African Journal of Psychiatry - Volume 14, Issue 1, 2011
Volume 14, Issue 1, 2011
Source: African Journal of Psychiatry 14, pp 1 –3 (2011)More Less
The recognition of psychiatric sub-specialties has been acknowledged and the importance of achieving parity for mental health in medical training, service provision and research stressed. Psychiatry has in the past suffered from relative neglect associated with the stigmatisation of mental illness. Within psychiatry there has been additional neglect and more severe stigmatisation of intellectual disability (ID). It is time to review the history and current status of and the associated challenges facing ID in Africa and to plan for the future. Njenga and Adnams have reviewed the epidemiology, policies and services for children and adults with intellectual disability in Africa and South Africa respectively.
Board of International Affairs Pan-African Division quarterly newsletter
African International Division, Royal College of Psychiatrists : newsletterSource: African Journal of Psychiatry 14, pp 8 –14 (2011)More Less
Source: African Journal of Psychiatry 14, pp 17 –22 (2011)More Less
In this review, the neuropathogenesis of HIV dementia (HIV-D) is discussed in the context of the local epidemic. HIV-D continues to be prevalent in the era of highly active anti-retroviral therapy. HIV neuro-invasion into the central nervous system may result in the development of separate HIV genotypes in an individual through compartmentalisation. The blood brain barrier continues to limit penetration of anti-retroviral drugs into the cerebrospinal fluid. Individuals with active neuro-inflammation appear to respond well to HAART. In some cases low grade neuro-degeneration persists with consequent clinical deterioration. In South Africa, the emergence of a sub-epidemic of HIV-D is being driven by various factors, including the incomplete coverage of HAART to all who need it, the late stage presentation of people living with HIV/AIDS (PLWHA) and a co-occurring methamphetamine epidemic. Differences in viral subtype do not appear to confer protection against HIV-D. Implications for PLWHA who are at risk for HIV-D in South Africa are explored, with a view to providing suggestions for improving practice and research into this area.
Acute mental health care according to recent mental health legislation part II. Activity-based costing : originalSource: African Journal of Psychiatry 14, pp 23 –29 (2011)More Less
Objective: This is the second of three reports on the follow-up review of mental health care at Helen Joseph Hospital (HJH). Objectives for the review were to provide realistic estimates of cost for unit activities and to establish a quality assurance cycle that may facilitate cost centre management. Method: The study described and used activity-based costing (ABC) as an approach to analyse the recurrent cost of acute in-patient care for the financial year 2007-08. Fixed (e.g. goods and services, staff salaries) and variable recurrent costs (including 'laboratory', 'pharmacy') were calculated. Cost per day, per user and per diagnostic group was calculated. Results: While the unit accounted for 4.6% of the hospital's total clinical activity (patient days), the cost of R8.12 million incurred represented only 2.4% of the total hospital expenditure (R341.36 million). Fixed costs constituted 90% of the total cost. For the total number of 520 users that stayed on average 15.4 days, the average cost was R1,023.00 per day and R15748.00 per user. Users with schizophrenia accounted for the most (35%) of the cost, while the care of users with dementia was the most expensive (R23,360.68 per user). Costing of the application of World Health Organization norms for acute care staffing for the unit, projected an average increase of 103% in recurrent costs (R5.1 million), with the bulk (a 267% increase) for nursing. Conclusion: In the absence of other guidelines, aligning clinical activity with the proportion of the hospital's total budget may be an approach to determine what amount should be afforded to acute mental health in-patient care activities in a general regional hospital such as HJH. Despite the potential benefits of ABC, its continued application will require time, infrastructure and staff investment to establish the capacity to maintain routine annual cost analyses for different cost centres.
Alcohol use and problem drinking in South Africa : findings from a national population-based survey : originalSource: African Journal of Psychiatry 14, pp 30 –37 (2011)More Less
Objective: This study formed part of the South African National HIV, Incidence, Behaviour and Communication (SABSSM) 2008 survey, which included questions assessing the extent of alcohol use and problem drinking among South Africans. Method: A multistage random population sample of 15 828 persons aged 15 or older (56.3% women) was included in the survey. Alcohol use was assessed using the Alcohol Use Identification Test (AUDIT). Tabulation of data for different age groups, geolocality, educational level, income, and population group produced the estimates and associated confidence intervals. The odds ratios for these variables in relation to hazardous or harmful drinking were also computed. Results: Current alcohol use was reported by 41.5% of the men and 17.1% of women. White men (69.8%) were most likely and Indian/Asian women (15.2%) least likely to be current drinkers. Urban residents (33.4 %) were more likely than rural dwellers (18.3%) to report current drinking. Risky or hazardous or harmful drinking was reported by 9%: 17% among men and 2.9% among women. In men, risky drinking was associated with: the 20-54 year age group; the Coloured population group; lower economic status; and lower education. Among women, risky drinking was associated with: urban residence; the Coloured population group; lower education; and higher income. Conclusion: An increase in current, binge drinking and hazardous or harmful drinking prevalence rates was observed from 2005 to 2008 in South Africa. Multilevel interventions are required to target high-risk drinkers and to create awareness in the general population of the problems associated with harmful drinking. Future prospective studies are needed to assess the impact of problem drinking.
Prevalence and correlates of atypical patterns of drug use progression : findings from the South African Stress and Health Study : originalSource: African Journal of Psychiatry 14, pp 38 –44 (2011)More Less
Objective: Atypical sequences of drug use progression are thought to have important implications for the development of substance dependence. The extent to which this assumption holds for South African populations is unknown. This paper attempts to address this gap by examining the prevalence and correlates of atypical patterns of drug progression among South Africans. Method: Data on substance use and other mental health disorders from a nationally representative sample of 4351 South Africans were analysed. Weighted cross tabulations were used to estimate prevalence and correlates of atypical patterns of drug use progression. Results: Overall, 12.2% of the sample reported atypical patterns of drug use progression. The most common violation was the use of extra-medical drugs prior to alcohol and tobacco. Gender was significantly associated with atypical patterns of drug use with the risk pattern varying by the type of drug. None of the anxiety or mood disorders were associated with atypical patterns of use. Atypical patterns of drug use were not associated with increased risk for a lifetime substance use disorder. Conclusion: Atypical patterns of drug use initiation seem more prevalent in South Africa compared to other countries. The early use of extra-medical drugs is common, especially among young women. Drug availability and social environmental factors may influence patterns of drug use. The findings have important implications for prevention initiatives and future research.
Diagnostic outcome of patients referred to psychiatry with medically unexplained symptoms : a retrospective study : originalSource: African Journal of Psychiatry 14, pp 45 –49 (2011)More Less
Objective: Medically unexplained symptoms (MUS) are commonly encountered in medical practice. In psychiatry, they are classified mostly as Somatoform Disorders and are often associated with anxiety and depression. The literature suggests that, in some cases, MUS may be ascribed to Somatoform Disorders when, fact, they are "organic" syndromes that are misdiagnosed. In developing countries, with fewer resources, MUS may be more difficult to assess. Method: We undertook a retrospective chart review to examine the demographics, referral pathway, management and diagnostic outcome of subjects (n = 50) referred to psychiatry with MUS over an 18 month period. Results: Subjects with MUS accounted for only 4.5% of the total number of files reviewed. In only 38% of cases did the final diagnosis in psychiatry concur with the referral diagnosis. In 28% of cases a new "organic" diagnosis was made and in 72% of cases a new psychiatric diagnosis was made. Subjects who were diagnosed with "organic" illness were seen fewer times prior to referral to psychiatry and were significantly older than other subjects. Conclusion: In developing countries like SA, a significant number of patients with MUS may have underlying "organic" illness, and most may have psychiatric disorders. Patients with MUS, especially older patients, should be more extensively investigated. Psychiatric referral of these patients is very appropriate.
Source: African Journal of Psychiatry 14, pp 50 –55 (2011)More Less
Objective: The aim of this study is to investigate the clinical presentation of schizophrenia among Sesotho speakers. Method: A sample of 100 participants diagnosed with schizophrenia was evaluated using the Psychiatric Interview Questionnaire. Results: Core symptoms of schizophrenia among Sesotho speakers do not differ significantly from other cultures. However, the content of psychological symptoms such as delusions and hallucinations is strongly affected by cultural variables. Somatic symptoms such as headaches, palpitations, dizziness and excessive sweating were prevalent among the Sesotho-speaking participants suffering from schizophrenia. Conclusion: In South Africa, as is the case throughout the African continent, health professionals are still trained in Western models, especially DSM-IV-TR and ICD-10. Certain changes should be made to these models to account for cultural differences that were found in this research.
Source: African Journal of Psychiatry 14, pp 56 –59 (2011)More Less
Objective: To evaluate the effectiveness of electroconvulsive therapy in the treatment of Bipolar I Disorder patients with a single manic episode. Method: In a retrospective study, we reviewed medical records of inpatients who had been admitted to treat a single manic episode of Bipolar I Disorder at Noor University Hospital, Isfahan, Iran between September 2004 and December 2008. Results: Out of a total of 275 single episode manic patients, 39 underwent ECT. Male / female ratios were 19/20 (48.7% vs. 51.3%) for the ECT series and 137/99 (58% vs. 42%) for the exclusive pharmacological treatment series (p>0.05). Mean age of patients in the ECT series (23.64 ± 8.00) was significantly lower than the pharmacological treatment series (27.65± 11.30, p= 0.008). The mean length of stay (LOSs) for the ECT series (20.0± 7.90) was significantly higher than the other group (14.63± 9.84, p =0.001). The mean time to first administered ECT (tECT) was 4.35 ± 3.79. There was no significant difference between the mean LOSs of the pharmacologic treatment series and the mean "LOSs minus tECT"(LOS-tECT) variable (16.57±8.43) in the ECT series (p>0.05). The mean duration from the onset of the symptoms to time of admission was 19.22± 3.53 for the ECT series. Catatonia was the indication for application of ECT in one patient (2.6%), while 25 (64.10%) received ECT because of aggressive behavior. The proportion of patients administered chemical and physical restraints before ECT (77%) significantly dropped (7.7%) after ECT administration (p<0.001). Conclusion: ECT is an effective, safe, and probably underused treatment method for single episode manic patients. Reducing the time until commencement of ECT should be considered, even in a single manic episode.
Promoting editorial capacity in psychiatric journals in low and middle income countries (LAMIC) : reportSource: African Journal of Psychiatry 14, pp 60 –62 (2011)More Less
Under the auspices of the WPA section for publications, the WPA Task Force on publications has been actively involved in promoting editorial capacity in LAMIC countries through workshops. The workshops review selected journals from regions within the LAMIC group. The current workshop focused on Africa and Asia, with selected editors presenting content related to their journals. The aim was to establish the readiness for indexation in international databases, and to provide strategic input to facilitate this process. However, beyond indexation the workshop provided an opportunity to contribute towards improving quality of publications that would lead to a positive impact on mental health content in these regions. A further workshop is planned for Central and South American publications.
Source: African Journal of Psychiatry 14, pp 64 –66 (2011)More Less
Olanzapine is a widely prescribed second generation antipsychotic (SGA) that can lead to metabolic syndrome. SGAs are not a homogeneous class, and differ from each other in many ways. The risk for metabolic syndrome is significantly higher with olanzapine than other second generation antipsychotics. It is neccessary for prescribing doctors to be aware of this risk in order to prevent it; and/or manage it appropriately. Psychiatric patients face numerous barriers with regard to access and quality of medical care. They especially receive poorer care for chronic conditions such as heart disease and diabetes. This leads to an increased risk of premature death. Addressing the physical needs of mentally ill patients needs to be given priority. Guidelines such as those arising from the Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes, have been formulated for monitoring metabolic status. The current study aimed to establish the extent to which metabolic and cardiovascular screening and monitoring was undertaken on patients prescribed olanzapine in a specialist psychiatric hospital setting. The hypothesis was that screening was suboptimal (i.e. less than 100%).
Author Franco P. VisseSource: African Journal of Psychiatry 14 (2011)More Less
If ever there was a topic of which I know very little, it is that of the world economy and the high-stakes game of investments, take-overs and stock exchanges. Wall Street: Money Never Sleeps is a follow-up to the 1987 block-buster Wall Street by the same producer, Edward R. Pressman and famed film-maker Oliver Stone.
Source: African Journal of Psychiatry 14 (2011)More Less
Bipolar disorder can be misdiagnosed or underdiagnosed as both manic and depressive symptoms frequently occur in other psychiatric conditions. Over the past few years, the range of treatment options available for use in bipolar mania has broadened. Atypical antipsychotics are now among the agents which have an established place in the management of acute mania. But are treatment decisions based on evidence or on traditions? In a survey done in 2007 by Perlis et al., 33% of clinicians reported that they routinely referred to all published guidelines when making decisions on treatment choice for bipolar mania.
Author Cindy Van WykSource: African Journal of Psychiatry 14, pp 80 –84 (2011)More Less
Substance use and abuse is becoming a major public health problem, both internationally and in South Africa. Globally, the United Nations Office on Drugs and Crime (UNODC) estimates that between 155 and 250 million people, or 3.5% to 5.7% of the population aged 15-64 years, had used illicit substances at least once in the previous year. The 2010 World Drug Report published by the UNODC states that cannabis (marijuana) users comprise the largest number of illicit drug users (129-190 million), with amphetamine-type stimulants (e.g. methamphetamine) being the second most commonly used illicit drugs, followed by opiates and cocaine.