African Journal of Psychiatry - Volume 14, Issue 5, 2011
Volume 14, Issue 5, 2011
The neural correlates of intimate partner violence in women, African Journal of Psychiatry, 14(4) 2011: pp. 310-314 : erratumSource: African Journal of Psychiatry 14 (2011)More Less
Author Christopher P. SzaboSource: African Journal of Psychiatry 14 (2011)More Less
As this is the final edition of the Journal for 2011 it is appropriate for me as Editor-in-Chief to extend my gratitude to all of the contributors and the reviewers for their efforts during this past year, acknowledging that those efforts may have borne fruit in this past year through publication but probably commenced even earlier. The Journal has gone from strength to strength and is increasingly providing evidence that is African, for Africa but also demonstrating to a broader international audience that as a continent our scientific efforts are meaningful.
Source: African Journal of Psychiatry 14, pp 343 –345 (2011)More Less
It is a popular belief that mental disorders in the elderly in Africa are less prevalent, less expensive to treat and not an important health care issue. Health problems facing African authorities are diverse. In South Africa where 32% of the population is in the 0-14 year age group, a high percentage of health resources have been shifted to maternal and child care. Primary health care priorities address needs such as human immunodeficiency virus (HIV),tuberculosis and other infectious diseases. Thus, resources for mental health care are limited. Human resources for mental health care in Nigeria are dismal, with virtually all mental health personnel concentrated in urban areas where far less Nigerians reside. There are no specially separated mental health services for older adults in rural or urban Nigerian communities.
Source: African Journal of Psychiatry 14, pp 351 –353 (2011)More Less
An International Congress was held 13 - 15 October in Cape Town, South Africa where the Pan African Network of Users and Survivors of Psychiatry deliberated the importance of the United Nations Convention on the Rights of People with Disabilities (2008) and mental health reform on the African Continent. Delegates from 10 African Organizations representing people with psychosocial disabilities from East, West and Southern Africa gathered together to debate the challenges and issues facing one of the most silent and marginalized voices on the Continent.
Source: African Journal of Psychiatry 14, pp 355 –366 (2011)More Less
Psychiatric disorders place a considerable healthcare burden on South African society. Incorporating genetic technologies into future treatment plans offers a potential mechanism to reduce this burden. This review focuses on psychiatric genetic research that has been performed in South African populations with regards to obsessive-compulsive disorder, schizophrenia and bipolar disorder. Preliminary findings from these studies suggest that data obtained in developed countries cannot necessarily be extrapolated to South African population groups. Psychiatric genetic studies in South Africa seem to involve relatively low-cost methodologies and only a limited number of large national collaborative studies. Future research in South Africa should therefore aim to incorporate high-throughput technologies into large scale psychiatric studies through the development of collaborations. On a global level, the vast majority of psychiatric genetic studies have been performed in non-African populations. South Africa, as the leading contributor to scientific research in Africa, may provide a foundation for addressing this disparity and strengthening psychiatric genetic research on the continent. Although the elucidation of the genetic architecture of psychiatric disorders has proved challenging, examining the unique genetic profiles found in South African populations could provide valuable insight into the genetics of psychiatric disorders.
Family therapy for schizophrenia : cultural challenges and implementation barriers in the South African context : review articleSource: African Journal of Psychiatry 14, pp 367 –371 (2011)More Less
Family therapy is an effective, evidence based intervention for schizophrenia. This literature review explores the impact of culture on family therapy as a treatment model for schizophrenia and examines how cultural beliefs impact on access to care. Although there is a good deal of evidence to suggest that certain principles of family therapy such as empathy and psycho-education are universal, there is a paucity of literature about the role of culture in designing family interventions for people living with schizophrenia in a culturally diverse setting such as South Africa. It is well acknowledged that cultural ideologies influence families' belief systems of schizophrenia, expected expressed emotion, and levels of stigma in relation to mental illness. Additionally, in adapting models designed for first-world settings, consideration needs to be given to aspects such as language, educational level and accessibility of mental health care facilities. Family therapists are increasingly recognising the need for the study and implementation of evidence based culture-relevant and culture-responsive therapeutic techniques. These techniques need to be cost-effective and will require training, supervision, staff support, and management input in order to become generally available.
Methamphetamine use and sexual risk behaviour in Cape Town, South Africa : a review of data from 8 studies conducted between 2004 and 2007 : original articleSource: African Journal of Psychiatry 14, pp 372 –376 (2011)More Less
Objective : Community studies and studies of admissions to drug treatment centers indicate a dramatic increase in the prevalence of methamphetamine use in Cape Town since 2003. There has also been a substantial increase over this time period in the prevalence of HIV infection among women attending public antenatal clinics in the Western Cape province. This study aimed to review research conducted in Cape Town on the link between methamphetamine use and sexual risk behaviour.
Method : A review of published research conducted in Cape Town between 2004 and 2007 was undertaken using PubMed, EBSCOhost and Science Direct.
Results : Eight studies were identified, both quantitative and qualitative, and focusing on diverse populations, such as learners in school, out of school youth, adults in the community, men who have sex with men and sex workers. The total sample across the studies was 8153. Across multiple studies methamphetamine was fairly consistently associated with early vaginal sex, condom use during sex, having casual sex and other HIV risk behaviours. For some sub-groups the direction of the relationship was in an unexpected direction.
Conclusion : The consistency of the findings across studies highlights the increased risk for contracting HIV among methamphetamine users, and reinforces the importance of interventions addressing both methamphetamine use and unsafe sexual behaviour among young people and other sectors of the population. The need for further research is also considered, particularly research that will explain some of the racial differences that were found.
Profile of clinically-diagnosed dementias in a neuropsychiatric practice in Abeokuta, South-Western Nigeria : original articleSource: African Journal of Psychiatry 14, pp 377 –382 (2011)More Less
Objective : Many subjects with dementia present primarily to neuropsychiatric practices because of behavioural and psychological symptoms (BPSD). This study reviewed the profile of clinically-diagnosed dementias and BPSD seen in a pioneer neuropsychiatric practice in Abeokuta, southwestern Nigeria over a ten year period (January 1998 - December 2007).
Methods : A review of hospital records of all patients with diagnoses of dementia or dementing illness using the ICD-10 criteria as well as specific diagnostic criteria for different dementia phenotypes. Associated BPSD, co-morbidities and treatments were also reviewed.
Results : Out of a total of 240,294 patients seen over the study period, 108 subjects met clinical diagnostic criteria for probable dementia giving a hospital frequency of 45 per 100,000. Alzheimer's disease (AD) and Vascular dementia (VaD) were the predominant phenotypes seen in 62 (57.4%) and 18 (16.7%) subjects respectively. Others include mixed dementia (4 cases), frontotemporal dementia (4 cases), Lewy body dementia (3 cases), alcohol-related dementia (3 cases), PD dementia (1 case) and unclassifiable (13 cases). Apathy, night time behaviour, aberrant motor behaviour, agitation and irritability were the most common BPSD features, while hypertension was the most common co-morbidity. Neuroleptics, anticholinergics and anti-hypertensives were most commonly prescribed. Anticholinesterase inhibitors were sparingly used.
Conclusion : Probable AD was the most prevalent dementia phenotype seen in this practice. Increased awareness of dementia and better utilization of specific treatments are needed among psychiatrists and primary care practitioners in Nigeria.
Risky behaviour and psychosocial correlates in adolescents - is there a link with tuberculosis? : original articleSource: African Journal of Psychiatry 14, pp 383 –387 (2011)More Less
Objective : Reasons for the increase in incidence of Tuberculosis (TB) in late adolescence are poorly understood. One hypothesis is that psychological and behavioural variables associated with adolescence may increase risk of developing TB. The study aimed to determine whether psychosocial and behavioural variables affect incidence of TB disease in adolescents.
Methods : A case-control study design was used in adolescents who were participants in a TB epidemiological study. Cases were adolescents diagnosed with TB disease. Approximately half of the controls had no TB disease but a positive TST indicative of latent TB. Half had neither TB disease nor latent TB. A self-administered questionnaire was completed by participants. The questionnaire consisted of a combination of standardised psychosocial instruments.
Results : Of 292 participants, 62 were cases, 112 had latent TB and 118 neither TB disease nor latent TB. There were no significant differences in instrument scores between cases and controls. There was a trend for certain adverse life events to be more common in the TB-disease group.
Conclusion : In adolescents, a trend for association between TB incidence and psychosocial and behavioural variables was not statistically significant. Given the trend, research with larger samples, and more comprehensive assessment of the relationship between stressors and TB, is warranted.
Functional status and its associated factors in Nigerian adolescents with bipolar disorder : original articleSource: African Journal of Psychiatry 14, pp 388 –391 (2011)More Less
Objective : This study assessed general functioning in Nigerian adolescents with bipolar disorder. It also determined the factors associated with functioning in these adolescents.
Methods : Adolescents with bipolar disorder diagnosed over one year or more attending the outpatient unit of Federal Neuro-Psychiatric Hospital, Enugu (FNHE), Nigeria for follow-up visits were interviewed with a socio-demographic questionnaire and their functioning was rated with the Children Global Assessment Scale (C-GAS) based on the clinical information obtained from the children and their care givers during a one year follow-up period. Further information such as history of sexual risk behavior, pre-morbid peer relationship, relationship with siblings, level of religion activities among others were also obtained through clinical interview.
Results : A total of 46 adolescents with bipolar disorder were followed up. Minimal to moderate impairment in functioning in the past year was found in these adolescents. The mean score on C-GAS was 68.41 ± 16.63. Factors including co-morbidity, pre-morbid peer relationship, relationship with siblings, level of religion activities and history of sexual risk behavior were significantly associated with functioning (p = 0.000), while marital status of the parents showed a weak association with functioning in these adolescents (p = 0.068). Negative correlation was also found between mean number of hospital admissions in the past year during follow up and mean score on C-GAS (r = - 0.908, p = 0.000).
Conclusion : Functional impairments complicate bipolar disorder in Nigerian adolescents. To ensure good overall outcome in these adolescents, attention needs to be focused on promoting those factors that help good functioning. Future longitudinal follow up studies that would assess long-term outcome and its correlates in children and adolescents with bipolar disorder in this environment are desirable.
Children with sickle cell disease who are experiencing psychosocial problems concurrently with their mothers : a Nigerian study : original articleAuthor M.F. Tunde-AyinmodeSource: African Journal of Psychiatry 14, pp 392 –401 (2011)More Less
Objective : The objective of the study was to identify children with Sickle cell disease (SCD) who are experiencing psychosocial problems concurrently with their mothers; and comparing the dyads to determine correlation, pattern of correlation and to identify correlating or modifying factors.
Method : The psychosocial impact of Sickle cell disease in affected children and their mothers was assessed using semi-structured questionnaire and standardized instruments (The Child Behaviour Questionnaire (CBQ) - Parents' version or Scale A2) for the children and Self Reporting Questionnaire (SRQ) for their mothers. Children with bronchial asthma and some with acute medical illnesses (AMI) and their mothers who were also assessed with the same instruments served as the control population.
Results : There was significant correlation between children who were probable cases with psychological problems based on Child Behaviour Questionnaire (CBQ score of ≥7) and corresponding mothers who were probable cases with psychosocial problems based on Self-Reporting Questionnaire (SRQ score of ≥5). Although there were some group-specific factors that influenced this pattern (child and mother having psychosocial problems concurrently) in one or 2 groups of these diseases, none cut across the 3 groups.
Conclusion : In psychosocial management of physical illnesses, assessment and care should include a focus on families rather than on the affected individual only. In addition, identifying emotional and social dysfunction in a family member should lead to a search in other members; in this way primary prevention or control can effectively be carried out. Finally, identifying more modifiable factors that positively influence this pattern in which child and mother experience psychosocial dysfunction concurrently should be the urgent task of future and larger studies in this environment.
New evidence of agomelatine's efficacy in the treatment of anxiety in depressed patients : product newsSource: African Journal of Psychiatry 14 (2011)More Less
At the recent 24th European College of Neuropsychopharmacology congress (ECNP) held in early September in Paris, new agomelatine (Valdoxane®) data was presented which highlighted the distinctive profile of agomelatine's efficacy in reducing anxiety symptoms in depression versus placebo and versus active comparators in patients with major depressive disorder.
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 406 –408 (2011)More Less
Elevation of plasma noradrenaline levels has been reported as a consistent clinical effect of clozapine, due to its potent effect on α2-adrenergic receptors. The relationship between this elevation and clinical effectiveness remains inconclusive. Davidson et al concluded that the elevation was unrelated to clinical effectiveness. However, Breier et al reported a positive correlation between plasma noradrenaline elevation and clinical improvement in patients on clozapine treatment.
Poly-pharmacy in psychiatry : a debatable contemporary practice? Not much evidence : letter to the editorAuthor O.M. PrakashSource: African Journal of Psychiatry 14 (2011)More Less
Poly-pharmacy involves the concomitant administration of two or more drugs in a single patient. Despite extensive research and recommendations as to the optimal prescription of drugs, poly-pharmacy is still widely prevalent in clinical practice throughout the world. The study of this phenomenon in psychiatry is inherently complex. There is enough literature in psychiatry that suggests that monotherapy permits documenting patient's response to an adequate trial of each medication, helping to reduce the complexity of the medication regimen, reducing the risk of adverse events, and making it easier to assess and manage future symptom exacerbations. On the other hand, whilst poly-pharmacy is common it might appear an irrational and debatable contemporary practice having its own advantages and disadvantages. There should be no doubt that a powerful trend toward poly-pharmacy exists.
Author Franco P. VisserSource: African Journal of Psychiatry 14 (2011)More Less
Walter Black (played by two-time Oscar winner Mel Gibson) is a struggling husband and unsuccessful executive of Jerry Co., a toy company on the verge of bankruptcy. He suffers from severe depression and the usual treatment avenues of therapy and medication have failed him. Kicked out by his wife Meredith (played by two-time Oscar winner Jodie Foster), Walter is forced to head to a hotel for accommodation. Full of alcohol and with his life hanging by a thread, Walter decides to commit suicide as he does not see his way out of his despair.
Sleep easy - the highs and lows of sleep and bipolar : patients as partners - brought to you by the South African Depression and Anxiety GroupSource: African Journal of Psychiatry 14, pp 418 –420 (2011)More Less
Mental illnesses like Bipolar Disorder are age-old, but every day we are learning more about them. And we're learning that treatment goes far beyond just using the right medication.
While we all have our good and bad days, our positive, energetic days and our low, grumpy days, people with Bipolar Disorder have far more severe peaks and valleys and their mood changes negatively impact their everyday lives. Bipolar Disorder (previously known as manic depression) causes severe changes in mood, energy, thinking and behaviour that can last for weeks or months. More information on Bipolar Disorder is available through the SA Depression and Anxiety Group's (SADAG's) Astra Zeneca Bipolar Helpline on 0800 70 80 90.
Caring for a loved one with schizophrenia : patients as partners - brought to you by the South African Depression and Anxiety GroupSource: African Journal of Psychiatry 14, pp 422 –424 (2011)More Less
Discovering that someone you care about has schizophrenia can be traumatic. Making things worse is the need for long-term treatment to calm symptoms. A person with schizophrenia often becomes confused and agitated, which some may mistake as behaviour directed towards them.
Schizophrenia often places a difficult burden on families. Fortunately, there are steps families can take to make the situation easier, including contacting the South African Depression and Anxiety Group (SADAG) on 0800 70 80 90 for information on the illness and referrals to mental health professionals. The key is for families to understand what they face when a loved one has schizophrenia.