South African Journal of Psychiatry最新文献

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.

Background: In recovery-oriented mental health care, family members of mental health care users form part of the caring team. Families are expected to care for mental health care users without support in the under-resourced rural Vhembe district in South Africa.

Aim: This study aims to describe the lifeworld of family members caring for mental health care users in rural areas to inform the development of a support programme.

Setting: Purposive sampling was used to select 16 family members from eight community health centres in the Vhembe district.

Methods: A qualitative approach, using a descriptive phenomenological design, was adopted to conduct unstructured interviews that were transcribed, translated and analysed using a descriptive method.

Results: Family members continuously contemplate their responsibilities. Endless concerns and stress result in forgetfulness and physical problems such as insomnia, hypertension and pain. Family members feel powerless and helpless when there is no improvement and support from community resources. Fear of being violated, embarrassed and stigmatised by community members results in social isolation and depression.

Conclusion: Caregiving is burdensome in poorly resourced areas. Feelings of helplessness and hopelessness Psychosomatic and depressive symptoms relate to the lack of effective community support which are likely to result in compromising the care they provide.

Contribution: The results call for the Department of Health to strengthen community mental health services and for health care professionals to provide supportive interventions based on the needs of mental health care users and their families.

Background: Limited research exists on mortality rates and contributing factors among individuals with severe mental illness (SMI) in long-term psychiatric care, especially in low- and middle-income countries (LMICs).

Aim: To analyse mortality rates and associated factors at Solomon Stix Morewa Memorial Hospital (SSMMH), a long-term psychiatric care facility in Johannesburg, South Africa.

Setting: SSMMH, a private facility in Selby Park, Johannesburg, has been contracted by the Gauteng Department of Health since March 2017 to provide inpatient care for SMI patients.

Methods: A retrospective analysis was conducted on records of 406 SMI patients admitted to SSMMH from March 2017 to February 2022. Mortality rates were calculated, and associated factors were analysed using descriptive statistics and logistic regression.

Results: Of the 406 participants, 34 (8%) died over five years, yielding a standardised mortality ratio (SMR) of 1.28 (95% CI: 0.85-1.71). Mortality was highest in the 60-69 years age group (SMR 2.7), with most deaths occurring in 2020-2021, likely due to COVID-19. Cardiovascular conditions were the leading cause of death (53%). Age at admission (OR: 2.35, 95% CI: 1.55-3.58) and transfer site (OR: 0.58, 95% CI: 0.42-0.81) were significant predictors of mortality.

Conclusion: Individuals with SMI face elevated mortality rates, with age, diagnosis, and comorbidities as key factors.

Contribution: This study provides insights into the comprehensive management of people with SMI to reduce mortality. Further research is needed to guide psychosocial and palliative care approaches.

Background: Negative attitudes towards electroconvulsive therapy (ECT) among health professionals have been attributed to a lack of knowledge, despite advancements in its administration and evidence of its efficacy in certain psychiatric conditions.

Aim: This study assesses knowledge and attitudes towards ECT among psychiatry and clinical psychology professionals.

Setting: The University of the Witwatersrand, Department of Psychiatry, Johannesburg, South Africa.

Methods: A quantitative cross-sectional design was used. All psychiatry and clinical psychology professionals associated with the university were invited to participate in an anonymous online survey from 01 September 2022 to 30 June 2023.

Results: The response rate was 49.6% (n = 58) among psychiatrits and 22.2% (n = 22) among clinical psychology professionals. Psyhiatrists had greater knowldge and more favourable attitudes than psychologists. Only 45.5% of psychologists had exposure to ECT, compared to 93.1% of psychiatrists. Knowledge and attitude scores were significanly correlated (p = 0.009, OR 6.7). Most psychologists (86.4%) recommended ECT theory be included in their curriculum.

Conclusion: Greater knowledge correlates with improved attitudes towards ECT. Increased training could enhance attitudes, particularly among psychology professionals.

Contribution: This study offers insights into knowledge and attitudes towarss ECT in a Johannesburg psychiatry department.

Background: Personality disorders (PDs) are estimated to occur in 6.8% of South Africans and in 45% to 80% of clinical populations. Mental health practitioners often harbour negative attitudes and lack confidence in working with such patients. Brief training in transference focused psychotherapy (TFP) has been shown to improve attitudes and confidence in the management of clinical encounters with PD.

Aim: This study aimed to describe the characteristics of attendees at a brief TFP training workshop and determine the impact of training on attitudes and clinical confidence towards patients with PD.

Setting: We conducted two 3 h online workshops, spaced 1 week apart to staff at South African University training hospitals.

Methods: At baseline, participants (N = 41) completed questionnaires on demographics, perceived need for training, supervision adequacy and perceived confidence. At baseline and after the second session, the Attitude to Personality Disorder Questionnaire (APDQ) and the Clinical Confidence in Personality Disorder Questionnaire (CCPDQ) were completed. Longitudinal data were analysed using linear mixed-effects regression.

Results: In the completer sample (N = 13), there were significant improvements in the APDQ enthusiasm subscale (p = 0.029) and in clinical confidence (CCPDQ) (p = 0.032). The APDQ total and other subscales also showed improvements. Participants with higher baseline confidence were more likely to drop out.

Conclusion: Brief training in TFP can lead to significant improvements in attitude and confidence in managing patients with PD.

Contribution: This is the first study in the South African context demonstrating the potential value of brief teaching in TFP.

Background: Attention deficit hyperactive disorder (ADHD) is a neurodevelopmental disorder occurring in children and adults. Pharmacotherapy remains the cornerstone of ADHD treatment. Stimulants such as methylphenidate are effective and have been one of the best studied and most frequently used treatment for ADHD. However, different delivery mechanisms and devices may potentially impact patient experience and real-life outcomes.

Aim: This study evaluated the effectiveness of Multiple-Unit Pellet System Delivered Extended-Release Methylphenidate (Contramyl XR) on symptom control and reported outcomes in ADHD patients, in a real-world setting.

Setting: A phase IV, open label, flexible dose, prospective, observational study conducted at six sites covering five provinces of South Africa.

Methods: About 119 participants with ADHD (both newly diagnosed [treatment-naïve] and methylphenidate-treated [switch-over] patients) were enrolled and initiated either on Contramyl XR or switched over from methylphenidate to Contramyl XR. Primary efficacy was assessed by Weiss Functional Impairment Rating Scale (WFIRS) over 12 weeks.

Results: In all, 117 participants completed the study (treatment-naïve patients: 46% [n = 55] and switch-over patients: 54% [n = 64]). Mean change from baseline in total WFIRS (95% confidence interval) was -17.7 (-21.1, -14.3; p < 0.001) at week 4 and -29.3 (-33.5, -25.2; p < 0.001) at week 12. At week 12, there was significant improvement in WFIRS scores, with treatment satisfaction reported by treatment-naïve patients. Switch-over patients also demonstrated comparable effectiveness.

Conclusion: Contramyl XR was found to be clinically effective either as de novo or as switch therapy. It was well tolerated, and all patients chose to continue with the treatment option.

Contribution: Despite distinct and different delivery mechanism of Contramyl XR, this study provides evidence for using it as an alternate treatment option versus reference methylphenidate, in both treatment-naïve and switch-over ADHD patients. Study participants willingness to continue Contramyl XR therapy post study, further strengthens the confidence on the effectiveness of Contramyl XR in managing ADHD patients.