Browsing by Author "Flisher, Alan J"
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- ItemOpen AccessThe association betweeen psychopathology and substance use in young people(2011) Saban, Amina; Flisher, Alan J; London, Leslie; Morojele, Neo KThe co-occurrence of problematic substance use and non-substance use psychopathology is very common in psychiatry, and is generally referred to as comorbidity. The phenomenon has been the subject of debate and widespread research, yet remains poorly understood. The thesis aimed to examine the association between psychopathology and substance use in young people in South African settings, to determine the nature and prevalence of comorbidity, and to identify sociodemographic factors that might influence the associations, as well as the influence of comorbidity on substance use treatment outcomes.
- ItemOpen AccessCharacteristics and predictors of treatment effectiveness of children seen at the Therapeutic Learning Centre, Division of Child and Adolescent Psychiatry, Red Cross War Memorial Children's Hospital during the period 1992-2008(2012) Dhansay, Yumna; Flisher, Alan J; Joska, JohnIncludes abstract. Includes bibliographical references.
- ItemOpen AccessCharacteristics of students receiving mental health services at the university of Cape Town(2000) De Beer, Jeremy Peter; Flisher, Alan J; Gillis, Lynn SThe objective of the study is to describe students presenting at the UCT-SHS-MHS; (li) to compare students presenting at the UCT-SHS-MHS with students presenting at the UCT-SHS who do NOT present at the UCT-SHS-MHS (controls); (iii) to compare students presenting at the UCT-SHS-MHS with all other students attending the University of Cape Town, and (iv) to examine the association between the number of consultations at the UCT -SHS-MHS. They are described in terms of selected demographic, academic, residential (home address), financial assistance and, where appropriate, clinical (diagnostic) variables: The study, which utilised official University of Cape Town student records, was descriptive in nature for Objective 1 and analytic in nature for Objective 2 (case-control study), Objective 3 (cross-sectional study) and Objective 4. 932 patients, 1 924 matched controls and 23 158 registered students. (i) Objective 1 (attendees) - minority groups such as Blacks (Africans, Coloureds and Indians), non-traditionally aged students, non-English first language speaking students, outof-town students and socio-economically disadvantaged students form a sizeable proportion of UCT-SHS-MHS attendees; (li) Objective 2 (patients versus controls) - non-minority groups such as English first language speaking students (rather than the minority groups reported in Objective I) utilise the UCT -SHS-MHS significantly more than the UCT -SHS; (iii) Objective 3 (patients versus the total student community) - minority groups such as Blacks (Africans, Coloureds and Indians), non-English first language speaking students, outof-town students and socio-economically disadvantaged students are significantly overrepresented amongst UCT-SHS-MHS attendees, and (iv) Objective 4 (number of consultations) - non-minority groups such as White students (rather than the minority groups reported in Objective 3) are responsible for the highest mean number of consultations at the UCT -SHS-MHS. (i) Objective 1 (attendees) - these results are largely related to the composition of the total student community although notable exceptions include female students, first year students and students whose home address is outside metropolitan Cape Town; (ii) Objective 2 (patients versus controls) - male students, non-English first language speaking students, nonArts, Music and Social Science and Humanities faculty students and students residing outside metropolitan Cape Town are either particularly unaware or extremely unsure of the potential benefits to be derived from the psychotherapeutic process; (iii) Objective 3 (patients versus the total student community) - the usage/utilisation rate is largely related to either background cultural and socio-e.conomic factors or academic-related concerns that affect students (e.g. race/population group, language and financial assistance can be closely interlinked and may relate to the set of adverse family and financial circumstances that could promote the development of mental disorders), and (iv) Objective 4 (number of consultations) - these results are largely related to the initial severity of the psychopathology, the level of resistance encountered by the student to the psychotherapeutic process employed, the need of the student for positive reinforcement from the therapist, and the range ofdependency issues affecting the student.
- ItemOpen AccessDelirium in children and adolescents(2009) Hatherill, Sean; Flisher, Alan JIncludes abstract. Includes bibliographical references (leaves 334-373).
- ItemOpen AccessThe development and implementation of an intervention programme for young sexual offenders(2006) Meys, Ulrich; Flisher, Alan JOver the last decade, sexual abuse committed by young sexual offenders has increasingly been reported in South Africa. Such offenders are often inappropriately managed by both mental health and related professionals and the justice system. This dissertation describes the process involved in the development and implementation of a diversion programme for young sexual offenders in the local setting by the use of action research. This is preceded by an overview of the concepts of diversion and the characteristics, assessment and management of young sexual offenders. The development and implementation process is presented in stepwise action cycles, highlighting the various action steps that were taken. These are evaluated in the 'observation' and 'reflection' sections of each cycle. Twelve action cycles, spanning a period of 6 years, are described, beginning with the identification that young sexual offenders and their management posed a problem, the development of a diversion programme and the initial pilot studies, through to the formation of SAYSTOP, a multidisciplinary umbrella organisation. Further steps describe the wider implementation of the programme, facilitator training and follow-up studies conducted on young sexual offenders. The multi-disciplinary role played by SAYSTOP in the management of young sexual offenders is discussed and the SAYSTOP diversion programme is compared to guidelines suggested in the literature. The strengths, weaknesses and limitations of both the process and the SAYSTOP diversion programme are discussed in the conclusion, followed by recommendations for future guidelines and policy decisions regarding young sexual offenders. Results indicate that sexual offences committed by youths in South Africa are common and that no intervention programmes exist that aim to rehabilitate these offenders. Professionals from various fields were able to combine their experience and develop a group intervention programme targeting these youths. Following successful administration of this programme to young sexual offenders a manual documenting both the content and objectives of group sessions was developed. Structured workshops with the aim of training future facilitators (probation officers) ensured that the diversion programme was implemented on a regional level in the Western and Eastern Cape. Follow-up studies on young sexual offenders and feedback from facilitators indicated that the core concepts of the programme were understood by participants although several areas were identified that needed to be addressed in more detail. The follow-up studies showed that none of the youths re-offended, although disappointingly only ± 30% of youths could be interviewed. A system whereby young sexual offenders could be managed and followed-up over a longer period within a continuum of care model could not be implemented. Insufficient resources and high staff turnover are identified as key factors that hampered both the development and implementation of the SAYSTOP diversion programme. Although the SAYSTOP diversion programme proved to be successful as a first line of intervention, further refinement of the programme content, development of a continuum of care model and a central management structure involving all role players is necessary for this form of diversion programme to be successful in the future.
- ItemOpen AccessThe doctor and the dying child(2003) Lik, Marta; Flisher, Alan J; Ziervogel, CarlIncludes bibliographical references.
- ItemOpen AccessEnhancing the role of nurses in substance abuse intervention : a study of nurses and nursing lecturers in the Western Cape(2000) Sheard, Denise; Clow, Sheila; Flisher, Alan JBibliography: leaves 134-158.
- ItemOpen AccessAn exploration of the nature of contemporaty adolescents' intimate relationships(2013) Gevers, Aník; Flisher, Alan J; Mathews, Catherine; Jewkes, RachelIntimate relationships in adolescence play an important role in psychosocial development and can impact on relationships during adulthood. There is a need for evidence-based interventions to prevent intimate partner violence (IPV), promote sexual and reproductive health, and equitable, enjoyable relationships during adolescence. A nuanced understanding of contemporary adolescents' intimate relationships is needed to inform intervention development. A series of studies was undertaken to explore (a) contemporary adolescents' ideas about and experiences of relationships; (b) young adolescents' sexual behaviour and dating; (c) adolescents' conceptions of a good relationship; and (d) published-evidence guidelines for developing school-based violence prevention interventions. For study (a), qualitative data were collected during focus group discussions and in-depth interviews with 14-18 year olds. Survey data from 13-16 year olds (for study b) and 15-18 year olds (for study c) were analysed using regression analyses. Adolescents’ intimate relationships are fluid and unstructured, highly gendered, and greatly influenced by peer relationships; however, experience with relationships and sex are varied. For girls, good relationships were associated with having a mutual main partnership with an older, educated boyfriend in which there was good, open communication particularly about sexual and reproductive health. For boys, a mutual main partnership and very little quarrelling were associated with good relationships. Young adolescents' reported engaging in a variety of sexual behaviours ranging from kissing to sexual intercourse with the former more common than the latter. These findings indicate a need for early interventions that are carefully adapted and acceptable to adolescents who have varying levels of experience with relationships, sex, and violence. Adolescents would benefit from developing gender equitable attitudes; critically reflecting on their ideas and practices related to good and poor relationships; building sexual decision-making skills to better prepare them to develop and maintain good, healthy relationships and end poor or abusive ones. Interventions should incorporate adolescents' perspectives and balance evidence-based best practice and resource availability.
- ItemOpen AccessFactors affecting condom usage among Cape Town high school students(2003) Vergnani, Tania; Flisher, Alan JThe HIV/AIDS epidemic in South Africa is characterised mainly by heterosexual transmission and an extremely rapid spread among adolescents and young adults in their early twenties, indicating the need for an increased focus on preventive efforts aimed at this age group. Apart from the development of a cure or vaccine to prevent HIV transmission, preventive programmes clearly offer the best chance of halting the spread of HIV, and these need to be based on behavioural change to modify or prevent risk behaviours. The challenge is to develop suitable theory-based programmes that address and promote safer sex behaviour, taking into account the local social and cultural environment. This cross-sectional study focused on a key HIV preventive behaviour, namely condom usage, and used as its research target adolescents, a key risk group for HIV infection in South Africa. It aimed to investigate the key variables that influence condom usage among adolescents in the Cape Town metropolitan area. The study was based on an integrated theoretical model using constructs from 5 of the most common social cognitive behavioural theories, namely, the Health Belief Model, Bandura’s Social Cognitive Theory, the Theory of Reasoned Action, the Theory of Planned Behaviour and the Theory of Subjective Culture and Interpersonal Relations. In addition, variables from Basch’s construct availability model were included. The sample comprised a representative three-stage sample of grade 11 adolescents from 36 schools in the Cape Town Metropolitan area (n = 1931). Formative research, in the form of an elicitation study using to focus group interviews with a purposive sample of adolescents, was used to develop the theory-based self-completion questionnaire used in this study. Twelve constructs were included in the questionnaire as potential correlates of condom use, namely: intention, self-standards, self-efficacy, affect, attitude, beliefs, norms, condom availability, health concern, worry about AIDS, construct availability and condom availability. The dependent variable was condom use on the last coital episode.
- ItemOpen AccessHIV/AIDS and psychiatry: Towards the establishment of a pilot programme for detection and treatment of common mental disorders in people living with HIV/AIDS in Cape Town(2008) Joska, John A; Stein, Dan J; Flisher, Alan JAs the roll-out of antiretrovirals (ARVs) to people living with HIV / AIDS (PLWHA) continues to increase in South Africa, so too does the need to integrate mental health services into HIV care. In this editorial, we argue that the role of mental health in ARV programmes is central. The prevalence of mental disorders in PLWHA is higher than in the general population, and the impact of these conditions is substantial. Screening tools for mental disorders are both available and feasible. These should be incorporated into routine ARV care, with support from dedicated HIV mental health services.
- ItemOpen AccessThe influence of sexual coercion at first sex on subsequent risk behaviours among adolescents in Cape Town, South Africa(2009) Soomar, Jerusha Nishana; Mathews, Catherine; Flisher, Alan JThe aim of this mini-dissertation was to assess whether sexual coercion at first sex predicts risk behaviours in a sample of school going adolescents by reviewing existing literature and examining a study of youth in Cape Town, South Africa. ... The systematic review appraised literature which aimed to assess the influence of sexual coercion on risk behaviours. The selection criteria included quantitative observational studies and studies with subjects that were sexually active males and females between 10 and 25 years of age. ... A secondary statistical analysis of data from the SATZ project was carried out to further assess the extent to which coercion at first sex predicts; sexual risk behaviour, experience or perpetration of physical abuse and substance use.
- ItemOpen AccessInjury-related behaviour among South African high-school students at six sites(2006) Flisher, Alan J; Ward, Catherine L; Liang, Holan; Onya, Handsome; Mlisa, Nomfundo; Terblanche, Susan; Bhama, Susan; Parry, Charles D H; Lombard, Carl JObjectives. To document and compare prevalence rates of adolescent injury-related risk behaviours at six sites in South Africa. Design. The identical self-administered instrument was used at all sites. Prevalence rates (with 95% confidence intervals) were calculated taking the multistage cluster sampling strategy into account. Setting and subjects. In Cape Town, Durban, Port Elizabeth and Mankweng participants were drawn from either grades 8 or 9, and grade 11, while in Queenstown and Umtata they were drawn from grade 11 only. We selected 39 schools in Cape Town and Durban, 33 in Port Elizabeth and 20 in each of the rural areas. Outcome measures. Road-related risk behaviour, violence, and suicide attempts. Results. Across the sites there were high rates of risk behaviour in all domains. For example, in the 12 months preceding the survey an estimated 52.8% of grade 11 males in Cape Town had travelled in the front seat of a motor vehicle without a seatbelt, 33.0% of grade 8 males in Mankweng had bullied others, while 44.5% of the same group had been bullied, and 18.6% of females in Port Elizabeth had attempted suicide. Rates were lower in rural areas for behaviour involving motor vehicles, but there were no consistent urban-rural findings for violence-related behaviour. Females were at higher risk of suicidal behaviour and males were at higher risk of other injury-related behaviour. Conclusions. There is a need for effective interventions to reduce the extent of injury-related risk behaviour in adolescents in urban and rural settings.
- ItemOpen AccessLeisure boredom and risk behaviour in adolescence(2008) Wegner, Lisa; Flisher, Alan JThere has been very little research investigating leisure boredom and risk behaviour among adolescents in South Africa. The purpose of the research reported in this thesis was to investigate how adolescents experience leisure and boredom in their free time, and how this is associated with risk behaviour - specifically substance use, sexual risk behaviour and premature school leaving (dropout). The thesis comprises five interrelated studies.
- ItemOpen AccessMental health is integral to public health: a call to scale up evidence-based services and develop mental health research(2008) Lund, Crick; Stein, Dan J; Corrigal, Joanne; Flisher, Alan JThe Global Burden of Disease studies documented the challenges posed by mental illness. Mental illness comprised an estimated 12% of the global burden of disease in 2000, and is predicted to rise to 15% by 2020. Mental disorders comprise 5 of the 10 leading causes of health disability; it is predicted that, by 2030, unipolar depression will be the world's second most disabling health condition.
- ItemOpen AccessMental health policy process: a comparative study of Ghana, South Africa, Uganda and Zambia(BioMed Central Ltd, 2010) Omar, Maye; Green, Andrew T; Bird, Philippa K; Mirzoev, Tolib; Flisher, Alan J; Kigozi, Fred; Lund, Crick; Mwanza, Jason; Ofori-Atta, Angela J; Mental Health and Poverty Research Programme Consortium (MHaPP)BACKGROUND: Mental illnesses are increasingly recognised as a leading cause of disability worldwide, yet many countries lack a mental health policy or have an outdated, inappropriate policy. This paper explores the development of appropriate mental health policies and their effective implementation. It reports comparative findings on the processes for developing and implementing mental health policies in Ghana, South Africa, Uganda and Zambia as part of the Mental Health and Poverty Project. METHODS: The study countries and respondents were purposively selected to represent different levels of mental health policy and system development to allow comparative analysis of the factors underlying the different forms of mental health policy development and implementation. Data were collected using semi-structured interviews and document analysis. Data analysis was guided by conceptual framework that was developed for this purpose. A framework approach to analysis was used, incorporating themes that emerged from the data and from the conceptual framework. RESULTS: Mental health policies in Ghana, South Africa, Uganda and Zambia are weak, in draft form or non-existent. Mental health remained low on the policy agenda due to stigma and a lack of information, as well as low prioritisation by donors, low political priority and grassroots demand. Progress with mental health policy development varied and respondents noted a lack of consultation and insufficient evidence to inform policy development. Furthermore, policies were poorly implemented, due to factors including insufficient dissemination and operationalisation of policies and a lack of resources. CONCLUSIONS: Mental health policy processes in all four countries were inadequate, leading to either weak or non-existent policies, with an impact on mental health services. Recommendations are provided to strengthen mental health policy processes in these and other African countries.
- ItemOpen AccessMental health service norms in South Africa(2002) Lund, Crick; Flisher, Alan JThis thesis includes four main aspects. Firstly, a situation analysis was conducted of current national public sector mental health services in South Africa, using nine service indicators. Secondly, a model was developed for estimating the mental health service needs of people with psychiatric conditions in a local South African population. Thirdly, a set of service norms was proposed for each of the nine service indicators, informed by data from the situation analysis. Fourthly, a practical user-friendly planning manual was developed, using the situation analysis, model and norms to provide guidelines for the planning of mental health services by local and provincial planners.
- ItemOpen AccessMethamphetamine (tik) use, sexual risk, aggression and mental health among school going adolescents in Cape Town(2010) Pluddemann, Andreas; Flisher, Alan J; Parry, Charles D H; McKetin, Rebecca; Lund, CrickMethamphetamine use has become a growing problem in many regions of the world.Cape Town has shown a particularly sharp increase in use over the past six years. The aim of this thesis is to establish the extent of methamphetamine use among adolescents in Cape Town, and to investigate mental health problems and sexual risk behaviour related to methamphetamine use among adolescents. In addition the study aimed to establish whether methamphetamine use is associated with not continuing to attend high school. The results of the thesis are presented through five journal articles, which address the above aims. The articles are based on two quantitative high school surveys and an ongoing surveillance of substance abuse counselling and rehabilitation centres in Cape Town. Findings in the first paper in Chapter 3 indicate that the proportion of individuals seeking substance abuse treatment for methamphetamine related problems increased steadily from 2004 to 2006 and that in 2006 73% of adolescents in treatment for substance abuse reported methamphetamine as their primary or secondary drug. Findings of the high school surveys in Chapters 4-7 indicated that between 9% and 12% of high school students (mean age = 15) reported life-time use of methamphetamine. The second and fourth papers in Chapters 4 and 6 indicated associations between methamphetamine use and sexual risk behaviour, particularly for students who reported recent use of methamphetamine. The third paper in Chapter 5 indicated associations between methamphetamine use in the past year and mental health problems among adolescents, including aggressive behaviour, depression and higher scores on a composite measure of mental health. The fifth paper in Chapter 7 showed that life-time methamphetamine use in addition to other substances was significantly associated with high school nonattendance when other non-substance use factors (repeating a year at school and being older than the norm for current grade) were taken into account. This thesis clearly demonstrates that methamphetamine use is a significant problem in Cape Town, and that developing strategies to curb and address this problem should be given priority. The thesis presents among the first and most comprehensive studies on adolescent methamphetamine use and associated problems internationally, and to our knowledge the first publications on this problem among adolescents in Africa. For South Africa, and Cape Town in particular, the greatest concern remains the associations between methamphetamine use and sexual risk behaviour, leading to an increased exposure to HIV. Further prevention efforts targeting both methamphetamine use and sexual risk behaviour should be a high priority for government and community based prevention efforts.
- ItemOpen AccessMunchausen syndrome by proxy : a form of pathological play?(2002) Korpershoek, Monica Jane; Flisher, Alan JThe primary aim of this dissertation was to gain an understanding of the psychopathology present in the perpetrator of Munchausen Syndrome by Proxy (MSP), exploring Jureidini's (1999) notion that this behaviour can be explained as the perpetrator engaging in a form of pathological play. A systematic literature review regarding MSP, with particular foci on psychopathology in perpetrators of MSP and the notion of pathological play was conducted. The notion that MSP is a form of pathological play was critically evaluated through the use of clinical case material. Two cases were selected, both of which met the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) diagnostic criteria for MSP, based on the assessment of a child psychiatrist with expertise in this area. The case material was analysed through the generation of common themes and identification of repetitive patterns which were then systematically analysed and compared with the findings cited in the literature review, with particular reference to MSP as a form of pathological play. Jureidini's (1999) theoretical statement was analysed in the light of the available evidence and the theoretical basis was then revised. Aspects explained by the theory were presented. Aspects not explained by the theory were rejected. Object Relations Theory was proposed as an alternative to understanding the psychopathology present in a perpetrator of MSP.
- ItemOpen AccessA narrative analysis of young people's talk of intimate partner violence(2009) Marais, Adéle; Flisher, Alan JThe aim of this study was to examine the issue of intimate partner violence from the perspective of young adults. My interest was to access participants’ stories of partner violence and to tap into their usual ways of thinking and talking about this issue. I wanted to attend to how young women and men actively imparted meaning to themselves and others, and how they constructed and performed their identities through the situated interaction of the research interview. Importantly, I used interactional, performative and narrative-discursive analytical perspectives in order to attend to three aspects of young adults’ talk: the content, the language and structure, and the telling as performance and interaction.
- ItemOpen AccessNeeds and services at ward one, Valkenberg hospital(2004) Joska, John A; Flisher, Alan JThe mental health needs of patients entering the program at ward one, Valkenberg Hospital, are not routinely measured. Their presenting problems are frequently complicated by basic and social needs, which impact on recovery and re-integration into the community. The Camberwell Assessment of Need is a valid and reliable instrument used to measure the mental health needs of psychiatric patients. In this study, this instrument was used with some modifications to assess the needs of patients on admission to ward one. At discharge, these needs were explored to measure the extent to which services and interventions were useful in meeting those needs. Where not, questions aimed at elucidating impediments to care were asked. All 60 patients completing the program agreed to participate. The average number of total needs on admission was 9.2, which included an average of 6.7 unmet needs. Psychiatric needs were the most commonly reported, with a need in the area of "depression" being declared in 59 patients. Help received prior to admission was scant, and patients had high expectations of ward one. Help received from ward one was highest in areas of psychiatric needs, with 89.8% of patients receiving moderate or high help in the area of depression. More than two-thirds of patients reported receiving low help in basic areas such as accommodation, self-care, and sexual expression. The services most often regarded as useful were organised group activities and therapies. Paired t-tests revealed that the patients without borderline personality had more unmet needs on admission. Regression analysis suggests that younger age and lower level of education confer a greater risk of unmet needs on admission and discharge. The routine use of a needs assessment instrument is recommended as an aid to guide clinicians. Attention needs to be given to basic and social needs, such as accommodation, daily activities and company, prior to admission to hospital. Where these needs persist, the active involvement of a social worker and occupational therapist is suggested. The high numbers of unmet needs in domains other than psychiatric problems, requires the input of the multidisciplinary team.
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