Scielo RSS <![CDATA[South African Journal of Psychiatry ]]> vol. 20 num. 4 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>Integrating spirituality in the approach to psychiatric practice</b>]]> <![CDATA[<b>South African Society of Psychiatrists guidelines for the integration of spirituality in the approach to psychiatric practice</b>]]> BACKGROUND: It was important to develop South African guidelines in view of the extent of local and worldwide religious affiliation, rapid growth of academic investigation, guidelines provided by other associations (e.g. Royal College of Psychiatrists), the South African Society of Psychiatrists (SASOP)'s own position statements on culture, mental health and psychiatry, the appropriate definition of spirituality, the need for an evolutionary and anthropological approach, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V)'s cultural formulation, local legislation, ongoing research, and teaching requirements. OBJECTIVE: To report on the outcome of the peer-reviewed process that was followed to draft local guidelines for psychiatric training and practice. METHODS: During 2013, comments by members of the SASOP on a framework for guidelines on the role of spirituality in psychiatry practice and training were collated and subsequently submitted to the SASOP board for approval. RESULTS: Guidelines were compiled in terms of: (i) integrating spirituality in clinical care and service provision; (ii) integrating spirituality in psychiatric training; (iii) ethically integrating spirituality within the professional scope of practice; and (iv) appropriate referral between psychiatrists and spiritual advisors. CONCLUSIONS: Integrating spirituality in the approach to practice and training cannot be ignored by local psychiatrists in the multicultural, multireligious and spiritually diverse South African context. <![CDATA[<b>Does religious identification of South African psychiatrists matter in their approach to religious matters in clinical practice ?</b>]]> BACKGROUND: It is not known whether psychiatrists' approach to religious matters in clinical practice reflects their own identification or non-identification with religion or their being active in religious activities. OBJECTIVE: This question was investigated among South African (SA) psychiatrists and psychiatry registrars, including the importance they attach to the religious beliefs of patients for diagnostic and therapeutic purposes. METHODS: Respondents from the SA Society of Psychiatrists (SASOP) completed a purpose-designed questionnaire anonymously online. Respondents were compared statistically with regard to whether they identified with a religion, and the regularity of their participation in religious activities. Further comparisons were made based on gender and years of clinical experience. RESULTS: Participants who identified with a religion showed no statistical differences in comparison with those who did not, regarding: how they viewed the importance of a patient's religious beliefs for purposes of diagnosis, general management, psychotherapy, pharmacotherapy, recovery from an acute episode, maintenance of recovery or remission, time to be spent on religious education, referral for religious/spiritual counselling according to patient's own beliefs; referral when patient and participant are of different religions; and whether referral is considered harmful when a patient's religious beliefs are similar to or different from the participant's. Statistically significant differences were found where participants who did not identify with a religion were more likely to indicate religion had 'little importance' for the purpose of understanding the patient and to indicate 'no' when asked if they would refer a patient for religious/spiritual counselling. When comparing regularity of participation in religious gatherings, participants who indicated their participation as 'no/never' were more likely to answer 'no' when asked if they would refer a patient for religious/spiritual counselling, even when of a similar religion to that of their patient. In comparing genders, males were more likely to answer 'yes' than females when asked if they considered religious/spiritual counselling (in accordance with the patient's own religious beliefs) potentially harmful when the patient's religion was different from the participant's. CONCLUSION: It appears that SA psychiatrists' identification with religion and regularity of participation in religious gatherings do not influence their approach to religious matters of their patients in most respects. The exception seems to be for those psychiatrists who do not identify with a religion (~16%), who tend to respond that they do not refer for religious counselling and that they consider the patient's religious identification to be of little importance in understanding the patient. <![CDATA[<b>Magnetic resonance imaging study of corpus callosum abnormalities in patients with different subtypes of schizophrenia</b>]]> BACKGROUND: Reductions in the size of the corpus callosum (CC) have been described for schizophrenia patients, but little is known about the possible regional differences in schizophrenia subtypes (paranoid, disorganised, undifferentiated, residual). METHODS: We recruited 58 chronically schizophrenic patients with different subtypes, and 31 age-and-gender matched healthy controls. The callosum was extracted from a midsagittal slice from T1 weighted magnetic resonance images, and areas of the total CC, its five subregions, CC length and total brain volume were compared between schizophrenia subtypes and controls. Five subregions were approximately matched to fibre pathways from cortical regions. RESULTS: Schizophrenia patients had reduced CC total area and length when compared with controls. Disorganised and undifferentiated schizophrenics had a smaller prefrontal area, while there was no significant difference for the paranoid and residual groups. The premotor/supplementary motor area was smaller in all schizophrenia subtypes. The motor area was smaller only in the disorganised group. A smaller sensory area was found in all subtypes except the residual group. Parietal, temporal and occipital areas were smaller in the paranoid and undifferentiated groups. Total brain volume was smaller in all schizophrenia subtypes compared with controls, but did not reach statistical significance. CONCLUSION: These findings suggest that the heterogeneity of symptoms may lead to the different CC morphological characteristics in schizophrenia subtypes. <![CDATA[<b>Sensitivity and specificity of neuropsychological tests for dementia and mild cognitive impairment in a sample of residential elderly in South Africa</b>]]> BACKGROUND: Neuropsychological tests can successfully distinguish between healthy elderly persons and those with clinically significant cognitive impairment. OBJECTIVES: A battery of neuropsychological tests was evaluated for their discrimination validity of cognitive impairment in a group of elderly persons in Durban, South Africa. METHOD: A sample of 117 English-speaking participants of different race groups (9 with dementia, 30 with mild cognitive impairment (MCI) and 78 controls) from a group of residential homes for the elderly was administered a battery of 11 neuropsychological tests. Kruskal-Wallis independent sample tests were used to compare performance of tests in the groups. Sensitivity and specificity of the tests for dementia and MCI were determined using random operating curve (ROC) analysis. RESULTS: Most tests were able to discriminate between participants with dementia or MCI, and controls (p<0.05). Area under the curve (AUC) values for dementia v. non-dementia participants ranged from 0.519 for the digit span (forward) to 0.828 for the digit symbol (90 s), with 14 of the 29 test scores achieving significance (p<0.05). AUC values for MCI participants ranged from 0.754 for controlled oral word association test (COWAT) Animal to 0.507 for the Rey complex figure test copy, with 17 of the 29 scores achieving significance (p<0.05). CONCLUSIONS: Several measures from the neuropsychological battery had discrimination validity for the differential diagnosis of cognitive disturbances in the elderly. Further studies are needed to assess the effect of culture and language on the appropriateness of the tests for different populations. <![CDATA[<b>Staff and bed distribution in public sector mental health services in the Eastern Cape Province, South Africa</b>]]> BACKGROUND: The Eastern Cape Province of South Africa is a resource-limited province with a fragmented mental health service. OBJECTIVE: To determine the current context of public sector mental health services in terms of staff and bed distribution, and how this corresponds to the population distribution in the province. METHOD: In this descriptive cross-sectional study, an audit questionnaire was submitted to all public sector mental health facilities. Norms and indicators were calculated at provincial and district level. This article investigates staff and bed distribution only. RESULTS: Results demonstrated that within the province, only three of its seven districts have acute beds above the national baseline norm requirement of 13/100 000. The private mental health sector provides approximately double the number of medium- to long-stay beds available in the public sector. Only two regions have staff/population ratios above the baseline norm of 20/100 000. However, there are significant differences in this ratio among specific staff categories. There is an inequitable distribution of resources between the eastern and western regions of the province. When compared with the western regions, the eastern regions have poorer access to mental health facilities, human resources and non-governmental organisations. CONCLUSION: Owing to the inequitable distribution of resources, the provincial authorities urgently need to develop an equitable model of service delivery. The province has to address the absence of a reliable mental health information system. <![CDATA[<b>Positive and negative symptoms of schizophrenia as correlates of help-seeking behaviour and the duration of untreated psychosis in south-east Nigeria</b>]]> BACKGROUND: Duration of untreated psychosis (DUP) has been widely recognised in recent years as a potentially important predictor of illness outcome, and the manifestations of schizophrenia have been known to influence its early recognition as a mental illness. OBJECTIVE: To assess the association between the positive and negative symptoms of schizophrenia, help-seeking and DUP. METHODS: We performed a cross-sectional study of 360 patients with schizophrenia, who had had no previous contact with Western mental health services. The Sociodemographic Questionnaire, World Health Organization Pathway Encounter Form and a questionnaire to establish DUP were used. The positive and negative syndrome scale and Composite International Diagnostic Interview were used for the assessment of mental disorders and to diagnose. RESULTS: Respondents who had predominant positive symptoms and who had a median DUP of 8 weeks or 24 weeks, tended to use psychiatric hospitals and other Western medical facilities, respectively, as their first treatment options. However, those who had predominant negative symptoms and who had a median DUP of 144 weeks or 310 weeks, tended to use faith healers and traditional healers, respectively, as first treatment options. CONCLUSION: The predominance of negative symptoms could militate against early presentation among people with schizophrenia, probably because negative symptoms are poorly recognised as indicating mental illness in Nigeria, as they could be interpreted as deviant behaviour or spiritual problems that would require spiritual solutions. <![CDATA[<b>The care, treatment, rehabilitation and legal outcomes of referrals to a tertiary psychiatric hospital according to the Mental Health Care Act No. 17 of 2002</b>]]> BACKGROUND: The Mental Health Care Act No. 17 of 2002 (MHCA) was introduced to combat poor care received by mentally ill persons. OBJECTIVE: The objective of this study was to evaluate diagnostic and treatment accuracy as well as compliance with procedural matters related to the MHCA, using a sample in the northern region of Gauteng Province, South Africa. METHOD: Files of 200 patients admitted to Weskoppies Hospital between June and December 2009 were evaluated for admission procedures, and care, treatment and rehabilitation (CTR). RESULTS: From referring hospitals, 174 (87%) persons had appropriate signs and symptoms documented in the referral note or MHCA forms. All of these were appropriately diagnosed. Although about one-third of the patients' treatment was not documented, more than 50% (n=163) received the correct treatment. In two-thirds of patients, correction of detected abnormalities was not documented. Approximately 50% of the admissions had documents that did not adhere to MHCA provisions. At Weskoppies Hospital, CTR was considered appropriate for 92% of the patients. The legal status of the majority of patients was involuntary at discharge point. The majority of persons stayed for <3 months but for longer than what medical aid schemes allow in the private sector. CONCLUSIONS: The study highlighted both improvements and gaps in CTR given to mentally ill persons in the northern Gauteng region, which might apply to the rest of the country. Medicolegal requirements stipulated by the MHCA are still a challenge a decade post enactment, but there may be a move in the right direction.