South African Journal of Psychiatry最新文献

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.

Background: Attention deficit hyperactivity disorder (ADHD) is a common childhood disorder, with a prevalence rate of 5% - 8%. Clinical practice guidelines have been developed internationally to standardise the care and management of patients with ADHD.

Aim: To assess compliance with clinical guidelines on the management of children with ADHD in two hospitals in the Eastern Cape province using the National Institute for Health and Care Excellence (NICE) guidelines as the gold standard.

Setting: Paediatric departments of two hospitals in the Buffalo City Municipality, Eastern Cape province, South Africa.

Methods: A clinical audit was conducted on children and adolescents diagnosed with ADHD attending neurodevelopmental clinics (NDCs). Patient folders were reviewed between June 2021 and December 2021, and data were collected using a 16-point audit tool based on the NICE guidelines for ADHD.

Results: A total of 111 patient folders met the inclusion criteria. Of the 16 audit standards, 8 demonstrated over 80% compliance, while 2 achieved fair compliance (50% - 79%). Significant gaps were identified in the 6 standards with poor compliance (< 50%). Co-morbidities were highly prevalent, with 83% of patients presenting with at least one co-existing condition.

Conclusion: The audit demonstrated overall good clinical compliance with the NICE guidelines for ADHD management, but it also exposed gaps in psycho-social interventions, caregiver support and the availability of structured support groups.

Contribution: This study highlights service gaps in resource-limited settings and is expected to further inform government policy planning in developing auxiliary services and multidisciplinary support for children with ADHD and their families in such settings.

Background: South Africa has been experiencing a persistently high unemployment rate among young people. This high youth unemployment is a stressor to young people, which may culminate in mental health issues.

Aim: The study aimed to describe the self-reported mental health effects of unemployment among young people in Mdantsane township, Eastern Cape province.

Setting: The study was conducted in Mdantsane township, at the Lingomso Youth Centre in the Eastern Cape province, South Africa.

Methods: A descriptive qualitative approach was used. Participants were recruited purposively until data saturation. Data were collected through individual face-to-face interviews. Thematic analysis was conducted using a six-step approach.

Results: The sample comprised 19 young people aged between 19 years and 29 years, and most were men. Two themes emerged: theme one was negative effects, which were characterised by substance use, feelings of worthlessness, stress and anxiety, masking of personality, and social isolation; theme two was that social support buffered the potential adverse effects of unemployment, and this was supported by interdependent role relationships that protected individuals from the effects of unemployment.

Conclusion: There is a need to recognise mental health issues emanating from unemployment, like social isolation, to enable comprehensive, appropriate interventions for young people.

Contribution: This study contributes to understanding mental health issues experienced by unemployed young people. Findings can be used to develop targeted interventions in a large township, such as Mdantsane, in South Africa.

Background: The prevalence of post-traumatic stress disorder (PTSD) is uncertain globally, and there is a paucity of information in South Africa. Perinatal PTSD may impair maternal functioning and negatively affect their parenting ability.

Aim: This study aimed to determine the prevalence and associated factors of PTSD in an antenatal population in South Africa.

Setting: The study was conducted at Johan Heyns Community Health Centre in Sedibeng district, Gauteng province.

Methods: A cross-sectional questionnaire-based survey was conducted in which the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5) was administered among women attending the Johan Heyns antenatal clinic. The PCL-5 is a validated screening tool for PTSD, which comprises 20 items scored on a 5-point Likert scale for symptom severity. A total score ≥ 31 indicates at least moderate PTSD.

Results: Of the 98 pregnant women who participated in the study, 53 (54%) reported having experienced or witnessed a traumatic event. Total PCL-50 scores ranged from 0-65 (mean 13.8 standard deviation [s.d. = 18.1]), with at least one intrusion symptom endorsed by 37 women, followed by cognition and mood change by 36, arousal and reactivity by 32, and avoidance by 24. Sixteen women (16.3%) screened positive for PTSD (mean score 49.2 [s.d. = 12.7]). While univariate analysis found no significant associations with PTSD, alcohol use was associated with an increased risk of PTSD on multivariate analysis (RR 2.7; [95% confidence interval [CI] 1.1-7.0; p = 0.036).

Conclusion: Post-traumatic stress disorder is common among antenatal women in Sedibeng district and may be associated with alcohol use in pregnancy.

Contribution: This study highlights the importance of screening pregnant women for PTSD to ensure early intervention and management.

Background: Anxiety, depression, and suicidal ideation are prevalent mental health conditions among university students. Persistent anxiety and depression are associated with morbidity and suicidal ideation predicts suicide. Namibian mental health data are limited.

Aim: This study aimed to determine and analyse the prevalence and predictors of anxiety, depression, and suicidal ideation among Namibian public university students.

Setting: The study was conducted at six campuses of the two Namibian public universities.

Methods: A quantitative, cross-sectional, descriptive study was conducted among 578 purposively sampled students, using self-administered questionnaire, incorporating Beck's Anxiety Inventory, Patient Health Questionnaire-9, and Columbia Suicide Severity Rating Scale. Data were analysed in SPSS version 30, including descriptive statistics, bivariate regression, Pearson's correlation coefficients, and hierarchical multiple regression.

Results: Among 578 respondents, 50.7% reported moderate to severe anxiety, 73.2% met depression criteria, and 9.1% reported an active suicidal plan. Current mental illness was significantly associated with depression and suicidal ideation (p < 0.001). Depression was predicted by current mental illness (β = 0.276, p < 0.001) and family conflict (β = -0.144, p < 0.001), while suicidal ideation was predicted by current mental illness (β = -0.198, p < 0.001), (p < 0.001), family conflict (β = -0.171, p < 0.001), and age (β = -0.103, p = 0.007).

Conclusion: Anxiety, depression, and suicidal ideation are highly prevalent among Namibian university students, necessitating increased mental health awareness and institutional interventions to prevent suicidality.

Contribution: This study provides empirical evidence on the anxiety, depression, and suicidal ideation among Namibian public university students.