Browsing by Author "Joska, J A"

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    Dealing with major depression in general practice
    (South African Academy of Family Physicians, 2013) Freeman, C P; Joska, J A
    One in ten South Africans will be diagnosed with major depressive disorder (MDD) at some point in their lives. MDD is a potentially disabling condition that affects many spheres of an individual's life and leads to marked social and occupational dysfunction. General practitioners are frequently required to diagnose and manage MDD, often in a time-pressured primary healthcare setting. This article aims to provide practitioners with an overview of MDD. It covers aspects of diagnosis, co-morbidity, pharmacology and special patient groups.
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    Integrating Mental Health into General Health Care: Lessons From HIV
    (2012) Joska, J A; Sorsdahl, K R
    Mental disorders are highly prevalent across all health settings. Where they are co-morbid with other chronic physical disorders, a complex bidirectional relationship exists between them. While mental disorders may result in an increase in adverse healthrelated outcomes, they are amenable to cost-effective treatments. In resource-limited settings, many barriers to the detection and treatment of mental disorders exist. One approach to the effective targeting of the available resources is to utilize a “risk-flag” approach, wherein individuals at-risk of treatment failure are identified and routed into more intensive mental health screening and intervention. This paper discusses how lessons from HIV services may inform how to improve mental health care and integration in HIV settings, as well as in other chronic diseases.
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    Needs and services at an in-patient psychotherapy unit
    (2007) Joska, J A; Flisher, A J
    Objective: To describe the impact of services provided, during an admission, on unmet needs and correlates of unmet needs. Method: The study used a modified version of The Camberwell Assessment of Need (CAN) to assess the perceived needs of 100 patients on admission to a psychotherapy unit, Valkenberg Hospital, Cape Town. At discharge, the study documented the extent to which the patients had perceived services and interventions to be useful. Results: The mean number of needs on admission was 8.6. At discharge, help received was highest for psychiatric needs. The services most often regarded as useful were organised group activities and therapies. Regression analysis suggests that a lower level of education and the presence of borderline personality traits contribute significantly to unmet need on discharge. Conclusion: The in-patient program is effective in meeting psychiatric needs, but less useful for addressing psycho-social needs. These needs may exacerbate psychiatric problems and should be managed more actively before, during and after an in-patient stay
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    The neurobiology of HIV dementia: implications for practice in South Africa
    (OMICS International, 2011) Joska, J A; Hoare, J; Stein, Dan J; Flisher, A J
    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.