Abstract Background: Physical activity, sleep, mental health, physical health, wellbeing, quality of life, cognition, and functioning in people who experience psychosis are interconnected factors. People experiencing psychosis are more likely to have low levels of physical activity, high levels of sedation, and sleep problems. Intervention: An eight-week intervention; including the provision of a Fitbit and its software apps, sleep hygiene and physical activity guidance information, as well as three discussion and feedback sessions with a clinician. Participants: Out of a sample of 31 using an early intervention psycho sis (EIP) service who took part in the intervention, fifteen participants consented to be interviewed—9 (60%) males and 6 (40%) females, age range: 19 -51 years, average age: 29 years. Method: In-depth interviews investigating patient experience of the intervention and its impact on sleep, exercise, and wellbeing were undertaken. Thematic analysis was applied to analyse the qualitative data and content analysis was used to analyse questions with a yes/no response. Results: Most of the participants actively used the Fitbit and its software apps to gain information, feedback, and set goals to make changes to their lifestyle and daily routines to improve quality of sleep, level of physical activity, and exercise. Conclusion: The intervention was reported to be beneficial,and it is relatively easy and low cost to implement and therefore could be offered by all EIP services. Furthermore, there is potential value for application in services for other psychiatric disorders, where there is often a need to promote healthy lifestyle, physical activity, and effective sleep.

Abstract Screening patients for psychotic features can pose a problem when using verbal based tests. Establishment of validity of non-verbal psychotic screening scale can enhance diagnostic specificity and address challenges associated with verbal based tests. The goal of this study is to check whether Bender Visual Motor Gestalt Test-II will serve as a diagnostic specific tool for distinguishing between psychotic patients and healthy population. A total of 40 participants 22 males and 18 females were employed in the study. They were made of 10 patients diagnosed with schizophrenia, another 10 with depressions associated with psychotic features, 10 with substance/medication induced disorders and 10 healthy adults as the control. Their ages ranged from 20 - 65 with a mean age of 35.70 and standard deviation of 6.04. The healthy control group was staff of the hospital that was comparable to the patients in terms of age, gender and studies. All participants available who met the inclusive criteria who were willing to participate were selected. The instruments were (BVMGT-II) and (WHODAS 2.0). The design of the study was between group designs and One Way ANOVA was employed for data analysis. The findings of the study showed that BVMGT-II discriminated between patients with psychotic disorder and healthy population. It is recommended that BVMGT-II should be employed as screening instrument by the clinical/neuropsychologists in clinical psychological assessment for distinguishing psychotic patients from healthy population.

Abstract Background: Chronic illnesses are often associated with functional disability ,thus compromising the ability to carry out everyday activities of daily living .The degree of disability depends on the severity and the type of illness experienced. Studies that compare the level of disability between people with chronic medical conditions and mental illnesses in North-Central Nigeria are scarce. This study aims to compare the disability levels between people with schizophrenia and Type 2 Diabetes Mellitus (T2DM) attending outpatient clinics at the Jos University Teaching Hospital, north-central Nigeria, and evaluate the factors associated with these conditions. Methods: It was a cross-sectional study with a total of 600 patients who were diagnosed with schizophrenia and T2DM, attending the Psychiatric and medical outpatient clinics of the Jos University Teaching Hospital, north-central Nigeria, be tween June 2017 and November 2017. The study assessed Psychotic and non-psychotic symptoms by applying the Brief Psychiatric Rating Scale(BPRS) among those with schizophrenia. We evaluated the level of disability by using World Health Organization Disability Assessment Schedule version 2.0 (WHODAS 2.00). Results: Disability was significantly higher among respondents with schizophrenia than those with T2DM. This difference occurred across all the domains except domain 2 (moving around). Marital status, living situation, occupation, and treatment adherence were significant common factors associated with disability in these conditions. In contrast ,age, educational status, income level, and duration of illness were significantly associated with disability among respondents with T2DM only. Conclusion :Disability and its associated factors among people with chronic diseases, if identified early and proper interventions instituted, disability can be avoided or minimized among people with chronic illnesses.

Abstract Psychiatry residents, who lack psychological mindedness, struggle to under stand the multiple determinants of behavior, or the numerous meanings of a single symptom. This is unfortunate because most psychiatry resident interns feel that they are finally among the group where they belong… like-minded physicians who share a fascination with human nature and a desire to grasp all the nuances and complexities of human behavior. This paper provides a framework for psychiatry departments to train residents along a continuum of psychological mindedness. The authors explain the concept of psychological mindedness, explore the pros and cons of acquiring psychological mindedness, and a scientific basis for its use in general psychiatry. A new model is included to capture any resident’s ability to become psychologically minded, with direction for Program Director’s to possibly develop growth in a resident’s psychological mindedness over four years of training.

Abstract The current paper is a theoretical proposal that interfaces the Cognitive Be havioral Analysis System of Psychotherapy (CBASP) and its emphasis on interpersonal consequences with the structured order of a Play Therapy Model for troubled 3 - 8-year-old children. This proposal is not a research paper or a review of literature; instead, it is a treatment proposal that is novel and un tested. CBASP psychotherapy, an empirically validated treatment, was developed originally to treat the persistently depressed adult. CBASP’s major focus of interpersonal consequation will be interfaced with a Play Therapy structured model to rectify the maladaptive preoperational functioning of five interpersonal types of problem-children. The types are classified interpersonally using D.J. Kiesler’s Interpersonal Message Inventory (IMI). Kiesler’s IMI is employed in this proposal as an ongoing assessment modality, a source of in formation to make treatment strategy consequation decisions, and thirdly as an evaluative outcome variable. The troubled child types described herein frequently become candidates for early-onset Persistent Depressive Disorder (PDD) unless rescued by successful treatment. The origins of early-onset PDD arise in dysfunctional households where toxic interpersonal relation ships predominate: where “survival from abuse,” not growth, describes the child’s modal developmental experiences. These children are often exposed to either serious traumas (e.g., sexual abuse, loss of a parent, physical abuse, physical or emotional neglect) or psychological insults (e.g., continuous, and chronic verbal and nonverbal abuse). The result, in the most serious cases, is a maturational stunting at the preoperational stage of development which, as noted above, if not successfully resolved, thrusts the child into early-onset PDD.

Abstract Background: When a disease is associated with stigma, there may be attendant negative consequences. Purpose: This review was to show how stigma associated diseases impact negatively on the psychological and social wellbeing of the affected persons. Methods: The relevant articles for the review were obtained through PubMed and Google Scholar search on the internet using relevant keywords. Results: Several infectious and non-infectious diseases are associated with stigma. The causes of stigma in these diseases include fear of contracting the disease and dying from it, disfiguring caused by the disease and ignorance and misconception concerning the cause, nature and infectivity of the disease. Those suffering from stigma-associated diseases are usually discriminated against and denied the privileges and opportunities available for those not suffering from stigma-associated diseases. This often leads to psychosocial or psychiatric complications such as social isolation, depression or even suicidal ideation. Conclusions: Stigma-associated diseases still remain a very important health problem with attendant psychosocial consequences. Multi-disciplinary and multi-level efforts are required for its effective mitigation.

Abstract Introduction: Opioid use is a public health problem today. The aim of this study was to describe the socio-demographic characteristics, judicial aspects, addictive behaviours and medical aspects of heroin users placed on methadone (HUM) at the Integrated Addiction Care Centre of Kodjoviakopé (CEPIAK). Framework and Method: This was a descriptive cross-sectional study conducted at the CEPIAK in Lomé, Togo, from December 1st, 2020 to January 31, 2021. Results: A total of 200 HUM were included in this study. They were Togolese in 89.0% of cases. Their mean age was 43.4 ± 9.6 years with extremes ranging from 16 to 66 years. Males accounted for 90.5% of the HUM, i.e. a sex ratio of 9.5. Primary education accounted for 39.0% of cases. Single people accounted for 44.0% of cases. One hundred and nineteen HUM (59.5%) had a history of incarceration. Cannabis, tobacco and cocaine were the other drugs associated with heroin use in 79.5%, 74.5% and 59.5% of cases respectively. A history of overdose accounted for 18.0% of the HUM in our sample. Suicide attempts accounted for 19.5% of the HUM. Tuberculosis was detected in 5.5% of the HUM. HIV accounted for 3.0% of the HUM. Conclusion: It is important for the Togolese health system to give more importance to this issue, which is shared by the medical and social sectors, in order to effectively reduce and prevent these social ills.

Abstract Purpose: Our study aimed to evaluate the psychological impact of COVID-19 pandemic on Chinese patients with common mental disorders in primary care in Hong Kong. Method: A cross-sectional study was conducted on 102 Chinese patients with common mental disorders and being followed up in two public integrated mental health clinics in Hong Kong from 1st November 2020 to 31st January 2021. Patients would be evaluated about the impact of COVID-19 pandemic on their mood and daily life by using a questionnaire which assessed social distancing effects, financial impact, relationship with family, anxiety and depressive symptoms. The Patient Health Questionnaire9 (PHQ-9) and General Anxiety Disorder-7 Questionnaire (GAD-7) would also be used to assess patients’ mood symptoms. Factors which were related to COVID-19 pandemic and associated with anxiety or depressive symptoms would be analysed. Results: The mean age of the subjects was 58.0 years and more patients were female (77.5%). There were 84.3% and 72.5% of patients reported their anxiety and depressive symptoms being affected by COVID-19 pandemic respectively. It was found that 17.6% of patients had their income decreased or were unemployed. About one-third (30.4%) of patients indicated that their relationship with their family was worsened while 8.8% was improved. Social distancing was significantly associated with anxiety (p =0.006) and depressive symptoms (p < 0.001) in patients with common mental disorders. Conclusion: There was considerably more psychological impact including an increase in anxiety and depressive symptoms due to COVID-19 pandemic in Chinese patients with existing common mental disorders in primary care. Primary care physicians should raise their awareness of the psychological impact of COVID-19 pandemic on their patients. Our findings shed light on mental health care planning and preventive measures during the COVID-19 pandemic and potential subsequent pandemics.

Abstract Purpose: Many medical students suffered from some levels of emotional disturbances or disorders, causing negative physical and mental health problems, affecting performance academically, professionally, and personally. This study was conducted to assess the stress among medical students in Rwanda, in order to design appropriate strategies to address or prevent any related potential negative consequences. Method: Medical students who were enrolled in the two medical schools in Rwanda completed an online survey that was developed based on the Stress in Academic Life Scale (SALS). The SALS has 27 4-point Likert scale questions assessing stress related to social support, motivation, curriculum and teaching, academic ambition, self-confidence, performance anxiety, and career. One open-ended question was also included for respondents’ comments. The SALS scores were categorized into “no to fairly”, “fairly to very” and “very to severely” stress levels. Results: A total of 137 samples responded. The overall median SAL score was 1.22, with over 54% of the respondents reported experiencing fairly to severe levels of stress.The highest stress levels were related to Curriculum and Teaching (median = 1.5), Self-confidence (median = 1.33), and Motivation (median = 1.33). The stress score was found to be negatively correlated to age (r = −0.205, P =0.02), and the number of years in the program (r = −0.218, P = 0.01), and associated with receiving government funding (P = 0.01). Lack of financial support, lack of support from instructors, and disorganized academic activities were also reported as sources of stress. Conclusion: The results of this study suggested mild to moderate levels of stress were faced by the medical students in Rwanda. Finance plays a role, but the main stressors stemmed from the curriculum, teaching, and administrative organization. Medical schools should proactively create appropriate interventions to improve students’ physical and psychological well-being and provide mental health services in schools.

Abstract Purpose: Compared to levels in the general population, people with experiences of psychosis have poorer physical fitness, more sedentary behaviour, lower physical activity, more sleep problems, and a higher incidence of insomnia. The aim of the current study was to examine the feasibility and impact of an intervention with the goal of addressing these issues. Method: Design: intervention with outcome measure data collection, with no control group. Forty-nine early intervention psychosis (EIP) service patients took part in an intervention: provision of a Fitbit, Fitbit software apps, sleep hygiene, and physical activity guidance, and three discussion sessions with clinicians. The sample consisted of 29 males and 20 females, with age range of 17 - 54 years, and average age of 29.5 years. Measures used were Fitbit activity and sleep data, and self-rated Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS) and Positive and Negative Affect Schedule (PANAS). Results: WEMWBS scores significantly improved, with a medium effect size. PANAS negative affect (NA) dropped significantly. Analysis of Fitbit activity and sleep data yielded non-significant results. Conclusion: The intervention was acceptable to EIP patients and is feasible. Improvements in mental wellbeing and negative affect indicate the positive impact of the intervention on mental health. EIP services should consider assessing sleep quality and physical activity/exercise levels, and using this study’s intervention to promote wellbeing and mental health within recovery focused practice. Further research could be undertaken through a sufficiently powered randomised control trial (RCT) comparing this intervention and treatment as usual (TAU).

Abstract Background: Persons living with severe mental illness (SMI) which includes schizophrenia, bipolar affective disorder and recurrent major depressive disorder are predisposed to risky sexual behavior (RSB). There is a paucity of data on this problem in sub-Saharan Africa and where research has been undertaken, only a limited range of risk factors have been considered and most of it was undertaken before antiretroviral therapy was universally available, hence the need for this study. The objective of this study was to determine the prevalence and factors associated with risky sexual behavior among individuals with SMI attending care in central and south western Uganda. Methods: A cross sectional study was conducted among 393 persons with SMI attending two psychiatric out-patient facilities in Uganda. Psychiatric disorder was confirmed using MINI International Neuropsychiatric Interview version 7.2. RSB was defined as engaging in at least one of four risky sexual behaviours that have been associated with HIV infection in the Ugandan psychosocial environment in the last three months using an 8 item RSB questionnaire used for assessment of RSB. Prevalence of RSB and associated correlates were determined using multiple logistic regression. Results: The Prevalence of RSB in last 3 months’ periods was 24.2% (95% CI: 20.2% - 28.7%). The factors that were independently significantly associated with RSB were: trauma related (history of childhood trauma, past and current sexual abuse, past and current physical abuse) current psychosocial challenges (mental health stigma) and psychiatric illness factors (history of a past manic episode, current psychotic episode, severity of depressive symptoms and severity of manic symptoms). Conclusions: One quarter of clinic attending respondents with severe mental illness in Uganda practice risky sexual behaviour. Factors associated with risky sexual behaviour fall under the domains of past and present trauma, current psychosocial challenges and psychiatric illness factors. This calls for a multisectoral approach that includes community awareness about the nature of SMI and the rights of persons with SMI and measures to improve Psychiatric symptom management.