Psychotic Disorders and Serious Mental Illness

The major public health problem that is HIV/AIDS in persons with a serious mental illness is aptly described a “syndemic.” Having HIV/AIDS puts one at much greater risk for developing a serious mental illness. Conversely, having a serious mental illness, such as schizophrenia, bipolar disorder, major depressive disorder, substance use disorder, is associated with many factors that place one at greater risk for contracting and transmitting HIV. And, in both cases of serious mental illness and HIV/AIDS, each disorder creates many new challenges in the management of the other disorder. This chapter addresses these challenges, which center around being able to participate actively and adhere to medication regimens needed to manage both medical and psychiatric conditions. Fortunately, specialized models of care like comprehensive, integrated clinics and nurse care managers are ways to provide effective, satisfying, and cost-effective care to this most vulnerable population.

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Pharmacological and behavioural interventions to promote smoking cessation in adults with schizophrenia and bipolar disorders: a systematic review and meta-analysis of randomised trials

BMJ Open ◽

10.1136/bmjopen-2018-027389 ◽

2019 ◽

Vol 9 (11) ◽

pp. e027389 ◽

Cited By ~ 4

Author(s):

Robert Pearsall ◽

Daniel J Smith ◽

John R Geddes

Keyword(s):

Systematic Review ◽

Mental Illness ◽

Smoking Cessation ◽

Serious Mental Illness ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Public Health Problem ◽

Controlled Trials ◽

Major Public Health Problem ◽

Randomised Controlled

ObjectiveSmoking in people with serious mental illness is a major public health problem and contributes to significant levels of morbidity and mortality. The aim of the review was to systematically examine the efficacy of methods used to aid smoking cessation in people with serious mental illness.MethodA systematic review and meta-analysis of randomised controlled trials to compare the effectiveness and safety of pharmacological and behavioural programmes for smoking cessation in people with serious mental illness. Electronic databases were searched for trials to July 2018. We used the Cochrane Collaboration’s tool for assessing the risk of bias.ResultsTwenty-eight randomised controlled trials were identified. Varenicline increased the likelihood of smoking cessation at both 3 months (risk ratio (RR) 3.56, 95% CI 1.82 to 6.96, p=0.0002) and at 6 months (RR 3.69, 95% CI 1.08 to 12.60, p=0.04). Bupropion was effective at 3 months (RR 3.96, 95% CI 1.86 to 8.40, p=0.0003), especially at a dose of 300 mg/day, but there was no evidence of effect at 6 months (RR 2.22, 95% CI 0.52 to 9.47, p=0.28). In one small study, nicotine therapy proved effective at increasing smoking cessation up to a period of 3 months. Bupropion used in conjunction with nicotine replacement therapy showed more effect than single use. Behavioural and bespoke interventions showed little overall benefit. Side effects were found to be low.ConclusionThe new information of this review was the effectiveness of varenicline for smoking cessation at both 3 and 6 months and the lack of evidence to support the use of both bupropion and nicotine products for sustained abstinence longer than 3 months. Overall, the review found relatively few studies in this population.

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Opportunistic Infections and Associated Factors among HIV/AIDS Patients taking Ante-Retroviral Therapy at Selected Hospitals in Sidama Zone, Southern Ethiopia: A facility-based cross-sectional study

10.21203/rs.2.17125/v1 ◽

2019 ◽

Author(s):

Demelash Wachamo ◽

Fisseha Bonja

Keyword(s):

Associated Factors ◽

Opportunistic Infections ◽

Public Health Problem ◽

Cross Sectional Study ◽

High Morbidity ◽

Major Public Health Problem ◽

Sectional Study ◽

Aids Patients ◽

Cross Sectional ◽

Hiv Aids

Abstract Background Opportunistic infections are late complications of HIV infection is the depletion of the immune system. It is a major public health problem and high morbidity AIDS patients die of AIDS-related infections in developing countries like Ethiopia. Identification of opportunistic infections (OIs) is important to develop a specific intervention. Therefore, this study aimed to assess the burden and associated factors of opportunistic infections.Method A facility-based cross-sectional study was conducted on 420 randomly selected HIV/AIDS patients taking anti-retroviral therapy. Data was collected from selected hospitals in Sidama Zone based on population proportion to size. Data was collected by a pre-tested questionnaire and a pre-tested checklist from the medical records of patients. Data entry and analyzed for descriptive and logistic regression models by SPSS v.23. The result declared as statistically significant at p < 0.05.Result The magnitude of opportunistic infections was 39.6%. Major identified OIs was oral candidacies 23.2%, recurrent bacterial pneumonia 21.5%, Herpes zoster 6.3%, and Pulmonary Tuberculosis 6.0%.The magnitude of opportunistic associated with; older age [AOR=2.69, 95% CI: 1.33-5.43], No formal education [AOR=3.12, 95% CI: 1.06-9.25], Low monthly income [AOR=2.27, 95%CI:1.35-3.83], initial CD4 count less than 200 cells/mm3 [AOR=1.91, 95% CI:1.05-3.46), WHO clinical stage II [AOR=2.43, 95% CI:1.34-4.42] and stage III and IV [AOR=4.27, 95% CI: 2.12-8.59], had no extra medicine additional to ART (prophylaxis) had [AOR= 5.91, 95% CI: 3.31-10.56], who interrupt ART medicines [AOR=2.03, 95% CI: 1.09- 3.80] and Khat chewing [AOR=5.48, 95% CI: 2.32-12.96] when compared to their counterparts.Conclusions The overall magnitude of opportunistic infections was high when compared with other studies. Health officials and clinicians need to give attention on the strengthening of the provision if ART with prophylaxis on early-stage and adhrerence, implementation of the TB/HIV collaboration activity, and early initiation of ART to reduce opportunistic infections.

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Overview of Schizophrenia and Other Psychotic Disorders

10.2310/psych.13011 ◽

2020 ◽

Author(s):

James A. Wilcox ◽

Donald W. Black

Keyword(s):

Psychotic Disorder ◽

Schizoaffective Disorder ◽

Psychotic Disorders ◽

Public Health Problem ◽

Premature Death ◽

Major Public Health Problem ◽

Schizophreniform Disorder ◽

Schizophrenia Spectrum ◽

Brief Psychotic Disorder ◽

The Individual

Psychotic disorders are among the most disabling conditions and constitute a major public health problem. Described throughout recorded time, they affect as many as 5% of the population and cause a disproportionate amount of suffering and loss to society. In the chapter on schizophrenia spectrum and other psychotic disorders, the DSM-5 lists delusional disorder, brief psychotic disorder, schizophreniform disorder, schizophrenia, and schizoaffective disorder, as well as categories for substance- or medically induced psychotic disorders. The term psychosis indicates that the individual has a severe inability to interpret the surrounding environment in a realistic way. Symptoms include hallucinations, delusions, and bizarre behavior. Psychotic disorders are associated with premature death, mostly attributable to suicide. The pathophysiology and etiology of psychotic disorders are only now beginning to be understood, and treatment for these conditions remains suboptimal. Researchers are currently refining the cause of these symptoms and developing more effective treatments. This review contains 3 tables, and 34 references. Key words: Brief psychotic disorder, delusions, hallucinations, psychosis, schizoaffective disorder, schizophrenia, schizophreniform disorder

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Antiparasitic phytotherapy perspectives, scope and current development

Infectio ◽

10.22354/in.v23i2.777 ◽

2019 ◽

Vol 23 (2) ◽

pp. 189 ◽

Cited By ~ 3

Author(s):

Jhon Carlos Castaño Osorio ◽

Alejandra María Giraldo García

Keyword(s):

Low Income ◽

Public Health Problem ◽

Cost Effective ◽

Prolonged Treatment ◽

Major Public Health Problem ◽

Middle Income ◽

Middle Income Countries ◽

Commercial Markets ◽

Health And Economic Development ◽

New Treatments

Tropical protozoan diseases are currently a major public health problem throughout the world and are strongly linked with poverty, this combined with a lack of commercial markets for potential drugs has created a large burden on the health and economic development of low-income and middle-income countries in Africa, Asia, and the Americas. Due to the low research interest and the high increase of resistance against the existing treatments, as well as increasing inefficiency, toxicity, prolonged treatment schedules and costs, there is an urgent need for cost-effective, safe and easy-to-administer, new effective compounds with novel mechanisms of action. Several studies of crude plant extracts have already identified potential compounds to treat Chagas’ disease, Leishmaniasis, Toxoplasmosis, Giardiasis, and Malaria among other protozoan parasites. Natural compounds of medicinal plants have shown lower toxicity together with higher specificity, creating an optimistic view of new treatments for diseases. Out of 1010 new active substances approved as drugs for medical conditions by regulatory agencies during the past 25 years, 490(48.5%) were from a natural origin.

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The Burden of Orphans and Vulnerable Children Due to HIV/AIDS in Cameroon

The Open AIDS Journal ◽

10.2174/1874613601206010245 ◽

2012 ◽

Vol 6 (1) ◽

pp. 245-258 ◽

Cited By ~ 13

Author(s):

Dickson S Nsagha ◽

Anne-Cécile ZK Bissek ◽

Sarah M Nsagha ◽

Jules-Clement N Assob ◽

Henri-Lucien F Kamga ◽

...

Keyword(s):

Public Health ◽

Integrated Care ◽

Health Problem ◽

Public Health Problem ◽

Hiv Prevalence ◽

Major Public Health Problem ◽

Vulnerable Children ◽

Orphans And Vulnerable Children ◽

Aids Orphans ◽

Hiv Aids

HIV/AIDS is a major public health problem in Cameroon and Africa, and the challenges of orphans and vulnerable children are a threat to child survival, growth and development. The HIV prevalence in Cameroon was estimated at 5.1% in 2010. The objective of this study was to assess the burden of orphans and vulnerable children due to HIV/AIDS in Cameroon. A structured search to identify publications on orphans and other children made vulnerable by AIDS was carried out. A traditional literature search on google, PubMed and Medline using the keywords: orphans, vulnerable children, HIV/AIDS and Cameroon was conducted to identify potential AIDS orphans publications, we included papers on HIV prevalence in Cameroon, institutional versus integrated care of orphans, burden of children orphaned by AIDS and projections, impact of AIDS orphans on Cameroon, AIDS orphans assisted through the integrated care approach, and comparism of the policies of orphans care in the central African sub-region. We also used our participatory approach working experience with traditional rulers, administrative authorities and health stakeholders in Yaounde I and Yaounde VI Councils, Nanga Eboko Health District, Isangelle and Ekondo Titi Health Areas, Bafaka-Balue, PLAN Cameroon, the Pan African Institute for Development-West Africa, Save the orphans Foundation, Ministry of Social Affairs, and the Ministry of Public Health. Results show that only 9% of all OVC in Cameroon are given any form of support. AIDS death continue to rise in Cameroon. In 1995, 7,900 people died from AIDS in the country; and the annual number rose to 25,000 in 2000. Out of 1,200,000 orphans and vulnerable children in Cameroon in 2010, 300,000(25%) were AIDS orphans. Orphans and the number of children orphaned by AIDS has increased dramatically from 13,000 in 1995 to 304,000 in 2010. By 2020, this number is projected to rise to 350,000. These deaths profoundly affect families, which often are split up and left without any means of support. Similarly, the death of many people in their prime working years hamper the economy. Businesses are adversely affected due to the need to recruit and train new staff. Health and social service systems suffer from the loss of health workers, teachers, and other skilled workers. OVC due to HIV/AIDS are a major public health problem in Cameroon as the HIV prevalence continues its relentless increase with 141 new infections per day. In partnership with the Ministry of Social Affairs and other development organizations, the Ministry of Public Health has been striving hard to provide for the educational and medical needs of the OVC, vocational training for the out-of- school OVC and income generating activities for foster families and families headed by children. A continous multi-sectorial approach headed by the government to solve the problem of OVC due to AIDS is very important. In line with the foregoing, recommendations are proposed for the way forward.

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Factors Associated with Anemia among People Living with HIV/AIDS Taking ART in Ethiopia

Advances in Hematology ◽

10.1155/2019/9614205 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Ketema Bizuwork Gebremedhin ◽

Tadesse Bedada Haye

Keyword(s):

Addis Ababa ◽

Clinical Stage ◽

Public Health Problem ◽

People Living With Hiv ◽

Major Public Health Problem ◽

Cross Sectional ◽

Factors Affecting ◽

Factors Associated ◽

Living With Hiv ◽

Hiv Aids

Background. Globally, anemia, among people living with HIV/AIDS, is a major public health problem. It has a significant effect on the progression of HIV/AIDS to advanced stages and there are a number of factors that often affect anemia. However, there is little insight regarding factors affecting anemia among HIV/AIDS patients in developing countries, including Ethiopia. Objective. This study aimed at investigating factors affecting anemia among people living with HIV/AIDS taking ART drug at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods. A hospital based cross-sectional study design was used to assess factors affecting anemia among people living with HIV/AIDS. Structured checklist was used to gather information from charts of patients selected by simple random sampling method. We analyzed the data to identify factors associated with anemia among people with HIV/AIDS using logistic regression models. Results. A total of 301 selected charts were reviewed. The median age was 38 ± 10.38. The majority (62.5%) of the patients were taking ZDV-containing ART drug (ZDV/3TC/NVP). The overall anemia prevalence was 34.6%, while about 5%, 15.6%, and 14% of the patients had severe, moderate, and mild prevalence of anemia, respectively. Factors that were found to affect anemia among these patients include gender (OR = 2.26 [95% CI: 1.22, 4.16]), occupation (OR: 0.57 [95%CI: 0.35, 0.92]), WBC count (OR = 2.30 [95% CI: 1.29, 4.09]), platelet count (OR = 2.89 [95% CI: 0.99, 8.41]), nutritional status (OR = 2.05 [95% CI: 0.69, 6.02]), and WHO clinical stage of HIV/AIDS (OR = 3.69 [95% CI: 1.86, 7.31]). Conclusions. About one in three patients was found to be anemic. Intervention aimed at diagnosing and treating anemia among people living with HIV/AIDS should be considered.

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Addressing Female Iron-Deficiency Anaemia in India: Is Vegetarianism the Major Obstacle?

ISRN Public Health ◽

10.5402/2012/765476 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 14

Author(s):

Anu Rammohan ◽

Niyi Awofeso ◽

Marie-Claire Robitaille

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anaemia ◽

Large Scale ◽

Public Health Problem ◽

Cost Effective ◽

Vegetarian Diet ◽

Major Public Health Problem ◽

Daily Consumption ◽

Indian Women ◽

Deficiency Anaemia

Objectives. We examined the influence of vegetarian diet on the risk of developing anaemia among Indian women and suggest initiatives for addressing diet-related iron-deficiency anaemia. Methods. We analysed data on diet, social class, and haemoglobin levels from the nationally representative Indian National Family and Health Survey 2005/06 for a sample of 81,301 women aged 15–49 years using logistic regression models. Results. After controlling for individual-level factors and household level socioeconomic characteristics, daily consumption of meat, fish, and eggs was associated with lower odds of being moderately or severely anaemic. Our analysis also revealed that economic characteristics such as being from higher wealth quintiles, being in paid employment, and rural residence reduced the odds of having iron-deficiency anaemia among Indian women. Discussion. As a large proportion of Indians subsist on iron-poor vegetarian diets for religious, economic, and cultural reasons, large-scale iron supplementation and fortification of commonly consumed vegetarian foodstuffs constitute a feasible, culturally appropriate, and cost-effective strategy for addressing this major public health problem. Consumption of cheap iron-rich foodstuffs should be promoted. Effective poverty alleviation and hookworm prevention programs are also important. Large-scale cohort and intervention studies are urgently required to further define the influence of vegetarianism on iron deficiency anaemia in India.

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Remote Ecological Momentary Testing of Learning and Memory in Adults With Serious Mental Illness

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa172 ◽

2020 ◽

Author(s):

Emma M Parrish ◽

Snigdha Kamarsu ◽

Philip D Harvey ◽

Amy Pinkham ◽

Colin A Depp ◽

...

Keyword(s):

Mental Illness ◽

Serious Mental Illness ◽

Real World ◽

Cognitive Abilities ◽

Verbal Learning ◽

Cost Effective ◽

Cognitive Testing ◽

Contextual Influences ◽

Learning Test ◽

List Memory

Abstract Smartphone-based ecological mobile cognitive tests (EMCTs) can measure cognitive abilities in the real world, complementing traditional neuropsychological assessments. We evaluated the validity of an EMCT of recognition memory designed for use with people with serious mental illness, as well as relevant contextual influences on performance. Participants with schizophrenia (SZ), schizoaffective disorder, and bipolar disorder (BD) completed in-lab assessments of memory (Hopkins Verbal Learning Test, HVLT), other cognitive abilities, functional capacity, and symptoms, followed by 30 days of EMCTs during which they completed our Mobile Variable Difficulty List Memory Test (VLMT) once every other day (3 trials per session). List length on the VLMT altered between 6, 12, and 18 items. On average, participants completed 75.3% of EMCTs. Overall performance on VLMT 12 and 18 items was positively correlated with HVLT (ρ = 0.52, P < .001). People with BD performed better on the VLMT than people with SZ. Intraindividual variability on the VLMT was more specifically associated with HVLT than nonmemory tests and not associated with symptoms. Performance during experienced distraction, low effort, and out of the home location was reduced yet still correlated with the in-lab HVLT. The VLMT converged with in-lab memory assessment, demonstrating variability within person and by different contexts. Ambulatory cognitive testing on participants’ personal mobile devices offers more a cost-effective and “ecologically valid” measurement of real-world cognitive performance.

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The Changing Epidemiology of HIV-Associated Adult Meningitis, Uganda 2015–2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz419 ◽

2019 ◽

Vol 6 (10) ◽

Cited By ~ 6

Author(s):

Jayne Ellis ◽

Ananta S Bangdiwala ◽

Fiona V Cresswell ◽

Joshua Rhein ◽

Edwin Nuwagira ◽

...

Keyword(s):

Public Health Problem ◽

Diagnostic Algorithm ◽

Cost Effective ◽

Primary Diagnosis ◽

Viral Meningitis ◽

Sub Saharan Africa ◽

First Episode ◽

Major Public Health Problem ◽

Diagnostic Threshold ◽

The Impact

Abstract Background Central nervous system (CNS) infections remain a major public health problem in Sub-Saharan Africa, causing 15%–25% of AIDS-related deaths. With widespread availability of antiretroviral therapy (ART) and the introduction of improved diagnostics, the epidemiology of infectious meningitis is evolving. Methods We prospectively enrolled adults presenting with HIV-associated meningitis in Kampala and Mbarara, Uganda, from March 2015 to September 2017. Participants had a structured, stepwise diagnostic algorithm performed of blood cryptococcal antigen (CrAg), CSF CrAg, Xpert MTB/RIF for tuberculous (TB) meningitis (TBM), Biofire multiplex polymerase chain reaction, and traditional microscopy and cultures. Results We screened 842 consecutive adults with HIV presenting with suspected meningitis: 57% men, median age 35 years, median CD4 26 cells/mcL, and 55% presented on ART. Overall, 60.5% (509/842) were diagnosed with first-episode cryptococcal meningitis and 7.4% (62/842) with second episode. Definite/probable TB meningitis was the primary diagnosis in 6.9% (58/842); 5.3% (n = 45) had microbiologically confirmed (definite) TB meningitis. An additional 7.8% (66/842) did not meet the diagnostic threshold for definite/probable TBM but received empiric TBM therapy. Bacterial and viral meningitis were diagnosed in 1.3% (11/842) and 0.7% (6/842), respectively. The adoption of a cost-effective stepwise diagnostic algorithm allowed 79% (661/842) to have a confirmed microbiological diagnosis at an average cost of $44 per person. Conclusions Despite widespread ART availability, Cryptococcus remains the leading cause of HIV-associated meningitis. The second most common etiology was TB meningitis, treated in 14.7% overall. The increased proportion of microbiologically confirmed TBM cases reflects the impact of new improved molecular diagnostics.

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