African Journal of Psychiatry最新文献

The recent National Mental Health Summit included discussion of research priorities for South Africa. This paper reviews some of the background literature that is relevant to this key issue. It draws attention to one contested question, the extent to which research in low and middle income countries should address questions about fundamental mechanisms and clinical treatments versus focusing on questions about implementation and systems research? In addressing this question, the paper argues that the boundary between good clinical practice and good academic scholarship is not nearly as distinct as is often assumed (the "research fallacy"); prospective rigorous assessments, retrospective clinical audits, evidence-based medicine, and useful information systems all point to the mutual interdependence of good practice and good scholarship. Finally, some general conclusions that the majority of summit delegates participating in the discussion on research agreed to, are presented.

Mental health is an essential component of health, yet it is often not given the attention that ir deserves as a global health and development issue. In this paper, we examine the global health context, including the substantial burden of disease, resources available for mental health, treatment gap, human rights issues, links between mental health and development, and economic impact of mental disorders. Then we consider recent actions taken at the global level to advance mental health as a global health issue. Finally, we look at South Africa as an example of a country that is ripe for change in its approach to mental health. This is a country with a high prevalence of mental disorders and a large treatment gap, yet it has a number of strengths on which to build a response to improving population mental health. We make suggestions as to how South Africa can move ahead on its mental health agenda, whilst also being a model for other countries in the region and across the globe.

Objective: The current study sought to investigate the association between age, gender, social support and the psychological wellbeing of people living with HIV and AIDS (PLHA) in Ghana.

Method: Cross-sectional data containing information on demographics, social support and psychological well-being (stress, depression, and anxiety), were collected from 107 men and women living with HIV/AIDS. To explore age group differences, participants were stratified by age (< 39 vs. 40+ years). Three anonymous self-administered questionnaires were used, namely the demographic data questionnaire, Sources of Social Support Scale, and the Depression Anxiety Stress Scale (DASS- 42).

Results: Correlation analysis revealed that social support was negatively associated with depression, stress and anxiety. Compared with males living with HIV, women reported higher levels of stress, depression and anxiety. Female gender and low social support were significant predictors of depression and stress after controlling for selected independent variables. Older participants experienced higher levels of stress than their younger counterparts.

Conclusion: Public health personnel and AIDS professionals may consider further interventions to promote psychological health in HIV/AIDS-positive individuals. More attention should be paid to the social environment of individuals diagnosed with HIV as the quality of social relationships may be particularly important for successful psychological adaptation to HIV.

Objective: To review literature from Africa on the epidemiology of ADHD as well attention deficit hyperactivity symptoms and associated co-morbid conditions among African children.

Method: A literature search was done through Pubmed/MEDLINE and Google Scholar using then following terms, "attention deficit", "hyperactivity disorders", "epidemiology", "co-morbid conditions", "Africa". Nine studies met the inclusion criteria with four studies coming from South Africa, two each from Democratic Republic of Congo and Nigeria respectively and one from Ethiopia.

Results: The prevalence of ADHD varied with rates of between 5.4% and 8.7%, amongst school children, 1.5% amongst children from the general population between 45.5% to 100.0% amongst special populations of children with possible organic brain pathology. Common associated co-morbid conditions were oppositional defiant disorder, conduct disorder as well as anxiety/depressive symptoms.

Conclusion: Published data from Africa is limited. For effective healthcare policy further studies are needed to define the magnitude and burden of ADHD and other childhood neurodevelopmental disorders in Africa.

Given that humans originated in Africa, it is likely that many seminal psychological observations and interventions originate in the continent. Relatively little attention has been paid, however, to more recent African contributions to the scientific fields of psychiatry and clinical psychology. This article notes that a number of major contributions to the understanding of brain-mind disorders have emerged from South Africa in particular. It briefly covers seminal contributions in evolutionary theory, psychotherapy, and neuroscience, as well as conceptual and practical contributions to reconciliation.

Objective: Various studies have reported increased prevalence of HIV infection among psychiatric patients. Psychiatric patients are under-evaluated in terms of their HIV risk behaviour. The study sought to establish the prevalence of HIV risk behaviour and determine the association between risk behaviour and demographic and clinical variables.

Method: Participants were 113 consenting adult in-patients. A structured interview was conducted with each participant. A total risk behaviour score was calculated. From the risk score, three risk behaviour categories were identified: 0 = no risk; 1 to 3 = medium risk; 4 to 9 = high risk. Associations between HIV risk behaviour and demographic and clinical variables were analysed.

Results: Of the 113 participants, 68% were men and 32% women. The mean age was 38. Forty-five per cent were sexually active and 48% fell into the "no-risk group", 29% in the "medium-risk" group, and 23% in the "high-risk" group. Female patients with a history of treatment for sexually transmitted disease and a diagnosis of personality disorder were associated with being sexually abused. Having multiple sex partners was associated with diagnoses of substance-related disorders and cognitive disorders. Sex with someone known for less than 24 hours was associated with long-term hospitalisation and diagnoses of cognitive and personality disorders.

Conclusion: The study confirmed that mentally ill patients are vulnerable and may be victimised. The study also suggests that mental illness may impair appreciation of consequences and lead to high-risk behaviour for contracting HIV. Special care should be taken to protect female patients in psychiatric institutions.

Objective: Studies have reported an increased prevalence of HIV infection among psychiatric patients. Inaccurate HIV knowledge is included as a factor in the increased risk of HIV infection in the mentally ill, but few studies have looked specifically at this factor. The aims of the study were to determine the knowledge of HIV and its transmission among adult psychiatric patients at Weskoppies Hospital and to determine the relationship between HIV knowledge and HIV risk behaviour.

Method: Structured interviews were conducted with 113 consenting adult patients at Weskoppies Hospital. They were divided into three groups according to their length of hospital stay. The structured interview included questions about demographic data, the diagnoses and the AIDS Risk Behaviour Knowledge Test (AIDS-KT). Scores of 13 out of 13 represented accurate knowledge of HIV (level I); scores of 10-12 represented good knowledge (level II); scores of ≤ 9 represented poor knowledge (level III).

Results: A total of 104 patients (92%) demonstrated excellent knowledge of HIV and its transmission (levels I and II). There was no significant linear association between HIV knowledge and risk-behaviour scores (Pearson's correlation coefficient r= -0.11).

Conclusion: The presence of high-risk behaviours despite good HIV-related knowledge in this group of patients, leads us to think that knowledge alone will not limit HIV risk behaviours. For this reason, educational programmes should not be limited to interventions that simply increase knowledge about HIV infection but should extend to clinical factors, including patients' motivation and readiness to change their behaviour.