bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of water extremes: A South African perspective on guidelines for policy and strategy development
Authors: Viljoen MF , Backeberg GR
Published: June 2017

This presentation endeavours to present some guidelines for policy and strategy development with regard to the effective management of floods and droughts. Insights are gained from a literature study about the social, economic and political impacts of irrigation droughts, research done on the impacts and management of floods and water restrictions in South Africa as well as analysing the disaster management policy process in South Africa since 1994. The South African experience in terms of the management of water extremes, serves as basis for policy and strategy development and should benefit all involved – including other regions.
Factors responsible for the growth of small business
Authors: Döckel JA , Ligthelm AA
Published: June 2017

Entrepreneurial conduct holds the key to economic growth. Thus those business that show growth and development are considered entrepreneurial, implying that SMME policy initiatives should focus on businesses with growth potential, and not the small business sector as a whole.  The success of a small business seems to depend on the intentions of the owner, together with factors associated with the ability of, and opportunity for, the specific business to grow.  The aim of this article is to make use of a multiple linear regression model to determine the variables that impact positively on business growth.  In addition to demand factors, it was established that smaller and younger businesses are the ones that grow faster. A successful business also shows a positive correlation between business management skills and entrepreneurial conduct.
An econometric model of the South African stock market
Authors: Moolman E , Du Toit C
Published: June 2017

A wealth of literature exists concerning the modelling of stock markets, as well as the examination of the relationshiop between share price and various economic factors, both theoretically and empirically.  However, most studies use data for developed countries in their analyses, while the literature moselling emerging stock markets in general, and the south African stock market in particular, is quite sparse.  This study develops a structural theoretically founded model of the South African stock market that is estimated using co-integration and error-correction techniques. These techniques respectively estimate the long-term equilibrium or intrinsic value of the stock market, and the short-term fluctuations around the quilibrium level. According to the results, share prices are co-integrated with the variables dictated by the expected present value model of asset price determination.  The short-term fluctuations are determined by various factors such as interest rates, a risk premium, the exchange rate, foreign stock market adn other variables.
Measuring the informal economy in South Africa
Authors: Saunders S , Loots E
Published: June 2017

Measuring the size of the South African informal economy has received inadequate attention, making it difficult for policy-makers to assess the impact of policy measures to stimulate informal economic activity. This article aims to estimate the size of the informal economy by using the Currency Demand Approach.  The empirical results reveal that the informal economy as a percentage of GDP decreased from 1967 to 1993, before levelling off.  The growth in the informal econmy has also underperformed in comparison to formal economic growth. There appears to be a causal relationship running from the informal to the formal economy. Macro-economic policies aimed at the formal economy will not necessarily 'trickle down' to the informal, while these polcies aimed at the informal economy may have a profound effect on the formal economy.
The impact of tariff reduction on poverty in Zimbabwe, A CGE top-down approach
Authors: Chitiga M , Mabugu R
Published: June 2017

This paper uses a relatively new approach to quantify the effects of trade liberalisation on poverty.  It relies on the combination of a standard, social accounting, matrix-based, computable general equilibrium model and household micro-data. These two tools are used sequentially in order to simulate the impact of trade policy reform.  This framework enables the decomposition of the effects of trade liberalisation, which in turn allows for an analysis of alternative social policy packages.  The methodology is applied to Zimbabwe for illustration.  The results show that poverty is reduced by tariff reduction, although the poor households get the least benefits.
Psychological empowerment and job satisfaction of engineers in a petrochemical industry
Authors: Buitendach JH , Hlalele RBT
Published: June 2017

The objective of this study was to determine the relationship between psychological empowerment and job satisfaction of engineers in a chemical industry. A cross-sectional design was used. Stratified random samples of engineers (N=91) were taken. The Measuring Empowerment Questionnaire and the Minnesota Job Satisfaction Questionnaire were used as measuring instruments. Pearson-moment correlations indicated a correlation of large effect between psychological empowerment and job satisfaction. Overall empowerment was found to be positively related to all satisfaction subscales. Positive correlations of large effect were obtained between job satisfaction and meaning, impact, and self-determination. A positive correlation of medium effect was obtained between job satisfaction and competence. Multiple regression analysis indicated that 70.5 per cent of the variance of job satisfaction was explained by subdimensions of psychological empowerment, although impact was not found to hold a significant amount of predictive value with regard to job satisfaction.
The future context of work in the business environment in South Africa: Some empirical evidence
Authors: Nel PS , Du Plessis AJ , Marx AE
Published: June 2017

The future is uncertain, but management needs to determine and also be informed about possible change trends. This research, however, reports on empirical results of the views of South African HRM practitioners to identify and prioritise business change trends for 2002 and 2010 in terms of the “hard” or “soft” HRM debate in the literature. All organisations employing HRM practitioners were include and a total of 1640 questionnaires were distributed resulting in 207 useable responses.   The results highlight trends such as increased international competition, globalisation and inadequate skills in different rankings for 2002 and 2010. It is concluded that HRM practitioners, are influenced by the “hard” or “soft” approach, when they participate in a strategic management context in organisations.
Technical efficiency and management factors in plantain production in humid forest zone of Nigeria: A simulation analysis
Authors: Awotide DO , Rahji MAY , Adejobi AO , Bamire AS
Published: June 2017

The paper investigated the effect of changing some management factors on technical efficiency in plantain production with a view to understanding the functional relationship between technical efficiency and agricultural productivity. Data were r collected from a cross-sectional survey of two local government areas and six villages in Ibadan area of Oyo State in the humid forest zone of Nigeria. Stochastic frontier and multiple regression models were fitted and a simulation analysis was carried out on the management levels of plantain farmers. The results revealed that educational level alone did not significantly influence technical efficiency but its combination with extension assistance significantly influenced technical efficiency in the study area. Periodic extension assistance received significantly influenced technical efficiency.
Clinical trials in psychiatry: Obtaining the evidence
Authors: Emsley Robin , Hawkridge Sue
Published: June 2017

NO ABSTRACT AVAILIBLE
The neuropsychiatry of brain tumours
Authors: Oosthizen Piet
Published: June 2017

NO ABSTRACT AVAILIBLE
Risk factors for psychiatric morbidity among bank workers in a northern city of Nigeria
Authors: Yussuf A D
Published: June 2017

Objective. To determine the prevalence of psychiatric morbidi- ty in bank workers in Ilorin, Nigeria, and the sociodemo- graphic and work-related factors that may be associated with poor psychological health.Method. This cross-sectional two-staged study conducted between March and July 1999 involved screening using the 30-item General Health Questionnaire (GHQ-30), a socio- demographic questionnaire, the Present State Examination (PSE) schedule and diagnostic criteria from the 10th edition of the International Classification of Diseases (ICD-10).Data source. Bank workers in the three local government areas (west, east, and south) of Ilorin, a city in the middle belt of Nigeria.Data analysis. Data were analysed using EpiInfo version 6.0. Frequency distribution, cross tabulation, and chi-square analy- ses were obtained. The level of statistical significance was set at 5%.Result. Four hundred and thirty workers responded satisfactori- ly to the questionnaires (response rate 76%); 77 respondents (18%) were GHQ-positive and therefore had psychiatric mor- bidity. There was a significant association between psychiatric morbidity and age, gender, number of children, belonging to a social club, workload, promotion, and job status.Conclusion. The implications of these findings are discussed and possible medical and administrative interventions advo- cated.
The effects of thioridazine on the QTc interval - cardiovascular safety in a South African setting
Authors: Seller Cathlene , Oosthuizen Piet
Published: June 2017

Background. Thioridazine has long been used as a first-line antipsychotic in South Africa without any apparent problems. Recently the American Food and Drug Administration (FDA) and Novartis have warned of potentially lethal arrhythmias that may result from the use of thioridazine. Abnormal QT-interval prolongation on the electrocardiogram (ECG) seems to be the most reliable indicator of risk of arrhythmias, such as torsade de pointes and ventricular fibrillation.Objective. The purpose of this study was to determine whether these warnings are of clinical relevance in a setting where there are already a limited number of antipsychotics available.Method. Thirty hospitalised subjects who required switching from a high-potency to a low-potency antipsychotic were included. All subjects were commenced on thioridazine 300 mg per day and had an ECG 1 week after initiation and 48 hours after each dose adjustment. QTc was determined using Bazett’s formula.Results. Thioridazine induced a significant increase (p = 0.0001) in QTc interval from baseline values of 400.6 (± 27.3) milliseconds to 429.1 (± 44.2) milliseconds. The QTc interval increased to above 450 milliseconds in 7 subjects (23%) and thioridazine was discontinued in 2 subjects because of a QTc interval greater or equal to 500 milliseconds.Conclusion. Thioridazine caused a significant, although asymptomatic, increase in QTc interval in almost one-quarter of subjects who received the medication as second-line treatment. Thioridazine should no longer be used as a first-line treatment and if used it should be accompanied by regular ECG monitoring.
Changing the editorial guard
Authors: Van Niekerk J P De V
Published: June 2017

NO ABSTRACT AVAILIBLE
A review of multispousal relationships - psychosocial effects and therapy
Authors: Moosa M Y H , Benjamin R , Jeenah F Y
Published: June 2017

Polygamy is defined as a marital system in which a man is married to more than one woman at the same time. This article reviews 210 articles from the literature. The aim is to place polygamy in a cultural context and suggest family therapy approaches to psychological and other stresses that may arise from these relationships. Polygamy is accepted and legally practised in many cultures worldwide. It may have both beneficial and deleterious psychosocial consequences for individuals involved in such relationships. Some of the issues arising in such multiparental families can be addressed by relational therapies, if those therapies are based on what is culturally acceptable.
Conceptual and experiential estrangement of the self - a neo-Fregean elucidation
Authors: Van Staden C W
Published: June 2017

Reductionist and non-reductionist philosophers and mental health professionals have debated about what and where the self is. In this article I deploy a neo-Fregean theory to clarify the process by which: (i) the self becomes so susceptible to this debate; and (ii) the self presents so variably in personal experiences. Accordingly, the self can be either estranged or well equipped, depending on the position it occupies in relations, whether in the conceptualisation or in the personal experiences of the self.
Changing the course of schizophrenia - predictors of treatment outcome revisited
Authors: Emsley R , Oosthuizen P , Niehaus D , Koen L , Chiliza B
Published: June 2017

Multiple factors play a role in determining the outcome of schizophrenia. However, the role of these factors is poorly understood, and research findings so far have been inconclusive and sometimes contradictory. Various demographic and baseline clinical factors have been reported to be associated with treatment outcome. Also, early symptom reduction after initiation of antipsychotic therapy is closely related to later treatment response. However, associations as such do not necessarily imply predictive value, and none of these factors can be regarded as clinically useful in predicting treatment outcome. This article discusses selected aspects of treatment outcome and its prediction in schizophrenia, focusing particularly on early treatment response, ethnicity, neurological soft signs, and the predictive value of a discriminant functional analysis model utilising a combination of putative predictors. Such a model holds promise, and it is to be hoped that future refinements will lead to a clinically useful model for predicting outcome.
Profile of mentally ill offenders referred to the Free State Psychiatric Complex
Authors: Barrett S P , Du Plooy J , Du Toit J , Wilmans S , Calitz F J W , Joubert G
Published: June 2017

NO ABSTRACT AVALIBLE
Longer duration of breastfeeding associated with risk of developing schizophrenia
Authors: Hartong M S , Oosthuizen P P , Emsley R A
Published: June 2017

Background. Some studies have suggested that breastfeeding may be protective against the development of schizophrenia. Such a theory supports the neurodevelopmental hypothesis of schizophrenia.

Objective. To determine whether there were differences in breastfeeding patterns between patients with schizophrenia and controls.

Method. Fifty subjects with schizophrenia and 50 age- and gender-matched controls were included in the study. All subjects and their mothers were interviewed using a structured questionnaire to determine the extent of breastfeeding in infancy and age of onset of psychosis.

Results. There was a significant difference in the duration of breastfeeding in patients versus controls (p < 0.05).

Conclusion. Breastfeeding seems to be protective against the development of schizophrenia. This supports the neurodevelopmental hypothesis of this disorder and may be indicative of the role of essential fatty acids in normal brain development and the prevention of schizophrenia.
Combining ECT and clozapine in the treatment of clozapine-refractory schizophrenia and schizoaffective disorder – a pilot study
Authors: Koen L , Van den Berg C E , Niehaus D J H
Published: June 2017

Objective. Clozapine is the current gold standard treatment for severe treatment-refractory schizophrenia, but even so 40 - 70% of these patients will continue to experience disabling symptoms when treated with clozapine monotherapy. Current clinical practice at Stikland Hospital holds that known clozapine-refractory schizophrenia patients who relapse due to non-compliance are treated with an initial combination of clozapine and ECT (if able to consent) when readmitted. The purpose of this study was to evaluate the validity of this practice.

Methods. Patients were divided into an ECT (EG) and non-ECT (CG) group. Clozapine was started and ECT administered as per protocol. Demographic data, psychiatric and medication history and data concerning adverse events were collected. Positive and Negative Symptom Scale (PANSS) scores were done at baseline and at days 21 and 42.

Results. At discharge, although numerically the average increase in clozapine dose was lower and the reduction in length of stay was greater in the EG, none of the variables measured were statistically significantly different between groups. More concomitants were also used in the EG.

Conclusions. This pilot study represents the first controlled trial of ECT-clozapine bitherapy in a population with clozapine- refractory schizophrenia and schizoaffective disorder reported in the literature. The validity of our choice of current clinical practice in this population was not supported by our results. However, the study did provide us with preliminary evidence for the safety and efficacy of this combination. It would therefore be reasonable to continue to use this strategy in selected cases, at least until other clozapine-refractory treatment strategies become more available in our setting.
Pain, madness and the limits of medicine
Authors: Baumann Sean
Published: June 2017

The problem of pain poses questions pertaining to some of the assumptions that underpin modern medicine, including the conceptualisation and treatment of psychiatric disorders. Problematic issues, such as subjectivity and meaning, seem particularly critical in the domains of pain and madness, but have relevance in the broader ranges of medicine. Of central concern is the relation such issues bear to notions of scientific practice. The subjective experience of illness and the meanings attached to it need to be accounted for, and cannot be considered to lie beyond the scope of scientific thinking, as not being measurable or objectively verifiable: yet attempts to incorporate these intrinsic dimensions remain elusive, and shape some of the shifting limitations of the various definitions of what might be considered to be a scientific perspective.
Health-seeking behaviour of mentally ill patients in Nigeria
Authors: Nonye Aniebue Patricia , Oseloka Ekwueme Christiandolus
Published: June 2017

Aim. To determine the health-seeking behaviour of mentally ill patients in Enugu, Nigeria.

Design. A consecutive recruitment of 397 patients receiving treatment at the neuropsychiatric hospital in Enugu was done. Using a structured questionnaire, information was obtained from the respondents including their socio-demographic characteristics, their knowledge of the cause of their mental illness, and the treatment that they first employed, with their reasons for doing so.

Results. The age range of the respondents was 15 - 75, with a mean of 31.6 years (SD±11 years). Two hundred and twenty- three (56.2%) respondents were male and 174 (43.8%) were female. Treatment options first employed by respondents were prayer houses (34.5%), followed by psychiatric hospital (32%). The main reasons for the treatment options employed were confidence of cure at the place of treatment (46.3%), ignorance of the existence of a mental health service (14.6%), and the belief that the mental condition was not amenable to orthodox treatment (8.1%). Patients’ perceptions of the cause of their ailment most commonly revealed a belief in demonic and spiritual forces. Gender, educational status, attributing of the mental illness to a rational cause, and living in an urban area were significantly associated with the employment of specialist care as the first treatment option.

Conclusion. Misconceptions regarding the cause of mental illness still abound among mentally ill patients in Nigeria. Consequently, psychiatric consultation is not usually initially employed, especially in rural areas. Community health education aimed at changing misconceptions, and the integration of mental health services into primary health care services, is advocated.
Attention deficit hyperactivity disorder and bipolar mood disorder in children and adolescents
Authors: Scribante L
Published: June 2017

n/a
Quality of psychiatric referrals to secondary-level care
Authors: Struwig W , Pretorius P J
Published: June 2017

Objectives. This study examined the quality of referrals to secondary-level outpatient psychiatric services rendered by the Department of Psychiatry, University of the Free State. Referral letters were evaluated according to specific quality criteria. Aspects that would enable secondary-level doctors to make informed decisions in terms of further management and need for special investigations were specifically considered.

Design. A descriptive study design was used, and convenience sampling included all referrals to the unit over a 6-month period (June - November 2007). All referral letters were screened according to a checklist designed for this study.

Setting. The study was undertaken at the Psychiatry Outpatient Department of the Pelonomi Provincial Hospital in Bloemfontein, which functions as a secondary-level referral centre for mental health in the southern Free State. Outcome measures. Descriptive statistics (percentages, means and standard deviations) were used to summarise results. Results. Two hundred and sixty-three referral letters were included in the study. Less than 20% of the referral letters included information on previous psychiatric consultations, current psychotropic medication, the outcome of physical examinations, and results of special investigations. Only 17 (6%) referral letters indicated a preliminary diagnosis according to an officially recognised classification system.

Conclusion. There was conclusive evidence that the quality of referrals to the Psychiatry Department was generally inadequate. A need for more effective referral strategies was identified.
Limited access to an individual’s mental content: a constraint on the strength of our knowledge in courts
Authors: Van Staden Werdie
Published: June 2017

No abstract available.
Audit of child and adolescent psychiatry in a teaching hospital in Nigeria: Prevalence, pattern and implication for improved services
Authors: Tunde-Ayinmode M F
Published: June 2017

Objective . This study aimed to identify the socio-demographic characteristics, pattern of psychiatric disorders and management of children and adolescents before the setting up of a dedicated child and adolescent unit at the University of Ilorin Teaching Hospital, Ilorin, Nigeria.

Method . A retrospective study, carried out at the Department of Behavioural Sciences of the hospital.

Results . The age range of the 94 children seen was 7 - 19 years, with a mean of 16.38 years (standard deviation 2.49); 82% were aged 14 - 19 years and 17% 7 - 13 years, while only 1 child was under 7 years old. The majority of the children lived with their parents in monogamous families with 5 or more children. The majority of the parents were educated and gainfully employed. The major diagnoses were schizophrenia (50%), delirium (15%) and seizure disorders (9%). Of the patients 64% were managed as outpatients and 36% as inpatients. Drug therapy was involved in the majority of cases, and the most frequently prescribed medication was haloperidol, atypical antipsychotics such as risperidone being used in only 8% of cases. Most of the patients were referred from the primary care- associated departments of the hospital, i.e. the general outpatient department (40%) and the internal medicine and paediatrics departments (29%). Referrals from welfare, judicial and educational institutions were uncommon (3%).

Conclusion . The pattern of patient presentation and management had not changed to any great extent over the past two decades. The introduction of a child and adolescent psychiatric unit is expected to improve consultation/liaison psychiatry and also child psychiatric service delivery and research. Understanding of the prevalence and pattern of presentation of mental disorders and their management is also expected to help improve the strategic planning and organisation of the new clinic.
Parenting style and conduct problems in children: Case report of deliberate self poisoning in a Nigerian child
Authors: Tunde-Ayinmode M F , Adegunloye Olusola Abejide
Published: June 2017

The correlation between psychosocially unhealthy parenting styles and child psychopathology has been established. This case report describes how chronic harsh and overbearing paternal parenting style tipped a young boy into deliberate self poisoning with the aid of organo-phosphorous chemicals (rat poison). This report is purposed to increase the interest of physicians and psychiatrists in parenting style research and in how potentially its modification could be a therapeutic and preventive tool.
Profile of forensic psychiatric inpatients referred to the Free State Psychiatric Complex, 2004–2008
Authors: Pienaar C , Dreyer A , Van der Merwe L , Jansen van Rensburg B , Calitz F J W , Van der Merwe L M , Joubert G
Published: June 2017

Introduction: An accused found unfit to stand trial and/or not responsible for his/her actions because of mental illness, is declared a state patient by the court.

Aim: The aim of the study was to analyse the biographical data and relevant particulars of forensic psychiatric inpatients who were admitted to the Free State Psychiatric Complex (FSPC) according to section 42 of the Mental Health Care Act (no. 17 of 2002), from 2004 to 2008. Study design A descriptive, retrospective study was conducted. Method One hundred and twenty forensic psychiatric inpatients admitted to the FSCP in the terms of section 42 of the Mental Health Care Act in the period 2004–2008, were included in the study.

Results: The majority (95.8%) of the offenders were male, unmarried (83.8%) and unemployed (81.5%). The median age was 32.5 years. Most of the offenses against persons were of a sexual nature (45.8%). More than half (55.5%) of the forensic inpatients were diagnosed with schizophrenia, followed by mental retardation (10%) and bipolar mood disorder. Eighty percent (80%) of these patients were found not competent to stand trial and unaccountable. Fifty percent (50%) of the participants received treatment for a mental illness prior to the crime, and were also known to have poor compliance and defaulted from treatment in the past.

Conclusion: The findings of this study can contribute to implement effective management and training programmes for the benefit of state patients.
A 4-year review of psychiatrists’ participation in prosecutorial workshops on criminal capacity
Authors: Kotze Carla , De Wet Paul Henry
Published: June 2017

Objective. The objective was to review psychiatric involvement in seven prosecutorial workshops on criminal capacity between 2004 and 2009. The aim was to evaluate the changing role of the psychiatrists in the workshops in order to identify areas in forensic psychiatry where prosecutors have a specific need for training, and to identify more suitable methods of training.

Method. The workshop programmes, copies of presentations, the number of attending prosecutors at each workshop, informal personal notes from the presenters, suggestions from meetings in preparation for workshops and formatted feedback reports were reviewed. Information from a total of seven workshops was reviewed and interpreted by 2 psychiatrists from Weskoppies Hospital Forensic Psychiatry Unit (WHFPU).

Results. The psychiatrists’ involvement increased over the years. Problematic topics that were identified include non-pathological criminal incapacity, child psychiatry and the different roles of the psychiatrist and the psychologist in court. Exposure to practical aspects, interactive workshops with case presentations, discussion groups and audience participation seemed to be the preferred method of training. Attitudes of prosecutors towards psychiatry improved with increased knowledge and understanding of the field, and overall the training was rated as relevant and enriching.

Conclusion. Psychiatrists can offer valuable training opportunities to legal professionals about the major mental illnesses and how they can affect criminal capacity, but evaluation of the training should be an ongoing process to address changing needs. Training sessions provide an opportunity for reciprocal sensitisation between the different fields. The ultimate goal is to work towards improved association between the criminal justice and mental health systems.
Excessive daytime sleepiness, nocturnal sleep duration and psychopathology among Nigerian university students
Authors: Mume Celestine Okorome , Olawale Kamildeen Oladimeji , Osundina Adeagbo Funminiyi
Published: June 2017

Background and objectives. Short nocturnal sleep duration resulting in sleep debt may be a cause of excessive daytime sleepiness (EDS). Severity of depression (psychopathology) has been found to be directly related to EDS. There is an association between sleep duration and mental health, so there may therefore be an interrelationship between sleep duration, EDS and psychopathology. The objectives of this study were to determine the prevalence rates of EDS and general psychopathology among university students in Nigeria; determine the range of and mean sleep duration in the students; and determine the extent to which sleep duration and EDS predict general psychopathology in the same group of subjects. Materials and methods. Eight hundred and forty-five students at Obafemi Awolowo University, Ile-Ife, Nigeria, were recruited for the study. The subjects were required to provide information on their age, gender and the total amount of sleep per night they usually had. General psychopathology was assessed using the English language version of the 30-item General Health Questionnaire (GHQ-30). They were also evaluated for EDS using the English language version of the Epworth Sleepiness Scale (ESS).

Results. Six hundred and thirty-four subjects (75.03% of the participants) provided complete data. The prevalence of EDS was 11.2% and the rate of general psychopathology in the subjects 13.1%. The range of sleep duration was 2 - 9 hours with a mean of 5.1 hours (standard deviation 1.3). On a regression model with the GHQ score as the dependent variable and sleep duration and ESS as the independent variables, the correlation coefficient between EDS, sleep duration and psychopathology (R) was 0.47.

Conclusion. EDS and psychopathology are common in the student population studied. Nocturnal sleep duration for an average student is far less than that for an average adult. Nocturnal sleep duration and EDS acted as moderate predictors of general psychopathology among Nigerian university students.
Social capital, pathway to care and duration of untreated psychosis: Findings from a low- and middle-income country context
Authors: Burns J K , Kirkbride J B
Published: June 2017

Background. Socio-environmental factors are associated with an increased incidence of psychosis and may affect the pathway to care in first-episode psychosis (FEP).

Objective. To determine the relationship between individual- and neighbourhood-level socio-environmental factors (household income and rated measures of neighbourhood social capital) and duration of untreated psychosis (DUP) in South Africa.

 Methods. We obtained data regarding sociodemographics, evolution of symptoms and pathway to care from interviews with 54 consecutively admitted FEP patients at Town Hill Hospital. Caregivers and clinical notes were also consulted. A population-based survey of social capital was conducted in the residential neighbourhood of each patient at onset. Cox regression analyses were used to test whether socioeconomic factors and overall neighbourhood social capital scores and sub-scores were associated with DUP.

Results. After controlling for age at onset, gender and income, a shorter DUP was independently associated with police involvement in pathways to care, while non-black ethnicity and greater levels of total social capital were associated with a longer DUP. Community participation, neighbourhood connectedness, and trust and safety were specifically associated with a longer DUP.

Conclusions. Individual factors including greater age at onset and police involvement in the care pathway were significantly associated with shorter DUP in this middle-income setting. Paradoxically, aspects of social capital pertaining to greater community involvement were associated with delays in pathways to appropriate care. It is possible that community members opted to care for individuals with early psychosis longer before sending them to formal health services. This is especially likely in contexts where mental health services are scarce and inaccessible, which has important implications for mental health education campaigns.
Misconceptions about traumatic brain injuries among South African university students
Authors: Pretorius Chrisma , Broodryk Mandi
Published: June 2017

Objective. To investigate the incidence and type of misconceptions about traumatic brain injuries (TBIs) harboured by university students. 

Method. A convenience sample of 705 university students were recruited and data were collected using an electronic survey. The link to the survey was sent via e-mail to all registered students at Stellenbosch University. The participants had to complete the Common Misconceptions about Traumatic Brain Injury (CM-TBI) questionnaire. 

Results. The findings of this study suggest that the students subscribe to misconceptions from each of the 7 categories of misconceptions about TBIs. The mean percentages of misconceptions about TBIs were calculated and the amnesia (mean 49.7%) and unconsciousness (mean 46.1%) categories were identified as the categories about which the respondents had the most misconceptions, while the mean percentages of misconceptions were lower for the categories of recovery (mean 27.6%), rehabilitation (mean 26.56%), prevention (mean 20.8%), brain injury sequelae (mean 18.7%) and brain damage (mean 8.4%). 

Conclusion. Generally, these findings appear to be in keeping with previous literature, which suggests that misconceptions about TBIs are common among the general population. This study’s identification of these misconceptions could help create awareness, provide a focus for information provision, and contribute to the development of educational intervention programmes tailored for the South African context.
Bipolar disorder
Authors: Colin F
Published: June 2017

Bipolar disorder (BD) presents in different phases over time and is often

complicated by comorbid conditions such as substance-use disorders

and anxiety disorders. Treatment usually involves pharmacotherapy

with combinations of different classes of medications and frequent

medication revisions.
A problem-based learning curriculum and undergraduate performance in the final psychiatry examination at the Nelson R Mandela School of Medicine
Authors: Saloojee Shamima , Van Wyk Jacqueline
Published: June 2017

Background. Medical education reformers must consider disease patterns, health system expectations and clearly specified outcomes to ensure that revised curricula are relevant. South Africa needs clinically competent doctors in adequate numbers to address the burden of psychiatric illnesses.

Objective. To evaluate the impact of a curricular reform, this study compared undergraduate students’ clinical competence in psychiatry following a change from a six-year traditional lecture-based (LB) curriculum to a five-year problem-based learning (PBL) curriculum. 

Method. The psychiatry examination records of 936 students enrolled in a PBL curriculum were compared with those of 771 students enrolled in a LB curriculum, covering a nine-year period from 2001 to 2009. Records covered the long case, case vignette and oral examinations. 

Results. Students in the PBL group performed significantly better in the problem-solving case vignette examination (p<0.02). There were no statistically significant differences in the mean marks for the long case and the oral examination. Because the revised curriculum is shorter, one additional class of 200 students graduated during the duration of the study than would have been possible under the previous curriculum. 

Conclusion. The new PBL curriculum produced more doctors, but there was no change in their psychiatric knowledge and skills compared with graduates from the old LB curriculum. Clinical teachers need to define outcomes prior to curriculum revision, because these are essential for evaluating the curriculum’s success.
South African Society of Psychiatrists guidelines for the integration of spirituality in the approach to psychiatric practice
Authors: Janse van Rensburg Albert B R
Published: June 2017

Background. It was important to develop South African guidelines in view of the extent of local and worldwide religious affiliation, rapid growth of academic investigation, guidelines provided by other associations (e.g. Royal College of Psychiatrists), the South African Society of Psychiatrists (SASOP)’s own position statements on culture, mental health and psychiatry, the appropriate definition of spirituality, the need for an evolutionary and anthropological approach, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V)’s cultural formulation, local legislation, ongoing research, and teaching requirements. 

Objective. To report on the outcome of the peer-reviewed process that was followed to draft local guidelines for psychiatric training and practice. 

Methods. During 2013, comments by members of the SASOP on a framework for guidelines on the role of spirituality in psychiatry practice and training were collated and subsequently submitted to the SASOP board for approval. 

Results. Guidelines were compiled in terms of: (i) integrating spirituality in clinical care and service provision; (ii) integrating spirituality in psychiatric training; (iii) ethically integrating spirituality within the professional scope of practice; and (iv) appropriate referral between psychiatrists and spiritual advisors. 

Conclusions. Integrating spirituality in the approach to practice and training cannot be ignored by local psychiatrists in the multicultural, multireligious and spiritually diverse South African context.
Does religious identification of South African psychiatrists matter in their approach to religious matters in clinical practice?
Authors: Welgemoed M A , Van Staden C W
Published: June 2017

Background. It is not known whether psychiatrists’ approach to religious matters in clinical practice reflects their own identification or non-identification with religion or their being active in religious activities. 

Objective. This question was investigated among South African (SA) psychiatrists and psychiatry registrars, including the importance they attach to the religious beliefs of patients for diagnostic and therapeutic purposes.

Methods. Respondents from the SA Society of Psychiatrists (SASOP) completed a purpose-designed questionnaire anonymously online. Respondents were compared statistically with regard to whether they identified with a religion, and the regularity of their participation in religious activities. Further comparisons were made based on gender and years of clinical experience.

Results. Participants who identified with a religion showed no statistical differences in comparison with those who did not, regarding: how they viewed the importance of a patient’s religious beliefs for purposes of diagnosis, general management, psychotherapy, pharmacotherapy, recovery from an acute episode, maintenance of recovery or remission, time to be spent on religious education, referral for religious/spiritual counselling according to patient’s own beliefs; referral when patient and participant are of different religions; and whether referral is considered harmful when a patient’s religious beliefs are similar to or different from the participant’s. Statistically significant differences were found where participants who did not identify with a religion were more likely to indicate religion had ‘little importance’ for the purpose of understanding the patient and to indicate ‘no’ when asked if they would refer a patient for religious/spiritual counselling. When comparing regularity of participation in religious gatherings, participants who indicated their participation as ‘no/never’ were more likely to answer ‘no’ when asked if they would refer a patient for religious/spiritual counselling, even when of a similar religion to that of their patient. In comparing genders, males were more likely to answer ‘yes’ than females when asked if they considered religious/spiritual counselling (in accordance with the patient’s own religious beliefs) potentially harmful when the patient’s religion was different from the participant’s.

Conclusion. It appears that SA psychiatrists’ identification with religion and regularity of participation in religious gatherings do not influence their approach to religious matters of their patients in most respects. The exception seems to be for those psychiatrists who do not identify with a religion (~16%), who tend to respond that they do not refer for religious counselling and that they consider the patient’s religious identification to be of little importance in understanding the patient.
Depressive symptoms in community-dwelling persons aged ≥60 years in Inanda, Ntuzuma and KwaMashu in eThekwini, KwaZulu-Natal
Authors: Narainsamy Jayalakshmi , Chipps Jennifer , Cassim Bilkish
Published: June 2017

Background. Physical and psychological ailments increase with age; while the physical ailments are well documented, mental health issues have received less attention. 

Objective. To determine the prevalence of depressive symptoms and associated risk factors in individuals aged ≥60 years living in a low-resource peri-urban area in South Africa. 

Methods. Secondary analysis was performed on data obtained from a primary study conducted to determine the influence of socioeconomic and environmental factors on the health status and quality of life in older persons living in the Inanda, Ntuzuma and KwaMashu (INK) area. The Center for Epidemiologic Studies Short Depression Scale (CES-D 10) was used to screen for depressive symptoms in the week preceding the interview, and respondents were categorised as having no (score <10), mild (10 - 14), or severe (>14) depressive symptoms. Risk factor associations were tested using Pearson’s χ2 tests and logistic regression. 

Results. There were 1 008 respondents (mean (standard deviation) age 68.9 (7.4) years), of whom 503 (49.1%) did not meet criteria for depressive symptoms. Of the 505 (50.1%) respondents who met the CES-D 10 criteria for depressive symptoms, 422 (41.9%) had mild and 83 (8.2%) had severe depressive symptoms. In the univariate analysis, significant associations were found with age (p=0.011), household size (p=0.007), income (p=0.033), disability (p=0.001), nutritional status (p≤0.001), the inability to count on family (p=0.008) and lack of mastery (p≤0.001). In direct binary logistic regression, there were significant associations with lack of mastery (p≤0.001), inability to count on family (p=0.027), malnutrition (p≤0.001) and household size (p=0.024).

Conclusion. This study highlights the high prevalence of depressive symptoms in the elderly in the INK area, and the need to promote successful ageing of the elderly population in this area.
Forensic state patients at Sterkfontein Hospital: A 3-year follow-up study
Authors: Marais Belinda , Subramaney Ugashvaree
Published: June 2017

Background. State patients are individuals who have been charged with offences involving serious violence and who have been declared unfit to stand trial and/or who are not criminally responsible because of their mental illness or defect. They are referred by the courts for treatment, rehabilitation and indefinite detention at a forensic psychiatric facility. However, many of these state patients may ultimately be released back into the community. As these individuals may be considered a high-risk group, their rates of relapse and recidivism are of importance. There is a paucity of South African literature on the long-term outcome of state patients. 

Objective. To describe the profile of state patients, and to examine their outcomes after 3 years, including recidivism rates. 

Methods. A descriptive, retrospective study of the clinical records of 114 state patients admitted to Sterkfontein Hospital in 2004 and 2005 was conducted, and their profile and 3-year outcomes were determined.

Results. The majority of state patients were male, single, unemployed, had a past psychiatric history (59%), and substance abuse history (71%). A third reported a past criminal history. The most common offences were assault with the intention to do grievous bodily harm (19%), rape (18%) and murder (13%). Psychotic disorders represented the most common diagnostic category (69%), with schizophrenia being the most frequent diagnosis (44%). Most state patients had been found unfit to stand trial (96%) and not criminally responsible (89%). At the end of the 3-year follow-up, the majority were in the community (69%), of whom most (72%) were out on leave of absence (LOA), while a quarter had absconded and a minority were reclassified (3%). Most absconders (83%) were state patients who had not returned from LOA. The recidivism rate was 4%. 

Conclusion. Most state patients were out in the community at the end of the 3-year period. The following recommendations are suggested: improved community psychiatric services, especially for those diagnosed with psychotic disorders and mental retardation, with a focus on improving treatment adherence and early detection of treatment defaulters; improved substance abuse rehabilitation programmes and community facilities, as well as strengthening of systems that manage absconders.
Achalasia as a complication of bulimia nervosa: A case report
Authors: Kutuk Meryem O. , Guler Gulen , Tufan Ali E. , Toros Fevziye , Kaytanli Umut
Published: June 2017

Objective: Oesophageal achalasia is a medical condition characterised by oesophageal aperistalsis, an increased resting pressure with partial or incomplete relaxation of the lower oesophageal sphincter. Bulimia nervosa (BN) is an eating disorder manifested by binge eating attacks followed by recurrent inappropriate compensatory behaviours, such as self-induced vomiting and excessive exercise. Dysphagia, regurgitation, vomiting, retrosternal pain, heartburn, weight loss, avoidance of eating, consumption of large amount of liquids and aberrant eating behaviours are symptoms of both achalasia and BN. Owing to these common signs and symptoms, oesophageal achalasia can be misdiagnosed as an eating disorder. In addition, oesophageal achalasia can occur as a complication of BN. It is often difficult to distinguish organic and psychological vomiting or comorbidity because of overlapping of the symptoms.Case report: We report the case of a patient who developed oesophageal achalasia following severe, repetitive vomiting as a complication of BN.Conclusion: We want to raise awareness regarding the development of a medical illness in the presence of a psychiatric disorder. Importantly, physicians should have a fundamental knowledge of these two diseases regarding their clinical patterns to differentially diagnose one or both disorders as quickly as possible.