Showing papers in "African Journal of Psychiatry in 2011"

Alcohol use and problem drinking in South Africa: findings from a national population-based survey.

Abstract: Objective: This study formed part of the South African National HIV, Incidence, Behaviour and Communication (SABSSM) 2008 survey, which included questions assessing the extent of alcohol use and problem drinking among South Africans. Method: A multistage random population sample of 15 828 persons aged 15 or older (56.3% women) was included in the survey. Alcohol use was assessed using the Alcohol Use Identification Test (AUDIT). Tabulation of data for different age groups, geolocality, educational level, income, and population group produced the estimates and associated confidence intervals. The odds ratios for these variables in relation to hazardous or harmful drinking were also computed. Results: Current alcohol use was reported by 41.5% of the men and 17.1% of women. White men (69.8%) were most likely and Indian/Asian women (15.2%) least likely to be current drinkers. Urban residents (33.4 %) were more likely than rural dwellers (18.3%) to report current drinking. Risky or hazardous or harmful drinking was reported by 9%: 17% among men and 2.9% among women. In men, risky drinking was associated with: the 20-54 year age group; the Coloured population group; lower economic status; and lower education. Among women, risky drinking was associated with: urban residence; the Coloured population group; lower education; and higher income. Conclusion: An increase in current, binge drinking and hazardous or harmful drinking prevalence rates was observed from 2005 to 2008 in South Africa. Multilevel interventions are required to target high-risk drinkers and to create awareness in the general population of the problems associated with harmful drinking. Future prospective studies are needed to assess the impact of problem drinking.

Autism spectrum disorders (ASD) in Africa: a perspective

Abstract: Background: The universal occurrence of autism spectrum disorders (ASD) was queried about twenty-six years ago. It was thought to occur only in western industrialized countries with high technological development. Over the last decade, knowledge about ASD and its prevalence has been documented as being on the rise in different regions of the world, with most literature coming from the western world – the situation in Africa on aspects of ASD remain unclear. Methods: Literature cited in Pubmed over the last decade on aspects of epidemiology, diagnosis, aetiology and knowledge of ASD in the African context were assessed. Keywords: autism, diagnosis, aetiology, knowledge and Africa were variously combined in the literature search. Results: No study specifically addressed the epidemiology of ASD in Africa. One of the two studies that were relevant addressed epidemiology of ASD in Arab countries, though included two Northern African countries. A higher proportion of non-verbal cases of ASD compared to verbal cases was documented in literature coming from Africa. Associated co-morbid disorders included intellectual disability, epilepsy and oculo-cutaneous albinism. Aetiological factors postulated included post-encephalitic infection, genetic and auto-immune factors, and vitamin D deficiency. Knowledge about ASD in Africa was noted to be low. Conclusion: There is a need for epidemiological studies in Africa to define the magnitude of the problem of ASD and the characteristics of children affected by ASD in this region. This would help in planning and might be helpful in answering the question of aetiology of ASD. Policy making needs to be directed at issues of childhood developmental disorders in Africa. Key Words: Epidemiology; Diagnosis; Aetiology; Knowledge; Autism; Africa

Screening tools for postpartum depression: validity and cultural dimensions.

Abstract: Objective The purpose of this study is to review the main postpartum screening tools currently used in terms of their ability to screen for postnatal depression. Furthermore, the cultural characteristics of depressive postpartum symptomatology are examined. Method A systematic literature search was conducted for the period 1987-2009, using the Medline electronic database for the following keywords: postpartum depression and postnatal depression. These terms were combined with: assessment, screening and psychometric tools. Results Of the four screening tools reviewed and compared, the Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Depression Screening Scale (PDSS) presented substantial sensitivity and specificity as screening tools. However, none of the instruments could be rated flawless when applied to different cultural contexts. Conclusions In addition to the EPDS, a new generation of instruments is currently available. Supplementary research is needed to substantiate their use as screening tools in general practice. Additional studies are needed to adapt and test instruments to detect postnatal depression within a wider range of languages and cultures.

Knowledge, attitude and practice (KAP) of mental illness among staff in general medical facilities in Kenya: practice and policy implications.

Abstract: Objective: To determine the knowledge, attitudes and beliefs about mental illness among staff in general hospitals. Method: A descriptive cross-sectional study conducted on staff in ten medical facilities in Kenya on their socio-demographic characteristics, professional qualifications and knowledge, attitudes and practice (KAP) toward mental illness. Results: A total of 684 general hospital staff: nurses (47.8%); doctors (18.1%); registered clinical officers (5.1%); students (9.5%) and support staff (19.5%) were recruited. About three quarters were under 40 years of age; most thought mental illness could be managed in general hospital facilities; the older the doctors were (age 40 years and older) the more they were aware of and positive towards mental illness. Most of the workers did not suspect any psychiatric symptoms among the patients they treated resulting in low referral rates for psychiatric services. Conclusion: There are gaps in knowledge on mental illness which could be constructively filled with Continued Medical Education (CME). Key words: Hospital, General; Health Knowledge, Attitudes, Practice; Mental disorders; Kenya

Attitudes of primary health care providers towards people with mental illness: evidence from two districts in Zambia

Abstract: Objective: The aim of this study was to explore health care providers’ attitudes towards people with mental illness within two districts in Zambia. It sought to document types of attitudes of primary health care providers towards people suffering from mental illness and possible predictors of such attitudes. This study offers insights into how health care providers regard people with mental illness that may be helpful in designing appropriate training or re-training programs in Zambia and other low-income African countries. Method: Using a pilot tested structured questionnaire, data were collected from a total of 111 respondents from health facilities in the two purposively selected districts in Zambia that the Ministry of Health has earmarked as pilot districts for integrating mental health into primary health care. Results: There are widespread stigmatizing and discriminatory attitudes among primary health care providers toward mental illness and those who suffer from it. These findings confirm and add weight to the results from the few other studies which have been conducted in Africa that have challenged the notion that stigma and discrimination of mental illness is less severe in African countries. Conclusion: There is an urgent need to start developing more effective awareness-raising, training and education programmes amongst health care providers. This will only be possible if there is increased consensus, commitment and political will within government to place mental health on the national agenda and secure funding for the sector. These steps are essential if the country is improve the recognition, diagnosis and treatment of mental disorders, and realize the ideals enshrined in the progressive health reforms undertaken over the last decade.

Psychological treatments for depression and anxiety disorders in low- and middle- income countries: a meta-analysis

Abstract: Objective: The objective of this meta-analysis was to determine the efficacy of psychological treatments for depression and anxiety disorders in low- and middle- income countries (LAMIC). Method: Meta-analysis of randomized controlled trials on psychological treatment of depression and anxiety disorders in low-and middle income countries using an existing database (www.evidencebasedpsychotherapies.org), PubMed, Embase, Psychinfo, Dissertation Abstracts International and the Cochrane Central Register of Controlled Trials were searched for studies published in all languages. Additional studies were identified from reference lists of found studies. Randomized controlled trials in which a psychological intervention for anxiety or depression was compared to a control condition (care-as-usual, waiting list, placebo, or another control group) were included. The randomized controlled trials needed to be conducted in a LAMI country (classification of LAMI countries according to the World Bank’s list of economies) to be eligible for inclusion in the meta-analysis. Psychological treatments were defined as interventions in which the core element of treatment consisted of verbal communication between a therapist and a patient. Results: Seventeen studies met our inclusion criteria, with a total of 3,010 participants. The mean standardized difference between the treatment and control groups at post-test was 1.02 (95% CI: 0.76~1.28) which corresponds well with the effects found in high-income countries. Conclusion: These results indicate that psychological treatments of depression and anxiety disorders are also effective in LAMI countries, and may encourage global dissemination of these interventions. Key words: Psychology; Clinical; Depression; Anxiety disorders; Developing countries; Meta analysis

Childhood trauma in adults with social anxiety disorder and panic disorder: a cross-national study

Abstract: OBJECTIVES:The influence of childhood trauma as a specific environmental factor on the development of adult psychopathology is far from being elucidated. As part of a collaborative project between ...

Gender differences in barriers to alcohol and other drug treatment in Cape Town, South Africa

Abstract: Objective: The study aimed to identify gender differences in barriers to alcohol and other drug (AOD) treatment use among disadvantaged communities in Cape Town, South Africa. The Behavioral Model of Health Services Utilization was used as an analytic framework. Method: A case-control design was used to compare 434 individuals with AOD problems from disadvantaged communities who had accessed treatment with 555 controls who had not accessed treatment on a range of variables. Logistic regression procedures were employed to examine the unique profile of variables associated with treatment utilization for male and female participants. Results: Few gender differences emerged in terms of the pattern of variables associated with AOD treatment use. Greater awareness of treatment options and fewer geographic access and affordability barriers were strongly associated with an increased likelihood of AOD treatment use for both men and women from disadvantaged communities. However, while similar types of barriers to treatment were reported by men and women, these barriers had a greater impact on treatment utilization for women compared to men. Conclusion: Compared to men, women from disadvantaged communities in South Africa do not have equal access to AOD treatment. Recommendations on how to reduce these barriers and ways to improve AOD treatment use among women from disadvantaged communities in South Africa are provided. Keywords: Health care quality; Access and evaluation; Gender; Substance abuse treatment centres; South Africa

Psychosocial aspects of epilepsy in Nigeria: a review

Abstract: Background: Epilepsy is a chronic disorder marked by intermittent, often unpredictable seizures which may be embarrassing and disruptive to the normal activity of daily living. This review was undertaken to provide information / data on the prevalence, seizure types, treatment issues and psychosocial impact of epilepsy in Nigeria. Method: We searched the PUBMED database with emphasis on studies conducted in Nigeria using a combination of the following words: epilepsy, seizure, convulsion, prevalence, epidemiology, psychiatric morbidity, social issues, quality of life, cognition, school performance, treatment issues and Nigeria. Result: 48 relevant studies that met the criteria were reviewed. The point prevalence of epilepsy varies from 5.3 to 37 per 1000 in Nigeria. Most studies showed a predominance of generalized tonic-clonic seizures. Nigerian patients with epilepsy suffer social deprivation and discrimination in education, employment, housing, marital life as well as associated psychiatric morbidity. Conclusion: Epilepsy, a stigmatizing disorder in Nigeria, has a significant impact on the day to day functioning of those with the condition. Keywords: Epilepsy; Psychosocial; Nigeria

Methamphetamine use and sexual risk behaviour in Cape Town, South Africa: a review of data from 8 studies conducted between 2004 and 2007.

Abstract: Objective: Community studies and studies of admissions to drug treatment centers indicate a dramatic increase in the prevalence of methamphetamine use in Cape Town since 2003. There has also been a substantial increase over this time period in the prevalence of HIV infection among women attending public antenatal clinics in the Western Cape province. This study aimed to review research conducted in Cape Town on the link between methamphetamine use and sexual risk behaviour. Method: A review of published research conducted in Cape Town between 2004 and 2007 was undertaken using PubMed, EBSCOhost and Science Direct. Results: Eight studies were identified, both quantitative and qualitative, and focusing on diverse populations, such as learners in school, out of school youth, adults in the community, men who have sex with men and sex workers. The total sample across the studies was 8153. Across multiple studies methamphetamine was fairly consistently associated with early vaginal sex, condom use during sex, having casual sex and other HIV risk behaviours. For some sub-groups the direction of the relationship was in an unexpected direction. Conclusion: The consistency of the findings across studies highlights the increased risk for contracting HIV among methamphetamine users, and reinforces the importance of interventions addressing both methamphetamine use and unsafe sexual behaviour among young people and other sectors of the population. The need for further research is also considered, particularly research that will explain some of the racial differences that were found. Keywords: Methamphetamine; Sexual behaviour; HIV; South Africa

Lifetime mental disorders and suicidal behaviour in South Africa.

Abstract: Background: There is relatively little data on the relationship between lifetime mental disorders and suicidal behaviour in low and middle income countries. This study examines the relationship between lifetime mental disorders, and subsequent suicide ideation, plans, and suicide attempts in South Africa. Method: A national survey of 4185 South African adults was conducted using the World Health Organization Composite International Diagnostic Interview (CIDI) to generate psychiatric diagnoses and suicidal behaviour. Bivariate, multivariate and discrete-time survival analyses were employed to investigate the associations between mental disorders and subsequent suicide ideation, plans, and attempts. Results: Sixty-one percent of people who seriously considered killing themselves at some point in their lifetime reported having a prior DSM-IV disorder. Mental disorders predict the onset of suicidal ideation, but have weaker effects in predicting suicide plans or attempts. After controlling for comorbid mental disorders, PTSD was the strongest predictor of suicidal ideation and attempts. There is a relationship between number of mental disorders and suicidal behaviour, with comorbidity having significantly sub-additive effects. Conclusion: Consistent with data from the developed world, mental disorders are strong predictors of suicidal behaviour, and these associations are more often explained by the prediction of ideation, rather than the prediction of attempts amongst ideators. This suggests some universality of the relevant mechanisms underlying the genesis of suicidal thoughts, and the progression to suicide attempts. Key Words: Suicide; Survey; South Africa; Mental Disorders

Developmental delay of infants and young children with and without fetal alcohol spectrum disorder in the Northern Cape Province, South Africa.

Abstract: Objective: To describe the extent and nature of developmental delay at different stages in childhood in a community in South Africa, with a known high rate of Fetal Alcohol Spectrum Disorder (FASD) Method: A cohort of infants, clinically examined for FASD at two time periods, 7-12 months (N= 392; 45 FASD) and 17-21 months of age (N= 83, 35 FASD) were assessed using the Griffiths Mental Developmental Scales (GMDS) Results: Infants and children with FASD perform worse than their Non-FASD counterparts over all scales and total developmental quotients Mean quotients for both groups decline between assessments across subscales with a particularly marked decline in the hearing and language scale at Time 2 (scores dropping from 1106 to 831 in the Non-FASD group and 1063 to 727 in the FASD group; P=0004) By early childhood the developmental gap between the groups widens with low maternal education, maternal depression, high parity and previous loss of sibling/s influencing development during early childhood Conclusion: The FASD group show more evidence of developmental delay over both time points compared to their Non-FASD counterparts Demographic and socio-economic factors further impact early childhood These findings are important in setting up primary level psycho-educational and national prevention programmes especially in periurban communities with a focus on early childhood development and FASD Keywords: Developmental Delay; Fetal Alcohol Syndrome (FAS); Griffiths Mental Developmental Scales (GMDS)

Family therapy for schizophrenia: cultural challenges and implementation barriers in the South African context.

Abstract: Family therapy is an effective, evidence based intervention for schizophrenia. This literature review explores the impact of culture on family therapy as a treatment model for schizophrenia and examines how cultural beliefs impact on access to care. Although there is a good deal of evidence to suggest that certain principles of family therapy such as empathy and psycho-education are universal, there is a paucity of literature about the role of culture in designing family interventions for people living with schizophrenia in a culturally diverse setting such as South Africa. It is well acknowledged that cultural ideologies influence families' belief systems of schizophrenia, expected expressed emotion, and levels of stigma in relation to mental illness. Additionally, in adapting models designed for first-world settings, consideration needs to be given to aspects such as language, educational level and accessibility of mental health care facilities. Family therapists are increasingly recognising the need for the study and implementation of evidence based culture-relevant and culture-responsive therapeutic techniques. These techniques need to be cost-effective and will require training, supervision, staff support, and management input in order to become generally available.

Prevalence of common phobias and their socio-demographic correlates in children and adolescents in a traditional developing society

Abstract: Objective: The aim of this study was to identify the most common phobias in children and adolescents and to determine the prevalence, age distribution, and socio-demographic correlates of phobias. Method: This was a prospective cross-sectional study conducted at public and private schools from July 2009 to February 2009. The questionnaire included socio-demographic information, extra-curricular activities and hobbies, behaviour at home and various phobic fears and it was distributed among children aged 6 to 18 years. Psychiatrists determined the definitive diagnosis for various phobias by checking and screening their symptoms. Results: Of the studied subjects, 44% were males and 56% were females. The overall prevalence of phobia in children and adolescents was 19.7%. Among children with phobia, females had higher rates of phobias (62.4% vs 37.6%) than males. Nearly half of total sufferers were in the 12-15 year age group (46.3%). Social phobia (12.7%) was the commonest phobia found followed by agoraphobia (8.6%). Secondary school children were highly afflicted with social phobia (14.9%), agoraphobia (11.7%) and specific phobia (9.6%), while preparatory students (8.3%) were more likely to have ‘medical’ phobia (fear of physical illness, medical tests and procedures). A significant difference was observed between the age groups in children with agoraphobia (p=0.002). Conclusion: The overall prevalence of phobia in children and adolescents in Qatar was higher than rates found in other epidemiologic studies, with the most common phobias observed being social phobia, agoraphobia and specific phobia. Key Words: Prevalence; Phobia; Children; Qatar

Risk factors for violence among long-term psychiatric in-patients : a comparison between violent and non-violent patients

Abstract: Objective: The problem of the prediction of violence in psychiatric patients has led to a proliferation of research over the last decade. This study focuses on enduring patient related risk factors of violence, and investigates which long-term patients in Weskoppies Hospital (a specialist psychiatric hospital) are the most likely to commit violent acts. Method: Nursing statistics on violent incidents and other security breaches were collected for 262 long-term in-patients over a six month period (April – September 2007). The 41 patients who committed violent acts were compared to the 221 non-violent patients in terms of demographic and clinical variables, using two-way tables and Chi-Square or Fisher’s Exact Tests. Results: The prevalence of violence among the long-term patients was 16%. Fighting among patients was the most common form of violence (58%). The most significant risk factors of violence among the long-term patients are: A diagnosis of mental retardation; first hospital admission before the age of 40 years; total hospital stay >12 years; current accommodation in a closed ward; habitual verbal aggression; absence of disorganised behaviour; and being clinically evaluated as unsuitable for community placement. Conclusion: The findings will help to identify those long-term patients most at risk of violence. The subgroup of patients with mental retardation is responsible for a disproportionately large number of violent acts in the hospital. The risk lies not so much in their psychiatric symptoms, but more in their cognitive ability, coping skills and inappropriate admission circumstances. Efforts should be directed – at a provincial level – towards their community placement. Key words : Violence; Risk factors; Inpatients; Mental disorders; South Africa

The prevalence and correlates of hallucinations in a general population sample: Findings from the South African Stress and Health Study

Abstract: Objective: Large epidemiological surveys conducted in the developed world have found rates of psychotic symptoms in the general population to be as high as 10-28%. However, there are few data available from developing countries, including African countries, on the prevalence and correlates of psychotic symptoms. This study investigates the prevalence and correlates of psychotic symptoms (ie hallucinations) in a general population sample of South African adults. Method: As part of the South African Stress and Health Study the prevalence of auditory and visual hallucinations was determined in a large community based sample of 4250 participants utilizing the Composite International Diagnostic Interview (CIDI). In addition, socio-demographic and clinical correlates as well as indicators of service utilization and functional impairment were determined. Results: The prevalence of any reported hallucination was 12.7%, a rate comparable to that found in studies from the developed world. Multivariate analyses revealed a significant association between role impairment, service utilisation, suicidality and reported auditory or visual hallucinations. No significant association was found between urbanicity and reported psychotic symptoms. Conclusion: Our finding that psychotic symptoms (ie hallucinations) are significantly associated with functional impairment and service utilization supports the potential clinical significance of such symptoms, even in the African context.

Patient aggression in psychiatric services: the experience of a sample of nurses at two psychiatric facilities in Nigeria.

Abstract: Objective: Aggression is a common feature in psychiatric in-patient units in Africa. The attitudes of psychiatric nurses and their perceptions of the frequency of in-patient aggression have not been explored in the Nigerian context. Method: Using a crosssectional study design, two self-report questionnaires (the Attitudes toward Aggression Scale (ATAS) and the Perception of the Prevalence of Aggression Scale (POPAS)) were administered to nursing staff (n=73) at two psychiatric facilities in Benin City, Nigeria. Results: Overall, nurses viewed aggression as offensive, destructive and intrusive. They were less likely to view it as a means of communication or serving protective functions. Verbal aggression was the commonest type of aggression experienced while sexual intimidation and suicide attempts were least common. Male nurses were more likely to experience physical violence and aggressive ‘splitting’ behaviours, while nurses with over a decade of professional experience were more likely to experience verbal and humiliating aggressive behaviours. In contrast to previous studies, fewer nurses required days off work due to aggressive behaviour. Conclusion: Aggression is commonly experienced by nurses in in-patient units in Nigeria. Their views were predominantly negative. Training programmes are required to change staff attitudes as well as research on the cultural factors mediating these attitude dispositions. Key words: Nurses; Aggression; Attitudes; Nigeria

Profile of clinically-diagnosed dementias in a neuropsychiatric practice in Abeokuta, South-Western Nigeria

Abstract: Objective: Many subjects with dementia present primarily to neuropsychiatric practices because of behavioural and psychological symptoms (BPSD). This study reviewed the profile of clinically-diagnosed dementias and BPSD seen in a pioneer neuropsychiatric practice in Abeokuta, southwestern Nigeria over a ten year period (January1998 – December 2007). Methods: A review of hospital records of all patients with diagnoses of dementia or dementing illness using the ICD-10 criteria as well as specific diagnostic criteria for different dementia phenotypes. Associated BPSD, co-morbidities and treatments were also reviewed. Results: Out of a total of 240,294 patients seen over the study period, 108 subjects met clinical diagnostic criteria for probable dementia giving a hospital frequency of 45 per 100,000. Alzheimer’s disease (AD) and Vascular dementia (VaD) were the predominant phenotypes seen in 62 (57.4%) and 18 (16.7%) subjects respectively. Others include mixed dementia (4 cases), frontotemporal dementia (4 cases), Lewy body dementia (3 cases), alcohol-related dementia (3 cases), PD dementia (1 case) and unclassifiable (13 cases). Apathy, night time behaviour, aberrant motor behaviour, agitation and irritability were the most common BPSD features, while hypertension was the most common co-morbidity. Neuroleptics, anticholinergics and anti-hypertensives were most commonly prescribed. Anticholinesterase inhibitors were sparingly used. Conclusion: Probable AD was the most prevalent dementia phenotype seen in this practice. Increased awareness of dementia and better utilization of specific treatments are needed among psychiatrists and primary care practitioners in Nigeria. Keywords: Dementia phenotypes; BPSD; Neuropsychiatric practice; Nigeria; Africa

The neurobiology of HIV dementia: implications for practice in South Africa.

Abstract: In this review, the neuropathogenesis of HIV dementia (HIV-D) is discussed in the context of the local epidemic. HIV-D continues to be prevalent in the era of highly active anti-retroviral therapy. HIV neuro-invasion into the central nervous system may result in the development of separate HIV genotypes in an individual through compartmentalisation. The blood brain barrier continues to limit penetration of anti-retroviral drugs into the cerebrospinal fluid. Individuals with active neuro-inflammation appear to respond well to HAART. In some cases low grade neuro-degeneration persists with consequent clinical deterioration. In South Africa, the emergence of a sub-epidemic of HIV-D is being driven by various factors, including the incomplete coverage of HAART to all who need it, the late stage presentation of people living with HIV/AIDS (PLWHA) and a co-occurring methamphetamine epidemic. Differences in viral subtype do not appear to confer protection against HIV-D. Implications for PLWHA who are at risk for HIV-D in South Africa are explored, with a view to providing suggestions for improving practice and research into this area.

A retrospective review of trends and clinical characteristics of methamphetamine-related acute psychiatric admissions in a South African context.

Abstract: Objective: Epidemiological studies indicate that methamphetamine (MA) abuse poses a major challenge to health in the Western Cape. The objectives of this study were to retrospectively assess the trends, clinical characteristics and treatment demand of MArelated admissions to a psychiatric ward in this region. Method: The clinical records of patients admitted to an acute psychiatric admission ward at Tygerberg Hospital from 1 January 2002 to 30 June 2002 and 1 January 2006 to 30 June 2006, were retrospectively reviewed. Admission numbers including those of adolescent and adult substance users were compared for both study periods. Study samples comparing demographic profile, admission status, length of stay, psychopathology, treatment requirements and referral pattern to other disciplines between MA users and non-users were collected for the 2006 period. Results: There was a significant (p consequences have become a major challenge. These effects in both adolescent and adult patient populations and the associated impact on psychiatric services demand urgent intervention strategies as well as prospective study. Keywords: Admissions; Methamphetamine; Psychopathology; Psychosis; South Africa

The neural correlates of intimate partner violence in women.

Abstract: Objective: To examine hippocampal volume and white matter tracts in women with and without intimate partner violence (IPV). Method: Nineteen women with IPV exposure in the last year, and 21 women without IPV exposure in the last year underwent structural magnetic resonance imaging (MRI) including diffusion tensor imaging (DTI) sequences. Additional data on alcohol use and presence of psychiatric disorder was collected. Differences in fractional anisotropy (FA) between the two groups were examined, using a statistical model that included demographic measures, alcohol use and psychiatric disorder. Results: IPV subjects did not demonstrate significantly different hippocampal volumes compared to subjects without recent IPV. FA was, however, significantly reduced in the body of the corpus callosum of IPV subjects. Adjusting for age, alcohol use, smoking and psychiatric diagnosis did not change the significance of the result. Conclusion: Data on hippocampal volume in IPV are inconsistent, perhaps reflecting the fact that multiple factors influence this measure. Reduced FA in the body of the corpus callosum in IPV suggests altered integrity of this white matter tract; additional work is needed to address the underlying mechanisms and clinical correlates of this finding. Key Words: Corpus callosum; Hippocampal volume; Intimate partner violence; Neuroimaging

Prevalence and correlates of psychiatric morbidity among caregivers of children and adolescents with neuropsychiatric disorders in Nigeria.

Abstract: Objective: To screen for psychiatric morbidity among caregivers of patients attending a child and adolescent psychiatric clinic. Method: A total of 155 patients and their caregivers were consecutively recruited over a 1 month period. Sociodemographic and clinical information on patients was obtained either from the hospital records or from the caregiver. Scoring on the Children’s Global Assessment Scale (CGAS) was done by clinicians. The caregivers were administered a sociodemographic questionnaire, GHQ-12, Zarit Burden interview, and the Columbia Impairment Scale. Results: Most caregivers observed in this study were females (80.5%) with mothers of the patients accounting for 78% of all the caregivers. A higher percentage of the patients were males (52.8%). Among the caregivers, 39.4% had GHQ Scores of 3 and above. Factors associated with psychiatric morbidity among caregivers include the high level of subjective burden of care, low level of functioning, high degree of impairment and low level of education among patients. Conclusion: The study reveals a high level of psychiatric morbidity among the carers of children and adolescents with mental health problems. Keywords: Psychiatric morbidity; Care giver; Children and adolescents

Acute mental health care according to recent mental health legislation Part II. Activity-based costing

Abstract: Objective: This is the second of three reports on the follow-up review of mental health care at Helen Joseph Hospital (HJH). Objectives for the review were to provide realistic estimates of cost for unit activities and to establish a quality assurance cycle that may facilitate cost centre management. Method: The study described and used activity-based costing (ABC) as an approach to analyse the recurrent cost of acute in-patient care for the financial year 2007-08. Fixed (e.g. goods and services, staff salaries) and variable recurrent costs (including laboratory’, ‘pharmacy’) were calculated. Cost per day, per user and per diagnostic group was calculated. Results: While the unit accounted for 4.6% of the hospital’s total clinical activity (patient days), the cost of R8.12 million incurred represented only 2.4% of the total hospital expenditure (R341.36 million). Fixed costs constituted 90% of the total cost. For the total number of 520 users that stayed on average 15.4 days, the average cost was R1,023.00 per day and R15748.00 per user. Users with schizophrenia accounted for the most (35%) of the cost, while the care of users with dementia was the most expensive (R23,360.68 per user). Costing of the application of World Health Organization norms for acute care staffing for the unit, projected an average increase of 103% in recurrent costs (R5.1 million), with the bulk (a 267% increase) for nursing. Conclusion: In the absence of other guidelines, aligning clinical activity with the proportion of the hospital’s total budget may be an approach to determine what amount should be afforded to acute mental health in-patient care activities in a general regional hospital such as HJH. Despite the potential benefits of ABC, its continued application will require time, infrastructure and staff investment to establish the capacity to maintain routine annual cost analyses for different cost centres. Key words: Cost analysis; Activity-based costing; Acute mental health care; Recurrent cost; Fixed and variable cost; Cost centre management; Hospital expenditure

Cannabis use predicts shorter duration of untreated psychosis and lower levels of negative symptoms in first-episode psychosis: a South African study.

Abstract: Objective: Cannabis use/abuse is a common co-morbid problem in patients experiencing a first episode of psychotic illness (FEP). The relationship between the clinical presentation of FEP and cannabis abuse is complex and warrants further investigation, especially within the South African context. Method: We tested associations between recent/current cannabis use and duration of untreated psychosis (DUP), age of onset (AO), PANSS-rated (Positive and Negative Syndrome Scale) positive, negative and general psychopathology symptoms and depressive symptoms (Calgary Depression Scale for Schizophrenia) in a sample of 54 patients with FEP. Results: Mean DUP was 34.4 weeks, while mean AO was 24.7 years. Co-morbid cannabis use occurred in 35% of the sample and was significantly associated with shorter DUP (Mann-Whitney U, p=0.026). While not significant, there was also a trend association between cannabis use and lower negative symptoms (Mann-Whitney U, p=0.051). Conclusion: Current/recent cannabis use was associated with clinical features of psychosis onset that previously have been associated with better outcome. Medium and long-term outcome for cannabis users however, is likely to depend on whether or not cannabis use is ongoing. Keywords: First-episode psychosis, Cannabis; Duration of untreated psychosis; Age of onset; Symptoms

Attention deficit hyperactivity disorder symptom self-report among medical students in Eldoret, Kenya

Abstract: Objective: To determine the prevalence of self-reported attention deficit hyperactivity disorder (ADHD) symptoms among medical students in Eldoret, Kenya. Method: A cross-sectional descriptive study of all medical students who gave consent to participate in the study. Undertaken at Moi University’s School of Medicine in Eldoret, Kenya. Comprising two hundred and fifty three (253) undergraduate medical students, with a mean age of 23.7 years (19-42, s.d. 4.1), of whom 51% were female. Measuring ADHD symptomatology using the Adult ADHD Self-Report Scale (ASRS v1.1). Results: The prevalence rate of self-reported ADHD symptoms using the ASRS screener was 23.7%. This was significantly associated with being in the age-group 17-20 years compared (p<0.05). The prevalence rate was higher among females (25.6%) than among males (21.8%), but this difference was not statistically significant. Preclinical students had a higher prevalence rate of ADHD symptoms (28.7%) compared to clinical students (19.6%), but this was also not statistically significant. Using a modification of the ASRS full symptom checklist to approximate a Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) ADHD diagnosis yielded a ‘possible ADHD’ prevalence rate of 8.7%. Of these, the inattentive type was the most common (40.9%). Conclusion: The prevalence rate of self-reported ADHD symptoms among medical students in Eldoret is very high and possibly interferes with the students’ social and academic functioning. Further studies are suggested to generate information on the real ADHD prevalence in the general population and in special populations such as schools and colleges. Key words : Attention Deficit Hyperactivity Disorder (ADHD); Medical Students; Prevalence; Self-Report

Culture-bound syndromes and the neglect of cultural factors in psychopathologies among Africans.

Abstract: One of the major problems in psychiatric practice worldwide is inability to reach a consensus as regards a globally acceptable classificatory system for the different psychopathologies. Consequently, apart from the WHO's International Classification of Diseases (ICD) that is expected to be universally applicable there are regional-based classificatory systems in some parts of the world. In Africa, a number of culture bound syndromes (CBS) have been described which have not been given international recognition. The possible consequences of this non-recognition are highlighted in this paper. Unfortunately there are serious constraints such as the relatively small number of psychiatrists on the continent, and inadequate funding for mental health research, which militate against producing an African classificatory system. Nevertheless, it is proposed that reports of African psychiatrists emanating from their research and clinical experience should be accorded adequate recognition in the WHO so as to assign these CBS their rightful placement in the International classificatory system.

Schizophrenia among Sesotho speakers in South Africa.

Abstract: Objective: The aim of this study is to investigate the clinical presentation of schizophrenia among Sesotho speakers. Method: A sample of 100 participants diagnosed with schizophrenia was evaluated using the Psychiatric Interview Questionnaire. Results: Core symptoms of schizophrenia among Sesotho speakers do not differ significantly from other cultures. However, the content of psychological symptoms such as delusions and hallucinations is strongly affected by cultural variables. Somatic symptoms such as headaches, palpitations, dizziness and excessive sweating were prevalent among the Sesothospeaking participants suffering from schizophrenia. Conclusion: In South Africa, as is the case throughout the African continent, health professionals are still trained in Western models, especially DSM-IV-TR and ICD-10. Certain changes should be made to these models to account for cultural differences that were found in this research. Keywords: Culture; Schizophrenia; clinical manifestations; symptoms

Clozapine-Induced Pericarditis

Abstract: Objective: To report a case of a patient treated with clozapine who developed pericarditis with pericardial effusion that resolved when the drug was discontinued Method: Case report of a 21-year-old man with psychotic disorder that had been stable on clozapine therapy for five months (after failure of atypical antipsyhotic agents) presented to the emergency department complaining of chest pain and progressive shortness of breath that had lasted for a few days Echocardiography showed a pericardial effusion suggestive of a cardiac tamponade, and the fluid was removed by pericardiocentesis All other possible causes of the pericardial effusion were ruled out and clozapine was suspected as the most likely explanation Clozapine was discontinued and the patient’s symptoms improved markedly Discussion: According to the Naranjo probability scale, clozapine is a probable cause of pericarditis Although clozapine is a known cause of myocarditis and cardiomyopathy, there are only several reports in the literature describing clozapine-induced pericarditis and pericardial effusion In our patient, the pericardial effusion cleared within several days following clozapine discontinuation Conclusion: There have been only a few cases of clozapine-induced pericarditis reported in the literature, however this adverse effect of clozapine can occur, as this case report clearly demonstrates Cardiac adverse effects of clozapine are potentially life threatening, hence early recognition is essential to prevent serious outcomes Key words: Clozapine; Pericarditis; Pericardial effusion; Adverse reaction

Diagnostic outcome of patients referred to psychiatry with medically unexplained symptoms: a retrospective study.

Abstract: Objective: Medically unexplained symptoms (MUS) are commonly encountered in medical practice. In psychiatry, they are classified mostly as Somatoform Disorders and are often associated with anxiety and depression. The literature suggests that, in some cases, MUS may be ascribed to Somatoform Disorders when, fact, they are “organic” syndromes that are misdiagnosed. In developing countries, with fewer resources, MUS may be more difficult to assess. Method: We undertook a retrospective chart review to examine the demographics, referral pathway, management and diagnostic outcome of subjects (n = 50) referred to psychiatry with MUS over an 18 month period. Results: Subjects with MUS accounted for only 4.5% of the total number of files reviewed. In only 38% of cases did the final diagnosis in psychiatry concur with the referral diagnosis. In 28% of cases a new “organic” diagnosis was made and in 72% of cases a new psychiatric diagnosis was made. Subjects who were diagnosed with “organic” illness were seen fewer times prior to referral to psychiatry and were significantly older than other subjects. Conclusion: In developing countries like SA, a significant number of patients with MUS may have underlying “organic” illness, and most may have psychiatric disorders. Patients with MUS, especially older patients, should be more extensively investigated. Psychiatric referral of these patients is very appropriate. Keywords: Medically unexplained symptoms; Psychiatric disorders; Retrospective review; Somatoform disorders

Acute mental health care and South African mental health legislation Part 1- morbidity, treatment and outcome

Abstract: Objective: This is the first of three reports on a follow-up review of mental health care at Helen Joseph Hospital (HJH) In this first part, qualitative and quantitative descriptions were made of the services and of demographic and clinical data on acute mental health care users managed at HJH, in a retrospective review of clinical records over a four year period Objectives for this review were to provide information on mental health care outcome, to do a cost analysis and to establish a quality assurance cycle that may facilitate a cost centre management approach The operational areas identified were service delivery, teaching, and research Activities within each area were in-patient care, out-patients and consultation/liaison, under- and postgraduate teaching and self initiated or contract research Method: The study reviewed the existing mental health care program and activities in context of relevant policy and legislation Results: Norms from a World Health Organization model for acute mental health care showed that significant staff shortages existed, especially for nursing A total of 520 users were admitted for in-patient mental health care during the financial year 2007/08 The average length of stay was 154 days and ranged from 1 to 85 days Ninety users (17%) had an extended period of stay of 25 days and more, while 39 users had multiple admissions during the 12 month period The most common Axis I diagnoses made were schizophrenia n=138 (29%), substance-related conditions n=99 (21%) and bipolar mood disorder n=69 (14%) After discharge, 139 users (27%) were referred back to the HJH out-patient department for follow-up Conclusion: The information from these reports may be used in the allocation of adequate resources to align this acute unit with its responsibilities according to recent legislation Key words: Mental health service; Legislation; South Africa