Scielo RSS <![CDATA[South African Journal of Psychiatry ]]> vol. 26 num. 1 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>Predictors of bullying reported by perpetrators in a sample of senior school students in Benin City, Nigeria</b>]]> BACKGROUND: Bullying behaviour amongst adolescents is becoming a significant public health challenge. Whilst the traditional and electronic bullying as reported by victims has been widely reported, surveys amongst perpetrators, particularly in Africa, are still lacking. AIM: This study is aimed at determining the prevalence of bullying by perpetrators and analysing the relationship between bullying perpetration and psycho-socio-demographic characteristics amongst senior school students in Benin City, Nigeria. SETTING: Senior secondary school in Benin City, Nigeria. METHODS: A cross-sectional survey of 465 final-year secondary school students aged 16-19 years, who were selected by multistage random sampling, was conducted. The students were made to fill a self-designed questionnaire, in addition to an adapted version of the Wagnild and Young's resilience scale. RESULTS: The lifetime prevalence of bullying was 16.3%. Binary logistic regression revealed bullying to be significantly associated with students who are male (adjusted odds ratio [AOD] = 2.13, confidence interval [CI] = 1.16-3.93), have poor relations with their teachers (AOR = 2.98, CI = 1.68-5.29), have used alcohol (AOR = 3.51, CI = 1.74-7.09) and are involved in cult and gangsterism (AOR = 9.14, CI = 2.55-32.75). CONCLUSION: The rate of bullying perpetration by youth in Benin City, Nigeria, is significant and is comparable to global occurrence. The predictors of bullying in this study suggest that perpetrators are individuals who may benefit from rehabilitative measures. <![CDATA[<b>Factors associated with the successful completion of a substance rehabilitation programme at a psychiatric training hospital</b>]]> BACKGROUND: Comorbid psychiatric and substance use disorders are common and present several treatment challenges. AIM: The aim of this study was to determine which patient and substance factors are associated with the completion of a substance rehabilitation programme in psychiatric inpatients. SETTING: The study was conducted at the Substance Rehabilitation Unit (SRU) at Weskoppies Hospital, a psychiatric training hospital in South Africa, which offers a 6-week programme at the hospital for psychiatric inpatients. METHODS: This descriptive, retrospective hospital-based study was carried out comparing completers and non-completers of the SRU programme with respect to patient and substance factors. All patients accepted into the SRU during 2013-2014 were included (n = 119). Data were collected over a year (2016-2017) from the clinical files, SRU referral forms, SRU attendance register, hospital computerised demographic records, nursing notes and administration files using a data collection sheet designed by the researchers for this study. Comparison between completers and non-completers was performed using Chi-Square or Fisher's Exact tests. RESULTS: The SRU accepted 119 patients from January 2013 to December 2014. The majority of the sample were involuntary patients (n = 39), 30-49 years old (n = 57), male (n = 89), unmarried (n = 112), never having received a disability grant (n = 27), unemployed (n = 96) and with a Grade 8-11 education (n = 49). Substance-induced psychotic disorders (n = 39), schizophrenia (n = 29) and bipolar disorders (n = 22) were found to be common. Frequent medical comorbidities included head injury (n = 27), cardiovascular disease (n = 18) and HIV reactivity (n = 7). Cannabis (n = 98), alcohol (n = 94) and nicotine (n = 90) were the most frequently used substances. Level of education (p = 0.004), disability grant status (p = 0.004), Nyaope use (p = 0.001) and nicotine use (p = 0.049) were statistically seen to be significantly associated with completion. Psychiatric diagnoses and general medical comorbidity were not associated with completion. CONCLUSIONS: This study has yielded several results in areas that have not yet been well researched in South Africa. Risk factors for non-completion may include lower levels of education, being on a disability grant and using Nyaope or nicotine, but may vary in different settings. Future research should focus on identifying further factors that may affect completion of substance rehabilitation in psychiatric inpatients, the role of disability grants in patients with co-occurring disorders and the effect of Nyaope and nicotine use on treatment outcomes in this population. Effective and accessible interventions to assist vulnerable patients also need to be identified. <![CDATA[<b>To scan or not to scan? Examining the controversial issue of performing neuroimaging in adolescent patients presenting to a tertiary psychiatric inpatient unit</b>]]> BACKGROUND: Imaging techniques such as computerised tomography (CT), magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT) scans are used in various clinical and diagnostic neuropsychiatric assessments. However, these investigations may be costlier when compared to their clinical utility. AIM: To examine the clinical utility of neuroimaging in an acute adolescent psychiatric inpatient population admitted to Tygerberg Hospital between January 2012 and December 2013. SETTING: The study was conducted at a tertiary level adolescent psychiatric inpatient unit at Tygerberg Tertiary Hospital, Parow, Cape Town, Western Cape, South Africa. METHOD: A retrospective chart review was conducted to gather data from 125 inpatient adolescents who had neuroimaging performed during admission. Clinical information was obtained from folders and collated with neuroimaging data. The Pearson Chi-squared test was used to test for correlations between clinical variables and the outcomes (abnormalities) of CT scans. There were too few MRI or SPECT scans to warrant statistical testing for these modalities. RESULTS: Out of the total CT scans performed (n = 120), 11 (9.2%) were clinically significant or pathological. Five cases (4.2% of all CT scans) resulted in a change in diagnosis and management. There was no association between clinical variables and clinically relevant CT abnormalities (n = 11). There were three MRI abnormalities (30%), with two resulting in changes in management. Single photon emission computed tomography scans revealed abnormalities in all 10 cases. CONCLUSION: Routine neuroimaging in this population of psychiatric adolescents has high clinical utility. However, the decision to conduct structural neuroimaging should be guided by good clinical assessment. Single photon emission computed tomography scanning is useful for detecting underlying neurophysiological abnormalities in patients presenting with psychiatric and behavioural symptoms to potentially aid diagnosis and for interventional purposes. <![CDATA[<b>Psycho-demographic and clinical predictors of medication adherence in patients with bipolar I disorder in a university hospital in Egypt</b>]]> BACKGROUND: Poor adherence to treatment is one of the main challenges to symptom control and preventing recurrence in bipolar disorder (BD). Numerous studies have established an association between patients' poor adherence and an increased risk of recurrence, relapse of the symptoms and admission to hospital. AIM: To study the socio-demographic and clinical factors associated with medication nonadherence in patients with BD who were admitted to the hospital. SETTING: The study was conducted at the Institute of Psychiatry, Ain Shams University. METHODS: A 1-year longitudinal prospective study of 110 patients, aged 18-60 years, with BD-I. Young Mania Rating Scale, Clinical Global Impression, Global Assessment of Functioning, Sheehan Disability Scale and Insight and Treatment Attitude Questionnaire were applied before and 6 months after discharge. Adherence was measured using the Morisky 8-Item Medication Adherence Scale. Sociodemographic data and level of functioning were studied in relation to adherence. RESULTS: Higher adherence was noticed in female, married and older patients and those with a higher level of education. However, low adherence was more common in male, non-married and less educated patients. Follow-up after 6 months revealed that the high adherence group scored the lowest in terms of disability. Meanwhile, the low adherence group scored the highest scores in disability. CONCLUSION: Several socio-demographic and clinical variables were found to be associated with a low adherence rate to the prescribed medication in patients with BD-I. Age and impaired insight were found to be significant predictive factors for non-adherence. <![CDATA[<b>Family history identifies sporadic schizoaffective disorder as a subtype for genetic studies</b>]]> BACKGROUND: Schizophrenia is a heterogeneous disorder with strong genetic vulnerability. Family history of schizophrenia has been considered in genetic studies under several models. De novo genetic events seem to play a larger role in sporadic cases. AIM: This study used the familial-sporadic distinction with the aim of identifying a more homogeneous phenotype to delineate the genetic and clinical complexity of schizophrenia. SETTING: The study was conducted at Weskoppies Hospital, Pretoria, South Africa. METHODS: The study included 384 participants with schizophrenia or schizoaffective disorder from the Afrikaner founder population in South Africa who are considered comparable to Caucasian patients from the United States. A comprehensive data capturing sheet was completed. RESULTS: When schizophrenia and schizoaffective disorder diagnoses were considered jointly, we found no significant differences between the sporadic and the familial groups for age at disease onset, season of birth, comorbid diagnoses, clinical symptomatology, history of suicide or marital status. When the diagnoses were examined separately, however, the sporadic schizoaffective disorder, bipolar type, was found to have a significantly lower age at onset (mean 20.6 vs. 25.3 years). CONCLUSION: The sporadic schizoaffective disorder, bipolar type, forms a more homogeneous subgroup for genetic studies. <![CDATA[<b>Methods of deliberate self-harm in a tertiary hospital in South Africa</b>]]> BACKGROUND: Little is known about the methods of deliberate self-harm (DSH) in South Africa (SA), despite the importance of means restriction as a public health strategy to reduce the morbidity and mortality associated with self-harm. AIM: The aim of this study was to investigate the range of methods used in DSH and identify the socio-demographic and clinical factors associated with violent and non-violent methods of DSH among patients treated at a tertiary hospital in SA. SETTING: The study was conducted at an urban, tertiary level emergency department at Groote Schuur hospital in Cape Town, South Africa. METHOD: Data were collected from 238 consecutive DSH patients who presented for emergency department treatment at the hospital. Logistic regression models were used to explore the factors associated with violent and non-violent methods of DSH. RESULTS: Self-poisoning was the most common method of self-harm (80.3%). Prescription medication was the most common form of self-poison (57.6%), while a large number of patients used non-prescription paracetamol (40.9%). In the regression analysis, male gender, stating that the reason for DSH was to escape a situation and history of substance use were associated with violent method of DSH. CONCLUSION: Improved monitoring of prescription medications commonly used in DSH is integral to public health suicide prevention strategies in SA. This study underscores the need for substance use interventions in the healthcare setting. <![CDATA[<b>Case study: A patient with severe delusions who self-mutilates</b>]]> BACKGROUND: Little is known about the methods of deliberate self-harm (DSH) in South Africa (SA), despite the importance of means restriction as a public health strategy to reduce the morbidity and mortality associated with self-harm. AIM: The aim of this study was to investigate the range of methods used in DSH and identify the socio-demographic and clinical factors associated with violent and non-violent methods of DSH among patients treated at a tertiary hospital in SA. SETTING: The study was conducted at an urban, tertiary level emergency department at Groote Schuur hospital in Cape Town, South Africa. METHOD: Data were collected from 238 consecutive DSH patients who presented for emergency department treatment at the hospital. Logistic regression models were used to explore the factors associated with violent and non-violent methods of DSH. RESULTS: Self-poisoning was the most common method of self-harm (80.3%). Prescription medication was the most common form of self-poison (57.6%), while a large number of patients used non-prescription paracetamol (40.9%). In the regression analysis, male gender, stating that the reason for DSH was to escape a situation and history of substance use were associated with violent method of DSH. CONCLUSION: Improved monitoring of prescription medications commonly used in DSH is integral to public health suicide prevention strategies in SA. This study underscores the need for substance use interventions in the healthcare setting. <![CDATA[<b>Eating disorders and substance use at a South African tertiary hospital over a 21-year period</b>]]> BACKGROUND: Eating disorders (EDs) and substance-related disorders pose a challenge when they co-occur and have implications for patient management. Clinical information on EDs and substance-related disorders as independent disorders is fairly well established in South Africa, but our understanding of the coexistence of these disorders is limited. AIM: To determine the prevalence, the concurrent nature and the possible trends of substance use among patients diagnosed with EDs at a South African tertiary hospital over a 21-year period. SETTING: The ED unit at Tygerberg Hospital, Cape Town, South Africa. METHODS: We performed a retrospective chart review of 162 patients who were treated for EDs between January 1993 and December 2014. RESULTS: The prevalence of ED subtypes was 40.1% bulimia nervosa (BN), 33.3% EDs not otherwise specified (EDNOS) and 26.5% anorexia nervosa. Most participants (71.0%) used at least one substance. Alcohol was the most prevalent substance of choice (54.8%). Most patients had an additional psychiatric disorder (62.3%), of which major depressive disorder was the most prevalent (46.3%). Apart from the use of alcohol and cannabis, which remained consistent, the use of most other substances as well as the prevalence of BN declined during the study period. CONCLUSION: Understanding the prevalence and trends of EDs and the corresponding patterns of substance misuse is essential to improve service provision. This study emphasises the need to better understand the ongoing and changing behavioural trends in EDs to improve patient management. <![CDATA[<b>Initiating clozapine treatment service and characteristics of clozapine-treated patients in a general hospital in Addis Ababa, Ethiopia</b>]]> BACKGROUND: At least one-third of patients with schizophrenia suffer from treatment-resistant schizophrenia needing treatment with clozapine. This is the first report on the experience of initiating clozapine service in Ethiopia. AIM: The aim of this study was to report the experience of setting up clozapine service and describe characteristics of patients treated with clozapine. SETTING: This study was conducted in a general hospital in Addis Ababa, Ethiopia. METHODS: Descriptive summary of the clozapine treatment service and review of characteristics of patients treated with clozapine were conducted. Clinical Global Impression (CGI) Scale and Abnormal Involuntary Movement Scale (AIMS) score were used to measure outcome. Quantitative data were analysed using Statistical Package for the Social Sciences (SPSS) Version 24. RESULTS: It was possible to provide clozapine treatment in a general hospital using the national guideline. During the first year of initiation of the service, a total of 22 patients were treated. The majority were men (20/22, 90.9%) and in the age group of 30-44 years (11/22, 50%). Indications for clozapine were treatment-resistant schizophrenia (15/22, 68.2%) and tardive dyskinesia (7/22, 31.8%). The average dose of clozapine was 350 mg/day. Common side effects included sedation, constipation and excessive salivation. On CGI Scale, mean severity index score dropped from 5.18 at admission to 3.68 during discharge, and average AIMS score changed from 16.8 to 6.5. None of the patients developed agranulocytosis; however, three patients discontinued because of adverse effects. CONCLUSION: Establishing clozapine treatment service was possible in a general hospital in Ethiopia where psychiatric service run by psychiatrists was available. Mechanisms should be in place to ensure adherence to the national guideline. <![CDATA[<b>Socio-economic factors associated with mental health disorders in Fort Portal, western Uganda</b>]]> BACKGROUND: Mental health disorders, which are interlinked with social issues such as poverty and stigma, present a significant burden in Uganda. AIM: This article explores perceptions about and experiences of mental health disorders in western Uganda, particularly as they pertain to the socio-economic context. SETTING: The research was conducted in the mental health unit at the Fort Portal Regional Referral Hospital, Kabarole District, Uganda. METHOD: This article is based on qualitative anthropological research conducted from January to March 2017, including 49 semi-structured interviews about ideas and determinants of mental health, with health workers, former mental health service users, their relatives and influential community members. RESULTS: Many interviewees felt that mental health disorders are an increasing problem in their community. Economic challenges, such as poverty, unemployment and financial stress, are seen as both a cause and a consequence of mental illness. Mental health challenges can be exacerbated by shortages in mental healthcare, which are shown to be complexly interrelated with stigma. CONCLUSION: This article provides an insight into mental health experiences in Fort Portal based on the perspectives of various interviewees. Further funding and research are recommended to inform contextually appropriate services. <![CDATA[<b>Subjective and objective cognition 6-week post-coronary artery bypass graft surgery: A descriptive pilot study</b>]]> BACKGROUND: Coronary artery bypass graft (CABG) surgery has been found to be associated with post-operative cognitive decline. Despite the large and growing numbers being conducted in South Africa, the associated or ensuing cognitive symptoms or impairment have received little research attention. AIM: The aim of this pilot study was to describe the nature and extent of subjective cognitive complaints (SCCs) and objective cognitive impairments in patients 6-week post-CABG surgery in a clinical sample in KwaZulu-Natal (KZN) Province, South Africa SETTING: A cross-sectional survey was conducted among outpatients attending their 6-week post-CABG surgical review at a cardiology clinic in a KZN provincial hospital. METHOD: Socio-demographic and clinical data were captured, with SCCs being determined by using standardised questions; cognition was assessed with the Montreal cognitive assessment (MoCA). RESULTS: The mean age of the sample (n = 28) was 58.72 years. The mean MoCA score was 23.96 (SD = 4.32); 60.71% (n = 17) screening positive (< 25/30) and more likely to be older, male, hypertensive and diabetic. A third (n = 9; 35.71%) reported at least one new SCC; their mean age was 55.36 years which was lower than those without subjective complaints (59.81). CONCLUSIONS: Subjective and objective cognitive impairments were evident in patients 6-week post-CABG surgery identifying a need for longitudinal cognitive screening both pre- and post- operatively in patients undergoing CABG surgery. <![CDATA[<b>Attitude and preferences towards oral and long-acting injectable antipsychotics in patients with psychosis in KwaZulu-Natal, South Africa</b>]]> BACKGROUND: Patient attitudes to and satisfaction with their treatment are associated with improved adherence. There is a paucity of data on patient drug attitudes and preference to oral compared to long-acting injectable (LAI) antipsychotic treatment. AIM: To describe patients attitudes and preferences towards oral versus LAI antipsychotic formulations and explore factors associated with their drug attitudes. SETTING: Two psychiatric hospitals in KwaZulu-Natal, South Africa. METHOD: A cross-sectional survey of 140 adult outpatients with schizophrenia spectrum disorders receiving LAI with or without oral antipsychotics (a total of 70) were compared to patients receiving oral antipsychotics only (N = 70). A sociodemographic-clinical questionnaire, chart review and the Drug Attitude Inventory scale (DAI-30) were used. RESULTS: Of the 140 participants, 98 (70%) preferred the medication formulation currently prescribed, and 132 (94.3%) reported a positive drug attitude towards their antipsychotic medication. The adjusted regression analysis indicated that study participants who were currently on a formulation that matched their preference scored better on the DAI-30 than individuals with a mismatch in use and preference (p < 0.04). In terms of covariates, we found, on one hand, that study participants who are divorced (compared to single) with schizophrenia diagnosis (compared to other psychotic or schizoaffective disorder) are more likely to have lower score on DAI-30. On the other hand, we found that study participants with a higher household income and longer duration of the psychotic illness were associated with greater DAI-30 score. CONCLUSION: The majority of participants preferred their current oral and LAI formulation. Drug attitude was influenced by several factors, including matched medication use. Focused psychoeducation should be considered for newly diagnosed, lower socio-economic groups and patients with non-affective psychosis to improve drug attitude. <![CDATA[<b>Burnout and job satisfaction of nursing staff in a South African acute mental health setting</b>]]> BACKGROUND: Psychiatric nurses constitute a fundamental part of the mental health care system in South Africa. However, high levels of burnout and job dissatisfaction among nursing staff have been associated with reduced empathy and quality of care, and poor service delivery. Stikland Psychiatric Hospital is a state psychiatric hospital situated in Belville and provides all levels of psychiatric care to a large part of the Cape metro region. To our knowledge, no previous studies have examined burnout and job satisfaction among nurses in this setting. AIM: We assessed the relationship between burnout and job satisfaction among the nursing staff. SETTING: The study was conducted at Stikland Psychiatric Hospital, Cape Town, South Africa. METHODS: This cross-sectional study used the Copenhagen Burnout Inventory and an established job satisfaction questionnaire to assess burnout and job satisfaction among 127 staff members associated with psychiatric nursing. RESULTS: In this population comprising mostly female (83.5%) nurses, scores for personal, work-related and client-related burnout were relatively high, but job satisfaction was also high. Higher levels of burnout were significantly associated (Pearson's linear correlation, r = -0.077, p < 0.01) with lower levels of job satisfaction. There were no significant associations between burnout or job satisfaction and gender, rank or years of experience. CONCLUSIONS: If mental health service delivery is to be optimised, supportive or preventative processes should be implemented to reduce the prevalence of burnout in psychiatric nurses. This study adds to the scarce local knowledge and provides information that can be used to inform the development of supportive strategies for psychiatric nursing staff in South Africa. <![CDATA[<b>Frequency of suicide attempts and attitudes toward suicidal behaviour among doctors and nurses in Lagos, Nigeria</b>]]> BACKGROUND: Competence and attitudes toward suicidal behaviour affect practice. These attitudes may influence the consideration of suicide during personal crisis among doctors and nurses. AIM: The attitudes of doctors and nurses towards suicidal behaviour was assessed using the Attitudes Toward Suicide Scale (ATTS), which was validated in another study by the authors, evaluated for the possible factors affecting this relationship and estimated the frequency of suicide attempts among doctors and nurses. SETTING: Lagos State University Teaching Hospital Lagos, Nigeria. METHODS: The cross-sectional survey about attitudes toward suicide was done among 226 doctors and nurses working at a tertiary institute hospital in Lagos, Nigeria, using the ATTS. Sociodemographic profile and self-rated competence, commitment, empathy and irritation toward suicide were obtained. Stratified random sampling was used, data were analysed using Statistical Package for Sociological Sciences. Data was summarised, reliability of the ATTS was assured and variables compared by t-test and ANOVA. Independent predictors were identified via multiple regression (p ≤ 0.05). RESULTS: Frequency of suicide attempts of 7.50% was found among respondents with a mean age of 35.84 ± 6.76 years. Attitudes toward suicidal behaviour were slightly positive (77.92 ± 9.90) and the independent predictors of less positive attitudes were nursing profession (β = 0.025, p < 0.001) and high self-rated irritation toward suicide (β = 0.18, p < 0.01). CONCLUSION: The frequency of suicide attempts is higher among doctors and nurses when compared to the general population. Doctors and nurses reported slightly positive attitudes toward suicidal behaviour with significant differences in the type of profession and levels of self-rated irritation toward suicide. <![CDATA[<b>Resilience and coping strategies of undergraduate medical students at the University of the Free State</b>]]> BACKGROUND: Medical studies place students at risk for burnout. Resilience enables students to cope with adversity. Students' coping skills will ensure the well-being of future healthcare professisonals. OBJECTIVES: This study investigated resilience and coping among undergraduate medical students. SETTING: Undergraduate students at the University of the Free State medical school. METHODS: A cross-sectional study was performed. Quantitative data regarding resilience (Connor-Davidson Resilience Scale), coping strategies (Brief COPE questionnaire) and relevant information were collected by means of an anonymous self-administered questionnaire. RESULTS: Five hundred students (pre-clinical n = 270; clinical n = 230; approximately 62% female) participated. Most students self-reported high resilience (84.6% pre-clinical; 91.8% clinical). Mean resilience scores were 72.5 (pre-clinical) and 75.4 (clinical). Clinical students had higher resilience scores, while black, pre-clinical, first-generation and female students scored lower Academic stress was most prominent (> 85%) and associated with lower resilience scores. Most students used adaptive coping strategies (e.g. instrumental or emotional support) associated with significantly increased resilience scores. Students who used dysfunctional strategies (e.g. substance abuse) had significantly lower resilience scores. CONCLUSION: Associations between resilience scores and year of study, gender, ethnicity, levels and type of stress varied. Academic pressure was a major source of stress. Adaptive coping strategies were associated with higher resilience scores <![CDATA[<b>The prevalence and clinical correlates of substance use disorders in patients with psychotic disorders from an Upper-Middle-Income Country</b>]]> BACKGROUND: Substance use disorders (SUDs) occur frequently in patients with psychotic disorders and have been associated with various demographic and clinical correlates. There is an absence of research on the prevalence and clinical correlates of SUDs in psychotic disorders in low-and-middle-income countries (LMICs AIM: We aimed to determine the prevalence and correlates of SUDs in psychotic disorders SETTING: Patients attending a large secondary-level psychiatric hospital in Cape Town South Africa METHODS: We used the Structured Clinical Interview for DSM-IV (SCID-I) to determine psychiatric and substance use diagnoses, depressive, anxiety, obsessive-compulsive and post-traumatic symptoms. We used logistic regression models to determine significant predictors of SUDs RESULTS: In total sample (N = 248), 55.6% of participants had any SUD, 34.3% had cannabis use disorders, 30.6% alcohol use disorders, 27.4% methamphetamine use disorders, 10.4% methaqualone use disorders and 4.8% had other SUDs. There were significant associations with male sex for most SUDs, with younger age and Coloured ethnicity for methamphetamine use disorders, and with lower educational attainment for cannabis use disorders. Anxiety symptoms and suicide attempts were significantly associated with alcohol use disorders; a diagnosis of a substance induced psychosis with cannabis and methamphetamine use disorders. Across most SUDs legal problems and criminal involvement were significantly increased CONCLUSION: This study found a high prevalence and wide distribution of SUDs in patients with psychotic disorders, consistent with previous work from high income countries. Given clinical correlates, in individuals with psychotic disorders and SUDs it is important to assess anxiety symptoms, suicidality and criminal involvement <![CDATA[<b>Prevalence and perception of drug use amongst secondary school students in two local government areas of Lagos State, Nigeria</b>]]> BACKGROUND: Drug abuse, an excessive and persistent self-administration of a drug without regard to the medically or culturally accepted patterns, has been reported amongst teenagers and adolescents in various regions of the world. AIM: This study aimed to measure the prevalence of drug use amongst students of junior and senior secondary schools (aged 10-15 years), SETTING: This study was conducted at two local government areas in Lagos State, METHODS: The cross-sectional study was carried out in Ikotun or Igando local council development area (LCDA) and Ikoyi LCDA of Lagos State. Students were sampled using stratified random sampling with classes as strata and sampling performed by balloting. The modified WHO Model Drug Use Survey Questionnaire was distributed to the students for self-reporting. Ethical approval was received from district school boards RESULTS: A total of 1048 students participated in the survey. In this study, alcohol had the highest lifetime drug prevalence rate (29.1%), followed by pharmaceutical opioids (9%). Gender, educational level, type of school management, and geographical economic distribution were found to be predictors of prevalence of drug use. This study demonstrated significant differences in the prevalence of tobacco and opioids use among students in private and public schools; and documented statistically significant differences in the prevalence of cocaine use between low income and high-income areas in two LCDAs in Lagos, Nigeria, CONCLUSION: Prevalence of lifetime, recent use, and current use of drugs among secondary school students in two LCDAs located in Lagos State, Nigeria were documented with alcohol as the drug with the highest prevalence <![CDATA[<b>Perinatal suicidality: Risk factors in South African women with mental illness</b>]]> BACKGROUND: Maternal Mortality is a global health concern. The lack of suicide data, particularly in low and middle income countries, is concerning and needs to be addressed. AIM: This study assessed suicidality and associated factors during pregnancy and the postpartum period amongst women with known psychiatric diagnoses. SETTING: The study sample included pregnant South African women over the age of 18 years with a psychiatric disorder who presented at two maternal mental health clinics. METHOD: Suicidality was assessed by means of psychiatric interviews - the Mini International Neuropsychiatric Interview and the Montgomery Asberg Depression Rating Scale. RESULTS: The results revealed that women were at a higher risk of experiencing suicidality if they had attempted suicide before, presented at a later gestation for psychiatric care or were employed. It was also clear that multiple assessments, carried out by means of clinical interviews and various scales, were necessary to screen suicidality successfully in pregnant women diagnosed with psychiatric illness. CONCLUSION: The results confirmed the view of the World Health Organization that in order to promote mental health and well-being, women's health should be viewed contextually, not in isolation. Screening for and treatment of perinatal mental illness, including suicidality, are essential if we hope to meet the maternal morbidity and mortality targets of the United Nations by 2030. <![CDATA[<b>Challenges experienced by South African families caring for state patients on leave of absence</b>]]> BACKGROUND: Families of state patients experience challenges related to the patient's mental illness and history of criminal behaviour. Family members who act as guardians when patients are on leave of absence take responsibility for the patient's basic needs, activities of daily living and treatment regimen. They need to safeguard the patient from potential self-harm and harming others. Few studies have explored the burden these family members experienceAIM: The aim of this study was to explore and describe the challenges experienced by families caring for mental state patients who are on leave of absenceSETTING: An urban area in South AfricaMETHODS: A qualitative approach was applied to answer the research question, 'what are the challenges experienced by families caring for mental state patients on leave of absence?' A purposive sample of nine participants who were caring for state patients on leave of absence was selected. Individual in-depth interviews were used to collect data. Data were analysed using thematic analysis. Ethical considerations and trustworthiness guided the studyRESULTS: Three themes illustrate the challenges experienced by family members, namely, challenges related to state patient's behaviour, emotional challenges and social challenges. A fourth theme focuses on the ways families used to cope with these challengesCONCLUSION: Mental healthcare professionals may use the results of this study to design therapeutic interventions for family members of state patients who focus on empathetic understanding and the mobilisation of effective coping skills and social support <![CDATA[<b>Professional quality of life amongst nurses in psychiatric observation units</b>]]> BACKGROUND: Professional quality of life amongst nurses in psychiatric observations units may be affected by working conditions such as an overflow of mental health care users (MHCUs), a shortage of nurses, lack of specialised staff and inadequate infrastructure to accommodate MHCUs amongst othersAIM: The aim of the study was to investigate the professional quality of life amongst nurses in psychiatric observation unitsSETTING: The study was conducted in psychiatric observation units in eight hospitals in the Metropole District Health Services in the Western CapeMETHOD: A quantitative descriptive survey design using the Professional Quality of Life (ProQoL version 5) questionnaire was conducted with an all-inclusive sample of 175 nurses. The ProQoL has two scales, namely, the compassion satisfaction and the compassion fatigue. Compassion fatigue includes two subscales, burnout and secondary traumatic stress. Ethics to conduct the study was obtained from the Research Ethics Committee at the university and the Department of Health in the Western CapeRESULTS: A response rate of 93% (n = 163) was obtained. Respondents reported moderate compassion satisfaction. Psychiatric nurse specialists and registered nurses reported lower compassion satisfaction than enrolled nurses and nursing assistants. This came with moderate levels of burnout and high levels of secondary traumatic stress, with enrolled nurses and enrolled nursing assistants reporting lower levels than the other professional groupsCONCLUSION: Psychiatric nurse specialists and registered nurses experienced higher burnout and secondary traumatic stress and lower compassion satisfaction than the lower categories of nurses <![CDATA[<b>Socio-ecological influences of adolescence marijuana use initiation: Qualitative evidence from two illicit marijuana-growing communities in South Africa</b>]]> BACKGROUND: Adolescence has been identified as a critical risk period for substance use initiation, such as marijuana. Although several factors have been cited for adolescent marijuana use, those that influence initiation, especially in an African setting where illicit marijuana activities are rife, have not been contextually exploredAIM: We ascertained the factors that influence adolescent marijuana use initiation in two marijuana-growing communities in the Eastern Cape province of South Africa, based on the constructs of the socio-ecological modelSETTING: The study was conducted in two selected illicit marijuana growing communities in the Ingquza Hill Local Municipality of the Eastern Cape province of South AfricaMETHODS: Focus group discussions (FGDs) were conducted among 37 participants, grouped into four focus groups. Purposive and snowball sampling techniques were used to select the communities and participants, respectively. An FGD guide was used to collect the data. The data were analysed using thematic content analysis approach and presented under various themesRESULTS: Twelve influences of adolescent marijuana use initiation, grouped under three main levels of socio-ecological influence, personal characteristics (curiosity, shyness and fulfilment of personal need), micro-level influences (peer pressure, negative school climate, presence of marijuana in households and parental or sibling marijuana use) and macro-level influences (child labour, poverty, presence of marijuana in communities, presence of negative adult role models and breakdown in communal restrictions against marijuana use), were foundCONCLUSION: Health promotion programmes, targeting socio-ecological motives of adolescent marijuana use initiation in the two communities, should be intensified to break the cycle of adolescent marijuana use. Also, alternative livelihood schemes should be implemented in the affected communities to break the cycle of illegal marijuana cultivation that promotes adolescent marijuana use <![CDATA[<b>Demographic and clinical profile of patients utilising a transitional care intervention in the Western Cape, South Africa</b>]]> BACKGROUND: The World Health Organization's action plan for 2020 has identified the need for service-based data to motivate for more appropriate community-based services. To date, there is no published data from step-up or step-down facilities in South AfricaAIM: To describe the demographic and clinical profile of all patients admitted to New Beginnings between 01 January 2011 and 31 December 2015SETTING: New Beginnings is an intermediary care facility focused on psychosocial rehabilitation and accommodates 40 patients in a step-up or step-down settingMETHODS: In this retrospective audit, we reviewed the medical records of all patients (N = 730) admitted to New Beginnings between 01 January 2011 and 31 December 2015RESULTS: Most admissions were male (n = 600; 82.2%), unmarried (92.1%) and unemployed (92.7%) patients with a mean age of 28 years. Only 20.7% had completed their schooling and 37.9% were receiving a disability grant. Most patients lived in the Cape Town Metro area (89%) with their families (94.7%), and 75.6% had no children. Schizophrenia (53.7%) was the most common primary psychiatric diagnosis, and most patients were on a combination of oral and depot treatment (46.8%). Illicit substances were used by 75.9% of patients with 30% using both cannabis and methamphetamine. Most patients (74.9%) had only one admission to New BeginningsCONCLUSIONS: These baseline data could inform improved service delivery. Further research is needed to evaluate the success of New Beginnings and highlight the need for more of these facilities in the Western Cape and across South Africa <![CDATA[<b>Prevalence and clinical correlates of substance use amongst acute psychiatric inpatients in Gauteng, South Africa</b>]]> BACKGROUND: Mental disorders and substance use disorders (SUD) commonly occur together, impacting healthcare outcomes. The diagnosis of substance use is often inadequate when comorbidity is present. It is vital to understand the prevalence of substance use amongst psychiatric patients to inform both clinical practice and service development in South Africa. AIM: To ascertain the prevalence and clinical correlates of SUD amongst acute psychiatric inpatients. SETTING: The setting for this study was Helen Joseph Hospital acute psychiatric ward. METHODS: A cross-sectional study was conducted whereby consecutively admitted patients were invited to participate in a structured clinical interview utilising the alcohol use disorders identification test (AUDIT) and drug use disorders identification test (DUDIT) questionnaires. Statistical comparisons were made between those with and without SUD. RESULTS: Of 150 participants, 100 (67%) were identified with a SUD. Those with SUD were younger (p = 0.0010), more often male (p = 0.012), less likely to have a disability grant (p = 0.015) and more likely to be brought to hospital by police, ambulance or self than by a family member (p = 0.025). Almost half of people with bipolar disorder (47.3%) and schizophrenia (41.4%) had comorbid SUD. Twenty-three (15%) participants identified with SUD on questionnaire had been missed clinically. Only two participants were referred for inpatient substance rehabilitation on discharge. CONCLUSION: Substance use disorders are highly prevalent amongst psychiatric inpatients. The AUDIT and DUDIT are potentially useful screening tools in routine clinical practice. Greater collaboration between psychiatric and substance rehabilitation services is recommended.