South African Psychiatry Review - Volume 9, Issue 1, 2006
Volume 9, Issue 1, 2006
Author Christopher P. SzaboSource: South African Psychiatry Review 9, pp 1 –5 (2006)More Less
Extracted from text ... South African Psychiatry Review ? February 2006 1 EDITORIAL S Afr Psychiatry Rev 2006;9:1-5 The Mental Health Care Act was promulgated in December 2004. Although this was not unexpected, the timing had certainly not been anticipated. Overnight the mental health care landscape was transformed. Not only had all of our professional designations been collapsed into a single entity of "mental health care practitioners", but our patients were now "users". One might say that this was purely semantics, still it was change and not change that one can recall ever having been canvassed about. But this was relatively minor. The ..
Training undergraduate medical students in 'soft skills' - a qualitative research project at the University of Pretoria : guest editorialSource: South African Psychiatry Review 9, pp 12 –14 (2006)More Less
Extracted from text ... South African Psychiatry Review ? February 2006 12 GUEST EDITORIAL S Afr Psychiatry Rev 2006;9:12-14 Training undergraduate medical students in 'soft skills' - a qualitative research project at the University of Pretoria C Kr?ger1, WJ Schurink2, A-M Bergh3, PM Joubert1, JL Roos1, CW Van Staden1, GE Pickworth4 , RR Du Preez1, SV Grey5, BG Lindeque6 1Department of Psychiatry, Faculty of Health Sciences, University of Pretoria, South Africa 2Social Science Research Consultancy (SSRC), Pretoria, South Africa 3Education Office, Faculty of Health Sciences, University of Pretoria, South Africa 4Education Consultant, Faculty of Health Sciences, University of Pretoria, South Africa 5Deputy Dean, Faculty ..
Source: South African Psychiatry Review 9, pp 17 –23 (2006)More Less
Whilst gains have been made in recent years in the pharmacological treatment of schizophrenia, a number of patients still have residual symptoms and disabilities, or simply do not show response to antipsychotic medications. For such 'treatment resistant' patients, there is little by way of randomised controlled data to support any particular type of further intervention, but combinations of agents (combined antipsychotics, augmentation with mood stabilisers, antidepressants, and other agents)can show benefit in certain patients in certain domains of symptomatology and psychosocial functioning. Certain psychological and psychosocial treatment strategies can also be of benefit in this regard. This article selectively reviews the literature treatment resistance in schizophrenia, and emphasises the importance of an holistic approach to individual patients.
Antidepressant induced sexual dysfunction, part 1 : epidemiology and clinical presentation : review articleAuthor S. JespersenSource: South African Psychiatry Review 9, pp 24 –27 (2006)More Less
Sexual dysfunction is a common side effect of treatment with antidepressants, particularly those with a predominantly serotonergic mechanism of action. Although there has been an increasing awareness of the problem in recent years, it is still probably true to say that sexual side effects often go undetected. Antidepressant induced sexual dysfunction has significant implications for a patient's quality of life and that of their family unit. The issue cannot be ignored because it is likely to impact on a patient's sense of wellbeing, their compliance with medication and ultimately the prognosis of their illness. This review will be presented in two parts. The first part focuses on the prevalence of antidepressant induced sexual dysfunction and its clinical presentation both generally and in the case of individual classes of antidepressants. The second part will focus on the assessment and management of the problem. The aim of this review is to improve overall awareness of sexual side effects and to suggest a rational approach to their detection and management. It is not intended to be a detailed exploration of underlying causative mechanisms and receptor neurochemistry.
Medical students on the value of role models for developing 'soft skills' - "That's the way you do it" : original articleSource: South African Psychiatry Review 9, pp 28 –32 (2006)More Less
<I>Objective:</I> The Soft Skills Project examined the professional development of medical students at the University of Pretoria, especially their doctor-patient interaction skills and professional socialisation. This paper reports on one of the findings of the project, namely the importance that medical students attach to role models in the development of soft skills. <br><I>Methods:</I> We used a qualitative method with symbolic interactionism and grounded theory as framework. Fourty two final-year students from the last cohort following the traditional curriculum at the University of Pretoria in 2001, and 49 final years from the first cohort following the reformed curriculum in 2002 were recruited. Data were collected by applying focus groups, in-depth, individual interviews, as well as autobiographical sketches. Data were captured by means of audio tape recordings, transcripts of the tapes, researchers' field notes, and written accounts by students, and were analysed by using a general inductive approach. <br><I>Results:</I> There were no striking differences between the comments of the two groups. Students considered registrars to be the most influential role models in the clinical teaching context, followed by specialist consultants. Their idea of a good role model was a clinically and academically competent doctor that cared about patients, had good interpersonal skills, and who could inspire students. Students needed and appreciated good role models to help them to develop their own soft skills. They expected guidance and behavioural examples from clinical teachers. Although there were competent role models, the students were exposed to poor role models. Poor role models mainly affect students negatively. Students tend to imitate and perpetuate unacceptable behaviour. Furthermore, poor role models have a negative emotional effect on students and are detrimental to their moral and learning environment. Sometimes, poor role models have a paradoxical positive effect in the sense that they inform students how not to behave. <br><I>Conclusion: </I> Medical schools and medical doctors working with medical students should be consciously aware of the importance of role models both when allocating clinical teachers to students, and while performing duties with students. It is especially necessary to realise that poor role modelling has important detrimental effects on students. Therefore, an attempt should be made to ensure that not only clinical examination skills, but also soft skills, are demonstrated at the bedside. Measures to ensure adequate exposure of students to positive role models could include: staff development; the identification of good role models to guide registrars; and a reallocation of tasks, where possible, to increase the exposure of students to the 'natural' role models.
The conceptualisation of "soft skills" among medical students before and after curriculum reform : original articleSource: South African Psychiatry Review 9, pp 33 –37 (2006)More Less
<br><I>Objective:</I> This paper reports on the conceptualisation of "soft skills" as part of a study carried out among two groups of undergraduate medical students before and after curriculum reform at the School of Medicine of the University of Pretoria. Congruent with a call from the World Psychiatric Association, the curriculum reform that was undertaken aimed, inter alia, to place more emphasis on soft skills, including professional interpersonal and social skills, communication skills, and professional and ethical attitudes. <br><I>Methods:</I> Qualitative methods were used to arrive at a descriptive comparison of the conceptualisation of soft skills by final-year medical students of the traditional curriculum with those of final-year students who had followed the reformed curriculum. A purposive-theoretical sampling method was followed; 42 students from the traditional curriculum and 49 from the reformed curriculum were sampled. Data were collected from seven focus groups, 16 individual interviews, and 23 essays (autobiographical sketches). <br><I>Results:</I> Both groups of students revealed conceptualisations of soft skills that were similar in kind. The themes they pinpointed were the doctor-patient relationship; relationships with other professionals; being a good listener; explaining things to patients; using good communication skills; establishing rapport with patients from different cultural backgrounds; having a professionally correct attitude; being really interested in patients' well being; having empathy; coping with patients, managing difficult situations, and being ethical and professional. However, the traditional curriculum students offered fewer examples and described fewer experiences that exemplified their soft skills. Students following the reformed curriculum gave rich accounts of their conceptualisation in terms of their own experiences and practical examples of how soft skills had been or could be used, particularly in difficult interpersonal situations. Moreover, they came up with helpful ways of dealing with difficult situations, which surpassed the suggestions offered by the students following the traditional curriculum. <br><I>Conclusion:</I> The educational and training efforts of the reformed curriculum are associated with an adeptness on the part of the students at applying soft skills to the demands of difficult clinical situations.
Source: South African Psychiatry Review 9, pp 38 –43 (2006)More Less
<I>Objective:</I> The newer atypical antipsychotics are prescribed because of their enhanced safety profiles and their larger pharmacological profile in comparison to the conventional antipsychotics. This has led to broad off-label utilisation. The aim of the present survey was to study the prescribing practice of hospital psychiatrists with regard to antipsychotic drugs, comparing patients treated for psychoses or other registered indications to patients receiving off-label antipsychotic treatment. <br><I>Methods:</I> As part of a pharmacovigilance/pharmacoepidemiology program, all drugs given on 5 reference days (1999 - 2001) in the 98- bed psychiatric hospital of the University of Lausanne, Switzerland, were recorded along with age, sex, and diagnosis. The prescriptions of 202 patients were assessed. Patients were classified in 3 diagnostic groups: (1) patient with psychotic disorders, (2) patients with manic episodes and depressive episodes with psychotic symptoms, and (3) patients with other disorders. Group (1) and (2) formed the class of patients receiving an antipsychotic for a registered indication, and the prescriptions in group (3) were considered as off-label. <br><I>Results:</I> A lesser number of psychotic patients received antidepressant (p<0.05) and nonbenzodiazepine hypnotics (p<0.001) compared to the patients of the other two groups. The patients with affective disorders seldom received a combination of an atypical and a conventional antipsychotic, whereas a lesser number of patients with offlabel indications received atypical antipsychotics less often than those of the two comparison groups (p<0.05). Stepwise logistic regression revealed that patients with a psychotic disorder were more likely to receive an antipsychotic medication in medium or high doses (p<0.001), in comparison to the two other groups. <br><I>Conclusion:</I> The new antipsychotic drugs seem to be prescribed with less hesitation and mainly for approved indications. Physicians prescribed new drugs, off-label , only after having gained some experience in the field of the approved indications, and were more cautious with regard to doses when treating on an offlabel basis.
International Anxiety Disorders Conference, 24- 26 February 2006, Spier Estate, Stellenbosch, South Africa : abstractsSource: South African Psychiatry Review 9, pp 45 –58 (2006)More Less
Extracted from text ... South African Psychiatry Review ? February 2006 45 ABSTRACTS S Afr Psychiatry Rev 2005;8:45-58 INTERNATIONAL ANXIETY DISORDERS CONFERENCE 24- 26 February 2006 Spier Estate, Stellenbosch, South Africa ORAL PRESENTATION ABSTRACTS Treatment of Generalised Anxiety Disorder Christer Allgulander Karolinska Institutet, Stockholm, Sweden The neurobiology of anxiety and mood disorders appears to be shared, and patients with primary anxiety disorders are at increased risk of developing secondary depressive episodes. Frequently, these disorders are found within the same family, indicating a shared diathesis. One study found an increased frequency of the short/short allele genotype for 5-HTTLPR (You et al 2005). According to ..
Author B.L. MeelSource: South African Psychiatry Review 9, pp 61 –62 (2006)More Less
Extracted from text ... South African Psychiatry Review ? February 2006 61 LETTER TO THE EDITOR S Afr Psychiatry Rev 2006;9:61-62 Transkei was a black homeland in South Africa before 1994. Historically, it is well known for spearheading the freedom fight against apartheid in South Africa because most of the leaders of the ANC hail from this region. Transkei is characterized by a lack of infrastructure and hence a high rate of unemployment. The majority of inhabitants are dependent on income from migrant mineworkers or subsistence farming at home. The Eastern Cape Province is the second largest in South Africa, comprising of 15.5% ..
Source: South African Psychiatry Review 9 (2006)More Less
Extracted from text ... South African Psychiatry Review ? February 2006 65 PRODUCT NEWS S Afr Psychiatry Rev 2006;9:65 The new dual reuptake inhibitors (SNRIs), such as duloxetine, display a balance between serotonin (5-HT) and noradrenaline (NA) selectivity. These new antidepressants may offer improvements in efficacy, in the same way that the SSRIs introduced improvements in tolerability over the TCAs (through reduced affinity for alpha 1, histamine H 1 and cholinergic receptors). Figure 1 It is likely that dual reuptake inhibition is able to cover more of the symptoms experienced with depression. This greater spectrum of effectiveness may result in more responders and ..
Author Winnie De RooverSource: South African Psychiatry Review 9, pp 67 –68 (2006)More Less
Extracted from text ... South African Psychiatry Review ? February 2006 67 PHOTOCOPY FOR YOUR PATIENTS!! PATIENTS AS PARTNERS Brought to you by The South African Depression and Anxiety Group Tel: +27 11 783 1474 Fax: +27 11 884 7074 E-mail: firstname.lastname@example.org website: www.anxiety.org.za Although there is an increasing awareness of psychiatric disorders in primary care, many of these conditions remain underdiagnosed and under-treated. Depression in particular, remains significantly unidentified in primary practice. This article aims to stipulate the crucial role the primary healthcare professional plays in the diagnosis and treatment of depression and anxiety in South Africa. The anxiety disorders: panic disorder ..