Browsing by Author "Williams-Ashman, Peter"

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    Open Access
    A retrospective observational study of the effectiveness of long acting antipsychotic injectable on hospital admissions
    (2018) Charles, Bhaskaran Nathamaniar; Horn, Neil; Williams-Ashman, Peter
    Background: The impact on hospitalisations/ relapse rates of utilising long-acting antipsychotic injectable (LAIs) in a South African population suffering from chronic psychotic spectrum mental illness is poorly researched. Aim: To compare the duration and number of hospitalisation episodes 12 and 24 months before and after the initiation of a LAI. Setting: Valkenberg Hospital’s adult acute inpatient psychiatry services. Method: This was a retrospective naturalistic observational mirror-image study. Hospitalisation was utilised as a proxy for relapse. Results: Sixty-one patients were identified for the study. A comparison of the 12 months before LAI initiation to the 12 months following LAI initiation showed a reduction in the number of admissions of 44% (55 to 31), and a reduction in the number of inpatient days of 23% (1892 to 1464). There was a statistically significant reduction in the median number of hospital admissions (p = 0.005) and median inpatient days (p = 0.040). Comparing the 24 months before to the 24 months following LAI initiation, there was a reduction in the number of admissions of 30% (91 to 64) and inpatient days of 4% (3477 to 3355). There was a statistically significant reduction in the median number of hospital admissions (p = 0.014) and a non-statistically significant reduction in median days (p = 0.428). Conclusion: The prescription of a LAI reduced the duration and number of hospital admissions over a 12-month period. After 24 months, there were fewer admissions but no significant reduction in the number of inpatient days. This study supports findings of international mirror-image studies.
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    Open Access
    Improving adherence in mental health service users with severe mental illness in South Africa: a pilot randomized controlled trial of a treatment partner and text message intervention vs. treatment as usual
    (BioMed Central, 2017-11-09) Sibeko, Goodman; Sibeko, Goodman; Mall, Sumaya; Williams-Ashman, Peter; Thornicroft, Graham; Susser, Ezra S; Lund, Crick; Stein, Dan J; Milligan, Peter D
    Objectives: Medication non-adherence is a significant problem in treatment of severe mental disorders and is associated with poor clinical outcomes and increased demand on services. Task-shifting interventions incorporating mobile health may improve adherence in mental health service users in low- and middle-income countries. Seventy-seven participants were recruited from a psychiatric hospital in Cape Town, with 42 randomized to receive the intervention and 35 to treatment as usual. Intervention pairs underwent treatment-partner contracting and psychoeducation, and received monthly text message reminders of clinic appointments. Primary outcomes were intervention acceptability and feasibility. Secondary outcome for efficacy were adherence to clinic visit; relapse; quality of life; symptomatic relief and medication adherence. Results: Treatment partner and psychoeducation components were acceptable and feasible. The text message component was acceptable but not feasible in its current form. Efficacy outcomes favoured the intervention but did not reach statistical significance. A treatment-partner intervention is acceptable and feasible in a low- and middle-income setting. Work is needed to ensure that additional components of such interventions are tailored to the local context. Appropriately powered efficacy studies are needed. Trial Registration PACTR PACTR201610001830190, Registered 21 October 2016 (Retrospectively registered)