicated time for research, lack of mentoring and lack of funding. The main facilitators were opportunities to receive mentorship and access to research funding. Conclusions: Action is needed to counteract the lack of ECPs interested in a career in research. Specific programs encouraging ECPs to pursue research careers and having access to mentors could help increase the current numbers of researching clinicians in the field.
Barriers, facilitators, research training, psychiatric training, early career psychiatrists, psychiatric trainees, residency training
Anxiety In A Dental And Maxillofacial Surgery Consulting Room: Does Previous Experience Matter?
Objectives: To explore the associations between previous dental visits and dental anxiety among patients presenting at the dental and maxillofacial surgery clinic of Department of Dental and Maxillofacial Surgery, Federal Medical Centre, Birnin Kebbi, Nigeria. Materials and methods: This study was a cross-sectional study conducted among 172 patients. Study instrument was a 9-item structured questionnaire, which obtained information about the participants regarding their: demographic profile; previous dental experience; and dental anxiety status in a dental and maxillofacial surgery consulting room. Data collected were analyzed using the SPSS Version 20 Software. Associations between variables were evaluated using Chi-square statistics using a p 0.05 to determine the level of statistical significance. Results: Roughly, six-tenth (57.6%) of the participants were males. The observed prevalence of dental anxiety among the participants was 47.7%. A history of pain experience during past dental treatment as well as a history of past dental visit were found to have statistically significant relationships with participants’ dental anxiety status (p-values 0.05). However, the frequency of previous dental visits, a history of past dental treatment, and a history of use of intraoral injections in the course of past dental treatment were found to have no statistically significant relationship with participants’ status of dental anxiety p-values 0.05. Finally, the prevalence of dental anxiety among the groups of female folks with “a history of previous visit to a dentist” and “a history of pain experience in the past dental treatment” were found to be significantly higher than that observed among similar groups among the male folks (p-values 0.05). Conclusion: Previous experience of pain plays a major role of influence over dental anxiety experience among patients. Hence, dental practitioners need to pay more attention towards dental anxiety management among patients, especially women.
Dental anxiety, dentist, dental, maxillofacial, surgery, experience, patient, pain management, treatment, Nigeria
Positive impact of clinical pharmacist interventions on antipsychotic use in patients on excessive polypharmacy evidenced in a retrospective cohort study
Objectives: Although antipsychotic prescribing in elderly patients using polypharmacy has not been studied in well-designed clinical trials and meta-analyses, there is an urgent need to monitor prescribing practice in this population. One of the possible approaches to optimize pharmacotherapy may be the involvement of clinical pharmacists (CPs). The aim of this research was to examine whether the involvement of a CP can improve treatment guidelines adherence and change the total number of medications per patient in older patients who are treated with excessive polypharmacy that includes antipsychotics. Methods: This cohort retrospective study included older patients (65 years or older) treated with at least one antipsychotic and excessive polypharmacy (10 or more medications concurrently) between 2012 and 2014 in primary care. The main outcome measures were antipsychotic treatment guidelines’ adherence and the total number of medications per patient after the CP’s interventions. Only interventions including antipsychotics were studied in detail (i.e., discontinuation, switching, initiation, dose adjustment, change of another medication because of a drug-related problem). Data on diagnoses, patient pharmacotherapy and the CP’s interventions were obtained from clinical records and medical reviews. Age and acceptance of the CP’s interventions were used as predictive factors for antipsychotic treatment guidelines’ adherence. Results: Forty-nine patients were included. The CP suggested 21 different interventions of which nine (42.8%) were accepted by the general practitioners. The number of medications that patients received decreased after the CP’s interventions (N of medications before: 15.4; N of medications after: 12.0, p 0.05). The acceptance of the CP’s recommendations, but not age, improved antipsychotic treatment guidelines’ adherence (p = 0.041). Conclusions: These results show that a collaborative care approach including a CP in primary care significantly improved the adherence to treatment guidelines. The results also support the implementation of this service in the Slovenian healthcare system, although more studies are needed.
Polypharmacy, clinical pharmacy, psychopharmacology, antipsychotics, aging, primary care
The Vulnerability and Resiliency of Childhood
Life is full of stressors, which have to be confronted efficiently to grow up. However, reaction to stressors is personalized, complex and coordinated. Vulnerable persons adjust poorly to stressors and express inappropriate responses, while resilient persons practice adaptive physiological and psychological responses. Promotion of resiliency is an intricated issue, which demands strategies at both macro and micro-level. Microlevel strategies are focused on the community, family and individual level, while macrolevel strategies formulate the principles. Nevertheless, prediction of vulnerability and resiliency is really a challenge, as different persons facing same stressors react differently. Some are growing as resilient and others as vulnerable. We aimed to discuss resiliency, vulnerability, importance in relation to health outcome, promotion of resiliency and controversies of vulnerability and resiliency.
Childhood vulnerability, childhood resiliency, chronic stress, vulnerable factors, resilient factors
A systematic review of mindfulness based interventions for children and young people with ADHD and their parents
Objective: Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent disorders in childhood, which may pose risks in later life such as academic underachievement and anti-social behaviour. It has been suggested that mindfulness-based interventions (MBI) may contribute to positive outcomes with child and adult populations. In this article, we aim to systematically review the literature regarding the effectiveness of MBI on both children with ADHD and their parents. Method: Seven databases were searched using the PRISMA criteria and included peer-reviewed journals and grey literature. Results: Ten studies met the inclusion criteria. Findings suggested that MBI had positive results in addressing attention deficits in children with ADHD, but in terms of hyperactivity, the evidence was conflicting. MBI interventions also appear to effectively address parental stress and family functioning. However, the rating from the quality assessment showed several methodological limitations. Discussion: The current evidence on the impact of MBI on ADHD symptoms is non-conclusive. However, promising data indicated the potential for MBI in addressing parental stress and family functioning. Further research is recommended to overcome the current methodological limitations.
ADHD, mindfulness, hyperactivity, attention, intervention, systematic review, effectiveness, children, young people, parents.
Can reading too much make me run mad? Exploring students’ assumptions and academic performance
Objectives: To determine the prevalence of the assumption that ‘reading too much’ could cause madness (i.e., severe mental illness) among medical, nursing, and community health students, and also explore the relationship between these students’ status on this assumption and their academic performance. Methods: This study was a cross-sectional study conducted among a convenient sample of medical, nursing, and community health students (n = 122) studying within the Usmanu Danfodiyo University Teaching Hospital campus, Sokoto, Nigeria. Study tool was a paper questionnaire, which obtained information on the demographic profile, awareness of ‘madness’, assumption that ‘reading too much’ is a cause of madness, and self-rating of the participants’ academic performance in their current course of study. Data collected was analysed using the SPSS version 20 software. Test of associations between variables were done using Chi square test. Results: The mean age of the 122 respondents was 27.3 years, majority (61.5%) of them were males, and 53.3% were medical students. More than half of the surveyed nursing students (54.2%) and community health students (55.6%), unlike the surveyed medical students (24.6%), had the assumption that reading too much could make them run mad. There was no statistically significant relationship between the assumption that ‘reading too much’ is a cause of mental illness and academic performance of the respondents. Conclusion: Assumption that reading too much could cause madness is a fairly common phenomenon among the surveyed tertiary school students, irrespective of their level of academic performance. There exists the need to disabuse the minds of tertiary school students from the assumption that reading too much could make one run mad.
Mental illness, belief, assumption, opinion, students, academic performance, health, school, education, Nigeria
The Impact of Childhood Trauma and Depressive Symptoms on Body Mass Index
Objectives: Obesity is associated with several somatic diseases and increased psychological burden. This study focused on two potential psychological predictors of the body mass index (BMI), childhood trauma and depressive symptoms. Methods: We used three independent populations: two general population samples (Study of Health in Pomerania, SHIP-2, N = 1,657; SHIP-TREND-0, N = 3,278) and one patient sample (GANI_MED, N = 1,742). Childhood trauma was measured with the childhood trauma questionnaire (CTQ) and depression with the Beck Depression Inventory (BDI-II) in SHIP-2 and the Patient Health Questionnaire (PHQ-9) in SHIP-TREND-0 and GANI_MED. We investigated the impact of childhood trauma and depression on BMI. Furthermore, we used mediation analysis to assess whether depression was a significant mediator on the path from childhood trauma to adult BMI in each of the three samples. Results: In all the three populations, depressive symptoms exhibited a significant association towards higher BMI (p 0.05). Childhood trauma was positively associated with BMI with significant associations in SHIP-TREND-0 (p 0.001) and GANI_MED (p = 0.005). The relationship between CTQ and BMI was significantly partially mediated (p 0.05) by depressive symptoms in SHIP-TREND-0 (38.0%) and GANI_MED (16.4%), in SHIP-2 results pointed in the same direction. All the trauma sub-dimensions, except sexual abuse, exhibited at least one significant association towards increased BMI in one of the samples. Conclusions: Childhood trauma and depressive symptoms may be considered as causes of obesity. These results suggest that psychological treatments against obesity should address childhood maltreatment as well as depressive symptoms in their diagnostic assessment and could facilitate psychotherapeutic treatment when necessary.
Depression, trauma, obesity, epidemiology, live events
The Proportion of Binge Drinking Among Female Social Drinkers of Kalingalinga in Lusaka, Zambia: A Pilot Study
Objectives: Alcohol is a psychoactive substance with dependence-producing properties. Alcohol’s harmful use causes large burden diseases like social and economic burden in societies. Binge drinking is one of the commonest forms of alcohol misuse and has been on an increase among many young women, who find alcohol a source of pleasure and enjoyment when they have timeout with friends and peers. Since binge drinking involves consumption of alcohol on an irregular basis, it may not be viewed as a hazardous form of alcohol use by many drinkers. The present study is aimed at estimating the proportion of female binge drinkers in the population of female social drinkers in Kalingalinga township of Lusaka, the capital city of Zambia. We hypothesised that the proportion of binge drinking in the population of female social drinkers is significantly high. Methods: Through snowball sampling, 100 questionnaires (i.e., Alcohol Use Disorders Identification Test-AUDIT) were successfully distributed to and collected from the female social drinkers aged 20–39 years between August and September, 2016. A two-fold process was followed in identifying the binge drinkers; screening for hazardous alcohol drinkers by identifying those that scored 8 points or above in the first place, and thereafter, identifying binge drinking characteristics from the hazardous drinkers by following scores from the first three questions on the AUDIT. Results: The results reviewed that 54 of the 100 participants had some form of hazardous alcohol use and 30 of the 54 hazardous drinkers possessed some binge drinking characteristics. The proportion of female binge drinkers in a population of female alcohol drinkers was estimated to be 0.556 (56.6%), while in the general population, it was estimated to be 0.094. This implies that 9.4% of women aged 20–39 years of Kalingalinga in Lusaka engage in alcohol binge drinking, consuming on average 7–9 drinks on occasion almost on a weekly basis. Further, if 56% of all female alcohol drinkers aged 20–39 years seem to engage in some form of alcohol binge drinking, it means that that binge drinking is the highest form of alcohol misuse among these female drinkers. Conclusion: The results of the present study suggest that there is more alcohol binge drinking among the female social drinkers of Kalingalinga in Lusaka, with an estimated proportion of 0.556 (55.6%) among the female alcohol drinkers and 0.094 (9.4%) in the general population of females aged between 20–39 years. The implication is that alcohol binge drinking seems to be the highest form of alcohol misuse among female drinkers in Kalingalinga.
Alcohol abuse, AUDIT Questionnaires, binge drinking (BD), heavy episodic drinking (HED), social drinkers