Adaptation problems in old age

The authors summarize available literature concerned with some problems of aging and old age. Attention is devoted in particular to factors which have an adverse impact on this process such as loss of the partner, retirement, disintegration of the home, reduced activity, etc. Some typical diseases of old age are mentioned. The authors emphasize that it is not enough to ensure economic and biological needs. Attention is paid in particular to problems of psychosocial adaptation of old people when going to a different, though sometimes more secure environment. Adaptation responses in the mental sphere may be sometimes very serious and may have tragic consequences for old people. As in contemporary society change of environment on social and health grounds is relatively frequently necessary, the authors summarize the literature on this problem and give an account of views how to prevent sequelae of impaired adaptation or how to mitigate them.     

Psychiatric problems among returned migrants in Mexico: updated findings from the Mexican Migration Project

Social Psychiatry and Psychiatric Epidemiology - Migration is often a stressful process that can have deleterious effects on health. We study the potential mental health consequences of migration...     

ATP1A3 mutation in the first asian case of rapid-onset dystonia-parkinsonism.

We report a 38-year-old Korean man with sporadic rapid-onset dystonia-parkinsonism (RDP), who had a Thr 618 Met mutation in the Na(+)/K(+)-ATPase alpha3 subunit gene (ATP1A3). At the age of 21, he acutely developed severe dystonia and parkinsonism, which rapidly deteriorated into a wheelchair-bound state within 4 days. He is the first Asian RDP patient confirmed by genetic testing, ascertaining that RDP gene mutation is present in Asians. Pathophysiological considerations are briefly discussed.     

Schizophrenic disorders among Turkish migrants in Germany. A controlled clinical study

Several studies have implied cultural differences in the psychopathology of schizophrenia between migrants and natives. In a diagnostically strictly controlled study, including comparison of diagnosis with a Turkish-speaking psychiatrist, 74 patients of Turkish and 48 of German origin, all with a diagnosis of schizophrenic disorder, were compared using PANSS and HAM-D. The Turkish sample showed higher depression and hostile excitement, even in the subsample of those with paranoid schizophrenia, and no differences in positive, negative or cognitive symptoms. The similarities especially concerning core symptoms reflect evidence from cross-cultural studies on schizophrenia. In conclusion this study shows main differences in psychopathology between psychotic migrants and natives, as discussed in the literature, may be mainly due to diagnostic differences.     

Eating attitudes and body image of asian and caucasian college women

Very few studies have investigated eating disorders among immigrants to the United States. The purpose of this study was to compare eating attitudes and behaviors, fear of fat, and body image in Asian and Caucasian women. Eating attitude and fear of fat were assessed with validated instruments, and body size perception was assessed with body mass index silhouettes. Both groups identified a similar, underweight body silhouette as the “ideal,” and both groups overestimated actual body size. Our results suggest that Asians in the United States have similar eating attitudes and behaviors and body dissatisfaction but a greater fear of fat than Caucasians, indicating a need for eating disorder awareness programs targeted to female Asian immigrants.     

EPA Guidance mental health care of migrants

Migration is an increasingly commonplace phenomenon for a number of reasons. People migrate from rural to urban areas or across borders for reasons including economic, educational or political. There is increasing recent research evidence from many countries in Europe that indicates that migrants are more prone to certain psychiatric disorders. Because of their experiences of migration and settling down in the new countries, they may also have special needs such as lack of linguistic abilities which must be taken into account using a number of strategies at individual, local and national policy levels. In this guidance document, we briefly present the evidence and propose that specific measures must be taken to improve and manage psychiatric disorders experienced by migrants and their descendants. This improvement requires involvement at the highest level in governments. This is a guidance document and not a systematic review.     

Adaptation characteristics of steady-state motion visual evoked potentials.

OBJECTIVE: Motion visual evoked potentials (motion VEPs) are used in clinical diagnosis and basic research. Employing steady-state rather than the usual transient motion VEPs simplifies statistical evaluation and might drastically reduce examination durations. Protocols for recording transient motion-onset VEPs usually involve fairly long recovery intervals between trials to avoid neural adaptation. This is not feasible for steady-state VEPs. We investigated how adaptation affects the steady-state motion VEP. METHODS: Oscillatory (13.3rev/s) and continuous uni-directional random-dot motion served as adaptation stimuli. Steady-state motion VEPs and, for comparison, transient motion VEPs were recorded. RESULTS: In the first experiment, we investigated how adaptation affects the recordings. Contrary to our expectation, we did not find any sizable effect. However, there was a large inter-individual variability in steady-state amplitude and no correlation across subjects between transient and steady-state amplitude. In the second experiment, we confirmed that the steady-state VEP reflects veridical motion processing by assessing its susceptibility to uni-directional pre-adaptation. CONCLUSIONS: Taken together, the results suggest that steady-state motion VEPs provide a fast method of recording motion responses without suffering from adaptation, but at the expense of inter-individual reproducibility.     

Help-seeking behaviour regarding mental health problems of Mediterranean migrants in the Netherlands: familiarity with care, consultation attitude and use of services

BACKGROUND: Ethnic minority groups differ in the pattern of their seeking help, and in their use of and attitude towards mental health systems. To meet the mental health needs of ethnic minority populations, insights into determinants of their help-seeking orientations are of great concern. AIM: To investigate help-seeking behaviour regarding mental health problems in terms of familiarity, attitude and service use among Mediterranean migrants in the Netherlands. METHODS: Samples of Mediterranean citizens in the general population (N = 292) and of Mediterranean (N = 114) and indigenous Dutch outpatients (N = 59) currently treated in mental health care were included. Data were acquired by administering a semi-structured interview. Quantified data were analysed using multivariate techniques. RESULTS: More recently arrived participants were less familiar with mental health services. Moroccan, lower educated and recently arrived respondents reported a more negative attitude towards consulting these agencies. The help-seeking behaviour of the Mediterranean participants was relatively similar to that of the indigenous Dutch subjects. CONCLUSIONS: With regard to care-seeking routes and use of mental health services, more inter-ethnic similarities than differences emerged. Sociodemographic variables like age, education and length of residence shape the process of help-seeking and service use.     

Depression in older Chinese migrants to Auckland

OBJECTIVE: This study was conducted to identify risk factors for depressive symptomatology among older Chinese migrants. METHOD: One hundred and sixty-two Chinese migrants aged 55 years or older, living in the community and recruited via Chinese community organizations and general practitioners, were interviewed using a Chinese version of the Geriatric Depression Scale and measures of stressful life events, morbid conditions, self-rated health, acculturation, social support and service utilization. RESULT: Twenty-six percent of participants met the criteria for depressive symptomatology. No recent migrants showed symptoms of depression. Multiple logistic regression analysis showed that lower emotional support, greater number of visits to a doctor, difficulties in accessing health services and low New Zealand cultural orientation increased the risk of showing symptoms of depression. CONCLUSION: Significant numbers of older Chinese migrants appear to be depressed or at risk for depression and, while participants with depressive symptoms consulted general practitioners more than their counterparts without such symptoms, they reported greater difficulty in accessing health services. The findings point to the need for further epidemiological study of this growing sector of the population and investigation of the nature of its engagement with health services. Social support and aspects of acculturation may play a significant role in preventing depression. This also requires further investigation.     

Refugees,labour migrants and psychological distress

This paper shows the strength and influence of ethnicity on mental health in comparison with material factors and lifestyle, which are well-known risk factors for psychological distress. The focus was on health differences between Latin-American refugees and labour migrants from Finland and the south of Europe. The study was designed as a population-based cross-sectional study, with 338 Latin-American refugees aged 16–74 years (response rate=81.8%) in Lund, a random sample of 396 Finnish and 161 South European labour migrants, and 996 age-, sex- and education-matched Swedish controls from the Swedish Annual Level-of-living Surveys. The data were analysed unmatched with logistic regression in main effect models. The strongest independent risk indicator for self-reported psychological distress was being a non-European refugee, i. a. a Latin-American refugee, with an estimated odds ratio of 4.39 (2.49–7.31). There was a non-significant association in logistic regression between South European labour migrants and psychological distress, but a crude odds ratio of 2.29 (1.09–4.81). There was no association between Finnish labour migrants and psychological distress. Not feeling secure in daily life was a strong riks indicator for psychological distress, with an estimated odds ratio of 3.29 (1.90–5.45).     

Adaptation of PMLS neurons to prolonged optic flow stimuli.

Changes in neuronal responses during and after adaptation to prolonged optic flow stimulation were investigated by extracellular single-unit recording in the posteromedial lateral suprasylvian area (PMLS) of the cat. In comparison with translation stimuli, the complex optic flow patterns (radiation and rotation) produced more pronounced adaptation and after-effects by inducing larger response reduction, and altered the direction selectivity of many neurons obviously as well. Generally, the adaptation effects were direction-specific for radiation/rotation, but independent of the direction of test stimulus for translation. These results suggest that PMLS may play an important role in the perception of motion after-effects to complex optic flow fields, while the adaptation to simple translation might be generated at a relatively earlier level of the visual system.     

Pharmacogenetics of naltrexone in asian americans: a randomized placebo-controlled laboratory study

Recent clinical and laboratory studies have shown that the effects of naltrexone for alcoholism may be moderated by the Asn40Asp single-nucleotide polymorphism (SNP) of the μ-opioid receptor gene (OPRM1). Allele frequencies for this polymorphism, however, have been shown to vary substantially as a function of ethnic background, such that individuals of Asian descent are more likely to carry the minor (Asp40) allele. The objective of this study is to test the naltrexone pharmacogenetic effects of the Asn40Asp SNP in a sample of Asian Americans. This study consists of a double-blinded, randomized, placebo-controlled laboratory trial of naltrexone. Participants (n=35, 10 females; 13 Asn40Asn and 22 Asp40 carriers) were non-treatment-seeking heavy drinkers recruited from the community. After taking naltrexone or placebo, participants completed an intravenous alcohol administration session. The primary outcome measures were subjective intoxication and alcohol craving. Results suggested that Asp40 carriers experienced greater alcohol-induced sedation, subjective intoxication, and lower alcohol craving on naltrexone, as compared to placebo, and to Asn40 homozygotes. There results were maintained when controlling for ALDH2 (rs671) and ADH1B (rs1229984) markers and when examining the three levels of OPRM1 genotype, thereby supporting an OPRM1 gene dose response. These findings provide a much-needed extension of previous studies of naltrexone pharmacogenetics to individuals of Asian descent, an ethnic group more likely to express the minor allele putatively associated with improved biobehavioral and clinical response to this medication. These findings help further delineate the biobehavioral mechanisms of naltrexone and its pharmacogenetics.     

Western versus asian types of multiple sclerosis: Immunogenetically and clinically distinct disorders

The polymorphism of HLA-DRBI, -DRB3, and -DRB5 genes as well as magnetic resonance images of the brain and spinal cord were studied in 57 Japanese patients with multiple sclerosis (MS). Twenty-three patients clinically displayed selective involvement of the optic nerve and spinal cord and were classified as having Asian-type MS. Patients with Asian-type MS had fewer brain lesions shown gy magnetic resonance imaging, but more gadolinium-enhanced spinal cord lesions than did patients with Western-type MS (47% vs 17%). Fruthermore, the DR2-associated DRBI1501 allele and DRB50101 allele were associated with Western-type MS (41.2%), but not with either Asian-type MS (0%) or healthy control subjects (14.2%). Heterogeneity inthe immunogenetic background and in the magnetic resonance imaging features between the two subtypes of MS thus suggests the presence of two etiologically distinct diseases in Asians.     

Racial differences in ischemic cerebrovascular disease: Clinical and magnetic resonance angiographic correlations of white and asian patients.

Objectives. We explored racial differences in ischemic cerebrovascular disease. Methods. Clinical and magnetic resonance angiographic (MRA) features were compared in 21 white and 21 Asian patients with symptomatic ischemic cerebrovascular disease. Results. When all carotid artery sites were combined and compared, whites had more stenotic lesions of internal carotid artery origin, and Asians had more stenotic lesions of the middle cerebral artery (MCA) stem. In the vertebrobasilar territory, there were no significant differences in the distribution of extracranial and intracranial stenotic lesions between the two races. In symptomatic territories, the distribution of extracranial and intracranial stenosis were not significant differences for white and Asian patients. In asymptomatic territories, whites had a higher tendency for isolated extracranial stenosis, whereas Asians had an increased incidence of isolated intracranial stenosis. In the combined symptomatic and asymptomatic, carotid and vertebrobasilar territories, there was an increased incidence of extracranial carotid stenotic lesions in white patients and intracranial anterior circulation stenotic lesions in Asians. Demographic factors alone seemed to explain the difference. Conclusions. Racial differences in the occurrence of extracranial and intracranial lesions raise the possibility of different pathophysiologic abnormalities.     

Issues of clinical and cultural competence in Caribbean migrants

The level of out-migration from the Caribbean is very high, with migration of tertiary-level educated populations from Caribbean countries being the highest in the world. Many clinicians in receiving countries have had limited diagnostic and therapeutic experience with Caribbean migrants, resulting in diagnostic and therapeutic controversies. There is an urgent need for better understanding of these cultural differences. The paper explores issues of clinical and cultural competence relevant to assessing, diagnosing, and treating Caribbean migrants with a focus on three areas: cultural influences on illness phenomenology; the role of language differences in clinical misunderstandings; and the complexities of culture and migration. Clinical issues are illustrated with case studies culled from four decades of clinical experience of the first author, an African Jamaican psychiatrist who has worked in the Caribbean, North America, Europe, and New Zealand.