Browsing by Author "Torline, John Ross"

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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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    Self -Reported Symptoms of Depression and Associated Features in Medical Interns at a South African Tertiary Health Facility
    (2021) Naidu, Kaveshin; Thornton, H B; Torline, John Ross
    Background: It is known that medical doctors suffer from increased rates of depression with medical interns being most at risk. Despite this, little is known about the prevalence of depression in interns in South Africa. Aim: This study aimed to assess the prevalence of depressive symptoms in interns. Setting: All 91 interns employed at Groote Schuur Hospital, a tertiary hospital in the Western Cape, from January 2017 until May 2018, were invited to participate in the study. Methods: The study was a cross-sectional study. Consenting interns were required to complete a demographic and related questionnaire and the Beck Depression Inventory 2 (BDI-2). Results: Fifty-four (59.3%) of all invited interns participated in the study. Twenty-two interns (41%) reported a Beck Depression Inventory 2 score of 14 or greater. Features associated with a BDI-2 score of 14 or greater, included female gender, a previous diagnosis of depression, seeing a psychotherapist and previously being on antidepressant medication during internship. Other features also significantly associated with higher BDI-2 scores included, suicidal ideation, thoughts of emigration, wanting to leave Medicine and using substances to cope. The most significant associated feature of high BDI-2 scores was feeling “burnt out”. Conclusion: Interns had a higher prevalence of depressive symptoms when compared to the general population. The feeling of being ‘burnout' was the most significant factor associated with the severity of depressive symptoms. It is imperative that the mental health of both medical students and newly qualified doctors be prioritised, supported and monitored.