Forging a new dimension of black psychiatry in the Caribbean

There is a concerted effort among many black politicians, academics and writers to paint the Caribbean with a black brush, unmindful of the presence and contribution of other ethnic groups within the Caribbean region. The recent upsurge of black consciousness among Afro-Caribbean people is necessary, but not at the detriment of other ethnic groups who have also contributed to the social, economic and cultural lifestyles of the Caribbean. Attempts to foist a version of United States imported black psychiatry in Jamaica with the introduction of a curriculum in black psychology have raised some concern among Trinidadian students studying there. In this chapter, A Trinidadian Psychologist who studied in the Jamaican system discusses the concept of Black Psychiatry and its relevance to the Caribbean.

Consultation-liaison psychiatry in Trinidad and Tobago with reference to suicidal behavior

Consultation-liaison psychiatry (C-LP) has been defined as the area of clinical psychiatry that encompasses clinical, teaching and research activities of psychiatrist and allied mental health professionals in the non psychiatric divisions of a general hospital. Over the years, consultation-liaison services have expanded to provide care in health care facilities other than the general hospital, such a community health clinics, rehabilitation centers, convalescent hospitals, nursing homes and doctors' private offices. The term Consultation-Liaisons reflects two interrelated roles of the consultant. Consultation refers to the provision of expert diagnostic opinion and advice on management regarding a patient's mental state and behavior at the request of another health professional. Liaison refers to a linking up of groups for the purpose of effective collaboration. The present chapter reviews how these roles are addressed in Trinidad and Tobago.

Social and cultural psychiatry experience from the Caribbean Region

Within recent years there has been an upsurge of research in psychiatry in the Caribbean region, particularly Trinidad, Tobago and Jamaica. This development has resulted in the need for sharing information across and about the Caribbean region, noting that there are as many Caribbean people abroad as there are at home. The Caribbean is not a homogenous society, but showcases a unity in diversity. This book the first of its kind in social psychiatry discusses a number of contemporary social issues in the Caribbean. it has a uniqueness of its own with an inter-mixture of superstition, religion and third world traditional practices superimposed on a microbiological basis of medicine. It is here defined as Carib-being Psychiatry. In this text a historical perspective of medicine is reviewed, the practice of psychiatry both at the institution and at the hospital, the roles of culture and its effect on behavior especially at Carnival time. Suicide, depression and substance abuse are common problems especially among the adolescent population. These issues are everyday problems that are in need of urgent public health policies. This book is intended to serve as a foundation text for the purposes of teaching, research and education for those at home and abroad with interest in Caribbean people. It is guaranteed to be a source of interest and discussion.

Defining Caribbeing psychiatry

Caribbeing psychiatry is a novel concept borrowed from the Caribbean film industry and applied here to Caribbean psychiatry. Caribbeing psychiatry is eclectic in nature, it is distinctly different to western psychiatry and there is a need for psychiatrists and psychologists to analyse the pictures, styles, language and culture of Caribbean psychiatry. The emphasis on international classificatory systems of mental disorders does not represent the nature of Caribbeing psychopathology. Caribbeing psychiatry examines supernaturalism and magical realism and the trans-generational linkage of these life forces with reference to their influences on emotions, behavior and thought. The aim is to articulate a Caribbeing identity and self definition in a post colonial society devoid of references to Eurocentric and North American standards. Secondly, to apply culturally appropriate treatment modalities (Caribbeing therapy) not aligned to the irrelevance of western psychological theories. It is necessary to harness the uniqueness of the Caribbeing experience and environment, the multicultural, plural and syncretic elements and the aesthetic style of psychological hybridity. Three cases are presented here that captures the exotic salience of Caribbeing people closely knitted into a web of witchcraft, priestcraft and mental illness.

Neurology for students

This book in neurology was prepared for students reading for the Doctor of Medicine in Psychiatry. It is also extremely useful for medical students, nurses and young doctors since it is written as an introduction to neurology providing a framework on which to build. Students should find the approach simple to follow with a slight emphasis on the borderland of psychiatry and neurology. Both neurological and psychiatric problems are very common, accounting for 10 percent and 40 percent respectively, of general practice consultations. This book will also serve as a supplement for the brief neurological and psychiatric attachments of students and interns (AU)

Pathways to care and ethnicity. 1: Sample characteristics and compulsory admission

BACKGROUND: Many studies have found high levels of compulsory admission to psychiatric hospital in the UK among African–Caribbean and Black African patients with a psychotic illness. AIMS: To establish whether African–Caribbean and Black African ethnicity is associated with compulsory admission in an epidemiological sample of patients with a first episode of psychosis drawn from two UK centres. METHOD: All patients with a first episode of psychosis who made contact with psychiatric services over a 2-year period and were living in defined areas were included in the (ÆSOP) study. For this analysis we included all White British, other White, African–Caribbean and Black African patients from the ÆSOP sampling frame. Clinical, socio-demographic and pathways to care data were collected from patients, relatives and case notes. RESULTS: African–Caribbean patients were significantly more likely to be compulsorily admitted than White British patients, as were Black African patients. African–Caribbean men were the most likely to be compulsorily admitted. CONCLUSION: These findings suggest that factors are operating at or prior to first presentation to increase the risk of compulsory admission among African–Caribbean and Black African patients.

A psychosocial profile of a cohort of African Caribbean patients in the forensic psychiatric service in Britain, 2000

Thirty-two African Caribbean Patients who were Forensic Psychiatric Service-users in England were assessed by a Consultant Psychiatrist during the four-year period of 1996-2000. These patients were the cohort for this study. The study involved a comparison of some of the characteristics of the native-born and migrant African Caribbean patients. Twenty-three patients (71.9 percent of the cohort) were born in Britain while the others were born in the Caribbean. The mean age of the cohort was 34.3 years. Seventy-five percent of the patients were men. According to this study, the place of assessment was associated with the territory of birth. The British-born patients were more likely to have been assessed in a psychiatric or legal institution (e.g. a secure psychiatric hospital or prison). The "companionship status" of each group was not significantly different from the other. When the patients were examined as one group, it was seen that more than a third of the patients (37.5 percent) lived alone. There was a weak association between territory of birth and primary caregivers, with the British-born patients being marginally more likely to have been reared by both parents (under the age of eighteen years) than the Caribbean-born patients. The association between territory of birth and previous social work care was not significant. The majority of patients in both groups had previous social work intervention. The type of accommodation was not significantly different between the groups. The educational level attained by the British-born patients was significantly higher than that of the migrant patients. The employment profiles of the two groups were similar, that is, there was no significant difference between them. There was no association between the forensic charges at the time of assessment and the territory of birth. In this study there was no association between the category of primary psychiatric diagnosis (Psychosis or Personality Disorder) and the territory of birth. The weak association seen between primary caregiver and territory of birth indicates that the British-Born patients are marginally more likely to have had the benefit of a higher educational level, did not confer an advantage over the migrant patients in terms of their rate of developing forensic psychiatric problems. The literature indicates that second-gneration African Caribbean people (those born to migrants) are those with the highest rate of psychosis. ...(AU)

Perceptions about mental illness among pre-clinical medical students in Trinidad and Tobago

Perceptions about mental illness among medical practitioners are likely to determine their capacity to recognise, treat appropriately and refer patients who have mental health problems. It is therefore important that training of medical students in psychiatry is undertaken with knowledge of their attitudes to mental health disorders. We determined the perceptions of 108 pre-clinical medical students (69 males, 39 females; mean age 22 years) toward mental illness in Trinidad and Tobago by analysing their responses to a questionnaire based on a case vignette of a young man with a paranoid psychotic illness. 88 percent felt that medical treatment in hospital was the best means of treating the illness and 86 percent suggested that discharge should be conditional on regular visits to a doctor. 89 percent however opposed the patient's marrying into their families and 85 percent to his teaching their children. This was associated significantly with having a personal relationship with someone having a mental illnes (p < 0.03). Surprisingly, 25 percent believed that mental illness could be caused by supernatural forces, particularly females who were almost twice as likely as males to express this belief.(AU)

The use of electroconvulsive therapy in Latin America and the Caribbean

Sixty years after its introduction into psychiatry, the use of electroconvulsive therapy (ECT) still fuels scientific, ideological, and ethical debate. One well-informed proponent has observed that ECT is probably more enshrouded in myth than any other procedure in medicine. Among the population at large, and especially patients and their family members, ECT may be the psychiatric intervention that arouses the most anxiety-although some authors dispute this assertion. This paper reports the results of a mail survey conducted in 1995 to obtain precise and authoritative data concerning the use of ECT in Latin American and the Caribbean. The objective was to facilitate the identification of psychiatric, administrative, and bioethical issues that will provide, if needed, the basis for action to ensure that ECT is used appropriately (AU)

An analysis of admissions to the psychiatric hospital through the court system of Barbados: a project report submitted in fulfillment of the requirement for the Degree of D.M. Psychiatry of the University of the West Indies

An increasing number of male admissions to the Psychiatric Hospital were being admitted on remand from the court system of Barbados. This was contributing to the overcrowding on the Forensic Unit in which they were being housed. This study was undertaken to ascertain reasons for admission to the Psychiatric Hospital, and gather information about, this group of offenders. All patients admitted to the Psychiatric Hospital during a five-month period on Remand were eligible for the study. Female patients were subsequently excluded from the study as they were geographically housed elsewhere than the Forensic Unit. Demographic and psychosocial data was collected. Subjects were assessed using the Present State Examination (PSE) to arrive at an ICD diagnosis (AU)

Psychiatry in Jamaica: growth and development

The history of psychiatry in the Caribbean island of Jamaica is presented based on ethnohistoriographic accounts of large group meetings of patients and staff of the Bellevue State Mental Hospital in the late 1970s. The development of psychiatric services is described from pre-colonial days of the indigenous Arawak Indians. The existing mental hospital was established in 1862 by the British Colonial Government, and the Mental Hospital Act of 1873 created the system whereby the mentally ill was arrested for lunacy and incarcerated in the mental hospital by Magistrates order. The development of a Community Psychiatric Service and the establishment of a deinstitutionalization programme for the mental Hospital in the decade of the 1960s and 70s is described, and a review of private and public community services presently existing in the island is also described. A brief review of the existing literature on Jamaican psychopathology is presented, including a disscussion on schizophrenia in Afro-Caribbeans, other common psychiatric conditions, developments in psychotherapy in Jamaicans, and psychodynamic issues of cultural identity.(Summary).

Caribbean psychiatry yesterday, today, and tomorrow

An historical look at British Caribbean psychiatry

Caribbean psychiatry yesterday, today, and tomorrow

An historical look at British Caribbean psychiatry

Non-psychotic psychiatric morbidity in general practice: implications for service delivery and training

Utilizing the 30 item version of the GHQ developed by Goldberg and validated in a Jamaican population by Harding, a sample of 98 respondents drawn from a general practice were analyzed. Thirty two percent (32 percent) were found to be "potential cases". Males and females had similar scores. Some implications of this finding for service delivery and training are discussed (AU)