African Journal of Psychiatry - Volume 15, Issue 3, 2012
Volume 15, Issue 3, 2012
Author Christopher P. SzaboSource: African Journal of Psychiatry 15 (2012)More Less
South African Psychiatry witnessed a recent event, that by all accounts is unprecedented in low and middle income countries: a national mental health summit, this according to one of the speakers at the summit- Shaker Saxena, of the World Health Organization. South Africa is divided into 9 provinces and prior to the national summit, provincial summits were held in order to identify issues and develop position statements for the national summit i.e. the process was systematic.
Board of International Affairs Pan-African Division Quarterly newsletter : African International Division, Royal College of Psychiatrists : quarterly newsletterSource: African Journal of Psychiatry 15, pp 152 –158 (2012)More Less
Source: African Journal of Psychiatry 15 (2012)More Less
Drug interaction in psychiatry is a clinically important issue, as it can cause side-effects and prevent adequate therapeutic effect. We report an unexpected interaction between the antidepressant mirtazapine and the antiemetic ondansetron in a 72 year old patient, weighing 68 kg, with a height of 173 cm.
Source: African Journal of Psychiatry 15, pp 162 –166 (2012)More Less
Most forensic mental health programmes focus primarily on treating patients' mental illness in much the same way that all psychiatric patients are managed. Risk management is usually presumed to have been accomplished when the patient achieves clinical recovery, which really means remission of illness and compliance with treatment. Not all patients require equal measures of risk management and psychiatric care, nor has it been possible to pursue both seamlessly as part of an overall treatment philosophy, although both seem to involve paternalistic care.
Source: African Journal of Psychiatry 15, pp 168 –171 (2012)More Less
"No health without mental health" has become a rallying call for the World Health Organization and numerous service providers, training institutions, health researchers, and advocacy groups around the world. It is timely to consider the implications of this call for South Africa. We review key evidence regarding the burden and risk factors for mental disorders in South Africa and crucial challenges for local mental health services and research. We emphasize that mental disorders are more impairing but less treated than physical disorders, and that existing services need to be scaled up and adapted to the local context. New research is needed to determine what interventions work best in the South African context.
What's in a name? AIDS dementia complex, HIV-associated dementia, HIV-associated neurocognitive disorder or HIV encephalopathy : reviewAuthor D. SinghSource: African Journal of Psychiatry 15, pp 172 –175 (2012)More Less
The current paper reviews currently used and proposed nomenclature for neurocognitive disorders associated with HIV, and proposes a unitary system as well as recommends an operational approach to screening / diagnosing severe forms of HIV associated neurocognitive disorder (HAND) in order to identify individuals who might benefit from antiretrovirals (ARVs). The terms HIV dementia complex, HIV-associated dementia (HAD) and HIV encephalopathy (HIE) are being replaced by more refined definitions for the spectrum HIV associated neurocognitive disorder (HANDs). The Diagnostic and Statistical Manual (DSM) will introduce a further term- major neurocognitive disorder. The nosology can become very confusing as the terms are not exactly equivalent. Clinicians need guidance on how to interpret new terms to implement current legislation and treatment guidelines that use the old term HIE. As a WHO stage 4 disease, patients with HIE are eligible for ARVs irrespective of their CD4 count. However, there are no locally available operational criteria how to diagnose HIV encephalopathy (HIE). The updated terminology is preferred because it requires assessing cognition objectively with neuropsychological tests. It is recommended that the International HIV Dementia Scale be used to screen patients and to thereafter confirm diagnosis with further neuropsychological tests e.g. the trail making and digit span tests.
Vulnerable long-term psychiatric inpatients need screening for physical-health problems : an audit of regular hospital statistics and clinical files : originalAuthor C. KrugerSource: African Journal of Psychiatry 15, pp 176 –184 (2012)More Less
Objective: Maintaining physical health in the presence of severe mental illness remains a challenge. The aims of this study were to identify the most pressing physical health problems of long-term psychiatric in-patients and to identify vulnerable subgroups, as part of a multi-phased programme evaluation project to improve service delivery to and quality of care of long-term patients in Weskoppies Hospital. Method: Regular nursing statistics on vital data, infections, injuries, deaths, and adverse incidents, as well as clinical file data, infection-control statistics and dietician statistics were recorded for 268 long-term in-patients at Weskoppies Hospital over six months. Adverse incidents including aggression were recorded because of their potential for injury and nursing implications. Subgroups of patients were compared using two-way tables and Fisher's Exact Tests, or Mann-Whitney-U and Kruskal-Wallis tests. Results: The blood pressure of hypertensive patients was well controlled. Prevalent problems were epilepsy, respiratory tract infections, and injuries (accidental and from fighting or assault). Most vulnerable are older male patients (prone to respiratory tract infections and lower body weight); patients with cognitive disorders (prone to any injury, especially accidents and falls); and younger male patients (prone to aggression and resultant injury). Conclusion: Increased screening should be conducted for older underweight male patients (for chronic respiratory or infectious diseases that might cause cachexia) and of patients with cognitive disorders or who have fallen (for treatable risk factors for falling and preventative measures). More patients should be referred for special diets. Nursing interventions should be emphasised more with aggressive and irritable patients.
The impact of a psychiatry clinical rotation on the attitude of Nigerian medical students to psychiatry : originalSource: African Journal of Psychiatry 15, pp 185 –188 (2012)More Less
Objective: Undergraduate medical students have ingrained and often negative attitudes towards psychiatry as a field and as a career. This in turn has affected recruitment of graduate medical students into the specialty. Little is known about the impact of psychiatry rotations during undergraduate medical training on students' attitudes about psychiatry and eventual specialty choice in developing countries. This study examined the impact of a psychiatry clinical rotation on medical students' attitudes to psychiatry and possible career choice. Method: Eighty-one and one hundred and six fifth year medical students completed the ATP-30, socio-demographic and career choice questionnaires at the beginning and the end of a four week clinical rotation respectively. Results: The overall attitude of the students to psychiatry was favourable at the beginning of the rotation with significant improvement following the rotation (p=0.003). Significant improvement in attitude was observed among female and younger students. Students who indicated preference for specialties other than psychiatry showed a greater improvement in their attitude to psychiatry following the rotation (p= 0.011). The rotation however did not enhance students' preference for psychiatry as a future career. Conclusion: The four-week clinical rotation in psychiatry resulted in increased mean attitudinal score, but not in enhanced preference for psychiatry as a career.
Comparison of clinical profiles and treatment outcomes between vagrant and non-vagrant mentally ill patients in a specialist neuropsychiatric hospital in Nigeria : originalSource: African Journal of Psychiatry 15, pp 189 –192 (2012)More Less
Objective: Vagrant mentally ill patients are a highly marginalized group that receive limited care and attention from society. There is a dearth of information on the clinical status of this group in low-income countries. The aim of this study was to compare the clinical profiles and treatment outcomes between vagrant and non-vagrant mentally ill patients admitted to Aro Psychiatric Hospital, Abeokuta, Nigeria. Method: We conducted a retrospective review of clinical records charting vagrant and non-vagrant mentally ill patients treated over a five year period from January 2004 to December 2008. Results: The medical records of 61 vagrant and 122 non-vagrant mentally ill patients were reviewed and compared. The vagrant patients were more likely to be older, unmarried and alone, poorly educated, unemployed or performing unskilled labour, and diagnosed with schizophrenia. This cohort was also more likely to have physical co-morbidities compared with the non-vagrant mentally ill patients. The median time to improvement among the vagrants (211.0 days) was significantly longer than for the non-vagrant patients (34.0 days) suggesting more intractable illnesses. Other factors found to prolong the time to improvement among all patients were old age, education, being single, unemployment, the diagnoses of schizophrenia, and substance abuse. Conclusion: The clinical profiles and treatment outcomes were poorer among the vagrant mentally ill patients, underscoring a need for more comprehensive healthcare resources directed to this patient group in Nigeria.
Perceptions among primary caregivers about the etiology of delirium : a study from a tertiary care centre in India : originalSource: African Journal of Psychiatry 15, pp 193 –195 (2012)More Less
Objective: To study caregivers' perceptions about the cause of delirium and their distress caused by symptoms of delirium. Method: Adult caregivers of patients with delirium, who gave consent, were asked about their perceptions of the cause of delirium. Patients were assessed for delirium by using the delirium rating scale-revised version (DRS-R-98). Results: The study included 72 primary caregivers of patients with delirium. About one-third of the caregivers (36.11%) attributed the symptoms of delirium to non-organic causes like supernatural beliefs, emotional stress resulting from physical illness or various social factors, attention seeking behaviour, or a result of religious disobedience. Approximately eight percent of the caregivers couldn't give any reason for the altered mental state of the patient. Others attributed the symptoms to medical-surgical causes. Conclusion: A significant proportion of caregivers attribute delirium to non-organic causes in this context.
Author Franco P. VisserSource: African Journal of Psychiatry 15 (2012)More Less
And the nominees for Best Picture are... The Artist, The Descendants, Extremely Loud & Incredibly Close, The Help, Hugo, Midnight in Paris, Moneyball, The Tree of Life and War Horse... And the winner is...The Artist. However, although not this years' Oscar winner, it won in the category 'Best Adapted Screenplay' and was nominated in the categories 'Best Achievement in Directing', 'Best Achievement in Film Editing', 'Best Performance of an Actor in a Leading Role' and the 'Best Motion Picture of the Year', the film The Descendants was chosen by me for review as it has been a while since I have viewed a film that was as surprising, as moving and as entertaining, all at the same time.
A new generation of eating disorders - not only for girls : patients as partners - brought to you by The South African Depression and Anxiety GroupAuthor Ryan G. EdmondsSource: African Journal of Psychiatry 15, pp 208 –210 (2012)More Less
Ana. Mia. Manorexia. Thinspiration - all words associate with the growing social culture of Eating Disorders among adolescents and young adults worldwide. Eating disorders have become a way of life, a sub-culture, kept aflame on websites dedicated to a destructive new movement called 'Pro-Ana.' In this article we will take a look at the growing trends of Pro-Ana and Pro-Mia (slang terms for "pro-Anorexia/Bulimia") among young people, and how this culture is re-enforcing Eating Disorders, and destructive behaviours, within the teen communities. Although the word "teen" is used in this article, the term also encompasses young adults below thirty-years-old.