OBJECTIVE: This study aimed to determine a demographic profile of methamphetamine (MA)-related admissions to major psychiatric services in Cape Town, obtain a substance use profile from admitted patients, a profile of co...OBJECTIVE: This study aimed to determine a demographic profile of methamphetamine (MA)-related admissions to major psychiatric services in Cape Town, obtain a substance use profile from admitted patients, a profile of common MA-related symptoms encountered during the assessment of the patients presenting with MA-related problems, and a brief profile of the psychiatric diagnoses made. METHOD: Staff in six psychiatric hospitals or wards in Cape Town collected data on methamphetamine related admissions between July and December 2008 using a one-page record review form. The data collection form consisted of the patient's demographic details, presenting symptoms, previous admission details, current MA and other substance use information, and DSM-IV diagnosis. RESULTS: A total of 235 forms were completed. Most patients were male (69%) and the mean age was 25 years. The most common presenting symptoms were aggressive behaviour (74%), followed by delusions (59%) and hallucinations (57%). Males were two times more likely to present with aggression as compared to females, while females were significantly more likely to present with depressed mood or euphoric/elevated mood. The majority of patients had substance-induced psychotic disorder (41%), followed by schizophrenia (31%). Twelve percent (12%) had bipolar mood disorder. CONCLUSION: MA-related psychiatric admissions pose serious challenges to all health services dealing with these patients. Further training and treatment protocol development and distribution is indicated.
OBJECTIVE: Caregivers of patients with epilepsy experience onsiderable emotional distress. The study aimed to assess the magnitude of the problem in a developing country. METHOD: A total 166 patients-caregivers were enro...OBJECTIVE: Caregivers of patients with epilepsy experience onsiderable emotional distress. The study aimed to assess the magnitude of the problem in a developing country. METHOD: A total 166 patients-caregivers were enrolled for the study. They were interviewed using a socio-demographic data collecting sheet and the Hospital Anxiety-Depression Scale (HADS). Data obtained were analysed using Statistical Package for Social Sciences Windows version 13. All statistical tests were carried out at a 5% level of probability. RESULTS: The mean age of the caregivers was 45.44 ± 6.67 years. Emotional distress was found among 109(65.7%) of the caregivers. This is was significantly associated with male gender of both care giver and patient as well as residing in a rural area. CONCLUSION: The study demonstrated a high level of emotional distress associated with caring for patients with epilepsy, which is comparable to other studies carried out in other parts of the world.
OBJECTIVE: Although many studies indicate that traditional healers are willing to collaborate with Western practitioners in South Africa, none focus specifically on mental health care, and none use a theory of health beh...OBJECTIVE: Although many studies indicate that traditional healers are willing to collaborate with Western practitioners in South Africa, none focus specifically on mental health care, and none use a theory of health behaviour to explain their findings. The present study applies the Theory of Planned Behaviour (TPB) to predict traditional healer referral practices of patients with a mental illness. METHOD: One hundred traditional healers were first interviewed to assess the TPB variables and were contacted again 5 months later to measure self-reported behaviour. RESULTS: Herbalists were less likely than other types of healers to refer patients with a mental illness to Western health professionals. From the TPB application, the following cognitive variables were found to predict intentions: attitudes (β = 0.612, p< 0.01); perceived behavioural control (β = 0.355, p< 0.01); and past behaviour (β = 0.704, p< 0.01). Subjective norms and knowledge of mental illness did not predict intentions. Finally, past behaviour (β = 0.297, p = 0.040) and intentions to refer patients (β = 0.758, p< 0.01) predicted greater self-reported behaviour. CONCLUSION: The TPB may be a useful theoretical model for predicting the referral practices of traditional healers. The empirical data here may be useful for future work designing interventions to provide traditional healers with the information and skills they require to appropriately refer patients with mental illness.
OBJECTIVE: The purpose of the study was to determine the effectiveness of a nurse-facilitated-cognitive-group (NFCG) intervention as an adjunct to antidepressant medication, in mild to moderately, depressed women. METHOD...OBJECTIVE: The purpose of the study was to determine the effectiveness of a nurse-facilitated-cognitive-group (NFCG) intervention as an adjunct to antidepressant medication, in mild to moderately, depressed women. METHOD: This was a quasi-experimental, nonequivalent, control group design study. A sample of 30 consenting participants was selected from an urban, community psychiatric clinic, and the participants were randomly allocated to the control and the intervention groups. The effectiveness of the intervention was measured using the Beck Depression Inventory (BDI). RESULTS: After six weeks of implementation of the NFCG intervention, there was a decrease in the BDI scores of the intervention group, and an increase in the BDI scores in the control group (CG) - but the difference in scores was not significant (Student's t-test=1.076, p=0.291). After 12 weeks of the group intervention, the BDI scores for the intervention group, showed a considerable reduction in their levels of depression, whilst the participants of the control group had a further increase in their scores. There was a statistically significant difference between the groups, with respect to the BDI scores (p<0.001). The Friedman test indicated that the mean BDI scores, were statistically significant (p<0.001) within the intervention group, meaning that the BDI scores improved, at the end of the intervention for all the participants. Analysis of the BDI scores, using the Friedman test, showed that there was no improvement in the control group (p=0.597). CONCLUSION: The NFCG intervention, as an adjunct to antidepressant medication, contributed to a reduction in depressive symptoms.
OBJECTIVE: Literature on the prevalence and clinical presentation of South African psychiatric HIV positive patients as well as their management is lacking. This study was performed to investigate these parameters. METHO...OBJECTIVE: Literature on the prevalence and clinical presentation of South African psychiatric HIV positive patients as well as their management is lacking. This study was performed to investigate these parameters. METHOD: A prospective study to investigate the prevalence and clinical presentation of HIV positive psychiatric female patients admitted to an acute ward (female psychiatric ward Cecilia Makiwane Hospital, East London Hospital Complex) was undertaken for a one year period from June 2009 to May 2010. Additional factors such as demographic profile, associated substance abuse, pre-existing psychiatric disorders and management were also studied. RESULTS: During this one year period 158 female patients were admitted to the acute female psychiatric ward for assessment and treatment. Of these 158 admissions 21 (13%) were HIV positive, but only 19 (12%) consented to the study. Ten of the 19 HIV positive patients (53%) had an Axis I diagnosis of a psychiatric disorder secondary to HIV, most commonly mood disorder (mania) with psychotic symptoms. Nine of the 19 HIV positive patients (47%) had a pre-existing primary psychiatric diagnosis, most commonly Bipolar Disorder, recent episode mania with psychotic symptoms. The most common psychotic symptoms were grandiose delusions followed by auditory hallucinations, paranoid delusions and visual hallucinations. The most common mood symptom was euphoria. Substance abuse was uncommon amongst the patients in the study group. Sixteen of the 19 patients (84%) were on antipsychotics, 14 of these 16 patients were on haloperidol. The most commonly used mood stabilizer was sodium valproate. CONCLUSION: In this study mania with psychotic symptoms was the most common presentation in both the group with a pre-existing primary psychiatric disorder and in the group without a primary psychiatric disorder. The prevalence of HIV positive admitted psychiatric females in this study was 12%. Co-morbid substance abuse was uncommon. Most patients tolerated low doses of typical antipsychotics in combination with a mood stabilizer (valproate being the most common).
Steyn R, Vawda N, Wyatt GE
… +2 more, Williams JK, Madu SN
Afr J Psychiatry (Johannesbg)
· 2013 Jan · PMID 23417631
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OBJECTIVE: Exposure to traumatic events may precipitate suicidal ideation. Once an individual is diagnosed with PTSD, a suicide risk assessment often follows. This study explores how PTSD symptom criteria correlate with...OBJECTIVE: Exposure to traumatic events may precipitate suicidal ideation. Once an individual is diagnosed with PTSD, a suicide risk assessment often follows. This study explores how PTSD symptom criteria correlate with suicidal ideation in a sample of police officers. While the psychometric measures of PTSD often mirror the DSM-IV-TR criteria, focusing on exposure, symptom, and duration criteria, suicidal ideation measures often focus on concepts quite different from that. In this report the focus was on investigating how PTSD symptom criteria correlate with the suicidal ideation. METHOD: A group of South African police officers (N = 217) were assessed by means of the Posttraumatic Diagnostic Scale and a short version of the Adult Suicide Ideation Questionnaire. Linear and hierarchical regressions were used to determine which PTSD symptom criteria best predict suicidal ideation. RESULTS: Hyperarousal was the primary predictor of suicidal ideation (R(2) [adjusted] = 0.249). Intrusive thoughts added only marginally to the model, contributing a further 2.5% to the declared variance. The contributions of the other two symptom types were negligible. CONCLUSION: In this study hyperarousal correlated significantly with suicidal ideation. It is suggested that practitioners be alert to these symptoms as possible indicators of suicidal ideation. Implications for suicide risk assessment and prevention measures are discussed.
Afr J Psychiatry (Johannesbg)
· 2012 Nov · PMID 23379015
Mental health is an essential component of health, yet it is often not given the attention that ir deserves as a global health and development issue. In this paper, we examine the global health context, including the sub...Mental health is an essential component of health, yet it is often not given the attention that ir deserves as a global health and development issue. In this paper, we examine the global health context, including the substantial burden of disease, resources available for mental health, treatment gap, human rights issues, links between mental health and development, and economic impact of mental disorders. Then we consider recent actions taken at the global level to advance mental health as a global health issue. Finally, we look at South Africa as an example of a country that is ripe for change in its approach to mental health. This is a country with a high prevalence of mental disorders and a large treatment gap, yet it has a number of strengths on which to build a response to improving population mental health. We make suggestions as to how South Africa can move ahead on its mental health agenda, whilst also being a model for other countries in the region and across the globe.
The need for greater attention to mental health promotion and the prevention of mental disorders in South Africa is highlighted by the cycle of poverty and mental ill-health, the potential for social gains, the question...The need for greater attention to mental health promotion and the prevention of mental disorders in South Africa is highlighted by the cycle of poverty and mental ill-health, the potential for social gains, the question of affordability of treatment in the face of the increasing burden of mental disorders, and the limitations of existing treatment methods. This article, which provides a desk review of the current status of mental health promotion and prevention of mental disorders in South Africa, suggests that South Africa has a number of policies that bode well for promoting mental health from infancy through to old age. There is, however, a need for programmatic interventions to promote resilience in vulnerable populations. Of note, is the need for programmes to address maternal depression and strengthen attachment and psychosocial stimulation during infancy, strengthen families, promote health enhancing school environments, and address intimate partner violence and build health enhancing social capital. Given the multifaceted nature of risk and protective influences, the need for a multi-sectoral plan of action is highlighted.
Suicidal behaviour is an important public health problem globally and in Africa. A brief overview of the nature and severity of the problem is provided, but the primary aim of this paper is to identify priorities and pre...Suicidal behaviour is an important public health problem globally and in Africa. A brief overview of the nature and severity of the problem is provided, but the primary aim of this paper is to identify priorities and prevention strategies for reducing suicidal behaviour in South Africa by discussing a framework for a proposed national prevention programme. South African suicide rates range from 11.5 per 100 000 to as high as 25 per 100 000 of the population, depending on sampling procedures and research methods. About 11% of all non-natural deaths are suicide related. On average 9.5% of non-natural deaths in young people are due to suicide. It is a complex phenomenon and risk factors are, therefore, multifactorial and multidimensional. Some of the most important ones are identified and several priorities and prevention possibilities for reducing suicidal behaviour are recommended. The outline and structure for such a national suicide prevention programme is underpinned by research undertaken locally and internationally. It requires a comprehensive multi-sectoral approach that involves both health care and non-health care sectors and action at various levels utilising a framework based on a set of guiding principles and a range of strategies with specific objectives as a national priority within an interdisciplinary context.
In the current mental health environment in South Africa, the development of a relevant mental health research agenda poses several challenges. This paper provides a brief overview of the current state of published resea...In the current mental health environment in South Africa, the development of a relevant mental health research agenda poses several challenges. This paper provides a brief overview of the current state of published research in mental health and, using a translation research framework, makes recommendations for five strategic directions to be considered in the development of a national mental health research agenda.
The recent National Mental Health Summit included discussion of research priorities for South Africa. This paper reviews some of the background literature that is relevant to this key issue. It draws attention to one con...The recent National Mental Health Summit included discussion of research priorities for South Africa. This paper reviews some of the background literature that is relevant to this key issue. It draws attention to one contested question, the extent to which research in low and middle income countries should address questions about fundamental mechanisms and clinical treatments versus focusing on questions about implementation and systems research? In addressing this question, the paper argues that the boundary between good clinical practice and good academic scholarship is not nearly as distinct as is often assumed (the "research fallacy"); prospective rigorous assessments, retrospective clinical audits, evidence-based medicine, and useful information systems all point to the mutual interdependence of good practice and good scholarship. Finally, some general conclusions that the majority of summit delegates participating in the discussion on research agreed to, are presented.
The large number of persons living with HIV in Southern Africa has implications for mental health services for this population. Data have emerged in recent years showing that a substantial number of persons living with H...The large number of persons living with HIV in Southern Africa has implications for mental health services for this population. Data have emerged in recent years showing that a substantial number of persons living with HIV also have mental health problems. Yet, the practice of routine screening for psychiatric disorders in the context of HIV care is controversial. Moreover, common mental health problems, if left undetected and untreated, may have severe consequences for adherence to antiretroviral therapy (ART), which in turn will likely lead to severe health consequences for patients. There are high costs associated with employing professional psychologists, counsellors, and social workers to provide psychosocial support to ART users. As a result, in many contexts lay counsellors and patient advocates have been employed as a less costly alternative. High standards of training of lay counsellors, as well as on-going supervision and support to patient advocates is necessary to ensure optimal outcomes/results.
Mental disorders are highly prevalent across all health settings. Where they are co-morbid with other chronic physical disorders, a complex bidirectional relationship exists between them. While mental disorders may resul...Mental disorders are highly prevalent across all health settings. Where they are co-morbid with other chronic physical disorders, a complex bidirectional relationship exists between them. While mental disorders may result in an increase in adverse healthrelated outcomes, they are amenable to cost-effective treatments. In resource-limited settings, many barriers to the detection and treatment of mental disorders exist. One approach to the effective targeting of the available resources is to utilize a "risk-flag" approach, wherein individuals at-risk of treatment failure are identified and routed into more intensive mental health screening and intervention. This paper discusses how lessons from HIV services may inform how to improve mental health care and integration in HIV settings, as well as in other chronic diseases.
The recovery movement has emerged as an important and powerful force in the design and implementation of mental health care in many countries around the world. This involves new and more positive understandings of the co...The recovery movement has emerged as an important and powerful force in the design and implementation of mental health care in many countries around the world. This involves new and more positive understandings of the concept of recovery, both as an individual outcome and as a goal of services. The basis for these understandings is examined, with particular emphasis on long-term outcomes in schizophrenia, and a brief history of the origins of the recovery movement is given. An argument is made for the implementation of a recovery framework within South African mental health services.
The Mental Health Care Act 17 of 2002 (MHCA) was promulgated in 2004. It has been hailed as one of the most progressive pieces of mental health legislation. A true measure of its merit is the degree to which it has trans...The Mental Health Care Act 17 of 2002 (MHCA) was promulgated in 2004. It has been hailed as one of the most progressive pieces of mental health legislation. A true measure of its merit is the degree to which it has transformed mental health services and in particular improved the quality of care. This paper will describe the impact of the Act on mental health care service delivery in the country. Literature pertaining to the MHCA published from 2006-2012, a report compiled by the South African Society of Psychiatrists and the results of a national survey conducted among Heads of Departments of Psychiatry, Mental Health Review Boards and Provincial Directors of Mental Health was reviewed. The MHCA has been successful in shifting the emphasis of care from psychiatric institutions to general hospitals. However, the integration of services has been hampered by infrastructure constraints and shortages of mental health personnel. It has been less successful in integrating mental health care into primary health services where the focus remains largely on the pharmacological maintenance treatment of the chronically mentally ill. Little attention has been given to the health promotion, disease prevention and rehabilitation aspects of care. Mental health review boards contend with limited resources, administrative challenges and limited political support. Isolated pockets of success characterised the implementation of the MHCA across the country. Greater investment of resources is needed to ensure the comprehensive implementation of the Act.