South African Journal of Psychiatry - Volume 21, Issue 3, 2015
Volume 21, Issue 3, 2015
Depressive symptoms among children whose parents have serious mental illness : association with children's threat related beliefs about mental illnessSource: South African Journal of Psychiatry 21, pp 74 –78 (2015) http://dx.doi.org/10.7196/SAJP.8253More Less
Background. Sixty-eight per cent of women and 57% of men with mental illness are parents. There is increasing evidence of adverse psychosocial impact of parental mental illness on their children. However, among children whose parents have mental illness, the potential contribution of the children's beliefs about mental illness to their own emotional distress is still poorly understood.
Aim. To explore among children whose parents have serious mental illness, the relationship between the children's beliefs about mental illness and their own depressive symptoms.
Methodology. We conducted an interview-administered questionnaire survey of 67 Nigerian children whose parents were psychiatricin patients. The children's beliefs about mental illness were explored with five questions - two of which embedded threat-related beliefs. Their depressive symptoms were assessed with the Short Mood and Feelings Questionnaire (SMFQ) (Cronbach alpha 0.91). Based on stigma theory, we hypothesised that among this cohort, the children who hold threat-related beliefs about people with mental illness would report statistically significantly more depressive symptoms than those without similar beliefs.
Results. The mean age (standard deviation (SD)) of the children was 13.3 (2.8) years, and 38% were males. Twenty-four per cent of the children believed mental illness is infectious. In line with our hypothesis, those holding this belief had statistically significantly more depressive symptoms compared with those without similar beliefs (p=0.001). Fifty-seven per cent of the children believed that people with mental illness are dangerous. However, contrary to our hypothesis, this belief was not associated with increased depressive symptoms (p=0.2). Multiple regression showed that statistically significant predictors of increased emotional symptoms were 'belief that mental illness is infectious' and younger age. The model explained 39.8% of the variance in SMFQ.
Conclusion. In this and similar settings, psycho-education for children whose parents have serious mental illness should explore whether the children believe that mental illness is infectious. Providing reassurance to children holding such beliefs could reduce their risk of psychological distress.
Source: South African Journal of Psychiatry 21, pp 80 –85 (2015) http://dx.doi.org/10.7196/SAJP.8252More Less
Background. Adolescence represents a challenging transitional period where changes in biological, emotional, cognitive and social domains can increase the risk of developing internalised problems including subthreshold depression. Adolescent-parent attachment style, perceived support and family functioning may increase risk for depressive symptoms or may reduce such risk. Adolescent-parent attachment, adolescent perceived support from parents and family functioning were examined as correlates of depressive symptom presentation within this age group.
Methods. Participants included a maternal parent and an adolescent (65.5% female) from each family. Adolescents were in Grade 7 (n=175) or Grade 10 (n=31). Data were collected through home interviews. The Self-Report of Family Inventory (SFI), Experiences of Close Relationships Scale (ECR), Network of Relationships Inventory (NRI), Children's Depression Inventory (CDI) and Child Behavior Checklist (CBCL) were used to assess depression, parental support and attachment.
Results. Two models were examined: one with adolescent report of depressive symptoms as the outcome and a second with parent report of adolescent internalising symptoms as the outcome. The model predicting adolescent-reported depressive symptoms was significant with older age, higher levels of avoidant attachment, and higher levels of youth-reported dysfunctional family interaction associated with more depressive symptomatology. In the model predicting parent report of adolescent internalising symptoms only higher levels of dysfunctional family interaction, as reported by the parent, were associated with higher levels of internalising symptoms.
Conclusion. Positive family communication, cohesion and support predictive of a secure parent-adolescent attachment relationship reduced the risk of a depressive symptom outcome. Secure adolescents were able to regulate their emotions, knowing that they could seek out secure base attachment relations within their family and from friends during times of stress, buffering against the development of depressive symptoms.
Source: South African Journal of Psychiatry 21, pp 86 –92 (2015) http://dx.doi.org/10.7196/SAJP.8255More Less
Background. State patients are individuals who have been charged with offences involving serious violence and who have been declared unfit to stand trial and/or who are not criminally responsible because of their mental illness or defect. They are referred by the courts for treatment, rehabilitation and indefinite detention at a forensic psychiatric facility. However, many of these state patients may ultimately be released back into the community. As these individuals may be considered a high-risk group, their rates of relapse and recidivism are of importance. There is a paucity of South African literature on the long-term outcome of state patients.
Objective. To describe the profile of state patients, and to examine their outcomes after 3 years, including recidivism rates.
Methods. A descriptive, retrospective study of the clinical records of 114 state patients admitted to Sterkfontein Hospital in 2004 and 2005 was conducted, and their profile and 3-year outcomes were determined.
Results. The majority of state patients were male, single, unemployed, had a past psychiatric history (59%), and substance abuse history (71%). A third reported a past criminal history. The most common offences were assault with the intention to do grievous bodily harm (19%), rape (18%) and murder (13%). Psychotic disorders represented the most common diagnostic category (69%), with schizophrenia being the most frequent diagnosis (44%). Most state patients had been found unfit to stand trial (96%) and not criminally responsible (89%). At the end of the 3-year follow-up, the majority were in the community (69%), of whom most (72%) were out on leave of absence (LOA), while a quarter had absconded and a minority were reclassified (3%). Most absconders (83%) were state patients who had not returned from LOA. The recidivism rate was 4%.
Conclusion. Most state patients were out in the community at the end of the 3-year period. The following recommendations are suggested: improved community psychiatric services, especially for those diagnosed with psychotic disorders and mental retardation, with a focus on improving treatment adherence and early detection of treatment defaulters; improved substance abuse rehabilitation programmes and community facilities, as well as strengthening of systems that manage absconders.
Source: South African Journal of Psychiatry 21, pp 94 –97 (2015) http://dx.doi.org/10.7196/SAJP.8260More Less
South Africa has the highest proportion of HIV-positive people in the world. HIV cannot be cured; however, there are several major classes of drugs used in its management. Efavirenz is one such agent of the class non-nucleoside reverse transcriptase inhibitors which inhibits the replication of the virus. Efavirenz is associated with causing neuropsychiatric side-effects (NPSEs), with almost 50% of patients experiencing at least one NPSE while on treatment. The NPSEs tend to occur within the first few days of initiation of therapy and resolve spontaneously within the first 4 - 6 weeks, with the most commonly reported being dizziness, insomnia, headache, abnormal dreams and impaired concentration. The plasma level of efavirenz and genetic polymorphisms are thought to play a role in the development of such NPSEs. NPSEs need to be treated according to severity. If necessary, efavirenz may be replaced with nevirapine or lopinavir/ritonavir. It should be remembered that nevirapine may also produce some severe side-effects such as skin abnormalities and hepatotoxicity. The monitoring of patients receiving efavirenz therapy should be ongoing, with those with a history of mental illness requiring closer monitoring than others.
Attendance at an outpatient follow-up clinic by HIV-positive psychiatric patients initiated on ART as inpatientsSource: South African Journal of Psychiatry 21, pp 98 –102 (2015) http://dx.doi.org/10.7196/SAJP.8254More Less
Background. Evidence suggests that the presence of mental illness may be associated with poorer adherence to antiretroviral therapy (ART). There is also a general understanding that patients initiated on ART as inpatients have poorer outcomes than those initiated as outpatients. Negative perceptions regarding future adherence may affect the clinical decision to initiate ART in hospitalised psychiatric patients. Attendance at clinic appointments is an indicator of medication adherence, and is easily measurable in a limited-resource setting.
Objectives. The primary objective of this study was to examine the rate of attendance at the first clinic appointment post discharge from a period of psychiatric hospitalisation in HIV-positive psychiatric patients initiated on ART as inpatients. A secondary objective was to determine which factors, if any, were associated with clinic attendance.
Methods. This study was a retrospective record review, conducted at the Luthando Neuropsychiatric HIV Clinic in Soweto, which is an integrated mental healthcare and ART clinic. Patients who were initiated on ART as psychiatric inpatients from 1 July 2009 to 31 December 2010, and subsequently discharged for outpatient follow-up at Luthando Clinic were included in the sample.
Results. There were 98 patients included in the analysis. The sample was predominantly female. The rate of attendance was 80%. The attendant and non-attendant groups were similar in terms of demographic and clinical data. Significantly fewer non-attendant patients had disclosed their HIV status to their treatment supporter (p=0.01).
Conclusion. Non-disclosure of HIV status needs to be further addressed in integrated psychiatric HIV treatment facilities in order to improve attendance. Female predominance in this setting should also be further investigated.
Source: South African Journal of Psychiatry 21, pp 104 –106 (2015) http://dx.doi.org/10.7196/SAJP.8251More Less
Background. The prevalence of body dysmorphic disorder (BDD) among South African students is explored in this article. BDD is regarded as an obsessive-compulsive-related disorder characterised by a preoccupation with one or more perceived defects or flaws in physical appearance and expressed in repetitive behaviours or mental acts as a response to the appearance concerns, causing clinically significant distress or impairment in functioning.
Objectives. To determine the prevalence of BDD among undergraduate students (N=395) at an inner-city university.
Methods. Proportionate stratified random cluster sampling was used to select the sample. The students completed a demographics survey and the Body Image Disturbance Questionnaire.
Results and conclusion. An overall prevalence rate of 5.1% was found in this study, which is similar to prevalence rates reported in existing literature among student populations. No clinically significant differences in the severity of the BDD were found on the demographic variables of gender, race or sexual orientation. However, students differed significantly in their experience of the severity of the disorder in terms of age, in that students over the age of 21 reported higher severity levels than students under the age of 21. Although the prevalence of the disorder compares with that in other countries, its severity seems to increase with age among South African students.
Overcrowding as a possible risk factor for inpatient suicide in a South African psychiatric hospital : letterSource: South African Journal of Psychiatry 21 (2015) http://dx.doi.org/10.7196/SAJP.8257More Less
The risk of suicide among people with mental illness is estimated to be 10 times higher than in the general population. About 4% of all suicides in England and Wales are estimated to occur while the person is an inpatient in a psychiatric facility. Surveys have found that most psychiatrists have personal experience of the suicide of a patient under their care in hospital. In order to actualise efficacious treatment, it is imperative that the contributing causes of inpatient suicides be examined.
The purpose of this letter is to explore the potential risk factors and to consider the possibility of whether overcrowding could have been a contributing element when three inpatients committed suicide in the male acute ward of a psychiatric hospital in the Eastern Cape, between March 2012 and August 2013.