South African Journal of Psychiatry - Volume 15, Issue 1, 2009
Volume 15, Issue 1, 2009
Author Sean Z. KaliskiSource: South African Journal of Psychiatry 15, pp 4 –6 (2009)More Less
The recent history of our non-pathological incapacity defence, in which strange terms such as emotional storm', 'catathymic crisis' and 'disintegrated ego' (inter alia) have been used to explain why an accused was not responsible for killing an intimate, remains as a testament to these unscientific musings. In every case, the real explanation was that the accused was just very very angry. The Court of Appeal eventually ruled in S v. Eadie (2) 2001 (1) SACR 185 that, for this defence to succeed, there has to be objective evidence (primarily by the nature of the accused's actions) that he had acted in a state of automatism.
Source: South African Journal of Psychiatry 15, pp 8 –12 (2009)More Less
Objective. Worldwide, cannabis is the most widely used illicit substance, and it has been identified as a correlate in schizophrenia samples for poorer symptomatic and functional outcomes in many international studies. The object of this retrospective study was to identify the prevalence of cannabis use / abuse and the demographic and clinical correlates therefor in a large homogeneous South African schizophrenia population.
Methods. As part of a large genetic study, 547 subjects with a diagnosis of schizophrenia were recruited. Demographic and clinical data were collected and each participant underwent a urinary drug screen. Use / abuse of cannabis was defined as using cannabis more than 21 times in a single year. Subjects with and without cannabis use / abuse were statistically compared.
Results. Significant differences between the two groups were found in terms of gender, marital status, age of onset of schizophrenia, number of hospitalisations and relapses, alcohol abuse, smoking, the Scale for the Assessment of Positive Symptoms (SAPS) scores for hallucinations, delusions, bizarre behaviour and formal thought disorder, and the Scale for the Assessment of Negative Symptoms (SANS) score for avolition / apathy.
Conclusion. The prevalence of cannabis use/abuse in this study was high, and our findings were comparable with those of previous international studies. Abuse / use started mainly in the teenage years, was more prevalent among males than females, and was associated with negative overall outcomes.There was also a positive correlation between cannabis and nicotine and alcohol use / abuse. Determination of cannabis abuse based solely on history was found to be reliable, and urine cannabis testing appeared to be of limited value in routine management of this group of schizophrenic patients.
University of the Free State medical students' view of at-risk drinking behaviour and psychoactive substance useSource: South African Journal of Psychiatry 15, pp 13 –18 (2009)More Less
Objectives. To investigate undergraduate medical students' knowledge of at-risk drinking behaviour and their own patterns of alcohol intake. The use of non-alcoholic psychoactive substances was also investigated.
Design. A cross-sectional study design was used. Participants completed a self-administered anonymous questionnaire designed using the US Department of Health and Human Services guidelines for identifying at-risk drinking.
Setting. The School of Medicine, University of the Free State, Bloemfontein.
Subjects. Participants included first-, fourth- and fifth-year medical students enrolled in 2006.
Results. Of 408 questionnaires, 371 (90.9%) were returned. Of students who repeated an academic year, 10% ascribed it to substance use. The majority of students conservatively estimated the maximum daily and weekly safe levels of alcohol consumption for both men and women as notably lower than set by the guidelines. Nevertheless, 32% of students admitted to alcohol intake exceeding these limits, and 55.3% were identified as at-risk drinkers. Marijuana was the most common non-alcoholic substance used by medical students (14.6%) in the preceding 3 years. Alcohol and other substances were most frequently used during social activities with friends.
Conclusions. Both medical students' knowledge of levels of alcohol intake associated with increased risks and their own drinking patterns could potentially influence their approach to patients with alcohol-related problems. Education regarding at-risk drinking behaviour therefore needs to be addressed.
Source: South African Journal of Psychiatry 15, pp 19 –22 (2009)More Less
Aim. To determine the health-seeking behaviour of mentally ill patients in Enugu, Nigeria.
Design. A consecutive recruitment of 397 patients receiving treatment at the neuropsychiatric hospital in Enugu was done. Using a structured questionnaire, information was obtained from the respondents including their socio-demographic characteristics, their knowledge of the cause of their mental illness, and the treatment that they first employed, with their reasons for doing so.
Results. The age range of the respondents was 15 - 75, with a mean of 31.6 years (SD±11 years). Two hundred and twenty-three (56.2%) respondents were male and 174 (43.8%) were female. Treatment options first employed by respondents were prayer houses (34.5%), followed by psychiatric hospital (32%). The main reasons for the treatment options employed were confidence of cure at the place of treatment (46.3%), ignorance of the existence of a mental health service (14.6%), and the belief that the mental condition was not amenable to orthodox treatment (8.1%). Patients' perceptions of the cause of their ailment most commonly revealed a belief in demonic and spiritual forces. Gender, educational status, attributing of the mental illness to a rational cause, and living in an urban area were significantly associated with the employment of specialist care as the first treatment option.
Conclusion. Misconceptions regarding the cause of mental illness still abound among mentally ill patients in Nigeria. Consequently, psychiatric consultation is not usually initially employed, especially in rural areas. Community health education aimed at changing misconceptions, and the integration of mental health services into primary health care services, is advocated.
Author L. AsmalSource: South African Journal of Psychiatry 15, pp 23 –24 (2009)More Less
Antipsychotic-induced tardive dyskinesia is a potentially irremediable and debilitating condition with the onset most commonly associated with the use of first-generation antipsychotics. The development of tardive dyskinesia on clozapine, a second-generation antipsychotic, is uncommon, and the drug is therefore a treatment option for those patients who develop the syndrome following treatment with first-generation agents. I report on the case of a 27-year-old man who developed severe tardive dyskinesia following initiation of clozapine treatment. To the best of my knowledge, this is the first case of tardive dyskinesia associated with clozapine use reported in South Africa.