African Journal of Psychiatry - Volume 12, Issue 4, 2009
Volume 12, Issue 4, 2009
Author Mike Ewart SmithSource: African Journal of Psychiatry 12, pp 249 –253 (2009)More Less
The recent study in the Journal by Emsley et al of teachers claiming occupational disability demonstrated the importance of work-related stress as a major contributory factor to the subjects' psychiatric morbidity. I have carried out a similar number of evaluations on teachers from the Northern provinces of South Africa applying for early retirement on the grounds of psychiatric disability. My findings have been uncannily, virtually identical to those of Emsley et al. But a striking factor in my teachers, not mentioned in the Cape study, was the length of time the applicants had been off work before eventually coming for independent assessment. About a couple of years was the norm. Amazingly, several had been receiving full salary while off work on sick leave for 4 or more years, pending final adjudication of their claims. Treatment during these waiting periods typically consisted of marking time with superficial symptom suppression until the desired escape from the noxious work environment was granted.
Author Christopher Paul SzaboSource: African Journal of Psychiatry 12 (2009)More Less
It is the end of another year, and with it the publication of the final edition of 2009. This has been a momentous year. The Journal was selected for inclusion in the MEDLINE database as well as a number of the Thomson Reuters databases, such as the Science Citation Index Expanded (also known as SciSearch). Such selection speaks of the acknowledgement that the Journal has received, and now places African psychiatry very squarely on the international stage.
Author S. RataemaneSource: African Journal of Psychiatry 12 (2009)More Less
This meeting was held at the Shehu Musa Yar'Adua Center in Abuja, Nigeria from 22 - 24 October 2009. It was organized jointly by the Association of Psychiatrists of Nigeria, African Association of Psychiatrists and Allied Professions (AAPAP) and World Psychiatric Association with support from the World Health Organization. This excellent meeting enjoyed active participation from a number of countries including the USA, Jamaica, Australia, UK & other European countries, South Africa, Ghana, Liberia, Kenya, Nigeria and other African countries. There was minimal support form the pharmaceutical industry but local support from various Nigerian Hospitals, Universities, private sector and Government sector was commendable.
Source: African Journal of Psychiatry 12, pp 265 –269 (2009)More Less
A basic understanding of consciousness and its neural correlates is of major importance for all clinicians, especially those involved with patients with altered states of consciousness. In this paper it is shown that consciousness is dependent on the brainstem and thalamus for arousal; that basic cognition is supported by recurrent electrical activity between the cortex and the thalamus at gamma band frequencies; and that some kind of working memory must, at least fleetingly, be present for awareness to occur. The problem of cognitive binding and the role of attention are briefly addressed and it is shown that consciousness depends on a multitude of subconscious processes. Although these processes do not represent consciousness, consciousness cannot exist without them.
Screening for HIV-related PTSD : sensitivity and specificity of the 17-item Posttraumatic Stress Diagnostic Scale (PDS) in identifying HIV-related PTSD among a South African sample : original articleSource: African Journal of Psychiatry 12, pp 270 –274 (2009)More Less
Objectives : The identification of HIV-positive patients who exhibit criteria for Post traumatic Stress Disorder (PTSD) and related trauma symptomatology is of clinical importance in the maintenance of their overall wellbeing. This study assessed the sensitivity and specificity of the 17-item Post traumatic Stress Diagnostic Scale (PDS), a self-report instrument, in the detection of HIV-related PTSD. An adapted version of the PTSD module of the Composite International Diagnostic Interview (CIDI) served as the gold standard.
Method : 85 HIV-positive patients diagnosed with HIV within the year preceding data collection were recruited by means of convenience sampling from three HIV clinics within primary health care facilities in the Boland region of South Africa.
Results : A significant association was found between the 17-item PDS and the adapted PTSD module of the CIDI. A ROC curve analysis indicated that the 17-item PDS correctly discriminated between PTSD caseness and non-caseness 74.9% of the time. Moreover, a PDS cut-off point of ≥ 15 yielded adequate sensitivity (68%) and 1-specificity (65%). The 17-item PDS demonstrated a PPV of 76.0% and a NPV of 56.7%.
Conclusion : The 17-item PDS can be used as a brief screening measure for the detection of HIV-related PTSD among HIV-positive patients in South Africa.
Sleep and daytime sleepiness in methylphenidate medicated and un-medicated children with attention-deficit / hyperactivity disorder (ADHD) : original articleSource: African Journal of Psychiatry 12, pp 275 –279 (2009)More Less
Objective : Excessive daytime sleepiness due to any cause can result in various symptoms similar to those used for the diagnosis of attention deficit / hyperactivity disorder (ADHD). A common treatment for children diagnosed with ADHD is methylphenidate which is also used to treat excessive daytime sleepiness. This paper reports on a study which compared the perceived levels of daytime sleepiness and prevalence of sleep disorders in medicated and un-medicated children with ADHD.
Method : The sample consisted of two matched groups of children who had been formally diagnosed with ADHD. One group (n=12) was taking immediate release methylphenidate twice daily, while the other group (n=11) had never, and were not currently, taking any medication. The two groups, as well as their parents, rated their levels of daytime sleepiness at three points in a single day.
Results : Significantly higher levels of daytime sleepiness were reported by the parents of the un-medicated children between the hours of 13:00 and 15:00, compared to the medicated children. The medicated children became increasingly sleepier from the first to the second measurement in both the morning and afternoon. There was no significant difference in the number of sleep disorders / disruptions reported by the parents of either group.
Conclusion : In a group of children with ADHD taking methylphenidate, there was a significant increase in sleepiness a few hours after taking the medication, which may then have a significant impact on their learning. The data also imply that part of the mechanism of action of methylphenidate effects in these children may be by reduction of daytime sleepiness.
Profiles of referrals to a psychiatric service : a descriptive study of survivors of the Nairobi US Embassy terrorist bomb blast : original articleSource: African Journal of Psychiatry 12, pp 280 –283 (2009)More Less
Objective : To document the socio-demographic characteristics and psychiatric profiles of the survivors of the Nairobi United States Embassy terrorist bomb blast referred to a psychiatric and psychotherapy (counselling) service.
Method : This was a descriptive cross-sectional study. Clinical interviews and structured questionnaires for post-traumatic stress disorder (PTSD) and stress were administered. Survivors of the bomb blast referred to a psychiatric and psychotherapy service one year or more after the bombing were included in this study. These survivors had been treated using psychopharmacotherapy and individualised (not group) therapy / counselling.
Results : Eighty-three consecutive referrals to a psychiatric service participated in this study. There were more males and the sample was generally well educated. The referrals made contact with the referring agency for a number of reasons including seeking psychological, financial and medical assistance. All the patients reported varying degrees of psychiatric symptoms and functional impairment on various aspects of social occupational functioning. High scores for PTSD and other related stress were recorded one or more years after the bombing.
Conclusion : Although the survivors indicated that initial counselling following the blast had helped them, they still scored high on PTSD suggesting that clinically, the initial counselling had little, if any impact on the development of PTSD. There is need for a holistic approach to the management of psychotrauma in individuals.
Source: African Journal of Psychiatry 12, pp 284 –286 (2009)More Less
Objective : Vitiligo is a chronic skin disease that causes loss of pigment, resulting in irregular pale patches of skin. The disease has profound psychological consequences. These effects range from mild embarrassment to a severe loss of self-confidence and social anxiety, especially for those who have lesions on exposed skin. The study sought to determine the psychological impact of vitiligo in Sudanese patients.
Method : This study is a cross-sectional, clinical-epidemiological and hospital-based study, underatken in Khartoum Dermatologic Hospital (KDH). The data was collected between June 2007 and November 2007. 111 adult patients were enrolled sequentially during the study period and they were tested using the 12-item General Health Questionnaire (GHQ-12).
Results : Psychological disturbances as a consequence of vitiligo were found in 36 (31 %) adult patients. Patients with mild psychological disturbances were found in 20 of these patients and severe disturbances in 16.
Conclusion : Psychological consequences are common in patients with vitiligo.
Screening for and monitoring of cardio-metabolic risk factors in outpatients with severe mental illness in a primary care setting : original articleSource: African Journal of Psychiatry 12, pp 287 –292 (2009)More Less
Objective : Recent findings suggest that premature death in patients with severe mental illness (SMI) can be attributed to the high comorbidity of cardio-metabolic disorders. This study investigated the prevalence and monitoring of some risk factors for cardio-metabolic disease in a cohort with SMI, compared to the general medical population.
Method : 101 participants with SMI and 100 controls were recruited from a primary care clinic. Assessments of risk factors with standard clinical measurements were done after healthcare workers and patient-participants had completed the structured questionnaires. Clinical files were reviewed to determine frequency of monitoring of risk factors.
Results : We found no differences between the groups in demographic variables. A similar prevalence of abnormal blood pressure (BP), increased Body Mass Index (BMI) and increased waist circumference was noted in both groups. Females in both groups were more likely to have an abnormal waist circumference. Patients with SMI were significantly less likely to have recordings of their weight or BP in their clinic file. Healthcare workers and patients with SMI were largely unaware of the increased risk of cardio-metabolic illness.
Conclusion : This study suggests that patients with SMI received poorer health monitoring than other patients attending a primary care clinic and that both healthcare workers and patients were poorly informed about the increased risk of cardio-metabolic disorders in patients with SMI.
Perceived economic and behavioural effects of the mentally ill on their relatives in Kenya : a case study of the Mathari Hospital : original articleSource: African Journal of Psychiatry 12, pp 293 –299 (2009)More Less
Objective : There is no documented evidence in Kenya on relatives' perceptions of economic and behavioural effects of the mentally ill patients and their coping mechanisms. To document what relatives of mentally ill patients perceive to be the economic effects of the patients on the family and how they are affected by and cope with the disturbed behaviours of the patients.
Method : This was a cross-sectional descriptive study conducted at the Mathari Psychiatric Hospital. Informed consent was obtained from both the relatives and the patients admitted at the hospital. Data on socio-demographic and economic profiles were obtained from the patients and their relatives. The relatives were interviewed using a structured questionnaire to determine what they perceived to be the economic effects of the mental illness, how the various disturbed behaviours of the mentally ill affected them, and how they coped. The data were analysed using SPSS version 11.5 and results are presented in narratives and tables.
Results : One hundred and seventy-five relatives and 107 patients were recruited and interviewed. The patients were younger and better educated but economically less well off than their relatives. The relatives perceived that the mentally ill patients caused financial constraints and that various disturbed behaviours, particularly, verbal and physical aggression and refusal of the patient to take medicine or go to hospital, affected the family in different ways. Different coping mechanisms were used, depending on whether or not the behaviours were intrusive.
Conclusion : Mentally ill patients adversely affect their families in diverse ways. There is need for appropriate policy to address the needs of families with mentally ill patients at the family and community levels. However, these must be evidence-based and this calls for further research.
Psychological morbidity and job satisfaction amongst medical interns at a Nigerian teaching hospital : scientific letterSource: African Journal of Psychiatry 12, pp 303 –304 (2009)More Less
Medical internship (houseman ship) is regarded as both educational as well as formative insofar as attitude to work, job satisfaction, relationships with colleagues, and future career directions are consolidated. Equally important is the fact that this is also believed to be the most stressful period of medical practice.
Author Franco. P. VisserSource: African Journal of Psychiatry 12 (2009)More Less
Based on the novel written by Elinor Lipman, Then She Found Me tells the story of a Kindergarten teacher named April Epner (played by Helen Hunt) and everything in her life that changes within a very short space of time. Her husband Ben (played by Matthew Broderick) tells her one evening that he wants a divorce. The couple struggled to have children, and Ben is no longer prepared to stay in the marriage. Soon after this April's adoptive mother dies. April meets, and falls in love with a book-cover illustrator named Frank (played by Collin Firth). Frank's children are attending the Kindergarten where April teaches. Then April's biological mother, Bernice Graves (played by Bette Midler) makes contact with her for the first time ever via Bernice's gay assistant, the isolated and professionally-absorbed Alan (played by John Benjamin Hickey). Bernice is a successful television star who has her own talk-show. She tries very hard to be part of April's life, although mostly with negative consequences.
Source: African Journal of Psychiatry 12 (2009)More Less
Second-generation antipsychotics (SGAs) are an effective treatment for patients with schizophrenia but there is substantial evidence that certain of these agents are associated with clinically significant weight gain, increased risk for insulin resistance, hyperglycemia and dyslipidemia compared with first-generation antipsychotics.
Source: African Journal of Psychiatry 12 (2009)More Less
As much as 85% of patients with schizophrenia have significant impairment in most domains of cognitive functioning. This impairment has been reported to be present shortly after recovery from the first period of psychosis and to persist. It is likely that it may precede the development of psychotic symptoms, becoming manifest, and contributing to the loss in function, during the prodromal period. The cognitive disturbance is slowly progressive in most patients, but a small proportion shows severe deterioration as the duration of illness increases. The degree of impairment in various domains of cognition differs in patients with schizophrenia, with some studies suggesting that the most severe cognitive impairments occur in measures of attention, verbal fluency, motor speed, and executive function. Moderate impairments in working memory, immediate memory span, and verbal learning and memory have been reported most frequently. All of these impairments are disproportionate to the mild intellectual decline demonstrated in patients with schizophrenia as a group.
But it makes you tough... doesn't it? Everyone goes through it... right?
The myths and truths behind bullying and self-esteem : patients as partners (SADAG)Author Janine ShamosSource: African Journal of Psychiatry 12, pp 319 –320 (2009)More Less
Bullying is on the increase in South Africa. Even more frightening is we tell our children to expect it - and accept it - because "kids will be kids". Bullying is abusive behaviour by one or more people against a victim. It can be a direct physical attack like teasing, taunting, hitting, punching and stealing or it can be more subtle and malicious through gossiping, spreading rumours and intentional exclusion. The result is the victim becomes socially rejected and isolated. Physical or psychological intimidation creates an ongoing pattern of harassment and abuse - the vicious cycle of bullying.