African Journal of Psychiatry - Volume 16, Issue 3, 2013
Volume 16, Issue 3, 2013
Source: African Journal of Psychiatry 16, pp 151 –155 (2013)More Less
"The best protection against wild over-diagnosis is to ignore DSM-5. It is not official. It is not well done. It is not safe. Don't buy it. Don't use it. Don't teach it". These are the words of Allen Frances, Emeritus Professor of Psychiatry at Duke University, who was chairperson of the taskforce that developed DSM-IV. A scathing indictment of the diagnostic system adopted years ago by our psychiatric forebearers in South Africa (SA) - a system drilled into the minds of students and trainee mental health professionals; adhered to religiously by the pharmaceutical industry and by health management organisations for reimbursement purposes; and cited in our courts of law to support the cause of justice in our country.
Author S. KaliskiSource: African Journal of Psychiatry 16, pp 161 –165 (2013)More Less
One of the core and essential elements of clinical practice, and in fact for all professional traditions, is the fiduciary relationship, in which the primary interest is to serve solely for the benefit of patients. In our increasingly complicated world a myriad of secondary interests always threaten to subvert our fiduciary obligations. These secondary interests may include financial gain from third parties, a desire for professional advancement or recognition, favours to significant others (such as colleagues or families), and even religious or political demands. When our professional judgement with respect to our primary interest is unduly influenced by our secondary interests there exists a conflict of interest. This has to be differentiated from the dilemma of 'dual agency' that usually occurs in forensic settings when from the outset the practitioner is faced with conflicting responsibilities or loyalties owed simultaneously to the person being examined and other third parties.
Source: African Journal of Psychiatry 16, pp 167 –169 (2013)More Less
Suicide is the act of intentionally causing one's own death. Some acts of suicide are recognized as impulsive (low-planned) behavior; while others are characterized by having signs of serious intent and planning (intermediate or high-planned) acts. Women and younger individuals are more likely to carry out low- and intermediate-planned than high-planned acts of suicide. The Beck's Suicide Intent Scale (SIS) is a semi-structured, interviewer administered assessment scale consisting of 15 items. The scale consists of 2 sections, the first of which is objective, and in the second section, subjective characteristics of the suicide attempt are evaluated. SIS scores obtained are classified as: 10 points "low- intent", 10-15 points "intermediate- intent", and >15 points "high- intent" suicides.
Stabbing nails into the neck : an unusual self-damaging behavior mandating neurosurgery : scientific letterSource: African Journal of Psychiatry 16, pp 169 –171 (2013)More Less
Patients with Munchausen's syndrome deliberately simulate symptoms of an illness to gain hospital admission and the attention of healthcare providers. Although rare, it is possibly under-recognized and leads to diagnostic dilemmas. The main features of the condition include the recurrent nature of the illness, repeated similar presentations, visiting different hospitals with the same complaint, and leaving treatment once the motive is discovered. The usual presentations are neurological or abdominal complaints. The origin of the condition is unknown but there is a suggestion that patients may have sustained brain damage prior to the beginning of their hospital addiction. Since their motivation is unknown, personality disorder and psychopathy have been suggested as probable causes.
Autonomic nervous system status and responsiveness and the levels of anxiety in a normal population : scientific letterSource: African Journal of Psychiatry 16, pp 173 –175 (2013)More Less
We live in times of deadlines and information overload. Many individuals are mentally and emotionally overextended with conscious - or subconscious - feelings of apprehension and worry chronically present. The increased heart rate associated with certain psychological states and disorders has, until recently, primarily been ascribed to increases in the activity of the sympathetic nervous system. However, it is now accepted that decreases in parasympathetic control, that is, decreases in the autonomic 'brake' on heart rate, are much more important than previously assumed. Perhaps of greater concern with regard to anxiety disorders are indications of an autonomic inflexibility or decreased responsiveness in the face of a challenge. In view of the importance of the autonomic nervous system (ANS) to instantaneously regulate many functions in line with mental and physical needs, lower responsiveness could have a significant influence on physical and psychological well-being. The question is whether anxiety, within the normative range, has an impact on resting ANS functioning and on the ANS responses to moderate everyday challenges.
Source: African Journal of Psychiatry 16, pp 177 –181 (2013)More Less
Neurosurgical interventions date back to ancient civilization, 5100 BC through a practice known as trephination. Due to past abuse and ethical considerations, neurosurgical interventions in psychiatry remain a controversial issue. This article aims to review the different surgical techniques and their current application in the treatment of psychiatric disorders. The U.S Food and Drug Administration (FDA) gave its approval for vagal nerve stimulation (VNS) for the management of treatment-resistant depression in 2005 and deep brain stimulation (DBS) for refractory obsessive-compulsive disorders (OCD) in 2009. These invasive but non destructive techniques represent the future of neurosurgery for mental disorder.
Attitude towards psychiatric treatment and referral pattern in the University of Maiduguri Teaching Hospital - a preliminary report : original articleSource: African Journal of Psychiatry 16, pp 182 –186 (2013)More Less
Objective : There is a paucity of literature on consultation-liaison psychiatry, in northern Nigeria. This study aimed to determine both the pattern of psychiatric referrals, and the attitudes of doctors toward the treatment of mental disorders in a teaching hospital, in northeast Nigeria.
Method : In this cross-sectional survey, we used a modified version of the self-rated Kumar 12-item questionnaire and a basic socio-demographic questionnaire to assess a non-random convenient sample of 100 postgraduate resident doctors (with a response rate of 70%) from the University of Maiduguri Teaching Hospital (UMTH). We subjected the data obtained to descriptive statistical analysis, using EPI info (2003), to report averages.
Results : A relatively low percentage (57.1%) of doctors acknowledged treating patients with mental disorders in their practice, with a higher proportion acknowledging referral (75%). Nearly one in five (17.6%) of the respondents were unaware that patients with functional illness could have psychological disorders. We found more awareness for psychotherapy (44.1%) than other non-pharmacological treatment interventions, while 10.3% were ignorant of non-pharmacological forms of treatment for psychological problems.
Conclusion : Although this is a preliminary report, the research reported here demonstrated that doctors in the teaching hospital concerned recognized the need for psychiatric consultation and referral. It is difficult to draw further conclusions because of the limitations of this study.
Organising for self-advocacy in mental health : experiences from seven African countries : original articleSource: African Journal of Psychiatry 16, pp 187 –195 (2013)More Less
Objective : This paper reports on overarching strategies which supported the establishment and sustainability of 9 mental health self-help organisations in seven African countries.
Method : Eleven key informants were identified through snowballing and interviewed regarding their experience in the organisations. Thematic analysis of the interview data and other documentary evidence was guided by a coding scheme derived using a framework analysis approach to defining, categorising, mapping and interpreting textual data.
Results : Sustainability strategies include: commitment to members' advocating for their rights and rebuilding their lives within their communities; independent decision-making, user-led membership and leadership; financial self-sufficiency, alliances with donor organisations, non-governmental organisations (NGOs), disabled people's organisations (DPOs) and ministries which support self-determination and promote control over agenda-setting and responsiveness to members' needs. Organisations' work include advocacy to destigmatise mental disorders and promote the protection of users rights, activities to improve access to health care and to income generation and social support, participation in legislative and policy reform, and capacity building of members.
Conclusion : Self-help organisations can provide crucial support to users' recovery in resource-poor settings in Africa. Support of Ministries, NGOs, DPOs, development agencies and professionals can assist to build organisations' capacity for sustainable support to members' recovery.
The attitudes of clergy in Benin City, Nigeria towards persons with mental illness : original articleSource: African Journal of Psychiatry 16, pp 196 –200 (2013)More Less
Objective : The clergy in sub-Saharan Africa play a major role in the care and pathways to orthodox mental health services of the mentally ill. Their attitudes concerning mental illnesses would influence community mental health intervention efforts. This study aimed to determine the attitudes of clergy towards persons with mental illness.
Method : A cross-sectional survey of clergy (n=107) of the Christian and Muslim faiths was conducted, using a socio-demographic questionnaire and the 40-item Community Attitudes towards Mental Illness (CAMI) scale.
Results : Stigmatizing attitudes were evident among members of the clergy surveyed. Most (71.1%) believed the mentally ill were different from other persons, while 68.2% were of the opinion that the mentally ill should be controlled like children. Over 80% of respondents were not comfortable with the idea of the mentally ill living in their vicinity and wanted mental health hospitals situated out of residential areas. Almost half of respondents (45.8%) were uncomfortable with women who were once mentally ill baby-sitting and 63.2% agreed that our mental hospitals seem more like prisons than where the mentally ill can be cared for.
Conclusion : Negative attitudes towards the mentally ill were widespread among the clergy sampled. Mental health professionals need to take proactive steps to improve the mental health knowledge of the clergy which may facilitate their roles in the pathway to mental health care.
Differences in the association between childhood trauma and BMI in black and white South African women : original articleSource: African Journal of Psychiatry 16, pp 201 –205 (2013)More Less
Objective : Childhood trauma has previously been associated with adult obesity. The aim of this study was to determine if ethnicity altered the relationship between childhood trauma and obesity in South African women.
Methods : Forty-four normal-weight (BMI<25kg/m2) and obese (BMI>30kg/m2), black and white premenopausal women completed the Childhood Trauma Questionnaire (CTQ), which retrospectively assessed emotional and physical neglect, and emotional, physical and sexual abuse in childhood.
Results : Body composition did not differ by ethnicity in the normal-weight and obese groups. However, independent of BMI group, there were significant differences in socioeconomic status (SES) between black and white women (P<0.01). Total CTQ score, as well as the sub-scales, physical and emotional neglect, and physical and sexual abuse were higher in black than white women (all P<0.05), but these scores did not differ between BMI groups. Apart from the sexual abuse score, the differences in physical and emotional neglect and physical abuse-scores were no longer significant after adjusting for ethnic differences in age and SES. For sexual abuse, there was a significant interaction between ethnicity and BMI group (P=0.04), with scores in normal weight women being higher in black than white women, but scores in obese women not differing by ethnicity.
Conclusion : Ethnicity alters the association between childhood sexual abuse and BMI status. Larger studies are required to verify this finding, including measures of body image and body size satisfaction that may explain these findings.
The correlates of stress, coping styles and psychiatric morbidity in the first year of medical education at a Nigerian University : original articleSource: African Journal of Psychiatry 16, pp 206 –215 (2013)More Less
Objectives : This study was prompted by the heightened concerns about the stress inherent in medical education evident from the incessant requests for suspension of studies due to psychological problems. The objectives of the study were to: (i) survey the students for possible psychological problems at admission, and follow them up till exit for possible changes in morbidity, and (ii) ascertain possible risk factors, and coping strategies.
Method : This is a preliminary 2-stage cross-sectional report, which is part of a longitudinal survey. It involves first year medical students of the College of Health Sciences of University of Ilorin between March and April, 2011. Questionnaires used included socio demographic, sources of stress, the general health questionnaire-12 (GHQ-12), Maslach's burnout inventory (MBI), and Brief COPE. Data were analysed using SPSS version 15 at 5% significance level. Chi-square, frequency distributions, Pearson's correlation, Odd ratios, and Confidence Intervals were calculated to determine the levels of risk.
Results : 79 students returned completed questionnaires. 12 (15.2%) were ghq-12 cases (i.e., scored ≥ 3). Students who had morbidity were 9 times at risk of being stressed consequent upon 'competing with their peers' and 4 times at risk due to 'inadequate learning materials'. Morbidity was significantly more likely to engender use of 'religion', 4 times less likely to engender use of 'positive reframing' with a trend in the use of 'self blame' as coping strategies.
Conclusion : Aside from psychosocial/ personal issues in this cohort, academic demand was an additional source of psychological problems thereby causing those who had morbidity to utilize 'religion' and 'positive reframing' to cope. There is therefore an apparent need to incorporate the principle of mental health promotion in medical education.
Author Franco P. VisserSource: African Journal of Psychiatry 16 (2013)More Less
From the multi award-winning director and film maker Ang Lee (Crouching Tiger Hidden Dragon, Brokeback Mountain, Sense and Sensibility) comes a magical and epic film about the tragic and extraordinary life of Pi Patel. Pi was given the names 'Piscine Molitor' by his respected uncle whom he referred to as Mamaji, a famous Indian swimmer, who named him after the famed art deco swimming pool complex next to the Bois de Boulogne Park in Paris. The Piscine Molitor swimming pool was built in the late 1920's and opened by amongst others the famous Johnny Weissmuller. This pool was also where Louis Réard introduced and popularised the bikini. Now sadly closed and vandalised by graffiti artists and the like, the Piscine Molitor remains a landmark historical monument in Paris.
A piece of me died too... when the ones we love are taken from us : patients as partners - brought to you by The South African Depression and Anxiety GroupAuthor Ryan G. EdmondsSource: African Journal of Psychiatry 16, pp 221 –223 (2013)More Less
"I don't think I'll ever truly forgive them," begins Claudette Peterson*. "He was only 22-years-old. He had such dreams. I think it's the thought of those dreams, unfulfilled, and how he had no choice in how he left this world. I mean, yes, do you ever really have a choice with how or when we die? I guess it's more about me now. I suppose it's the feelings I am left with. I can tell you one thing - no pill can take away this pain; or the empty hole in my heart that once was lit by the living, loving smile of my only son."