South African Journal of Psychiatry - Volume 13, Issue 4, 2007
Volume 13, Issue 4, 2007
Source: South African Journal of Psychiatry 13, pp 122 –123 (2007)More Less
A new set of guidelines to address the mental health and psychosocial needs of survivors of conflict and disaster have been agreed by international humanitarian agencies.
Africa, with only 0.32 nurses in mental health settings per 100 000 population, has among the lowest proportion of mental health nurses globally, and well below the world average of 2.23 nurses per 100 000 population. And these are divided almost equally between mental hospitals and psychiatric units in general hospitals, with none recorded in community mental health settings.
Person-centred psychiatry : the recent 10th International Conference on Philosophy, Psychiatry and Psychology : editorialAuthor Werdie Van StadenSource: South African Journal of Psychiatry 13 (2007)More Less
Real persons, including patients and psychiatrists, are at the centre of psychiatry! So guided the theme 'Hypotheses, Neuroscience and Real Persons' of the 10th International Conference on Philosophy, Psychiatry and Psychology (PPP) held at extravagant Sun City from 26 to 30 August 2007. This theme was announced at the 7th International Conference in Heidelberg, Germany, in 2004, after the bid to host the conference in South Africa had been accepted in 2002. The Organising Committee was particularly pleased to learn later that the theme of real persons being at the centre of psychiatry is also a top programmatic priority of the World Psychiatric Association (WPA), for in 2005 the General Assembly of the WPA approved the Institutional Program for Psychiatry of the Person (WPA-IPPP).
Source: South African Journal of Psychiatry 13, pp 126 –131 (2007)More Less
The purpose of this review is to synthesise cannabis use data from surveys, specialised alcohol and drug treatment centres, cannabis-related trauma unit admissions and arrestee studies over the past 12 years in South Africa.
Results indicate that cannabis is the most common illicit substance used in South Africa, with particularly high use among the youth. Current self-reported cannabis use was 5 - 10% among adolescents and 2% among adults, higher among men than women, higher in urban than rural areas, higher in the urban provinces of Western Cape and Gauteng than the other provinces and higher among coloureds and whites than other racial groups. Cannabis is commonly misused by trauma patients (29 - 59%) and is often associated with crime (39%). There has been an increase in seizures and treatment demand for cannabis. The current (2006) treatment demand for the whole country was 17% for cannabis and 3.4% for cannabis and mandrax (methaqualone), which has implications for treatment service delivery. Screening and brief intervention of substance (cannabis) use should be included in health care settings.
The general profile of children and adolescents with major depression referred to the Free State Psychiatric ComplexSource: South African Journal of Psychiatry 13, pp 132 –136 (2007)More Less
Background. Depression can have far-reaching effects on the functioning and adjustment of young people. Among both children and adolescents depression confers an increased risk for illness, interpersonal and psychosocial difficulties.
Objective. The aim of this study was to determine the profile of children (birth - 12 years) and adolescents (13 - 18 years) with major depression referred to the Child Mental Health Unit at the Free State Psychiatric Complex (FSPC) from 1 January 2004 to 31 December 2004.
Method. A total of 904 children and adolescents were referred to the Unit during 2004. From these referrals 100 children and adolescents (11.06%) were diagnosed with major depression and were included in the study.
Data analysis. The data were summarised using frequencies and percentages (categorical variables) and means of percentiles (numerical variables).
Results. The majority (74%) of the cases were in the adolescent age group and 61% were girls. The main complaints presented by the parents or in the referral letter by the general practitioners were behavioural problems (37%) such as stealing, aggression and attention-seeking behaviour, followed by decrease in school performance (25%), suspected depression (21%), suicidal tendencies (17%), and school refusal (8%). Twelve per cent of the group had lost a family member. The main presenting clinical symptoms of major depression in the study group were sleep disturbance (59%), dysphoric (depressed) mood (57%), disturbance in appetite (49%), constant fatigue/loss of energy (43%), inability to enjoy activities that would normally give pleasure (37%), and impaired concentration (36%). Somatic complaints occurred in 42% of the study population. Most of the complaints involved headaches (28%), stomach aches (14%), neck and back pain (8%) and nausea (6%). Thirty-three per cent of the participants with physical complaints were on medication. Behavioural problems present among the children/adolescents included fighting (26%), disobedience (23%), staying away from school (15%), stealing (13%), telling lies (13%), running away from home (8%), and aggression (4%). Fifty-six per cent (56%) of the participants showed a decline in school perfomance and 4% had enuresis.
Conclusion. Of particular interest was the finding that the clinical features in this South African community are consistent with samples studied in First-World countries. These areas or symptoms are sleep disturbance, depressed mood, disturbance in appetite, constant fatigue or loss of energy, inability to enjoy activities that would normally give pleasure, impaired concentration and suicidal thoughts. Other notable clinical features were behaviour problems, substance abuse and somatic complaints. There is no doubt that this research will also encourage other extrapolations of First-World findings such as treatment safety and efficacy of major depression in children and adolescents.
Author D.L. MkizeSource: South African Journal of Psychiatry 13, pp 137 –142 (2007)More Less
Background. Following allegations of human rights abuses at a psychiatric hospital in Pietermaritzburg, KwaZulu-Natal, that were reported in one of the local newspapers, the national and provincial Ministers of Health visited the hospital. Because of the seriousness of the allegations, the national Minister of Health established a Committee of Enquiry to investigate the allegations. The 7 committee members included experts in mental health care services, legal services, public service sector, a hospital board member, and a representative of the community.
Objectives. The terms of reference of the Committee of Enquiry were to investigate allegations of human rights abuses of psychiatric patients at the hospital, and to report their findings to the Minister, in line with the media reports.
Methods. The public was invited through notices in the print and electronic media to make submissions relating to the allegations. Interviews and site inspections were conducted. Written submissions were received. Legislative and regulatory frameworks were studied. Reports of previous commissions as well as hospital records were analysed.
Findings. The findings of the Committee confirmed all media allegations of human rights abuses as appearing in the terms of reference. In addition, the Committee identified the following systemic defects: (i) weak management over a long period of time; (ii) absence of a hospital board; (iii) inadequacies in the physical layout and quality of facilities; (iv) abuse of staff by patients; (v) staff reporting on duty under the influence of alcohol; (vi) high rate of absenteeism; (viii) shortage of staff; (viii) lack of discipline; (ix) evidence of racism, nepotism and favouritism; and (x) strained relations between the management and unions.
Recommendations. The Committee recommended that remedial and preventive measures be undertaken as a matter of urgency to combat human rights abuses and address deficiencies in the system.
Source: South African Journal of Psychiatry 13, pp 143 –146 (2007)More Less
Objective. Hoarding is commonly defined as the acquisition of and failure to discard possessions of little use or value, and is included as a symptom in the diagnostic criteria for obsessive compulsive personality disorder (OCPD) and obsessive compulsive disorder (OCD). However, it has also been observed in other clinical syndromes including schizophrenia. This study was conducted to investigate the prevalence and clinical presentation of hoarding behaviour in schizophrenia among Xhosa patients.
Method. The sample consisted of 102 patients, recruited as part of a larger genetic study in the Cape Town metropole between November 2004 and January 2005, diagnosed with schizophrenia or schizoaffective disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. They were screened for clinically significant hoarding symptoms. If these were present, additional information on the phenomenology was obtained by means of a structured questionnaire. The Mini International Neuropsychiatric Interview (MINI) (screen and full version), the Yale Brown Obsessive Compulsive Scale (Y-BOCS) Checklist, Y-BOCS, Clutter Image Rating Scale (CIRS) and a structured questionnaire on hoarding were administered.
Results. Only four patients with schizophrenia were classified as hoarders. Although their clinical presentation resembled that of hoarders described elsewhere in the literature, they had low Y-BOCS scores and did not report other obsessive-compulsive symptoms.
Conclusion. Our results suggest that hoarding behaviour is not common in Xhosa patients with schizophrenia. Further investigation of protective factors for hoarding behaviour in the Xhosa population is warranted.
Psychiatric evaluation of intellectually disabled offenders referred to the Free State Psychiatric Complex, 1993 - 2003Source: South African Journal of Psychiatry 13, pp 147 –152 (2007)More Less
Background. Increased crime is a problem in South Africa and complications arise when the accused is intellectually disabled. The accountability and fitness to stand trial of such individuals is an important facet that needs to be managed by the judicial and health systems.
Objective. To analyse the accountability and triability of intellectually disabled people awaiting trial referred to the Free State Psychiatric Complex (FSPC) from 1993 to 2003 according to Sections 77 and 78 of the Criminal Procedures Act (Act 51 of 1977).
Method. A retrospective study was conducted. The study population consisted of 80 intellectually disabled people awaiting trial in the Free State, referred to the FSPC. The reason for referral was the possibility that they were not triable or accountable. A data form was compiled to transfer the relevant information from the patients' clinical files.
Results. The study found that the majority of subjects were male (96.3%), unmarried (76.3%) and unemployed (63.8%). The median age was 27 years. A relatively high percentage (49%) had received some schooling and 16% had attended a special school. Most (32%) were referred from the Bloemfontein area and 68% were referred from the remainder of the Free State and other areas. The majority were referred according to Sections 77 and 78. The highest number of the offences were of a sexual nature (78%). Of the subjects, 62 (62.5%) were diagnosed as having mild mental retardation, while 16% were diagnosed as having moderate mental retardation. A total of 71 (71.25%) were found to be untriable and unaccountable.
Conclusion. Triability and accountability are not only reflected by IQ score, but also involve the accused's understanding of his/her environment, his/her speech and language proficiency, level of education, reasoning ability and the manner in which the crime was committed. It is important to note that having an IQ of 70 or less does not automatically mean that the accused is unfit to stand trial or is not accountable. It is possible for an intellectually disabled person to be triable, accountable or diminished accountable.