South African Journal of Psychiatry - Volume 15, Issue 3, 2009
Volume 15, Issue 3, 2009
Limited access to an individual's mental content - a constraint on the strength of our knowledge in the courts : editorialAuthor Werdie Van StadenSource: South African Journal of Psychiatry 15 (2009)More Less
Access to an individual's mental content is dependent on its disclosure by that individual. Such disclosure may be direct, i.e. described by the individual, or indirectly disclosed through other ways of communication (gestures, etc.). In addition, we may be able to deduce indications that would support or refute particular mental content from the individual's behaviour. If mental content is not disclosed, we mental health workers are left with mere indications of an individual's mental content (in his or her suggestive behaviour, for example). Even when such indications are very strong, they remain mere indications.
Suicide risk in schizophrenia - a follow-up study after 20 years : part 1 : outcome and associated social factorsSource: South African Journal of Psychiatry 15, pp 56 –62 (2009)More Less
Objective. This study re-evaluated, after a period of 20 years, a cohort of patients with schizophrenia who had been considered to be at high risk for suicide. The outcome and social factors associated with their suicide risk were investigated over the two decades.
Method. Subjects were contacted and interviewed face to face using a questionnaire devised for this purpose. The Beck Hopelessness Scale (BHS) was administered and ratings were compared with those from the original study. The Calgary Depression Scale for Schizophrenia (CDSS) was administered. Cross-tabulations were performed to identify factors associated with increased suicide risk. A psychological autopsy was performed for those subjects who had committed suicide since the original study.
Results. Fourteen of the original 33 high-suicide-risk schizophrenia patients were traced. Three subjects had committed suicide during the 20-year period. Among the living subjects, risks for suicide were found to be lower than those 20 years earlier. Male gender, poor social support, early age of illness onset, current admission to or recent discharge from hospital, and a higher level of education were all factors associated with increased suicide risk.
Conclusion. Demographic factors and those related to illness course found to be associated with suicide risk in patients with schizophrenia in this study are in accord with those reported in the literature.
Author K. SukeriSource: South African Journal of Psychiatry 15, pp 63 –66 (2009)More Less
Background. Parasuicide is a serious public health concern. Understanding the methods used will help in developing preventive strategies.
Objective. To investigate the agent(s) used in parasuicide attempts by individuals aged 10 - 20 years in Buffalo City (which includes the municipalities of East London, King William's Town and Bhisho in the Eastern Cape).
Method. All referrals for parasuicide to the East London Mental Health Unit, the only mental health facility servicing Buffalo City, for the period January 2006 to December 2008 were analysed with regard to age, agent(s), number of attempts and psychiatric disorder.
Results. Of 1 169 patients referred after parasuicide by ingestion of substances, 360 (31%) were between the ages of 10 and 20 years. Eighty-three per cent were female and 17% male. Cattle dip was the commonest agent used, followed by amitriptyline.
Conclusion. The study showed that organophosphates were the commonest agent used in parasuicide in Buffalo City and that the incidence of parasuicide was higher in females than in males.
Routine pre-admission screening for a medical illness in aggressive patients who required sedation in the emergency department - necessary or not?Author S. SaloojeeSource: South African Journal of Psychiatry 15, pp 67 –71 (2009)More Less
Objectives. To determine the need for routine screening for exclusion of a medical illness causing or contributing to the aggression in aggressive patients who required sedation in the emergency department (ED). The value of the individual components of the screening process was also investigated.
Methods. The charts of 339 aggressive patients who presented at two general hospital EDs in Durban from January to December 2006 were retrospectively reviewed. Charts were analysed and the results of a screening protocol consisting of a psychiatric history, a physical examination and laboratory investigations were recorded on sheets designed for the study.
Results. The prevalence of a causal/contributory medical illness was 24.2%. Six patients (1.76%) with missed medical illnesses were inappropriately admitted to the psychiatric ward. The variables that emerged as significantly associated with a causal/contributory medical illness were an abnormal physical examination (odds ratio (OR) 42.151, 95% confidence interval (CI) 4.36 - 406, p<0 .001), an abnormal full blood count (OR 2.363, 95% CI 1.08 - 5.13, p<0.03), and abnormal urea and electrolyte levels (OR 3.531 (95% CI 1.3 - 9.55, p<0.01). These had sensitivities of 63%, 57% and 40%, respectively, for the identification of a medical illness causing or contributing to the aggression. The sensitivity of the past psychiatric history was 28% and that of the random blood glucose level was 21%.
Conclusion. The prevalence of a causal/contributory medical illness in this study was significant and supports the need for routine screening. Abnormal findings on physical examination were the most sensitive component of the screening protocol and were strongly associated with a medical cause of aggression.
Source: South African Journal of Psychiatry 15, pp 72 –75 (2009)More Less
Restraints are usually used for the protection of patients and others when medication and verbal therapies are insufficient to control potentially violent patients. Many fear the abuse of restraints as well as their psychological, physical and emotional consequences.
In South Africa, according to the Mental Health Care Act No. 17 of 2002, the use of restraints is permissible but subject to certain regulations. Restraint may not be used any longer than is necessary to prevent serious bodily harm to the patient or others. When restraint has the desired effect of settling the patient's behaviour to the point where control is regained, its further imposition is illegal.
Restraints may be classified into three main categories: (i) environmental restraints; (ii) physical restraints; and (iii) chemical restraints. There is much debate over what types of restraint are superior. There may be differences in cost, risk of serious staff injury, requirements of staff time for monitoring and implementation, and impacts on staff and patient attitudes.
It is hoped that the use of environmental and physical restraint will be rendered obsolete by advances in the field of psychiatry such psychopharmacology and the therapeutic milieu. In order to reach this goal more research needs to be done on restraint practices across a wide range of psychiatric treatment settings.