African Journal of Psychiatry - Volume 14, Issue 3, 2011
Volume 14, Issue 3, 2011
Source: African Journal of Psychiatry 14, pp 169 –171 (2011)More Less
Psychiatry has a long history of having to justify its place, as a discipline, in mainstream medicine. As the focus becomes more biological and knowledge more scientific, it would be expected that stigma towards those suffering from mental illness would decrease. However, this is not the case. While there seems to be increasing acceptance of depression, for example, as an illness rather than a personal weakness, addiction, unfortunately, has not made the transition and has remained in the domain of social welfare agencies. This has resulted in substance use disorders often being managed from a moral rather than clinical / scientific standpoint. The result is the entrenchment of stigma and poor access to health services for addicts. With the scientific progression to the medicalization of addictions, opposition from many nonscientific quarters has been strong.
Author Bernard Janse van RensburgSource: African Journal of Psychiatry 14, pp 173 –175 (2011)More Less
It was with anticipation - and then with some surprise - that the long-awaited South African Mental Health Care Act, No 17 of 2002 (MHCA) was finally promulgated in December 2004. From one day to the next, we moved into a new dispensation for mental health care delivery in South Africa: the era of the "new" Mental Health Care Act, setting a historic "before" and "after" point of reference. The new legislation was generally welcomed, in particular for two principles that it advocates: the management of users in the least restrictive environment; and the comprehensive protection of the human rights of mental health care users.
African Association of Child and Adolescent Mental Health (AACAMH) : newsletter no. 14, June 2011 : AACAMH newsletterSource: African Journal of Psychiatry 14, pp 180 –192 (2011)More Less
Child and adolescent mental health: change has come to the African continent!
My journey in the field of child and adolescent mental health, including subspecialty training in child and adolescent psychiatry.
My journey so far
Training in child and adolescent psychiatry at the University of Pittsburgh
The revolution in Tunisia - impact on children
Short CAMH news from Africa
Africa in IACAPAP Bulletin
African participation to ESCAP Congress in Helsinki
Don't forget the next IACAPAP congress in Paris www.iacapap2012.org
Sanofi-aventis Registrar Development Award
Author M. NagdeeSource: African Journal of Psychiatry 14, pp 194 –199 (2011)More Less
The evaluation of dementia in individuals with intellectual disability (ID), which will guide subsequent intervention, care and management depends on the systematic review of a number of factors: (1) the individual historical context, obtained from multiple sources, (2) evaluation of the pre-existing cognitive, behavioural, psychiatric, medical and adaptive skill profile, (3) the constellation, and pattern of evolution, of presenting signs and symptoms, (4) results of focused investigations, and (5) refinement of the differential diagnosis. In patients with ID, standard clinical methods need to be supplemented by careful, longitudinal behavioural observations, and individually tailored assessment techniques. Co-morbidity, multiple biological, psychological and socio-environmental factors, and complex interactions among events, are the reality for many ageing people with ID. Determining the various influences is often a formidable clinical task, but should be systematically carried out using medical, cognitive, behavioural, neuropsychiatric and psycho-social frameworks.
Psychological treatments for depression and anxiety disorders in low- and middle-income countries : a meta-analysis : reviewSource: African Journal of Psychiatry 14, pp 200 –207 (2011)More Less
Objective: The objective of this meta-analysis was to determine the efficacy of psychological treatments for depression and anxiety disorders in low- and middle- income countries (LAMIC). Method: Meta-analysis of randomized controlled trials on psychological treatment of depression and anxiety disorders in low-and middle income countries using an existing database (www.evidencebasedpsychotherapies.org), PubMed, Embase, Psychinfo, Dissertation Abstracts International and the Cochrane Central Register of Controlled Trials were searched for studies published in all languages. Additional studies were identified from reference lists of found studies. Randomized controlled trials in which a psychological intervention for anxiety or depression was compared to a control condition (care-as-usual, waiting list, placebo, or another control group) were included. The randomized controlled trials needed to be conducted in a LAMI country (classification of LAMI countries according to the World Bank's list of economies) to be eligible for inclusion in the meta-analysis. Psychological treatments were defined as interventions in which the core element of treatment consisted of verbal communication between a therapist and a patient. Results: Seventeen studies met our inclusion criteria, with a total of 3,010 participants. The mean standardized difference between the treatment and control groups at post-test was 1.02 (95% CI: 0.76~1.28) which corresponds well with the effects found in high-income countries. Conclusion: These results indicate that psychological treatments of depression and anxiety disorders are also effective in LAMI countries, and may encourage global dissemination of these interventions.
Source: African Journal of Psychiatry 14, pp 208 –210 (2011)More Less
Background: The universal occurrence of autism spectrum disorders (ASD) was queried about twenty-six years ago. It was thought to occur only in western industrialized countries with high technological development. Over the last decade, knowledge about ASD and its prevalence has been documented as being on the rise in different regions of the world, with most literature coming from the western world - the situation in Africa on aspects of ASD remain unclear. Methods: Literature cited in Pubmed over the last decade on aspects of epidemiology, diagnosis, aetiology and knowledge of ASD in the African context were assessed. Results: No study specifically addressed the epidemiology of ASD in Africa. One of the two studies that were relevant addressed epidemiology of ASD in Arab countries, though included two Northern African countries. A higher proportion of non-verbal cases of ASD compared to verbal cases was documented in literature coming from Africa. Associated co-morbid disorders included intellectual disability, epilepsy and oculo-cutaneous albinism. Aetiological factors postulated included post-encephalitic infection, genetic and auto-immune factors, and vitamin D deficiency. Knowledge about ASD in Africa was noted to be low. Conclusion: There is a need for epidemiological studies in Africa to define the magnitude of the problem of ASD and the characteristics of children affected by ASD in this region. This would help in planning and might be helpful in answering the question of aetiology of ASD. Policy making needs to be directed at issues of childhood developmental disorders in Africa.
The prevalence and correlates of hallucinations in a general population sample : findings from the South African Stress and Health Study : originalSource: African Journal of Psychiatry 14, pp 211 –217 (2011)More Less
Objective: Large epidemiological surveys conducted in the developed world have found rates of psychotic symptoms in the general population to be as high as 10-28%. However, there are few data available from developing countries, including African countries, on the prevalence and correlates of psychotic symptoms. This study investigates the prevalence and correlates of psychotic symptoms (ie hallucinations) in a general population sample of South African adults. Method: As part of the South African Stress and Health Study the prevalence of auditory and visual hallucinations was determined in a large community based sample of 4250 participants utilizing the Composite International Diagnostic Interview (CIDI). In addition, socio-demographic and clinical correlates as well as indicators of service utilization and functional impairment were determined. Results: The prevalence of any reported hallucination was 12.7%, a rate comparable to that found in studies from the developed world. Multivariate analyses revealed a significant association between role impairment, service utilisation, suicidality and reported auditory or visual hallucinations. No significant association was found between urbanicity and reported psychotic symptoms. Conclusion: Our finding that psychotic symptoms (ie hallucinations) are significantly associated with functional impairment and service utilization supports the potential clinical significance of such symptoms, even in the African context.
Anxiety, psychosis and substance use : prevalence, correlates and recognition in an outpatient mental health setting : originalSource: African Journal of Psychiatry 14, pp 218 –224 (2011)More Less
Objective: The current study examined anxiety in people with substance use disorder (SUD) and a psychotic disorder. It is hypothesised that: anxiety disorders (AD) would be highly prevalent (greater than 20%) in people identified as having SUD and psychotic disorders; those with comorbid AD would fair worse than those without, on measures of quality of life, severity of substance dependence, locus of control, suicidality and psychotic symptoms; and, the presence of such anxiety disorder symptomatology would be under-detected by their mental health case mangers. Method: Outpatients with co-occurring substance use disorder and psychosis were interviewed to collect data about their diagnosis, depressive and psychotic symptoms, severity of dependence on substances, quality of life and locus of control. Participants' case managers made blind ratings of the presence and severity of participants' anxiety. Results: Fifty eight percent of participants had at least one anxiety disorder. Of these, 56% - 70% had case managers who had identified them as having an anxiety problem. The occurrence of anxiety disorder was associated with more external locus of control, greater intensity of suicidal thinking, worse psychotic symptoms, lower quality of life and greater severity of dependence on substances. Conclusion: This research suggests anxiety in people with substance use disorder and psychosis is highly prevalent, is associated with poorer outcomes, and is under detected by case managers. Further examination of this issue may lead to important advances in the treatment and prognosis of people with substance use disorder and psychosis.
Knowledge, attitude and practice (KAP) of mental illness among staff in general medical facilities in Kenya : practice and policy implications : originalSource: African Journal of Psychiatry 14, pp 225 –235 (2011)More Less
Objective: To determine the knowledge, attitudes and beliefs about mental illness among staff in general hospitals. Method: A descriptive cross-sectional study conducted on staff in ten medical facilities in Kenya on their socio-demographic characteristics, professional qualifications and knowledge, attitudes and practice (KAP) toward mental illness. Results: A total of 684 general hospital staff: nurses (47.8%); doctors (18.1%); registered clinical officers (5.1%); students (9.5%) and support staff (19.5%) were recruited. About three quarters were under 40 years of age; most thought mental illness could be managed in general hospital facilities; the older the doctors were (age 40 years and older) the more they were aware of and positive towards mental illness. Most of the workers did not suspect any psychiatric symptoms among the patients they treated resulting in low referral rates for psychiatric services. Conclusion: There are gaps in knowledge on mental illness which could be constructively filled with Continued Medical Education (CME).
Source: African Journal of Psychiatry 14, pp 236 –238 (2011)More Less
Objective: To report a case of a patient treated with clozapine who developed pericarditis with pericardial effusion that resolved when the drug was discontinued. Method: Case report of a 21-year-old man with psychotic disorder that had been stable on clozapine therapy for five months (after failure of atypical antipsyhotic agents) presented to the emergency department complaining of chest pain and progressive shortness of breath that had lasted for a few days. Echocardiography showed a pericardial effusion suggestive of a cardiac tamponade, and the fluid was removed by pericardiocentesis. All other possible causes of the pericardial effusion were ruled out and clozapine was suspected as the most likely explanation. Clozapine was discontinued and the patient's symptoms improved markedly. Discussion: According to the Naranjo probability scale, clozapine is a probable cause of pericarditis. Although clozapine is a known cause of myocarditis and cardiomyopathy, there are only several reports in the literature describing clozapine-induced pericarditis and pericardial effusion. In our patient, the pericardial effusion cleared within several days following clozapine discontinuation. Conclusion: There have been only a few cases of clozapine-induced pericarditis reported in the literature, however this adverse effect of clozapine can occur, as this case report clearly demonstrates. Cardiac adverse effects of clozapine are potentially life threatening, hence early recognition is essential to prevent serious outcomes.
Culture, religion and psychosis - a case study from Limpopo Province, South Africa : scientific letterSource: African Journal of Psychiatry 14, pp 239 –240 (2011)More Less
Culture and religion may impact on mental health. A case from Limpopo province is described with the aim of informing and alerting medical and nursing practitioners working in rural South Africa (with relevance no doubt to other similar African settings) to the dynamics of the case that may warrant more comprehensive attention and consideration, than may be generally afforded in the routine dualistic clinical assessment of patients.
Can we close the barn door before the horses get out? A case study of high genetic loading and subsequent development of psychosis : scientific letterSource: African Journal of Psychiatry 14, pp 242 –244 (2011)More Less
We would like to report on a 10 year old girl who was referred to a genetic study of schizophrenia in the Afrikaner population because of a high familial genetic loading. This patient subsequently at the age of 16 years was diagnosed with a psychotic disorder. The initial presentation at 10 years of age as well as the course of illness until the diagnosis of psychosis was made will be reported on. Possible predictors of the ultimate development of psychosis will be highlighted and the continuous follow-up of a high-risk case is emphasized.
Author Franco P. VisserSource: African Journal of Psychiatry 14 (2011)More Less
It is very seldom that one comes across a South African film that speaks to you on so many levels, but here is such a film. Based on the book by Jan van Tonder with the same name, the film Roepman (The Call-man) is set in the South Africa of 1966, when the country was in the firm grip of the Afrikaans, mainly Dutch Reformed Church and the Verwoerd Apartheid-Government. The story of Roepman deals with an Afrikaans, white, railway community and the unique and often challenging issues of the then Afrikaans culture and psyche.
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 250 –254 (2011)More Less