OpenUCT :: Browsing by Subject "Psychiatry"

Browsing by Subject "Psychiatry"

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Open Access
A cross-sectional study of the association between cognitive impairment and haemoglobin levels in HIV-infected South Africans established on antiretroviral therapy
(2019) Vermaak, John-Randel; Joska, John; Decloedt, Eric
Background Sub-Saharan Africa, the epicenter of the global population of people living with HIV (PLHIV), is estimated to have more than 25 million PLHIV. In the era before the widespread availability of antiretroviral therapy (ART), anaemia (low serum haemoglobin) was a common clinical finding that was seen as a potential risk factor for HIV-associated neurocognitive impairment. The association between haemoglobin levels and neurocognitive function has not been assessed in a Sub-Saharan study population in the era of ART. Methods A cross-sectional secondary data analysis was performed to assess the association between serum haemoglobin level and neurocognitive function in 129 participants who had both neurocognitive test (global deficit score) and full blood count results performed as part of a randomised placebo controlled trial that evaluated the efficacy of lithium carbonate for the treatment of HIV associated neurocognitive disorders. Results The majority of our participants were female (87%) with a mean age of 37 ±7.78 years. Participants were all established on ART with a median CD4 count of 495 cells/µL (IQR=315- 629). The median haemoglobin level was 12.2 (IQR=11.6-13.00) and anaemia was present in 8.5%. Serum haemoglobin level was not associated with global deficit scores (GDS) and fewer years of education was the only independent risk association for GDS-defined neurocognitive impairment. Conclusion We found that in South Africans, who are established on ART, anaemia is less common than in the pre-ART era and importantly, that low-normal serum Hb levels do not present a risk for GDS-defined neurocognitive impairment. These findings are relevant as they show that aggressive management of low-normal Hb levels is not necessary provided individuals are otherwise clinically well and virally suppressed.
Open Access
A Retrospective Analysis of Referrals to Consultation-Liaison Psychiatry over a Five-Year Period in a Tertiary Hospital in South Africa
(2022) Romburgh, Bailee Jean; Hoare, Jacqueline
Objective: The aim of this study was to review referrals to the consultation-liaison psychiatric service at Groote Schuur Hospital including the number of referrals, demographic details of referred patients, medical and psychiatric diagnoses, management and outcome over a five-year-period. It was anticipated that referrals had increased on an annual basis. Method: The study was observational and was conducted at Groote Schuur Hospital in Cape Town, South Africa. All inpatients referred to consultation-liaison psychiatry (CLP) during the study period were included. The study information was gathered via data capture sheets that are completed for patients referred to the division. Results: A total of 1978 patients were referred to CLP and analysed in the study. Most referrals occurred in 2018 (n=499; 25.2%). The majority of referrals came from the division of internal medicine (n=607; 30.7%), and the main reasons for referral were unspecified (n=402; 20.3%), suicide/risk assessment (n=333; 16.8%), and other symptoms of mental illness (n=264; 13.3%). The most frequent immediate management included medication initiation or adjustment (n=793; 40.1%), and supportive counselling/psychoeducation (n=511; 25.8%). Conclusion: Referral numbers to the division have increased during the study period as hypothesized. As expected, most referrals came from the internal medicine division. The results from this study highlight the importance of the consultation-liaison service at Groote Schuur Hospital.
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
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.
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
The association betweeen psychopathology and substance use in young people
(2011) Saban, Amina; Flisher, Alan J; London, Leslie; Morojele, Neo K
The co-occurrence of problematic substance use and non-substance use psychopathology is very common in psychiatry, and is generally referred to as comorbidity. The phenomenon has been the subject of debate and widespread research, yet remains poorly understood. The thesis aimed to examine the association between psychopathology and substance use in young people in South African settings, to determine the nature and prevalence of comorbidity, and to identify sociodemographic factors that might influence the associations, as well as the influence of comorbidity on substance use treatment outcomes.
Open Access
Baseline concussion assessments can identify mental disorders: the SCAT-5 Symptom Evaluation compared to other screening tools in South African club rugby
(2023) Burger, James; Joska, John; Andersen, Lena
Mental disorders are common in athletes, but often go undiagnosed. Although mental health screenings are not routinely conducted in rugby, the Sport Concussion Assessment Tool – Fifth Edition (SCAT-5) is widely performed and measures affective, cognitive, sleep, and physical symptoms. This study investigated the psychometric properties of the SCAT-5 to explore its potential as a mental health screening tool. During preseason for the 2021 Western Province Super League A in South Africa, clinicians conducted mental health assessments of 71 adult male rugby union players. The SCAT-5 Symptom Evaluation, Baron Depression Screener for Athletes (BDSA), Athlete Psychological Strain Questionnaire (APSQ), Center for Epidemiologic Studies–Depression (CES-D), and Generalised Anxiety Disorder-7 (GAD-7) were compared to each other and to fully-structured diagnostic interviews by mental health professionals using the Mini International Neuropsychiatric Interview (MINI) 7.0.2. Lifetime MINI-defined mental disorders were common, being identified in 33.8% (95%CI 22.79 to 46.17%). Only 4.29% of these had a previous diagnosis. Exploratory Factor Analysis indicated a mental health construct of depression/anxiety being measured by the SCAT-5. The SCAT-5 had strong internal consistency ( = 0.94) and showed moderate convergent validity with the CES-D (r = 0.34; p = 0.008) and GAD-7 (r = 0.49; p < 0.0001). The area under the curve for identifying current disorders was 0.87 (p = 0.003). Since the SCAT-5 has the potential to identify depression and anxiety, it may allow mental health screening without the need for additional measures. Follow-up studies should further explore its discriminative ability in larger samples.
Open Access
Building the capacity of policy-makers and planners to strengthen mental health systems in low- and middle-income countries: a systematic review
(2016) Hanlon, Charlotte
Abstract Background Little is known about the interventions required to build the capacity of mental health policy-makers and planners in low- and middle-income countries (LMICs). We conducted a systematic review with the primary aim of identifying and synthesizing the evidence base for building the capacity of policy-makers and planners to strengthen mental health systems in LMICs. Methods We searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Web of Science, Scopus, CINAHL, LILACS, ScieELO, Google Scholar and Cochrane databases for studies reporting evidence, experience or evaluation of capacity-building of policy-makers, service planners or managers in mental health system strengthening in LMICs. Reports in English, Spanish, Portuguese, French or German were included. Additional papers were identified by hand-searching references and contacting experts and key informants. Database searches yielded 2922 abstracts and 28 additional papers were identified. Following screening, 409 full papers were reviewed, of which 14 fulfilled inclusion criteria for the review. Data were extracted from all included papers and synthesized into a narrative review. Results Only a small number of mental health system-related capacity-building interventions for policy-makers and planners in LMICs were described. Most models of capacity-building combined brief training with longer term mentorship, dialogue and/or the establishment of networks of support. However, rigorous research and evaluation methods were largely absent, with studies being of low quality, limiting the potential to separate mental health system strengthening outcomes from the effects of associated contextual factors. Conclusions This review demonstrates the need for partnership approaches to building the capacity of mental health policy-makers and planners in LMICs, assessed rigorously against pre-specified conceptual frameworks and hypotheses, utilising longitudinal evaluation and mixed quantitative and qualitative approaches.
Open Access
Building the capacity of policy-makers and planners to strengthen mental health systems in low- and middle-income countries: a systematic review
(BioMed Central, 2016-10-21) Keynejad, Roxanne; Semrau, Maya; Toynbee, Mark; Evans-Lacko, Sara; Lund, Crick; Gureje, Oye; Ndyanabangi, Sheila; Courtin, Emilie; Abdulmalik, Jibril O; Alem, Atalay; Fekadu, Abebaw; Thornicroft, Graham; Hanlon, Charlotte
Background: Little is known about the interventions required to build the capacity of mental health policy-makers and planners in low- and middle-income countries (LMICs). We conducted a systematic review with the primary aim of identifying and synthesizing the evidence base for building the capacity of policy-makers and planners to strengthen mental health systems in LMICs. Methods: We searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Web of Science, Scopus, CINAHL, LILACS, ScieELO, Google Scholar and Cochrane databases for studies reporting evidence, experience or evaluation of capacity-building of policy-makers, service planners or managers in mental health system strengthening in LMICs. Reports in English, Spanish, Portuguese, French or German were included. Additional papers were identified by hand-searching references and contacting experts and key informants. Database searches yielded 2922 abstracts and 28 additional papers were identified. Following screening, 409 full papers were reviewed, of which 14 fulfilled inclusion criteria for the review. Data were extracted from all included papers and synthesized into a narrative review. Results: Only a small number of mental health system-related capacity-building interventions for policy-makers and planners in LMICs were described. Most models of capacity-building combined brief training with longer term mentorship, dialogue and/or the establishment of networks of support. However, rigorous research and evaluation methods were largely absent, with studies being of low quality, limiting the potential to separate mental health system strengthening outcomes from the effects of associated contextual factors. Conclusions: This review demonstrates the need for partnership approaches to building the capacity of mental health policy-makers and planners in LMICs, assessed rigorously against pre-specified conceptual frameworks and hypotheses, utilising longitudinal evaluation and mixed quantitative and qualitative approaches.
Open Access
Caulrophobia: An investigation of clinical features
(2019) Planting, Talia; Stein, Dan J
Background: Coulrophobia describes the experience of significant distress, fear and/ or revulsion when exposed to the image and/or person of a clown (Stevenson, 2010). It may start in childhood and continue into adulthood (Spratley, 2009). There is limited scientific literature on this topic despite multiple online support groups attesting to the reality of this condition. Methods: Data collection using a self-administered online questionnaire from Surveymonkey was made available via a link on the larger of these online support groups on Facebook. It explored socio-demographic information and symptom phenomenology -symptom severity, course, duration, comorbid illnesses, and extent of psychological distress and functional impairment - in individuals who self-report coulrophobia. Fear of clowns is more commonly associated with fear (45.3%) than disgust (37.9%). The possibility that fear of clowns comprises a specific phobia was also examined. Those from the fear predominant group are also more likely to fulfill DSM-5 criteria for specific phobia. Extent of psychological distress and functional impairment were measured and compared to symptom severity and duration. Results: There were 95 respondents to the online survey, of which 79 were female and 16 male showing it to be more common in females. The mean age of participants was 39.82 ±12.60 years, mean age of symptom onset 9.02 ±6.12 years and mean duration of 30.44 ±12.94years. It appears to have a chronic course from onset with 30.53% identifying a specific trigger and 22.11% a positive family history of coulrophobia. It is more commonly associated with fear than disgust (45.3%). Those from the fear predominant group are also more likely to fulfill DSM-5 criteria for specific phobia. The most common comorbid disorders are major depressive disorder, obsessive compulsive disorder, panic disorder and social anxiety disorder. Use of the Kessler Psychological Distress Scale indicated a significant level of psychological distress associated with coulrophobia. The greatest area of impairment in coulrophobia was in social functioning, measured by the Sheehan Disability Scale Functional impairment was strongly associated with severity of symptoms, but not with symptom duration. Conclusion: Coulrophobia is a phenomenon that warrants clinical attention, as it is associated with significant comorbidity, psychological distress, and impaired functioning.
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
Child and adolescent mental health services in the Western Cape of South Africa: policy evaluation, situational analysis, stakeholder perspectives, and implications for health policy implementation
(2021) Mokitimi, Stella; de Vries, Petrus; Schneider, Marguerite
In spite of the need for child and adolescent mental health (CAMH) services across the globe, very little has been done to develop and strengthen CAMH in low- and middle-income countries (LMIC). South Africa is an example of an LMIC where CAMH services have been very limited as a result of various potential factors, including the legacy of apartheid, stigma associated with mental health, and lack of priority of CAMH. In this thesis, we set out to generate an evidence-base about CAMH services in one South African province to inform service strengthening across the full healthcare system through policy development and implementation. We proposed that a comprehensive understanding of specific services requires a multilevel exploration of ‘hardware' (structural) and ‘software' (social) elements in the health systems that support these services. We started by reviewing the CAMH policy landscape with an analysis of the current state of policy development and implementation at national and provincial levels in all nine provinces of South Africa. Using the Walt and Gilson policy analysis triangle (1994), we examined the content, context, processes and actors involved in mental health or CAMH-specific policies. We then evaluated the hardware and software elements of CAMHS in the Western Cape Province by performing a situational analysis using the WHO-AIMS version 2.2 of 2005 (Brief version) adapted for the South African context and to CAMHS. We proceeded to seek the perspectives of stakeholders within the province – firstly a SWOT analysis with senior stakeholders, and secondly, qualitative analysis of the perspectives of grassroots service providers, and of parents/caregivers and adolescent service users. We collected information from these stakeholder groups through a stakeholder engagement workshop, focus group discussions and semi-structured individual interviews. Using the World Health Organization (WHO) (2007) and Gilson (2012) health systems frameworks, we reviewed both the hardware and the software elements of CAMH services and concluded with a synthesis of findings to provide a set of recommendations for policy development and service strengthening based on the evidence generated. In terms of service delivery, findings showed that child and adolescent mental health services (CAMHS) in the Western Cape were provided at all levels of care (primary, secondary and tertiary) and, at least at inpatient and outpatient level, based on catchment/geographical service areas. However, CAMHS were still limited and were provided under very resource-constrained conditions by inadequately trained service providers. In terms of the health workforce, CAMHS were provided by a range of professionals including child & adolescent psychiatrists, general psychiatrists, medical officers, clinical psychologists, social workers, mental health nurses, occupational therapists, and speech and language therapists. However, multidisciplinary expertise and psychosocial interventions were only available in specialist CAMHS at tertiary level of care. In addition, the specialist services were all based in the City of Cape Town, with no direct access to specialist CAMHS at secondary levels of care or in any of the rural districts of the province. Health information systems were not fit-for-purposes to generate disaggregated data on under-18-yearolds, thus made it extremely difficult to provide a comprehensive view of CAMHS in the province. In terms of access to essential medicines, basic classes of psychiatric medications were available at all levels of care, but not consistently so. An exploration of financing showed that no ring-fenced or disaggregated budgets were available for CAMHS, thus making it impossible to comment on the appropriateness of funding for the mental health needs of children and adolescents. In terms of leadership and governance, a national CAMH policy existed, but no implementation plans had been developed since the publication of the CAMH policy in 2003. Our findings highlighted a lack of dedicated CAMH leadership and governance in the province. We argued that the absence of a clear CAMH leadership structure also explained why provincial plans and strategies had not been developed and implemented over the last two decades. A very consistent finding from our data was a need for a dedicated provincial lead for CAMH. We concluded the thesis with hardware and software recommendations for policy implementation, service development, training and research.
Open Access
Children affected by HIV/AIDS attending programmes to improve psychosocial well-being: current status and pathways to effective interventions
(2017) Skeen, Sarah Ann; Tomlinson, Mark; Sherr, Lorraine
The HIV/AIDS pandemic has a substantial impact on children across the globe and particularly in sub-Saharan Africa. Across sub-Saharan Africa, there are a number of organisations and programmes providing care and support to children affected by HIV/AIDS. However, this strong programmatic focus on mitigating the impact of HIV/AIDS on children at community level has not been matched with concomitant research investment into the needs of children who attend these programmes at these organisations, their health and development, how these organisations work, and whether they are effective. This thesis attempts to address this gap by reporting on three separate analyses of data from the Child Community Care study in South Africa and Malawi, and a systematic review on interventions to improve psychosocial wellbeing of this group. The first analysis describes developmental outcomes of children affected by HIV/AIDS attending community-based programmes and the types of services these children are receiving. The second analysis reports on the mental health of carers of children affected by HIV. In the third analysis I report on the relationship between different forms of violence and mental health status among children affected by HIV/AIDS in the sample. The fourth part is a systematic review of interventions developed to improve the psychosocial well-being of children affected by HIV/AIDS, published between January 2008 and February 2016. The results of these studies highlight the complex needs of children affected by HIV/AIDS attending these organisations. CBOs are reaching a vulnerable group of children and their families, and are well-placed to intervene with this population. There are promising models of interventions available, although the evidence base remains small. Caregivers should not be neglected in programming; parenting programmes provide a potential mechanism for delivering integrated interventions that address multiple risk factors for caregiver and child wellbeing. Mental health, particularly of caregivers, should be explicitly addressed as a part of CBO programming. However, funding for programming needs to be implemented with opportunities for training and supervision. In addition, there is a need for increased partnerships between practitioners and researchers in order to evaluate existing programmes and to design evaluation studies that suit community settings, and that can feed into the growing evidence base.
Open Access
Comparisons of risk factors for violence in defendants referred for psychiatric assessment
(2002) Kaliski, Sean Z
Aims: to determine which static and dynamic risk factors contributed to the commission of violent offences, and to habitual violence in offenders that had been referred for pre-trial psychiatric assessment. b. to assess, by logistic regression modelling, the relative importance of the significant risk factors. All defendants admitted to the Forensic Psychiatry Unit at Valkenberg Hospital for 30 day pre-trial assessments over a 6 month period were entered. All subjects were assessed by 2 psychiatrists and a clinical psychologist, who used semi-structured interviews A forensic social worker interviewed family members. Court documentation provided information about the events of the offence and conviction record. A psychometrist administered Barrat's Impulsivity Scale (BIS), Zuckerman's Sensation Seeking Scale (ZSS), and Annett's Handedness Test (Zuckerman et al. 1964). Nursing staff and occupational therapists compiled daily reports on the subjects' behaviour in the ward.
Open Access
A comprehensive literature study on the effect of cannabis use on cognition and aggressiveness, including a small study to explore these variables
(1997) Fanshawe, Nigel Charles
Twenty seven consecutive black male patients who were admitted as acute admissions to FEH were examined in this thesis. The following demographic information characterized the sample group. a) Age: Bimodal distribution with peaks at 21-25 years and 31-35 years. Five patients were older than 35 years. b) Marital Status: In the sample. 59.2% were single. 11.1 % married and 29.6% the marital status was unknown. c) Number of Children: In the sample. 75% did not know how many children they had. Numbers ranged from no children (14.3%) to 2 children (7.1% of the sample). d) Employment Status: In the sample 81 .1 % were unemployed. e) Level of Schooling: In one third of cases, level of schooling was unknown. Most men did reach secondary level of education.
Open Access
The diagnostic yield of computerised tomography in human immunodeficiency virus (HIV) positive psychiatric patients at a tertiary hospital in the Western Cape
(2017) Berwers, Juan; Joska, John A
Background. HIV infection increases the risk for mental illness. Neuroimaging is an important part of the diagnostic workup in HIV+ psychiatric patients; CT is the primary neuroimaging modality available in resource limited settings. Despite advances in neuroimaging no clear guidelines exist for the use of CT in psychiatric settings. Objective. To determine the diagnostic yield of CT brain (CTB) scans in HIV+ psychiatric patients and to describe these abnormalities as well as demographic and clinical variables associated with abnormal CT scans. Methods. A retrospective study was conducted at the Department of Psychiatry and Mental illness at Groote Schuur Hospital, Cape Town, South Africa. Clinical and radiological data for HIV+ psychiatric patients who received a CTB scan during admission were analysed for the period January 2013 - June 2015. Results. A total of 65 patients met the inclusion criteria. The mean age of the participants in this study was 36.2 years (range 18 - 64). The most common presenting psychiatric symptoms were psychosis (81.54%), cognitive deficits (72.41%) and mood symptoms (69.23%). CT scans results consisted of 29 (44.62%) normal scans and 36 (55.38%) abnormal scans. Atrophy was the most common (72%) radiological finding in abnormal CT scans. No associations were found between current proposed CT guidelines in psychiatric patients, although a history of previous traumatic brain injury (TBI) approached significance (p = 0.054). There was a significant correlation between abnormal CT scans and past or current substance use (X² = 5.9508 P = .015). Abnormal CT findings increased with the Centers for Disease Control and Prevention (CDC) HIV immunological stage progression. The management of 9 patients changed; 7 of these CT scans were abnormal. Conclusion. In this study of CTB scans in HIV+ psychiatric inpatients, previously suggested criteria proposed in guidelines for imaging were not associated with significantly higher rates of abnormal CT findings. Current or previous substance use correlated with significant higher rates of abnormal CT findings. Due to the high yield of abnormal CT scans in this study, it is suggested that HIV+ psychiatric inpatients with previous or current substance use, a history of TBI or HIV immunological stages B or C, are considered for imaging. It is recommended that further studies with larger sample sizes, consisting of inpatient and outpatient populations, with control groups be conducted to investigate current or previous substance use as an indication in guidelines for CTB scan in HIV+ psychiatric patients.
Open Access
Documenting of care arrangements for children of mothers admitted to a psychiatric hospital: A South African case study
(2018) Dawood, Nisaar Ahmed; Schneider, Marguerite
Background: Enquiring about and documenting care arrangements for children of inpatient mothers with mental illness is paramount. Failure to do so could have a negative impact on the well-being of their children. Documenting care arrangements on admission signals good practice on the part of the admitting medical staff and ensures compliance with the requirements of the South African Children’s Act of 2004. This study explores the current practice at a large government run tertiary female inpatient psychiatric unit in Cape Town, regarding the enquiring and documenting practice within the first 24 hours of admission, of these care arrangements. Methods: The study is a cross sectional study using a mixed methods approach including: i) a case note audit of 100 consecutive patient folders examining the documentation of care arrangements within the first 24 hours of admission and ii) a structured self-administered questionnaire to professional staff working on the unit. Results: A total of 87 clinical folders were audited. Ninety nine percent of these folders had written down in them whether the women had children or not. Fifty eight percent of women had minor children and had 87 children between them. Fifteen percent of women had no care arrangements documented and 20% of women had unclear documentation of care arrangements. Fifteen completed staff questionnaires were returned. All staff agreed that it was important to ask the mothers about care arrangements. Conclusion: Significant more women that those identified on admission may have children who may have been in unsafe care arrangements at the time of their admission. There is room for improving the clarity of documenting of care arrangements and the enquiring into the specific care arrangements.
Open Access
DSM-5: a collection of psychiatrist views on the changes, controversies, and future directions
(BioMed Central Ltd, 2013) Nemeroff, Charles; Weinberger, Daniel; Rutter, Michael; MacMillan, Harriet; Bryant, Richard; Wessely, Simon; Stein, Dan; Pariante, Carmine; Seemuller, Florian; Berk, Michael; Malhi, Gin; Preisig, Martin; Brune, Martin; Lysaker, Paul
The recent release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association has led to much debate. For this forum article, we asked BMC Medicine Editorial Board members who are experts in the field of psychiatry to discuss their personal views on how the changes in DSM-5 might affect clinical practice in their specific areas of psychiatric medicine. This article discusses the influence the DSM-5 may have on the diagnosis and treatment of autism, trauma-related and stressor-related disorders, obsessive-compulsive and related disorders, mood disorders (including major depression and bipolar disorders), and schizophrenia spectrum disorders.
Open Access
Effects of bipolar disorder on intrinsic brain networks
(2016) Starke, Jonathan Alan; Horn, Neil; Beckmann, Christian
Introduction: Bipolar disorder (BD) is a brain network disorder that affects cognitive and emotional functioning, and is associated with prefrontal and/or limbic dysfunction. Functional Magnetic Resonance Imaging (fMRI) allows identification of intrinsic brain networks (IBN), like the default mode network (DMN) and executive control network (ECN), which are consistent with previously established functional and anatomical relationships within the brain. Analysing the functional connectivity (integrity, extent and inter-relationships) of these networks, allows a deeper understanding of brain function in health and disease. In BD, there are functional connectivity changes in the DMN, ECN and cerebellar network (CERN). We evaluate IBN in BD, to explore changes in the functional connectivity between the cerebellum, fronto-cortical and paralimbic regions. Methods: Data from 14 BD subjects and 10 control subjects was analysed after fMRI. Changes were evaluated in 3 IBN (DMN, ECN and CERN) using an FMRIB Software Library (FSL) pipeline: MELODIC/ICA-AROMA, dual-regression, randomise and Local False Discovery Rate (FDR) to identify changes in functional connectivity bipolar subjects compared to controls. Results: Subjects with BD showed decreased connectivity between the CERN and a cluster in the right precuneus; and between the ECN and a cluster in the left OFC. There was also increased connectivity between the ECN and a cluster in the left temporal pole. No connectivity changes involving the DMN were identified. Voxels within the clusters were significant at p < 0.05 with local FDR. Peaks within the clusters remained significant after further Bonferroni correction for multiple comparisons (p < 0.017). Conclusion: The finding of altered functional connectivity in BD, in networks and regions involved in cognitive/emotional processes, highlights its complex neurobiology, and suggests that abnormal connectivity may help to explain the clinical picture. These findings should be replicated with larger samples, but may represent a further advance in understanding the role of functional connectivity in the pathology of BD, and contribute to laying the foundation for functional neuroimaging as a diagnostic tool in psychiatry.
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.