Management of first episode psychotic illness in Afro-Caribbean patients

Article Abstract:

When assessing psychiatric illness among different ethnic groups, it is sometimes hard to explain the differences that are found. There may be different causes of illness in ethnic groups, differences in interpreting behavior based upon cultural variations, and racial discrimination can be a factor. In the UK there have been reports of higher rates of admission for certain ethnic groups; differences in attitudes of doctors and patients toward treatment have been found to significantly vary based, in part, upon ethnicity. To study these issues further 80 patients who were treated for a psychotic illness for the first time were evaluated, half of whom were Afro-Caribbean and half were not (the control group). Psychosis was identified by symptoms that included hallucinations, delusions, thought disorder, and/or grossly inappropriate behavior. The two groups were matched for age, sex, and certainty of diagnosis. Upon analysis of the various components of their symptoms and treatment programs, patients in both groups initially received comparable drug dosages. However, peak dosage (highest dose administered) was higher among the Afro-Caribbean patients. Behavioral disturbances were recorded more frequently for this group as well. It was also found that Afro-Caribbeans tended to be admitted to treatment more quickly and, upon discharge, over half of these patients were maintained on medication. Only about one-fifth of the control group patients were so treated after discharge. The results provide some evidence to support concerns that Afro-Caribbean patients with psychosis are treated differently than those of other ethnic backgrounds. This difference is not as apparent initially as it is later in treatment and after hospital discharge. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Standards, Race, Psychiatric hospital care, Psychiatric hospitals

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Effect of caffeine intake on psychotic in-patients

Article Abstract:

Caffeine is a potent drug that is classified as psychoactive (i.e., it affects the mind). Its behavioral effects may be mediated by the catecholamine system in the brain, which controls many of the body's physiological responses to stress, including the nerves, muscles, and heartbeat. Studies have shown that extreme caffeine consumption is capable of inducing psychotic symptoms (e.g., hallucinations) in some people and some researchers in particular have shown this effect in schizophrenics. Two cases are reported of caffeine-induced complications of psychiatric illnesses. The first is of a 32-year-old schizophrenic man with a history of alcohol abuse who, after ingesting large amounts of caffeine, because delusional. When his coffee intake was restricted, the delusions did not return, until the patient stole a jar of coffee. The patient ''pounded the walls'' whenever he drank excessive amounts of coffee. The second case is of a 29-year-old man with a history of chronic psychotic illness and substance abuse. When he ingested caffeine, he became unmanageable in the hospital and required seclusion. Several characteristics were identified in these and other patients: a substance abuse history, affective symptoms (such as depression) and sleep problems that did not respond well the treatment, persistent caffeine-seeking behavior, observable signs of acute caffeine intoxication (flushed face, irritability), and sometimes brief, sudden fluctuations in the clinical course of the psychiatric illness. Careful restriction of caffeine is usually helpful. Treatment staff should be familiar with the profile presented here. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Complications and side effects, Physiological aspects, Caffeine, Psychiatric hospital patients

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