South African Psychiatry Review - latest Issue

Anxiety disorders are amongst the most common psychiatric disorders affecting approximately 25% of all adults. Fear and anxiety have many shared neuroanatomical and neurochemical characteristics. In this paper we refer to a) fear conditioning, (i.e. after a harmless and an aversive stimulus have coincided, the harmless stimulus encountered on its own will cause fear), b) the fear response, including the effects on the hypothalamo-pituitary-adrenal (HPA) axis, c) sensitization, which refers to a general hyperresponsivity of the fear circuits, d) fear memory, and e) extinction, the new learning that the harmless stimulus no longer forecasts a threat. The role of the amygdala and long-term potentiation (LTP) are discussed. Possible anatomical correlates of anxiety disorders and different therapeutic modalities, including the novel drug D-cycloserine, are briefly discussed.

Objective : In this article, war experiences and the impact of physical abuse on formerly abducted boys in Northern Ugandaare assessed.

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Method : In a cross-sectional self-report design, Impact of Events Scale - Revised (IES-R), War ExperiencesChecklist questionnaires were administered to 216 formerly abducted boys between August and November 2004 and data fromrecords at three rehabilitation centres were retrospectively assessed and analysed.

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Results : The boys were exposed to warevents, participated in atrocities, were physically abused, and manifested many signs and symptoms of post traumatic stress. Consequently, many were psychologically distressed at the time of the study.

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Conclusions :: The psychosocial intervention activities proposed include teaching better coping skills, entrepreneurial skills training, and provision of micro credit facilities.

Objective : To obtain a retrospective profile of the clinical presentation, inpatient management and their initial access to HAART of service users tested for HIV status while admitted to an acute bed psychiatric unit.

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Method : A retrospective clinical audit of HIV positive service users' discharge data sets was undertaken for the year September 2003 to August 2004. Data was compared with existing literature.

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Results : During the study period a total of 443 service users were admitted of whom 17.4% (n=77) were tested for HIV status. Of these, 7.7% (n=34) of the total admissions tested positive. Presenting psychiatric symptoms included elevated mood, psychosis, disorganized behavior, confusion, aggression and mutism. The most common DSM IV diagnoses were mood disorder or psychosis due to general medical condition. Predominantly risperidone and haloperidol in combination with valproate were used in treatment and at relatively high dosages.

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Conclusion : Amongst HIV positive service users acute psychiatric symptoms almost exclusively consisted of associated psychosis or manic symptoms rather than depression. The clinically successful addition of valproate to antipsychotic medication in 50% of cases in this study requires further research to establish if it could also be recommended on the basis of empirical findings. Service users' capacity to adhere to strict treatment regimes might have been affected if not supervised, in view of their generally low global assessment of functioning (GAF) scores on discharge.

Objective : The aim of this paper was to describe and compare the results of students in psychiatry at various training sites during the course of an academic year at the University of Witwatersrand following recent reforms in training and assessment methods.

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Method : All fifth year medical students (in a six year course) in 2005 were included in the study. Students were assessed at the end of each six-week block. At the end of the year the performances of all groups of students, in each of the various assessment tools, were captured. Each set of assessments over the seven blocks was checked to determine if all the objectives set out in the curriculum were assessed. Comparisons were made between the mean marks obtained in each of the assessment tools by students at the four clinical sites and over the seven blocks

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Results : 191 students were assessed in 2005. The overall results of the various assessment tools were as follows: mean ward performance mark 14.6 (SD 1.07); mean case presentation mark 14.2 (SD 1.15); mean MCQ's mark 12.2 (SD 2.16); mean MEQ's mark 14.1 (SD 2.53); and mean OSCE mark 15.9 (SD 1.99). Three students failed (<60 marks) and had to repeat the block. Analysis of all the assessment tools in each of the seven blocks confirmed that all the objectives set out at the beginning of the course were assessed. One-way analysis of variance showed significant differences in the mean ward marks (p &lt;0.05); MCQ marks (p &lt;0.05); MEQ marks (p <0.05) and OSCE marks (p <0.05) between the groups in the seven blocks but no differences in the mean case presentation marks (p = 0.52). There were no significant differences in the mean ward marks (p &gt;0.05); case presentation mark (p&gt;0.05); MCQ marks (p &gt;0.05); MEQ marks (p >0.05) and OSCE marks (p >0.05) between the groups at the four clinical sites.

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Conclusion : The revised process by Division of Psychiatry at the University of Witwatersrand seems to have brought about improvements in the training and assessment of students by virtue of consistency at the various sites and in the different blocks in the given academic year.

Objective : To determine the persistence of Attention Deficit Hyperactivity Disorder (ADHD) into adulthood in parents of children diagnosed with ADHD and currently attending child and adolescent psychiatric clinics (located at a tertiary academic hospital and a community based clinic).

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Method : A structured questionnaire was completed by 58 parents of ADHD children. Those parents identified as having childhood ADHD were further required to complete a screening questionnaire for adult ADHD.

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Results : 37.9% (22) of the 58 participants were found to have had childhood ADHD. Of these 22 participants 36.4% (8) were still found to have symptoms suggestive of ADHD.

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Conclusion : Childhood ADHD has been reconceptualised as a lifespan disorder. Our study was in keeping with other studies showing a persistence of ADHD symptoms into adulthood.