African Journal of Psychiatry - Volume 11, Issue 4, 2008
Volume 11, Issue 4, 2008
Author Christopher P. SzaboSource: African Journal of Psychiatry 11 (2008)More Less
Speaking of environmental influences, once again the debate raged about the influence of certain types of music on adolescent behaviour as well as the influence of Satan. More specifically, the influence of music and Satan on violent, murderous adolescent behaviour. Whilst these issues tended to dominate, the role of parents and the education authorities are critical elements, with concerns related to quality of parenting, bullying, access to and screening for weapons all in some way part of the complexity.
Author Mark PottertonSource: African Journal of Psychiatry 11 (2008)More Less
In the final analysis, it is difficult to predict where and when the next school massacre will happen. The context of violence in schools and as well as in broader society, together with poor levels of pastoral surveillance in schools provides fertile ground for further school violence. Individuals in schools will just have to take time to listen, to respond, to empathise and to care for the students whom they teach.
Board of International Affairs Pan-African Division Quarterly newsletter, African International Division, Royal College of Psychiatrists : quarterly newsletterSource: African Journal of Psychiatry 11, pp 253 –255 (2008)More Less
The multidimensional assessment of psychopathology in mood and psychotic disorders. A proposal for Axis II in DSM-V/ICD-11 : reviewSource: African Journal of Psychiatry 11, pp 260 –263 (2008)More Less
The inclusion of dimensional elements in the psychiatric diagnostic systems have been advocated for many years, however it has been resisted due to concerns about clinical utility. Recent suggestions have been for a combination of categorical and dimensional data in future diagnostic classification systems. In this paper we discuss the overlap in symptom complexes between mood disorders and schizophrenia and a multi-dimensional model of the mood-psychosis interface. We propose that the personality diagnoses should be included in Axis I and suggest the inclusion of a five factor dimensional diagnosis of mood and psychotic disorders on Axis II of DSM-V/ICD-11.
Source: African Journal of Psychiatry 11, pp 264 –271 (2008)More Less
During most of the latter part of the last century, South Africa has followed international trends in the training of psychiatrists. Training programmes have become increasingly focused on the neurobiological aspects of psychiatric disorders with less attention being paid to psychotherapy. This is consistent with developments in psychiatric research. In the clinical arena this manifests as a focus on pharmacological and medically based interventions and a resulting relative inattention to non-pharmacological interventions, most especially psychotherapy. In an effort to address this imbalance there has been an international initiative, over the past two decades, to establish an acceptable level of competence in psychotherapy in the training of psychiatrists. A South African programme is needed that can take account of international trends and adapt them for the local context. In order to produce a programme for establishing competence in psychotherapy for psychiatric registrars at the Nelson R. Mandela School of Medicine, the authors examine directives for the development of psychotherapy skills from international regulatory bodies for graduate medical training and their application. Defining and setting preliminary standards for competence is emphasized. A programme based on five core psychotherapy components using a portfolio based model to facilitate learning and assessment of competencein psychotherapy, is proposed.
Source: African Journal of Psychiatry 11, pp 272 –275 (2008)More Less
Although the integration of psychiatric services into the community has potentially been beneficial to many patients, this transition has not been without problems. A major obstacle to establishing successful community-based treatment in South Africa has been that the reduction in number of inpatients beds did not coincide with the development of adequate community resources. This, in combination with our patients' poor socio-economic circumstances, has contributed to a substantial increase in the so-called ''revolving door'' or high frequency use phenomenon in state psychiatric facilities. Clearly, there is need for a renewed approach to address this problem in our setting. With this in mind the APH in the Western Cape appointed three community treatment teams in January 2007. This publication serves to give an overview of the Stikland Psychiatric Hospital team's experiences in the first 12 months since establishment. To date, we have been confronted by several challenges that complicate the successful implementation of an ''assertive'' outreach service in the South African context. However, there seems to be some hope as early findings demonstrate a reduction in number of admissions as well as inpatient days. Furthermore there has been a very positive response from service users, their families and other staff members leaving us to conclude that this initiative seems to be a much needed step in the right direction.
Medical students' perceptions of accessibility and barriers to the utilisation of the University of Pretoria's support systems : original articleSource: African Journal of Psychiatry 11, pp 276 –281 (2008)More Less
Objective : A campus-based website was set up by medical students following their study that showed a low awareness and utilsation of support systems at the University of Pretoria. The aim of the website was to improve the utilisation of the existing support systems. This study evaluated the students' perception of the support systems and whether the website would resolve barriers hindering utilisation of support. Method : Focus groups were selected by theoretical sampling in the first and final quarter of the academic year. The sample group consisted of 120 medical students from all years of study. The transcribed tape recordings, field notes, e-mail responses and observations of the focus groups were analysed for themes by open, axial and selective coding. Results : The medical students varied in their awareness of the available support systems. The majority were unaware of procedures to access the support systems and what services were offered by each. There were numerous barriers to utilising the support systems effectively. The barriers included the students' perception of failure in admitting that they require assistance and the remainder were mostly of an administrative nature. Most students were aware of the website but utilisation was minimal. Conclusions: The majority of students were aware of but underutilised the support systems for various reasons. The website failed to improve utilisation of the extensive existing support systems. The barriers suggest other ways of improving support that include addressing social support, socialisation and life skills training as well as streamlining the marketing of existing support systems.
The utility of a rapid screening tool for depression and HIV dementia amongst patients with low CD4 counts- a preliminary report : original articleSource: African Journal of Psychiatry 11, pp 282 –286 (2008)More Less
Objective: To assess the utility of the International HIV Dementia Scale (IHDS) and Centre for Epidemiological Studies Depression Scale (CESD) as rapid screening tools of depression and HIV dementia amongst patients with low cluster of differentiation 4 (CD4) counts. Method: The rapid screening tools were tested on a sample of 20 patients with low CD4 counts who were recruited from the inpatient ward at McCord Hospital from August to October 2007. Results: The CESD was found to have 91 % sensitivity and 44 % specificity. Using the recommended cut-off of 10, the sensitivity of the IHDS was 88 %. The specificity was 50 %. The results suggest that CESD and IHDS are sensitive, however their low specificity may limit their clinical utility. Conclusions: This is a pilot study and no firm conclusions are drawn. Further research is needed to verify the high burden of depression and neuro-cognitive impairment (NCI) among people with low CD4. A larger study is needed to validate the IHDS in South Africa. Other researchers are encouraged to validate and determine the optimal cut off value for the IHDS in their local population.
Antipsychotic prescription patterns in Xhosa patients with schizophrenia or schizoaffective disorder : original articleSource: African Journal of Psychiatry 11, pp 287 –290 (2008)More Less
Objective: To examine the degree to which South African physicians use similar treatment guidelines in their prescription of antipsychotic medication. Method: Data on the prescriptions for Xhosa patients with schizophrenia and schizoaffective disorder were retrospectively examined to investigate differences between three catchment areas in the Western Cape, especially in terms of clozapine use. Results: There was an overall low rate (10.0%) of clozapine use and a relatively high occurrence of polypharmacy (28.6% of 510 patients). There were statistically significant differences between the three catchment areas in terms of clozapine (p=0.002) and haloperidol (p=0.001) use. Valkenberg hospital had the highest number of clozapine prescriptions and the lowest of haloperidol. Prescriptions of depot antipsychotics did not differ between catchment areas. Conclusion: Discrepancies in antipsychotic medicine prescription patterns were evident between the examined hospitals. It is becoming paramount for practical implementation of guidelines to be improved in South Africa to address, e.g., low clozapine use and the high frequency of polypharmacy.
Business meeting minutes of the AAPAP annual general meeting held in Accra, Ghana, 28th June 2008 : African Association of Psychiatrists and Allied ProfessionalsSource: African Journal of Psychiatry 11, pp 292 –295 (2008)More Less
The chairperson acknowledged the presence of Professor Adomakoh whom he identified as the link between the defunct APA (African Psychiatric Association) and the current AAPAP. He then gave an update of the history of AAPAP. He summarized that this was an organization that was formally inaugurated in 2002 (during the WPA World Congress in Yokohama). He informed members that the association had since become an affiliate of the WPA. He proceeded to read out the names of the current AAPAP executive. He informed members that even though the AAPAP constitution stipulates that the positions of the executive should be held for 2 years and the current executive has stayed in office since 2002, there has however been no opportunity to conduct an election.
Author Franco P. VisserSource: African Journal of Psychiatry 11, pp 299 –301 (2008)More Less
This film is an exceptional one in terms of several aspects. The film's directors achieve great success in drawing in the viewer from the first moment to the last. The film was shot in the middle-east on actual locations, a first for a film that achieved such high acclaim and recognition, making the story so much more intense and real - the scenery adding great value to the film's overall appearance and appeal.
Psychiatry in Nigeria
Psychiatry in Nigeria. A partly annotated Bibliography, A. Boroffka : book reviewAuthor Goffredo BartocciSource: African Journal of Psychiatry 11, pp 301 –303 (2008)More Less
In July 1969, ten psychiatrists founded at the University College Hospital in Ibadan the ''Association of Psychiatrists'' in Nigeria. No one would have dared to guess that in 2001 during the author's last visit to Nigeria, the Association would meet the 32nd time for its annual and Scientific Meeting. In this occasion the Author ended his presentation with the following statement: ''If the whole of Nigeria would have developed in the same way as Psychiatry, Nigeria would be number one in Africa.''
Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder : product newsSource: African Journal of Psychiatry 11 (2008)More Less
In their discussion the authors also refer to the CATIE trial which had consistent results with the EUFEST trial when insufficient efficacy was the reason for discontinuation, and time to discontinuation was longer in the olanzapine group than in the perphenazine and quetiapine groups. The EUFEST trial also noted that olanzapine showed a longer time to discontinuation than did ziprasidone, which was different from what was reported in CATIE.