African Journal of Psychiatry - Volume 16, Issue 1, 2013
Volume 16, Issue 1, 2013
Author Christopher P. SzaboSource: African Journal of Psychiatry 16, pp 3 –7 (2013)More Less
The issue of specialist training is perennial as disciplinesconstantly seek to ensure that qualified specialists aresuitably equipped to perform the tasks they are registeredto perform. This requires continuous review andrefinement. There are a multitude of factors that impact onthe training of specialists, with such factors extending fromthe undergraduate to the postgraduate and ultimatelywork based specialist settings. The content which followsis not exhaustive, with a selective focus on certain issues.
Reinstitutionalization by stealth : the Forensic Mental Health Service is the new chronic system : forensic forumAuthor S. KaliskiSource: African Journal of Psychiatry 16, pp 13 –17 (2013)More Less
In 1997 the Forensic Mental Health Service (FMHS) in theWestern Cape had a total of 205 state patients in its database, most of whom were inpatients at Valkenberg and Lenteguer Hospitals. Currently the database has just over 800 state patients. The number of state patients in the Western Cape has more than tripled over 15 years, and there are now 9 forensic wards in the FHMS. Seven of these are low secure wards that house state patients whose abject social circumstances are the sole obstacles for granting them long leaves of absences and discharge into the community.
Author Marie Jo BourdinSource: African Journal of Psychiatry 16 (2013)More Less
Professor Omar Sylla was born on the 22nd of November 1948 in Dakar; he died November 5, 2012 at the age of 64, leaving a great void in psychiatry in Senegal. A Professor of Psychiatry, he received his training at the medical school ofFann Dakar under Professor Henri Collomb. He practiced psychiatry at the Moussa Diop clinic of Fann Hospital as well as in his private office.
Posttraumatic stress disorder diagnostic criteria and suicidal ideation in a South African Police sampleSource: African Journal of Psychiatry 16, pp 19 –22 (2013)More Less
Objective: Exposure to traumatic events may precipitate suicidal ideation. Once an individual is diagnosed with PTSD, a suicide risk assessment often follows. This study explores how PTSD symptom criteria correlate with suicidal ideation in a sample ofpolice officers. While the psychometric measures of PTSD often mirror the DSM-IV-TR criteria, focusing on exposure, symptom, and duration criteria, suicidal ideation measures often focus on concepts quite different from that. In this report the focus was on investigating how PTSD symptom criteria correlate with the suicidal ideation.
Method: A group of South African police officers (N = 217) were assessed by means of the Posttraumatic Diagnostic Scale and a short version of the Adult Suicide Ideation Questionnaire. Linear and hierarchical regressions were used to determine which PTSD symptom criteria best predict suicidal ideation.
Results: Hyperarousal was the primary predictor of suicidal ideation (R2 [adjusted] = 0.249). Intrusive thoughts added only marginally to the model, contributing a further 2.5% to the declared variance. The contributions of the other two symptom types were negligible.
Conclusion: In this study hyperarousal correlated significantly with suicidal ideation. It is suggested that practitioners be alert to these symptoms as possible indicators of suicidal ideation. Implications for suicide risk assessment and prevention measures are discussed.
Prevalence and clinical presentation of HIV positive female psychiatric inpatients : original articleAuthor H. UysSource: African Journal of Psychiatry 16, pp 23 –38 (2013)More Less
Objective: Literature on the prevalence and clinical presentation of South African psychiatric HIV positive patients as well as their management is lacking. This study was performed to investigate these parameters.
Method: A prospective study to investigate the prevalence and clinical presentation of HIV positive psychiatric female patients admitted to an acute ward (female psychiatric ward Cecilia Makiwane Hospital, East London Hospital Complex) was undertaken for a one year period from June 2009 to May 2010. Additional factors such as demographic profile, associated substance abuse, pre-existing psychiatric disorders and management were also studied.
Results: During this one year period 158 female patients were admitted to the acute female psychiatric ward for assessment and treatment. Of these 158 admissions 21 (13%) were HIV positive, but only 19 (12%) consented to the study. Ten of the 19 HIV positive patients (53%) had an Axis I diagnosis of a psychiatric disorder secondary to HIV, most commonly mood disorder (mania) with psychotic symptoms. Nine of the 19 HIV positive patients (47%) had a pre-existing primary psychiatric diagnosis, most commonly Bipolar Disorder, recent episode mania with psychotic symptoms. The most common psychotic symptoms were grandiose delusions followed by auditory hallucinations, paranoid delusions and visual hallucinations. The most common mood symptom was euphoria. Substance abuse was uncommon amongst the patients in the study group. Sixteen of the 19 patients (84%) were on antipsychotics, 14 of these 16 patients were on haloperidol. The most commonly used mood stabilizer was sodium valproate.
Conclusion: In this study mania with psychotic symptoms was the most common presentation in both the group with a pre-existing primary psychiatric disorder and in the group without a primary psychiatricdisorder. The prevalence of HIV positive admitted psychiatric females in this study was 12%. Co-morbid substance abuse was uncommon. Most patients tolerated low doses of typical antipsychotics in combination with a mood stabilizer (valproate being the most common).
Effectiveness of a nurse facilitated cognitive group intervention among mild to moderately-depressed-women in KwaZulu-Natal, South Africa : original articleSource: African Journal of Psychiatry 16, pp 29 –34 (2013)More Less
Objective: The purpose of the study was to determine the effectiveness of a nurse-facilitated-cognitive-group (NFCG) intervention as an adjunct to antidepressant medication, in mild to moderately, depressed women.
Method: This was a quasi-experimental, nonequivalent, control group design study. A sample of 30 consenting participants was selected from an urban, community psychiatric clinic, and the participants were randomly allocated to the control and the intervention groups. The effectiveness of the intervention was measured using the Beck Depression Inventory (BDI).
Results: After six weeks of implementation of the NFCG intervention, there was a decrease in the BDI scores of the intervention group, and an increase in the BDI scores in the control group (CG) â?? but the difference in scores was not significant (Student's t-test=1.076, p=0.291). After 12 weeks of the group intervention, the BDI scores for the intervention group, showed a considerable reduction in their levels of depression, whilst the participants of the control group had a further increase in their scores. There was a statistically significant difference between the groups, with respect to the BDI scores (p<0.001). The Friedman test indicated that the mean BDI scores, were statistically significant (p<0.001) within the intervention group, meaning that the BDI scores improved, at the end of the intervention for all the participants. Analysis of the BDI scores, using the Friedman test, showed that there was no improvement in the control group (p=0.597).
Conclusion: The NFCG intervention, as an adjunct to antidepressant medication, contributed to a reduction in depressive symptoms.
Predicting referral practices of traditional healers of their patients with a mental illness : an application of the Theory of Planned BehaviourSource: African Journal of Psychiatry 16, pp 35 –40 (2013)More Less
Objective: Although many studies indicate that traditional healers are willing to collaborate with Western practitioners in South Africa, none focus specifically on mental health care, and none use a theory of health behaviour to explain their findings. The present study applies the Theory of Planned Behaviour (TPB) to predict traditional healer referral practices of patients with a mental illness. Method: One hundred traditional healers were first interviewed to assess the TPB variables and were contacted again 5 months later to measure self-reported behaviour. Results: Herbalists were less likely than other types of healers to refer patients with a mental illness to Western health professionals. From the TPB application, the following cognitive variables were found to predict intentions: attitudes (ß = 0.612, p < 0.01); perceived behavioural control (ß = 0.355, p < 0.01); and past behaviour (ß = 0.704, p < 0.01). Subjective norms and knowledge of mental illness did not predict intentions. Finally, past behaviour (ß = 0.297, p = 0.040) and intentions to refer patients (ß = 0.758, p < 0.01) predicted greater self-reported behaviour. Conclusion: The TPB may be a useful theoretical model for predicting the referral practices of traditional healers. The empirical data here may be useful for future work designing interventions to provide traditional healers with the information and skills they require to appropriately refer patients with mental illness.
Emotional distress among caregivers of patients with epilepsy in Katsina State, Northern Nigeria : original articleSource: African Journal of Psychiatry 16, pp 41 –44 (2013)More Less
Objective: Caregivers of patients with epilepsy experience considerable emotional distress. The study aimed to assess the magnitude of the problem in a developing country. Method: A total 166 patients-caregivers were enrolled for the study. They were interviewed using a socio-demographic data collecting sheet and the Hospital Anxiety-Depression Scale (HADS). Data obtained were analysed using Statistical Package for Social Sciences Windows version 13. All statistical tests were carried out at a 5% level of probability. Results: The mean age of the caregivers was 45.44±6.67 years. Emotional distress was found among 109(65.7%) of the caregivers. This is was significantly associated with male gender of both care giver and patient as well as residing in a rural area. Conclusion: The study demonstrated a high level of emotional distress associated with caring for patients with epilepsy, which is comparable to other studies carried out in other parts of the world.
Monitoring the prevalence ofmethamphetamine-related presentations at psychiatric hospitals in Cape Town, South Africa : original articleSource: African Journal of Psychiatry 16, pp 45 –49 (2013)More Less
Objective: This study aimed to determine a demographic profile of methamphetamine (MA)-related admissions to major psychiatric services in Cape Town, obtain a substance use profile from admitted patients, a profile of common MA-related symptoms encountered during the assessment of the patients presenting with MA-related problems, and a brief profile of the psychiatric diagnoses made.
Method: Staff in six psychiatric hospitals or wards in Cape Town collected data on methamphetamine related admissions between July and December 2008 using a one-page record review form. The data collection form consisted of the patient's demographic details, presenting symptoms, previous admission details, current MA and other substance use information, and DSM-IV diagnosis.
Results: A total of 235 forms were completed. Most patients were male (69%) and the mean age was 25 years. The most common presenting symptoms were aggressive behaviour (74%), followed by delusions (59%) and hallucinations (57%). Males were two times more likely to present with aggression as compared to females, while females were significantly more likely to present with depressed mood or euphoric/elevated mood. The majority of patients had substance induced psychotic disorder (41%), followed by schizophrenia (31%). Twelve percent (12%) had bipolar mood disorder.
Conclusion: MA-related psychiatric admissions pose serious challenges to all health services dealing with these patients. Further training and treatment protocol development and distribution is indicated.
Gestalt psychotherapy in theoutpatient treatment of borderlinepersonality disorder : a case report : scientific letterSource: African Journal of Psychiatry 16, pp 52 –54 (2013)More Less
Borderline personality disorder (BPD) is the most frequent and the most severe of all personality disorders in clinical practice. Although BPD bears the reputation of being "untreatable", psychotherapy for patients with BPD has been the treatment of choice. A number of papers show the use and effectiveness of various psychotherapeutic approaches. This article presents the use of Gestalt psychotherapy in the treatment of BPD patients. The authors obtained the informed consent of the client for publication of this content.
Author R. ShahSource: African Journal of Psychiatry 16, pp 53 –54 (2013)More Less
Frontotemporal Dementia (FTD) is a degenerative disorder of the brain that affects the frontal and temporal cortices resulting in impairments in reasoning, personality, movement, speech, social graces, language and memory. The changes in personal and social conduct, which occur in the early stages of the disease, include loss of inhibition, apathy, social withdrawal, hyperorality and ritualistic compulsive behaviors. These changes can be dramatic and may be misdiagnosed as a psychiatric disorder. We present a case wherein FTD was misdiagnosed and treated as mania and highlight the features of late-onset 'mania' that should raise clinical suspicion.
Comparing community based and hospital based treatment in Psychiatry : what does my experience reveal? : letter to editorAuthor Satyasheel RamfulSource: African Journal of Psychiatry 16, pp 55 –56 (2013)More Less
Mauritius is a small island in the Indian Ocean which can pride itself on having one of Africa's highest per capita incomes. The state being the vehicle of most social services, healthcare is free and the health profile of the population fits that of a developed country with a mean life expectancy of 75 years. Mental healthcare in Mauritius has traditionally been under the aegis of a single psychiatric hospital. Only recently has the provision of such care been devolved through the allocation of psychiatrists to major public hospitals.
Mirtazapine and ondansetron : a dual pharmacodynamic and pharmacokinetic interaction : letter to editorAuthor R. LozanoSource: African Journal of Psychiatry 16 (2013)More Less
In accordance with H Koch et al, (Important interactionbetween mirtazapine and ondansetron Afr J Psychiatry2012;15:160) regarding the interaction of mirtazapine and ondansetron, we would like to report a similar observation of this novel double pharmacodynamic-pharmacokinetic interaction.
To Rome with love
A Sony Pictures Classic presentation.
Written and directed by Woody Allen : movie reviewAuthor Franco P. VisserSource: African Journal of Psychiatry 16 (2013)More Less
The film To Rome with Love was a perchance-choice while ambling around in the movie store one lazy Friday afternoon. Seeing a picture of Rome with its clearly recognisable skyline I picked the cover up immediately. Shall I just say that anything Italiano gets me in a state of immense bliss, and I think it was the cover of the film that sold it to my viewing pleasures immediately.
Binge eating disorder's link to obesity
South African Depression & Anxiety Group : Patients as partnersAuthor Karin DumaSource: African Journal of Psychiatry 16, pp 62 –64 (2013)More Less
In 2010, South Africa was ranked as the third-most obesity stricken nation following the United States and the United Kingdom. With one out of four people in South Africa being obese or morbidly obese, this figure has alerted international health bodies such as the World Health Organization (WHO) about the rising pandemic of obesity. But what exactly is happening to the waistlines of South Africans?
Lack of knowledge feeds stigma surrounding bipolar
South African Depression and Anxiety Group : Patients as partnersSource: African Journal of Psychiatry 16, pp 66 –67 (2013)More Less
A physical illness marked by extreme changes in mood, energy, thinking and behaviour, bipolar disorder is a very disruptive mental illness that affects a person's family, work and social life. Unfortunately, it is often misunderstood and stigmatised, leaving loved ones sceptical about the disorder and patients feeling like it's something to be ashamed of