Psychiatry

Permanent URI for this communityhttps://hdl.handle.net/10413/6709

Browse

Now showing 1 - 20 of 21

Cannabis use in psychiatry inpatients.
(2008) Talatala, Mvuyiso.; Nair, Margaret Gemma.; Mkize, Dan Lamla.
Background: Cannabis among patients admitted in psychiatric units is higher than the general population and this has been shown in various countries where studies on cannabis use have been undertaken. Such an observation has been made by psychiatrists in South Africa and the association between cannabis use and psychotic presentation among these patients has also been observed. Cannabis use by patients with severe or chronic medical illnesses to ameliorate the symptoms of such illnesses has been documented in the literature. A study to explore use of cannabis among psychiatric inpatients as well as medical patients was undertaken. Purpose: The purpose of this study was to firstly determine the prevalence of cannabis use in psychiatric patients admitted to an acute admissions unit in King Edward VIII Hospital and to correlate it with the psychiatric diagnosis. Secondly, it was to compare the cannabis use in psychiatric patients admitted to an acute admissions unit to patients admitted in a medical ward at King Edward VIII Hospital. Thirdly, to assess self reporting of cannabis use by psychiatric and medical patients. Methods: A case control study was conducted at King Edward VIII Hospital, Durban, where cannabis use among 64 subjects included in the study admitted in a psychiatric ward was compared with a control group of 63 control subjects admitted in a medical ward. Both groups were tested for urinary cannabinoids and a questionnaire was filled. The questionnaire contained demographic details as well as a question on use of substances including cannabis. Results: 17 subjects (26.6%) in the study group tested positive for urinary cannabinoids and 2 subjects (3.2%) in the control group tested positive. Cannabis use was significantly higher among males when compared to females in both the study group and the control group. Only 7 subjects in the study group reported cannabis use and out of those 7 subjects, 4 subjects tested positive for urinary cannabinoids. The commonest diagnosis among the study group subjects were the psychotic disorders and schizophrenia being the most common psychotic disorder. Conclusion: Cannabis use is significantly higher among psychiatric patients as compared to medical patients and it is probably higher than in the general population. Self reporting of cannabis use among psychiatric patients is low and unreliable and psychiatrists treating these patients must continue to use objective measures such as objective testing as well as collateral information to determine such use. In this study most subjects who tested positive for urine cannabis were likely to have a psychotic disorder and tended to be of younger age groups. The low prevalence of cannabis use in the control group makes it unlikely that there was a significant number of subjects in this group who were using cannabis for medicinal purposes.
Dyskinesia : An analysis of abnormal involuntary movement types among white psychiatric inmates of Town Hill Hospital, Pietermaritzburg.
(1985) Dunn, John Anthony.; Wessels, Wessel Hendrik.
An overview of the varied clinico-neurological features of dyskinesias in general is presented, and literature an the epidemiology af tardive dyskinesia since the introduction of antipsychotic drugs in 1950, reviewed. Furthermore reasons for the wide variations in previously published prevalence figures have been critically highlighted, and suggestions based upon the current state of clinical and experimental knowledge put forward concerning the pathogenesis of drug induced movement disorders. The type and prevalence of abnormal or purposeless involuntary movements has been surveyed among a large sample of long term White patients resident in Town Hill Hospital for a period of not less than 4 years, mast af whom were either currently receiving or had received neuroleptic medication. This sample comprised 190 men and 98 women whose ages ranged from the third to the ninth decade. Patients manifesting abnormal movements were grouped into 5 general diagnostic categories for analysis viz. schisophrenic disorders, affective disorders, organic brain disorders and syndromes, defective mental development and discrete neurological disorder. The movements were clinically classified in terms cf the areas of the body involved and semi quantitatively measured according to a standardised duration rating scale procedure. Involuntary movements were noted to be present in a total o-f 83 patients examined, most o-f which were adjudged to correspond to the syndrome currently termed 'tardive dyskinesia'. Subtype analysis o-f movement distribution indicated that 277. of cases manifested classical oro-facial dyskinesia while 527. showed body dyskinesia o-f the type designated ' pseudaakathisia'; the balance o-f the patients presented combinations o-f the two types. Schizophrenic disorders constituted the commonest diagnostic category in the dyskinesia group up to the fifth decade. Functionally obtrusive involuntary movements were observed in only some 77. of the patients with dyskinesia. Prevalence overall was equal between the sexes, and no correlations were discerned between age, sex, diagnosis or dyskinesia subtype of cases and the rating scores obtained. Prevalence rates obtained by this survey are favourably low by comparison with many results of overseas investigators, and are similar in this respect to figures reported in the very few prevalence studies carried out to date in South African institutions.
A psychiatric study of Zulu male certified patients, comparing those who had been exposed to extreme civil unrest before admission, with those who had not been so exposed : with special emphasis on post-traumatic stress disorder.
(1991) Brayshaw, Bertram Maclear.; Lasich, Angelo.
No abstract available.
Psychiatric morbidity in postpartum Zulu women at King Edward VIII Hospital.
(1992) Laban, Premakanthie Rosemary.; Nair, Margaret Gemma.
Psychiatric morbidity in the postpartum period has been a subject of research for years that has been plagued by much controversy. Most of the studies have come from Western countries. Studies that were done in Africa have concentrated on psychotic disorders in in-patients. A pilot study done by Cheetham et al (1981) at King Edward VIII Hospital found a high incidence of 'transient situational disturbances', which required further investigation. AIMS AND OBJECTIVES: 1. To document the spectrum of psychiatric morbidity in an out-patient population of postpartum Zulu women; 2. To define predictive factors which would identify women 'at risk'; 3. To assess the feasibility of 'Western' screening instruments; 4. To investigate whether 'postpartum blues' occurs in Zulu women. RESEARCH DESIGN A prospective, descriptive study was undertaken. Sample Selection: 177 postpartum Zulu women attending the ' Well-Baby' Clinic at King Edward VIII Hospital were randomly selected for inclusion in the study. Methodology: Three questionnaires: The General Health Questionnaire- 30, Pitt's Questionnaire of Anxiety and Depression and The Kennerley Blues Questionnaire were administered to the subjects. A Structured Clinical Interview DSM-III (SCID) was conducted in those women with symptoms. FINDINGS: 1. The majority of the sample were between the ages of 20 and 30 years, unmarried, with a Senior Primary education and a baby of 20 weeks. 2. 45.76% of the sample had a psychiatric diagnosis, with 18.07% having major depression. Other disorders included: adjustment disorders, schizophrenia and dysthymia. 3. Significant variables using Chi-square analysis were: inadequate antenatal care, a negative response from the partner and the absence of cultural rituals. No association was found with demographic and obstetric variables. 4. T-test analysis showed a correlation between the questionnaires and the SCID. 5. 37.3% had experienced 'postpartum blues'. CONCLUSIONS: 1. The spectrum of psychiatric morbidity is affective in nature and similar to other studies. 2. 'Postpartum blues' does occur in Zulu women. 3. Antenatal screening with 'Western' instruments could reduce psychiatric morbidity. 4. The nomenclature of puerperal disorders is inadequate and needs review. 5. More prospective, community-based research is needed, especially in rural Zulu women.
A controlled study of life events, social support, and religious affinity among depressed Indian South Africans.
(2006) Mansoor, Fathima Bibi.; Lasich, A. L.; Naidoo, L. R.
Cross cultural research on the association between Life Events, Social Support, Religious Affinity, and Depression is limited. In view of the clinical impression that depression is becoming more prevalent in the Indian South African population, a community which is culturally distinct from Anglo-American populations, and the fact that there are no studies on these three variables in the Indian population, a study was planned to investigate the association between Life Events, Social Support, Religious Affinity, and Depression in the Indian South African population. The research design involved the analysis of data on Life Events, Social Support, and Religious Affinity. This data was obtained from a sample of 15 female depressives (which formed the Experimental group) and 15 matched community controls (henceforth designated the Control group). Informed consent was obtained from both sample groups prior to participation in the study. A 50 item Social Readjustment Rating Questionnaire - Chohanls Adaptation (SRRQ-CA), a 4 item Social Support Scale, and a 4 item Religious Affinity Scale was administered to both groups to assess Life Events, Social Support, and Religious Affinity respectively. A t-Test analysis of the scores obtained produced the following major findings: 1. The Experimental group experienced a significantly higher degree of life stress than the Control group. 2. The Experimental group experienced a significantly greater number of life events than the Control group. 3. The Experimental group experienced lower social support than the Control group. This result was not statistically significant. 4. The Experimental group reported less religious affinity than the Control group. This result was not statistically significant. These findings lend themselves to further research in this field and have significant therapeutic implications.
The prevalence of human immundeficiency seroposivity in patients presenting with first episode psychosis.
(2007) Mashaphu, Sibongile.; Mkize, Dan Lamla.
Background Patients infected with the human immunodeficiency virus (HIV), the causative agent of the acquired immunodeficiency syndrome (AIDS), have high rates of psychiatric morbidity. The effects of HIV on the Central Nervous System may lead to psychiatric morbidity even before the appearance of the full-blown AIDS syndrome. Sero-prevalence studies of patients with psychoses have found an estimated 5-20% to be HIV positive. However, sero-prevalence estimates vary from study to study due to the differences in sampling by geographic location, socio-economic class, race and ethnicity, and psychiatric-diagnostic composition. The Republic of South Africa has some of the highest prevalence rates in the world and research in this field is escalating rapidly. However research on HIV in patients with mental illness, particularly psychosis is very sparse. Aim of the study To determine the prevalence of HIV sero-positivity amongst patients admitted to Town Hill hospital presenting with first episode psychosis. Method All patients presenting to Town Hill hospital with first episode of psychotic symptoms were recruited to participate in the study. The treating doctor in collaboration with the multi-disciplinary team made the diagnosis of Psychosis. A total number of 63 patients participated in the study. Results. 23.8% of the patients tested positive for the human immunodeficiency virus. Conclusions. The prevalence of HIV sero-positivity is high amongst patients presenting with first episode psychosis. The HIV epidemic could have an important effect on the aetiology and clinical presentation of psychosis. Recommendations State mental health authorities should pursue the promotion of voluntary HIV testing programs, in patients presenting with first episode psychosis as soon as they are capable of giving informed consent.
A Cultural study of auditory hallucinations in psychotic Indian males from the Durban area.
(1985) Kajee, Abdool Haq Suleman.; Wessels, Wessel Hendrik.
The aim of this project was to study the phenomenology of auditory hallucinations in Indians. The sample investigated consisted of thirty adult Indian males domiciled in the Durban area, attending neuroclinics, who had been diagnosed as having suffered from a psychosis and who had experienced auditory hallucinations. The patients were examined by the author and in addition relevant data was extracted from their case files. This included religion, previous diagnosis, age at onset of illness and present age, mother tongue, language of daily usage, language of hallucinations, source of hallucinations, comprehensibi1ity of hallucinations, content of hallucinations, patient's initial reaction to hallucinations, time when hallucinations were experienced, media of transmission, direction of voices and whether the patient had consulted a traditional healer. The findings were that a significant majority of patients: 1) described their hallucinations as being voices coming from supernatural beings (84%). 2) did not attribute their hallucinations to being voices belonging to their deceased ancestors (88%). 3) did not attribute their hallucinations to voices which were being relayed by technical transmitting apparatuses (88%) . 4) diagnosed as suffering from schizophrenia initially, found their hallucinations to be distressful (89%) whereas 80% of the patients diagnosed as suffering from manic depressive psychosis found their hallucinations to be pleasant. 5) did not ascribe their hallucinations to animals (100%). 6) had visited a traditional healer (100%). Hallucinations were generally thought by the majority of patients to have occurred as a result of being possessed by spirits and that the possession had occurred following some "evil" done to them by enemies, rivals, or other persons who wanted the patient to come to harm. Their belief in spirits was derived both from religion and from folk-lore. Its connection with auditory hallucinations arose from the notion that evil spirits can invade human beings causing abnormal behaviour and also symptoms of mental illness including auditory hallucinations. All the patients had visited traditional healers presumably to exorcise the spirits that had possessed them. The Durban Indian community has been reported to be a deculturing community with many of its members adopting Western cultural attitudes and values. The following factors (religion, language grouping, and beliefs derived from folk-lore), specific to Indian culture, appear to have an important influence in shaping some aspects of the phenomenology of auditory hallucinations of psychotic Indian males.
An Investigation into dopamine function in bipolar and unipolar primary affective disorders measuring prolactin when challenged by chlorpromazine and L-Dihydroxyphenylalanine.
(1986) Hart, George Allan Desmond.; Wessels, Wessel Hendrik.
This work is the result of an investigation into aspects of prolactin and dopamine in primary affective disorders. It is introduced by a discussion on the need for obtaining good scientific data on the organic and psychosocial aspects of psychiatric illness, and in particular, primary affective disorders. A short perspective of the history of depressive illness preceeds the review of relevant scientific literature on primary affective disorder. The literature survey covers aspects which indicate organic causal factors as well as viewing numerous organic studies which are thought to be relevant to this investigation. The role of dopamine in motor behaviour is considered in some detail. Psychopharmacological evidence that the mesolimbic and nigrostriatal dopaminergic systems are involved in motor regulation is reviewed. The role of dopamine receptors in motor behaviour is important to the conceptual framework of this thesis. Dopamine D 2 and D 1 receptors are considered and the opposing roles of these receptors is thought to be significant. Drugs affecting manic and depressive phases of primary affective disorders are reviewed. Emphasis is placed on dopaminergic aspects of various drugs in primary affective disorders as with pimozide as an antimanic agent, and nomifensine as an antidepressant. The possible role of noradrenaline in learning and mood regulation and in the dialogue with dopamine is looked at from an experimental and clinical point of view. Dopaminergic control of prolactin is reviewed and in particular the nature of the D4 receptor. The fact that these receptors which are on the pituitary mammotrophs have similarities to the D2 receptors is relevant. Thus considerable commonality exists between the dopaminergic regulation of motor behaviour and regulation of prolactin. Prolactin is used as an index of dopamine function in patients with primary affective disorders. Motor behaviour is strongly influenced by affective disorders.The central theme of the study itself was to indirectly evaluate dopamine function in primary affective disorder by measuring prolactin levels. As strong tonic inhibition is exerted by dopamine on prolactin, a series of challenges to the dopamine system was decided upon in order to generate a number of serum prolactin values. A dopamine agonist L-dihydroxyphenylalanine (indirect) and an antagonist, chlorpromazine, were used to stress the system mildly. The procedure was carried out under standard conditions both in the illness phase and upon significant recovery. Both these investigations were conducted in a drug-free state. The data generated was subjected to statistical analysis. The results of the analysis suggests that prolactin levels are low in depressed patients, and increase upon recovery, while manic patients have elevated levels which decrease with recovery. The pattern of the curves obtained from the challenge procedure suggests a possible supersensitivity of dopamine receptors in the manic patients. Blunting of responses of depressed patients remains a possibility but a study against normal controls is required to further assess this aspect. Evidence is therefore found for altered prolactin levels in illness phases of primary affective disorders. This is thought to be due to an abnormality in the dopamine regulation of prolactin. A discussion on the possible mechanisms and significance of these changes involves Beta-endorphin in an attempt to tie motor changes to mood regulation. Shortcomings of the study and future implications and developments are considered.
Structural violence and schizophrenia : psychosocial, economic and cultural impacts on the onset of psychoses.
(2010) Burns, Jonathan Kenneth.; Emsley, Robin A.
Schizophrenia is a common and serious mental disorder affecting approximately 1% of the population (WHO, 1973). That genetic and other developmental factors give rise to a predisposition or vulnerability to schizophrenia is well recognized. However, the role of the environment in conferring risk for the disorder is now indisputable. Psychosocial, economic and cultural factors all impact on risk as evidenced by recent epidemiological studies reporting variable incidence in relation to factors including unemployment, urbanicity, migration and trauma. Complex gene-gene and gene-environment (GxE) interactions lie at the origin of this common human disorder and account for the diversity of epidemiological findings and clinical presentations that we encounter in research and clinical practice. This thesis comprises of six research papers and includes data from two separate studies of first-episode psychosis (FEP) conducted in KwaZulu-Natal, South Africa. The first study (Chapter 2) explored the impact of income inequality and poverty on the incidence of FEP and the results provide the first evidence for an association between increasing income inequality and increased incidence of FEP. The second study (Chapter 3) investigated the impact of a number of psychosocial, economic and cultural factors on the clinical presentation of FEP. Previous experiences of trauma were associated with positive and affective symptoms at psychosis onset, while cannabis use was associated with clinical features of FEP that previously have been associated with better outcome. Cultural factors such as spiritual attributions of cause and previous consultation with traditional healers may delay entry to psychiatric care and thereby negatively impact on prognosis of FEP. Chapter 4 addresses the issue of how the environment acts through GxE interactions to modify risk and alter the clinical presentation and course of schizophrenia. In this paper, new epidemiological findings are integrated with an evolutionary genetic theory of schizophrenia. In Chapter 5, I present a human rights perspective on the inequities and inequalities that characterize the lives of those with serious mental disorders such as schizophrenia, resulting from psychosocial, political, economic and cultural forces in the environment. The concluding chapter draws all of the data together, highlights key findings and conclusions from the thesis, addresses weaknesses and limitations of these conclusions and identifies priority areas for future research in this field.
A study of the characteristics of crimes committed by mentally ill offenders.
(1992) Boyes, Sharon Wynne.; Mansoor, Fathima Bibi.
There is ongoing controversy concerning the relationship between crime, violence and mental illness. Studies from the first half of the century reported low arrest rates amongst the mentally ill. However recent researchers have suggested an increase in crime amongst the mentally ill since the advent of deinstitutionalisation, while other studies have implicated social factors, inadequate community facilities and prior criminality to account for this apparent trend. A longitudinal prospective and descriptive study was therefore planned to investigate the relationship between crime and mental illness. All consecutive admissions to the Midlands Hospital Observation Unit during a six month period were included in this study. Relevant information was obtained from personal interviews by the author and from court records. The final study sample consisted of those in whom a final finding was made in terms of Section 78(2) of the Criminal Procedures Act 51 of 1977. The significant findings were: DEMOGRAPHIC CHARACTERISTICS. The majority of mentally ill offenders were young males in the age range 20-29 years. CHARACTERISTICS OF CRIMES COMMITTED BY MENTALLY ILL OFFENDERS. The majority of mentally ill offenders were apprehended for property offences, theft being most common. Chi square analysis produced the following statistically significant findings pertaining to mentally ill offenders: 1. Mentally ill offenders committed significantly more property offences. Crimes were significantly less dangerous and less physically violent. 2. Fewer crimes involved use of a weapon. 3. Significantly more crimes were seemingly without a motive or in response to an hallucination or delusion. 4. Offences were seldom planned. 5. Crimes were more visible, most occurring during the day, with little attempt made to conceal the act. In conclusion most mentally ill offenders committed commonplace offences which due to their greater visibility may have predisposed them being channelled through the criminal justice system. Investigation revealed a need for further research into this controversial sub-group of mentally ill patients.
A biopsychosocial evaluation of readmissions to a mental hospital.
(1993) Moodley, Krishnavallie.; Moodley, Sathiasiven.
Since deinstitutionalization many patients, instead of remaining in the community, revolve through the doors of psychiatric facilities resulting in the "Revolving Door Syndrome". Hence a biopsychosocial evaluation of readmissions was undertaken to see what processes came into play once a patient was discharged from a mental hospital and subsequently readmitted. Seventy Indian patients admitted to the Midlands hospital complex, Pietermaritzburg were interviewed and the data was collected. This comprised 40 readmissions and a control group of 30 first admissions. The diagnosis was made according to DSM-III-R. The results obtained were statistically analyzed and a chi square analysis was done to ascertain if there were any significant differences between the 2 groups. The following were the major findings 1. Most of the patients were in age group 20-29 years. 2. There was a preponderance of males in both groups. 3. Most of the patients in the readmitted group were unemployed and were receiving a disability grant. 4. The majority of patients was single or separated. 5. Most of the patients were discharged on a combination of drug and depot preparation. 6. A large percentage had two and more previous admissions. 7. Length of stay was less than 1 month in a large number of patients. 8. Community tenure was less than 1 year in most of the patients. 9. Even though the majority of patients reported regular attendance, a fair percentage reported attendance at the community clinic. 10. The reason for readmission was mainly aggressive behaviour and aggressive behaviour associated with substance abuse. 11. The discharge diagnosis was schizophrenia in a large number of patients. This study has several important implications for the community care of the patient and various recommendations are made to curtail the revolving door, as follows : 1. There is an urgent need for community based resources. eg. sheltered workshops, supervised housing, industrial and occupational therapy, halfway houses and day hospitals, which would help the chronically mentally ill patients lead more meaningful lives following discharge. 2. The family of the chronically mentally ill patient needs to be actively involved in the management of these patients and mental health workers must solicit the family's support, by educating them about schizophrenia, helping them to increase coping mechanisms and to decrease stress. It is recommended that support groups be held in the community for the families of patients. 3. The patient's family needs to be advised that when the patient show signs of decompensation, they should take the patient to the community clinic, rather than to the District Surgeon to avoid unnecessary rehospitalization. 4. The importance of maintenance medication cannot be overemphasised. There is a need to change the attitude of the patient and family with regard to their negative attitude about medication. 5. The high rate of readmission due to aggressive behaviour (which is aggravated by substance abuse) needs intervention. Substance abuse groups must be held in the community and the community needs to be educated about the consequences of substance abuse in the mentally ill.
The distinction between malingering and mental illness in black forensic patients
(1997) Buntting, Basil,Gregory.; Wessels, Wessel Hendrik.; Van Rensburg, P. H. J. J.
One of the main problems facing the psychiatrist in forensic psychiatry is the distinction between malingering and mental illness especially in Zulu speaking patients. This study identified twenty items from the literature and clinical practice that separate malingering from mental illness. The validity of these items was assessed through an experimental, cross -sectional study design which compared two groups. These were a sample of fifty malingering African patients, male and female and a control group of fifty mentally-ill African forensic patients who were classified as State Patients. Since the data was categorical, that is, the outcome was either positive (that is malingering) or negative (that is mentally ill) the groups were compared by employing such methods as the chi-square test and Fisher's exact test. Seventeen items we re found to be statistically significant and were regarded as valid items that separate malingering from mental illness. Then the effectiveness of these seventeen items in separating malingering from mental illness was determined by calculating their sensitivity, specificity, their false positive rate and their false negative rate. The items fell into Group four categories or groups. Group I are those three items with a high sensitivity, a high specificity, a few false positives, a few false negatives, high positive predictive values and high negative predictive values. They were able to diagnose both malingering and sickness with a high degree of accuracy. Group 11 consisted of eight items with a high specificity, a few false negatives and high positive predictive values. i1 These items are good at diagnosing malingering patients directly. Group III consisted of six items with a high sensitivity, a few false positives and high negative predictive values. These items are good at diagnosing sick patients and therefore diagnose malingering indirectly by excluding mental illness. Group IV consisted of three items which did not show statistical significance between malingering and mentally ill patients. This study proved that seventeen items were able to separate malingering from mental illness to a statistically significant extent and are effective for the use in the diagnostic assessment of Zulu speaking forensic patients.
A cross-sectional study of teacher stress and job satisfaction among South African Indian teachers in the Durban area.
(1990) Garbharran, Hari Narain.; Wessels, Wessel Hendrik.
There is growing concern over the large number of Indian teachers in South Africa resigning from the profession to seek alternate employment or to emigrate. Despite this concern, very little empirical research has been undertaken to investigate the probable sources of stress and dissatisfaction among Indian teachers in this country. The present study was planned to investigate the incidence and association between emotional distress, work-related stress and job satisfaction among South African Indian teachers. The research design involved the analysis of data on Psychological Stress, Event Stress and Satisfaction with Teaching, which was obtained from a sample of 75 Indian teachers drawn from schools in the Durban area. Informed consent was obtained from the subjects prior to participation in the research. The 30-item General Health Questionnaire (GHQ), a Teacher Stress Questionnaire consisting of a 25-item Event Stress Inventory and a 25-item Satisfaction With Teaching Questionnaire, were administered. The following were the major findings: 1. The degree of emotional distress experienced by Indian teachers was significantly high. 2. Although the overall levels of work-related stress were high they were not significantly related to the number of years of teaching experience or to the mental health of the teachers. 3. There was a positive association between psychological distress and job dissatisfaction. The older teachers experienced greater psychological stress and job dissatisfaction. 4. Secondary school teachers were found to be experiencing more severe degrees of psychological distress, much higher levels of work-related stress and lower levels of job satisfaction than primary school teachers. The findings highlight the need for further research and have implications for therapeutic intervention.
A study of the acute neurological side effects in hospitalized psychiatric patients receiving neuroleptic drug treatment.
(1993) Raymond, Neville Vincent.; Moodley, Sathiasiven.
Neuroleptic drugs are essential in the treatment of schizophrenia and many other psychiatric disorders. These drugs do however cause a wide range of side effects which can be very distressing to patients. In particular the acute neurological side effects of parkinsonism, akathisia and dystonia, which are termed extrapyramidal syndromes, can be a limiting factor in the use of these drugs (Weiden et al 1987). Fort Napier Hospital is a large psychiatric referral hospital and the majority of patients admitted require neuroleptic drug treatment. Extrapyramidal side effects are regularly seen amongst these patients. This study was designed to discover the incidence of parkinsonism, akathisia and dystonia amongst patients treated with neuroleptic drugs and what specific factors were responsible for these side effects. Relevant literature on this topic was reviewed and comparable studies done in America, Europe and South Africa are discussed. The study sample consisted of one hundred patients who were examined regularly over a two week period for signs of parkinsonism, akathisia, or dystonia which were rated quantitatively according to specific rating scales. Patient and drug variables were then analysed to assess what factors were responsible for these side effects. The incidence of drug-induced parkinsonism was 29%, akathisia 35% and dystonia 20%. Combinations of these three syndromes were observed resulting in an overall incidence of 47%. High potency drugs such as haloperidol and trifluoperazine were responsible for a large percentage of all the side effects, while of the low potency drugs, thioridazine produced less side effects than chlorpromazine. Oral drugs combined with intramuscular depot drugs resulted in a high incidence of side effects. The phase of treatment was clinically important with dystonia occurring more often within the first three days of treatment, akathisia within ten days and parkinsonism after ten to fourteen days. Other factors that were studied included the patients age, sex and prior history of neuroleptic-induced neurological side effects. Due to the predominantly young patient population in this study, the mean age of those patients who developed parkinsonism was 26,7 years, akathisia 27,5 years and dystonia 25,8 years. These side effects were seen more commonly in males than in females. Of the 27 patients in this study who had a prior history of neurological side effects, 15 (56%) developed similar side effects following re-exposure to neuroleptic drugs. Conclusions derived from this study include the need for clinicians to select the correct type and dose of neuroleptic for individual patients in order to minimize the development of neurological side effects. Accurate, early diagnosis of side effects by regular examination of patients is necessary for effective patient management. Clinicians should be made more aware of the side effects that can develop with the use of neuroleptic drugs and the effect these side effects have on patients.
Involuntary hospitalisation : the discrepancy between actual practice and legal requirements in the Lentegeur Hospital (Cape Town) catchment area.
(1993) Jhetam, Naeem Ahmed.; Nair, Margaret Gemma.; Olivier, Henry.
The aim of this study was to document the safeguards inherent in the Mental Health Act (MHA) of 1973, and to examine the extent " to which these are observed in practice. The research was conducted at Lentegeur Hospital in Mitchells Plain, Cape Town. The population consisted of 726 certified patients who were admitted involuntarily (i.e. under sections 9 and 12 of the MHA) from 01 January 1990 to 31 December 1990. Data for each of these patients was collected from the admission register, clinical files, administrative files, and the certified post book. In addition, the official hospital statistics were examined. Measurements obtained included demographic data, the validity of the document contents, the validity of the certification process, and an overall measure of the validity of each of t he certifications taking into account both document contents and observance of the time strictures set out in the MHA. Twenty nine patients (4,0%) were admitted by Urgency (Section 12), and 697 (96,0%) on Reception Order (Section 9). The study focused mainly on the Section 9 patients, because of the small sample size for Urgency admissions. It was found that 609 (87,4%) of the 697 admissions were legally flawed in terms of document contents criteria and the time limits in the certification process. Document content criteria were not fulfilled in: 3,0% of the Applications for Reception Order; 32,1% of Medical Certificates; 20,1% of Reception Orders; and 3,6% of Reports to the Attorney-General. In 40,0% of certifications the Report to the Attorney-General (G2/28) could not be traced. Examination of temporal safeguards revealed that the least satisfactory aspect was the delay in the completion of the post-admission Report to the Attorney-General. It was found that 32,3% of these Reports were not submitted on time. Reasons for the discrepancy ("gap") between legal standards and actual practice are discussed. Recommendations are made which could help minimise or eradicate this "gap". These include suggestions for changes in the document format, for the use of a certification booklet, for stricter control of late and inadequate documentation, and for inservice training of all those involved in the certification process.
Stress among Indian general practitioners in the greater Durban area.
(1991) Kathrada, Ahmed Suliman.; Mansoor, Fathima Bibi.
Research on stress factors among General Practitioners in relation to burnout is limited. In view of the clinical impression that stress is becoming more prevalent amongst Indian General Practitioners in urban areas, a study was planned to investigate the demographic variables, stress factors in practice and burnout among Indian General Practitioners in the Greater Durban Area. The research design involved the analysis of data on demographic variables, stress factors in practice and burnout. This data was obtained from a sample of 106 Indian General Practitioners in the Greater Durban Area. Informed consent was obtained by a letter that was sent to the General Practitioners. A Demographic Inventory, a 4 item Stress of Practice Questionnaire and the Maslach Burnout Inventory was administered by a postal questionnaire. The analysis of the scores obtained from the Stress of Practice Questionnaire and the Maslach Burnout Inventory provided the following findings: 1. The stress of practice - 6 factors were identified of which 3 were related to demands of the job, work: home interface and workload. 2. The Indian General Practitioners experienced a low to moderate degree of burnout. 3. The correlation of stress factors and Maslach Burnout Inventory subscales were weak. 4. For emotional exhaustion - dimensions of frequency and intensity, some of the stress related factors explained a fair amount of variation but the relationship was not strong. These findings lend themselves to further research in this field and have significant therapeutic implications for both practitioner and their patients.
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 .
Anxiety and depressive symptoms amongst caregivers of children with mental illness.
(2016) Ramdhial, Mayuri.; Burns, Jonathan Kenneth.
Abstract not available.
Exploring movement of embodied, enacted, and inscribed knowledge through policy consultation: a case study of a mental health policy consultation process in South Africa.
(2018) Marais, Debra Leigh.; Petersen, Inge.; Quayle, Michael Frank.
This study is concerned with the intersection of knowledge and policy in the context of mental health system challenges in a developing country. Its focus is specifically on the way in which different forms of knowledge, from multiple sources, move through a policy consultation process to inform mental health policy. Policymakers tasked with developing mental health policies must balance a number of competing demands, including the need to develop policies that are applicable on a national level, while simultaneously addressing the idiosyncratic and contextual particularities associated with mental ill health at individual and local levels. Marrying the principles of evidence-based policymaking, with its focus on what works, with the principles of consultative policymaking, with its focus on what works for whom, means finding ways to integrate multiple knowledge inputs to incorporate these into policy decisions. In this sense, policymaking represents something of a knowledge problem for policymakers. In the South African legislative context, public participation in policymaking is taken as a given, with little guidance specifying how such processes should be conducted, nor whether or how the inputs from such processes are used in policy decisions. The consultation process around first mental health policy was the focus of this case study. The aim was to trace the movement of knowledge inputs through the consultation summits into policy outputs. Research suggests that certain forms of experiential knowledge may not be amenable to being captured in policy consultation processes. This study thus used a) conceptual schema of knowledge functions in policy as its analytical framework. This schema distinguishes between three phases of knowledge embodied, enacted, and inscribed that can be transformed between phases through various kinds of action. It provided a lens through which to trace the enactment and movement of embodied (experiential and evidence-based) knowledge through the consultation process, to determine the extent to which this form of knowledge was transferred into the inscribed knowledge of consultation recommendations and policy outputs. Data included mental health policy documents, reports and audio recordings from the provincial and national consultation summits, and key informant interviews. Thematic framework and thematic content analyses were conducted using the embodied-enacted-inscribed analytical framework. Findings revealed that no substantive changes were made to the mental health policy following the consultation summits, and suggest that the consultation summits had minimal impact on policy. In particular, there do not seem to have been systematic processes for facilitating and capturing knowledge inputs, or for transferring these inputs through increasing levels of summarisation during the consultation process. knowledge was not followed through to be incorporated into consultation and policy outputs. The implications of the findings for mental health policy consultation in South Africa are discussed. This is the first study to document, in depth, a significant part of the consultation process around mental health policy in South Africa, using the embodied-enacted-inscribed framework to explore how knowledge inputs informed policy. In doing so, it draws attention to the unique challenges in reconciling the contextual detail of embodied knowledge with the abstract generalisability of inscribed (policy) knowledge an undertaking that has particular relevance for mental health policy consultation. The study highlights the importance of designing participatory processes that enable optimal use of knowledge inputs in these enacted spaces, in order to align assumptions about the value of policy consultation with consultation practice, as well as to strengthen the policy development-consultation implementation link.
The development and feasibility of a community mental health education and detection (CMED) tool in the Amajuba District, KwaZulu-Natal, South Africa.
(2022) Grant, Merridy.; Petersen, Inge.; Luvuno, Zamasomi Prudence Busisiwe.
Background Poor mental health literacy, misinformation about treatment and stigma result in low demand for mental health services in low-and middle-income countries. Community-based interventions that raise mental health awareness and facilitate detection of mental health conditions, are instrumental in increasing demand of available mental health services. The CMED tool was developed to provide psychoeducation on mental health conditions and identify people with potential mental health problems at a household level who may benefit from available mental health interventions. Aims/Objectives Objectives of the study were 1) To develop the CMED Tool for adults for use by Ward-based Primary Health Care Outreach Teams (WBPHCOTs) in South Africa aligned with their roles of health promotion, screening and linkage to care; 2) To assess the accuracy of the CMED in identifying patients with a mental health problem and 3) to assess the feasibility of the CMED for use by WBPHCOTs and community members. Methods The research was made up of three sub-studies 1) Formative study, 2) an Accuracy study 3) and a Feasibility study. The Formative study (Objective 1) involved engagement with the KwaZulu-Natal Department of Health (KZN DoH) to ensure co-creation of the CMED tool and alignment with routine WBPHCOT activities; adaptation of the CMED tool; review of the CMED vignettes and illustrations by a panel of local and international mental health care experts to establish contextual and cultural relevance; and process mapping and focus group discussions with WBPHCOTs in one district to establish cultural and contextual appropriateness as well as coherence and compatibility with existing community-based services. The Accuracy study (Objective 2) involved assessing the accuracy of the newly developed CMED against the validated Brief Mental Health screening tool as the gold standard in identifying individuals in households with possible mental health conditions at a community level. The Feasibility study (Objective 3) was assessed using Bowen et al.’s (2009) framework which informed the study design, interview tools and analysis. The feasibility study involved four phases: (1) observations of the CMED consultation to evaluate the administration of the tool; (2) semi-structured interviews with household member/s after the CMED was administered to explore experiences of the visit; (3) follow-up interviews of household members referred using the CMED tool to assess uptake of referrals; (4) and weekly focus group discussions with the community health team to explore experiences of using the tool. Framework analysis was used to inform a priori themes and allow inductive themes to emerge from the data. Results The formative study resulted in a co-produced CMED tool consisting of five case vignettes and related illustrations to facilitate psychoeducation and detection of possible depression, anxiety, psychosis, harmful alcohol and drug use by WBPHCOTs. The tool was found to be culturally and contextually appropriate and aligned to the services provided by WBPHCOTs. The accuracy study found the CMED to perform at an acceptable level having a 79% sensitivity and 67% specificity. The feasibility study found the CMED to be acceptable to both community health teams and household members, demand for the tool was evident, implementation, practicality and integration within the existing health system were also indicated. Conclusion Collectively, the formative, accuracy and feasibility studies that make up this thesis, provide a valid and feasible tool that enables community health workers to perform their functions at a household level of health promotion, screening and linkage to care in relation to mental health. It enables mental health to be practically integrated at a community level as part of primary health care services through a people-centered, task sharing approach. This approach is aligned to international guidelines (Sustainable Development Goals) and National policy (South African Mental Health Act and the National Mental Health Framework and Strategic Plan) which call for the integration of mental health into primary health care), as well as the South African District Health System model through the PHC re-engineering strategy and the community-oriented primary care model where care extends from primary health care facilities into the community.

Browse

Browsing Psychiatry by Date Accessioned