bluuebunny/crossref_metadata_2025 huggingface dataset:
Antidepressants versus interpersonal psychotherapy in treating depression in HIV-positive patients.
Authors: Moosa M Y H , Jeenah F Y
Published: June 2017

Aim. Despite the prevalence of HIV and AIDS in South Africa reaching pandemic proportions, very few studies have been published on co-morbid depression. This study at Chris Hani Baragwanath Hospital was conducted on a group of HIV-positive patients with depression who were receiving antiretroviral treatment. The aim of the study was to describe their response to treatment with either an antidepressant or psychotherapy.

Method. The study was prospective, randomised and controlled. The sampling was a convenience sampling, as it included patients attending the HIV clinic. At entry to the study, a clinical diagnostic evaluation and the Hamilton Depression Rating Scale (HAMD) were performed on all subjects by the investigator. The depressed patients were randomly assigned to receive either an antidepressant (citalopram) or psychotherapy (interpersonal psychotherapy, IPT). The HAMD was repeated at the study endpoint of 8 weeks. Results. Sixty-two HIV-positive persons on antiretrovirals participated in this study. Thirty of them were not depressed and served as controls, and 32 were depressed. There were no significant differences between the controls and the patients (either receiving pharmacotherapy or psychotherapy) in respect of any of the socio-demographic characteristics evaluated (p>0.05). Approximately 60% (n=19) of the depressed patients were, randomised to receive pharmacotherapy, while 40.6% (n=13) received IPT. The mean HAMD scores of the patients on pharmacotherapy decreased from 25.7 to 6.2 from entry to completion of the study, and those for patients receiving psychotherapy decreased from 22.5 to 8.2. The decreases in HAMD scores in patient groups receiving either pharmacotherapy or psychotherapy were not significantly associated with any socio-demographic variables (p>0.05).

Conclusion. Both pharmacotherapy and psychotherapy may be equally effective in the treatment of depression in HIV-positive patients. The choice of treatment will be influenced by factors such as adverse effects of antidepressants and adding another medication to an already complex antiretroviral regimen. In such cases, IPT may be particularly beneficial.
Building our identity of psychiatry in the past, present and future South Africa
Authors: Van Staden Werdie
Published: June 2017

No abstract available.
Significant historical changes in private practice psychiatry during the past two decades
Authors: Colin Franco
Published: June 2017

No abstract available.
Provider-initiated HIV counselling and testing (PICT) in the mentally ill
Authors: Moosa M Y H , Jeenah F Y
Published: June 2017

The prevalence of HIV infection is substantially higher in mentally ill individuals than in the general population. Despite this, HIV testing is not yet standard practice among the mentally ill population, and many mental health settings do not encourage HIV testing. This paper discusses provider-initiated HIV counselling and testing (PICT) and some of the ethical dilemmas associated with it, on the basis that PICT may be used to increase the number of mentally ill persons tested for HIV. The authors conclude that PICT should be promoted to all psychiatric admissions and mentally ill individuals receiving outpatient services, and that this is within the parameters of existing policies and legislations in South Africa.
Attention deficit hyperactivity disorder in children and adolescents
Authors: Flisher A J , Hawkridge S
Published: June 2017

Attention deficit hyperactivity disorder (ADHD), although commonest in childhood and adolescence, can be diagnosed across the age span.
Panic Disorder
Authors: Szabo C P
Published: June 2017

Panic disorder (PD) is a prevalent anxiety disorder with lifetime

prevalence rates ranging from 1.1% to 3.7% in the general population

and 3.0% to 8.3% in clinic settings.

[1]

The presence of agoraphobia in

patients with PD is associated with substantial severity, comorbidity

(e.g. major depression, other anxiety disorders, alcohol abuse) and

functional impairment.

[1]
A case of nonconvulsive status epilepticus presenting as dissociative fugue
Authors: Erol Almila , Yigit Ayla , Dogan Gozde , Ozer Behiye
Published: June 2017

Nonconvulsive status epilepticus is characterised by changes in behaviour, memory, affect or level of consciousness. We report a case of nonconvulsive status epilepticus precipitated by carbamazepine that presented as dissociative fugue. The patient was a 49-year-old man. He first experienced a tonic-clonic seizure nine years previously and was diagnosed with grand mal epilepsy. He had been using carbamazepine 800 mg daily for the last eight years. He had not had any tonic-clonic seizures since carbamazepine was introduced but began to display behavioural disturbances periodically. He also left home many times, and remembered nothing about the period he had been away after he returned. He was hospitalised with a preliminary diagnosis of dissociative fugue. He had recurrent episodes with dissociative symptoms during his stay in the hospital. An electroencephalogram (EEG) and a 24-hour video EEG revealed nothing abnormal. An EEG recording taken during an episode indicated complex partial status epilepticus. Carbamazepine was substituted with valproate, and the patient was discharged in remission. 
Contributions from the South African Society of Psychiatrists (SASOP) to the National Mental Health Action Plan
Authors: Janse van Rensburg Albert Bernard
Published: June 2017

The national Mental Health Action Plan (MHAP) flowed from the Ekurhuleni Declaration, adopted at the National Mental Health Summit (NMHS) in April 2012. The final draft of the MHAP included eight national objectives, with key activities which were believed to be ‘catalytic.’ These objectives include: district-based mental health service; institutional capacity; surveillance, research and innovation; infrastructure and capacity; mental health technology, equipment and medicines; inter-sectoral collaboration; human resources; and advocacy, mental health promotion and prevention of illness. A representative group of regional State Employed Special Interest Group (SESIG) delegates met during April 2013, to: operationalise the 12 South African Society of Psychiatrists (SASOP)/SESIG position statements of the previous year; review SASOP’s position statements in the context of the proposed national MHAP; and to identify SASOP’s role and responsibilities accordingly. This paper describes the contextual events in the drafting of the MHAP, as well as the appraisal of the MHAP during the 2013 SASOP/SESIG meeting, and SASOP’S envisaged role and responsibilities according to the national MHAP. 
The South African Society of Psychiatrists is speaking up for good reasons
Authors: Grobler Gerhard P
Published: June 2017

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Children and adolescents treated for post-traumatic stress disorder at the Free State Psychiatric Complex
Authors: Calitz F J W , De Jongh N J , Horn A , Nel M L , Joubert G
Published: June 2017

Background. Children and adolescents can develop post-traumatic stress disorder (PTSD) after exposure to a range of traumatic events, including domestic, political or community violence, violent crime, physical and sexual abuse, hijacking, witnessing a violent crime and motor vehicle accidents. This is particularly critical given the substantial challenge that PTSD poses to the healthy physical, cognitive and emotional development of children and adolescents.

Methods. The clinical records of 1 229 children (age 2 - 11 years) and adolescents (age 12 - 18 years) treated at the Child Mental Health Unit of the Free State Psychiatric Complex (FSPC) were screened for the diagnosis of PTSD and analysed for the purpose of this study.

Results. Forty-nine (4.0%) of the children and adolescents treated at the unit were diagnosed with PTSD, of whom most were female (63.3%). Approximately 22% of the participants had comorbid major depressive disorder. The main traumatic event in both groups was witnessing the death of a close relative (32.7%), followed by sexual assault (25%), rape (25%) and physical attack (10.2%). Associated stressors identified included problems at school (55.1%), isolation (39%), fear or anxiety (37%), problematic family relationships (29%), emotional (27%) and physical (23%) abuse, and lack of social support (23%). Most of the participants (59.2%) received psychotherapy.

Conclusions. Children and adolescents referred to the FSPC are also exposed to traumatic events which lead to the development of PTSD. The Free State is a sprawling province with remote areas where specialist services and facilities are limited. It is therefore recommended that preventive programmes, training opportunities and consultation services are implemented to identify and treat children and adolescents with PTSD. Schools with limited access to psychological services and large classrooms, impeding the diagnosis and treatment of PTSD specifically, face similar challenges. Reinforcement of professional services and the upgrading of facilities will decrease the burden on the Child Mental Health Unit, but will require collaborative efforts from role players such as the National Departments of Health and Education.
Reserpine for the treatment of refractory mania
Authors: Eloff Ingrid Geeske , Esterhuysen Willem
Published: June 2017

We report a case of refractory mania treated successfully with reserpine. The patient was a 26-year-old man with bipolar I disorder, who had recurrent hospital admissions for manic episodes that failed to respond to multiple mood stabilisers and antipsychotics. The patient also suffered from hypertension. His manic symptoms improved markedly with the addition of reserpine to the treatment regimen. Reserpine is a centrally acting antihypertensive with anti-adrenergic properties. It has been found to reduce the duration of a manic episode rapidly in a small group of studies. This proved to be the case with this patient. Reserpine used  in conjunction with other psychotropic medication may be considered in the treatment of refractory mania, but controlled trials are necessary to support our finding more generally.
Conjoint alcohol and tobacco use among tuberculosis patients in public primary healthcare in South Africa
Authors: Peltzer Karl
Published: June 2017

Objective. To determine the prevalence of, and factors associated with conjoint alcohol and tobacco use among tuberculosis (TB) patients in South Africa (SA).

Methods. In a cross-sectional survey, 4 900 (54.5% men, 45.5% women) consecutively selected TB patients (including new TB and new TB retreatment patients) from 42 public primary care clinics in three districts in SA were assessed using various measures (including those for alcohol and tobacco use), within one month of anti-TB treatment.

Results. Overall, 10.1% (15.5% among men; 3.4% among women) were conjointly hazardous, harmful or dependent alcohol users and daily or almost-daily tobacco users. The proportion of daily or almost-daily tobacco users among hazardous, harmful or dependent alcohol users was 48.9%, (53.3% among men; 26.4% among women). Those with hazardous, harmful or dependent alcohol use had significantly higher odds of having anxiety and/or depression (odds ratio (OR) 1.37; confidence interval (CI) 1.13 - 1.65) and exhibiting daily or almost-daily tobacco use (OR 5.94; CI 4.33 - 5.87). The mean ± standard deviation alcohol use disorders identification test (AUDIT) score among conjoint hazardous, harmful or dependent alcohol users and daily or almost-daily tobacco users was significantly higher (17.1±6.1) than among hazardous, harmful or dependent alcohol users who were not current tobacco users (15.4±5.6) (p<0.001). In multivariate analysis, male gender, coloured ethnicity, lower education and greater poverty, TB retreatment patient status and non-adherence to anti-TB medication were associated with a greater risk for conjoint alcohol and tobacco use.

Conclusions. A high prevalence and several risk factors for conjoint alcohol and tobacco use were found among TB patients. The findings of this study call for dual-intervention approaches to alcohol and tobacco use.
De-stigmatising manipulation: An exercise in second-order empathic understanding
Authors: Stanghellini G
Published: June 2017

Standard definitions of ‘manipulation’, especially regarding people with a borderline personality diagnosis, usually highlight the alloplastic purpose of manipulativity, i.e. the intention to produce a belief in, or action by another person. In this article, I will try to show that this is only one side of the coin, and shed light on a complementary aspect of manipulative behaviour: manipulation can serve an epistemic, rather than alloplastic, pragmatic motif – the attempt to establish contact with the other in order to achieve a more distinct experience and representation of the other. My tentative hypothesis is based on the meaning of manipulation as touching (‘manus’ means ‘hand’) in infant behaviour where manipulation is a means to explore, rather than a way to modify the other’s state of mind.
Childhood disintegrative disorder misdiagnosed as childhood-onset schizophrenia
Authors: Sawant Neena Sanjiv , Parkar Shubhangi , Kulkarni Prathamesh
Published: June 2017

Childhood disintegrative disorder (CDD) is a rare pervasive developmental disorder, which is often misdiagnosed as schizophrenia, probably due to the resultant severe social impairment and withdrawn behaviour with stereotypys that could be mistaken for psychosis. We report a case of CDD that was misdiagnosed by a psychiatrist as childhood-onset schizophrenia and treated with high doses of antipsychotics. The patient did not show any improvement. This highlights ethical issues that arise from treatment modalities, with polypharmacy being the biggest culprit, and also points to the need to continue medical education at the level of primary health services and among practising rural doctors where tertiary centres with child guidance facilities and a multidisciplinary team are not available.
Staff and bed distribution in public sector mental health services in the Eastern Cape Province, South Africa
Authors: Sukeri Kiran , Alonso-Betancourt Orlando , Emsley Robin
Published: June 2017

Background. The Eastern Cape Province of South Africa is a resource-limited province with a fragmented mental health service. 

Objective. To determine the current context of public sector mental health services in terms of staff and bed distribution, and how this corresponds to the population distribution in the province.

Method. In this descriptive cross-sectional study, an audit questionnaire was submitted to all public sector mental health facilities. Norms and indicators were calculated at provincial and district level. This article investigates staff and bed distribution only.

Results. Results demonstrated that within the province, only three of its seven districts have acute beds above the national baseline norm requirement of 13/100 000. The private mental health sector provides approximately double the number of medium- to long-stay beds available in the public sector. Only two regions have staff/population ratios above the baseline norm of 20/100 000. However, there are significant differences in this ratio among specific staff categories. There is an inequitable distribution of resources between the eastern and western regions of the province. When compared with the western regions, the eastern regions have poorer access to mental health facilities, human resources and non-governmental organisations. 

Conclusion. Owing to the inequitable distribution of resources, the provincial authorities urgently need to develop an equitable model of service delivery. The province has to address the absence of a reliable mental health information system.
Magnetic resonance imaging study of corpus callosum abnormalities in patients with different subtypes of schizophrenia
Authors: Unlu Ebru , Bagcioglu Erman , Acay Mehtap B , Kacar Emre , Turamanlar Ozan , Gonul Yucel , Cevik Mehmet , Akpinar Abdullah , Coskun Kerem Senol
Published: June 2017

Background. Reductions in the size of the corpus callosum (CC) have been described for schizophrenia patients, but little is known about the possible regional differences in schizophrenia subtypes (paranoid, disorganised, undifferentiated, residual). 

Methods. We recruited 58 chronically schizophrenic patients with different subtypes, and 31 age-and-gender matched healthy controls. The callosum was extracted from a midsagittal slice from T1 weighted magnetic resonance images, and areas of the total CC, its five subregions, CC length and total brain volume were compared between schizophrenia subtypes and controls. Five subregions were approximately matched to fibre pathways from cortical regions. 

Results. Schizophrenia patients had reduced CC total area and length when compared with controls. Disorganised and undifferentiated schizophrenics had a smaller prefrontal area, while there was no significant difference for the paranoid and residual groups. The premotor/supplementary motor area was smaller in all schizophrenia subtypes. The motor area was smaller only in the disorganised group. A smaller sensory area was found in all subtypes except the residual group. Parietal, temporal and occipital areas were smaller in the paranoid and undifferentiated groups. Total brain volume was smaller in all schizophrenia subtypes compared with controls, but did not reach statistical significance. 

Conclusion. These findings suggest that the heterogeneity of symptoms may lead to the different CC morphological characteristics in schizophrenia subtypes.
Rape victim assessment: Findings by psychiatrists and psychologists at Weskoppies Hospital
Authors: Coetzee Kobus , Lippi G
Published: June 2017

Background. A significant increase in rape victim assessment referrals by the courts has been noted in recent years at Weskoppies Hospital. Rape victims are referred by courts to determine: (i) their competency as a witness; (ii) their ability to give consent to sexual acts; (iii) their mental age; and (iv) their level of mental retardation. These evaluations are done by psychologists and psychiatrists at state hospitals. The findings are reported to the courts in a report format.

Objectives. To present the findings of the reports compiled by psychologists and psychiatrists on rape victims from 2009 to 2013 as they comment on the court’s referral questions, and compare these findings with similar studies done at other psychiatric institutions.

Methods. A total of 108 reports was obtained from the electronic database at Weskoppies Hospital. The findings of the reports were summarised on a datasheet and were categorised according to the referral questions of the courts. 

Results. In the 68 reports where mention was made of mental age, almost three-quarters found it to be between 4 and 12 years. Intellectual disability was found as the diagnosis in the vast majority of reports. Of these, the most common severity of impairment was moderate (n=22, 21.8%) and moderate to severe (n=21, 20.8%) in nature. Most reports (n=61, 56.6%) found that the rape victims were not able to consent to sexual intercourse. Seventy-one (65.7%) reports stated that victims were not able to testify in court.

Conclusion. Most reports stated that victims suffered from intellectual disability and their capacity to testify in court was impaired. More than half of the victims evaluated did not have the capacity to give consent to sexual acts.
Needs-based gap analysis for service transformation in the Eastern Cape
Authors: Sukeri Kiran , Alonso-Betancourt Orlando , Emsley Robin
Published: June 2017

Objectives. Part I of this research article presents a needs-based analysis for the management of schizophrenia, bipolar mood disorder and major depression for the Eastern Cape (EC) Province, South Africa. This part of the research paper focuses on quantifying human resources and bed needs for these three severe mental illnesses. Human resource expenditure is calculated for nursing staff at acute, ambulatory and medium-to-long-stay services. A further objective was to conduct a gap analysis for human resources and beds for the EC in order to assist mental health planners in the commissioning of services. 

Methods. Data from previous research conducted in the province, and international and national epidemiological studies were utilised to quantify the requirements for human resources (psychiatrists, medical officers/registrars, psychologists, nurses, occupational therapists and social workers) and beds for acute, medium-to-long-stay and ambulatory services at provincial and regional levels, to provide mental healthcare. The authors focused on three of the eight priority conditions set by the World Health Organization. A target coverage rate of 80% was used in all calculations. A gap analysis was conducted to demonstrate deficits and excesses, utilising available data on human resources and beds available in the province.

Results. The results showed that the districts of Alfred Nzo and Ukhahlamba have no human resources or beds for the provision of mental health services. The province has a deficit of 23 psychiatrists and 243 nurses trained in psychiatry, and an oversupply of 486 other nurses. The results also clearly demonstrated an inequitable distribution of resources in the province. 

Conclusions. This is the first study that has provided detailed estimates of human resource and bed deficits in the EC. The study demonstrates that the areas of greatest need in terms of bed and human resource requirements are in the eastern regions of the province, which includes the former homelands of the Transkei and Ciskei. This study will assist provincial mental health planners/commissioners in developing an equitable mental health delivery programme.
What patients with bipolar disorder and major depressive disorder perceive as adverse life events precipitating a current major depressive episode
Authors: Van Schoor Robyn Anne , Joubert Pierre M
Published: June 2017

Background. Adverse life events (ALEs) as precipitants of a major depressive episode (MDE) have been the subject of many studies. These studies indicate an increase in ALEs in the 6 months preceding an MDE.

Objectives. The study examined what participants, suffering from major depressive disorder (MDD) or bipolar disorder (BD), perceived as the precipitating ALE of a current MDE. The severity and categories of ALEs were compared between these two patient groups.

Methods. Consenting, adult inpatients were sourced from Weskoppies Hospital, Steve Biko Academic Hospital, Tshwane District Hospital, Denmar Psychiatric Hospital and Vista Clinic in the Pretoria area. A semi-structured questionnaire was used to obtain demographic data and the diagnosis. Information regarding the course of the disorder, including the number of previous MDEs and the age at which the first MDE occurred, was also obtained. The perceived precipitating ALE was detailed for each participant. A severity value referred to as a Life Change Unit Score (LCU score), based on the Recent Life Changes Questionnaire (RLCQ) by Miller and Rahe, was then assigned to each participant’s perceived precipitant.

Results. Of the 64 participants, 12.7 % were experiencing a first MDE. In those participants who had experienced prior episodes the average number (standard deviation (SD)) of previous episodes was 3.86 (2.46). The mean approximate age (SD) at first onset of an MDE was 24.81 (10.9) years. The BD group had significantly more previous MDEs than the MDD group. Although the average LCU scores were higher in the BD group than the MDD group this did not reach statistical significance. Therefore, this study could not find a difference in the severity of the perceived precipitants between the BD group and MDD group. However, when the LCU scores were analysed within subcategories of the RLCQ, it was found that participants with BD perceived significantly more problems associated with the workplace as precipitants of a current MDE than individuals with MDD.

Conclusion. Most participants could link an ALE to the onset of a current MDE. The study did not find a differential response to ALEs between patients with BD and MDD. The severity of the social precipitants did not differ significantly between the two groups. The notion of a ‘kindling effect’ could not be supported by the outcome of this study. Because some study participants experienced ALEs not accounted for by the RLCQ, a more comprehensive assessment instrument may be more appropriate for similar studies.
Adolescent attachment, family functioning and depressive symptoms
Authors: Rawatlal Nishola , Kliewer Wendy , Pillay Basil J
Published: June 2017

Background. Adolescence represents a challenging transitional period where changes in biological, emotional, cognitive and social domains can increase the risk of developing internalised problems including subthreshold depression. Adolescent-parent attachment style, perceived support and family functioning may increase risk for depressive symptoms or may reduce such risk. Adolescent-parent attachment, adolescent-perceived support from parents and family functioning were examined as correlates of depressive symptom presentation within this age group.

Methods. Participants included a maternal parent and an adolescent (65.5% female) from each family. Adolescents were in Grade 7 (n=175) or Grade 10 (n=31). Data were collected through home interviews. The Self-Report of Family Inventory (SFI), Experiences of Close Relationships Scale (ECR), Network of Relationships Inventory (NRI), Children’s Depression Inventory (CDI) and Child Behavior Checklist (CBCL) were used to assess depression, parental support and attachment. 

Results. Two models were examined: one with adolescent report of depressive symptoms as the outcome and a second with parent report of adolescent internalising symptoms as the outcome. The model predicting adolescent-reported depressive symptoms was significant with older age, higher levels of avoidant attachment, and higher levels of youth-reported dysfunctional family interaction associated with more depressive symptomatology. In the model predicting parent report of adolescent internalising symptoms only higher levels of dysfunctional family interaction, as reported by the parent, were associated with higher levels of internalising symptoms.

Conclusion. Positive family communication, cohesion and support predictive of a secure parent-adolescent attachment relationship reduced the risk of a depressive symptom outcome. Secure adolescents were able to regulate their emotions, knowing that they could seek out secure base attachment relations within their family and from friends during times of stress, buffering against the development of depressive symptoms.
Depressive symptoms among children whose parents have serious mental illness: Association with children’s threat-related beliefs about mental illness
Authors: Ola Bolanle , Suren Rakendu , Ani Cornelius
Published: June 2017

Background. Sixty-eight per cent of women and 57% of men with mental illness are parents. There is increasing evidence of adverse psychosocial impact of parental mental illness on their children. However, among children whose parents have mental illness, the potential contribution of the children’s beliefs about mental illness to their own emotional distress is still poorly understood.

Aim. To explore among children whose parents have serious mental illness, the relationship between the children’s beliefs about mental illness and their own depressive symptoms.

Methodology. We conducted an interview-administered questionnaire survey of 67 Nigerian children whose parents were psychiatric inpatients. The children’s beliefs about mental illness were explored with five questions – two of which embedded threat-related beliefs. Their depressive symptoms were assessed with the Short Mood and Feelings Questionnaire (SMFQ) (Cronbach alpha 0.91). Based on stigma theory, we hypothesised that among this cohort, the children who hold threat-related beliefs about people with mental illness would report statistically significantly more depressive symptoms than those without similar beliefs. 

Results. The mean age (standard deviation (SD)) of the children was 13.3 (2.8) years, and 38% were males. Twenty-four per cent of the children believed mental illness is infectious. In line with our hypothesis, those holding this belief had statistically significantly more depressive symptoms compared with those without similar beliefs (p=0.001). Fifty-seven per cent of the children believed that people with mental illness are dangerous. However, contrary to our hypothesis, this belief was not associated with increased depressive symptoms (p=0.2). Multiple regression showed that statistically significant predictors of increased emotional symptoms were ‘belief that mental illness is infectious’ and younger age. The model explained 39.8% of the variance in SMFQ.

Conclusion. In this and similar settings, psycho-education for children whose parents have serious mental illness should explore whether the children believe that mental illness is infectious. Providing reassurance to children holding such beliefs could reduce their risk of psychological distress.
Non-medical use of methylphenidate among medical students of the University of the Free State
Authors: Jain Roshini , Chang Ch Chiech , Koto Mpho , Geldenhuys Alden , Nichol Richard , Joubert Gina
Published: June 2017

Background: Faced with demanding training programmes, medical students may be more prone to use methylphenidate for non-medical purposes in order to improve concentration, alertness and academic performance.Aim: The study aimed to investigate the prevalence of the non-medical use of methylphenidate and knowledge of this drug among undergraduate medical students of the University of the Free State.Methods: This was a cross-sectional study. A self-administered, anonymous questionnaire was distributed during lectures to all students in the five year groups of the undergraduate medical programme.Results: Of the 643 undergraduate medical students, 541 completed the questionnaire (response rate: 84.1%). Approximately 11.0% of surveyed students were using methylphenidate at the time of the study, of which the majority (67.9%) used it for academic purposes and 70.6% received it from a medical health professional. Less than a third of users had been diagnosed with Attention-Deficit/Hyperactivity Disorder. Methylphenidate users’ median knowledge was greater than non-users, and methylphenidate knowledge increased from first-year and second-year students to third-year to fifth-year students. Median knowledge scores per year group ranged from 52.0% to 60.0%.Conclusion: Methylphenidate is mainly used for non-medical purposes by medical students. Students generally have a low level of knowledge on methylphenidate. Specific information on methylphenidate should be included in lectures on stress management and study methods during the course of the medical curriculum.
Sniffing out olfactory reference syndrome
Authors: Thomas Eileen , Voges Juanè , Chiliza Bonginkosi , Stein Dan J. , Lochner Christine
Published: June 2017

Olfactory reference syndrome is characterised by the erroneous belief that one emits an unpleasant body odour. This results in significant distress and is often accompanied by repetitive behaviour such as frequent showering in an attempt to camouflage the perceived odour. The body odour concerns may have a delusional quality and do not respond to simple reassurance or counterexample. Herein, we report the case of an olfactory reference disorder (ORD) patient who had received multiple medical interventions and undergone polysurgery prior to an accurate diagnosis being established. ORD may lead to significant disability, yet often goes unrecognised for many years. For many patients, poor insight will contribute to their reluctance to consider psychiatric treatment. This case demonstrated that a multimodal treatment approach comprising judicious medication use, combined with cognitive behavioural therapy, in the context of a therapeutic alliance yielded therapeutic success.
News
Authors: Affiliation AAPAP
Published: June 2017

AAPAP AFFILIATION; 2002 MEDIA AWARDS
Summer ozone in the northern Front Range metropolitan area: weekend–weekday effects, temperature dependences, and the impact of drought
Authors: Abeleira Andrew J. , Farmer Delphine K.
Published: June 2017

Abstract. Contrary to most regions in the US, ozone in the northern Front Range metropolitan area (NFRMA) of Colorado was either stagnant or increasing between 2000 and 2015, despite substantial reductions in NOx emissions. We used available long-term ozone and NOx data in the NFRMA to investigate these trends. Ozone increased from weekdays to weekends for a number of sites in the NFRMA with weekend reductions in NO2 at two sites in downtown Denver, indicating that the region was in a NOx-saturated ozone production regime. The stagnation and increases in ozone in the NFRMA are likely due to a combination of decreasing NOx emissions in a NOx-saturated environment and increased anthropogenic volatile organic compound (VOC) emissions in the NFRMA. Further investigation of the weekend–weekday effect showed that the region outside of the most heavily trafficked Denver area was transitioning to peak ozone production towards NOx-limited chemistry. This transition implies that continued NOx decreases will result in ozone being less sensitive to changes in either anthropogenic or biogenic VOC reactivity in the NFRMA. In contrast to anthropogenic VOCs, biogenic VOCs are unlikely to have increased in the NFRMA between 2000 and 2015, but are temperature dependent and likely vary by drought year. Ozone in the NFRMA has a temperature dependence, albeit smaller than many other US locations, consistent with biogenic VOC contributions to ozone production in the region. We show that while ozone increased with temperature in the NFRMA, which is consistent with a NOx-saturated regime coupled to temperature-dependent VOCs, this relationship is suppressed in drought years. We attribute this drought year suppression to decreased biogenic isoprene emissions due to long-term drought stress. Thus, while anthropogenic NOx and VOCs likely dominate ozone production regimes in the NFRMA, biogenic VOCs may also impact regional ozone and its temperature dependence.
A new downscaling method for sub-grid turbulence modeling
Authors: Rottner Lucie , Baehr Christophe , Couvreux Fleur , Canut Guylaine , Rieutord Thomas
Published: June 2017

Abstract. In this study we explore a new way to model sub-grid turbulence using particle systems. The ability of particle systems to model small-scale turbulence is evaluated using high-resolution numerical simulations. These high-resolution data are averaged to produce a coarse-grid velocity field, which is then used to drive a complete particle-system-based downscaling. Wind fluctuations and turbulent kinetic energy are compared between the particle simulations and the high-resolution simulation. Despite the simplicity of the physical model used to drive the particles, the results show that the particle system is able to represent the average field. It is shown that this system is able to reproduce much finer turbulent structures than the numerical high-resolution simulations. In addition, this study provides an estimate of the effective spatial and temporal resolution of the numerical models. This highlights the need for higher-resolution simulations in order to evaluate the very fine turbulent structures predicted by the particle systems. Finally, a study of the influence of the forcing scale on the particle system is presented.
Regional background O3 and NOx in the Houston–Galveston–Brazoria (TX) region: a decadal-scale perspective
Authors: Suciu Loredana G. , Griffin Robert J. , Masiello Caroline A.
Published: June 2017

Abstract. Ozone (O3) in the lower troposphere is harmful to people and plants, particularly during summer, when photochemistry is most active and higher temperatures favor local chemistry. Local precursor emissions, such as those of volatile organic compounds (VOCs) and nitrogen oxides (NOx), together with their chemistry contribute to the O3 and NOx mixing ratios in the Houston–Galveston–Brazoria (HGB) region. In addition to local emissions, chemistry and transport, larger-scale factors also contribute to local O3 and NOx. These additional contributions (often referred to as regional background) are not well quantified within the HGB region, impeding more efficient controls on precursor emissions to achieve compliance with the National Ambient Air Quality Standards for O3. In this study, we estimate ground-level regional background O3 and NOx in the HGB region and quantify their decadal-scale trends.We use four different approaches based on principal component analysis (PCA) to quantify background O3 and NOx. Three of these approaches consist of independent PCA on both O3 and NOx for both 1 and 8 h levels to compare our results with previous studies and to highlight the effect of both temporal and spatial scales. In the fourth approach, we co-varied O3, NOx and meteorology.Our results show that the estimation of regional background O3 has less inherent uncertainty when it was constrained by NOx and meteorology, yielding a statistically significant temporal trend of −0.68 ± 0.27 ppb yr−1. Likewise, the estimation of regional background NOx trend constrained by O3 and meteorology was −0.04 ± 0.02 ppb yr−1 (upper bound) and −0.03 ± 0.01 ppb yr−1 (lower bound). Our best estimates of the 17-year average of season-scale background O3 and NOx were 46.72 ± 2.08 ppb and 6.80 ± 0.13 ppb (upper bound) or 4.45 ± 0.08 ppb (lower bound), respectively. Average background O3 is consistent with previous studies and between the approaches used in this study, although the approaches based on 8 h averages likely overestimate background O3 compared to the hourly median approach by 7–9 ppb. Similarly, the upper bound of average background NOx is consistent between approaches in this study (A–C) but overestimated compared to the hourly approach by 1 ppb, on average. We likely overestimate the upper-bound background NOx due to instrument overdetection of NOx and the 8 h averaging of NOx and meteorology coinciding with MDA8 O3.Regional background O3 and NOx in the HGB region both have declined over the past 2 decades. This decline became steadier after 2007, overlapping with the effects of controlling precursor emissions and a prevailing southeasterly–southerly flow.
Intercomparison of stratospheric temperature profiles from a ground-based microwave radiometer with other techniques
Authors: Navas-Guzmán Francisco , Kämpfer Niklaus , Schranz Franziska , Steinbrecht Wolfgang , Haefele Alexander
Published: June 2017

Abstract. In this work the stratospheric performance of a relatively new microwave temperature radiometer (TEMPERA) has been evaluated. With this goal almost three years of temperature measurements (January 2015–September 2016) from TEMPERA radiometer were intercompared with the measurements from different techniques as radiosondes, MLS satellite and Rayleigh lidar. This intercomparison campaign was carried out at the aerological station of MeteoSwiss at Payerne (Switzerland). In addition, the temperature profiles from TEMPERA were used to validate the temperature outputs from SD-WACCM model. The results showed in general a very good agreement between TEMPERA and the different instruments and the model with a high correlation (higher than 0.9) in the temperature evolution at different altitudes between TEMPERA and the different datasets. An annual pattern was observed in the stratospheric temperature with in general higher temperatures in summer than in winter and with a higher variability during wintertime. A clear change in the tendency of the temperature deviations was detected in summer 2015 which was due to the repair of an attenuator in the TEMPERA spectrometer. The mean and the standard deviations of the temperature deviations between TEMPERA and the different measurements were calculated for two periods (before and after the reparation) in order to quantify the accuracy and precision of this radiometer along these almost three years. The results showed absolute biases and standard deviations lower than 2 K for most of the altitudes and comparisons proved the good performance of TEMPERA to measure the temperature in the stratosphere.
Disentangling fast and slow responses of the East Asian summer monsoon to reflecting and absorbing aerosol forcings
Authors: Wang Zhili , Lin Lei , Yang Meilin , Xu Yangyang , Li Jiangnan
Published: June 2017

Abstract. We examine the roles of fast and slow responses in shaping the total equilibrium response of the East Asian summer monsoon (EASM) to reflecting (sulfate, SO4) and absorbing (black carbon, BC) aerosol forcings over the industrial era using the Community Earth System Model version 1. Our results show that there is a clear distinction between fast and slow responses of the EASM to aerosol forcings and the slow climate response due to aerosol-induced change in sea surface temperature plays an important role in the impacts of aerosols on the EASM. The EASM is weakened by a decrease in land-sea surface thermal contrast in the fast response component to SO4 forcing, whereas the weakening is more intensive by the changes in tropospheric thermodynamic and dynamic structures in the slow response component to SO4. The total climate adjustment caused by SO4 is a significant weakening of the EASM and a decrease in precipitation. The BC-induced fast adjustment strengthens the EASM both by increasing the local surface land-sea thermal contrast and shifting the East Asian subtropical jet northwards. BC-induced slow climate adjustment, however, weakens the EASM through altering the atmospheric temperature and circulation. Consequently, the EASM is enhanced north of 30° N but slightly reduced south of 30° N in the total response to BC. The spatial patterns of precipitation change over East Asia due to BC are similar in total response and slow response. This study highlights the importance of ocean response to aerosol forcings in driving the changes of the EASM.
Diversity of Rainfall Thresholds for early warning of hydro-geological disasters
Authors: De Luca Davide L. , Versace Pasquale
Published: June 2017

Abstract. For early warning of disasters induced by precipitation (such as floods and landslides), different kinds of rainfall thresholds are adopted, which vary from each other, on the basis on adopted hypotheses. In some cases, they represent the occurrence probability of an event (landslide or flood), in other cases the exceedance probability of a critical value for an assigned indicator I (a function of rainfall heights), and in further cases they only indicate the exceeding of a prefixed percentage a critical value for I, indicated as Icr. For each scheme, it is usual to define three different criticality levels (ordinary, moderate and severe), which are associated to warning levels, according to emergency plans. This work briefly discusses different schemes of rainfall thresholds, focusing attention on landslide prediction, with some applications to a real case study in Calabria region (southern Italy).
Late Holocene temperature variability in Tasmania inferred from borehole temperature data
Authors: Suman Asadusjjaman , Dyer Fiona , White Duanne
Published: June 2017

Abstract. Thirty-six borehole temperature–depth profiles were analysed to reconstruct the ground surface temperature history (GSTH) of eastern Tasmania for the past 5 centuries. We used the singular value decomposition method to invert borehole temperatures to produce temperature histories. The quality of borehole data was classified as high or low based on model misfit. The quality of the borehole data was not dependent on topography or land use. Analysis reveals that three to five high-quality borehole temperature–depth profiles were adequate to reconstruct robust paleotemperature records from any area. Average GSTH reconstructed from Tasmanian boreholes shows temperature increases about 1.2 ± 0.2 °C during the past 5 centuries. Reconstructed temperatures were consistent with meteorological records and other proxy records from Tasmania during their period of overlap. Temperature changes were greatest around the north-east coast and decreased towards the centre of Tasmania. The extension of the East Australian Current (EAC) further south and its strengthening around the north-east coast of Tasmania over the past century was considered a prime driver of warmer temperatures observed in north-east Tasmania.
What does Pokémon Go teach us about geography?
Authors: Gong Huiwen , Hassink Robert , Maus Gunnar
Published: June 2017

Abstract. Pokémon Go, a highly popular, recently launched augmented-reality-based video game, fosters players' interaction with the real world. In this commentary we elaborate on how location-based games, such as Pokémon Go, have provided insights into the perception and understanding of space, as well as into their impact on patterns of mobility. In addition to that, we compare Pokémon Go with geocaching, another location-based game, to further elaborate on what Pokémon Go fails to do in terms of the practices of geographical exploration.
INVESTIGATIONS ON THE POTENTIAL OF CONVOLUTIONAL NEURAL NETWORKS FOR VEHICLE CLASSIFICATION BASED ON RGB AND LIDAR DATA
Authors: Niessner R. , Schilling H. , Jutzi B.
Published: June 2017

Abstract. In recent years, there has been a significant improvement in the detection, identification and classification of objects and images using Convolutional Neural Networks. To study the potential of the Convolutional Neural Network, in this paper three approaches are investigated to train classifiers based on Convolutional Neural Networks. These approaches allow Convolutional Neural Networks to be trained on datasets containing only a few hundred training samples, which results in a successful classification. Two of these approaches are based on the concept of transfer learning. In the first approach features, created by a pretrained Convolutional Neural Network, are used for a classification using a support vector machine. In the second approach a pretrained Convolutional Neural Network gets fine-tuned on a different data set. The third approach includes the design and training for flat Convolutional Neural Networks from the scratch. The evaluation of the proposed approaches is based on a data set provided by the IEEE Geoscience and Remote Sensing Society (GRSS) which contains RGB and LiDAR data of an urban area. In this work it is shown that these Convolutional Neural Networks lead to classification results with high accuracy both on RGB and LiDAR data. Features which are derived by RGB data transferred into LiDAR data by transfer learning lead to better results in classification in contrast to RGB data. Using a neural network which contains fewer layers than common neural networks leads to the best classification results. In this framework, it can furthermore be shown that the practical application of LiDAR images results in a better data basis for classification of vehicles than the use of RGB images.
FACADE SEGMENTATION WITH A STRUCTURED RANDOM FOREST
Authors: Rahmani K. , Huang H. , Mayer H.
Published: June 2017

Abstract. In this paper we present a bottom-up approach for the semantic segmentation of building facades. Facades have a predefined topology, contain specific objects such as doors and windows and follow architectural rules. Our goal is to create homogeneous segments for facade objects. To this end, we have created a pixelwise labeling method using a Structured Random Forest. According to the evaluation of results for two datasets with the classifier we have achieved the above goal producing a nearly noise-free labeling image and perform on par or even slightly better than the classifier-only stages of state-of-the-art approaches. This is due to the encoding of the local topological structure of the facade objects in the Structured Random Forest. Additionally, we have employed an iterative optimization approach to select the best possible labeling.