Scielo RSS <![CDATA[South African Journal of Psychiatry ]]> http://www.scielo.org.za/rss.php?pid=2078-678620200001&lang=en vol. 26 num. 1 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Predictors of bullying reported by perpetrators in a sample of senior school students in Benin City, Nigeria</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862020000100001&lng=en&nrm=iso&tlng=en 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>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862020000100002&lng=en&nrm=iso&tlng=en 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>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862020000100003&lng=en&nrm=iso&tlng=en 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>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862020000100004&lng=en&nrm=iso&tlng=en 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>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862020000100005&lng=en&nrm=iso&tlng=en 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>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862020000100006&lng=en&nrm=iso&tlng=en 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>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862020000100007&lng=en&nrm=iso&tlng=en 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>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862020000100008&lng=en&nrm=iso&tlng=en 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>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862020000100009&lng=en&nrm=iso&tlng=en 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>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862020000100010&lng=en&nrm=iso&tlng=en 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>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2078-67862020000100011&lng=en&nrm=iso&tlng=en 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.