bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of anxiety and depressive symptoms in men with erectile dysfunction
Authors: Pankhurst K , Joubert G , Pretorius P J
Published: June 2017

Objectives. To determine the prevalence of anxiety and depressive symptoms in men presenting to a sexual dysfunction clinic in Bloemfontein with erectile dysfunction (ED); to determine the relationship, if any, between age and mood/anxiety symptoms in such patients; and to make clinicians aware of the co-morbidity of anxiety/mood symptoms and ED.Methods. An observational analytical study was undertaken of 100 consecutive male patients of all ages presenting with ED (with a score less than 20 on the 5-item intensity scale for ED). Age, race, marital and employment status were noted as well as social habits including smoking and alcohol use. The presence of known medical conditions and surgical procedures was ascertained. All current prescription medication was recorded. Panic disorder, obsessive-compulsive disorder, generalised anxiety disorder and social phobia were rated using the Mini International Neuropsychiatric Interview, while the Hamilton Rating Scale for Depression was used to rate depressive symptoms.Results. Thirty-three per cent of respondents had depressive symptoms, and of this group 36% had a co-morbid anxiety disorder. In total, 21% of patients had an anxiety disorder. Anxiety disorders were more common with moderate to severe ED. No anxiety disorders occurred in patients with mild ED. The majority of participants suffering from severe ED were evenly spread in age from 30 to 69 years. Participants suffering from moderate to severe ED were more likely to have medical conditions, most notably hypertension.Conclusion. The results of this study suggest that men suffering from ED are likely to have a co-morbid psychiatric disorder (42%), with the prevalence of depressive symptoms (33%) and anxiety disorders (21%) being higher than in the general population. Significant concomitant medical conditions (most notably hypertension) were more common in men with moderate to severe ED.
News
Authors: Emsley Robin
Published: June 2017

No abstract available.
Institutional management of the mentally ill in South Africa
Authors: Zabow Tuviah
Published: June 2017

NO ABSTRACT AVAILIBLE
Pitfalls in the care of the very sick psychotic patients
Authors: Ross J L
Published: June 2017

NO ABSTRACT AVAILIBLE
Amisulpride as adjunct to clozapine in treatment-resistant schizophrenia and schizoaffective disoder: An open-label pilot study
Authors: Koen Liezl , Niehaus Dana J , Schutte Angelica , Muller Jacqueline , Emsley Robin , Oosthuizen Piet
Published: June 2017

Background. Although clozapine is the treatment of choice for treatment-resistant schizophrenia, many patients remain symptomatic despite adequate treatment with this medication. One suggested strategy to improve efficacy has been the addition of a potent D2 blocker such as amisulpride to treatment with clozapine.

Methods. In this study, 20 subjects who were treatment-resistant to conventional antipsychotics and who were still symptomatic despite adequate treatment with clozapine received amisulpride as adjunctive treatment. After baseline assessment all subjects were titrated to amisulpride 400 mg per day and then reassessed after 8 weeks by a blinded rater.

Results. Analysis showed statistically significant improvements in PANSS (Positive and Negative Symptom Scale) total score (t = 3.49, df = 18, p = 0.003), PANSS negative subscale score (t = 3.22, df = 18, p = 0.005), and PANSS depression factor score (t = 3.89, df = 19, p = 0.001).

Discussion. This study suggests that addition of the second- generation antipsychotic amisulpride to a stable treatment regimen with clozapine may offer additional benefits in terms of negative and depressive symptoms.
Migration and exile - some implications for mental health in post-apartheid South Africa
Authors: Marchetti-Mercer M C , Roos J L
Published: June 2017

The age of globalisation and the socio-political changes that have taken place in South Africa in the past decade have created powerful contexts within which the issues of belonging and finding a ‘home’ have become very relevant to all South Africans.

This article explores the phenomena of migration and exile, which are strongly characterised by an attempt to find a place one can call ‘home’ and where one can belong, and then shows how these experiences can provide a useful framework for understanding a multicultural context such as the one in South Africa.

Some of the implications of these phenomena for mental health, specifically the link between schizophrenia and migration, will also be discussed.
CT scans in psychiatric patients - an exploratory study at Chris Hani Baragwanath Hospital
Authors: Jeenah F Y , Moosa M Y H
Published: June 2017

Objective. An exploratory study was undertaken to determine the value of computed tomography (CT) in the assessment of mentally ill patients at Chris Hani Baragwanath Hospital.

Method. All mentally ill inpatients aged 18 years and older who presented during the period March - August 2005, were screened for eligibility for CT of the head. The patients’ demographic data, clinical details, special investigations and the results of the CT were recorded.

Results. Of approximately 600 admissions, 55 were eligible for CTs during the study period. The mean age of the study population was 38.3 years (standard deviation (SD) 16.3 years). Twenty patients (36.4%) had abnormal CTs; 7 (35%) of these patients were over the age of 60 years. There was a significant correlation between abnormal CTs and advancing age (r = 0.5, p < 0.001). In the group with abnormal CTs the gender distribution was similar, 15 (75%) presented with a first episode of psychosis, 5 (25%) had a concurrent abnormal physical examination, and 7 (35%) had abnormal special investigations. There was no significant difference between this group and the group with normal CTs with regard to gender (χ2 = 0.75, p = 0.385), first-episode psychosis (χ2 = 2.76, p = 0.096), abnormal physical findings (χ2 = 0.51, p = 0.473), or abnormal laboratory findings (χ2 = 0.13, p = 0.714) respectively.

Conclusion. In this psychiatric population CT scanning revealed a significant number of abnormalities, especially in patients with first-episode psychosis. The study also suggests that clinical abnormalities (physical and laboratory) may not be reliable predictors of abnormal CTs and therefore the need for further research with bigger sample size.
Biological Psychiatry Congress 2007
Authors: Office Editorial
Published: June 2017

Background: Depressive symptoms and major depressive disorder (MDD) occur ≥ 3 times as common in coronary artery disease (CAD) patients as in the general community, which confers an adjusted relative risk of 2 to 4 for mortality. There are emerging data on how to manage depressed CAD patients with MDD.

Method: The two previous clinical trials (SADHART and ENRICHD) confirm (i) failure of cognitive-behavior therapy to affect survival, (ii) improvement with placebo and usual care, (iii) clinical effect of sertraline, particularly in those with recurrent MDD, (iv) cardiac safety of sertraline. This presentation will highlight the findings of the recently concluded CREATE (Canadian cardiac evaluation of antidepressant and psychotherapy efficacy) study.

Results: In a 2-by-2 factorial trial 284 patients with stable CAD were assigned to interpersonal psychotherapy (IPT) or clinical management (CM) and citalopram or placebo for 12 weeks. Citalopram reduced depressive symptoms more than placebo at 6 weeks (p=.01) and at 12 weeks (HAM-D-Hamilton Depression difference 3.3 points, p=.005). Citalopram was efficacious for 43% with recurrent depression compared to those experiencing MDD for the first time. However, there was no additional benefit of adding IPT to CM (HAM-D difference -2.3 points; p=.06), favoring CM over IPT in lowering depressive symptoms. IPT improved depression compared to CM for those subjects with high levels of functional performance. There were 12 cardiovascular and 23 other serious adverse events classified by independent committee and no electrocardiogram effects of the active drug were noted.

Conclusion: Citalopram can be considered as a first line treatment of MDD in CAD patients. So far, besides CM, it has not been shown if any form of psychotherapy is indicated for such patients.
Hypotheses, neuroscience and real persons: The theme of the 10th International Conference on Philosophy, Psychiatry and Psychology
Authors: Van Staden C W , Fulford K W M
Published: June 2017

NO ABSTRACT AVAILIBLE
Towards real persons: Clinical judgement and philosophy of psychiatry
Authors: Thornton Tim
Published: June 2017

One of the motivations for the new philosophy of psychiatry is the need to understand changing ideas in mental health care. In the last century, changes in both physical and biological theory prompted work in philosophy of physics and philosophy of biology to understand those fields better, attempts which were continuous with empirical work. At the start of this century, changes in psychiatry promise increased interest in the philosophy of psychiatry as an attempt, alongside empirical research, to understand the conceptual underpinnings of mental heath care. While philosophical methods are distinct from empirical methods, the work is truly interdisciplinary, growing organically from the complexities of demand on psychiatric care and, although philosophical, carried out by philosophers and psychiatrists alike. One focus is the nature of clinical judgement in psychiatric diagnosis. In this short note I will briefly sketch some issues that arise from a current idea: that psychiatric diagnosis should include idiographic elements.
Treating depression in HIV/AIDS
Authors: Moosa M Y H , Jeenah F Y
Published: June 2017

The prevalence of HIV/AIDS has reached alarming proportions in South Africa. Although it is strongly associated with depressive moods, there are very few published studies on its treatment in patients with HIV/AIDS. This article reviews the prevalence, treatment and potential effects of depressive disorders on immunity and adherence to antiretroviral therapy (ART).The studied prevalence of depressive disorders in HIV-positive patients varies widely, ranging from 0% to 47.8%. However, these patients have nearly twice the likelihood of having had a recent episode of major depressive disorder compared with HIV-negative individuals.
Currently available antidepressant medications are equally effective in treating HIV/AIDS patients and the general population. Furthermore, intervention studies have shown that psychotherapy reduces depressive symptoms and is well tolerated. Interpersonal psychotherapy is more successful than supportive psychotherapy in lessening depression, and patients experience improved functioning physically and emotionally.

Untreated depression may be associated with reduced adherence to ART, immunosuppression, and more rapid HIV illness progression. In South Africa, HIV/AIDS patients may be at greater risk for psychiatric disorder given the potentially stressful living conditions including high rates of unemployment and poverty, poor and unstable housing, inadequate social services, and high rates of crime and domestic violence. A lack of data on depression in South Africa underscores the need for further research.
Guidelines to improve psychological and social support in emergecies
Authors: Spencer-Jones Jonathan
Published: June 2017

No abstract available.
The psyche and the soma - redefining the role of the psychiatrist in medical care
Authors: Oosthuizen Piet
Published: June 2017

n/a
'My brain made me do it' - how neuroscience may change the insanity defence
Authors: Kaliski Sean Z
Published: June 2017

n/a
Suicide Risk in Schizophrenia - a follow-up study after 20 years. Part 2: Symptomatology and pharmacotherapy
Authors: Lippi G , Smit D J , Jordaan J C , Roos J L
Published: June 2017

Objective:  This study prospectively re-evaluated, after a period of 20 years, a cohort of patients with schizophrenia who had been considered to be at high risk for suicide. The outcome and social factors associated with their suicide risk were investigated over the 2 decades. Method Subjects were contacted and interviewed face-to-face by following a questionnaire devised for this purpose. The Beck Hopelessness Scale (BHS) was administered and ratings were compared to those from the original study. The Calgary Depression Scale for Schizophrenia (CDSS) was administered. Cross tabulations were performed to identify factors associated with increased suicide risk. A psychological autopsy was performed, for those subjects who had committed suicide since the original study.

Results:Fourteen of the original 33 high suicide risk schizophrenia patients were found. Three subjects committed suicide during the 20 year period. Among the living subjects, risks for suicide were found to be lower than 20 years ago. Male gender, poor social support, early age of illness onset, current admission to or recent discharge from hospital and a higher level of education were all factors associated with increased suicide risk.

Conclusion: Demographic factors and those related to illness course, found in this study to be associated with suicide risk in patients with schizophrenia, are congruous with those mentioned in the literature.
Telepsychiatry in South Africa – present and future
Authors: Wynchank Sinclair , Fortuin Jill
Published: June 2017

The recent progress in telepsychiatry results from advancing technology and videoconferencing as an effective alternative to classic face-to-face psychiatric interaction, in terms of both results and cost-effectiveness. The wide range of applications of telepsychiatry is outlined – in particular, emergency, forensic, prison and adolescent psychiatry. Attitudes of patients and the providers of psychiatric services are discussed, and a short account is given of the place of tele-education in psychiatric teaching. The advantages of telepsychiatry are outlined and its limitations. Lastly, the limited experience and relevance of telepsychiatry in South Africa (and hence for other developing countries) are presented. The conclusion is that telepsychiatry is well established, its successes documented, and that it should be applied in planning future public health services in South Africa.
Behavioural problems among schoolchildren in Nigeria
Authors: Akpan M U , Ojinnaka N C , Ekanem E
Published: June 2017

Background. Behavioural problems among schoolchildren can pose a burden on families and society.

Objective. To determine the prevalence and pattern of behavioural problems among children living in Uyo, a town in South-South Nigeria.

Methods. A cross-sectional study was carried out among 572 pupils from six primary schools selected randomly from private and government schools in Uyo. Pupils with a normal IQ were selected using a systematic sampling method. The Rutter behavioural scale for teachers (B2) was completed by their teachers, and that for parents (A2) was completed by the parents. Student’s t-test was used to compare pairs of means, frequencies were compared using the chi-square test, and p<0.05 was taken as significant.

Results. According to the teachers’ scale 132 pupils (23.1%) had scores within the range indicating behavioural problems, compared with 103 pupils (18.0%) on the parents’ scale. This was statistically significant (χ2 = 19.8, p=0.001). Pupils in government and private schools had mean scores of 7.4 (standard deviation (SD) 6.41) and 5.12 (SD 6.26) and 7.29 (SD 5.84) and 6.96 (SD 5.76), respectively. Behavioural problems were more common among children in government schools and among those in the lower socio-economic class. Boys had significantly higher mean scores than girls, and both scales showed more boys to be disturbed. Antisocial behaviour was commonest among boys and older children.

Conclusion. There is a high prevalence of behavioural problems among primary school children in Uyo, with a predominance of antisocial behaviour. The government needs to provide appropriate services to deal with this state of affairs.
Confounding placebo response in clinical trials: Analysing the little we know and current strategies to address the crisis
Authors: Pretorius Paul J , Van der Merwe Lucas M , Westmore Ian B
Published: June 2017

No abstract available.
The regulation of informed consent to participation in clinical research by mentally ill persons: An overview
Authors: Nienaber A
Published: June 2017

The article examines the legal requirements relating to the informed consent of mentally ill persons to participation in clinical research in South Africa. First, the juridical basis of informed consent in South African law is outlined; and second, the requirements for lawful consent developed in South African common law and case law are presented. Finally, the article deliberates upon the requirements for the participation of mentally ill persons in research as laid down by the Mental Health Care Act and its regulations, the National Health Act and its (draft) regulations, and the South African Constitution.
The demographic, clinical and forensic profile of offenders diagnosed with epilepsy referred to the Free State Psychiatric Complex Observation Unit in terms of section 77 and/or 78 of the Criminal Procedure Act 51 of 1977
Authors: Marais P J , Calitz F JW , Van Rensburg P HJJ , Joubert G
Published: June 2017

Introduction. Limited information regarding the relation between psychopathology associated with epilepsy, crime and the legal aspects thereof is available in South Africa.

Objectives: The demographic, clinical and forensic profile of alleged offenders diagnosed with epilepsy and referred to the Free State Psychiatric Complex (FSPC) Observation Unit from 2001 to 2006, was investigated. Design A retrospective cross-sectional study was conducted.

 Results: Of the 69 alleged offenders, aged 17–79 years (median 30 years), 94.2% were male, 81.2% Black, 72.5% single, and 69.9% unemployed. The median qualification was grade six. Offences were violent in nature and committed against a person in 75% of cases. A direct link between epilepsy and the alleged offences occurred in 7% of cases. Generalised epilepsy (34.8%) and interictal psychosis (20.3%) were the most commonly diagnosed conditions. Twenty-nine (42%) alleged offenders lacked criminal responsibility and were not fit to stand trial. Most observati (79.2%) diagnosed with generalised epilepsy were criminally liable and fit to stand trial. The highest rate of criminal incapacity was found among observati with interictal psychoses (85.7%) and comorbid mental retardation (90%). Almost 60% of referred cases were declared as state patients by the court.

Conclusion: In only 16% of cases, observati were found unaccountable because of epilepsy (automatisms) or postictal confusional states. Our findings confirmed an increased prevalence of violent behaviour during seizure-free periods. This contributes to evidence that factors associated with epilepsy, rather than the epilepsy itself, play an important role in the possible increased risk of violent behaviour in people with epilepsy.
The functional neuro-anatomy of the human response to fear: A brief review
Authors: Casale A Del , Ferracuti S , Kotzalidis G D , Rapinesi C , Serata D , Ambrosi E , Simonetti A , Savoja V , Pompili M , Angeletti G , Tatarelli R , Girardi P
Published: June 2017

The perception of fear and subsequent appropriate behavioral responding are crucial for the adaptation of species to their living environment. Functional neuroimaging studies of the neural basis of fear during the last few decades in humans contributed to significant advancement in the understanding of its mechanisms. Imaging studies help us delineating the role of amygdala-based neurocircuitry in fear activation and attention capture. The aim of this paper was to briefly review the most recent functional neuroimaging studies of fear perception, modulation and learning. Important knowledge was acquired about the factors that set fear in motion, including the role of nonconscious processes and the character of fear in guiding attention. A subcortical network interacts with the prefrontal cortex to modulate emotional response that allows better coping with environmental and social circumstances. Fear learning reduces the need to relearn about danger, and flexibility processes readjust fear behavior when external circumstances change. Future improvement of functional and other neuroimaging techniques may promote better clarification of the neurocircuitry involved in fear perception, learning and modulation.
Community rehabilitation for schizophrenia patients
Authors: Botha Ulla
Published: June 2017

No abstract available.
Sexual dissatisfaction and associated factors in a sample of patients on antiretroviral treatment in KwaZulu-Natal, South Africa
Authors: Peltzer Karl
Published: June 2017

Background: Sexual expression affects physical, mental and social well-being. There is a lack of understanding on sexual problems among patients on antiretroviral treatment in Africa.

Methods: Using systematic sampling, HIV-positive patients were selected prior to commencing on ART from outpatient departments from three hospitals and followed-up for 20 months (n=495) and interviewed with a questionnaire.

Results: Rates of self-reported sexual problems were high (34.3%, among men: 30.3% and women 36.0%) but significantly reduced from prior to ART (57.7%) to 20 months on ART (34.3%) (P=0.006). In multivariate analysis not being formally employed (odds ratio: 0.4, 0.2-0.9), having had sexual intercourse in the past 3 months (OR: 5.8, 1.7-19.8), taking medications for HIV-related opportunistic infections (OR: 2.5, 1.1-5.7), internalized stigma (OR: 1.4, 1.2-1.6), lack of social support (OR: 0.4, 0.3-0.6), and low depressive symptoms (OR: 0.9, 0.8-1.0) were found to be associated with sexual problems.

Conclusions: This prospective study with a large sample of persons on ART showed evidence of reduction of sexual problems over time and a number of factors influencing sexual problems which should be addressed in health care provider interventions.
Freudian unconscious and cognitive neuroscience
Authors: Rebelo Ethelwyn Eleonore
Published: June 2017

Talvitie proposes a four-level model to accommodate an understanding of the Freudian unconscious in terms of cognitive neuroscience. The model is reviewed with reference to both Talvitie's exposition of the unconscious and that of other neuroscientists.
Hopelessness, depression and suicidal ideation in HIV-positive persons
Authors: Govender R D , Schlebusch L
Published: June 2017

Background and objectives. HIV/AIDS and suicidal behaviour are major public health concerns. The aim of this study was to examine the relationship between hopelessness, depression and suicidal ideation in HIV-infected persons.

Methods. The sample consisted of all adult volunteers attending a voluntary counselling and testing (VCT) HIV clinic at a university affiliated state hospital. Suicidal ideation and depression were measured using the Beck Hopelessness Scale (BHS) and the Beck Depression Inventory (BDI), respectively, at two intervals, viz. 72 hours and 6 weeks after HIV diagnosis.

Results. Of the 156 patients who tested positive for HIV, 32 (20.5%) had a hopelessness score of 9 or above on the BHS and 130 patients (82.8%) were depressed according to the BDI at 72 hours after diagnosis. Of the 109 patients assessed 6 weeks after diagnosis, 32 (28.8%) had a hopelessness score of >9 on the BHS and 86 (78.2%) were depressed according to the BDI. A moderately positive correlation at both time periods was found between hopelessness and depression. A ROC analysis showed optimal sensitivity, indicating that the HIV-positive depressed patients were at risk for suicidal behaviour.

Conclusion. The significant correlations between hopelessness, depression and suicidal ideation are important markers that should alert healthcare professionals to underlying suicide risks in HIV-positive patients. Early recognition of this and suicide prevention strategies should be incorporated into the treatment offered at VCT HIV clinics.
Disability claims on psychiatric grounds in the South African context: A review
Authors: Mokoka Matlhodi T , Rataemane Solomon T , Dos Santos Monika
Published: June 2017

We review the nature of disability claims on psychiatric grounds in the South African context, including factors contributing to disability claims, specific disorders usually leading to disability claims, impairment and disability, assessing the degree of impairment, guidelines in assessing psychiatric disability, ethical considerations, consequences of medical boarding, and rehabilitation. Psychiatrists should consider the potential benefits of supervised and mentored work rehabilitation programmes, graded return to work or an appropriate alternative position in consultation with employers.
Stress among medical doctors working in public hospitals of the Ngaka Modiri Molema district (Mafikeng health region), North West province, South Africa
Authors: Govender I , Mutunzi E , Okonta H I
Published: June 2017

Introduction. Stress and burnout are common among healthcare professionals, including doctors and nurses. Work-related stress rates among the general working population average 18%, while among doctors the rate is reported to be around 28%. Stress in doctors can result in multiple negative consequences. Detecting stress early may have positive outcomes for doctors, their families and the patients they care for. There is growing concern about stress in doctors working in public hospitals, yet there is a paucity of studies on stress among these doctors in South Africa.

Methods. A cross-sectional, descriptive study using a self-administered, standardised questionnaire (12-item General Health Questionnaire (GHQ-12)) was conducted among medical doctors working in four hospitals of the Ngaka Modiri Molema (NMM) district, North West province. The research questionnaire was distributed and returned anonymously to ensure confidentiality.

Results. Of the 67 doctors in the study, 34 (51%) were found to be stressed; 18 (27%) of the participants were highly stressed (morbidly stressed). This result was compared with figures obtained by Govender in an earlier study conducted among private general practitioners in KwaDukuza, KwaZulu-Natal, in which 38% were stressed according to the GHQ-12; 23% of the subjects were morbidly stressed.

Conclusion. The rate of stress among doctors working in the four hospitals of the NMM district is higher than that found in other studies, which report a stress prevalence of 28 - 38% among doctors.
Depression and anxiety among Grade 11 and 12 learners attending schools in central Bloemfontein
Authors: Strydom M A A , Pretorius P J , Joubert G
Published: June 2017

Objectives. Anxiety disorders are the most common childhood psychiatric disorders. Previous research suggests that South African rates may be high. Our study examined the prevalence and severity of anxiety and depression among Grade 11 and 12 learners attending schools in central Bloemfontein. Learners’ perception of the important stressors as well as the most relevant coping strategies were investigated.

 Methods. A cross-sectional study was conducted by using self-assessment rating scales and questionnaires. The Hospital Anxiety and Depression Scale (HADS) was used to screen for anxiety and depressive symptoms. Participants were provided with an additional list of possible stressors and coping skills, from which they identified those applicable to themselves. All students enrolled in Grades 11 and 12 at the selected schools during August 2009 were eligible for inclusion.

Results. Five hundred and fifteen learners participated in the study, of whom 32.0% presented with moderate or severe anxiety and 5.3% with moderate or severe depressive symptoms. Mild symptoms were reported by an additional 29.0% on the anxiety subscale and 14% on the depression subscale of the HADS. Academic workload was reported as the main source of stress (81.4%).

Conclusions. Although the study has limitations in terms of methodology and size, resulting in undetermined validity, it indicates possible higher prevalence rates for anxiety and depression than in previous South African studies and worldwide prevalence rates for adolescents. Pupils were generally hesitant to seek help from formal assistance structures provided by the schools, and preferred discussing problems with parents or friends.
Future challenges in psychiatry from the reflections of a quinquagenerian
Authors: Swingler David
Published: June 2017

No abstract available.
Cognitive functioning and associated factors in older adults in South Africa
Authors: Peltzer K , Phaswana-Mafuya N
Published: June 2017

Objective. To investigate cognitive functioning and associated factors in a national probability sample of older South Africans who participated in the Study of Global AGEing and Adult Health (SAGE) in 2008.

Methods. In 2008 we conducted a national population-based cross-sectional study with a sample of 3 840 adults aged ≥50 years in South Africa. We administered a questionnaire surveying socio-demographic characteristics, health variables, and anthropometric and blood pressure measurements. Multivariate regression analyses were used to assess the association of socio-demographic factors and health variables with cognitive functioning.

 Results. Mean variables in the sample were: 5.9 recalled words, a verbal fluency of 9.9 words in a specified category (animals), a forward and backward digit span of 5.2 and 3.2, respectively, and an overall mean cognition score of 48.5. Higher overall cognitive functioning (a combination of memory and executive functioning) was positively associated with: younger age; white, Indian/Asian or coloured ethnicity; being married; a higher level of education; greater wealth; a higher level of physical activity; a greater quality of life; and a better subjective health status.

Conclusions. Our findings can be used to refine future projections of cognitive function and healthcare needs in ageing middle-income societies such as those in South Africa.
Personality, depressive symptoms and prior trauma exposure of new recruits at two Metropolitan Police Service academies in South Africa
Authors: Subramaney U , Libhaber E , Pitts N , Vorster M
Published: June 2017

Background. Police officers are predisposed to trauma exposure. The development of depression and post-traumatic stress disorder (PTSD) may be influenced by personality style, prior exposure to traumatic events and prior depression.

 Objectives. To describe the personality profiles of new Metropolitan Police Service (MPS) officers, and to determine the association between personality profiles, trauma exposure and depressive symptoms.

 Methods. We performed a cross-sectional analysis of 139 new recruits at two MPS academies in South Africa. A questionnaire elucidating traumatic life events and personality profiles was developed using the Millon Clinical Multiaxial Inventory-III (MCMI-III). Depressive symptoms were measured using the Hamilton Depression Rating Scale (HAMD).

Results. Almost all subjects (99.3%) had previous trauma exposure, most commonly the unexpected death of a loved one and motor vehicle accidents. Prevalence of clinical depression was low (mean HAMD 3.57; standard deviation ±3.37). Personality characteristics revealed a high prevalence of anxiety (64.7%; 95% CI 56.8 - 72.6), depressive clinical patterns (34.5%; 95% CI 26.6 - 42.2), paranoia (33.1 %; 95% CI 26.6 - 42.2) and major depression (10.3%; 95% CI 5.1 - 15.1). There were no significant associations between any of the traumatic events and depressive symptoms, nor were there any significant associations between any of the personality variables and HAMD score (p>0.05).

Conclusion. The presence of depressive symptoms among MPS officers was low, with no significant associations between traumatic events, personality variables and depressive symptoms.
Consent to research by mentally ill children and adolescents: The implications of Chapter 9 of the National Health Act
Authors: Nienaber Annelize Gertruida
Published: June 2017

Chapter 9 of the National Health Act came into effect in March 2012. This article examines the Act’s statutory requirements relating to the informed consent to participation in clinical research by mentally ill children and adolescents in South Africa. The necessity of doing clinical research in mentally ill children and adolescents is canvassed briefly and the requirements that chapter 9 sets out for lawful child and adolescent consent to research participation are presented. The article deliberates upon the limitations of the newly enacted legislation and proposes selective improvements. Because of the likely erosion of the minor’s privacy, the article finds that the requirement that a parent or legal guardian must consent to children’s and adolescents’ participation in research has the potential to obstruct much-needed mental health research. This requirement is likely to be found unconstitutional. In certain circumstances, ethics committees tasked with the review of research should be allowed to dispense with parental consent, and adolescents recognised as having the necessary capacity to consent independently to research participation. Furthermore, the Act’s classification of research into therapeutic and non-therapeutic categories is considered problematic. The article recommends that research permissible in minors be stated in terms of well-defined risk standards. Finally, the article finds the requirement set in subsection 71(3) for ministerial consent in the case of non-therapeutic research in children and adolescents to be overly protectionist, as it precludes the capacity of ethics committees to judge the ethics of the proposed research.
Depressive features among adult patients receiving antiretroviral therapy for HIV in Rustenburg district, SA
Authors: Bongongo T , Tumbo John , Govender Indiran
Published: June 2017

Background. Globally, it is estimated that depressive features occur in 15 - 36% of people suffering from chronic diseases and 60% of people with HIV/AIDS. A high prevalence of mental disorders among HIV-infected individuals has been shown in South Africa and other parts of sub-Saharan Africa. Untreated depression leads to poor adherence to treatment and poor quality of life for patients with chronic diseases.

Methods. Using the Zung self-rating scale, we screened for depressive features among adult patients receiving highly active antiretroviral therapy (HAART) who attended primary healthcare facilities in the Rustenburg district of North West Province in South Africa during December 2009.

Results. Among 117 participants, 81 (69.2 %) had mild depressive features, 2 (1.7%) had moderate depressive features, 1 (0.9 %) had severe depressive features and 33 (28.2%) did not have depressive features. Depressive features were more common in males (77.1%) than in females (69.5%), and were most common in patients taking the combination of efavirenz, lamivudine and stavudine.

Conclusion. Depressive features seem to be common among adult patients receiving HAART and attending primary healthcare facilities in the Rustenburg district. 
Attitudes of undergraduates towards mental illness: A comparison between nursing and business management students in India
Authors: Vijayalakshmi P , Reddy D , Math S B , Thimmaiah R
Published: June 2017

Background. Mental illness is an important public health issue worldwide; stigmatisation and negative attitudes towards people with mental illness are widespread among the general public. However, little is known about the attitudes of undergraduates to mental illness. 

Purpose. To compare the attitudes towards mental illness among undergraduates enrolled in nursing courses v. those enrolled in Bachelor of Business Management (BBM) courses. 

Methods. A cross-sectional descriptive design was adopted for the present study. A total of 268 undergraduates were selected to complete the Attitude Scale for Mental Illness (ASMI) and the Opinions about Mental Illness in the Chinese Community (OMICC) questionnaires. 

Results. We found significant differences between the number of nursing and BBM students who agreed with statements posed by the questionnaires, e.g., that they would move out of their community if a mental health facility was established there (χ2=16.503, p<0.002), that they were not afraid of treated mentally ill people (χ2=15.279, p<0.004), and that people with mental illness tend to be violent (χ2=14.215, p<0.007) and dangerous (χ2=17.808, p<0.001). Nursing students disagreed that people with mental illness are easily identified (χ2=30.094, p<0.000), have a lower IQ (χ2=70.689, p<0.000) and should not have children (χ2=24.531, p<0.000). Nursing students were more benevolent than BBM students, as they agreed that people with mental illness can hold a job (χ2=49.992, p<0.000) and can return to their former position (χ2=11.596, p<0.021), that everyone faces the possibility of becoming mentally ill (χ2=38.726, p<0.000), and that one should not laugh at the mentally ill (χ2=17.407, p<0.002). Nursing students held less pessimistic attitudes, as they felt that the mentally ill should receive the same pay for the same job (χ2=10.669, p<0.031) and that the public are prejudiced towards people with mental illness (χ2=17.604, p<0.001).

Conclusion. College students’ attitudes towards people with mental illness vary based on the course that they are enrolled in. Attitudes may be positively improved by revising curriculum design to incorporate educational sessions about mental illness. These are essential steps to combat discrimination, and potentially enhance the promotion of human rights for the mentally ill.
Post-traumatic Stress Disorder
Authors: Seedat S
Published: June 2017

Post-traumatic stress disorder (PTSD) is among the most prevalent

anxiety disorders, both in terms of lifetime and 12-month prevalence
rates documented in epidemiological studies worldwide.
Social Anxiety Disorder
Authors: Seedat S
Published: June 2017

According to epidemiological studies, rates of social anxiety disorder

(SAD) or social phobia range from 3% to 16% in the general

population.

[1,2]

Social phobia and specific phobias have an earlier age
of onset than other anxiety disorders.
Stiff person syndrome (SPS): Literature review and case report
Authors: Pretorius Erna , Struwig Wilmarie
Published: June 2017

Stiff person syndrome (SPS) is a rare, debilitating condition which presents with progressive and inconsistent neurological features. The main symptoms are stiffness and intermittent, painful muscle spasms, triggered and exacerbated by stressful and emotional stimuli. The fluctuating clinical nature of SPS, and otherwise normal neurological examination, often lead to a misdiagnosis of conversion disorder. Psychiatric symptoms frequently accompany this disorder and patients are often first seen by psychiatrists. SPS is autoimmune-based: antibodies are directed against glutamate decarboxylase, resulting in dysregulation of gamma-aminobutyric acid (GABA) in the brain which is considered the cause of the neuropsychiatric symptomatology. SPS should be considered in the differential diagnosis of conversion disorder. Effective management requires early detection, a collaborative approach with GABA-ergic medication and intravenous immunoglobulins, and management of concomitant psychiatric disorders. We describe a patient with SPS. Only one other case has been reported in South Africa.

 
Designing an educational programme in mental health for general practitioners in South Africa
Authors: Nichol Richard John , De Klerk Brenda , Nel Maria Magdalena , Van Zyl Gert Jacobus , Hay John Francis
Published: June 2017

Background. With the new Mental Health Care Act in use, additional demands will be placed on general practitioners to provide adequate care for mental health patients. The College of Psychiatry of the Colleges of Medicine of South Africa awards a Postgraduate Diploma in Mental Health (PGDipMH) to medical doctors, but there is no standardised formal tuition or curriculum available to potential candidates.

Objectives. A study was undertaken to design a postgraduate programme using a six-step process to assist medical practitioners in preparing for the PGDipMH.

Methods. The Delphi research method, a nomi nal group technique for developing forecasts and trends based on the collective opinion of knowledgeable experts, was used. Data, obtained by means of closed items in a questionnaire, were analysed, and the opinions and ideas of the expert respondents were used to adapt the formulated set of criteria for each subsequent round of Delphi. This process was repeated until 80% consensus or stability had been reached. After the last round, a framework and final set of criteria were compiled.

Results. The preferred mode of teaching was online distance learning utilising electronic learning and limited formal learning. The content of the curriculum was based on the findings of the Delphi study experts. The programme as a complete entity contains six steps.

Conclusion. Using the recommendations and findings of the Delphi panel, a comprehensive programme was developed, which shows an appreciation for the interfaces between the different role-players (the patient/so-called mental healthcare user and the doctor as learner), outcomes-based education and distance learning.
Neuropsychiatric symptoms in patients with thymoma-associated and non-thymoma myasthenia gravis
Authors: Freeman Carla , Lewis I , Heckmann J M
Published: June 2017

Background. Around 10 - 15% of patients with myasthenia gravis (MG) have a thymoma, and non-motor symptoms are more frequent in these patients. We hypothesised that neuropsychiatric symptoms would also be more frequent. 

Methods. A cross-sectional study of 30 consecutive MG patients attending a clinic at Groote Schuur Hospital, Cape Town, South Africa, was done over a 6-month period in 2010. Each patient underwent a series of single-blinded neuropsychiatric assessments, including the 16-item, self-reported Flanagan Quality of Life (QOL) scale, the Beck Depression Inventory second version, the Young Mania Rating Scale, the Hamilton Anxiety Rating Scale and the Brief Psychiatric Rating Scale (BPRS).  

Results. The frequency and nature of neuropsychiatric symptoms were similar between thymoma (n=9) and non-thymoma (n=21) MG patients. Symptoms of moderate or severe depression and anxiety were present in around 30%. The severity of depression symptoms correlated with MG severity. Prednisone dosing was not associated with neuropsychiatric symptoms or QOL scores. Those with longer duration of MG were more likely to have higher scores on the BPRS and anxiety scales. Those with younger-onset MG had higher BPRS scores and a tendency to suicidal behaviour. 

Conclusion. Although no association with thyoma was found, this study shows that neuropsychiatric conditions may be underdiagnosed in patients with MG. Systematic depression screening should be done at outpatient clinics, particularly for those who developed symptoms at a young age, those with severe disease and those with a long duration of illness.
The care, treatment, rehabilitation and legal outcomes of referrals to a tertiary psychiatric hospital according to the Mental Health Care Act No. 17 of 2002
Authors: Madlala Dumisile Priscilla , Sokudela F B
Published: June 2017

Background. The Mental Health Care Act No. 17 of 2002 (MHCA) was introduced to combat poor care received by mentally ill persons. 

Objective. The objective of this study was to evaluate diagnostic and treatment accuracy as well as compliance with procedural matters related to the MHCA, using a sample in the northern region of Gauteng Province, South Africa. 

Method. Files of 200 patients admitted to Weskoppies Hospital between June and December 2009 were evaluated for admission procedures, and care, treatment and rehabilitation (CTR). 

Results. From referring hospitals, 174 (87%) persons had appropriate signs and symptoms documented in the referral note or MHCA forms. All of these were appropriately diagnosed. Although about one-third of the patients’ treatment was not documented, more than 50% (n=163) received the correct treatment. In two-thirds of patients, correction of detected abnormalities was not documented. Approximately 50% of the admissions had documents that did not adhere to MHCA provisions. At Weskoppies Hospital, CTR was considered appropriate for 92% of the patients. The legal status of the majority of patients was involuntary at discharge point. The majority of persons stayed for <3 months but for longer than what medical aid schemes allow in the private sector. 

Conclusions. The study highlighted both improvements and gaps in CTR given to mentally ill persons in the northern Gauteng region, which might apply to the rest of the country. Medicolegal requirements stipulated by the MHCA are still a challenge a decade post enactment, but there may be a move in the right direction.
When apparent schizophrenia is excluded
Authors: Fourie Hester F , Koen Liezl , Niehaus Dana J H , Schoeman Mardelle , Botha Ulla A
Published: June 2017

Where must a clinician turn when straightforward schizophrenia suddenly turns out to be just the opposite? Fortunately, these days, there are protocols for just about everything. But how much value do these add? This article outlines the journey of our attempt to follow one such protocol.

 
Medical students’ experience and perceptions of their final rotation in psychiatry
Authors: Du Preez Renata , Bergh Anne-Marie , Grimbeek Jackie , Van der Linde Mike
Published: June 2017

Background. Evaluation of specific courses, rotations or attachments in medical education is common practice. 

Objective. To evaluate medical students’ perceptions of their final psychiatry rotation of 7 weeks. 

Methods. A questionnaire was developed for medical students to give feedback on their psychiatry rotation at Weskoppies Hospital in Tshwane, South Africa. Four scores were developed: (i) a clinical exposure score for psychiatric conditions encountered during the rotation; (ii) an ethics exposure score comprising confidentiality and informed consent; (iii) an admissions exposure score for different admission options; and (iv) a perception score related to students’ experience of the rotation. The evaluation took place over a period of 4 years, between 2006 and 2009.

Results. Over the study period, 87% of 708 students completed the questionnaire. The higher number of female respondents (63%) was in accordance with the general student profile. The four resulting scores were: clinical exposure 67%; ethics exposure 78%; admissions exposure 86%; and perceptions 75%. The main strengths of the rotation were identified as the positive learning environment, exposure to patients, discussions and ward conferences, and approaches followed.

Conclusions. The conceptualisation of the tool to elicit specific scores was useful for presenting the findings. The student feedback provided valuable information for the psychiatry curriculum planners and teachers, and led to further adaptations to the structure of the rotations and the learning opportunities provided.
Overcrowding as a possible risk factor for inpatient suicide in a South African psychiatric hospital
Authors: Grobler Christoffel , Strumpher Johanita , Jacobs Ruwayda
Published: June 2017

About 4% of all suicides are estimated to occur while being an inpatient in a psychiatric facility. Staff generally assume that an inpatient suicide reflects a failure on their part to recognise the patient’s suicidal intent and whether it could have been prevented in any way.

Inpatients who commit suicide do not seem to be a homogenous group, but some risk factors have been identified, including being young, single, male, unemployed, abusing substances, schizophrenia and personality- and affective disorders. Number of admissions in the previous month also appears to be a risk factor.

When the numbers of inpatients are high, more violent incidents occu. Although literature presently do not suggest an association, overcrowding in psychiatric inpatient wards should be considered a risk factor for inpatient suicide.