Prevalence of psychiatric disorders in a mandatory screening program for infection with human immunodeficiency virus: a pilot study

Ninety-five randomly selected human immunodeficiency virus (HIV)-seropositive Air Force personnel were psychiatrically examined during a routine medical evaluation. Of the 95, 95% did not have acquired immunodeficiency syndrome and were largely asymptomatic; 61.1% had clinical axis I diagnoses, which included simple phobia, adjustment disorders, hypoactive sexual desire disorder, alcohol use disorder, major depression, and organic mental disorders; 30.5% had personality disorders. Significantly higher frequencies (p less than 0.05) of simple phobia and hypoactive sexual desire disorder were noted with knowledge of HIV seropositivity. Disorders that occurred more commonly than in age-matched Epidemiologic Catchment Area (ECA) participants included: simple phobia, antisocial personality disorder, alcohol abuse, and organic mental disorders. The high prevalence of major psychiatric illness in this sample supports the notion that screening for psychiatric illness, and counseling where indicated, should be integral to HIV screening programs.     

AIDS in contemporary Islamic ethical literature

AIDS has been mentioned in Islamic ethical literature since about 1985 as an illness pertaining to European and American homosexuals. Only since about 1990 has the presence of HIV/AIDS in Islamic countries cast light on the fact that the actual sexual behaviour of the population does not always conform to religious norms. The increase in the numbers of people with HIV has compelled religious leaders to take a stand on sexual practices they consider "deviant", from prostitution to homosexuality and extramarital sex. The aim of this paper is to analyse the attitude of Muslim religious authorities towards individual sexual behaviour and AIDS. It is based mainly on contemporary legal responses that largely provide the necessary information on most of Islamic medical ethics. According to Muslim scholars, AIDS is a warning from God not to indulge in illicit conduct. As a remedy against the spread of AIDS, they encourage compliance with traditional family values and the enhancement of faith and devotion and strongly oppose sex education. They oppose promotion of condoms or any form of safe sex outside of marriage, which they perceive as promoting promiscuity and defiance of divine law. All the above-mentioned arguments are not exhaustive of the Islamic attitude towards AIDS. Some religious groups disagree with such a conservative way of conceiving the fight against AIDS as being antithetical to both men's and women's well-being. They support an alternative view of reproductive health and human rights within the Islamic framework and stress the great tolerance of Islam and why it must include people with HIV and AIDS.     

Psychological profiles of adult sexual assault victims

This is a retrospective analysis of the psychological and psychiatric history of adult patients who attended the Lancashire Sexual Assault and Forensic Examination Centre between April 1st 2010 and March 31st 2011 for forensic examination. During this time 269 adults attended for forensic examination; the records of these patients were audited for evidence of psychological or psychiatric ill health. Affective disorders were disclosed in 48.7% of cases (depression, depression and anxiety, anxiety, bipolar affective disorder) and 3.0% declared having been diagnosed with a psychotic illness (schizophrenia, psychotic illness, psychotic behaviour). Furthermore, deliberate self-harm was disclosed by 29.4% of complainants and 22.3% of attendees had attempted suicide at least once in their lifetime. This study highlights increased prevalence of mental illness in sexual assault complainants which contributes to increased states of vulnerability. This and further similar research efforts have a role to influence prevention schemes, management strategies and healthcare planning for those individuals who are sexually assaulted.     

Predictors of psychiatric hospitalization in the Navy

Mental disorders represent an important source of morbidity among U.S. military personnel and are a common reason for early separation from the military. The objective of this study was to identify factors predictive of hospitalization for mental health disorders in a large sample of enlisted Navy personnel. Demographic variables and a variety of psychosocial variables assessed on the Sailors' Health Inventory Program questionnaire were studied as predictors of psychiatric hospitalization. Three psychiatric categories were examined: adjustment reaction, personality disorder, and all other mental health disorders. Several variables were significantly predictive of all three categories of psychiatric hospitalization: female gender, low education level, history of abuse (physical, emotional, or sexual), and tobacco smoking. The results of this study support efforts to develop better psychological screening methods and potential interventions aimed at helping recruits adapt to military life.     

Suicidal tendencies among the elderly in Mie Prefecture, Japan, between 1996 and 2002

This study aims to show the causative factors of suicide among the elderly (over 65) in Mie Prefecture, and to discuss the prevention of the factors contributing to suicide in the elderly group. We obtained an agreement from the Mie Prefectural Police Headquarters and investigated all inquest records collected between 1996 and 2002 in Mie Prefecture and focused on suicide in the elderly group. During the test period, the number of suicides in the elderly group was 842. In causative factors, the two major causative factors of suicide were "suffering from physical illness" and "psychiatric disorders". In particular, the three most frequent physical illnesses were "cardiovascular disease", "orthopedic disorder", and "digestive organ disease", and these physical illnesses are mentally stressful, and thus have a psychiatric component, the same as psychiatric illnesses do. Consequently, it is concluded that improvements in the home nursing and mental health care should include the prevention of suicide in the elderly who "suffer from physical illness" and "psychiatric disorders" to prevent suicide. In addition, medical staff and the general public should be educated on the factors that can influence elderly persons' mental condition, and should be cautioned to observe elderly persons for suicidal signs and symptoms.     

1. The myth of child rape as a cure for HIV/AIDS in Transkei: a case report

South Africa has one of the highest cases of HIV/AIDS infection in Africa, and Transkei, a former black homeland, now a part of the Eastern Cape Province, is one locality with a large number of HIV/AIDS sufferers. The unemployment level is very high and crime, including child rape, is very common. This report presents the case of a victim of rape, a nine-year old female child who was brought to the Umtata General Hospital, a victim of the mistaken belief that sex with a virgin will cure an HIV-infected person or AIDS sufferer of his illness. The alleged rapist was an HIV-positive uncle of the child. The myth of the 'HIV/AIDS virgin cure' is prevalent in the community. The history, physical examination and laboratory investigations of this case are given. A conclusion is drawn and preventive methods are suggested.     

Diagnostic status and treatment recommendations for Persian Gulf War Veterans with multiple nonspecific symptoms.

BACKGROUND: Unexplained symptoms have frequently been observed in deployed Persian Gulf War veterans (GWVs). Using factor analysis, the Centers for Disease Control and Prevention (CDC) has established criteria for Gulf War illness (GWI). We report here on the prevalence of GWI, identify comorbidities, and compare these with those of veterans without GWI. METHODS: GWVs who consented to complete questionnaires and laboratory measures were given complete physical and mental health examinations. Outcome measures included CDC criteria for GWI, the Medical Outcomes Study Short Form 36 (SF-36), clinical and laboratory evaluations, and structured psychiatric interviews. RESULTS: One hundred twenty GWVs were enrolled, and 89 received complete physical and mental health examinations; 83% met CDC criteria for GWI. Veterans with GWI (1) were older, (2) reported more combat exposure, (3) scored higher on measures of depression, post-traumatic stress disorder, and fibromyalgia, and (4) had poorer health-related quality of life. More than half had anxiety or depressive disorders, and 93% had at least one medical and/or psychiatric diagnosis. The SF-36 predicted mental health status with a positive predictive value of 81.58. By adding the Hamilton D rating for depression, the positive predictive value increased to 88.57. INTERPRETATION: The CDC criteria accurately identified GWVs negative for GWI. Most GWVs were positive for GWI. Neither CDC criteria nor CDC severity rankings distinguish between veterans with psychiatric syndromes and those without: both groups endorsed the same symptoms. More than half of those with GWI had a treatable anxiety or depressive disorder. The SF-36 was a valid predictor of mental health status, particularly when paired with the Hamilton depression interview.     

Concerns about career stigma by military parents of children with psychiatric illness

Stigma is known to have deleterious effects on individuals with psychiatric disorders as well as their family members. In this study, we examined stigma with regard to career concerns among active duty members of the Air Force with children who have psychiatric disorders. Albeit a weak relationship, a bivariate correlation confirmed a significant relationship between the child's mental health utilization (i.e., severity of illness) and participants concerns about the potential effects on their military (r = 0.423, p < 0.01), as well as civilian (r = 0.353, p < 0.01), careers. These findings indicate that among military members with children who have psychiatric disorders, illness severity significantly relates to concerns about the impact of stigma on careers, particularly military careers.     

The legal situation concerning notification of sexual partners of HIV/AIDS patients in Costa Rica: problems in contact tracing

Among solutions to the problems of HIV/AIDS, a public health preventive measure has been proposed to notify the sexual partners of patients, this being a justifiable exception to professional secrecy. Every such measure must conform to a legal framework in order to facilitate the task of the health care worker, to respect the patient's right to privacy and to protect life as a juridical value. The General Law governing HIV/AIDS and its Costa Rican regulations propose a procedure to notify sexual partners. This study analyses how the procedure is developing in Costa Rica as well as its legal justificaitons.     

Psychiatric illness and the workplace: perspectives for occupational medicine in the military.

In inpatient psychiatric wards and outpatient mental health clinics throughout the military, psychiatrists and other mental health professionals are often faced with patients suffering from emotional distress attributed to occupational stress. There has been scant research into how the routine military work environment affects the mental health status of military employees. This paper provides a review of the occupational medicine literature on the relationship between the work environment and employee mental health. There is a growing recognition that stress resulting from the workplace can provoke psychiatric illness, but the research is limited at this time. The data existing on the work force in general are examined, and the relationship of these findings to the military work environment is discussed. This review suggests that a comprehensive examination of the relationship between the military work environment and the mental health of military employees is needed. By gathering these data, interventions can be planned to mitigate the effect of stress caused by the military work environment on the mental health of its members.     

Prevalence of HIV risk factors for individuals examined in clinical forensic medicine

Objective: to identify the prevalence of high-risk factors for infection with Human Immunodeficiency Virus (HIV) in individuals examined in clinical forensic medical practice and to determine opinions and attitudes about HIV in this patient group. Design: Anonymised questionnaire completed by consecutive individuals seen in clinical forensic medical practice. Setting: Police stations in London attended by Group IV forensic medical examiners. Subjects: 518 individuals examined in police stations (including prisoners and suspects, those detained in police custody, police officers and victims of crime). Results: 164 (31.7%) individuals did not respond to the questionnaire because of: 1) refusal (12.6%) 2) inability because of drugs and/or alcohol (11.4%) 3) mental illness/disorder (4.2%) or 4) language difficulties (3.5%). 28.4% of the respondents were in at least one of the 'high-risk' categories for HIV infection. 26.5% were intravenous drug misusers; 15% were prostitutes; 9.8% (or their sexual partners) had lived in Central or East Africa since 1977; 5.9% were male homosexuals and 0.5% were haemophiliacs. 5.1% were infected with HIV or had Acquired Immunodeficiency Syndrome (AIDS). Only 28.8% of individuals always used condoms in short-term sexual relationships. 44.4% of respondents believed that everyone should be tested for HIV. Conclusion: Over one-quarter of the respondents were in higher-risk groups for infection with HIV. Almost one-third could or would not respond. It is concluded that it is not possible to identify by questionnaire, individuals at higher risk of HIV infection in forensic medical practice. This reinforces the necessity of observing good clinical practice to reduce contamination risks in this work environment. It is clear that education about risks for HIV infection is still much needed.     

AIDS awareness in the conduct of radiologic procedures: guidelines to safe practice

The epidemic of the acquired immunodeficiency syndrome (AIDS) has affected all geographic regions of the United States. Indeed, it is likely that a majority of U.S. hospitals have cared for patients who are infected with the human immunodeficiency virus (HIV), the virus that causes AIDS. More than 46,000 individuals with HIV infection have fulfilled the strict diagnostic criteria for AIDS (1). All of these patients with AIDS have been seriously ill and have been hospitalized, often multiple times and for prolonged periods. Another, larger group patients with HIV infection has had another form of the disease, the so-called AIDS-related complex. Many of these patients have also spent time in hospitals. An even larger group of individuals has been infected with HIV but has remained asymptomatic to date. Some of these persons have been admitted to hospitals or have received outpatient diagnostic procedures for intercurrent medical or dental complaints that were unrelated to their asymptomatic HIV infection. At the time of their medical evaluation, some of these asymptomatic individuals were known to have a positive HIV antibody test. It is likely, however, that the serologic status of the majority of asymptomatically infected patients was unknown. Thus, by now a very large number of health-care personnel in the United States, including diagnostic radiology staff, have assisted in the care of HIV-infected patients.     

Psychiatric comorbidity and mortality among veterans hospitalized for congestive heart failure

A Behavioral Model of Health Services Utilization approach was used to examine the impact of comorbid mental illness on mortality of veterans admitted to Veterans Affairs medical centers in fiscal year 2001 with a primary diagnosis of congestive heart failure (n = 15,497). Thirty percent had a psychiatric diagnosis, 4.7% died during the index hospitalization, and 11.5% died during the year following discharge. Among those with mental illness, 23.6% had multiple psychiatric disorders. Multivariable logistic regression models found dementia to be positively associated with inpatient mortality. Depression alone (excluding other psychiatric disorders) was positively associated with one-year mortality. Primary care visits were associated with a reduced likelihood of both inpatient and one-year mortality. Excepting dementia, VA patients with a mental illness had comparable or higher levels of primary care visits than those having no mental illness. Patients with multiple psychiatric disorders had more outpatient care than those with one psychiatric disorder.     

Migration psychosis and homicide in Singapore: a five year study

Psychiatric research into violent offences, particularly murder, have been scant in the South East Asian region, with the last major review of homicides in Singapore and their association with psychiatric disorders being as far back as 1985. This study seeks to update the psychiatric community on individuals charged with murder in Singapore from 1997 to 2001 and particularly to further investigate the phenomenon of 'migration psychosis' in relation to foreigners in this sample who have committed homicide. One hundred and ten individuals in Singapore were charged with murder between 1997 and 2001. Socio-demographic data, psychiatric diagnoses, offence and victim profiles and court outcomes were obtained. The group consisting of offenders who were Singapore citizens or permanent residents was compared with those offenders who were foreigners. Analysis was done using the statistical package, SPSS. The proportion of foreigners in this study who committed homicide is significantly higher than the proportion of citizens/permanent residents in the general population. Foreigners who commit homicide also appear to (i) suffer from the more serious psychiatric illnesses of mood and psychotic disorders compared with locals, (ii) be less likely to have a known history of violence or a past forensic history and (iii) be more likely to be new to psychiatric services compared with the local homicide offenders. Compared with locals, foreigners appear to have a higher risk for committing homicide. Yet, they are less likely to appear early enough before mental health services. Some form of basic education to employers of foreigners as well as to the foreigners themselves on the early signs of mental illness is recommended.     

Female genital mutilation: medico-legal issues

The rising prevalence and severe impact of HIV/AIDS in relation to women still persists in South Africa. Both economically and socially the HIV/AIDS pandemic strikes women the hardest, with disadvantaged black women mainly at risk of higher infection. The theoretical framework of this paper focuses on the connection between HIV/AIDS, sexual inequalities and sexual violence, and more precisely, female genital mutilation, a cultural practice and custom which amplifies women's exposure to HIV. Pertinent to this focus is inescapably an analysis of apparent threats to precise essential human rights as a result of the continued use of the practice of female genital mutilation in South Africa.     

武警某部战士艾滋病健康教育现状与需求分析

 目的 了解武警部队战士艾滋病健康教育现状和健康教育需求.方法 采用多阶段抽样对4个地区3154名武警战士进行现场自填问卷调查,内容包括基本情况、艾滋病知识、态度信念、行为和艾滋病健康教育需求5项内容.结果 本次调查结果 显示,战士对艾滋病基本知识和传播途径总体掌握较好,艾滋病流行状态的相关信念持有率为79.5%,对部队应加强艾滋病健康教育的信念持有率为95.1%;对自身感染艾滋病的应对的行为持有率为93.1%,自愿进行艾滋病检测的行为持有率为92.0%,而非理性性行为中,使用安全套(54.6%)的行为持有率则较低.战士对艾滋病的基本概念和传播途径有着较高的需求.结论 武警部队基层战士艾滋病健康教育有待加强、需求较高,应大力开展健康教育.     

Musculoskeletal disorders associated with HIV infection and AIDS. Part I: Infectious musculoskeletal conditions

The musculoskeletal system can be affected by a variety of abnormalities in association with human immunodeficiency virus (HIV) infection. Although not as common as complications involving other organ systems, such as the pulmonary and the central nervous systems, HIV-associated musculoskeletal disorders are sometimes the initial presentation of the viral illness. Knowledge of the existence and the characteristic appearance of the conditions affecting bone, joint, and muscle in HIV-infected patients is valuable to radiologists for diagnosis and to clinicians for detection and appropriate treatment. We reviewed recent literature to provide a comprehensive assessment of the HIV-associated musculoskeletal disorders, and present radiologic examples from our own collection. This article is divided into two parts. In the first part we review the infectious musculoskeletal disorders associated with HIV illness and AIDS, including cellulitis, abscesses, pyomyositis, septic bursitis, septic arthritis, osteomyelitis, and bacillary angiomatosis. We also present a comprehensive spectrum of mycobacterial infections, consisting of tuberculous spondylitis and spondylodiskitis, arthritis, osteomyelitis, and tenosynovitis, as well as infections caused by atypical mycobacteria. Part II of this review will concentrate on non-infectious musculoskeletal conditions, including rheumatic disorders and neoplasms.     

Priorities for psychiatric research in the U.S. military: an epidemiological approach

Among the 1.4 million active duty U.S. military service members, 6% receive outpatient treatment for a mental disorder each year. Over 25% of these service members leave military service within 6 months, a rate that is more than two times higher than the rate following treatment for any other illness category. There is clearly a need to define psychiatric research priorities and an unprecedented opportunity to enhance the field of psychiatric research in general using the well-characterized military population. The first priority is to better define the burden of mental disorders in terms of incidence, prevalence, severity, risk factors, and health care use. The impact of mental disorders on occupational functioning, particularly among new recruits, needs to be better characterized. Suicide research should include efforts to validate mortality data, define the normal level of rate variability, and establish surveillance for clusters. The highly structured occupational environment of the military lends itself to studies of preventive interventions designed to reduce disability or occupational attrition resulting from mental/behavioral problems.