South African Journal of Psychiatry最新文献

Background: A steady growth in the use of medication for the treatment of attention-deficit hyperactivity disorder (ADHD) has been evident over the past few decades. While growth attests to increased awareness of ADHD and improved access to diagnosis and treatment, concerns have been raised about poor adherence to treatment and diversion of medication.

Aim: This current study explored the seasonal and/or temporal use of methylphenidate (MPH) in South Africa.

Setting: The study was conducted in South Africa.

Methods: A retrospective database analysis was conducted to examine unit sales of MPH over a 9-year period. The unit sales of MPH were compared to those of atomoxetine for the same period.

Results: Unit sales for MPH peaked in May and October, which coincided with the academic high-pressure periods for school learners and university students. This was most evident for MPH immediate release 10 mg. There was a noticeable decrease in unit sales for MPH during December. Atomoxetine demonstrated much less seasonal variation.

Conclusion: The seasonal and/or temporal use of MPH fluctuates following the academic calendar. These changes are driven by both temporary interruptions of treatment, such as 'drug holidays', and the misuse and diversion of MPH for non-medical use. This holds significant implications for interventions to improve ADHD outcomes. It is crucial to balance accessibility to treatment with the prevention of misuse of MPH.

Contribution: Our findings highlight the need to reconsider current policies and regulations regarding the appropriate diagnosis and management of ADHD and the scripting, dispensing and monitoring of MPH.

Introduction: Dissociative identity disorder (DID) is a complex and controversial psychiatric condition characterised by the presence of two or more distinct identities, personality states, or identities that recurrently take control of an individual's behaviour. The identities or personality states may have distinct characteristics, memories, and behaviours, making identifying and differentiating them challenging. We describe a complex case that presented diagnostic challenges because of the fluctuations in psychiatric presentations associated with DID, and we outline a multidisciplinary and biopsychosocial intervention.

Patient presentation: A 15-year-old transgender female presented with psychosis, suicidal ideation, a history of self-harm and aggressive behaviour, and panic attacks. She had a diary with excerpts that she could not remember writing and a history of forgetting certain parts of her day. She displayed extreme variations of psychiatric presentations, including depression, mania, panic, and aggression.

Management and outcome: The patient's alters were individually treated based on their psychiatric presentation and theme. Management followed the phased approach of the International Society for the Study of Trauma and Dissociation (ISSTD guidelines), which included establishing safety and symptom reduction, integration of traumatic memories and identity as well as rehabilitation.

Conclusion: In this case report, we present an adolescent with a myriad of psychiatric presentations and describe her management. We summarise key difficulties that a clinician can encounter in diagnosing DID.

Contribution: We bring awareness to the complexity of this diagnosis. Lastly, we propose an Multidisciplinary team (MDT) biopsychosocial approach that helps to manage the condition.

Background: Medication non-adherence is a significant public health concern and is prevalent among mental healthcare users. Approximately 65% of patients with severe mental illness do not adhere to their prescribed medication. Medication nonadherence may worsen mental illness and result in poorer clinical outcomes, including frequent relapses and rehospitalisation rates, as well as long time to remission, which may contribute to increased cost of care.

Aim: We explored perspectives regarding reasons for medication non-adherence among readmitted psychiatric patients.

Setting: Weskoppies Psychiatric Hospital, Pretoria, South Africa.

Methods: We adopted the social constructivism paradigm for this exploratory qualitative study. Purposive sampling was used to select 15 re-admitted patients, who were nonadherent to their medication. Data were collected through individual semi-structured interviews. The interviews were audio recorded and transcribed. The data were thematically analysed, using the principles of grounded theory.

Results: Substance abuse, a lack of family support and poor health literacy were the most common reasons for non-adherence to medication. Other reasons included medication side effects, healthcare system drawbacks and a lack of finances to access healthcare. Some patients did not adhere to their medication because they believed that their mental illnesses were spiritual in origin.

Conclusion: Multiple factors contributed to patients not adhering to their medication, ultimately resulting in their relapse and readmission. Clinicians should be cognisant of these factors when trying to prevent relapse and readmission.

Contribution: Clinicians also ought to identify patients who are at risk of not adhering to medication. Targeted interventions should be established for tackling medication non-adherence.

Background: Good mental health literacy (MHL) has proven to aid in providing adequate and timely care, promote positive attitudes towards mental health and assist in the integration of mental healthcare with other services. Studies have shown that enhancing the MHL of healthcare workers (HCWs) can help alleviate the burden of mental illness.

Aim: The study aims to explore the MHL of HCWs at a tertiary hospital in Johannesburg.

Setting: The study was conducted at Helen Joseph Hospital.

Methods: A quantitative, descriptive, cross-sectional study via a self-administered questionnaire consisting of: (1) a demographic, work and exposure to mental illness and mental healthcare services questionnaire and (2) the Mental Health Literacy Scale (MHLS) was employed. The MHLS identifies people with low MHL who could benefit from further interventions.

Results: Two hundred and fifty-two HCWs participated in the study. The overall median MHLS score was 129, in keeping with a previous study conducted in SA and Zambia. Younger HCWs with less than 5 years of experience scored higher. Among the various professions, doctors scored highest and nurses lowest. The anaesthetic and psychiatric departments obtained the highest MHLS scores. Personal exposure to mental illness and mental health services was associated with higher MHLS scores.

Conclusion: This study highlighted areas where mental health awareness and education are lacking, which are crucial for improving MHL. Targeted interventions to fill these identified gaps are therefore recommended.

Contribution: To our knowledge, this was the first South African study to assess MHL among tertiary-level HCWs across various professions.

Background: South African psychiatric hospitals' inpatient average length of stay is approximately 220 days. Inpatient care accounts for over 80% of the mental national healthcare budget. However, there is limited research on factors associated with length of stay (LOS) in tertiary psychiatric hospitals.

Aim: To determine the threshold for long-stay and describe the socio-demographic and clinical profile of long-stay patients admitted to a tertiary psychiatric hospital.

Setting: Townhill Hospital: a tertiary psychiatric hospital in Pietermaritzburg, KwaZulu-Natal, South Africa.

Methods: A retrospective review of clinical records of admissions between January 2019 and January 2020 was conducted. Information on LOS, sociodemographic and clinical factors was collected. The interquartile range (IQR) of LOS in days was calculated, with patients above 75th percentile classified as long-stay patients.

Results: In total, 326 records were included. The 75th percentile LOS was 120 days. Eighty-three patients (25.46%) had a stay of 120 days or longer. The median LOS was 73 (IQR 49-120) days. Factors associated with long-stay included being male (p < 0.001), a psychotic disorder diagnosis (p = 0.019), receiving a disability grant (p = 0.050), involuntary admission (p = 0.010) and multiple readmissions (p = 0.010).

Conclusion: Psychotic disorders and associated factors are key contributors to long-stay hospitalisations.

Contribution: This study highlights the burden of inpatient care for psychotic disorders and the need for interventions that optimise care and promote remission. To reduce the economic impact of prolonged hospitalisations, early intervention and enhanced community-based mental healthcare services focused on psychotic disorders are recommended.

Background: Coronavirus disease 2019 (COVID-19) infection caused unparalleled hastening of the transmission of infection worldwide, commonly affecting healthcare workers' well-being. Nursing staff spend most hours caring for patients and are the first contact that patients utilise when reporting symptoms or receiving treatment.

Aim: This study aims to evaluate the knowledge of COVID-19 among psychiatric nurses at a tertiary psychiatric hospital.

Setting: Weskoppies Hospital, Gauteng, South Africa.

Methods: We conducted a qualitative study comprising 14 semi-structured interviews with nurses working at Weskoppies Hospital in South Africa. We used open-ended questions to facilitate the discussion and provide some structure for the interview while still allowing the participants to elaborate freely. The recordings were later transcribed into text.

Results: Twenty nurses working full time at the hospital, were recruited for the study. The nurses' knowledge about COVID-19 was summarised into five major themes, each with subthemes: signs and symptoms of COVID-19, risk of contracting the virus, the spread of COVID-19, prevention, and complications. In this study, the majority of participants had relatively good knowledge regarding COVID-19.

Conclusion: The majority of nurses at the hospital had adequate knowledge about COVID-19 but limited knowledge about the mode of transmission of the infection. Consistently improving healthcare workers' knowledge about infection control measures through training, supplying information and identifying areas for improvement can ultimately enhance patient care and outcomes.

Contribution: This study sheds light on the value of nurses' understanding of COVID-19, particularly in a psychiatric setting.

Background: Psychiatric patients in specialist units are more vulnerable to infections such as SARS-COV-2 (severe acute respiratory syndrome coronavirus 2) because of hospital infrastructure and patients' mental health.

Aim: This study aimed to describe the psychiatric and medical profile, and the risk factors associated with more severe disease and clinical outcomes of coronavirus disease 2019 (COVID-19) in patients with severe mental illness (SMI) admitted to a specialist psychiatric hospital in South Africa between 01 April 2020 and 30 September 2021.

Setting: The study was executed at the Vàlkenberg Hospital (VBH), which is a government-funded, specialised psychiatric hospital. The hospital comprises 370 beds made up of 145 forensic service beds and 225 acute service beds. It provides in-patient and out-patient services.

Methods: Demographic and clinical information were collected for all VBH in-patients who tested positive for SARS-COV-2 from 01 April 2020 to 30 September 2021.

Results: A total of 254 participants tested positive for SARS-COV-2. The sample comprised 75% (n = 191) males with a mean age of 35.7 years. Most patients were diagnosed with schizophrenia (37%, n = 94), bipolar disorder (21%, n = 54) and schizoaffective disorder (19%, n = 49). Reported comorbidities included nicotine use (71%, n = 181), hypertension (11%, n = 28) and human immunodeficiency virus (7%, n = 18). Most patients (62%, n = 156) were symptomatic for COVID-19. Seven per cent (n = 17) required transfer to a medical ward. Almost all patients (99%, n = 252) recovered and 1% (n = 2) died.

Conclusion: Contrary to early fears of high mortality among institutionalised SMI patients, most experienced mild COVID-19 illness and recovered.

Contribution: This descriptive study provided information on in-patients with COVID-19 disease at a specialised psychiatric hospital during the pandemic.

Background: Post-stroke depression (PSD) negatively impacts the physical and mental well-being of stroke survivors. However, data on the prevalence and risk factors of PSD in African countries such as Cameroon are limited.

Aim: This study aims to determine the prevalence and factors associated with PSD among stroke survivors at a hospital in Cameroon and inform clinical practice.

Setting: The study was carried out in the Nkwen Baptist Hospital in the North West region of Cameroon.

Methods: This was a hospital-based cross-sectional study. Stroke patients were systematically screened for PSD using the patient health questionnaire (PHQ-9). PSD was present if a patient scored ≥ 4 points on the scale. The multidimensional scale of perceived social support was used to assess the level of social support, the modified Rankin tool and Barthel index were used to assess functional independence, and the Fatigue assessment tool was used to assess post-stroke fatigue. A multivariate analysis was performed to identify factors associated with PSD.

Results: A total of 103 patients were included in the study. The mean age was 55.55 ± 12.15. Most patients were males (58.25%). The mean depression score was 5.17 ± 6.26. The overall prevalence of PSD was 36.89%. A higher functional impairment, post-stroke fatigue, perceived social support, recent stroke and being divorced were all associated with high PSD scores.

Conclusion: In this study, we found a high prevalence of PSD using a systematic screening approach, suggesting that systematic screening for PSD can lead to early detection and management.

Contribution: Systematic screening for PSD in stroke patients can lead to early diagnosis and, consequently, early initiation of treatment. Integration of mental health support and care as part of the routine stroke is warranted.