South African Journal of Psychiatry最新文献

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.

Background: Most studies on the influence of mothers' trauma-related psychopathology on their offspring's hypothalamic-pituitary-adrenal (HPA) axis functioning have been conducted in Western contexts. Furthermore, those studies have focused on the association between mothers' post-traumatic stress disorder (PTSD) and their offspring's HPA axis functioning. More research is needed among African populations exposed to mass violence to mitigate the intergenerational transmission of trauma.

Aim: To investigate the link between mothers' PTSD and depression and their offspring's basal cortisol level.

Setting: This cross-sectional study was conducted in two provinces of Rwanda (Kigali City and the Southern Province) among families of survivors of the 1994 genocide perpetrated against the Tutsi.

Methods: A total of 45 dyads of mothers and their adult offspring were recruited. They answered questionnaires that measured sociodemographic characteristics, trauma exposure, PTSD and depression symptoms. Participants also provided saliva samples for cortisol extraction.

Results: Mothers' depression was negatively associated with their offspring's overall basal cortisol level. There was no link between mothers' PTSD and their offspring's overall basal cortisol level. The relationship between the offspring's overall basal cortisol level and their own psychopathology was not significant.

Conclusion: These preliminary findings showed an HPA axis disruption among offspring of mass violence-exposed and depressed mothers.

Contribution: This study contributes to the literature by showing that depression is a relevant correlate of neuroendocrine functioning and should be investigated more consistently in research on the intergenerational consequences of trauma exposure.

Background: Substance and alcohol use during pregnancy confers significant risk to the mother and foetus. Substance and alcohol use is common in South African general population. However, there is a paucity of literature on the extent of the problem among pregnant women.

Aim: This study assessed the prevalence of substance use and its predictors among pregnant women attending antenatal care (ANC) at a tertiary hospital in Johannesburg, South Africa.

Setting: This study was conducted at Rahima Moosa hospital, Johannesburg.

Methods: This study was a retrospective record review of 399 consecutively selected pregnant women attending ANC. Socio-demographic, clinical, and substance use data were extracted and analysed using descriptive statistics and multivariate analyses.

Results: Most pregnant women (84%) were aged between 20 years and 40 years. Substance use was documented in 45% (N = 178) of the records. Of these, concurrent use of alcohol and tobacco was 63% (n = 113). Factors that predicted the use of substances in pregnancy were low birth weight (aOR = 2.5, 95% CI = 1.23, 5.16, p = 0.01) and a positive HIV status (aOR = 0.6. 95% CI = 0.35, 0.96, p = 0.04).

Conclusion: There was a high prevalence of substance use among pregnant women in the context of this study.

Contribution: The increased risk of contracting HIV and having babies with low birth weights when substances are used in pregnancy highlights the need for appropriate behaviour modification for these women during antenatal care and this is in line with the health belief model.

Background: Individuals with borderline personality disorder (BPD) struggle with relationships because of impulsivity and emotional regulation difficulties. Specialised skills are needed for care, but existing models are lacking. A new model was developed to help psychiatric nurses support couples with one partner having BPD. This innovative psychiatric nursing model emphasises the need for implementation and evaluation in care.

Aim: To explore the psychiatric nurses' experiences of implementation of a model to facilitate constructive intra- and interpersonal relationships for couples in a relationship where one is living with BPD.

Setting: The study was conducted at a mental health institution in Gauteng province where the one partner with BPD receives treatment.

Methods: The study adopted a qualitative, exploratory design conducting in-depth interviews with psychiatric nurses who implemented the model, triangulated with observations and field notes and analysed thematically.

Results: Four themes emerged, namely: (1) the model served as a helpful tool for empowerment; (2) the positive results yielded by the model; (3) challenges related to using the model; and (4) suggestions for expanding the model's reach. The psychiatric nurses found the model acceptable and feasible to facilitate the relationships of couples where one is living with BPD.

Conclusion: Psychiatric nurses need guidelines to enhance care for individuals with BPD, highlighting the importance of implementing supportive models to improve relationships in various settings.

Contribution: Implementation of this model is unique in the care of persons living with BPD making it a valuable tool for psychiatric nurses in mental health care provision.