African Journal of Psychiatry - Volume 15, Issue 5, 2012
Volume 15, Issue 5, 2012
Source: African Journal of Psychiatry 15, pp 311 –313 (2012)More Less
Lilliputian hallucinations are a rare type of visual hallucination where imaginary objects, persons or animals of diminutive size are perceived. These small images are usually described as brightly coloured mobile creatures. The earliest description was given by Macarius in 400 AD who described these as 'little strangers', but the term 'Lilliputian' was first used by Leroy. Lilliputian hallucinations have been described in a variety of clinical conditions such as delirium, dementia, alcohol withdrawal states, following intake of dihydrocodein phosphate and dl-methylephedrine hydrochloride (a cough syrup), and medical conditions like toxoplasmosis, basilar migraine, mesencephalic lesions, cerebral tumors, epilepsy, Charles Bonnet Syndrome, and trichloroethylene poisoning. Lilliputian hallucinations were first described in schizophrenia by Lewis, but have been reported as a rare phenomenon.
Aetiological understanding important for preventing mistreatment of dual diagnosis patients : letter to editorSource: African Journal of Psychiatry 15 (2012)More Less
We completely agree with one of the most pertinent points raised by Dr. Mustafa that the diagnostic uncertainty between substance induced and primary psychotic disorders often leads to the "withdrawal-diagnostic test" on such patients by the psychiatrists. This diagnostic approach is poorly supported by scientific evidence. The author supports this viewpoint against the practice in respect of two main factors:
(a) Schizophrenic patients may remain clinically stable for a considerable duration of time after discontinuation of medication.
(b) There have been instances of rebound psychosis upon withdrawal of antipsychotic drugs in patients with substance induced psychosis.
Author S. KaliskiSource: African Journal of Psychiatry 15, pp 317 –321 (2012)More Less
Most psychiatrists are consistently ethical and professional. But there are some who are known to be 'hired guns', that is, they will produce assessments and reports according to the desires of those who engage their services. They usually operate in those areas of practice that are relatively free from regulation and accountability, such as the psycholegal and drug research arenas. This must be distinguished from our usual (and ethical) advocacy role (to get the best care for our patients) that the fiduciary relationship demands. 'Hired guns' cynically manipulate psychiatric diagnoses and assessments, and in effect prostitute the values of our profession. They appear to be acting as advocates for the best interests of their clients, but actually cleverly exploit the ambiguities and weaknesses that do bedevil our discipline, in order to achieve outcomes that most of their colleagues would consider an abuse of psychiatry. An obvious example that springs to mind is the psychiatrist who supported his client's claim against McDonalds on the grounds that she had suffered PTSD when a waiter spilt hot coffee in her lap (she lost the case).
Author D.J. SteinSource: African Journal of Psychiatry 15, pp 323 –328 (2012)More Less
Given that humans originated in Africa, it is likely that many seminal psychological observations and interventions originate in the continent. Relatively little attention has been paid, however, to more recent African contributions to the scientific fields of psychiatry and clinical psychology. This article notes that a number of major contributions to the understanding of brain-mind disorders have emerged from South Africa in particular. It briefly covers seminal contributions in evolutionary theory, psychotherapy, and neuroscience, as well as conceptual and practical contributions to reconciliation.
A survey of risk behaviour for contracting HIV among adult psychiatric patients. A South African study - part 1 : originalSource: African Journal of Psychiatry 15, pp 329 –334 (2012)More Less
Objective : Various studies have reported increased prevalence of HIV infection among psychiatric patients. Psychiatric patients are under-evaluated in terms of their HIV risk behaviour. The study sought to establish the prevalence of HIV risk behaviour and determine the association between risk behaviour and demographic and clinical variables.
Method : Participants were 113 consenting adult in-patients. A structured interview was conducted with each participant. A total risk behaviour score was calculated. From the risk score, three risk behaviour categories were identified: 0 = no risk; 1 to 3 = medium risk; 4 to 9 = high risk. Associations between HIV risk behaviour and demographic and clinical variables were analysed.
Results : Of the 113 participants, 68% were men and 32% women. The mean age was 38. Forty-five per cent were sexually active and 48% fell into the "no-risk group", 29% in the "medium-risk" group, and 23% in the "high-risk" group. Female patients with a history of treatment for sexually transmitted disease and a diagnosis of personality disorder were associated with being sexually abused. Having multiple sex partners was associated with diagnoses of substance-related disorders and cognitive disorders. Sex with someone known for less than 24 hours was associated with long-term hospitalisation and diagnoses of cognitive and personality disorders.
Conclusion : The study confirmed that mentally ill patients are vulnerable and may be victimised. The study also suggests that mental illness may impair appreciation of consequences and lead to high-risk behaviour for contracting HIV. Special care should be taken to protect female patients in psychiatric institutions.
A survey of HIV-related knowledge among adult psychiatric patients. A South African Study - part 2 : originalSource: African Journal of Psychiatry 15, pp 335 –339 (2012)More Less
Objective : Studies have reported an increased prevalence of HIV infection among psychiatric patients. Inaccurate HIV knowledge is included as a factor in the increased risk of HIV infection in the mentally ill, but few studies have looked specifically at this factor. The aims of the study were to determine the knowledge of HIV and its transmission among adult psychiatric patients at Weskoppies Hospital and to determine the relationship between HIV knowledge and HIV risk behaviour.
Method : Structured interviews were conducted with 113 consenting adult patients at Weskoppies Hospital. They were divided into three groups according to their length of hospital stay. The structured interview included questions about demographic data, the diagnoses and the AIDS Risk Behaviour Knowledge Test (AIDS-KT). Scores of 13 out of 13 represented accurate knowledge of HIV (level I); scores of 10-12 represented good knowledge (level II); scores of ≤9 represented poor knowledge (level III).
Results : A total of 104 patients (92%) demonstrated excellent knowledge of HIV and its transmission (levels I and II). There was no significant linear association between HIV knowledge and risk-behaviour scores (Pearson's correlation coefficient r=-0.11).
Conclusion : The presence of high-risk behaviours despite good HIV-related knowledge in this group of patients, leads us to think that knowledge alone will not limit HIV risk behaviours. For this reason, educational programmes should not be limited to interventions that simply increase knowledge about HIV infection but should extend to clinical factors, including patients' motivation and readiness to change their behaviour.
Author K. Oppong AsanteSource: African Journal of Psychiatry 15, pp 340 –345 (2012)More Less
Objective : The current study sought to investigate the association between age, gender, social support and the psychological wellbeing of people living with HIV and AIDS (PLHA) in Ghana.
Method : Cross-sectional data containing information on demographics, social support and psychological well-being (stress, depression, and anxiety), were collected from 107 men and women living with HIV/AIDS. To explore age group differences, participants were stratified by age (< 39 vs. 40+ years). Three anonymous self-administered questionnaires were used, namely the demographic data questionnaire, Sources of Social Support Scale, and the Depression Anxiety Stress Scale (DASS- 42).
Results : Correlation analysis revealed that social support was negatively associated with depression, stress and anxiety. Compared with males living with HIV, women reported higher levels of stress, depression and anxiety. Female gender and low social support were significant predictors of depression and stress after controlling for selected independent variables. Older participants experienced higher levels of stress than their younger counterparts.
Conclusion : Public health personnel and AIDS professionals may consider further interventions to promote psychological health in HIV/AIDS-positive individuals. More attention should be paid to the social environment of individuals diagnosed with HIV as the quality of social relationships may be particularly important for successful psychological adaptation to HIV.
A preliminary investigation of the AUDIT and DUDIT in comparison to biomarkers for alcohol and drug use among HIV-infected clinic attendees in Cape Town, South Africa : originalSource: African Journal of Psychiatry 15, pp 346 –351 (2012)More Less
Objective : There is growing concern about the effect of substance use on HIV treatment outcomes. The study objectives included: (i) evaluating whether the use of validated questionnaires (AUDIT and DUDIT) provide useful and consistent information of alcohol and drug consumption when compared with the use of biomarkers of alcohol in (urine and hair) and drugs in (urine) and (ii) assessing the feasibility of using self-report measures compared with urine and hair tests.
Method : Participants were HIV positive patients attending an HIV community health clinic in Kraaifontein, Cape Town. Hair and urine samples were collected and analysed for alcohol, in Fatty Acid Ethyl Esters (FAEE) and in Ethyl Glucuronide and (EtG), and drugs. Biological markers were compared with self-report measures of alcohol and drug consumption in terms of sensitivity, specificity. Forty-three participants completed the self-report measures, while 30 provided hair and urine samples.
Results : On the AUDIT, 18 (41.9%) participants screened positive for harmful and hazardous drinking and 13 (30.2%) participants on the DUDIT screened positive for having a drug-related problem. Two of 30 participants (7%) tested positive for alcohol abuse on FAEE analysis. For EtG, 6 of 24 (25%) participants tested positive for alcohol abuse. On hair drug analysis, all 30 participants tested negative for cannabis, amphetamines, opiates, cocaine, PCP and methaqualone. On the urinalysis, 1 of 30 participants tested positive for cannabis and everyone tested negative for all other drugs included in the screening.
Conclusion : Substance use among patients attending HIV clinics appears to be a problem, especially alcohol. Self-report measures seem to be a more cost effective option for screening of alcohol and drug abuse in resource poor settings.
Source: African Journal of Psychiatry 15, pp 352 –357 (2012)More Less
Objective : To examine psychosocial correlates of lifetime alcohol use among adolescents in rural South African high schools.
Method : Questionnaires were administered to 1600 students from 20 randomly selected high schools in the Mankweng district within Limpopo province. Self-report data on alcohol use, demographic, environmental and psychosocial variables were collected.
Results : About 22% of the students had ever used alcohol. Males were 2.4 times more likely to use alcohol than females. For students who attended religious services, the odds of ever having used alcohol were double those of students who did not attend religious services. The fitted logistic regression model shows that gender, age, ever having smoked a cigarette, ever damaged property, walking home alone at night, easy availability of alcohol, thinking alcohol use was wrong, attending religious services and number of friends who used alcohol are the best predictors of alcohol use among high school students in this setting.
Conclusion : The results underline the importance of addressing personal, family, peer and school conduct factors as part of alcohol education initiatives. Efforts to prevent alcohol use among rural high school students should focus on changing drinking behaviour and on reducing risk factors for problem drinking.
Attention deficit hyperactivity symptoms and disorder (ADHD) among African children : a review of epidemiology and co-morbidities : originalAuthor M.O. BakareSource: African Journal of Psychiatry 15, pp 358 –361 (2012)More Less
Objective : To review literature from Africa on the epidemiology of ADHD as well attention deficit hyperactivity symptoms and associated co-morbid conditions among African children.
Method : A literature search was done through Pubmed/MEDLINE and Google Scholar using then following terms, "attention deficit", "hyperactivity disorders", "epidemiology", "co-morbid conditions", "Africa". Nine studies met the inclusion criteria with four studies coming from South Africa, two each from Democratic Republic of Congo and Nigeria respectively and one from Ethiopia.
Results : The prevalence of ADHD varied with rates of between 5.4% and 8.7%, amongst school children, 1.5% amongst children from the general population between 45.5% to 100.0% amongst special populations of children with possible organic brain pathology. Common associated co-morbid conditions were oppositional defiant disorder, conduct disorder as well as anxiety/depressive symptoms.
Conclusion : Published data from Africa is limited. For effective healthcare policy further studies are needed to define the magnitude and burden of ADHD and other childhood neuro-developmental disorders in Africa.
Author Franco P. VisserSource: African Journal of Psychiatry 15 (2012)More Less
As a clinician I always found psychoanalysis and psychoanalytic theory to be boring, too intellectual and overly intense. Except for the occasional Freudian slip, transference encountered in therapy, the odd dream analysis around the dinner table or discussing the taboos of adult sexuality I rarely venture out into the field of classic psychoanalysis. I have come to realise that my stance towards psychoanalysis mainly has to do with a lack of knowledge and specialist training on my part in this area of psychology. I will also not deny that I find some of the aspects of Sigmund Freud's theory and methods highly intriguing and at times a spark of curiosity makes me jump into the pool of psychoanalysis and psychoanalytic theory and 'swim' around a bit - mainly by means of reading or surfing the internet on the topic.
Pharmacology and efficacy of asenapine for manic and mixed states in adults with bipolar disorder : product newsAuthor Roger S. McIntyreSource: African Journal of Psychiatry 15 (2012)More Less
Asenapine sublingual is a novel atypical antipsychotic approved in August 2009 for the acute treatment of schizophrenia, as well as for manic or mixed episodes as part of adult bipolar I disorder. Asenapine's in vitro profile is similar to other atypical antipsychotic agents insofar as there is higher affinity for serotonin 5-HT2A versus dopamine D2 receptors. Asenapine exhibits a unique effect on monoamine, histamine and muscarinic receptor affinities, as well as effects on NMDA and AMPA receptors.
When pain stifles your sleep : patients as partners - brought to you by The South African Depression and Anxiety GroupSource: African Journal of Psychiatry 15 (2012)More Less
Wide awake again? Have you been tossing and turning? Maybe you can't fall asleep or you wake up in the middle of the night and can't go back to sleep? While you're certainly not alone if you suffer from symptoms of insomnia, if you have a chronic pain condition, your insomnia may be a nightly issue rather than a transient irritation. According to sleep experts, two out of three people with chronic pain conditions have trouble sleeping.
Suicide, and the ones it leaves behind : patients as partners - brought to you by The South African Depression and Anxiety GroupAuthor Ryan G. EdmondsSource: African Journal of Psychiatry 15, pp 370 –373 (2012)More Less
After her partner committed suicide, Lori Barausse started a Support Group in Durban for patients and loved ones of those affected by suicide. She shares her story after having been down a long and emotional road and now is able to share her experiences, and learnings, for those 'left behind' by suicide.
Clarifying the role of the SAPS in mental healthcare : patients as partners - brought to you by The South African Depression and Anxiety GroupAuthor Lian TaljaardSource: African Journal of Psychiatry 15, pp 374 –376 (2012)More Less
The South African Depression and Anxiety Group (SADAG), the leading advocacy and educational voice on mental health, runs a 15-line counselling call centre and is often contacted by people concerned about a loved one who is mentally ill but is not willing to seek help or is not complying with treatment. In some cases, this person poses a danger to him/herself or to others and family members are desperate to find a way to assist. This is not always easy.