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Purpose: While positive contributions of religion and spirituality (R/S) to quality of life (QOL) are confirmed by a growing body of evidence, only limited research has involved people with intellectual disabilities and so far, no studies included prelingually deaf individuals with intellectual disabilities. This study explores the role of R/S in people with intellectual disabilities and deafness living in three therapeutic living communities specifically adapted to their needs. Methods: Forty-one individuals (mean age: 46.93 years, 43.9% female) with prelingual deafness and mild to moderate intellectual disability participated in structured sign language interviews adapted to their cognitive–developmental level, regarding their QOL, individual spirituality and participation in spiritual practices in the community. Participants' QOL was assessed with an established short measure for QOL (EUROHIS–QOL) adapted to easy-to-understand sign language. With 21 participants, qualitative interviews were conducted. In addition, proxy ratings from caregivers were obtained. Results: The participants' ratings of their individual spirituality (r = 0.334; p = 0.03) and spiritual practices-in-community (r = 0.514; p = 0.00) correlated positively with their self-reported QOL. Qualitative findings illustrate the importance of R/S and give insights into R/S concepts and practices. Conclusions: Personal spirituality and participating in spiritual practices are positively related to self-reported quality of life in deaf individuals with intellectual disability (ID). As a consequence, access to spiritual and religious services should be included in comprehensive programs and society at large. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate whether socio-demographic variables and physical disability (e.g. sensory impairment and mobility problems) were associated with self-reported stigma in people with intellectual disabilities (ID), and to examine whether age, sex and ethnicity modified the relationship between severity of intellectual disability and self-reported stigma.Methods: 229 participants with mild or moderate intellectual disabilities were recruited from 12 centres/sites in England from community intellectual disability services, day centres, supported housing schemes, voluntary organisations and invitation letters. Information on physical disability and socio-demographic variables were obtained using a structured data collection form. Self-reported stigma was measured using a validated questionnaire.Results: Age was associated with self-reported stigma, with older adults reporting more stigmatising experiences. Participants with moderate intellectual disabilities were more likely to report being treated differently such as being made fun of and being treated like children. Physical disability such as sensory, mobility and speech problems were not associated with self-reported stigma. Gender modified the relationship between severity of ID and self-reported stigma as participants who were male and had moderate ID were more likely to report stigma compared to females with moderate ID. Categorical age also modified the relationship between severity of ID and self-reported stigma as older participants who had moderate ID were more likely to report stigma compared to younger people with moderate ID.Conclusions: Older adults and those with moderate ID are potentially at higher risk of being targets of public stigma or are more likely to report stigma. Interventions to help individuals cope with stigma could be targeted to this group. [ABSTRACT FROM AUTHOR]

Purpose: To describe demographic and diagnostic profiles in a national cohort of older people with intellectual disability (ID) who were prescribed antipsychotics.Methods: Using national registers, we identified people with ID who were 55 + years in 2012 (n = 7936), as well as a subcohort with complete information on demographic factors (sex, year of birth, severity of ID, presence of behavior impairment, and residence in special housing; n = 1151). Data regarding diagnoses and prescription of antipsychotics were added for the time period 2006-2012. The potential effects of demographic factors and diagnoses on the prescription of sedating and less-sedating antipsychotics, respectively, were assessed in separate models by estimating the relative risks (RRs) of prescription.Results: Of the demographic factors, severe/profound ID (RR 1.17), behavior impairment (RR 1.34), and living in special housing (RR 1.25) were associated with prescription of sedating antipsychotics, whereas only behavior impairment (RR 1.42) was associated with prescription of less-sedating antipsychotics. For both sedating and less-sedating antipsychotics, the diagnoses with the largest association (i.e., highest relative risk) were schizophrenia (RR 2.17 for sedating and RR 1.81 for less-sedating) and ID (RR 1.84 and RR 1.68, respectively), followed by disorders of psychological development (for sedating antipsychotics, RR 1.57) and organic mental disorders (for less-sedating antipsychotics, RR 1.55).Conclusions: The associations between prescription of antipsychotics and demographic factors and non-psychotic diagnoses, respectively, suggest that older people with ID may be prescribed antipsychotic medication without thorough psychiatric diagnosing. If so, there is a need for improving the abilities of health care professionals to properly diagnose and manage psychiatric illness in this population. [ABSTRACT FROM AUTHOR]

Associations between demographic and clinical variables and severe behavioural problems in people with intellectual disabilities were examined in a cross-sectional survey of 408 adults consecutively referred to a specialist mental health service. Severe behavioural problems were present in 136 (33.3%) of the sample. The demographic and clinical predictors of severe behavioural problems in this sample were identified by logistic regression. Age and gender were not associated with severe behavioural problems. The presence of severe ID independently predicted the presence of severe behavioural problems. Schizophrenia spectrum disorders and personality disorders independently predicted the presence of severe behavioural problems, whereas the presence of an anxiety disorder independently predicted their absence. There is an increasing evidence base of relationships between mental disorders and behavioural problems in people with ID although the pattern of these relationships remains unclear. [ABSTRACT FROM AUTHOR]

Purpose: People with intellectual disability (PWID) appear more likely to be victims and perpetrators of crime. However, extant evidence pertaining to these risks is limited by methodological weaknesses and the absence of consistent operational definitions. This research aimed to estimate the prevalence of criminal histories and victimisation using a large, well-defined sample of PWID.Methods: A case-linkage study was conducted comprising 2220 PWID registered with disability services in Victoria, Australia, whose personal details were linked with a state-wide police database. Criminal charges and reports of victimisation were compared to a non-disabled community comparison sample (n = 2085).Results: PWID were at increased risk of having a history of criminal charges, particularly for violent and sexual offences. Although the non-disabled comparison group had a greater risk of criminal victimisation overall, PWID had a greatly increased risk of sexual and violent crime victimisation.Conclusions: PWID are at increased risk of victimisation and perpetration of violent and sexual crimes. Risk of sex offending and victimisation is particularly elevated, and signalling the need for specialised interventions to prevent offending and to ensure victims is assisted with access to justice, support, and treatment. [ABSTRACT FROM AUTHOR]

Purpose: There is consensus that Quality of Life (QOL) should be obtained through self-reports from people with intellectual Disability (ID). Thus far, there have been no attempts to collect self-reported QOL from people who are deaf and have ID. Methods: Based on an established short measure for QOL (EUROHIS-QOL), an adapted easy-to-understand sign language interview was developed and applied in a population (n = 61) with severe-to-profound hearing loss and mild-to-profound ID. Self-reports were conducted at two time points (t1 and t2), 6 months apart. The Stark QOL, an established picture-based questionnaire, was also obtained at t2 and three Proxy ratings of QOL (from caregivers) were conducted for each participant at t1. Results: Self-reported QOL was successfully administered at both time points for 44 individuals with mild and moderate ID (IQ reference age between 3.3 and 11.8 years). The self-reports showed sufficient test–retest reliability and significant correlations with the Stark QOL. As anticipated, self-reported QOL was higher than proxy-reported QOL. Test–retest reliability and internal consistency were good for self-reported QOL. Conclusion: Reliable and valid self-reports of QOL can be obtained from deaf adults with mild-moderate ID using standard inventories adapted to the linguistic and cognitive level of these individuals. [ABSTRACT FROM AUTHOR]

Purpose: Disability acquisition in adulthood is associated with deterioration in mental health. Social support may act as a "buffer" against poor mental health following disability acquisition. We tested the hypothesis that women and men with low social support experienced larger declines in mental health on acquisition of a disability compared to women and men with high social support.Methods: We assessed whether social support, measured both prior and subsequent to disability acquisition, modified the association between disability acquisition and mental health using 14 annual waves of data from the Household, Income and Labour Dynamics in Australia Survey. Participants reported at least two consecutive waves of disability preceded by at least two consecutive waves without disability (2200 participants, 15,724 observations). Fixed-effects linear regression models were used to estimate average differences in mental health between waves with and without disability, for women and men separately. We tested for effect measure modification of the association by social support, including a three-way interaction between disability and social support prior and subsequent to disability acquisition.Results: Though the effects of disability acquisition on mental health were much larger for women, for both women and men there was a consistent pattern of association with social support. There was evidence that social support modified the association between disability acquisition and mental health, with the largest effects for those experiencing a change from high to low social support subsequent to disability and for people with consistently low social support.Conclusions: These findings highlight the importance of developing new policy and practice strategies to improve the mental health of people with disabilities, including interventions to promote social support at the time of disability acquisition. [ABSTRACT FROM AUTHOR]

Purpose: Mental ill health in adults with intellectual disability (ID) is a neglected field in psychiatry and thus still widely understudied. This paper provides data on the prevalence of mental illness and problem behaviour and analyses support needs, mental health service use and psychotropic medication in a representative sample of adults with mild to moderate ID.Methods: A set of well-established instruments was used to assess the main parameters in n = 371 participants recruited within a cross-sectional epidemiological multicentre study using a stratified randomised cluster sampling.Results: Point prevalence of mental disorders was 10.8 %, that of problem behaviour 45.3 %. Most study participants needed help in specific lower order need areas (e.g., money budgeting, food, accommodation), and these need areas were mostly rated as met. The highest ratios of unmet to met need were found with respect to sexuality issues and with respect to mental health problems. The focus of psychiatric treatment was psychotropic medication.Conclusions: Referring to ICD-10 based diagnostic criteria and consequently avoiding confusing problem behaviour with mental disorders, point prevalence of mental disorders was lower than in the general population. A systematic deficit in meeting mental health problems in adults with ID indicates the need for implementing strategies to maximise the quality of identification and management of mental disorders. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests that substance abuse negatively affects both psychiatric symptom severity and quality of life (QOL) in people with severe mental illness (SMI). However, these relationships have not been examined simultaneously, nor have they been characterized over time. Thus, it is difficult to appreciate the extent to which substance abuse exerts an enduring effect on psychiatric symptoms and distress and/or QOL in this population. The purpose of this study is to test a conceptual model linking these factors together.Methods: Subjects were participants in a longitudinal evaluation of community mental healthcare in Ontario (n = 133). Comprehensive consumer assessments were conducted at treatment entry, and at 9 and 18 months. Subjects were receiving intensive case management or assertive community treatment throughout the 18-month study period. Structural equation modelling was used to examine the concurrent and longitudinal relationships between substance abuse, symptoms and distress, and QOL.Results: The prevalence of substance abuse was 55.0%. The SEM analysis suggested that substance abuse at baseline was associated with elevated symptomatology and distress and lower QOL, and that these effects endured after 18 months of treatment. Psychiatric symptoms and distress mediated the negative relationship between substance abuse and QOL.Conclusions: The mediating role played by symptom and distress levels in the relationship between substance abuse and QOL suggests the importance of closely monitoring changes in these factors among SMI patients with substance problems. Tracking symptom severity and distress levels over time will allow service providers to intervene and potentially improve the QOL of individuals with SMI. [ABSTRACT FROM AUTHOR]

Background: While much attention has been given to the prediction of violent offending behaviour amongst people with psychotic disorders, less attention has been given to the fact that these same individuals are often the victims of violence. In this paper, we examine victimisation amongst participants in a prevalence study of psychosis, and describe demographic and clinical correlates of victimisation. METHOD The study was based on the Australian National Survey of Mental Health and Wellbeing--Low Prevalence (Psychotic) Disorders. The participants were asked if they had been a victim of violence in the previous year. The association between selected demographic and clinical variables and being a victim of violence was examined using logistic regression.Results: Of the 962 individuals with psychosis, 172 reported being a victim of violence in the past 12 months (17.9 %). The odds of being a victim were increased in those who: (a) were female, (b) were homeless, (c) had a lifetime history of substance abuse, (d) had been arrested in the previous 12 months, (e) had poorer social and occupational function, and (f) had higher scores on the disorganisation summary score.Conclusions: Clinicians should remain mindful that one out of every six individuals with a psychotic disorder reports being a victim of violence in the previous year. Models of care that address issues related to symptom relief, accommodation, and exposure to high-crime areas may reduce the rates of victimisation amongst those with psychotic disorders. [ABSTRACT FROM AUTHOR]

Background and Aims: A standardised and systematic analysis of commitment laws in the European Union Member States is still missing. This study aimed at gathering, describing and analysing information on the differences or similarities of legal frameworks for involuntary placement and treatment of mentally ill patients across the European Union Member States.Method: Information was gathered by means of a detailed questionnaire filled in by experts from all EU Member States. Legal criteria for compulsory admission and details of the assessment and decision process of compulsory admission are outlined.Results: Although common patterns among Member States can be identified upon comparison of crucial legislative or procedural details, these patterns are far from being consistent across all analysed items or approaches. With regard to compulsory admission quotas no significant influence of legal commitment criteria and the involvement of judicial authorities could be found, but Member States with an obligatory inclusion of a legal representative during the commitment procedure showed significantly lower compulsory admission quotas.Conclusion: Results of this study show the strong necessity for further research in this field. Common international health reporting standards as annually updated involuntary placement rates detailed for regular and emergency cases seem to be essential. [ABSTRACT FROM AUTHOR]

There are four services providing mental health care to the people of Kumasi, Ghana. This study aimed to identify previous help sought by patients presenting to the services for an initial assessment. Of the 322 patients presenting to the four sites, only 6% had seen a traditional healer whereas 14% had seen a pastor before presentation. There was a greater delay in presenting to that service if the patient had seen a traditional healer or pastor. Many patients had previously used one of the other mental health units in Kumasi. It is possible that fewer patients with mental health problems present to traditional healers in modern, urban Africa compared to rural areas. More patients consult with pastors than traditional healers and liaison with these groups may improve mental health care. It is important to maintain liaison between the four services as patients presenting to one clinic may have presented previously to another local clinic. [ABSTRACT FROM AUTHOR]

The General Health Questionnaire allows for distinguishing patients suffering from psychiatric problems from those in good mental health. There is some controversy as to the best scoring method. Two different methods have been proposed: GHQ and cGHQ. The present study aims at verifying whether there is confirmation of the hypothesis that the population resulting from the cGHQ calculation presents greater chronicity. Two discordant groups of patients were identified: Group 1 (acute cases only), positive on the GHQ, but negative on the cGHQ (n=124), and Group 2 (chronic cases only), negative on the GHQ and positive on the cGHQ (n=64). Patients in Group 2 were older (p<0.001),were more worried about their health (p=0.06) and their health problem had lasted for a longer time (p=0.02). Patients in Group 2 were twice as likely to remain positive on the GHQ and/or the cGHQ as those in Group 1 in the 1- and 3-month follow-ups. The results suggest the presence of notable differences between the two groups, generally explainable by the hypothesis of greater chronicity in the cGHQ patients. The results confirm the impact of the choice of calculation method on the composition of the two groups. Finally, the authors suggest using the two calculation methods simultaneously. [ABSTRACT FROM AUTHOR]

The aims of this study were to estimate the prevalence of substance misuse among people with severe mental illness in a large urban centre of a developing country, and to investigate which are the individual characteristics associated with such comorbidity. One hundred and ninety-two subjects were included. The prevalence of substance misuse was 10.4% (95% CI: 6.5­15.6), with 7.3% fulfilling criteria for alcohol abuse or dependence, and 4.7% fulfilling criteria for abuse or dependence of illegal or non-prescribed substances. Subjects with any abuse or dependence had lower scores for negative symptoms. Male subjects and those with a diagnosis of non-affective psychosis other than schizophrenia had higher probability of being cases of misuse of illegal or non-prescribed substances. Prevalence of substance misuse was lower than that found in developed countries. The lack of social policies for those suffering from severe mental illnesses, with consequent dependence on family support must play a major role. Cultural factors also seem to contribute to the prevalence of substance misuse. [ABSTRACT FROM AUTHOR]

Background Little is known about the temporal relationship between illness onset and the possible beginning of a criminal career among people with schizophrenia, even though criminality, especially violent criminality, has been shown to be more common among people with schizophrenia than among people in general. Aim: The aim of this study was to analyse the temporal relationship between registered crime and contact to the psychiatric hospital system. Method: This is a register-based study merging data on the psychiatric career with criminal records. Results: Among the males with schizophrenia, 37% started a criminal career and 13% had committed first violent crime before first contact with the psychiatric hospital system. Conclusion: The criminality committed before first contact to the psychiatric hospital system is substantial, especially among males with schizophrenia. [ABSTRACT FROM AUTHOR]

Background: Two measures in the English Mental Health Act allow requirements to be imposed upon patients living in the community. These are Guardianship (Section 7) and Supervised Discharge (Section 25A).Aims: The paper aims to compare patients with mental illnesses, made subject to Guardianship or Supervised Discharge.Method: Data on patient characteristics, impairment, needs and interventions were collected from keyworkers in a random national sample of Trusts and local authorities. Ratings were obtained on standardised measures of disability, impairment and needs.Results: Patients placed on Supervised Discharge were more likely to have problems of treatment compliance and drug misuse, whilst those on Guardianship were more likely to have problems of social welfare and higher ratings of disability and impairment. Supervised Discharge has a higher proportion of African-Caribbean patients. Interventions delivered are rated as effective for both measures.Conclusions: Legal changes proposed in England include a single power for supervision in the community. This should not mean a focus on risk management to the neglect of social welfare interventions. [ABSTRACT FROM AUTHOR]

Purpose: Existing research shows that people with hearing loss have a high risk of additional physical and mental disorders. However, only a few population-based studies have been conducted. This study assesses the prevalence and characteristics of additional disorders among adults with hearing loss in Denmark and thereby contributes a population-based study to this area of research.Method: Data on self-reported physical and mental disorders from a national survey of 772 adults with hearing loss were compared to corresponding data from a national survey of 18,017 adults from the general population.Results: People with hearing loss reported more physical and mental disorders than the general population. Specifically, they reported higher incidences of visual impairment, cerebral palsy, intellectual impairment, and "other mental disorders".Conclusion: Adults with hearing loss have a greater risk of additional physical and mental disorders. It is important for clinicians to have some understanding of the communication needs and characteristics of deaf and hard-of-hearing patients, so that they can recognize and treat symptoms and provide appropriate support. [ABSTRACT FROM AUTHOR]

Purpose: To examine the associations between depression course, functional disability, and Not in Education or Training (NEET) status in a clinical sample of young adults with mental health problems.Methods: Young adults aged 15-25 years seeking help from four primary mental health services were invited to participate in a prospective cohort study evaluating the course of psychiatric disorders in youth. Demographic and clinical characteristics, including depressive symptomatology and functioning, were evaluated through clinical interview and self-report at baseline and 12 month follow-up.Results: A total of 448 young adults participated (70 % female; M: 20.05 years, SD = 2.85). A significant interaction effect for time and depression course was found, such that those who became depressed reported an increase in functional disability and those whose depression remitted reported a significant reduction in functional disability. Developing depression was not a significant predictor of becoming NEET and vice versa: remitted depression did not make a person more likely to reengage in employment or education.Conclusions: This is the first study to examine the course of depression, functional disability, and NEET rates among help-seeking young adults. This study confirms the importance of symptom reduction for improved functioning; however, functional disability remained greater than that seen in young people in the community and there was no association between a change in depression and a change in NEET status. These results argue that services need to address functional outcomes and reengagement with education and employment in addition to symptom reduction. [ABSTRACT FROM AUTHOR]

The present study examined lay recognition of psychopathy and beliefs about the behavioural manifestations, aetiology, and treatments of psychopathy. A community sample of 232 participants completed a questionnaire consisting of a vignette-identification task, a ratings task of 45 attitudinal items about psychopathy, and demographics. Analysis of the vignette-identification data showed that participants were significantly less likely to correctly identify a case of psychopathy than they were of either depression or schizophrenia. Factors derived from principal components analysis of the attitudinal items revealed that participants generally believed psychopaths to be intelligent and to have criminal tendencies, and that psychopathy was likely caused by early trauma and stress. Overall, participants may have had monological beliefs about the manifestations, aetiology, and treatments of psychopathy. These results suggest that educational programmes are required to improve mental health literacy in relation to psychopathy among the general public. [ABSTRACT FROM AUTHOR]

The aim of the study was to examine an alternative way of scoring the Camberwell Assessment of Need (CAN) for the purpose of service evaluation, using the by us defined Social Services (SI) and Psychiatric Services (PI) subindices. CAN assessments in 1997 and 1999 of 262 outpatients (mean age 45 years, 77.1% psychotic disorders) were reanalysed to fit the SI and the PI, which were compared to the full CAN. The mean total needs on the full CAN decreased from 6.65 to 6.22 ( P = 0.007), as did the mean unmet needs (1.55–1.81, P = 0.049). The mean total needs on the PI decreased from 2.42 to 2.22 ( P = 0.006), as did the mean unmet needs (1.66–0.57, P < 0.001). No changes in mean needs occurred on the SI. All significant changes occurred on the PI, indicating a more beneficial outcome of the psychiatric care than the social care in terms of meeting needs, a result impossible to discern from the total scores of the CAN. Thus, output scores on subindices of the CAN might be useful as outcome measures in service evaluation. [ABSTRACT FROM AUTHOR]

Psychiatric patients have the right to strive for well-being and not only be confined to symptom reduction. Studies are needed to assess global well-being during recovery from depression by comparing the assessments of patients and clinicians. A 6-year natural follow-up of 185 depressive out-patients was carried out with health questionnaires at baseline, 0.5, 1, 2 and 6 years, including scales on depression (BDI, HDRS), general psychopathology (SCL), functional capacity (GAF, SOFAS) and life satisfaction (LS). A structured diagnostic interview was carried out at baseline, 2 and 6 years. Complete follow-up data were obtained from 121 patients. In general, depressive patients mainly attained a normal mood, adequate functional capacity and life satisfaction. Those with a slow recovery improved with successive treatment contacts, eventually reaching levels of mental health not significantly different from the others. Throughout the follow-up, recovery was similarly shown with the self-reported BDI-21, SCL-90 and LS-4, while intercorrelations between clinician ratings were low at baseline. Adequate mental health and global well-being can be reached among depressive patients, but it may take time in treatment. Subjective assessments are reliable. The 4-item life satisfaction scale is a global well-being indicator and a valid treatment outcome measure. [ABSTRACT FROM AUTHOR]

We sought to obtain an overview of electroconvulsive therapy (ECT) practice in Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, which is the biggest hospital for psychiatry in Turkey. From 1st January 2006 to 30th June 2007, a form enquiring about evaluation of ECT was filled retrospectively. The total number of patients, admitted for psychiatry during the survey period was 265,283. A total of 1,531 patients (12.4% among inpatients and 0.58% in all psychiatric admissions) received 13,618 sessions (including multiple hospitalizations) of ECT from 12,341 psychiatric inpatients during the survey period. Ninety-eight patients had multiple hospitalizations. The male-to-female ratio was 1.26–1. Patients with bipolar affective disorder, current episode manic with or without psychotic symptoms received ECT most frequently (30.3%), followed by patients with schizophrenia (29.5%), severe depressive episode with or without psychotic symptoms (include bipolar affective disorder current episode severe depression) (15.2%), other non-organic psychotic disorders (14.4%), schizoaffective disorders (6.3%), mental and behavioral disorders due to psychoactive substance abuse with psychotic disorders (3.5%) and catatonic schizophrenia (0.7%). Patients who received ECT were in age group of 25–44 years (64.7%), followed by 45–64 years (17.7%), 18–24 years (15.4%), 65 years and older (1.4%), and younger than 18 years (0.8%). All patients received modified ECT. There were no ECT-related deaths during the survey. The rate of ECT among all psychiatric inpatients during the survey period was 12.4%. The majority of patients who received ECT were diagnosed with bipolar affective disorder-current episode manic and schizophrenia. ECT training programs for psychiatry residents and specialists should be planned, and conducted systematically. [ABSTRACT FROM AUTHOR]

Recent studies of homicide during psychotic illness have shown that the risk of homicide is greatest during the first episode of psychosis. It is also possible that the proportion of patients who commit homicide before they receive effective treatment may be associated with the length of time they were unwell. We aimed to establish whether there was an association between the average duration of untreated psychosis and the proportion of homicides committed during the first episode of psychosis in the same countries. Systematic searches of published studies of homicide in psychosis and the duration of untreated psychosis were conducted. The results were combined to examine the relationship between the reported delay in receiving treatment and the proportion of homicides committed before initial treatment. We found 16 studies that reported the proportion of psychotic patients who committed homicide prior to treatment. The proportion of first episode patients ranged from 13% to 76%. We were able to match 13 of those studies with DUP studies from the same country. Longer average DUP was associated with a higher proportion of patients who committed homicide prior to receiving treatment. The possibility that the proportion of patients who commit homicide before receiving treatment may be related to the average treatment delay in the region that the homicide occurs needs to be examined using a case controlled design. If this finding were confirmed, then any measure that reduced the delay in treating emerging psychosis would save lives. [ABSTRACT FROM AUTHOR]

Background: Psychiatric commitment laws have been reformed in many European countries. We assessed the relative importance of the different legal criteria in explaining involuntary commitment under the Belgian Mental Health Act of 1990.Method: Psychiatric assessments were requested for 346 patients living in Brussels who were randomly selected from a larger group and were being considered for involuntary commitment. A retrospective study of these patients' files was carried out.Results: More than half of the requests for involuntary commitment were turned down. The lack of a less restrictive alternative form of care was the criterion most crucial in decisions in favour of commitment. Alternative forms of care were more likely to be unavailable for psychotic individuals, foreigners, and patients not living in a private household.Conclusion: Involuntary commitment is mainly due to the inability of the mental health care system to provide more demanding patients with alternative forms of care. [ABSTRACT FROM AUTHOR]

Background: Over the last decade sickness absence and disability pension (DP) due to psychiatric disorders have increased considerably in Western countries. The scientific knowledge base about prognoses for such absences is very limited, but employers and clinicians often predict them to be very long. The aim of this study was to investigate sickness absence and disability pension in a cohort of employees who initially were on long-term sick leave due to psychiatric disorders, with regard to gender, age, socioeconomic status, and previous sickness absence.Methods: The cohort included 4,891 employees in Sweden, who, in 1999 were aged 20-61 and had a new sick-leave spell >90 days with a psychiatric disorder. Retrospective and prospective registry data on sickness absence and DP for 1996-2002 were obtained. Logistic regressions were performed to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for having a low, intermediate, or high level of sickness absence (<17, 17-90, and 91-365 days, respectively) or DP in 2002.Results: The mean number of sick-leave days per person per year 3 years prior to inclusion was low; 17 days, but had increased to 211 days by 2000. In 2002, 26% had been granted DP, significantly higher rate among men, while a higher rate of the women had long-term sickness absence. Of all 4,891 subjects, 35% had <17 sick-leave days in 2002. The OR of having low, intermediate, or long-term sickness absence decreased with age. The reverse was found for obtaining DP, for which also low socioeconomic status was an independent predictor of an increased risk (OR = 3.40, CI 2.28-5.08).Conclusions: Employees with long-term sick leave due to psychiatric disorders did not have a high level of sickness absence in the 3 years prior to inclusion in the study. Also, 3 years after inclusion, only 35% had very low levels of sickness absence, whereas 26% had been granted DP. Employees who were aged 55-61 showed the lowest risk of sick leave but the highest risk of DP. Low SES was a significant predictor of DP in 2002. [ABSTRACT FROM AUTHOR]

Background: A lack of motivation for treatment on the part of patients is a major problem for emergency psychiatric services. Little is known about its determinants. The aim of this study was to investigate determinants of treatment motivation in emergency psychiatric patients.Method: A cross-sectional study of 719 patients was made. Motivation for treatment and other clinical variables were assessed using the Severity of Psychiatric Illness scale and the Brief Psychiatric Rating Scale.Results: In all, 47% of patients were not motivated for treatment and they also had severe clinical problems. Lack of motivation was associated with danger to others [odds ratio (OR) 2.03; confidence interval (CI) 1.21-3.40], substance abuse (OR 1.71; CI 1.09-2.67), suspiciousness (OR 1.4; CI 1.19-1.64), grandiosity (OR 1.19; CI 1.01-1.4), anxiety (OR 0.74; CI 0.64-0.86), and GAF score (OR 0.98; CI 0.96-0.99).Conclusions: Lack of motivation for treatment is a common phenomenon among severely mentally ill patients seen by emergency psychiatric services. Lack of motivation was associated with danger and paranoid symptoms. Motivational techniques as well as involuntary treatment may help to overcome problems due to lack of motivation in these patients. [ABSTRACT FROM AUTHOR]

Background: There is a growing body of evidence that patients with early psychosis have undesirable pathways to care, yet few studies have explored the factors related to compulsory admission in patients with psychosis. The aim of the present study was to examine the demographic and clinical factors and pathways to care influencing compulsory admission in first-admitted subjects with psychosis.Methods: Pathways to care, clinical and demographic characteristics, were assessed using multiple sources of information in 86 subjects with psychosis first admitted in two hospitals of South-Western France. Characteristics independently associated with compulsory admission were explored using logistic regressions.Results: Nearly two-thirds of the subjects (61.6%) were compulsorily admitted. Compulsory admission was independently predicted by being a male (adjusted OR = 3.2, 95 % CI 1.2-8.6, p = 0.02), having a diagnosis of schizophrenia broadly defined (adjusted OR = 2.8, 95 % CI 1.02-7.4, p = 0.04) and absence of depressive or anxiety symptoms (adjusted OR = 0.05, 95% CI 0.005-0.5, p=0.01).Conclusion: These results suggest that factors related to the disease itself play an important role in decisions concerning compulsory admission. The high frequency of compulsory admission as the first mode of contact with psychiatric hospital in subjects with psychosis constitutes a major public health issue. Further research on the strategies aimed at avoiding compulsory admission in subjects with incipient psychosis is necessary. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to examine in a national survey sample the risks of having a specific personality disorder (PD) and associations with gender, of having one or more physical conditions, of having one or more Axis 1 conditions, and of the severity (or degree) of disability. We also examined the association of specific PDs with having sought a consultation for health or mental health problems with a general practitioner (GP), a psychologist, or psychiatrist over the past 12 months.Method: Data were derived from the Australian National Mental Health and Well-Being Survey, conducted between May and August 1997. A stratified random sample of households was generated, from which all persons aged 18 or over were considered potential interviewees. There were 10,641 survey respondents, this representing a response rate of 78%. Each interviewee was asked 59 questions indexing specific ICD-10 PD criteria.Results: Logistic regressions identified that some specific PDs, especially borderline PD, were more strongly associated with having one or more Axis I conditions, greater mental disability and lost days of total and partial role functioning than having No PD, and that others, notably anankastic PD, were less likely to be associated with the same variables. Some specific PDs, again most notably borderline PD, were more associated than others, again most notably anankastic PD, with having sought mental health consultations from GPs, psychiatrists, and psychologists. By contrast, PD associations with gender, physical conditions, physical disability and health consultations with the three professional groups were weaker as reflected in the comparatively smaller odds ratios and were also less consistent than the pattern with the previously mentioned variables.Conclusion: The study reports findings from a nationwide survey and, as such, the data are less influenced by the selection and setting bias found in most other studies investigating these variables. The findings of the study do point to some specific PDs, such as borderline PD, being associated with greater Axis 1 psychopathology, disability and mental health consultations than others, such as anankastic PD. It appears that although anankastic PD in itself is associated with more disability than having No PD, it becomes significantly more disabling when it is associated with other comorbid PDs. [ABSTRACT FROM AUTHOR]

Background: Providing care for people with serious and enduring mental health problems has been prioritised in a number of countries. It has been recognised that good liaison between primary and secondary care services is required for care to be effective. However, little is known about the resource implications of different levels of 'shared care'. The aim of this study is to compare service use and costs of different levels of shared care between primary and secondary care services. Method: Service use data were collected at baseline and one year later for participants with severe mental illness and costs were calculated. Levels of shared care were categorised into low, medium and high tertiles. Comparisons were made between the groups using multivariate analysis to control for participant characteristics. Results: Participants receiving a low level of shared care used residential care less and were less likely to have contacts with a psychiatrist or social worker than those receiving medium or high levels of shared care. Mean costs for a low level of shared care were significantly lower than for a medium level (a difference of pound 2606, 90% CI pound 452 to pound 4923), but not significantly lower than for a high level of shared care (difference of pound 1867, 90% CI- pound 287 to pound 3903). Conclusion: Different levels of shared care are associated with different patterns of service use, with greater resource consumption associated with a medium level of shared care. Further work is required to investigate the causal links between integrated care and service use and costs. [ABSTRACT FROM AUTHOR]

This research was conducted to examine the prediction that accuracy of particular kinds of knowledge of mental illness would be related to particular attitudes towards people with mental illness. Multiple regression analyses provided some support for the hypothesis that some areas of knowledge (particularly knowledge concerning guidance and support, and knowledge concerning the role of avoidance of morbid thoughts in mental health) are predictive of specific attitudes, but much of the variance remained unexplained by the predictive knowledge variables. Post hoc analyses revealed that those people who had had personal experience of people with mental illness were generally more positive in their attitudes towards them. Selected knowledge factors only accounted for a modest amount of the variance in attitude factor scores. Affective (e.g. fear, revulsion, anxiety) information may explain a greater percentage of variance in attitude factor score. It is suggested that this should be considered in future research and the limitations of the present study are discussed. [ABSTRACT FROM AUTHOR]

Substantial information is now available at a global and regional level relating to the burden of mental disorders, yet hardly any international data are available on the resources that are needed to respond to this global burden. The aim of this study was to develop consensus-driven estimates of resource utilisation, coverage and adherence for key mental health care interventions capable of reducing leading neuropsychiatric causes of disease burden. Sixty-seven psychiatrists took part in the first Delphi round and 60 completed the seven consensus panels in the second Delphi round. Expected resource use was highest for acute psychosis, mania, severe depression and severe dementia (at least monthly outpatient visits, and over 25% of cases admitted to hospital with an average length of stay one month). Aggregated estimates for current treatment coverage ranged from below 20% for Alzheimer's disease to 60% for epilepsy. Coverage and adherence levels for affective disorders were both below 50%. The Delphi technique proved to be a feasible and efficient method for data collection and consensus generation concerning mental health care resource utilisation. Results provide a set of range estimates for mental health resource planning and evaluation in a variety of developing regions. [ABSTRACT FROM AUTHOR]

The Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS-ADD) is a semi-structured clinical interview designed for use with respondents who have learning disability. The first version was based on the Present State Examination. The revised version was derived from the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), and makes ICD 10 diagnoses using the SCAN diagnostic program. This current version has a 4-point scale of severity, compared with the 3-point scale of the first version. It also has a new module relating to psychotic disorders. The sample consisted of 40 individuals representing a spectrum of neurotic, depressive and psychotic disorders. Videotapes of 40 PAS-ADD interviews were re-rated by trained interviewers who had not been involved in the original study in which the videotapes were produced. The mean Kappa across all individual item codes was 0.65, ranging from 0.94 to 0.35. The mean Kappa agreement on item groups was 0.66. Correlation between total symptom scores was 0.74. Agreement on index of definition was Kappa 0.70. We concluded that, agreement was generally lower than for the ICD 9 version. This was probably due mainly to the increase in the severity categories from three to four. However, the new items (most of which related to psychosis) were of comparable reliability to other items. [ABSTRACT FROM AUTHOR]

Abstract The rationale and design of a large, multi-centre, prospective follow-up study on the outcome of severe mental disorders is presented. The study is currently under way in Italy, where psychiatric care has been uniquely characterised since 1978 by the statutory prohibition of admitting patients to psychiatric hospitals. The main purpose of the study is to describe the 5-year outcome of patients with a diagnosis of schizophrenia, paranoid disorder, affective psychosis, reactive psychosis or personality disorder with respect to five areas (clinical condition, personal autonomy, work, and family and social relationships); a secondary objective is to describe the heterogeneity of practices and resources of psychiatric services. The study is being carried out by 76 outpatient psychiatric services throughout the country, covering approximately onetenth of the Italian population. [ABSTRACT FROM AUTHOR]

Purpose: Due to the courtesy stigma of autism spectrum disorder, many parents of autistic children are devaluated and discriminated against by the public. Despite the high prevalence of this courtesy stigma, very few studies have examined its negative effects on parents of autistic children and explored the factors that may protect the parents from these negative effects. The present study utilized a 2-year, two-wave prospective longitudinal design to examine the associations of courtesy stigma with adverse cognitive (self-stigma), affective (depressive and anxiety symptoms), and social (parent–child and inter-parental conflicts) consequences for parents of autistic children and to test whether these associations would be moderated and mitigated by self-compassion. Methods: A total of 381 parents of autistic children completed questionnaires about courtesy stigma, self-compassion, self-stigma, depressive and anxiety symptoms, and parent–child and inter-parental conflicts at time 1 (T1) and time 2 (T2). Results: Courtesy stigma interacted with self-compassion at T1 in predicting self-stigma, depressive and anxiety symptoms, and parent–child and inter-parental conflicts at T2. Specifically, the associations of courtesy stigma with the adverse psychological consequences were weaker for parents with high self-compassion than for those with low self-compassion. Conclusion: Our results demonstrate the prospective associations of courtesy stigma with adverse cognitive, affective, and social consequences for parents of autistic children, as well as the protective effects of self-compassion against such associations. These results highlight the importance of increasing parents' self-compassion to help them cope with courtesy stigma and improve their psychological well-being. [ABSTRACT FROM AUTHOR]

Purpose: People with intellectual and developmental disabilities (IDD) experience high rates of depression. Evidence indicates that physical activity, or participation in a sports club, in a supportive social environment has mental and physical health benefits. Adults with IDD, on average, engage in low levels of physical activity. The purpose of this study was to compare the rates of depression among young adult Special Olympics participants with IDD compared to non-participants with IDD. Methods: This was a 20-year retrospective cohort study of young adults (19–29 years) with IDD in the province of Ontario, Canada that compared rates of depression among Special Olympics participants (n = 8710) to non-participants (n = 42,393) using administrative health databases housed at ICES (formerly the Institute for Clinical Evaluative Sciences). Using cox proportional hazard models, the crude hazard ratios were calculated for the association between each independent variable and the dependent variable. Results: After controlling for other variables, the hazard rate for depression among Special Olympics participants compared to the hazard rate for depression among non-participants generated an adjusted hazard ratio of 0.51. Over the 20-year follow-up, the participants were 0.51 times as likely to develop depression as non-participants; this represents a 49% reduction in risk among Special Olympics participants. This result was statistically significant and represents a medium effect size. Conclusion: Future research is needed on how much of this risk reduction is related to a physiological response to physical activity/exercise, and how much is related to the social connectedness of being part of a group participating in Special Olympics. [ABSTRACT FROM AUTHOR]

Purpose: To examine the risk of perinatal mental illness, including new-onset disorders and recurrent or ongoing use of mental health care, comparing women with physical, sensory, intellectual/developmental, and multiple disabilities to those without a disability. Methods: From all women aged 15–49 years with a singleton birth in Ontario, Canada (2003–2018), those with physical (n = 144,972), sensory (n = 45,249), intellectual/developmental (n = 2,227), and ≥ 2 of these disabilities ("multiple disabilities"; n = 8,883), were compared to 1,601,363 without a disability on risk of healthcare system contact for mental illness from conception to 365 days postpartum. The cohort was stratified into: (1) no pre-pregnancy mental illness (to identify new-onset illness), (2) distal mental illness (> 2 years pre-pregnancy, to identify recurrent illness), and (3) recent mental illness (0–2 years pre-pregnancy, to identify ongoing contact). Modified Poisson regression generated relative risks (aRR), adjusted for age, parity, income quintile, and rural residence. Results: About 14.7, 26.5, and 56.6% of women with no disabilities had new-onset, recurrent, and ongoing contact for mental illness, respectively, perinatally. Risks were elevated across disability groups for new-onset (physical: aRR 1.18, 95% CI 1.16–1.20; sensory: 1.11, 1.08–1.15; intellectual/developmental: 1.38, 1.17–1.62; multiple: 1.24, 1.15–1.33), recurrent (physical: 1.10, 1.08–1.12; sensory 1.06, 1.02–1.09; intellectual/developmental: 1.24, 1.11–1.37; multiple: 1.16, 1.09–1.23), and ongoing contact (physical: 1.09, 1.08–1.10; sensory: 1.08, 1.06–1.10; intellectual/developmental: 1.31, 1.26–1.37; multiple: 1.20, 1.16–1.23). Conclusion: The heightened use of new, recurrent, and ongoing mental health care across disability groups in the perinatal period suggests that adapted screening and intervention approaches are critical to optimize perinatal mental health in this population. [ABSTRACT FROM AUTHOR]

Purpose: Loneliness is associated with poor health including premature mortality. There are cross-sectional associations with depression, anxiety, psychosis, and other mental health outcomes. However, it is not known whether loneliness is causally linked with the new onset of mental health problems in the general population. Longitudinal studies are key to understanding this relationship. We synthesized evidence from longitudinal studies investigating the relationship between loneliness and new onset of mental health problems, in the general population. Method: We systematically searched six electronic databases, unpublished sources, and hand-searched references, up to August 2021. We conducted a meta-analysis of eight independent cohorts and narrative synthesis of the remaining studies. Results: We included 32 studies, of which the majority focused on depression. Our narrative synthesis found most studies show loneliness at baseline which is associated with the subsequent new onset of depression. The few studies on anxiety and self-harm also showed a positive association. Our meta-analysis found a pooled adjusted odds ratio of 2.33 (95% CI 1.62–3.34) for risk of new onset depression in adults who were often lonely compared with people who were not often lonely. This should be interpreted with caution given evidence of heterogeneity. Conclusion: Loneliness is a public mental health issue. There is growing evidence it is associated with the onset of depression and other common mental health problems. Future studies should explore its impact across the age range and in more diverse populations, look beyond depression, and explore the mechanisms involved with a view to better informing appropriate interventions. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic has potential to disrupt and burden the mental health care system, and to magnify inequalities experienced by mental health service users.Methods: We investigated staff reports regarding the impact of the COVID-19 pandemic in its early weeks on mental health care and mental health service users in the UK using a mixed methods online survey. Recruitment channels included professional associations and networks, charities, and social media. Quantitative findings were reported with descriptive statistics, and content analysis conducted for qualitative data.Results: 2,180 staff from a range of sectors, professions, and specialties participated. Immediate infection control concerns were highly salient for inpatient staff, new ways of working for community staff. Multiple rapid adaptations and innovations in response to the crisis were described, especially remote working. This was cautiously welcomed but found successful in only some clinical situations. Staff had specific concerns about many groups of service users, including people whose conditions are exacerbated by pandemic anxieties and social disruptions; people experiencing loneliness, domestic abuse and family conflict; those unable to understand and follow social distancing requirements; and those who cannot engage with remote care.Conclusion: This overview of staff concerns and experiences in the early COVID-19 pandemic suggests directions for further research and service development: we suggest that how to combine infection control and a therapeutic environment in hospital, and how to achieve effective and targeted tele-health implementation in the community, should be priorities. The limitations of our convenience sample must be noted. [ABSTRACT FROM AUTHOR]

Purpose: People with mental disorders show mortality rates up to 22.2 times higher than that of the general population. In spite of progressive increase in life expectancy observed in the general population, the mortality gap of people suffering from mental health problems has gradually widened. The aim of this paper was to study mortality rates in people suffering from mental illness in a cohort of people (16,981 subjects) in the local mental health register of the province of Modena during the decade 2006-2015.Methods: Standardized Mortality Ratios (SMRs) were calculated to compare the mortality of people with mental disorders to the mortality of people living in the province of Modena and the excess of mortality was studied in relation to the following variables: gender, age group, diagnosis and causes of death. In addition, Poisson regression analysis was performed to study the association between patient characteristics and mortality.Results: An overall excess mortality of 80% was found in subjects under the care of mental health services as compared to the reference population (SMR = 1.8, 95% CI 1.7-1.9). Subjects in the 15-44 year group presented the highest SMR (9.2, 95% CI 6.9-11.4). The most prevalent cause of death was cancer (28.1% of deaths). At the Poisson regression, the diagnosis "Substance abuse and dependence" showed the highest relative risk (RR) (4.00). Moreover, being male, single, unemployed and with a lower qualification was associated with higher RRs.Conclusions: Our study confirms that subjects with mental illness have higher SMR. Noteworthy, the overall higher risk of mortality was observed in the younger age group. [ABSTRACT FROM AUTHOR]

Purpose: To explore relationships between family quality of life, day occupations and activities of daily living (ADL) of young persons with Down syndrome. Method: Data were collected from 150 families with a young person with Down syndrome aged 16-30 years participating in the Down syndrome 'Needs Opinions Wishes' database. Data described the young person's characteristics (including functional abilities, behaviour and day occupations) and family characteristics (including income, family and community supports and quality of life). Results: Compared to families of young people attending open employment, families of young people participating in sheltered employment tended to report poorer family quality of life, after adjusting for personal characteristics, behaviour and income (coeff −6.78, 95 % CI −14.38, 0.81). Family supports reduced this relationship (coeff −6.00, 95 % CI −12.76, 0.76). Families of young people with greater functioning in ADL reported better family quality of life regardless of personal and environmental factors (coeff 0.45, 95 % CI 0.05, 0.85) and inclusion of family factors such as family supports reduced this association (coeff 0.29, 95 % CI −0.10, 0.67). Conclusions: Participation of young people with Down syndrome in open employment may positively influence family quality of life. Services that facilitate functioning in ADL and assist the families in accessing suitable family supports have the potential to positively influence family quality of life. [ABSTRACT FROM AUTHOR]

Background: Young people with disabilities have poorer mental health than their non-disabled peers. However, people with disabilities are more likely than others to experience financial hardship and low social support, both of which have been linked with poor mental health outcomes. This article explores the extent to which the relatively poor mental health of young people with disabilities is related to the social conditions in which they live. Methods: Secondary analysis was performed on Wave 6 (2006) of the survey of Household Income and Labour Dynamics in Australia (HILDA). This nationally representative sample included 3,392 young Australians, aged 15-29, of whom 475 reported having a long-term health condition, impairment or disability. Results: Young people with disabilities reported poorer mental health than their non-disabled peers. However, this relationship was moderated by both social adversity and social support, with minimal differences in mental health observed between the groups under conditions of high social support and low financial hardship. Discussion: The results suggest that disability represents a potential adversity that may be exacerbated or ameliorated by the effects of wealth/financial hardship and social support. Conclusion: It may be possible to improve the mental health of disabled people by addressing their social exclusion. [ABSTRACT FROM AUTHOR]

To determine within a nationally representative sample of young Australian children: (1) the association amongst intellectual disability, borderline intellectual functioning and the prevalence of possible mental health problems; (2) the association amongst intellectual disability, borderline intellectual functioning and exposure to social disadvantage; (3) the extent to which any between-group differences in the relative risk of possible mental health problems may be attributable to differences in exposure to disadvantageous social circumstances. The study included a secondary analysis of a population-based child cohort of 4,337 children, aged 4/5 years, followed up at age 6/7 years. The main outcome measure was the scoring within the ‘abnormal’ range at age 6/7 years on the parent-completed Strengths and Difficulties Questionnaire. When compared to typically developing children, children identified at age 4/5 years as having intellectual disability or borderline intellectual functioning: (1) showed significantly higher rates of possible mental health problems for total difficulties and on all five SDQ subscales at age 6/7 years (OR 1.98–5.58); (2) were significantly more likely to be exposed to socio-economic disadvantage at age 4/5 and 6/7 years. Controlling for the possible confounding effects of exposure to socio-economic disadvantage (and child gender) significantly reduced, but did not eliminate, between-group differences in prevalence. Children with limited intellectual functioning make a disproportionate contribution to overall child psychiatric morbidity. Public health and child and adolescent mental health services need to ensure that services and interventions fit to the purpose and are effective for children with limited intellectual functioning, and especially those living in poverty, as they are for other children. [ABSTRACT FROM AUTHOR]

Studies of the relationship between the level of intellectual disability and mental and behavioural disorders have reported divergent findings regarding the direction of the relationship and how it is related to different mental disorders. To investigate the relationship between levels of intellectual disability and mental disorders and problem behaviour after adjusting for other relevant factors: age, gender, autism, genetic syndromes, the neurological conditions cerebral palsy and epilepsy, negative life events and quality of the social care provided. A community sample of adults with intellectual disabilities ( N = 593) were assessed using the Psychopathology Checklists for Adults with Intellectual Disability. A hierarchical regression model with forced entry was employed. Both linear and curvilinear relationships between intellectual disability and mental disorders were found after controlling for relevant factors that was independently associated with specific mental disorders. Psychopathology models for adults with intellectual disabilities should include the level of intellectual disability, either in a linear or a non-linear way. Future research on this issue should focus on people with borderline intellectual disability. [ABSTRACT FROM AUTHOR]

To determine the point prevalence, incidence, and remission over a 2-year period of psychosis in adults with intellectual disabilities, and to investigate demographic and clinical factors hypothesised to be associated with psychosis. A population-based cohort of adults with intellectual disabilities ( n = 1,023) was longitudinally studied. Comprehensive face-to-face mental health assessments to detect psychosis, plus review of family physician, psychiatric, and psychology case notes were undertaken at two time points, 2 years apart. Point prevalence is 2.6% (95% CI = 1.8–3.8%) to 4.4% (95% CI = 3.2–5.8%), dependant upon the diagnostic criteria employed. Two-year incidence is 1.4% (95% CI = 0.6–2.6), and for first episode is 0.5% (95% CI = 0.1–1.3). Compared with the general population, the standardised incidence ratio for first episode psychosis is 10.0 (95% CI = 2.1–29.3). Full remission after 2 years is 14.3%. Visual impairment, previous long-stay hospital residence, smoking, and not having epilepsy were independently associated with psychosis, whereas other factors relevant to the general population were not. The study of psychosis in persons with intellectual disabilities benefits the population with intellectual disabilities, and advances the understanding of psychosis for the general population. Mental health professionals need adequate knowledge in order to address the high rates of psychosis in this population. [ABSTRACT FROM AUTHOR]

Background: Reports on the quality of life (QOL) of family caregivers of psychiatric patients are uncommon.Objective: The objective of this study was to assess the subjective QOL of caregivers of stable Sudanese outpatients using the World Health Organization 26-item Quality of Life Instrument compared with a general population sample, and assess the factors associated with caregivers' QOL.Method: Responses of caregivers of outpatients with schizophrenia (99), major affective disorders (120), and neuroses (81) were compared with 211 general population subjects.Results: Caregivers were satisfied with the items related to the strengths of the traditional society and dissatisfied with the items related to national economic indices. Schizophrenia caregivers had lower scores than the others (P > 0.05) who scored significantly higher than general population subjects and patients. Parents had the least scores. Patients' variables were not significantly associated with caregivers' QOL. Caregivers' sociodemographic variables were significantly associated with QOL. Caregivers' QOL was predicted by their impression of patients and state of health. Schizophrenics had the least correlations with caregivers' QOL.Conclusion: Caregivers who are women, parents, and sick seemed relatively vulnerable and need assistance. Their areas of dissatisfaction with material circumstances should be addressed in a social welfare program. Caregivers' inner strengths, extended family supports, and positive appreciation of the patients are resources for enhancing their caregiving role. [ABSTRACT FROM AUTHOR]