OpenUCT :: Browsing by Author "Temmingh, Henk"

Browsing by Author "Temmingh, Henk"

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Open Access
Cluster analysis of disorders characterized by impulsivity in patients with methamphetamine use disorder
(2019) Rall, Edrich; Lochner, Christine; Temmingh, Henk
Background Individuals with methamphetamine use disorder (MUD) frequently present with psychiatric comorbidities with impulsive features. Little research has been conducted on comorbidity with impulsive features in MUD. Therefore, this cross-sectional study aimed to delineate comorbid disorders with impulsivity in adult patients with a primary diagnosis of MUD. Methods Participants with lifetime MUD were included. Well established measures screened for comorbid psychiatric disorders with impulsive features. Illness severity was measured by the Yale Brown Obsessive-Compulsive Scale – adapted for drug use. The UPPS-P Impulsive Behavior Scale was used to assess impulsivity levels. A cluster analysis (CA) of lifetime comorbid disorders with impulsive features was performed. Demographic and clinical correlates of each identified cluster were identified. Results Sixty five (n = 65) adults with a primary diagnosis of MUD took part in the study. They were predominantly female (44 females; 21 males), with ages ranging between 18 and 44 years (mean = 30 years; SD = 6.53). The CA rendered 4 groups. Cases (n=12) in the “alcohol cluster” presented with AUD as their only impulsive disorder other than MUD. Cases (n=19) in the “healthy cluster” had no comorbidity. Cases (n=15) in the “antisocial cluster” all had comorbid antisocial personality disorder as well as polysubstance use disorders. Cases (n=19) in the “borderline cluster” had borderline personality disorder and polysubstance use disorders. Illness severity (Y-BOCS-du: p=0.03) and impulsivity levels (UPPS-P: p=0.01) differed significantly between the clusters. The “alcohol cluster” had the highest illness severity and the “antisocial cluster reported the highest levels of impulsivity. Conclusion The findings of this contribute to the paucity data on impulsivity in MUD and may have implications for treatment. Understanding how these conditions cluster in MUD, and remaining cognizant of the demographic and clinical correlates of each cluster in MUD, could potentially enable clinicians to identify patients who are at higher risk for engaging in risky behaviors rendering them more vulnerable to treatment non-adherence or relapse
Open Access
Disability grant utilization and barriers to access for patients with personality pathology: A mixed methods study
(2023) Julius, Hayley; Temmingh, Henk; Lund Crick
Background Personality disordered (PD) patients suffer the misnomer of “difficult to treat”. Difficulties in interpersonal style attendant with this diagnosis can impact on clinician attitude. This suggests that negotiating access to government health and social services, including the disability grant, might be a process with unique barriers for this group of patients. This study aims to investigate barriers that patients with PD (disorder or traits) experience in accessing the government disability grant. Methods A multi-method approach was used to identify barriers and facilitators to accessing the government disability grant in a group of psychiatric patients attending the Ward 1 therapeutic programme at Valkenberg hospital, South Africa. In the first phase, files of patients attending the programme in 2018 and 2019 were reviewed. Variables related to PD diagnosis, disability grant and others of interest were analysed using SPSS. In the second phase, purposive sampling for patients with PD and disability grant was done to conduct semi-structured interviews. Nvivo software was used to categorise and assist with analysis of themes. In the third phase an online clinician survey was conducted amongst psychiatrists and psychiatry registrars within the Department of Health, Western Cape who are tasked to assist with disability grant applications for this patient group. This was done to determine clinician beliefs and attitudes to making disability grant applications for patients with PD that may serve as barriers. Results File review: Valid data from 237 patient folders indicated that a total of 53 (22.4 %) patients had everaccess to the government disability grant (DG) and 6 (2.5 %) to private disability pay-out (Total: n = 59, 24.9 %). Half of patients admitted over the two years had a PD diagnosis (n = 122, 51.5 %). Borderline personality disorder was the most diagnosed PD (n = 68, 29 % of the sample). Although the majority of those with disability grant access had a PD diagnosis (n = 31, 52.5 %), there was no significant association between having a PD and receiving DG support. Patient interviews: Framework analysis was used to derive at 5 themes that related to Knowledge and beliefs about impairment and the disability grant, Course and access to the grant, Barriers to access, the Psychosocial impact of the disability grant, and Participant service needs related to recovery and possible sustained economic participation. Sub-theme findings related to the relationship with mental health professionals as facilitators to access, the impact of disability grant lapse on mental well-being, and three-way stigma related to having a 1) disability grant, 2) psychiatric diagnosis and 3) disability grant access for a psychiatric diagnosis. Internalised stigma was a significant finding and stigmatising judgement was experienced in interaction with general health professionals and may serve as a barrier to first access . Clinician survey: Respondent rate to the survey was low (n = 12, 21.8 %). Clinicians had much experience working with adult patients with PD, but most did not consider disability grant assessments with PD patients a routine part of their work. Confusion about how to make disability assessments for this group, compared to those with a primary common mental disorder or a serious psychiatric disorder, was salient. Most clinicians experienced dual role conflict in treating the PD patient and assessing them for a disability grant application, endorsing that the task should be delegated to another professional. Interpersonal interaction with PD patients was a challenge for clinicians but they did not believe this prevented them from considering treatment options for the patient that could support recovery and more sustained economic participation. Discussion and Recommendations: Barriers to initial access to the disability grant related to internalised stigma and patient readiness, as well as general health professional attitude. Recipients of disability grants motivated for access based on impaired functioning, in keeping with recommendations by the Department of Social Development (DSD). Functional impairment related to instability of affect, mood dysregulation that contributed to inconsistencies in behaviour, and interpersonal difficulties. These were implicated in difficulties returning to work and continuation of the disability grant. The disability grant was experienced as a significant source of support and relationships with mental health practitioners were an invaluable source of mental health support. Stigma was experienced from communities and general health professionals. The DSD mandate to routinely review access to the disability grant was a barrier contributing to distress, deterioration in mental health and socioeconomic well-being, and avoidant engagement with employment options. Recommendations to the DSD are highlighted to address realignment of the ‘temporary' grant with incentivisation for recovery and economic participation. Government multi-sectoral coordination to address stigma is highlighted. Recommendations for clinician training and practice for more confident assessment of impairment in PD patients, and to support mental health in this patient population, are made.
Open Access
Methamphetamine use and HIV risk among severely mentally ill inpatients
(2013) Moodley, Aneshree; Temmingh, Henk
Sub-Saharan Africa accounts for 69% of the global HIV burden. Due to a variety of social, economic and behavioural factors, mentally ill patients are more likely to engage in high risk sexual behaviours. In turn, co-morbid substance use which is present in up to 75% of mentally ill patients is a leading risk factor for sexual risk behaviours. Worldwide methamphetamines are the most commonly used illicit stimulant. Both injectable and noninjectable methamphetamines have evidenced associations with high risk sexual behaviours. Smoking and inhalation of crystal methamphetamine is the predominant mode of use in South Africa. The use of crystal methamphetamine amongst mentally ill persons in Cape Town has escalated over the last decade. We aimed to determine the occurrence of methamphetamine use and risky sexual practices amongst mentally ill patients. In addition we aimed to explore the associations between methamphetamine use and HIV sexual risk behaviours in a sample of mentally ill inpatients in Cape Town, South Africa.
Open Access
Prevalence and correlates of anxiety disorders in psychotic illness
(2017) Reid, Kirsten; Milligan, Peter D; Temmingh, Henk
Background: Comorbid anxiety disorders in psychotic illness are reported in the international literature as highly prevalent and have a significant negative impact on patient outcomes. Local literature describing such comorbidity in the South African population is limited and clinically, anxiety symptoms are seldom recognised or treated in patients with psychotic disorders. More data on prevalence rates across psychotic disorder diagnoses, as well as sociodemographic correlates would aid recognition, diagnosis, and treatment, and potentially improve clinical outcomes in this population. Method: We performed a secondary analysis of an existing database which comprised data from participants of three previous studies. The sample was made up of patients from Valkenberg Hospital and healthcare facilities in its catchment area. All patients had a diagnosis of a psychotic disorder. Socio-demographic information was collected using a structured questionnaire. Clinical information and diagnosis was determined using the Structured Clinical Interview for DSM (SCID-I). Rates of comorbid anxiety disorders were compared across various sociodemographic categories. Results: The overall prevalence of any anxiety disorder in the entire sample (N=226) was 14.6% (n=33), 95% CI [10.27-19.89%]. The most common anxiety disorder comorbidities were, in descending order, panic disorder (n=12, 5.31%; 95% CI [2.77-9.09%]), PTSD (n=9, 3.98%; 95% CI [1.84-7.42%]), specific phobia (n=7, 3.10%; 95% CI [1.25-6.28%]), anxiety disorder not otherwise specified (n=7, 3.10%; 95% CI [1.25-6.28%]), social phobia (n=4, 1.77%; 95% CI [0.48%-4.47%]), generalised anxiety disorder (n=4, 1.77%; 95% CI [0.48-4.47%]), substance-induced anxiety disorder (n=4, 1.77%; 95% CI [0.48-4.47%]) and obsessive compulsive disorder (n=2, 0.88%; 95% CI [0.11-3.16%]). There was a significant association between diagnosis and the presence of post-traumatic stress disorder (PTSD), with the schizoaffective disorder group having a higher rate of PTSD (13.3% vs. 3.3% in schizophrenia, 3.2% in substance-induced mood/psychotic disorder and 0% in bipolar I disorder) (Fisher's exact test, p=0.039). In turn, there was a trend level association between diagnosis and the presence of panic disorder (PD), with schizoaffective disorder patients having higher rates of PD (16.6% vs. 4.1% in schizophrenia spectrum, 3.2% in substance-induced mood/psychotic disorder and 2.2% in bipolar I disorder) (Fisher's exact test, p=0.052). A significant association was found between level of education and the presence of PTSD, with higher rates of PTSD in patients with seven or less years of education (8.8%) compared to lower rates in those with 8-12 years of education (5.3%) and > 12years of education (0%) (Fisher's exact test, p=0.020). Conclusion: The overall prevalence of anxiety disorders in psychotic illness was lower than what has been described in previous literature. Prevalence rates of individual anxiety disorders were also lower than previously published literature. Possible reasons for this include use of the SCID which utilises a strict diagnostic hierarchy, that the majority of the sample were in-patients, no use of self-report questionnaires or other anxiety-specific diagnostic instruments, or possible geographical and/or ethnic differences in South African patients. The most frequent comorbid anxiety disorders in our study were panic disorder and PTSD. This is out of keeping with other literature which has mostly found obsessive compulsive disorder and social anxiety disorder to be the most common anxiety comorbidities in psychotic illness. Further research into comorbid anxiety in psychotic disorders is needed, particularly amongst South African populations.
Open Access
The prevalence of and factors associated with antipsychotic polypharmacy in patients with serious mental illness: Findings from a cross-sectional study in a low-middle income country
(2017) Armstrong, Kerryn; Temmingh, Henk
Rationale: Antipsychotic polypharmacy (APP) appears to be a common practice worldwide despite treatment guidelines advising against the practice for most patients in view of lack of evidence and possible risk of harm. Our study aimed to address deficiencies in local and international research by examining the current prevalence of APP in a South African context and investigating a broad range of patient, illness and treatment characteristics that may be associated with the practice. In doing so, we aimed to provide an indication of possible areas to be addressed in order to improve local mental health care practice. Methods: We conducted a cross-sectional study of discharge records using Valkenberg Hospital's electronic patient database. We collected data on patient, illness and treatment characteristics for patients discharged on one or more antipsychotic agent from January to June 2014. Hierarchical multivariable logistic regression analysis was conducted to assess the relationship between APP and demographic and clinical variables and prescription patterns were analysed. Results: Discharge records of 565 patients were examined. The prevalence of APP in our study population was 29.03% (95% CI= 25.31%-32.96%). Analysis of demographic and clinical characteristics revealed that age>29, male sex, diagnosis of schizophrenia compared to bipolar and substance-induced disorders, co-morbid intellectual disability, co-morbid substance use, greater number of hospital admissions and high-dose prescribing were significantly associated with APP. While highest rates of APP in patients with schizophrenia and schizoaffective disorders occurred, APP was also observed in a number of patients with bipolar and substance-induced disorders. Prescription patterns demonstrated the prominent use of first-generation antipsychotics and long acting injectables in APP combinations. Patients receiving APP were significantly more likely to have anticholinergic agents and sodium valproate co-prescribed in their treatment regimen. Discussion: The prevalence of APP found in our study is fairly high in comparison with international rates. Antipsychotic prescription patterns reflect a complex interplay among patient, illness and treatment characteristics of our population. Our findings indicate that patients receiving APP may be those with greater illness severity, complexity, chronicity and treatment resistance, with complicating factors including co-morbid substance use involved. While APP is most common in patients with schizophrenia, antipsychotics may also be used in combination to manage mood and psychotic symptoms in patients with schizoaffective, bipolar and substance-induced disorders. The frequent use of long acting injectables in combinations may suggest concern over compliance in our population. The positive associations of APP with high-dose prescribing and co-prescription of anticholinergic medication contributes to concern over the safety of APP. Conclusion Our study suggests concern over current local practice in that combination antipsychotic agents were prescribed for a number of patients with a range of psychiatric diagnoses without sufficient evidence for efficacy of this practice and at possible cost of increased adverse effects. Additional research is needed examining the practice of APP across diagnoses, focusing on the multiple aspects affecting local practice and various contributing factors that could be targeted for intervention. This would be a positive step towards improving the quality of our service and providing optimal patient management in a resource-limited setting.
Open Access
Schneiderian first-rank symptoms in schizophrenia and methamphetamine psychosis: a comparative study
(2015) Shelly, James Bradly; Temmingh, Henk
Objective: To determine the occurrence and associations of Schneiderian first-rank symptoms in patients diagnosed with schizophrenia and methamphetamine psychosis using structured clinical interviews for DSM-IV (SCID-I). Method: Data from SCID-I interviews collected on two samples of patients, diagnosed with schizophrenia and with methamphetamine psychosis, as part of two separate research projects, was retrieved from the respective databases and compared. The two groups were compared on the presence of any one first rank symptom, those who had two first-rank symptoms, and those who had more than two first-rank symptoms. We calculated the prevalence of different first-rank symptoms in schizophrenia and methamphetamine psychosis. We further performed a logistic regression and calculated adjusted and unadjusted odds ratios for the association between first-rank symptoms and diagnosis. Results: One hundred and two patients fulfilled inclusion criteria for the study, 33 from the methamphetamine psychosis sample, and 69 from the schizophrenia sample. Prevalence of one, two, and more than two first-rank symptoms in the methamphetamine psychosis and schizophrenia groups was calculated as 69.6% and 69.7%, 21.2% and 20.3 %, and 27.3% and 27.5% respectively. After adjusting for covariates, thought broadcasting occurred significantly more often in patients with schizophrenia compared to those with methamphetamine psychosis (Odds ratio=3.61; 95% CI: 1.26-10.33; p<0.05). In turn, the odds of having auditory hallucinations in the form of voices conversing was significantly lower in patients with schizophrenia compared to those with methamphetamine psychosis (Odds ratio=0.27; 95% CI: 0.1-0.75; p<0.05). We found no significant association between any other first-rank symptoms as measured by the SCID-I and a diagnosis of schizophrenia or methamphetamine psychosis. Conclusion: The symptom of thought broadcasting was significantly more likely to occur in patients diagnosed with schizophrenia than in patients diagnosed with methamphetamine psychosis. Auditory hallucinations of voices heard conversing was significantly less likely to occur in patients with schizophrenia than in those with methamphetamine psychosis. Overall, there was a significant overlap of first-rank symptoms and a diagnosis of either schizophrenia or methamphetamine psychosis, but this study did not show that patients with a diagnosis of schizophrenia are more likely to have first-rank symptoms when compared to those with methamphetamine psychosis.
Open Access
Service users' perceptions of the relationships between cigarette use and recovery from substance use disorders
(2022) Chiseya, Lorraine Samba; Myers, Bronwyn; Temmingh, Henk
Introduction Information on the relationship between cigarette use and recovery from substance use disorders (SUDs) is contradictory and limited to studies conducted in high-income countries characterised by a predominance of injection drug use. In South Africa, a low-and-middleincome country where drugs are mainly smoked, there is an absence of research examining the relationship between smoking and SUD treatment outcomes. This study seeks to bridge this gap by exploring service users' perceptions of smoking and how cigarette use affects their recovery from SUDs. Methods This exploratory study employed a qualitative research design. Twenty participants were recruited from six Matrix Outpatient SUD treatment programmes in the greater Cape Town region for in-depth interviews. A semi-structured interview guide structured the interviews. Interviews were audio-recorded before being transcribed verbatim. Qualitative data were analysed using the framework approach. Results Three main findings emerged from the data. First, powerful socio-cultural and contextual factors seem to underpin participants early initiation and maintenance of cigarette use. Participants identified socio-cultural processes that strongly influenced their perceptions of smoking and the social and emotional functions it served, which contributed to continued cigarette use. Second, participants described the intertwining of cigarettes and other substances, with shared modes of administration and mixing of substances - they thought this made it very challenging to maintain recovery from substances while continuing to smoke tobacco. Third, although service users perceive benefits to tobacco cessation for health and recovery from SUDs, most participants using tobacco expressed ambivalence about quitting and seem to lack confidence in their ability to stop smoking and maintain their abstinence from other substances. Conclusion The current study suggests that SUD service users view cigarette use as potentially detrimental to their SUD treatment and recovery. As such, this study provides support, from a service user perspective, for (i) the introduction of interventions to prevent tobacco initiation among young people as part of SUD prevention and (ii) the integration of tobacco cessation interventions into SUD treatment programming to improve the likelihood of successful treatment outcomes for people who smoke tobacco. More specifically, findings highlight the potential value of a client-centred approach in screening service users for tobacco use as they enter SUD treatment, educating them about the potential impacts of continued smoking on SUD recovery, and integrating evidence-based smoking cessation programmes into SUD treatment.
Open Access
Textbook of Psychiatry First Edition, Draft 2
(Wikibooks, 2014-09-18) Stein, Dan; Maud, Catherine; van der Merwe, Nicolina; Tasman, Allan; Fountoulakis, Konstantinos; Pies, Ronald; Simonsen, Erik; Summergrad, Paul; McDermott, Bruce; Ansari, Arash; Milev, Roumen; Kohn, Robert; Arboleda-Florez, Julio; Osser, David; Temmingh, Henk; Thomas, Stuart; Ojserkis, Rachel; Attia, Evelyn; Allgulander, Christer; Preda, Adrian; Page, Lisa; Spiegel, David; Chopra, Kapil; Jaffa, Tony; Bestha, Durga Prasad; Madeen, Vishal; Wilson, Daniel
This multi-authored collaborative textbook on psychiatry, originally created on Wikibooks, discusses a range of psychiatric disorders, including psychotic, mood and and anxiety disorders, amongst many others. It covers other aspects of psychiatric care such as diagnosis, neurobiology, psychopharmacology, treatment methods, and dealing with agitated or violent patients.
Open Access
The occurrence of childhood trauma in patients with severe mental illness with and without co-occurring substance disorders
(2022) Hector, Marc; Temmingh, Henk
Background Childhood trauma (CT) has been associated with development of substance use disorders (SUDs) and severe mental illness (SMI) in community cohorts. There is a paucity of data on correlates of CT in dually diagnosed clinical populations in South Africa. We investigated the association among mono-substance use, polysubstance use and CT. Additionally, we explored demographic and clinical correlates of CT. Study aims We investigated associations between CT and SUD in patients with SMI. Setting Participants included patients aged 18–59 years with psychotic disorders attending specialist psychiatric hospital. Methods A cross-sectional study was conducted and the structured clinical interview for DSM-IV, (SCID – I) to determine SUD and SMI, and the childhood trauma questionnaire (CTQ) to measure CT were administered. Results Of the 74 patients, the mean age was 29 years (SD = 8.6) and 64% were male; 64% had schizophrenia-spectrum diagnoses, 23% had BMD-I and 14% had SIPD. Of the patients, 41% were taking no drugs, 22% were mono-drug users and 38% were poly-drug users. There was no significant difference between substance use groups in terms of age or level of education. However, those with no SUDs were significantly more likely to be female, whereas those with mono- or-poly-substance use were significantly more likely to be male. Patients with poly-SUD were significantly less likely to have been married and significantly more likely to have had a diagnosis of SIPD. There were no significant differences in CTQ scores by SUD groups. In this sample of patients with SMI, we found no significant association between CT and SUDs. Conclusion More research is needed into the effects CT has on dual diagnoses to inform treatment approaches to explore traumatic experiences.
Open Access
The Validity of the Alcohol, Smoking and Substance Involvement Screening Test in Patients with Psychotic Disorders
(2022) Adlard, Rosalind; Temmingh, Henk; Roos, Tessa
Background Given the high prevalence of substance use disorders among patients with persistent mental illnesses, with resultant negative health consequences, a brief and easily administered screening test is needed in this population to identify those at risk in order to intervene appropriately. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was developed by the World Health Organisation as a screening instrument. It has been validated in a variety of settings, including in primary care and treatment settings and in first episode psychosis. Aim To determine the validity and reliability of the ASSIST in detecting substance use disorders in patients with multi-episode psychotic disorders. Setting Western Cape, South Africa. Methods The Structured Clinical Interview for DSM-IV Axis I Disorders was used as the gold standard for detecting DSM-IV substance abuse and dependence. Cronbach's alpha was used to determine the internal consistency of the ASSIST, and receiver operating characteristic analysis was used to evaluate its screening properties. Optimal cut off scores were calculated to maximize sensitivity and specificity. Results A total substance involvement lifetime score of 13 was found to have both sensitivity and specificity of just over 74%. A specific substance involvement score of 4 for alcohol and 3 for cannabis, methamphetamine and ‘other drugs' was found to have optimal balance between sensitivity and specificity. Conclusion The ASSIST is a psychometrically valid screening test for substance use disorders in general, as well as for alcohol, cannabis and methamphetamine use disorders, in patients with multi-episode psychotic disorders.

Browsing by Author "Temmingh, Henk"

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