Scholarly works in Psychiatry

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Concepts of madness in diverse settings: a qualitative study from the INTREPID project.
(BioMed Central, 2016) Cohen, A.; Padmavati, R.; Hibben, M.; Oyewusi, S.; John, S.; Esan, O.B.; Patel, V.; Weiss, H.; Murray, R.; Hutchinson, G.; Gureje, O.; Thara, R.; Morgan, C.
Background: In order to facilitate case identification of incident (untreated and recent onset) cases of psychosis and controls in three sites in India, Nigeria and Trinidad, we sought to understand how psychoses (or madness) were conceptualized locally. The evidence we gathered also contributes to a long history of research on concepts of madness in diverse settings. Methods: We conducted focus group discussions and individual interviews to collect information about how informants in each site make sense of and respond to madness. A coding framework was developed and analyses of transcripts from the FGDs and interviews were conducted. Results: Analyses suggest the following: a) disturbed behaviors are the primary sign of madness; b) madness is attributed to a wide range of causes; and, c) responses to madness are dictated by cultural and pragmatic factors. These findings are congruent with similar research that has been conducted over the past 50 years. Conclusions: The INTREPID research suggests that concepts about madness share similar features across diverse settings: a) terms for madness are often derived from a common understanding that involves disruptions in mental processes and capacities; b) madness is recognized mostly by disruptive behaviours or marked declines in functioning; c) causal attributions are varied; and, d) help-seeking is a complex process.
Explanatory model of psychosis: impact on perception of self-stigma by patients in three sub-saharan African cities
(Springer Science + Business Media, 2016) Makanjuola, V.; Esan, O.B.; Oladeji, B.; Kola, L.; Appiah-Poku, J.; Harris, B.; Othieno, C.; Price, L.; Seedat, S.; Gureje, O.
Mental disorders are cross-culturally ubiquitous [1]. Psychosis is, by far, the more easily recognisable form of mental disorder by the lay public and traditional healers [2]. While the experience of psychosis is universal, interpretation of the experience, notions of causation, treatment, preferred source of care, and the consequences and perceptions of associated stigma vary from one culture to another. We used a mixed-methods approach consisting of in-depth interviews with key informants to explore respondents’ explanatory models of the causation of psychosis as well as questionnaire assessment of the level of internalized (or self) stigma. The conduct of the interviews was guided by the specifications of the McGill Illness Narrative Interview (MINI) [32], a semi-structured interview guide which, among other things, elicits lay illness narratives. A purposively selected sample of patients who were receiving treatment from traditional healers was interviewed. The transcribed interviews were read several times by the first author and subjected to thematic analysis. Supernatural and biopsychosocial explanatory models of the causation of psychosis were both endorsed by our respondents. Despite this, the majority of the respondents with severe forms of self-stigma held supernatural attributions. However, we also found that some respondents with low self-stigma embraced a supernatural model while some respondents with high self-stigma proffered a biopsychosocial explanation. Our findings suggest that individualising interventions to minimize self-stigma may be a better approach than programs that generically promote biopsychosocial models or discourage supernatural models.
Searching for psychosis: INTREPID (1): systems for detecting untreated and first-episode cases of psychosis in diverse settings
(Springer Science + Business Media, 2015) Morgan, C.; Hibben, M.; Esan, O. B.; John, S.; Patel, V.; Weiss,H.A.; Murray, R.M.; Hutchinson, G.; Gureje, O.; Thara, R.; Cohen, A.
Purpose: Our understanding of psychotic disorders is largely based on studies conducted in North America, Europe and Australasia. Few methodologically robust and comparable studies have been carried out in other settings. INTREPID is a programme of research on psychoses in India, Nigeria, and Trinidad. As a platform for INTREPID, we sought to establish comprehensive systems for detecting representative samples of cases of psychosis by mapping and seeking to engage all professional and folk (traditional) providers and potential key informants in defined catchment areas. Method: We used a combination of official sources, local knowledge of principal investigators, and snowballing techniques. Results: The structure of the mental health systems in each catchment area was similar, but the content (i.e., type, extent, and nature) differed. Tunapuna–Piarco (Trinidad), for example, has the most comprehensive and accessible professional services. By contrast, Ibadan (Nigeria) has the most extensive folk (traditional) sector. We identified and engaged in our detection system—(a) all professional mental health services in each site (in- and outpatient services—Chengalpet, 6; Ibadan, 3; Trinidad, 5); (b) a wide range of folk providers (Chengalpet, 3 major healing sites; Ibadan, 19 healers; Trinidad: 12 healers); and c) a number of key informants, depending on need (Chengalpet, 361; Ibadan, 54; Trinidad, 1). Conclusions: Marked differences in mental health systems in each catchment area illustrate the necessity of devel oping tailored systems for the detection of representative samples of cases with untreated and first-episode psychosis as a basis for robust, comparative epidemiological studies.

Scholarly works in Psychiatry

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