South African Journal of Psychiatry - Volume 16, Issue 4, 2010
Volume 16, Issue 4, 2010
Author Sean BaumannSource: South African Journal of Psychiatry 16, pp 114 –116 (2010)More Less
An adequate understanding of the phenomena of the psychoses remains elusive. This might seem a rather perplexing observation given strenuous research endeavours and a wealth of scientific information, particularly in recent years in the domains of molecular biology and neuro-imaging. A wide range of factors may be held to account for these limitations, one being that the brain is the most complex thing in the known universe, and should not be expected to yield its workings in much the same way as broken bones. Another is the enduring and profoundly mysterious gulf between observable neurobiological events and, for example, the experience of having thoughts inserted into one's brain, an enigma as much for philosophers as for psychiatrists. Related to this is a problem that some might regard as among the most significant achievements of modern psychiatry, the ICD and DSM diagnostic systems.
The regulation of informed consent to participation in clinical research by mentally ill persons in South Africa : an overviewAuthor A. NienaberSource: South African Journal of Psychiatry 16, pp 118 –124 (2010)More Less
The article examines the legal requirements relating to the informed consent of mentally ill persons to participation in clinical research in South Africa. First, the juridical basis of informed consent in South African law is outlined; and second, the requirements for lawful consent developed in South African common law and case law are presented. Finally, the article deliberates upon the requirements for the participation of mentally ill persons in research as laid down by the Mental Health Care Act and its regulations, the National Health Act and its (draft) regulations, and the South African Constitution.
A review of the applications for involuntary admissions made to the Mental Health Review Boards by institutions in Gauteng in 2008Source: South African Journal of Psychiatry 16, pp 125 –130 (2010)More Less
Aim. To review applications for involuntary admissions made to the Mental Health Review Boards (MHRBs) by institutions in Gauteng.
Method. A retrospective review of the register / database of the two review boards in Gauteng for the period January - December 2008. All applications for admissions (involuntary and assisted inpatient) and outpatient care (involuntary and assisted), and periodic reports for continued care (inpatient or outpatient care) were included.
Results. During the study period the two MHRBs received a total of 3 803 applications for inpatient care, of which 2 526 were for assisted inpatient care (48.1% regional hospitals, 29.6% specialised psychiatric hospitals, 22.2% tertiary academic hospitals). Of the applications for involuntary inpatient care, 73.1% were from the specialised psychiatric hospitals (65.2% from Sterkfontein Hospital). Applications for outpatient care, treatment and rehabilitation (CTR) numbered 1 226 (92% assisted outpatient CTR). Although the health establishments in northern Gauteng applied for more outpatient CTR compared with those in southern Gauteng (879 v. 347, respectively), the ratios of assisted to involuntary outpatient applications for CTR for each region were similar (approximately 12:1 and 9:1, respectively). The boards received 3 805 periodic reports for prolonged CTR (93.5% inpatient, 6.5% outpatient) in the majority of cases for assisted CTR.
Conclusion. The study suggests that in the 4 years since the promulgation of the Mental Health Care Act (MHCA) in 2004, there have been significant strides towards implementation of the procedures relating to involuntary admission and CTR by all stakeholders. Differences in levels of implementation by the various stakeholders may result from differences in knowledge, perceptions, attitudes and understanding of their roles and therefore indicate the need for education of mental health care professionals and the public on a massive scale. The Department of Health also needs to invest more funds to improve mental health human resources and infrastructure at all health establishments.
Author B.H. VogelzangSource: South African Journal of Psychiatry 16, pp 131 –137 (2010)More Less
Background. Cannabis has been a topic of political and medical controversy in many countries over the past century. Although many publications on this topic are available, there is currently no comprehensive evaluation of global research activities in the field.
Objective. This study was conducted in order to provide a quantitative and qualitative analysis of the worldwide research output on cannabis. Methods. In a quantitative approach, items concerning cannabis published between 1900 and 2008 were retrieved from the ISI Web of Science databases developed by the Thompson Institute of Scientific Information and analysed using scientometric methods. In a second step, research fields of growing interest were identified.
Results. We found that publications on this topic increased during the late 1960s, as well as during the period 1990 - 2008. We noted that South Africa was one of the countries with a high research output, having published numerous articles on cannabis. A comparison of cannabis with other drugs (e.g. alcohol, tobacco, cocaine and heroin) showed that in relation to the proportion of respective drug users, cocaine and heroin are overly represented in terms of research output. When analysing the main subjects of the publications, psychiatry was prominent, especially with regard to research on psychosis.
Conclusion. There is increasing interest in research on cannabis. The research only partially reflects the drug's importance with regard to number of users.
Religious beliefs, coping skills and responsibility to family as factors protecting against deliberate self-harmSource: South African Journal of Psychiatry 16, pp 138 –146 (2010)More Less
Background. Deliberate self-harm (DSH) ranges from behaviours aiming to communicate distress or relieve tension, but where suicide is not intended, to suicide. Not all individuals are prone to DSH, which suggests that there are factors that protect against it. Identifying these could play an important role in the management and prevention of DSH.
Objectives. This study examined whether religious beliefs, coping skills and responsibility to family serve as factors protecting against DSH in Kota Kinabalu, Sabah, Malaysia.
Method. A cross-sectional comparative study assessed DSH patients consecutively admitted or directly referred to Queen Elizabeth General Hospital and Hospital Mesra Bukit Padang during the period December 2006 - April 2007. DSH patients (N=42) were matched with controls (N=42) for gender, age, religion, race, occupation and marital status. The DSH and control groups were compared using psychosocial tests that assess coping skills, religious beliefs and responsibility to family.
Results. There were significant differences in religious beliefs (p=0.01) and responsibility to family (p=0.03) between the DSH patients and the control group. There were also significant differences in coping skills, DSH patients tending to use emotion-orientated coping (p=0.01) as opposed to task and avoidance-orientated coping. Conclusion. Consistent with international studies, coping skills (i.e. task-orientated skills), religious beliefs and responsibility to family were more evident in patients who did not attempt DSH than in those who did. These findings imply that treating DSH should not start only at the point of contact. Protective factors such as religious beliefs, responsibility to family and coping strategies can be inculcated from a very young age. However, caution is required in generalising the results owing to limitations of the study. Further extensive research on religious and psychotherapeutic interventions and prospective studies on protective factors will be helpful.
Author N.C. AghukwaSource: South African Journal of Psychiatry 16, pp 147 –152 (2010)More Less
Background. This study determined and compared responses of 5th- and 6th (final)-year medical students on their attitudes to psychiatry as a profession. Also elicited were their choices of area of future medical specialisation.
Method. A prospective and cross-sectional study using an adapted 27-item self-administered questionnaire to obtain responses from 91 5th- and 6th-year medical students atBayero University, Kano, Nigeria.
Results. More than 60% of the students' first choices for future specialisation were surgery, obstetrics/gynaecology or internal medicine. Psychiatry was the first preference for less than 2%. More than 75% of the students' views on the overall merits and efficacy of psychiatry were positive, although they felt that psychiatry had low prestige and status as a profession. In addition, the same proportion considered that psychiatry was scientific, making advances in the treatment of major mental disorders, and helpful in liaison practice. More than 50% stated that psychiatry would not be their choice of last resort for residency education and the same proportion felt that friends and fellow students rather than family members would discourage them from specialising in psychiatry. More than 50% would feel uncomfortable with mentally ill patients, felt that psychiatry would not be financially rewarding, and did not think that psychiatrists abuse their legal power to hospitalise patients.
Attitudes of the two groups of students to psychiatry as a profession were not significantly different (p>0.05).
Conclusion. A clinical clerkship in psychiatry did not influence the students' choice of future specialisation.