South African Journal of Psychiatry最新文献

Background: Lesbian, gay, bisexual, and transgender (LGBT) individuals have a higher prevalence of mental illness compared to the general population. Discriminatory behaviour from mental health care providers impedes access to culturally competent mental health care. Undergraduate psychiatry education plays an important role in adequately preparing medical doctors to care for mental illness in LGBT patients.

Aim: This study aims to assess the knowledge, attitudes and clinical preparedness of final-year medical students in caring for LGBT patients after completion of their psychiatry rotation.

Setting: Faculty of health sciences at a large public university in Gauteng.

Methods: This was a cross-sectional study using an anonymous self-administered questionnaire. The questionnaire comprised demographic data, the lesbian, gay, bisexual, and transgender development of clinical skills scale (LGBT-DOCSS) and questions relating to their subjective knowledge and preparedness in LGBT mental health care. The LGBT-DOCSS is a validated tool consisting of three subscales: basic knowledge, attitudinal awareness, and clinical preparedness.

Results: Data from 170 final-year students were used in the analyses. Participants scored within the low range for clinical preparedness and basic knowledge subscales but high in the attitudinal subscale. Gender, sexual orientation and academic background were associated with higher overall scores and higher basic knowledge and attitudinal awareness scores.

Conclusion: Final-year medical students were not adequately prepared in caring for LGBT patients with mental illness as indicated by the LGBT-DOCSS.

Contribution: This study identifies a gap in undergraduate psychiatric training in providing culturally competent mental health care for a vulnerable population.

Background: The process of medical clearance aims to exclude a general medical condition as an underlying cause for mental and behavioural disorders and involves routine screening with special investigations. Current evidence, however, suggests that clinician gestalt should guide the need for special investigations and that there is no benefit to routine screening.

Aim: This study aimed to determine the effectiveness of and adherence to the Western Cape (WC) provincial guidelines for routine investigations of adult patients with behavioural disturbances.

Setting: This study was conducted at Mitchells Plain Hospital in Cape Town, South Africa.

Methods: This descriptive study was conducted at Mitchells Plain Hospital in Cape Town, South Africa. Data were collected from existing electronic registries over a 6-month period. Adult mental healthcare users were risk stratified into the probability of having a general medical condition and the results of their special investigations were described against their outcome.

Results: Of the 688 patients included in this study, 66% had abnormal vital signs and of the 312 patients who received special investigations, 56% were abnormal, including 18% who were clinically significantly abnormal. Abnormal special investigations changed the clinical outcome for 3 (<1%) patients. Adherence to the guidelines was reasonable (82%) but non-adherence resulted in unnecessary investigations.

Conclusion: The results of this study support the existing evidence that clinical assessment and clinician gestalt should guide the need for special investigations and that there is no benefit to routine screening in the emergency centre (EC). The results also demonstrate that non-adherence rarely changed patient outcomes.

Contribution: This study provides information on the value of routine screening investigations in ECs.

Introduction: The successful use of ECT as treatment for catatonia, in the context of HIV (human immunodeficiency virus) infection, has been described previously. Ketamine has been used as an anaesthetic induction agent for ECT, although not considered the induction agent of choice. There are also case reports suggesting that ketamine may be an alternative treatment specifically for catatonia.

Patient presentation: This case report describes the management of a female patient who presented with catatonia, evidenced by stupor, waxy flexibility, mutism, negativism, and stereotypy, as well as stage four HIV infection, with poor response to previous psychotherapeutic interventions.

Management and outcome: We describe the course of management of this patient with ECT, following poor initial clinical response to ECT with propofol induction, the subsequent use of ketamine as an anaesthetic induction agent for ECT, with associated improvement in seizure quality, and good overall clinical response to ECT demonstrated thereafter.

Conclusion and contributions: This case report suggests that ketamine may be a viable induction agent for ECT in this clinical setting.

Background: Research revealed a high prevalence of negative attitudes towards psychiatry and mental illness among medical students prior to formal psychiatric education. Anti-stigma interventions at the medical student level have been postulated to reduce the risk of negative attitudes, which may drive stigmatization impacting recruitment into training posts and overall medical care.

Aim: To determine the prevalence of negative attitudes towards psychiatry and mental illness in a sample of fourth-year medical students prior to formal psychiatric teaching. To ascertain possible sociodemographic correlations with findings.

Setting: The University of the Witwatersrand.

Methods: A cross-sectional, quantitative, descriptive study was conducted using the Mental Illness: Clinicians' Attitudes Scale 2 questionnaire and a socio-demographic questionnaire.

Results: Of the total scores, 97.2% participants fell below the median potential score of 56, reflecting a low prevalence of stigmatising attitudes. The African cohort expressed less interest in psychiatry (P=0.0017), compared to other race cohorts (ranging from 92.1% to 100.0%).

Conclusion: This study revealed a low prevalence of negative and stigmatising attitudes towards psychiatry and mental illness. Of statistical significance, was a relative difference in attitudes towards psychiatry and mental illness in different race cohorts (P=0.0017); however, overall race cohorts showed a low prevalence of negative and stigmatising attitudes towards psychiatry.

Contribution: This study creates awareness of the impact factors on attitudes of medical students towards mental illness and specialization in psychiatry.

Background: The need for a culturally suitable scale for suicidality within the multilingual Nigerian society necessitated this research interest.

Aim: The study is a development and validation of the Redeemer's University Suicidality Scale (RUSS).

Setting: South western Nigeria.

Methods: This comprised of initial generation of items; face and content validity, item refinement and administration of RUSS to 150 university undergraduates, using exploratory factor analysis at the first, second and third stages. In the fourth stage, 184 undergraduates responded to the 20-item RUSS, Suicide Ideation Scale (SIS) and General Health Questionnaire (GHQ-12). Data gathered at this stage were analysed for congruent validity, reliability and norms.

Results: The principal component analysis extracted four components from items whose eigenvalues exceeded one. Twenty-one of the 25 items loaded best in the first, two in the second and one on the third component(s). Only items in the first component were retained. Item-total correlation further showed that the values of one item in the first component fell below the very good discrimination and was deleted from the scale. The RUSS has a Cronbach's alpha of 0.93. Congruence validity coefficient of r = 0.881 (p < 0.001) and r = 0.605 (p < 0.001) was observed between RUSS and SIS and between RUSS and GHQ-12, respectively.

Conclusion: The RUSS is gender-sensitive, has acceptable psychometric properties and is recommended as a diagnostic tool for assessing suicidal behaviour in adolescents and adults.

Contribution: This article contributes to the development of a culture sensitive measure for suicidality.

Background: Doctors are at high risk of burnout, which has far-reaching consequences on an individual and organisational level. Several studies have shown an association between burnout and depression.

Aim: This study aimed to determine the rate of burnout and depressive symptoms among doctors, as well as factors associated with both conditions.

Setting: Charlotte Maxeke Johannesburg Academic Hospital.

Methods: Burnout was measured using the Maslach Burnout Inventory-Human Services Survey and defined as the total score of high emotional exhaustion (≥ 27 points) + high depersonalisation (≥ 13 points). Individual subscales were analysed separately. Depressive symptoms were screened using the Patient-Health Questionnaire-9 (PHQ-9) and a score of ≥ 8 was deemed indicative of depression.

Results: Of the respondents (n = 327 for burnout and n = 335 for depression), 46.2% screened positive for burnout, whilst 53.73% screened positive for depression. Factors associated with increased burnout risk were younger age; Caucasian race; internship and/or registrarship; the discipline of emergency medicine; and having a prior psychiatric diagnosis of depressive and/or anxiety disorder. Factors associated with increased risk of depressive symptoms were females; younger age; being an intern, medical officer or registrar; disciplines of anaesthetics and obstetrics and gynaecology; having a prior psychiatric diagnosis of depressive and/or anxiety disorder; and family history of psychiatric disorder.

Conclusion: A high rate of burnout and depressive symptoms was determined. Although there is an overlap between the two conditions in terms of both symptomatology and risk factors, specific risk factors were determined for each in this population.

Contribution: This study highlighted the rate of burnout and depressive symptoms experienced by doctors at the state level hospital necessitating individual and institutional interventions to address this.

Background: Several trauma-focused treatments have been developed to treat post-traumatic stress disorder (PTSD). Yet there are limited studies on how trauma survivors perceive and experience trauma-focused treatments such as prolonged exposure therapy (PE) for PTSD, especially in low- and middle-income countries (LMIC).

Aim: The study aimed to explore the perceptions and experiences of trauma survivors receiving prolonged exposure therapy for PTSD and the general acceptability of PE for PTSD in a LMIC.

Setting: The study was conducted at a community psychology clinic in the Eastern Cape, South Africa.

Method: Using a qualitative method, seven adult trauma survivors who completed six sessions of brief PE for PTSD were interviewed. Thematic analysis was used to identify relevant themes and to understand how participants perceived and experienced PE for PTSD.

Results: The analysis yielded five themes, namely structure, obstacles, gender, exposure and experiences of recovery.

Conclusion: The findings suggested that participants perceived and experienced PE to be generally beneficial for the treatment of PTSD. Moreover, the study suggested that PE is an acceptable trauma therapy in a contextually diverse setting such as the Eastern Cape, South Africa. Overall, considering the evidence base of PE for PTSD, this study contributed to the literature on the acceptability of PE in a South African setting.

Contribution: The findings of the study are in keeping with the extant literature on how persons perceive and experience PE for PTSD. The findings of the study suggests that PE is an acceptable and beneficial trauma therapy for PTSD in a contextually diverse setting such as South Africa. It is recommended that large scale implementation studies be conducted to further investigate the effectiveness, feasibility, and acceptability of PE in South Africa.

Background: Clozapine is the gold standard medication for treatment-resistant psychosis, with robust evidence supporting its efficacy in multiple symptom domains. However, clozapine's side effect profile contributes to its underutilisation and discontinuation.

Aim: This study aimed to explore the magnitude of clozapine use and describe factors that impact on its effective use among in-patients.

Setting: Tara Hospital, a specialised psychiatric hospital in Johannesburg.

Methods: This was a retrospective, cross-sectional file review of clozapine-treated patients admitted over the 2-year study period. Data variables included: demographics, clinical information, discharge prescription, clozapine-related side effects and details of clozapine discontinuation, where applicable.

Results: A cohort of 33.2% of patients from Tara's biological wards received a trial of clozapine. Participants experienced anti-cholinergic clozapine-related side effects that included weight gain (79.5%), tachycardia (35.2%) and constipation (35.2%). Clozapine was discontinued in 13.7% of participants, and no life-threatening side effects or deaths occurred. Significantly more use of flupenthixol decanoate (64.3% vs. 30.7%; p = 0.0322) and anticholinergics (35.7% vs. 11.4%; p = 0.0474) occurred in the clozapine-discontinued group. Polypharmacy rates were high for psychiatric and non-psychiatric medications.

Conclusion: One-third of patients received clozapine trials, most of whom continued at discharge. Although side effects occurred frequently, life-threatening side effects did not. Clozapine monitoring protocols, side effect rating scales, pre-emptive management of side effects, lifestyle interventions and clinician education may improve outcomes of clozapine use. The use of plasma clozapine levels may be beneficial.

Contribution: This study expands our limited knowledge regarding current clozapine prescribing trends in South Africa.

Background: Burnout is a psychological syndrome resulting from exposure to chronic work-related stress. There are, however, a few works of literature on burnout among trainee doctors in Nigeria.

Aim: To determine the prevalence of burnout and its predictors among resident doctors across 16 medical specialties and/or subspecialties.

Setting: The University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria.

Methods: A cross-sectional study was conducted among 176 resident doctors between October 2020 and January 2021. The survey included the Proforma and Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS MP).

Results: The mean age of participants was 35.10 (SD 4.07) years. The prevalence of burnout was 21.6% for high emotional exhaustion (EE), 13.6% for high depersonalization (DP), and 30.7% for low personal accomplishment (PA). Being a younger resident doctor aged 31-35 (OR = 3.715, 95% CI [1.270 - 10.871]) was the only significant predictor for the EE. Predictors of DP included the age group 31-35 years (OR = 7.143, 95% CI [2.297 - 22.216]), duty hours >50 hours per week (OR = 2.984, 95% CI [1.203 - 7.401]), and presence of work-related stress (OR = 3.701, 95% CI [1.315 - 10.421]). A good relationship with colleagues negatively predicted low PA (OR = 0.221, 95% CI [0.086 - 0.572]).

Conclusion: High levels of burnout are prevalent among resident doctors, comparable to international studies. Therefore, the government and other relevant stakeholders must drive legislation and formulate policies toward addressing the work-related factors associated with burnout in the Nigerian healthcare industry.

Contribution: This study highlighted the determinants of burnout among Nigerian resident doctors, which necessitates targeted interventions to address them.