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Doctoral Degrees (Psychiatry)

Permanent URI for this collectionhttps://hdl.handle.net/10413/7064

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Browsing Doctoral Degrees (Psychiatry) by Author "Pillay, Basil Joseph."

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    Screening for and diagnosing dementia in an elderly residential home population : a validation study.
    (2014) Ramlall, Suvira.; Pillay, Basil Joseph.; Bhigjee, Ahmed Iqbal.
    Background: With the projected increase in the elderly population and expected rise in the prevalence of dementia, particularly in low-and-middle-income countries, early case identification is necessary for planning and delivering clinical services. The effectiveness of dementia screening depends on the availability of suitable screening tools with good sensitivity and specificity to confidently distinguish normal age-related cognitive decline from dementia. The aims of this research study were to report on the prevalence of cognitive impairment (dementia and Mild Cognitive Impairment-MCI), and to assess the performance of selected screening tools and a neuropsychological battery of tests in a heterogeneous local population. Methodology A cross-sectional study was conducted in a heterogeneous elderly South African population and consisted of three stages of data collection. In the first stage, cognitive screening measures were administered to a group of 302 participants, aged +60 years, living in a residential facility for the aged. The second stage consisted of a sub-sample of 140 participants who were assessed for cognitive impairment based on the Diagnostic and Statistical Manual of Mental Disorders 4th Edition-Text Revised criteria (DSM-IV-TR). Criteria A and B for Alzheimer’s and Vascular dementia were applied to assign a diagnosis of dementia without reference to aetiology. The participants were also assessed for Mild Cognitive Impairment (MCI), based on the criteria of the International Working Group on Mild Cognitive Impairment. Of the 140 participants in stage two, 117 were administered a neuropsychological battery of tests in the third stage. The influence of demographic variables and the sensitivity, specificity and optimum cut-off scores were determined for the following seven selected screening measures, individually and in combination: the Mini- Mental State Examination (MMSE), Subjective Memory Complaint (SMC), Subjective Memory Complaint Clinical (SMCC), Subjective Memory Rating Scale (SMRS), Deterioration Cognitive Observee (DECO), Subjective Memory Complaint Clinical (SMCC) and the Clock Drawing Test (CDT). The sensitivity and specificity of the neuropsychological tests in the detection of dementia were also determined. Results Eleven (7.9%) dementia and 38 (27.1%) MCI cases were diagnosed. Performance on the screening measures was influenced by race, age and education. Using ROC analyses, the SMCC, MMSE and CDT were found to be moderately accurate in screening for dementia with AUC >.70. Neuropsychological test performance was influenced by the age, gender, race and education level of participants. With the exception of the Digit Span (forward), Digit Span (total), COWAT-A, Narrative Memory Test (delayed recall), Token Test and the Luria Hand Sequence Test, all the neuropsychological test measures displayed significance in distinguishing between the three classification groups (controls, MCI, dementia). Conclusion SMCC’s are valid screening questions as a first level of ‘rule-out’ screening. The MMSE can be included at a second stage of screening at general hospital level and the CDT in specialist clinical settings. Several measures from the neuropsychological battery of tests evaluated have discriminant validity and diagnostic accuracy for the differential diagnosis of cognitive disturbances in an elderly heterogeneous South African population .
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    A study of the relation between health attitudes, values and beliefs and help-seeking behaviour with special reference to a representative sample of black patients attending a general hospital.
    (1993) Pillay, Basil Joseph.; Schlebusch, Lourens.
    There is strong evidence supporting the view that beliefs and attitudes influence health behaviour. Furthermore, cultural and social beliefs also have been shown to influence the way health care facilities are used. Although western medicine plays a dominant role in the mass control of disease, traditional or folk medicine continues to play an important role in the health care of black communities. They therefore, possess unique attitudes, values and beliefs about health and illness which integrally influence their health behaviour. This study aims therefore to: understand phenomenologically the urban African’s perception of illness, disease and health; identify attitudes that directly influence health behaviour: identify “trigger factors” that precipitate health action and isolate factors that contribute to “negative” health behaviour. The sample in this study consisted of 3 groups of urban Africans who were 20 years and older. Group 1 comprised first time attenders to a medical outpatients department Group 2 and Group 3 were sample groups drawn from the Umlazi Township and the Kwa Mashu Township respectively. The Health and Illness Battery in the language of the participants were administered by trained interviewers. This study has demonstrated the following: urban Africans have a personal conception of illness, health and disease that influences their manner of help‐seeking; there are certain attitudes and beliefs that directly influence both positive and negative health behaviour;. there are several health beliefs which interact in a complex way and may lead to medical help‐seeking. Health action was found to be influenced by significant individuals in the subject's environment; demographic variables, such as, age, sex, education and urbanisation strongly influence the health and illness beliefs; these results validated some of the fundamental aspects of the common western health and illness models; the use of services and facilities are determined by the location, accessibility and the quality of services; financial costs, time, transport, lack of community supports, negatively affected helpseeking; symptoms have been identified as a “trigger factor” of help‐seeking. Individuals use other forms of treatments independent of medical treatments. A model of help‐seeking for urban Africans is proposed.