African Journal of Psychiatry - Volume 11, Issue 2, 2008
Volume 11, Issue 2, 2008
Impact of tertiary and quaternary service funding processes on medication selection in the SA essential drugs programme : guest editorialAuthor A.G. ParrishSource: African Journal of Psychiatry 11, pp 93 –95 (2008)More Less
Health care provision of tertiary and quaternary services in South Africa is still largely driven by historical precedent and a 'catch up' philosophy: in the past, new technologies and medications from developed world countries were lobbied for and adopted as soon as they were considered affordable, or on occasion, where it seemed politically expedient to do so. This has resulted in a piecemeal system of entrenched services in centres of excellence, which drive costs and new advances, but seldom foster equity goals.
Board of International Affairs Pan-African Division, Quarterly newsletter, African International Division, Royal College of Psychiatrists : newsletterSource: African Journal of Psychiatry 11, pp 103 –107 (2008)More Less
"From the editor"
Lack of psychiatrists : brain drain, export or recruitment
The psychological challenges of recent events in Kenya
Book review : Essentials of Clinical Psychiatry for sub-Saharan Africa, edited by Frank Njenga, Wilson Acuda, Vikram Patel and Mario Maj
Source: African Journal of Psychiatry 11, pp 109 –112 (2008)More Less
Society deems that mentally ill patients who lack insight and judgement may be treated involuntarily in institutions as a way of protecting them and the society around them. The ethical principle of 'paternalism' supersedes the principle of 'autonomy'. In South Africa, the new Mental Health Care Act (MHCA), No 17, 2002 has raised the issues and profile of mental health and serves as an advocate for mental health care users. In accordance with this MHCA, a mental health care user may be treated involuntarily at a health establishment on an inpatient basis under very specific regulations that serve to protect the users' rights as much as possible. However, the implementation of involuntary treatment whilst upholding users' rights within a health care service, which is plagued by human resource and infrastructure constraints, is extremely difficult and likely to infringe on these rights. The understanding of the regulations and principles governing involuntary treatment is important as it is a means of helping users' who despite needing it, refuse such treatment. If it is done sensitively, respectfully and conservatively, we can both protect the users' and societies' interests whilst at the same time are compliant with the principles of the MHCA.
Management of perceived mental health problems by spiritual healers : a Nigerian study : original articleSource: African Journal of Psychiatry 11, pp 113 –118 (2008)More Less
Objective : Anecdotal reports and research findings have suggested that religious healers are widely consulted by many Nigerians in time of mental health crisis. The study aimed at examining the knowledge, attitude and practice of mental health care among a syncretic Church's healers, and their readiness to cooperate with Psychiatrists. Method : A modified, pilot-tested, self-completed questionnaire was used to obtain information from consenting spiritual healers who satisfy the inclusion criteria. Focus group discussions (FGDs), Participatory Observation (PO) and Key Informant Interviews (KII) were used to corroborate or refute the findings. Results : The respondents' knowledge of mental disorders was limited to psychotic disorders; their explanatory model was similar to beliefs of the populace. In practice, they combined some modern medical approach, some native methodology and some eclectic religious practices such as prophecy, trance and dream. Only 6% of them ever referred their clients to medical practitioners. Conclusion : Religious healers still constitute an important route to access mental health care providers to some Nigerians.
Post traumatic stress disorder : undiagnosed cases in a tertiary inpatient setting : original articleSource: African Journal of Psychiatry 11, pp 119 –122 (2008)More Less
Objective : Post traumatic stress disorder (PTSD) is a common, debilitating anxiety disorder characterized by emotional and physical symptoms that may occur after exposure to a severely traumatic event. Since it occurs commonly as a comorbid diagnosis with other mood- and anxiety disorders, we postulated that this disorder may be under-diagnosed in therapeutic wards where anxiety and mood disorders are treated. The study thus sought to determine the prevalence of undiagnosed PTSD in an inpatient population, and to compare the demographic details and comorbid diagnoses of subjects with and without PTSD. Method : The Clinician-administered PTSD Scale for DSM-IV (CAPS) was administered to 40 subjects who were inpatients in a therapeutic ward of a large psychiatric hospital and who had never had a diagnosis of PTSD before. Results :16 (40%) subjects met the DSM-IV criteria for PTSD. We did not find significant clinical differentiating factors between subjects with and without PTSD; however subjects with PTSD were more likely to use cannabis. Conclusions : PTSD remains undiagnosed in many patients admitted to therapeutic units.
Clinical neuropsychiatric correlates and EEG findings among children with developmental disorders in Lagos, Nigeria : original articleSource: African Journal of Psychiatry 11, pp 123 –127 (2008)More Less
Objective : Developmental disorders with or without associated neuropsychiatric complications continue to be one of the major health problems in Africa. The grossly inadequate management / rehabilitative facilities further worsen this. A prospective study aimed at finding the types of developmental disorders and associated neuropsychiatric complications among children aged ≤15 years that presented with developmental disorder in the study centers over 36 month study duration. Methods : The study was carried out in the paediatric and child psychiatric clinics as well as the Electroencephalographic (EEG) unit of two major health facilities in Lagos, Nigeria : Lagos University Teaching Hospital (LUTH) and Psychiatric Hospital, Yaba, Lagos. For each subject, socio-demographic data was obtained and appropriate clinical evaluation was carried out to obtain the necessary data and clinical diagnoses. Furthermore, each of the subjects had waking EEG recording using 20-channel computerized Medelec® EEG machine. The EEG interpretation was blinded to the clinical history of the subjects. Results : Overall, one hundred and eleven (111) subjects were evaluated over the 36 month study period. The cohort was made up of 63 (56.8%) males and 48 (43.2%) females. The mean age was 4.8 (± 3.9) years, with most subjects falling in the age group of 0-5 years (69.4%). Mixed specific developmental disorders were most common (55%) followed by that of specific developmental disorders of speech and language (34.2%). Forty-one (36.9%) subjects suffered from one or more types of complications, with seizure, 22 (19.8%) being the most common. The waking EEG recording was normal in 22 (19.8%) subjects; while abnormal epileptiform activities were found in 85 (76.6%) of recordings. No statistically significant relationship existed between EEG abnormalities and the factors of age and clinical diagnoses (i.e developmental abnormalities). Conclusion : The small number of subjects in this study is a major hindrance to drawing a general conclusion. However, it has been shown that a number of the cohort in addition to their developmental disorders suffered from such complications as seizures, hyperactivity etc. Furthermore, a significant proportion had EEG abnormalities of the epileptiform types possibly reinforcing the previously known fact of prevalent subtle brain damage among African children. The need for preventive health care is therefore emphasized.
Source: African Journal of Psychiatry 11, pp 128 –132 (2008)More Less
Objective : In the face of recently introduced government health reform and the dwindling number of available beds for acutely ill patients, a cross sectional study was carried out on long-stay patients at the 100 years old psychiatric hospital Yaba, Lagos, Nigeria with a view to discharging most of them. Method : Necessary consent was obtained from the Hospital Research and Ethical Committee. All the long-stay patients were evaluated with a specially designed proforma to elicit socio-demographic, clinical and long-stay variables. Further more, each of them had clinical assessment to make diagnosis in accordance with ICD - 10 and finally, the subjects were also assessed with the Brief Psychiatric Rating Scale (BPRS). Results : Fifty-one (51) subjects; that is, occupying 10.7% of the hospital functional beds fulfilled the criteria of long-stay. They included 36 (70.6%) males and 15 (24.4%) females. The mean age was 47.3 ± 16.5 years with age range of 18-92 years. The average length of stay was 11.4 ± 15.0 years and range of 0.5 to 57 years; with significant gender difference (males higher than females) (t = 3.51, p < 0.02). The vast majority of the subjects were diagnosed with schizophrenia (84.3%), followed by mental retardation with seizure disorder (5.9%). One-third (33.3%) of the subjects had co-morbid physical pathologies most especially epilepsies, hypertension, Koch's disease, HIV / AIDS. Despite being on high doses of antipsychotics (conventional and / or atypical) the majority of the subjects (86.3%) exhibited poor mental state with BPRS scores of ≥ 10. The mean BPRS score was 23.6 ± 22.0 and range of 4-56 with a significant gender difference (t = 3.66, p < 0.02). Conclusion : These patients would continue to require long-stay hospitalization despite been a burden to the study center; or, in the alternative provision of mid-way facilities for their rehabilitation.
Depression in African women presenting for psychological services at a general hospital : original articleSource: African Journal of Psychiatry 11, pp 133 –137 (2008)More Less
Objective : Despite the increase in knowledge of depression, little is known about depression among African populations, especially African woman. In South Africa, inadequate mental health services generally and specifically for African people in our society, has led to under reporting and under diagnosing of the disorder. The object of the study was to understand depression in African women attending a state health service. Method : Clinical records of all patients presenting with depression to a general hospital located in a densely populated African township, over a 2 year period, were examined. Results : The epidemiological data is described. Depression in these women was related to poverty, overcrowding, unemployment, high levels of crime, lack of services and sexual abuse. Conclusion : African women return to a social context within which depression is increasingly prevalent. Establishing psychological services relevant to needs as well as means of ensuring that therapeutic gains extend to their social context are considered.
Source: African Journal of Psychiatry 11, pp 139 –141 (2008)More Less
Author Franco P. VisserSource: African Journal of Psychiatry 11 (2008)More Less
For something more serious and disturbing this time I have chosen a film about Oliver O'Grady, a Roman Catholic parish Priest who molested, raped and sodomised scores of children in California over several decades. 'Father Ollie', as he was lovingly referred to by his various parish members, was never formally sanctioned or disciplined by the church managers, instead he was moved from parish to parish as the 'heat' became intolerable for him and his superiors.
Lilly continues to invest in overall health of patients suffering from psychotic conditions - reached R1 million mark : product newsSource: African Journal of Psychiatry 11 (2008)More Less
Recognising the need to further educate and assist people suffering from psychotic conditions such as schizophrenia and bipolar disorder to live healthier lives, leading pharmaceutical company, Eli Lilly, has been offering the "Lilly Wellness Plus" programme to patients since March 2006.
Source: African Journal of Psychiatry 11 (2008)More Less
Painful physical symptoms are present in up to three out of every four patients with major depressive disorder (MDD). These symptoms include headaches, stomach pain, neck and back pain, diffuse musculoskeletal pain and vague poorly localised pains. They are important for a number of reasons. Firstly, they confound the diagnosis of MDD. A recent multinational survey reported that 69% of patients who were diagnosed with depression in primary care facilities presented with pain as their only complaint. Secondly, where these symptoms are not adequately addressed during treatment for MDD, residual painful symptoms have been shown to be predictive of a poor outcome in the long-term. Conversely, Fava has shown that addressing these painful symptoms during treatment for depression results in higher remission rates.
So you have Bipolar - what now? Accepting your diagnosis and helping your family help you : The South African Depression and Anxiety Group - patients as partnersAuthor Janine ShamosSource: African Journal of Psychiatry 11, pp 159 –160 (2008)More Less
When she was diagnosed with Bipolar Disorder, Tammy felt like she'd been 'kicked in the stomach'. She felt totally shocked and betrayed, but strangely relieved that maybe she didn't have to live in fear of herself anymore. But still the mask of 'normality' remained tight, she couldn't accept she was ill, refused to believe there was something wrong with her. Bipolar Disorder is still highly stigmatised, as are mental illnesses generally, and she was terrified she would be shunned professionally and socially if anyone found out.