African Journal of Psychiatry - Volume 14, Issue 4, September 2011

Depression is an illness that affects about 25% of South Africans of all ages and socio-economic groups, but people with diabetes may be at greater risk. Research also shows that people with depression have a 37% increased risk of developing type 2 diabetes. Many people with depression suffer in silence and in isolation, never getting the help they need. According to US research, only 30% of patients with depression and diabetes receive adequate treatment for depression and fewer than 20% complete more than four visits for psychotherapy. But treatment for depression is highly successful and is critical to improving and managing symptoms of both diabetes and depression

Consultation liaison psychiatry (CLP) - also known as psychosomatic medicine - is the psychiatric subspecialty that focuses on the diagnosis and treatment of psychiatric disorders / difficulties in complex medically ill patients.

HIV / AIDS carries a heavy burden for society, with between 31.4 and 35.3 million people infected and / or living with HIV / AIDS globally in 2009 and the largest proportion of these individuals living in Sub-Saharan Africa (22.5 million). At an individual level, the disease is associated with significant physical and psychiatric sequelae.

From the editor

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The Royal College of Psychiatrists meeting - From an African perspective

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A meeting with Prof Sue Bailey

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The Nairobi Conference on Psycho-Trauma

This article aims to describe the difference between descriptive and dynamic psychiatry. As part of the latter every psychiatrist should be able to construct a psychodynamic formulation. A psychodynamic formulation, an indication of psychological mindedness, helps the psychiatrist to recognize the unique, personal aspects of the illness and the life of the patient. The formulation furthermore helps with the initial orientation towards the patient: it anticipates and predicts how the patient might interact with the psychiatrist and how defenses and underlying conflicts will manifest themselves in treatment. The formulation can therefore be very useful in the treatment of any patient, since it can help to understand and manage the patient's attitude towards being prescribed medication, as well as compliance and prognosis and serve as an initial guide in the psychotherapy. The psychodynamic formulation is unfortunately seldom incorporated in the psychiatric presentation of patients; guidelines are therefore given to especially help psychiatric trainees with the construction of such a formulation.

One of the major problems in psychiatric practice worldwide is inability to reach a consensus as regards a globally acceptable classificatory system for the different psychopathologies. Consequently, apart from the WHO's International Classification of Diseases (ICD) that is expected to be universally applicable there are regional-based classificatory systems in some parts of the world. In Africa, a number of culture bound syndromes (CBS) have been described which have not been given international recognition. The possible consequences of this non-recognition are highlighted in this paper. Unfortunately there are serious constraints such as the relatively small number of psychiatrists on the continent, and inadequate funding for mental health research, which militate against producing an African classificatory system. Nevertheless, it is proposed that reports of African psychiatrists emanating from their research and clinical experience should be accorded adequate recognition in the WHO so as to assign these CBS their rightful placement in the International classificatory system.

Objective: To determine the prevalence of self-reported attention deficit hyperactivity disorder (ADHD) symptoms among medical students in Eldoret, Kenya.

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Method: A cross-sectional descriptive study of all medical students who gave consent to participate in the study. Undertaken at Moi University's School of Medicine in Eldoret, Kenya. Comprising two hundred and fifty three (253) undergraduate medical students, with a mean age of 23.7 years (19-42, s.d. 4.1), of whom 51% were female. Measuring ADHD symptomatology using the Adult ADHD Self-Report Scale (ASRS v1.1).

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Results: The prevalence rate of self-reported ADHD symptoms using the ASRS screener was 23.7%. This was significantly associated with being in the age-group 17-20 years compared (p<0.05). The prevalence rate was higher among females (25.6%) than among males (21.8%), but this difference was not statistically significant. Preclinical students had a higher prevalence rate of ADHD symptoms (28.7%) compared to clinical students (19.6%), but this was also not statistically significant. Using a modification of the ASRS full symptom checklist to approximate a Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) ADHD diagnosis yielded a 'possible ADHD' prevalence rate of 8.7%. Of these, the inattentive type was the most common (40.9%).

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Conclusion: The prevalence rate of self-reported ADHD symptoms among medical students in Eldoret is very high and possibly interferes with the students' social and academic functioning. Further studies are suggested to generate information on the real ADHD prevalence in the general population and in special populations such as schools and colleges.

Objective: The aim of this study was to explore health care providers' attitudes towards people with mental illness within two districts in Zambia. It sought to document types of attitudes of primary health care providers towards people suffering from mental illness and possible predictors of such attitudes. This study offers insights into how health care providers regard people with mental illness that may be helpful in designing appropriate training or re-training programs in Zambia and other low-income African countries.

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Method: Using a pilot tested structured questionnaire, data were collected from a total of 111 respondents from health facilities in the two purposively selected districts in Zambia that the Ministry of Health has earmarked as pilot districts for integrating mental health into primary health care.

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Results: There are widespread stigmatizing and discriminatory attitudes among primary health care providers toward mental illness and those who suffer from it. These findings confirm and add weight to the results from the few other studies which have been conducted in Africa that have challenged the notion that stigma and discrimination of mental illness is less severe in African countries.

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Conclusion: There is an urgent need to start developing more effective awareness-raising, training and education programmes amongst health care providers. This will only be possible if there is increased consensus, commitment and political will within government to place mental health on the national agenda and secure funding for the sector. These steps are essential if the country is improve the recognition, diagnosis and treatment of mental disorders, and realize the ideals enshrined in the progressive health reforms undertaken over the last decade.

Objective: To describe the extent and nature of developmental delay at different stages in childhood in a community in South Africa, with a known high rate of Fetal Alcohol Spectrum Disorder (FASD).

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Method: A cohort of infants, clinically examined for FASD at two time periods, 7-12 months (N= 392; 45 FASD) and 17-21 months of age (N= 83, 35 FASD) were assessed using the Griffiths Mental Developmental Scales (GMDS).

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Results: Infants and children with FASD perform worse than their Non-FASD counterparts over all scales and total developmental quotients. Mean quotients for both groups decline between assessments across subscales with a particularly marked decline in the hearing and language scale at Time 2 (scores dropping from 110.6 to 83.1 in the Non-FASD group and 106.3 to 72.7 in the FASD group; P=0.004). By early childhood the developmental gap between the groups widens with low maternal education, maternal depression, high parity and previous loss of sibling/s influencing development during early childhood.

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Conclusion: The FASD group show more evidence of developmental delay over both time points compared to their Non-FASD counterparts. Demographic and socio-economic factors further impact early childhood. These findings are important in setting up primary level psycho-educational and national prevention programmes especially in peri-urban communities with a focus on early childhood development and FASD.

Objective: To screen for psychiatric morbidity among caregivers of patients attending a child and adolescent psychiatric clinic.

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Method: A total of 155 patients and their caregivers were consecutively recruited over a 1 month period. Sociodemographic and clinical information on patients was obtained either from the hospital records or from the caregiver. Scoring on the Children's Global Assessment Scale (CGAS) was done by clinicians. The caregivers were administered a sociodemographic questionnaire, GHQ-12, Zarit Burden interview, and the Columbia Impairment Scale.

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Results: Most caregivers observed in this study were females (80.5%) with mothers of the patients accounting for 78% of all the caregivers. A higher percentage of the patients were males (52.8%). Among the caregivers, 39.4% had GHQ Scores of 3 and above. Factors associated with psychiatric morbidity among caregivers include the high level of subjective burden of care, low level of functioning, high degree of impairment and low level of education among patients.

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Conclusion: The study reveals a high level of psychiatric morbidity among the carers of children and adolescents with mental health problems.

Objective: To examine hippocampal volume and white matter tracts in women with and without intimate partner violence (IPV).

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Method: Nineteen women with IPV exposure in the last year, and 21 women without IPV exposure in the last year underwent structural magnetic resonance imaging (MRI) including diffusion tensor imaging (DTI) sequences. Additional data on alcohol use and presence of psychiatric disorder was collected. Differences in fractional anisotropy (FA) between the two groups were examined, using a statistical model that included demographic measures, alcohol use and psychiatric disorder.

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Results: IPV subjects did not demonstrate significantly different hippocampal volumes compared to subjects without recent IPV. FA was, however, significantly reduced in the body of the corpus callosum of IPV subjects. Adjusting for age, alcohol use, smoking and psychiatric diagnosis did not change the significance of the result.

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Conclusion: Data on hippocampal volume in IPV are inconsistent, perhaps reflecting the fact that multiple factors influence this measure. Reduced FA in the body of the corpus callosum in IPV suggests altered integrity of this white matter tract; additional work is needed to address the underlying mechanisms and clinical correlates of this finding.

Catatonia is a complex condition characterized by the presence of various motor signs and symptoms. It remains a poorly understood, poorly studied, and poorly recognized syndrome. Catatonic features are seen in a range of psychiatric conditions including psychotic disorders, mood disorders, conversion disorder and dementia. Studies have also identified over 35 medical and neurological illnesses associated with catatonia including corticosteroids exposure, central nervous system (CNS) structural damage, encephalitis and other CNS infections, seizures, metabolic disturbances, phencyclidine exposure, neuroleptic exposure, lupus cerebritis, disulfuram, porphyria, and other conditions. These medical causes of catatonia account for between 20% to 30% of such cases.

Mental Health Review Boards (MHRBs) are regarded as the watch dog structures to protect the human rights of mental health care users and to generally uphold the principles of the Mental Health Care Act (MHCA).

George Aylwin Hogg (played by Jonathan Rhys-Meyers), a young adventurer and independent reporter for Associated Press arrived in Shanghai China in January 1938 after travelling to Japan with his aunt, Muriel Lester, a well-known pacifist and personal friend of Mohandas Ghandi.

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.

The discovery of the relationship between disturbed circadian rhythms and depression resulted in research into a completely new approach to treating it. A new treatment based on this approach represents the start of a new era in antidepressant therapy, offering hope to the thousands of patients worldwide who suffer from major depression and fail to respond or respond only partially to current treatment options.