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Biomedical subjects

D Bhugra

Publications and source records attributed to D Bhugra.

At least 19 recordsLinked to original sources
PubMed2006

The evidence base of complementary and alternative therapies in depression.

BACKGROUND: Depression is one of the leading indications for using Complementary and Alternative Medicine (CAM). This paper reviews the evidence of efficacy of different types of CAM in depression with the aim of identifying the highest level of evidence. METHODS: We conducted literature searches restricted to the English language for studies on CAM as monotherapy in depression. All papers were reviewed by two researchers and the evidence was ranked according to a widely referenced hierarchy of evidence. RESULTS: 19 papers formed the final review. We found Grade 1 evidence on the use of St. John's wort, Tryptophan/5-Hydroxytryptophan, S-adenosyl methionine, Folate, Inositol, Acupuncture and Exercise in Depressive disorders, none of which was conclusively positive. We found RCTs at the Grade 2 level on the use of Saffron (Herbal medicine), Complex Homoeopathy and Relaxation training in Depressive disorders, all of which showed inconclusive results. Other RCTs yielded unequivocally negative results. Studies below this level yielded inconclusive or negative results. LIMITATIONS: Searches were restricted to the English language. Our list of CAM approaches may not have been comprehensive. We excluded studies on the use of CAM as an adjunctive treatment and this review aimed to identify only the highest level of evidence. CONCLUSIONS: None of the CAM studies show evidence of efficacy in depression according to the hierarchy of evidence. The RCT model and the principles underlying many types of CAM are dissonant, making its application in the evaluation of those types of CAM difficult. The hierarchy of evidence we used has limited utility in grading trials of CAM.

Complementary Therapies↗
PubMed2006

Severe mental illness across cultures.

OBJECTIVE: International studies have shown that the outcome of illnesses like schizophrenia vary across cultures. The good outcome in developing countries depends upon a number of factors. METHOD: Using both primary and secondary sources, existing literature was reviewed. Using terms severe mental illness, culture and schizophrenia, Medline, Psychinfo and Embase were searched. Further searches were conducted using secondary searches. RESULTS: The impact of culture and its components on the individual and their families influences compliance, engagement with services and expectations of treatment. Cultures also impact upon identity and explanatory models of individuals. CONCLUSION: Severe mental illness is as likely to be affected by culture as other illnesses. Clinicians need to use multi-model assessment and management techniques.

Causality↗
PubMed2006

Antidepressants and sexual dysfunction.

OBJECTIVE: Many patients with depression suffer from sexual dysfunction and sexual dysfunction is a recognized side-effect of antidepressants. The aim of this review was to examine the prevalence of psychosexual dysfunction associated with antidepressants, and to review treatment options which are specific to the affected component of sexual functioning and antidepressants. METHOD: Comprehensive literature review using Medline and Cochrane databases. RESULTS: Up to 70% of patients with depression may have sexual dysfunction. Tricyclic antidepressants, selective-serotonin reuptake inhibitors and venlafaxine are most and the non-serotonergic antidepressants and duloxetine least likely to produce sexual dysfunction. Pharmacological treatment options include antidepressants less likely associated or 'antidotes' to reverse sexual dysfunction. CONCLUSION: Sexual dysfunction may be a preventable or treatable side-effect of antidepressants. Patients need routinely to be asked about sexual function to identify problems early. If sexual dysfunction is ignored it may maintain the depression, compromise treatment outcome and lead to non-compliance.

Antidepressive Agents↗
PubMed2006

Experiences and expectations of refugee doctors: Qualitative study.

BACKGROUND: Refugee doctors constitute a potentially valuable resource for reducing the recruitment crisis in psychiatry. However, various hurdles make their route into the National Health Service (NHS) difficult. AIMS: To explore the perceptions and experiences of refugee doctors trying to practise psychiatry in the UK. METHOD: Thirty-one refugee doctors participated in qualitative interviews designed to elicit their experiences in trying to practise as doctors in the UK. Twenty were re-interviewed about 6 months later. RESULTS: Doctors identified a range of practical problems that made it difficult for them to take the required steps towards practising in the UK. These included lack of appropriate information, lack of a clear route through the system and feelings of isolation. The English language examination was seen as a particular bottleneck, as were finding clinical attachments. The psychological impact of the experience was profound. CONCLUSIONS: These findings have important implications for how refugee doctors are introduced to the practice of psychiatry in the NHS.

Adult↗
PubMed2005

Insight in people with psychosis: the influence of culture.

The assessment of insight is a part of the routine clinical examination for people with mental illness. Such assessment, by psychiatrists, is based on the current definitions of insight, which rely on western notions of health and illness. This paper discusses the recent findings of explanatory models of people with a variety of physical diseases in Vellore, India. It also summaries the results of studies on insight in schizophrenia, which examined explanatory models of illness among patients, relatives, and the general population, in Vellore. The findings argue for the fact that the assessment of insight should be against the local cultural standards rather than universal yardsticks.

Culture↗
PubMed2005

'They're all depressed, aren't they?' A qualitative study of social care workers and depression in older adults.

Statutory and voluntary social services provide care and support for vast numbers of vulnerable older adults, yet little is known about how social care practitioners respond to depression in this high risk population. This study elicited the perceptions and conceptualizations of this condition among social care staff, and views on how the response of social care and other agencies might be improved. Qualitative interviews were conducted with 20 social care practitioners working in generic services for older adults in south London. Depression was perceived to be remarkably common among clients, a phenomenon largely attributed to the adverse circumstances of old age, particularly social isolation. A key message from participants was that social causes indicate a need for social interventions. While primary care was criticised for not taking depression seriously in older people, mental health services were generally praised. Expansion of social, recreational and psychological interventions was advocated.

Aged↗
PubMed2005

Cultural identities and cultural congruency: a new model for evaluating mental distress in immigrants.

OBJECTIVE: Societies and cultures have been described as being individualistic or collectivist (also called ego-centric or socio-centric). Similarly individuals are idiocentric or allocentric. METHOD: Using migration, migrants, ethnic minorities, collectivism and individualism, four databases of Embase, Medline, PsychInfo and Social Sciences abstracts were searched. Other key words included mental disorder, mental distress, psychiatric and psychological disorders. In addition, hand searches were conducted from the relevant books, monographs and secondary references. RESULTS: Migration, cultural identity and mental distress are linked. In addition, social support can provide a buffer against mental illness. Other vulnerability factors in migrants include the type of society they originate from and the type of society they settle in. CONCLUSION: When individuals migrate from one type of culture to another it is likely that depending upon their own personality traits (along with their biopsycho-social vulnerabilities) may develop psychiatric disorders. The cognitions and idioms of distress will be influenced by cultural factors. The clinicians must take into account cultural background when planning any interventions to enable a stronger therapeutic alliance.

Acculturation↗
PubMed2005

Does it make sense to do repeated surveys?--the Lundby Study, 1947-1997.

OBJECTIVE: To describe the Lundby Study and the difficulties in doing repeated surveys. METHOD: Best-estimate consensus diagnoses have been used since 1957 together with DSM-IV and ICD-10 in 1997. RESULTS: The Lundby population consisting of 3563 probands was investigated in 1947, 1957 and 1972. Sufficient information was available for 98-99%. In 1997-2000 a fourth field investigation was carried out. Attrition rate for the interviews was 13% (238/1797). About 36% (1030/2827) had died between 1972 and 1997, but data from registers, case notes and key-informants for the period 1972 and 1997 completed the information for 94% (2659/2827). The population has followed the same pattern of development as many rural populations in Sweden since the 1940s. Multiple sources of information are preferable in longitudinal studies in order to tackle the problem of changing diagnostic systems. CONCLUSION: Low attrition rates over 50 years and reasonable diagnostic uniformity make comparisons over time justifiable.

Aged↗
PubMed2005

Mad tales from Bollywood: the impact of social, political, and economic climate on the portrayal of mental illness in Hindi films.

OBJECTIVE: To study the portrayal of mental illness (especially psychosis) in Hindi films since 1950 and to study the influence of prevalent social, political and economic factors on each portrayal. METHOD: Using two encyclopedias and one source book, films that had mental illness affecting one of the protagonists were identified. The social, economic and political factors were identified using history texts. RESULTS: In the 1960s after India became a Republic, the political climate was one of idealism and as a result the portrayal of mental illness was gentle, more international in its outlook, and used psychoanalytic techniques. In the 1970s and 1980s, as a result of increased political and bureaucratic corruption and an unstable political climate, the portrayals became harder and psychopaths were portrayed more often. In the 1980s, the trend continued with female psychopaths, and avenging women emerged as a major force because the political and judicial systems were seen as impotent in delivering justice. In the 1990s, following economic liberalization, the women were seen and used as possessions in society and the cinema, and portrayals of stalking and morbid jealousy increased. CONCLUSION: Hindi films since the 1950s appear to have been influenced by changing cultural norms which in turn affected the way mental illness is portrayed.

Adult↗
PubMed2004

Migration and mental health.

OBJECTIVE: Migration and its accompanying stressors affect migrating individuals and their families. The process of migration is not simple or straightforward. The aim of this review is to distil existing information on how migration influences individuals' mental state and how it determines help seeking as well as pathways to care. METHOD: The review relies on published studies in both MEDLINE and non-MEDLINE journals as well as relevant monographs. The search was employed using migration, ethnic communities, stress and other relevant words for purposes of the review. RESULTS: The review provides a background on the typology of migration, its impact on communities as well as individuals. Furthermore, the relationship of mental illness to migration is explored and described. Future research plans are advocated in relationship with these findings. CONCLUSION: Migration is and can be a very stress-inducing phenomenon. Yet not all migrants go through the same process. The clinician needs to be aware of coping strategies as well as resilience among migrants.

Adaptation, Psychological↗
PubMed2004

'I was running away from death'- the pre-flight experiences of unaccompanied asylum seeking children in the UK.

OBJECTIVE: To collect information about the pre-flight experiences of unaccompanied asylum seeking children (UASC) in the UK to increase the understanding of support needed on arrival in the UK. METHODS: Retrospective social services case file and legal statement review and semi-structured in-depth interviews with 100 UASC. RESULTS: Nearly half of all UASC have experienced separation from or loss of parents and/or family members (47%), and a further 41% had personally experienced or witnessed violence. Sexual violence (such as rape) was reported by 24% of African girls. Many children reported complex journeys to the UK. CONCLUSIONS: UASC arrive in the UK with a variety of potentially traumatic experiences. Whilst research is starting to identify some of the experiences of UASC, further culturally appropriate research is needed to identify their health and social needs after arrival. Further research will help to identify the specific experiences of UASC, indicating where services should be improved to deal with their complex and diverse needs.

Adolescent↗
PubMed2003

Migration and depression.

OBJECTIVE: Migrants migrate for a number of reasons and varying duration. The objective in this paper is to review the findings to ascertain whether rates of depression among migrants are higher compared with the non-migrant populations. METHOD: We used the published data to review the theoretical background for migration and to study the existing literature on rates of depression in various migrant and ethnic groups. RESULTS: The rates of depressive neurosis vary according to migrant status. Migrants in some groups are less likely to report symptoms of depression. Using fluency in language as a proxy measure of acculturation it appears that acculturated individuals are more likely to be depressed. CONCLUSION: The impact of migration on depression is not as clear and straightforward as for other psychiatric conditions. More work needs to be carried out in understanding the impact of migration on depression.

Cultural Characteristics↗
PubMed2003

Pregnancy and birth complications in patients with schizophrenia in Trinidad and London.

It has been shown that an excess of pregnancy and birth complications (PBCs) does not contribute to the excess rates of schizophrenia reported for the population of Caribbean origin in Britain compared with the native Caucasian British population. We therefore attempted to compare the rate of PBCs between a sample of schizophrenics in Britain with that of a sample from Trinidad where some of the Caribbean migrants to Britain originated. First contact patients with schizophrenia according to the CATEGO system diagnosis were identified in Trinidad and London. Their mothers, where available, were interviewed using the Lewis-Murray scale for pregnancy and birth complications. Data from Trinidad and Tobago concerning 56 patients were compared with those of the Caucasian (n = 61) and African-Caribbean (n = 50) patients in London. The rate of PBCs was similar for the Caucasian British patients (24.6%) and the patients in Trinidad and Tobago (21.7%). The rates were lowest in the African-Caribbean patients in London (14.0%), though this difference was not statistically significant. These findings suggest that pregnancy and birth complications are a risk factor for a substantial minority of patients with schizophrenia in Trinidad and London. It also confirms that the excess rates of schizophrenia reported for the Caribbean population in Britain are not due to these complications.

Adolescent↗
PubMed2001

Cultural influences on the prevalence of common mental disorder, general practitioners' assessments and help-seeking among Punjabi and English people visiting their general practitioner.

BACKGROUND: Culture influences symptom presentation and help-seeking and may influence the general practitioner's assessment. METHODS: We recruited Punjabi and English GP attenders to a two-phase survey in London (UK) using the Amritsar Depression Inventory and the General Health Questionnaire as screening instruments. The Clinical Interview Schedule was the criterion measure. General practitioners completed Likert assessments. RESULTS: The second phase was completed by 209 Punjabi and 180 English subjects. The prevalence of common mental disorders was not influenced by culture. Punjabi cases more often had 'poor concentration and memory' and 'depressive ideas' but were not more likely to have somatic symptoms. General practitioners were more likely to assess Punjabis with common mental disorder as having 'physical and somatic' symptoms or 'sub-clinical disorders'. Punjabi cases with depressive ideas were less likely to be detected compared with English ones. In comparison to English men, English women were under-detected by Asian general practitioners. Help-seeking English subjects were more likely to be correctly identified as cases. CONCLUSIONS: The prevalence of common mental disorders and somatic symptoms does not differ across cultures. Among English subjects, general practitioners were more likely to identify correctly pure psychiatric illness and mixed pathology; but Punjabi subjects with common mental disorders were more often assessed as having 'sub-clinical disorders' and 'physical and somatic' disorders. English women were less well detected than English men. English help-seeking cases were more likely to be detected.

Adolescent↗
PubMed2001

Ideas of distorted ethnic identity in 43 cases of psychosis.

OBJECTIVE: Distorted ethnic identity is a difficult concept to define, but relates to individuals from one ethnic group thinking that they want to belong to another ethnic group or that they do so already, but have been "misattributed" to the wrong category. The aim of the present study is to study descriptions of these behaviours. METHOD: Patients admitted to three hospitals in London were screened by the respective teams looking after them and case notes studied. No direct interviews were carried out. RESULTS: A total of 43 cases were identified. A large proportion were African-Caribbean males who fulfilled the criteria for DSM-IV diagnosis of paranoid schizophrenia. Female patients were more likely to use extreme measures to alter their appearance. CONCLUSIONS: Majority white culture may influence vulnerable patients who have psychoses to incorporate a range of ideas of distorted ethnic identity in their psychopathology.

Adult↗
PubMed2001

Transcultural psychiatry: some social and epidemiological research issues.

BACKGROUND: Mental Health Research across cultural groups is often criticised for using imprecise measures of cultural group and for using outcome measures as if they have universal validity. AIMS: 1. To Investigate the effect of using different cultural group variables on the findings of a survey of prevalence of Common Mental Disorders. 2. To demonstrate that assumptions of validity for outcomes measures can affect the interpretation of data from prevalence surveys. METHODS: We recruited Punjabi and English subjects to a phase prevalence survey that included the Amritsar Depression Inventory and the General Health Questionnaire as screening instruments. The Clinical Interview Schedule was the outcome measure. This paper reports on a secondary analysis of the data. We used ethnic group, place of birth, religion, first language and language spoken at interview as possible cultural group variables and compared the prevalence estimates. We then considered the limitations of conventional methods to assess prevalence, by looking at mean scores on each of the three instruments in both cultural groups. RESULTS: Cultural group variables did not influence the prevalence estimates for Common Mental Disorder. Although conventional scoring methods showed no difference in prevalence across cultures, the mean scores on each instrument, when compared across cultural groups, differed for the Amritsar Depression Inventory. This instrument showed a higher mean score for the Punjabis suggesting a higher prevalence. The findings are discussed in the context of value laden 'assumptions' about validity. CONCLUSIONS: The findings of prevalence surveys depend on assumptions of validity. The 'culture' of psychiatry is a closed system in which validation studies support its basic assumptions.

Cross-Cultural Comparison↗