South African Journal of Psychiatry最新文献

Background: Psychotropic polypharmacy is increasing globally. In South Africa (SA), Complex Psychotropic Polypharmacy (CPP) prevalence is 36.3%. Being on CPP is associated with adverse drug reactions and worsened patient outcomes, but there exists limited knowledge on CPP risk factors in SA.

Aim: To determine CPP prevalence and its associated clinical and sociodemographic factors in a community setting in SA.

Setting: The study was conducted in five randomly selected community mental health clinics in Soweto township from 01 January 2021 to 31 December 2022.

Methods: A retrospective study of 348 adult patient records was conducted from January 2021 to December 2022. Data on prescriptions, clinical and sociodemographic variables were extracted. Being on CPP was defined as having 3 or more psychotropics. Chi-square tests and logistic regression were used to identify factors associated with CPP.

Results: The CPP prevalence was 25.3%. The most common CPP combination (26.1%) was oral antipsychotic, long-acting injectable antipsychotic and mood stabiliser prescriptions. Psychiatric diagnosis was significantly associated with CPP, p-value = 0.012. The most common adverse drug effect was associated with use of anticholinergic drugs (13.2%) of which 28.3% were on CPP. Those who were widowed or divorced were 4.3 times more likely to be on CPP compared to those never married (single) Adjusted odds ratio (AOR) = 4.3 (95% CI:1.2-16.1).

Conclusion: There is notably high prevalence of CPP. The risk of adverse effects rises with an increase in the number of medications. Evidence-based prescribing and periodic review of medication should be emphasised.

Contribution: Increased monitoring of prescribing practices is needed to determine if the practice of Complex psychotropic polypharmacy (CPP) prescription is in line with treatment guidelines for psychiatric diagnosis.

Background: Untreated postpartum depression (PPD) has the potential to cause significant distress or impairment in functioning with a consequent negative impact on a developing child.

Aim: This study aimed to determine the prevalence of PPD and its associated factors in women attending postpartum primary care clinics.

Setting: The study setting involved randomly selected three 24-h clinics in Gaborone, the capital city of Botswana.

Methods: A cross-sectional study was conducted among 295 conveniently sampled postpartum mothers. The Edinburgh Postnatal Depression Scale (EPDS) questionnaire, researcher-designed socio-demographic questions and the Oslo Social Support Scale 3 (OSSS-3) were utilised to collect data on the PPD, demographic factors and social support, respectively. Variables identified to be associated with PPD on bivariate analyses were entered into multivariate analysis to determine factors associated with PPD.

Results: The prevalence of PPD was 33.9% (95% CI 28.5% - 39.6%). Factors predictive of PPD included the history of being involved in intimate partner violence (AOR = 4.789 95% CI [2.276-10.077]), poor relationship with the partner's mother (AOR 2.657, [1.080-6.538]), poor and moderate social support (AOR 2.685 [1.013-7.111] and AOR 5.897 [2.140-16.248]), respectively.

Conclusion: The high prevalence of PPD highlights the need for routine screening for PPD and its associated factors in antenatal and postnatal clinics. Continued practice of traditional postpartum cultural practices can be recommended as these promote social support and can potentially decrease PPD in our setting.

Contribution: This is the first study to report on the prevalence and factors associated with PPD in Botswana, thus useful in tailoring culturally appropriate interventions.

Introduction: Stuttering, a speech disorder marked by disruptions in fluency, can be developmental or acquired. Acquired stuttering often stems from neurological causes, psychological trauma or certain medications, with antipsychotics such as clozapine implicated in several cases. Clozapine, particularly at higher doses, has been associated with dose-dependent stuttering although the precise mechanisms remain uncertain. While clozapine's effects dopamine pathways and seizure thresholds are proposed mechanisms, movement disorders such as focal dystonia and prior extrapyramidal symptoms (EPSEs) are also implicated.

Patient presentation: A 40-year-old man with HIV, schizophrenia and a history of previous severe dystonic reaction to typical antipsychotics, developed stuttering after initiation of clozapine. His stuttering was accompanied by involuntary oral movements.

Management and outcome: The patient's psychotic symptoms were found to be treatment-resistant, unresponsive to trials of two antipsychotics, and thus necessitating the initiation of clozapine. Following clozapine administration, the patient developed stuttering, which was unresponsive to benzodiazepine therapy and showed no abnormalities on electroencephalogram (EEG) assessment. Gradual resolution of stuttering was observed upon clozapine discontinuation and a switch to amisulpiride.

Conclusion: Clozapine was identified as the likely cause of stuttering in the presence of additional risk factors such as HIV and a history of EPSEs.

Contribution: This case highlights the importance of recognising clozapine-induced stuttering.

Background: Mining industries are high-risk workplaces for psychological distress. Unaddressed psychological distress can lead to accidents, absenteeism and decreased productivity.

Aim: This study sought to determine levels of psychological distress and associated sociodemographic factors among employees working at a mining company in South Africa.

Setting: The study was conducted at four sites, including three underground mines and a head office, across a number of provinces in South Africa.

Methods: A quantitative correlation design was used with 927 respondents recruited through convenience sampling. Data were collected using a questionnaire containing sociodemographic items, the Kessler Psychological Distress Scale (K10) and the Alcohol Use Disorder Identification Test. The response rate was 84%.

Results: Two-thirds (69%) of participants reported no or mild psychological distress, while a third (31%) experienced moderate to severe distress. Women, younger employees, employees at site 1 and those with increased likelihood of alcohol consumption at higher risk levels, were more likely to experience higher levels of psychological distress.

Conclusion: Psychological distress potentially impacts daily functioning for a third of employees, indicating a need for prevention and management interventions addressing personal, workplace and environmental factors.

Contribution: This study identifies critical sociodemographic factors associated with psychological distress among South African mine employees. These factors can inform targeted mental health interventions to improve employees' mental health, safety and productivity. The findings highlight the need to focus on targeted mental health interventions for women and younger employees and to design interventions that address alcohol use and mental health in an integrated manner.

Background: The coronavirus disease 2019 (COVID-19) pandemic has changed life globally and significantly disrupted psychiatric inpatient care, with infection control measures altering therapeutic environments and exacerbating patient distress. Both staff and inpatients had to quickly adapt to new norms while maintaining care in an already vulnerable setting.

Aim: This study aimed to explore psychiatric inpatients' experience of adapting to the COVID-19 pandemic.

Setting: The study was conducted in Weskoppies Psychiatric Hospital, Tshwane, Gauteng.

Methods: We conducted a qualitative study comprising 15 semi-structured interviews with psychiatric inpatients admitted to Weskoppies Hospital in South Africa during the COVID-19 pandemic, using purposive sampling. Open-ended questions encouraged detailed responses and guided the conversation. Recordings were later transcribed for analysis.

Results: Our study showed that psychiatric inpatients displayed an engagement strategy, rather than a disengagement approach, in adapting to a crisis. They actively tried to control, manage, and change stressful situations by accepting the hospital infrastructure and new COVID-19 rules, seeking social support, and holding on to their faith.

Conclusion: Psychiatric inpatients at Weskoppies Hospital adapted to the COVID-19 pandemic through support from staff, family, hospital systems, and personal coping strategies. These findings highlight the need for holistic, patient-centred care that includes psychosocial and spiritual support during times of crises.

Contribution: This study provided insights into psychiatric inpatients' experiences and can help mental healthcare practitioners to ensure a more positive experience during rehabilitation and reintegration of psychiatric patients into society.

Background: Traditional healers play a significant role in healthcare seeking in South Africa. Many South Africans often seek healthcare services from both medical practitioners and traditional healers simultaneously for the same condition. Despite this, many medical practitioners seem ignorant about the practices of traditional healers.

Aim: This study aimed to explore the similarities and differences between the practices of a traditional healer (TH) and a psychiatrist in training (PIT) regarding an inpatient mental healthcare user (MHCU).

Setting: This study was conducted at an inpatient ward at Weskoppies Hospital, Pretoria.

Methods: An autoethnographic method was utilised in this study.

Results: The TH and PIT evaluated the same MHCU. While doing so, the PIT used participant observation, field notes, and finally a qualitative content analysis. The findings of the content analysis were validated with the TH. Two previously unpublished findings in South African traditional healing emerged: the use of a doll (effigy) and calling on angels.

Conclusion: The TH and PIT followed the same basic steps in evaluating and treating the MHCU, but there were notable differences in the details (subcategories) of those steps. These differences reflect very different epistemologies about mental illness: the PIT used an evidence-based, naturalistic (or positivistic) model, while the TH used a model that can best be designated as transcendent.

Contribution: This study contributes towards an understanding of a TH's approach to a mentally disordered patient.

Background: Adolescence is characterised by profound changes in physical, cognitive, emotional and social functioning and is associated with psychological distress and suicidal tendencies. The family plays a significant role in safeguarding and promoting adolescents' mental health. However, little is known about the influence of family functioning on adolescents' psychological distress and suicidal tendencies in Ghana.

Aim: This study examined the association between family functioning, psychological distress and suicidal tendencies among adolescents in Ghana.

Setting: The study was conducted at three public senior high schools in Accra, Ghana.

Methods: This cross-sectional study randomly recruited 600 students. We analysed the data using Spearman's rho correlation and simultaneous multiple logistic regression.

Results: The study revealed that poor family problem-solving had no statistically significant relationship with adolescents' psychological distress and suicidal tendencies. After covarying by gender and age, poor family communication was not statistically and significantly associated with adolescent psychological distress but had a statistically significant positive association with suicidal tendencies. However, and more importantly, poor family affective involvement predicted both adolescents' psychological distress and suicidal tendencies.

Conclusion: These findings suggest the key role of the family in adolescents' psychological distress and suicidal tendencies, emphasising the need for tailored family psychological interventions in Ghana.

Contribution: This study contributes to the emerging literature on family functioning and its association with adolescent psychological distress and suicidal tendencies, underpinned by the McMaster model of family functioning (MMFF) in the Ghanaian setting.

Background: Statistics indicated that, in 2019, over 3 million of South Africa's population of 58 million people presented as gender non-conforming. This is challenging, as in South Africa, the Western binary concept is still prevalent. In light of the above, South African research on trans and gender-diverse (TGD) interventions is essential. There is limited research on existing TGD group interventions in a South African public context.

Aim: This article aimed to report on the personal reflections of the two clinical psychologists who co-facilitated a support group for TGD people at Chris Hani Baragwanath Academic Hospital (CHBAH). This study highlights the importance of group intervention in particular.

Setting: Chris Hani Baragwanath Academic Hospital in South Africa.

Methods: A reflexive thematic analysis was utilised. Thoughts and self-reflective themes discussed after each group were included. No participants or instruments were utilised in this research.

Results: The following themes were identified in this research: gaps in our knowledge, the role of facilitators, misgendering and gender fluidity, collective self-esteem, corrective experience and basic rights.

Conclusion: This group contributed to our learning and development as facilitators. The role of reparation and empathy as facilitators was highlighted.

Contribution: The results support the importance of support groups for TGD individuals in public healthcare as well as the further development of healthcare professionals. Because of a scarcity of psychological services rendered in public hospitals to TGD people, this article may potentially be a rich source of data for future TGD support groups and/or services.

Background: Perinatal alcohol and non-prescribed substance use may be detrimental to foetal and infant growth.

Aim: This observational study investigated how combined and continued alcohol and non-prescribed substance use throughout antenatal and 1-year postnatal periods were associated with adverse child length and weight outcomes up to 24 months.

Setting: Data from participants (n = 1098) with information on alcohol and non-prescribed substance use and infant and child outcomes, were drawn from a prospective birth cohort in the Drakenstein Child Health Study (DCHS), conducted in the Western Cape province of South Africa.

Methods: Generalised estimating equations were conducted on standardised child length and weight outcomes at 12, 18 and 24 months.

Results: Non-prescribed substances consisted mostly of tobacco use (77%). Child length and weight were significantly lower in those exposed to the combined use of alcohol and substances compared to no-use and all other use groups (p < 0.001), as confirmed by multivariable analyses. Child length and weight were also significantly lower in those exposed to alcohol and/or substance use throughout the antenatal and 1-year postnatal periods, as confirmed by multivariable analyses.

Conclusion: Interventions to address the potential long-term adverse effects of combined alcohol and substance use particularly tobacco use, as well as continuous use throughout antenatal and early postnatal periods on subsequent child growth, are needed.

Contribution: This study has contributed to the field by showing that combined and continued use of alcohol and other substances during pregnancy and postpartum is associated with impaired early child growth.