South African Journal of Psychiatry - Volume 14, Issue 4, 2008
Volume 14, Issue 4, 2008
Author Jonathan Kenneth BurnsSource: South African Journal of Psychiatry 14, pp 120 –121 (2008)More Less
During May 2008, xenophobic attacks broke out against African migrants and refugees in Johannesburg, Durban and Cape Town, leading to at least 50 deaths and the displacement of several thousand people. These events attracted much media attention and were condemned by politicians, community leaders and academic institutions. Of course such crises provide good opportunities for politicians to make mileage, and their proclamations should be received with a healthy dose of scepticism. But, interestingly, some of the responses come fairly close to identifying real causal factors behind the xenophobic violence. For example, in a statement in mid-June, Jacob Zuma identified 'poverty' and 'poor service delivery' as the major factors behind the attacks. He is quoted as saying, 'the conditions of the informal settlements themselves are actually responsible for people to behave in a particular way'.
HIV / AIDS and psychiatry : towards the establishment of a pilot programme for detection and treatment of common mental disorders in people living with HIV / AIDS in Cape Town : editorialSource: South African Journal of Psychiatry 14, pp 122 –124 (2008)More Less
As the roll-out of antiretrovirals (ARVs) to people living with HIV / AIDS (PLWHA) continues to increase in South Africa, so too does the need to integrate mental health services into HIV care. In this editorial, we argue that the role of mental health in ARV programmes is central. The prevalence of mental disorders in PLWHA is higher than in the general population, and the impact of these conditions is substantial. Screening tools for mental disorders are both available and feasible. These should be incorporated into routine ARV care, with support from dedicated HIV mental health services.
Author Sean BaumannSource: South African Journal of Psychiatry 14, pp 125 –130 (2008)More Less
The problem of pain poses questions pertaining to some of the assumptions that underpin modern medicine, including the conceptualisation and treatment of psychiatric disorders. Problematic issues, such as subjectivity and meaning, seem particularly critical in the domains of pain and madness, but have relevance in the broader ranges of medicine. Of central concern is the relation such issues bear to notions of scientific practice. The subjective experience of illness and the meanings attached to it need to be accounted for, and cannot be considered to lie beyond the scope of scientific thinking, as not being measurable or objectively verifiable: yet attempts to incorporate these intrinsic dimensions remain elusive, and shape some of the shifting limitations of the various definitions of what might be considered to be a scientific perspective.
Combining ECT and clozapine in the treatment of clozapine-refractory schizophrenia and schizoaffective disorder - a pilot studySource: South African Journal of Psychiatry 14, pp 131 –135 (2008)More Less
Objective. Clozapine is the current gold standard treatment for severe treatment-refractory schizophrenia, but even so 40 - 70% of these patients will continue to experience disabling symptoms when treated with clozapine monotherapy. Current clinical practice at Stikland Hospital holds that known clozapine-refractory schizophrenia patients who relapse due to non-compliance are treated with an initial combination of clozapine and ECT (if able to consent) when readmitted. The purpose of this study was to evaluate the validity of this practice.
Methods. Patients were divided into an ECT (EG) and non-ECT (CG) group. Clozapine was started and ECT administered as per protocol. Demographic data, psychiatric and medication history and data concerning adverse events were collected. Positive and Negative Symptom Scale (PANSS) scores were done at baseline and at days 21 and 42.
Results. At discharge, although numerically the average increase in clozapine dose was lower and the reduction in length of stay was greater in the EG, none of the variables measured were statistically significantly different between groups. More concomitants were also used in the EG.
Conclusions. This pilot study represents the first controlled trial of ECT-clozapine bitherapy in a population with clozapine-refractory schizophrenia and schizoaffective disorder reported in the literature. The validity of our choice of current clinical practice in this population was not supported by our results. However, the study did provide us with preliminary evidence for the safety and efficacy of this combination. It would therefore be reasonable to continue to use this strategy in selected cases, at least until other clozapine-refractory treatment strategies become more available in our setting.
Source: South African Journal of Psychiatry 14, pp 136 –140 (2008)More Less
Background. Owing to many complaints by health care workers and patients and a perceived poor standard of care, the mental health care services in North West province were assessed using quantitative and qualitative methods. The Mental Health Care Act of 2002 makes provision for the integration of services into primary health care. Previously, dedicated mental health care co-ordinators were doing the bulk of the management of this category of patients.
Methodology. The qualitative part of the study consisted of free attitude interviews with professional nurses at clinics and focus group interviews with patients, caregivers and mental health care co-ordinators.
Results. There was general satisfaction with the current services. Some dissatisfaction was expressed regarding issues of individualised care versus integration into the general primary care services. Concerns were expressed about resource constraints - in terms of human and physical resources, communication, training, and the role of specialised care.
Conclusion. This study highlights issues around integration of mental health care services into primary care, and has provided information for managers and clinicians to utilise in the improvement of mental health care.