South African Journal of Psychiatry - latest Issue
Volume 22, Issue 1, 2016
Conjoint moderate or high-risk alcohol and tobacco use among male out-patients in Thailand : original researchSource: South African Journal of Psychiatry 22, pp 1 –5 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajpsychiatry.v22i1.763More Less
Objective: To better understand conjoint alcohol and tobacco use among male hospital out-patients, the purposes of this study were: (1) to assess the prevalence of conjoint use and (2) to determine the factors associated with the conjoint alcohol use and tobacco use.
Methods: In a cross-sectional survey, consecutive male out-patients from four district hospitals in Nakhon Pathom province in Thailand were assessed with the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), Hospital Anxiety and Depression Scale (HADS), self-reported chronic conditions and health-seeking behaviour. The sample included 2208 study participants, with a mean age of 36.2 years (SD = 11.7) and an age range of 18-60 years.
Results: Overall, 34.5% of the male hospital out-patients were conjoint moderate or high-risk alcohol and tobacco users, and 31.1% were moderate or high-risk alcohol or tobacco users. In multivariate analysis, younger age, having primary or less education, being separated, divorced or widowed, not having diabetes and not being obese were associated with conjoint moderate or high-risk alcohol and tobacco use.
Conclusion: High prevalence and several risk factors of conjoint alcohol and tobacco use were found among hospital male out-patients. The findings of this study call for dual-intervention approaches for both alcohol and tobacco.
Methylphenidate use and poly-substance use among undergraduate students attending a South African university : original researchAuthor Francois SteynSource: South African Journal of Psychiatry 22, pp 1 –4 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajpsychiatry.v22i1.760More Less
Background: Methylphenidate hydrochloride (MPH) is used in the treatment of attention deficit hyperactivity disorder (ADHD). The non-medical use of MPH by learners and students has been reported by numerous studies from abroad. The practice stems from beliefs about the benefits of MPH in achieving academic success. Little is known about the use of MPH in South African student populations.
Objectives: The study set out to determine (1) the extent and dynamics associated with MPH use and (2) poly-substance use among undergraduate students attending a South African university.
Methods: 818 students took part in a written, group-administered survey. Data analysis resulted in descriptive results regarding MPH use and tests of association identified differences in MPH and poly-substance use among respondents.
Results: One in six respondents (17.2%) has used MPH in the past, although only 2.9% have been diagnosed with ADHD. Nearly a third (31.7%) of users obtained MPH products illegally. The majority (69.1%) used MPH only during periods of academic stress. A significant association ( p < 0.001) was found between MPH use and the frequency of using alcohol, tobacco, cannabis, hard drugs (e.g. cocaine) and prescription medication.
Conclusion: MPH use among students appears similar to experiences abroad, especially in the absence of clinical diagnosis for ADHD. Institutions of higher education should inform parents and students about the health risks associated with the illicit use of MPH. Prescribers and dispensers of MPH products should pay close attention to practices of stockpiling medication and poly-substance use among students who use MPH.
Spirituality, depression and quality of life in medical students in KwaZulu-Natal : original researchSource: South African Journal of Psychiatry 22, pp 1 –6 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajpsychiatry.v22i1.731More Less
Background: The majority of studies on spirituality demonstrate its positive association with mental health. Despite the increasing number of studies, there remains a dearth of studies emanating from African countries looking at the relationship between mental illness, quality of life and measures of spirituality. The present study evaluates the role of spirituality in relation to current depression and quality of life in medical students, who are known to be at high risk for depression.
Objectives: The aim of this study was to determine the prevalence of moderate and severe depressive symptoms in this population and explore potential correlations between spirituality,depression and quality of life.
Methods: 230 medical students were surveyed at the University of KwaZulu-Natal Medical School, using the Zung Self-Rating Depression Scale (Zung SDS), Spiritual Involvement and Beliefs Scale (SIBS), WHO Quality of Life Scale (WHOQOL) and a demographic data sheet.
Results: There was a high prevalence of depressive symptoms in the medical students, with a significant proportion (15.6%) showing evidence of severe depressive symptoms (indicating likely depressive illness). Those with a history of mental illness or of having attended traditional, complementary or alternate medical practitioners showed higher levels of depression. Lower spirituality was associated with non-adherence to a major religion and a history of mental illness. Quality of life was better in second and fifth year students and poorer in those with a history of mental illness.
Conclusion: Medical students' experiences of depression (most probably due to stress) and its relationship with spirituality and quality of life merit further investigation with a view to establishing policy guidelines for dealing with this issue.
Source: South African Journal of Psychiatry 22, pp 1 –2 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajpsychiatry.v22i1.814More Less
Depression is a common psychiatric disorder and can be costly, having a significant impact on the individual and employers. The South African Depression and Anxiety Group (SADAG) in partnership with HEXOR, with the support of Lundbeck, undertook research into depression in the workplace, because South African information is not available on this topic. It provides insight into the prevalence of depression within the workplace in South Africa, as well as the impact of depression on the employees and employers in terms of sick leave and levels of productivity, especially when the symptoms include cognitive impairment. It is apparent that stigma plays a pivotal role in the reasons for non-disclosure to employers. It further highlights the magnitude of awareness, early detection and the provision of a holistic support system within the work environment, free from bias, to ensure that optimum benefit can be achieved for both employer and employee.
Assessing the usefulness of electroencephalography in psychiatry : outcome of referrals at a psychiatric hospital : scientific letterSource: South African Journal of Psychiatry 22, pp 1 –3 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajpsychiatry.v22i1.702More Less
This retrospective study was conducted at Sterkfontein psychiatric hospital in Gauteng. The objectives included investigating reasons for referral to conduct an electroencephalography (EEG) and to determine whether EEG findings have impact on clinical management. Source data included EEG reports over an 18-month period and clinical records. The total sample was 85 adult inpatients (53 males; 32 females). Seizure disorder exclusion was the main reason for EEG referral (69.0%). Seventy-four (87.0%) records were normal, 7 (8.2%) were abnormal, 2 (2.4%) were inconclusive and 2 (2.4%) EEG reports were unavailable. There was no statistically significant correlation between abnormal EEG results and demographic variables, symptoms,admission diagnosis and medications. EEG recording demonstrated a low yield of abnormal results. In this study, EEG results did not appear to influence the treating psychiatrists regarding management, but this could be as a result of the small sample size. As interactions between psychiatric conditions and epilepsy are important and well established, negative EEGs are indeed useful and it is recommended that clinicians should carefully consider which patients should be referred for EEGs.
Depressive symptoms and marital adjustment among primary care patients with erectile dysfunction in Umuahia, Nigeria : original researchSource: South African Journal of Psychiatry 22, pp 1 –6 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajpsychiatry.v22i1.979More Less
Objectives: The aim of this study was to investigate the relationship between erectile dysfunction (ED), marital adjustment and depression.
Methods: The survey was conducted among primary care patients at Federal Medical Centre, Umuahia. Subjects were 678 married, male primary care patients; aged 20-70 years (mean age = 45 years). ED was assessed by International Index of Erectile Function 5 (IIEF-5) score, the presence of clinically significant depressive symptoms was assessed with the 5-item version of the Center for Epidemiological Studies Depression Scale (CES-D), and marital adjustment was assessed with the Revised Dyadic Adjustment Scale (RDAS).
Results: The prevalence of probable depression by CES-D and ED by IIEF-5 score was 20.9% and 26.0%, respectively. Marital distress was rampant (62.0%) among subjects with ED (p < 0.05, X2 = 196.58). Erectile dysfunction was associated with marital adjustment (p < 0.05). Partial correlation revealed that depression affects both ED and marital adjustment, and is closely related to both variables.
Conclusion: Partner involvement and screening for depression should be emphasised in the care of patients with ED.
Anxiety and depressive features in chronic disease patients in Cambodia, Myanmar and Vietnam : original researchSource: South African Journal of Psychiatry 22, pp 1 –4 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajpsychiatry.v22i1.940More Less
Objective: The aim of this study was to estimate the prevalence and relationship of anxiety and depressive features among patients diagnosed with a variety of chronic diseases in three Southeast Asian countries (Cambodia, Myanmar and Vietnam).
Methods: A cross-sectional survey was conducted in 2014 among 4803 adult patients with chronic diseases who were recruited cross-sectionally from health facilities. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale.
Results: Overall, 17.0% of patients screened positive for anxiety disorder and 39.1% for depressive disorder. Patients with cancer (47.8%) had the highest rate of anxiety features, and those with chronic obstructive pulmonary disease (COPD) (62.1%), kidney disease (55.5%), Parkinson's disease (53.7%) and cardiovascular disorders (CVDs) (52.6%) the highest prevalence of depressive features. Stomach and intestinal diseases, CVDs, migraine or frequent headaches and kidney disease were positively associated with anxiety and depression after adjusting for socio-demographics and illness duration. In addition, cancer and Parkinson's disease were positively associated with anxiety, and arthritis, diabetes, and COPD were positively associated with depression. In multivariate logistic regression, having two or more chronic conditions and poor quality of life was associated with anxiety and depression.
Conclusion: Considering the high rate of anxiety and depression among these patients with chronic disease, more efforts should directed to on the psychosocial management of these patients.
Reliability of the GAIN-SS, CRAFTT and PESQ screening instruments for substance use among South African adolescents : original researchSource: South African Journal of Psychiatry 22, pp 1 –6 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajpsychiatry.v22i1.932More Less
Introduction: Screening for adolescent substance use can assist with the early identification of substance-related problems and guide the provision of appropriate services. As such, psychometrically sound screening tools are needed. The aim of this study was to compare the reliability of the CRAFFT, Global Appraisal of Individual Needs-Short Screener (GAIN-SS) substance use subscale and Personal Experience Screening Questionnaire (PESQ) among adolescents from disadvantaged communities in Cape Town, South Africa.
Methods: Adolescents aged 12-19 years (n = 231) completed the three screeners at two points in time.
Results: Findings show that all three of the screeners had adequate internal consistency (Cronbach ɑ ≥ 0.8). Test-retest reliability was similar for all three screeners, with intraclass correlation coefficient values slightly higher for the PESQ (0.82, 95% CI: 0.77-0.86) than for the GAIN-SS substance use subscale (0.79, 95% CI: 0.73-0.84) and CRAFFT (0.76; 95% CI: 0.66- 0.83). Kappa values indicated that the GAIN-SS substance use subscale and CRAFFT had moderate levels of agreement, while the PESQ had substantial levels of agreement for identifying those who had moderate or higher substance use risks at Time 1 and Time 2.
Conclusion: The findings indicate that all of these short screeners seem to have acceptable reliability when used in this population. All of the three screeners are appropriately reliable when used with adolescents from disadvantaged communities in Cape Town, but the PESQ performed slightly better. Future studies should also include the assessment of validity of these screeners in this context.
Anxiety, depression and psychological well-being in a cohort of South African adults with Type 2 diabetes mellitus : original researchSource: South African Journal of Psychiatry 22, pp 1 –9 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajpsychiatry.v22i1.935More Less
Background: The prevalence of diabetes mellitus (DM) has increased at alarming rates globally. South Africa has the second highest number of people in Africa living with DM, with prevalence rates being among the top five countries in Africa. Accordingly, psychological issues associated with DM have been a growing focus of attention. Studies have found that patients with DM have elevated levels of anxiety and depression, and decreased levels of well-being. In South Africa, there is a paucity of studies on the psychological issues associated with DM.
Objectives: The aim of this paper was to explore the prevalence and association of anxiety, depressive features and psychological well-being in patients with Type 2 DM.
Method: In a cross-sectional survey, patients with Type 2 DM were recruited from public and private facilities. The Hospital Anxiety and Depression Scale (HADS), the General Health Questionnaire (GHQ-28) and WHO-5 Well-being Index (WHO-5) were administered.
Results: Four hundred and one participants completed the questionnaires. On the WHO-5, 277 (69%) reported good well-being, while 124 (31%) indicated poor well-being and were considered at risk for depressive features. On the HADS, 186 (46%) had mild-to-severe depressive features and 128 (32%) had mild-to-severe anxiety. There was a strong negative correlation between the WHO-5, HADS and General Health Questionnaire (GHQ) scales, which indicated that an increase in anxiety and depressive features decreased psychological well-being.
Conclusion: Health-care providers should identify and treat anxiety and depression as a standard part of diabetes care. Patients should also be referred to the appropriate mental health professional as part of the management of diabetes.
Prevalence and correlates of non-medical stimulants and related drug use in a sample of South African undergraduate medical students : original researchSource: South African Journal of Psychiatry 22, pp 1 –6 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajp.v22i1.795More Less
Background: The non-medical use of prescription psychostimulants or cognitive-enhancing substances among healthy college students is a growing concern. This use appears to be particularly high among medical students. To our knowledge, no literature is available on the non-medical use of stimulants among South African medical students.
Objective: To determine the prevalence and correlates of non-medical stimulant use as well as subjective opinion on peer numbers using stimulants and university attitude towards stimulant use among a sample of South African undergraduate medical students.
Methods: A descriptive observational study was conducted by means of a self-report questionnaire. Second- and fourth-year medical students (n = 252) completed the questionnaire.
Results: Of the sample, 44 (18%) reported a lifetime use of stimulants for non-medical purposes and 33 (85%) of this group reported use within the past year. A total of six (2%) students reported a diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD). In the group without a diagnosis of ADHD, non-medical stimulant use was associated with the year of study (p = 0.03) and illicit substance use (p = 0.01). Most of the students in this group (31, 32%) reported using stimulants to improve concentration.
Conclusion: Non-medical use of stimulants to improve concentration and academic performance is prevalent among the South African medical students sampled in this study. Further research at other institutions and under non-medical students would be helpful to assess the scope of this phenomenon.
Inpatient management of borderline personality disorder at Helen Joseph Hospital, Johannesburg : original researchSource: South African Journal of Psychiatry 22, pp 1 –8 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajpsychiatry.v22i1.678More Less
Objective: The aim of this report was to establish a profile of patients with borderline personality disorder (BPD) admitted to the acute inpatient psychiatric assessment unit at the Helen Joseph Hospital, in Johannesburg, over the course of 1 year.
Methods: A retrospective record review was conducted to investigate the prevalence,demographics, reasons for admission, treatment, length of stay and follow-up of a group of inpatients during 2010 with a diagnosis of BPD, based on DSM-IV-TR diagnostic criteria,allocated on discharge.
Results: Considering evidence retrospectively, the quality of the BPD diagnosis allocated appeared adequate. Statistical analysis revealed findings mainly in keeping with other reports, for example, that patients with BPD are above-average users of resources who make significantly more use of emergency services and that they generally do not adhere well to their scheduled outpatient follow-up arrangements. The longer average length of inpatient stay of this group with BPD, however, exceeded the typically brief period generally recommended for acute inpatient containment and emergency intervention.
Conclusion: Implementation of targeted prevention and early intervention strategies, based on systematised programmes such as dialectical behavioural therapy and mentalisation based therapy, may be useful in addressing these problems experienced with integrating the in- and outpatient management of BPD.
Does psychiatry need religion and spirituality in its treatment approach? Narcissism as an example : original researchAuthor Manfred BohmerSource: South African Journal of Psychiatry 22, pp 1 –6 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajpsychiatry.v22i1.563More Less
Background: Although religion and spirituality are increasingly recognised as important in the understanding and treatment of patients, there are also concerns about their role in psychiatry. The recommendation for the integration of spirituality in the approach to psychiatric practice highlights the importance to further think about this practice.
Objective: To contribute to the debate on the role of spirituality in psychiatry by considering the opinions of two prominent thinkers in this field, the theologian Tillich, and the psychoanalyst Symington.
Method: The approach of Tillich and Symington to mental health problems are compared. Narcissism is focussed on, since Symington describes narcissism as the core of all pathology and states that the prime aim of psychoanalysis is the transformation of narcissism. The contributions of Kohut and Kernberg are also briefly discussed.
Results: In Symington's opinion more than psychoanalysis is needed to help those in the grip of narcissism. Tillich emphasises the difference between existential anxiety and anxiety due top sychopathology. Psychotherapy can only heal the latter. Yet he also states that we are incapable of change without self-acceptance. For this a larger experience of acceptance or grace is needed, since we are incapable of offering ourselves this type of acceptance.
Conclusion: In the struggle to get a grip on narcissism, good nurturing experiences, transformative self objects, a confrontation with the darker sides of the self and the message of ultimate acceptance are needed. Religion and spirituality have an important contribution to make to psychiatric or psychotherapeutic treatment.
The functioning and behaviour of biological parents of children diagnosed with attention-deficit/hyperactivity disorder, attending the outpatient department at Weskoppies Hospital, Pretoria : original researchSource: South African Journal of Psychiatry 22, pp 1 –6 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajpsychiatry.v22i1.836More Less
Background: ADHD (attention-deficit/hyperactivity disorder) is gradually being acknowledged as a functionally impairing disorder across the lifespan, underscored by heritability. Nonetheless, lack of ADHD (adult attention-deficit/hyperactivity disorder) data from South Africa is alarming which could be due to either the unawareness of ADHD symptoms or underutilisation of available screening measures. Undiagnosed ADHD may influence family- and working lives unpleasantly. Parenting a child with ADHD may intensify parental stress through functional impairment notwithstanding the diagnosis of ADHD.
Methods: Eighty-one biological parents of children diagnosed with attention-deficit/ hyperactivity disorder were screened using self-reporting measurements. ADHD self-report scale (ASRS-V 1.1) identified either positive or negative subgroups; the Weiss functional impairment rating scale (WFIR-S) for functional impairment and the Jerome drivingquestionnaire (JDQ) for risk-taking behaviour specifically driving.
Results: Of the 39 (48%) parents who experienced impairment in all seven areas of functioning, 23 (59%) screened negative for ADHD, while 16 (41%) screened positive. A significant association was found between parents who screened either positive or negative for ADHD and functional impairment across five of the seven individual categories namely family, work, self-concept, life-skills and social functioning.
Conclusion: This study emphasised the high incidence of functional impairment in parents of ADHD children. Although a substantial number of parents screened negative for ADHD, they still reported impairment in functioning; probably due to undiagnosed ADHD with comorbid psychiatric disorders, and/or parental stress due to the complex behaviour of the child. Parents of children diagnosed with ADHD should be screened for functional impairment followed by referral for psychiatric assessment and parent management training to achieve better clinical outcomes.
Substance use and duration of untreated psychosis in KwaZulu-Natal, South Africa : original researchSource: South African Journal of Psychiatry 22, pp 1 –7 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajpsychiatry.v22i1.852More Less
Background: Substance use and psychiatric disorders cause significant burden of disease in low- and middle-income countries. Co-morbid psychopathology and longer duration of untreated psychosis (DUP) can negatively affect treatment outcomes.
Objectives: The study assessed substance use amongst adults with severe mental illness receiving services at a regional psychiatric hospital in KwaZulu-Natal (South Africa). We describe the prevalence and correlates of lifetime substance use and examine the association between substance use and DUP.
Methods: A cross-sectional survey recruited adults diagnosed with severe mental illness and assessed lifetime and past 3-month substance use using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test. Regression analyses were conducted to determine associations between lifetime substance use (other than alcohol and tobacco) and DUP as measured by the World Health Organization Encounter Form.
Results: Amongst 87 participants, alcohol (81.6%), tobacco (75.6%) and cannabis (49.4%) were the most common substances reported for lifetime use. Risk of health-related problems (health, social, financial, legal and relationship) of cannabis use was associated with younger age, single marital status and lower education. Adjusted regression analyses indicated that use of amphetamines and methaqualone is associated with longer DUP.
Conclusions: Substance use is prevalent amongst psychiatric patients in KwaZulu-Natal and may contribute to longer DUP. Mental health services in this region should address co-morbid substance use and psychiatric disorders.
Case series of females charged with murder or attempted murder of minors and referred to Weskoppies Hospital in terms of the Criminal Procedure Act over a period of 21 years : original researchSource: South African Journal of Psychiatry 22, pp 1 –7 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajpsychiatry.v22i1.887More Less
Women charged with murder or attempted murders of children are usually sent for forensic psychiatric evaluation. In South Africa research and literature on this population is scarce. A case series was studied of forensic files of 32 females charged with murder or attempted murder of children. These files contained information on such females. The forensic psychiatric observation was mainly to establish whether a psychiatric diagnosis could be made, and whether they were triable and accountable. Files from 01 Jan 1990 to 31 Dec 2010 (21 years) were obtained of cases observed in Weskoppies Hospital. The aim of describing this case series was to attempt to find a psychiatric profile of such cases, as well as to find other information for example, demographics. The findings, after forensic observation regarding their ability to follow court proceedings and their ability to contribute meaningfully to their defence (trialability) as well as their ability to distinguish between right and wrong, and their ability to act in accordance with the said appreciation (accountability) at the time of the alleged offence were also reported. This information could contribute to making medical practitioners and mental health care workers aware of risk factors involving such cases and to encourage them to enquire about these risk factors.
Author Johannes L. RoosSource: South African Journal of Psychiatry 22, pp 1 –6 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajp.v22i1.831More Less
Background: Recent genetic findings have led to profound changes in genetic and family counselling for schizophrenia patients and their families.
Objectives: The article gives an overview of the present knowledge regarding the genetic and family counselling for schizophrenia.
Method: Literature searches were performed on the MEDLINE databse (2011-2015) and African Healthline. A current alert service which provides the most recent literature on the topic on a monthly basis was also used in the study. A clinical case example is presented as is experienced in daily psychiatric practice.
Results: Genetic risk communication has become the responsibility of the multi-professional treatment team, moving away from specialists in the field. The treatment team provides information on a daily basis regarding risk predictors in the management of schizophrenia, including risk of relapse, suicide and comorbid substance use. Although genetic information is unique and has implications for blood relatives, genetic risk factors only rarely provideinformation that is inherently different from that provided by other risk predictors commonly used in healthcare. The common variant common disease and rare variant common disease models as contrasting hypothesis of the genetics of schizophrenia are discussed and debated. An example of a family counselled is given and the place of commercial companies that offer directly to the consumer affordable personal DNA testing for psychiatric illness is discussed. Ethical issues without resolution regarding genetic counselling of schizophrenia are debated.
Conclusions: Recent genetic findings must lead to profound changes in genetic and family counselling in schizophrenia. Exposed attributable risk has immediate effects on genetic counselling of schizophrenia. Psychiatric risk counselling has thus changed from risk estimates based on family history to estimates based on test results in specific individuals.
A comparison between the Mini-Mental State Examination and the Montreal Cognitive Assessment Test in schizophrenia : original researchSource: South African Journal of Psychiatry 22, pp 1 –5 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajpsychiatry.v22i1.890More Less
Background: Cognitive impairment is a core feature of schizophrenia that also has strong prognostic significance. In most clinical settings comprehensive neuropsychological testing to detect cognitive impairment in schizophrenia patients is not readily available, but because cognitive deficits in schizophrenia are clinically important it would be useful to detect or at least screen for them in a clinical setting. Unfortunately there are no validated, brief screening instruments for the detection of cognitive impairment in schizophrenia. Nevertheless, the Montreal Cognitive Assessment Test (MoCA) and the Mini-Mental State Examination (MMSE) show promise in this regard. The objective of this study was to compare the results of the MMSE and MoCA in a group of outpatient schizophrenia sufferers to contribute to research into the instruments' potential usefulness as screening tools for cognitive impairment in schizophrenia.
Method: The Afrikaans versions of the MMSE and MoCA were administered to Afrikaans-speaking adult outpatients. Participants had at least seven years of formal education and had been in partial or full remission for at least 3 months. The MMSE and MoCA scores for each participant were matched and compared using the non-parametric Wilcoxon matched pairs test.
Results: The sample consisted of 30 Afrikaans-speaking outpatients with schizophrenia. The mean MMSE score was 27.17 ± 2.64, and the mean MoCA score was 22.53 ± 3.91. There was a statistically significant difference between participants' performance on the MMSE and MoCA tests (p = 0.000008).
Conclusion: Compared to the MMSE, the MoCA may be a more useful instrument to detect cognitive impairment in patients with schizophrenia. Further studies are required.
Forensic mental health services : current service provision and planning for a prison mental health service in the Eastern Cape : original researchSource: South African Journal of Psychiatry 22, pp 1 –8 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajpsychiatry.v22i1.787More Less
Objectives: No research data exists on forensic psychiatric service provision in the Eastern Cape, Republic of South Africa. The objective of this research was to assess current forensic psychiatric service provision and utilisation rates at Fort England Hospital. This is important in improving and strengthening the service. A related objective was to develop a model for a provincial prison mental health service.
Methodology: This study is a situational analysis of an existing forensic psychiatric service in the Eastern Cape. The design of the study was cross sectional. An audit questionnaire was utilised to collate quantitative data, which was submitted to Fort England Hospital, Grahamstown. A proposed prison mental health service was developed utilising prevalence rates of mental illness among prisoners to calculate bed and staff requirements for an ambulatory and in-patient service.
Results: During the study period a total of 403 remand detainees were admitted to the forensic psychiatry division of Fort England Hospital. The average length of stay was 494 days and thebed utilisation rate was determined at 203.54%. We estimate that to provide a provincial prison mental health service to treat psychotic illnesses and major depression the province requires a 52 bedded facility and a total staff complement of approximately 31.
Conclusions: Forensic psychiatric services include the assessment, management and treatment of mentally disordered persons in conflict with the law and prisoners requiring psychiatric assessments. The Eastern Cape Province does not have plans or policies to assess and manage mentally ill offenders, resulting in an increased load on available services. We recommend that an inter-departmental task team, which includes Health, Justice and Constitutional Development and Correctional Services, should be established in the province, to develop a strategy to assist in the development of an effective and efficient forensic psychiatric service. This should be driven by the provincial Department of Health.
Schizoaffective Disorder in an acute psychiatric unit : profile of users and agreement with Operational Criteria (OPCRIT) : original researchSource: South African Journal of Psychiatry 22, pp 1 –6 (2016) http://dx.doi.org/http://dx.doi.org/10.4102/sajpsychiatry.v22i1.790More Less
Background: Schizoaffective Disorder is a controversial and poorly understood diagnosis. Experts disagree on whether it is a discrete disorder; whether it is on a spectrum between Bipolar Disorder and Schizophrenia or whether it even exists. Lack of individual research attention given to this disorder, changing diagnostic criteria and hence poor diagnostic stability have all contributed to the dearth of knowledge surrounding Schizoaffective Disorder.
Objectives: To describe the profile of mental health care users (MHCUs) diagnosed with Schizoaffective Disorder and determine the degree of agreement between the clinicians' diagnosis and Operational Criteria (OPCRIT).
Method: All MHCUs at Helen Joseph Hospital psychiatric unit with Schizoaffective Disorder between 01 January 2004 and 31 December 2010 were included. The demographic, clinical and treatment profiles as well as data required for OPCRIT were extracted from hospital records and discharge summaries.
Results: Most MHCUs with Schizoaffective Disorder were female (68.89%), with a mean age of illness onset of 25 years (SD ± 7.11), had a family history of mood disorders (76.92%) and displayed impaired functioning. Majority (80%) were treated with at least one antipsychotic and one mood stabiliser. No agreement was found between the clinicians' diagnosis and OPCRIT.
Conclusion: While the profile of MHCUs with Schizoaffective Disorder in this study is similar to other studies, the lack of agreement between the clinicians' and OPCRIT diagnoses calls for further research using larger population samples and a dimensional approach to diagnoses in order to improve understanding and management of Schizoaffective Disorder.
Homeless wanderers : Movement and mental illness in the Cape Colony in the nineteenth century, Sally Swartz : book reviewAuthor Rory Du PlessisSource: South African Journal of Psychiatry 22, pp 1 –2 (2016)More Less
Sally Swartz, one of the foremost South African scholars working in the history of psychiatry, has over two decades published an extensive array of journal articles that have contributed significantly to the debates and discourses of colonial psychiatry. Homeless Wanderers is a testament to Swartz's fluent mastery, expert knowledge and sophisticated scholarship.
The book explores mental illness in the Cape Colony from 1890 to 1910. A central aim of Swartz is to chart 'a variety of ways in which the insane in the Cape Colony might be studied as a vulnerable population on the move'. Accordingly, the emphasis is on how insane individuals moved between families, jails, asylums, countries, continents and colonies. In this movement to different institutions, sites and contexts, the insane individual came 'in and out of view' to family members and authorities: at times, it is the suffering of the individual that is brought into view; at other times, the trauma, suffering, vulnerability and needs for care came out of view and were in many ways discarded, rejected and denied.