RESUMEN
To assess the lunar hypothesis as predictive of mental health emergencies and antisocial behaviour, the relation of lunar phases and the occurrence of psychiatric hospital admissions or aggressive behaviour by the inpatients of the hospital for the five-year period 1986-1990 were examined. The first admissions, readmissions and total admissions by gender during four lunar phases (New moon, First quarter, Full moon and Last quarter) were compared with each other, and with the average daily admissions during the rest of the lunar month. All agressive outbursts or fights whether resulting in any form of injury during these lunar phases were compared with each other and with those during the rest of the month. Chi-square analysis did not show any significant variation in admissions or aggressive behaviour during the various moon phases of the lunar cycle and the rest of the month. Variations by month followed no consistent pattern by gender, number of admissions, the year of study or a combination of these factors. The results of the study show that contrary to popular belief there is no scientific basis to support the view that the moon's phases play a significant role in an increase of first admissions or readmissions to the psychiatric hospital or that the phases of the moon predispose the mentally ill to violence or aggressive behaviour (AU)
Asunto(s)
Humanos , Salud Mental , Luna , Trastorno de la Conducta Social , Trastorno de Personalidad AntisocialRESUMEN
There are many reports that births during the cooler winter months produce an excess of schizophrenics diagnosed in later life. This is also reported to be true in South Africa where the seasons are reversed. Thus, the seasonality effect of schizophrenic births is fairly well established. If this hypothesis is true, then in countries without a true winter, there should not be an increase in schizophrenic births during the so-called winter months. We tested this hypothesis on a group of 466 schizophrenics (who met the DSM III R diagnostic criteria) born between the years 1915 and 1976 and treated at the psychiatric Hospital in Barbados. Barbados is a tropical island situated at 13§08'N and 59§36'W, has no pronounced winters (average monthly temperature - 78.8§F; SDñ 1.7) with a population which is predominantly of African descent. We searched for seasonal/quarterly and monthly birth trends, using the total population as controls. We used Chi Square Test, Edwards Test and the GLIM programme to analyze the data. We did not find any significant differences in the monthly or quarterly birth patterns of schizophrenics when compared to the general population. There was also no significant difference when the paranoid subgroup was compared with the controls. Our findings suggest the lack of seasonality in Barbados results in a more uniform monthly distribution of births of persons who subsequently become schizophrenic (AU)
Asunto(s)
Humanos , Estaciones del Año , Esquizofrenia/epidemiología , Barbados/epidemiologíaRESUMEN
A prospective analysis of re-admissions to the Psychiatric Hospital, Barbados, conducted in 1990 by the author, revealed that the re-admission rate of patients registered with the District Psychiatric Nursing Services (DPNS) was substantially lower than the re-admission rate from the Outpatient Department (OPD) of the hospital and other services. It was proposed that expansion of the DPNS, especially to include the urban parishes (which contributed over 60 percent of the admissions), would significantly reduce the number of re-admissions. In 1991, the DPNS was extended to include to the urban parish of St. Michael and later the entire island. This study analyses the effects of the DPNS on admissions to the Psychiatric Hospital. It was found that for the first time in 16 years, instead of a rise in admissions, there was a 19 percent reduction in re-admissions during the years 1991 and 1992. In addition there was a 24 percent reduction in first admissions during the same period. The annual re-admission rate from the DPNS was 10 percent while in the case of OPD it was 65 percent (Xý=172.99, df=1, p<0.001). The DPNS at present provides highly specialized care for over 1308 outpatients while 1408 patients are manaaged by the OPD and all other services of the hospital. The extra cost incurred in the expansion of DPNS was BD$60,036.00 while the average cost for hospitalization of these patients for 3 weeks would have been BD$501, 765.00. The total annual cost of fullt expanded DPNS is BD$418,535.52 p.a. Thus the DPNS is not only responsible for reducing admissions and reducing patient morbidity, but also highly cost-effective (AU)
Asunto(s)
Humanos , Servicios Comunitarios de Salud Mental , Readmisión del Paciente , Enfermería Psiquiátrica , BarbadosRESUMEN
The Glendary Prison is the only prison in Barbados. It accomodates over 500 prisoners of whom 20 per cent suffer from mental illness at any given time. This study analyses the mentally ill prisoners attending the Prison Mental Health Clinic during the four-year period between September, 1988 and August, 1992. Of 211 patients studied during this period, 78.2 per cent had a history of mental illness prior to incarceration. The total number of visits to the clinic was 3,065, resulting in an average of 32 patients being seen on each clinic day. These figures highlight the need for a Forensic Mental unit within the prison premises, with more prison officers trained in Mental Health Nursing. There is also need for forensic training of psychiatrists and nurses at the Psychiatric Hospital (AU)
Asunto(s)
Humanos , Trastornos Mentales , Prisiones , Servicios de Salud Mental , Enfermería Psiquiátrica , BarbadosRESUMEN
A retrospective review of adolescent admissions (12 to 18 years) to the Queen Elizabeth Hospital (QEH) and the Psychiatric Hospital for the period of October, 1991 to September, 1992 was undertaken to determine the causes of hospitalization. There were 725 admissions consisting of 297 males and 428 females. The majority of the patients (535, i.e. 74 percent) spent between 1 and 5 days, while only 55 patients (7.6 percent) spent more than 14 days in hospital. The three most frequent causes of hospitalization were trauma (165), abortions (153), drug abuse/overdose (53). Psychiatric conditions accounted for 38 admissions. Based on our data, we estimated that a 15-bed adolescent unit set up at the QEH can serve the in-patient needs of the adolescent population in Barbados. This can be speedily achieved by restructuring the existing paediatric unit (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Hospitalización , Admisión del Paciente/estadística & datos numéricos , BarbadosRESUMEN
Antipsychotic (neuroleptic) drugs control symptoms of psychosis by blocking the central dopaminergic receptors. This reaction alleviates symptoms but can lead to neuroleptic malignant syndrome (NMS), a life-threatening adverse drug reaction to neuroleptics. The records of all patients diagnosed as suffering from NMS during the period January, 1989 to October, 1992 were analyzed. A total of 5,562 patients (4,168 males and 1,394 females) were treated as inpatients with neuroleptics at the Psychiatric Hospital in Barbados during the same period. A total of 11 cases (0.195 per cent) were diagnosed as suffering from NMS and had to be transferred to the Queen Elizabeth Hospital for further management. All patients were of African descent and we are unaware of any large scale study on the incidence of NMS in patients of African descent. The incidence of females (0.65 per cent) was much higher than in males (0.05 per cent). The mortality rate in these patients was very high (45 per cent) which may be due to the use of high doses of neuroleptics and also the use of combinations of haloperidol and depot (fluphenazine/flupenthixol) preparations, which are considered high-risk drugs for NMS. The mortality rate in patients managed conservatively was 75 per cent whereas in those receiving bromocriptine and/or dantrolene it was 29 per cent. General medical practitioners should be aware of NMS because early diagnosis and prompt initiation of treatment with drugs like bromocriptine and/or dantrolene would reduce the mortality considerably (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Síndrome Neuroléptico Maligno , BarbadosRESUMEN
The purpose of this study was to ascertain the causes and the frequency for re-admission to the Psychiatric Hospital in Barbados, and to suggest remedial measures where possible. All re-admissions over the three-month period February - May 1991 were administered a structured questionaire by interview. Demographic data on admissions were obtained from published hospital statistics over the last 16 years. The results show that 74 per cent of the re-admissions were male which compares with 48 per cent of males in the general population of the country. Some of the factors associated with male re-admission, as compared with females, were an earlier age of onset of illness (males: 25.15 years; females 32.21 years), poor drug compliance (78 percent), a higher incidence of alcohol and other drug abuse (males: 89 percent; females: 13 percent) and a higher incidence of aggression and criminal behaviour (males: 50 percent; females: 7 percent). Most patients were from the urban parishes (60 percent), were unemployed (68 percent), and came from lower socio-economic backgrounds (88 percent). A finding of significance was that only 1 in every 35 patients registered with the outpatient services in the hospital. However, the district nursing service was not available in the urban areas from where 60 per cent of the patient came. It is concluded that the provision of adequate drug and alcohol rehabilitation facilities, and expansion of the Psychiatric District Nursing Services to urban areas, would reduce the number of patients readmitted to the psychiatric Hospital (AU)
Asunto(s)
Masculino , Femenino , Humanos , Hospitales Psiquiátricos/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Barbados , Servicios de Salud MentalRESUMEN
With lifetime prevalence estimates of drug abuse among schizophrenics as high as 47.01 percent, there is an increasing awareness of the importance of this "dual diagnosis" and the global deficiencies in our knowledge of this co-morbid condition. These patients place a significant burden on the mental health delivery system through chronic disability, social dysfunction, frequent rehospitalizations and poor overall treatment compliance. The prevalence of alcohol and drug abuse among the mentally ill was analyzed by studying all admissions to the Psychiatric Hospital, Barbados, during the year 1993. Besides alcohol, cocaine and marijuana are the most commonly abused drugs in Barbados. Of the 1,139 admissions during the period of study, drug abuse accounted for 358 (31.4 percent) admissions and was the second most common diagnosis after schizophrenic illnesses. Of the admissions only 4.7 percent were diagnosed as being addicted to alcohol/drugs without any psychosis, 47 (4.1 percent) were admitted with a "drug induced mental disorder" while the rest were admitted primarily due to a psychosis associated with drug abuse (dual diagnosis). Most of the patients (86 percent of alcoholics and 98 percent with marijuana and/or cocaine abuse) were males. Overall, cocaine and marijuana users tended to be young males with the largest number (38 percent) in the 20 - 34-year age group. Alcoholics were usually older, with 40 percent being 35 - 44 years old and 24 percent in the 45 - 64 year age group. It is thus evident that adequate inpatient alcohol and drug rehabilitation is essential for proper management of the mentally ill (AU)