South African Journal of Psychiatry - Volume 17, Issue 3, 2011
Volume 17, Issue 3, 2011
Author F.J.W. CalitzSource: South African Journal of Psychiatry 17, pp 66 –72 (2011)More Less
Persons with mental retardation face multiple emotional, cognitive and social challenges. Mental health professionals increasingly agree that individuals with mental disabilities are more vulnerable to sexual abuse and exploitation than the general population. They are particularly exposed to peril because of their often lifelong dependence on caregivers, relatively powerless position in society, emotional and social insecurities, and lack of education regarding sexuality and sexual abuse. Shortcomings and discrepancies in the medical and legal definition of mental retardation make the position of such individuals even more difficult. These shortcomings are discussed in the article.
Source: South African Journal of Psychiatry 17 (2011)More Less
Sexual dissatisfaction and associated factors in a sample of patients on antiretroviral treatment in KwaZulu-Natal, South AfricaAuthor Karl PeltzerSource: South African Journal of Psychiatry 17, pp 74 –80 (2011)More Less
Background. Sexual expression affects physical, mental and social well-being. There is a lack of understanding on sexual dissatisfaction among patients on antiretroviral treatment in Africa.
Methods. Using systematic sampling, HIV-positive patients were selected from outpatient departments from three hospitals before commencing antiretroviral therapy (ART), followed up for 20 months (N=495) and interviewed with a questionnaire.
Results. Rates of self-reported sexual dissatisfaction were high (32.6%), but reduced significantly from before starting ART (56.1%) to 20 months on ART (32.6%) (p=0.006). Sexual dissatisfaction increased among sexually active compared with sexually inactive participants over the 20-month assessment period. In multivariate analysis, not being formally employed (odds ratio (OR) 0.4, 95% confidence interval (CI) 0.2 - 0.9), having had sexual intercourse in the past 3 months (OR 5.8, 95% CI 1.7 - 19.8), taking medications for HIV-related opportunistic infections (OR 2.5, 95% CI 1.1 - 5.7), internalised stigma (OR 1.4, 95% CI 1.2 - 1.6), lack of social support (OR 0.4, 95% CI 0.3 - 0.6) and low depressive symptoms (OR 0.9, 95% CI 0.8 - 1.0) were found to be associated with sexual dissatisfaction.
Conclusions. This prospective study of a large sample of persons on ART showed evidence of reduction of overall sexual dissatisfaction over time and a number of factors influencing sexual dissatisfaction that should be addressed in health care provider interventions.
Source: South African Journal of Psychiatry 17, pp 82 –88 (2011)More Less
Among the many features with which velocardiofacial syndrome (VCFS) may present, we review in this paper the literature on working memory deficits, dysmorphic features, co-morbid obsessive-compulsive disorder, early deviant behaviour, functional impairment, and early age of onset of schizophrenia. These features are considered in a case series of 5 patients, and in addition we report on uncommon features. We highlight the importance of appropriate genetic counselling and need for preventive treatments in the future. Considering that covert symptoms in VCFS may easily be overlooked, we call for clinical vigilance in detecting VCFS among patients suffering from schizophrenia using the Bassett and Chow criteria, because the diagnosis of VCFS is of importance in determining prognosis and providing appropriate genetic counselling.
Detecting child psychiatric disorders during routine clinic work : a pre-interventional study of primary care physicians in Ilorin, NigeriaSource: South African Journal of Psychiatry 17, pp 89 –93 (2011)More Less
Background. Primary care physicians (PCPs) are accessible to most patients and are gatekeepers to specialist care. In our hospital the primary care department is potentially the main source of referral to our recently established child and adolescent psychiatric clinic, which is experiencing low attendance or under-utilisation. We suspected that child mental health problems were being under-detected at the primary level of care and that we needed to intervene.
Objective. To explore the existing level of ability of PCPs in our primary care unit to identify children with mental health problems.
Study setting. The study was carried out in the Paediatric Clinic of the Department of Family Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
Method. A cross-sectional two-stage study in which 350 children aged 7 - 14 years, seen by PCPs in the course of their routine work, were subsequently screened with the parents' version of the Child Behaviour Questionnaire or Rutter Scale A2. Of these, a stratified sub-sample of 157 children, consisting of all the 36 high scorers (score≥7) and 121 low scorers (i.e. about 1 in every 3 low scorers), were selected and interviewed jointly with their mothers using the children's version of the Schedule for Affective Disorders and Schizophrenia (K-SADS) to establish Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnoses.
Results. The PCPs identified 12 of the 157 children (7.6%) as having mental health problems of some sort. The K-SADS identified 40 of the 157 children (22.5%) as having a psychiatric disorder. A comparison of diagnoses by PCPs and the K-SADS shows that 8 of the 12 children diagnosed as having mental health problems were among the 40 identified by the K-SADS, suggesting that PCP had a low diagnostic ability rating of 8/157 (5.1%). The PCPs performed poorly in discriminating between cases and non-cases (p=0.002). Poor school attendance (p=0.001), frequent hospital visits (p=0.009) and longstanding illness (p=0.039) were significantly associated with a child being identified as having a psychiatric disorder.
Conclusion. Because of the apparent poor ability of the PCPs in this study to detect child psychiatric cases, some form of intervention is vitally needed to improve attendance at our child and adolescent psychiatric unit. Use of a guideline or protocol and interactive educational programmes to improve the child mental health literacy of our PCPs are being considered.
Author Ethelwyn Eleonore RebeloSource: South African Journal of Psychiatry 17, pp 94 –96 (2011)More Less
'... [T]he psychological unconscious documented by latter-day scientific psychology is quite different from what Sigmund Freud and his psychoanalytic colleagues had in mind in fin de siècle Vienna. Their unconscious was hot and wet; it seethed with lust and anger; it was hallucinatory, primitive, and irrational. The unconscious of contemporary psychology is kinder and gentler than that and more reality bound and rational, even if it is entirely cold and dry.'
Kihlstrom, Barnhardt and Tataryn (p. 789), quoted in Talvitie (p. 2)
It was this 'hot and wet' perception of Freud's notion of the unconscious that first attracted me to psychoanalysis. However, the question regarding whether, when neuroscientists speak of unconscious processing, they are speaking in the same terms as psychoanalysts or not, has become of increasing interest to me. It was, therefore, my sense that Talvitie's work served as something of a bridge between the two paradigms that drew me to it.