South African Psychiatry Review - Volume 8, Issue 4, 2005
Volume 8, Issue 4, 2005
Author Myles ConnorSource: South African Psychiatry Review 8, pp 125 –126 (2005)More Less
The prevalence of disabling stroke in South Africa is already higher than in high income countries. Exposure to stroke risk factors is already at alarming levels and is likely to increase, adding further to the burden of stroke. The obvious solution from a health care perspective is to reduce risk at a population and high-risk individual level. However, for the individual presenting with an acute stroke the best possible care is needed to optimise their outcome and own personal long-term burden of disease.
Major depressive disorder as a co-morbid diagnosis in schizophrenia versus the diagnosis of schizoaffective disorder - depressed type : reviewSource: South African Psychiatry Review 8, pp 134 –139 (2005)More Less
The purpose of this article is to focus on the importance of depressive symptoms in patients suffering from schizophrenia, and the dilemma posed by hierarchical classification methods, which exclude co-morbid diagnoses such as Major Depressive Disorder in patients with schizophrenia. The question arises that if Major Depressive Disorder is only categorized under the diagnosis of Schizoaffective Disorder (depressed type), are we able to recognize these symptoms promptly and treat them sufficiently? The duration of the substantial period of depressed mood referred to in the DSM IV TR criteria for Schizoaffective Disorder is unspecified. We suggest that one should only allocate the latter diagnosis if the substantial period is that of one third or more of the whole duration of the illness. Identification of the optimal cutoff point can generate further hypothesis testing research and refinement of the diagnostic model. It is not only important to refine the diagnosis, but it is even more important to detect these symptoms and treat promptly and effectively. According to the latest literature, the best possible treatment for depression in schizophrenia appears to be the combination of a second-generation antipsychotic and cognitive psychotherapy.
Standards for the mental health care of people with severe psychiatric disorders in South Africa : part 1. Conceptual issues : reviewSource: South African Psychiatry Review 8, pp 140 –145 (2005)More Less
Part one describes conceptual issues underlying the development of South African standards for people with severe psychiatric disorders. Mental health care standards seek to describe what is an acceptable and adequate quality of mental health care for service users. A focus on service quality is especially crucial in resource constraint contexts. Standards are essential tools for quality assurance, advocacy and rights protection, capacity and management development and dialogue. They should be appropriate, useful and patient-centred, and operationalise local policy and legislation. Mental health standards are a challenge to define, and need to combine both a consumer and rights based approach. International and local standards and views were adapted and included in order to develop these standards which should be applicable, measurable and gradable across all South African contexts.
Standards for the mental health care of people with severe psychiatric disorders in South Africa : part 2. Methodology and results : original articleSource: South African Psychiatry Review 8, pp 146 –152 (2005)More Less
Objective : Mental health care standards have been developed to describe what is an acceptable and adequate quality of mental health care for service users in South Africa. Part two describes the standards development methods, the range of standards developed and, as an example, the rights and protection standards domain.
Methods : A systematic literature review and broad consultation to develop a set of normative-based standards. Consultation included widespread draft document distribution/feedback, in-depth provincial workshops, and focus groups. Structually, detailed criteria and sub-criteria were developed for measurability and adequate detail in key service areas.
Results : Three types of standards were developed: core standards, standards for service delivery and for specific settings. Standards to ensure the rights and protection of varied service users within a range of contexts are described.
Conclusion : A standards document is an essential component of a quality improvement process, within the context of a supportive legislative, political and managerial framework.
Early non-psychotic deviant behaviour as an endophenotypic marker in bipolar disorder, schizo-affective disorder and schizophrenia : original articleSource: South African Psychiatry Review 8, pp 153 –159 (2005)More Less
Objective : To determine and compare the incidence of early non-psychotic deviant behaviour (i.e. under the age of ten) in Afrikaner patients with bipolar disorder, schizo-affective disorder and schizophrenia.
Methods : Patients with bipolar disorder, schizo-affective disorder and schizophrenia were interviewed using a structured questionnaire probing for early deviant childhood behaviour starting before the age of 10 years. Information from close family members was also obtained where possible. Seven areas of possible deviance were probed into: social dysfunction, unprovoked aggression, extreme anxiety, chronic sadness, extreme odd behaviours, attention impairment and learning difficulties. Demographic data included: age, marital status, gender, and years of formal education. The following clinical features were also recorded: age of onset of illness and suicide attempts.
Results : A total of 74 patients diagnosed with bipolar disorder, 43 patients diagnosed with schizo-affective disorder and 80 patients diagnosed with schizophrenia were interviewed. Early deviant behaviour was statistically more prevalent in schizophrenia (65%) and schizo-affective disorder (60, 5%), than in the bipolar group (21, 6%). Deviant childhood behaviour was grouped into 3 clusters: social functioning impairment cluster (social isolation, aggression, extreme odd behavior), mood/anxiety cluster (extreme fears, chronic sadness) and a cognitive impairment cluster (attention impairment, learning disability). Bipolar patients showed significantly less social functioning and cognitive impairment compared to patients with schizo-affective disorder and schizophrenia.
Conclusion : Our findings suggest that early deviant behaviour may be a possible endophenotypic marker in schizophrenia and schizoaffective disorder.
Substance abuse and HIV risk behaviours amongst primary health care service users in Cape Town : original articleSource: South African Psychiatry Review 8, pp 160 –165 (2005)More Less
Objective : To document prevalence of, and association between, substance use and HIV risk behaviours among primary care patients.
Method : Cross-sectional survey. Four primary care clinics in Cape Town. We selected clinics using stratified sampling, and systematically selected 131 patients from attendance logs. We assessed substance use with the Alcohol, Smoking and Substance Involvement Screening Test, and HIV risk with items addressing injection drug use, blood-sharing rituals, and sexual risk behaviours.
Results : Substances most used at hazardous levels were tobacco (28.2%) and alcohol (14.8%). Among possible HIV risk factors, highest prevalence was participation in blood-sharing rituals (25%), and having had an STI (19.8%). An association between substance use and sexual risk behaviours was only found among those aged 18-24.
Conclusion : In younger patients, presence of substance use or HIV risk behaviours increases the probability that the other is present.
Source: South African Psychiatry Review 8 (2005)More Less
The Regular Annual WPA/Eastern & Southern Africa Meeting will next year take place in Addis Ababa, together with the AAPAP Scientific meeting. The call for abstracts is now out and you are encouraged to send in your abstracts before the stated deadline as per attached call message from the Chairman Organising Committee, Dr. Atalay Alem. Your attendance will enrich the usually very exciting congresses in our Region.
Author M. NaidooSource: South African Psychiatry Review 8 (2005)More Less
At first glance, one may not see how we as psychiatrists can surf the IT wave. I am not referring to our daily contact at present with PowerPoint, Excel, Word etc, I refer to using innovative software and hardware which we can integrate into our practice. Having now worked for 18 months on the Medical officer/Registrar rotation, I have identified a few areas where IT can be integrated.
Author S. BaumannSource: South African Psychiatry Review 8 (2005)More Less
While I am grateful to the Journal for publishing my perhaps rather unconventional and discursive article, "The schizophrenias as disorders of self-consciousness" (August 2005) I was dismayed that the title I had chosen was discarded, without consultation with myself, and without explanation. My title was "Do elephants suffer from schizophrenia?" with the above as a subtitle, with the important addendum: "a southern African perspective." Did the editor think the question about elephants merely frivolous, not befitting the arid conventions of a scientific journal, and the southern African context irrelevant?
Author B.A. IssaSource: South African Psychiatry Review 8, pp 171 –173 (2005)More Less
Autism or autistic disorder was first described by Kanner in 1943. It is associated with abnormalities of communication, of social development and a restriction of behaviour and interests. The prevalence of autism is put at 30-40 per 100, 000 children and is four times as common in boys as in girls. Onset is usually before age of three (3) years The etiology of autism has been a matter of speculation.
Source: South African Psychiatry Review 8 (2005)More Less
Source: South African Psychiatry Review 8, pp 178 –180 (2005)More Less
Electroconvulsive Therapy (ECT) is a medical procedure used to treat various mental and neurological illnesses. It is, however, most commonly used to treat severe clinical depression, a condition characterized by a depressed mood and various other physiological disturbances, including sleep and appetite disturbances, and libido dysfunction. The procedure is performed by a highly skilled psychiatrist and involves inducing a controlled seizure. Its efficacy in treating severe mental illness is recognized by, amongst others, the American Psychiatric Association, the American Medical Association and the National Institute of Mental Health.