RESUMEN
BACKGROUND AND HYPOTHESIS: There is a substantial gap in life expectancy between patients with severe mental illness (SMI) and the general population and it is important to understand which factors contribute to this difference. Research suggests an association between tardive dyskinesia (TD) and mortality; however, results are inconclusive. In addition, studies investigating associations between parkinsonism or akathisia and mortality are rare. We hypothesized that TD would be a risk factor for mortality in patients with SMI. STUDY DESIGN: We studied a cohort of 157 patients diagnosed predominantly with schizophrenia on the former Netherlands Antilles. TD, parkinsonism, and akathisia were assessed with rating scales on eight occasions over a period of 18 years. Twenty-four years after baseline, survival status and if applicable date of death were determined. Associations between movement disorders and survival were analyzed using Cox regression. Sex, age, antipsychotics, antidepressants and benzodiazepines at each measurement occasion were tested as covariates. STUDY RESULTS: Parkinsonism was a significant risk factor with an HR of 1.02 per point on the motor subscale of the Unified Parkinson's Disease Rating Scale (range 0-56). TD and akathisia were not significantly associated with mortality. CONCLUSIONS: Parkinsonism may be an important risk factor for mortality in SMI patients. This finding calls for more follow-up and intervention studies to confirm this finding and to explore whether treatment or prevention of parkinsonism can reduce excess mortality.
Asunto(s)
Antipsicóticos , Enfermedades de los Ganglios Basales , Discinesia Inducida por Medicamentos , Enfermos Mentales , Trastornos Parkinsonianos , Discinesia Tardía , Antipsicóticos/efectos adversos , Enfermedades de los Ganglios Basales/inducido químicamente , Enfermedades de los Ganglios Basales/diagnóstico , Enfermedades de los Ganglios Basales/epidemiología , Curazao , Discinesia Inducida por Medicamentos/diagnóstico , Discinesia Inducida por Medicamentos/epidemiología , Discinesia Inducida por Medicamentos/etiología , Humanos , Agitación Psicomotora , Síndrome , Discinesia Tardía/inducido químicamenteRESUMEN
BACKGROUND: The aim was to assess incidence, prevalence and risk factors of medication-induced tremor in African-Caribbean patients with severe mental illness (SMI). METHOD: A prospective study of SMI patients receiving care from the only mental health service of the previous Dutch Antilles. Eight clinical assessments, over 18 years, focused on movement disorders, medication use, and resting tremor (RT) and (postural) action tremor (AT). Risk factors were modeled with logistic regression for both current (having) tremor and for tremor at the next time point (developing). The latter used a time-lagged design to assess medication changes prior to a change in tremor state. RESULTS: Yearly tremor incidence rate was 2.9% and mean tremor point prevalence was 18.4%. Over a third of patients displayed tremor during the study. Of the patients, 5.2% had AT with 25% of cases persisting to the next time point, while 17.1% of patients had RT of which 65.3% persisted. When tremor data were examined in individual patients, they often had periods of tremor interspersed with periods of no tremor. Having RT was associated with age (OR=1.07 per year; 95% confidence interval 1.03-1.11), sex (OR=0.17 for males; 0.05-0.78), cocaine use (OR=10.53; 2.22-49.94), dyskinesia (OR=0.90; 0.83-0.97), and bradykinesia (OR=1.16; 1.09-1.22). Developing RT was strongly associated with previous measurement RT (OR=9.86; 3.80-25.63), with previous RT severity (OR=1.22; 1.05-1.41), and higher anticholinergic load (OR= 1.24; 1.08-1.43). Having AT was associated with tremor-inducing medication (OR= 4.54; 1.90-10.86), cocaine use (OR=14.04; 2.38-82.96), and bradykinesia (OR=1.07; 1.01-1.15). Developing AT was associated with, previous AT severity (OR=2.62 per unit; 1.64-4.18) and tremor reducing medication (OR=0.08; 0.01-0.55). CONCLUSIONS: Long-stay SMI patients are prone to developing tremors, which show a relapsing-remitting course. Differentiation between RT and AT is important as risk factors differ and they require different prevention and treatment strategies.
RESUMEN
OBJECTIVE: To test the efficacy of current treatment recommendations for parkinsonism and tardive dyskinesia (TD) severity in patients with severe mental illness (SMI). METHODS: We present an 18-year prospective study including all 223 patients with SMI (as defined by the 1987 US National Institute of Mental Health, which were based on DSM-III-R diagnostic criteria) receiving care from the only psychiatric hospital of the former Netherlands Antilles. Eight clinical assessments (1992-2009) focused on movement disorders and medication use. Tardive dyskinesia was measured by the Abnormal Involuntary Movement Scale and parkinsonism by the Unified Parkinson's Disease Rating Scale. Antipsychotics were classified into first-generation antipsychotic (FGA) versus second-generation antipsychotic (SGA) and high versus low dopamine 2 (D2) affinity categories. The effect that switching has within each category on subsequent movement scores was calculated separately by using time-lagged multilevel logistic regression models. RESULTS: There was a significant association between reduction in TD severity and starting/switching to an FGA (B = -3.54, P < .001) and starting/switching to a high D2 affinity antipsychotic (B = -2.49, P < .01). Adding an SGA to existing FGA treatment was associated with reduction in TD severity (B = -2.43, P < .01). For parkinsonism, stopping antipsychotics predicted symptom reduction (B = -7.76, P < .01 in FGA/SGA-switch model; B = -7.74, P < .01 in D2 affinity switch model), while starting a high D2 affinity antipsychotic predicted an increase in symptoms (B = 3.29, P < .05 in D2 affinity switch model). CONCLUSIONS: The results show that switching from an FGA to an SGA does not necessarily result in a reduction of TD or parkinsonism. Only stopping all antipsychotics reduces the severity of parkinsonism, and starting an FGA or a high D2 affinity antipsychotic may reduce the severity of TD.
Asunto(s)
Antipsicóticos/efectos adversos , Antipsicóticos/uso terapéutico , Sustitución de Medicamentos , Trastornos Mentales/tratamiento farmacológico , Enfermedad de Parkinson Secundaria/inducido químicamente , Enfermedad de Parkinson Secundaria/epidemiología , Discinesia Tardía/epidemiología , Adulto , Antipsicóticos/administración & dosificación , Estudios Transversales , Dopaminérgicos/efectos adversos , Dopaminérgicos/uso terapéutico , Femenino , Adhesión a Directriz , Humanos , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Antillas Holandesas , Examen Neurológico/efectos de los fármacos , Resultado del TratamientoRESUMEN
Brua is an Afro-Caribbean religion and healing tradition from the southern part of the former Netherlands Antilles. Like other Caribbean healing traditions, it plays a significant role in shaping how individuals experience and express disorders which Western health professionals consider to require psychiatric care. Because little has been published on Brua, and because patients from Aruba, Bonaire, and Curaçao are often reluctant to discuss their commitment to this tradition, they are often misdiagnosed and either over- or undertreated by biomedically trained health professionals. The present paper provides a review of the literature on Brua and its relation to psychiatry. A systematic search was carried out in PubMed, the Ovid database, Google Scholar, and the historical literature. Our search yielded 35 texts on Brua, including three peer-reviewed scientific papers and eight academic theses. From those texts Brua emerges as a holistic patchwork of creolized beliefs and practices which are considered to be both cause and remedy for a wide variety of ailments. Despite the fact that tension between the Brua discourse and Western-oriented psychiatric practice is significant, adherence to Brua does not seem to cause much patient delay in help-seeking. However, belief in Brua as a possible source of mental and physical complaints, as well as patients' frequent recourse to Brua practices, including the use of hallucinogens, may affect the diagnosis and treatment of mental disorders.
Asunto(s)
Etnopsicología , Medicina Tradicional , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Religión y Medicina , Terapias Espirituales , Humanos , Trastornos Mentales/etnología , Trastornos Mentales/etiología , Antillas Holandesas/epidemiología , Supersticiones/psicologíaRESUMEN
OBJECTIVE: The aim of this study was to examine paternal age in relation to risk of autism spectrum disorders (ASDs) in a setting other than the industrialized west. DESIGN: A case-control study of Aruban-born children (1990-2003). Cases (N = 95) were identified at the Child and Adolescent Psychiatry Clinic, the only such clinic in Aruba; gender and age matched controls (N = 347) were gathered from public health records. Parental age was defined categorically (≤ 29, 30-39, 40-49, ≥ 50 y). The analysis was made, using conditional logistic regression. RESULTS: Advanced paternal age was associated with increased risk of ASDs in offspring. In comparison to the youngest paternal age group (≤ 29 y), risk of autism increased 2.18 times for children born from fathers in their thirties, 2.71 times for fathers in their forties, and 3.22 thereafter. CONCLUSION: This study, part of the first epidemiologic study of autism in the Caribbean, contributes additional evidence, from a distinctive sociocultural setting, of the risk of ASD associated with increased paternal age.
Asunto(s)
Trastorno Autístico/epidemiología , Edad Paterna , Medición de Riesgo/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Trastorno Autístico/etnología , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Humanos , Indígenas Sudamericanos , Modelos Logísticos , Masculino , Edad Materna , Persona de Mediana Edad , Países Bajos/etnología , Medición de Riesgo/métodos , Factores de Riesgo , España/etnología , Indias Occidentales/epidemiologíaRESUMEN
OBJECTIVE: Previously we found that the incidence of anorexia nervosa (AN) in the general population was much lower in the Netherlands Antilles than in the Netherlands. As a follow-up we compared the incidence of AN in the Netherlands in persons from the Netherlands Antilles to native Dutch. METHOD: A national register of psychiatric hospital admissions was screened for cases of AN. Incidence rates (IR) and incidence rate ratios (IRR) were computed. RESULTS: The IR of AN was 1.32 per 100 000 person years (95% confidence interval (CI): 0.53-2.71) for Netherlands Antilleans and 1.09 (95% CI: 1.04-1.15) for native Dutch. The age- and sex-adjusted IRR was 1.21 (95% CI: 0.58-2.54). CONCLUSION: Contrary to the Netherlands Antilles, in the Netherlands AN is as common among Netherlands Antilleans as among native Dutch. Exposure to the Western idealization of thinness is a risk factor for the development of AN, possibly in interaction with migration-related stress.
Asunto(s)
Anorexia Nerviosa/etnología , Anorexia Nerviosa/epidemiología , Emigrantes e Inmigrantes/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Adulto , Anorexia Nerviosa/psicología , Comparación Transcultural , Emigrantes e Inmigrantes/psicología , Femenino , Humanos , Incidencia , Masculino , Países Bajos/epidemiología , Antillas Holandesas/etnología , Factores de Riesgo , Cambio SocialRESUMEN
This article presents the results of a large efficacy study comparing different forms of therapy for major depressive disorder (MDD), including interpersonal psychotherapy (IPT) and pharmacotherapy. Patients were randomized to either IPT, IPT in combination with anti-depressant medication, IPT in combination with pill-placebo or medication only. The primary outcome measure was the Hamilton Rating Scale for Depression (HAMD). Patients were treated for 12 to 16 weeks. Ratings were performed at baseline, after 6 weeks of treatment and at the end of treatment. Ethnic minority patients (EMP) had higher scores on the HAMD than non-EMP for every rating period. However, the rate of improvement was the same for EMP and non-EMP. The higher mean scores of EMP on the HAMD could not be explained as solely due to higher scores on somatic items of the rating scales. The attrition rate in EMP (45.9%) was significantly higher than in non-EMP (24.4%), even in the structured treatment format studied. The results suggest that standard antidepressant therapy, be it medication, psychotherapy or both, may be effective for depressed minority patients but therapists should focus on enhancing adherence to treatment.
Asunto(s)
Antidepresivos de Segunda Generación/uso terapéutico , Comparación Transcultural , Trastorno Depresivo Mayor/etnología , Trastorno Depresivo Mayor/terapia , Psicoterapia , Triazoles/uso terapéutico , Adulto , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Marruecos/etnología , Países Bajos , Piperazinas , Suriname/etnología , Turquía/etnologíaRESUMEN
Recent studies demonstrate an association between antipsychotic-induced parkinsonism (AIP) and rs4606 SNP of RGS2 gene in Jewish and African-Americans. The current study investigates the association between rs4606 and AIP or its subsymptoms (rest tremor, rigidity, and bradykinesia) in 112 psychiatric inpatients of African-Caribbean origin. Presence of AIP, rigidity, bradykinesia, and tremor was measured by the UPDRS. We applied chi(2) (or Fisher Exact) and logistic regression analyses in several models including rs4606, age, gender, dose of antipsychotics, and anticholinergics, and two other putatively functional SNPs in DRD2 (-141CIns/Del) and HTR2C (Cys23Ser) genes. In contrast to recent literature, we find no evidence for an association between rs4606 and AIP or any of its subsymptoms. We hypothesize that the observed lack of association is due probably to differences in serotonin 2A-receptor affinities of the antipsychotics utilized (in contrast to the other published studies, the majority of our patients utilized typical antipsychotics).
Asunto(s)
Antipsicóticos/efectos adversos , Trastornos Parkinsonianos/genética , Polimorfismo de Nucleótido Simple , Proteínas RGS/genética , Adulto , Factores de Edad , Antipsicóticos/administración & dosificación , Antipsicóticos/farmacología , Población Negra , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Trastornos Parkinsonianos/inducido químicamente , Escalas de Valoración Psiquiátrica , Receptor de Serotonina 5-HT2A/metabolismo , Factores de Riesgo , Factores Sexuales , Indias OccidentalesRESUMEN
To study autism outside of a narrow range of settings previously studied, and in a particularly distinctive setting in the Caribbean. The aim of the Aruba Autism Project was to determine the prevalence of autism spectrum disorders (ASDs) in birth years 1990-1999 in Aruba. A record review study was conducted; cases were ascertained from children treated at the Child & Adolescent Psychiatry Clinic of Aruba, the first and only child psychiatry service on the island. In these 10 birth years we found a prevalence for autistic disorder (AD) of 1.9 per 1,000 (95% CI 1.2-2.8) and for autism spectrum disorders of 5.3 per 1,000 (95% CI 4.1-6.7). Comparison analysis with a cumulative incidence report from the UK, showed a similar cumulative incidence to age five in Aruba. Prevalence of ASDs in birth years 1990-1999 and cumulative incidence to age five in Aruba are similar to recent reports from the United Kingdom and the United States.
RESUMEN
We studied the association between polymorphisms of genes coding for dopamine D(2) (DRD2), dopamine D(3) (DRD3), serotonin 2(a) (HTR2A), and serotonin 2(c) (HTR2C) receptors and Antipsychotic-Induced Parkinsonism (AIP), rigidity, bradykinesia, and rest-tremor in African-Caribbeans treated with antipsychotics. Polymorphisms of DRD2 (-141CIns/Del, TaqIA, 957C > T), DRD3 (Ser9Gly), HTR2A (-1438A > G, 102T > C, His452Tyr), and HTR2C (-759C > T, Cys23Ser) genes were determined according to standard protocols. The Unified Parkinson Disease Rating Scale was used for the measurement of AIP, rigidity, bradykinesia, and rest-tremor. Chi-squared or Fisher's exact tests were applied for the association analyses. The t-test was applied for continuous data. Ninety nine males and 27 females met the inclusion criteria (Schizophr Res 1996, 19:195). In males, but not in females, there were significant associations between -141CDel-allele carriership (DRD2) and rigidity (Fisher's Exact Test: P = 0.021) and between 23Ser-allele carriership (HTR2C) and bradykinesia (P = 0.026, chi(2) = 5.0) or AIP (P = 0.008, chi(2) = 7.1). Rest-tremor was not associated with any of the polymorphisms studied. Analyses of the age, chlorpromazine equivalents, benztropine equivalents, the number of patients using anticholinergic medication, and the utilization patterns of the antipsychotic medication did not show statistically significant differences between patients with and without AIP, rigidity, bradykinesia, rest-tremor. Conducting the analysis without gender stratification did not affect our findings considerably, except for the association between bradykinesia and 23Ser-allele which failed to reach statistical significance in the total sample (P = 0.0646, chi(2) = 3.41). Since AIPs subsymptoms (rigidity, bradykinesia, and rest-tremor) may differ pharmacogenetically, our data strongly support symptom-specific analysis of AIP. However, further research is warranted to confirm our findings.
Asunto(s)
Población Negra/genética , Hipocinesia/genética , Rigidez Muscular/genética , Trastornos Parkinsonianos/genética , Receptores Dopaminérgicos/genética , Receptores de Serotonina/genética , Temblor/genética , Adulto , Anciano , Antipsicóticos/uso terapéutico , Benzodiazepinas/uso terapéutico , Antagonistas Colinérgicos/uso terapéutico , Resistencia a Medicamentos/genética , Femenino , Frecuencia de los Genes , Genotipo , Humanos , Hipocinesia/tratamiento farmacológico , Pacientes Internos , Masculino , Persona de Mediana Edad , Rigidez Muscular/tratamiento farmacológico , Trastornos Parkinsonianos/tratamiento farmacológico , Farmacogenética , Temblor/tratamiento farmacológico , Indias Occidentales/etnologíaRESUMEN
Lithium may have neuroprotective properties and therefore could affect the occurrence of tardive dyskinesia (TD). We conducted a nine-year follow-up study with one baseline and six follow-up assessments including all psychiatric inpatients in Curaçao (N=194). TD was measured with the Abnormal Involuntary Movement Rating Scale (AIMS). There were 758 follow-up observations in the 166 patients (mean age 54.4 yrs, SD 16.0) with at least one follow-up assessment. Most patients (74%) had schizophrenia. The mean baseline score of the AIMS was 4.1 (SD 4.7). Sixteen patients (9.6%) used lithium at baseline and eight patients started lithium during follow-up. Prevalent and incident lithium significantly reduced the severity of existing TD with respectively 2.3 and 2.9 point reduction on the AIMS (AIMS score range: 0-23) and a standardised effect size of 0.5 for prevalent TD and 0.6 for incident TD. In the restricted sample of those with a baseline score of zero on the AIMS, prevalent lithium significantly lowered the risk of new abnormal movements (standardised effect size of 0.7). In conclusion, the use of lithium was significantly negatively associated with both persistence and onset of TD. These results suggest a beneficial effect on TD of lithium in some patients using long-term antipsychotics.
Asunto(s)
Antimaníacos/uso terapéutico , Discinesia Inducida por Medicamentos/prevención & control , Adulto , Anciano , Región del Caribe/epidemiología , Estudios de Cohortes , Discinesia Inducida por Medicamentos/epidemiología , Femenino , Humanos , Compuestos de Litio , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: A high incidence of psychotic disorders has been reported in immigrant ethnic groups in Western Europe. Some studies suggest that ethnic density may influence the incidence of schizophrenia. The authors investigated whether this increased incidence among immigrants depends on the ethnic density of the neighborhoods in which they live. METHOD: This was a prospective first-contact incidence study of psychotic disorders in The Hague, by ethnicity and neighborhood of residence. Over a 7-year period, individuals who made contact with a physician for a suspected psychotic disorder underwent diagnostic interviews and received DSM-IV diagnoses. A comprehensive municipal registration system provided the denominator for incidence rates. Data were sufficient to examine incidence rates in native Dutch and in first- and second-generation immigrants from Morocco, Suriname, and Turkey. The ethnic density of a neighborhood was computed for each immigrant group as the proportion of residents belonging to that group. Multilevel regression analyses predicted the incidence of psychotic disorders as a function of individual ethnicity and neighborhood ethnic density. Models were fitted for all immigrants together and for each immigrant group separately. RESULTS: A total of 226 native Dutch and 240 immigrants were diagnosed as having a psychotic disorder. Compared with native Dutch, the adjusted incidence rate ratio for immigrants was significantly increased in low-ethnic-density neighborhoods (2.36) but not in high-ethnic-density neighborhoods (1.25). There was a strong interaction between individual ethnicity and neighborhood ethnic density as predictors of incidence of illness. These findings were consistent across all immigrant groups. CONCLUSIONS: The incidence of psychotic disorders was elevated most significantly among immigrants living in neighborhoods where their own ethnic group comprised a small proportion of the population.
Asunto(s)
Emigrantes e Inmigrantes/estadística & datos numéricos , Etnicidad/estadística & datos numéricos , Densidad de Población , Trastornos Psicóticos/epidemiología , Características de la Residencia/estadística & datos numéricos , Adolescente , Adulto , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Marruecos/etnología , Países Bajos/epidemiología , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/etnología , Clase Social , Suriname/etnología , Turquía/etnologíaRESUMEN
BACKGROUND: It is well established now that the incidence of schizophrenia is extremely high for several ethnic minority groups in western Europe, but there is considerable variation among groups. We investigated whether the increased risk among these groups depends upon the degree to which they perceive discrimination based on race or ethnicity. METHODS: We studied the incidence of psychotic disorders over 7 years in The Hague, a city with a large and diverse population of ethnic minorities. To compare the incidence of schizophrenic disorders (DSM IV: schizophrenia, schizophreniform disorder, schizoaffective disorder) in each ethnic minority group with the incidence in native Dutch, we computed incidence rate ratios (IRRs). Based on a population study and on rates of reported incidents of discrimination in The Hague, the degree of perceived discrimination of ethnic minority groups was rated: high (Morocco), medium (Netherlands-Antilles, Surinam and 'other non-western countries'), low (Turkey) or very low ('western or westernized countries'). RESULTS: The age- and gender-adjusted IRRs of schizophrenic disorders for ethnic minority groups exposed to high, medium, low, and very low discrimination were 4.00 (95% CI 3.00-5.35), 1.99 (1.58-2.51), 1.58 (1.10-2.27), and 1.20 (0.81-1.90), respectively. When not only schizophrenic, but all psychotic disorders were included in the analysis, the results were similar. CONCLUSIONS: These results suggest that discrimination perceived by ethnic minority groups in western Europe, or some factor closely related to it, may contribute to their increased risk of schizophrenia.
Asunto(s)
Grupos Minoritarios , Prejuicio , Trastornos Psicóticos/epidemiología , Adulto , Trastorno Bipolar/epidemiología , Trastorno Bipolar/etnología , Femenino , Humanos , Incidencia , Masculino , Marruecos/etnología , Países Bajos/epidemiología , Antillas Holandesas/etnología , Trastornos Psicóticos/etnología , Riesgo , Esquizofrenia/epidemiología , Esquizofrenia/etnología , Factores Socioeconómicos , Estadísticas no Paramétricas , Suriname/etnología , Migrantes , Turquía/etnologíaRESUMEN
OBJECTIVE: Tardive dyskinesia (TD) and tardive dystonia (TDt) syndromes represent severe side effects of first-generation antipsychotics (FGAs). Although second-generation antipsychotics (SGAs) confer a lower risk for tardive syndromes, many patients continue to use FGAs alone or in combination with SGAs. Some patients remain free of TD or TDt even after many years of antipsychotic treatment with predominantly FGAs. Do these patients remain at risk for TD or TDt and, consequently, should a switch to SGAs be considered? A longitudinal cohort study in patients on long-term antipsychotic treatment may answer this question. METHOD: A 9-year cohort study (1992-2001) was conducted of the whole, mostly chronic, psychiatric inpatient population on the Caribbean island of Curaçao (N = 194). Almost all patients (95%) were of African Carribean origin. TD and TDt were assessed (1 baseline, 6 follow-ups) with the Abnormal Involuntary Movement Scale and the Fahn-Marsden rating scale, respectively. New cases of TD or TDt were diagnosed if they fulfilled the criteria at 2 successive follow-up visits. RESULTS: In patients with a mean antipsychotic use of approximately 18 years, the yearly incidence rates of TD and TDt were 10.2% (95% CI = 7.7 to 13.5) and 0.7% (95% CI = 0.4 to 1.5), respectively. The severity of TD was strongly associated with the severity of TDt (beta = 0.08, 95% CI = 0.03 to 0.14) and vice versa (beta = 0.10, 95% CI = 0.03 to 0.16). TD severity was positively associated with age and akathisia but negatively associated with parkinsonism. CONCLUSIONS: Patients who are free of TD after many years of antipsychotic treatment still have a considerable risk for TD. Switching to an SGA may be warranted. The risk for incident TDt in this group was very low.
Asunto(s)
Antipsicóticos/efectos adversos , Discinesia Inducida por Medicamentos/epidemiología , Distonía/inducido químicamente , Adulto , África/etnología , Anciano , Antipsicóticos/uso terapéutico , Región del Caribe/epidemiología , Discinesia Inducida por Medicamentos/etnología , Discinesia Inducida por Medicamentos/patología , Distonía/epidemiología , Distonía/etnología , Distonía/patología , Femenino , Humanos , Incidencia , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Trastornos Psicóticos/tratamiento farmacológico , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: In an earlier study, we found that anorexia nervosa (AN) does not occur among Black women on the Caribbean island of Curaçao. METHOD: A case report is presented of a Black Antillean woman with AN, who was referred to a center for eating disorders in The Netherlands. In Curaçao, our patient succeeded in gaining weight to become more attractive. Due to subsequent problems in the relationship with her partner, she deliberately lost weight to become less attractive. RESULTS: After immigrating to The Netherlands, she adopted the Western cultural ideal of thinness and developed AN. CONCLUSION: This case illustrates the role and possible effects of sociocultural factors in the development of AN.
Asunto(s)
Anorexia Nerviosa/etnología , Anorexia Nerviosa/psicología , Población Negra/psicología , Medio Social , Aculturación , Adulto , Emigración e Inmigración , Femenino , Humanos , Países Bajos , Antillas Holandesas/etnologíaRESUMEN
OBJECTIVE: Although anorexia nervosa was once thought to occur only in affluent societies, cases have now been documented across the globe. To examine whether anorexia nervosa emerges in societies undergoing socioeconomic transition, the authors studied the incidence of anorexia nervosa on the Caribbean island of Curaçao. METHOD: The authors contacted the full range of community health and service providers on Curaçao, including dietitians, school counselors, and all 82 general practitioners. They also studied inpatient records for 84,420 admissions to Curaçao General Hospital and two private hospitals in 1995-1998. Probable-incident subjects were interviewed. RESULTS: The incidence rates in 1995-1998 per 100,000 person-years for anorexia nervosa on Curaçao were 1.82 (95% confidence interval [CI]=0.74-2.89) for the total population and 17.48 (95% CI=4.13-30.43) for the high-risk group of 15-24-year-old females. No cases were found among the majority black population. For the Curaçao mixed and white population, the incidence rate per 100,000 person-years for anorexia nervosa was 9.08 (95% CI=3.71-14.45). CONCLUSIONS: The overall incidence of anorexia nervosa on Curaçao is much lower than in the affluent societies of the United States and Western Europe. Within Curaçao, sociocultural factors appear to be associated with differential incidence rates of anorexia nervosa. The incidence of anorexia nervosa among the majority black population is nil, while the incidence among the minority mixed and white population on Curaçao is similar to that of the United States and the Netherlands.
Asunto(s)
Anorexia Nerviosa/epidemiología , Adolescente , Adulto , Anorexia Nerviosa/psicología , Población Negra/psicología , Población Negra/estadística & datos numéricos , Servicios de Salud Comunitaria/estadística & datos numéricos , Comparación Transcultural , Europa (Continente)/epidemiología , Femenino , Humanos , Incidencia , Masculino , Grupos Minoritarios/estadística & datos numéricos , Antillas Holandesas/epidemiología , Factores de Riesgo , Cambio Social , Estados Unidos/epidemiología , Población Blanca/psicología , Población Blanca/estadística & datos numéricosRESUMEN
Anorexia nervosa (AN), once thought to be a problem of wealthier, Western countries has now been documented in survey studies and case reports across geographic and economic groups; however, few epidemiological studies including interview have been done on these populations. We report on a comprehensive study on Curaçao, a Caribbean island in economic transition, where the majority of the population is of predominantly black African origin. As part of an epidemiological study on the island of Curaçao indigenous cases of AN were identified. Participants were interviewed and asked to complete standardized measures of eating behaviors and cultural attitudes. In addition, matched controls completed the same measures and were seen in a focus group to assess their knowledge of eating disorders and perceived current and future challenges to young Curaçao women. Six of the nine indigenous cases of AN were successfully traced; all were of mixed race. No cases of anorexia were found among the majority black population. The women with AN were from the high-education and high-income sectors of the society and the majority had spent time overseas. The women with a history of anorexia reported higher levels of perfectionism and anxiety than the matched controls. All of the women reported challenges to maintaining an active professional and personal life and viewed themselves as different from the norm. Women who presented with AN evidenced vulnerability to a triple threat to identity formation: (1) they were of mixed race, aspiring to fit into the mobile elite (and mostly white) subgroup while distancing themselves from the black majority; (2) they had the means for education and travel that left them caught between modern and traditional constructs of femininity; and (3) they had lived overseas, and therefore struggled upon reentry with the frustrations of what was possible within the island culture. The race, class and overseas exposures of the women with anorexia were anything but typical on the island. Cases of anorexia in other developing countries may similarly be limited to specific subgroups, which require specialized treatment and planning efforts.