Psychiatric disorder in young adults in Jamaica

INTRODUCTION: Much research into psychiatric disorder in Jamaica has investigated psychotic illness but studies of neurotic disorders are lacking. This study investigated psychiatric disorder in a group of mainly urban, lower social class, young adults who had been regular clinic attenders as a physically healthy control group in a cohort study of sickle cell disease. METHOD: The study was cross-sectional in design. Subjects, 44 male and 45 female, were aged 18 to 20 years at the time of the study. The Psychiatric Assessment Schedule was used to determine psychiatric disorder at Index of Definition level 5. RESULTS: All subjects approached participated. Rates of psychiatric disorder were 6 (14 percent) in the male group and 16 (36 percent) in the female group. There were no psychotic disorders. In the group as a whole, psychiatric disorder was associated with female gender, unemployment, difficulties with social adjustment and number of episodes of physical illness in the 6 months prior to interview. Variables associated with psychiatric distress amongst male included not having a steady relationship, unemployment, criminal activity and difficulties with social adjustment. Variables associated with psychiatric distress amongst females included lack of domestic amenities, not having a mother at home, lack of education, unemployment and social adjustment difficulties. CONCLUSION: Rates of psychiatric disorder were higher than expected, especially for women. Larger studies are indicated to investigate the prevalence of neurotic disorders amongst young people in Jamaica, compared to similar groups in other countries(AU)

Cross-cultural cognition: developing tests for developing countries

The problems of adapting measures of cognitive performance to Third World conditions are described, and three novel adaptations are proposed, one based on speed of sentence comprehension, one on vocabulary acquisition, and a third on speed of visual search using pictorial material. These and other existing tests are applied to studying the cognitive performance of Jamaican children as part of an investigation into the effects on cognition of infection by the parasitic worm Trichuris trichiura. We demonstrate that the tests are usable under Third World field conditions, and give reliable results. The validity of our proposed test is indicated by their capacity to predict scholastic performance. Despite their brevity and avoidance of any demand on literacy, they yielded substantial correlations with the reading, spelling and arithmetic sales of the Wide Range Achievement Test.(AU)

A three month study of parasuicide presenting in Kingston, Jamaica

A three month study of parasuicide presenting in Kingston, Jamaica. A case controlled study of 41 persons who attempted suicide was conducted over a three month period. The risk factors identified in this population are: being unemployed, living in rented accomodation or boarding homes, having a chronic medical illness, experiencing conflicts with parents and family members, family instability, depression and hopelessness. Drug abuse was associated with parasuicide. The more common precipitating factors include: dispute with parents, conflict with other family members and lovers quarrel. The most common method of attempting suicide seem to be the ingestion of medication. Teenagers and young adults made up the majority of cases. Depression and hopelessness were prominent features among the cases and were also identified as risk factors. These findings have important implications for the planning of health services and the management of patients. (AU)

Key issues in generating a psychological-testing protocol

An individual's behavior is created by an amalgam of genetic, environmental, cultural, and historical variables working in concert and changing over time. Variations in nutrition are one class of environmental factors. Linking these to outcome effects requires carefully designed studies. Many considerations are involved, and this paper draws attention to some of the fundamental ones. Psychological and behavioral functions tend to be complex, in part because they are affected by a wide range of variables. Almost any given state-a particular constellation of psychological characteristics displayed by an individual at a given time-can be produced in a variety of ways (AU)

Home visiting of varying frequency and child development

Two studies were made of home visiting and psychosocial stimulation with deprived urban children in Jamaica. The aim was to determine the relative effectiveness of different frequencies of visiting on the children's developmental levels and the feasibility of integrating the model into government primary health care services. Health paraprofessionals supervised by a nurse from a local health centre conducted the intervention. In the first study 152 children aged 6 to 30 months were assigned to groups visited biweekly, monthly, or not at all by area of residence. The biweekly group showed small but significant increases in scores on the Griffiths Mental Development Scales (developmental quotient) and performance subscale compared with the monthly and control groups, whereas no benefit was shown in the Griffiths scores of the monthly group. In the second study 58 children aged 16 to 30 months from the same neighbourhoods were randomly assigned to weekly visited and control groups. The group visited weekly showed marked improvements in the performance and hearing and speech subscales as well as the developmental quotient scores. The results indicate that as the frequency of visiting increases from none through monthly and biweekly to weekly, the benefits increase as well. (AU)

Effects of missing breakfast on the cognitive functions of school children of differing nutritional status

We examined the effects of omitting breakfast on the cognitive functions of three groups of children: stunted, nonstunted controls, and previously severely malnourished. They were admitted to a metabolic ward twice. After an overnight fast half the children received breakfast on their first visit and a cup of tea the second time. The treatment order was reversed for the other half. When breakfast was omitted, both the stunted and previously malnourished groups responded similarly. The malnourished groups had lower scores in influency and coding whereas the control group had higher scores in arithmetic. The children were divided into wasted and nonwasted groups. Wasted children were adversely affected in digit span backwards test and wasted members of the malnourished groups were adversely affected on efficiency of problem solving and those control group in digit span forwards. These results indicate that cognitive functions are more vulnerable to missing breakfast in poorly nourished children (AU)

The psychophysiological mediators of stress as it relates to oncology in humans and animals

This study was designed to investigate the effect of stress on cancer development and treatment, and also to determine whether there is any cancer association personality profile. Human studies were supplemented by controlled animal studies. Twenty-nine male and female cancer subjects were studied along with twenty-nine controls. The animal study comprised ninety female Sprague-Dawley rats, which were divided into nine groups of ten. One group was treated with noise stress alone, while another group received no treatment at all. Three groups received the carcinogen 7,12-Dimethylbenz(a)anthracene together with either noise stress, cortisone acetate or 6-mercaptopurine and the rate of tumour growth in these animals was compared to a group that received only the carcinogen, and after tumour growth these animals were subjected to chemotherapy. In addition to the chemotherapy, one of these groups received noise stress and another cortisone acetate. The stress level of the humans and animals was determined by physiological and psychological tests where applicable. The results of the human study revealed that the level of stress among the cancer subjects was higher than among the controls. Even though in some cases cancer development occured after an event that may be considered stressful, it was not easy to conclude whether stress occurred before or after the cancer development. The controlled animal studies revealed, though, that stress alone could not induce tumour development in the observation period of 280 days. Stress, however, influenced tumour growth when the rats were treated with the carcinogen. The findings of this study also suggested that immunosuppression might play a vital role in cancer development. A cancer associated personality profile, depicting among other things a schizophrenic character, was also detected among the human cancer subjects. The treatment of the cancer subjects who had high stress levels was less successful, and this was substantiated by the results of the animal study, which showed that stressed decreased the life span of the animals receiving chemotherapy and stress. The findings of this study suggest that even though stress may not initiate tumour growth, stress influences the growth of potential tumour cells, and may interfere with the response to treatment (AU)

A longitudinal study of the mental development of severely malnourished children who received psychosocial stimulation - abstract

Children who suffer from severe malnutrition in early childhood have lower levels of school achievement and intelligence quotients, and more behavioural problems than their peers or siblings for many years. Few studies have attempted intervention, and these have been short-term and had only transient benefits. We previously reported a programme of two years intervention, which had marked benefits. We now report the childrens' progress over a third year of intervention and three years following its cessation. The development of 16 children , who were in hospital with severe malnutrition and participated in a home visiting programme of psychosocial stimulation, was compared with that of two other groups who were also in hospital but received standard medical care only; another severely malnourished group (n=18) and an adequately nourished one (n = 20). All groups were assessed regularly on the Griffiths Mental Development Scales and then the Stanford Binet tests. Both malnourished groups were markedly behind the adequately nourished group on admission to hospital and the non-intervened group showed little signs of catching up. The intervened group caught up to the adequately nourished group in two years and showed no further improvement in the third year of intervention. Over the following three years, they showed a decline in three of the five Griffiths subscales. They, however, retained a marked advantage over the non-intervened malnourished group on the Standard Binet test to the end of follow-up, showing no further decline in the last year. Both malnourished groups failed to catch up to the adequately nourished group in height. It was concluded that relatively simple intervention can benefit the development of severely malnourished children (AU)

The effects of short term fasting on the cognitive functioning of 9 and 10-year-old children of differing nutritional status - abstract

Schoolfeeding programmes may benefit children through the relief of hunger. There are no studies on the effects of hunger on the congitive function of malnourished children, who may be particularly vulnerable. We therefore, examined the effects of omitting breakfast on the cognitive functions of chronically undernourished children (n = 30). Malnourished and control subjects were admitted overnight to the ward on two occasions, on week apart. They received a standard dinner (940 Kcals) in the evening. By random assingment, half the children received a standard breakfast (590 Kcals) on the morning of their first visit and a placebo on their second visit. The treatment order was reversed for the other half. Tests of cognitive functioning were given at 11:00 a.m. Since the previously malnourished and the chronically undernourished children behaved similarly, they were combined and compared to the adequately nourished. In the fasted state, the malnourished group had lower scores in fluency but the adequately nourished were not affected (group x treatment, p < 0.05); whereas in arithmetic, the adequately nourished had better scores and the malnourished group was not affected (group x treatment, p< 0.05). When weight-for-height was considered, the wasted children (<90 percent expected weight-for-height) tended to do worse when fasted, and the non-wasted slightly better in short-term memory and problem-solving ability (group x treatment, p<0.05). Omitting breakfast appears to have a detrimental effect in poorly nourished children but not in adequately nourished ones. The former are therefore most likely to benefit from schoolfeeding programmes (AU)

Behaviour disorders among a sample of Jamaican adolescents

Most maladjusted children's behaviour is different in quantity rather than quality from the behaviour of other children. The prevalence of behaviour disorders among a sample of 13 and 14 year old Jamaican high school and all age school adolescents was examined. The identification of aetiological factors involved in behaviour disorders was also attempted. Teachers can improve their assessment of maladjustment in children through observations of children's behaviour. The Revised Behaviour Problem Checklist R.B.P.C. was found to be a useful measure of common behaviour disorders and showed that Jamaican adolescents had a higher prevalence of behaviour disorders than their North American counterparts. An instrument assessing the adolescent's psycological adjustment - the Personality Screening Inventory P.S.I. was also found to be an indicator of behaviour disorders, and it seems that the R.B.P.C. used in conjunction with the P.S.I. would provide a more complete picture of the adolescent's problems. Males scored higher on most subscales of the R.B.P.C. Maladjusted behaviour was also seen to be affected by long periods of separation from parents especially if the child was quite young. Adolescents from the lower social class groups were significantly higher on behaviour disorders than the middle social class groups. However, this finding may also have been a function of low intellectual level. These results suggest that identification of behaviour disordered children in Jamaica is imperative, so that literacy can be improved and more importantly the normal personality, behavioural and emotional development of tomorrow's adults can be assured (AU)

A review of persons referred by the police and the courts for psychiatric evaluation in Western Jamaica - abstract

A review of 114 persons, half referred by the Courts and half brought directly by the Police for psychiatric evaluation over a two year period in Western Jamaica, shows the majority (54 percent) were labouring class males aged under 30 years. 59 percent had previous hospital admission for psychiatric illness, and 95 percent were charge with offences relating to disturbed behaviour in public. All of the referred persons were being detained in custody. All of them did prove to be psychiatrically disturbed, with 75 percent of the males exhibiting schizophreniform illness (vs. 21 percent affectively) while of the 10 females half were schizophreniform, half manic and noe depressed. The charges brought against these persons (assault, trespassing, malicious destruction of property, treatening behaviour) the fact that they all proved to be ill and that almost invariably the charges were withdrawn suggests that the police use arrest as a way of bringing psychiatrically ill persons to treatment. Only 28 of these persons were admitted to hospital, the remainder being discharged back to police custody where they depended on the staff of the lockup to dispense their medication to them. These findings highlight the inadequate provision curently made for the management of distured persons whose behaviour brings them to the attention of the police and who are arrested and awaiting "trial". The high percentage of patients with previous admission for psychiatric illness suggests that among sentencing options, our magistrates should include compulsory psychiatric follow-up more frequently (AU)

A new look at the asssessment of mental development in young children recovering from severe malnutrition

Previous studies of malnourished children is hospital have shown that their developmental quotients (DQs) improve as their nutritional status improves, but they have not taken into account the possible effects of being in hospital and of test practice. The present study assessed development of malnourished and adequately nourished children in hospital and found that mean DQs of each group rose to a similar extent during recovery from illness. It is concluded that DQs on admission to hospital were lowered by the children's discomfort and unhappiness at being in hospital, and/or by illness, and that rises in DQ shown by children recovering from malnutrition are not necessarily attributable to improving nutritional status. (AU)

A theoretical note on sex linkage and race differences in spatial visualization ability

Evidence on the poorer spatial visualization ability in various Negro populations compared to the white populations and the direction and magnitude of sex differences in spatial ability relative to other abilities suggests the genetic hypothesis that spatial ability is enhanced by a sex-linked recessive gene and that, since the 20-30 percent admixture of Caucasian genes in American Negroes came mostly from male white ancestors, relatively fewer X-linked than autosomal Caucasian genes were transmitted to the American Negro gene pool. The genetic model as explicitly formulated indicates the kinds of data which could substantiate or disprove the theory, but which do not now exist (AU)

The significance of marihuana in a small agricultural community in Jamaica / Cannabis and culture

A comprehensive field study, including videotape coverage and extensive laboratory research, was carried out in a small agricultural community in Jamaica, the West Indies. The research sought to explore whether cannabis altered the user's cognitive and psychological frame of reference in a specific socioeconomic and cultural context. The findings indicate that (1) heavy cannabis smokers enact subtle alterations in the stream of consciousness; (2) subjective (smoker) impressions of cannabis-induced alterations in specific tasks contrast with descriptions based on analysis of research records of those activities; (3) alterations associated with cannabis smoking seem to be appropriate to the users as members of the socioeconomic cultural system. Multidisciplinary research procedures are suggested for further study of these findings. (AU)

A survey of nurses' attitudes to psychiatric patients in two General Hospitals in Jamaica and Trinidad

In summary our study would seem to point to (i) the need for pyschiatric training for general nurses, (ii) the need for psychiatric units in General Hospitals to be administered in such a way that the psychiatric services are integrated into the General Hospital as a whole and are not too isolated from the hospital culture, and (iii) the need for psychological testing of nursing applicants to eliminate those with high neuroticism. That segregation breeds prejudice has long been demonstrated by Sociologists. It should therefore be no surprise for us to learn that the old fashioned concept of segregating mental patients in separate institutions breeds prejudicial attitudes in General Hospital nurses. We should note however, that although surveys have shown us that there are psychiatric patients in every General Medical ward (Marriot, 1968) the nurses who care for these patients may continue to hold antipathetic attitudes to them unless their experience is coupled with adequate training. A finding of importance is the danger of negative attitudes created by seeing patients in bad settings such as the now obsolete Observation ward at the Trinidad Hospital (AU)