African Journal of Psychiatry - Volume 16, Issue 4, 2013
Volume 16, Issue 4, 2013
Author D.J. SteinSource: African Journal of Psychiatry 16, pp 227 –229 (2013)More Less
Work on DSM-5 and ICD-11, and the simultaneous development of alternative approaches to psychiatric classification such as the Research Domain Criteria of the National Institute of Mental Health, has led to renewed interest of colleagues, patients, decision-makers, and the lay media in psychiatric diagnosis. Psychiatrists find themselves reading rationales for these classification systems by those who have worked on them, as well as strong criticisms by those who have perceived key weaknesses. How should we respond?
Author A. VohraSource: African Journal of Psychiatry 16, pp 236 –238 (2013)More Less
Clozapine is a novel dibenzodiazepine derivative, atypical antipsychotic which exhibits antagonistic activity on 5HT2, alpha 1, alpha 2, H1 and M1, M2, M3 and M5 receptors; agonist activity at the M4 muscarinic receptor and modest antagonistic effect on D2-like receptors. Clozapine is known to be superior to other antipsychotics and is effective in 30-50% of patients diagnosed with treatment-resistant schizophrenia. However, its use is restricted mainly due to its side effect of agranulocytosis.
Source: African Journal of Psychiatry 16, pp 238 –240 (2013)More Less
The known pharmacokinetic profile of a medication does not always point to its therapeutic potential. Many treatments were discovered serendipitously as a consequence of careful clinical observation, often in the context of treatment of apparently unrelated conditions. Consequently, many widely-used therapies have current uses well removed from their initial indications, for instance the use of aspirin in cardiovascular protection.
Sublingual atropine for the treatment of severe and hyoscine-resistant clozapine-induced sialorrhea : scientific letterSource: African Journal of Psychiatry 16 (2013)More Less
Sialorrhea is a common adverse effect of clozapine therapy, which may increase the risk of aspiration pneumonia, a potentially life threatening condition. M4 agonism, α2 antagonism and impaired deglutition have been hypothesised as probable underlying mechanisms. A few previous case reports have shown topical atropine, an antimuscarinic agent, to be effective in the management of clozapine induced sialorrhea (CIS). Informed consent was received for publication of the following case material.
Source: African Journal of Psychiatry 16, pp 247 –255 (2013)More Less
A review of the international medical literature was undertaken on the role of spirituality in the discipline of psychiatry, within the context that a perceived change is taking place in the health care environment in South Africa. Revitalized interest in spirituality was evident from the literature partly because Western societies have, through the migration of people, become more heterogeneous in recent years. The literature concurred that spirituality must be incorporated into the current approach to the practice and training of psychiatry, but within the professional scope of the discipline, while all faith traditions and belief systems should be regarded equally. Beyond South Africa, it is envisaged that the review has implications for the practice of psychiatry in Africa.
Use of interactive teaching techniques to introduce mental health training to medical schools in a resource poor setting : originalSource: African Journal of Psychiatry 16, pp 256 –263 (2013)More Less
Objective : There are currently no practising psychiatrists in Somaliland. In 2007 the first medical students graduated from universities in Somaliland without mental health training. We aimed to pilot an intensive but flexible package of mental health training to all senior medical students and interns using interactive training techniques and to evaluate its effectiveness by assessing knowledge, skills and attitudes.
Methods : Teaching techniques included didactic lectures, case based discussion groups and role playing. Informal feedback informed a flexible teaching package. Assessment tools designed specifically for this course included a pre and post course MCQ exam and an OSCE. Changes in students' attitudes were evaluated using a questionnaire administered before and after the course. In addition, a questionnaire administered following the course evaluated the changes students perceived in their knowledge and attitudes to mental health.
Results : The MCQ improved from 50.7% pre course to 64.4% post course (p=9.73 E-08). Students achieved an average overall OSCE mark of 71%. The pre and post attitudes questionnaire was most significantly different for statements relevant to aetiology, stigma and the overlap between mental and physical health. The statement most strongly agreed with after the course was 'I now understand more about the overlap between mental and physical health'.
Conclusion : Interactive teaching provided a learning experience for both students and trainers. On site and distance learning based on the teaching described here has widened the scope of the training possible in psychiatry and allowed the provision of regular teaching, supervision and peer support in Somaliland. However, the current lack of local expertise means that important issues of sustainability need to be considered in future work.
The role of psycho-education in improving outcome at a general hospital psychiatry clinic in Uganda : originalSource: African Journal of Psychiatry 16, pp 264 –270 (2013)More Less
Objective : While psychoeducation has been shown to positively affect outcomes in psychiatric disorders, its utility has been little studied in developing countries. The current study sought to examine the role of psychoeducation at a general psychiatric outpatient clinic in Kampala, Uganda in improving clinic attendance, treatment adherence, and clinical outcomes.
Method : A prospective case-control study using a quasi-experimental design was conducted in 117 patients suffering various psychiatric disorders. Participants were recruited for two months and then followed for a further three months after recruitment ended. Participants in the intervention group received formalized psychoeducation sessions at each clinic visit in addition to the usual psychiatric evaluation and care. Participants in the control group received the usual clinical care. Measured outcomes were knowledge of mental illness, compliance with medications and follow-up, and Clinical Global Impression (CGI).
Results : The groups did not differ with respect to socio-demographic characteristics or attendance at scheduled follow-up visits. Both groups significantly improved on the CGI, but with no significant difference between the groups. However, the intervention group was more likely to adhere to medication, and their knowledge of mental illness was significantly higher at follow-up.
Conclusion : These data suggest that psychoeducation is a beneficial mental health intervention in a developing country that may increase compliance with medication and result in greater knowledge of mental illness. However, other factors such as distance from a centralized clinic or cost of treatment may impact outcomes, including attendance at scheduled follow-up visits.
The experiences of parents of children with mental disability regarding access to mental health care : originalAuthor R.A. CoomerSource: African Journal of Psychiatry 16, pp 271 –276 (2013)More Less
Objective : The aim of this qualitative study was to describe the problems that parents or caregivers of children with mental health disabilities and disorders in Namibia experience when accessing healthcare resources for their children.
Method : Data was collected through focus group discussions with the participants and individual interviews with the key informants. Overall, a total of 41 people provided information for this study. Thematic data analysis was used to assess the data.
Results : The main barriers experienced by the parents were poor service provision, transport and money, whilst access to education services facilitated access to healthcare services.
Conclusion : The challenges go beyond commonly-reported problems such as sub-optimal service provision and include the basic challenge of lack of transportation to reach healthcare services. Many of the barriers identified in this study have been related to general problems with the healthcare system in Namibia. Therefore there is a need to address general concerns about healthcare provision as well as improve specific services for children with mental health disabilities and disorders in Namibia.
Psychosocial rehabilitation in a chronic care hospital in South Africa : views of clinical staff : originalSource: African Journal of Psychiatry 16, pp 277 –282 (2013)More Less
Objective : The study was based at a South African hospital providing inpatient care for people with chronic mental disorders, and aimed at investigating the multidisciplinary team (MDT) members' views, understanding and attitudes towards psychosocial rehabilitation (PSR).
Method : A survey method was used, with the MDT members completing a questionnaire that tapped, inter alia, their understanding of PSR, perceived aims and goals of PSR, adequacy of their professional training to implement PSR, availability of resources to implement PSR, and their views of chronic mentally ill patients, including their functional skills, needs and prognosis.
Results : Of 114 respondents, 19.3% felt they had sufficient knowledge of PSR practice, 53.5% reported that their professional training included teaching on PSR, 90.4% wanted to undertake further training in PSR, 64.9% believed that the hospital environment lends itself to PSR, and 23.7% felt the hospital had sufficient resources to perform PSR. Most (93%) believed that patients with chronic mental disorders can improve their functioning, and 65.8% thought that such patients could make decisions for themselves.
Conclusion : It is not surprising that most of the clinical staff in this investigation do not feel sufficiently equipped to perform PSR interventions, considering that past mental health policies and training failed to emphasize this component of mental health care. The need for training programmes to address this deficit is evident.
Pattern of attendance and predictors of default among Nigerian outpatients with schizophrenia : originalSource: African Journal of Psychiatry 16, pp 283 –287 (2013)More Less
Objective : To assess the pattern of and factors associated with outpatient clinic attendance among patients diagnosed with schizophrenia at a Nigerian psychiatric hospital.
Method : This was a cross-sectional descriptive study of 313 consecutive outpatients with diagnosis of schizophrenia confirmed with the Structured Clinical Interview for Diagnosis (SCID). Data was collected on sociodemographics, clinic attendance, perceived social support, perceived satisfaction with hospital care and illness severity (assessed using the Brief Psychiatric Rating Scale, BPRS). Logistic regression analysis was used to identify factors associated with outpatient clinic default.
Results : Overall, 20.4% respondents were defaulters, with a median duration of clinic nonattendance of 8 weeks. Outpatient clinic defaulters had significantly higher BPRS scores and had missed more outpatient clinic appointments compared with non-defaulters. A significantly higher proportion of defaulters resided more than 20km away from the hospital and reported "not satisfied" with their outpatient care. Being financially constrained was the commonest reason given by defaulters for missing their clinic appointments. The significant predictors of outpatient clinic default included residing more than 20km from the hospital, missing previous appointments and dissatisfaction with outpatient care.
Conclusion : Outpatient clinic non-attendance is common among patients with schizophrenia, and is significantly associated with demographic, clinical and service related factors. Interventions targeted at addressing the risk factors for defaulting peculiar to developing country settings similar to the location of this study, could significantly improve treatment outcome.
Depressive symptoms after a sexual assault among women : understanding victim-perpetrator relationships and the role of social perceptions : originalSource: African Journal of Psychiatry 16, pp 288 –293 (2013)More Less
Objective : Although mental health impact of gender based violence has been documented for many decades, the impact of the socio-cultural dimensions and type of perpetrator on mental health outcomes has not been described outside of developed countries. We explore depression symptomatology four to six weeks post-rape in South Africa and examine whether this differs according to the circumstances of the rape.
Method : 140 participants recruited from public hospital services in the Eastern and Western Cape provinces were interviewed within two weeks after completing the post exposure prophylaxis (PEP) medication. A structured questionnaire was used to collect data on socio-demographic and sexual assault characteristics including perpetrator. Depressive symptomatology was measured using the Centre for Epidemiological Studies Depression Scale.
Results : 84.3% (95% CI: 78.1-90.3) women were found to have high levels of depressive symptoms, but lower levels were found among women raped in circumstances in which there was a lesser likelihood of blame such as those raped by strangers rather than intimate partners (Odds Ratio: (OR) 0.28 (95% Confidence Intervals (CI): 0.11-0.69) and higher levels were associated with experiencing four or more side effects related to PEP medication (OR: 3.79: CI: 1.03-13.94). Receiving support and severe sexual assaults (involving weapons and multiple perpetrators) were not associated with depression.
Conclusion : The study does not support the general assumption that more violent rape causes more psychological harm. These results have important implications for individual treatment because it is more generally assumed that multiple perpetrator rapes, stranger rapes and those with weapons would result in more psychological trauma and thus more enduring symptoms. Our findings point to the importance of understanding the socio-cultural dimensions, including dynamics of blame and stigma, of rape on mental health sequelae.
CCAMH - University of Ibadan Centre for Child & Adolescent Mental Health
Keeping dreams alive! : announcementSource: African Journal of Psychiatry 16, pp 294 –296 (2013)More Less
Author Franco P. VisserSource: African Journal of Psychiatry 16 (2013)More Less
Based on the historical 1862 novel by Victor Hugo with the same name, Les Misérables is a British made musical film that caused quite a sensation when it was released in 2012. The film is also based on the musical version of Victor Hugo's epic book as directed and produced by Alain Boublil and Claude-Michel Schönberg. Boublil and Schönberg were also involved in scripting the current musical film version together with William Nicholson and Herbert Kretzmer. The film's director, Tom Hooper was also responsible for another film that I previously reviewed for the Journal - The King's Speech. The film portrays the heartbreaking story of Jean Valjean (played by Hugh Jackman) who, after serving a lengthy prison sentence for stealing bread for a hungry family member, was paroled by the French prison authorities. With strict parole conditions Valjean attempts to reconstruct a life for himself, although his criminal record follows him wherever he goes and he is driven out of every town which he comes across on his journey.
Source: African Journal of Psychiatry 16 (2013)More Less
SADAG supporting and guiding your patients when you can't : Patients as partners - brought to you by The South African Depression and Anxiety GroupAuthor Janine ShamosSource: African Journal of Psychiatry 16 (2013)More Less
Miserable, manic or misdiagnosed? : Patients as partners - brought to you by The South African Depression and Anxiety GroupAuthor Robin BleekersSource: African Journal of Psychiatry 16, pp 306 –308 (2013)More Less
Going to a medical practitioner can sometimes be quite a daunting process, especially when you are not sure exactly what the problem is. The medical practitioner needs to know as much as possible about what you are experiencing to ensure that they are able to best determine exactly what is wrong with you. In some cases the doctor can make the mistake of misdiagnosing what is wrong with you. In relation to mental health disorders a very common misdiagnosis relates to Temporal Lobe Epilepsy (TLE).