Social Distance in COVID-19: Drawing the line between protective behavior and stigma manifestation.

Social stigma has long been defined by Ervin Goffman as an attribute that it is deeply discrediting and reduces the individual who bears it from a whole and usual person to a tarnished one, unfit to be included into the mainstream society.1 As stigma spans time and space and has been documented in other social species such as ants and chimpanzees, one might argue for its adaptive potential. Neuberg and colleagues2 have suggested that humans generate stigmas against threats to effective group functioning, with a notable case being infectious diseases. A similar explanation has been put forward by other researchers who consider stigma to have evolved from disease-avoidance mechanisms.3 Hence, it is not surprising that tuberculosis, HIV and leprosy have been surrounded by stigma and discrimination.4,5 More recently, people who had survived the 2013-2016 Ebola outbreak tackled social exclusion and unemployment after returning to their neighborhoods.6 Nowadays, the global community faces an unprecedented challenge of grappling with the COVID-19 pandemic. From the very outset, social distance measures were introduced in order to contain the spread of the virus, ranging from maintaining 1.5 meters physical distance to strict lockdowns. However, this may easily escalate into stigmatizing and discriminatory behaviours (desired social distance is a proxy of discrimination) against people who have suffered from COVID-19, their relatives and their caregivers, with the United Nations stating that "fear, rumours and stigma" are the key challenges surrounding COVID-19.7 Apart from the psychological distress experienced by the stigmatized individuals, due to anticipated stigma people might start concealing their illness, avoid or delay seeking medical advice or testing until they are seriously ill and be reluctant to collaborate with authorities on tracing contacts. Therefore, timely identifying stigma and addressing it is an integral part of an effective health response to the ongoing pandemic. In spite of its importance, research on COVID-19 related stigma is scarce. From the perspective of the stigmatized individuals, a study in China8 demonstrated that COVID-19 survivors faced heightened levels of overall stigma, social rejection, financial insecurity, internalized shame and social isolation, compared to healthy controls. From the perspective of the general population, a study in US9 substantiated low levels of anticipated stigma and stereotype endorsement; however, respondents who anticipated greater stigma were less likely to seek a COVID-19 test. It is therefore clear that the international literature is still on its infancy with respect to COVID-19 related stigma. In this context, in the First Department of Psychiatry, University of Athens, we conducted a survey on public attitudes to COVID-19 and to mental disorders. The study would inform the design and implementation of anti-stigma initiatives, funded by the Regional Governor of Attica. As physical distancing and social distancing are interwoven, with some researchers and practitioners using the terms interchangeably, and social distancing is also a protective public health measure against COVID-19, we enquired about attitudes and desired social distance from people who had recovered from COVID-19. Nonetheless, it merits noting that evidence from other diseases indicates that stigma may persist even after recovery.10 Moreover, rather than describing public attitudes overall, we were more interested in investigating where COVID-19 related stigma stands as compared to the most stigmatizing health condition to date, i.e., severe mental illness.11 Interestingly enough, which elements of severe mental illness render it the most stigmatized as compared to other conditions is still speculative: is it the fear of madness? the severity and the type of symptoms? the purported incurability or its chronicity? In our study, evidence from a convenience sample of 370 residents of Attica indicates that the general population holds more negative attitudes towards people who have recovered from COVID-19 than towards people with mental disorders. Nonetheless, respondents reported lower levels of desired social distance from recovered COVID-19 cases as compared to mental illness cases in social interactions of graded intimacy; however, the difference between the two groups was found to decrease as the level of intimacy decreased as well. In other words, desired social distance from COVID-19 cases is more easily discernible in transient social encounters, like talking to a stranger. It is therefore clear that social distance is still a public health protective measure rather than a stigma manifestation. For social encounters of greater intimacy, usually a sign of discriminatory behaviours, having recovered from COVID-19 is not a deterrent to interaction. Findings can be explained by the acute (non-chronic) nature of the disease, both in terms of symptoms as well as the 10-day period since symptom onset for being contagious. Nonetheless, with emerging evidence substantiating the notion of long COVID-19, defined as the persistence of symptoms for 3 weeks after infection,12 this might quickly change. Moreover, with many public health protective measures available, such as the use of mask, diagnostic testing and vaccination, people who become infected are more likely to be blamed for contracting the disease and thus deemed responsible for this, in line with the Attribution Theory.13 Specifically, overarching evidence from stigma research in many diseases/conditions indicates that when an illness or a social condition, such as economic disadvantage, is attributed to internal causes, as compared to external, lay people are more likely to hold stigmatizing attitudes.14-16 Therefore, as attitudes towards COVID-19 are worse compared to those towards people with mental illness, if tailored anti-stigma action is not undertaken, it is only a matter of time for prejudices to evolve into discriminatory behaviours, with devastating consequences on both the individuals and the course of the pandemic. Concomitantly, as severe mental illness is neither life threatening nor contagious, but COVID-19 is, it is interesting to explore how stigma is related to evolutionary mechanisms favouring adaptability and survival as well as which elements are the drivers of stigma development and establishment. Therefore, comparing and contrasting the stigma surrounding these conditions may shed light on the underpinnings of social stigma and facilitate effective interventions to reduce it and eventually eliminate it.

Activity limitations in leprosy and their association to cognition and neuropsychiatric symptoms.

OBJECTIVES: to analyze activity limitations in patients with leprosy and their association to cognition and neuropsychiatric symptoms. METHODS: this cross-sectional design study included sixty patients with multibacillary leprosy assisted at a reference center. Participants were divided according to their physical disability and submitted to instruments assessing daily activities (basic and instrumental), cognitive functions, and neuropsychiatric symptoms. The order of the instruments was random to avoid any interference of test sequence on the results. RESULTS: fifty-five percent of the participants presented physical disabilities. All patients were independent in performing basic activities but sixty-six percent presented difficulties in performing instrumental activities. Cognitive decline and neuropsychiatric symptoms were seen in advanced stages of the disease, but they were more associated to patient age than to leprosy. CONCLUSIONS: leprosy patients presented physical disabilities and difficulties in performing instrumental daily activities. Cognitive decline and neuropsychiatric symptoms were more associated to aging than to leprosy itself.

Activity limitations in leprosy and their association to cognition and neuropsychiatric symptoms / Limitaciones de tarea en la enfermedad de Hansen y su relación con cognición y síntomas neuropsiquiátricos / Limitações de tarefa na hanseníase e sua associação com cognição e sintomas neuropsiquiátricos

ABSTRACT Objectives: to analyze activity limitations in patients with leprosy and their association to cognition and neuropsychiatric symptoms. Methods: this cross-sectional design study included sixty patients with multibacillary leprosy assisted at a reference center. Participants were divided according to their physical disability and submitted to instruments assessing daily activities (basic and instrumental), cognitive functions, and neuropsychiatric symptoms. The order of the instruments was random to avoid any interference of test sequence on the results. Results: fifty-five percent of the participants presented physical disabilities. All patients were independent in performing basic activities but sixty-six percent presented difficulties in performing instrumental activities. Cognitive decline and neuropsychiatric symptoms were seen in advanced stages of the disease, but they were more associated to patient age than to leprosy. Conclusions: leprosy patients presented physical disabilities and difficulties in performing instrumental daily activities. Cognitive decline and neuropsychiatric symptoms were more associated to aging than to leprosy itself.

RESUMEN Objetivo: analizar limitaciones de tarea en pacientes con Lepra y su relación con cognición y síntomas neuropsiquiátricos. Métodos: este estudio transversal incluyó 60 pacientes con Lepra multibacilar atendidos en centro de referencia. Participantes fueron divididos segundo la disfunción física y evaluados cuanto a las actividades diarias (básicas y instrumentales), funciones cognitivas y síntomas neuropsiquiátricos. Orden de aplicación de los instrumentos aleatoria para evitar interferencia de la secuencia de tests sobre los resultados. Resultados: de los participantes, 55% presentaron disfunción física. Todos pacientes eran independientes en las actividades básicas, pero 66% mostraron dificultades en las actividades instrumentales. Declive cognitivo y síntomas neuropsiquiátricos fueron observados en etapas avanzadas de la enfermedad, pero estos estaban más relacionados a la edad del paciente que a la Lepra. Conclusiones: pacientes con Lepra evidenciaron disfunción física y dificultades en las actividades instrumentales. Declive cognitivo y síntomas neuropsiquiátricos están más relacionados al envejecimiento que a la Lepra.

RESUMO Objetivo: analisar as limitações de tarefa em pacientes com hanseníase e sua associação com cognição e sintomas neuropsiquiátricos. Métodos: este estudo transversal incluiu 60 pacientes com hanseníase multibacilar atendidos em um centro de referência. Os participantes foram divididos segundo a disfunção física e avaliados quanto às atividades diárias (básicas e instrumentais), às funções cognitivas e aos sintomas neuropsiquiátricos. A ordem de aplicação dos instrumentos foi aleatória para evitar interferência da sequência dos testes sobre os resultados. Resultados: dos participantes, 55% apresentaram disfunção física. Todos os pacientes eram independentes nas atividades básicas, mas 66% mostraram dificuldades nas atividades instrumentais. Declínio cognitivo e sintomas neuropsiquiátricos foram observados em estágios avançados da doença, porém estes estavam mais associados à idade do paciente do que à hanseníase. Conclusões: pacientes com hanseníase evidenciaram disfunção física e dificuldades nas atividades diárias instrumentais. Declínio cognitivo e sintomas neuropsiquiátricos estão mais associados ao envelhecimento do que à hanseníase.

Common mental disorders and associated factors among people with leprosy: cross-sectional analysis in Cuiabá, Brazil, 2018. / Transtornos mentais comuns e fatores associados entre pessoas com hanseníase: análise transversal em Cuiabá, 2018.

OBJECTIVE: To analyze the occurrence of common mental disorders (CMDs) and associated factors in people with leprosy with complications in the state of Mato Grosso, Brazil, in 2018. METHODS: This was a cross-sectional study with people attending Júlio Müller University Hospital. The Self-Report-Questionnaire (SRQ-20) was used. Poisson regression analysis was performed to estimate prevalence ratios (PR) and 95% confidence intervals (95%CI). RESULTS: Among 206 people with leprosy, CMDs were found in 70.4% (95%CI 61.10;76.67) and were associated with the female sex (PR=1.29 - 95%CI 1.09;1.53), the 26-45 age range (PR=1.52 - 95%CI 1.09;2.11) and the 46-60 age range (PR=1.40 - 95%CI 1.01;1.95), low family income (PR=1.25 - 95%CI 1.05;1.49), and unsatisfactory quality of life in the physical domain (PR=3.03 - 95%CI 1.12;8.19) and the psychological domain (PR=1.91; 95%CI 1.40;2.61). CONCLUSION: CMDs were frequent and associated with female sex, productive age group, low income and unsatisfactory quality of life. Actions aimed at mental health in this population group are necessary.

Transtornos mentais comuns e fatores associados entre pessoas com hanseníase: análise transversal em Cuiabá, 2018 / Trastornos mentales comunes y factores asociados entre las personas con lepra: análisis transversal en Cuiabá, Brasil, 2018 / Common mental disorders and associated factors among people with leprosy: cross-sectional analysis in Cuiabá, Brazil, 2018

Objetivo: Analisar a ocorrência e fatores associados aos transtornos mentais comuns (TMCs) em pessoas com hanseníase com intercorrências no estado de Mato Grosso, Brasil, em 2018. Métodos: Estudo transversal com pessoas atendidas no Hospital Universitário Júlio Müller. Aplicou o self-report-questionnaire (SRQ-20). Empregou-se regressão de Poisson para estimar razões de prevalências (RP) e intervalos de confiança de 95% (IC 95% ). Resultados: Entre 206 pessoas com hanseníase, TMCs estiveram presentes em 70,4% (IC 95% 61,10;76,67), associada ao sexo feminino (RP=1,29 - IC 95% 1,09;1,53), faixas etárias de 26-45 anos (RP=1,52 - IC 95% 1,09;2,11) e 46-60 anos (RP=1,40 - IC 95% 1,01;1,95), baixa renda familiar (RP=1,25 - IC 95% 1,05;1,49) e qualidade de vida insatisfatória nos domínios físico (RP=3,03 - IC 95% 1,12;8,19) e psicológico (RP=1,91 - IC 95% 1,40;2,61). Conclusão: Os TMCs foram frequentes e associados ao sexo feminino, faixa etária produtiva, baixa renda e qualidade de vida insatisfatória. Ações voltadas para a saúde mental nesse grupo populacional são necessárias.

Objetivo: Analizar el aparecimiento y los factores asociados s los trastornos mentales comunes (TMCs) en personas con lepra con complicaciones en Mato Grosso, Brasil, en 2018. Métodos: Estudio transversal con personas atendidas en el Hospital Universitario Júlio Müller. El TMCs fue evaluado por Self-Report-Questionnaire (SRQ-20). Se realizó un análisis con la regresión de Poisson para estimar razones de prevalencia (RP) e intervalos de confianza del 95% (IC 95%). Resultados: Entre 206 personas con lepra, los TMCs sucedieron en 70,4% (IC 95% 61,10;76,67) asociados al sexo femenino (RP=1,29 - IC 95% 1,09;1,53), grupos de edad de 26-45 años (RP=1,52 - IC 95% 1,01;1,95) y 46-60 años (RP=1,40 - IC 95% 1,01;1,95), baja renta familiar (RP=1,25 - IC 95% 1,05;1,49), y calidad de vida insatisfactoria en los dominios físico (RP=3,03 - IC 95% 1,12;8,19) y psicológico (RP=1,91 - IC 95% 1,40;2,61). Conclusión: Los TCM en personas con lepra fueron frecuentes y asociados al sexo femenino, a edad productiva, bajos ingresos y calidad de vida insatisfactoria. Se hacen necesarias las acciones dirigidas a la salud mental en este grupo de la población.

Objective: To analyze the occurrence of common mental disorders (CMDs) and associated factors in people with leprosy with complications in the state of Mato Grosso, Brazil, in 2018. Methods: This was a cross-sectional study with people attending Júlio Müller University Hospital. The Self-Report-Questionnaire (SRQ-20) was used. Poisson regression analysis was performed to estimate prevalence ratios (PR) and 95% confidence intervals (95%CI). Results: Among 206 people with leprosy, CMDs were found in 70.4% (95%CI 61.10;76.67) and were associated with the female sex (PR=1.29 - 95%CI 1.09;1.53), the 26-45 age range (PR=1.52 - 95%CI 1.09;2.11) and the 46-60 age range (PR=1.40 - 95%CI 1.01;1.95), low family income (PR=1.25 - 95%CI 1.05;1.49), and unsatisfactory quality of life in the physical domain (PR=3.03 - 95%CI 1.12;8.19) and the psychological domain (PR=1.91; 95%CI 1.40;2.61). Conclusion: CMDs were frequent and associated with female sex, productive age group, low income and unsatisfactory quality of life. Actions aimed at mental health in this population group are necessary.

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.

Mental disorders in leprosy: an underdiagnosed and untreated population.

OBJECTIVE: To describe the frequency of psychiatric comorbidities in leprosy patients and check if they had been previously diagnosed and were in psychiatric care. METHOD: The study was conducted with a sample of 120 leprosy patients being treated at two reference hospitals for leprosy in Salvador, Bahia, Brazil. Survey participants were more than 18 years of age, had a confirmed diagnosis of leprosy and was undergoing antimicrobial treatment. Patients were evaluated face-to-face with a socio-demographic questionnaire and the Mini-International Neuropsychiatric Interview (MINI-Plus) in Portuguese. The period of data collection was between October 2009 and June 2012. RESULTS: The assessment using the MINI-Plus showed that 34 (28.3%) patients did not receive any psychiatric diagnosis and 86 (71.7%) met the criteria for at least one. Of these 86 patients, 25 (20.8%) had one diagnosis, 26 (21.7%) had two diagnoses and the rest, 35 (29.2%), had three or more psychiatric diagnoses. All patients with a moderate or high risk of suicide had one or more psychiatric comorbidities. CONCLUSION: Leprosy patients have a high prevalence of psychiatric comorbidities. Furthermore, most of them had no previous psychiatric diagnosis and the majority was not undergoing treatment.

Comorbidities in psoriasis.

Moderate to severe psoriasis is associated with concomitant diseases that may have a significant impact on patients. It is necessary for the treating physician to recognize these concomitant diseases, known as comorbidities, early as they influence the management options. Important comorbidities are psoriatic arthritis, metabolic syndrome, Crohn's disease, depression, and cancer. Patients with severe psoriasis may be at an increased risk for myocardial infarction and this subgroup of patients tends to have a reduced life expectancy. The presence of co-morbid diseases is associated with an increase in concomitant medication, some of which may worsen psoriasis; conversely, systemic treatment of psoriasis with certain drugs may impact the co-morbid conditions. As dermatologists are the primary health-care providers for psoriasis, adequate knowledge of comorbidities helps in choosing the appropriate therapy as well as timely intervention.

Psychodermatology: a comprehensive review.

Psychodermatology is an interesting domain of dermatology that overlaps with psychiatry. This arena in dermatology has received limited diligence, partly due to lack of training in this realm. We present here a comprehensive review of salient features and treatment updates in primary psychiatric dermatoses and have also discussed the role of psyche in psychophysiological cutaneous disorders. Secondary psychiatric morbidity is relatively common among patients visiting the dermatologists but often overlooked and uncared for. Dermatologist should be able to initiate basic pharmacotherapy, should be knowledgeable about various non-pharmacological treatments and know the right time to refer the patient to the psychiatrist. Awareness and pertinent treatment of psychodermatological disorders among dermatologists will lead to a more holistic treatment approach and better prognosis in this unique group of patients.

Neuropathic pain and psychological morbidity in patients with treated leprosy: a cross-sectional prevalence study in Mumbai.

BACKGROUND: Neuropathic pain has been little studied in leprosy. We assessed the prevalence and clinical characteristics of neuropathic pain and the validity of the Douleur Neuropathique 4 questionnaire as a screening tool for neuropathic pain in patients with treated leprosy. The association of neuropathic pain with psychological morbidity was also evaluated. METHODOLOGY/PRINCIPAL FINDINGS: Adult patients who had completed multi-drug therapy for leprosy were recruited from several Bombay Leprosy Project clinics. Clinical neurological examination, assessment of leprosy affected skin and nerves and pain evaluation were performed for all patients. Patients completed the Douleur Neuropathique 4 and the 12-item General Health Questionnaire to identify neuropathic pain and psychological morbidity. CONCLUSIONS/SIGNIFICANCE: One hundred and one patients were recruited, and 22 (21.8%) had neuropathic pain. The main sensory symptoms were numbness (86.4%), tingling (68.2%), hypoesthesia to touch (81.2%) and pinprick (72.7%). Neuropathic pain was associated with nerve enlargement and tenderness, painful skin lesions and with psychological morbidity. The Douleur Neuropathique 4 had a sensitivity of 100% and specificity of 92% in diagnosing neuropathic pain. The Douleur Neuropathique 4 is a simple tool for the screening of neuropathic pain in leprosy patients. Psychological morbidity was detected in 15% of the patients and 41% of the patients with neuropathic pain had psychological morbidity.

A process report on physical and psychological determiners of social functioning in leprosy patients.

Management and rehabilitation of leprosy patients needs information aoout the social acceptance and its association with physical and psychological problems of the affected person. Ninety three leprosy patients (72 male and 21 female) were selected from outpatient department of the hospitals/clinics and their demographic and clinical informations were recorded. The patients were screened for common menta diseases using GHQ-60 (Bengali version). The social functioning was assessed using SSFI. Mean age was 35.19 +/- 12.5 years, 69.9% of the subjects were from urban areas. Multibacillary cases accounted for 60.2% of the cases, 21.5% of the patients had deformity, 53.8% of the patients screened positive for common psychiatric diseases. Social functioning impairment of mild, moderate and severe level was 9.7%, 82.8, and 7.5% respectively. On Univariate analysis, presence of deformity was the only variable showing significant association with moderate to severe degree of social impairment. Using decision tree (Exhaustive CHAID) analysis, presence of deformity along with urban residence was strongly predicted severe social functioning impairment. The results of the study show the need to formulate suitable psychosocial intervention strategy especially in the context of high psychiatric morbidity.

A case control study of psychiatric morbidities among subjects with leprosy in Lagos, Nigeria.

OBJECTIVES: To determine the pattern of psychiatric morbidity prevalent among leprosy patients and to compare it with two control groups; those suffering from Tinea vesicolor and Normal subjects. DESIGN: Eighty-eight leprosy patients were matched for age and sex with those suffering from Tinea vesicolor as well as normal subjects. The subjects were assessed for psychiatric morbidity through a clinical interview with PSE-9. RESULTS: The prevalence of psychiatric morbidity among leprosy patients (580/1000) was significantly more than those with tinea vesicolor patients (182/1000) and normal subjects (148/1000) (p < 0.05). Depressive illness was the most common diagnosis in the three groups. CONCLUSIONS: Leprosy patients are more likely to manifest with psychiatric illness than those suffering from Tinea vesicolor and normal subjects.

Psychiatric morbidity among leprosy patients in Teso and Busia districts of Western Kenya.

OBJECTIVE: To establish the magnitude of psychiatric disorders among leprosy patients in western Kenya. DESIGN: A cross-sectional descriptive study. SETTING: Busia and Teso districts in western Kenya. SUBJECTS: A sample of 152 male and female, adult leprosy patients. RESULTS: The prevalence of psychiatric morbidity (PM) was 53.29%. The PM was positively correlated with physical disability and marital status but not with age, sex, education, type of leprosy, or duration of the illness. The prevalence of psychiatric morbidity was lower among Kenyan leprosy patients compared to studies carried out in India (56% to 78%). It was high compared to the rate of psychiatric morbidity in those seeking medical help in primary health care centres in Kenya, which was recently estimated to be 10%. CONCLUSION: The prevalence of PM in leprosy patients in western Kenya was lower than that in studies carried out in India. This could be attributed to de-institutionalisation and re-integration of leprosy sufferers back into their local communities. Since the rate was more than double that in the general Kenyan population and seemed to be related to presence of physical disability, an appraisal of psychiatric services offered to these patients is needed.

Prevalence of mental distress in the outpatient clinic of a specialized leprosy hospital. Addis Ababa, Ethiopia, 2002.

Leprosy is a chronic disease that leads to physical disability as a result of nerve damage. Stigma and associated psychosocial problems are common and may increase the risk of mental disorders. This study was conducted to estimate the prevalence of mental distress amongst people attending a Specialized Leprosy and Dermatology Hospital, ALERT, Addis Ababa. Alternate patients from the daily register of outpatients were interviewed for symptoms of mental distress using the Self Reporting Questionnaire (SRQ). This questionnaire was administered by two specially trained nurses. The study population consisted of 786 people. Of these, 60% had leprosy and the remainder had other skin diseases. The sex distribution of the study population was approximately equal. The overall prevalence of mental distress was found to be 34.6%. Among people with leprosy the prevalence was 52.4%, compared with 7.9% in those with other skin conditions. This represented a 7-fold increased risk of mental distress in people with leprosy, adjusted OR = 7.14 (95% CI; 4.15, 12.35). Physical disability was also strongly associated with mental distress. This study showed that the 1-month prevalence of mental distress was significantly higher in patients with leprosy compared to patients with other dermatological conditions. Such a study allows identification of non-specific mental distress. Thus, future work should be directed at further characterizing the nature and severity of mental disorder in this group. However, our study has indicated a need for the integration of psychosocial care into our current medical treatment of patients with leprosy.

Psychiatric morbidity in displaced leprosy patients.

One hundred confirmed leprosy patients, all of them migrated from elsewhere, were examined for psychiatric co-morbidity. Forty-six of them were from an 'ashram' and the others were from a slum area. 76% of the patients were found to be having psychiatric illness. Of these, 55% were having neurotic depression and 21% had anxiety neurosis. Single, unemployed, socio-economically backward and patients with physical deformities were suffering significantly more often with psychiatric symptoms. Psychiatric morbidity was found to be more frequent in the patients staying in slum than in those in the 'ashram' where they had some security.

[Community health and national sanatoria for Hansen's disease in Japan--survey of receipts of National health insurance].

National sanatoria for Hansen's disease in Japan were special institutions that only treated in-patients. But a few sanatoria for Hansen's disease located in islands and rural districts should have other duty, namely service to community health because there was no other clinic office. New patients with Hansen's disease are very small in number and inpatients become older and older. Then the new role should be seeked to National sanatoria for Hansen's disease in Japan. Amami-wakoen, National sanatorium for Hansen's disease in Amami island started skin clinic for out-patients with skin diseases in March, 1983 because there were few skin clinics in Amami district. The number of patients with skin diseases increases year by year (from 12.3 persons every day in 1983 to 36.4 in 1989). We surveyed receipts of National health insurance for the purpose of studying the main diseases in Amami main island and the behavior of the patients with skin diseases. The results of survey are followings; 1. The percentage of patients with skin diseases in Amami main island in August, 1987 was significantly superior. 2. The percentage of patients with mental diseases and pregnant woman in hospital and patients with gastrointestinal disorders and pregnant women in clinic were significantly large in May, 1987 in Amami main island. 3. There was a tendency that the patients with skin diseases visited to the clinic near in place. It was found that we treated only 5.1 percent persons of patients with skin diseases in August, 1987.

Psychiatric disturbances among leprosy patients. An epidemiological study.

An epidemiological study was done to determine the prevalence of psychiatric disturbances among leprosy patients. Using a stratified random sampling technique, 540 subjects with leprosy were selected from a total population of 5745 leprosy patients. A mental health evaluation was conducted on 494 of these subjects. Forty-nine of these patients were found to have a psychiatric disturbance, giving a prevalence rate of about 99 per 1000. Depressive reaction was the most common disturbance seen. Those patients who were sick for a longer time and those who developed physical deformities were found to be more prone to get psychiatric disturbances. It is emphasized that supportive psychotherapy is important in the management and rehabilitation of leprosy patients.