Masters Degrees (Psychiatry)

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    Anxiety and depressive symptoms amongst caregivers of children with mental illness.
    (2016) Ramdhial, Mayuri.; Burns, Jonathan Kenneth.
    Abstract not available.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.