African Journal of Psychiatry - Volume 13, Issue 5, 2010
Volume 13, Issue 5, 2010
Source: African Journal of Psychiatry 13, pp 329 –331 (2010)More Less
The issue of sub-specialization within a developing world setting has been raised as an issue for developing world psychiatrists. The current editorial poses the question as to whether sub specialists in child and adolescent psychiatry are a luxury or a necessity. In a continent where over 50% of the population are children and adolescents and one in five will have a mental health problem, how appropriate is this question? Yet the question needs to be answered if effective Child and Adolescent Psychiatry (CAP) services are to be developed and extended in Africa.
Author Deborah GlencrossSource: African Journal of Psychiatry 13, pp 338 –340 (2010)More Less
The following is an address given to the Division of Psychiatry, University of the Witwatersrand, Johannesburg, South Africa as part of their annual Research Day - 9th June 2010. Professor Glencross is a leading academic, and an artist with a number of group and stand alone exhibitions to her credit.
Board of International Affairs Pan-African Division Quarterly newsletter
African International Division, Royal College of Psychiatrists : newsletterSource: African Journal of Psychiatry 13, pp 342 –348 (2010)More Less
From the Editor
Training workshop for Lagos state PHC workers in recognition and management of common mental illnesses and substance abuse
Mental health and socioeconomic and political turbulence
Nigeria: Early but steady steps towards evidence-based community psychiatry
Source: African Journal of Psychiatry 13, pp 351 –356 (2010)More Less
Background : Epilepsy is a chronic disorder marked by intermittent, often unpredictable seizures which may be embarrassing and disruptive to the normal activity of daily living. This review was undertaken to provide information / data on the prevalence, seizure types, treatment issues and psychosocial impact of epilepsy in Nigeria. Method : We searched the PUBMED database with emphasis on studies conducted in Nigeria using a combination of the following words: epilepsy, seizure, convulsion, prevalence, epidemiology, psychiatric morbidity, social issues, quality of life, cognition, school performance, treatment issues and Nigeria. Result : 48 relevant studies that met the criteria were reviewed. The point prevalence of epilepsy varies from 5.3 to 37 per 1000 in Nigeria. Most studies showed a predominance of generalized tonic-clonic seizures. Nigerian patients with epilepsy suffer social deprivation and discrimination in education, employment, housing, marital life as well as associated psychiatric morbidity. Conclusion : Epilepsy, a stigmatizing disorder in Nigeria, has a significant impact on the day to day functioning of those with the condition.
Source: African Journal of Psychiatry 13, pp 357 –365 (2010)More Less
Objective : The purpose of this study is to review the main postpartum screening tools currently used in terms of their ability to screen for postnatal depression. Furthermore, the cultural characteristics of depressive postpartum symptomatology are examined. Method : A systematic literature search was conducted for the period 1987-2009, using the Medline electronic database for the following keywords: postpartum depression and postnatal depression. These terms were combined with: assessment, screening and psychometric tools. Results : Of the four screening tools reviewed and compared, the Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Depression Screening Scale (PDSS) presented substantial sensitivity and specificity as screening tools. However, none of the instruments could be rated flawless when applied to different cultural contexts. Conclusions : In addition to the EPDS, a new generation of instruments is currently available. Supplementary research is needed to substantiate their use as screening tools in general practice. Additional studies are needed to adapt and test instruments to detect postnatal depression within a wider range of languages and cultures.
Risk factors for violence among long-term psychiatric in-patients : a comparison between violent and non-violent patients : original articleSource: African Journal of Psychiatry 13, pp 366 –377 (2010)More Less
Objective : The problem of the prediction of violence in psychiatric patients has led to a proliferation of research over the last decade. This study focuses on enduring patient related risk factors of violence, and investigates which long-term patients in Weskoppies Hospital (a specialist psychiatric hospital) are the most likely to commit violent acts. Method : Nursing statistics on violent incidents and other security breaches were collected for 262 long-term in-patients over a six month period (April - September 2007). The 41 patients who committed violent acts were compared to the 221 non-violent patients in terms of demographic and clinical variables, using two-way tables and Chi-Square or Fisher's Exact Tests. Results : The prevalence of violence among the long-term patients was 16%. Fighting among patients was the most common form of violence (58%). The most significant risk factors of violence among the long-term patients are : A diagnosis of mental retardation; first hospital admission before the age of 40 years; total hospital stay >12 years; current accommodation in a closed ward; habitual verbal aggression; absence of disorganised behaviour; and being clinically evaluated as unsuitable for community placement. Conclusion : The findings will help to identify those long-term patients most at risk of violence. The subgroup of patients with mental retardation is responsible for a disproportionately large number of violent acts in the hospital. The risk lies not so much in their psychiatric symptoms, but more in their cognitive ability, coping skills and inappropriate admission circumstances. Efforts should be directed - at a provincial level - towards their community placement.
Childhood trauma in adults with social anxiety disorder and panic disorder : a cross-national study : original articleSource: African Journal of Psychiatry 13, pp 376 –381 (2010)More Less
Objectives : The influence of childhood trauma as a specific environmental factor on the development of adult psychopathology is far from being elucidated. As part of a collaborative project between research groups from South Africa (SA) and Sweden focusing on genetic and environmental factors contributing to anxiety disorders, this study specifically investigated rates of childhood trauma in South African and Swedish patients respectively, and whether, in the sample as a whole, different traumatic experiences in childhood are predictive of social anxiety (SAD) or panic disorder (PD) in adulthood. Method : Participants with SAD or PD (85 from SA, 135 from Sweden) completed the Childhood Trauma Questionnaire (CTQ). Logistic regression was performed with data from the two countries separately, and from the sample as a whole, with primary diagnoses as dependent variables, gender, age, and country as covariates, and the CTQ subscale totals as independent variables. The study also investigated the internal consistency (Cronbach alpha) of the CTQ subscales. Results : SA patients showed higher levels of childhood trauma than Swedish patients. When data from both countries were combined, SAD patients reported higher rates of childhood emotional abuse compared to those with PD. Moreover, emotional abuse in childhood was found to play a predictive role in SAD/PD in adulthood in the Swedish and the combined samples, and the same trend was found in the SA sample. The psychometric qualities of the CTQ subscales were adequate, with the exception of the physical neglect subscale. Conclusion : Our findings suggest that anxiety disorder patients may differ across countries in terms of childhood trauma. Certain forms of childhood abuse may contribute specific vulnerability to different types of psychopathology. Longitudinal studies should focus on the potential sequential development of SAD/PD among individuals with childhood emotional abuse.
Acute mental health care and South African mental health legislation : Part 1 - morbidity, treatment and outcome : original articleAuthor A.B.R. Janse van RensburgSource: African Journal of Psychiatry 13, pp 382 –389 (2010)More Less
Objective : This is the first of three reports on a follow-up review of mental health care at Helen Joseph Hospital (HJH). In this first part, qualitative and quantitative descriptions were made of the services and of demographic and clinical data on acute mental health care users managed at HJH, in a retrospective review of clinical records over a four year period. Objectives for this review were to provide information on mental health care outcome, to do a cost analysis and to establish a quality assurance cycle that may facilitate a cost centre management approach. The operational areas identified were service delivery, teaching, and research. Activities within each area were in-patient care, out-patients and consultation / liaison, under- and postgraduate teaching and self initiated or contract research. Method : The study reviewed the existing mental health care program and activities in context of relevant policy and legislation. Results : Norms from a World Health Organization model for acute mental health care showed that significant staff shortages existed, especially for nursing. A total of 520 users were admitted for in-patient mental health care during the financial year 2007/08. The average length of stay was 15.4 days and ranged from 1 to 85 days. Ninety users (17%) had an extended period of stay of 25 days and more, while 39 users had multiple admissions during the 12 month period. The most common Axis I diagnoses made were schizophrenia n=138 (29%), substance-related conditions n=99 (21%) and bipolar mood disorder n=69 (14%). After discharge, 139 users (27%) were referred back to the HJH out-patient department for follow-up. Conclusion : The information from these reports may be used in the allocation of adequate resources to align this acute unit with its responsibilities according to recent legislation.
A retrospective review of trends and clinical characteristics of methamphetamine-related acute psychiatric admissions in a South African context : original articleSource: African Journal of Psychiatry 13, pp 390 –394 (2010)More Less
Objective : Epidemiological studies indicate that methamphetamine (MA) abuse poses a major challenge to health in the Western Cape. The objectives of this study were to retrospectively assess the trends, clinical characteristics and treatment demand of MA-related admissions to a psychiatric ward in this region. Method : The clinical records of patients admitted to an acute psychiatric admission ward at Tygerberg Hospital from 1 January 2002 to 30 June 2002 and 1 January 2006 to 30 June 2006, were retrospectively reviewed. Admission numbers including those of adolescent and adult substance users were compared for both study periods. Study samples comparing demographic profile, admission status, length of stay, psychopathology, treatment requirements and referral pattern to other disciplines between MA users and non-users were collected for the 2006 period. Results : There was a significant (p <0.01) increase in adolescent substance user admissions between the study periods. A significant (p <0.01) increase in adolescent and adult MA user admissions was also noted. MA users were significantly (p = 0.04) younger than non-MA users, whilst the former presented mainly with psychotic features associated with aggression, requiring involuntary admission of an average of 8 weeks. MA users required significantly (p = 0.007) more benzodiazepines compared to non-MA users. Conclusion : Although MA use is relatively recent to the Western Cape, its adverse psychiatric effects and consequences have become a major challenge. These effects in both adolescent and adult patient populations and the associated impact on psychiatric services demand urgent intervention strategies as well as prospective study.
Cannabis use predicts shorter duration of untreated psychosis and lower levels of negative symptoms in first-episode psychosis : a South African study : original articleSource: African Journal of Psychiatry 13, pp 395 –399 (2010)More Less
Objective : Cannabis use / abuse is a common co-morbid problem in patients experiencing a first episode of psychotic illness (FEP). The relationship between the clinical presentation of FEP and cannabis abuse is complex and warrants further investigation, especially within the South African context. Method : We tested associations between recent / current cannabis use and duration of untreated psychosis (DUP), age of onset (AO), PANSS-rated (Positive and Negative Syndrome Scale) positive, negative and general psychopathology symptoms and depressive symptoms (Calgary Depression Scale for Schizophrenia) in a sample of 54 patients with FEP. Results : Mean DUP was 34.4 weeks, while mean AO was 24.7 years. Co-morbid cannabis use occurred in 35% of the sample and was significantly associated with shorter DUP (Mann-Whitney U, p=0.026). While not significant, there was also a trend association between cannabis use and lower negative symptoms (Mann-Whitney U, p=0.051). Conclusion : Current / recent cannabis use was associated with clinical features of psychosis onset that previously have been associated with better outcome. Medium and long-term outcome for cannabis users however, is likely to depend on whether or not cannabis use is ongoing.
A CBS Films Presentation. A Double Feature Films Production. A Tom Vaughan Film : movie reviewAuthor Franco P. VisserSource: African Journal of Psychiatry 13 (2010)More Less
Inspired by a true story, the film Extraordinary Measures tells the story of a father's determination to do everything in his power to save his daughter's life. Brendan Fraser plays the part of John Cowley, a father of two children, both diagnosed with Pompe Disease. John and his wife Aileen (played by Keri Russell) embark on a campaign to raise awareness and funding for much needed research into a possible cure for their children's disease.
Clozapine withdrawal catatonia or lethal catatonia in a schizoaffective patient with a family history of Parkinsons Disease : scientific letterSource: African Journal of Psychiatry 13, pp 402 –404 (2010)More Less
Catatonia has been documented since 1874 and may be attributable to many causes. It has been observed even prior to the advent of antipsychotics in association with extreme psychosis and was termed lethal catatonia. Sometimes catatonia has occurred on abrupt cessation of drugs especially clozapine. Clozapine has dual actions in a psychotic patient with Parkinson's Disease (PD) in that it both treats psychosis as well reduces tremors of PD. Abrupt discontinuation of clozapine generally causes a recurrence of tremors. The following case report illustrates a patient, whose parents both suffered from PD but who himself manifested no evidence of the disease.
Painful physical symptoms and treatment outcome in major depressive disorder : a STAR*D (Sequenced Treatment Alternatives to Relieve Depression) report : product newsSource: African Journal of Psychiatry 13 (2010)More Less
The most common symptom in medicine is pain. More than half of complaints to physicians are reports of pain - commonly headache or back pain, on a chronic or acute basis. Up to 40% of the general population complains of chronic pain, with nearly 15% complaining of pain on a daily basis. Commonly, the basis for pain is not clearly identified.
Patients preference of olanzapine orodispersible tablet compared with olanzapine conventional oral tablet : product newsSource: African Journal of Psychiatry 13 (2010)More Less
Patient preference can have long-term implications in terms of patient's motivation and insight into their disease state and treatment necessities and this might have a direct impact on compliance and treatment adherence. Studies investigating patient preference can be used to support studies with traditional efficacy measures when drug compliance is an important issue. Poor adherence to antipsychotics is a major problem in long term treatment of schizophrenia, a relationship between poor adherence and relapse is well documented in the literature. One of the factors that may affect compliance is antipsychotic formulation.
Source: African Journal of Psychiatry 13 (2010)More Less
Sleep disturbances and treatment-related sedation are common in patients with schizophrenia. Many antipsychotic medications cause sedation but not all of these drugs have the same sedative effect and the sedation can be mistaken for a number of negative symptoms, including cognitive impairment, withdrawal, anhedonia and amotivation.
Author Laila AsmalSource: African Journal of Psychiatry 13 (2010)More Less
Nancy Mairs, a feminist writer with multiple sclerosis writes in a collection of essays that "to view your life as blessed, does not require you to deny your pain. It simply demands a more complicated vision, one in which a condition or event is not either good or bad but is, rather, both good and bad, not sequentially but simultaneously.
Author Ronald PiesSource: African Journal of Psychiatry 13 (2010)More Less
What does psychopharmacology have to do with philosophy? If we consider philosophy to consist of epistemology, metaphysics, logic, and ethics - the traditional break-down - one might be puzzled, at first, by a book entitled, Philosophy of Psychopharmacology. Yet the burgeoning specialty known as the philosophy of science has much to contribute to the medical sciences, including psychiatry and its rather controversial scion, psychopharmacology.
Building greater awareness in South Africa of social anxiety disorder (SAD) through the South African Depression and Anxiety Group (SADAG) : patients as partnersAuthor David A. RosensteinSource: African Journal of Psychiatry 13, pp 415 –416 (2010)More Less
I first encountered Social Anxiety Disorder (SAD) during my internship year as a clinical psychologist, at Baragwanath Hospital in Soweto. It appeared to be a poorly understood mental health care problem both in the community and with many of the resident doctors and mental health care professionals. Through my later work with the South African Depression and Anxiety Group (SADAG), I have come to treat many individuals with SAD and found that it is slowly becoming a better understood and more widely acknowledged difficulty for people affected here in South Africa.