South African Journal of Psychiatry - Volume 21, Issue 1, 2015
Volume 21, Issue 1, 2015
Source: South African Journal of Psychiatry 21, pp 3 –7 (2015) http://dx.doi.org/10.7196/SAJP.609More Less
Objectives. Part I of this research article presents a needs-based analysis for the management of schizophrenia, bipolar mood disorder and major depression for the Eastern Cape (EC) Province, South Africa. This part of the research paper focuses on quantifying human resources and bed needs for these three severe mental illnesses. Human resource expenditure is calculated for nursing staff at acute, ambulatory and medium-to-long-stay services. A further objective was to conduct a gap analysis for human resources and beds for the EC in order to assist mental health planners in the commissioning of services.
Methods. Data from previous research conducted in the province, and international and national epidemiological studies were utilised to quantify the requirements for human resources (psychiatrists, medical officers/registrars, psychologists, nurses, occupational therapists and social workers) and beds for acute, medium-to-long-stay and ambulatory services at provincial and regional levels, to provide mental healthcare. The authors focused on three of the eight priority conditions set by the World Health Organization. A target coverage rate of 80% was used in all calculations. A gap analysis was conducted to demonstrate deficits and excesses, utilising available data on human resources and beds available in the province.
Results. The results showed that the districts of Alfred Nzo and Ukhahlamba have no human resources or beds for the provision of mental health services. The province has a deficit of 23 psychiatrists and 243 nurses trained in psychiatry, and an oversupply of 486 other nurses. The results also clearly demonstrated an inequitable distribution of resources in the province.
Conclusions. This is the first study that has provided detailed estimates of human resource and bed deficits in the EC. The study demonstrates that the areas of greatest need in terms of bed and human resource requirements are in the eastern regions of the province, which includes the former homelands of the Transkei and Ciskei. This study will assist provincial mental health planners/commissioners in developing an equitable mental health delivery programme.
A decentralised model of psychiatric care : profile, length of stay and outcome of mental healthcare users admitted to a district-level public hospital in the Western CapeSource: South African Journal of Psychiatry 21, pp 8 –12 (2015) http://dx.doi.org/10.7196/SAJP.538More Less
Background. There is a lack of studies assessing the profile and outcome of psychiatric patients at entry-level public hospitals that are prescribed by the Mental Health Care Act to provide a decentralised model of psychiatric care.
Objective. To assess the demographic and clinical profile as well as length of stay and outcomes of mental healthcare users admitted to a district-level public hospital in the Western Cape.
Method. Demographic data, clinical diagnosis, length of stay, referral profile and outcomes of patients (N=487) admitted to Helderberg Hospital during the period 1 January 2011 - 31 December 2011 were collected.
Results. Psychotic disorders were the most prevalent (n=287, 59%) diagnoses, while 228 (47%) of admission episodes had comorbid/secondary diagnoses. Substance use disorders were present in 184 (38%) of admission episodes, 37 (57%) of readmissions and 19 (61%) of abscondments. Most admission episodes (n=372, 76%) were discharged without referral to specialist/tertiary care.
Conclusion. Methamphetamine use places a significant burden on the provision of mental healthcare services at entry-level care. Recommendations for improving service delivery at this district-level public hospital are provided.
Depressive symptoms in community-dwelling persons aged ≥60 years in Inanda, Ntuzuma and KwaMashu in eThekwini, KwaZulu-NatalSource: South African Journal of Psychiatry 21, pp 13 –18 (2015) http://dx.doi.org/10.7196/SAJP.576More Less
Background. Physical and psychological ailments increase with age; while the physical ailments are well documented, mental health issues have received less attention.
Objective. To determine the prevalence of depressive symptoms and associated risk factors in individuals aged ≥60 years living in a low-resource peri-urban area in South Africa.
Methods. Secondary analysis was performed on data obtained from a primary study conducted to determine the influence of socioeconomic and environmental factors on the health status and quality of life in older persons living in the Inanda, Ntuzuma and KwaMashu (INK) area. The Center for Epidemiologic Studies Short Depression Scale (CES-D 10) was used to screen for depressive symptoms in the week preceding the interview, and respondents were categorised as having no (score <10), mild (10 - 14), or severe (>14) depressive symptoms. Risk factor associations were tested using Pearson's χ2 tests and logistic regression.
Results. There were 1 008 respondents (mean (standard deviation) age 68.9 (7.4) years), of whom 503 (49.1%) did not meet criteria for depressive symptoms. Of the 505 (50.1%) respondents who met the CES-D 10 criteria for depressive symptoms, 422 (41.9%) had mild and 83 (8.2%) had severe depressive symptoms. In the univariate analysis, significant associations were found with age (p=0.011), household size (p=0.007), income (p=0.033), disability (p=0.001), nutritional status (p≤0.001), the inability to count on family (p=0.008) and lack of mastery (p≤0.001). In direct binary logistic regression, there were significant associations with lack of mastery (p≤0.001), inability to count on family (p=0.027), malnutrition (p≤0.001) and household size (p=0.024).
Conclusion. This study highlights the high prevalence of depressive symptoms in the elderly in the INK area, and the need to promote successful ageing of the elderly population in this area.
Source: South African Journal of Psychiatry 21, pp 19 –23 (2015) http://dx.doi.org/10.7196/SAJP.394More Less
Background. A significant increase in rape victim assessment referrals by the courts has been noted in recent years at Weskoppies Hospital. Rape victims are referred by courts to determine: (i) their competency as a witness; (ii) their ability to give consent to sexual acts; (iii) their mental age; and (iv) their level of mental retardation. These evaluations are done by psychologists and psychiatrists at state hospitals. The findings are reported to the courts in a report format.
Objectives. To present the findings of the reports compiled by psychologists and psychiatrists on rape victims from 2009 to 2013 as they comment on the court's referral questions, and compare these findings with similar studies done at other psychiatric institutions.
Methods. A total of 108 reports was obtained from the electronic database at Weskoppies Hospital. The findings of the reports were summarised on a datasheet and were categorised according to the referral questions of the courts.
Results. In the 68 reports where mention was made of mental age, almost three-quarters found it to be between 4 and 12 years. Intellectual disability was found as the diagnosis in the vast majority of reports. Of these, the most common severity of impairment was moderate (n=22, 21.8%) and moderate to severe (n=21, 20.8%) in nature. Most reports (n=61, 56.6%) found that the rape victims were not able to consent to sexual intercourse. Seventy-one (65.7%) reports stated that victims were not able to testify in court.
Conclusion. Most reports stated that victims suffered from intellectual disability and their capacity to testify in court was impaired. More than half of the victims evaluated did not have the capacity to give consent to sexual acts.
Source: South African Journal of Psychiatry 21, pp 24 –30 (2015) http://dx.doi.org/10.7196/SAJP.641More Less
Background. Evaluation of specific courses, rotations or attachments in medical education is common practice.
Objective. To evaluate medical students' perceptions of their final psychiatry rotation of 7 weeks.
Methods. A questionnaire was developed for medical students to give feedback on their psychiatry rotation at Weskoppies Hospital in Tshwane, South Africa. Four scores were developed: (i) a clinical exposure score for psychiatric conditions encountered during the rotation; (ii) an ethics exposure score comprising confidentiality and informed consent; (iii) an admissions exposure score for different admission options; and (iv) a perception score related to students' experience of the rotation. The evaluation took place over a period of 4 years, between 2006 and 2009.
Results. Over the study period, 87% of 708 students completed the questionnaire. The higher number of female respondents (63%) was in accordance with the general student profile. The four resulting scores were: clinical exposure 67%; ethics exposure 78%; admissions exposure 86%; and perceptions 75%. The main strengths of the rotation were identified as the positive learning environment, exposure to patients, discussions and ward conferences, and approaches followed.
Conclusions. The conceptualisation of the tool to elicit specific scores was useful for presenting the findings. The student feedback provided valuable information for the psychiatry curriculum planners and teachers, and led to further adaptations to the structure of the rotations and the learning opportunities provided.
Source: South African Journal of Psychiatry 21, pp 31 –34 (2015) http://dx.doi.org/10.7196/SAJP.573More Less
Where must a clinician turn when straightforward schizophrenia suddenly turns out to be just the opposite? Fortunately, these days, there are protocols for just about everything. But how much value do these add? This article outlines the journey of our attempt to follow one such protocol.
Genital self-mutilation in a non-psychotic male to get rid of excessive sexual drive : a case reportSource: South African Journal of Psychiatry 21, pp 35 –36 (2015) http://dx.doi.org/10.7196/SAJP.580More Less
Genital self-mutilation (GSM) is a rare phenomenon. In the majority of cases, GSM is secondary to psychotic illness. Among the nonpsychotics, the motives behind GSM are varied. We report a rare case in which a non-psychotic, non-paraphilic patient suffering from excessive sexual drive carried out GSM to curb hypersexuality. Aetiological factors behind GSM are discussed. This case report emphasises that excessive sexual drive may lead to distress and GSM. Effective management of excessive sexual drive and active inquiry into any intentions of GSM in such patients may be helpful in preventing GSM.