South African Journal of Psychiatry - Volume 15, Issue 4, 2009
Volume 15, Issue 4, 2009
Source: South African Journal of Psychiatry 15 (2009)More Less
The editorial team of the South African Journal of Psychiatry is delighted to report that the editor of this journal, Professor Werdie van Staden, has recently been appointed as Professor of Philosophy & Psychiatry, heading the new Division of Philosophy and Ethics of Mental Health at the University of Pretoria.
Suicide risk in schizophrenia - a follow-up study after 20 years
Part 2 : symptomatology and pharmacotherapySource: South African Journal of Psychiatry 15, pp 79 –85 (2009)More Less
Objective. This study followed up, after a period of 20 years, a group of patients with schizophrenia who were considered to be at high risk for suicide. In Part 1 we reported on outcome and associated social factors, and in this paper we discuss re-evaluated suicide risk in these patients and investigate symptomatology and pharmacotherapy over the past two decades.
Method. The subjects were interviewed and a questionnaire evaluating suicide risk was completed. 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 also administered. Cross-tabulations were then performed to identify factors associated with increased suicide risk. For those subjects who had committed suicide since the original study, a psychological autopsy was performed.
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 ago. Hopelessness and depressive symptoms correlated with independently evaluated suicide risk. Social withdrawal, blunting of affect and delusions were also associated with elevated risk. Good insight into illness and a history of previous suicide attempts coincided with high suicide risk. Cannabis abuse and poor or periodic adherence to treatment, as well as weight gain, akathisia and parkinsonian adverse effects, were also associated with an increase in risk of suicide. Formal thought disorder, avolition and cognitive impairment were associated with a lower risk of suicide.
Conclusion. Hopelessness, depression, certain positive symptoms and adverse effects of medication found to be associated with suicide risk in patients with schizophrenia in this study are in accord with those reported in the literature. Despite current knowledge about this subject, suicide remains notoriously and ominously unpredictable in patients with schizophrenia.
Adolescent-onset psychosis : a 2-year retrospective study of adolescents admitted to a general psychiatric unitSource: South African Journal of Psychiatry 15, pp 86 –92 (2009)More Less
Background. KwaZulu-Natal had no dedicated inpatient adolescent psychiatric service during the study period, and adolescents were admitted to general psychiatric wards.
Aim of study. This is a descriptive review of adolescents with psychotic symptoms admitted to a psychiatric hospital. It aims to describe their demographic profile, associated risk factors and clinical profile, and management strategies utilised.
Method. The files of all adolescent patients, aged 12 - 18 years, admitted to a psychiatric hospital with psychotic symptoms from July 2005 to June 2007 were reviewed.
Results. Seventy adolescents with psychosis were admitted to adult psychiatric wards over the 2-year period. The age range was 13 - 18 years. Of the patients 80.0% were male, 37.1% reported a positive family history of mental illness, 50.0% smoked nicotine and 61.4% reported cannabis use. The most common diagnoses were schizophrenia (30.0%) and schizophreniform disorder (27.1%). Sixty (85.7%) of the patients had a trial on a first-generation antipsychotic and 10 (15.5%) were initiated on a second-generation antipsychotic de novo. The average length of stay in hospital was 27.8 days. Of the patients, 40% defaulted follow-up after discharge.
Conclusions. Schizophrenia was the most common diagnosis. There were high rates of cannabis use. The adolescents were managed in general psychiatric wards. The majority of patients had a trial on first-generation antipsychotics. There was a high rate of defaulting the first outpatient appointment. There is a need to develop specialised inpatient adolescent psychiatric facilities and services, as well as to address comorbid substance use and non-adherence to treatment.
Source: South African Journal of Psychiatry 15, pp 93 –96 (2009)More Less
Objective. Depressive symptoms are prevalent, underrecognised and clinically important in patients suffering from schizophrenia. Depressive symptoms in schizophrenia patients are associated with distinct morbidity and mortality. The objective of this study was to investigate the prevalence of depressive symptoms in a subgroup of chronic schizophrenia, Kraepelinian schizophrenia, and the association with severity of illness. Kraepelinian schizophrenia is characterised by a chronic, unremitting, severe course of illness and severe deterioration of functioning in social, work and self-care domains.
Method. The Calgary Depression Scale for Schizophrenia (CDSS) and the Clinical Global Impression Severity (CGI-S) scale were administered to 113 patients who fulfilled the criteria of Kraepelinian schizophrenia.
Results. Sixty-eight males and 45 females participated in the study. Of this group, 17.7% scored 5 or more on the CDSS. The CGI-S scores indicated that almost half of the patients were moderately ill (i.e. a score of 4 on the CGI-S scale). Of the patients, 94 were receiving first-generation antipsychotic medication and 19 second-generation antipsychotic medication. Thirteen patients were also receiving antidepressant medication.
Conclusion. The findings of this study are consistent with current reports in the literature that depressive symptoms are not common in Kraepelinian schizophrenia, even though patients are moderately to severely ill in both symptom and functional domains.
Source: South African Journal of Psychiatry 15, pp 97 –100 (2009)More Less
Background. Sleep paralysis in the absence of narcolepsy is common. Individuals experience episodes of profound muscular paralysis on waking from sleep in the morning or during the night. These episodes are disturbing, especially because they often involve feeling unable to breathe deeply or voluntarily. Previous studies have suggested an association between isolated sleep paralysis (ISP) and adverse psychosocial situations. This study examines an association between ISP and anxiety in orthopaedic patients suffering from physical injuries, patients with multiple somatic complaints (suffering from psychological disorders), and healthy controls.
Methods. Healthy individuals, orthopaedic patients and patients with multiple somatic complaints were asked to fill out a survey that determined the 3-month prevalence of ISP. Anxiety was scored on the Hamilton Anxiety Rating Scale (HARS).
Results. ISP was reported by 28% of the healthy subjects, 44% of the orthopaedic patients and 56% of the patients with multiple somatic complaints. The degree of anxiety among the orthopaedic patients was significantly higher than that in the healthy subjects and significantly lower than that reported by the patients with multiple somatic complaints.
Conclusion. This study suggests that although ISP occurs in healthy individuals, it is more common in association with