African Journal of Psychiatry - Volume 16, Issue 2, 2013
Volume 16, Issue 2, 2013
Author C. AllgulanderSource: African Journal of Psychiatry 16 (2013)More Less
Opportunities for transnational and translational R&D was the title of a paper for this Journal's readers in 2005 (when it was still South African Psychiatry Review). It was intended to encourage exploring opportunities for collaborative research. So what has evolved? Here are some examples of what has been accomplished, and what is in the pipeline of psychiatric collaboration between South Africa (SA), Uganda, and Europe. My intention was not to approach this a a neo-colonialist, rather to stress what I believe to be mutually beneficial projects, emanating from the needs of the African psychiatric patient in various settings.
Author R. ShahSource: African Journal of Psychiatry 16 (2013)More Less
Board of International Affairs, Pan-African Division quarterly newsletter, African International Division, Royal College of PsychiatristsSource: African Journal of Psychiatry 16, pp 79 –85 (2013)More Less
Monosymptomatic hypochondriacal psychosis (somatic delusional disorder) : a report of two cases : scientific letterSource: African Journal of Psychiatry 16, pp 87 –91 (2013)More Less
Historically, the term Monosymptomatic Hypochondriacal Psychosis (MHP) was first used by Munro in 1978. MHP isclassified as a somatic type of delusional disorder in DSM-IV and is defined as an erroneous conviction of bodily disease, abnormality or alteration. It includes delusional beliefs about bodily sensations or functions; such as feeling malodorous, being infected by parasites, having dysmorphic features, or that a certain organ is no longer functioning. MHP has been divided into 4 main categories: Delusions of infestation (including parasitosis); delusions of dysmorphophobia, such as of misshapenness, personal ugliness, or exaggerated size of body parts (this seems closest to that of body dysmorphic disorder); delusions of foul body odours or halitosis or delusional bromosis (also known as olfactory reference syndrome); and a miscellaneous group.
Self-inflicted bilateral orchidectomy precipitated by erotic bizarredelusions : a case report : scientific lettersSource: African Journal of Psychiatry 16, pp 89 –91 (2013)More Less
Deliberate Self-harm (DSH) is defined as the intentional, direct injuring of the body tissue without suicidal intent.The degree of harm or injury, be it isolated or repetitive,may vary from mild to very severe. Deliberate self-harm is a behavior which may arise in a variety of psychiatric illnesses such as depression, schizophrenia, alcohol use disorders, and personality disorders. DSH patients with psychiatric illness have a high risk of committing repeated acts of DSH. The following is a report of a patient with schizophrenia, substance misuse and persistent ambivalence towards sexual activity who serially removed his testes, an act largely prompted by bizarre erotic delusions during psychotic relapses.
Author O. EsanSource: African Journal of Psychiatry 16 (2013)More Less
The long held view that schizophrenia affects about 1% of the population has been shown to be an overestimate and in fact derived from incorrect data. Also, for many years, it was believed that the prevalence of schizophrenia varied little between sites. It is in fact the case that the estimates of the prevalence of schizophrenia are characterized by a multiplicity of variations.
The outcome of Mental Health Care Users admitted under Section 40 of the South African Mental Health Care Act (No 17 of 2002) : original articleSource: African Journal of Psychiatry 16, pp 94 –103 (2013)More Less
Objective: To determine the outcomes of mental health care users (MHCU's) admitted in terms of Section 40 of the South African Mental Health Care Act (No 17 of 2002) (MHCA) and the factors, if any, that are associated with these outcomes.
Method: The study was a retrospective record review of MHCU's, 18 years and older, referred by the South African Police Service (SAPS) to Chris Hani Baragwanath Hospital (CHBH). All mental health care users handed over to CHBH by SAPS with completed MHCA form 22's during the period July 2007 to December 2007 were included in the study. The outcomes, demographics and clinical characteristics of these referrals were obtained from hospital records.
Results: During the six-month study period, 718 MHCU's were referred by members of SAPS to the CHBH Emergency Department. Associations were found between discharged MHCU's and i) being male, ii) being less than 35 years of age, iii) being unemployed, iv) having a lower level of education, v) having a past history of substance abuse and/or vi) a past psychiatric illness. Females were twice as likely to be unemployed and admitted to hospital (either to a psychiatric or general medical ward). MHCU's diagnosed with delirium were more likely to be admitted into a medical ward as compared to a psychiatric ward.
Conclusion: As has been the case in most countries where police services have been incorporated into mental health acts, South Africa's new Mental Health Care Act (No 17 of 2002) has resulted in a large number of referrals by the police to mental health services. However, many of these referrals may not be necessary as most MHCU's end up not being admitted. The characteristics of police referrals suggest that the receiving facility should have the capacity to identify factors that favour outpatient care (especially substance abuse problems) and divert MHCU's presenting with such factors to appropriate treatment facilities without admitting them to the hospital.
Source: African Journal of Psychiatry 16, pp 104 –109 (2013)More Less
Objective: Alcohol abuse poses special risks for increased morbidity and mortality among older adults. Little attention has focused on assessing alcohol use and associated factors among older adults in transitional societies such as South Africa. This study aimed to determine the prevalence of alcohol use and associated factors in older South Africans who participated in the Study of Global Ageing and Adults Health (SAGE) in 2008.
Method: We conducted a national population-based cross-sectional study with a sample of 3840 aged 50 years or older in South Africa in 2008. In this study we analysed data from all 2144 participants who were over 60 years old. The questionnaire included socio-demographic characteristics, alcohol intake as well as comorbidity. Risky drinking was defined in two ways: heavy drinkers (>7 drinks/week) and binge drinkers (>3 drinks/one occasion/week).
Results: Four percent of participants reported heavy drinking and 3.7% binge drinking. Male gender (Odds Ratio (OR) =3.79, Confidence Interval (CI) =1.38-10.37) and white population group (OR=3.01, CI=1.31-6.89) were associated with risky drinking in multivariate analysis; as well as tobacco use (OR=5.25, CI=2.20-12.52) and not being obese (OR=0.14, CI=0.05-0.35). Hypertension, diabetes and depression were not associated.
Conclusion: This study reveals moderate rates of risky drinking among older adults (60 years and more) in South Africa that puts them at risk of morbidity. Alcohol problems among older adults are commonly under-recognized, indicating a need for health care worker intervention.
The relationship between schizoaffective, schizophrenic and mood disorders in patients admitted at Mathari Psychiatric Hospital, Nairobi, Kenya : original articleSource: African Journal of Psychiatry 16, pp 110 –117 (2013)More Less
Objective:: The prevalence of schizoaffective disorder (SAD) and the relationship between schizophrenia (SCZ), SAD and mood disorders (MD) in non-Western countries is unknown. To determine the prevalence of SAD and the relationship between SCZ, SAD and MD in relation to socio-demographic, clinical and therapeutic variables in 691 patients admitted at Mathari Psychiatric Hospital,Kenya.
Method: A cross-sectional comparative study using both clinician and SCID-1 for DSM-IV diagnoses.
Results: Approximately twenty three percent (n=160) met DSM-IV criteria for SAD using SCID-1. There were significant differences between SCZ, SAD and MD regarding: affective and core symptoms of schizophrenia (with the exception of core symptoms of schizophrenia between SCZ and SAD); presence of past trauma; a past suicide attempt; and comorbidity with alcohol and drug abuse disorders. SAD and MD patients took significantly more mood stabilizers than SCZ patients. There were no significant differences between the three groups regarding socio-demographic variables, brief psychiatric rating scale scores, cognitive performance, anxiety and depressive symptoms, presence of obsessions, and usage of both antipsychotics and antidepressants.
Conclusion: There is no distinct demarcation between the three disorders. This lends support to recent evidence suggesting that SAD might constitute aheterogeneous group composed of both SCZ and MD patients or a middle point of a continuum between SCZ and MD.
Source: African Journal of Psychiatry 16, pp 118 –122 (2013)More Less
Objective: There is a high incidence of distressing psychological symptoms including anxiety in pregnancy. Nevertheless, predictors of distress and anxiety during pregnancy have not been well characterized. We determined whether temperament and character, trait anxiety, resilience, and social support predicted distress and anxiety symptoms in pregnancy.
Method: Pregnant women (n=105) with low risk singleton pregnancies were recruited from Midwife Obstetric Units. Assessments of distress (using the K-10) and anxiety (using the Spielberger State Inventory) were undertaken in trimester 2 and 3. Measures of temperament and character, trait anxiety, resilience and social support were undertaken at the same time points. Regression analyses were used to determine predictors of distress and anxiety at each trimester.
Results: Predictors of distress and anxiety were lower selfdirectedness, higher harm avoidance, higher trait anxiety, lower resilience, and lower social support, at each time point.
Conclusion: Understanding predictors of distress and anxiety in pregnancy may be useful in developing interventions for addressing such symptoms, as well as perhaps in preventing potential sequelae such as anxiety and mood disorders
Source: African Journal of Psychiatry 16, pp 123 –133 (2013)More Less
Objective: Public attitudes toward mental illness in two widely disparate cultures, Canada and Cameroon, were compared using an experimental version of a survey instrument, the Public Opinion Survey of Human Attributes-Mental Illness or POSHA-MI(e).
Method: 120 respondents rated POSHA-MI(e) items relating to mental illness on 1-9 equal appearing interval scales: 30 in English and 30 in French in both Cameroon and Canada. Additionally, 30 matched, monolingual English, American respondents were included as a comparison group.
Result: In Canada (and in the USA), attitudes were generally more positive and less socially stigmatizing toward mental illness than in Cameroon. Differences between countries were much larger than differences between language groups.
Conclusion: Consistent with other research, beliefs and reactions of the public regarding mental illness reflect stigma, especially in Cameroon. Cultural influences on these public attitudes are more likely important than language influences. Results of this field test of the POSHA-MI(e) , documenting differences in public attitudes toward mental illness in two divergent cultures, support its further development
Traditional healers and provision of mental health services in cosmopolitan informal settlements in Nairobi, KenyaAuthor D.M. NdeteiSource: African Journal of Psychiatry 16, pp 134 –140 (2013)More Less
Objective: The study aimed to investigate the types of mental illnesses treated by traditional healers, and their methods of identifying and treating mental illnesses in their patients.
Method: In urban informal settlements of Kibera, Kangemi and Kawangware in Nairobi, Kenya, we used opportunistic sampling until the required number of traditional healers was reached, trying as much as possible to represent the different communities of Kenya. Focus group discussions were held with traditional healers in each site and later an in-depth interview was conducted with each traditional healer. An in-depth interview with each patient of the traditional healer was conducted and thereafter the MINIPLUS was administered to check the mental illness diagnoses arrived at or missed by the traditional healers. Quantitative analysis was performed using SPSS while focus group discussions and in-depth interviews were analysed for emerging themes.
Results: Traditional healers are consulted for mental disorders by members of the community. They are able to recognize some mental disorders, particularly those relating to psychosis. However, they are limited especially for common mental disorders.
Conclusion: There is a need to educate healers on how to recognize different types of mental disorders and make referrals when patients are not responding to their treatments.
Author Franco P. VisserSource: African Journal of Psychiatry 16 (2013)More Less
A topic that is very dear to my heart is that of adoption. As someone with personal experience of adoption it was 'per chance' that I came upon the fantasy drama film The odd life of Timothy Green which led to me choosing this film to review for this edition of the Journal.
SADAG targets suicidal behaviour in SA youth : over 380 schools and counting - one class at a time : South African Depression and Anxiety Group : Patients as partnersAuthor L. TaljaardSource: African Journal of Psychiatry 16, pp 144 –146 (2013)More Less
Research shows that it's difficult to compare countries or even regions within a country when it comes to suicidal behaviour. However, it's critical to have a thorough understanding of risk factors and causes of depression and suicide to effectively deal with them.
With a focus on youth, the South African Depression and Anxiety Group (SADAG) feels it's essential that learners can identify signs and symptoms of depression and suicide, be informed of the conditions and treatments and, know where to get local help from teachers, clinics, churches, support groups, and via their toll free help-lines and SMS's.