African Journal of Psychiatry - Volume 15, Issue 1, 2012
Volume 15, Issue 1, 2012
Source: African Journal of Psychiatry 15, pp 3 –7 (2012)More Less
Forensic Psychiatry has a history that dates back almost two thousand years, and has evolved into a recognised discipline with a robust background of scientific enquiry, mostly because mental health care has always had an important interface with the law. Nevertheless, even in the developed world there are differences between countries with respect to the extent forensic mental health services have developed. This has been exacerbated by the differences in legal systems, resources and priorities in each country. Consequently comparisons and cooperation between forensic psychiatrists internationally has been difficult. In Africa, which is the second largest and most populous continent and containing an immense diversity of languages, religious traditions, ethnic groups and sociopolitical systems forensic psychiatry has largely remained underdeveloped within the context of a pervasive neglect in the provision of mental health services. The situation is compounded by the dearth of information about forensic services on the continent. As described by an eminent African psychiatrist, "the practice of forensic psychiatry in Africa is shrouded in both mystery and confusion". In addition to the lack of appropriate facilities, most countries in Africa have, on average, one psychiatrist per one million inhabitants. Moreover many psychiatrists have migrated to developed countries, leaving a small number of mental health professionals burdened with large numbers of patients.
Author S. KaliskiSource: African Journal of Psychiatry 15, pp 13 –15 (2012)More Less
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will be released in 2013, and if, as anticipated, introduces wide ranging changes, may not only wipe out large swathes of accepted research but will reinforce the already prevalent view that psychiatric diagnoses are mostly arbitrary and have questionable validity. No other medical speciality suffers this indignity. The President of the American Psychiatric Association (APA) recently pointed out that the original purpose of DSM was to improve interrater reliability in psychiatric diagnosis, and although the original intention was to stimulate research into establishing their validity DSM diagnoses have actually become reified (as if they were real entities). In the bad old days psychiatric diagnoses were often idiosyncratic and localised either to a country, or theorist. Even nowadays some of those curious entities still bubble up into our courts, such as the quaint 'catathymic crisis' that is often produced to explain that a defendant lost his temper, because he simply couldn't take it (whatever 'it' was) anymore.
Source: African Journal of Psychiatry 15, pp 17 –23 (2012)More Less
Elevated plasma homocysteine in association with decreased vitamin B12, folate, serotonin, lipids and lipoproteins in depressed patients : original articleSource: African Journal of Psychiatry 15, pp 25 –29 (2012)More Less
Objective : Increased plasma homocysteine, decreased vitamin B12 and folic acid levels have been implicated in depressive mood. Plasma homocystine, vitamin B12, folic acid tryptophan, lipids and lipoproteins were determined in depressed patients and controls.
Method : Sixty subjects consisting of 30 depressed patients and 30 apparently healthy volunteers, who served as controls, were selected for this study. Anthropometric indices and biochemical parameters were determined using standard procedures.
Results : The results showed a significantly higher plasma homocysteine level amongst depressed patients when compared with the corresponding controls (p<0.001), the percentage increase was 116%, while the plasma vitamin B12 (p<0.01), total cholesterol, high density lipoprotein cholesterol and low density lipoprotein cholesterol levels (p<0.001) were markedly lower when amongst depressed patients when compared with the corresponding controls; the percentage differences were 21%, 42% and 42% respectively. Plasma triglyceride, folic acid and tryptophan levels amongst depressed patients were not significantly different from the controls. The male subjects had significantly higher plasma tHcy levels than the female counterparts (p<0.001).
Conclusion : This study showed a significant increase in plasma tHcy coexisting with a decrease in plasma vitamin B12 TC, LDLC and HDLC, in depressed patients. Increased plasma homocysteine could be a sensitive indicator of plasma B vitamin deficiency.
Source: African Journal of Psychiatry 15, pp 30 –35 (2012)More Less
Objective : The aim of this study was to determine the prevalence of serious mental disorders in a prison population in Durban, South Africa, one of the largest prisons in the Southern hemisphere.
Method : 193 prisoners were interviewed using the Mini Neuro-psychiatric Interview, a screening questionnaire and a demographic questionnaire.
Results : The study demonstrated that 55.4% of prisoners had an Axis 1 disorder. The commonest disorder being substance and alcohol use disorders (42.0%). 23.3% of prisoners were diagnosed with current psychotic, bipolar, depressive and anxiety disorders. 46.1% were diagnosed with antisocial personality disorder. The majority of prisoners diagnosed as having an Axis 1 disorder in this study, were neither diagnosed nor treated in prison.
Conclusion : There is a high prevalence of mental disorders among prisoners in a prison population in Durban, South Africa. The majority of these prisoners are untreated in prison, related to non detection of the mental disorder. Greater mental health awareness and provision of mental health services focusing on staff training programmes to detect mental illnesses are needed and further research is recommended throughout South Africa.
The clinical utility and cost effectiveness of routine thyroid screening in adult psychiatric patients presenting at Stikland Hospital, Cape Town, South Africa : original articleSource: African Journal of Psychiatry 15, pp 36 –41 (2012)More Less
Objective : The use of thyroid tests to assess psychiatric patients remains debatable. Therefore, this study was conducted to examine the utility and cost effectiveness of the current protocol used in thyroid testing in adult psychiatric patients presenting at Stikland Hospital, Cape Town, South Africa.
Method : This was a retrospective chart review conducted at Stikland Hospital between 1 January 2000 and 31 December 2005. The following data was recorded: demographic variables, clinical diagnoses at admission and discharge, number of days from admission to a thyroid test request, the reason for thyroid screening, number of thyroid tests, their yield and costs involved, as well as the action taken following an abnormal thyroid test result.
Results : The mean age of patients (n = 1080: n = 364 male, n = 716 female) was 42.8 years (SD ±16.6). Pre-existing thyroid disease was documented in 70 (6%) of patients. Normal Thyroid Stimulating Hormone (TSH) test results significantly (p = 0.0001) increased, whilst abnormal TSH test results significantly (p = 0.0001) decreased from baseline to follow-up. Except for gender, the outcome of TSH screening was independent of demographic and clinical diagnoses. Only 16% of TSH tests yielded clinically significant results.
Conclusion : The findings of this study do not support the early, routine screening for thyroid dysfunction in psychiatric patients at this facility. It is possible that thyroid screening may present with transient abnormalities of no particular clinical significance, and would therefore not be a cost effective practice.
Source: African Journal of Psychiatry 15, pp 42 –46 (2012)More Less
Objective : Common mental disorders constitute a considerable disease burden in low-income countries, and there is a need for acceptable and effective brief interventions for such disorders in low-income countries. This article examines cultural based interpretations of the diagnosis of panic disorder (PD) in a rural Tanzanian hospital setting through clinical work. It also examines how to adapt and apply brief cognitive behaviour therapy (CBT) interventions to this setting.
Method : A qualitative analysis of clinical data from ten participants in a hospital-setting in rural Tanzania.
Results : The analysis suggests that the diagnosis of PD is relevant to this rural Tanzanian setting. Patients, relatives, and health personnel at the hospital accepted brief CBT interventions for PD and regarded psychoeducational information to patients as especially useful.
Conclusion : A manual for brief interventions for PD may be adapted to a rural Tanzanian setting, also taking into consideration the limited financial and human resources in a rural low-income country setting.
HIV sero-positivity in recently admitted and long-term psychiatric in-patients : prevalence and diagnostic profile : original articleSource: African Journal of Psychiatry 15, pp 47 –53 (2012)More Less
Objective : Research on HIV in South Africa has not reflected the impact of the disease on psychiatric patients. The aims of the study were: to compare the HIV prevalence among patient groups in Weskoppies Hospital; to compare psychiatric diagnoses of infected and non-infected patients; to assess intravenous drug use and high-risk sexual behaviour; to establish HIV-syphilis association; and to investigate the rapid test performance for screening, compared to the confirmatory ELISA test.
Method : One-hundred-and-ninety-five patients were grouped into four categories according to their duration of admission and gender. HIV rapid testing, HIV ELISA, syphilis-RPR and TPHA testing were performed.
Results : The HIV prevalence of 11% in the sample was significantly associated with 'gender-and-duration-of-admission' categories (p=0.003). No significant association between HIV infection and psychiatric diagnoses or intravenous drug use was found, but a significant association existed between HIV infection and high-risk sexual behaviour (p=0.002), and between HIV and syphilis (p=0.012). The HIV rapid screening test had a sensitivity of 91.7% and a specificity of 98.2%.
Conclusion : The overall HIV prevalence at Weskoppies Hospital remains lower than the national average, but has increased since a previous local study. The rapid test for HIV had a lower sensitivity than was expected, and it is recommended that HIV ELISA testing be performed as a first line test in the setting of hospitalised patients. Due to the high prevalence of HIV and syphilis in the psychiatric population it is recommended that all patients be tested for both of these diseases.
Source: African Journal of Psychiatry 15, pp 55 –57 (2012)More Less
Studies have shown an association between homicidal behaviour and psychiatric disorders although it remains difficult to conclude that definite causal relationships exist between specific mental illnesses and particular forms of homicide. However, matricide has been linked to schizophrenia for several decades with an assortment of explanations to explain the connection. To review the psychosocial, contextual and clinical issues involved in the perpetration of matricide by patients with schizophrenia. Two detailed case reports are presented alongside review of relevant literature. There are complex psychodynamic, phenomenological and contextual factors in the act of matricide by persons with schizophrenia. The observation that ambivalent relationships exist between schizophrenics and their mothers (or other carers) probably suggests the need for adequate clinical intervention with families of affected patients in resolving psychological tension which might be the provoking stimulus to murder.
Middle cranial fossa arachnoid cyst presenting with obsessive compulsive behaviour associated with psychosis - two cases : scientific letterSource: African Journal of Psychiatry 15, pp 59 –60 (2012)More Less
Arachnoid cysts are benign space-occupying lesions of the brain containing cerebrospinal fluid (CSF). From an etiological point of view, the primary or true cysts are congenital in nature and false cysts are secondary to the post-inflammatory accumulation of CSF during cranial traumas, infections or intracranial hemorrhages.
Author Franco P. VisserSource: African Journal of Psychiatry 15 (2012)More Less
Now if ever there was a film that I thoroughly enjoyed for many reasons, some a bit less savoury, it was this film, Horrible Bosses. Nick Hendricks (played by Jason Bateman), Kurt Buckman (played by Jason Sudeikis) and Dale Arbus (played by the very funny Charlie Day) are three ordinary guys with ordinary jobs, although one hallmark about their occupations that they share is that they all three have bosses from hell.
New evidence of agomelatine's efficacy in the treatment of anxiety in depressed patients : product newsSource: African Journal of Psychiatry 15 (2012)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.
ADHD - children who can't pay attention : patients as partners - brought to you by The South African Depression and Anxiety GroupSource: African Journal of Psychiatry 15 (2012)More Less
Many parents are distressed when they receive a note from school saying that their child won't listen to the teacher or causes trouble in class. The reality is that as many as 5 out of every 100 children in school may have Attention Deficit/Hyperactivity Disorder (ADHD), with boys being 3 times more likely than girls to receive this diagnosis.
15 tips to manage your mental health in 2012 : patients as partners - brought to you by The South African Depression and Anxiety GroupAuthor Janine ShamosSource: African Journal of Psychiatry 15, pp 71 –72 (2012)More Less
It's 2012 and many of us have promised to make this year a 'better' one. We make resolutions and promises but we don't always stick to them. "Many people don't know where to start or how to tackle the problems," says SADAG's Zane Wilson. 2011 was a very tough year for many South Africans and heading into the new year - getting back into work and school and all the emotional, physical and financial responsibilities this includes - can be hard and many people are struggling to cope. "People may already be suffering hardship and for those experiencing depression, anxiety or trauma, the start of the new year may not be as easygoing as they'd like," says psychologist Lee-Ann Hartman.