South African Journal of Psychiatry - Volume 20, Issue 2, 2014
Volume 20, Issue 2, 2014
Source: South African Journal of Psychiatry 20, pp 34 –39 (2014) http://dx.doi.org/10.7196/SAJP.568More Less
The development of mental health services in the Eastern Cape Province is inextricably entwined in South Africa's colonial history and the racist policy of apartheid. Prior to the development of mental hospitals, mental health services were provided through a network of public and mission hospitals. This paper explores the development of early hospital and mental health services in the Eastern Cape from the time of the Cape Colony to the dissolution of apartheid in 1994, and highlights the influence of colonialism, race and legislation in the development of mental health services in this province. The objective is to provide a background of mental health services in order to identify the historical factors that have had an impact on the current shortcomings in the provision of public sector mental health services in the province. This information will assist in the future planning and development of a new service for the province without the stigma of the past. This research indicates that one lesson from the past should be the equitable distribution of resources for the provision of care for all that inhabit this province, as enshrined in South Africa's constitution.
Referral and collaboration between South African psychiatrists and religious or spiritual advisers : views from some psychiatristsSource: South African Journal of Psychiatry 20, pp 40 –45 (2014) http://dx.doi.org/10.7196/SAJP.533More Less
Background. Referral between psychiatrists and spiritual workers (e.g. Christian pastoral care workers, traditional healers, imams, rabbis and others) in the heterogeneous South African (SA) society is complicated and requires investigation to establish appropriate norms.
Objective. To capture the views of some local psychiatrists on referral and collaboration between SA psychiatrists and religious or spiritual advisers.
Methods. This explorative qualitative study involved in-depth, semistructured interviews with 13 local academic psychiatrists selected through purposive sampling. Each participant had a single interview with the aim of exploring themes related to the referral and collaboration process between psychiatrists and spiritual advisers. Theme content analysis of interview transcripts was done. Results for one of the six identified themes are reported; other results are reported elsewhere.
Results. Within the theme 'referral and collaboration between psychiatrists and spiritual professionals', three subthemes were identified: facilitating appropriate referral and intervention for individual users; information sharing and mutual awareness between disciplines; and addressing stigmatisation of users with psychiatric conditions.
Conclusion. Dialogue between psychiatrists and religious or spiritual advisers should be developed on an individual practitioner and facility basis, as well as on an organised basis between representative societies. The process of formalising a relationship between local psychiatrists and different spiritual workers may, however, still have some way to go.
Features of residency training and psychological distress among residents in a Nigerian teaching hospitalSource: South African Journal of Psychiatry 20, pp 46 –50 (2014) http://dx.doi.org/10.7196/SAJP.426More Less
Background. Resident doctors at University College Hospital (UCH), Ibadan, Nigeria, made a series of complaints about inadequate consultant supervision, lack of structure in the training programme and excessive workload. These complaints led to an evaluation of residency training.
Objective. To investigate perceptions of the residency training programme and levels of psychological distress among residents.
Methods. All 250 resident doctors at UCH were invited to complete questionnaires about their residency training and general health as part of a cross-sectional study. Data were analysed using SPSS 16.
Results. A total of 128 residents (51.2%) responded to the questionnaire. Of the respondents, 72% rated their consultant supervision as good and 82.6% rated support from nurses as good; 61.8% had <5 hours of formal educational activities and 65.1% had <5 hours of research or private study per week. There was evidence of psychological distress in 48.4% of the respondents, and there was a significant association between psychological distress and the intensity of work (p<0.01).
Conclusion. The residency training programme at UCH appears to prioritise service provision over research and education activities. Residents who report high workloads also have high levels of psychological distress. Tackling these issues could improve overall satisfaction with residency training and reduce complaints.
Source: South African Journal of Psychiatry 20, pp 50 –53 (2014) http://dx.doi.org/10.7196/SAJP.519More Less
Background. Around 10 - 15% of patients with myasthenia gravis (MG) have a thymoma, and non-motor symptoms are more frequent in these patients. We hypothesised that neuropsychiatric symptoms would also be more frequent.
Methods. A cross-sectional study of 30 consecutive MG patients attending a clinic at Groote Schuur Hospital, Cape Town, South Africa, was done over a 6-month period in 2010. Each patient underwent a series of single-blinded neuropsychiatric assessments, including the 16-item, self-reported Flanagan Quality of Life (QOL) scale, the Beck Depression Inventory second version, the Young Mania Rating Scale, the Hamilton Anxiety Rating Scale and the Brief Psychiatric Rating Scale (BPRS).
Results. The frequency and nature of neuropsychiatric symptoms were similar between thymoma (n=9) and non-thymoma (n=21) MG patients. Symptoms of moderate or severe depression and anxiety were present in around 30%. The severity of depression symptoms correlated with MG severity. Prednisone dosing was not associated with neuropsychiatric symptoms or QOL scores. Those with longer duration of MG were more likely to have higher scores on the BPRS and anxiety scales. Those with younger-onset MG had higher BPRS scores and a tendency to suicidal behaviour.
Conclusion. Although no association with thyoma was found, this study shows that neuropsychiatric conditions may be underdiagnosed in patients with MG. Systematic depression screening should be done at outpatient clinics, particularly for those who developed symptoms at a young age, those with severe disease and those with a long duration of illness.
Source: South African Journal of Psychiatry 20, pp 54 –57 (2014) http://dx.doi.org/10.7196/SAJP.528More Less
Background. Clozapine use is known to be associated with significant side-effects, including prolongation of the QT-interval, agranulocytosis and metabolic syndrome. However, few data exist on the prevalence of clozapine side-effects in patients of Xhosa descent.
Objective. To gather data from Xhosa patients with schizophrenia to establish the prevalence of clozapine side-effects in this population.
Methods. Twenty-nine Xhosa patients with schizophrenia (as per the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)) who had been receiving clozapine treatment for >1 year on an outpatient basis were selected for inclusion. All patients were participating in a genetics study in the Cape Metropolitan area. The participants were evaluated for the presence of side-effects (tests including an electrocardiogram, white blood cell count (WCC) and fasting blood glucose).
Results. The prevalence of metabolic syndrome was 44.8% (95% confidence interval (CI) 26.7 - 62.9) and of undiagnosed diabetes mellitus 13.8% (95% CI 1.24 - 26.34). There was a significant association between metabolic syndrome and body mass index (BMI) (p<0.01). The mean (SD) WCC was 7.8 x 109/L (2.8), with 3.4% of the subjects having a WCC <3.5 x 109/L. Sedation (82.8%; 95% CI 69.0 - 96.5), hypersalivation (79.3%; 95% CI 64.6 - 94.1) and constipation (44.8%; 95% CI 26.7 - 62.9) were common. The mean QT-interval was 373.8 (35.9) ms and 10% had a corrected QT-interval >440 ms. There was an association between the duration of clozapine treatment and QT-interval (with Bazett's correction).
Conclusion. The high prevalence of metabolic syndrome and undiagnosed diabetes mellitus in this sample points to a need to monitor glucose levels and BMI on a regular basis. A larger study should be done to accurately quantify the differences in prevalence of side-effects between population groups.
Source: South African Journal of Psychiatry 20, pp 58 –59 (2014) http://dx.doi.org/10.7196/SAJP.491More Less
Background. Researchers have evinced interest in the effect of seasonal variations on mood and behavioural patterns in affective disorders.
Objective. To study seasonality in bipolar disorder (BD) patients and also the factors affecting this seasonality.
Method. Forty-nine patients with BD in euthymic phase were recruited and analysed using the Seasonal Pattern Assessment Questionnaire and Morningness-Eveningness Questionnaire.
Results. Most of the patients were morning types but chronotype had no influence on seasonality. Age of patient and number of episodes were the most important factors affecting seasonality in BD.
Conclusion. Seasonality and its influencing factors must be considered while managing bipolar disorder.
Source: South African Journal of Psychiatry 20, pp 60 –62 (2014) http://dx.doi.org/htto://dx.doi.org/10.7196/SAJP.494More Less
Kleine-Levin syndrome (KLS) is a rare disorder characterised by hypersomnia, hyperphagia and behavioural disturbances. It typically occurs in adolescent men and may mimic a variety of neuropsychiatric conditions. Here we report what appears to be the first published case of KLS in South Africa and trace the clinical course, investigations and diagnostic difficulties encountered in the management of this condition. An overview of the literature guiding the diagnosis, differentials and treatment is discussed.
Source: South African Journal of Psychiatry 20, pp 63 –64 (2014) http://dx.doi.org/10.7196/SAJP.529More Less
In August 2013, the South African (SA) Society of Psychiatrists (SASOP) published their treatment guidelines for psychiatric disorders. We commend the authors and editors for completing such a huge undertaking. In the spirit of ongoing peer review, we would like to point out a few issues that may warrant consideration for future guideline updates.