African Journal of Psychiatry - Volume 14, Issue 2, 2011
Volume 14, Issue 2, 2011
Source: African Journal of Psychiatry 14 (2011)More Less
A rigorous and comprehensive bibliometric analysis of South Africa's scientific outputs over the last two decades was recently published. On a listing of scientific fields, according to publication counts, psychiatry moved from position 120 during the 1990-1994 period, to position 21 in the 2004-2008 period. The ratio of 120:21 was 9.4; the highest noted for any scientific field. Infectious disease and virology were the fields with the next highest ratios, perhaps unsurprising in view of the opportunities and need for research in relation to our HIV and TB epidemics. Beyond indicating that psychiatry was an "outlier", there was no further comment on this particular finding.
Public and community health psychiatry in Africa : from humble beginnings to a promising future : guest editorialSource: African Journal of Psychiatry 14, pp 89 –91 (2011)More Less
There is clear and unambiguous evidence of the magnitude of mental disorders globally - as one in every four persons will develop a mental disorder at some point in their lifetime. Neuropsychiatric disorders are the most important cause of Years Lost due to Disability (YLD). It has been estimated that unipolar depression will be the second most important cause of disability worldwide by the year 2020. While a huge gap has been identified between the prevalence of mental disorders and the actual estimate of patients receiving any form of treatment globally, this gap is more pronounced in low and middle income countries - where most African countries belong.
Board of International Affairs Pan-African Division quarterly newsletter
African International Division, Royal College of Psychiatrists : newsletterSource: African Journal of Psychiatry 14, pp 96 –102 (2011)More Less
Author J.L. RoosSource: African Journal of Psychiatry 14, pp 105 –111 (2011)More Less
The expected identification of susceptibility genes for psychiatric disorders may bring new opportunities and expectations from patients and families for the clinical translation of research findings in psychiatric genetics. In this article information is provided about familial risk of schizophrenia with the theory behind individualizing risk of recurrence highlighted. Recent new findings regarding the new genetic frontier, Copy Number Variations (CNV), are summarized and the genetic architecture of familial and sporadic schizophrenia applicable to the clinical situation is reviewed. A scenario in which genetic testing could be applied in velocardiofacial syndrome (VCFS) type schizophrenia is debated. Referring to genetic discrimination in mental disorders, reference is made to the implementation of the Federal Genetic Information non-discrimination Act (GINA) of 2008 in the USA and the Mental Health Care Act of 2002 in SA.
Acute mental health care according to recent mental health legislation. Part III. Structuring space for acute mental health care : originalSource: African Journal of Psychiatry 14, pp 112 –119 (2011)More Less
Objective: This is the third of three reports on the follow-up review of mental health care at Helen Joseph Hospital (HJH). The study reviewed existing South African standards for mental health care facilities. Architectural principles and implications for the use of space were deducted from recent legislation. Objectives were to evaluate the use of space in the existing physical facilities, to identify appropriate architectural solutions considering identified human rights requirements and to provide provisional cost estimates to align the unit towards its designated functions.
Method: Personal interviews were conducted. An on-site assessment and survey was made of existing and potential new spaces.
Results: Spatial requirements for implementing the Mental Health Act, No. 17 of 2002 (MHCA) were explored. Principles for spatial design of acute facilities include that: - spaces should communicate clear individual identity; - space should be segregated into zones according to user functionality and privacy; - communal leisure spaces should open into safe contained outdoor spaces; - circulation routes should preferably be circular; - sufficient visual connection should exist between circulation space and group activities; and - open lines of sight should be provided to all access points. The potential options for extension included: - an extensive unused single storey structural shell for a potential office wing on the same floor; - a huge vacant double volume space which could be accessed across the existing flat roof for potential occupational therapy activities; and - the existing roof area could be altered and secured to become an adequate outside leisure and garden area. A proposed concept design in two phases - based on these principles - was submitted to hospital and provincial management.
Conclusion: To implement the MHCA without violating the human rights of mental health care users at HJH will require specific adjustment and extension of the current use of space at HJH.
Patient and social work factors related to successful placement of long-term psychiatric in-patients from a specialist psychiatric hospital in South Africa : originalSource: African Journal of Psychiatry 14, pp 120 –129 (2011)More Less
Objective: The slow discharge of long-term psychiatry patients from Weskoppies Hospital into the community has not matched the national and international drive towards de-institutionalisation. This article investigates patient and social work factors related to successful community placement, in the context of limited community care facilities.
Method: Thirty-six long-term patients who were successfully placed outside of the hospital during a seven month period were compared to 235 unplaced long-term patients in terms of demographic and clinical variables. Social work services were analysed in terms of which patients received the most interventions, and the most common type of interventions.
Results: The most significant patient factors associated with successful placement were: female patients; medium-to-high level of functioning; having involved relatives living far away; a low frequency of behavioural problems (especially of cannabis abuse, verbal or physical aggression, uncontrolled sexual activity), and agitation or restlessness. These patient factors were mirrored in the social work services rendered to the long-term patients during the study period: The recipients were mostly female, in open wards (higher-functioning); and the social services utilised were mostly related to planning for placement and patient support.
Conclusion: The lack of community care facilities in the Pretoria area that are able to care for the more difficult long-term psychiatry patients, limits successful placement and increases the burden of hospital based social workers. The problem cannot be resolved at a hospital level and needs to be addressed in the context of provincial and national health departments.
Patient aggression in psychiatric services : the experience of a sample of nurses at two psychiatric facilities in Nigeria : originalSource: African Journal of Psychiatry 14, pp 130 –133 (2011)More Less
Objective: Aggression is a common feature in psychiatric in-patient units in Africa. The attitudes of psychiatric nurses and their perceptions of the frequency of in-patient aggression have not been explored in the Nigerian context.
Method: Using a crosssectional study design, two self-report questionnaires (the Attitudes toward Aggression Scale (ATAS) and the Perception of the Prevalence of Aggression Scale (POPAS)) were administered to nursing staff (n=73) at two psychiatric facilities in Benin City, Nigeria.
Results: Overall, nurses viewed aggression as offensive, destructive and intrusive. They were less likely to view it as a means of communication or serving protective functions. Verbal aggression was the commonest type of aggression experienced while sexual intimidation and suicide attempts were least common. Male nurses were more likely to experience physical violence and aggressive 'splitting' behaviours, while nurses with over a decade of professional experience were more likely to experience verbal and humiliating aggressive behaviours. In contrast to previous studies, fewer nurses required days off work due to aggressive behaviour.
Conclusion: Aggression is commonly experienced by nurses in in-patient units in Nigeria. Their views were predominantly negative. Training programmes are required to change staff attitudes as well as research on the cultural factors mediating these attitude dispositions.
Source: African Journal of Psychiatry 14, pp 134 –139 (2011)More Less
Background: There is relatively little data on the relationship between lifetime mental disorders and suicidal behaviour in low and middle income countries. This study examines the relationship between lifetime mental disorders, and subsequent suicide ideation, plans, and suicide attempts in South Africa.
Method: A national survey of 4185 South African adults was conducted using the World Health Organization Composite International Diagnostic Interview (CIDI) to generate psychiatric diagnoses and suicidal behaviour. Bivariate, multivariate and discrete-time survival analyses were employed to investigate the associations between mental disorders and subsequent suicide ideation, plans, and attempts.
Results: Sixty-one percent of people who seriously considered killing themselves at some point in their lifetime reported having a prior DSM-IV disorder. Mental disorders predict the onset of suicidal ideation, but have weaker effects in predicting suicide plans or attempts. After controlling for comorbid mental disorders, PTSD was the strongest predictor of suicidal ideation and attempts. There is a relationship between number of mental disorders and suicidal behaviour, with comorbidity having significantly sub-additive effects.
Conclusion: Consistent with data from the developed world, mental disorders are strong predictors of suicidal behaviour, and these associations are more often explained by the prediction of ideation, rather than the prediction of attempts amongst ideators. This suggests some universality of the relevant mechanisms underlying the genesis of suicidal thoughts, and the progression to suicide attempts.
Prevalence of common phobias and their socio-demographic correlates in children and adolescents in a traditional developing society : originalSource: African Journal of Psychiatry 14, pp 140 –145 (2011)More Less
Objective: The aim of this study was to identify the most common phobias in children and adolescents and to determine the prevalence, age distribution, and socio-demographic correlates of phobias.
Method: This was a prospective cross-sectional study conducted at public and private schools from July 2009 to February 2009. The questionnaire included socio-demographic information, extra-curricular activities and hobbies, behaviour at home and various phobic fears and it was distributed among children aged 6 to 18 years. Psychiatrists determined the definitive diagnosis for various phobias by checking and screening their symptoms.
Results: Of the studied subjects, 44% were males and 56% were females. The overall prevalence of phobia in children and adolescents was 19.7%. Among children with phobia, females had higher rates of phobias (62.4% vs 37.6%) than males. Nearly half of total sufferers were in the 12-15 year age group (46.3%). Social phobia (12.7%) was the commonest phobia found followed by agoraphobia (8.6%). Secondary school children were highly afflicted with social phobia (14.9%), agoraphobia (11.7%) and specific phobia (9.6%), while preparatory students (8.3%) were more likely to have 'medical' phobia (fear of physical illness, medical tests and procedures). A significant difference was observed between the age groups in children with agoraphobia (p=0.002).
Conclusion: The overall prevalence of phobia in children and adolescents in Qatar was higher than rates found in other epidemiologic studies, with the most common phobias observed being social phobia, agoraphobia and specific phobia.
Gender differences in barriers to alcohol and other drug treatment in Cape Town, South Africa : originalSource: African Journal of Psychiatry 14, pp 146 –153 (2011)More Less
Objective: The study aimed to identify gender differences in barriers to alcohol and other drug (AOD) treatment use among disadvantaged communities in Cape Town, South Africa. The Behavioral Model of Health Services Utilization was used as an analytic framework.
Method: A case-control design was used to compare 434 individuals with AOD problems from disadvantaged communities who had accessed treatment with 555 controls who had not accessed treatment on a range of variables. Logistic regression procedures were employed to examine the unique profile of variables associated with treatment utilization for male and female participants.
Results: Few gender differences emerged in terms of the pattern of variables associated with AOD treatment use. Greater awareness of treatment options and fewer geographic access and affordability barriers were strongly associated with an increased likelihood of AOD treatment use for both men and women from disadvantaged communities. However, while similar types of barriers to treatment were reported by men and women, these barriers had a greater impact on treatment utilization for women compared to men.
Conclusion: Compared to men, women from disadvantaged communities in South Africa do not have equal access to AOD treatment. Recommendations on how to reduce these barriers and ways to improve AOD treatment use among women from disadvantaged communities in South Africa are provided.
Source: African Journal of Psychiatry 14, pp 154 –156 (2011)More Less
We report on a patient with recurrent panic attacks, depression, and palpitations caused by a phaeochromocytoma. The diagnosis was missed for ten years, and was only considered after she developed a potentially catastrophic intraoperative hypertensive crisis. The anxiety symptoms resolved completely after removal of the tumour. It is important to consider cathecholamine producing tumours in the work up for organic causes of psychiatric disorders.
Author Franco P. VisserSource: African Journal of Psychiatry 14 (2011)More Less
February 2012 will mark the 60th anniversary of the death of King George VI, the royal Prince who was not supposed to be King. On the morning of 2 February 1952 the King's valet found him dead in his room at Sandringham, the royal family's country retreat in Norfolk. The Queen Mother, then Queen Elizabeth the Queen Consort was notified and she immediately rushed to his room, but to no avail. The King had died peacefully in his sleep after a long illness, suffering from lung cancer and arteriosclerosis amongst other ailments.
Source: African Journal of Psychiatry 14 (2011)More Less
Bipolar disorder can be misdiagnosed or underdiagnosed as both manic and depressive symptoms frequently occur in other psychiatric conditions. Over the past few years, the range of treatment options available for use in bipolar mania has broadened. Atypical antipsychotics are now among the agents which have an established place in the management of acute mania. But are treatment decisions based on evidence or on traditions? In a survey done in 2007 by Perlis et al., 33% of clinicians reported that they routinely referred to all published guidelines when making decisions on treatment choice for bipolar mania.
Source: African Journal of Psychiatry 14, pp 164 –166 (2011)More Less
For the first time in the history of South African journalism, 34 editors, feature editors, health editors, journalists, television and radio journalists gathered in Johannesburg in April 2011 to explore more about mental illness from some of the country's finest experts