Racism in psychiatry: paradigm lost--paradigm regained

Racism and psychiatry have been 'linked' in the public imagination, largely because psychiatry is seen as an instrument of social control, and racism as a different form of oppression which permeates society at large. Racism in psychiatry is often believed to be the mediating factor in cases of 'psychiatric misdiagnosis' and 'mismanagement.' Misdiagnosis includes underdiagnosis and overdiagnosis; this can account for the non-delivery of appropriate treatments because of an erroneous diagnostic label. In some instances this leads to a deferred intervention, or in some ethnic groups, help-seeking is delayed for unnecessarily long periods. Racism is not a recent phenomenon. The blunt application of the word 'racism' perpetuates conceptual confusion about what is meant by the term, what processes are taking place, how much of the processes are institutionalized or individual and to what degree individuals are aware of the impact of their actions. We propose a way of understanding racism in psychiatric practice, and suggest that within such a framework, the therapist/professional and the patient can work together towards improving patient care.     

Common mood and anxiety states: gender differences in the protective effect of physical activity

  Background: We wished to examine the impact of the duration and intensity of physical activity on common anxiety and depressive states. Method: A nested case-control design was applied to data from the Health and Lifestyle Survey. Anxiety and depressive states were measured by caseness on the General Health Questionnaire. Physical activity variables were defined from a detailed activity schedule. Results: After adjustment for potential confounders, the findings suggest that compared to men who reported 0–44 min of daily physical activity, there is benefit to men who exercise for at least 92 min a day (92–161 min a day: OR = 0.57, 95% CI = 0.37–0.87, P < 0.01; 162–554 min a day: OR = 0.65, 95% CI = 0.43–0.97, P < 0.05), but not to women. The protective effect does not appear to vary according to the intensity of activity in men or women. Conclusions: Physical activity of long duration amongst men confers protection against common mood and anxiety states. This study found no such protection for women. Accepted: 21 October 1999     

Investigation of rotameric conformations of substituted imidazo-[1,2-a]pyrazine: experimental and theoretical approaches

The different rotameric conformations of imidazo-[1,2-a]pyrazine have been synthesized and characterized by means of different experimental techniques, such as NMR, FTIR, and absorption spectroscopy and quantum chemical calculations. The different conformations were stabilized by hydrogen bonds, such as OH⋯N, ArH⋯N and ArH⋯ArH. The ground state optimizations and potential energy surface (PES) scanning profiles produced using density functional theory (DFT) show two stable rotameric forms for each molecule. The relative population of the conformations is affected by the strength of the hydrogen bonds. The calculated absorption spectra and isotopic shielding constants were acquired by time-dependent density functional theory (TD-DFT) and gauge invariant atomic orbitals (GIAO)-DFT, respectively. The strength of the hydrogen bonding interactions that resulted in the different conformations was studied by quantum theory of atoms in molecules (QTAIM).

The different rotameric conformations of imidazo-[1,2-a]pyrazine have been synthesized and characterized by means of different experimental techniques, such as NMR, FTIR, and absorption spectroscopy and quantum chemical calculations.     

Moving beyond randomized controlled trials in the evaluation of compulsory community treatment

Compulsory community treatment for people with severe mental illness remains controversial due to conflicting research evidence. Recently, there have been challenges to the conventional view that trial‐based evidence should take precedence. This paper adds to these challenges in three ways. First, it emphasizes the need for critiques of trials to engage with conceptual and not just technical issues. Second, it develops a critique of trials centred on both how we can have knowledge and what it is we can have knowledge of. Third, it uses this critique to develop a research strategy that capitalizes on the information in large‐scale datasets.     

Beneficial effects of chrysin and benzoflavone on virility in 2-year-old male rats

This work describes the potential usefulness of bioflavonoids for countering the deleterious effects of aging on male sexuality in 2-year-old rats. A flavone chrysin from Passiflora caerulea Linn. and a benzoflavone moiety (BZF) recently isolated from Passiflora incarnata Linn. were administered to 2-year-old male rats for a period of 30 days. After cessation of these treatments, there was a significant improvement in overall sexual functions in the rats given bioflavonoids, compared with control rats. The rats receiving chrysin (1 mg/kg) and BZF (10 mg/kg) exhibited increased libido when they were allowed to interact with nonestrous female rats. Additionally, both treated groups had increased sperm count, greater fertilization potential, and greater litter size when they were allowed to interact with proven proestrous female rats of a similar strain. BZF was more potent than chrysin as an antiaromatase agent and exhibited better effects on the sexual system of the 2-year-old male rats. Plant flavonoids have great potential for clinical and therapeutic applications against the physiological and biochemical effects of aging.     

Causal explanations of distress and general practitioners' assessments of common mental disorder among Punjabi and English attendees

Background: The literature on the primary care assessment of mental distress among Indian sub-continent origin patients suggests frequent presentations to general practitioner, but rarely for recognisable psychiatric disorders. This study investigates whether cultural variations in patients' causal explanatory models account for cultural variations in the assessment of non-psychotic mental disorders in primary care. Methods In a two-phase survey, 272 Punjabi and 269 English subjects were screened. The second phase was completed by 209 and 180 subjects, respectively. Causal explanatory models were elicited as explanations of two vignette scenarios. One of these emphasised a somatic presentation and the other anxiety symptoms. Psychiatric disorder was assessed by GPs on a Likert scale and by a psychiatrist on the Clinical Interview Schedule. Results Punjabis more commonly expressed medical/somatic and religious beliefs. General practitioners were more likely to assess any subject giving psychological explanations to vignette A and English subjects giving religious explanations to vignette B as having a significant psychiatric disorder. Where medical/somatic explanations of distress were most prevalent in response to the somatic vignette, psychological, religious and work explanations were less prevalent among Punjabis but not among English subjects. Causal explanations did not fully explain cultural differences in assessments. Conclusions General practitioners' assessments and causal explanations are related and influenced by culture, but causal explanations do not fully explain cultural differences in assessments. Accepted: 18 September 2001     

A survey of sexual problems amongst psychiatric inpatients

This paper reports the findings of a survey of 39 men and 17 women who had been admitted to the acute psychiatric wards of an inner London psychiatric unit. The patients were seen within 7 days of their admission and were interviewed about existing sexual and relationship problems. The admissions consisted largely of single men with schizophrenia and married or cohabiting women with affective disorders. Of the men, 62% of those with a diagnosis of schizophrenia, between 63 and 75% of those with affective disorders and 17% of those with other diagnoses reported current sexual or relationship problems. Of the women, 25% of those with a diagnosis of schizophrenia, 50–100% of those with affective disorders and 25% with other diagnoses reported a sexual or relationship problem. The high prevalence of such problems amongst inpatients indicates that such matters should be enquired after and therapeutic interventions considered at the time of admission. We examined the limitations of this work and proposed areas of potential research.