The incidence of psychoses in diverse settings, INTREPID (2): a feasibility study in India, Nigeria, and Trinidad.

BACKGROUND: There are striking global inequities in our knowledge of the incidence, aetiology, and outcome of psychotic disorders. For example, only around 10% of research on incidence of psychotic disorders originates in low- and middle-income countries. We established INTREPID I to develop, implement, and evaluate, in sites in India (Chengalpet), Nigeria (Ibadan), and Trinidad (Tunapuna-Piarco), methods for identifying and recruiting untreated cases of psychosis, as a basis for investigating incidence and, subsequently, risk factors, phenomenology, and outcome. In this paper, we compare case characteristics and incidence rates across the sites. METHOD: In each site, to identify untreated cases of psychoses in defined catchment areas, we established case detection systems comprising mental health services, traditional and spiritual healers, and key informants. RESULTS: Rates of all untreated psychoses were 45.9 (per 1 00 000 person-years) in Chengalpet, 31.2 in Ibadan, and 36.9 in Tunapuna-Piarco. Duration of psychosis prior to detection was substantially longer in Chengalpet (median 232 weeks) than in Ibadan (median 13 weeks) and Tunapuna-Piarco (median 38 weeks). When analyses were restricted to cases with a short duration (i.e. onset within preceding 2 years) only, rates were 15.5 in Chengalpet, 29.1 in Ibadan, and 26.5 in Tunapuna-Piarco. Further, there was evidence of age and sex differences across sites, with an older average age of onset in Chengalpet and higher rates among women in Ibadan. CONCLUSION: Our findings suggest there may be differences in rates of psychoses and in the clinical and demographic profiles of cases across economically and socially distinct settings.

Non-fatal suicidal behaviour: associated factors

OBJECTIVE: To investigate the factors that influence non-fatal suicidal behaviour. DESIGN AND METHODS: A cross sectional study was undertaken and data were collected from a review of medical records of patients in addition to structured interviews with patients using the Columbia Suicide Severity rating scale. RESULTS: The survey findings (n=20) revealed that one-quarter of patients had more than one attempt. More than one third of the patients began having suicidal thoughts years ago (n=9, 45%). Half of the responders had thoughts ranging from twice a week to many times a day and the thoughts lasted from one to four hours a day to most of the day in 60% of responders. Six patients told someone of their plan. While females used the method of overdosing on pills, males tended to drink a poisonous substance or use more lethal means of attempting suicide. From the case note review (n=42), more females (n=31, 74%) attempted suicide compared to males (n=11, 26%). CONCLUSION: These findings suggest there were factors that may highlight at-risk persons e.g. those with past attempts, and those who confide in others about their plans. It appears persons have suicidal thoughts for several years and the majority think about these on most days and these thoughts last at least 1-4 hours a day. There is therefore a role for health education to the public who need to be aware of warning signs and how to handle the situation if they are told about a planned attempt.

Interpersonal trust, homicide and life expectancy: global patterns between 2000-2012

OBJECTIVE: This study investigated whether 1) correlations exist among homicide rates, life expectancy and interpersonal trust among 38 countries between 2000-2012; and (2) whether correlations exist between life expectancy and homicide rates in 14 Caribbean countries between 2000-2012. DESIGN AND METHODS: An ecological study using an aggregated data analysis design was constructed using publicly available data. Interpersonal trust data were gathered from wave 6 (2010-2014) of the world values survey. Life expectancy data (2000-2012) were gathered from the World Bank; homicide rates were provided by the global homicide report published by the United Nations Office on Drugs and Crime (UNODC) in 2013. Data was analyzed in SPSS version 16. RESULTS: Spearman correlation testing indicated that interpersonal trust and homicide rates were significantly correlated (p<.05). Homicide rates and life expectancy were also significantly correlated between the years of 2005-2012 (p<.05). Trust and life expectancy were not significantly correlated. Spearman correlation analysis of homicide and life expectancy in selected Caribbean countries revealed no significant correlation. CONCLUSIONS: The significant correlation between trust and homicide rates suggests that there may be a cultural connection between interpersonal trust and violence at a global level. The consistent correlation between homicide rates and life expectancy between the years of 2005-2012 also implies that population level longevity is detrimentally affected by this connection between interpersonal trust and country level homicide rates. Interpersonal trust presents a potential avenue of public health intervention that may affect rates of crime and increase years of population life expectancy over time.

Child Sexual Abuse and Continuous Influence of Cultural Practices: A Review.

AIM: To provide information on the possible influence of cultural practices in perpetuating child sexual abuse and to examine documented examples of these cultural influences. METHODS: A computer literature search was done of Medline, Science Direct, PSYCInfo, Embase and PubMed for keywords. There were also manual searches in the library of journals that are not accessible online. Keywords for searches included: sexual abuse, child abuse, psychopathology, name of countries (eg Jordan, China and Morocco), culture and cultural practices. RESULTS: There is documented evidence of cultural practices that continue to fuel the persistently high level of child sexual abuse across the globe. The definition has evolved to now include simple genital-genital and non-genital contact such as oral-genital contacts, exhibitionism and pornography. CONCLUSIONS: Cultural practices are no longer restricted to one geographical collection of people due to migratory influence, as these practices may also spread to different groups who intermingle. There are few empirical studies of child sexual abuse in the Caribbean, but one factor that could be used as a proxy is age of first sexual activity. The World Bank reports that this age is youngest in the Caribbean and is likely to be significantly influenced by child sexual abuse.

Modelling the interplay between childhood and adult adversity in pathways to psychosis: initial evidence from the AESOP study.

BACKGROUND: There is evidence that a range of socio-environmental exposures is associated with an increased risk of psychosis. However, despite the fact that such factors probably combine in complex ways to increase risk, the majority of studies have tended to consider each exposure separately. In light of this, we sought to extend previous analyses of data from the AESOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study on childhood and adult markers of disadvantage to examine how they combine to increase risk of psychosis, testing both mediation (path) models and synergistic effects. METHOD: All patients with a first episode of psychosis who made contact with psychiatric services in defined catchment areas in London and Nottingham, UK (n = 390) and a series of community controls (n = 391) were included in the AESOP study. Data relating to clinical and social variables, including parental separation and loss, education and adult disadvantage, were collected from cases and controls. RESULTS: There was evidence that the effect of separation from, but not death of, a parent in childhood on risk of psychosis was partially mediated through subsequent poor educational attainment (no qualifications), adult social disadvantage and, to a lesser degree, low self-esteem. In addition, there was strong evidence that separation from, but not death of, a parent combined synergistically with subsequent disadvantage to increase risk. These effects held for all ethnic groups in the sample. CONCLUSIONS: Exposure to childhood and adult disadvantage may combine in complex ways to push some individuals along a predominantly sociodevelopmental pathway to psychosis.

The prevalence of depressive symptoms in a Trinidadian cardiac population / Prevalencia de síntomas depresivos en una población cardiaca de Trinidad

The current study investigated the prevalence of depressive symptoms in persons with self-reported cardiovascular disease and the interactions of depressive symptoms, reported cardiovascular disease and gender in a Trinidadian population. Between June 2009 and August 2009, 425 participants were recruited from the Eric Williams Medical Sciences Complex (EWMSC) Heart Clinic and all the participants completed the Center for Epidemiologic Studies Depression Scale. Clinical and demographic variables were obtained from the sociodemographic questionnaire. Forty-seven per cent of the self-reported cardiovascular disease participants were identified as having high depressive symptoms as compared to 32% of those who did not report having a cardiovascular illness. The odds ratio indicated that high depressive symptoms are more likely to occur in individuals with reported cardiovascular disease. The Mann-Whitney test revealed females had significantly higher levels of depressive symptoms than males. Previous studies suggest that depression is a risk factor for adverse prognosis in a cardiac population, therefore future research examining the link between depression and cardiovascular disease is warranted.

El presente estudio investigó la prevalencia de síntomas depresivos en personas con enfermedad cardiovascular autoreportadas y las interacciones de los síntomas depresivos, las enfermedades cardiovasculares reportadas y el género en una población de Trinidad y Tobago. Entre junio y agosto de 2009, 425 participantes fueron reclutados de la Clínica Cardiológica del Complejo de Ciencias Médicas Eric Williams (EWMSC), todos los participantes respondieron la Escala de Depresión del Centro de Estadios Epidemiológicos, y se obtuvieron las variables demográficas y clínicas del cuestionario sociodemográfico. Cuarenta y siete por ciento de los participantes con enfermedades cardiovasculares autoreportadas fueron identificados con síntomas depresivos altos en comparación con el 32% de aquellos que no reportaron tener enfermedad cardiovascular. El cociente de probabilidades (OR) indicó que los síntomas depresivos altos tienen mayor probabilidad de ocurrir en individuos con enfermedades cardiovasculares reportadas. La prueba de Mann-Whitney reveló que las hembras presentaban niveles significativamente mayores de síntomas depresivos que los varones. Los estudios previos sugieren que la depresión es un factor de riesgo para un pronóstico adverso en una población cardiaca. Por lo tanto, es un hecho que la investigación futura necesita examinar el vínculo entre depresión y enfermedad cardiovascular.

The prevalence of Type D personality in a Trinidadian cardiac population.

OBJECTIVE: The current study investigated the prevalence of Type D personality in persons with self-reported cardiovascular disease and the interactions of Type D personality, reported cardiovascular disease and gender in a Trinidadian cardiac population. METHODS: Between June 2009 and August 2009, 425 participants were recruited from the Eric Williams Medical Sciences Complex (EWMSC) Heart Clinic and all the participants completed the Type D Scale. Clinical and demographic variables were obtained from the sociodemographic questionnaire. RESULTS: Forty-two per cent of participants with self-reported cardiovascular disease were identified as Type D as compared to 26% of participants who did not report having a cardiovascular illness. The odds ratio indicated individuals identified with Type D personality are 2.0 times more likely to report having cardiovascular disease and females with cardiac disease are 1.6 times more likely to be identified with Type D personality as compared to males. CONCLUSIONS: Previous studies suggest Type D personality is a risk factor for adverse prognosis in the cardiac population, therefore future research examining the link between Type D personality and cardiovascular disease is warranted.

The prevalence of depressive symptoms in a Trinidadian cardiac population.

The current study investigated the prevalence of depressive symptoms in persons with self-reported cardiovascular disease and the interactions of depressive symptoms, reported cardiovascular disease and gender in a Trinidadian population. Between June 2009 and August 2009, 425 participants were recruited from the Eric Williams Medical Sciences Complex (EWMSC) Heart Clinic and all the participants completed the Center for Epidemiologic Studies Depression Scale. Clinical and demographic variables were obtained from the sociodemographic questionnaire. Forty-seven per cent of the self-reported cardiovascular disease participants were identified as having high depressive symptoms as compared to 32% of those who did not report having a cardiovascular illness. The odds ratio indicated that high depressive symptoms are more likely to occur in individuals with reported cardiovascular disease. The Mann-Whitney test revealed females had significantly higher levels of depressive symptoms than males. Previous studies suggest that depression is a risk factor for adverse prognosis in a cardiac population, therefore future research examining the link between depression and cardiovascular disease is warranted.

The prevalence of Type D personality in a Trinidadian cardiac population / Prevalencia de la personalidad de Tipo D en una población cardíaca Trinitense

OBJECTIVE: The current study investigated the prevalence of Type D personality in persons with selfreported cardiovascular disease and the interactions of Type D personality, reported cardiovascular disease and gender in a Trinidadian cardiac population. METHODS: Between June 2009 and August 2009, 425 participants were recruited from the Eric Williams Medical Sciences Complex (EWMSC) Heart Clinic and all the participants completed the Type D Scale. Clinical and demographic variables were obtained from the sociodemographic questionnaire. RESULTS: Forty-two per cent of participants with self-reported cardiovascular disease were identified as Type D as compared to 26% of participants who did not report having a cardiovascular illness. The odds ratio indicated individuals identified with Type D personality are 2.0 times more likely to report having cardiovascular disease and females with cardiac disease are 1.6 times more likely to be identified with Type D personality as compared to males. CONCLUSIONS: Previous studies suggest Type D personality is a risk factor for adverse prognosis in the cardiac population, therefore future research examining the link between Type D personality and cardiovascular disease is warranted.

OBJETIVO: El presente estudio investigó la prevalencia de la personalidad tipo D en personas con enfermedades cardiovasculares autoreportadas, así como las interacciones de la personalidad de tipo D, las enfermedades cardiovasculares reportadas, y el género en una población cardíaca de Trinidad y Tobago. MÉTODOS: Entre junio y agosto de 2009, 425 participantes fueron reclutados de la Clínica Cardiológica del complejo de Ciencias Médicas Eric Williams (EWMSC), y todos los participantes llenaron el cuestionario de la Escala de Tipo D. Las variables demográficas y clínicas fueron obtenidas del cuestionario sociodemográfico. RESULTADOS: Cuarenta y dos por ciento de los participantes con enfermedad cardiovascular autoreportada, fueron identificados como tipo D, en comparación con el 26% de los participantes que no reportó tener una enfermedad cardiovascular. El cociente de probabilidades (odds-ratio) indicó que los individuos identificados con personalidad de tipo D son 2.0 veces más propensos a reportar su enfermedad cardiovascular, y las mujeres con enfermedad cardiaca presentan 1.6 veces más probabilidades de ser identificadas con personalidad tipo D en comparación con los varones. CONCLUSIONES: Estudios previos sugieren que la personalidad de tipo D es un factor de riesgo que apunta a una prognosis adversa en la población cardiaca. Por lo tanto, las investigaciones futuras que examinen el vínculo entre la personalidad de tipo D y las enfermedades cardiovasculares tienen un lugar asegurado.

Caribbean contributions to contemporary psychiatric psychopathology.

The intellectual exploration of phenomenological and psychiatric discovery that has flowered in the Caribbean in the period of political independence from British colonization is a reflection of the scholarship that has emerged from the academic nurturance by The University of the West Indies. Burgeoning migration of Caribbean people to England in the twentieth century has resulted in high reported rates of psychosis for this migrant population. Caribbean research into this condition has revealed that there exist hostile racial and environmental challenges in Britain that have had a profound pathological effect on the mental health of African Caribbean migrants. These findings have significantly shifted the pendulum of understanding of the aetiology of this condition from a genetic to a biopsychosocial position. Research has also revealed longstanding psychopathological effects of slavery and colonialism in the Caribbean that have had significantly negative long term effects on the mental health of many within the Caribbean population. Current research suggests that there is a need to nurture protective strategies to enhance resilience and social capital, which would ensure the wellness and continued survival of Caribbean people in spite of the many challenges they face.

Caribbean contributions to contemporary psychiatric psychopathology / Contribuciones caribeñas a la psicopatología psiquiátrica contemporánea

The intellectual exploration of phenomenological and psychiatric discovery that has flowered in the Caribbean in the period of political independence from British colonization is a reflection of the scholarship that has emerged from the academic nurturance by The University of the West Indies. Burgeoning migration of Caribbean people to England in the twentieth century has resulted in high reported rates of psychosis for this migrant population. Caribbean research into this condition has revealed that there exist hostile racial and environmental challenges in Britain that have had a profound pathological effect on the mental health of African Caribbean migrants. These findings have significantly shifted the pendulum of understanding of the aetiology of this condition from a genetic to a biopsychosocial position. Research has also revealed longstanding psychopathological effects of slavery and colonialism in the Caribbean that have had significantly negative long term effects on the mental health of many within the Caribbean population. Current research suggests that there is a need to nurture protective strategies to enhance resilience and social capital, which would ensure the wellness and continued survival of Caribbean people in spite of the many challenges they face.

La exploración intelectual del descubrimiento fenomenológico y psiquiátrico que ha florecido en el Caribe en el periodo de independencia política de la colonización británica, es un reflejo de la erudición surgida del cultivo académico de la Universidad de West Indies. La pujante migración de personas del Caribe a Inglaterra en el siglo 20, ha traído como consecuencia reportes de altas tasas de psicosis en relación con esta población de emigrantes. La investigación caribeña de esta condición ha revelado la existencia de retos producidos por la hostilidad racial y ambiental en Gran Bretaña, que han tenido un profundo efecto en la salud mental de los emigrantes afrocaribeños. Estos resultados han desplazado significativamente el péndulo de la comprensión de la etiología de esta condición, desde una posición genética a una posición biopsicosocial. La investigación también ha revelado la presencia de efectos psicopatológicos pertinaces provenientes de la esclavitud y el colonialismo en el Caribe. Se trata de efectos significativamente negativos y a largo plazo, sobre la salud mental de muchos dentro de la población caribeña. La investigación actual sugiere que hay una necesidad de fomentar estrategias de protección a fin de mejorar la resiliencia y el capital social, que asegurarían el bienestar y la continuación de la supervivencia de las personas del Caribe, a pesar de los muchos desafíos a que se enfrentan.

Differing patterns of brain structural abnormalities between black and white patients with their first episode of psychosis

BACKGROUND: African-Caribbean and black African people living in the UK are reported to have a higher incidence of diagnosed psychosis compared with white British people. It has been argued that this may be a consequence of misdiagnosis. If this is true they might be less likely to show the patterns of structural brain abnormalities reported in white British patients. The aim of this study therefore was to investigate whether there are differences in the prevalence of structural brain abnormalities in white and black first-episode psychosis patients. METHOD: We obtained dual-echo (proton density/T2-weighted) images from a sample of 75 first-episode psychosis patients and 68 healthy controls. We used high resolution magnetic resonance imaging and voxel-based methods of image analysis. Two separate analyses were conducted: (1) 34 white British patients were compared with 33 white British controls; (2) 41 African-Caribbean and black African patients were compared with 35 African-Caribbean and black African controls. RESULTS: White British patients and African-Caribbean/black African patients had ventricular enlargement and increased lenticular nucleus volume compared with their respective ethnic controls. The African-Caribbean/black African patients also showed reduced global grey matter and increased lingual gyrus grey-matter volume. The white British patients had no regional or global grey-matter loss compared with their normal ethnic counterparts but showed increased grey matter in the left superior temporal lobe and right parahippocampal gyrus. CONCLUSIONS: We found no evidence in support of our hypothesis. Indeed, the finding of reduced global grey-matter volume in the African-Caribbean/black African patients but not in the white British patients was contrary to our prediction.

The varying impact of type, timing and frequency of exposure to childhood adversity on its association with adult psychotic disorder.

BACKGROUND: Childhood adversity has been associated with onset of psychosis in adulthood but these studies have used only general definitions of this environmental risk indicator. Therefore, we sought to explore the prevalence of more specific adverse childhood experiences amongst those with and without psychotic disorders using detailed assessments in a large epidemiological case-control sample (AESOP). METHOD: Data were collected on 182 first-presentation psychosis cases and 246 geographically matched controls in two UK centres. Information relating to the timing and frequency of exposure to different types of childhood adversity (neglect, antipathy, physical and sexual abuse, local authority care, disrupted living arrangements and lack of supportive figure) was obtained using the Childhood Experience of Care and Abuse Questionnaire. RESULTS: Psychosis cases were three times more likely to report severe physical abuse from the mother that commenced prior to 12 years of age, even after adjustment for other significant forms of adversity and demographic confounders. A non-significant trend was also evident for greater prevalence of reported severe maternal antipathy amongst those with psychosis. Associations with maternal neglect and childhood sexual abuse disappeared after adjusting for maternal physical abuse and antipathy. Paternal maltreatment and other forms of adversity were not associated with psychosis nor was there evidence of a dose-response effect. CONCLUSIONS: These findings suggest that only specific adverse childhood experiences are associated with psychotic disorders and only in a minority of cases. If replicated, this greater precision will ensure that research into the mechanisms underlying the pathway from childhood adversity to psychosis is more fruitful.

The social determinants of psychosis in migrant and ethnic minority populations: a public health tragedy.

High rates of schizophrenia and other psychoses have been repeatedly found in migrant populations. However, the development of public health responses has been hindered by unfounded claims that the high rates are an artefact of misdiagnosis. Recent research implicating exposure to social adversity across the life course as the key explanation for these high rates has the potential to inform initiatives to tackle this major public health problem.

Differing patterns of brain structural abnormalities between black and white patients with their first episode of psychosis.

BACKGROUND: African-Caribbean and black African people living in the UK are reported to have a higher incidence of diagnosed psychosis compared with white British people. It has been argued that this may be a consequence of misdiagnosis. If this is true they might be less likely to show the patterns of structural brain abnormalities reported in white British patients. The aim of this study therefore was to investigate whether there are differences in the prevalence of structural brain abnormalities in white and black first-episode psychosis patients. METHOD: We obtained dual-echo (proton density/T2-weighted) images from a sample of 75 first-episode psychosis patients and 68 healthy controls. We used high resolution magnetic resonance imaging and voxel-based methods of image analysis. Two separate analyses were conducted: (1) 34 white British patients were compared with 33 white British controls; (2) 41 African-Caribbean and black African patients were compared with 35 African-Caribbean and black African controls. RESULTS: White British patients and African-Caribbean/black African patients had ventricular enlargement and increased lenticular nucleus volume compared with their respective ethnic controls. The African-Caribbean/black African patients also showed reduced global grey matter and increased lingual gyrus grey-matter volume. The white British patients had no regional or global grey-matter loss compared with their normal ethnic counterparts but showed increased grey matter in the left superior temporal lobe and right parahippocampal gyrus. CONCLUSIONS: We found no evidence in support of our hypothesis. Indeed, the finding of reduced global grey-matter volume in the African-Caribbean/black African patients but not in the white British patients was contrary to our prediction.

Letter to the editor: prevention is better than cure: a reply to McKenzie, March et al. and Selten & Cantor-Graae

We are grateful to the commentators for their constructive observations on our review. We agree with Kwame McKenzie (2009) that consensus needs to be built ; the key point we attempted to make is that, to gain such a consensus, the problem of high rates of psychosis in migrant and minority ethnic populations needs to be de-coupled from the no less important issue of service provision for minority ethnic patients. In the same way that improving customer services for insurance claimants following an accident is irrelevant to reducing the rate at which such accidents occur, so reforming mental health services (important as this no doubt is) will have no impact on population rates of disorder.

Combining dimensional and categorical representation of psychosis: the way forward for DSM-V and ICD-11?

BACKGROUND: There is good evidence that psychotic symptoms segregate into symptom dimensions. However, it is still unclear how these dimensions are associated with risk indicators and other clinical variables, and whether they have advantages over categorical diagnosis in clinical practice. We investigated symptom dimensions in a first-onset psychosis sample and examined their associations with risk indicators and clinical variables. We then examined the relationship of categorical diagnoses to the same variables. METHOD: We recruited 536 patients as part of a population-based, incidence study of psychosis. Psychopathology was assessed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). A principal axis factor analysis was performed on symptom scores. The relationship of dimension scores with risk indicators and with clinical variables was then examined employing regression analyses. Finally, regression models were compared to assess the contribution of dimensions versus diagnosis in explaining these variables. RESULTS: Factor analysis gave rise to a five-factor solution of manic, reality distortion, negative, depressive and disorganization symptom dimensions. The scores of identified dimensions were differentially associated with specific variables. The manic dimension had the highest number of significant associations; strong correlations were observed with shorter duration of untreated psychosis, acute mode of onset and compulsory admission. Adding dimensional scores to diagnostic categories significantly increased the amount of variability explained in predicting these variables; the reverse was also true but to a lesser extent. CONCLUSIONS: Categorical and dimensional representations of psychosis are complementary. Using both appears to be a promising strategy in conceptualising psychotic illnesses.

Efficacy of an injectable combination anthelmintic (nitroxynil+clorsulon+ivermectin) against early immature Fasciola hepatica compared to triclabendazole combination flukicides given orally or topically to cattle.

The objective was to compare the efficacy against artificially induced 2- and 4-week old early immature triclabendazole-susceptible liver flukes (Fasciola hepatica) of an injectable combination of nitroxynil, clorsulon and ivermectin with oral and pour-on combination formulations containing triclabendazole. Groups of yearling Angus or Angus cross cattle were confirmed fluke free before being artificially infected with 500 Sunny Corner strain triclabendazole-susceptible liver fluke metacercariae. Two or four weeks after infection, cattle were treated with the test combination Nitromec (10.2mg/kg nitroxynil, 2.0mg/kg clorsulon, 0.2mg/kg ivermectin), or oral Flukazole C+Se (triclabendazole/oxfendazole/Selenium), oral Fasimec C (triclabendazole/ivermectin) or Genesis Ultra Pour-On (triclabendazole/abamectin). At intervals cattle were weighed, faecal sampled for liver fluke egg counts and blood sampled for liver serum enzyme analysis. Cattle were slaughtered 14 weeks after infection for recovery of adult flukes; fluke egg counts and liver pathology assessment. All cattle increased in body weight by 0.4-0.8kg/day but there were no significant differences between control and treated groups or between the treatment groups. Geometric mean 14-week fluke egg counts and total fluke counts for all treatments, were significantly less (p<0.05) than the control group, except for the group treated with Genesis Ultra Pour-On, 2 weeks after infection. Nitromec treatment of 2-week old flukes was 83% and 95% effective as assessed by 14-week egg and fluke counts, respectively, compared to Flukazole C; 96% and 99%, Fasimec C; 70% and 46%, and Genesis Pour-On, which was ineffective, with egg and fluke count reductions of 0% and 8%, respectively. Against 4-week old flukes, Nitromec treatment was 88% and 99% effective when assessed by 14-week egg and fluke counts, respectively, with Flukazole C; 98% and 99%, Genesis Pour-On; 98% and 82% and Fasimec C; 91% and 61% effective, respectively. Group mean levels of the bile duct-associated enzyme gamma glutamyl transpeptidase (GGT) and the parenchymal associated enzymes, aspartate amino-transferase (AST) and glutamate dehydrogenase (GLDH) increased above the normal range 8 and 11 weeks after infection in the untreated control animals and the group treated 2 weeks after infection with Genesis Pour-On. The groups treated with Fasimec at 2 or 4 weeks after infection, also had elevated enzyme levels. The use of liver-associated enzyme assay is supported as supplementary indicators of fluke-induced pathology.

Ethnicity, social disadvantage and psychotic-like experiences in a healthy population based sample.

OBJECTIVE: We sought to investigate the prevalence and social correlates of psychotic-like experiences in a general population sample of Black and White British subjects. METHOD: Data were collected from randomly selected community control subjects, recruited as part of the AESOP study, a three-centre population based study of first-episode psychosis. RESULTS: The proportion of subjects reporting one or more psychotic-like experience was 19% (n = 72/372). These were more common in Black Caribbean (OR 2.08) and Black African subjects (OR 4.59), compared with White British. In addition, a number of indicators of childhood and adult disadvantage were associated with psychotic-like experiences. When these variables were simultaneously entered into a regression model, Black African ethnicity, concentrated adult disadvantage, and separation from parents retained a significant effect. CONCLUSION: The higher prevalence of psychotic-like experiences in the Black Caribbean, but not Black African, group was explained by high levels of social disadvantage over the life course.