South African Journal of Psychiatry最新文献

Background: In recovery-oriented mental health care, family members of mental health care users form part of the caring team. Families are expected to care for mental health care users without support in the under-resourced rural Vhembe district in South Africa.

Aim: This study aims to describe the lifeworld of family members caring for mental health care users in rural areas to inform the development of a support programme.

Setting: Purposive sampling was used to select 16 family members from eight community health centres in the Vhembe district.

Methods: A qualitative approach, using a descriptive phenomenological design, was adopted to conduct unstructured interviews that were transcribed, translated and analysed using a descriptive method.

Results: Family members continuously contemplate their responsibilities. Endless concerns and stress result in forgetfulness and physical problems such as insomnia, hypertension and pain. Family members feel powerless and helpless when there is no improvement and support from community resources. Fear of being violated, embarrassed and stigmatised by community members results in social isolation and depression.

Conclusion: Caregiving is burdensome in poorly resourced areas. Feelings of helplessness and hopelessness Psychosomatic and depressive symptoms relate to the lack of effective community support which are likely to result in compromising the care they provide.

Contribution: The results call for the Department of Health to strengthen community mental health services and for health care professionals to provide supportive interventions based on the needs of mental health care users and their families.

Background: Negative attitudes towards electroconvulsive therapy (ECT) among health professionals have been attributed to a lack of knowledge, despite advancements in its administration and evidence of its efficacy in certain psychiatric conditions.

Aim: This study assesses knowledge and attitudes towards ECT among psychiatry and clinical psychology professionals.

Setting: The University of the Witwatersrand, Department of Psychiatry, Johannesburg, South Africa.

Methods: A quantitative cross-sectional design was used. All psychiatry and clinical psychology professionals associated with the university were invited to participate in an anonymous online survey from 01 September 2022 to 30 June 2023.

Results: The response rate was 49.6% (n = 58) among psychiatrits and 22.2% (n = 22) among clinical psychology professionals. Psyhiatrists had greater knowldge and more favourable attitudes than psychologists. Only 45.5% of psychologists had exposure to ECT, compared to 93.1% of psychiatrists. Knowledge and attitude scores were significanly correlated (p = 0.009, OR 6.7). Most psychologists (86.4%) recommended ECT theory be included in their curriculum.

Conclusion: Greater knowledge correlates with improved attitudes towards ECT. Increased training could enhance attitudes, particularly among psychology professionals.

Contribution: This study offers insights into knowledge and attitudes towarss ECT in a Johannesburg psychiatry department.

Background: Personality disorders (PDs) are estimated to occur in 6.8% of South Africans and in 45% to 80% of clinical populations. Mental health practitioners often harbour negative attitudes and lack confidence in working with such patients. Brief training in transference focused psychotherapy (TFP) has been shown to improve attitudes and confidence in the management of clinical encounters with PD.

Aim: This study aimed to describe the characteristics of attendees at a brief TFP training workshop and determine the impact of training on attitudes and clinical confidence towards patients with PD.

Setting: We conducted two 3 h online workshops, spaced 1 week apart to staff at South African University training hospitals.

Methods: At baseline, participants (N = 41) completed questionnaires on demographics, perceived need for training, supervision adequacy and perceived confidence. At baseline and after the second session, the Attitude to Personality Disorder Questionnaire (APDQ) and the Clinical Confidence in Personality Disorder Questionnaire (CCPDQ) were completed. Longitudinal data were analysed using linear mixed-effects regression.

Results: In the completer sample (N = 13), there were significant improvements in the APDQ enthusiasm subscale (p = 0.029) and in clinical confidence (CCPDQ) (p = 0.032). The APDQ total and other subscales also showed improvements. Participants with higher baseline confidence were more likely to drop out.

Conclusion: Brief training in TFP can lead to significant improvements in attitude and confidence in managing patients with PD.

Contribution: This is the first study in the South African context demonstrating the potential value of brief teaching in TFP.

Background: Attention deficit hyperactive disorder (ADHD) is a neurodevelopmental disorder occurring in children and adults. Pharmacotherapy remains the cornerstone of ADHD treatment. Stimulants such as methylphenidate are effective and have been one of the best studied and most frequently used treatment for ADHD. However, different delivery mechanisms and devices may potentially impact patient experience and real-life outcomes.

Aim: This study evaluated the effectiveness of Multiple-Unit Pellet System Delivered Extended-Release Methylphenidate (Contramyl XR) on symptom control and reported outcomes in ADHD patients, in a real-world setting.

Setting: A phase IV, open label, flexible dose, prospective, observational study conducted at six sites covering five provinces of South Africa.

Methods: About 119 participants with ADHD (both newly diagnosed [treatment-naïve] and methylphenidate-treated [switch-over] patients) were enrolled and initiated either on Contramyl XR or switched over from methylphenidate to Contramyl XR. Primary efficacy was assessed by Weiss Functional Impairment Rating Scale (WFIRS) over 12 weeks.

Results: In all, 117 participants completed the study (treatment-naïve patients: 46% [n = 55] and switch-over patients: 54% [n = 64]). Mean change from baseline in total WFIRS (95% confidence interval) was -17.7 (-21.1, -14.3; p < 0.001) at week 4 and -29.3 (-33.5, -25.2; p < 0.001) at week 12. At week 12, there was significant improvement in WFIRS scores, with treatment satisfaction reported by treatment-naïve patients. Switch-over patients also demonstrated comparable effectiveness.

Conclusion: Contramyl XR was found to be clinically effective either as de novo or as switch therapy. It was well tolerated, and all patients chose to continue with the treatment option.

Contribution: Despite distinct and different delivery mechanism of Contramyl XR, this study provides evidence for using it as an alternate treatment option versus reference methylphenidate, in both treatment-naïve and switch-over ADHD patients. Study participants willingness to continue Contramyl XR therapy post study, further strengthens the confidence on the effectiveness of Contramyl XR in managing ADHD patients.

Background: Body shaming, a pervasive issue, has severe psychological and societal repercussions, particularly for early adolescents. This study addresses the gap in understanding body shaming in smaller urban settings such as Jember City, often overlooked in favour of larger metropolitan areas.

Aim: The study aimed to investigate the psychological effects, trigger factors and potential preventive measures of body shaming among junior high school students in Jember City.

Setting: The study was conducted in junior high schools in Jember City, East Java, Indonesia.

Methods: An observational, cross-sectional design with both quantitative and qualitative approaches was used. Data were collected through self-administered questionnaires and in-depth interviews. The quantitative analysis was performed using the Spearman's rank test.

Results: The study included 320 adolescents aged between 12 and 15 years. Of these, 6.3% were 12 years old, 31.2% were 13, 31.6% were 14, and 30.9% were 15. Additionally, 56.2% of the participants were female. The majority (95%) identified as Muslim, and 72.8% had parents with bachelor's degrees. Parental occupations ranged from private business to civil service. In terms of body mass index, 34.7% were classified as very thin, 18.1% as thin, 40.9% as normal, and 3.1% as fat or obese. Body shaming was widespread, with 73.1% criticized for their clothing, 59.9% for their speech, and 66.7% compared to others. The main sources of body shaming were family, peers, media, and personal insecurities. There was also a significant correlation between body shaming and stress (ρ = 0.404, p < 0.01).

Conclusion: Body shaming affects mental health, particularly among adolescents. It stems from societal norms and media perpetuation.

Contribution: This study provides insights into body shaming in smaller urban settings, highlighting the need for targeted prevention efforts to mitigate its effects and promote healthier self-esteem and body image.

Background: Adolescents living with HIV (ALWHIV) are more vulnerable to developing depressive symptoms. Despite this knowledge, the screening for depression is not routinely integrated into HIV treatment programmes.

Aim: The study aimed to determine the prevalence of depressive symptoms among ALWHIV.

Setting: The study was carried out in the primary healthcare clinics and an antiretroviral clinic situated in a district hospital, West Rand District, Johannesburg.

Methods: This was a cross-sectional study of 125 ALWHIV. The modified Patient Health Questionnaire for Adolescents (PHQ-A) was used to screen for depressive symptoms with a score of ≥ 5 deemed significant. A distress protocol was used for immediate psychological intervention.

Results: The prevalence of depressive symptoms was 44.8% and the majority of ALWHIV reported mild-moderate symptoms (36.8%). Overall, 25.6% of adolescents had suicidal behaviours. Those with psychosocial difficulties and those who reported a previous suicide attempt were 3.6 (adjusted odds ratio [aOR] 3.59, 95% confidence interval [CI]:1.17-11.03) and 6.9 (aOR 6.93, 95% CI:1.39-34.55) times likely to develop depressive symptoms, respectively.

Conclusion: A high prevalence of depressive symptoms was found in ALWHIV. Psychosocial difficulties and previous suicide attempts were predictive factors for depressive symptoms. This highlights the unmet need for the integration of mental health screening and overall mental health services into adolescent HIV programmes.

Contribution: This study emphasises an urgent need for routine mental health screening and prompt psychosocial support in ALWHIV.

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Background: Disruptive mood dysregulation disorder (DMDD) is characterised by severe emotion regulation difficulties, particularly anger and irritability, in children. Despite the impact of attachment on emotional and behavioural regulation, the link between attachment style and DMDD is under-researched.

Aim: This study investigated whether attachment style and parasympathetic regulation differentiate the response profiles to frustrating conditions between children diagnosed with DMDD and controls.

Setting: Participants were assessed at schools in Johannesburg, Gauteng, South Africa.

Methods: Thirty participants were divided into two matched groups (n _DMDD = 15; n _Control = 15) and assessed. Respiratory sinus arrhythmia (RSA) and heart period were measured during an Affective Posner Task, inducing frustration. Attachment style was assessed using the Attachment Style Classification Questionnaire for children. Parents of children with DMDD completed a social interaction problems questionnaire.

Results: The DMDD group showed a higher prevalence of avoidant attachment style (p = 0.013) compared to controls. Both groups displayed adaptive vagal withdrawal and recovery during the task (p = 0.005; p = 0.021). Controls had significantly higher heart period throughout the assessment (game 1: p = 0.006; game 2: p = 0.013; game 3: p = 0.007). In the DMDD group, lower vagal tone during frustration correlated with more social interaction problems (p = 0.049).

Conclusion: The study demonstrates a potential link between attachment style and altered physiological state in children with DMDD.

Contribution: The findings provide insight into possible atypical vagal regulation of the heart and avoidant attachment styles in DMDD, highlighting potential therapeutic and intervention targets.

Background: Coronavirus disease 2019 (COVID-19) has impacted on a range of physical, mental and societal health indices. Increased levels of psychological stress are often reported following pandemics.

Aim: To describe and compare the presentations of mental health care users pre- and post-initiation of the lockdown, with an emphasis on demographic profiles and final diagnoses.

Setting: The study was conducted as a retrospective record review over the predetermined period at a large public hospital in Johannesburg and included all mental health care users requiring psychiatry consultation during the study period.

Methods: Clinical records were traced via the emergency department registration desk, and information pertaining to demographics, presenting complaints, date of presentation and diagnosis was extracted.

Results: A significant increase was seen in patients with psychotic disorders from pre-COVID-19 to post-COVID-19. There was a reduction in presentations of mood disorders and substance-related disorders. Patients presenting in the post-COVID-19 time period were significantly younger than in the pre-COVID-19 time period.

Conclusion: Pandemics result in notable negative mental health sequelae. Policies aimed at mitigating the spread of infective agents should be implemented with consideration of the burden of psychological distress following the pandemic.

Contribution: This study provides insights into clinical and demographic variables in a mental health care population serviced at a government hospital pre- and post-COVID-19 lockdown regulations.

Background: The coronavirus disease 2019 (COVID-19) pandemic has placed the psychological functioning of mental healthcare practitioners under severe strain. Coping methods may affect mental health outcomes.

Aim: The study examined the relationship between depression, anxiety, stress, and coping styles utilised by mental healthcare practitioners during the COVID-19 pandemic.

Setting: Three private and one public mental healthcare facility in Bloemfontein, South Africa.

Methods: Respondents completed the Depression, Anxiety and Stress Scale (DASS-21) and Brief Coping Orientation to Problems Experienced (Brief-COPE) inventories. An ordinal regression model was used to assess the relationship between coping styles, anxiety and depression.

Results: A total of 212 practitioners were included in the analysis. According to DASS-21 measures, approximately 41% and 28% of respondents had moderate to severe depressive and anxiety symptoms, respectively, with the highest prevalence among younger female respondents and nurses. The association between stress severity, anxiety and depression was significant. Avoidant coping methods and two approach coping strategies (planning and acceptance) were associated with depression and anxiety. Anxiety was linked to an increased likelihood of transitioning to higher avoidant categories, while participants with depression were less likely to move to higher avoidant or approach categories.

Conclusion: Mental healthcare practitioners, especially nurses, experienced significant COVID-19-related psychological distress during the pandemic. Avoidant coping mechanisms may increase the risk of poor mental health outcomes.

Contribution: This study added data on the mental health effects of COVID-19 on mental healthcare practitioners, as well as psychological methods used to cope during the pandemic.