South African Journal of Psychiatry - Volume 11, Issue 1, 2005
Volume 11, Issue 1, 2005
Source: South African Journal of Psychiatry 11, pp 2 –4 (2005)More Less
Extracted from text ... 2 editorial In the last few decades psychiatric discourse has undergone an important change in its scope and focus. During the heady days of psychoanalytic hegemony, psychiatrists were willing to prognosticate or pontificate on just about anything, from individual neurosis through to social maladies, from medicine to literature, from the unconscious to the conscious. Nowadays, psychiatry self-consciously emphasises its origins as a medical discipline, focuses its diagnostic efforts on operationally defined psychiatric disorders, and argues the value of specific pharmacotherapies and psychotherapies in treating these conditions. There is plenty to keep the medically orientated psychiatrist busy. Neuropsychiatric disorders comprise ..
Author Piet OosthuizenSource: South African Journal of Psychiatry 11, pp 6 –11 (2005)More Less
Extracted from text ... Every psychiatrist who has worked in the clinical field for some time will be able to relate a story of a patient who presented with psychiatric symptoms but eventually turned out to have a brain tumour. We all fear that someday we will misdiagnose a brain tumour and therefore fail to save a patient's life. The purpose of this article is to give a brief outline of the important clinical issues related to brain tumours and psychiatry. The mere fact that we have these stories to tell suggests that tumours of the central nervous system (CNS) are not as ..
Source: South African Journal of Psychiatry 11, pp 12 –15 (2005)More Less
<I>Objective.</I> Published studies on the prevalence of depressive symptoms using rating scales and the relationship between depression and immune status offer inconsistent results. Depressive symptoms are common and impact on functioning, quality of life, and health status, highlighting the importance of diagnosis and treatment of patients with HIV infection. The aim of the study was to determine the occurrence of depression among HIV-positive patients using the Beck's Depression Inventory (BDI) and to determine a relationship, if any, between depressive symptoms and CD4 count. <br><I>Method. </I> Forty-one patients aged 18 years or more were recruited from the HIV outpatient clinic. All the subjects completed the 21-item BDI and their CD4 counts were determined. Patients who had a score of 10 or more on the BDI were considered positive for a depressive disorder. <br><I>Results.</I> More than half (56%) of the study sample had a BDI of = 10 indicating significant symptoms of depression. There was no significant difference in the CD4 counts between the depressed and non-depressed groups (p > 0.05), and no correlation between CD4 counts and BDI scores in the total study sample (r = 0.27, p > 0.05). The affective components of the BDI contributed significantly to the overall BDI score compared with the somatic component (p < 0.05). <br><I>Conclusion.</I> The evidence from the study supports the BDI as a suitable measure for identifying those patients who meet the <I>Diagnostic and Statistical Manual of Mental Disorders (DSM)</I> criteria for minor or major depression. The HIV epidemic is the most serious health challenge in South Africa and it is imperative that HIV-infected patients who complain of fatigue or insomnia be screened routinely for major depression, followed by a structured interview to confirm the diagnosis.
Observational study of outpatients with schizophrenia in the Middle East and Africa - 3- and 6-month efficacy and safety results : the Intercontinental Schizophrenia Outpatient Health Outcomes StudySource: South African Journal of Psychiatry 11, pp 16 –24 (2005)More Less
<I>Objectives.</I> To examine the comparative outcomes associated with the antipsychotic treatment of outpatients with schizophrenia and to describe changes in clinical status over the first 6 months of treatment in participating patients from the Middle East and Africa (MEA). <br><I>Methods.</I> The Intercontinental Schizophrenia Outpatient Health Outcomes (IC-SOHO) Study is a 3-year, prospective, observational study of health outcomes associated with antipsychotic medication in outpatients treated for schizophrenia. This article reports the 6-month interim results in the MEA region (N = 1399). Subjects, aged 18 years and over and undergoing treatment for schizophrenia were enrolled if, at the discretion of the treating psychiatrist, they initiated or changed antipsychotic medication. For the primary analyses, two treatment groups were established; viz. olanzapine and 'other antipsychotics' (non-olanzapine including risperidone) groups. Subanalysis of olanzapine versus risperidone groups was also done as secondary comparison. Measures of treatment effectiveness (Clinical Global Impression of Severity (CGI-S)), and safety (incidence of extrapyramidal symptoms (EPS), tardive dyskinesia (TD), side-effects (sexual dysfunction and weight change)) were taken at baseline and at 3 and 6 months after enrolment. <br><I>Results.</I> Olanzapine (58.9%) and risperidone (13.8%)) were the most frequently prescribed antipsychotics in this study. Coprescription of anticholinergics was at least four times more frequent for risperidone-treated patients than for those treated with olanzapine at any time point. Olanzapine was more efficacious in the treatment of overall symptom severity (CGI-S) than other antipsychotics or risperidone. In all other symptom domains (CGI-S), patients responded significantly better to treatment with olanzapine than to treatment with other antipsychotics. EPS significantly declined over the treatment period for patients taking olanzapine. Compared with patients on other antipsychotics, fewer patients receiving olanzapine therapy developed TD post-baseline. In addition, more patients on olanzapine therapy presented with a remission of TD symptoms after 3 and 6 months of treatment compared with patients on other antipsychotics and risperidone. The prevalence of side-effects associated with sexual function (loss of libido, impotence/sexual dysfunction) was significantly reduced (p < 0.001) with olanzapine treatment compared with other antipsychotics. Compared with those patients taking other antipsychotics or risperidone, fewer patients developed loss of libido, and more patients recovered from these symptoms in the course of 6 months of olanzapine treatment. Similarly, fewer olanzapine patients suffered from impotence/sexual dysfunction over the first 3 months of treatment, and more patients had recovered from pre-existing symptoms after 6 months than those taking other antipsychotics or risperidone. Patients taking olanzapine were significantly more likely to gain more than 7% of their baseline weight over a 6-month period. <br><I>Conclusions.</I> Initial 3- and 6-month findings included in this progress report indicate that patients treated with olanzapine showed greater improvements in terms of effectiveness of treatment, and that this was associated with a more favourable overall safety profile than that of patients treated with other antipsychotics or risperidone.
Source: South African Journal of Psychiatry 11, pp 25 –36 (2005)More Less
Extracted from text ... Psychiatry: Selected abstracts ANTIPSYCHOTICS ACROSS THE SPECTRUM: AN OVERVIEW OF THEIR MECHANISMS OF ACTION Anissa Abi-Dargham (Professor of Clinical Psychiatry and Radiology at Columbia University) Imaging studies in schizophrenia have shown an association between dopaminergic hyperactivity in the mesolimbic pathway and positive symptoms, and suggested dopaminergic hypoactivity in the mesocortical pathway underlying cognitive impairment and negative symptoms. In addition, studies of dopamine glutamate interactions have shown that dopaminergic alterations in schizophrenia may be secondary to a glutamatergic dysfunction. These data support a predominant and well established role for D2 antagonism in the treatment of schizophrenia, while providing new strategies for ..