South African Journal of Psychiatry - Volume 17, Issue 1, 2011
Volume 17, Issue 1, 2011
Source: South African Journal of Psychiatry 17, pp 3 –8 (2011)More Less
Fear perception and subsequent appropriate behavioural response are crucial for the adaptation of species. During the past few decades functional neuro-imaging studies in humans exploring the neural basis of fear have contributed significantly to the understanding of its mechanisms. Imaging studies help to clarify the role of the amygdala-based neurocircuitry in fear activation. The aim of this paper is briefly to review the most recent functional neuro-imaging studies on fear perception, modulation and learning. Important knowledge has been acquired about the factors that set fear in motion, including the role of nonconscious processes and how fear drives attention. A subcortical network interacts with the prefrontal cortex to modulate emotional responses that allow better coping with environmental and social demands. Fear learning reduces the need to relearn about dangerous stimuli. Flexible processes allow fear behaviour to be readjusted when circumstances change. Future improvement of functional and other neuro-imaging techniques may better clarify the role of the neurocircuitry involved in fear perception, learning and modulation.
Revisiting validity in cross-cultural psychometric test development : a systems-informed shift towards qualitative research designsSource: South African Journal of Psychiatry 17, pp 10 –15 (2011)More Less
The validity of clinical psychological tests remains a challenging issue, especially when the tests are applied in cultural groups other than those for which they were originally developed. Before the appearance of the International Test Commission (ITC) Guidelines, the commonly used cross-cultural test adaptation approaches often neglected intergroup differences in cultural values and jeopardised construct validity. The ITC Guidelines on adapting tests have shaped and streamlined current clinical cross-cultural test adaptation practice by promoting the equivalence of constructs and the elimination of bias. However, the emphasis appears to have remained on quantitative methods and the meaning behind the concepts is often still neglected. The culturally complex South African context has yielded commendable examples of clinical cross-cultural psychometric test development, but there has not been sufficient progress.
In this paper we explore the potential benefits of applying systemic thinking in the field of clinical cross-cultural psychometric test development. We apply systemic concepts - viz. circularity, relationality, neutrality, and a concern with process issues - to suggest that qualitative research designs might be used more frequently. Multidisciplinary, multicultural test-developing teams that include members of the target cultural group could consult and collaborate with the target groups before embarking on test-adaptation or test-development activities. Teamwork would help to ensure that the meaning of the relevant concept or concepts is captured in a valid way for each cultural group. The emphasis might be on building theory and generating hypotheses, in order to pursue a deeper understanding of the constructs under investigation. Further exploration and application of the suggested procedures could form a focus for future research.
The demographic, clinical and forensic profile of offenders diagnosed with epilepsy referred to the Free State Psychiatric Complex Observation Unit in terms of section 77 and/or 78 of the Criminal Procedure Act 51 of 1977Source: South African Journal of Psychiatry 17, pp 16 –22 (2011)More Less
Limited information regarding the relationship between psychopathology associated with epilepsy, crime and the legal aspects thereof is available in South Africa.
Objectives. The demographic, clinical and forensic profile of alleged offenders diagnosed with epilepsy and referred to the Free State Psychiatric Complex Observation Unit from 2001 to 2006 was investigated.
Design. A retrospective cross-sectional study was conducted.
Results. Of the 69 alleged offenders aged 17 - 79 years (median 30 years), 94.2% were male, 81.2% black, 72.5% single and 69.9% unemployed. The median level of education was grade 6. Offences were violent in nature and committed against a person in 75% of cases. There was a direct link between epilepsy and the alleged offences in 7% of cases. Generalised epilepsy (34.8%) and interictal psychosis (20.3%) were the most commonly diagnosed conditions. Twenty-nine alleged offenders (42%) lacked criminal responsibility and were not fit to stand trial. Most observati (79.2%) diagnosed with generalised epilepsy were criminally liable and fit to stand trial. The highest rate of criminal incapacity was found among observati with interictal psychoses (85.7%) and co-morbid mental retardation (90%). Almost 60% of referred cases were declared as state patients by the court.
Conclusion. In only 16% of cases, observati were found unaccountable because of epilepsy (automatisms) or postictal confusional states. Our findings confirmed an increased prevalence of violent behaviour during seizure-free periods. This contributes to the evidence that factors associated with epilepsy, rather than epilepsy itself, play an important role in the possible increased risk of violent behaviour in people with epilepsy.
Prevalence of attention-deficit/hyperactivity disorder (ADHD) symptomatology and psychiatric co-morbidity among adolescents diagnosed with ADHD in childhoodSource: South African Journal of Psychiatry 17, pp 24 –28 (2011)More Less
Objectives. Given the paucity of research on adolescent attention-deficit/hyperactivity disorder (ADHD), this study aimed to establish the prevalence of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) ADHD in a cohort of South African adolescents who had been diagnosed with the disorder in childhood. It also aimed to establish the prevalence of psychiatric co-morbidities and adjustment difficulties in this sample.
Method. Data regarding age of diagnosis, current ADHD status, current ADHD-related pharmacological management, current psychopathology and current adjustment were gathered from 64 adolescents and their guardians via self-report questionnaire. Descriptive statistics were calculated with regard to current ADHD status, co-morbid psychopathology and adjustment difficulties, as well as current ADHD-related medication.
Results. According to parent reports, 59.38% of the sample met DSM-IV criteria for ADHD Inattentive subtype, while 37.50% met the criteria for ADHD Hyperactive/Impulsive subtype. Of the adolescents, 64.06% were still using stimulant medication. Based on the adolescent self-report, 43.75% of the sample had clinically significant symptoms of psychopathology or maladjustment. Furthermore, 39.28% met the diagnostic criteria for at least one psychiatric co-morbidity.
Conclusion. ADHD persisted into adolescence in the current sample. A significant psychopathological and maladjustment load appears evident among adolescents previously diagnosed with ADHD, despite continuous pharmacological management of the condition.
Source: South African Journal of Psychiatry 17, pp 29 –31 (2011)More Less
We report on a young adolescent diagnosed with early-onset schizophrenia and subsequently treated with clozapine. Clozapine is often used as the last line of treatment for patients with schizophrenia, even in the paediatric population. This report highlights the usefulness and challenges of using clozapine in adolescents with schizophrenia.
Author Ulla BothaSource: South African Journal of Psychiatry 17 (2011)More Less
To the Editor: I read the editorial entitled 'Community rehabilitation for schizophrenia patients: Is it feasible in South Africa?' with interest, but was very surprised to see that no mention was made of the Assertive Community Treatment Programme that has been running in the Western Cape since 2007.