Scielo RSS <![CDATA[South African Journal of Psychiatry ]]> vol. 23 num. 1 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>Non-medical use of methylphenidate among medical students of the University of the Free State</b>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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>]]> 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.