African Journal of Psychiatry - Volume 10, Issue 4, 2007
Volume 10, Issue 4, 2007
Author Christopher P. SzaboSource: African Journal of Psychiatry 10, pp 185 –187 (2007)More Less
The deliberations that led to the emergence of the African Journal of Psychiatry, saw as part of that process the agreement for an association with International Psychiatry, a publication of the Royal College of Psychiatrists in the United Kingdom. International Psychiatry is more specifically a publication of the Royal College of Psychiatry's "Board of International Affairs" whose aim, through International Psychiatry, was to create a publication that serves both College members and psychiatrists around the world, providing them with an overview of both current practice and policy in different countries.
African International Division, Royal College of Psychiatrists Annual Meeting in Edinburgh 19 - 22 July 2007 : newsletterSource: African Journal of Psychiatry 10, pp 193 –197 (2007)More Less
The Annual meeting this year was an opportunity for three members of the executive committee to meet formally and informally to discuss areas of mutual concern and interest. The large distances make face to face meetings difficult but all the more valuable. A business meeting of the executive officers of the College with the international divisions provided the opportunity to exchange ideas and to realise that the issues were international. Amongst topics discussed were the shaping of mental health policy, volunteer placement exchanges and anti-stigma approaches. A further meeting of the division with the Board of International Affairs addressed regional developments and plans.
Author A.B.R. Janse Van RensburgSource: African Journal of Psychiatry 10, pp 205 –209 (2007)More Less
One of the main aims of the new Mental Health Care Act, Act No. 17 of 2002 (MHCA) is to promote the human rights of people with mental disabilities in South Africa. However, the upholding of these rights seems to be subject to the availability of resources. Chapter 2 of the MHCA clarifies the responsibility of the State to provide infrastructure and systems. Chapters 5, 6 and 7 of the Act define and regulate the different categories of mental health care users, clarify the procedures around these categories and spell out mental health practitioners' roles and responsibilities in this regard. Also according to the National Health Act No. 61 of 2003, the State remains the key role player in mental health care provision, being responsible for adequate mental health infrastructure and resource allocation. Due to "limited resources" practitioners however often work in environments where staff ratios may be fractional of what should be expected and in units of which the physical structure and security is totally inadequate. The interface between professional responsibility of clinical workers versus the inadequacy of clinical interventions resulting from infrastructure and staffing constraints needs to be defined. This paper considered recent legislation currently relevant to mental health care practice in order to delineate the legal, ethical and labour framework in which public sector mental health practitioners operate as state employees. These included the Mental Health Care Act, No.17 of 2002; the National Health Act, No. 61 of 2003 and the proposed Traditional Health Practitioners Act, No. 35 of 2004. Formal legal review of and advice on this legislation as it pertains to public sector mental health practitioners as state employees, is necessary and should form the basis of the principles and standards for care endorsed by organized mental health care practitioner groups such as the South African Society of Psychiatrists (SASOP).
Source: African Journal of Psychiatry 10, pp 210 –214 (2007)More Less
Objective: Paediatric HIV remains a major challenge in Sub-Saharan Africa. Paediatric HIV is a multi-generational disorder with far-reaching implications for the whole family. Parenting stress in caregivers of HIV infected children has been studied in developed countries but never in South Africa. The aim of this study was to determine the extent of parenting stress in caregivers of children infected with HIV in South Africa. Further objectives were to monitor the levels of stress over one year after caregivers started attending a paediatric HIV clinic and to ascertain what factors were predictive of a decrease in parenting stress over that time.
Method: One hundred and twenty two caregiver and children dyads were recruited into this study. Caregivers completed the Parenting Stress Index / Short form at baseline and after six and 12 months. Demographic information was collected and the children's heights, weights and CD4 counts were recorded at each visit.
Results: The families that participated in this study came from very poor socio-economic backgrounds. Eighty five percent of the children were still being cared for by their biological mothers. The parenting stress levels of the caregivers in this study were extremely high at baseline. Although the parenting stress levels did come down significantly over the study period (p < 0.001) they remained high and warrant further investigation and management. A better level of education, better housing facilities and fewer adults living in the household were the three most important factors predicting a decrease in parenting stress over a one year period.
Conclusion: Parenting stress of caregivers of young children infected with HIV is extremely high and warrants further investigation and long term management.
Source: African Journal of Psychiatry 10, pp 215 –218 (2007)More Less
Objective: To describe and analyze patterns of polypharmacy among psychiatric outpatients in northern Nigeria and identify predictors of psychotropic polypharmacy.
Method: A cross-sectional study, using chart review of new patients at out-patient clinics of two regional psychiatric hospitals in northern Nigeria, measuring rates, patterns and predictors of psychotropic polypharmacy.
Results: A total of 278 patients were seen, of whom 92% were given two or more psychotropic agents. The pattern of psychotropic polypharmacy revealed that total, multi-class and adjunctive polypharmacy rates were high, while augmentation and same class polypharmacy rates were low. Age of respondent and diagnosis were the factors associated with total polypharmacy.
Conclusion: The complex interplay of factors influencing physician prescription practices requires that a more pragmatic approach be adopted in efforts to curtail polypharmacy practice, rather than a wholesale, absolute condemnation of the practice.
Prevalence and clinical characteristics of obsessive-compulsive disorder and obsessive compulsive symptoms in Afrikaner schizophrenia and schizoaffective disorder patients : original articleSource: African Journal of Psychiatry 10, pp 219 –224 (2007)More Less
Objective: There is evidence of variation in the prevalence of co-morbid obsessive-compulsive disorder in schizophrenia amongst ethnic groups. This study evaluated the lifetime prevalence and clinical characteristics of obsessive-compulsive disorder (OCD) / obsessive-compulsive symptoms (OCS) in Afrikaner schizophrenic and schizoaffective disorder patients.
Method: An ongoing genetic study of schizophrenia is currently being conducted on the Afrikaner founder population. In this cohort of 400 subjects from the original genetic study, we identified 53 subjects with schizophrenia or schizoaffective disorder and co-morbid OCD / OCS (study group). They were matched for gender and age of onset of illness with 59 subjects who do not have OCD / OCS (control group). The diagnostic instrument used in this cohort is the Diagnostic Interview for Genetic Studies (DIGS) version 2, which has been translated into Afrikaans. In addition to the DIGS, information for the relevant clinical characteristics reported in this study was also drawn from a detailed narrative chronological summary report and clinical files. A checklist was completed.
Results: The prevalence of co-morbid OCD / OCS amongst 400 subjects with schizophrenia or schizoaffective disorder was 13.2% [n=53] of which 40 were male and 13 female patients. The prevalence of OCD was 10.7% and OCS was 2.5%. Contamination obsessions [n=17] were the most common type of obsession reported, followed by religious obsessions [n=8]. The most prevalent compulsions were repetitive rituals [n=32] followed by checking behaviour [n=22]. Onset of psychotic symptoms was found to be insidious in 86.8% of the study group compared to 24.6% of the control group (p<0.0001). Second-generation antipsychotic use was found to be statistically more prevalent in the study group (77.4%), compared to the control group (45.8%) (p=0.0008). 73% of the study group experienced depressive symptoms compared to 50.8% of the control group. Both groups were found to have a similar incidence of suicidal thoughts and suicide attempts. Substance abuse amongst the control group was significantly higher (35.9%) compared to the study group (19.2%) (p <0.05). Cannabis was most commonly abused in both groups, followed by alcohol.
Conclusion: The prevalence rate of 13.2% of co-morbid OCD / OCS in Afrikaner schizophrenia and schizoaffective disorder patients differs from findings in other ethnic groups, suggesting the possible role of genetic and cultural factors in the prevalence of co-morbid OCD / OCS. Second-generation antipsychotic use amongst schizophrenia and schizoaffective disorder patients with co-morbid OCD / OCS was found to be significantly higher than in those without co-morbid OCD / OCS. Clinical characteristics of Afrikaner schizophrenics and schizoaffective disorder patients with and without co-morbid OCD / OCS are the same, both groups were associated with significant psychopathology and a poor prognosis.
Psychiatric disorders among war-abducted and non-abducted adolescents in Gulu district, Uganda : a comparative study : original articleSource: African Journal of Psychiatry 10, pp 225 –231 (2007)More Less
Objective: We aimed to assess the nature and patterns of psychiatric disorders among adolescents who had been war-abducted in the war in northern Uganda, compared to non-abducted adolescents living in Gulu district, Uganda.
Method: A cross sectional study that used an unmatched case-control design compared 82 abducted and 71 non-abducted adolescents for scores on measures of psychological distress and for selected psychiatric diagnoses using the Strength and Difficulties Questionnaire (SDQ) and the Mini International Neural-Psychiatric Interview for Children and Adolescents English version 2.0 (M.I.N.I-KID).
Results: More than 90% of adolescents reported exposure to severe trauma, either through direct or indirect experiences. Significantly more war abducted adolescents reported PTSD (26.8% v. 12.7%) (p=0.03) major depression (19.5% v. 4.2%) (p=0.004), and generalised anxiety disorder (13.4 v. 4.2%) (p=0.049) than non abducted adolescents. By contrast, non-abducted adolescents reported more past suicidality (p=0.004, χ2=8.2) than adolescents who were abducted. However, despite high rates of psychiatric disorder, these adolescents had good psychosocial adjustment.
Conclusion: Adolescents in war affected areas whether war-abducted or not have varied and clinically significant emotional responses to different kinds of traumatic exposure. In a war-affected area, the development of a sustainable service for adolescents that tries to address the full range of mental health problems may be more appropriate than a psychological trauma service that focuses on one diagnosis.
Author Thabo RangakaSource: African Journal of Psychiatry 10, pp 233 –239 (2007)More Less
The South African Human Rights Commission (SAHRC) recently launched a public enquiry into the right to have access to health care services. The following is the submission to the SAHRC by Dr Thabo Rangaka on behalf of the South African Society of Psychiatrists (SASOP), in his capacity as President of SASOP. The submission was made on the 31st May 2007. The terms of reference for the inquiry can be found at : http://www.info.gov.za/gazette/notices/2007/29611l.pdf
Driving Lessons : a 2006 Sony Pictures Classics release, written and directed by Jeremy Brock : movie reviewAuthor Franco P. VisserSource: African Journal of Psychiatry 10 (2007)More Less
Ben Marshall (played by Rupert Grint) is trapped in a dysfunctional and fragmented family life. As the son of the local parish vicar, Robert (played by Nicolas Farrell), Ben struggles to form his own identity as a 17 year-old on the verge of adulthood. Ben is caught between the overly religious, controlling and at times bizarre life of his mother, Laura (played by Laura Linney) and that of his father who appears to be a desperately helpless individual torn between his different responsibilities and stuck in his own emotional processes.
Author Janine ShamosSource: African Journal of Psychiatry 10, pp 255 –256 (2007)More Less
A frightening new 'trend' among teens appears to be the expression of deep emotional pain through the infliction of pain. The South African Depression and Anxiety Group (SADAG), a local mental health NGO has detected an alarming rise in the number of teenagers who self-injure - and the mean age is dropping.