South African Journal of Psychiatry - Volume 19, Issue 1, 2013
Volume 19, Issue 1, 2013
Source: South African Journal of Psychiatry 19, pp 2 –3 (2013)More Less
There are enormous challenges in developing a mental healthcare service that meets the needs of South Africans. Many of these challenges have been described in the lay press and in both local and international journals. In recognition of these challenges, the South African Society of Psychiatrists (SASOP) has expressed its support for formalising a national mental health policy, in a position statement released following a strategic workshop in 2012. The workshop was co-ordinated by members of its State Employed Special Interest Group (SESIG).
Source: South African Journal of Psychiatry 19, pp 4 –10 (2013)More Less
Background. Mental health research appears to be continually transforming. Recent literature reflects a greater appreciation for the ways in which pathoplastic features of culture modulate emotional regulation. This article introduces those aspects of the literature which explore the (re)consideration of culture as a dynamic and essential construct in the clinical formulation of psychopathology.
Objectives. The study aims to review literature that focuses on the dynamic influence of culture in psychopathology. Furthermore, the researchers aim to present a view on the ways in which culture appeared to shape the topography of psychopathology nosology.
Method. A literature review of 31 sources.
Results. The review indicated that 29 literature sources were conceptual in design, suggesting a great need for more empirical research. This section also explores themes identified during the literature review. The literature is tabulated according to features and emerging themes. Three major themes were identified and included: the cultural context; the evolving definitions of culture; and culture and psychopathology.
Conclusion/discussion. An analysis of the themes is offered. The authors conclude by highlighting the significance of the literature at present. Areas of particular interest suggest that health and behaviour are dependent, at least in part, on culture; psychopathology may also be appreciated as a social construct; culture influences psychopathology regardless of the aetiology; diagnostic classes do not adequately consider operational definitions; and a greater focus on hermeneutic perceptivity in appreciating cultural dynamics in psychopathology will benefit clinical assessment.
Author M.A. RashedSource: South African Journal of Psychiatry 19, pp 12 –15 (2013)More Less
This article offers a commentary on Hassim and Wagner's article, Considering the cultural context in psychopathology formulations, published in this issue of the South African Journal of Psychiatry (http://dx.doi.org/10.7196/SAJP.400). It clarifies aspects of the concepts of culture and psychopathology. A distinction is drawn between the content of culture and the demarcation of cultures. The former refers to socially acquired meanings and significances that condition subjective experience and the latter to specific, demarcated cultural groups. It is argued that these two meanings of culture must be kept apart, and that only the former is relevant to the project of understanding the range of cultural influences on mental health problems. This is premised on the idea, arising partially from anthropological critique, that while cultural designations (e.g. Maori or Muslim) might serve as important political and identity markers, they obscure rather than reveal the actual influences the subject is exposed to, and which condition subjective experience as seen through the modulation of distress or symptom formation.
Psychiatric features in perpetrators of homicide-unsuccessful-suicide at Weskoppies Hospital in a 5-year periodSource: South African Journal of Psychiatry 19, pp 15 –18 (2013)More Less
Background. In the absence of medical literature reporting on homicide-unsuccessful-suicide (HUS), those cases in which the perpetrator is referred for forensic psychiatric observation present an opportunity to explore psychiatric features pertaining to the event.
Objective. To identify possible contributing psychiatric features in HUS cases.
Method. A retrospective, single-centre, descriptive study was conducted, in which we reviewed clinical records of HUS subjects referred for observation to Weskoppies Hospital from December 2005 to January 2011. We reviewed socio-demographic and psychiatric information.
Results. Nine cases were reviewed. The median age of the subjects was 29 years and 7 subjects were male. Five cases involved family members. Cases involving couples demonstrated male subjects and cases involving filicide demonstrated female subjects. Only 1 case involved the use of a firearm. At the time of the incident, 4 of the cases had no psychiatric diagnosis, but did have notable interpersonal difficulties. Psychotic disorders were diagnosed in 3 subjects, a depressive disorder in 1 subject and a depressive and anxiety disorder in 1 subject.
Conclusion. Subjects commonly used less lethal methods than shooting. The high rate of psychiatric disorders diagnosed is in keeping with court referrals occurring when a mental illness is suspected. Some cases may require specialised probing before psychosis becomes apparent. Identification of psychosocial stressors and failure of coping mechanisms during periods of strife within an intimate relationship may be a focus of future research in homicide-suicide cases. Separation should possibly be investigated as an independent factor which promotes the interpersonal difficulty associated with homicide-suicide.
Consent to research by mentally ill children and adolescents : the implications of Chapter 9 of the National Health ActAuthor A. NienaberSource: South African Journal of Psychiatry 19, pp 19 –23 (2013)More Less
Chapter 9 of the National Health Act came into effect in March 2012. In this article, the Act's statutory requirements relating to the informed consent to participation in clinical research by mentally ill children and adolescents in South Africa are examined. The necessity of doing clinical research in mentally ill children and adolescents is canvassed briefly and the requirements that chapter 9 sets out for lawful child and adolescent consent to research participation are presented. Furthermore, the limitations of the newly enacted legislation is deliberated upon and selective improvements are proposed.
Because of the likely erosion of the minor's privacy, the requirement that a parent or legal guardian must consent to children's and adolescents' participation in research has the potential to obstruct much-needed mental health research. This requirement is likely to be found unconstitutional. In certain circumstances, ethics committees tasked with the review of research should be allowed to dispense with parental consent, and adolescents recognised as having the necessary capacity to consent independently to research participation. Furthermore, the Act's classification of research into therapeutic and non-therapeutic categories is considered problematic. It is recommended that research permissible in minors be stated in terms of well-defined risk standards.
Finally, the requirement set in subsection 71(3) for ministerial consent in the case of non-therapeutic research in children and adolescents is found to be overly protectionist, as it precludes the capacity of ethics committees to judge the ethics of the proposed research.