Browsing by Author "Hoare, Jacqueline"

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    Open Access
    A Retrospective Analysis of Referrals to Consultation-Liaison Psychiatry over a Five-Year Period in a Tertiary Hospital in South Africa
    (2022) Romburgh, Bailee Jean; Hoare, Jacqueline
    Objective: The aim of this study was to review referrals to the consultation-liaison psychiatric service at Groote Schuur Hospital including the number of referrals, demographic details of referred patients, medical and psychiatric diagnoses, management and outcome over a five-year-period. It was anticipated that referrals had increased on an annual basis. Method: The study was observational and was conducted at Groote Schuur Hospital in Cape Town, South Africa. All inpatients referred to consultation-liaison psychiatry (CLP) during the study period were included. The study information was gathered via data capture sheets that are completed for patients referred to the division. Results: A total of 1978 patients were referred to CLP and analysed in the study. Most referrals occurred in 2018 (n=499; 25.2%). The majority of referrals came from the division of internal medicine (n=607; 30.7%), and the main reasons for referral were unspecified (n=402; 20.3%), suicide/risk assessment (n=333; 16.8%), and other symptoms of mental illness (n=264; 13.3%). The most frequent immediate management included medication initiation or adjustment (n=793; 40.1%), and supportive counselling/psychoeducation (n=511; 25.8%). Conclusion: Referral numbers to the division have increased during the study period as hypothesized. As expected, most referrals came from the internal medicine division. The results from this study highlight the importance of the consultation-liaison service at Groote Schuur Hospital.
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    Common Mental Disorders Among Adolescents Accessing HIV Treatment In Cape Town, South Africa
    (2020) Mtukushe, Bulelwa; Sorsdahl, Katherine; Hoare, Jacqueline
    Background: At the present time, data on the prevalence of common mental disorders (CMD) among adolescents living with HIV (ALHIV) in South Africa (SA) is limited. Studies that exist focus mainly on HIV-infected adults with mental health problems besides a few studies investigating depression and anxiety in children and adolescents living in SA. Research on the mental health of this vulnerable population remains very limited. Therefore, this study aims to address this gap by assessing the prevalence of CMD among adolescents living with HIV in SA; and determining the factors associated with CMD among this vulnerable population. Specific objectives: Specific objectives included, assessing the CMD among adolescents accessing ARV treatment; and determining factors associated with CMD among adolescents accessing HIV treatment. Methods: 121 Participants were recruited into the study through convenience sampling and interviewed. To be included in the study, participants had to be 10 to 19 years old; have knowledge of their own HIV-positive status; and presently on HIV treatment. Participants over 18 years were excluded if they did not provide informed consent and those under 18 were excluded if parent consent or adolescent assent was not obtained. Interviews with participants were conducted by study research assistants using a survey questionnaire which included the following mental health measures; Beck Depression Inventory for youth (BDI-Y), Beck Anxiety Inventory for youth (BAI-Y). Data collection for the study took place at two HIV treatment clinics in Cape Town, Groote Schuur hospital and Kuyasa clinic. Two logistic regression models were developed. Unadjusted and adjusted associations between socio-demographics, SES, food insecurity, alcohol use, years child known status and the presence of anxiety and depression were explored through logistic regression. Age, gender and variables that were significant in the unadjusted associations were included in the adjusted logistical regression models. Significance was set at p<0.05. Results: Four main findings emerged from the current study: 13.2% of participants were at risk for anxiety and 13.2% were at risk for depression; 6.6% participants were at risk for both anxiety and depression; the only variable associated with anxiety was socio-economic status and this was only significant in the unadjusted model; and the only variable associated with depression was highest level of schooling completed (i.e. currently in high school/completed high school) and this was significant in both unadjusted and adjusted models. Overall, adolescents with a higher educational level were less likely to develop depressive symptoms (adjusted model: OR=0.10, 95% CI 0.02-0.68). Conclusion: The present study assessed the prevalence of CMD, including determining the factors associated with CMD among adolescents accessing HIV treatment in Cape Town. Findings revealed that participants were at risk for anxiety, depression and comorbid anxiety and depression. Only highest level of schooling completed was found to be a protective factor against depression for this vulnerable population. Based on these findings, considerations for improving mental health outcomes for this population should include, screening for mental health conditions in ARV clinics, early identification and treatment of mental health problems, and evidence-based mental health counselling
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    Common Mental Disorders Among Adolescents Accessing HIV Treatment In Cape Town, South Africa
    (2020) Mtukushe, Bulelwa; Sorsdahl, Katherine; Hoare, Jacqueline
    Background: At the present time, data on the prevalence of common mental disorders (CMD) among adolescents living with HIV (ALHIV) in South Africa (SA) is limited. Studies that exist focus mainly on HIV-infected adults with mental health problems besides a few studies investigating depression and anxiety in children and adolescents living in SA. Research on the mental health of this vulnerable population remains very limited. Therefore, this study aims to address this gap by assessing the prevalence of CMD among adolescents living with HIV in SA; and determining the factors associated with CMD among this vulnerable population. Specific objectives: Specific objectives included, assessing the CMD among adolescents accessing ARV treatment; and determining factors associated with CMD among adolescents accessing HIV treatment. Methods: 121 Participants were recruited into the study through convenience sampling and interviewed. To be included in the study, participants had to be 10 to 19 years old; have knowledge of their own HIV-positive status; and presently on HIV treatment. Participants over 18 years were excluded if they did not provide informed consent and those under 18 were excluded if parent consent or adolescent assent was not obtained. Interviews with participants were conducted by study research assistants using a survey questionnaire which included the following mental health measures; Beck Depression Inventory for youth (BDI-Y), Beck Anxiety Inventory for youth (BAI-Y). Data collection for the study took place at two HIV treatment clinics in Cape Town, Groote Schuur hospital and Kuyasa clinic. Two logistic regression models were developed. Unadjusted and adjusted associations between socio-demographics, SES, food insecurity, alcohol use, years child known status and the presence of anxiety and depression were explored through logistic regression. Age, gender and variables that were significant in the unadjusted associations were included in the adjusted logistical regression models. Significance was set at p<0.05. Results: Four main findings emerged from the current study: 13.2% of participants were at risk for anxiety and 13.2% were at risk for depression; 6.6% participants were at risk for both anxiety and depression; the only variable associated with anxiety was socio-economic status and this was only significant in the unadjusted model; and the only variable associated with depression was highest level of schooling completed (i.e. currently in high school/completed high school) and this was significant in both unadjusted and adjusted models. Overall, adolescents with a higher educational level were less likely to develop depressive symptoms (adjusted model: OR=0.10, 95% CI 0.02-0.68). Conclusion: The present study assessed the prevalence of CMD, including determining the factors associated with CMD among adolescents accessing HIV treatment in Cape Town. Findings revealed that participants were at risk for anxiety, depression and comorbid anxiety and depression. Only highest level of schooling completed was found to be a protective factor against depression for this vulnerable population. Based on these findings, considerations for improving mental health outcomes for this population should include, screening for mental health conditions in ARV clinics, early identification and treatment of mental health problems, and evidence-based mental health counselling
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    Depression amongst caregivers of children and adolescents with perinatally acquired HIV in Cape Town, South Africa
    (2022) Booysen, Gillian; Hoare, Jacqueline; Phillips, N
    Background Depression remains the most commonly diagnosed mental health disorder. It adds significantly to the global burden of disease and is responsible for the most years of life lost to disability in both men and women (Rehm & Shield, 2019). The successful roll-out of antiretroviral therapy (ART) to those living with HIV has resulted in the emergence of an increasing population of children and adolescents with perinatally acquired-HIV (PHIV) requiring care. Caregivers of PHIV are at increased risk for the development of depression due to parental, child and socio-economic factors. Few studies have focused on the specific factors associated with caregiver depression in the context of caring for ART-treated and untreated PHIV. Aims and Objectives The aims of this cross-sectional study are to assess the prevalence of depression in caregivers of PHIV compared with caregivers of a HIV-seronegative matched control group (HC). In the HIV-impacted families, a comparison will be drawn between the prevalence of depression in biological and non-biological caregivers. Factors associated with depression in this vulnerable group will be assessed using various caregiver, child and socio-economic measures. Methods Caregivers of 75 PHIV and 30 HC were selected from a community healthcare setting in Cape Town. Results There was no difference found between levels of depression in PHIV caregivers (biological or non-biological) and caregivers of HC. Internalising and externalising child behaviours, poor family resources (including basic needs, money, time for self and time for family) and limited social support were associated with depression in both caregiver groups. In caregivers of HC, parental stress was associated with higher levels of depression. Conclusion Factors independent of HIV status of children may be driving depression in caregivers of children and adolescents in Cape Town, South Africa where HIV is endemic. Thus, this study could facilitate a better understanding of depression in the context of caring for PHIV and better inform interventions in these vulnerable family systems.
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    A diffusion tensor imaging and neurocognitive study of ART-naïve and ART-treated children in Cape Town
    (2015) Hoare, Jacqueline; Stein, Dan J
    There are still no diagnostic criteria for a spectrum of neurocognitive disorders (ND) secondary to HIV infection for children. The American Academy of Neurology (AAN) proposes guidelines for assessment of HIV associated neurocognitive disorders (HAND) in HIV infected adults. A cross-sectional clinical cohort study was initiated in Cape Town, in which 120 participants, including a HIV negative healthy control group for comparison, completed clinical and neurocognitive assessments. HIV infected children were either stable on antiretroviral treatment (ART) for a minimum of 6 months or ART naïve. Neuroimaging was completed on 105 children in the cohort study. We compared 75 children vertically infected with HIV aged 6 to 16 years, including both children on antiretroviral therapy (ART) and ART-naïve, with 30 matched controls using diffusion tensor imaging (DTI) measures. We then used the detailed neurocognitive battery; an assessment of adaptive functioning and the AAN system for diagnosing ND to establish whether this system could detect a spectrum of ND in HIV infected older children and adolescents. When comparing HIV uninfected children to HIV infected children this DTI study found damaged neuronal microstructure in the HIV infected children. Significant associations were found between failing first line ART regimen, socio-demographic factors, nutritional-hematological status, HIV-relevant clinical variables, cognitive functioning and white matter integrity in children stable on ART. Children with a clinical diagnosis of encephalopathy (HIVE) had greater white matter damage when compared ART treated children without encephalopathy. DTI also found significant myelin loss in ART naïve children when compared with ART treated children. Using the AAN criteria for HAND, we found that 45.35% of the HIV infected children had a ND. ART naïve slow progressors, who receive limited attention from heath care service s, as they are thought to be 'well', were found to have neurocognitive impairment and white matter microstructural damage. HIV infected children were also more likely to have impaired competence in various domains of functioning. The current findings also underline the possible association of first line treatment failure with white matter brain dysfunction in children on ART. Despite the use of ART and improved virological control with immune reconstitution, there were still a significant percentage of children in this study who were found to have ND. Our findings also suggest that children on ART remain at risk for developing CNS disease, and that this risk extends to physically well ARV naïve slow progressors. The AAN HAND criteria designed for adults was able to identify children and adolescents with important functional cognitive impairments who don't fit criteria for HIVE and would therefore not have been identified otherwise.
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    Factors associated with deliberate self-harm method among patients in a tertiary hospital in South Africa
    (2018) Pieterse, Deirdre; Hoare, Jacqueline; Louw, Kerry-Ann
    Background: Hospital-based research provides important insight into the burden of suicide behaviour and methods used in deliberate self-harm (DSH). The information on methods used in DSH may be useful to plan suicide-related intervention and prevention programmes. We aimed to investigate the socio-demographic and clinical factors associated with the methods used in DSH at a tertiary hospital in Cape Town, South Africa. Methods: Socio-demographic, clinical and treatment data were collected from 238 consecutive DSH patients who presented for emergency department treatment at the hospital. Univariate analyses and a logistic regression model were used to explore the associations between these variables and violent and non-violent method of DSH. Results: Self-poisoning was the most common method of self-harm (80.3%, n=191). Prescription medication was the most common form of self-poison (57.6%, n=137) while a large number of patients used the non-prescription medication paracetamol (40.9%, n=54). In the bivariate regression analysis, male gender, stating that the reason for DSH was to escape a situation and history of substance use were associated with violent method of DSH. Conclusion: This study contributes to emerging literature on methods used in DSH in South Africa. There is an urgent need to improve monitoring of prescription medication commonly used in DSH. More research on the source of prescription medication and its relationship to DSH is needed. Limiting the quantity and reviewing the packaging of paracetamol available in supermarkets may be effective strategies of means restriction that could be adopted in South Africa. This study underscores the need for increased collaboration between the Department of Social Development and the Department of Health in providing substance use interventions to high-risk population groups.
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    Inpatient referrals to consultation-liaison psychiatry at a tertiary hospital in South Africa
    (2016) Torline, John Ross; Hoare, Jacqueline; Louw, K
    Introduction. Consultation-liaison psychiatry is the subspeciality that provides for the psychiatric assessment and management of patients in a hospital setting, serving as an interface between psychiatry and other medical disciplines. This study aimed to provide an analysis of the Consultation-liaison psychiatry service at Groote Schuur Hospital. It was hypothesised that the hospital has a large burden of psychiatric illness amongst inpatients with unique characteristics and high rates of referrals related to HIV, alcohol and methamphetamine use. Methods. A retrospective review was performed of all inpatients referred for psychiatric consultation from other departments over a period of thirteen months. Patients referred by the emergency medical and surgical departments were excluded from this study, as they are seen by the department of emergency psychiatry. Results. A total of 452 patients (males n=174; females n=278) between the ages of 12 and 90 years were consulted, with the majority of the patients (82%, n=360) belonging to the age group of 18 to 59 years (mean age of 37 years). The referral rate to Consultation-liaison psychiatry was 0.95% (when combined with emergency psychiatry referrals the combined referral rate was 4.7%). Most referrals were from the department of medicine (56%, n=252), with the highest number of medical subspeciality referrals from neurology (6%, n=29). Request of a general review (69%) of current psychiatric symptoms (87%) occurred most frequently. The most common symptoms noted by the referring non-psychiatrist were mood symptoms (n=159; 36%), followed by suicidal behaviour (23%, n=102) and behavioural problems (21%, n=94). The mean number of psychiatric diagnoses following assessment was one (SD 1; 0:5), and most patients were assigned a definitive diagnosis (78%, n=342). Alcohol use disorder was diagnosed in 9% (n=41). Methamphetamine use was identified in 5% (n=22) of patients, with the majority being diagnosed with methamphetamine abuse. The use of other substances was identified in 9% (n=38). The HIV status was confirmed positive in 16% (n=70), with the majority of this group being female (67%). Most subjects had psychosocial and environmental problems (55%, n=249). Registrars performed a mean number of one consultation and the majority of patients were seen within 24 hours of the referral. Medication was initiated in 31% (n=139) of cases. The majority (65%, n=292) of patients were discharged from psychiatric care, and 14% (n=61) required admission to an inpatient psychiatric unit. Conclusion. The combined referral rate (consultation-liaison and emergency psychiatry) compares favourably to that of high-income countries, and is higher than any other published studies of this nature in low-income and middle-income countries. There was no substantial agreement between psychiatrist and non-psychiatrist diagnoses. As expected, mood disorders were the most common diagnoses, with only fair agreement between psychiatrist and non-psychiatrist clinicians. A high proportion of referred patients were substance users, but methamphetamine rates were lower than expected and the rate of HIV was higher than anticipated. The results presented here may facilitate improvements in the practice of Consultation-liaison psychiatry.
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    Neuropsychological outcomes in adults commencing highly active anti-retroviral treatment in South Africa: a prospective study
    (BioMed Central Ltd, 2012) Joska, John; Westgarth-Taylor, Jennifer; Hoare, Jacqueline; Thomas, Kevin; Paul, Robert; Myer, Landon; Stein, Dan
    BACKGROUND:Infection with HIV may result in significant neuropsychological impairment, especially in late stage disease. To date, there have been no cohort studies of the impact of highly active anti-retroviral treatment (HAART) in South Africa where clade C HIV is predominant. METHODS: Participants in the current study were recruited from a larger study of HIV-associated neurocognitive disorders (HAND) and included a group of individuals commencing HAART (n = 82). Baseline and one-year neuropsychological function was assessed using a detailed battery, and summary global deficit scores (GDS) obtained. Associations with change in GDS were calculated. RESULTS: Participants had a median CD4 cell count of 166 at baseline and 350 at follow-up. There were significant difference across groups of GDS severity at baseline with respect to level of education and GDS change at one year (p = 0.00 and 0.00 respectively). Participants with severe impairment at baseline improved significantly more than those with lesser degrees of impairment. Significant improvements were observed in the domains of attention, verbal fluency, motor function, and executive functions. There were unadjusted associations between GDS change and male gender, lower levels of education, baseline CD4 count and baseline GDS severity. In an adjusted model, only baseline GDS severity (p = 0.00) remained significant, with a lower level of education nearing significance (p = 0.05). The overall model was highly significant (p = 00; r-squared = 0.58).DISCUSSION:In individuals in late stage HIV commencing HAART in South Africa, those with severe baseline neuropsychological impairment improved significantly more than those less impaired. While improvement across a number of neuropsychological domains was observed, high rates of impairment persisted. CONCLUSIONS: The effects of HAART and participant variables, such as test experience, require clarification. Studies with larger comparison groups, and where HIV disease characteristics are needed to establish whether the trends we identified are clinically meaningful.
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    The relationship between neurocognitive disorders, prospective memory impairment and white matter damage in clade C HIV-positive subjects
    (2010) Hoare, Jacqueline; Joska, John Anton; Stein, Dan J
    AIMS: To examine the relationship between prospective memory, cognitive function and Diffusion tensor imaging (DTI)/ White matter integrity of human immunodeficiency virus (HIV) positive individuals in the Western Cape. We hypothesize that: 1. Individuals infected with HIV will exhibit significantly poorer microstructural integrity of the white matter than HIV negative individuals, as determined by in vivo diffusion tensor imaging. We expect that values of fractional anisotropy (FA) - a measure of directional water diffusion- in the frontal white matter will be significantly lower among HIV patients compared to controls 2. Lower FA measured in the frontal white matter will correlate significantly with impaired performance on tests of prospective memory
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    Structural brain connectivity of HIV-positive children: a graph network analysis study
    (2018) Fouche,Jean-Paul; Stein, Dan J; Hoare, Jacqueline; Meintjes, Ernesta
    Vertical transmission of human immunodeficiency virus (HIV) from mother to child is a major problem in sub-Saharan Africa. As in adults, a variety of cognitive impairments may be evident in HIV infected children being treated with combined antiretroviral therapy (ART). The HIV virus compromises visual perception, attention, memory, language and executive functioning. Prior imaging studies have shown abnormal brain structure in adults and children infected by HIV. Graph theory analyses have been applied to HIV neuropathogenesis previously, these have demonstrated significant disruptions to brain connectivity in older HIV+ adults on treatment. However, no previous studies have investigated the same topological organization or structural connectivity of brain structure in infected children, or correlated this with markers of disease severity. The aims of this project were first, to delineate the topological organization of brain structure in children living with HIV currently on treatment and contrast it with healthy HIV negative children, second to investigate differences in measures of brain structure between healthy controls and children living with HIV and third to correlate brain imaging measures with markers of disease severity. The studies presented here examine the structural connectivity between nodes in the brain by utilizing magnetic resonance imaging and graph theory methods, and also investigated gray matter structure and cortical complexity. Children living with HIV displayed abnormal structural connectivity in regions of the dorsal posterior cingulate and inferior frontal gyrus of the frontal lobe, as well as in superior regions of the temporal lobe when compared to healthy HIV negative children. Significantly decreased cortical thickness was found in precentral and postcentral regions and the superior and middle frontal regions of children living with HIV compared to the healthy group. Deficits in cortical complexity of the inferior frontal gyrus and fusiform gyri were also apparent in the HIV infected group. Cortical thickness, surface area and gyrification were positively associated with CD4 count as a marker of disease severity. In conclusion, this project demonstrated abnormal brain structure and structural connectivity of brain structure in regions involved with motor development, executive function, and language fluency and generation in treated children living with HIV. Abnormal structural connectivity may indicate disruption to brain network integrity in developing children. Even in the post-ART era, infected children remain at risk for abnormal brain development. Longitudinal studies in larger cohorts are needed to address the issue of changes in brain structure and topology over time during adolescent brain development.