South African Psychiatry Review - Volume 9, Issue 4, 2006
Volume 9, Issue 4, 2006
Author Christopher P. SzaboSource: South African Psychiatry Review 9, pp 193 –195 (2006)More Less
The drive towards evidence based approaches in medicine, is designed to inform clinical practice. To this end, there are journals (generally not open access, e.g. Evidence Based Mental Health) and internet sites dedicated to informing mental health care practitioners of evidence on a range of issues related to clinical practice, including prescribing. This is certainly to be welcomed insofar as both clinicians and patients might feel more comfortable with treatment decisions.
Author Jonathan D. JansenSource: South African Psychiatry Review 9, pp 203 –205 (2006)More Less
a. By 'discovery' Boyer means inquiry, or what we traditionally call 'research' into knowledge; application refers to the service role of academic knowledge; integration means the drawing together of knowledge from across disciplines; and teaching as an act that extends and deepens, rather than simply transmits, knowledge.
b. I deploy the term 'discipline' here as a convenient catch-call phrase that includes the many ways in which the traditional 'disciplines' are configured, including trans-, multi- and interdisciplinary forms of scholarly inquiry.
Consent procedures and electroconvulsive therapy in South Africa : impact of the Mental Health Care Act : review articleSource: South African Psychiatry Review 9, pp 206 –215 (2006)More Less
The introduction of the new Mental Health Care Act (MHCA) No 17 of 2002 has highlighted the ethical treatment in least restrictive environments for patients suffering from mental illness. The legislation has highlighted several shortcomings in the consent procedures that were previously utilised for psychiatric patients. Electroconvulsive Therapy (ECT) is a controversial treatment modality hence consent procedures for its use are particularly important. The use of ECT is a highly regulated and legislated treatment in most countries, but not in South Africa. Up until the introduction of the MHCA, and its implementation in December of 2004, legislation and monitoring of the use of ECT in South Africa had been conspicuous by its absence. The MHCA will potentially have an impact on the practice of ECT in a variety of ways. This paper is intended to highlight, for the ECT practitioner, both the implications of these changes as well as propose new consent procedures for ECT.
Source: South African Psychiatry Review 9, pp 216 –219 (2006)More Less
Violence has become a pervasive part of the social fabric of South African society, and researchers have shown that young people are twice as likely as adults to be victims of at least one crime. As a result schools are frequently perceived as places associated with harm and fear. This paper sets out to briefly explore the policy context, describe some of the shooting incidents and considers some ways of addressing accidental shootings in school. While there are many concerns related to school violence, this paper focuses on accidental shootings.
Some simple steps are proposed to make students more aware of potential tragedies associated with guns.
- Schools should have periodic talks or lectures about the lethality of guns, especially with boys and students should be made aware of the incidents that have occurred in schools.
- Parents must be made aware that many youths get guns from home. Guns need to be locked-up, or not owned at all. Parents must be made aware in writing that they can be held responsible if a gun is taken from home by a youth and brought to school.
- Students should be made aware of the importance of immediately reporting if they see a gun or suspect that a student has a gun.
These steps cannot guarantee a gun-free school or that gun-related violence will not occur; rather, they are steps that are useful in helping to prevent a tragedy, as they raise awareness and communication about guns in school.
Source: South African Psychiatry Review 9 (2006)More Less
Violence has become part of everyday life. As such, the content of the article makes a valuable contribution. A recent two-day conference held by the Human Rights Commission of South Africa in Cape Town placed the phenomenon of violence in our schools in the spotlight. The conference took the form of public hearings over the two-day period and the message was clear: violence in schools is a significant problem and its occurrence is on the increase.
Source: South African Psychiatry Review 9 (2006)More Less
Sevoflurane induction for electroconvulsive therapy (ECT)- a clinical review and cost analysis : original articleSource: South African Psychiatry Review 9, pp 223 –228 (2006)More Less
Objective : The search for an ideal induction agent for use in electroconvulsive therapy (ECT) has been a long one. To date numerous agents have been used and there is little uniformity in clinical practice regarding agent of choice. Recent reports in the literature suggesting the efficacy of the volatile anaesthetic agent sevoflurane for ECT have appeared. As a result of these reports the Tara ECT unit converted to sevoflurane for induction purposes, hence the need for both a clinical review and cost analysis.
Method : This report is a retrospective clinical chart review of all patients treated with sevoflurane induction over the course of the first year of its use in this ECT unit, together with a brief cost analysis comparison to the previous induction agent used.
Results : In our experience sevoflurane has been fairly well tolerated and has improved patient anaesthetic induction morbidity but appears to be associated with a shorter duration of motor seizure, potential haemodynamic complications and an increased financial burden for the hospital.
Conclusion : This report is from a naturalistic setting with most patients being on concomitant medications and suffering with various medical and psychiatric problems and thus should be generalizable to other ECT units.
Agenesis of the corpus callosum with associated inter-hemispheric cyst and right frontal pachygyria presenting with psychiatric symptoms in a Kenyan : case reportSource: South African Psychiatry Review 9, pp 229 –230 (2006)More Less
This case report presents a 26 year old man who had a history of childhood onset seizures, mild cognitive slowing and social withdrawal. He gradually developed symptoms of depression and attempted suicide once. He presented to the authors following a recurrence of his seizures. On examination they noted a normal general and neurological examination apart from some frontal lobe signs on mental status examination. He also had features of psychosis and labile mood. On CT brain scan he had agenesis of the corpus callosum (CC) with associated interhemispheric cyst and right frontal pachygyria. The authors suggest that clinicians in developing countries should be alert to organic disorders presenting with psychiatric symptoms.
Source: South African Psychiatry Review 9, pp 231 –234 (2006)More Less
A family was discovered living in isolation in the Free State region of South Africa. Certain members of this family, (the mother and three sons and a daughter) displayed primitive and ape-like behaviour, prompting the local and international press to refer to them as a feral family. The affected members of the family are presented as a case study describing how the family became isolated, their response to outside intervention and eventually how the family was "discovered". Clinical presentations are also documented as well as the therapeutic interventions used. After evaluation, the affected members of the family were shown to have various degrees of mental retardation. The words 'feral' and 'neglect' are defined and certain similar documented cases of feral children discovered previously in other regions are mentioned. The etiology of the condition is explored, discussing the effects of the environment on various aspects of neural development in children, especially referring to the lack of neuro-stimulation and other insults to the brain during the critical phase of brain plasticity. Cognitive deficits, poor mastery of language and decrease in brain size are often found in feral children. The role of a child's genetic predisposition and a paucity of environmental stimulation is also explained in the article.
Source: South African Psychiatry Review 9 (2006)More Less
"This is the voice I want to use...." Bree Osbourne (played by Felicity Huffman) repeats over and over in the opening scene of a film about a pre-operative male-to-female transsexual 'going through the motions' in establishing her new sexual identity. This first-glance appearance soon changes drastically as the plot develops and new characters are introduced. Bree receives a phone call one day that makes her realise she 'fathered' a son - Toby Wilkens (played by Kevin Zegers).
Author Z. AshtariSource: South African Psychiatry Review 9 (2006)More Less
Akinetic mutism (AM) is defined as a form of stupor, characterised by severe apathy. In AM the patient is alert, conscious of surroundings and able to see and hear, but unable to move (akinetic) and unable to communicate (mutism). Minimal motor responses to painful stimuli are typically preserved.
Publication bias - a reason for decreased research output in developing countries : letter to editorAuthor Dinesh SinghSource: South African Psychiatry Review 9 (2006)More Less
In the article Publication bias - a reason for decreased research output in developing countries, the table of result in support of this hypothesis was inadvertently not published. Editors from three of the eight high impact psychiatric journals surveyed submitted data on the country of origin of manuscripts, the number of articles submitted and accepted. Below are the results of this survey.
Source: South African Psychiatry Review 9, pp 249 –260 (2006)More Less
Background : Consumer research was last conducted among South African patients with mental health problems in 1997/8 by GAMAIN (The Global Alliance of Mental Health and Advocacy Networks). Respondents at the time suffered primarily from anxiety and/or unipolar depression. Updated consumer research was conducted between February 2004 and April 2005 by Linda Trump of Cat Communications to find out how mental health patients were faring in the current South African environment and to determine which factors were mitigating most against their recovery. The study was funded by Cat Communications and partial grants from AstraZeneca, Eli Lilly and Solvay Pharma.
Method : The survey questionnaire was developed by Linda Trump and checked by Charmaine Hugo of the Mental Health Information Centre (MHIC), Dr. Colinda Linde of SADAG, and Dr. Eugene Allers of the SA Society of Psychiatrists. It was distributed and posted with a self-addressed envelope and freepost address to leaders and members of SADAG, the SA Bipolar Association, Central Gauteng Mental Health, the Schizophrenic & Bipolar Disorder Alliance (SABDA) and the OCD Association. The questionnaire was also e-mailed to the Schizophrenia Foundation, some members of SADAG and members of the Johannesburg Bipolar Support Group. In addition, it was hosted on the Health 24 and SA Bipolar Association websites.
Results : The sample comprised 331 respondents. 75% had a single diagnosis, with 25% having dual or multiple diagnoses. Diagnoses included unipolar depression (30%), bipolar mood disorder (40%) and schizophrenia / schizoaffective disorder (13%). 49% of respondents suffered from one or more types of anxiety. The median age of symptom onset for respondents was 26.5, with the median respondent waiting two years before seeking help. 69% of the cohort experienced a comorbid physical ailment, entailing chronic pain. 72% of the respondents saw two or more caregivers before receiving a correct diagnosis and it took more than a year for 55% of respondents to get a correct diagnosis. 74% of respondents received the correct diagnosis from a psychiatrist, with GPs, psychologists and social workers playing a minimal role in confirming diagnoses. 68% of respondents discontinued medication at some stage of their illness and only 46% of respondents ended psychotherapy because it had served its purpose. 40% of respondents did not know what type of psychotherapy they had. Only 20% of respondents could work adequately while ill and 19% of respondents became unemployed during the course of their illness. 26% (of 304 respondents) eventually separated or divorced as a direct result of their illness.
Conclusions : Ongoing education is needed to inform the public about the hazards of delaying treatment for psychiatric symptoms. Doctors need to be more forthcoming about potential side-effects and how to manage them. GPs, psychologists and social workers may need additional psychiatric education. Psychologists need to tell patients what methodology they are using and they need to be more upfront in setting objectives and discussing the desired outcomes of therapy. Ideally, psychotherapy should include the patient's partner or family when there are significant domestic tensions. Stigma needs to be reduced in the workplace.