Prevalence, service use and clinical correlates of hallucinations and delusions in an out-patient population from India.

BACKGROUND: Despite the persistent public health problem of positive psychotic symptoms, understanding of symptom specific prevalence rates, clinical correlates and service utilisation are sparse. AIMS: The current study aimed to establish prevalence, clinical and service utilisation correlates of hallucinations and delusions in people accessing outpatient clinics in Tamil Nadu, India. METHODS: Secondary patient data from outpatient clinics, over a 12-month period, in 2016, was used for analysis (N = 917). Based on the presence of positive psychotic symptoms (PPSx), the sample was divided into four groups for analysis- hallucinations-only (H), delusions-only (D), both hallucinations and delusions (HD) and neither PPSx (N-PPSx). RESULTS: Findings indicate that the most prevalent PPSx were hallucinations (10.7%) however, barriers to service utilisation and clinical correlates were associated predominantly with the D and the HD group; as was severe work impairment. Yet, this group was most likely to remain with psychiatric services. Lastly, diagnostic challenges were apparent within the sample. CONCLUSIONS: The study revealed that despite more barriers to service utilisation, persons with PPSx remain in contact with services. Yet prognosis remains only moderate at best, indicating other mediating and underlying factors impeding recovery may be interplaying and, therefore, a need for enhanced biopsychosocial approaches.

Adapting the Trauma History Questionnaire for use in a population of homeless people with severe mental illness in Tamil Nadu, India: qualitative study.

BACKGROUND: The Trauma History Questionnaire (THQ) is one of the most widely used traumatic event inventories, but its lack of validation makes it unsuitable for the millions of homeless people with severe mental illness in India, who are particularly vulnerable to trauma exposure. AIMS: To translate and culturally adapt the THQ for use in a population of homeless people with severe mental illness in Tamil Nadu, India. METHOD: We used Herdman et al's model of cultural equivalence to conduct an in-depth qualitative assessment of the cultural validity of the THQ. Following several translations, conceptual, item, semantic and operational equivalence of the THQ was assessed through four focus groups with user-survivors (n = 20) and two focus groups with mental health professionals (n = 11). RESULTS: Several adaptations, including the addition of 18 items about relationships, homelessness and mental illness, were necessary to improve cultural validity. Three items, such as rape, were removed for reasons of irrelevance or cultural insensitivity. Items like 'adultery' and 'mental illness' were reworded to 'extramarital affair' and 'mental health problem', respectively, to capture the cultural nuances of the Tamil language. Findings revealed a divergence in views on tool acceptability between user-survivors, who felt empowered to voice their experiences, and mental health professionals, who were concerned for patient well-being. Providing a sense of pride and autonomy, user-survivors preferred self-administration, whereas mental health professionals preferred rater administration. CONCLUSIONS: Culture significantly affects what types of events are considered traumatic, highlighting the importance of cultural validation of instruments for use in novel populations and settings.

"If somebody could just understand what I am going through, it would make all the difference": Conceptualizations of trauma in homeless populations experiencing severe mental illness.

Exposure to violence, vulnerability due to lack of shelter, alienation due to stigma, the experiences of severe mental illness (SMI) and subsequent institutionalization, make homeless persons with SMI uniquely susceptible to trauma exposure and subsequent mental health consequences. This study aims to contribute to the development of culturally sensitive interventions for identifying and treating trauma in a population of homeless persons with SMI in Tamil Nadu, India by understanding the manifestations of trauma and its associated consequences in this population. Free-listing exercises followed by in-depth interviews were conducted with a convenience sample of 26 user-survivors who have experienced homelessness or were at risk of homelessness, and suffered from SMI. Topics explored included events considered to be traumatic, pathways to trauma, associated emotional, physical and social complaints, and coping strategies. Results indicate discrepancies in classification of traumatic events between user-survivors and the Diagnostic and Statistical Manual of Mental Disorders. Traumatic experiences, particularly relating to social relationships and poverty, mentioned by user-survivors did not match traditional conceptualizations of trauma. Positive coping strategies for trauma included being mentally strong, knowledge and awareness, whereas the main negative coping strategy is avoidance. User-survivors attributed their experiences of homelessness and SMI to past traumas. Differing views of trauma between user-survivors and mental health professionals can lead to misdiagnosis and under-recognition of trauma in this population of homeless persons with SMI.

Reliving, Replaying Lived Experiences Through Auditory Verbal Hallucinations: Implications on Theories and Management.

Objective: This study aims to understand the impact of negative life experience (NLE) in auditory hallucinations (AHs) and explain the heterogeneity in phenomenology of auditory verbal hallucinations (AVHs). Method: In depth interviews were conducted with 21 individuals (7 males and 14 females) experiencing AHs and accessing mental health treatment services at a not-for-profit organization. Maximum variation purposive sampling technique was used to select the sample to ensure variegation is accounted for and was collected until saturation of themes data was obtained. Results: Various different forms and functions of hallucinations are obtained with an evident pattern that links voices back to the NLE of the individual. Implications for therapeutic methods focusing on distress arising from said NLE is emphasized. Conclusions: The results obtained from this study implicate NLEs as a contributing factor in the development and maintenance of hallucinations. Sociocultural factors act as a catalyst with psychological factors creating distress and contributing to the voice-hearing experience. Treatment strategies must thus focus on content of voices and past experiences of the individual to promote recovery. A model toward conceptualization of the diversity in phenomenology is put forth.

Disruptions to processing of self referential emotional material are associated with positive symptoms of schizotypy.

The current experiment examined emotional processing difficulties related to self referential material in high schizotypal individuals employing the mnemic neglect paradigm. Participants read about behaviors, in reference to themselves, that were either central or peripheral, and positive or negative, before recalling those behaviors. Levels of self reported unusual experiences and cognitive disorganization were associated with reduced recall of central positive behaviors, and increased recall of central negative behaviors. These findings are discussed in terms of emotional processing of stimuli in schizotypy, and suggest that high schizotypal individuals are insensitive to emotional self referential material.