Scielo RSS <![CDATA[South African Journal of Psychiatry ]]> vol. 25 num. 1 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>Maternal alcohol use during pregnancy in a general national population in South Africa</b>]]> OBJECTIVE: Alcohol use in pregnancy is linked with various negative health effects on the infant. The aim of this study was to examine the prevalence of maternal alcohol use during pregnancy and socio-demographic and health correlates. METHODS: Data of ever-pregnant women from the cross-sectional 'South African National Health and Nutrition Examination Survey (SANHANES-1) 2011-2012' were analysed. The sample included 5089 adolescents and adult women aged 15-55 years. They responded to questions on alcohol use, socio-demographic and health indicators. RESULTS: The results indicated that 3.7% (95.0% confidence interval [CI] = 3.1, 4.5) of South African women had engaged in alcohol use during their pregnancy. In adjusted analysis, being mixed race, not employed, poor self-rated health status, ever been diagnosed with tuberculosis and having partial post-traumatic stress disorder were found to be associated with alcohol use during pregnancy. CONCLUSIONS: The study findings suggest links between socio-demographic and health variables and prenatal alcohol use, which may have public health policy implications. <![CDATA[<b>Fine motor deficits and attention deficit hyperactivity disorder in primary school children</b>]]> BACKGROUND: Many children with attention deficit hyperactivity disorder (ADHD) display motor deficiencies during their daily routine, which may have impact on their developmental course. Children with ADHD who experience motor deficiencies often display deficits in tasks requiring movements, such as handwriting. AIM: This study investigated deficiencies in fine motor skills in primary school children with ADHD. The study further sought to establish whether ADHD subtypes differ in deficiencies of fine motor performance, recorded for both the dominant and non-dominant hands. METHODS: The Disruptive Behavior Disorders Rating Scale, completed by educators and parents, was used to screen for ADHD symptoms. Researchers confirmed the diagnosis of ADHD. Motor functioning was assessed using the Grooved Pegboard and Maze Coordination. The children diagnosed with ADHD were matched for age and gender with controls without ADHD. The sample consisted of an ADHD group (160) and control group (160) of primary school children from the Moletjie area. RESULTS: Children with ADHD (predominantly inattentive subtype) and ADHD (combined subtype) performed significantly more poorly than the control group on the Grooved Pegboard (p < 0.05) with both the dominant and non-dominant hand. No significant difference between the hyperactivity and impulsiveness subtype and the controls were found. There was no difference on the Maze Coordination Task (p &gt; 0.05) between the ADHD subtypes and the controls. CONCLUSION: Difficulties in fine motor skills are prevalent in children with ADHD, particularly in the ADHD-PI and ADHD-C. Problems are encountered in distal, complex, speeded tasks. The effect may lead to poor handwriting and academic performance. <![CDATA[<b>Social anxiety disorder and childhood trauma in the context of anxiety (behavioural inhibition), impulsivity (behavioural activation) and quality of life</b>]]> BACKGROUND: Social anxiety disorder (SAD) is one of the most prevalent psychiatric disorders in South Africa. Previous studies have linked childhood trauma with the development of SAD. The behavioural inhibition system (BIS) and the behavioural activation system (BAS), two dimensions of personality related to anxiety and impulsivity, respectively, are said to influence the development of psychopathology, including SAD. Both SAD and childhood trauma have an impact on quality of life. This study investigated the relationship between BIS, BAS and quality of life in patients with SAD with and without exposure to childhood trauma, compared to healthy controls. METHOD: Data were collected for 102 adults. A total of 76 participants met SAD criteria, of which 51 were exposed to childhood trauma and 25 were not. The remaining 26 participants were demographically matched healthy controls. Measures of anxiety, impulsivity and quality of life were obtained by administering Carver and White's BIS/BAS scales and the Quality of Life Enjoyment and Satisfaction Questionnaire - Self Report. RESULTS: A positive correlation was found between the severity of SAD symptoms and the amount of childhood trauma exposure. No significant differences in impulsivity were found across the three groups. Healthy controls reported significantly lower anxiety and a better quality of life than both groups with SAD, while no differences were found between patients with SAD and childhood trauma and those without childhood trauma. CONCLUSION: More childhood trauma exposure appears to be associated with greater SAD severity. The lack of differences in BIS, BAS and quality of life in patients with SAD with or without childhood trauma requires further investigation. <![CDATA[<b>Patients' opinions about referral from a tertiary specialist psychiatric hospital to primary healthcare</b>]]> BACKGROUND: Referral of patients from tertiary specialist psychiatric hospitals to primary healthcare settings is a worldwide goal. This is of particular importance in South Africa with its considerable burden of mental disorders and limited resources. However, patients are often reluctant to be referred and studies have shown that patients may prefer a dedicated psychiatric service over an integrated primary healthcare service AIM: This study explored the opinions of patients receiving care at a tertiary psychiatric hospital's outpatient department (OPD) about referral to a primary healthcare clinic (PHCC). SETTING: The study was conducted at Weskoppies Psychiatric Hospital OPD. METHODS: This was a qualitative study based on grounded theory. Participants were recruited through purposive-theoretical sampling. Data were collected by means of individual interviews and mini-essays. RESULTS: From the 80 participants, 18 had individual interviews and 62 wrote mini-essays. Thirty-nine participants had previously attended a PHCC, while 41 had not. Perceived advantages of referral to PHCCs included: close proximity to participants' homes, resulting in saving on travelling time and transport costs, as well as the convenience of receiving psychiatric and other medical treatment at the same healthcare facility. Perceived disadvantages of PHCCs included: unavailability of treatment; lack of doctor-based care; lack of specialised care; loss of established relationships with hospital healthcare workers; mistreatment by PHCC nursing staff; longer waiting times; more stigmatisation. CONCLUSION: The perceived disadvantages of referral from a tertiary psychiatric hospital to a PHCC outweighed the perceived advantages. Nonetheless, participants expressed willingness for such a referral if their concerns were addressed. <![CDATA[<b>The relationship between locus of control and depression: A cross-sectional survey with university students in Botswana</b>]]> BACKGROUND: Research has consistently revealed a positive association between external locus of control and depression. Little, if any, research has investigated locus of control and depression in the sociocultural context of Botswana. AIM: To explore the relationship between locus of control and depression among undergraduate students in Botswana and to determine the impact of age and gender on this relationship. SETTING: University of Botswana. METHODS: A sample of 272 students was surveyed through a self-administered questionnaire, which included the Levenson's multidimensional locus of control scale, the Beck Depression Inventory-II and demographic questions. Data analysis utilised descriptive statistics, correlation analysis, independent samples t-tests and standard multiple regression analysis. RESULTS: Of the 272 participants, 47.3% scored low (minimal) levels of depression, 23.4% scored mild levels, 18.0% scored moderate levels and 11.3% scored severe levels of depression. Students who believed that they were in control of events in their lives were less likely to present with depressive symptoms (r = -0.29, p = 0.000), while students who believed that chance (r = 0.45, p = 0.000) or powerful others (r = 0.40, p = 0.000) controlled their lives were more likely to have high depression scores. Both internal and external locus of control, together with age, explained 31% of the variance in depression scores; gender made no significant contribution to levels of depression. CONCLUSION: The study results draw attention to locus of control as one of the cognitive variables associated with depression. Further research is needed to determine how locus of control can be addressed in the treatment and prevention of depression in university contexts. <![CDATA[<b>The psycho-social and clinical profile of women referred for psycho-legal evaluation to forensic mental health units in South Africa</b>]]> BACKGROUND: There is a paucity of research on women offenders in the South African context, particularly those referred for forensic psychiatric observation. Little is known about their life histories, the nature of their offences or the psycho-social contexts that enable, or are antecedents to, women's criminal offending. AIMS: This research study, the largest of its kind in South Africa, examined the psycho-social contexts within which women offenders referred for psychiatric evaluation come to commit offences. The profiles of both offenders and victims, as well as reasons for referral and forensic mental health outcomes, were investigated. METHODS: A retrospective record review of 573 cases, spanning a 12-year review period, from six different forensic psychiatric units in South Africa, was conducted. RESULTS: The findings describe a population of women offenders who come from backgrounds of socio-demographic and socio-economic adversity, with relatively high pre-offence incidences of being victims of abuse themselves, with significant levels of mental ill-health and alcohol abuse permeating their life histories. The majority of index offences which led to court-ordered forensic evaluations were for violent offences against the person, with murder being the single most common index offence in the sample. Most victims of violence were known to the accused. There were also relatively high rates of psychotic and mood-spectrum disorders present, with relatively low rates of personality disorders. The majority of women were deemed to be trial competent and criminally responsible in relation to their index offences. CONCLUSION: It is recommended that more standardised and gender-sensitive forensic mental health assessment approaches, documentation and reporting be employed throughout the country. Future research should compare male and female offending patterns and forensic mental health profiles. <![CDATA[<b>A hermeneutic analysis of delusion content from the casebooks of the Grahamstown Lunatic Asylum, 1890–1907</b>]]> BACKGROUND AND OBJECTIVES: This study sought to investigate the content of the delusions recorded in the casebooks of the Grahamstown Lunatic Asylum as a means to explore how the colonial context shaped or influenced psychopathology. To this end, the study aimed to (1) identify the sociopolitical events of the time period that were reflected in the delusion content presented by the patients and (2) pinpoint discernible patterns in the delusion content based on the race and gender of the patient. The study was delimited to the period of Dr T.D. Greenlees' tenure as medical superintendent, 1890-1907. METHODOLOGY: The study sampled the casebook records of 400 patients. A qualitative analysis of the casebooks was followed by adopting a Gadamerian approach to hermeneutics. The analysis drew upon the clearly articulated method and step-by-step approach for Gadamerian hermeneutics outlined by Fleming, Gaidys and Robb. RESULTS: The sociocultural and political events of South Africa during the turn of the 20th century had a marked influence on the content of the patients' delusions. The South African War (1899-1902), the rinderpest epidemic of 1896-1898, diamond mining in Kimberley and the discovery of gold in the Witwatersrand were common features in the delusion content. Moreover, there is evidence of discernible patterns in the content of the delusions based on the race and gender of the patients. CONCLUSION: The study identified how the colonial context influenced the delusional content presented by the patients of the Grahamstown Lunatic Asylum. Of key significance is the fact that the study retrieved themes in the delusional content presented by black subjects that were silenced, omitted or censored from psychiatric texts published during colonialism. <![CDATA[<b>Psychiatric comorbidity among alcohol-dependent individuals seeking treatment at the Alcohol Rehabilitation Unit, Stikland Hospital</b>]]> BACKGROUND: International studies have found high rates of psychiatric comorbidity among patients with alcohol use disorders (AUDs) and highlighted the clinical and prognostic implications of this finding. There is a paucity of information with regard to the extent of this problem within the South African context. AIM: The aim of this study was to investigate the prevalence of psychiatric comorbidity (DSM IV-TR) in treatment-seeking, alcohol-dependent South Africans. SETTING: This study was conducted at the Alcohol Rehabilitation Unit (ARU), Stikland Hospital, Western Cape. METHODS: This cross-sectional study was conducted over a 6-month period. The Mini-International Neuropsychiatric Interview (MINI, version 5) was used to assess psychiatric comorbidity in 101 (male, n = 65; 64.5%) alcohol-dependent patients. Interviews were conducted after the first week of admission to ward 13. RESULTS: Most participants (n = 63, 62.4%) had a co-occurring psychiatric disorder, the most common being major depressive (n = 30, 29.7%) and anxiety disorders (n = 43, 42.6%). Of the anxiety disorders, agoraphobia without a history of panic disorder (n = 10, 9.9%) and social phobia (n = 10, 9.9%) occurred most frequently, followed by generalised anxiety disorder (n = 9, 8.9%) and post-traumatic stress disorder (n = 9, 8.9%). Thirteen patients (13%) had a comorbid substance use disorder other than AUD. CONCLUSION: The prevalence of psychiatric comorbidity at this unit is high, especially among female patients. The findings emphasise a need to thoroughly assess patients and provide treatment and personnel who can manage the complex needs of a dual diagnosis patient population. <![CDATA[<b>Prevalence and correlates of depression among Nigerian stroke survivors</b>]]> BACKGROUND: There is mixed evidence for the hypothesis that the risk of depression after stroke is influenced by the location of lesions in the hemispheres, demographic and clinical factors, and disability of stroke survivors. AIM: The current study determined the prevalence of depression and its socio-demographic and clinico-pathological correlates among stroke survivors in a tertiary hospital in Lagos, Nigeria. METHOD: The cross-sectional study was carried out among 112 adult patients with a clinical history of stroke confirmed by neuroimaging. Depression was diagnosed using Mini International Neuropsychiatric Interview. The socio-demographic profile was obtained, and cognitive impairment was assessed using the Mini-Mental State Examination. Stroke severity was assessed retrospectively using the National Institute of Health Stroke Scale and current disability was measured using the Modified Rankin Scale. RESULTS: There were 48 (42.9%) stroke survivors with a clinical diagnosis of depression. Using binary logistic regression, the independent determinants of depression were younger age, unemployment, perceived poor social support, increasing number of previous admissions because of stroke, cognitive impairment, severity of stroke and current disability status. However, there was no significant association between depression and lesion location. CONCLUSION: Depression is a common associate of stroke, and there is a need for sustained focus on young stroke survivors with severe stroke, especially those who do not have social support and have low socio-economic status, who may have a higher risk of developing depression following stroke. <![CDATA[<b>A pilot study: Use of the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Scale in a South African patient population</b>]]> BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder which typically presents in childhood. This diagnosis may often be overlooked in adulthood, particularly in psychiatric populations. The Adult ADHD Self-Report Scale (ASRS) is an internationally used and reliable screener; however, studies investigating its use in African populations are limited AIM: To investigate the application of the ASRS in a South African setting. SETTING: A patient population in Port Elizabeth, South Africa, was identified as representing a developing or low- and middle-income country population. METHODS: A convenience sample of acutely presenting psychiatric participants admitted for stabilisation was used. Fieldworkers administered the ASRS; collected information relating to demographics, differential diagnoses, substance use disorder (SUD) presence and substance consumption; and prescribed medication relating to current or historical treatment of ADHD. RESULTS: The study sample included 30 participants, with black people representing the majority of participants. Adult ADHD Self-Report Scale completion revealed the rate of ADHD within the study population to be 43.3%, a contrast to the initially presumed prevalence of 6.7% which was based on reported methylphenidate therapy. A difference in SUD prevalence was identified between subjects screening positively and negatively for ADHD with a greater tendency towards SUDs seen for ASRS-positive individuals. Significant differences were identified in relation to cannabis- and polysubstance use for ASRS-positive individuals. CONCLUSION: Despite limitations related to the sample used and challenges in ASRS administration, investigation findings support recommendations for ADHD screening inclusion in acute inpatient settings in South Africa and ASRS translation into indigenous African languages. <![CDATA[<b>Correlates of sedentary behaviour among adolescents and adults with hazardous, harmful or dependent drinking in South Africa</b>]]> BACKGROUND: There is lack of information on the correlates of sedentary behaviour among persons with alcohol use disorders. The study aimed to examine socio-demographic and health correlates among adolescents and adults with hazardous, harmful or probable dependent alcohol use (= problem drinking METHOD: Data from the cross-sectional South African National Health and Nutrition Examination Survey (SANHANES-1) 2011-12 were analysed. From a total sample of 15 085 persons aged 15 years and older, 2849 adolescents and adults (mean age = 37.1 years, standard deviation [s.d.] = 15.1) were identified as problem drinkers, based on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Multivariable logistic and linear regression were used to determine the associations between socio-demographic characteristics, health variables and high sedentary behaviour (≥8 h/day) and total minutes of sedentary behaviour a day RESULTS: The prevalence of high sedentary behaviour (≥ 8 h/day) was 11.9% overall (11.9% among men and 12.1% among women), and the mean (s.d.) duration of sedentary behaviour was 263 (169) min/day. In bivariate analysis, older age, population group, functional disability, cognitive impairment, having hypertension, having had a stroke and posttraumatic symptoms were correlated with high sedentary behaviour. In adjusted logistic regression analysis, older age and being Indian or Asian were positively, and having been diagnosed with angina was negatively, associated with high sedentary behaviour. In linear regression analysis, older age, not employed and having had a stroke were positively, and being of mixed race and having angina were negatively, associated with total minutes (up to 960 min/day) of sedentary behaviour in a day CONCLUSION: The study provides socio-demographic and health correlates of sedentary behaviour among problem drinkers. This information can guide possible future interventions in reducing sedentary behaviour among problem drinkers <![CDATA[<b>Depressive symptoms and associated factors in medical interns at a tertiary hospital</b>]]> BACKGROUND: It is known that medical doctors suffer from increased rates of depression with medical interns being most at risk. Despite this, little is known about the prevalence of depression in interns in South Africa OBJECTIVES: This study aimed to assess the prevalence of depressive symptoms in interns employed at Groote Schuur Hospital, a tertiary hospital in the Western Cape METHOD: The study was a cross-sectional study. All 91 interns were invited to participate in the study and consenting interns were required to complete a demographic and related questionnaire and the Beck Depression Inventory 2 (BDI-2 RESULTS: Fifty-four (59.3%) of all invited interns participated in the study. Twenty-two interns (40.7%) reported a BDI-2 score of 14 or greater, indicating at least mild self-reported symptoms of depression. Features associated with a BDI-2 score of 14 or greater, included female gender, a previous diagnosis of depression, seeing a psychotherapist and previously being on antidepressant medication during internship. Other features also significantly associated with higher BDI-2 scores included suicidal ideation, thoughts of emigration, wanting to leave medicine and using substances to cope. The most significant associated feature of high BDI-2 scores was a subjective feeling of being 'burnt out' CONCLUSION: Interns had a higher prevalence of depressive symptoms when compared to the general population. The feeling of being 'burnt out' was the most significant factor associated with the severity of depressive symptoms. It is imperative that the mental health of both medical students and newly qualified doctors be prioritised, supported and monitored <![CDATA[<b>Prevalence of iron deficiency in a South African adolescent inpatient psychiatric population: Rates, risk factors and recommendations</b>]]> BACKGROUND: Severe iron deficiency is associated with anaemia, but iron deficiency with normal haemoglobin (Hb) may also affect morbidity and quality of life and contribute to psychiatric illness onset and severity. Psychiatric presentations in adolescence are often indicative of serious long-term morbidity, and addressing contributing health risk factors, such as iron deficiency, is important OBJECTIVES: To determine rates of iron deficiency in a South African inpatient adolescent psychiatric population and possible associations between psychiatric diagnosis and iron deficiency risk factors METHODS: We conducted a retrospective chart review of all adolescent patients (13-18 years old) who were admitted to the Adolescent Psychiatric Inpatient Unit at Tygerburg Hospital (Cape Town, South Africa) during 2016. Patient records were limited to those with haemoglobin and ferritin levels available, as well as a psychiatric disorder diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders. The final sample consisted of 93 patients RESULTS: Of all participants, 7.6% were anaemic, while 22.6% were iron deficient. We found 29% of our population to have anaemia in the absence of iron deficiency. Gender was the only statistically significant correlate, with adolescent females at particular risk of compromised iron status as indicated by a low ferritin level (45% of female sample CONCLUSION: Iron deficiency rates remain a relevant health concern, and testing Hb alone is inadequate to assess iron status in this population. Ferritin is a necessary additional parameter and should be included in the usual medical workup <![CDATA[<b>Prevalence of depression in people living with HIV and AIDS at the Kalafong Provincial Tertiary Hospital Antiretroviral Clinic</b>]]> BACKGROUND: Compared to the general population, there is an increased prevalence of depression in people living with HIV and AIDS (PLWHA). The combination of these two common illnesses has profound consequences on the patient and on the healthcare system OBJECTIVE: This study determined the prevalence of depressive symptomatology in PLWHA attending the Kalafong Hospital ARV Clinic. The study also established if the patients received definitive treatment for unipolar depression METHODS: A cross-sectional, descriptive study was carried out on 622 adult patients, aged 18 years or older. A brief rating scale for depression, the Centre for Epidemiological Study Depression Scale (CES-D) was administered to participants. The CES-D is a 20-item self-rating scale that assesses current levels of depression as per DSM-IV criteria. The traditional score of 16 and above was used to define a case of depression RESULTS: The prevalence of depression according to CES-D scale was 53.8%. The study found that none of the 622 patients ever received definitive treatment for depression. A lower CD4 count is associated with more depressive symptomatology, most significantly in patients with a CD4 count of 50 or less CONCLUSIONS: Depressive symptomatology was highly prevalent in the study patients. Despite the high prevalence, none of the study sample patients were treated for clinical depression. The findings reflect the importance of evaluating for depression in PLWHA, especially in high-risk groups such as patients presenting for their initiation visit or patients with a CD4 count of 50 or less. Depression remains under-recognised and under-treated in PLWHA <![CDATA[<b>A clinical profile of inpatient admissions to the psychogeriatric unit at Stikland Hospital</b>]]> BACKGROUND: Globally, the number of older people is rising. As a consequence of greater longevity, an increased burden on both medical and mental health care is expected. As a first step towards developing strategies to provide quality mental health care for this growing population, practitioners need to have a thorough understanding of the composition and needs of these patients. AIM: To profile the inpatient population of a psychogeriatric unit in terms of demographics, diagnostic makeup, average length of stay and selected outcomes. SETTING: This study was conducted at the psychogeriatric unit of Stikland Hospital, Western Cape, South Africa. METHODS: Demographic and clinical data were retrospectively collected from patient files, discharge summaries and an admission database over a 3-year period. RESULTS: A total of 903 patients were referred to Stikland Hospital during a 3-year period. Of the 498 patients who were admitted, 56 were readmissions. The mean age of patients was 67 years, and more than 57% of patients were female. The majority of patients (97.1%) were admitted as involuntary mental health users. The diagnosis of a cognitive disorder was made in 49.5% of admissions followed by psychotic disorders in 36.9% and mood disorders in 23.2%. The median length of stay was 53 days. CONCLUSION: The findings of this study illustrate that mental health services for the elderly in the Western Cape are insufficient, as only patients with severe illness and comorbidity could be admitted. The study emphasises the need for the restructuring of resources and the implementation of strategies, which may decrease the frequency of admissions to inpatient geriatric units. <![CDATA[<b>A profile of adult acute admissions to Lentegeur Psychiatric Hospital, South Africa</b>]]> BACKGROUND: The Western Cape province has the highest documented lifetime prevalence of common mental disorders in South Africa. To ensure the efficient, equitable and effective distribution of current resources, there is a need to determine the profile of patients requiring psychiatric admission. AIM: To describe patients admitted to the acute adult admissions unit at Lentegeur Hospital. SETTING: Lentegeur Psychiatric Hospital is situated in Mitchells Plain, Cape Town, and serves about 1 million people from nearby urban and rural areas. METHODS: This retrospective study involved an audit of all patients (18-60 years of age) admitted between 01 January 2016 and 30 June 2016. The clinical records of 573 adult patients were examined RESULTS: The median age of the cohort was 29 years. Most patients (63%) were educated to the secondary level. Only 12% of the patients were employed, and 37% received disability grants. More than 90% of the patients presented with psychotic symptoms. Of these, 28% presented with a first-episode of psychosis. Of all patients, 20% were referred with manic symptoms and 7% with depressive symptoms. Many patients (62%) used substances concurrently in the period leading up to admission. Significantly more males (73%) used substances compared to females (38%). Cannabis was the most widely used substance (51%), followed by methamphetamine (36%). Recent violent behaviour contributed to 37% of the current admissions. A total of 70 patients (13%) tested positive for human immunodeficiency virus (HIV), and 49 (9%) tested positive for syphilis. CONCLUSION: Substance use and a history of violence contributed to admissions in this population. <![CDATA[<b>Psychoactive substance use among outpatients with severe mental illness: A comparative study</b>]]> BACKGROUND: Despite several studies on the prevalence and pattern of substance use in Nigeria, there is little information on substance use in patients diagnosed with serious mental illness (SMI) such as schizophrenia and bipolar affective disorder (BD). AIM: The aim of the study was to compare the pattern of psychoactive substance use among outpatients with BD and schizophrenia. SETTING: The study was conducted in a neuropsychiatric hospital in Nigeria. METHODS: Seventy five consecutive patients with a MINI-PLUS diagnosis of BD were compared with an equal number of patients obtained by systematic random sampling with a MINI-PLUS diagnosis of schizophrenia. RESULTS: The respondents with schizophrenia were aged 18-59 years (37.2 ± 9.99) and were predominantly young adult (49, 65.3%), men (46, 61.3%), who were never married (38, 50.7%). Overall, lifetime drug use prevalence was 52%, while for current use, overall prevalence was 21.3%. Participants with BD were aged 18-63 years (36.7 ± 10.29) and were predominantly young adult (53, 70.7%), women (44, 58.7%), who were married (32, 42.7%), with tertiary education (31, 41.3%). Overall, lifetime drug use prevalence was 46.7%, while current overall prevalence was 17.3%. These rates (lifetime and current) for both diagnostic groups are higher than what was reported by the World Health Organization in the global status report of 2014 (0% - 16%). The statistically significant difference between the two diagnostic groups was related to their sociodemographic and clinical variables and psychoactive substance use. CONCLUSION: Psychoactive substance use remains a burden in the care of patients diagnosed with schizophrenia and BD. Future policies should incorporate routine screening for substance use at the outpatient department with a view to stemming the tide of this menace. <![CDATA[<b>Dangers of <i>Clostridium perfringens</i> food poisoning in psychiatric patients</b>]]> Clostridium perfringens food poisoning can be fatal in patients with chronic constipation. We report the investigation and management of a probable outbreak of C. perfringens food poisoning among psychiatric patients in Cape Town, South Africa, in 2013. <![CDATA[<b>Erratum: Identifying factors associated with the discharge of male State patients from Weskoppies Hospital</b>]]> Clostridium perfringens food poisoning can be fatal in patients with chronic constipation. We report the investigation and management of a probable outbreak of C. perfringens food poisoning among psychiatric patients in Cape Town, South Africa, in 2013. <![CDATA[<b>Alcohol use among high school learners in rural areas of Limpopo province</b>]]> BACKGROUND: Alcohol use is a serious public health concern among youth in South Africa and worldwide. AIM: To determine the factors contributing to alcohol use among high school learners in the rural areas of Limpopo province. SETTING: The Greater Marble-Hall municipality, Sekhukhune district in Limpopo province. METHOD: A quantitative, cross-sectional study design was conducted on 314 learners from three high schools in a rural area in Limpopo. A stratified random sampling technique was used to select learners from 11 to 25 years of age. The drinking behaviour was classified according to predetermined Alcohol Use Disorders Identification Test (AUDIT). Data were analysed using SPSS Software v23.0. RESULTS: More than half of the respondents were consuming alcohol 169 (53.8%). Also, 173 (55.1%) of respondents had parents who consume alcohol and 204 (65%) had friends who drank alcohol. Most respondents were classified as low-risk drinkers (AUDIT score < 8) and a quarter of the respondents were classified as almost dependent on alcohol (AUDIT score &gt; 13). Significant associations were found between learners' alcohol consumption and parents and friends who drank alcohol (p = 0.000; p = 0.000, respectively CONCLUSION: Alcohol use was prevalent among high school learners in the area under investigation. Also, learners who had parents and friends who consume alcohol were more likely to consume alcohol. Further, learners who were classified as almost dependent on alcohol needed urgent intervention as their health-related quality of life was likely to be poor. <![CDATA[<b>High physical activity is associated with post-traumatic stress disorder among individuals aged 15 years and older in South Africa</b>]]> BACKGROUND: Some research seems to suggest that physical activity (PA) was beneficial for post-traumatic stress disorder (PTSD). AIM: This study examined the association between levels of PA and PTSD among individuals 15 years and above in South Africa. SETTING: Community-based survey sample representative of the national population in South Africa. METHODS: In all, 15 201 individuals (mean age 36.9 years) responded to the cross-sectional South African National Health and Nutrition Examination Survey (SANHANES-1) in 2012. RESULTS: One in five (20.1%) of participants reported exposure to at least one traumatic event in a lifetime, and 2.1% were classified as having a PTSD, 7.9% fulfilled PTSD re-experiencing criteria, 3.0% PTSD avoidance criteria and 4.3% PTSD hyperarousal criteria. Almost half (48.1%) of respondents had low PA, 17.4% moderate PA and 34.5% high PA. In logistic regression analysis, adjusted for age, sex, population group, employment status, residence status, number of trauma types, problem drinking, current tobacco use, sleep problems and depressive symptoms, high PA was associated with PTSD (odds ratio [OR] = 1.75, confidence interval [CI] = 1.11-2.75), PTSD re-experiencing symptom criteria (OR = 1.43, CI = 1.09-1.86) and PTSD avoidance symptom criteria (OR = 1.74, CI = 1.18-2.59), but high PA was not associated with PTSD hyperarousal symptom criteria. In generalised structural equation modelling, total trauma events had a positive direct and indirect effect on PTSD mediated by high PA, and high PA had a positive indirect effect on PTSD, mediated by psychological distress and problem drinking. CONCLUSION: After controlling for relevant covariates, high PA was associated with increased PTSD symptomatology. <![CDATA[<b>Barriers to care among people with schizophrenia attending a tertiary psychiatric hospital in Nigeria</b>]]> BACKGROUND: Individuals with schizophrenia in low- and middle-income countries and their caregivers face multiple barriers to care-seeking and continuous engagement with treatment services. Identifying specific barrier patterns would aid targeted interventions aimed at improving treatment access. AIM: The aim of this study was to determine stigma- and non-stigma-related barriers to care-seeking among persons with schizophrenia in Nigeria. SETTING: This study was conducted at the Outpatient Clinics of the Federal Neuro-Psychiatric Hospital, Benin City, Nigeria. METHODS: A cross-sectional study of a dyad of persons with schizophrenia and caregivers (n = 161) attending outpatient services at a neuro-psychiatric hospital in Nigeria. Stigma- and non-stigma-related barriers were assessed using the 30-item Barriers to Access to Care Evaluation (BACE) scale. RESULTS: Lack of insight, preference for alternative care, illness severity and financial constraints were common barriers to care-seeking among persons with schizophrenia. Females were significantly more likely to report greater overall treatment barrier (p < 0.01) and stigma-related barriers (p < 0.02). CONCLUSION: This study shows that attitudinal barriers impede care access and engagement among persons with schizophrenia in Nigeria. <![CDATA[<b>Depression, anxiety and stress symptoms in patients presenting with dyspepsia at a regional hospital in KwaZulu-Natal province</b>]]> BACKGROUND: Depression, anxiety and stress (DAS) have been shown to be co-morbid with dyspepsia. Local data on the factors associated with these co-morbidities could inform the role of psychiatric intervention in affected patients AIM: The aim of this study was to describe the frequency of undiagnosed DAS and their associated protective and risk correlates in a sample of patients undergoing endoscopies for dyspepsia SETTING: The study was conducted at a regional hospital's gastro-intestinal unit in KwaZulu-Natal province METHOD: A cross-sectional survey was conducted on 201 in- and outpatients with symptoms of dyspepsia awaiting endoscopy. Information on DAS symptomatology (using the DASS-21 screening questionnaire, as well as socio-demographic and clinical data) were collected ANALYSES: Following a descriptive analysis of the participants' socio-demographic and clinical details, linear regression models were fitted to identify potential risk and protective correlates linked to DAS symptomatology RESULTS: The mean age of participants (N = 201) was 48.89 years, of whom approximately two-thirds (n = 133; 66.17%) were women, 97% (n = 195) were African and 64.68% (n = 130) resided in rural areas. Anxiety was the most prevalent symptom category (n = 149; 74.13%) versus depression (n = 96; 47.76%) and stress (n = 68; 33.83%) in each category of symptom (mild to extremely) severity. In the severe and extremely severe range, anxiety existed without co-morbid depression or stress in 61.19% of anxious patients. Alcohol use was significantly associated with all three symptom categories (p < 0.01 CONCLUSIONS: Given high frequencies of depression and anxiety in patients undergoing endoscopies for dyspepsia, screening for common mental disorders is essential <![CDATA[<b>Therapeutic relationships and the problem of containment: Experiences of patients at a psychiatric training hospital</b>]]> BACKGROUND: The biopsychosocial model emphasises the role of human relationships in psychiatric care. Therapeutic relationships that improve treatment outcome and provide containment are desperately needed by patients in distress. Despite the importance of human relationships, they are neglected in an era dominated by biological psychiatry. AIM: This qualitative research project explores the experiences, perceptions and subsequent needs of patients. The role of therapeutic relationships, and the factors that patients felt influenced their relationship with their therapists, were examined SETTING: A psychiatric training hospital in South Africa. METHOD: Thirty in-depth semi-structured interviews were conducted with 15 inpatients. A qualitative, explorative-descriptive, collective case study design was used. Purposive sampling ensured maximum variation and richness of information. Grounded theory methods were used to analyse transcribed recordings. RESULTS: Patients valued therapeutic relationships that provide containment and potentially obviate the need for 'measures of control'. A model of containment was developed to demonstrate the various factors that interact in the attempt to provide containment to patients in a psychiatric training hospital system. CONCLUSION: Training hospitals should emphasise the role of therapeutic relationships in achieving containment and positive treatment outcomes. In developing countries, severe shortcomings in mental healthcare resources hinder the building of personal therapeutic relationships. <![CDATA[<b>First-episode psychosis and substance use in Nelson Mandela Bay: Findings from an acute mental health unit</b>]]> BACKGROUND: Use of psychoactive substances is a common finding in studies on first-episode psychosis (FEP), and this has prognostic implications. We know very little about psychoactive substance use (SU) among patients with FEP in the Eastern Cape province (EC) of South Africa (SA0). AIM: The study seeks to determine SU prevalence and associated features among inpatients with non-affective FEP in an acute mental health unit (MHU) in Nelson Mandela Bay, EC. SETTING: Researchers conducted a retrospective clinical file review of a 12-month admission cohort of patients with FEP, without a concurrent mood episode, to the Dora Nginza Hospital MHU. Information collected included SU history, psychiatric diagnoses, and demographics. Data were then subjected to statistical analysis. METHODS: Researchers conducted a retrospective clinical file review of a 12-month admission cohort of patients with FEP, without a concurrent mood episode, to the Dora Nginza Hospital MHU. Information collected included SU history, psychiatric diagnoses and demographics. Data were then subjected to statistical analysis. RESULTS: A total of 117 patients (86 [73.5%] males; 31 [26.5%] females) aged 18-60 years (mean 29 years) met the inclusion criteria. After controlling for missing information, 95 of 117 (81.2%) patients had a history of active or previous SU, 82 of 90 (91.1%) were single and 61 of 92 (66.3%) were unemployed. A significant association was found between SU and unemployment (p < 0.001), as well as male sex (p < 0.001). The most common substances used were cannabis (59.8%), followed by alcohol (57.3%) and stimulants (46.4%). CONCLUSION: In keeping with national and international literature, the results of this study showed a high prevalence of substance use in South African patients with first-episode psychosis. The high prevalence of lifetime substance use in this cohort compared to previous studies in South Africa requires further investigation and highlights the urgent need for dual diagnosis services in the Eastern Cape province. <![CDATA[<b>Prevalence and factors associated with postpartum depression at a primary healthcare facility in Eswatini</b>]]> BACKGROUND: Routine mental health screening has not been integrated into maternal and child health (MCH) services in many developing countries, including in Eswatini (formerly Swaziland). As a result, the burden of postpartum depression (PPD) is not well understood and thus PPD remains untreated in such settings. AIM: To describe the prevalence and factors associated with PPD among women seeking postnatal and child welfare services at a primary healthcare facility in Eswatini. SETTING: The study was conducted at the King Sobhuza II Public Health Unit in Manzini, Eswatini. METHODS: This was a cross-sectional study that used convenience sampling and the Edinburgh Postnatal Depression Scale (EPDS) to screen for depression among 114 mothers during the first 6 weeks of postpartum at the King Sobhuza II Public Health Unit, Manzini, Eswatini. Multiple logistic regression analysis was conducted to determine sociodemographic and clinical factors associated with PPD. RESULTS: A majority of the participants were older than 24 years (52.6%) and unemployed (64.9%), whereas 47.4% screened positive for PPD (≥ 13 score). Adjusting for other covariates, those who were unemployed (odds ratio [OR] = 3.20, 95% confidence interval [CI] 1.17-8.79) and with poor social support from their partners (OR = 9.41, 95% CI: 3.52-25.14) were more likely to be depressed, while those who attended antenatal classes fewer than four times were less likely to be depressed (OR = 0.32, 95% CI 0.11-0.920. CONCLUSION: We found a high prevalence of PPD. There is a need to introduce routine maternal mental health screening during the postpartum period to ensure early detection and treatment of PPD. <![CDATA[<b>A systematic review of online depression screening tools for use in the South African context</b>]]> BACKGROUND: According to the World Health Organization, the alarming increase in rates of depression globally has become a serious concern. In 2010, the prevalence rate of depression in South Africa was 4.6%. Given the context of South Africa where the majority of the population have limited access to healthcare facilities and 59.3% of the population have access to the Internet, an online depression screening tool would have much to offer. OBJECTIVE: To determine whether online depression screening tools would be suitable for use in South Africa. METHODS: This study presents a systematic review of online depression screening tools to determine whether one would be suitable for use in South Africa. Articles were accessed from seven electronic databases from 1970 to 2018. All articles included in the review were critically appraised. RESULTS: A total of 17 articles met the inclusion criteria. From the results, there was only one screening tool available on an open access platform for use by the general population. The most common depression online screening tools were the Beck Depression Inventory-II (BDI-II), the Center for Epidemiology Studies Depression Scale (CES-D) and the Patient Health Questionnaire (PHQ-9). It was also evident that there were negligible differences in the psychometric properties of online versus paper versions of the online screening tools. Furthermore, there were very few studies that considered the African or South African population and no online screening tools for major depressive disorder (MDD) developed in these contexts. CONCLUSION: There appears to be a need for a depression screening tool to be adapted for online usage in South Africa. It is recommended that the online screening tool should be adapted from the three commonly used online depression screening tools: PHQ-9, CES-D and BDI-II.