Academic literature on the topic 'Caribbean studies|Psychology|Clinical psychology'

Studying behavioral disturbances of dementia across cultures allows us to identify commonalities and differences that may be useful in determining the best approach to managing these problems. However, what we tend to find in cross-cultural studies is that the best approach may not be the same approach, given the different prevalence of and levels of tolerance for various behavioral problems. These differences are apparent in the authors' studies of four populations—Jamaicans in Kingston; Cree in Northern Manitoba, Canada; Yoruba in Ibadan, Nigeria; and African Americans in the United States. The Jamaicans in this study live in a poor suburb of Kingston, the Cree live in two fairly small, isolated communities in Northern Manitoba, and the Yoruba live in Ibadan, a city of more than 1 million people. The Yoruba community the authors are studying, although concentrated in the city center, functions much like a village. The African-American population resides in Indianapolis, Indiana, a moderately sized city of approximately 1 million people.

BackgroundNumerous studies have reported high rates of psychosis in the Black Caribbean population in the UK. Recent speculation about the reasons for these high rates has focused on social factors. However, there have been few empirical studies. We sought to compare the prevalence of specific indicators of social disadvantage and isolation, and variations by ethnicity, in subjects with a first episode of psychosis and a series of healthy controls.MethodAll cases with a first episode of psychosis who made contact with psychiatric services in defined catchment areas in London and Nottingham, UK and a series of community controls were recruited over a 3-year period. Data relating to clinical and social variables were collected from cases and controls.ResultsOn all indicators, cases were more socially disadvantaged and isolated than controls, after controlling for potential confounders. These associations held when the sample was restricted to those with an affective diagnosis and to those with a short prodrome and short duration of untreated psychosis. There was a clear linear relationship between concentrated disadvantage and odds of psychosis. Similar patterns were evident in the two main ethnic groups, White British and Black Caribbean. However, indicators of social disadvantage and isolation were more common in Black Caribbean subjects than White British subjects.ConclusionsWe found strong associations between indicators of disadvantage and psychosis. If these variables index exposure to factors that increase risk of psychosis, their greater prevalence in the Black Caribbean population may contribute to the reported high rates of psychosis in this population.

Background. Subjective memory impairment (SMI) is common in older populations but its aetiology and clinical significance is uncertain. Depression has been reported to be strongly associated with SMI. Associations with objective cognitive impairment are less clear cut. Other factors suggested to be associated with SMI include poor physical health and the apolipoprotein E (APOE) ε4 allele. Studies of SMI have been predominantly confined to white Caucasian populations.Method. A community study was carried out in a UK African-Caribbean population aged 55–75, sampled from primary care lists. Twenty-three per cent were classified with SMI. Depression was defined using the 10-item Geriatric Depression Scale. Other aetiological factors investigated were education, objective cognitive function, APOE genotype, disablement and vascular disease/risk. The principal analysis was restricted to 243 participants scoring > 20 on the Mini-Mental State Examination (85%). A second analysis included all 290 participants.Results. Depression, self-reported physical impairment and APOE ε4 were associated with SMI. The association between SMI and physical impairment was not explained by depression, vascular disease/risk, or disability/handicap. The association between ε4 and SMI increased as MMSE scores decreased and was particularly strong in those with depression. The ε4 allele was present in 69% (95% CI 41–89%) of those with depression and SMI compared with 28% (20–36%) of those with neither.Conclusions. Depression may not be a sufficient explanation for subjective memory complaints. Memory complaints in the presence of depression are associated with high prevalence of ε4 and therefore, presumably, a raised risk of subsequent dementia.

Alzheimer’s disease (AD) and dementia has emerged as a significant societal issue and a global priority. The prevalence of dementia is rising more rapidly in low and middle income countries (LMIC) than in high income countries. Yet, knowledge of dementia risk factors is dominated by research from high income countries (HIC), which cannot be readily translated to LMIC. Latin American countries (LAC) have unique challenges related to dementia, including rapid aging population, high admixture degree and risk factors profile, which influence the prevalence and presentation of dementia. Several epidemiological studies during the past decade have shown a rapid increase of dementia in LAC, but the impact of genetic, protective and risk factors remain poorly understood. This research session will feature a series of short and engaging talks about new trends of dementia in the region and will answer key questions regarding dementia determinants and consequences in Hispanic populations. Participants will be first introduced to the aging process in LAC, prevalence and incidence of dementia within the region. The second presentation will report on genetics of Alzheimer disease in Hispanic populations. The third presenter will discuss the complexities of dementia multimorbidity and the impact of neuropsychiatric symptoms. The fourth presenter will discuss about Nationals and Regional Strategies to address dementia and reflects on recommendations and future directions for the region. All presentations will be based on findings from multiple research projects across the region. Furthermore, presenters will extended comparison to Non-Hispanics whites and Hispanics populations living in US, which allows cross countries/society comparisons. Overall, new information about dementia will be shared with the audience. Attendees will be able to identify the unique genetic and social determinants that drive AD in LAC. Recommendations will be given for preventive strategies tailored to LMIC. The findings to be shared will be essential for building evidence-based interventions that achieve the goals of the National Plan to Address Alzheimer’s Disease.

Background: Variability in dementia rates across racial and ethnic groups has been estimated at 60%. Studies suggest disparities in Caribbean Hispanic and Black populations, but community-based data are limited. Objective: Estimate the prevalence of mild cognitive impairment (MCI) and dementia in the racially and ethnically diverse community-based Northern Manhattan Study cohort and examine sociodemographic, vascular risk factor, and brain imaging correlates. Methods: Cases of MCI and dementia were adjudicated by a team of neuropsychologists and neurologists and prevalence was estimated across race/ethnic groups. Ordinal proportional odds models were used to estimate race/ethnic differences in the prevalence of MCI or dementia adjusting for sociodemographic variables (model 1), model 1 plus potentially modifiable vascular risk factors (model 2), and model 1 plus structural imaging markers of brain integrity (model 3). Results: There were 989 participants with cognitive outcome determinations (mean age 69±9 years; 68% Hispanic, 16% Black, 14% White; 62% women; mean (±SD) follow-up five (±0.6) years). Hispanic and Black participants had greater likelihood of MCI (20%) and dementia (5%) than White participants accounting for age and education differences. Hispanic participants had greater odds of MCI or dementia than both White and Black participants adjusting for sociodemographic variables, vascular risk factors, and brain imaging factors. White matter hyperintensity burden was significantly associated with greater odds of MCI or dementia (OR = 1.3, 1.1 to 1.6), but there was no significant interaction by race/ethnicity. Conclusion: In this diverse community-based cohort, cross-sectional data revealed significant race/ethnic disparities in the prevalence of MCI and dementia. Longer follow-up and incidence data are needed to further clarify these relationships.

This article contributes to the still limited analysis of gender and sexuality in the exploration of HIV infection in the Caribbean. In Trinidad and Tobago, child sexual abuse was identified as a prevalent behavior. This motivated a gendered exploration of the sociocultural factors underlying child sexual abuse and the link with HIV. Using a qualitative action research methodology, researchers sought to understand the patterns of behavior, sociocultural and gendered meanings, and significance of child sexual abuse; to sensitize stakeholders to these issues; and to develop multidisciplinary community-based interventions and policies. This article reports on the analysis of data collected from the interventions carried out as part of the action research methodology, as well as a range of national and community-specific action research activities including ethnographic case studies, national stakeholders meetings, and a study of service providers. It provides a nuanced understanding of the meanings, underlying assumptions, perceptions, and taboos associated with child sexual abuse in Trinidad and Tobago, as well as new ways of understanding child sexual abuse in the Caribbean. Findings showed that the social and gender context for child sexual abuse involves several interconnecting factors located within a framework of gender ideologies and expressions, sexual expectations and behaviors, and social norms based on patriarchal values. These findings would be of significance for the prevention of child sexual abuse and the associated HIV risk in Trinidad and Tobago, and the management of victims and perpetrators of child sexual abuse.

Abstract Case report - Introduction Here we explore a case of a 31-year-old female treated with juvenile arthritis rebranded as Blau syndrome. This is characterised by sarcoid involvement principally of her eyes as well as skin, kidneys, and joints. We aim to explore her management challenges and complications. Case report - Case description 31 MS of Afro-Caribbean descent was diagnosed with early onset sarcoidosis at the age of 18 months. She was later found to be NOD2 gene positive but has no significant family history. Her health has been further complicated by her diagnoses of growth hormone deficiency and hyperthyroidism secondary to multinodular goitre. Clinically MS has a short stature and profound deafness. A legacy of the ophthalmic morbidity, panuveitis, has led to a visual acuity is 6/15 in her left eye and her right reduced to counting fingers due to developing endophthalmitis in 2019. Her arthritis is stable, but there are flexion deformities primarily involving her proximal interphalangeal joints reducing her grip function. In adulthood she does not have significant cutaneous changes. Investigations have revealed her to be anti-nuclear and anti-neutrophil cytoplasmic antibody negative. Radiologically, hand films show sparing of erosive changes, radiocarpal subluxation, and deformity of carpi in keeping with bilateral Madelung deformity. MRI has never suggested synovial enhancement of sacroiliac joints. Therapeutically she has trialled conventional disease modifying therapy including azathioprine, mycophenolate, and methotrexate. Disease activity continues to be high despite anti-TNF biologic DMARDs (adalimumab, infliximab and golimumab). Use of anti-TNF therapy has been complicated by development of CMV disease and identification of anti-infliximab antibodies following interruption. Ongoing steroid use from 18 months, hyperthyroidism and a chronic inflammatory state has led to osteoporosis. DEXA Z-scores reveal lumbar -2.7, right femoral neck -3.2 and left femoral neck -4.7. Systemic corticosteroid has tried to be offset through dexamethasone intravitreal implants. Consequentially, uncontrolled disease burden has also led to significant input from orthopaedics, including bilateral total knee replacements by age 28. However, with MS, we are hopeful with the commencement of anti-IL6 receptor therapy (Tocilizumab) that this may represent a new line of effective treatment. Case report - Discussion Blau syndrome is a juvenile sarcoidosis characterised by the triad of granulomatous arthritis, recurrent uveitis, and dermatitis. It is inherited in an autosomal dominant pattern due to a missense mutation in the gene encoding for nucleotide-binding oligomerisation domain containing protein 2 (NOD2/CARD15). It is proposed that NOD2 as intracellular receptors, for antigen such as lipopolysaccharide, may subsequently act like toll-like receptors to cascade NF-kappa B and downstream inflammatory pathways. Its role is also implicated in other inflammatory conditions such as Crohn’s disease. As represented in our case, uveitis presents the highest morbidity, with median age of eye disease presenting at 60 months and remains persistent despite topical or systemic therapy in more than 50% of patients. In comparison to Juvenile idiopathic arthritis, Blau often leads to a pan rather than anterior segment only uveitis and in a greater proportion of cases. In addition to biological factors, much of MS’s treatment decisions have been guided by her and her psychology. In attempting to address the difficulties of her condition, including coordinating several specialities clinics whilst developing as a young woman, she has frequently discontinued therapy which may represent an area that she can exact control given little perceived benefit. TNF-alpha inhibitors have been validated through randomised controlled trials for the use of refractory sarcoidosis. However recent literature has highlighted the use of targeting the IL-6 pathway in multisystem chronic sarcoidosis. It is believed this may represent a key cytokine in promoting Th17 effector cells that have been implicated in sarcoidosis bio-pathology. However ongoing case reports and ideally large-scale studies are needed. Case report - Key learning points Blau syndrome as a rare lifelong form of early onset sarcoidosis offers insight into challenging therapeutic decision making where limited clinical trial data is available.

Abstract Background A higher incidence of psychotic disorders has been consistently reported among black and other minority ethnic groups, particularly in northern Europe. It is unclear whether these rates have changed over time. Methods We identified all individuals with a first episode psychosis who presented to adult mental health services between 1 May 2010 and 30 April 2012 and who were resident in London boroughs of Lambeth and Southwark. We estimated age-and-gender standardised incidence rates overall and by ethnic group, then compared our findings to those reported in the Aetiology and Ethnicity of Schizophrenia and Other Psychoses (ÆSOP) study that we carried out in the same catchment area around 10 years earlier. Results From 9109 clinical records we identified 558 patients with first episode psychosis. Compared with ÆSOP, the overall incidence rates of psychotic disorder in southeast London have increased from 49.4 (95% confidence interval (CI) 43.6–55.3) to 63.1 (95% CI 57.3–69.0) per 100 000 person-years at risk. However, the overall incidence rate ratios (IRR) were reduced in some ethnic groups: for example, IRR (95% CI) for the black Caribbean group reduced from 6.7 (5.4–8.3) to 2.8 (2.1–3.6) and the ‘mixed’ group from 2.7 (1.8–4.2) to 1.4 (0.9–2.1). In the black African group, there was a negligible difference from 4.1 (3.2–5.3) to 3.5 (2.8–4.5). Conclusions We found that incidence rates of psychosis have increased over time, and the IRR varied by the ethnic group. Future studies are needed to investigate more changes over time and determinants of change.

This study explored the parallels between psychological healing practice in the Cave of San Francisco and contemporary psychotherapy. Interviews were conducted in the Dominican Republic with seven individuals who had experienced healing effects as a result of participation in this healing system. A psychological phenomenological methodology was utilized to analyze the interviews resulting in a general structural account of the experience. Seven primary psychological themes operative in a tri-part sequence define the healing experience within this system. These themes include presenting problem, belief system, healing relationships, ritual actions, pivotal moment, setting, and outcome. The first part of the healing sequence appears to set up the healing response. The second part involves the pivotal moment and acts as a demarcation point between the experience of illness and first steps toward health. The third part of the healing sequence acts to cement already obtained healing gains.

The results of this research reveal (a) a psychological healing system which represents a form of psychotherapy, (b) a cultural healing system which stands as a portrait of healing for a certain segment of the Dominican population, (c) a healing practice related to a cave shrine which illuminates the potential healing effects of cave shrines worldwide. A significant finding relates healing response to setting, suggesting that the specific space of the cave is implicated in stimulating the innate, total healing response in the person. The holistic, cohesive nature of this system, highlighting the interaction between universal psychological healing ingredients, strongly suggests that psychological healing is a broader and more comprehensive operation than it is characterized by many current psychotherapies. Finally, through exploring the roots of psychological healing in the naturalistic setting of a cave, this research reminds psychotherapy of the archetypal healing power that is at its basis.

Puerto Rico has endured horrendous natural disasters in the last few years, leaving thousands to cope with the aftermath; a mental health crisis. Therefore, understanding how Puerto Ricans navigate adversities, be that childhood adversity, natural disasters or daily stress is of utmost importance. Understanding the role resilience and drinking play in Puerto Rico will help us to further understand how they navigate adversities. Hence the reason why in this study we looked at how Adverse Childhood Experiences, Perceived Stress, Natural Disaster Adversity and Shame relate to each other and to Drinking behaviors and Resiliency. Data were collected on Puerto Rico via an online survey. Several individuals participated in the study (N = 189). Modifying variables included, age, place of residence on the island, gender, ethnicity, education, occupation and socio economic status. The results demonstrated significant differences between some modifying variables. Differences were seen between men and women in levels of Shame and ACES. No significant differences were found between ethnicities in levels of Shame, Stress, ACES, Hurricane Adversities and Resiliency. Similarly, no relationship was found between respondents level of drinking and SES. When looking at the sample as a whole there was no relationship between ACES and hurricane adversities as well as with drinking. However, there appears to be a positive relationship between ACES and Shame, and a small positive relationship between drinking and Shame. On the other hand, a negative relationship was found between Shame, ACES and Resiliency. However, a small positive relationship was found between the number of drinks people have and Resiliency. Additional analysis was conducted to further understand these variables and their relationships. Additional research, exploratory research, is needed to understand the variables and the relationship between them. Exploratory research is needed as a way to further understand the role culture plays in understanding Shame, ACES, Stress, Hurricane Adversities, Drinking and Resiliency in Puerto Rico.

Scope of Study: The scope of this theoretical study is comprised of an extensive review and interpretation of published studies by governmental organizations such as the World Health Organization (WHO); non-governmental organizations (NGOs); and individuals detailing the theories, concepts, and relationships that exist regarding the social and economic effects of the global burden of mental health disorders and the substantial treatment gap of mental health conditions in low-resourced settings such as Haiti. Humanitarian emergencies are presented as opportunities to build better mental health systems in low-income countries (LICs). Exploring Haiti’s trauma signature (TSIG) identified risk factors for post-disaster mental health consequences to include posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) within the adult population. Three culturally relevant community-based mental health programs Soulaje Lespri Moun (SLM), Partners in Health/Zanmi Lasante (PIH/ZL), and Pwogwam Sante´ Mantal (PSM), and one hospital-centered program, Project Medishare Hospital, are highlighted to demonstrate the implementation of successful mental health care services in post-earthquake Haiti. This project is focused on confronting the barriers to mental health services in Haiti with the goal of developing a long-term sustainable mental health system.

Findings and Conclusions: This research project’s findings are congruent with previous research, which described coordinating with local leadership and integrating culturally relevant, community-focused, and evidence-based mental health care with existing health services. These elements are essential in the development of long-term sustainable services in LICs.

The final chapter is a presentation of recommendations for future areas of inquiry to contribute to greater understanding of global mental health needs, prevention, and delivery of services in LICs before and after complex humanitarian crises. Expanding sustainable mental health care for Haiti will reduce disability and suffering from mental illnesses and build a stronger and more resilient society.