Background: The proportion of people with mental disorders in treatment is relatively small in low and middle income countries. However, little is known about patterns of recent service use in a country like South Africa. Methods: A nationally representative household survey of 4,351 adult South Africans was carried out. Twelve-month DSM-IV disorders were determined using the WHO composite international diagnostic interview (CIDI). Prevalence and correlates of treatment were assessed among respondents with anxiety, mood and substance use disorders. Results: One-fourth (25.5%) of respondents with a 12-month disorder had received treatment in the past 12 months either from a psychiatrist (3.8%), nonpsychiatrist mental health specialist (2.9%), general medical provider (16.6%), human services provider (6.6%), or complementary-alternative medical (CAM) provider (5.9%). Only 27.6% of severe cases had received any treatment. In addition, 13.4% of respondents with no disorder had accessed services in the past year. Blacks were significantly more likely than other racial groups to access the CAM sector while Whites were more likely to have seen a psychiatrist. Conclusions: The majority of South Africans with a 12-month mental disorder have unmet treatment needs. In addition to a greater allocation of resources to mental health services, more community outreach and awareness initiatives are needed.

Heritable and environmental factors contribute to an individual’s risk of substance abuse and psychosis. Individuals diagnosed with a mental disorder have greater vulnerability for substance abuse. Our laboratory established that neonatal treatment of rats with quinpirole (NQ), a dopamine (DA) D2-like agonist, results in a significant increase of DAD2 receptor sensitivity throughout the animal’s lifetime. An increase of DAD2 receptor sensitivity is relevant to a model of schizophrenia (SZ), although increases of DAD2 receptor activity also occur in a number of clinical disorders, including bipolar disorder, obsessive-compulsive disorder, panic disorder, and major depression. Common amongst these clinical conditions is a dramatic increase in cigarette smoking compared to the general population. We bred NQ-treated male and female rats with their NQ-treated or neonatal saline (NS)-treated counterparts once they reached adulthood to determine whether increases in DAD2 sensitivity were passed to the next generation. Offspring of these animals, regardless of whether one or both founders received NQ-treatment, also demonstrated increases of DAD2 receptor sensitivity both behaviorally and neurobiologically. RNASeq preliminary data revealed an increase in cortisol synthesis and release in F1 generation animals, demonstrating an enhanced response to stress, consistent with a model of drug abuse vulnerability. Consistent with this finding, F1 generation rats demonstrated enhanced nicotine conditioned place preference (CPP) and had an enhanced brain derived neurotrophic factor (BDNF) response to nicotine in the nucleus accumbens (NAcc), a brain area critical to drug reward. The DAD2 receptor forms a triple heteromer with the adenosine A(2A) and metabotropic glutamate type 5 (mGlu5) receptor, such that stimulation of either receptor results in a decrease of DAD2 activity. Therefore, we analyzed whether use of a positive allosteric modulator (PAM) of mGlu5 in the F1 generation would block nicotine CPP and improve sensorimotor gating deficits, which is a hallmark of psychosis. In both experiments, the mGlu5 PAM effectively blocked the enhanced rewarding effects of nicotine and also alleviated sensorimotor gating deficits in this model. In essence, we demonstrate in results reported here that there may be a common therapeutic target for the dual treatment of substance abuse and psychosis.

Background: Globally, studies have established that 40-50% of psychiatric patients with SMDs are readmitted within one year of discharge from the acute hospital admission. Lowand middle-income countries (LMICs) such as Malawi have also reported high rates of psychiatric readmissions. This poses challenges when providing psychiatric care to patients. Most of Malawi`s health institutions, including Saint John of God Psychiatric Hospital (SJOG), rely primarily on donor funding. In order to maximise the available donor funding, there is a need to reduce readmissions resulting from modifiable or controlled factors. There are no studies in Malawi which have investigated these risk factors. The study aimed to establish the frequency of readmissions and the associated factors among patients at SJOG Psychiatric Hospital in Mzuzu, Malawi. The specific areas examined were sociodemographic and clinical-related factors associated with readmission. Methods: This was a retrospective cohort case record review study. Two hundred and seventy five clinical files of patients admitted for the first time at SJOG Psychiatric Hospital Mzuzu, Malawi between 1 January, 2014 and 31 December, 2015 were extracted. Data on socio-demographics and clinical information were collected using an extraction sheet at 3, 6 and 12 months post-discharge from the acute (first) hospital admission. Logistic regression models were developed to investigate the associations between socio-demographics, clinicalrelated factors and readmissions. Ethical approval for this study was granted by the Faculty of Health Sciences Human Research Ethics Committee at the University of Cape Town. Approval to conduct this research in Malawi was obtained from the National Health Sciences Research Ethics Committee. Results: Readmission rates of 1.5%, 4.4%, and 11.3% were found within the 3, 6 and 12 months of discharge from the acute hospital admission respectively. None of the independent variables predicted readmission within the 3 month of discharge from the acute hospital admission. In the unadjusted logistic regression model, having children (OR=0.26, 95% C.I 0.07-0.96) protected against readmissions within the 6 month of follow-up period. In the unadjusted logistic regression model, having children (OR= 0.40, 95% C.I 0.18-0.88), staying outside the hospital catchment area (OR=0.44, 95% C.I 0.20-0.96), and having insight (OR=0.22, 95% C.I 0.10-0.49) into their illness were protective factors to readmission, while taking SGAs (OR=4.67, 95% C.I 1.33-16.39) predicted readmission within the 12 month follow-up period. After adjusting for age and gender in the multivariable analysis, staying outside catchment area (OR=0.33, 95% C.I 0.14-0.79) and having insight (OR=0.19, 95% C.I 0.08-0.46) to their illness were protective factors, while taking SGAs (OR=5.29, 95% C.I 1.43-19.51) remained a predictor of readmission within 12 months of discharge from the acute admission. Conclusion: The findings of this study demonstrated that readmissions are associated with socio-demographic and clinical factors such as catchment area, patient insight into their condition and type of antipsychotics. The study identifies the need to develop interventions targeting the groups at risk of being readmitted.

Research is lacking on the efficacy of aggression management training programs based on clinical outcomes. This study examined the efficacy of an aggression management training on managing aggression and violent behavior at East Mississippi State Hospital (EMSH), an inpatient behavioral health program. This training, The Mandt System, replaced a previous training, Techniques for the Management of Aggressive Behavior (TMAB), which was considered to be non-replicable outside state facilities in Mississippi. This study should not be seen as a comparative study between The Mandt System and TMAB, but rather as an investigation into the effects of implementing The Mandt System as a new training at EMSH. The efficacy of The Mandt System was examined through 4 key variables: patient to patient incidents, patient to staff incidents, seclusion episodes and restraint episodes. Over a 6 year period, incidents of aggression and violence were identified by extracting archival data from incident reports. Archival data were examined 3 years prior to the implementation of The Mandt System and 3 years after the implementation of the training. The researcher found that the rate of patient to patient incidents decreased as well as the rate of seclusions and restraint episodes following implementation of The Mandt System training. The rate of the patient to staff incidents did not decrease. Effective training on the management of aggression is essential in decreasing aggressive and violent behavior. Nevertheless, these findings are difficult to validate due to a scarcity of research that is supported by evidence from randomized controlled studies. A review of the literature revealed that researchers do not give precedence to the study of aggression management training when dealing with aggressive behavior in inpatient behavior health settings. This is possibly due to the findings of Hage, Van Meijel, Fluttert, and Berden (2009) that research on the effectiveness of intervention strategies requires a more complicated study design and involves many methodological and logistical challenges. Although the results of this study suggest that this training can have a positive effect on aggression and violence, much more needs to be done to evaluate the effectiveness of aggression management training programs.

Playwrights write about what is familiar to them. Their inspiration comes from their childhood, past relationships, and their personal view of the world. But could a playwright write about something to which they have no personal connection? Using the book Triggered: A Memoir of Obsessive-Compulsive Disorder, I will write a one act play about mental illness. I have no personal experience or personal connection to mental illness, but I will approach the process the same way as an actor does a character. I will go into the writing process as an actor, completing character analyses for the characters and using the information found within the book. I will direct a reading of my play with the goals of educating the audience about mental illness, evoking empathy for the characters within the piece, and proving that a playwright can write about something that is foreign to them, much like an actor can portray a character that is remarkably different from themselves.

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Introduction: Hispanic-American youth are less likely to receive mental health services despite being at increased risk for depression and anxiety. Having depression and anxiety at a young age can have detrimental long-term effects such as sexual risk behavior, delinquency, and suicide. Various kinds of nurses interact with this age group which can be a missed opportunity to intervene for the welfare of these youth. Interventions exist for depression and anxiety; however, they are not specific to nurses who care for young Hispanic-American patients. Methods: An integrative literature review was performed to identify nursing interventions for Hispanic American youth with depression and anxiety. Inclusion criteria included English language, academic journal articles from 2000 to 2022, and addressing interventions for Hispanic American children and youth with depression and anxiety. Results: The nursing interventions identified in the review of the literature were found to decrease feelings of anxiety and depression and have significant positive impacts on Hispanic-American youth. Discussion: Education, role play, coping skills, and ways to express emotions were the interventions that impacted depression and anxiety symptoms. Suggestions were made on applying them to nursing practice and future research.

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