African Journal of Psychiatry - Volume 10, Issue 3, 2007
Volume 10, Issue 3, 2007
Source: African Journal of Psychiatry 10, pp 135 –141 (2007)More Less
The central noradrenergic system belongs to a group of brainstem neuromodulatory systems previously referred to as the ascending reticular activating system. In this article a heuristic model is presented of the central noradrenergic system depicting the major projections to other cerebral areas, its interactions with other neuromodulatory systems, mechanisms through which it can influence cerebral function, as well as the major functions and disorders associated with alterations in central noradrenergic activity. It is not the aim of this paper to provide fine detail on the various aspects, but rather to provide a concise overview where structure and function, as well as the interactions with other systems are brought together. The contents of the paper are summarized in a diagram.
A survey of the prevalence of diabetes type 2 amongst schizophrenics in a chronic care treatment facility : original articleSource: African Journal of Psychiatry 10, pp 143 –146 (2007)More Less
Objective: The determination of the prevalence of type 2 diabetes in a group of patients suffering from schizophrenia who have been hospitalized in a chronic care facility and to consider the role of factors which may contribute to the increased risk of developing diabetes.
Method: The hospital files of patients suffering from diabetes type 2 were reviewed and assessments were made in terms of age, gender and body mass index (BMI) duration of stay and co-existing medical conditions. Fasting blood glucose estimations were done on all schizophrenic patients not receiving treatment for diabetes. Medications of patients were recorded. A protocol was prepared and approval to conduct the study was obtained from the hospital authorities.
Results: Of 494 schizophrenic patients 19 (3.85%) were found to suffer from diabetes. 68% of patients in the diabetic group were found to be overweight in terms of BMI rating. Only one patient had a medical condition. Proportionately the number of women was relatively high.
Conclusion: The prevalence if diabetes type 2 in a group of chronically ill hospitalised patients with schizophrenia is significantly lower than in outpatient populations. Residing in a facility long term may serve as a protective factor. The exclusion of psychological stressors such as isolation, poverty and abandonment may account for the finding.
Source: African Journal of Psychiatry 10, pp 149 –156 (2007)More Less
Objective: To describe the impact of services provided, during an admission, on unmet needs and correlates of unmet needs.
Method: The study used a modified version of The Camberwell Assessment of Need (CAN) to assess the perceived needs of 100 patients on admission to a psychotherapy unit, Valkenberg Hospital, Cape Town. At discharge, the study documented the extent to which the patients had perceived services and interventions to be useful.
Results: The mean number of needs on admission was 8.6. At discharge, help received was highest for psychiatric needs. The services most often regarded as useful were organised group activities and therapies. Regression analysis suggests that a lower level of education and the presence of borderline personality traits contribute significantly to unmet need on discharge.
Conclusion: The in-patient program is effective in meeting psychiatric needs, but less useful for addressing psycho-social needs. These needs may exacerbate psychiatric problems and should be managed more actively before, during and after an in-patient stay.
Clinical profile of acutely ill psychiatric patients admitted to a general hospital psychiatric unit : original articleAuthor A.B.R. Janse van RensburgSource: African Journal of Psychiatry 10, pp 159 –163 (2007)More Less
Objectives: Helen Joseph Hospital in southern Gauteng Province is one of five specialist hospitals on the academic circuit of the University of the Witwatersrand. Against a background of new mental health legislation, implemented in South Africa during December 2004 with no formal mechanisms in place to monitor mental health services on different levels of care or in regions, a study with three objectives was undertaken, namely: (I) to provide a baseline on psychiatric morbidity and treatment outcome; (II) to establish the state of affairs analysis for mental health care and (III) to establish a framework for cost centre management. The current study focuses on objective one.
Method: A retrospective clinical audit was undertaken of mental health service delivery, teaching and research at Helen Joseph Hospital over a one-year period from September 2003 to August 2004. This article reports on the two service delivery datasets identified: the "Inpatient Discharge Summary Report" and the "Consultation / Liaison Report".
Results: A total number of 438 service users were admitted and a monthly average of 80 consultation / liaison assessments was conducted during the study period. Persistent unfavourable nursing staff ratios continued, while the number of service users from other African countries was generally underrated. Non-compliance and substance abuse contributed significantly to the admission of service users. Schizophrenia was indicated as the most likely diagnosis in almost a quarter of cases.
Conclusion: Morbidity and treatment outcome at Helen Joseph Hospital will only be contextualized after the implementation of a regular clinical audit process in all the facilities of its referral network.
Visual deterioration 1½ years after wrapping an un-clippable anterior communicating artery aneurysm : report of a case and review of the literature regarding opto-chiasmatic arachnoiditis : case reportAuthor J. OumaSource: African Journal of Psychiatry 10, pp 164 –166 (2007)More Less
Objective: Optochiasmatic arachnoiditis (OCA) is a serious complication that can occur after wrapping of aneurysms in the proximity of the optic pathways. This paper seeks to illustrate one such case with a view to drawing attention to the dangers of this practice.
Method: Single case report and review of the literature.
Results: The clinical and radiological features of OCA are presented and discussed, which in this patient involved failing visual acuity as well as an inflammatory mass of the suprasellar area with oedema of the optic apparatus.
Conclusion: Optochiasmatic arachnoiditis and its attendant visual morbidity is a serious condition. In the setting described, it arose as a result of wrapping an unclippable aneurysm. The tide of aneurysm management has turned, and presently more and more of them are being obliterated by endovascular techniques. Among other benefits, this reduces the likelihood of such complications as OCA.
The Descent of Madness - Evolutionary Origins of Psychosis and the Social Brain, Jonathan Burns : book reviewAuthor David KibelSource: African Journal of Psychiatry 10, pp 171 –177 (2007)More Less
Author Janine ShamosSource: African Journal of Psychiatry 10, pp 183 –184 (2007)More Less