South African Journal of Psychiatry - Volume 21, Issue 2, 2015
Volume 21, Issue 2, 2015
Extent of alcohol use and mental health (depressive and post-traumatic stress disorder symptoms) in undergraduate university students from 26 low-, middle- and high-income countriesSource: South African Journal of Psychiatry 21, pp 39 –43 (2015) http://dx.doi.org/10.7196/SAJP.662More Less
Objective. To estimate if there is a non-linear association between varying levels of alcohol use and poor mental health (depressive and post-traumatic stress disorder (PTSD) symptoms) in university students from low-, middle- and high-income countries.
Methods. Using anonymous questionnaires, data were collected from 19 238 undergraduate university students (mean age 20.8; standard deviation (SD) 2.8) from 27 universities in 26 countries across Asia, Africa and the Americas. Alcohol use was assessed in terms of number of drinks in the past 2 weeks and number of drinks per episode, and measures of depression and PTSD symptoms were administered.
Results. The proportion of students with elevated depression scores was 12.3%, 16.9%, and 11.5% for non-drinkers, moderate drinkers, and heavy drinkers, respectively, while the proportion of students with high PTSD symptoms was 20.6%, 20.4% and 23.1% for non-drinkers, moderate drinkers, and heavy drinkers, respectively. Logistic regression found that non-drinkers and heavy drinkers had a lower odds than moderate drinkers to have severe depression, after adjusting for sociodemographic variables, social support and subjective health status. Further, heavy, more frequent drinkers and more frequent binge drinkers had a higher odds to have elevated PTSD symptoms than moderate and non-drinkers, after adjusting for sociodemographic variables, social support and subjective health status.
Conclusion. The results suggest a reverse U-shaped association between recent alcohol use volume and frequency and depressive symptoms (unlike that previously identified), and a J-shaped association between binge drinking frequency and depressive symptoms and alcohol use and PTSD symptoms.
What patients with bipolar disorder and major depressive disorder perceive as adverse life events precipitating a current major depressive episodeSource: South African Journal of Psychiatry 21, pp 44 –47 (2015)More Less
Background. Adverse life events (ALEs) as precipitants of a major depressive episode (MDE) have been the subject of many studies. These studies indicate an increase in ALEs in the 6 months preceding an MDE.
Objectives. The study examined what participants, suffering from major depressive disorder (MDD) or bipolar disorder (BD), perceived as the precipitating ALE of a current MDE. The severity and categories of ALEs were compared between these two patient groups.
Methods. Consenting, adult inpatients were sourced from Weskoppies Hospital, Steve Biko Academic Hospital, Tshwane District Hospital, Denmar Psychiatric Hospital and Vista Clinic in the Pretoria area. A semi-structured questionnaire was used to obtain demographic data and the diagnosis. Information regarding the course of the disorder, including the number of previous MDEs and the age at which the first MDE occurred, was also obtained. The perceived precipitating ALE was detailed for each participant. A severity value referred to as a Life Change Unit Score (LCU score), based on the Recent Life Changes Questionnaire (RLCQ) by Miller and Rahe, was then assigned to each participant's perceived precipitant.
Results. Of the 64 participants, 12.7 % were experiencing a first MDE. In those participants who had experienced prior episodes the average number (standard deviation (SD)) of previous episodes was 3.86 (2.46). The mean approximate age (SD) at first onset of an MDE was 24.81 (10.9) years. The BD group had significantly more previous MDEs than the MDD group. Although the average LCU scores were higher in the BD group than the MDD group this did not reach statistical significance. Therefore, this study could not find a difference in the severity of the perceived precipitants between the BD group and MDD group. However, when the LCU scores were analysed within subcategories of the RLCQ, it was found that participants with BD perceived significantly more problems associated with the workplace as precipitants of a current MDE than individuals with MDD.
Conclusion. Most participants could link an ALE to the onset of a current MDE. The study did not find a differential response to ALEs between patients with BD and MDD. The severity of the social precipitants did not differ significantly between the two groups. The notion of a 'kindling effect' could not be supported by the outcome of this study. Because some study participants experienced ALEs not accounted for by the RLCQ, a more comprehensive assessment instrument may be more appropriate for similar studies.
Source: South African Journal of Psychiatry 21, pp 48 –53 (2015) http://dx.doi.org/10.7196/SAJP.587More Less
Selective serotonin reuptake inhibitor (SSRI) antidepressants are considered the primary pharmacological treatment for moderate to severe depression during pregnancy. Data regarding the safety of their use during pregnancy remain controversial and conflicting. Decisions regarding the prescription of antidepressant treatment are often fraught with concern around potential harmful medication effects on the pregnancy, fetus and infant. Information on potential risks remains extremely varied and inconsistent across sources. This lack of clarity regarding drug safety brings significant uncertainty not only for treating physicians, but also for women seeking information about depression during pregnancy. This review aims to summarise and evaluate the current evidence base and to aid clinicians in performing a risk/benefit analysis for SSRI use during pregnancy and lactation.
Source: South African Journal of Psychiatry 21, pp 54 –56 (2015) http://dx.doi.org/10.7196/SAJP.550More Less
Aim. To investigate sociotropic-autonomic personality characteristics and their clinical implications in social anxiety disorder (SAD).
Methods. The study included 68 consecutive patients who were either being followed up on an outpatient basis or presented for the first time to the psychiatric clinics of Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery or Trakya University School of Medicine between May 2012 and May 2013, and were diagnosed primarily with generalised SAD according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnostic criteria. Beck Depression Inventory (BDI), Sociotropy-Autonomy Scale (SAS), Symptom Checklist-90-R (SCL-90-R), Liebowitz Social Anxiety Scale (LSAS) and a sociodemographic data collection form designed by the authors were used as primary assessment instruments.
Results. The mean age (standard deviation (SD)) of the sample group was 23.73 (8.85) years; 37 (54.4%) were female and 31 (45.6%) were male. LSAS mean (SD) total fear score was 63.51 (13.74), mean total avoidance score was 61.24 (14.26), BDI mean score was 16.99 (9.58), SAS mean sociotropy score was 71.06 (16.79), and mean autonomy score was 63.22 (16.04). A statistically significant positive correlation was found between SAS sociotropy scores and LSAS fear and avoidance total scores, BDI scores and all subscales of SCL-90-R (p<0.01). There were no statistically significant correlations between SAS autonomy scores and LSAS fear and avoidance total scores, BDI scores and all subscales of SCL-90-R (p>0.05).
Conclusion. Sociotropic personality characteristics in patients with SAD have been found to positively correlate with depression and social anxiety levels. Addressing this finding during treatment sessions and helping the patient increase flexibility in appraisal of social life events may have a positive impact on treatment outcome.
Source: South African Journal of Psychiatry 21, pp 57 –61 (2015) http://dx.doi.org/10.7196/SAJP.590More Less
Background. Cannabis use may trigger or perpetuate clinical features of schizophrenia in vulnerable individuals, thereby contributing to the morbidity of schizophrenia and its burden of disease. These findings have mostly not considered the views of schizophrenia patients on cannabis use and its effect on their mental health.
Methods. A semi-structured 16-point opinion-type questionnaire was formulated from the results of a previous qualitative study on schizophrenia patients' opinions about cannabis use. The questionnaire was applied to 60 participants from an inpatient schizophrenia population at Weskoppies Hospital, Pretoria, South Africa, who had a Diagnostic and Statistical Manual of Mental Disorders, 4th edition (text revision) (DSM-IV-TR) diagnosis of schizophrenia and a documented history of cannabis use.
Results. According to participants' responses, 61.7% admitted to suffering from a mental illness, 95.0% admitted to using cannabis in the past, and 20.0% of participants admitted to the current use of cannabis. Over half (51.7%) of the participants responded that cannabis had adverse effects on their mental health, 26.7% that their mental illness was caused by using an illicit drug other than cannabis, 26.7% that only impure cannabis had adverse effects on their mental health, and 48.3% that only using too much cannabis had bad effects on their mind. A high percentage (58.3%) of participants responded that cannabis use helped reduce tension, 56.7% that it helped reduce anxiety, 66.7% that it helped to lift their mood, 63.3% that it helped them to relax, 60.0% that it helped to relieve their boredom, 43.3% that it helped them feel more energetic, 58.3% that it helped them sleep better, 13.3% that it helped reduce auditory hallucinations, and 31.7% that the beneficial effects of cannabis outweighed its negative effects.
Conclusion. Most of the participants who responded that they were not using cannabis currently had positive views about its effects on their mental health, despite responding that cannabis may have adverse effects on their mental health. This is a worrisome outcome, since those participants who feel that cannabis has more beneficial than detrimental effects might not remain abstinent.
Source: South African Journal of Psychiatry 21, pp 62 –66 (2015) http://dx.doi.org/10.7196/SAJP.823More Less
Objectives. Part I of this research paper presented a needs and gap analysis for the management of schizophrenia, bipolar mood disorder and major depression for the Eastern Cape Province, South Africa. It identified deficits and inequitable distribution of human resources and beds in the province. In this article, Part II, the authors propose a plan for public sector mental health services to address the human resource needs in the poorer eastern regions of the province. The plan focuses on human resource training and development.
Methods. Evidence-based data on staff development in mental health from low-middle income countries were utilised to develop strategies to increase staff capacity to address unmet need. A financing model with a poverty index was developed to sustain a needs-based plan. Databases searched included Pubmed, Medline, Google and Google Scholar. The key words used included: mental health, mental health training, mental health resources, mental health in low-middle-income countries, mental health policy and plans, mental health needs based planning, primary healthcare, primary mental healthcare, mental health financing. In addition the websites of the World Health Organization and the World Psychiatric Association were searched for similar resources.
Conclusions. It is feasible, with careful attention to planning and implementation of evidence-based tools, to improve public mental health service delivery in this province. Sustained political will and professional commitment will ensure successful delivery of mental health services in a resource-limited province.
Psychiatric consultations and the management of associated comorbid medical conditions in a regional referral hospitalSource: South African Journal of Psychiatry 21, pp 67 –72 (2015) http://dx.doi.org/10.7196/SAJP.551More Less
Background. Psychiatrists are often called upon to evaluate patients with a medical condition and psychiatric symptoms, either as a complication thereof or initial presenting symptoms. There are often grey areas with regard to neuropsychiatric disorders in which psychiatrists and specialists from other clinical disciplines would need to co-manage or share ideas on the comprehensive treatment of a presenting patient.
Objectives. This study was undertaken to provide a demographic and clinical profile of all patients consulted by the consultation-liaison psychiatry (CLP) service at the Helen Joseph Hospital (HJH) in Johannesburg, and to describe the clinical management of patients admitted with a diagnosis of a mental disorder associated with a comorbid medical condition, including delirium, dementia and a mood or psychotic disorder due to a general medical condition.
Methods. A retrospective record review of all patients referred to the HJH CLP team over a 6-month period.
Results. A total of 884 routine and emergency consultations were done for 662 patients (males n=305; females n=357) between the ages of 13 and 90 years who were referred from various other clinical departments. The most common documented reason for referral was a request for assessment (n=182; 27.5%), which consisted of mental state assessment, reconsultation and assessing capacity. A total of 63 patients (10.0% of cases consulted) were admitted to either the medical or psychiatric wards with a confirmed diagnosis of delirium, dementia and/or a mood or psychotic disorder due to a general medical condition (although admission wards were identified in 55 files only). The medical wards admitted the majority (n=37; 67.3%) mostly for delirium (n=28; 50.9%). HIV was identified as the most common systemic aetiological factor (n=23; 67.7%).
Conclusion. In this study, a female patient between 31 and 45 years of age was slightly more likely to be referred to the HJH CLP service for assessment, and was more likely to be managed in the medical wards for delirium, which was most often associated with HIV/AIDS. The study highlighted the need for development of guidelines to facilitate adequate and effective use of this service for the local practice of CLP in a general specialist referral hospital like HJH, which would cover the following: clinical management; training needs; and administrative procedures.