South African Journal of Psychiatry - latest Issue
Volume 23, Issue 1, 2017
Source: South African Journal of Psychiatry 23, pp 1 –5 (2017) http://dx.doi.org/10.4102/sajpsychiatry.v23.1006More Less
Background: Faced with demanding training programmes, medical students may be more prone to use methylphenidate for non-medical purposes in order to improve concentration, alertness and academic performance.
Aim: The study aimed to investigate the prevalence of the non-medical use of methylphenidate and knowledge of this drug among undergraduate medical students of the University of the Free State.
Methods: This was a cross-sectional study. A self-administered, anonymous questionnaire was distributed during lectures to all students in the five year groups of the undergraduate medical programme.
Results: Of the 643 undergraduate medical students, 541 completed the questionnaire (response rate: 84.1%). Approximately 11.0% of surveyed students were using methylphenidate at the time of the study, of which the majority (67.9%) used it for academic purposes and 70.6% received it from a medical health professional. Less than a third of users had been diagnosed with Attention-Deficit/Hyperactivity Disorder. Methylphenidate users’ median knowledge was greater than non-users, and methylphenidate knowledge increased from first-year and second-year students to third-year to fifth-year students. Median knowledge scores per year group ranged from 52.0% to 60.0%.
Conclusion: Methylphenidate is mainly used for non-medical purposes by medical students. Students generally have a low level of knowledge on methylphenidate. Specific information on methylphenidate should be included in lectures on stress management and study methods during the course of the medical curriculum.
A rapid appraisal of the status of mental health support in post-rape care services in the Western CapeSource: South African Journal of Psychiatry 23, pp 1 –8 (2017) http://dx.doi.org/10.4102/sajpsychiatry.v23.959More Less
Background: Despite the well-known impact of rape on mental health and the widespread problem of rape in South Africa, mental health services for rape victims are scant and not a priority for acute-phase services. Survivors encounter multiple mental health struggles in this period including adherence to the post-exposure prophylaxis drugs to prevent HIV and finding support from important others. We have little information on what mental health is provided, by whom and how it is integrated into the post-rape package of care.
Aim: The aim of the study was to do a rapid appraisal of mental health services for rape survivors to gain a better understanding of the current acute and long-term (secondary) mental health services.
Method: We conducted a qualitative study using a rapid assessment with a purposive sample of 14 rape survivors and 43 service providers recruited from post-rape sexual assault services in urban and rural Western Cape Province. Data were collected using semi-structured in-depth interviews and observations of survivor sessions with counsellors, nurses and doctors. The data were coded thematically for analysis.
Results: Survivors of rape experienced a range of emotional difficulties and presented varying levels of distress and various levels of coping. Receiving support and care from others assisted them, but the poor integration of mental health within post-rape services meant few received formal mental health support or effective referrals. Multiple factors contributed to the poor integration: mental health was not given the same level of priority as other rape services (i.e. clinical care, including forensic management), the inadequate capacity of service providers to provide mental healthcare, including mental health illiteracy, the lack of continuity of care, the poor linkages to ongoing mental healthcare, and the mental health challenges caused by vicarious trauma and compassion fatigue.
Conclusion: Providing effective, compassionate mental health services should be seen as essential components of post-rape care. The strengthening of support for providers and linkages to ongoing mental healthcare are essential to improve mental health services within acute post-rape services.
Source: South African Journal of Psychiatry 23, pp 1 –5 (2017) http://dx.doi.org/10.4102/sajpsychiatry.v23.1016More Less
Olfactory reference syndrome is characterised by the erroneous belief that one emits an unpleasant body odour. This results in significant distress and is often accompanied by repetitive behaviour such as frequent showering in an attempt to camouflage the perceived odour. The body odour concerns may have a delusional quality and do not respond to simple reassurance or counterexample. Herein, we report the case of an olfactory reference disorder (ORD) patient who had received multiple medical interventions and undergone polysurgery prior to an accurate diagnosis being established. ORD may lead to significant disability, yet often goes unrecognised for many years. For many patients, poor insight will contribute to their reluctance to consider psychiatric treatment. This case demonstrated that a multimodal treatment approach comprising judicious medication use, combined with cognitive behavioural therapy, in the context of a therapeutic alliance yielded therapeutic success.
Adult attention-deficit hyperactivity disorder : a database analysis of South African private health insuranceSource: South African Journal of Psychiatry 23, pp 1 –6 (2017) http://dx.doi.org/10.4102/sajp.v23.1010More Less
Background: Adult attention-deficit hyperactivity disorder (ADHD) is a chronic, costly and debilitating disorder. In South Africa (SA), access to funding for care and treatment of ADHD is limited, and research is lacking.
Aim: This study aimed to establish the current situation with regard to the psychiatric management of and funding for treatment of adult ADHD in the private sector in SA.
Methods: A diagnostically refined retrospective claims database analysis was conducted. We examined the prevalence, costs and funding profile of claims over a 2-year period for adult beneficiaries with possible ADHD of a large medical administrator in SA.
Results: The prevalence of adult ADHD was lower than published international rates. The presence of adult ADHD increased the prevalence of comorbidity and doubled the health care costs of beneficiaries. Contrary to public belief, comorbidities (including their medicine costs) rather than psychiatric services or medicines were the main cost drivers.
Conclusion: The current private health insurance funding model for ADHD limits access to funding. This affects early diagnosis and optimal treatment, thereby escalating long-term costs. Improved outcomes are possible if patients suffering from ADHD receive timely and accurate diagnosis, and receive chronic and comprehensive care. Balanced regulation is proposed to minimise the risk to both medical schemes and patients. A collaborative approach between stakeholders is needed to develop an alternative cost-effective funding model to improve access to treatment and quality of life for adults with ADHD in SA.
Clinical and demographic factors associated with sexual behaviour in children with autism spectrum disordersSource: South African Journal of Psychiatry 23, pp 1 –7 (2017) http://dx.doi.org/10.4102/sajpsychiatry.v23.862More Less
Introduction: The sexual behaviour and development of children with autism spectrum disorders (ASDs) have been mostly overlooked in research and practice. This study aimed to determine the association between certain clinical and demographic factors found in a sample of children with ASDs, and their reported sexual behaviour (RSB).
Methods: The study was conducted at a school in Gauteng, South Africa, for learners with ASDs. Two questionnaires completed by caregivers/parents enquired about family stability, clinical profile and RSB (if any) in their child. RSB was analysed via three domains: self-care, socio-sexual skills and actual RSB, with additional information from school records.
Results: Of the 107 questionnaires distributed, only 31 parents responded and 24 agreed to participate. The 24 (100%) children included 10 pubertal and 14 pre-pubertal children, of which 18 (n = 18) had more stable primary caregiver statuses as well as more stable socioeconomic and family environments. Two of the 14 pre-pubertal children had abnormal self-care, whereas none of the 10 pubertal children had any abnormal self-care. Eight of the 18 children from more stable environments displayed abnormal sexual behaviours. Of the 6 children from less stable environments, two displayed more abnormal socio-sexual skills, whereas 9 of the 18 children from more stable environments displayed more abnormal sexual behaviour. In contrast with the postulated hypothesis that children from less stable socioeconomic and family environments would exhibit more abnormal sexual behaviours, this study did not find any evidence of such a relationship or association.
Conclusion: ASDs are characterised by deficits in communication and social skills. These may lead to an affected individual struggling to develop appropriate sexual behaviour. If specific risk factors that contribute to the development of abnormal sexual behaviour can be identified, one can try to modify/prevent these where some degree of prevention or alleviation may be possible.
Source: South African Journal of Psychiatry 23, pp 1 –3 (2017) http://dx.doi.org/10.4102/sajpsychiatry.v23.996More Less
Objective: Oesophageal achalasia is a medical condition characterised by oesophageal aperistalsis, an increased resting pressure with partial or incomplete relaxation of the lower oesophageal sphincter. Bulimia nervosa (BN) is an eating disorder manifested by binge eating attacks followed by recurrent inappropriate compensatory behaviours, such as self-induced vomiting and excessive exercise. Dysphagia, regurgitation, vomiting, retrosternal pain, heartburn, weight loss, avoidance of eating, consumption of large amount of liquids and aberrant eating behaviours are symptoms of both achalasia and BN. Owing to these common signs and symptoms, oesophageal achalasia can be misdiagnosed as an eating disorder. In addition, oesophageal achalasia can occur as a complication of BN. It is often difficult to distinguish organic and psychological vomiting or comorbidity because of overlapping of the symptoms.
Case report: We report the case of a patient who developed oesophageal achalasia following severe, repetitive vomiting as a complication of BN.
Conclusion: We want to raise awareness regarding the development of a medical illness in the presence of a psychiatric disorder. Importantly, physicians should have a fundamental knowledge of these two diseases regarding their clinical patterns to differentially diagnose one or both disorders as quickly as possible.