Scielo RSS <![CDATA[South African Journal of Psychiatry ]]> http://www.scielo.org.za/rss.php?pid=2078-678620170001&lang=en vol. 23 num. 1 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Non-medical use of methylphenidate among medical students of the University of the Free State</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100001&lng=en&nrm=iso&tlng=en BACKGROUND: Faced with demanding training programmes, medical students may be more prone to use methylphenidate for non-medical purposes in order to improve concentration, alertness and academic performance. AIM: The study aimed to investigate the prevalence of the non-medical use of methylphenidate and knowledge of this drug among undergraduate medical students of the University of the Free State. METHODS: This was a cross-sectional study. A self-administered, anonymous questionnaire was distributed during lectures to all students in the five year groups of the undergraduate medical programme. RESULTS: Of the 643 undergraduate medical students, 541 completed the questionnaire (response rate: 84.1%). Approximately 11.0% of surveyed students were using methylphenidate at the time of the study, of which the majority (67.9%) used it for academic purposes and 70.6% received it from a medical health professional. Less than a third of users had been diagnosed with Attention-Deficit/Hyperactivity Disorder. Methylphenidate users' median knowledge was greater than non-users, and methylphenidate knowledge increased from first-year and second-year students to third-year to fifth-year students. Median knowledge scores per year group ranged from 52.0% to 60.0%. CONCLUSION: Methylphenidate is mainly used for non-medical purposes by medical students. Students generally have a low level of knowledge on methylphenidate. Specific information on methylphenidate should be included in lectures on stress management and study methods during the course of the medical curriculum. <![CDATA[<b>A rapid appraisal of the status of mental health support in post-rape care services in the Western Cape</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100002&lng=en&nrm=iso&tlng=en BACKGROUND: Despite the well-known impact of rape on mental health and the widespread problem of rape in South Africa, mental health services for rape victims are scant and not a priority for acute-phase services. Survivors encounter multiple mental health struggles in this period including adherence to the post-exposure prophylaxis drugs to prevent HIV and finding support from important others. We have little information on what mental health is provided, by whom and how it is integrated into the post-rape package of care. AIM: The aim of the study was to do a rapid appraisal of mental health services for rape survivors to gain a better understanding of the current acute and long-term (secondary) mental health services. METHOD: We conducted a qualitative study using a rapid assessment with a purposive sample of 14 rape survivors and 43 service providers recruited from post-rape sexual assault services in urban and rural Western Cape Province. Data were collected using semi-structured in-depth interviews and observations of survivor sessions with counsellors, nurses and doctors. The data were coded thematically for analysis. RESULTS: Survivors of rape experienced a range of emotional difficulties and presented varying levels of distress and various levels of coping. Receiving support and care from others assisted them, but the poor integration of mental health within post-rape services meant few received formal mental health support or effective referrals. Multiple factors contributed to the poor integration: mental health was not given the same level of priority as other rape services (i.e. clinical care, including forensic management), the inadequate capacity of service providers to provide mental healthcare, including mental health illiteracy, the lack of continuity of care, the poor linkages to ongoing mental healthcare, and the mental health challenges caused by vicarious trauma and compassion fatigue. CONCLUSION: Providing effective, compassionate mental health services should be seen as essential components of post-rape care. The strengthening of support for providers and linkages to ongoing mental healthcare are essential to improve mental health services within acute post-rape services. <![CDATA[<b>Sniffing out olfactory reference syndrome</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100003&lng=en&nrm=iso&tlng=en Olfactory reference syndrome is characterised by the erroneous belief that one emits an unpleasant body odour. This results in significant distress and is often accompanied by repetitive behaviour such as frequent showering in an attempt to camouflage the perceived odour. The body odour concerns may have a delusional quality and do not respond to simple reassurance or counterexample. Herein, we report the case of an olfactory reference disorder (ORD) patient who had received multiple medical interventions and undergone polysurgery prior to an accurate diagnosis being established. ORD may lead to significant disability, yet often goes unrecognised for many years. For many patients, poor insight will contribute to their reluctance to consider psychiatric treatment. This case demonstrated that a multimodal treatment approach comprising judicious medication use, combined with cognitive behavioural therapy, in the context of a therapeutic alliance yielded therapeutic success. <![CDATA[<b>Adult attention-deficit hyperactivity disorder: A database analysis of South African private health insurance</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100004&lng=en&nrm=iso&tlng=en BACKGROUND: Adult attention-deficit hyperactivity disorder (ADHD) is a chronic, costly and debilitating disorder. In South Africa (SA), access to funding for care and treatment of ADHD is limited, and research is lacking. AIM: This study aimed to establish the current situation with regard to the psychiatric management of and funding for treatment of adult ADHD in the private sector in SA. METHODS: A diagnostically refined retrospective claims database analysis was conducted. We examined the prevalence, costs and funding profile of claims over a 2-year period for adult beneficiaries with possible ADHD of a large medical administrator in SA. RESULTS: The prevalence of adult ADHD was lower than published international rates. The presence of adult ADHD increased the prevalence of comorbidity and doubled the health care costs of beneficiaries. Contrary to public belief, comorbidities (including their medicine costs) rather than psychiatric services or medicines were the main cost drivers. CONCLUSION: The current private health insurance funding model for ADHD limits access to funding. This affects early diagnosis and optimal treatment, thereby escalating long-term costs. Improved outcomes are possible if patients suffering from ADHD receive timely and accurate diagnosis, and receive chronic and comprehensive care. Balanced regulation is proposed to minimise the risk to both medical schemes and patients. A collaborative approach between stakeholders is needed to develop an alternative cost-effective funding model to improve access to treatment and quality of life for adults with ADHD in SA. <![CDATA[<b>Clinical and demographic factors associated with sexual behaviour in children with autism spectrum disorders</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100005&lng=en&nrm=iso&tlng=en INTRODUCTION: The sexual behaviour and development of children with autism spectrum disorders (ASDs) have been mostly overlooked in research and practice. This study aimed to determine the association between certain clinical and demographic factors found in a sample of children with ASDs, and their reported sexual behaviour (RSB). METHODS: The study was conducted at a school in Gauteng, South Africa, for learners with ASDs. Two questionnaires completed by caregivers/parents enquired about family stability, clinical profile and RSB (if any) in their child. RSB was analysed via three domains: self-care, socio-sexual skills and actual RSB, with additional information from school records. RESULTS: Of the 107 questionnaires distributed, only 31 parents responded and 24 agreed to participate. The 24 (100%) children included 10 pubertal and 14 pre-pubertal children, of which 18 (n = 18) had more stable primary caregiver statuses as well as more stable socioeconomic and family environments. Two of the 14 pre-pubertal children had abnormal self-care, whereas none of the 10 pubertal children had any abnormal self-care. Eight of the 18 children from more stable environments displayed abnormal sexual behaviours. Of the 6 children from less stable environments, two displayed more abnormal socio-sexual skills, whereas 9 of the 18 children from more stable environments displayed more abnormal sexual behaviour. In contrast with the postulated hypothesis that children from less stable socioeconomic and family environments would exhibit more abnormal sexual behaviours, this study did not find any evidence of such a relationship or association. CONCLUSION: ASDs are characterised by deficits in communication and social skills. These may lead to an affected individual struggling to develop appropriate sexual behaviour. If specific risk factors that contribute to the development of abnormal sexual behaviour can be identified, one can try to modify/prevent these where some degree of prevention or alleviation may be possible. <![CDATA[<b>The dual model of perfectionism and depression among Chinese University students</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100006&lng=en&nrm=iso&tlng=en The dual model of perfectionism was adopted to explore the influence of adaptive and maladaptive perfectionism on depression in college students. The results support the dual process model of perfectionism in Chinese undergraduates. A sample of 206 Chinese undergraduates completed measures of perfectionism, General Self-efficacy Measure, Beck Depression Inventory, State Anxiety Inventory, Positive and Negative Affect Scale (Time 1) and Beck Depression Inventory 4 months later (Time 2). Exploratory and confirmatory factor analysis revealed that the three-factor model of perfectionism with dimensions of maladaptive perfectionism, adaptive perfectionism and order factor fit the date well. Partial correlations analyses revealed that maladaptive perfectionism was related to psychopathology, whereas adaptive perfectionism was more closely correlated with positive features of mental health. In cross-sectional analyses, the discrepancy which measures the perceived difference between the standards one has set for one's own behaviour and actual performance and the socially prescribed perfectionism subscales of maladaptive perfectionism could significantly predict baseline depressive symptoms. However, after controlling for the initial scores of depression, none of the perfectionism subscales significantly predicted the change in depression across a 4-month lag. Distinguishing adaptive and maladaptive aspects of perfectionism may be beneficial to understanding the influence of perfectionism on depression. <![CDATA[<b>Traumatic stress and psychological functioning in a South African adolescent community sample</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100007&lng=en&nrm=iso&tlng=en BACKGROUND: Traumatic stress may arise from various incidents often leading to posttraumatic stress disorder (PTSD). The lifetime prevalence of PTSD is estimated at 1% - 2% in Western Europe, 6% - 9% in North America and at just over 10% in countries exposed to long-term violence. In South Africa, the lifetime prevalence for PTSD in the general population is estimated at 2.3%. AIM: To examine the prevalence of posttraumatic stress symptomatology and related psychological functioning in a community sample of adolescents. SETTING: Low-socioeconomic communities in KwaZulu-Natal. METHODS: Home interviews with adolescents and their maternal caregivers were used to collect the data using standardised instruments. Adolescents completed the Trauma Symptom Checklist for Children; Children's Depression Inventory; Children's Somatization Inventory; and Revised Children's Manifest Anxiety Scale. The Child Behaviour Checklist was completed by the caregivers. The sample comprised Grade 7 (n = 256) and Grade 10 (n = 68) learners. Sixty-five percent of the sample was female, and ages ranged from 9 to 18 (M = 13.11, s.d. = 1.54). RESULTS: Almost 6% of the sample endorsed PTSD and an additional 4% of the participants had clinically significant traumatic stress symptomatology. There was a significant, large, positive correlation between posttraumatic stress and anxiety, and medium positive correlations between posttraumatic stress and depression and somatic symptoms. CONCLUSION: Posttraumatic stress symptomatology can be debilitating, often co-occurring with symptoms of depression, anxiety and somatic complications. This may lead to long-term academic, social and emotional consequences in this vulnerable group. <![CDATA[<b>The use of cyproterone acetate in a forensic psychiatric cohort of male sex offenders and its associations with sexual activity and sexual functioning</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100008&lng=en&nrm=iso&tlng=en BACKGROUND: Cyproterone acetate (CPA) is a steroidal anti-androgenic medication used in the field of psychiatry for the treatment of paraphilic disorders, hypersexuality, and inappropriate sexual behaviour which may be present in patients with disorders such as mild and major neurocognitive disorders. In the forensic psychiatric population, it is prescribed for these indications especially for patients with a history of committing a sexual offence or who are at moderate to high risk of recidivism. OBJECTIVES: To investigate the use of CPA in a forensic psychiatric cohort of male sex offenders and its associations with sexual activity and sexual functioning. METHODS: Seventy-six forensic psychiatric patients from Weskoppies Hospital in Pretoria, South Africa, participated in the study which measured their sexual functioning. A specifically designed questionnaire was used to capture relevant background information. The use of CPA was studied. The Changes in Sexual Functioning Questionnaire, Male Clinical Version (CSFQ-M-C) was used to measure sexual functioning of participants. The CSFQ-M-C scores, and those of all its subscales, of participants on CPA were compared to those not on the drug. Relevant statistical analyses were performed. RESULTS: Thirteen out of the 76 participants were being treated with CPA (17.11%). In total, 53.85% of the participants on CPA and 65.08% not on CPA had scores indicating the presence of sexual dysfunction. The total CSFQ-M-C scores for participants on CPA (mean = 40.54; median = 42) were not statistically significantly lower than those not on the drug (mean = 41.22; median = 41). More notable is that the use of CPA in this population was associated with lower levels of desire, frequency of and pleasure from sexual activity. There was an association between having intellectual disability and being treated with CPA. CONCLUSION: That all the participants were being treated with psychotropic medication could account for the high percentage of sexual dysfunction in any or all areas of sexual functioning and contribute to the small difference in CSFQ-M-C scores between the two groups. Only a tentative conclusion can be made that CPA may be more effective in decreasing levels of desire, frequency and pleasure related to sexual activity than other areas of sexual functioning. The indication for the use of CPA in this population should be assessed clinically according to patient circumstances and risk assessment. <![CDATA[<b>Achalasia as a complication of bulimia nervosa: A case report</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100009&lng=en&nrm=iso&tlng=en OBJECTIVE: Oesophageal achalasia is a medical condition characterised by oesophageal aperistalsis, an increased resting pressure with partial or incomplete relaxation of the lower oesophageal sphincter. Bulimia nervosa (BN) is an eating disorder manifested by binge eating attacks followed by recurrent inappropriate compensatory behaviours, such as self-induced vomiting and excessive exercise. Dysphagia, regurgitation, vomiting, retrosternal pain, heartburn, weight loss, avoidance of eating, consumption of large amount of liquids and aberrant eating behaviours are symptoms of both achalasia and BN. Owing to these common signs and symptoms, oesophageal achalasia can be misdiagnosed as an eating disorder. In addition, oesophageal achalasia can occur as a complication of BN. It is often difficult to distinguish organic and psychological vomiting or comorbidity because of overlapping of the symptoms. CASE REPORT: We report the case of a patient who developed oesophageal achalasia following severe, repetitive vomiting as a complication of BN. CONCLUSION: We want to raise awareness regarding the development of a medical illness in the presence of a psychiatric disorder. Importantly, physicians should have a fundamental knowledge of these two diseases regarding their clinical patterns to differentially diagnose one or both disorders as quickly as possible. <![CDATA[<b>Neuropsychiatric symptoms and diagnosis of grey matter heterotopia: A case-based reflection</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100010&lng=en&nrm=iso&tlng=en Neuropsychiatric symptoms can be related to less common underlying neuropsychiatric conditions - in this case report, the condition discussed is that of grey matter heterotopia (GMH). The patient presented with a history of prominent aggression, impulsivity and manipulative and attention-seeking behaviour. Episodes of depression and incidents of deliberate self-harm and suicide attempts had been reported. Neuropsychiatric symptoms included anxiety, a labile mood, delusional thinking and auditory hallucinations. Testing revealed some cognitive difficulties and severe impairment of frontal lobe functions. A magnetic resonance imaging (MRI) scan of his brain revealed the presence of GMH, which had previously been misdiagnosed as tuberous sclerosis. An MRI scan of the brain is the special investigation of choice for the correct diagnosis of GMH. The pathognomonic finding is that of heterotopic grey matter abnormally located within areas of white matter. Defective foetal neuronal migration between the third and fifth month of pregnancy can lead to GMH, which can present later on in childhood or adolescence with epilepsy, intellectual impairment or reading difficulties. During the late teenage years or early adulthood, a wide variety of neuropsychiatric symptoms may be present, which can lead to diagnostic difficulties. <![CDATA[<b>Factors associated with and prevalence of depressive features amongst older adults in an urban city in eastern China</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100011&lng=en&nrm=iso&tlng=en BACKGROUND: Mental health problems have become serious for older Chinese adults who have lived through the process of urbanisation. This current research aimed to determine the prevalence of and associated factors for depressive features in a community-based sample of older adults in China. METHODS: A community-based survey of 4077 adults aged 60 or older was conducted in Suzhou, China. Information including demographic characteristics, health behaviours, social support, disease histories and physical function was collected using a pre-designed questionnaire. Depressive features were assessed using the self-rating depression scale. Multivariate logistic regression analysis was performed to identify associated factors for depression. RESULTS: The overall prevalence of depressive features in the surveyed population was 47.4% (45.9% in men and 48.5% in women). In a multiple logistic regression analysis, the significant variables of depressive features were no fixed occupation (odds ratio [OR] = 0.28; 95% confidence interval [CI]: 0.21-0.37), doing non-technical and service work (OR = 0.23; 95% CI: 0.19-0.28) or being a manager and technical personnel (OR = 0.25; 95% CI: 0.19-0.32), physical activities (OR = 0.71; 95% CI: 0.61-0.82), never taking dietary supplements (OR = 0.73; 95% CI: 0.58-0.91), not having hobbies (OR = 1.34; 95% CI: 1.15-1.56), never interacting with neighbours (OR = 1.79; 95% CI: 1.28-2.50), cold relationship with a spouse (OR = 3.34; 95% CI: 1.18-9.45) and limited activities of daily living (OR = 2.27; 95% CI: 1.91-2.69. CONCLUSION: There is an urgent need for public policy interventions to address depression in elderly people located in Suzhou in China. <![CDATA[<b>An exploration of alcohol use amongst undergraduate female psychology students at a South African university</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100012&lng=en&nrm=iso&tlng=en BACKGROUND: Alcohol use amongst tertiary education students, particularly female undergraduates, is increasing. Heavy alcohol use by tertiary students leads to a variety of alcohol-related problems such as damage to property, poor academic performance, problematic peer relationships, high dropout rates, unprotected sexual activity, physical injuries, date rape and suicide. Abuse of alcohol is attributed to curiosity and experimentation, peer pressure, low self-esteem, enjoyment, parental modelling, socio-cultural influences, stress and life events, self-medication and concerns about weight and appearance Our study explores alcohol use and the reasons behind it amongst undergraduate female psychology students at the University of Limpopo. The findings will be important, as these students represent many future psychologists who are going to advise others on harms related to alcohol use. METHODS: This was a descriptive survey, and the qualitative results are presented. The sample consists of 700 undergraduate female psychology students. A self-administered questionnaire included five open-ended questions which elicited the thoughts and experiences of these students about alcohol use. Responses to these questions were analysed using thematic content analysis RESULTS: The themes that arose were as follows: fun and enjoyment, socio-cultural influences, alcohol use leads to negative behaviour(s), peer influence, destress, concerns about weight and appearance, abstinence from alcohol and it improves self-esteem CONCLUSION: The themes were reasons that female students gave for consuming alcohol. The majority of participants reported responsible drinking behaviour, but a notable proportion of female students' drinking behaviours (across all year levels) are cause for concern in terms of negative impact at both social and academic levels <![CDATA[<b>High risk of metabolic syndrome among black South African women with severe mental illness</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100013&lng=en&nrm=iso&tlng=en BACKGROUND: There is an increased prevalence of metabolic syndrome (MetS) in individuals with severe mental illness (SMI) globally. The prevalence of MetS is higher in black women compared to black men from South Africa AIM: To compare the prevalence of MetS between black South African men and women with SMI taking antipsychotic medication. Further, this prevalence was compared to the prevalence in a matched control group of black South African men and women without SMI SETTING: A general hospital psychiatric unit METHODS: A cross-sectional study was undertaken to compare the prevalence of MetS in a group of multi-ethnic participants with SMI treated with antipsychotic medication and a matched control group without SMI, applying the 2009 Joint Interim Statement (JIS) criteria. Here, we included only the black African participants to compare MetS prevalence between men and women RESULTS: There were 232 participants in the group with SMI (male 155 and female 77) and without SMI (male 156 and female 76). The prevalence of MetS was more than three times higher in women with SMI compared to men with SMI (37.7% vs. 10.3%, p < 0.001). There was no significant difference in the prevalence of MetS in men or women between the groups with and without SMI. In multivariate logistic regression analysis, female gender (odds ratio [OR] 7.66), advancing age (OR 1.08) and longer duration of illness (OR = 1.15) were significant risk factors for MetS in SMI CONCLUSION: In black South Africans with SMI on antipsychotic medication, there is a higher prevalence and risk for MetS in women compared to men <![CDATA[<b>Validation of the Whooley questions for antenatal depression and anxiety among low-income women in urban South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100014&lng=en&nrm=iso&tlng=en BACKGROUND/OBJECTIVE: In South Africa, approximately 40% of women suffer from depression during pregnancy. Although perinatal depression and anxiety are significant public health problems impacting maternal and infant morbidity and mortality, no routine mental health screening programmes exist in the country. A practical, accurate screening tool is needed to identify cases in these busy, resource-scarce settings. METHOD: A convenience sample of 145 women between 22 and 28 weeks gestation was recruited from Rahima Moosa Hospital antenatal clinic in Johannesburg. All women completed a biographical interview, the Edinburgh Postnatal Depression Scale (EPDS), the Whooley questions and a structured clinical interview. RESULTS: The results demonstrate the sensitivity and specificity of the Whooley questions and the EPDS in identifying depression, anxiety and stress disorders of varying severity. The importance of personal, social and cultural context in influencing the content and expression of these common perinatal conditions was also identified. DISCUSSION AND CONCLUSION: The validity of the Whooley questions in the context of urban South Africa, and the importance of ensuring clinical interviews to supplement any screening tools, is emphasised. <![CDATA[<b>The development of the ICD-11 chapter on mental disorders</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100015&lng=en&nrm=iso&tlng=en BACKGROUND/OBJECTIVE: In South Africa, approximately 40% of women suffer from depression during pregnancy. Although perinatal depression and anxiety are significant public health problems impacting maternal and infant morbidity and mortality, no routine mental health screening programmes exist in the country. A practical, accurate screening tool is needed to identify cases in these busy, resource-scarce settings. METHOD: A convenience sample of 145 women between 22 and 28 weeks gestation was recruited from Rahima Moosa Hospital antenatal clinic in Johannesburg. All women completed a biographical interview, the Edinburgh Postnatal Depression Scale (EPDS), the Whooley questions and a structured clinical interview. RESULTS: The results demonstrate the sensitivity and specificity of the Whooley questions and the EPDS in identifying depression, anxiety and stress disorders of varying severity. The importance of personal, social and cultural context in influencing the content and expression of these common perinatal conditions was also identified. DISCUSSION AND CONCLUSION: The validity of the Whooley questions in the context of urban South Africa, and the importance of ensuring clinical interviews to supplement any screening tools, is emphasised. <![CDATA[<b>The South African Society of Psychiatrists/Psychiatry Management Group management guidelines for adult attention-deficit/hyperactivity disorder</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100016&lng=en&nrm=iso&tlng=en DISCLAIMER: These guidelines do not aim to provide a comprehensive review of all the pertinent literature comprising the evidence base and, as such, should be utilised in conjunction with other guidelines as well as the responsibility of practitioners to maintain a high level of personal knowledge and expertise. Despite the known efficacy of treatment and the substantial costs of untreated attention-deficit/hyperactivity disorder (ADHD), access to healthcare and treatment is not a given for many patients in South Africa (SA). In SA, there is poor identification and treatment of common mental disorders at primary healthcare level and limited access to specialist resources with a service delivery and treatment gap of up to 75%. Medication options are also often limited in emerging markets and in SA psychiatrists, and patients do not have access to the medication armamentarium available in established markets. Furthermore, the majority of South Africans currently utilise the public healthcare sector and may not have access to treatment options referred to in these guidelines. These guidelines should therefore not be seen as a policy document. THE PROCESS: The South African Society of Psychiatrists' Special Interest Group (SIG) for adult ADHD was launched on 25 September 2015, with doctors Rykie Liebenberg and Renata Schoeman as convenor and co-convenor, respectively. The overall objective of the ADHD SIG is to improve the basket of care available to patients with ADHD. This is only possible through a combined and concerted effort of individuals with a special interest in and passion for ADHD to improve knowledge about and funding for the care of individuals with the disorder. One of the specific aims of the ADHD SIG was to develop South African guidelines for the diagnosis and treatment of adult ADHD specifically and update guidelines for the treatment of child, adolescent and adult ADHD. Dr Schoeman has recently completed her MBA at the University of Stellenbosch Business School with a thesis entitled 'A funding model proposal for private health insurance for adult attention-deficit/hyperactivity disorder in the South African context'. This is first South African study exploring the situation with regard to the prevalence and treatment of adult ADHD. Dr Schoeman was tasked by the SIG with the drafting of guidelines. Dr Liebenberg provided valuable input. The guidelines were then circulated to the SIG members, as well as the Chair of the Public Sector SIG, for written feedback and evidence-based suggestions which were then incorporated into the guidelines. The final guidelines were circulated for written approval by the SIG members, followed by formal approval at a SIG meeting held on 14 August 2016, after which it was submitted to the South African Society of Psychiatrists (SASOP) and Psychiatry Management Group (PsychMG) boards for recommendation and ratification. <![CDATA[<b>Regional aspects of long-term public sector psychiatric care in the Eastern Cape</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100017&lng=en&nrm=iso&tlng=en OBJECTIVES: The objective of this research was to determine regional aspects (such as clinical, geographic and socio-demographic) influencing the use of public sector long-term psychiatric services in the Eastern Cape. This is important in improving service delivery, to assist policy developers with evidence-based research and in providing equitable and efficient resource utilisation. METHODOLOGY: A situational analysis of Tower Psychiatric Hospital and Psychosocial Rehabilitation Centre (TPHPRC) in the Eastern Cape was conducted. Patient administrative data were utilised to determine geographic origin, date and age at admission, gender and diagnosis as of December 2015. The number of admissions from each region for the years 2010-2015 was also extracted from these data RESULTS: As of December 2015, there were a total of 390 patients at TPHPRC. Of these, 87% were male patients. The average age at admission for male and female patients was 36 years and 44 years, respectively. Of the patients, 53% originated from the western regions and 57% of female patients presented with a dual diagnosis. The highest number of admissions was in 2015, with the majority originating from Port Elizabeth. CONCLUSION: Despite higher access to public psychiatric care in the western region, the majority of patients originated from there. Contributing factors to this include diagnoses, insufficient bed numbers and the absence of admission criteria and referral pathways. It is recommended that the provincial Department of Health set up a task team to determine a standardised working framework for all public sector psychiatric institutions. This should be informed by national policies, legislation and provincial norms and indicators. <![CDATA[<b>Couples-based interventions in the context of HIV discordance</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100018&lng=en&nrm=iso&tlng=en OBJECTIVES: The objective of this research was to determine regional aspects (such as clinical, geographic and socio-demographic) influencing the use of public sector long-term psychiatric services in the Eastern Cape. This is important in improving service delivery, to assist policy developers with evidence-based research and in providing equitable and efficient resource utilisation. METHODOLOGY: A situational analysis of Tower Psychiatric Hospital and Psychosocial Rehabilitation Centre (TPHPRC) in the Eastern Cape was conducted. Patient administrative data were utilised to determine geographic origin, date and age at admission, gender and diagnosis as of December 2015. The number of admissions from each region for the years 2010-2015 was also extracted from these data RESULTS: As of December 2015, there were a total of 390 patients at TPHPRC. Of these, 87% were male patients. The average age at admission for male and female patients was 36 years and 44 years, respectively. Of the patients, 53% originated from the western regions and 57% of female patients presented with a dual diagnosis. The highest number of admissions was in 2015, with the majority originating from Port Elizabeth. CONCLUSION: Despite higher access to public psychiatric care in the western region, the majority of patients originated from there. Contributing factors to this include diagnoses, insufficient bed numbers and the absence of admission criteria and referral pathways. It is recommended that the provincial Department of Health set up a task team to determine a standardised working framework for all public sector psychiatric institutions. This should be informed by national policies, legislation and provincial norms and indicators. <![CDATA[<b>Alcohol use disorder and tuberculosis treatment: A longitudinal mixed method study in Thailand</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100019&lng=en&nrm=iso&tlng=en OBJECTIVE: The relationship between tuberculosis (TB) treatment and alcohol use disorders over time is under-researched. The aim of this investigation was to study alcohol use and TB medication adherence and its predictors among TB patients over a period of 6 months. METHODS: A longitudinal investigation was carried out with new TB and TB retreatment patients systematically selected from two hospitals and had screened positive for hazardous or harmful alcohol use in Sisaket Province in Thailand. Alcohol use disorders were measured with Alcohol Use Disorder Identification Test (AUDIT)-C at baseline, 3 months and 6 months. RESULTS: Of the 295 TB patients who were screened with AUDIT-C, 72 (24.4%) tested positive for hazardous or harmful alcohol use. At 6 months, 72 TB patients had completed the follow-up. At the 6-month follow-up, hazardous or harmful drinking was reduced by 84.7%. Multivariate logistic regression analysis using generalised estimation equation modelling found that alcohol use significantly reduced over time, whereas there was no change in current tobacco use. CONCLUSION: The prevalence of alcohol use disorders significantly reduced over a period of 6 months. <![CDATA[<b>Accountable or not accountable: A profile comparison of alleged offenders referred to the Free State Psychiatric Complex Forensic Observation Ward in Bloemfontein from 2009 to 2012</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100020&lng=en&nrm=iso&tlng=en BACKGROUND: The crime rate in South Africa is extraordinarily high. The problem of crime is further complicated when a person, who suffers from a mental illness, becomes involved in a crime. Furthermore, the forensic evaluation of a person suspected of having a mental illness involved in alleged criminal behaviour can be challenging. However, a dearth of information exists in South African literature regarding the link between crime and mental illness. AIM: To determine the percentage of alleged offenders, referred to the Free State Psychiatric Complex (FSPC) for observation, found accountable and not accountable, and to compare the biographical, diagnosis and offence profiles of these two groups. The analysis of differences can contribute to a better understanding of the complex process of forensic assessments. SETTING: Forensic Observation Ward, FSPC, Bloemfontein. METHODS: In this comparative, retrospective study, all 505 trial-awaiting alleged offenders (observati) referred from 2009 to 2012 for a 30-day observation period, according to Sections 77 and/or 78 of the Criminal Procedures Act, were included. Results were summarised as frequencies and percentages, and means or percentiles. Significant differences between the groups were determined by sample t-tests or chi-squared tests. RESULTS: Observati found not accountable were in the majority (64.5%). Significant differences were found regarding marital and employment status, substance abuse, type of offence and diagnoses between the two groups. Almost all of the observati found to be not accountable were diagnosed with mental illness at the time of the assessment, whereas most observati found to be accountable for their actions at the time of the alleged offence were not found to be mentally ill. Observati found not accountable were significantly more likely to be diagnosed with schizophrenia, intellectual disability and substance-induced psychotic disorder, and committed mostly assault, murder and vandalism. Observati found accountable committed mostly rape, murder and theft. CONCLUSION: The majority of observati were found not accountable, with significant differences found between the two groups regarding demographic characteristics, type of diagnosis and offences committed. The identified differences can be used to assist in establishing criteria for the appropriate referral of alleged offenders by courts. Unnecessary referrals have a serious financial impact on the Department of Health. Furthermore, the high incidence of substance abuse among persons referred to the FSPC highlights the need for more substance rehabilitation centres in the Free State Province. <![CDATA[<b>Association between depression, glycaemic control and the prevalence of diabetic retinopathy in a diabetic population in Cameroon</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100021&lng=en&nrm=iso&tlng=en PURPOSE: The prevalence of diabetes mellitus is increasing especially in low- and middle-income countries in which 75% of the world's diabetic population reside. The macro- and microvascular complications of diabetes such as diabetic retinopathy are also set to increase in these populations. The relationship between depression and glycaemic control has been established in high-income countries, but evidence from low- and middle-income countries is scarce. This research aimed to determine an association between depression and glycaemic control and record the prevalence of diabetic retinopathy in a diabetic population in Cameroon. METHODS: Analysis of cross-sectional data from the 'Improving access to HbA1c measurements in sub-Saharan Africa' study was used. Primary data were collected from six diabetic care facilities in Yaoundé, Cameroon. Participants were aged ≥ 18 years with at least a 6-month history of diabetes. Depression was assessed using the Centre for Epidemiological Studies Depression Scale (CES-D). A CES-D score ≥ 16 was used to identify the presence of clinically significant depressive symptoms. Data on glycaemic control were measured using HbA1c measurements at baseline. The presence of diabetic retinopathy was established through ophthalmoscopy and angiography using the Early Treatment Diabetic Retinopathy Study classification. RESULTS: A total of 261 participants were included in the study, and information on depressive symptoms at baseline (CES-D score) were available for 240 participants. The results of the data analysis found that 60% of the study participants had clinically significant depressive symptoms (CES-D > 16). A weak non-significant positive correlation was found between CES-D score and HbA1c level (p = 0.46, r = 0.05) using the Pearson's correlation co-efficient. Gender and attendance to a patient support group were significantly associated with the presence of clinically significant depressive symptoms. Poor glycaemic control (HbA1c > 7%) was found in 72.8% of the population. Educational level and insulin use were significantly associated with glycaemic control. The prevalence of diabetic retinopathy was 27.2% (23.4% non-proliferative, 2.5% pre-proliferative and 3.2% proliferative), and the prevalence of diabetic maculopathy was 10.0%. CONCLUSION: The study found that a large proportion of diabetic patients may be experiencing depressive symptoms for which they are currently not receiving treatment or support. We also found a large proportion to have poor glycaemic control that is known to worsen the vascular complications of diabetes. In light of the increasing epidemic of type 2 diabetes in sub-Saharan Africa, it is important that the recognition of depressive symptoms becomes integrated into future healthcare policies in the nations of sub-Saharan Africa. This research suggests that individuals experiencing depressive symptoms may be more likely to engage in patient support groups. These groups can be beneficial in providing patients with diabetes valuable information, which could lead to better glycaemic control. <![CDATA[<b>The clinical value of brain computerised tomography in a general hospital psychiatric service</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100022&lng=en&nrm=iso&tlng=en BACKGROUND: The use of neuroimaging modalities in psychiatry has been evaluated in several studies. The vast majority seem to suggest that neuroimaging may be overutilised in psychiatry. There is a significant constraint on availability and cost related to neuroimaging of patients at general state medical facilities. The routine use of computerised tomography (CT) scanning is thus questioned. METHODS: A retrospective analysis was undertaken of all psychiatric inpatients who had CT scans performed from 01 January 2011 to 31 December 2012. Demographic data, mental state examination, physical examination findings, substance use and diagnosis upon admission were recorded. The relationship between these variables and CT scan findings was analysed. RESULTS: A total of 897 admissions were retrospectively analysed. One hundred and three patients had documented CT scan imaging. In total, 17 of the 23 patients with abnormal findings on CT scan were found to be psychotic (74.0%). The remaining 26.0% included depression and dementia. There was no statistically significant difference between the normal and abnormal CT scan groups with regard to gender, age, family history, substance use and physical examination. The majority (65.2%) had cerebral atrophy and/or cerebral calcifications. A smaller group of other documented findings was noted. CONCLUSIONS: Selective indications and clinical markers may be utilised in order to justify brain imaging studies rather than performing them routinely. That being true, a multicentre study with a larger sample size is indicated to further improve the statistical significance and assist in formulating a more concrete guideline for neuroimaging of psychiatric patients. <![CDATA[<b>Achievements hitherto and a new editorial team for the <i>South African Journal of Psychiatry</i></b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100023&lng=en&nrm=iso&tlng=en BACKGROUND: The use of neuroimaging modalities in psychiatry has been evaluated in several studies. The vast majority seem to suggest that neuroimaging may be overutilised in psychiatry. There is a significant constraint on availability and cost related to neuroimaging of patients at general state medical facilities. The routine use of computerised tomography (CT) scanning is thus questioned. METHODS: A retrospective analysis was undertaken of all psychiatric inpatients who had CT scans performed from 01 January 2011 to 31 December 2012. Demographic data, mental state examination, physical examination findings, substance use and diagnosis upon admission were recorded. The relationship between these variables and CT scan findings was analysed. RESULTS: A total of 897 admissions were retrospectively analysed. One hundred and three patients had documented CT scan imaging. In total, 17 of the 23 patients with abnormal findings on CT scan were found to be psychotic (74.0%). The remaining 26.0% included depression and dementia. There was no statistically significant difference between the normal and abnormal CT scan groups with regard to gender, age, family history, substance use and physical examination. The majority (65.2%) had cerebral atrophy and/or cerebral calcifications. A smaller group of other documented findings was noted. CONCLUSIONS: Selective indications and clinical markers may be utilised in order to justify brain imaging studies rather than performing them routinely. That being true, a multicentre study with a larger sample size is indicated to further improve the statistical significance and assist in formulating a more concrete guideline for neuroimaging of psychiatric patients. <![CDATA[<b>Perceived parental rejection mediates the effects of previous maltreatment on emotional and behavioural outcomes in Chinese adolescents whereas mental illness has no moderating effect</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100024&lng=en&nrm=iso&tlng=en OBJECTIVE: This study assessed the mediating role of perceived parental rejection in the relationship between childhood maltreatment experience and behavioural problems in Chinese adolescents. METHODS: A total of 2484 adolescents (1305 males and 1179 females; aged 12-16 years) from Hunan Province, China, participated in the study. Behavioural problems, parental rejection scores and child abuse experiences were evaluated by the Child Behavior Checklist (parental version), the Memories of Parental Rearing Behavior Scale and the Childhood Trauma Questionnaire, separately. Mediating effects were examined by structural equation modelling using Amos 20 software. RESULTS: The study found that perceived maternal rejection partially mediated the association between abuse and internalising behaviours in the male cohort, whereas perceived father's rejection partially mediated this association in the female cohort. However, mental illness had no moderating effect on these relationships. CONCLUSION: These results are consistent with the literature on maltreatment and parent-child relationships and provide empirical support for the view that emotional and behavioural problems related to perceived parental rejection underlie the development of psychosocial problems in adolescents. <![CDATA[<b>Junior medical students' knowledge about and attitudes towards electroconvulsive therapy in a South African setting</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100025&lng=en&nrm=iso&tlng=en BACKGROUND: Although electroconvulsive therapy (ECT) is a safe and effective treatment modality with a long history of use in psychiatry, it remains controversial owing to misconceptions and negative attitudes among the public and medical profession. The aim of this study was to explore the state of knowledge and attitudes towards ECT among a sample of South African medical students. METHOD: Prior to their theoretical psychiatry module, 131 second-year medical students responded to an anonymous online survey designed to assess the source and extent of their ECT knowledge as well as their attitude towards ECT and psychiatry in general. RESULTS: The Internet (46.6%) and TV and/or movies (30.5%) were the principal sources of knowledge of ECT while 'professional publication' was the least common (0%). The students' attitudes towards psychiatry were generally positive and nearly one-third (29.8%) would consider specialising in the field. Overall, perception towards ECT was mixed, with many respondents approving of its use albeit only as a last resort. Notably, low ECT knowledge scores were associated with more negative attitudes towards this treatment modality and a lower perception of psychiatry as a medical speciality. CONCLUSION: The findings indicate that for these students, media is the main source of ECT knowledge. While they are generally knowledgeable about ECT, they still harbour some misconceptions and negative attitudes about the treatment. Knowledge appears able to amend these attitudes, thus underlining the importance of integrating accurate information about ECT into the preclinical medical curriculum rather than leaving it to mass media to forge warped perceptions and attitudes for these future clinicians. <![CDATA[<b>Community mental health services in Southern Gauteng: An audit using Gauteng District Health Information Systems data</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100026&lng=en&nrm=iso&tlng=en BACKGROUND: Community mental health services (CMHS) are a central objective of the National Mental Health Policy Framework and Strategic Plan. Three core components are described: residential facilities, day care and outpatient services. Primary mental health care with specialist support is required according to an intervention pyramid. Staffing norms provide for a minimum mental health service coverage of 2.7% of the population for adults and 1.5% for children and adolescents. AIM: The aim of this study was to describe the existing CMHS in Southern Gauteng in terms of the National Mental Health Policy. METHODS: The CMHS of the City of Johannesburg, Ekurhuleni, Sedibeng and West Rand districts were studied. Information regarding service organisation and staffing was obtained via the Gauteng Directorate of Mental Health. Routinely collected District Health Information Systems data for the 2014/2015 year were analysed. RESULTS: The organisation of services was not consistent with that recommended by the Mental Health Policy, and specialist CMHS were inappropriately situated within primary care. Only 2.23% of clinic visits were for mental health, and 80% of these were at specialist CMHS. Overall mental health coverage was approximately 0.3% of the population for adults and 0.02% for children and adolescents. Staffing, residential facilities and day care were far below the cited norms for minimal cover. CONCLUSION: Our audit revealed that the CMHS in Southern Gauteng did not meet any of the norms cited by the Mental Health Policy. Barriers to implementation of this aspect of the Mental Health Policy need to be explored. <![CDATA[<b>A retrospective record review and assessment of cost of quetiapine use in a community psychiatric setting in the Sedibeng district of Gauteng</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100027&lng=en&nrm=iso&tlng=en BACKGROUND: With the revision of the National Essential Medicines List in South Africa, quetiapine is only available at the discretion of individual institutions in the public health sector. However, quetiapine is effective in managing all aspects of bipolar disorder, including preventative treatment of depressive episodes, and may be a cost-effective option in severe illness. AIM: To present the first retrospective review of quetiapine use in a peri-urban health district of South Africa, describing the patient profile, clinical response and prescribing patterns. METHODS: The clinical files of all patients in Sedibeng District who received quetiapine over a defined 3-year period (2011-2013) were reviewed. A positive clinical response was defined as both symptomatic and functional improvement. Demographic and clinical characteristics of responders were compared with that of non-responders. Pre- and post-quetiapine scripts of the responders were audited and costed. RESULTS: Patients who received quetiapine (n = 40) had chronic disabling illness, often with multiple medication trials and hospitalisations prior to quetiapine use. Bipolar II disorder (followed by bipolar I disorder) was the most common primary psychiatric diagnosis documented. Other than improvement in functioning (p < 0.0001), responders differed significantly from non-responders in terms of a higher level of polypharmacy and a significant reduction in median number of medications from pre- to post-quetiapine (p = 0.0057). CONCLUSION: Quetiapine use was associated with a highly significant improvement in functioning; however, it came at a 52% increase in medicine cost. Pre-quetiapine treatments, though, did not achieve an optimal level of functioning, and overall costs may be reduced by more rational prescribing habits. <![CDATA[<b>Antipsychotic use in a resource-limited setting: Findings in an Eastern Cape psychiatric hospital</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862017000100028&lng=en&nrm=iso&tlng=en BACKGROUND: Second-generation antipsychotics (SGAs) are commonly prescribed despite the fact that large, naturalistic studies have failed to show superior efficacy and tolerability when compared with first-generation antipsychotics (FGAs). In addition to this, the availability of SGAs in the South African public health sector is limited because of higher acquisition costs. Therefore, judicious use of FGAs, which are affordable and more widely available, should be considered. AIMS: This study aimed to (1) determine how frequently patients are switched from an FGA to an SGA in an acute psychiatric hospital in the Eastern Cape, (2) determine reasons for switching and (3) compare the profiles of the switch group to the non-switch group. METHOD: The study is a cross-sectional survey conducted as a retrospective chart review at a psychiatric hospital in the Eastern Cape over a study period of 2 months. The demographics, diagnostic data, antipsychotic drug used and whether a switch from an FGA to an SGA took place were recorded using a data collection document. The sample included 169 patients. RESULTS: Of the 169 patients, 125 (74%) were initiated on an FGA and 44 (26%) on an SGA on admission. Of the 125 patients who were initiated on an FGA, 43 (34%) were switched to an SGA during the course of the admission. Therefore, 87 (51%) participants were discharged on an SGA. The main reasons for switching were the emergence of extrapyramidal side-effects (EPSE) (63%) followed by lack of efficacy (19%). The only statistically significant difference between the switch and non-switch groups was that the switch group was on average younger than the non-switch group. CONCLUSION: SGAs, with the exception of clozapine, have not been proven to be superior to FGAs. Although FGAs are more prone to cause EPSE, SGAs carry significant risks of their own. FGAs are also more freely available and cost effective in South-Africa. Despite these facts the prescribing of and switching to SGAs remain prevalent in our setting with a switch rate of 34% and more than half of our patients being discharged on SGAs.