South African Journal of Psychiatry最新文献

Background: Mental Health Literacy (MHL) refers to knowledge, skills and attitudes related to mental health and is often measured by the revised Mental Health Literacy Scale (MHLS). This scale has been validated on a group of primary healthcare (PHC) workers in Zambia and South Africa, but its usefulness for a group of nursing students has not been investigated until now.

Aim: To investigate the psychometric properties of the revised scale for a group of undergraduate nursing students at a South African university, while also assessing the level of MHL in the group under investigation.

Setting: Nursing students (N = 121) studying for their Bachelor of Nursing degree at a South African public university.

Methods: A quantitative, cross-sectional survey was conducted between July 2023 and August 2023, using a purposive sampling technique. A socio-demographic data form and a revised version of the MHLS were used to collect data online. Descriptive statistics, Cronbach's alpha, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to analyse the data.

Results: The EFA and CFA seemed to confirm a new 5-factor structure, including only 17 items. This structure holds similar factors to the MHL subscales. The reliability of most of the new factors was good, with two factors that need further intervention. This version of the MHLS proposed satisfactory levels of MHL for this group.

Conclusion: This study proposes a shortened, 5-factor structure version of the MHLS to be used to assess nursing students.

Contribution: The revised 5-factor structure measure can potentially identify gaps in the MHL of students, and this can inform appropriate interventions to address the MHL needs in South Africa generally.

Background: Studies have revealed a global surge in gambling and gambling disorders, particularly among young adults, including university students. This disturbing trend poses significant risks not only to individual's mental well-being but also to the wider community.

Aim: The objectives of the study were to determine the prevalence of gambling, gambling disorder and the associated socio-demographic factors among undergraduate students of University of Ilorin.

Setting: The study was conducted at the University of Ilorin, a federal government owned tertiary educational institution located in Kwara State, North-Central Nigeria.

Methods: A pro forma questionnaire was used to obtain socio-demographic information about the students. Respondents who had gambled in their lifetime proceeded to complete the self-administered South Oaks Gambling Screen (SOGS). Score of at least 1 out of 20 on the SOGS indicated gambling disorder, having met the criteria for either problem gambling (score 1-4) or pathological gambling (score ≥ 5).

Results: Responses of 2044 of the respondents were analysed. Their mean age was 21.74 ± 2.64 years, and male respondents accounted for 54.5%. A total of 409 (20%) of respondents had ever gambled in their lifetime, with sports betting been the most gambled activity. About 14.9% of the respondents had gambling disorders (10.5% problem gambling; 4.4% pathological gambling). Male gender, positive family history of mental illness, a lack of adequate financial support and staying off-campus were significantly associated with presence of gambling disorders. Logistic regression revealed that only positive family history of mental illness was predictive of gambling disorder (OR = 6.987, 95% CI [2.119-23.038], p = 0.001).

Conclusion: This study revealed that three-quarters of respondents with a lifetime history of gambling developed gambling disorder.

Contribution: This implies that a significant proportion of individuals who initially engage in social gambling may have a propensity to develop gambling disorder overtime.

Background: Individuals with intellectual disability (ID) are often prescribed psychotropic medications at disproportionately high rates, particularly for managing psychiatric symptoms or behaviours that challenge (BTC). International guidelines emphasise cautious, evidence-based use and the prioritisation of non-pharmacological interventions.

Aim: This audit evaluated prescribing practices at a specialist psychiatric hospital in South Africa to determine the extent of alignment with internationally recommended standards for psychotropic use in individuals with ID.

Setting: Outpatient department (OPD) of an advanced psychiatric care institution in Cape Town.

Methods: A retrospective folder and prescription review was conducted for 103 patients with ID who were newly referred between January 2018 and August 2019. Prescribing decisions at the first visit and 6-month follow-up were assessed against guidance from the World Psychiatric Association (WPA) and National Institute for Health and Care Excellence (NICE).

Results: Psychotropic medications were prescribed to 88% of patients. Antipsychotics were the most frequently used agents, comprising over half of all prescriptions, often for BTC in the absence of a psychotic disorder. While certain elements of guideline-based care were evident - such as use of low effective doses - gaps were noted in documentation of rationale, review scheduling, side-effect monitoring and consistent use of behavioural strategies. These areas highlight opportunities for strengthening practice.

Conclusion: This audit emphasises the complexity of psychotropic prescribing for individuals with ID and the need for structured, multidisciplinary approaches to ensure safe and appropriate medication use.

Contribution: Embedding standard protocols and regular reviews into clinical workflows may support better adherence to international best-practice standards.

Background: Women in Khyber Pakhtunkhwa face several barriers, including poverty, cultural stigma, intense social pressure and a lack of accessible services, which prevent them from addressing drug use and mental health issues.

Aim: The study aimed to explore the impact of socio-economic and psychological factors on substance use among women aged 25-34.

Setting: This study was conducted at community centres and private schools across several cities in Khyber Pakhtunkhwa, Pakistan, including Peshawar, Charsadda, Nowshera, Swabi and Mardan.

Methods: A mixed-methods approach was employed, combining quantitative surveys from 120 participants to analyse drug use patterns and qualitative interviews with 20 participants to investigate personal and social challenges through in-depth interviews.

Results: Quantitative data indicated that unemployment, financial hardship and low education significantly predicted drug use, whereas moderate depression, anxiety and stress exacerbated it. Perceived stigma serves as a protective role in this study. Qualitative findings highlight themes such as socioeconomic challenges, mental health issues, cultural pressures and barriers to treatment that exacerbate these problems.

Conclusion: This study highlights the importance of rehabilitation centres and community counselling services tailored to women's specific needs, along with legislative measures to address gaps in support and resources for women facing drug use issues.

Contribution: This study contributes to the understanding of the complex relationships between mental health, socioeconomic status and cultural factors influencing drug use among women and aims to inform public health policy and strategy.

Background: Chronic kidney disease (CKD) is a progressive condition associated with high morbidity and mortality. Haemodialysis (HD) patients experience significant psychological and physiological stress. Non-pharmacological interventions such as music listening sessions can alleviate anxiety and depression without drug-related side effects.

Aim: This study was conducted to evaluate the effects of music therapy on psychological well-being and selected biochemical parameters in HD patients.

Setting: This study was conducted with 49 HD patients at the Dialysis Unit of Harran University Faculty of Medicine between May and July 2025.

Methods: All patients underwent a 4-week music listening programme (12 sessions, each session consisting of 30 min of traditional music). Psychological status was assessed before and after the intervention using the Beck Anxiety and Depression Inventories. Biochemical parameters and dialysis efficiency indicators were also recorded. Data were analysed using the Wilcoxon Signed-Rank Test.

Results: Significant decreases were observed in anxiety and depression scores (p < 0.001). Biochemical analyses showed significant changes in sodium (p < 0.001), calcium (p = 0.002), glucose (p = 0.024) and albumin (p < 0.001) levels. No significant changes were observed in dialysis efficiency indicators.

Conclusion: Music listening sessions administered during HD sessions improved patients' psychological state and affected selected biochemical parameters. This is a safe, cost-effective, complementary intervention that may increase comfort and potentially improve physiological outcomes.

Contribution: This study highlights the potential of music listening sessions as an adjunct to conventional treatments in HD care.

Background: In South Africa, the use of substances is associated with serious health challenges, exacerbated by limited health resources. Substance use is often associated with first-episode psychosis (FEP). Prevention and treatment protocols can be established by understanding the socio-demographic and clinical characteristics of patients with FEP.

Aim: To determine the prevalence, patterns, socio-demographic and clinical factors associated with substance use in patients with FEP at Chris Hani Baragwanath Academic Hospital.

Setting: The study was conducted at Chris Hani Baragwanath Academic Hospital, a tertiary healthcare facility in Soweto, South Africa.

Methods: The study was a retrospective chart review analysis of clinical records of 200 patients presenting with FEP. The data were then statistically analysed, and patients with and without substance use in FEP were compared.

Results: The prevalence of substance use was 73.6%. Most patients were male and between 21 years old and 30 years old (37.0%). Substance-induced psychotic disorder was the most common diagnosis. Cannabis (THC) (46.0%) was the most commonly used substance. Substance use was associated with aggression (45.0%), and only 34.0% of substance users were referred to social services.

Conclusion: Substance use is a modifiable risk factor in the presentation of psychotic disorders. Integrated models of care, addressing both mental health and substance use and targeting early intervention, are essential to improve patient outcomes.

Contribution: In this study, the focus was on the interrelationship between substance use and psychosis. It emphasised the need for integrated strategies for the treatment of mental health and substance use. It provides a crucial insight into the socio-demographic and clinical predictors of substance use in patients with FEP, which can inform clinical practice and intervention strategies.

Background: Depression and anxiety are pervasive mental health concerns worldwide that pose significant challenges to individuals and societies.

Aim: The aim of the study is to investigate the prevalence of co-occurring depression symptoms and anxiety among adult patients receiving care.

Setting: Primary clinics within the Family and Community Medicine Department, in Najran University Hospital, Saudi Arabia.

Methods: A cross-sectional study was conducted in February 2024, recruiting 300 adult patients across seven primary care clinics serving diverse populations. Data were collected using a comprehensive questionnaire that included socio-demographics, medical history, and screening for anxiety and depression symptoms. Multivariate regression analysis was employed.

Results: Most participants were aged 21-30 years (33.0%), predominantly female (64.0%), and Saudi (68.7%). Chronic diseases affected 26.4%, and 31.6% had a past medical history. Depression symptoms were reported by 21.7%, while 14% had anxiety, and 10.7% experienced both. Multivariate regression analysis revealed that stress, psychiatric conditions, herbal medication use, and sleep problems were independent risk factors for co-occurring symptoms.

Conclusion: Co-occurring anxiety and depression symptoms were prevalent in the study population.

Contribution: The findings advocate for comprehensive mental health strategies that priorities the early detection of co-occurring depression and anxiety, by considering factors essential for improving patient outcomes.

Background: Current evidence-based guidelines recommend the use of antipsychotic monotherapy at the lowest effective dose. Nonetheless, high-dose antipsychotics and antipsychotic polypharmacy appear to be common in clinical practice, often deviating from established recommendations.

Aim: This study aimed to estimate the prevalence and factors associated with high-dose antipsychotic prescribing among adult psychiatric inpatients.

Setting: The study was conducted at Ibn Rushd Psychiatric Teaching Hospital in Baghdad, Iraq.

Methods: The medical records of inpatients admitted from 24 April 2023 to 12 September 2023, were retrospectively analysed to extract routinely collected patient-level data and medication details; dosing appropriateness was based on that stated in the British National Formulary.

Results: Of the 225 eligible patients, 51.1% were male, aged 18-82 years (mean = 33.9). Altogether, 48.6% of patients received antipsychotic polypharmacy, and 35.6% were prescribed high-dose antipsychotics. No significant associations were found between high-dose antipsychotic prescribing and patients' characteristics, including age, sex, length of hospital stay, and number of admissions. Predictors of high-dose antipsychotics were polypharmacy (adjusted odd ratio [AOR]:12.61; 95% confidence interval [CI]: 1.78, 89.50), first-generation antipsychotics (AOR: 7.049; 95% CI 1.33, 37.44), quetiapine (AOR: 5.66; 95% CI 1.16, 27.53), procyclidine (AOR: 0.17; 95% CI 0.05, 0.55), and antidepressants (AOR: 0.19; 95% CI 0.05, 0.76).

Conclusion: Approximately one in three patients received regular high-dose antipsychotic therapy, which contradicts optimal clinical practice and risks patient safety. Targeted educational interventions are warranted to enhance guideline adherence and promote safe and appropriate use of antipsychotics.

Contribution: This is the first study to assess the magnitude and factors associated with high-dose antipsychotic prescription in Iraq.