South African Journal of Psychiatry - Volume 13, Issue 1, 2007
Volume 13, Issue 1, 2007
Source: South African Journal of Psychiatry 13, pp 4 –9 (2007)More Less
Multiple factors play a role in determining the outcome of schizophrenia. However, the role of these factors is poorly understood, and research findings so far have been inconclusive and sometimes contradictory. Various demographic and baseline clinical factors have been reported to be associated with treatment outcome. Also, early symptom reduction after initiation of antipsychotic therapy is closely related to later treatment response. However, associations as such do not necessarily imply predictive value, and none of these factors can be regarded as clinically useful in predicting treatment outcome. This article discusses selected aspects of treatment outcome and its prediction in schizophrenia, focusing particularly on early treatment response, ethnicity, neurological soft signs, and the predictive value of a discriminant functional analysis model utilising a combination of putative predictors. Such a model holds promise, and it is to be hoped that future refinements will lead to a clinically useful model for predicting outcome.
Author C.W. Van StadenSource: South African Journal of Psychiatry 13, pp 10 –12 (2007)More Less
The article argues that a functional approach is ethically better than a categorical approach in deciding whether involuntarily admitted patients have the capacity to give informed consent to participation in research. Congruent with current South African laws, a functional approach requires that a patient's capacity to give informed consent to participation in research should be assessed clinically rather than assumed by virtue of his / her belonging to a category of legal admission status. Concerns about protection against exploitation may cause a categorical approach to appear attractive, but these concerns can be addressed deliberately through a functional approach without attracting the infringements of rights and entitlements of patients that are brought about by a categorical approach.
Source: South African Journal of Psychiatry 13, pp 13 –21 (2007)More Less
Background. The Diagnostic and Statistical Manual of Mental Disorders (DSM) system has certain limitations when applied to two South African examples of dissociation, because it is descriptive (non-explanatory) and focuses on intrapsychic (non-communal)processes. Even the existing Western explanatory models of dissociation fail to accommodate fully the communal aspects of dissociation in our South African context.
Objectives and methods. The aim was to explore an expanded perspective on dissociation that does not limit it to an intrapsychic phenomenon, but that accounts for the interrelatedness of individuals within their social context. Autoethnography was used. In this article a collective, socially orientated, contextual hermeneutic was applied to two local examples of dissociation. Three existing Western models were expanded along multicontextual, collective lines, for them to be more useful in the pluralistic South African context.
Results. This preliminary contextual model of dissociation includes a person's interpersonal, socio-cultural, and spiritual contexts, in addition to the intrapsychic context. Dissociationis considered to be a normal information-processing tool that maintains balanced, coherent selves-in-society, i.e. individuals connected to each other. In the South African context dissociation appears mostly as a normal phenomenon and seldom as a sign of mental illness. Dissociation is pivotal for the normal construction of individual and communal identities in the face of conflicting sets of information from various contexts. Dissociation may help individuals or communities to survive in a world of conflicting messages, where conflict is often interpersonal / cultural / societal in nature, rather than primarily intrapsychic.
Conclusions. This model should be developed and evaluated further. Such evaluation would require suitable new local terminology.
Source: South African Journal of Psychiatry 13, pp 22 –25 (2007)More Less
Objective. An exploratory study was undertaken to determine the value of computed tomography (CT) in the assessment of mentally ill patients at Chris Hani Baragwanath Hospital
Method. All mentally ill inpatients aged 18 years and older who presented during the period March - August 2005, were screened for eligibility for CT of the head. The patients' demographic data, clinical details, special investigations and the results of the CT were recorded.
Results. Of approximately 600 admissions, 55 were eligible for CTs during the study period. The mean age of the study population was 38.3 years (standard deviation (SD) 16.3 years). Twenty patients (36.4%) had abnormal CTs; 7 (35%) of these patients were over the age of 60 years. There was a significant correlation between abnormal CTs and advancing age (r = 0.5, p < 0.001). In the group with abnormal CTs the gender distribution was similar, 15 (75%) presented with a first episode of psychosis, 5 (25%) had a concurrent abnormal physical examination, and 7 (35%) had abnormal special investigations. There was no significant difference between this group and the group with normal CTs with regard to gender (c2 = 0.75, p = 0.385), first-episode psychosis (c2 = 2.76, p = 0.096), abnormal physical findings (c2 = 0.51, p = 0.473), or abnormal laboratory findings (c2 = 0.13, p = 0.714) respectively.
Conclusion. In this psychiatric population CT scanning revealed a significant number of abnormalities, especially in patients with first-episode psychosis. The study also suggests that clinical abnormalities (physical and laboratory) may not be reliable predictors of abnormal CTs and therefore the need for further research with bigger sample size.
Biological Psychiatry Congress 2007 25 - 28 February, Lord Charles Hotel, Somerset West, W Cape : abstractsSource: South African Journal of Psychiatry 13, pp 26 –36 (2007)More Less