Application of the SRQ20 and the protocol of psychological assessment in patients with leprosy in a Reference Centre in Brazil.

This study aims to apply the protocol of psychological assessment (PAP) and the SRQ-20 to analyse the psychological profile of 130 leprosy patients, in order to evaluate the incidence of Common Mental Disorders (CMD), and screen patients with higher risk of psychological distress. The following results were found in the PAP: 31.53%, 23.8% and 16.9% reported an unsatisfactory childhood, adolescence and adulthood, respectively; 31.53% are afraid of being discriminated against and 16.9% experienced discrimination. Also, 13.07% reported drastic life changes due to leprosy; 29.23% have low self-esteem, 31.53% have real fear and 22.3% have phantasmal fear. In the SRQ-20, the prevalence of CMDs was 32.3%, with the majority being female, married, with low education (primary education), low self-esteem, and with a drastic change in life. Conclusion: This is one of the few studies on the psychological profile of leprosy patients demonstrating the importance of the application of investigative technologies in psychopathological screening, aiming on adherence to treatment and psychotherapy planning. Furthermore, it provides support for reflection on the integrality of healthcare for leprosy patients and the importance of psychologists in health teams.

Gaining a comprehensive understanding of pruritus.

Pruritus is a common symptom associated with many dermatoses, systemic abnormalities, and psychiatric / psychosomatic diseases. Additionally, pruritus is one of the most intractable symptoms due to its complex pathogenesis involving an increasing number of mediators and receptors, undefined neurophysiologic pathways, unclear cerebral processing, and psychophysiology interaction. Clinically, the first challenge of dermatologists is how to get general and interdisciplinary vision of pruritus and to preliminarily figure it out whether there might be underlying systemic or psychosocial disorders. The second challenge is to select efficient individual tailored anti-pruritic treatment, which includes targeted drugs and cognitive-behavioral therapy.

Evaluation of psychodynamic psychotherapy in a community mental health center.

This study describes an evaluation of the effectiveness of psychodynamic psychotherapy provided in an outpatient community mental health clinic. The study used a single group pretest-posttest design involving 78 clients. Clinical outcomes included overall psychosocial functioning and quality of life, level of subjective distress, interpersonal functioning and role functioning, measured by the Outcome Questionnaire (Lambert, Hansen, Umpress, Lunnen Okilshi, & Burlingame, 2000). Clients showed statistically significant improvement from pretest (first sessions) to completion of treatment in overall functioning, and quality of life, level of subjective distress, interpersonal functioning and role functioning. Eighty-five percent of clients made statistically and clinically significant change. Calculation of effect sizes for each outcome found moderate to strong change effects ranging from d = .4 to .9. The study illustrates a method of intervention research that therapists and agencies can use to integrate practical evaluation methods into their clinical services in order to improve mental health service to clients, to demonstrate the effectiveness of interventions, and to provide data to support coverage for needed services for clients.

Screening for mental disorders in leprosy patients: comparing the internal consistency and screening properties of HADS and GHQ-12.

OBJECTIVE: The aim of the study was to investigate the internal consistency and screening properties of the General Health Questionnaire-12 (GHQ-12) and the Hospital Anxiety and Depression Scale (HADS) in Turkish patients with leprosy. METHODS: The two screening instruments and a fully structured diagnostic interview (CIDI) were administered to 65 people drawn from all leprosy inpatient units in Turkey between March and June of 2001. The scales were evaluated using Cronbach's alpha and Receiver Operating Characteristics (ROC) analyses. For each scale, criterion validity was assessed for any psychiatric disorder, depressive disorder and anxiety disorder. RESULTS: The Cronbach alpha coefficients for the GHQ-12 and HADS were 0.84 and 0.81 respectively. For detecting any psychiatric disorder, the optimal cut-off for the GHQ-12 was 4/5 (sensitivity 0.82, specificity 0.62). The optimal cut-off for the HADS total score was 12/13 (sensitivity 0.80, specificity 0.77). CONCLUSION: The results indicate that the General Health Questionnaire-12 and Hospital Anxiety and Depression Scale have satisfactory internal consistency, and performed well to a similar extent for detecting psychiatric disorders in leprosy patients.

Improving physical health care in a mental health trust.

It is a challenge both to general medicine and psychiatry to develop systems that are better equipped to meet the physical health needs of mental health patients and reduce mortality rates (Hansen et al, 1997). Central and North West London Mental Health NHS Trust is establishing a department of physical health care staffed by nurses with general nursing backgrounds to tackle this problem. This nurse-led department is designed to train nurses and doctors in key aspects of physical health assessment and treatment interventions.

[Acute psychogenic disorders in lepers]. / Ostrye psikhogennye narusheniia u bol'nykh leproi.

The authors carried out clinical follow-up and psychological examinations of 40 patients suffering from leprosy and treated at the Astrakhan Institute for Leprosy Research. Under study there were acute psychogenic reactions arising in the patients on diagnosing the disease and putting them to the leprosery. Clinical variants of adequate situational reactions (21 patients) and anomalous neurotic and psychopathic ones (19 patients) are described. These reactions were found to depend on the premorbid characteristics of the patient's personality and influence the subsequent course of the underlying disease.