South African Journal of Psychiatry最新文献

Background: Internalising disorder, which is characterised by anxiety and depression, is a mental health disorder observed among in-school adolescents in Nigeria, with consequent school dropout, substance use and suicide.

Aim: This study examined the effects of adverse childhood experiences (ACEs) and personality traits on internalising disorder among in-school adolescents in Lagos State, Nigeria.

Setting: The study was conducted among in-school adolescents attending secondary schools in Lagos State, Nigeria.

Methods: A cross-sectional design and multistage sampling techniques were used to select 357 participants (138 males = 38.7%; 219 females = 61.3%) from five high schools in Lagos State, who responded to the ACEs Questionnaire, Personality Inventory and Revised Children's Anxiety and Depression Scale.

Results: The prevalence of ACEs is 23.8% mild, 33.1% moderate, 13.4% severe experiences being higher on internalising disorder, and 29.7% with no experience. Sixteen per cent of children were clinically significant on internalising behaviour, with 19.3% significant on anxiety and 9% on depression. Adverse childhood experiences significantly predicted internalising disorder; likewise, conscientiousness, neuroticism, and openness to experience consistently and significantly predicted internalising disorder. Adverse childhood experiences and personality traits contributed a significant variance of 16% in anxiety, 26% in depression and a combined 20% to the total variance in internalising disorder.

Conclusion: The study encourages practical, tailored interventions that address ACEs and foster positive personality traits to mitigate against internalising disorder.

Contribution: The study underscores the importance of personality traits in the outcomes of children and adolescents exposed to ACEs in Nigeria.

Background: The rigorous demands associated with caring for critically ill patients place intensive care unit (ICU) nurses at a heightened risk for mental health issues.

Aim: This study investigated the individual and combined benefits of two distinct intervention strategies, resilience training and yoga training, on enhancing the mental health of ICU nurses.

Setting: Hospitals located in Bitlis Province, Turkey.

Methods: A sample of 84 participants was chosen and randomly and equally allocated to resilience, yoga, resilience+yoga or the control group. Resilience or yoga training comprised eight sessions, each lasting 45 min. Participants in the combined group completed both resilience and yoga training. Data analysis was conducted using an analysis of variance test.

Results: Engagement in either resilience or yoga training alone led to a significant decrease in depression, anxiety and stress levels (p < 0.05). Finally, the resilience + yoga training had additive benefits and resulted in a significantly greater reduction in depression, anxiety and stress levels compared to the individual resilience or yoga training (p < 0.05).

Conclusion: Intensive care unit nurses should engage in both resilience and yoga training to reap the associated physical and psychological benefits.

Contribution: This study sheds light on the value of the resilience and yoga combination for the mental health of ICU nurses.

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.