OpenUCT :: Browsing by Author "Kaliski, Sean"

Browsing by Author "Kaliski, Sean"

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Open Access
A retrospective audit comparing state patients with schizophrenia and bipolar mood disorder who have committed violent crime admitted to the male forensic unit at Valkenberg Hospital
(2018) Maharaj, Avani; Kaliski, Sean
Background There is a consensus that psychosis confers a modest risk toward violent offending. Most research to date has shown that a statistical relationship does exist between schizophrenia and bipolar disorder, and violence and aggressive behavior In forensic mental health, state patients are rehabilitated in a general program regardless of diagnosis. It is not known whether different rehabilitation management strategies should be implemented on those with bipolar disorder as compared to those with schizophrenia. This study is an attempt to ascertain if there are differences between those diagnosed with schizophrenia and bipolar disorders, and if so, whether these have implications for their rehabilitation programs. Objectives The study aims to compare the demographic profiles and comorbidities (in terms of substance use and personality disorders) of state patients with bipolar disorder and schizophrenia who have offended violently. Methods This was a quantitative, cross sectional study. State patients who were diagnosed with schizophrenia and bipolar disorder and committed a violent crime were included in the study from the 1st January 2000 to 31st December 2014. The study population comprised a total of 93 male state patients. Of these 46 patients had a diagnosis of bipolar disorder and 47 patients had a diagnosis of schizophrenia. Results The results show that in general the differences between the schizophrenia group and the bipolar disorder group are marginal. A higher percentage of patients with schizophrenia committed murder at 17.02% and attempted murder at 12.77%. The bipolar disorder group had a significantly higher number of patients diagnosed with co morbid personality disorder at 59.57% (p value of 0.01.) Substance abuse was common in both groups. The mean age at admission was 31,23 years in schizophrenia and 36,85 years in bipolar disorder. This demonstrates an earlier onset of criminality in the group with schizophrenia. Patients with bipolar disorder were more likely to be married (13.04%), divorced (10.8%) or separated (2.17%). Conclusion There were no major differences elicited between the 2 groups of patients. Certain aspects such as therapeutic programs for personality disordered patients and social interventions in patients with poor social support would contribute to improving the quality of the rehabilitation programs currently used. The commonalities found in the 2 groups suggest that a common approach to rehabilitation would be adequate in this setting.
Open Access
An Investigation of Male Observation Cases That Had Been Charged With Murder to Compare Those Diagnosed With Schizophrenia to Those Diagnosed With Bipolar or Schizoaffective Disorders
(2021) Gondwe, Saulos Kalizga; Kaliski, Sean
Background The prevalence of violent crime, including murder, is moderately but significantly increased amongst those with severe mental illness compared to the general population. Understanding the characteristics of mentally ill murder offenders may help in the application of evidence-based treatment and rehabilitation strategies. Rationale In the Republic of South Africa (R.S.A), little is known about the characteristics of patients with severe mental illness who are charged with murder. This study has the potential of improving our understanding of these patients. This would subsequently facilitate the development of evidence based interventions in the South African context. Aims The current study aimed to describe the demographic, clinical and criminological characteristics of murder offenders with a diagnosis of schizophrenia or bipolar/schizoaffective disorder and to establish if there are any differences between the two patient groups. Methods Clinical records of male patients diagnosed with schizophrenia or bipolar/schizoaffective disorder following a charge of murder who had been admitted as State patients to the forensic unit of Valkenberg Hospital (VBH) were reviewed. Purposive sampling was used. Data were collected using a questionnaire specifically designed for the study. Those with comorbid intellectual disability (ID) or a neurocognitive disorder and those with missing information were excluded. Ethical approval was obtained from the University of Cape Town, faculty of health sciences human research ethics committee. Results Thirty-seven male patients were included in the study. Twenty-three had a diagnosis of schizophrenia and fourteen had a diagnosis of bipolar/schizoaffective disorder (SCAD). The mean age of the sample was 32.54 years (range: 17-50). Most had a secondary school level of education and were unemployed. There were no sociodemographic differences between the two groups. Persecutory delusions were the most common symptom for both groups (67.57%). The majority of patients had a psychiatric admission prior to the index offence (62.16%). The modal duration of illness for schizophrenia prior to the index offence was less than one year (37.5%) and more than ten years for bipolar/SCAD patients (57.14%). Comorbid personality disorder (PD) was present in 62.5% of the sample. Antisocial PD was the most prevalent. The most commonly used substances were cannabis (70.27%) and alcohol (59.46%). Bipolar/SCAD patients were more likely to use other substances than alcohol or cannabis compared to schizophrenic patients. 89% of the victims were known to the offenders. Family members were victims in 65.2% of the murders. Most of the victims were male (70.27%). Most of the murders occurred at home (75.68%). Schizophrenia patients were more likely than bipolar/SCAD patients to commit the murder at home. Stabbing with a knife was the most common method of murder for both groups (49.45%). Conclusions and Recommendations It can therefore be concluded that patients with schizophrenia or bipolar/SCAD share most demographic, clinical and criminological characteristics which are thought to play a causative role in the commission of murder. Hence, they do not require different rehabilitation strategies. However, general rehabilitation programs for both patient groups should cover several important areas including: social deficits, occupational functioning, substance misuse, treatment adherence and family involvement. Forensic rehabilitation programs should also fully integrate dual diagnosis interventions. Risk assessment and management in both civil and forensic psychiatry services should specifically address persecutory delusions. This should include optimising psychotropic treatment, cognitive behavioural approaches and emphasis on clinicians' duty to warn any potential imminent victims. There should be more robust assessment for comorbid personality disorders as this has a significant impact on the course of illness and the risk for recidivism. In future, a South African multicentre study of similar design should be conducted to increase the sample size and improve the generalisability of the study findings. Future studies should also examine female murder offenders as a separate sample as they may essentially be different from male murder offenders.
Open Access
Characteristics of domestic homicide perpetrated by persons with severe mental illness - a forensic psychiatry observation population-based study
(2017) Bruwer, Marise; Kaliski, Sean
Background: Domestic homicide (killing of a person aged 16 or older by a family member or a current or former partner) accounts for 50% - 70% of homicides perpetrated by offenders with mental illness. Despite these statistics, surprisingly little is currently known about the characteristics of domestic homicides perpetrated by those with severe mental illness. To the best of our knowledge, domestic homicide in the context of severe mental illness has not been researched in South Africa. Objective: To investigate domestic homicides by offenders with severe mental illness referred to the Forensic Mental Health Service at Valkenberg Hospital for forensic psychiatric observation. Methods: A five-year retrospective folder review was conducted to obtain data on the characteristics of offenders and victims, as well as the circumstances surrounding the homicide. Results: The majority of the offenders in our sample were young (mean age of 31), single, unemployed males who were known to mental health care services. Substance use disorders and non-adherence to medication were common. Psychotic disorders were the most prevalent diagnoses. The majority of victims were male and a significant minority of the domestic homicides were parricides (28.6%). The incident took place at the victim's residence or the victim and perpetrator's shared residence in most cases. Stabbing was the most common method used. Almost half of the perpetrators were psychotic when the incident took place and 60% of these were first episode psychoses. In spite of the high prevalence of substance use disorders (66.7%), only 23.8% of the sample reported that they were intoxicated when they committed the offence. Conclusions: The majority of our sample was known to mental health care services. This implies that there were potential missed opportunities to prevent these lethal assaults. Our research identified treatment adherence, comorbid substance use disorders and aggressive treatment of first episode psychosis as a possible focus of future interventions in order to prevent domestic homicides due to mental illness.
Open Access
The elderly, arginine vasopressin & selective serotonin reuptake inhibitors
(1999) Kirchner, Vincent; Kaliski, Sean
The association between selective serotonin reuptake inhibitors (SSRis) and hyponatraemia has been well documented, the elderly appearing to be at greatest risk. An analysis of data of hyponatraemia in the elderly using SSRis from all published cases and from the Committee on Safety of Medicines found that the mean time to detection was about 3 weeks after commencing SSRis. A wide range of time to detection (1-253 days) and non-specific symptoms suggest hyponatraemia is detected by chance rather than being specifically looked for. This is probably a sporadic, idiosyncratic phenomenon that is not dose related as A VP function determined by serum and urine concentrations was found to be normal in six elderly patients using sertraline. In the elderly there are physiological changes, a high prevalence of medical illnesses and concomitant drug use which may precipitate hyponatraemia. Together with a risk of altered water regulation in psychiatric illness this may account for the particular susceptibility of this group to hyponatraemia whilst using SSRis. AIMS & HYPOTHESIS: This dissertation will explore the physiology of Arginine V asopressin and how changes in this system along with other physiological changes in the elderly make the elderly susceptible to hyponatraemia. This problem will then be explored in the context of elderly people with depression using SSRis which are known to cause hyponatraemia. In the first part of the research section the aims are to report the published cases of hyponatraemia occurring whilst using SSRis from the United Kingdom and specifically focus on cases in people 60 years and older. Secondly to re-analyse all case reports in the literature looking only at this population. The third aim was to investigate whether dysregulation of vasopressin function in the elderly using SSRis is a sporadic or usual phenomenon. The null hypothesis is that A VP function is not disturbed by SSRis.
Open Access
Family Histories of Mental Illness and Violence in State Patients
(2021) Vogts, Elizabeth; Roffey, M; Kaliski, Sean; Ramesar, S
Background: It is known that both severe mental illness and violence have genetic components. Multiple genes play a role in the cause of violent behaviour. Violence is one of the leading causes of death for young people in South Africa and yet little is known about its prevalence in state patients and their family members. Aim: This study aimed to investigate the prevalence of violence and mental illness in the families of state patients, to what extend these coincide and to compare schizophrenia and mood psychosis in that context. Setting: The study included 60 state patients' folders, all of whom were diagnosed with a psychotic disorder, in accordance with DSM5 criteria. The subjects were divided into two groups: those who have committed violence and those who have not committed violence. Method: Patients' folders were selected by purposive sampling. These folders were then reviewed by the researcher and a questionnaire was completed. Results: Violent patients had more first-generation relatives with violent convictions (68.2%), compared to 36.4% of non-violent patients. Only 3.3% of non-violent patients witnessed domestic violence, whereas 13.3% of violent patients witnessed domestic violence. A significantly higher proportion of patients with bipolar disorder had been convicted of physical assault (p=0.035). 17.6% of violent schizophrenia patients had a family history of violence and mental illness, compared to 18.2% of violent patients with mood psychoses which is not statistically significant. Conclusion: It was found that violence runs in families and that mental illness and violence was prevalent in the described group. Of further concern was that more violent patients witnessed domestic violence compared to non-violent patients, emphasising the idea that the cause of violence is multifactorial (genetic, environmental), and that identification of not only high-risk patients but also high-risk families need to be implemented.
Open Access
The prevalence of physical illness in defendants referred for psychiatric observation
(2013) Young, Merryn; Kaliski, Sean
The rationale of doing thorough medical screening of all psychiatric patients is clear, because there is a relationship between medical illness and mental illness. It remains unresolved which screening tests should be performed routinely in general psychiatric patients even though the prevalence of medical illness is relatively high. Even less is known about the prevalence of medical illnesses in criminal defendants referred for observation, most of whom do not have a serious psychiatric disorder. Special investigations may be necessary in the diagnosis of these medical conditions. Within the context of psychiatry as a whole, the population referred for forensic observation may be subject to more stringent investigation as a legal requirement. However there is little information available on this group regarding the prevalence of medical illnesses and the impact that these have on the psycho-legal assessment. This study will therefore seek to assess the current practice of routine investigations in assessing criminal defendants that have been referred to the forensic observation unit in order to assess whether these findings contribute significantly to the psycho-legal assessment, and to determine the prevalence of medical illness in this population. It is hoped that it will be possible to decide whether there is utility to do routine tests, essentially by coercion, in this group.
Open Access
A retrospective analysis of factors used to assess fitness to stand trial in adult male defendants referred for psychiatric observation
(2017) Jacobson, Candice; Kaliski, Sean
Background. A court orders a forensic observation of a defendant to determine a defendant's fitness to stand trial and/or ability to appreciate wrongfulness of action (criminal responsibility) at the time of the alleged offence. Fitness to stand trial is the focus of this review rather than criminal responsibility. In this instance, the court requests an expert to determine whether the defendant's current mental state would significantly impair his or her ability to participate meaningfully in his or her own trial. In South Africa, this process involves multiple assessments by a multidisciplinary forensic psychiatry team in a dedicated forensic psychiatry unit. However, at present no standardised format has been adopted for such an evaluation, the findings of which may have dire consequences for the individual being assessed. Furthermore, there is a paucity of current literature on fitness to stand trial evaluation. Objectives. To establish whether fitness to stand trial is adequately assessed in the Western Cape, South Africa. A further objective is to establish whether mental illness is the sole factor that differentiates defendants fit to stand trial from those who are found not fit to stand trial, and whether defendants with mental illness are less likely to be asked the relevant questions to determine fitness to stand trial than those without mental illness. Methods. A descriptive, retrospective review was conducted (via the application of a checklist) of clinical records of the last 100 male defendants' ≥18 years of age admitted to the Valkenberg Hospital Forensic Psychiatry Unit prior to March 2015. Results. 30 defendants (30%) were found to have a psychiatric diagnosis. Of the 30 defendants, all were noted to have a serious mental illness (mostly psychotic disorder or cognitive impairment) and were found not fit to stand trial. Seventy (70%) of the defendants were found fit to stand trial by the expert panel. From the findings, it was noted that the forensic team asked and recorded the necessary factors to determine fitness to stand trial in 56% of the study population (based on frequency of responses: n = 894), with 32% of questions not appearing to have been addressed at all (especially those pertaining to role players in court and a defendant's understanding of his rights). Furthermore, various questions appeared to have been indirectly addressed in fewer than 50% of defendants. No significant difference was noted in how the forensic team conducted its assessments between those defendants found to have a serious mental illness and those without serious mental illness. Conclusion. The results of the study suggest the need for a more in-depth review of the forensic evaluation process in the Western Cape to further ascertain the benefits of using a checklist during the evaluation process. Furthermore, additional research would assist in determining the factors contributing to a number of questions not having been addressed and the consequences thereof.
Open Access
The Prevalence Of Metabolic Disorders And Their Associated Risk Factors In Forensic Patients With Schizophrenia Spectrum Disorders On Clozapine Compared To Haloperidol At Valkenberg Hospital
(2019) Mungly, Shazia; Kaliski, Sean
Background: Various studies have shown that people with serious mental illness have an increased risk for metabolic syndrome with prevalence ranging from 28.7% to 60%. Given the amount of evidence suggesting a link between clozapine and metabolic syndrome, several guidelines have recommended regular clinical monitoring of metabolic syndrome in patients on clozapine. Aim: To determine the screening, prevalence and associated risk factors of metabolic disorders in forensic patients with schizophrenia spectrum disorders who are on clozapine (study group) compared to patients on haloperidol (control group). Methods: It is a retrospective, folder review of forensic male adult patients at Valkenberg Hospital, Observatory Cape Town. Results: There were 45 patients in the study group and 23 patients in the control group. Eight patients (17.8%) in the study group (Clozapine) met criteria for metabolic syndrome according to the NCEP-ATP III criteria and none of the patients in the control group (Haloperidol) did (χ 2 (1) = 4.441, p = .035 V = .257). Patients who had a diagnosis of schizoaffective disorder were also on mood stabilisers in addition to clozapine. Again, while none of the patients on Haloperidol met the criteria for Metabolic syndrome, 6 (24%) of the 25 patients on concurrent Clozapine and sodium valproate did, (χ 2 (1) = 6.051, p = .023 V = .359). In terms of metabolic disorders, a significantly higher proportion of patients in the study group has hypertension and hyperlipidaemia (p = .003 and p = .021 respectively). Less than 25% of all patients were fully screened for metabolic syndrome. There was a very low rate of screening of blood tests: fasting glucose, total cholesterol, trigylcerides, High Density Lipoprotein(HDL) or Low-Density Lipoprotein (LDL). Conclusion: The prevalence of metabolic syndrome was higher in the clozapine group than haloperidol group, which is unsurprising since clozapine is usually associated with a higher risk of metabolic syndrome. However, the prevalence on metabolic syndrome in this study sample was relatively low compared to other studies. This could be due to the low rate of screening of each criteria of metabolic syndrome. Screening for metabolic syndrome should be regularly performed by health professionals in patients with serious mental illness. Further studies are needed to investigate the risk of metabolic syndrome for patients who are on a combination of clozapine and mood stabilisers.

Browsing by Author "Kaliski, Sean"

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