South African Psychiatry Review - Volume 8, Issue 3, 2005
Volume 8, Issue 3, 2005
Author Barry Vincent MendelowSource: South African Psychiatry Review 8, pp 89 –94 (2005)More Less
The molecular dimension of biology has been finding practical applications in all fields of medicine over the last few decades, but arguably one of the most challenging and exciting areas is that of molecular psychiatry. Much progress has been gained from traditional linkage studies into gene candidates for various psychiatric disorders, including schizophrenia, bipolar states, bulimia, autism and attention deficit hyperactivity disorder. This review outlines basic principles of molecular medicine from the perspective of the human genome project and its role in enabling rapid progress in the understanding of molecular neuro-anatomy, physiology and pathology. These insights have facilitated rather than complicated the diagnostic process, and have paved the way, in what has been termed the "post-genome era", for a rational approach to therapy in a growing range of disorders. A patient's inherited genetic constitution is but one aspect of molecular medicine, and rich insights are also being gained into the operation of the genome as it interacts with its environment, including its pharmacological environment. From parallel processing technologies and genomic expression profiling, massive knowledge is being gained into the anatomical and physiological patterns of gene expression in different tissues and organs, their derangements in disease and their pharmacological manipulation. The brain is no exception, and an appreciation is being accumulated of the three dimensional anatomical localization of cerebral gene expression patterns, of great relevance to a fundamental understanding of neurobiology. From this new paradigm and others, insights are now being gained into the molecular biology of a variety of topics previously thought to be beyond the scope of molecular dissection, such as language and emotion.
Author Sean Exner BaumannSource: South African Psychiatry Review 8, pp 95 –99 (2005)More Less
There are limitations to the meaningfulness and usefulness of the diagnosis of schizophrenia. These limitations have important treatment implications. A re-evaluation of the phenomenology of the disorder, and in particular the formation of delusions, provides a potentially useful heuristic framework. A disturbance of the experience of the self, and of the self in relation to the external world, may underpin the phenomenology of schizophrenia. Putative biological substrates are described, and an integrative model is proposed, whereby higher centres, or mind, strive to modulate lower biological events, experienced as anomalous, in order to restore a meaningful homeostasis. These distorted representations form the characteristic symptoms of schizophrenia. Analogies are drawn with current strategies for managing chronic pain. Differences in the value accorded to the self across cultures, and the variations in outcome corresponding with these differences, are proposed as evidence and indicate a need for a paradigm shift in the philosophy of treatment of the disorder.
Community placement and reintegration of service users from long-term mental health care facilities : original articleAuthor Bernard Janse van RensburgSource: South African Psychiatry Review 8, pp 100 –103 (2005)More Less
<I>Objective:</I> To ascertain community placement and reintegration of service users from long-term mental health care facilities. <br><I>Method:</I> This study reviewed the progress during 2003 with the alternative placement of a selected candidate group of 27 service users in some of Lifecare's long-term mental health care facilities in Gauteng. <br><I>Results:</I> Despite a significant amount of time and effort to find alternative options with family, old age homes or other non-governmental organizations, only 9 (33%) were placed a year later. A longer follow-up period however is necessary to ascertain the actual successful outcome of these placements. <br><I>Conclusions:</I> Concerns exist about sufficient development of community-based services in accordance with the new Mental Health Care Act (Act No. 17 of 2002), parallel to hospital-based care.
Source: South African Psychiatry Review 8, pp 104 –107 (2005)More Less
<I>Objective:</I> Non-fatal suicidal behaviour (NFSB) severely impacts on the health services and the resources of a country and should be prevented. The aim of this control study was to describe a group of patients with NFSB and to elicit, if any, the factors associated with this behaviour compared to a non-suicidal control group. <br><I>Method:</I> Interviews were conducted on patients with NFSB treated in the Johannesburg Hospital medical emergency rooms. The information was gathered by way of a questionnaire and included: patient demographics, past history of psychiatric and medical illness, family history, habits and social adjustment. <br><I>Results:</I> The study sample comprised forty-three patients with NFSB (mean age = 29.7 years) and control group of forty-five non-suicide attempters (mean age = 30.9 years). 26 (60.5%) of the patients and 33 (73.3%) of the controls were females. 10 (23.3%) of the patients had been treated for NFSB within the preceding 12 months. Patients with a past history of a psychiatric illness or of physical or sexual abuse were significantly more likely to exhibit NFSB compared to the control group (p < 0.05). <br><I>Conclusions:</I> Patients who threaten deliberate self-harm and who have a history of previous NFSB, past psychiatric illness and physical or sexual abuse, are at a higher risk of this behaviour as compared to the general population. If NFSB intentions are suspected in or voiced by an individual, then these risk factors should be assessed and appropriate preventative measures instituted.