South African Journal of Psychiatry - Volume 16, Issue 1, March 2010

In helping people, psychiatrists and other mental health workers are often struck by how stuck patients are in their difficulties and their past - without hope for the future and / or unable to take up purpose. I notice that, in similar ways, some of our fellow-South Africans are stuck in the socio-political past, whereas so much of recovery is about embracing and chasing a future with most of one's time and efforts.

Objective. The aim of this secondary analysis of the South African National HIV Prevalence, Incidence, Behaviour and Communication (SABSSM) 2008 survey is to provide current data on illicit drug use that could assist in the development and implementation of effective substance abuse policies and intervention programmes aimed at these populations in South Africa.

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Method. A multistage random population sample of 15 828 people age ≥15 (56.3% women) was included in the survey. Illicit drug use was assessed by 2 sections of the Alcohol, Smoking and Substance use Involvement Screening Test (ASSIST). Frequency analyses for different age groups, geolocality, educational level, income, and population group were calculated, as were odds ratios for these variables regarding combined illicit drug use.

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Results. Current cannabis use was reported by 3.3% of the population sample - 6.1% of the men and 1.2% of the women - and the use of combined all-other illicit drugs (cocaine, amphetamines, inhalants, sedatives, hallucinogens, opiates) was reported by 1.8% of the participants. Coloured men (14.3%) were most likely, and Indian or Asian women (0.6%) least likely, to be cannabis users. Illicit drug use (combined) among men was associated with the 20 - 34-year age group and the coloured and white population groups, and among women in the younger age groups, the coloured and white population groups, and low and higher income.

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Conclusion. An increase of cannabis and other illicit drug prevalence rates was observed from 2005 (2.1%) to 2008 (3.3%) in the population sample. Multilevel interventions are required to target illicit drug users, in addition to creating awareness in the general population of the problems associated with illicit drug use. There is a need to address illicit drug use in national and provincial policy planning and intervention efforts and, in terms of treatment, a need to ensure that treatment practitioners are adequately trained to address illicit drug use. Future prospective studies are necessary to assess the impact of illicit drug use.

The recent progress in telepsychiatry results from advancing technology and videoconferencing as an effective alternative to classic face-to-face psychiatric interaction, in terms of both results and cost-effectiveness. The wide range of applications of telepsychiatry is outlined - in particular, emergency, forensic, prison and adolescent psychiatry. Attitudes of patients and the providers of psychiatric services are discussed, and a short account is given of the place of tele-education in psychiatric teaching. The advantages of telepsychiatry are outlined and its limitations are discussed. Lastly,the limited experience and relevance of telepsychiatry in South Africa (and hence for other developing countries) are presented. The conclusion is that telepsychiatry is wellestablished, its successes documented, and that it should be applied in planning future public health services in South Africa.

Objective. This study aimed to identify the socio-demographic characteristics, pattern of psychiatric disorders and management of children and adolescents before the setting up of a dedicated child and adolescent unit at the University of Ilorin Teaching Hospital, Ilorin, Nigeria.

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Method. A retrospective study, carried out at the Department of Behavioural Sciences of the hospital.

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Results. The age range of the 94 children seen was 7 - 19 years, with a mean of 16.38 years (standard deviation 2.49); 82% were aged 14 - 19 years and 17% 7 - 13 years, while only 1 child was under 7 years old. The majority of the children lived with their parents in monogamous families with 5 or more children. The majority of the parents were educated and gainfully employed. The major diagnoses were schizophrenia (50%), delirium (15%) and seizure disorders (9%). Of the patients 64% were managed as outpatients and 36% as inpatients. Drug therapy was involved in the majority of cases, and the most frequently prescribed medication was haloperidol, atypical antipsychotics such as risperidone being used in only 8% of cases. Most of the patients were referred from the primary care-associated departments of the hospital, i.e. the general outpatient department (40%) and the internal medicine and paediatrics departments (29%). Referrals from welfare, judicial and educational institutions were uncommon (3%).

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Conclusion. The pattern of patient presentation and management had not changed to any great extent over the past two decades. The introduction of a child and adolescent psychiatric unit is expected to improve consultation/liaison psychiatry and also child psychiatric service delivery and research. Understanding of the prevalence and pattern of presentation of mental disorders and their management is also expected to help improve the strategic planning and organisation of the new clinic.

Background. The few studies on child abuse in Nigeria have focused on the child victims. However, little is known about characteristics of the parents who are the perpetrators of this abuse.

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Aim. To assess the opinions and attitudes of parents concerning child abuse and neglect, and the factors associated with the practice of child abuse.

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Method. We interviewed 260 randomly selected parents in the city of Ilorin, Nigeria, using a questionnaire to ascertain socio-demographic data and details about the understanding and practice of various forms of child abuse such as hawking, child labour, physical beating, sending children to work as house-helps, and sexual abuse.

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Results. Sixty per cent of the subjects were women, and 72.7% were less than 40 years old; 30.4% sent their children to hawk goods, 34.2% believed that a child must work before receiving food, 10.4% had sent or would send their children to work as house-helps, and 52.3% discipline their children by physical beating. Older age (40 years and over), being unmarried, being unemployed, having 3 or more children, and a low level of education were significantly associated with the tendency to abuse children.

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Conclusion. Child abuse is still practised in Ilorin, Nigeria. Socio-economic factors associated with child abuse were identified. We recommend that government should assist citizens financially and support programmes that educate parents about the dangers of child abuse.