South African Journal of Psychiatry最新文献

Background: Adverse childhood experiences (ACEs), substance use, depressive symptoms, and HIV outcomes in people living with HIV (PLWHIV) have not been comprehensively investigated within a single study.

Aim: The aim of this study was to investigate the prevalence and association of ACEs, substance use, depressive symptoms and human immunodeficiency virus (HIV) outcomes in PLWHIV accessing HIV care during the coronavirus disease 2019 (COVID-19) pandemic.

Setting: District hospital HIV clinic in South Africa.

Methods: A total of 196 PLWHIV completed a socio-demographic and clinical questionnaire; an adapted World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test; WHO ACEs International Questionnaire, and Patient Health Questionnaire.

Results: The most common ACEs were having one or no parent, parental separation or divorce (n = 131, 66.8%), exposure to collective (n = 57, 29.1%) and community violence (n = 55, 28.1%), with 40.3% (n = 79) experiencing ≥ 3 ACEs. The most commonly used substances were alcohol (n = 34, 17.3%), tobacco (n = 33, 16.8%), and cannabis (n =13, 6.6%). The prevalence of depressive symptoms was 19.4% (n = 38). Linear regression analyses indicated greater alcohol (adj β = 2.84, p < 0.01), tobacco (adj β = 3.64, p < 0.01) and cannabis use risk scores (adj β = 2.39, p < 0.01) were associated with ≥ 3 ACEs. Logistic regression indicated depressive risk (adjusted odds ratio [OR] = 9.39, 95% confidence interval [CI] 4.78-23.51) was associated with ≥ 3 ACEs.

Conclusion: A high prevalence of ACEs, substance use and depressive symptoms exists among PLWHIV, along with an association between cumulative ACEs and both substance use and depressive symptoms.

Contribution: Enhanced screening and management services are recommended to address this triple burden in PLWHIV.

Background: Bipolar disorder (BD) is a chronic, disabling mental illness that may require recurrent hospitalisation. The length of hospital stay (LOS) for BD patients is variable, and literature suggests that this is because of clinical and socio-demographic factors.

Aim: To determine the average LOS for patients admitted for BD at a hospital and its relation to clinical and socio-demographic factors.

Setting: A public tertiary hospital in South Africa.

Methods: Clinical and socio-demographic data were obtained from a retrospective record review of patient admissions at a hospital over 1 year. Length of hospital stay, defined as the duration between admission and discharge date, and other variables were retrieved.

Results: A total of 215 patients were admitted during the study period. The mean LOS was 30 days. The mean age of the patients was 35.9 years (standard deviation [s.d.] = 12.4, range 18-72 years). There were similar numbers of males and females admitted. Significantly more patients were not married (p < 0.001), unemployed (p < 0.001), and had a history of substance use (p < 0.001). Employed patients were 2.5 times more likely to have a short stay than those unemployed (p = 0.03). There was a statistically significant association between the number of comorbidities and LOS.

Conclusion: The study findings align with the literature's results. The median length of stay was 25 days and was impacted by socio-demographic but not clinical factors.

Contribution: The study provided insight into the impact of variable factors in LOS for BD patients.

Background: Depression is reported as one of the most common mental disorders. Research on Indian men's understandings of depression is limited.

Aim: The authors aimed to explore South African Indian men's understanding of depression in a community, and how this guides help-seeking behaviour.

Setting: Community dwelling participants in Gauteng, South Africa.

Methods: An exploratory qualitative design was employed and a purposive sampling method was used to recruit participants. Semi-structured interviews were conducted with seven Indian adult men and analysed using thematic analysis.

Results: The findings of this study yielded a total of six themes. These included understanding of depression, depression is taboo, diverging gender role expectations and depression, help-seeking behaviour, barriers to help-seeking, and mental health community support.

Conclusion: The findings suggest a lack of understanding and awareness of depression among participants and discussions around mental illness being regarded as taboo. Gender roles and societal expectations were considered as one of the contributors to depression onset. Coping and help-seeking behaviour included adaptive and maladaptive coping mechanisms with professional psychological help being least prioritised. Self-stigmatisation and fear of discrimination were highlighted as barriers to help-seeking behaviours.

Contribution: This study contributed to the limited body of knowledge on understanding of depression among Indian men in South Africa and highlighted the importance of mental health awareness campaigns and professional help-seeking behaviour.

Background: Patient-reported outcome measures (PROMs) are used as part of clinical practice to determine the impact of the condition and treatment interventions on a patient's health and quality of life. The Patient Health Questionnaire-9 (PHQ-9) is a self-administered diagnostic tool that has been widely adopted for the detection and monitoring of depression.

Aim: This analysis reports the change in PHQ-9 scores from admission to discharge in patients admitted for depression to a South African acute psychiatric facility and aims to quantify the treatment effect of the admission using the PHQ-9 as the measurement tool.

Setting: South African acute psychiatric facility.

Methods: This was a retrospective observational study of all patients admitted to Netcare Akeso acute psychiatric facilities from 01 January 2018 to 31 October 2022. Patients were included if they were ≥ 18 years of age, admitted with a primary International Classification of Disease (ICD)-10 code for depression (i.e. F32-F33) and fully completed both an admission and discharge PHQ-9 questionnaire. We excluded facilities focusing only on the treatment of patients with specialised conditions such as addiction or eating disorders.

Results: This analysis included 13 308 patients admitted for depression at 10 different facilities. The median PHQ-9 score on admission was 19 (interquartile range [IQR] 14-23) and 5 (IQR 2-11) on discharge, with a median change of -12 (IQR -5 to -18). A minimal clinically important difference was seen in 87.6% patients (n = 10 091/11 515); a treatment effect was seen in 74.5% of patients and a clinically significant improvement was seen in 72.1% of patients.

Conclusion: With the average patient reporting a four-fold reduction in the severity of their depression scores, PROMs provide a critical patient-centred window into the benefit that an inpatient admission has on those suffering with depression.

Contribution: These changes are consistent with those seen internationally and provide a baseline for understanding the treatment efficacy of an inpatient admission for the treatment of depression.

Background: Studies show that youth in low socioeconomic communities suffer significant disturbances in mental and emotional health because of exposure to violence and peer victimisation, manifesting in internalising disorders such as depression, anxiety and traumatic stress.

Aim: To examine the relation between risks and exposure to community violence and peer victimisation.

Setting: Low socioeconomic communities in Durban, KwaZulu-Natal.

Methods: Data were collected via school and home interviews with youth and maternal caregivers using standardised schedules and instruments. These included the Demographics and Questions about Child's Health schedule, the Family History of Risk Questionnaire, the Child Behaviour Checklist, the Social Experiences Questionnaire and the Survey of Children's Exposure to Violence. Youth sample comprised 256 participants, with age range from 9 to 18 years, and 65% being female.

Results: Sociodemographic risks were significantly associated with lifetime witnessing violence, victimisation and hearing about violence. Low maternal education was associated with overt peer victimisation and cyber-victimisation. Internalising conditions such as worry and oversensitivity, fear and concentration, youth anxiety and maternal anxiety were also significantly associated with violence exposure and peer victimisation.

Conclusion: Predisposing risks for exposure to violence and victimisation occur in all domains, suggesting that interventions should target these domains to minimise their impact. Co-occurring experience of violence at the personal, proximal and distal levels perpetuate a cyclical loop of violence, intersecting and influencing each other.

Contribution: Risk factors such as anxious attachment, avoidant attachment and anxiety, conceptually often seen as maladaptive outcomes, also serve as predisposing risks for violence exposure.

Introduction: Lithium-induced neurotoxicity is almost always reversible but can cause irreversible neurological sequelae, namely the syndrome of irreversible lithium-effectuated neurotoxicity (SILENT). As there is no definitive treatment for SILENT, caution is required when administering lithium. Reports on the effect of lithium-effectuated neurotoxicity on cognitive function are limited. We report a case in which high cognitive function was lost after lithium overdose and hardly recovered, as evaluated using multiple neuropsychological tests during a 1-year hospitalisation period.

Patient presentation: A 52-year-old man on lithium medication with bipolar disorder was admitted to the intensive care unit because of lithium overdose. The patient achieved lucid consciousness after continuous haemodiafiltration. However, he could not move his body as desired or produce appropriate verbal expressions; thus, he was moved to our psychiatric ward, where his treatment continued.

Management and outcome: After several months, the patient was diagnosed with SILENT owing to persistent motor and cognitive dysfunctions. Multiple neuropsychological tests were performed, and cognitive function was evaluated. The Neurobehavioural Cognitive Status Examination showed a worsening trend, and the full intelligence quotient of the Wechsler Adult Intelligence Scale-Third Edition was in the mild intellectual disability range.

Conclusion: This is a clear case of cognitive dysfunction due to SILENT and is difficult to treat. Thus, it is crucial to prevent the onset of SILENT.

Contribution: This report is valuable because it is one of the few to track changes in cognitive function over time in a patient with SILENT using objective measures over 1 year of hospitalisation.

Background: Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, with a chronic, and potentially debilitating course if untreated. Medication adherence is poor - negatively affecting emotional, social, educational and employment outcomes. The current Schedule 6 status of methylphenidate (MPH) drives healthcare resource utilisation and costs - a potential barrier to care.

Aim: This study explored stakeholders' understanding and perceptions of the potential impact of a regulatory shift in the scheduling of MPH on treatment accessibility and adherence for ADHD.

Setting: Participants from multiple stakeholder groups, involved in ADHD management in South Africa, were recruited via professional networks.

Methods: A qualitative analysis of semi-structured interviews with 23 stakeholders was conducted to explore their views on the utility, benefits and risks associated with rescheduling MPH.

Results: Six key themes emerged from the interviews: 'adherence', 'accessibility', 'affordability', 'stigma', 'rescheduling of MPH' and 'risk mitigation'. Core to these themes is the role of the scheduling of MPH - which can have a protective societal role, but also acts as a barrier to care for individuals with ADHD.

Conclusion: The current Schedule 6 status of MPH is not an effective strategy to prevent misuse and diversion but negatively impacts on treatment adherence. The positive outlook from stakeholders on rescheduling MPH holds significant implications for the ADHD landscape in South Africa.

Contribution: It is crucial to address stigma, facilitate fundamental change in service delivery and remove structural and practical barriers to care to improve outcomes for individuals with ADHD. A framework for ADHD treatment adherence is provided.

Background: Non-compliance with psychiatric medication among patients diagnosed with depression ranges from 28% to 52% exacerbating illness and reducing treatment effectiveness. There is a paucity of research on medication non-compliance and its causes in South Africa and globally, and an urgent need to develop appropriate interventions.

Aim: This study aimed to explore and describe the experiences of adults living with depression who are non-compliant with their psychiatric medication and formulate recommendations to facilitate their medication compliance.

Setting: The study was conducted in a psychiatric ward at a public hospital in Gauteng, South Africa.

Methods: The study employed a qualitative, exploratory, descriptive and contextual research design. Ten adults' lived experiences were explored using in-depth individual interviews, and Tech's coding method was used to analyse data.

Results: Two themes emerged from the data: adults living with major depression offered several reasons for non-compliance, and adults living with major depression experienced non-compliance, which created a setback to their recovery.

Conclusion: Non-compliance with medication is a common challenge among adults receiving mental health care and treatment. Ensuring compliance to medication is crucial for improving the prognosis of psychiatric conditions. Therefore, it is essential for healthcare practitioners in the field of psychiatry to have a comprehensive understanding of medication compliance and to effectively address any challenges that may arise in this area.

Contribution: This paper contributes to the research field and adds knowledge to clinical nursing practice by exploring adults' experiences with non-compliance to psychiatric medications while living with depression in the South African context.