African Journal of Psychiatry - Volume 15, Issue 4, 2012
Volume 15, Issue 4, 2012
Author M. MarsSource: African Journal of Psychiatry 15, pp 215 –217 (2012)More Less
The burden of disease in Africa is great, its people are poor and there is an extreme shortage of health professionals. Over half of sub-Saharan Africans live on less than US$1.00 (purchasing power parity) a day, and in rural areas. As a result, the tax base in most countries is small and government spending on healthcare provision is low. Access to, and the standard of, medical care is largely dependent on income and geographic location. Furthermore, it is forecast that the population of Africa will double over the next forty years, exacerbating the problem.
Source: African Journal of Psychiatry 15, pp 223 –225 (2012)More Less
Zoophilia is a disorder of sexual preference characterized by recurrent, intense, sexually arousing fantasies, urges, or behaviours involving animals. Sexual contact with animals often occurs as a substitute for heterosexual relations when the animal is more readily accessible than a human partner. It may also be the result of curiosity or desire for novelty. In rare cases, however, Zoophilia becomes the principal form of sexual arousal and precludes the formation of normal sexual relationships. Although patients with schizophrenia make up a relatively small proportion of sex offenders, this small group may present significant clinical and legal challenges.
'To predict or not to predict - that is the question'
An exploration of risk assessment in the context of South African forensic psychiatry : forensic forumSource: African Journal of Psychiatry 15, pp 227 –233 (2012)More Less
In ancient times, events of particular significance to individuals, societies and countries, were mostly considered to be the result of fate, luck or divine intervention. 'Omens', that is signs spontaneously revealed through acts of nature, or elicited from it by the actions of priests and diviners, were in fact an early form of prediction, and great significance was attached to their appearance.
Effectiveness and feasibility of telepsychiatry in resource constrained environments? A systematic review of the evidence : reviewSource: African Journal of Psychiatry 15, pp 235 –243 (2012)More Less
Objective : A review of systematic reviews of the effectiveness and feasibility of videoconference-based telepsychiatry services for resource constrained environments was conducted. Specifically with the aim of producing an evidence-based review of the effectiveness and feasibility of videoconference-based telepsychiatry services in resource constrained countries like South Africa.
Methods : Eight key questions on telepsychiatry effectiveness and feasibility were identified and inclusion and exclusion criteria were developed. Review of citations from 2000-2011 from CINAHL, Medline, Pubmed, PsycInfo, EBSCOhost, SABINET, Cochrane Database of Systematic Reviews (CCTR), Cochrane Controlled Trial Registry (CCTR), Database of Abstracts of Reviews of Effectiveness (DARE), unpublished abstracts through NEXUS and internet search engines (Google/Google scholar) was conducted.
Results : Ten systematic reviews were included for review. Despite the methodological limitations and heterogeneity of the systematic reviews, there appears to be good evidence of effectiveness (reliability and improved outcomes) and feasibility (use, satisfaction, acceptability and cost) for videoconference-based telepsychiatry internationally. The application of this evidence in lower middle income countries is dependent on the integration of telepsychiatry into local health system contexts.
Conclusion : Based on the evidence, resource constrained countries such as South Africa should be encouraged to develop telepsychiatry programs along with rigorous evaluation methods.
Source: African Journal of Psychiatry 15, pp 244 –247 (2012)More Less
Objective : South Africa has a shortage of facilities and psychiatrists to assess adjudicative competence of prisoners awaiting assessment under sections 77 to 79 of the Criminal Procedures Act of 1977. Various solutions have been proposed by the Department of Health. The recent linking of a Magistrate's court and a prison by videoconferencing offers the opportunity to implement a forensic telepsychiatry service. The literature on forensic telepsychiatry for assessment of adjudicative competence was reviewed.
Method : The electronic databases, PubMed, Scopus, Cinahl and Google Scholar were searched for papers on forensic telepsychiatry. The inclusion criterion was papers reporting the use of videoconferencing for assessment of adjudicative competence or for assessment for referral out of the judicial system, by psychiatrists or psychologists.
Results : 411 papers were found of which 13, published between 1997 and 2008 were relevant. The use of videoconferencing for forensic psychiatric assessment was reported from four countries. The courts in those jurisdictions have accepted the use of videoconferencing for assessment and no successful appeals have been mounted on the basis of the use of videoconferencing for assessment. User satisfaction has not been reported for assessing adjudicative competence. Forensic telepsychiatry has been found to be cost effective, improve access to scarce specialist skills and reduce transport of prisoners under guard to hospitals or psychiatrists to prisons.
Conclusion : There is nothing in the literature to suggest that a forensic telepsychiatry service is not feasible in South Africa and a pilot project is being planned.
Videoconference-based education for psychiatry registrars at the University of KwaZulu-Natal, South Africa : originalSource: African Journal of Psychiatry 15, pp 248 –254 (2012)More Less
Objective : Psychiatry registrars form the backbone of specialized psychiatric service provision in South Africa. Medical schools are centralized while clinical services need to be widespread and accessible. Video-conferencing has the potential to link registrars at satellite hospitals with academic centers. The study thus evaluated of the use of videoconferencing in a Psychiatry Education Program delivered via videoconferencing.
Method : To evaluate the implementation of the videoconference-based psychiatry registrar program, a pre- and post evaluative design was used. This involved all registrars in the 2008 and 2009 academic education program at the University of KwaZulu-Natal, South Africa. Access to education, satisfaction, suitability and costs of the psychiatry registrar education were studied.
Results : In the evaluation of the Registrar Program, general satisfaction with the videoconferencing program was reported, though concerns were expressed about the level of interaction using this mode, the quality of the transmitted pictures of the anatomy specimens and the quality of the sound. Access to education was improved with potential cost savings identified.
Conclusion : Well supported and planned videoconference-based teaching is a feasible, cost-effective and acceptable method of supporting registrars at sites distant from academic centers.
Source: African Journal of Psychiatry 15, pp 255 –263 (2012)More Less
Objective : In 2009, the Departments of Psychiatry and Telehealth of the University of KwaZulu-Natal (UKZN) initiated a three year project to develop telepsychiatry services in KwaZulu-Natal. This paper describes the challenges and opportunities of this project.
Method : This was a collaborative, in situ health service project and an action research framework was adopted. Over the three years, following a needs assessment and an e-health Readiness Assessment, two action research cycles were completed. Cycle 1: The preparation, implementation and evaluation of educational material, technical requirements and clinical guidelines and clinical support materials. Cycle 2: Preparation and evaluation of educational and clinical outreach sessions.
Results : Videoconference education sessions were beneficial to health staff without post-qualification psychiatry training. A flexible format for education improved knowledge outcomes. Clinical sessions are feasible, but require administration and technical support for facilitation. With facilitator training, 128Kbps is a suitable bandwidth for education but 384Kbps is preferred for clinical consultation.
Conclusion : Telepsychiatry offers tremendous potential to facilitate the three strategies suggested by the World Psychiatric Association to address the treatment gap, save time and costs and improve access to the small pool of specialist psychiatrists in resource constrained environments.
A telepsychiatry model to support psychiatric outreach in the public sector in South Africa : originalSource: African Journal of Psychiatry 15, pp 264 –270 (2012)More Less
The access of rural Mental Health Care Users in South Africa to specialist psychiatrists and quality mental health care is currently sub-optimal. Health professionals and planners working in psychiatry lack a well-defined and feasible outreach model to facilitate the delivery of services to remote and rural areas. In response to this challenge, a three-year action research telepsychiatry study was undertaken by the Departments of Psychiatry and TeleHealth at the University of KwaZulu-Natal, to develop a telepsychiatry outreach model based on local research and international evidence. The Model draws on needs and infrastructure assessments of the designated psychiatric hospitals in the province, a review of the published international evidence on telepsychiatry and videoconference-based education, and an evaluation of local clinical and educational telepsychiatry implementations in KwaZulu-Natal. The Model proposed is "virtual", i.e. not bound to provincial or district referral patterns, aims not to add to the burden on the current workforce and is intended to be integrated into psychiatry outreach services and policy. The Model should be subjected to in situ testing for validation and implementation. It is hoped that an implementation of this Model will improve the access of Mental Health Care Users to specialist psychiatry care.
Source: African Journal of Psychiatry 15, pp 271 –282 (2012)More Less
Telepsychiatry, the practice of psychiatry over distance using information and communication technologies is, after teleradiology, the most practiced form of telemedicine in the world. As with any new technology, clinical service, or intervention in medicine, it is prudent to have guidelines for the safe and efficacious use of the technology in clinical practice. Guidelines facilitate best practice and provide both clinicians and patients with a set of standards and procedures that serve to protect their interests. Protection is particularly important when dealing with vulnerable groups.
Author Franco P. VisserSource: African Journal of Psychiatry 15 (2012)More Less
When the actor Colin Firth (The King's Speech, Mama Mia) called out Meryl Streep's name as the winner of the Best Actress in a Leading Role Oscar at this year's 84th Annual Academy Awards for her portrayal of Margaret Thatcher, one thought came to my mind... Finally! Nominated a record 17 times and having won three Oscars to date no actress has made a bigger impact on Hollywood and the film industry than Meryl has. Her career, first as a stage actress before moving on to motion pictures, spans some 40 years and she is widely regarded as the most talented actress in Hollywood history. It thus came as no surprise that she of all people acted the role of one of the strongest political leaders of the 20st century.
Agoraphobia - the risk of untreated panic disorder : Panic Awareness Day, 10 July 2012 : patients as partners - brought to you by The South African Depression and Anxiety GroupAuthor Dessy TzonevaSource: African Journal of Psychiatry 15, pp 290 –296 (2012)More Less
Many of us know what it's like not to want to get out of the house... especially now that the temperatures are dropping and it's so much cosier indoors. Sometimes, even going to the garage up the road seems like a huge task, even if it's for something we really need. But what if it was an intense fear and not convenience that kept you from stepping outside the comfort of your home? What if the thought of going outside was petrifying enough to keep you housebound for years?
Source: African Journal of Psychiatry 15 (2012)More Less
In 2012 the South African Society of Psychiatrists celebrates its 60th anniversary. We will be commemorating this through the course of the year, but with a special focus during the 17th National Congress in September. We welcome the opportunity to engage with all those connected to SASOP, to reflect on the past, consider the present and plan for the future.