African Journal of Psychiatry - Volume 12, Issue 3, 2009
Volume 12, Issue 3, 2009
Author Jonathan BurnsSource: African Journal of Psychiatry 12, pp 181 –185 (2009)More Less
Psychiatric and Mental Health Research in Low-and-Middle-Income-Countries (LMIC's) is poorly resourced, inadequately funded, lacks cohesion and suffers from a scarcity of skills and experience. Where national research institutions do offer grants and scholarships, these are generally modest amounts in local currencies and cannot compare with the massive funding support available to colleagues from institutions such as the National Institute of Health and the Fogarty Foundation in the USA and the Medical Research Council and the Wellcome Trust in the UK. And where funding is available for health research in LMIC's, major high-profile health problems such as HIV / AIDS and other infectious diseases as well as maternal and child health problems are prioritized for support.
Source: African Journal of Psychiatry 12, pp 192 –198 (2009)More Less
Dispelling a myth : developing world poverty, inequality, violence and social fragmentation are not good for outcome in schizophrenia : review articleAuthor J. BurnsSource: African Journal of Psychiatry 12, pp 200 –205 (2009)More Less
The WHO multi-site studies of schizophrenia concluded that course and outcome of the disorder was better in developing countries. This has become psychiatric lore. However, the reality is that significant political, social and economic ills that characterize many countries in Africa, Latin America and Asia constitute psychosocial stressors that mediate strongly against better outcome in individuals living with this disorder. Outcome studies of schizophrenia in developing countries are reviewed and concepts of poverty, inequality and violence in relation to the course of the illness in this context are debated. The generally poor state of mental health services and policies in these regions are discussed. The belief that community and family life in the developing world is widely intact and that it provides a nurturing environment that facilitates recovery and promotes social and economic empowerment of seriously mentally ill individuals is dispelled as a myth. Idealisation of the under-developed South as a haven for schizophrenia sufferers will only add to the already heavy burden experienced by these individuals, their families and these societies in coping with this disabling disease.
Psychiatric symptoms and disorders in HIV infected mine workers in South Africa - a retrospective descriptive study of acute first admissions : original articleSource: African Journal of Psychiatry 12, pp 206 –212 (2009)More Less
Objective : The social and living conditions of mine workers in South Africa contribute to a rapid transmission of human immunodeficiency virus (HIV) and other sexually transmitted infections. HIV-associated dementia is a serious condition during HIV disease. Several other psychiatric symptoms and disorders, such as psychosis, secondary mania and depression, have also been associated with clinical HIV infection. We describe the onset of psychiatric symptoms and signs in a group of untreated, HIV-infected male mine workers first admitted for psychiatric treatment at the Rand Mutual Hospital in Johannesburg.
Method : Between 1987 and 1997, 38 consecutive cases were admitted, and their files were retrieved for study in 2006. The subjects were 38 black male mine workers admitted acutely for psychiatric care due to psychiatric symptoms, and subsequently diagnosed with HIV infection. The presenting psychiatric symptoms on admission and diagnoses at discharge were compiled for all patients, not to infer causality but to establish the range of symptoms that the clinician has to deal with.
Results : The 38 patients presented with a wide range of psychiatric symptoms. The dominating symptoms were those of cognitive deficits, and different psychotic manifestations. 12 of the patients, almost one third of the individuals, were diagnosed with dementia. The patients with dementia exhibited cognitive deficits, and in addition often abnormal behaviour and psychotic symptoms, and several also had symptoms of secondary mania. 5 of the patients presented with delirium. Psychosis, without concurrent dementia, was diagnosed in 5 patients. Bipolar disorder with mania, without concurrent dementia, and major depression was present in 2 patients, respectively. Screening for substance abuse showed that 9 of the patients had ongoing cannabis abuse and 10 had alcohol abuse. Cannabis-induced psychotic disorder was present in 5 patients.
Conclusion : The findings confirm that patients with a new diagnosis of HIV may present with disorders of thought and / or cognition as well as gross behavioural disturbance, and that psychotic symptoms and secondary mania could be manifestations of the clinical onset of HIV / acquired immune deficiency syndrome (AIDS) infection.
Occurrence of comorbid substance use disorders among acute psychiatric inpatients at Stikland Hospital in the Western Cape, South Africa : original articleSource: African Journal of Psychiatry 12, pp 213 –217 (2009)More Less
Objective : Little is known about the epidemiology of substance use disorders (SUD) among psychiatric inpatients in the Western Cape, South Africa. Therefore, this study was conducted to examine the prevalence of SUD among acute adult psychiatric inpatients at Stikland Hospital, one of three state acute psychiatric hospitals in the Western Cape.
Method : A prospective descriptive prevalence survey was undertaken over a three-month period. During this period, data was collected on psychiatric patients (N=298) who were hospitalized in the acute psychiatric wards at Stikland. This included patient demography, psychiatric and substance use history. Urine was also collected and analyzed for substances commonly abused in the Western Cape.
Results : A co-morbid SUD (abuse or dependence) was diagnosed in 51% of patients. In addition, a diagnosis of a substance-induced psychiatric disorder was made in 8% of these patients, 1% of who was diagnosed with a substance-induced mood disorder, while 7% was diagnosed with a substance-induced psychotic disorder. Patients diagnosed with a co-morbid SUD were younger than those without a SUD and more likely to have been involuntary admissions. These patients also displayed more violence prior to admission that contributed to their admission and were more likely to have used cannabis or methamphetamine as their preferred drug of abuse. Only a small group of patients had documented evidence of any prior interventions for their SUD.
Conclusion : SUD are prevalent among psychiatric inpatients and contribute to their morbidity. This has implications for staff training and service development.
Stigma, treatment beliefs, and substance abuse treatment use in historically disadvantaged communities : original articleSource: African Journal of Psychiatry 12, pp 218 –222 (2009)More Less
Objective : Access to substance abuse treatment among historically disadvantaged communities (HDCs) in Cape Town, South Africa is limited, despite a growing demand for services. Although research has reported on structural barriers to treatment access, nonstructural factors remain largely unexplored. The aim of this paper is to describe two nonstructural influences on the use of substance abuse treatment services for people from HDCs : stigma and negative beliefs about treatment.
Method : Findings from the qualitative component of a multi-method study are reported. In-depth interviews were conducted with 20 key informants, all of whom worked or lived in HDCs in the greater Cape Town area. Content and thematic techniques were used to analyse data.
Results : According to key informants (i) stigma towards individuals with substance use disorders was prevalent in HDCs and negatively impacted on attempts to access services; (ii) negative beliefs about the quality and effectiveness of treatment were commonplace and acted as barriers to the use of existing services; and (iii) several factors contributed to these nonstructural barriers including media representations of both individuals with substance use disorders and treatment facilities for these disorders.
Conclusion : This paper moves beyond the description of structural barriers to treatment to describe how two nonstructural factors, stigma and negative beliefs about treatment, hinder treatment seeking for substance use disorders. Recommendations for addressing these barriers include efforts to (i) shift discourses about substance abuse treatment, (ii) improve service quality, and (iii) address myths and misconceptions about treatment.
Source: African Journal of Psychiatry 12, pp 223 –226 (2009)More Less
Objective : School-teachers are exposed to high levels of stress and have high rates of premature retirement on psychiatric grounds. This study investigated factors associated with occupational disability due to psychiatric disorders in teachers in South Africa.
Method : This retrospective study investigated 81 school-teachers in the Cape Town area who had been declared permanently medically disabled as a consequence of psychiatric disorders.
Results : Patients were relatively young (44±6.1 yrs), had experienced symptoms for 5.2±3.8 yrs, and had been treated for 4±3.5 yrs. Almost half had a family history of psychiatric disorder, and the majority (N = 66. 81%) cited work-related stress as a significant contributing factor. Major depressive disorder was the commonest diagnosis (83%), and 56% had co-morbid Axis-I diagnoses. Thirty percent had prominent underlying obsessive-compulsive personality traits, and 46% displayed classroom phobia.
Conclusion : Work-related stress is a major factor in South African teachers with occupational disability on psychiatric grounds.
Neuropsychiatric complications associated with interferon - alpha -2b treatment of malignant melanoma : case reportSource: African Journal of Psychiatry 12, pp 227 –228 (2009)More Less
Several adverse effects have been associated with interferon alpha 2b treatment and neuropsychiatric effects have also been commonly reported. Psychosis and mood disorders have been described in the literature. This case report is of a 30 year old man with malignant melanoma stage 3a who was receiving adjuvant alpha 2b interferon and developed a manic episode two weeks post switching after one month of treatment on a high dose to a low dose. There was no previous psychiatric illness and no known family history of mental illness. This is in keeping with previous reports that mania has been observed in patients undergoing interferon treatment especially after significant dose-reduction or treatment breaks. Mania induced by interferon responds well to antimanic drugs. Since interferon alpha 2b is now commonly used in the treatment of malignant melanoma and other conditions, the need to be aware of its neuropsychiatric complications is essential.
Source: African Journal of Psychiatry 12, pp 231 –232 (2009)More Less
The shift towards community care for patients with chronic mental illness has resulted in an increase in the number of forensic patients. This has been associated with other factors such as gender, education, poverty, diagnosis, psychopathology and lack of access to mental health services. In Sub-Saharan Africa and other Low and Middle Income Countries (LAMIC) access to mental health facilities is poor and often difficult. A study in Nigeria estimated that 70% of the population had no access to mental health facilities. Moreover, in Nigeria, all the mental health centres are located in urban areas and require out-of pocket payment for access to their services. The situation is further complicated by the tortuous pathway to mental health services in Nigeria leading to delay in presentation, increased morbidity and poor outcome.
Generalized Anxiety Disorder Across the Lifespan : An Integrative Approach, Michael E. Portman : book reviewAuthor Vladan StarcevicSource: African Journal of Psychiatry 12 (2009)More Less
Two aspects of this book are striking. The first is that "integrative approach" is not just a part of its title. Indeed, integration is the underlying philosophy of this work, which is, therefore, a truly integrative effort to present our current understanding of generalized anxiety disorder (GAD) and its treatment. Although a larger part of the book describes psychological models and psychological treatment of GAD, there is adequate information on neurobiological approaches and pharmacological treatment, with a good balance achieved between the two. The second aspect of the book that I found striking and that I liked is that it often emphasizes what every good clinician knows, but is sorely missing from much of the contemporary literature in psychiatry and clinical psychology : the fact that our patients have different preferences and goals, a need for clinicians to respect that, be flexible, and adapt their treatment strategy to these preferences and goals, and the importance of the patient-therapist relationship and clinical experience.
Author Franco P. VisserSource: African Journal of Psychiatry 12 (2009)More Less
The Hollywood entertainment industry regularly produces films with the Jewish Holocaust either as its main theme, or as a theme woven somewhere into a story plot. The discriminatory nature of mankind (which perpetually manifests itself) serves to warn us that events such as Holocaust should not be forgotten.
Early response or nonresponse of schizophrenia symptoms to antipsychotic medication is a predictor of long-term outcome : product newsSource: African Journal of Psychiatry 12 (2009)More Less
After prescribing antipsychotic medication, many clinicians will wait 4 to 8 weeks before deciding whether to maintain the current treatment or to change it if the patient displays a suboptimal clinical response. However, a recent meta-analysis of randomised clinical trials (RCTs) has demonstrated that this delay is unnecessary, because the greatest reduction of symptoms occurs during the first 2 weeks of therapy. Furthermore, post hoc analyses of RCTs have shown that nonresponse in the first 2 weeks after treatment initiation is a reliable predictor of subsequent nonresponse in patients with schizophrenia.
Source: African Journal of Psychiatry 12 (2009)More Less
It has been predicted that 220 million people worldwide will be afflicted with diabetes mellitus by 2010. Diabetic neuropathy, which is often painful and disabling, is one of the most common complications of diabetes, and epidemiological studies suggest that painful diabetic neuropathy occurs in 7.5-24% of patients with diabetes. There is a considerable negative impact on quality of life (QOL).