Scielo RSS <![CDATA[South African Journal of Psychiatry ]]> vol. 20 num. 1 lang. es <![CDATA[SciELO Logo]]> <![CDATA[<b>Profile of rape victims referred by the court to the Free State Psychiatric Complex, 2003 - 2009</b>]]> BACKGROUND: The psychological evaluation of rape victims to determine their competency to testify in court and whether they are capable of consenting to sexual intercourse is challenging, especially when the rape victim is mentally retarded. OBJECTIVE: To describe the profile of mentally retarded rape victims referred to the Free State Psychiatric Complex (FSPC) in Bloemfontein from 2003 to 2009. METHODS: A descriptive retrospective study was conducted. The study consisted of 137 rape victims referred by the court to the FSPC for psychological evaluation from 2003 to 2009. Patient files were used to obtain information. RESULTS: The majority of individuals (n=129; 94.2%) in the cohort were female. The mean age of the participants was 19 years (range 3 - 52). The number of victims evaluated increased from four in 2003 to 36 in 2009. Most participants were diagnosed with moderate (67.2%), followed by severe (18.3%) and mild (14.6%) mental retardation. Only two of the victims were able to give legal consent to sexual intercourse. Only one participant was able to testify in a court of law. A noteworthy finding was that in only 25 (18.2%) cases, a clinical psychologist was subpoenaed to testify in court. CONCLUSION: The vast majority of mentally retarded rape victims in our cohort, regardless of their level of intellectual functioning, were not able to testify in court and were not able to give informed consent to sexual intercourse. <![CDATA[<b>The burden of untreated mental disorders in KwaZulu-Natal Province - mapping the treatment gap</b>]]> BACKGROUND: Low- and middle-income countries carry the major burden of mental disorders, yet owing to a significant lack of resources, they experience a 'treatment gap' in the range of 75 - 85%. METHODS: Epidemiological data on mental disorders in South Africa, national census data and locally developed models for establishing treatment needs were used to calculate expected annual acute admissions and inpatient care, as well as expected annual ambulatory visits in KwaZulu-Natal (KZN) Province, South Africa. These were compared with actual acute admission and inpatient care rates as well as actual ambulatory visits to mental health services in the province, derived from the District Health Information Systems. These comparisons allowed an estimation of the treatment gap for mental disorders in the province. RESULTS: Approximately 956 000 adults were estimated to live with mental disorders in KZN. Only 19.8% (10 620) of expected admissions (53 623) took place during the one-year reporting period; while the total number of acute inpatient days accounted for 26.1% of the expected number. Average length of stay (ALOS) for acute admissions was longer (21 days) than the expected ALOS (16 days). At the recommended level of 30% coverage, ambulatory visits to mental health facilities accounted for 21% of the expected visits during the one-year period. CONCLUSION: In keeping with previous estimates, these results provide evidence that the 'treatment gap' for acute inpatient and ambulatory mental healthcare in KZN is ~80%. This rate is similar to the estimated mental health resource gap in the province, suggesting that gross inadequacies in mental health service provision translate directly into major unmet needs for those living with mental disorders. <![CDATA[<b>De-stigmatising manipulation: An exercise in second-order empathic understanding</b>]]> Standard definitions of 'manipulation', especially regarding people with a borderline personality diagnosis, usually highlight the alloplastic purpose of manipulativity, i.e. the intention to produce a belief in, or action by another person. In this article, I will try to show that this is only one side of the coin, and shed light on a complementary aspect of manipulative behaviour: manipulation can serve an epistemic, rather than alloplastic, pragmatic motif - the attempt to establish contact with the other in order to achieve a more distinct experience and representation of the other. My tentative hypothesis is based on the meaning of manipulation as touching ('manus' means 'hand') in infant behaviour where manipulation is a means to explore, rather than a way to modify the other's state of mind. <![CDATA[<b>Children and adolescents treated for post-traumatic stress disorder at the Free State Psychiatric Complex</b>]]> Background: Children and adolescents can develop post-traumatic stress disorder (PTSD) after exposure to a range of traumatic events, including domestic, political or community violence, violent crime, physical and sexual abuse, hijacking, witnessing a violent crime and motor vehicle accidents. This is particularly critical given the substantial challenge that PTSD poses to the healthy physical, cognitive and emotional development of children and adolescents. Methods: The clinical records of 1 229 children (age 2 - 11 years) and adolescents (age 12 - 18 years) treated at the Child Mental Health Unit of the Free State Psychiatric Complex (FSPC) were screened for the diagnosis of PTSD and analysed for the purpose of this study. Results: Forty-nine (4.0%) of the children and adolescents treated at the unit were diagnosed with PTSD, of whom most were female (63.3%). Approximately 22% of the participants had comorbid major depressive disorder. The main traumatic event in both groups was witnessing the death of a close relative (32.7%), followed by sexual assault (25%), rape (25%) and physical attack (10.2%). Associated stressors identified included problems at school (55.1%), isolation (39%), fear or anxiety (37%), problematic family relationships (29%), emotional (27%) and physical (23%) abuse, and lack of social support (23%). Most of the participants (59.2%) received psychotherapy. Conclusions: Children and adolescents referred to the FSPC are also exposed to traumatic events which lead to the development of PTSD. The Free State is a sprawling province with remote areas where specialist services and facilities are limited. It is therefore recommended that preventive programmes, training opportunities and consultation services are implemented to identify and treat children and adolescents with PTSD. Schools with limited access to psychological services and large classrooms, impeding the diagnosis and treatment of PTSD specifically, face similar challenges. Reinforcement of professional services and the upgrading of facilities will decrease the burden on the Child Mental Health Unit, but will require collaborative efforts from role players such as the National Departments of Health and Education. <![CDATA[<b>Conjoint alcohol and tobacco use among tuberculosis patients in public primary healthcare in South Africa</b>]]> OBJECTIVE: To determine the prevalence of, and factors associated with conjoint alcohol and tobacco use among tuberculosis (TB) patients in South Africa (SA). METHODS: In a cross-sectional survey, 4 900 (54.5% men, 45.5% women) consecutively selected TB patients (including new TB and new TB retreatment patients) from 42 public primary care clinics in three districts in SA were assessed using various measures (including those for alcohol and tobacco use), within one month of anti-TB treatment. RESULTS: Overall, 10.1% (15.5% among men; 3.4% among women) were conjointly hazardous, harmful or dependent alcohol users and daily or almost-daily tobacco users. The proportion of daily or almost-daily tobacco users among hazardous, harmful or dependent alcohol users was 48.9%, (53.3% among men; 26.4% among women). Those with hazardous, harmful or dependent alcohol use had significantly higher odds of having anxiety and/or depression (odds ratio (OR) 1.37; confidence interval (CI) 1.13 - 1.65) and exhibiting daily or almost-daily tobacco use (OR 5.94; CI 4.33 - 5.87). The mean ± standard deviation alcohol use disorders identification test (AUDIT) score among conjoint hazardous, harmful or dependent alcohol users and daily or almost-daily tobacco users was significantly higher (17.1±6.1) than among hazardous, harmful or dependent alcohol users who were not current tobacco users (15.4±5.6) (p<0.001). In multivariate analysis, male gender, coloured ethnicity, lower education and greater poverty, TB retreatment patient status and non-adherence to anti-TB medication were associated with a greater risk for conjoint alcohol and tobacco use. CONCLUSIONS: A high prevalence and several risk factors for conjoint alcohol and tobacco use were found among TB patients. The findings of this study call for dual-intervention approaches to alcohol and tobacco use. <![CDATA[<b>Designing an educational programme in mental health for general practitioners in South Africa</b>]]> BACKGROUND: With the new Mental Health Care Act in use, additional demands will be placed on general practitioners to provide adequate care for mental health patients. The College of Psychiatry of the Colleges of Medicine of South Africa awards a Postgraduate Diploma in Mental Health (PGDipMH) to medical doctors, but there is no standardised formal tuition or curriculum available to potential candidates. OBJECTIVES: A study was undertaken to design a postgraduate programme using a six-step process to assist medical practitioners in preparing for the PGDipMH. METHODS: The Delphi research method, a nominal group technique for developing forecasts and trends based on the collective opinion of knowledgeable experts, was used. Data, obtained by means of closed items in a questionnaire, were analysed, and the opinions and ideas of the expert respondents were used to adapt the formulated set of criteria for each subsequent round of Delphi. This process was repeated until 80% consensus or stability had been reached. After the last round, a framework and final set of criteria were compiled. RESULTS: The preferred mode of teaching was online distance learning utilising electronic learning and limited formal learning. The content of the curriculum was based on the findings of the Delphi study experts. The programme as a complete entity contains six steps. CONCLUSIONS: Using the recommendations and findings of the Delphi panel, a comprehensive programme was developed, which shows an appreciation for the interfaces between the different role-players (the patient/so-called mental healthcare user and the doctor as learner), outcomes-based education and distance learning. <![CDATA[<b>Reserpine for the treatment of refractory mania</b>]]> We report a case of refractory mania treated successfully with reserpine. The patient was a 26-year-old man with bipolar I disorder, who had recurrent hospital admissions for manic episodes that failed to respond to multiple mood stabilisers and antipsychotics. The patient also suffered from hypertension. His manic symptoms improved markedly with the addition of reserpine to the treatment regimen. Reserpine is a centrally acting antihypertensive with anti-adrenergic properties. It has been found to reduce the duration of a manic episode rapidly in a small group of studies. This proved to be the case with this patient. Reserpine used in conjunction with other psychotropic medication may be considered in the treatment of refractory mania, but controlled trials are necessary to support our finding more generally.