South African Journal of Psychiatry最新文献

Background: In South Africa, the South African Police Service (SAPS) is often called to facilitate access to mental healthcare for individuals with severe behavioural disturbances posing risks to themselves or others, as outlined in the Mental Health Care Act (2002). Understanding the experiences of mental healthcare users (MHCUs) and their families during these encounters is essential for improving mental health services.

Aim: To explore the experiences of MHCUs and their families during interactions with SAPS when seeking assistance for hospital admission, focusing on perceptions of SAPS attitudes and responses.

Setting: The study was conducted at the outpatient and inpatient psychiatric departments of Chris Hani Baragwanath Academic Hospital in Southern Johannesburg.

Methods: Between June and December 2023, 15 semi structured interviews were conducted with five inpatients, five outpatients, and five family members. Interviews were audio-recorded, transcribed verbatim, and analysed inductively to identify emergent themes.

Results: Five major themes emerged, highlighting confusion, fear, and feelings of criminalisation. Participants reported inadequate SAPS support, with the escalation of force often worsening anxiety and distress. Families were frequently misinformed, including being advised to call an ambulance, which delayed care. SAPS involvement often led to public embarrassment, affecting MHCUs' dignity.

Conclusion: SAPS responses to mental health emergencies frequently increased distress among MHCUs and families. The findings highlight the need for SAPS training and clear protocols to manage psychiatric crises with care and sensitivity.

Contribution: This study informs interventions aimed at improving SAPS-MHCU interactions.

Background: While women with mental illness are prone to unplanned pregnancies, sexual violence and exposure to teratogenic medications, there is limited knowledge of contraceptive use and counselling in this vulnerable group.

Aim: This study aims to determine the prevalence of contraceptive use and counselling in women of childbearing age attending a psychiatric facility in KwaZulu-Natal Province, South Africa.

Setting: This study was conducted on in- and outpatients attending Townhill Hospital, a tertiary psychiatric facility in Pietermaritzburg that provides specialised services for the uMgungundlovu District and surrounds.

Methods: An interviewer-designed and administered questionnaire was used to obtain data from 186 participants in this quantitative, cross-sectional study. Clinical information was obtained from the participants' medical records.

Results: Among the 186 participants, the prevalence of consistent contraceptive use was 50%, 65.9% of prior pregnancies were unplanned, 35.5% reported a history of forced sex, 25.8% reported having unmet contraceptive needs and 59.7% requested integrated health care services. Only a quarter (25.3%) reported having received contraceptive counselling from their mental health care practitioner, while 31.2% (n = 58) received counselling on medication teratogenicity. Both contraceptive counselling (p = 0.018) and teratogenicity counselling (p = 0.007) were significantly associated with contraceptive use (n = 111).

Conclusion: There is inconsistent contraceptive use and low levels of counselling among women with mental illness. Integrated health care and contraceptive counselling by mental health care practitioners could improve the consistency of contraceptive use in this vulnerable group.

Contribution: Contraceptive counselling should be incorporated into psychiatric services to increase contraceptive uptake and reduce the impact of unplanned pregnancy and teratogenicity in this vulnerable population.

Background: Patients with schizophrenia rely on antipsychotic medication, with adherence being critical for symptom management. Poor adherence leads to relapse, disability and increased healthcare costs.

Aim: This study investigated the impact on antipsychotic adherence among schizophrenia patients on the introduction of an intervention utilising a psychiatric nurse as a virtual treatment buddy.

Setting: Participants were recruited from a psychiatric clinic in KwaZulu-Natal, South Africa.

Methods: This quantitative pre-test-post-test control group study recruited 117 schizophrenia patients. Participants were randomly assigned to an intervention group (n = 82) receiving daily text message support or a control group (n = 35) without support. Pre- and post-intervention questionnaires assessed medication adherence. The McNemar test compared medication cessation frequencies pre- and post-intervention. Pearson's chi-squared test, factor analysis and linear regressions were employed to correlate variables. A p < 0.05 was deemed statistically significant.

Results: Adherence improved from 60.8% to 83.51% post-intervention (p < 0.001). Obstacles to adherence, including inadequate disease knowledge, treatment duration, side effects, misunderstanding instructions and forgetfulness, were reduced post-intervention. Additionally, symptom relapse, rehospitalisation, specialist referrals, the need for more potent medication and employment loss decreased post-intervention.

Conclusion: Virtual buddy support has demonstrated promise in improving medication adherence and minimising adverse effects of discontinuation among schizophrenia patients.

Contribution: This study contributes a method to improving antipsychotic adherence and reducing negative outcomes in schizophrenia patients by emphasising personalised support, education and collaborative care among healthcare providers and support systems.

Background: World Health Organization defines substance use as harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. There is an increased rate of substance use among youths and adolescents. Substance use significantly increases the risk for mental disorders.

Aim: The aim of this study was to determine the prevalence of substance use and knowledge of its effects among secondary school students in Lagos, Nigeria.

Setting: The study was conducted among Secondary schools in Lagos, Nigeria.

Methods: We conducted a cross-sectional, descriptive study among 800 participants who were selected using a multi-stage sampling method. The instrument for data collection was the amended WHO students' drug-use questionnaire. The data were analysed using Epi Info 7 software.

Results: The lifetime prevalence of substance use was 13.6%, while current users' prevalence was 6.9%. Apart from alcohol consumption, the substance most frequently used was tramadol (52.7%), followed by marijuana (36.4%). Almost all the participants (98.1%) were aware of substance use. Most students (88.7%) were able to identify the effects of substance use, including short-term complications (79.1%) and long-term complications (61.1%).

Conclusion: The high prevalence of alcohol and tramadol use among the participants underscores the need for stricter government policies on the accessibility of these products to adolescents and the need for increased awareness of their effects.

Contribution: The lower knowledge of long-term complications of substance use (61.1%) in comparison to short-term complications (79.1%) underscores the need for further research and increased advocacy on long-term complications of substance use among youths and adolescents.

Background: In African countries, including Zimbabwe, about half of those with depression respond to first-line therapies like problem-solving therapy. Predicting who needs more intensive treatment is challenging. In the US and Europe, tools like the Facial Emotion Perception Test (FEPT) help match treatments to likely responders. However, its applicability in Zimbabwe is unexplored.

Aim: To develop a racially diverse adaptation of the FEPT for Shona-speaking Zimbabweans.

Setting: Outpatient primary healthcare clinics at Marondera Provincial Hospital and Chitungwiza Central Hospital, Zimbabwe.

Methods: Facial Emotion Perception Test was adapted using the Ecological Validity Model's eight constructs through a four-step process: expert consultation, preliminary content adaptation, iterative content adaptation, and finalising adaptation. Three focus groups and 12 cognitive interviews assessed cultural appropriateness, suitability, usability and acceptability of FEPT for Zimbabwean Shona speakers. Fifteen participants, including graduates, primary healthcare workers and individuals with lived experience of depression, took part.

Results: Key adaptations of FEPT-Multiple-Races (MR)-Shona include: (1) added 20 black and 20 Asian face stimuli for cultural relevance; (2) improved stimuli resolution for clarity; (3) extended test duration from 6 to 10 minutes for repeatable tutorials; (4) provided bilingual instructions in Shona and English; (5) shifted to a low-cost touchscreen tablet, familiar to Zimbabwean participants.

Conclusion: The adaptation shows promising cultural relevance and usability for Shona speakers. Further testing with diverse educational and contextual backgrounds is needed to enhance cross-cultural and ecological validity.

Contribution: This study highlights the importance of culturally adapting cognitive performance tools that can potentially improve depression treatment outcomes in low-income countries.

Introduction: This case report highlights one of the less common variants of major neurocognitive disorder because of Alzheimer's disease, posterior cortical atrophy. There is a paucity of data about this condition in sub-Saharan Africa.

Patient presentation: A 54-year-old female presented to the geriatric clinic following a 2-year history of poor memory and inability to fulfil her work obligations. The most prominent symptom was visual disturbance, with a normal ophthalmic examination.

Management and outcome: Workup done to reveal reversible causes of dementia did not yield any positive results. After a full history, physical and cognitive examination and radiological investigations, a diagnosis of posterior cortical atrophy variant of major neurocognitive disorder because of Alzheimer's disease as the most likely aetiology was established.

Conclusion: Posterior cortical atrophy is a rare variant of Alzheimer's disease, and no case reports from South Africa are available in the literature.

Contribution: This case reminds us that unusual presentations of cognitive impairment require a broad differential diagnosis.

Background: Insomnia is defined as poor quantity or quality of sleep resulting in impaired daytime functioning and distress. Insomnia has been found to occur at higher rates in health care workers and has been associated with physiological dysfunction, illness and distress as well as many socio-demographic and lifestyle-related factors.

Aim: This study aims to establish the burden of insomnia and its associated socio-demographic, lifestyle and occupation-related factors among nurses.

Setting: Nurses employed in the public sector in Kwazulu-Natal Province South Africa comprised the study group. A cross-sectional descriptive online survey was conducted.

Methods: Nurses were invited to participate in an online survey from September to December 2023. The survey comprised a socio-demographic questionnaire and three instruments: the Sleep Condition Indicator, the Single Item Measure of Burnout and the Sleep-Hygiene Index (SHI).

Results: Of the 235 participants surveyed, 41.7% screened positive for insomnia and had significantly lower frequencies of good sleep-hygiene practices on the SHI. After controlling for socio-demographic, clinical and work-related covariates, a psychiatric history adjusted odds ratio [aOR]: 5.52; CI:1.06-28.66) and poor sleep hygiene (aOR: 1.07; CI: 1.02-1.13) displayed significant association with insomnia. All levels of work-related stress were significantly associated with insomnia (p < 0.01), with total burnout having a 10.3-fold increased association.

Conclusion: The study highlights the concerning burden of insomnia and its association with burnout, poor sleep hygiene and a psychiatric comorbidity, among nurses.

Contribution: Given that the risk factors associated with insomnia identified in our study (i.e. poor sleep hygiene, burnout and psychiatric illness) are all potentially modifiable, our findings may serve as a reference for future health-promotion initiatives, aimed at health care professionals, such as health education, screening and mindfulness and wellness programmes.

Background: South Africa bears a high burden of adverse childhood events (ACEs), which have been identified as a primary factor that can lead to negative mental health outcomes for adults. While studies within South Africa have examined the associations between ACEs, adult trauma and adult mental illness, there is less knowledge of how these preceding factors interact to affect mental distress together and which ACEs are most likely to lead to adverse mental health outcomes.

Aim: The main aim of this study was to explore the mediating effects of recent adult trauma on mental illness among patients at two psychiatric hospitals in Johannesburg, South Africa, using path analysis.

Setting: This study took place at two public psychiatric facilities in Johannesburg, South Africa.

Methods: Surveys were conducted with 309 adults living in Gauteng province. Mediational path analysis explored the association between ACEs, adult traumatic events, and depression, anxiety, and stress.

Results: Adult traumatic events partially mediated the association between verbal abuse, emotional neglect, mental illness and substance use in the household as a child and adult mental illness. Adult traumatic events fully mediated the associations between experiencing domestic violence in childhood or child sexual abuse.

Conclusion: This study highlights the importance of disaggregating ACEs when exploring their effects while also reinforcing previous findings that ACEs increase the likelihood of experiencing adult trauma and adult mental illness.

Contribution: Future studies should further pinpoint which ACEs are most impactful and target those for prevention in childhood and intervention in adulthood to mitigate their deleterious impacts.

Background: Food insecurity is a problem for many people globally. Women and people living with mental illnesses are at a particular risk. There is limited information regarding food insecurity in women living with mental illnesses from South Africa.

Aim: To describe the prevalence of food insecurity, its association with socio-demographic and clinical factors, as well as quality of life (QoL) in women with mental illnesses attending a psychiatric hospital.

Setting: King Dinuzulu Hospital Complex in eThekwini KwaZulu-Natal over a 6-month period.

Methods: A researcher-designed questionnaire was used to collect socio-demographic and clinical data, while the Household Food Insecurity Access Scale (HFIAS) and the World Health Organization QoL questionnaire (WHO QOL-BREF) were used to collect data on food insecurity and QoL, respectively.

Results: The 123 participants had a mean age of 50 years (standard deviation [s.d.] ± 13.89), and an overall prevalence of food insecurity of 47.1%. In a bivariate analysis, food insecurity was significantly associated with younger age (p = 0.02), having no monthly household income (p = 0.01), a comorbid psychiatric diagnosis (p = 0.02) and a poorer overall QoL (p < 0.001).

Conclusion: Women with mental illnesses had a higher prevalence of food insecurity, with an associated poorer QoL. Additional measures are required to improve food security in this vulnerable group.

Contribution: This study found that women with mental illness had more than twice the prevalence of food insecurity than the general population in KwaZulu-Natal.

Background: The Brief Psychiatric Rating Scale - Expanded version (BPRS-E) is a 24-item clinician-administered scale whereby severity of psychopathology is rated using seven scoring categories for each item. Although useful in research and clinical settings, the construct validity has not been tested in South Africa.

Aim: Examine the construct validity of the BPRS-E using Rasch model analysis.

Setting: Community psychiatric clinics in the Sedibeng District of Gauteng province, South Africa.

Methods: A retrospective record review was conducted of adult psychiatric patients in whom the BPRS-E was used in routine clinical assessment by trained psychiatric nurses and doctors. Clinical records with completed BPRS-Es were purposively sampled from three community psychiatric clinics in the Sedibeng District. Data were entered into RUMM2030^® software, and construct validity was analysed using the Rasch model, a probabilistic model that assesses item fit, response category functioning, and unidimensionality.

Results: Clinical records of 192 patients (93 males and 99 females; aged between 18 and 79 years) were reviewed. Total BPRS-E scores ranged from 24 to 93, with a score of 39 or less in 52% of records (n = 100). Rasch analysis revealed good item fit and unidimensionality for the 24 BPRS-E items but disorganised threshold curves and inconsistent differential item functioning for the severity scoring categories.

Conclusion: This study supports the construct validity of the BPRS-E items when used clinically in a South African community psychiatric setting. However, severity scoring using the BPRS-E scoring categories in this setting requires further investigation.

Contribution: This study provides evidence that the BPRS-E is valid in a community psychiatric setting in South Africa.