Gender and violence against people with severe mental illness

Men and women with severe mental illness (SMI) are at significantly increased risk of violent victimisation, but the gender pattern for this has not been systematically examined. In the general population, men are at higher risk of overall and physical victimisation, whilst women are at increased risk of domestic and sexual violence. We re-examined published victimisation studies from a gender perspective, and found that, compared to the general population, women with SMI are at greater excess risk than men, leading to a narrowing in the ‘gender gap’. We discuss theoretical explanations for this and implications for prevention and research.     

Gender and violence against people with severe mental illness

Men and women with severe mental illness (SMI) are at significantly increased risk of violent victimisation, but the gender pattern for this has not been systematically examined. In the general population, men are at higher risk of overall and physical victimisation, whilst women are at increased risk of domestic and sexual violence. We re-examined published victimisation studies from a gender perspective, and found that, compared to the general population, women with SMI are at greater excess risk than men, leading to a narrowing in the 'gender gap'. We discuss theoretical explanations for this and implications for prevention and research.     

精神分裂症患者QTc问期延长的影响因素

目的 调查精神分裂症患者心电图QTc间期延长及相关影响因素。方法 对服用稳定剂量抗精神病药的522例住院精神分裂症患者进行横断面调查,收集人口学资料,测定空腹血糖等生化指标,并进行心电图检查,以QTc≥440ms作为QTc间期延长标准,分析QTc间期延长状况及其相关因素。结果 QTc间期延长发生率12．8％,女性（22．7％）高于男性（7．8％）,差异有统计学意义（P〈0．01）,心电图窦性心动过速和传导阻滞患者QTc间期延长风险分别是心电图正常患者的2．6和3．1倍（P〈0．05）。结论 抗精神病药治疗期间QTc间期延长发生率存在性别差异,女性QTc间期延长的风险可能更高。     

Gender disadvantage and common mental disorders in women

Research in the area of gender and mental health indicates that women are disproportionately affected by common mental disorders (CMDs) as well as co-morbid mental disorders. However, the concept of gender disadvantage, its correlates, and mental health outcomes has received relatively less research attention. In addition, there are no known systematic reviews in the area of gender disadvantage and common mental disorders in recent years. In this review we have therefore attempted to deconstruct the concept of gender disadvantage, identify important correlates of gender disadvantage and illustrate their influence on common mental disorders. Since gender is a social construct and is greatly influenced by one's culture and ethnicity, we have made an attempt to integrate international literature on the subject and highlight cultural and ethnic relevance of topics as they emerge. Finally, we have provided take home messages from existing literature, identified gaps in literature, and formulated directions for future research in this area.     

Gender disadvantage and common mental disorders in women

Research in the area of gender and mental health indicates that women are disproportionately affected by common mental disorders (CMDs) as well as co-morbid mental disorders. However, the concept of gender disadvantage, its correlates, and mental health outcomes has received relatively less research attention. In addition, there are no known systematic reviews in the area of gender disadvantage and common mental disorders in recent years. In this review we have therefore attempted to deconstruct the concept of gender disadvantage, identify important correlates of gender disadvantage and illustrate their influence on common mental disorders. Since gender is a social construct and is greatly influenced by one's culture and ethnicity, we have made an attempt to integrate international literature on the subject and highlight cultural and ethnic relevance of topics as they emerge. Finally, we have provided take home messages from existing literature, identified gaps in literature, and formulated directions for future research in this area.     

农村"留守儿童"心理健康状况的性别差异分析

目的了解性别因素对农村“留守儿童”心理健康状况的影响。方法采用EPQ(7岁~15岁)个性问卷和儿童自我意识量表作为调查工具,将160名“留守儿童”作为研究组,154名非留守儿童作为对照组进行调查,两组各自进行因子分之间的性别比较。结果留守组儿童男女之间在内外向、神经质、行为、智力与学校情况、合群和自我意识总分这6个因子上有显著差异,非留守组男女之间仅在行为因子上有差异。结论男性“留守儿童”心理健康状况较女童差。     

Employment supports: Perceptions of people with severe mental disorders

Professional rehabilitation of people with severe mental illness is a field of research often left aside. Despite the aspiration of people with severe mental illness to employment, their presence in the job market remains low. Lack of supports appears to be one explanation. Thus, the aim of this study was to identify the types of necessary supports to maintain these people in employment. Six (6) participants have been recruited following a qualitative methodology. Ten types of supports have been identified and classified according to their direct association to work or to the residential or community environment. To conclude, the authors suggest a greater involvement from mental health workers in the identification and development of supports that favour maintaining these people in employment.     

Stigma and discrimination against older people with mental disorders in Europe

BACKGROUND AND OBJECTIVES: The European Office of the World Health Organization (WHO/EURO) has established a Task Force On Destigmatization. Upon the release of the Technical Statement on Old Age Psychiatry 'Reducing stigma and discrimination against older people with mental disorders', the Task Force run a small survey in two European subregions to investigate the extent of stigma and discrimination with reference to the elderly person affected from a psychiatric disorder in the countries of those subregions. METHODS: WHO/EURO mental health counterparts completed a short questionnaire inquiring on the inclusion of epidemiological studies on the elderly in their country's research program; the time devoted to the teaching to old age psychiatry during psychiatric residence; the degree of coverage of services for the elderly person and their caregivers; and the extent of stigma present in society with regard to three psychiatric disorders. RESULTS: Stigma and discrimination seem to be present both in the health sector and among the public at large. CONCLUSION: The development of effective health and social facilities to support older persons with mental disorders should be a high priority of any strategy to reduce stigma and discrimination. These facilities should coordinate their efforts with those of other sectors of society to reach the highest possible impact.     

Gender differences in caregiving among family - caregivers of people with mental illnesses

All over the world women are the predominant providers of informal care for family members with chronic medical conditions or disabilities, including the elderly and adults with mental illnesses. It has been suggested that there are several societal and cultural demands on women to adopt the role of a family-caregiver. Stress-coping theories propose that women are more likely to be exposed to caregiving stressors, and are likely to perceive, report and cope with these stressors differently from men. Many studies, which have examined gender differences among family-caregivers of people with mental illnesses, have concluded that women spend more time in providing care and carry out personal-care tasks more often than men. These studies have also found that women experience greater mental and physical strain, greater caregiver-burden, and higher levels of psychological distress while providing care. However, almost an equal number of studies have not found any differences between men and women on these aspects. This has led to the view that though there may be certain differences between male and female caregivers, most of these are small in magnitude and of doubtful clinical significance. Accordingly, caregiver-gender is thought to explain only a minor proportion of the variance in negative caregiving outcomes. A similar inconsistency characterizes the explanations provided for gender differences in caregiving such as role expectations, differences in stress, coping and social support, and response biases in reporting distress. Apart from the equivocal and inconsistent evidence, there are other problems in the literature on gender differences in caregiving. Most of the evidence has been derived from studies on caregivers of elderly people who either suffer from dementia or other physical conditions. Similar research on other mental illnesses such as schizophrenia or mood disorders is relatively scarce. With changing demographics and social norms men are increasingly assuming roles as caregivers. However, the experience of men while providing care has not been explored adequately. The impact of gender on caregiving outcomes may be mediated by several other variables including patient-related factors, socio-demographic variables, and effects of kinship status, culture and ethnicity, but these have seldom been considered in the research on gender differences. Finally, it is apparent that methodological variations in samples, designs and assessments between studies contribute a great deal to the observed gender differences. This review highlights all these issues and concludes that there is much need for further research in this area if the true nature of gender differences in family-caregiving of mental illnesses is to be discerned.     

QTc prolongation and antipsychotic medications in a sample of 1017 patients with schizophrenia

Many antipsychotic drugs cause QT prolongation, although the effect differs based on the particular drug. We sought to determine the potential for antipsychotic drugs to prolong the QTc interval (> 470 ms in men and > 480 ms in women) using the Bazett formula in a “real-world” setting by analyzing the electrocardiograms of 1017 patients suffering from schizophrenia. Using logistic regression analysis to calculate the adjusted relative risk (RR), we found that chlorpromazine (RR for 100 mg = 1.37, 95% confidence interval (CI) = 1.14 to 1.64; p < .005), intravenous haloperidol (RR for 2 mg = 1.29, 95% CI = 1.18 to 1.43; p < .001), and sultopride (RR for 200 mg = 1.45, 95% CI = 1.28 to 1.63; p < .001) were associated with an increased risk of QTc prolongation. Levomepromazine also significantly lengthened the QTc interval. The second-generation antipsychotic drugs (i.e., olanzapine, quetiapine, risperidone, and zotepine), mood stabilizers, benzodiazepines, and antiparkinsonian drugs did not prolong the QTc interval. Our results suggest that second-generation antipsychotic drugs are generally less likely than first-generation antipsychotic drugs to produce QTc interval prolongation, which may be of use in clinical decision making concerning the choice of antipsychotic medication.     

Multi-modal weight control intervention for people with persistent mental disorders

Obesity, a major problem worldwide, is more prevalent among people with schizophrenia. This study examined the effect of behavior intervention, nutritional information and physical exercise on the body mass index (BMI) and weight of people who were hospitalized with persistent DSM-IV schizophrenia and schizoaffective disorders. Fifty nine inpatients with a BMI greater than 25 participated, (28 intervention group; 31 control group). Significant reductions in BMI and weight were observed in the intervention group after 3 months and were maintained 1-year post study [F(1,52) = 6.1, p = .017) and F(1,52) = 3.7, P = .006, respectively]. If provided with adequate information and an appropriate framework, people with persistent schizophrenia can significantly reduce BMI and weight and maintain the loss.     

Ambulatory sleep-wake patterns and variability in young people with emerging mental disorders

Background

The nature of sleep-wake abnormalities in individuals with mental disorders remains unclear. The present study aimed to examine the differences in objective ambulatory measures of the sleep-wake and activity cycles across young people with anxiety, mood or psychotic disorders.

Methods

Participants underwent several days of actigraphy monitoring. We divided participants into 5 groups (control, anxiety disorder, unipolar depression, bipolar disorder, psychotic disorder) according to primary diagnosis.

Results

We enrolled 342 participants aged 12–35 years in our study: 41 healthy controls, 56 with anxiety disorder, 135 with unipolar depression, 80 with bipolar disorder and 30 with psychotic disorders. Compared with the control group, sleep onset tended to occur later in the anxiety, depression and bipolar groups; sleep offset occurred later in all primary diagnosis groups; the sleep period was longer in the anxiety, bipolar and psychosis groups; total sleep time was longer in the psychosis group; and sleep efficiency was lower in the depression group, with a similar tendency for the anxiety and bipolar groups. Sleep parameters were significantly more variable in patient subgroups than in controls. Cosinor analysis revealed delayed circadian activity profiles in the anxiety and bipolar groups and abnormal circadian curve in the psychosis group.

Limitations

Although statistical analyses controlled for age, the sample included individuals from preadolescence to adulthood. Most participants from the primary diagnosis subgroups were taking psychotropic medications, and a large proportion had other comorbid mental disorders.

Conclusion

Our findings suggest that delayed and disorganized sleep offset times are common in young patients with various mental disorders. However, other sleep-wake cycle disturbances appear to be more prominent in broad diagnostic categories.     

Possible association of QTc interval prolongation with co-administration of quetiapine and lovastatin.

BACKGROUND: QTc interval prolongation can occur as a result of treatment with both conventional and novel antipsychotic medications and is of clinical concern because of its association with the potentially fatal ventricular arrhythmia, torsade de pointes. METHODS: One case is described in which a patient with schizophrenia, who was being treated for dyslipidemia, developed a prolonged QTc interval while taking quetiapine and lovastatin. RESULTS: QTc returned to baseline when the lovastatin dose was reduced. CONCLUSIONS: QTc prolongation associated with antipsychotic medication occurs in a dose-dependent manner. We therefore hypothesize that the addition of lovastatin caused an increase in plasma quetiapine levels through competitive inhibition of the cytochrome P(450) (CYP) isoenzyme 3A4. Our case highlights the potential for a drug interaction between quetiapine and lovastatin leading to QTc prolongation during the management of dysipidemia in patients with schizophrenia.     

抗精神病药致首发精神疾病QTc 间期变化的相关 因素分析

目的 调查抗精神病药致首发精神疾病QTc间期延长的影响因素.方法 对服用稳定剂量抗精神病药治疗1月的309例首发精神疾病患者进行回顾性调查,收集人口学资料、空腹血糖、血压、血脂等生化指标、心电图资料,以QTc≥440ms作为QTc间期延长的标准,分析QTc间期延长的状况及其相关因素.结果 QTc间期延长的发生率为10.6%.药物治疗组QTc间期均值大于基线期,差异有统计学意义(P<0.05);药物联合电休克治疗组以及药物联合脑电治疗组QTc间期与基线期相比,差异无统计学意义(P>0.05).单一抗精神病药治疗组QTc间期与基线期差异无统计学意义(P>0.05);而抗精神病药联用以及抗精神病药联用抗抑郁药/心境稳定剂组QTc间期均值大于基线期,差异有统计学意义(P<0.05).抗精神病药等效氯丙嗪剂量<1000mg/d组别QTc间期与基线期相比差异有统计学意义(P<0.05).抗精神病药剂量与QTc间期没有相关性.女性是QTc间期延长的风险因素(OR=3.26,95%CI=1.050~10.094),其他因素未进入回归方程.结论 首发精神疾病患者抗精神病药治疗期间QTc间期延长存在性别差异,女性发生QTc间期延长的风险是男性的3.26倍.药物联用延长的QTc间期并未达到异常值.抗精神病药剂量与QTc间期没有相关性.除了性别因素外,其他指标不是QTc间期延长的风险因素.     

Pharmacy students' attitudes toward and professional interactions with people with mental disorders

BACKGROUND: Health professionals frequently exhibit negative attitudes toward people with mental disorders. It is not known whether stigmatising attitudes among pharmacy students predict less positive attitudes toward consumer participation in decision-making about medications. AIMS: (1) To assess the attitudes of pharmacy students toward people with schizophrenia, and (2) to determine whether stigma predicts less positive attitudes toward concordant medication counselling. METHOD: All pharmacy students enrolled in a five-year degree program were invited to participate. Students completed the seven-item Social Distance Scale, six items related to stereotypical attributes of people with schizophrenia and the 14-item Leeds Attitudes Toward Concordance Scale. RESULTS: Completed survey instruments were received from 157 students (94% response rate). Previous employment in a pharmacy and personal experience of a mental disorder were associated with low social distance. Later year of study, believing that people with schizophrenia are difficult to talk to, and believing people with schizophrenia have themselves to blame were predictive of high social distance. Low social distance and later year of study were associated with positive attitudes toward providing concordant medication counselling. CONCLUSION: Mental health stigma was common and predictive of less positive attitudes toward consumer participation in decision-making about medications.