South African Journal of Psychiatry - Volume 19, Issue 4, 2013
Volume 19, Issue 4, 2013
Author Gerhard GroblerSource: South African Journal of Psychiatry 19, pp 201 –204 (2013)More Less
The South African Society of Psychiatrists (SASOP) is gearing up to shape mental health services in the country like never before. In this issue of the SAJP, Professor Bernard Janse van Rensburg explains SASOP's contributions to the National Mental Health Action Plan, following various recent strategic initiatives driven by the dictum, 'There can be no health without mental health, there can be no complete mental health without psychiatry'.
Contributions from the South African Society of Psychiatrists (SASOP) to the National Mental Health Action PlanAuthor A.B.R. Janse van RensburgSource: South African Journal of Psychiatry 19, pp 205 –212 (2013)More Less
The national Mental Health Action Plan (MHAP) flowed from the Ekurhuleni Declaration, adopted at the National Mental Health Summit (NMHS) in April 2012. The final draft of the MHAP included eight national objectives, with key activities which were believed to be 'catalytic'. These objectives include: district-based mental health service; institutional capacity; surveillance, research and innovation; infrastructure and capacity; mental health technology, equipment and medicines; inter-sectoral collaboration; human resources; and advocacy, mental health promotion and prevention of illness. A representative group of regional State Employed Special Interest Group (SESIG) delegates met during April 2013, to: operationalise the 12 South African Society of Psychiatrists (SASOP)/SESIG position statements of the previous year; review SASOP's position statements in the context of the proposed national MHAP; and to identify SASOP's role and responsibilities accordingly. This paper describes the contextual events in the drafting of the MHAP, as well as the appraisal of the MHAP during the 2013 SASOP/SESIG meeting, and SASOP'S envisaged role and responsibilities according to the national MHAP.
Trends in pharmacotherapy selection for the treatment of alcohol withdrawal in the Free State Province, South AfricaSource: South African Journal of Psychiatry 19, pp 213 –217 (2013)More Less
Background. The selection of pharmacotherapy for the treatment of alcohol withdrawal remains a clinical challenge. Research continues into the underlying pathophysiology of dependence and withdrawal. A spectrum of clinical presentations of alcohol dependence is emerging, yet recommendations and guidelines have remained unchanged for some time.
Objectives. To engage with the problem of translating research into practice, as reflected by the selection of pharmacotherapy for alcohol withdrawal by medical practitioners in the Free State Province, South Africa.
Methods. A questionnaire-based survey and interviews were conducted among 121 professionals in both the private and public sectors across the province. A subgroup was formed comprising the 58 doctors who indicated that they prescribe for alcohol withdrawal. Participants worked in private general practice, specialist psychiatry practice, in a state hospital or in a treatment centre.
Results. Prescribing practices varied based on practitioners' geographical distribution and professional capacity. Deviation from standard recommendations included the routine use of clothiapine and antidepressants in withdrawal regimens. Prescribing clothiapine appears to be a local custom. While prescription of antidepressants may indicate unrealistic expectations of therapeutic benefit, there are clear indications that this is maintained to mask the diagnosis of an alcohol-related condition. Prescribing for alcohol withdrawal is therefore not necessarily determined by pathophysiology or efficacy of medication.
Conclusion. Withdrawal regimens need to be reassessed by researchers, policy makers and funders, balancing new developments with the real-life experiences and challenges of prescribers and their patients.
A problem-based learning curriculum and undergraduate performance in the final psychiatry examination at the Nelson R Mandela School of MedicineSource: South African Journal of Psychiatry 19, pp 218 –221 (2013)More Less
Background. Medical education reformers must consider disease patterns, health system expectations and clearly specified outcomes to ensure that revised curricula are relevant. South Africa needs clinically competent doctors in adequate numbers to address the burden of psychiatric illnesses.
Objective. To evaluate the impact of a curricular reform, this study compared undergraduate students' clinical competence in psychiatry following a change from a six-year traditional lecture-based (LB) curriculum to a five-year problem-based learning (PBL) curriculum.
Method. The psychiatry examination records of 936 students enrolled in a PBL curriculum were compared with those of 771 students enrolled in a LB curriculum, covering a nine-year period from 2001 to 2009. Records covered the long case, case vignette and oral examinations.
Results. Students in the PBL group performed significantly better in the problem-solving case vignette examination (p<0.02). There were no statistically significant differences in the mean marks for the long case and the oral examination. Because the revised curriculum is shorter, one additional class of 200 students graduated during the duration of the study than would have been possible under the previous curriculum.
Conclusion. The new PBL curriculum produced more doctors, but there was no change in their psychiatric knowledge and skills compared with graduates from the old LB curriculum. Clinical teachers need to define outcomes prior to curriculum revision, because these are essential for evaluating the curriculum's success.
Reasons for parasuicide among patients admitted to Tshilidzini Hospital, Limpopo Province : a qualitative studyAuthor I. GovenderSource: South African Journal of Psychiatry 19, pp 222 –225 (2013)More Less
Background. Suicide and suicide attempts are commonly encountered in primary healthcare. To manage them competently and in a non-judgmental manner, health workers require an in-depth understanding of this problem.
Objective. To determine the reasons for suicide attempts among patients admitted at Tshilidzini Hospital.
Method. A descriptive qualitative study used an unstructured in-depth interview for data collection, with 10 purposively selected participants. The data were analysed thematically.
Results. The participants gave the following reasons for their suicidal acts: poverty, unemployment and its associated financial difficulties; domestic violence; interpersonal conflicts; HIV/AIDS-related problems; maternal death; depression; hallucinations; and accusations of witchcraft. These factors interacted, producing feelings of hopelessness, worthlessness and lack of meaning in life, thereby driving the individual to resort to desperate measures. The choice of method for each suicide attempt was influenced by availability, knowledge, experience and the seriousness of intent to die.
Conclusion. This study supports the idea that a suicidal act is a complex phenomenon arising in an distinctive way in each individual, based on the interplay of various factors.
Source: South African Journal of Psychiatry 19, pp 226 –227 (2013)More Less
Nonconvulsive status epilepticus is characterised by changes in behaviour, memory, affect or level of consciousness. We report a case of nonconvulsive status epilepticus precipitated by carbamazepine that presented as dissociative fugue. The patient was a 49-year-old man. He first experienced a tonic-clonic seizure nine years previously and was diagnosed with grand mal epilepsy. He had been using carbamazepine 800 mg daily for the last eight years. He had not had any tonic-clonic seizures since carbamazepine was introduced but began to display behavioural disturbances periodically. He also left home many times, and remembered nothing about the period he had been away after he returned. He was hospitalised with a preliminary diagnosis of dissociative fugue. He had recurrent episodes with dissociative symptoms during his stay in the hospital. An electroencephalogram (EEG) and a 24-hour video EEG revealed nothing abnormal. An EEG recording taken during an episode indicated complex partial status epilepticus. Carbamazepine was substituted with valproate, and the patient was discharged in remission.
Source: South African Journal of Psychiatry 19, pp 228 –231 (2013)More Less
Stiff person syndrome (SPS) is a rare, debilitating condition which presents with progressive and inconsistent neurological features. The main symptoms are stiffness and intermittent, painful muscle spasms, triggered and exacerbated by stressful and emotional stimuli. The fluctuating clinical nature of SPS, and otherwise normal neurological examination, often lead to a misdiagnosis of conversion disorder. Psychiatric symptoms frequently accompany this disorder and patients are often first seen by psychiatrists. SPS is autoimmune-based: antibodies are directed against glutamate decarboxylase, resulting in dysregulation of gamma-aminobutyric acid (GABA) in the brain which is considered the cause of the neuropsychiatric symptomatology. SPS should be considered in the differential diagnosis of conversion disorder. Effective management requires early detection, a collaborative approach with GABA-ergic medication and intravenous immunoglobulins, and management of concomitant psychiatric disorders. We describe a patient with SPS. Only one other case has been reported in South Africa.