Browsing by Author "Dannatt, Lisa"

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    A research report to meet the requirements of the master of medicine in psychiatry at the University of Cape Town
    (2025) Swartz, Michelle; Dannatt, Lisa
    Background: Cannabis is the most widely used substance worldwide and its use is much higher amongst adolescents. However, adolescents are at higher risk of negative sequelae secondary to this use, including poorer developmental outcomes and the possible development of mental disorders. On 31 March 2017, the South African High Court ruled that cannabis use by an adult in a private dwelling should be decriminalized. Aim: The aim of this study is to determine the clinical profile of adolescents who use cannabis, that present to a tertiary hospital in Cape Town, South Africa, before and after the high court ruling in 2017. Setting The study was conducted reviewing folders of adolescents admitted at Groote Schuur Hospital (GSH) in the Emergency Psychiatric Unit, Ward C23 in Cape Town, South Africa. Methods: This study was a retrospective folder review of adolescents admitted from April 2015 to March 2019. Results:The study included 266 participants and the total number of adolescents using cannabis admitted during the study period was 116. Cannabis use was the most commonly used substance in the study, with increased use seen post-ruling (n = 75; 65%). The most common frequency of cannabis use reported was daily use (n = 43; 57%). When comparing psychiatric diagnoses between cannabis users and non-cannabis users, a significantly higher proportion of patients who used cannabis pre-ruling had psychotic disorder (p < 0.001) and substance use disorder (p = 0.01). Post–ruling, the significance was p < 0.001 for psychotic and substance use disorders. The most common DSM-5 diagnoses in cannabis users pre-ruling were psychotic disorders (n = 27; 65.9%); post-ruling, it was psychotic disorders (n =36; 48%) and trauma and stressor-related disorders (n = 31; 41.3%). Conclusion: The study showed an increasing prevalence of cannabis use in adolescents admitted with mental illness after the high court ruling in 2017. This study also demonstrates that adolescents remain a vulnerable population to the effects of cannabis. This highlights the need for more focused adolescent interventions and services.
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    Mental health care providers' suggestions for suicide prevention among people with substance use disorders in South Africa: a qualitative study
    (BioMed Central, 2018-12-07) Goldstone, Daniel; Bantjes, Jason; Dannatt, Lisa
    Abstract Background People with substance use disorders (PWSUDs) are a clearly delineated group at high risk for suicidal behaviour. Expert consensus is that suicide prevention strategies should be culturally sensitive and specific to particular populations and socio-cultural and economic contexts. The aim of this study was to explore mental health care providers' context- and population-specific suggestions for suicide prevention when providing services for PWSUDs in the Western Cape, South Africa. Methods Qualitative data were collected via in-depth, semi-structured interviews with 18 mental health care providers providing services to PWSUDs in the public and private health care sectors of the Western Cape, South Africa. Data were analysed inductively using thematic analysis. Results Participants highlighted the importance of providing effective mental health care, transforming the mental health care system, community interventions, and early intervention, in order to prevent suicide amongst PWSUDs. Many of their suggestions reflected basic principles of effective mental health care provision. However, participants also suggested further training in suicide prevention for mental health care providers, optimising the use of existing health care resources, expanding service provision for suicidal PWSUDs, improving policies and regulations for the treatment of substance use disorders, provision of integrated health care, and focusing on early intervention to prevent suicide. Conclusions Training mental health care providers in suicide prevention must be augmented by addressing systemic problems in the provision of mental health care and contextual problems that make suicide prevention challenging. Many of the suggestions offered by these participants depart from individualist, biomedical approaches to suicide prevention to include a more contextual view of suicide prevention. A re-thinking of traditional bio-medical approaches to suicide prevention may be warranted in order to reduce suicide among PWSUDs.
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    Outcomes of patients with opioid use disorders seen at the Groote Schuur Hospital Addictions Clinic from 2014 to 2020
    (2023) Kadenge, Betty; Dannatt, Lisa; Myers, Bronwyn
    BACKGROUND: The 2019 World Drug Report estimates an increased rate of non-medical use of opioids globally. A significant amount of this is attributable to the use of heroin. This rising trend is of particular concern in South Africa, a country which holds a background of high prevalence rates of blood borne infections such as HIV and Hepatitis C. Despite existing evidence for positive outcomes of Opioid Substitution Treatment (OST) in international and local studies, its use remains limited in South Africa, where medications suitable for use as OST are only listed in the Essential Medicines List for detox and not long-term maintenance treatment. METHODS: This study was a retrospective, descriptive study conducted at the Groote Schuur Hospital addictions clinic, a tertiary academic hospital in the Western Cape. Data was extracted from a total of 45 folders meeting inclusion criteria for this study and analysed using the SPSS software package. Descriptive statistics (frequencies, mean, and median) were used to examine the distribution of all socio-demographic, substance use, within-treatment, and treatment outcome variables. Chi-square tests were used to explore associations between sociodemographic, substance use, factors at baseline and the treatment outcomes of interest (abstinence and remission from OUD). For each outcome of interest, variables associated with the outcome at p<0.1 were entered into multiple logistic regression models. This purposeful method of selecting covariates to enter the models is widely used and recommended for researchers interested in identifying factors associated with an outcome and not just predicting the effects of a single covariate. The intention of these logistic regression analyses was to explore whether variables associated with the outcome of interest in bivariate analyses remained significantly associated with the outcome when adjusting for the presence of other variables associated with the outcome. RESULTS: The majority of participants in this study were male (53.3%), unemployed (84.4%), and did not attain more than 12 years of education (81%). The most common comorbid psychiatric condition in this study was major depressive disorder. Most participants in this sample were using heroin with a third of these participants injecting heroin. Comorbid SUD included tobacco (n=13, 30%) and stimulants (n=13, 29%) The use of OST overall held positive associations across all outcomes investigated in this study. CONCLUSION: This study highlights the complex interplay of sociodemographic, clinical and substance use factors of patients with opioid use disorders. It also highlights the benefits of maintenance OST and may add value to existing treatment services by identifying positive predictive factors for remission and abstinence. The authors of the study recommend replicating similar large-scale studies and continuing to advocate for inclusion of maintenance OST as part of integrated treatment of comorbid medical, psychiatric and substance use disorders, including tobacco use disorder in South Africa.
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    The use of Electroconvulsive Therapy in the treatment of psychiatric conditions at Valkenberg Psychiatric Hospital in Cape Town. A retrospective audit
    (2024) Clay, Keagan; Dannatt, Lisa
    Background: Mental disorders are amongst the most prevalent and pervasive group of disorders worldwide. In South Africa the treatment for mental disorders utilizes a biopsychosocial approach. A small proportion of patients may require ECT. In South Africa the use of ECT is sparse with great heterogeneity regarding indications and practice. More research within the South African context would aid policy planners and managerial stakeholders to set protocols and standards for national and provincial guidelines and standard operating procedures for quality assurance in research and practice. The aim of the study was to perform a clinical audit of the ECT service at Valkenberg Hospital by investigating the prevalence, demographics, diagnoses, indications and outcomes of patient's medical folders receiving ECT. Methods: This study utilized a retrospective cohort quantitative design; and was completed by examining the folders and ECT records of all patients who received ECT at the Valkenberg Psychiatric Hospital ECT Lab from January 2015 to January 2020. Patient data was collected and exported to an Excel spreadsheet and statistical analysis was completed looking at defined data criteria. Results: A total of 22 patients received ECT at Valkenberg Psychiatric Hospital between January 2015 to January 2020. Half the patients were 35 years of age or younger. Just over half (n = 12; 54.5%) were male. Most patients (63.6%) were on the Schizophrenia spectrum. The main indication for ECT was catatonia (n = 12; 55%), followed by bipolar depression (n = 4; 18%). The least common indications for ECT were bipolar mania and schizophrenia (n = 1; 4%). Patients had an average of 9 ECT sessions. 81% of patients had adequate short-term response to the treatment. 72.7% had adequate long-term treatment response. The majority of patients (81.8%) had no complications from treatment. Conclusion: ECT sessions had low complication rates and high rates of adequate short-term outcomes. In this setting ECT was primarily used in treatment resistant patients. ECT is being underutilized as a treatment option despite its low complication rate and effectiveness. Key Words. ECT (Electro-convulsive therapy); Valkenberg Psychiatric Hospital; Schizophrenia Spectrum Disorders; Treatment Resistance.
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    The views of healthcare providers on providing a brief treatment to address methamphetamine use among patients with a dual diagnosis
    (2020) Dannatt, Lisa; Sorsdahl, Katherine; Stein, Dan
    BACKGROUND: Methamphetamine (MA) use disorder in individuals with severe mental disorders (SMDs) has significant impact on clinical presentation and care. Although treatments exist, these are met by significant challenges. Notably, brief treatments for MA use within the general population have been feasible, acceptable and effective. An individualized, integrated treatment for MA use within a psychiatric inpatient setting would allow adjustment of the treatment according to individual patient needs. It is important to understand the patient needs and potential service barriers to care before formulating a treatment. This study begins to address this gap by seeking to understand the views of healthcare providers on a brief treatment to address MA use among patients with a dual diagnosis. METHODS: Thirteen key stakeholders working with patients with mental disorders including severe mental disorders and co morbid MA use were interviewed using an open-ended semi- structured interview schedule designed to explore their views on a brief treatment for MA use among patients with a dual diagnosis. Interviews were transcribed and the framework approach was used to conduct data analysis. RESULTS: Numerous themes emerged from the data. First, there are multiple risk factors for MA use. Second, this use has a significant impact on multiple aspects of patient presentation and care including individual impacts, family impacts, and impact on care. Third, although treatments for MA use disorders exist, these have significant challenges at multiple levels. Lastly, the integration of a modified brief treatment for MA use in patients with dual diagnosis would be possible if it was adjusted to patient-specific needs within the existing system and if the team adapting the treatment were cognizant of existing and potential challenges. CONCLUSIONS: The adaptation and integration of a brief treatment for MA use among patients with severe mental disorders was considered possible and even necessary if existing and potential challenges were carefully addressed.