South African Journal of Psychiatry - Volume 19, Issue 3, 2013
Volume 19, Issue 3, 2013
Author Werdie (C.W.) Van StadenSource: South African Journal of Psychiatry 19 (2013)More Less
Two issues of the South African Journal of Psychiatry applaud a future in which South Africa pursues both better mental health and better attitudes towards psychiatric difficulties and illnesses. The first, a Special Issue of the SAJP, features the Treatment Guidelines of the South African Society of Psychiatrists, which is published by the SAJP without being subsidised by advertisements from the pharmaceutical industry. This is the first publication of its kind in South Africa, resulting from peer consultation and refinement by psychiatrists and carefully compiled and edited by Professors Soraya Seedat and Robin Emsley. It aims to cater to both the public and private sectors of psychiatric practice.
Source: South African Journal of Psychiatry 19, pp 60 –64 (2013)More Less
The prevalence of HIV infection is substantially higher in mentally ill individuals than in the general population. Despite this, HIV testing is not yet standard practice among the mentally ill population, and many mental health settings do not encourage HIV testing. This paper discusses provider-initiated HIV counselling and testing (PICT) and some of the ethical dilemmas associated with it, on the basis that PICT may be used to increase the number of mentally ill persons tested for HIV. The authors conclude that PICT should be promoted to all psychiatric admissions and mentally ill individuals receiving outpatient services, and that this is within the parameters of existing policies and legislations in South Africa.
Attitudes of undergraduates towards mental illness : a comparison between nursing and business management students in IndiaSource: South African Journal of Psychiatry 19, pp 66 –73 (2013)More Less
Background. Mental illness is an important public health issue worldwide; stigmatisation and negative attitudes towards people with mental illness are widespread among the general public. However, little is known about the attitudes of undergraduates to mental illness.
Purpose. To compare the attitudes towards mental illness among undergraduates enrolled in nursing courses v. those enrolled in Bachelor of Business Management (BBM) courses.
Methods. A cross-sectional descriptive design was adopted for the present study. A total of 268 undergraduates were selected to complete the Attitude Scale for Mental Illness (ASMI) and the Opinions about Mental Illness in the Chinese Community (OMICC) questionnaires.
Results. We found significant differences between the number of nursing and BBM students who agreed with statements posed by the questionnaires, e.g., that they would move out of their community if a mental health facility was established there (χ2=16.503, p<0.002), that they were not afraid of treated mentally ill people (χ2=15.279, p<0.004), and that people with mental illness tend to be violent (χ2=14.215, p<0.007) and dangerous (χ2=17.808, p<0.001). Nursing students disagreed that people with mental illness are easily identified (χ2=30.094, p<0.000), have a lower IQ (χ2=70.689, p<0.000) and should not have children (χ2=24.531, p<0.000). Nursing students were more benevolent than BBM students, as they agreed that people with mental illness can hold a job (χ2=49.992, p<0.000) and can return to their former position (χ2=11.596, p<0.021), that everyone faces the possibility of becoming mentally ill (χ2=38.726, p<0.000), and that one should not laugh at the mentally ill (χ2=17.407, p<0.002). Nursing students held less pessimistic attitudes, as they felt that the mentally ill should receive the same pay for the same job (χ2=10.669, p<0.031) and that the public are prejudiced towards people with mental illness (χ2=17.604, p<0.001).
Conclusion. College students' attitudes towards people with mental illness vary based on the course that they are enrolled in. Attitudes may be positively improved by revising curriculum design to incorporate educational sessions about mental illness. These are essential steps to combat discrimination, and potentially enhance the promotion of human rights for the mentally ill.
Source: South African Journal of Psychiatry 19, pp 75 –79 (2013)More Less
Objective. To investigate the incidence and type of misconceptions about traumatic brain injuries (TBIs) harboured by university students.
Method. A convenience sample of 705 university students were recruited and data were collected using an electronic survey. The link to the survey was sent via e-mail to all registered students at Stellenbosch University. The participants had to complete the Common Misconceptions about Traumatic Brain Injury (CM-TBI) questionnaire.
Results. The findings of this study suggest that the students subscribe to misconceptions from each of the 7 categories of misconceptions about TBIs. The mean percentages of misconceptions about TBIs were calculated and the amnesia (mean 49.7%) and unconsciousness (mean 46.1%) categories were identified as the categories about which the respondents had the most misconceptions, while the mean percentages of misconceptions were lower for the categories of recovery (mean 27.6%), rehabilitation (mean 26.56%), prevention (mean 20.8%), brain injury sequelae (mean 18.7%) and brain damage (mean 8.4%).
Conclusion. Generally, these findings appear to be in keeping with previous literature, which suggests that misconceptions about TBIs are common among the general population. This study's identification of these misconceptions could help create awareness, provide a focus for information provision, and contribute to the development of educational intervention programmes tailored for the South African context.
Recollected experiences of first hospitalisation for acute psychosis among persons diagnosed with schizophrenia in South AfricaSource: South African Journal of Psychiatry 19, pp 81 –85 (2013)More Less
First-time admission to a psychiatric hospital for acute psychosis has been reported to be extremely traumatic, and this has not been adequately researched in the South African context. This study approached persons diagnosed with schizophrenia and explores their recollected, subjective experiences of their first admission to a South African psychiatric hospital ward for acute psychosis. Semi-structured individual interviews were conducted with seven participants diagnosed with schizophrenia. These were analysed using thematic content analysis. While some participants had positive experiences, the majority reported frightening, distressing, emotionally painful or traumatic experiences during their first hospitalisation. The first hospital admission was also described as having serious long-term implications for the person's wellbeing, particularly as the diagnosis of schizophrenia made them feel isolated and stigmatised, which further hinders them from recovering from their symptoms and reintegrating into society. This study therefore draws attention to aspects of the process of first admission to psychiatric wards in South Africa, which may benefit from proactive intervention and closer research attention.
Source: South African Journal of Psychiatry 19, pp 86 –87 (2013)More Less
Abnormal phospholipid metabolism in the brain plays an important role in neuropsychiatric diseases. Phospholipase A2 is crucial for maintaining normal neuro-physiological function. The aim of this study was to investigate the association between polymorphisms of the membrane-associated calcium-independent phospholipase A2 gamma (PNPLA8) gene and schizophrenia in Han Chinese in north China. The PCR-based ligase detection reaction was applied to detect 3 single nucleotide polymorphisms (SNPs) in the PNPLA8 gene among 201 Chinese pedigrees. The genotypic frequency of the PNPLA8 polymorphisms did not deviate from the Hardy-Weinberg equilibrium both in affected offspring and parental groups. Haploid relative risk (HRR) and transmission disequilibrium tests (TDT) showed that the 3 SNPs were not associated with schizophrenia (p>0.05), but further analysis with TDT showed that the rs40876 polymorphism was associated with schizophrenia in males (χ2=4.667, p=0.031). Our data suggest that rs40876 in PNPLA8 may be associated with schizophrenia in males.
Source: South African Journal of Psychiatry 19, pp 91 –126 (2013)More Less
Introduction : The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric DisordersSource: South African Journal of Psychiatry 19, pp 134 –135 (2013)More Less
The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric Disorders have been developed in order to address the local need for guidelines in our unique clinical setting. The need for treatment guidelines has frequently been expressed by South African psychiatrists and other medical practitioners, as well as by other role players such as medical scheme and other funding body advisors and the pharmaceutical industry. While several well-developed international treatment guidelines are readily accessible and are indeed extensively utilised in South Africa, they are not always applicable to our own circumstances. There are often important differences, not only regarding the availability of various psychotropic medications, but also in healthcare settings and availability of resources that need to be considered when selecting particular medications. For example, prescribing compounds that require regular monitoring such as lithium and clozapine may not always be feasible in certain rural settings in South Africa.
Attention deficit hyperactivity disorder in children and adolescents : The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric DisordersSource: South African Journal of Psychiatry 19, pp 136 –140 (2013)More Less
Attention deficit hyperactivity disorder (ADHD), although commonest in childhood and adolescence, can be diagnosed across the age span. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) defines the disorder using the core features of hyperactivity, impulsivity and/or inattention which are inappropriate for developmental stage.
Dementia : The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric DisordersAuthor F.C.V. PotocnikSource: South African Journal of Psychiatry 19, pp 141 –152 (2013)More Less
By definition, dementia is an acquired global impairment in memory, personality and intellect in an alert patient, that is sufficiently severe to interfere with social and/or occupational functioning. In the absence of a stroke or rapidly growing cerebral tumours (among other causes), the onset is usually gradual and the cognitive decline is always progressive. In the absence of a cure for the disease, non-pharmacological inventions and the judicious use of pharmacotherapy may not only help the patient and alleviate the stress on the caregiver, but can also help in delaying institutionalisation.
Schizophrenia : The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric DisordersSource: South African Journal of Psychiatry 19, pp 153 –156 (2013)More Less
Schizophrenia is a major mental disorder that imposes a significant burden on the individual including poor quality of life and increased morbidity and mortality; it disrupts interpersonal relationships and family structures, and has significant economic costs to society. While there are substantial limitations to current treatments, an integrated package of biopsychosocial interventions is essential to alleviate the negative impact of the disorder and enhance quality of life. Active early intervention, in particular, can improve long-term outcomes.
Major depressive disorder : The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric DisordersAuthor G. GroblerSource: South African Journal of Psychiatry 19, pp 157 –163 (2013)More Less
This treatment guideline draws on several international guidelines: (i) Practice Guidelines of the American Psychiatric Association (APA) for the Treatment of Patients with Major Depressive Disorder, Second Edition; (ii) Clinical Guidelines for the Treatment of Depressive Disorders by the Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments (CANMAT); (iii) National Institute for Clinical Excellence (NICE) guidelines; (iv) Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Depression (RANZCAP); (v) Texas Medication Algorithm Project (TMAP) Guidelines; (vi) World Federation of Societies of Biological Psychiatry (WFSBP) Treatment Guideline for Unipolar Depressive Disorder; and (vii) British Association for Psychopharmacology Guidelines.
Bipolar disorder : The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric DisordersAuthor F. ColinSource: South African Journal of Psychiatry 19, pp 164 –171 (2013)More Less
Bipolar disorder (BD) presents in different phases over time and is often complicated by comorbid conditions such as substance-use disorders and anxiety disorders. Treatment usually involves pharmacotherapy with combinations of different classes of medications and frequent medication revisions.
Panic disorder : The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric DisordersAuthor C.P. SzaboSource: South African Journal of Psychiatry 19, pp 172 –174 (2013)More Less
Panic disorder (PD) is a prevalent anxiety disorder with lifetime prevalence rates ranging from 1.1% to 3.7% in the general population and 3.0% to 8.3% in clinic settings. The presence of agoraphobia in patients with PD is associated with substantial severity, comorbidity (e.g. major depression, other anxiety disorders, alcohol abuse) and functional impairment. The disorder is more common in women than in men, with a 3:1 ratio in patients with agoraphobia and 2:1 in patients without agoraphobia. While panic attacks are a core feature of PD, panic attacks are also experienced by patients with post-traumatic stress disorder, social anxiety disorder and specific phobias. However, unlike in PD, these are typically cued by exposure to or anticipation of specific anxiety-provoking situations.
Generalised anxiety disorder : The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric DisordersSource: South African Journal of Psychiatry 19, pp 175 –179 (2013)More Less
Generalised anxiety disorder (GAD) is a common disorder with a lifetime prevalence of 6.1% and a 1-year prevalence of 2.9% in one large study. It occurs most commonly in the 45-55-year age group with women twice as likely as men to have GAD. Although symptoms typically wax and wane in intensity over time, the disorder is characterised by chronicity and is associated with high levels of psychiatric comorbidity (e.g. major depression and other anxiety disorders), physical comorbidity (e.g. gastrointestinal, respiratory, and thyroid disorders) and reduced quality of life. There have been important advances in the nosology and treatment of this disorder. In particular, there is increasing evidence that patients with GAD and mixed anxiety-depression frequently present in primary care settings, and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition provides fairly user-friendly criteria for the diagnosis of GAD.
Obsessive compulsive disorder : The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric DisordersSource: South African Journal of Psychiatry 19, pp 180 –186 (2013)More Less
This guideline focuses on the pharmacotherapy of obsessive-compulsive disorder (OCD). OCD is characterised by obsessions and compulsions. A number of other disorders are also characterised by repetitive thoughts and rituals and may also respond to modifications of standard OCD treatment. These so-called OCD spectrum disorders include body dysmorphic disorder (characterised by recurrent concerns with imagined ugliness), hypochondriasis (characterised by recurrent concerns with imagined illness), trichotillomania (characterised by recurrent hair-pulling), and obsessive-compulsive personality disorder. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition has a new chapter on obsessive-compulsive and related disorders, which includes several of these conditions.
Post-traumatic stress disorder : The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric DisordersSource: South African Journal of Psychiatry 19, pp 187 –191 (2013)More Less
Post-traumatic stress disorder (PTSD) is among the most prevalent anxiety disorders, both in terms of lifetime and 12-month prevalence rates documented in epidemiological studies worldwide. The National Comorbidity Survey Replication (NCS-R) study conducted in the USA, for example, found the lifetime prevalence of PTSD to be 6.8% while the 12-month prevalence was 3.5%. The South African Stress and Health Study (SASH) documented lower lifetime (2.3%) and 12-month (0.6%) rates, although PTSD was among the anxiety disorders with the highest proportion of severe cases (36% of all individuals diagnosed with PTSD were severely ill). High rates of PTSD (19.9%) have also been documented among South African patients attending primary healthcare clinics.
Social anxiety disorder (social phobia) : The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric DisordersSource: South African Journal of Psychiatry 19, pp 192 –196 (2013)More Less
According to epidemiological studies, rates of social anxiety disorder (SAD) or social phobia range from 3% to 16% in the general population. Social phobia and specific phobias have an earlier age of onset than other anxiety disorders. The median age of onset for the disorder is 13 years with an onset after age 25 relatively uncommon. The disorder typically persists throughout adult life and is associated with significant functional impairment. Individuals with SAD are more likely to be females; however in clinical samples SAD seems to be more equally distributed among men and women.