Self-poisoning by pesticide and other substances in a general hospital

Self-poisoning by pesticides is a major public health problem, especially in agricultural communities. The purpose of this study is to investigate the pattern of poisoning of all patients admitted to an emergency care at a general hospital in Trinidad for the period 2003-2004. In a two-year retrospective study, data on self-poisoning from hospital archives were analyzed for demographic and other patterns. A total of 765 cases of self poisoning were identified. The most common source of poisoning was ingestion of pesticides (n=275, 35.9% of all cases). Differences in age and gender were found; patients with pesticide ingestion were younger (mean age 25.8 years) and more frequently female. The majority of patients with pesticide poisoning were admitted to wards and one death reported. Poisoning by pesticides is prevalent in South Trinidad. The high incidence indicates an urgent need for implementing public health strategies for prevention in keeping with the recommendations of the World Health Organization.

Depression and psychosis associated with cannabis abuse in a developing country

Notwithstanding the increase use of cannabis among adolescents in both developing and developed countries, few studies have looked at cannabis use and mood disorders. In a series of case studies, this research project seeks to investigate patterns of clinical presentations seen among cannabis users in psychiatric outpatients in Trinidad. Five clinical patterns of presentations are identified among cannabis users and abusers based on variables of dosing, age of initial use, duration of use, tolerance and reverse tolerance and poly-drug abuse. All patients in these case studies were standardized for method of use and potency of cannabis used. Patients were screened by urine tests to determine co-morbid use of other substances. Other variables such as environmental factors and genetic vulnerability were reviewed as far as possible from historical accounts of family members. The five patterns described are low, controlled use with mild euphoria and heightened awareness, moderate use with mixed depressive symptoms and suicidal behavior, heavy, short term use with manic symptoms, long term incremental use with psychotic symptoms due to the trumping of depressive symptoms and cannabis mixed with other substances resulting in florid psychosis. Mood disorders appear to be a common finding among adolescents using cannabis. Sensitization to symptomatic presentation and early detection of cannabis use in young adolescents are necessary. Further research is needed on the effect of cannabinoids on emotions, behavior and thinking and its relationship to mental disorders. This study is useful as a guideline for the implementation of public health strategies and legislation concerning the use of cannabis in youths.

Adolescent depression in Trinidad and Tobago.

This study investigates depression in adolescents in Trinidad and Tobago and identifies any significant trends associated with its occurrence. A stratified random sample of 1.845 adolescent students from 24 schools was administered a questionnaire requesting demographic information and responses to the Reynolds Adolescent Depression Scale. In all, 14% of the sample was depressed. Depression was 2.18 times more likely to occur in females than males (17.9 % vs. 8.2 %). The peak age was 16 years with a rate of 15.9%. Both attendance at a religious institution and prayer with the family resulted in lower depression rates. Intact families had the lowest rate (11.7 %),while the reconstituted family had the highest rate (25.7 %). Individuals who had alcohol abuse in their family were 1.8 times more likely to be depressed than those without abuse. Adolescents from non-prestige schools were more likely to be depressed than those from prestige schools (p < 0.01). There were no ethnic differences in depression. The findings of this study are comparable to those of developed countries and provide guidelines for the planning and development of strategies for fighting depression in developing countries.

Adolescent depression in Trinidad and Tobago

This study investigates depression in adolescents in Trinidad and Tobago and identifies any significant trends associated with its occurrence. A stratified random sample of 1.845 adolescent students from 24 schools was administered a questionnaire requesting demographic information and responses to the Reynolds Adolescent Depression Scale. In all, 14 per cent of the sample was depressed. Depression was 2.18 times more likely to occur in females than males (17.9 per cent vs. 8.2 per cent). The peak age was 16 years with a rate of 15.9 per cent. Both attendance at a religious institution and prayer with the family resulted in lower depression rates. Intact families had the lowest rate (11.7 per cent),while the reconstituted family had the highest rate (25.7 per cent). Individuals who had alcohol abuse in their family were 1.8 times more likely to be depressed than those without abuse. Adolescents from non-prestige schools were more likely to be depressed than those from prestige schools (p < 0.01). There were no ethnic differences in depression. The findings of this study are comparable to those of developed countries and provide guidelines for the planning and development of strategies for fighting depression in developing countries.

Cannabis and suicidal behaviour among adolescents: a pilot study from Trinidad.

Cannabis use and suicidal behaviour are causes of adolescent morbidity and mortality worldwide. Changing trends in these behaviours in younger age groups, higher incidence, gender differences and sociocultural variations present an enormous challenge. There is no consensus whether these complex relationships are either a direct or an indirect effect due to other mental disorders, or a social response of disclosure of drug taking habits to family members and school authorities. This paper reviews the epidemiology of suicidal behaviour and cannabis use among adolescents and looks at the relationship of these behaviours regionally and internationally. The Caribbean islands have an established use of cannabis with higher suicidal rates, which provides an ideal setting to investigate the interrelationship of these disorders. Preliminary research findings in Trinidad indicate high rates of cannabis use among school students with higher rates in vocational schools compared to grammar schools. Utilising the CAPE questionnaire, depressive and psychotic experiences were common findings in adolescent cannabis users with a significant preponderance of depressive experiences (p<0.01). Our findings suggest that there is a convincing relationship between suicidal behaviour and cannabis use, the latter awakening depressive experiences. Suicidal behaviour and cannabis use are major public health problems and require a multidimensional approach with culturally competent preventive interactions. School based prevention programmes are necessary at the levels of parent-teacher partnership and classroom intervention. The treatment of adolescent disorders remains a major challenge of the future. Double disorders such as cannabis use and suicidal behaviour are uncharted areas and need novel approaches.