South African Journal of Psychiatry - Volume 17, Issue 4, 2011
Volume 17, Issue 4, 2011
Author Zahir VallySource: South African Journal of Psychiatry 17, pp 98 –102 (2011)More Less
HIV infection is associated with disturbances in brain function referred to as HIV-associated neurocognitive disorders (HAND). This literature review outlines the recently revised diagnostic criteria for the range of HAND from the earliest to the more advanced stages: (i) asymptomatic neurocognitive impairment; (ii) mild neurocognitive disorder; and (iii) HIV-associated dementia. Relevant literature is also reviewed regarding the differential impact upon component cognitive domains known to be affected in HAND, which in turn should ideally be targeted during clinical and neuropsychological assessments: psychomotor and information processing speed, learning and memory, attention and working memory, speech and language, executive functioning and visuospatial functioning. A discussion outlining the neuropsychological tools used in the diagnostic screening of HAND is also included. The central mechanisms of HAND appear to revolve primarily around psychomotor slowing and cognitive control over mental operations, possibly reflecting the influence of disrupted fronto-striatal circuits on distributed neural networks critical to cognitive functions. The accurate assessment and diagnosis of HAND depends on meeting the need for statistically sound neuropsychological assessment techniques that may be used confidently in assessing South African populations, as well as the development of relevant norms for comparison of test performance data.
The Brunel Mood Scale : a South African norm study, South African Journal of Psychiatry, 17 (4) 2011 : pp. 244-54 : erratumAuthor Charles H. Van WijkSource: South African Journal of Psychiatry 17 (2011)More Less
Source: South African Journal of Psychiatry 17, pp 104 –107 (2011)More Less
Objectives. The national Department of Health strongly advocates the strengthening of primary health care systems, and recommendations for appropriate level of care referrals exist. Very few published data on the scope of current ambulatory specialised psychiatric hospital services in South Africa are currently available, making it difficult to assess whether these recommendations are being followed. As a starting point, an audit was conducted to obtain a profile of new non-urgent general adult patients seen at Stikland Hospital with a view to evaluating system needs and demands.
Methods. The folders of 103 consecutively seen patients were selected for retrospective review. Patient demographic, referral and assessment information was entered into a single database. Descriptive statistics were compiled with reference to the above variables using SPSS.
Results. Overall 58.3% of referrals were from the private sector. More than a third (36.7%) of referral letters stated no clear reason for referral and 41.7% no psychiatric diagnosis, and 29.1% of patients were referred without psychotropic medication being started. On assessment 62.1% of patients were found to have a single Axis I diagnosis. Despite virtually no referral letters making any mention of them, substance use disorders (30.1%), personality traits/disorders (35.9%) and co-morbid medical illness (36.7%) were commonly found on assessment.
Conclusions. A significant portion of the patients in our sample could have been managed at primary care level and were referred prematurely. The overall quality of referral letters was poor, and they lacked vital information required for appropriate pre-assessment decision making. Undergraduate training focusing on these skills should be intensified, and consideration should be given to incorporating aspects of our findings into primary health care updates.
Excessive daytime sleepiness, nocturnal sleep duration and psychopathology among Nigerian university studentsSource: South African Journal of Psychiatry 17, pp 108 –111 (2011)More Less
Background and objectives Short nocturnal sleep duration resulting in sleep debt may be a cause of excessive daytime sleepiness (EDS). Severity of depression (psychopathology) has been found to be directly related to EDS. There is an association between sleep duration and mental health, so there may therefore be an interrelationship between sleep duration, EDS and psychopathology. The objectives of this study were to determine the prevalence rates of EDS and general psychopathology among university students in Nigeria; determine the range of and mean sleep duration in the students; and determine the extent to which sleep duration and EDS predict general psychopathology in the same group of subjects.
Materials and methods. Eight hundred and forty-five students at Obafemi Awolowo University, Ile-Ife, Nigeria, were recruited for the study. The subjects were required to provide information on their age, gender and the total amount of sleep per night they usually had. General psychopathology was assessed using the English language version of the 30-item General Health Questionnaire (GHQ-30). They were also evaluated for EDS using the English language version of the Epworth Sleepiness Scale (ESS).
Results. Six hundred and thirty-four subjects (75.03% of the participants) provided complete data. The prevalence of EDS was 11.2% and the rate of general psychopathology in the subjects 13.1%. The range of sleep duration was 2 - 9 hours with a mean of 5.1 hours (standard deviation 1.3). On a regression model with the GHQ score as the dependent variable and sleep duration and ESS as the independent variables, the correlation coefficient between EDS, sleep duration and psychopathology (R) was 0.47.
Conclusion. EDS and psychopathology are common in the student population studied. Nocturnal sleep duration for an average student is far less than that for an average adult. Nocturnal sleep duration and EDS acted as moderate predictors of general psychopathology among Nigerian university students.
Source: South African Journal of Psychiatry 17, pp 112 –117 (2011)More Less
Objective. The objective was to review psychiatric involvement in seven prosecutorial workshops on criminal capacity between 2004 and 2009. The aim was to evaluate the changing role of the psychiatrists in the workshops in order to identify areas in forensic psychiatry where prosecutors have a specific need for training, and to identify more suitable methods of training.
Method. The workshop programmes, copies of presentations, the number of attending prosecutors at each workshop, informal personal notes from the presenters, suggestions from meetings in preparation for workshops and formatted feedback reports were reviewed. Information from a total of seven workshops was reviewed and interpreted by 2 psychiatrists from Weskoppies Hospital Forensic Psychiatry Unit (WHFPU).
Results. The psychiatrists' involvement increased over the years. Problematic topics that were identified include nonpathological criminal incapacity, child psychiatry and the different roles of the psychiatrist and the psychologist in court. Exposure to practical aspects, interactive workshops with case presentations, discussion groups and audience participation seemed to be the preferred method of training. Attitudes of prosecutors towards psychiatry improved with increased knowledge and understanding of the field, and overall the training was rated as relevant and enriching.
Conclusion. Psychiatrists can offer valuable training opportunities to legal professionals about the major mental illnesses and how they can affect criminal capacity, but evaluation of the training should be an ongoing process to address changing needs. Training sessions provide an opportunity for reciprocal sensitisation between the different fields. The ultimate goal is to work towards improved association between the criminal justice and mental health systems.
Excess of non-verbal cases of autism spectrum disorders presenting to orthodox clinical practice in Africa - a trend possibly resulting from late diagnosis and interventionSource: South African Journal of Psychiatry 17, pp 118 –120 (2011)More Less
Objectives. Characteristics of children with autism spectrum disorders (ASDs) in Africa are not known because of unavailability of large-scale epidemiological studies in this region. This review explored the age at first presentation to orthodox clinical practice of African children with ASDs and their expressive language ability at presentation.
Methods. A literature search of case series and case reports of ASDs from Africa was done through PubMed / MEDLINE,Google Scholar, African Journals Online (AJOL), and archives of the Nigerian Journal of Psychiatry. Six articles included content relating to age of the child at first presentation to orthodox clinical practice and symptoms at presentation related to expressive language ability and therefore fulfilled the inclusion criteria. Suggestions are made to explain the observations emanating from the review.
Results. An excess of non-verbal over verbal cases of ASDs have been presenting to orthodox clinical practice and there is a common denominator of late presentation / diagnosis and in turn late intervention, with most cases presenting for the first time well above 8 years of age. Attempts to explain these observations included low levels of knowledge and awareness about ASDs in Africa; problems with help-seeking behaviour; and lack of mental healthcare facilities and trained personnel.
Conclusions. Enhancement of processes directed at ensuring early diagnosis and interventions, especially interventions aimed at improving speech and language development well and sufficiently early, may bring about a shift in the trend of excess non-verbal cases of ASDs over verbal cases presenting to orthodox clinical practice.