bluuebunny/crossref_metadata_2025 huggingface dataset:
Factor analysis of the Children's Behaviour Questionnaire in a Nigerian paediatric primary care population
Authors: Omigbodun O O , Gureje O
Published: June 2017

Objective. This paper examines the factor structure of the Yoruba translation of the Children’s Behaviour Questionnaire for Completion by Parents (CBQ) administered in a Nigerian paediatric primary care population.Design. A cross-sectional questionnaire survey.Subjects. Four hundred and seventy-eight children aged 7 - 14 years who attended a primary care clinic in Ibadan, Nigeria, over a 3-month period.Methods. Parents’ ratings of the children were obtained using the Yoruba translation of the CBQ. The factor structure of this instrument was examined using principal component analysis with varimax rotation. Only factors with eigenvalues of greater than 1 were examined further.Results. The first seven dimensions were readily conceptu- alised. These factors are conduct problem, hyperactivity, emotional problem, irritability, problems with elimination, a somatic complaint and a school problem dimension.Conclusion. These factors are similar to what has been observed in other studies involving populations of children with psychopathology, with the exception of the somatic com- plaint and school problem dimension. The emergence of these two factors, which are quite different from what has been observed in other studies, may demonstrate differences that reflect the influence of language, culture and the peculiarities of a primary care setting. On the other hand the similarity of most of the factors to those found in previous studies con- firms the broad similarities in the behaviour of children across different cultures.
Psychiatry in the medico-legal setting
Authors: Vorster Meryl
Published: June 2017

NO ABSTRACT AVAILIBLE
The patient who complains of erectile dysfunction
Authors: Levinson Bernard
Published: June 2017

NO ABSTRACT AVAILIBLE
Risk factors in repeat non-fatal suicidal behaviour
Authors: Schlebusch Lourens
Published: June 2017

NO ABSTRACT AVAILIBLE
Repeat non-fatal suicidal behaviour at Johannesburg Hospital
Authors: Moosa M YH , Jeenah F Y , Vorster M
Published: June 2017

Objective. To describe the characteristics of non-fatal suicide behaviour (NFSB) in a group of patients and to determine factors, if any, that may be associated with repetition of this behaviour.Method. The study included all patients treated for NFSB at Johannesburg Hospital during the period August 2002 - October 2002. The information was gathered by means of a structured questionnaire designed to evaluate characteristics of the behaviour.Results. The study sample comprised 43 patients with NFSB (mean age 29.7 years, range of 16 - 75 years), of whom 26 (60%) were female. Sixty-three per cent of the patients overdosed with medication and 33% ingested household poisons. Events that precipitated the event included relationship problems (70%), illness (12%), financial difficulties (9%), and depressed mood (9%). In 65% of patients the behaviour was impulsive. Factors associated with non-fatal repetition included being in the 18 - 30-year age group (76%) (χ2 = 6.74, p < 0.05); being female (90%) (χ2 = 4.75, p < 0.05); having children (90%) (χ2 = 4.72, p < 0.05); a past psychiatric history (50%) (χ2 = 4.08, p < 0.05); and the current attempt deemed medically serious (50%) (χ2 = 6.67, p < 0.05).Conclusions. NFSB is a major problem in South Africa and the incidence is still increasing. Hospital-based interventions following admission are recommended to reduce repeat attempts in such patients. Significant factors associated with non-fatal repetition include among others, a history of a previous medically serious attempt and/or a known psychiatric illness.
Serious mental illness and HIV / AIDS
Authors: Freeman Melvyn , Thom Rita
Published: June 2017

n/a
Clozapine-induced intestinal obstruction - a critical examination of four cases
Authors: Seller C , Koen L , Niehaus D J H
Published: June 2017

Clozapine is an atypical antipsychotic drug indicated for the management of severely ill patients with schizophrenia who fail to respond adequately to standard antipsychotic treatment. It has demonstrated superior efficacy in treating both the positive and negative symptoms in treatment-refractory cases. It also has the added benefit of causing minimal extrapyramidal side- effects, producing no tardive dyskinesia and having little effect on prolactin levels
Homicidal violence during foreign military missions - prevention and legal issues
Authors: Okulate G T , Oguine C
Published: June 2017

Objectives. The study involved Nigerian soldiers engaged in peacekeeping missions in Liberia and Yugoslavia. Using case illustrations, the study sought to describe patterns of homicidal violence among soldiers from the same country or soldiers from allied forces, and to suggest possible reasons for the attacks.

Design and setting. Nigeria was actively involved in peacekeeping missions in Liberia between 1990 and 1996. During this period, intentional homicidal attacks occurred among the Nigerian military personnel. Post- homicidal interviews conducted among the perpetrators were combined with evidence obtained at military courts to produce the case studies.

Subjects. Six Nigerian military personnel who attacked other Nigerians or soldiers from allied forces, with homicidal intent.

Results. Possible predisposing and precipitating factors for these attacks were highlighted. The possibility of recognising these factors before embarking on overseas missions was discussed, so that preventive measures could be instituted as far as possible. Finally, medico-legal implications of homicide in the military were discussed.

Conclusions. A certain degree of pre-combat selection is essential to exclude soldiers with definite severe psychopathology. A clearly defined length of duty in the mission areas and adequate communication with home could reduce maladjustment. Health personnel deployed to mission areas should be very conversant with mental health issues so that early recognition of psychological maladjustment is possible.
The evolution of antipsychotic medication: a long-acting injectable formulation of a second-generation antipsychotic
Authors: Oosthuizen Piet
Published: June 2017

NO ABSTRACT AVAILIBLE
Mild hypoxia is associated with quantitative EEG changes, but not with dissociative symptoms
Authors: Smith H W , Kruger C , Le Roux C , Van der Linde M J , Groeneveld H T , Bartel P , Pretorius F
Published: June 2017

Backround and aims. Hypoxia at altitude may lead to mental changes resembling dissociative symptoms. This study examined whether hypoxia precipitates dissociative states in normal subjects and whether quantitative electro- encephalographic (EEG) changes occur.

Methods. Dissociative symptoms and EEG changes were examined in a hypobaric chamber.

Results. No dissociation was noted. EEG slowing accompanied hypoxia, replicating previous findings.
Prevalence and risk factors for psychiatric morbidity among tertiary hospital consultants in Nigeria
Authors: Yussuf A D , Balogun O R , Kuranga S A
Published: June 2017

Objective. To determine the prevalence of psychiatric morbidity among consultants in a tertiary health care institution in Ilorin, Nigeria, and the sociodemographic and work characteristics that may be associated with poor mental health.

Method. This was a cross-sectional study involving use of the 30-item general health questionnaire (GHQ-30) and a questionnaire on sociodemographic/work-related factors.

Data Source. Consultants in the employ of the University of Ilorin Teaching Hospital.

Data analysis. Data were analysed using the Statistical Package for Social Sciences version 11.0 (SPSS 11.0). Frequency distribution, cross tabulation, and chi-square analysis were obtained, with level of significance set at 5%.

Result. Fifty-four consultants responded satisfactorily to the questionnaires (response rate 69.2%); 10 (18.5%) scored 4 and above on the GHQ-30 (i.e GHQ-positive) and were therefore considered to have psychiatric morbidity. No socio demographic or work-related factors had any significant association with morbidity.

Conclusion. Teaching hospital consultants are as likely as any other occupational group to develop psychological morbidity, possibly owing to the role of inherently dominant factors. Regular organisation of stress management workshops/seminars and hospital management-consultant interactive forums is advocated.
Product News
Authors: Spencer Jones Jonathan
Published: June 2017

No abstract available.
Mental Health research challenges in Africa
Authors: Spencer-Jones Jonathan
Published: June 2017

NO ABSTRACT AVAILIBLE
Depression worsens health of people with chronic illness
Authors: Spencer-Jones Jonathan
Published: June 2017

Individuals with depression are generally less healthy than those with a major chronic disease, according to data collected by the World Health Organization (WHO) in its World Health Survey on health and health-related outcomes and their determinants in adults aged 18 years and older and presented in the organisation’s World Health Statistics 2007.
Anxiety, depression, health attitudes and coping strategies in doctors and teachers in a Cape Town setting
Authors: Van der Bijl H , Oosthuizen P
Published: June 2017

Objective. To investigate two professional groups (doctors and teachers) with regard to symptoms of anxiety and depression as a measure of psychological distress, as well as perceptions regarding job satisfaction, workload and adequacy of remuneration. To assess health care behaviour as evidenced by substance use, psychotropic medication use, self-prescribing habits (in doctors), help-seeking behaviour as well as negative coping strategies as indicated by the intention to emigrate and/or leave the profession.

Design. Data were collected from randomly distributed questionnaires which included a validated objective screening instrument, the Hospital Anxiety and Depression Scale (HADS).

Subjects and setting. Questionnaires were distributed among 260 physicians at Tygerberg Academic Hospital and 200 teachers from five different schools in the northern suburbs of metropolitan Cape Town.

Results. We found high levels of job dissatisfaction and symptoms of anxiety and depression in both groups, with teachers more affected than doctors. A large proportion of respondents with clinically significant levels of anxiety and depression remain untreated. Many respondents displayed a passive attitude with regard to seeking help. A significant proportion of doctors self-prescribed antidepressant and benzodiazepine medications. Only a small minority of doctors had a general practitioner whom they would consult when ill. Twenty-nine per cent of doctors indicated their intention to emigrate and 40% of teachers were planning to leave their profession.

Conclusion. Our results suggest that doctors and teachers in South Africa are two professional groups at high risk for developing serious mental health problems, with low levels of recognition and intervention at present.
Psychiatry for the person and its ethical perspectives
Authors: Mezzich Juan E , Christodoulou George
Published: June 2017

Every medical (and psychiatric) act is or should be an ethical act. This is consistent with the fundamental aspirations of the medical and health field, from Hippocratic and similar ancient philosophical perspectives to recent developments in public and clinical policies. Ethical concerns have been priority institutional commitments since the beginnings of the World Psychiatric Association (WPA). In line with the above, the WPA established in 2005 an Institutional Program on Psychiatry for the Person. This editorial summarises the precedents, goals, structure and activities of this WPA initiative and outlines some of its ethical perspectives.
Community psychiatry: An audit of the services in southern Gauteng
Authors: Moosa M Y H , Jeenah F Y
Published: June 2017

Aim. To audit the community psychiatric services in southern Gauteng with a view to determining whether the objectives of the country’s mental health legislation and policies are being achieved.

Results. Although southern Gauteng’s community psychiatric clinics are situated in a primary health setting, primary health clinicians play no active role in the management of mentally ill patients. Care is supplied mainly by specialist psychiatrists, psychiatric registrars (in training) and psychiatric nurses. For first appointments, a mean of 2 patients are seen per doctor per clinic day for a mean duration of 30 minutes. For follow- up appointments, a mean of 17 patients are seen per doctor per clinic day for a mean duration of 8 minutes. The waiting time for new patient appointments is a mean of 6 months. Follow-up patients are seen once a month by nursing staff and approximately once every 4 months by doctors. An average of 1 in 5 patients is treated with oral atypical antipsychotics; in the majority of clinics, this is the total extent of care. However, where psychologists, social workers and occupational therapists are present, only 0.2% of all users have access to them.

Conclusion. The community psychiatric services, although better than those in some other countries, fall short of what is required by South African legislation and policies. General community health services ought to play an active role in the structure and delivery of psychiatric services by developing and strengthening the current limited services, with an emphasis on cost-effective and preventive approaches. Existing community psychiatric services, if so transformed, could serve as a model for other countries in Africa.
Orexin - does it have a role in mental illness?
Authors: Moosa M Y H , Jeenah F Y
Published: June 2017

Orexin-A and Orexin-B (also known as hypocretin 1 and 2) are, respectively, 33- and 28-amino acid residue peptides that activate a G-protein-coupled ‘orphan’ receptor, i.e. which has no known ligand.  Immuno-cytochemical studies show that orexin-positive neurons are located in the lateral hypothalamic area and arcuate and perifornical nuclei. They are also found in various sites beyond the hypothalamus such as the thalamic paraventricular and reuniens nuclei, locus coeruleus, nucleus of the solitary tract, raphe and septal nuclei. The hypothalamus has a major role in regulating various behaviours that contribute to homeostasis (such as arousal, feeding, and thermoregulation) by integrating external and internal stimuli.  It is involved in the regulation of nutritional status via the co-ordination of many neurotransmitter systems implicated in food intake and energy expenditure. The hypothalamic orexin system directly and strongly innervates and potently excites noradrenergic, dopaminergic, serotonergic, histaminergic and cholinergic neurons. Orexin also has a major role in modulating the release of glutamate and other amino acid transmitters. This widespread distribution and effect of orexin on multiple neurotransmitters suggests that it may be implicated in functions other than feeding, viz. other vegetative and neuroendocrine regulations or those related to general arousal states.
What do patients with psychotic and mood disorders know about their illness and medication?
Authors: Kotze C , King M P , Joubert P M
Published: June 2017

n/a
Xenophobia - evolved 'outgroup' hatred or product of a toxic social environment?
Authors: Burns Jonathan Kenneth
Published: June 2017

n/a
Evaluation of primary mental health care in North West province – a qualitative view
Authors: Van Deventer Claire , Couper Ian , Wright Anne , Wright Anne , Tumbo John , Kyeyune Charles
Published: June 2017

Background. Due to many complaints by health care workers and patients and a perceived poor standard of care, the mental health care services in the North West province were assessed using quantitative and qualitative methods. The Mental Health Care Act of 2002 makes provision for the integration of services into primary health care. Previously, dedicated mental health care co-ordinators were doing the bulk of the management of this category of patients.

 Methodology. The qualitative part of the study consisted of free attitude interviews with professional nurses at clinics and focus group interviews with patients, caregivers and mental health care coordinators.

Results. There was general satisfaction with the current services. Some dissatisfaction was expressed regarding issues of individualised care versus integration into the general primary care services. Concerns were expressed about resource constraints – in terms of human and physical resources, communication, training, and the role of specialised care.

Conclusion. This study highlights issues around integration of mental health care services into primary care, and has provided information for managers and clinicians to utilise in the improvement of mental health care.
Anxiety associated with colposcopy at Chris Hani Baragwanath Hospital, Johannesburg
Authors: Moosa MYH , Chait L , Cohen A , Diamond L , Dunlop J , Masela M , Matlhatsi T , Mehlomakhulu T E , Naidu J , Ngutshane B , Vythilingum P
Published: June 2017

Given the high incidence of cervical cancer in South Africa and the distress it causes, we aimed to determine the extent of anxiety in patients undergoing colposcopy at Chris Hani Baragwanath (CHB) Hospital, Johannesburg.

Method. A descriptive and cross-sectional study design was applied on a convenient sample of patients from the waiting area of the colposcopy clinic at CHB Hospital. Females attending a first colposcopy appointment were invited to participate by completing the State-Trait Anxiety Inventory (STAI) after written informed consent had been obtained.

 Results. Among a total of 31 women, the mean STAI score for state anxiety was 46.77 (SD=12.92) and the mean STAI score for trait anxiety was 46.81 (SD=9.50); 51.6% of the patients had a STAI state anxiety score of >50, while 41.9% of the patients had a STAI trait anxiety score >50. There was no significant association between either elevated STAI state or trait anxiety scores and age group ( χ 2 =1.77; p= 0.18 and χ 2 =0.001; p= 0.98, respectively); marital status ( χ 2 =0.301; p= 0.58 and χ 2 =0.834; p= 0.36); level of education ( χ 2 =0.444; p= 0.51 and χ 2 =2.40; p= 0.12); employment status ( χ 2 =1.78; p= 0.18 and χ 2 =0.001; p= 0.98); monthly income ( χ 2 =1.15; p= 0.28 and χ 2 =0.03; p= 0.86) or using stimulants ( χ 2 =0.416; p= 0.52 and χ 2 =0.394; p= 0.53). There was a significant negative correlation between age and STAI state anxiety scores ( r 2 =0.004; p= 0.017) and a positive correlation between age and STAI trait anxiety scores ( r 2 =0.004; p= 0.019).

Conclusion. This study reported significantly elevated trait anxiety scores relating to colposcopy and emphasises the need to identify the anxiety and institute a plan to ameliorate it with information booklets, leaflets, video colposcopy and educational counselling.
Suicide Risk in Schizophrenia, a 20 Year Cohort Study, Part 1: Outcome and associated social factors
Authors: Lippi G , Smit D J , Jordaan J C , Roos J L
Published: June 2017

Objective: This study prospectively followed up, after a period of 20 years, a group of patients with schizophrenia who were considered to be at high risk for suicide. In Part 1, we reported on outcome and associated social factors, and in this paper we discuss re-evaluated suicide risk in these patients and investigated symptomology and pharmacotherapy over the last 2 decades.

 Method: The subjects were interviewed, and a questionnaire evaluating suicide risk was completed. The Beck Hopelessness Scale (BHS) was administered and ratings were compared to those from the original study. The Calgary Depression Scale for Schizophrenia (CDSS) was also administered. Cross tabulations were then performed to identify factors associated with increased suicide risk. For those subjects who committed suicide since the original study, a psychological autopsy was performed.

Results: Fourteen of the original 33 high suicide risk schizophrenia patients were found. Three subjects committed suicide during the 20 year period. Among the living subjects, risks for suicide were found to be lower than 20 years ago. Hopelessness and depressive symptoms correlated with independently evaluated suicide risk. Social withdrawal, blunting of affect and delusions were also associated with elevated risk. Good insight into illness and a history of previous suicide attempts correlate with high suicide risk. Cannabis abuse, poor or periodic adherence to treatment, as well as weight gain, akathisia and parkinsonian adverse effects were also associated with an increase in risk for suicide. Formal thought disorder, avolition and cognitive impairment were associated with lower risk of suicide.

Conclusion: Hopelessness, depression, certain positive symptoms and adverse effects of medication, found in this study to be congruent with suicide risk in patients with schizophrenia, coincide with those mentioned in the literature. Despite current knowledge about this subject, suicide remains notoriously and ominously unpredictable in patients with schizophrenia.
The use of restraints in psychiatric patients
Authors: Moosa M Y H , Jeenah F Y
Published: June 2017

Restraints are usually used for the protection of patients and others when medication and verbal therapies are insufficient to control potentially violent patients. Many fear the abuse of restraints as well as their psychological, physical and emotional consequences. In South Africa, according to the Mental Health Care Act No. 17 of 2002, the use of restraints is permissible but subject to certain regulations. Restraint may not be used any longer than is necessary to prevent serious bodily harm to the patient or others. When restraint has the desired effect of settling the patient’s behaviour to the point where control is regained, its further imposition is illegal. Restraints may be classified into three main categories: ( i ) environmental restraints; ( ii ) physical restraints; and ( iii ) chemical restraints. There is much debate over what types of restraint are superior. There may be differences in cost, risk of serious staff injury, requirements of staff time for monitoring and implementation, and impacts on staff and patient attitudes. It is hoped that the use of environmental and physical restraint will be rendered obsolete by advances in the field of psychiatry such psychopharmacology and the therapeutic milieu. In order to reach this goal more research needs to be done on restraint practices across a wide range of psychiatric treatment settings.
Depression in Kraepelinian Schizophrenia
Authors: Naude H E , Du Preez Renata Ronelle , Sykes R , Pretorius H W , Van der Linde M J , Pauw J
Published: June 2017

Objective. Depressive symptoms are prevalent, under- recognised and clinically important in patients suffering from schizophrenia. Depressive symptoms in schizophrenia patients are associated with distinct morbidity and mortality. The objective of this study was to investigate the prevalence of depressive symptoms in a subgroup of chronic schizophrenia, Kraepelinian schizophrenia, and the association with severity of illness. Kraepelinian schizophrenia is characterised by a chronic, unremitting, severe course of illness and severe deterioration of functioning in social, work and self-care domains.

Method. The Calgary Depression Scale for Schizophrenia (CDSS) and the Clinical Global Impression Severity (CGI-S) scale were administered to 113 patients who fulfilled the criteria of Kraepelinian schizophrenia.

Results. Sixty-eight males and 45 females participated in the study. Of this group, 17.7% scored 5 or more on the CDSS. The CGI-S scores indicated that almost half of the patients were moderately ill (i.e. a score of 4 on the CGI-S scale). Of the patients, 94 were receiving first-generation antipsychotic medication and 19 second- generation antipsychotic medication. Thirteen patients were also receiving antidepressant medication.

Conclusion. The findings of this study are consistent with current reports in the literature that depressive symptoms are not common in Kraepelinian schizophrenia, even though patients are moderately to severely ill in both symptom and functional domains.
Adolescent Onset Psychosis: A 2-year retrospective study of adolescents admitted to a general psychiatric unit
Authors: Paruk S , Ramlall S , Burns Jonathan K
Published: June 2017

Background:KwaZulu-Natal had no dedicated in-patient adolescent psychiatric service during the study period and adolescents were admitted to general psychiatric wards.

Aim of Study: This is a descriptive review of adolescents admitted with psychotic symptoms to a psychiatric hospital. It aims to describe their demographic profile, associated risk factors, clinical profile and management strategies utilized.

Method: The files of all adolescent patients with psychotic symptoms, aged twelve to eighteen years old, admitted to a psychiatric hospital from July 2005 to June 2007 were reviewed.

Results: 70 adolescents with psychosis were admitted to adult psychiatric wards over the 2 year period. The age range was 13 to 18 years old. 80% of the adolescent patients were male, 37% reported a positive family history of mental illness, 50% smoked nicotine and 61.4% reported cannabis use. The most common diagnoses were schizophrenia (30%) and schizophreniform disorder (27.1%). 85.5%(60) of adolescent patients had a trial on a first generation antipsychotic and 10 patients were initiated on a second generation antipsychotic de- novo. The average length of stay in hospital was 27.8 days. 40% defaulted follow up post discharge.

Conclusion: Schizophrenia was the most common diagnosis. There were high rates of cannabis use. The adolescents were managed in psychiatric wards for significant periods and the majority of patients were initiated on first-generation antipsychotics. There is a need to develop specialized inpatient adolescent psychiatric facilities and services, as well as to address the issues of co-morbid substance use and non-adherence to treatment.
Stuck in the past or heading for flourishing people in their diversity?
Authors: Van Staden Werdie
Published: June 2017

No abstract available.
Epidemiology of drug abuse treatment in South Africa
Authors: Ramlagan Shandir , Peltzer Karl , Matseke Gladys
Published: June 2017

Background. The aim of the study was to explore the epidemiology of drug abuse treatment in South Africa.

Methods. Treatment demand statistics were analysed from South African National Council on Alcoholism and Drug Dependence and the South African Community Epidemiology Network on Drug Use records, and a rapid situation assessment was conducted. Twenty-one key informant interviews were conducted in all 9 provinces among provincial substance abuse co-ordinators, and one manager per treatment centre from a sample of treatment centres. Three focus groups were conducted and 46 self-administered questionnaires were distributed among inpatients at 2 selected treatment centres in Free State and North West provinces. Qualitative data were analysed using grounded theory, and quantitative data analysed using SPSS.

Results. Treatment records show that the most frequent substance of abuse was alcohol (51%), followed by cannabis (21%), crack/cocaine (9.6%), heroin/opiates (7.9%), methamphetamine (Tik) (4.5%), prescription/over-the-counter drugs (2.0%), and cannabis/mandrax (1.7%). More substance abusers were male, of lower education, white or black, than were female, more highly educated, coloured and Indian/Asian. Key informant interviews showed that females are the ‘hidden’ substance abusers and tend not to be identified in research statistics and at treatment centres. Poverty, unemployment, lack of recreational facilities, being surrounded by substance abusers, and long work shifts were also mentioned as factors contributing to substance abuse. The age of initiation of substance abuse using non-drugs such as glue was 9 years old, alcohol 10 - 12 years old, dagga 11 - 12 years old, poly-drug use (alcohol, tobacco and dagga) 14 years old, and harder drugs such as cocaine and heroin at 16 - 17 years old, as reported by key informants. Family care and support, improved socio-economic conditions and increased law enforcement would help to discourage substance abuse.

Conclusion. Prevention interventions and policies in South Africa should focus on reducing substance abuse by targeting the ‘at risk populations’ identified in this study.
Depression among patients with diabetes mellitus in a Nigerian teaching hospital
Authors: James Bawo Onesirosan , Omoaregba Joyce Ohiole , Eze George , Morakinyo Olufemi
Published: June 2017

Objectives. Depression is associated with diabetes mellitus and affects treatment goals negatively. We aimed to determine the prevalence of depression and identify its socio-demographic or clinical correlates among patients with diabetes mellitus attending an out-patient clinic in Nigeria.

Methods. Two hundred consecutively recruited diabetes patients (index group) were compared with a similar number of apparently healthy controls in a cross-sectional survey. In both groups, in addition to obtaining socio-demographic details, depression was diagnosed using the Schedule for the Clinical Assessment in Neuropsychiatry (SCAN), while the Beck Depression Inventory (BDI) was used to assess depression symptom severity.

Results. Sixty (30%) diabetes patients met a SCAN diagnosis for clinical depression, compared with 19 (9.5%) in the control group. Having a smaller income and more children were significantly correlated with higher depression symptoms on the BDI.

Conclusion. Depression is highly co-morbid with diabetes mellitus. The care of individuals with diabetes mellitus should include the screening and possible treatment for depression in order to achieve and sustain treatment goals.
'Defeating the dragon' - can we afford not to treat patients with heroin dependence?
Authors: Weich Lize
Published: June 2017

A worrying increase in heroin use disorders has been noted in South Africa over recent years. Despite this, very limited treatment options exist in the state sector. This article provides a brief overview of the local extent of the problem and its implications, and discusses treatment options. It briefly investigates international treatment implementation strategies and makes suggestions for local policy.
Attitudes towards psychiatry of undergraduate medical students at Bayero University, Nigeria
Authors: Aghukwa N C
Published: June 2017

Background. This study determined and compared responses of 5th- and 6th (final)-year medical students on their attitudes to psychiatry as a profession. Also elicited were their choices of area of future medical specialisation.

Method. A prospective and cross-sectional study using an adapted 27-item self-administered questionnaire to obtain responses from 91 5th- and 6th-year medical students at Bayero University, Kano, Nigeria.

Results. More than 60% of the students’ first choices for future specialisation were surgery, obstetrics/gynaecology or internal medicine. Psychiatry was the first preference for less than 2%. More than 75% of the students’ views on the overall merits and efficacy of psychiatry were positive, although they felt that psychiatry had low prestige and status as a profession. In addition, the same proportion considered that psychiatry was scientific, making advances in the treatment of major mental disorders, and helpful in liaison practice. More than 50% stated that psychiatry would not be their choice of last resort for residency education and the same proportion felt that friends and fellow students rather than family members would discourage them from specialising in psychiatry. More than 50% would feel uncomfortable with mentally ill patients, felt that psychiatry would not be financially rewarding, and did not think that psychiatrists abuse their legal power to hospitalise patients. Attitudes of the two groups of students to psychiatry as a profession were not significantly different (p>0.05).

Conclusion. A clinical clerkship in psychiatry did not influence the students’ choice of future specialisation.
A review of the applications for involuntary admissions made to the Mental Health Review Boards by institutions in Gauteng in 2008
Authors: Moosa M Y H , Jeenah F Y
Published: June 2017

Aim. To review applications for involuntary admissions made to the Mental Health Review Boards (MHRBs) by institutions in Gauteng.

Method. A retrospective review of the register/database of the two review boards in Gauteng for the period January - December 2008. All applications for admissions (involuntary and assisted inpatient) and outpatient care (involuntary and assisted), and periodic reports for continued care (inpatient or outpatient care) were included.

Results. During the study period the two MHRBs received a total of 3 803 applications for inpatient care, of which 2 526 were for assisted inpatient care (48.1% regional hospitals, 29.6% specialised psychiatric hospitals, 22.2% tertiary academic hospitals). Of the applications for involuntary inpatient care, 73.1% were from the specialised psychiatric hospitals (65.2% from Sterkfontein Hospital). Applications for outpatient care, treatment and rehabilitation (CTR) numbered 1 226 (92% assisted outpatient CTR). Although the health establishments in northern Gauteng applied for more outpatient CTR compared with those in southern Gauteng (879 v. 347, respectively), the ratios of assisted to involuntary outpatient applications for CTR for each region were similar (approximately 12:1 and 9:1, respectively). The boards received 3 805 periodic reports for prolonged CTR (93.5% inpatient, 6.5% outpatient), in the majority of cases for assisted CTR.

Conclusion. The study suggests that in the 4 years since the promulgation of the MHCA in 2004 , there have been significant strides towards implementation of the procedures relating to involuntary admission and CTR by all stakeholders. Differences in levels of implementation by the various stakeholders may result from differences in knowledge, perceptions, attitudes and understanding of their roles and therefore indicate the need for education of mental health care professionals and the public on a massive scale. The Department of Health also needs to invest more funds to improve mental health human resources and infrastructure at all health establishments.
The problematic neglect of phenomenology in contemporary psychiatry
Authors: Baumann Sean
Published: June 2017

No abstract available.
Revisiting validity in cross-cultural psychometric-test development: A systems-informed shift towards qualitative research designs
Authors: Swanepoel Isabelle , Kruger Christa
Published: June 2017

Background: The problem of enhancing validity in cross-cultural psychometric-test development in the field of clinical psychology has been perpetuated by several factors. Societal biases and value judgements, a positivistic paradigm, and challenges associated with multiculturalism continually spill over into cross-cultural research methodology. An overemphasis on quantitative methods and insufficient exploration of the meaning of the concepts to be measured tend to threaten construct validity.

Objectives and Methods: This article tracks some of the progress in the field of clinical cross-cultural psychometric-test development – prior to and since the International Test Commission Guidelines, and including the complex South African situation – to give support to the perspective that previous cross-cultural research inadequately equips contemporary researchers to develop valid tests for multicultural clinical contexts.

Results: A systems-informed paradigm shift is proposed, which involves the application of systemic concepts such as circularity, relationality, neutrality, and a concern with process issues. Ideally, multidisciplinary, multicultural test-developing teams that include members of the target-cultural group should consult and collaborate with the target groups before embarking on test-adaptation or test-development activities. Such teamwork would help to ensure that the meaning of the relevant concept/s is captured in a valid way for each cultural group. Furthermore, such collaboration should form a part of using qualitative research designs more frequently in clinical cross-cultural psychometric-test development.

Conclusions: The emphasis should be on building theory and generating hypotheses, in order to pursue a deeper understanding of the constructs under investigation, and to advance theoretical developments in the field of clinical cross-cultural psychometric-test development.
Applications to Mental Health Review Boards by institutions in Gauteng
Authors: Janse van Rensburg Albert Bernard Repsold
Published: June 2017

Letter
Psychotherapy in psychiatry - reality, delusion or relic?
Authors: Bohmer Manfred
Published: June 2017

If you talk about things you have not experienced, you are wasting your and other people’s time. As you continue the practice of looking deeply, you will see this more and more clearly, and you will save a lot of paper and publishing enterprises and have more time to enjoy your tea and live your daily life in mindfulness.’Psychotherapy has been viewed as a core clinical activity of psychiatrists.Is this still the case in our modern era, with more and more focus on pharmacotherapy? As we prepare for the Fellowship of the College of Psychiatrists of South Africa (FCPsych) to be the only exit examination to qualify as a psychiatrist in South Africa, it is prudent to reconsider this and related questions
Prevalence of psychological distress and associated factors in urban hospital outpatients in South Africa
Authors: Peltzer Karl , Pengpid Supa , Skaal Linda
Published: June 2017

Objective. The aim of this study was to assess the prevalence of psychological distress and associated factors among outpatients in an urban hospital in South Africa.

Method. A sample of 1 532 consecutively selected patients (56.4% men and 43.6% women) from various hospital outpatient departments were interviewed with a structured questionnaire.

Results. Based on assessment with the Kessler Psychological Distress Scale, a measure of psychological distress, 17.1% of the patients (15.5% of men and 19.4% of women) had severe psychological distress. Logistic multiple regression identified no income, poor health status, migraine headache and tuberculosis as significant factors associated with severe psychological stress for men. For women the factors identified were lower education, no income, having been diagnosed with a sexually transmitted disease, stomach ulcer and migraine headache.

Conclusion. The study found a high prevalence of psychological distress among hospital outpatients in South Africa. Brief psychological therapies for adult patients with anxiety, depression or mixed common mental health problems treated in hospital outpatient departments are indicated. Accurate diagnosis of co-morbid depressive and anxiety disorders in patients with chronic medical illness is essential in understanding the cause and optimising the management of somatic symptom burden.
A retrospective chart review of the clinical and psychosocial profile of psychotic adolescents with co-morbid substance use disorders presenting to acute adolescent psychiatric services at Tygerberg Hospital
Authors: Lachman Anusha , Nassen Rene , Hawkridge Sue , Emsley Robin A
Published: June 2017

Background. A large number of adolescents meet criteria for ‘dual diagnosis’ (a psychiatric disorder plus co-morbid substance use disorder (SUD), which prolongs treatment response and complicates intervention strategies. The current service model in Cape Town divides the care of such patients into psychiatric treatment and a separate substance use intervention. Child and adolescent mental health services face the challenge of high rates of readmission of adolescents into psychiatric facilities before utilisation of community-based substance abuse services.

Objective. There is a scarcity of available treatment guidelines for dual-diagnosis adolescents, and a lack of systematically documented epidemiological and clinical data in South African adolescent populations.

Method. A retrospective chart review of adolescent psychiatric admissions to the Tygerberg Adolescent Psychiatric Unit during 2010 was conducted. Relevant epidemiological, clinical and demographic data for those presenting with a dual diagnosis (specifically psychotic disorders and SUD) was recorded.

Results. Results suggest a high prevalence of SUD among adolescents presenting with a first-episode psychosis. Statistically significant correlations with lower levels of education were found in those with ongoing substance abuse (specifically cannabis and methamphetamine), and a significant relationship between choice of debut drug and ongoing drug use was also demonstrated. Risk factors for SUD (psychosocial adversities, childhood trauma, family and community exposure to substances, early debut drug ages), risky sexual behaviours, and clinical psychiatric profiles of adolescents with dual diagnosis are described.

Conclusions. This cohort had an enhanced risk as a result of genetic vulnerability and environmental availability of substances, and the findings emphasise the differences in presentation, choice of drugs of abuse and psychosocial difficulties of adolescents with a dual diagnosis presenting to a psychiatric facility. We aim to influence role-players to provide more integrated services, and highlight the need for future prospective studies in this adolescent group to assist in improving outcomes.
Help-seeking by substance dependants presenting to healthcare professionals in the Free State Province
Authors: Van Zyl P M , Gagiano C A , Mollentze W F , Snyman J S , Joubert G
Published: June 2017

Introduction. Current data regarding treatment needs in South Africa for substance dependence are based on admissions to specialised treatment centres. The data therefore do not include patients presenting to independent healthcare workers and state hospitals.

Aim. The aim of this study was to investigate help-seeking behaviour for substance dependence disorders from the perspective of healthcare professionals at various levels of the referral chain in Free State Province. Design. A descriptive study was performed.

Setting. Treatment environments in Free State Province accessible to substance-dependent persons. Participants. General practitioners, private psychiatrists, prescribing healthcare professionals at state hospitals and treatment centres, and non-prescribing therapists responsible for management of substance-dependent persons.

Measurements. A questionnaire was used to determine the level of help-seeking experienced by the participants regarding various classes of psycho-active substances.

Findings. The presentation of alcohol, cannabis, opioid, benzodiazepine, ecstasy, cocaine and inhalant dependency at general practitioners, private psychiatrists, treatment centres and non-prescribing therapists was compared. Different patterns of help-seeking for substance dependence from the various professional groups were detected. Regarding alcohol dependence, 40.3% of private general medical practitioners reported being confronted with alcohol dependence at least once per month, compared with 100% of treatment centre representatives and private psychiatrists, 70.6% of state hospitals and 53.8% of non-prescribers. State hospitals reported the highest frequency for contact with cases of cannabis dependence, compared with the other professional groups, while psychiatrists reported the highest contact with cases involving benzodiazepine, cocaine and ecstasy. Therapists reported a higher level of contact with inhalant dependence, while this group virtually never presented at general practitioners and private psychiatrists.

Conclusion. Help-seeking data can be used in conjunction with other data, such as treatment demand data, to inform and adapt policies and practice. Variations in the manifestation of help-seeking behaviour at various groups may be important pointers to conditions that influence help-seeking, and therefore should be investigated further.
Syphilis sero-positivity in recently admitted and long-term psychiatric inpatients: Screening, prevalence and diagnostic profile
Authors: Henning Maria P , Kruger Christa , Fletcher Lizelle
Published: June 2017

Background. Syphilis research has neglected the prevalence of the disease among psychiatric patients, and traditional syphilis screening has been reported as inadequate.

Objectives. (i) To assess the syphilis prevalence among psychiatric patients; (ii) to compare psychiatric diagnoses of syphilis-infected and -uninfected patients; (iii) to assess self-reported high-risk sexual behaviour; (iv) to establish syphilis/HIV co-morbidity; and (v) to investigate the performance of the rapid plasma reagin (RPR) test in syphilis screening, compared with the Treponema pallidum haemagglutination (TPHA) test.

Methods. Psychiatric inpatients at Weskoppies Hospital, Pretoria, who consented to participate in the study (N=195) were categorised according to gender and length of admission (long-term or recent). Non-treponemal RPR, confirmatory TPHA, HIV-rapid and HIV enzyme-linked immunosorbent assay (ELISA) tests were performed. A reactive TPHA test was used to diagnose syphilis.

 Results. The estimated prevalence of syphilis was 11.7%. There was no significant association between TPHA sero-positivity and primary psychiatric diagnosis or self-reported high-risk sexual behaviour. Significant co-morbidity existed between syphilis and HIV (p=0.012). Compared with the TPHA test, the RPR test performed poorly, identifying only 2/23 patients who had a sero-positive TPHA test (8.7% sensitivity and 100% specificity).

Conclusions. The prevalence of syphilis was higher than anticipated, supporting the need for routine testing. The significant co-morbidity and alarming prevalence of HIV and syphilis warrant testing for both conditions in all psychiatric admissions. Current syphilis screening with a single RPR test is inadequate; both RPR and TPHA tests should be performed.
Exploring the role of Islam in perceptions of mental illness in a sample of Muslim psychiatrists based in Johannesburg
Authors: Bulbulia T , Laher S
Published: June 2017

Background. Western definitions of, and approaches to, mental illness have been critiqued for their lack of incorporation of cultural and spiritual elements.

 Objective. To explore perceptions of mental illness, particularly in terms of the role of Islam in the understanding of mental illness among South African Muslim psychiatrists practising in Johannesburg.

Methods. Using a qualitative design, semi-structured interviews were conducted with a convenience sample of 7 Muslim psychiatrists in the Johannesburg area. Thematic content analysis was used to analyse the transcribed data.

Results. Psychiatrists subscribe to a more biomedical model of illness. The findings of this study also suggest that psychiatrists attempt to remain objective and to refrain from imposing their religious and cultural beliefs on their patients. However, their conceptualisation of mental illness is influenced by their religion and culture. Furthermore, all participating psychiatrists indicated that they always draw on Islamic values when treating their patients. Issues of cultural competence were also highlighted. Psychiatrists indicated that they were open to collaboration with traditional healers and psychologists but that this was quite challenging.

Conclusion. The necessity for formal bodies to develop routes for collaboration between healthcare professionals and traditional healers was brought to the fore. So, too, was the need to incorporate indigenous theory and knowledge into mainstream definitions and approaches to mental illness. 