Research Articles (Psychiatry)

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Schneiderian first rank symptoms significantly predict a dissociative disorder diagnosis in psychiatric in-patients
(Taylor and Francis, 2025) Kruger, Christa; Fletcher, Lizelle; christa.kruger@up.ac.za
Previous empirical studies on the relationship between psychotic symptoms and dissociative disorders focused on auditory hallucinations only or employed limited statistical analyses. We investigated whether the frequency of Schneiderian first rank symptoms (FRS) predicts the presence or absence of a dissociative disorder (DD). Psychiatric in-patients (n = 116) completed measures of dissociation, FRS and general psychological distress (GPD). DD diagnoses were confirmed by multidisciplinary teams or administering the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised (SCID-D-R). The FRS were recorded in the Multidimensional Inventory of Dissociation (MID) and a mean score obtained for 35 relevant items: Voices arguing, voices commenting, made feelings, made impulses, made actions, influences on body, thought withdrawal, and thought insertion. A global severity index (GSI) of GPD was obtained from the Symptom Checklist–90–Revised (SCL-90- R). Logistic regression models examined whether FRS predict diagnostic classification of patients under a DD (n = 16) or not (n = 100), controlling for GSI. The overall fit of the model was significant (p = .0002). DD was correctly classified using frequency of FRS, controlling for GSI. The latter was moderately associated with FRS (r = 0.56). FRS more than doubled the odds of a DD diagnosis (odds = 2.089; 95% CI = 1.409–3.098; correct classification rate 87.1%). The study provides convincing evidence that FRS are closely related to DDs. FRS should alert clinicians to consider DDs in differential diagnosis of psychiatric in-patients. Future research should analyze whether FRS also predict a diagnosis of schizophrenia or other psychiatric disorders.
Vigour as a marker of positive mental health among social media respondents
(Elsevier, 2024-10) Dlagnekova, Antonia; Van Staden, Werdie; werdie.vanstaden@up.ac.za
BACKGROUND : Quantitative research on vigour as a therapeutically responsive marker of positive mental health, has become possible by virtue of the validation of the Vigour Assessment Scale (VAS). Considering that its validation and therapeutic responsiveness were examined in an avolitional schizophrenia population, using the VAS outside these constraints requires that its psychometric properties be investigated in a more general non-clinical population. METHOD : Social media respondents (n = 787) were recruited on social media through snowball sampling and data were obtained for statistical analyses through an online questionnaire comprising the VAS and measures of work-place vigour, active involvement in personal growth, behavioural activation, procrastination, and fatigue. RESULTS : Convergent validity was confirmed in moderate to strong positive correlations between the VAS and measures approximate to vigour including physical strength (r = 0.805), cognitive liveliness (r = 0.676), planfulness (r = 0.61), and intentional behaviour (r = 0.595). Discriminant validity was evident in negative correlations with procrastination (r = −0.593) and fatigue (r = −0.786). The VAS showed good internal consistency (Cronbach α = 0.951), split-half reliability (r = 0.892), test-retest reliability (r = 0.861), and a low standard error of measurement of 3.73 within a theoretical range of 82 points. Exploratory factor analysis yielded a clear two-factor structure. LIMITATIONS : Results are limited to willing participants who responded through social media. CONCLUSIONS : Vigour may now be measured clinically as an indication of positive mental health and well-being. It may also be further investigated for its relations to other parameters of health, personality, and the efficacy of professional and self-enhancing interventions that aim for the cultivation of vigour.
Agentive steadfastness as trait marker in relation to temperament and character
(Elsevier, 2024-09) Vosloo, Cristel; Van Staden, Werdie; werdie.vanstaden@up.ac.za
BACKGROUND : Agentive steadfastness was identified as a potential trait marker with which to anticipate prognostically that a patient will persevere steadfastly and take congruent action in facing the demands of living. Taken as an enduring expression of personality, this study investigated agentive steadfastness among adult social media respondents (n = 511) in relation to temperament and character as captured in Cloninger's psychobiological model of personality. METHODS : Participants recruited though snowball sampling on social media platforms, applied the 27-item Agentive Steadfastness Index (ASI) and the 240-item Temperament and Character Inventory (TCI-R-240). RESULTS : Agentive steadfastness was statistically predicted by the Self-directedness (β = 0.634), Self-transcendence (β = 0.119), Harm Avoidance (β = -0.142) and the Reward Dependence (β = 0.071) scales, accounting for 63.3 % of the variance in one stepwise regression model. In another stepwise model for the TCI-R-240 subscales, the Purposeful (β = 0.359), Anticipatory Worry (β = -0.353), and the Responsibility (β = 0.259) subscales accounted for respectively 56.8 %, 11.2 % and 2.8 % of the variance in ASI scores. LIMITATIONS : Results are limited to adult social media respondents who were willing to participate. CONCLUSIONS : Agentive steadfastness may serve as a trait marker of well-being and the good prognostic associations that have been established for high self-directedness, low harm avoidance, as well as resilience, and character strengths. It may be assessed clinically to anticipate prognostically the extent to which a patient will persevere steadfastly and take congruent action in facing the demands of living and adversity.
The effects of inpatient suicide on nurses at Weskoppies Hospital : a qualitative study
(AOSIS, 2024-05-21) Zola, Nomthandazo; Mtetwa, Thandazile G.; Khamker, Nadira
BACKGROUND : Inpatient suicide is a serious adverse event in psychiatric wards. Suicide can cause severe trauma to both patients and health professionals, who may develop maladaptation with poor coping skills. Healthcare practitioners are the second victims and historically, this concept has been overlooked. The psychological effects and lack of support have not been sufficiently explored. AIM : The emotional well-being and clinical practice of nurses who experienced inpatient suicide at Weskoppies Psychiatric Hospital was explored. SETTING : Weskoppies Psychiatric Hospital, South Africa. METHODS : In this qualitative case study, 12 nurses who had lost a patient to inpatient suicide some time during their employment were purposefully selected. Data were collected through individual in-depth interviews, which were audio recorded and transcribed. The data were thematically analysed. RESULTS : Nurses were negatively affected by inpatient suicide resulting in a range of emotional and psychological effects, including fear, anger, sadness, flashbacks, guilt, and difficulty in coping. Clinical practice factors included being doubtful and extra vigilant. Although nurses received psychological support from the institution, they recommended in-service training with periodic reviews to prevent and manage inpatient suicide. CONCLUSION : Inpatient suicide is a serious adverse event, and mental health practitioners become second victims. These events do not only impact the psychological well-being of nurses but also influence the clinical practice. Mental health practitioners should receive adequate training and support in preventing and handling inpatient suicide. CONTRIBUTION : This study provided insights into nurse’s perspectives on the effects of inpatient suicide and how they can be supported.
Factors associated with long hospitalisation for psychotic disorder patients in an acute ward : tertiary care hospital
(AOSIS, 2024-04-23) Paliweni-Zwane, Tshepiso I.; Modisane, Lucas N.; Grobler, Gerhard Paul
BACKGROUND : The average length of stay is often used to indicate health system efficiency; shorter stays are associated with reduced costs. In South Africa, mental healthcare expenditure is spent on inpatient care. AIM : To identify factors associated with a long stay in an acute psychiatric unit. SETTING : A tertiary hospital. METHODS : A case-control study review of inpatients diagnosed with psychotic symptoms was used. Sample was divided into two groups, length of stay (LOS) (LOS greater than 21 days, LOS less than 14 days). Total of 82 patients were divided into short stay group (SSG, n = 23) and long stay group (LSG) (n = 59). A comparison of demographic, clinical and system variables was conducted. RESULTS : In demographics, LSG had fewer men compared to SSG (78.3%) and differed statistically from LSG with p = 0.05. Long stay groups were older in comparison to SSG with a p = 0.02. Illicit substance use in LSG was 44.1% and statistically less than SSG (73.91%; p = 0.02). A high proportion of LSG had medical or surgical and psychiatric comorbidities (67.8%) compared to SSG (43.5%) (p = 0.04). A total of 95% patients in SSG had family support. CONCLUSION : Longer stay was found to be associated with older females with primary psychotic disorders. Comorbidities with less availability of family support were associated with younger males presenting with psychotic symptoms that may be related to illicit substances that respond to rapid stabilisation. CONTRIBUTION : Active surveillance of medical comorbidities amongst older female patients is necessary for early liaison services to reduce their length of stay.
Comparing the medication costs of treating patients with schizophrenia who use cannabis with those who do not
(AOSIS, 2024-04-15) Nowbath, Nikhil; Abdelatif, Nada; Lippi, Gian; gian.lippi@up.ac.za
BACKGROUND: Cannabis use is more prevalent among people with schizophrenia than in the general population. This usage detrimentally impacts disease prognosis, contributing to escalated admissions, heightened severity of psychotic symptoms, and reduced medication response. The recent decriminalisation of cannabis in South Africa may lead to an upsurge in usage, consequently intensifying the strain on mental healthcare services. AIM : This study aimed to compare the medication costs of patients with schizophrenia depending on cannabis use. SETTING : Weskoppies Hospital, Pretoria, South Africa, 2018–2019. METHODS : Data pertaining to medication expenses during the 2018–2019 period were acquired from the hospital pharmacy. Data were collected from 114 patient records to form two equal cohorts: one exposed to cannabis and the other non-exposed, as indicated by urine drug screens or admission of cannabis use. Medications prescribed from admission to time of being ready for discharge were recorded and corresponding costs were calculated. RESULTS : Patients who were exposed to cannabis had higher medication costs (R 516.47) than patients who were non-exposed (R 328.69) (p = 0.0519), over the whole admission period. CONCLUSION : Cannabis exposure escalates the financial burden of treating schizophrenia at Weskoppies Hospital. This might be attributed to failure of cost-effective, first-line medications prompting the prescription of costlier, second-line alternatives or higher prescribed dosages. CONTRIBUTION : This study contributes to findings that it is more expensive to treat patients with schizophrenia who have relapsed, if they are using cannabis. This finding has future cost implications when budgeting for pharmacotherapeutic treatment.
Validity and reliability of the agentive steadfastness index
(Wiley, 2024-06) Vosloo, Cristel; Van Staden, Werdie; werdie.vanstaden@up.ac.za
Agentive steadfastness is a hitherto unarticulated and unmeasured construct, although clinicians may have drawn intuitively on it in anticipating clients' prognosis and anticipated responsiveness to adverse events. Following the conceptualisation and articulation of the agentive steadfastness construct and a measure thereof, the current study examined the validity and reliability of the agentive steadfastness index (ASI) among responding adult social media users (n = 511). Results confirmed convergent validity between agentive steadfastness and closest related psychological constructs, which were resilience (r = .715) and character strength (r = .704). Its discriminant validity was observed with other related but notably distinct psychological constructs, which were anxiety (r = −.599) and ego-strength (r = −.244). Temporal stability was confirmed over a period of 6 months (r = .763). The ASI showed good internal (Cronbach alpha = .937) and split-half reliability (r = .838) and a low standard error of measurement of 7.57 points within a theoretical range of 190 points. These results suggest that the ASI is a valid and a reliable measure of agentive steadfastness. Equipped with the ASI, further research is enabled on agentive steadfastness as a psychotherapeutic target and its relations with various aspects of personality, prognosis and adversity.
Ethical principles, challenges and opportunities when conducting genetic counselling for schizophrenia
(Frontiers Media, 2023-06-21) Zingela, Zukiswa; Sokudela, Funeka; Thungana, Yanga; Van Wyk, Stephan
Ethical challenges of genetic counselling for schizophrenia include effective communication of critical scientific information in an easily understood manner by patients and relatives, and the ability to ensure communication is unencumbered by medical jargon. Levels of literacy in the target population may limit this process, making it difficult for patients to attain the desired levels of informed consent to make crucial decisions during genetic counselling. Multilingualism in target communities may further complicate such communication. This paper outlines the ethical principles, challenges and opportunities facing clinicians when conducting genetic counselling for schizophrenia and how these might be met, drawing on lessons from South African studies. The paper draws on reflections of clinician and researcher experiences gained from clinical practice or research on the genetics of schizophrenia and psychotic disorders in South Africa. The context of genetic studies in schizophrenia is used to illustrate the ethical challenges in genetic counselling for schizophrenia, both in clinical and research settings. Attention is also drawn to multicultural and multilingual populations, particularly where the preferred language lacks a well-developed scientific language of communication for some of the genetic concepts that have to be presented during the genetic counselling process. The authors describe the ethical challenges and how to address these to empower patients and relatives to make well-informed decisions despite these obstacles. Principles applied by clinicians and researchers during the genetic counselling are described. Potential solutions, including the establishment of community advisory boards to address potential ethical challenges inherent to the genetic counselling process, are also shared. Genetic counselling for schizophrenia still faces ethical challenges which require a balance of principles of beneficence, autonomy, informed consent, confidentiality and distributive justice, while striving to present accuracy in the science that guides the process. Evolution in language and cultural competency therefore needs to occur alongside scientific advances in genetic research. Key stakeholders need to partner and build capacity and expertise in genetic counselling through the provision of funding and resources. The goal of partnerships is to empower patients, relatives, clinicians and researchers to share scientific information in a manner guided by empathy while retaining scientific accuracy.
Readmission of adolescent psychiatric patients to a specialised unit in Gauteng, South Africa
(Health and Medical Publishing Group, 2023-07-27) Brown, Sarah-Anne; Moeketsi, Tshepiso D.; Musekiwa, Alfred; Moodley, Saiendhra Vasudevan
BACKGROUND : Readmission rates to child and adolescent psychiatric units among the youth have been reported to be increasing. AIM : The study aimed to determine the readmission rate and factors associated with readmission of adolescent psychiatric patients at a child and adolescent psychiatric unit. SETTING : A specialised psychiatric hospital in Gauteng province, South Africa. METHODS : This retrospective cohort study utilised data from the records of patients admitted to the adolescent inpatient unit over a period of five years. The cumulative incidence and incidence rate of readmission within one year of discharge from the index admission was calculated using survival analysis methods. Characteristics significantly associated with readmission were determined by applying the multivariable Cox proportional hazards regression model. RESULTS : Among the 189 patients included in the analysis, the cumulative incidence of readmission within one year of discharge was 17.5%. The incidence rate was 5.31 readmissions per 10 000 person-days. The final multivariable model showed that a diagnosis of schizophrenia (p = 0.015), a diagnosis of attention deficit hyperactivity disorder (p = 0.039), and coming from a child and youth care centre or temporary safe care (p = 0.018) increased the risk of readmission while having a medical condition (p = 0.008) reduced the risk. CONCLUSION : Psychiatric diagnosis and residential care could be potential risk markers for readmission. Improving the collaboration between health and social services in residential care would be beneficial. CONTRIBUTION : Identifying factors that predispose adolescent psychiatric patients to readmission can inform and improve management and risk assessments.
Factors affecting readmission of adolescent mental healthcare users to a psychiatric hospital
(AOSIS, 2023-11-15) Eichstadt, Stephanie A.; Chetty, Shren; Magagula, T.G.; Swart, Xan
BACKGROUND : Adolescent mental illness is increasing worldwide, leading to more admissions to psychiatric institutions. Many adolescents may require multiple readmissions, which is disruptive to their holistic well-being and costly for the healthcare sector. Identifying especially modifiable risk factors for readmission remains an important step in providing potential areas for improving patient care. AIM : This study investigated the risk factors associated with the readmission of adolescent mental healthcare users to a specialist psychiatric unit. SETTING : The specialist adolescent unit at Weskoppies Psychiatric Hospital. METHODS : In this retrospective study, the clinical files of 345 adolescents admitted between 2015 and 2019 were reviewed. The primary outcome variable was readmission, that is, whether a patient was readmitted to Weskoppies Hospital (n = 98) compared to those with no recorded readmission (n = 247). RESULTS : Readmitted adolescents were significantly younger on first admission compared to the non-readmitted group (13.46 vs 14.26, p = 0.016). Bivariate analysis showed that the readmitted group had a much higher rate of non-adherence to treatment (38.1% vs 10.5%, p = < 0.001). Patients with a family history of mental illness had a significantly higher risk of readmission (52.2% vs 37.5%, p = 0.015). CONCLUSIONS : Adolescents were more likely to be readmitted if they had first admission at a younger age, a family history of mental illness or non-adherence to treatment. CONTRIBUTION : Identifying especially modifiable risk factors for readmission of adolescents to improve patient care, particularly in the South African context where there is a paucity of research on this topic.
Attitudes of medical students regarding legalisation of cannabis and cannabis-education
(AOSIS, 2023-11-07) Eiselen, Evan; Naidu, Kalai; Viljoen, Maryn
BACKGROUND : Recreational and medicinal use of cannabis is topical in the light of more permissive legislation regarding the substance worldwide. AIM : The primary purpose of this study is to determine the attitudes that final-year medical students at the University of Pretoria (UP) hold about recreational and medicinal use of cannabis, as well as determining if they feel they are being adequately trained in this regard. SETTING : The research was conducted at Weskoppies Psychiatric Hospital, affiliated with the UP. METHODS : The study follows a cross-sectional, comparative, quantitative design. Data were collected by means of a structured questionnaire. Final-year medical students were identified as participants via a convenience sampling technique. Participation was voluntary and anonymous. RESULTS : A total of 57 valid responses were recorded. The study shows that most medical students had permissive views about cannabis and that the majority feel that they are not being adequately trained to advise patients about medical cannabis in a lecture setting (64.9%, n = 37) or clinical setting (68.4%, n = 38). Results also show that previous personal experience with cannabis led to more permissive views. CONCLUSION : This study illustrates the need for academic research regarding medicinal cannabis but interestingly shows that medical students want more guidance from their training institution about the topic. CONTRIBUTION : This research shows that the conversation surrounding cannabis in medicine is continuous and universities should make a conscious effort to familiarise students with the topic.
Pathophysiological aspects of exposure to dampness-associated indoor mould and mycotoxins : a mini-overview
(Elsevier, 2023-02) Viljoen, Margaretha; Claassen, Nicolaas
Indoor mould growth presents a potential health risk. The aim of this writing is to provide an overview on the pathophysiological aspects of exposure to dampness-associated indoor mould and mycotoxins. The paper briefly deals with the host’s defence against mould invasion; mechanisms by which moulds can override the host’s de- fence mechanisms; potential adverse health effects posed by moulds, as well as symptoms and disorders associated with exposure to indoor moulds, including respiratory disorders, and non-respiratory disorders. References to re- cent in-depth reviews on specific aspects of the subject are provided. The prominent role of the inflammatory response, both as a defence mechanism against mould invasion and as the basis for mould-associated pathology is pointed out.
The validity of a therapeutic invigoration task in avolitional schizophrenia outpatients
(Wiley, 2024-01) Dlagnekova, Antonia; Van Staden, Werdie; werdie.vanstaden@up.ac.za
BACKGROUND AND OBJECTIVES : Avolition is associated with much morbidity and functional impairment in schizophrenia patients. Vigor may be taken as, in part, the inverse of avolition, but it has not been investigated as a therapeutic pursuit before. To this end, a therapeutic invigoration task was developed drawing on cognitive-behavioral and guided imagery therapies. This study investigated the validity and reliability of a therapeutic invigoration task in avolitional residual phase schizophrenia outpatients. METHODS : In a proof-of-concept quasi-experimental one-group sequentially repeated pretest/posttest study design, patients (n = 76) participated in a structured invigoration task that was repeated after 1 month (n = 70). RESULTS : Patients' vigor during the preceding 7 days measured on the Vigor Assessment Scale increased highly significantly in anticipation of the subsequent 7 days on both occasions with respectively very large (Cohen's δ with Hedges' correction [δ] = 1.46) and large (δ = 1.04) effect sizes. The anticipated vigor after the first occasion was partially consummated during the subsequent month in that vigor during the 7 days preceding the second occasion was lower than participants had anticipated but still significantly higher than at baseline (p < 0.001; δ = 0.70). Repeating the task a month later, together with homework, had a cumulative effect as indicated by a very large effect size (δ = 1.61). CONCLUSION : Results suggest that the invigoration task did what it was supposed do, and did so consistently, in patients with avolitional residual schizophrenia. These results warrant a subsequent randomized controlled trial to establish the efficacy of the invigoration task.
Twelve weeks of additional fish intake improves the cognition of cognitively intact, resource-limited elderly people : a randomized control trial
(Springer, 2022-02) Kühn, Lizette; MacIntyre, Una Elizabeth; Kotze, Carla; Becker, Piet J.; Wenhold, Friedeburg Anna Maria
INTRODUCTION : Dietary omega 3 polyunsaturated fatty acids (PUFA) may reduce the risk of dementia. Many studies have investigated PUFA supplementation in high-income countries, yet food-based randomized control trials using omega 3 PUFA rich fish in lower to middle income countries, are lacking. OBJECTIVE : To determine the effect on cognition of adding either fish or non-fish foods for twelve weeks to an enhanced diet of cognitively intact, independently living, resource-limited elderly people. DESIGN : Randomized control trial (National Health Trial register: DOH-27-061-6026) SETTING : Retirement center in urban South Africa. PARTICIPANTS : Fifty-seven (74% female, mean age: 72±7 years) elderly participants with cognitive function exceeding 22 on the Mini Mental State Examination were randomized into an intervention (n=31) and control (n=26) group. INTERVENTION : The usual diets of both groups were enhanced with context-appropriate foods to mimic elements of the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet. The intervention group additionally received canned pilchards and fish spread every week amounting to an additional (theoretical) intake of 2.2g omega 3 PUFA daily. The control group received canned meatballs and texturized soya every week. MEASUREMENTS : Cognition was measured twice before and once after the intervention phase using the Cognitive Abilities Screening Instrument (CASI). Adherence was assessed by a study-specific food frequency questionnaire and red blood cell (RBC) PUFA biomarkers. Data were analyzed using a non-parametric analysis of covariance (ANCOVA) with, and without, bootstrap imputation. RESULTS : Participants in the intervention group had a significantly higher post intervention (P=0.036) CASI score than the control group, when the model was fitted with imputation and controlled for baseline scores. Participants in the intervention group also had a significantly higher intake of calculated dietary omega 3 PUFA and higher levels of RBC eicosapentaenoic acid and docosapentaenoic acid content than the control group (P < 0.05). CONCLUSION : Twelve weeks of fish intake in the context of a modified MIND diet may improve the cognition of cognitively intact, resource-limited elderly people.
Race in health research : considerations for researchers and research ethics committees
(South African Medical Association, 2023-04) Van Staden, Werdie; Nienaber, A.; Rossouw, T.; Turner, Astrid Chrisilda; Filmalter, Cecilia Jacoba; Nel, Jan Gert; Bapela, S.; Beetge, Mia-Michaela; Blumenthal, Ryan; Castelyn, Camille De Villebois; De Witt-Jordaan, T.W. (Wilma); Dlagnekova, Antonia; Kotze, Carla; Mangwane, S.; Napoles, Lizeka; Somers, R.; Sykes, Leanne M.; Van Zyl, W.B.; Venter, Marietjie; Uys, Andre; Warren, Nichola
This article provides ethical guidance on using race in health research as a variable or in defining the study population. To this end, a plain, non-exhaustive checklist is provided for researchers and research ethics committees, preceded by a brief introduction on the need for justification when using race as a variable or in defining a study population, the problem of exoticism, that distinctions pertain between race, ethnicity and ancestry, the problematic naming of races, and that race does not serve well as a presumed biological construct in genetic research.
Factors associated with longer hospital admission in elderly patients with major neurocognitive disorder
(AOSIS, 2023-10-23) Steenkamp, Tarina; Mazibuko, Paslius S.; Kotze, Carla
BACKGROUND : Major neurocognitive disorder presents many challenges to patients, families and healthcare systems, especially when a patient requires admission to a psychiatric hospital. AIM : To identify characteristics of older patients with major neurocognitive disorder at risk of prolonged admission in a psychiatric hospital. SETTING : A tertiary psychiatric hospital in Gauteng province, South Africa. METHODS : The authors conducted a retrospective review of the hospital database and clinical files. Clinical and demographic data were collected from the files of 50 inpatients, 60 years and older, who were diagnosed with major neurocognitive disorder and admitted between 2015 and 2019. Anonymised data from patient records were captured on an electronic spreadsheet and analysed using T-tests and analysis of variance (ANOVA) to investigate the relationship between patient characteristics and length of hospital admission. RESULTS : The mean duration of admission was 18.29 months. Involuntary admission status (β = 0.239, p = 0.049), level of assistance required (moderate level of assistance [β = 0.378, p = 0.005]; high level of assistance [β = 0.336, p = 0.015]), availability of social support (β = −0.319, p = 0.016) and the presence of behavioural or psychological problems (β = 0.437, p = 0.002) were significantly correlated with longer admission. Using a stepwise regression model, the only significant variable associated with a shorter length of stay was the presence of social support (β = −0.512, p = 0.009). Age, type of major neurocognitive disorder and number of comorbidities were not correlated with the duration of admission (p > 0.005). CONCLUSION AND CONTRIBUTION : Social support plays an important role in the management of patients with major neurocognitive disorder. The findings in this study highlight healthcare shortages and a need for adequate placement facilities in South Africa for patients who have no other form of support.
Illness-perception in adolescent attention-deficit/hyperactivity disorder : a qualitative study
(AOSIS, 2023-03-28) Botha, Wanita; Van der Westhuizen, Deborah
BACKGROUND : Adolescents with attention-deficit/hyperactivity disorder (ADHD) experience aspects of their lives in diverse ways. They often have more energy and creativity which are positive traits of ADHD, while their inability to control their actions in academic or social spheres may cause feelings of inadequacy. AIM : To explore illness-perception, including emotional experiences, in adolescent ADHD. SETTING : Using convenience sampling, 12 adolescent participants, eight boys and four girls, diagnosed with ADHD, were included. Participants followed up at Weskoppies Tertiary Psychiatric Hospital’s child-and-adolescent outpatient clinic. METHODS : This qualitative study used semi-structured question guides to conduct interviews that allowed participants to actively construct their knowledge of their disorder. Maintaining a phenomenological perspective, thematical analysis of data was done. RESULTS : Adolescents’ perceptions of their ADHD could be placed into three categories. ‘Negative self-perception in ADHD’ represented adolescents’ descriptions of ‘inability’ and ‘lack of control’ over their cognitive processes, behaviour, emotions, and restlessness. Adolescents perceived ‘feeling judged by others’, amplified self-stigmatisation and discrimination. This antagonistic environment caused conflict between their self-perception and others’ perception of them, further intensifying feelings of ‘not being normal’. The theme ‘self-empowerment strategies’, included controlling external stimuli, accepting support from others, and personalised learning strategies. CONCLUSION : Adolescents with ADHD struggle with cognitive, behavioural, and emotional control, and frequently experience stigmatisation and discrimination. They often learn to rely on self-taught coping strategies. CONTRIBUTION : This research grants perspective to educators and clinicians on experiences of adolescents with ADHD, and identifies the need to address stigmatisation. It recognises the value of personalisation of coping methods.
South Africa’s psychiatric training capacity in 2008 and in 2018. Has training capacity improved?
(AOSIS, 2023-03-30) Beath, Natalie; Subramaney, Ugasvaree; Zingela, Zukiswa; Chiliza, Bonginkosi; Joska, John A.; Kotze, Carla; Ramlall, Suvra; Seedat, Soraya
BACKGROUND : There is a deficit of psychiatrists in South Africa, and to our knowledge, there is no situational analysis of training posts for psychiatrists in the country. AIM : To compare the number of specialists and subspecialists in training and training posts available in 2008 and 2018. SETTING : South African medical schools with departments of psychiatry. METHODS : A situational analysis involving data collection through a survey completed by eight heads of academic psychiatric departments followed by a comparative analysis of the two aforementioned years. RESULTS : Data shows an 11% increase in funded and unfunded posts combined and a 9.3% increase in funded posts. The occupancy of funded posts decreased (92% in 2008 to 82% in 2018). When considering both funded and unfunded posts, only three more psychiatrists were being trained in 2018. Supernumeraries appointed in unfunded posts can be expected to return to their countries of origin. As such, a decrease in filled funded posts likely reflects a decrease in training psychiatrists destined to work in South Africa. While child and adolescent psychiatry was the only subspeciality with accredited training posts in 2008, all sub-specialities included on the questionnaire had accredited training posts in 2018, and the number of accredited training posts in child and adolescent psychiatry doubled. That said, many of the posts were unfunded and vacant. CONCLUSION : While there was an increase in posts from 2008 to 2018, many posts remained unfilled. As such, not only are additional funded training posts required but also strategies to increase post-occupancy and successful completion of training. CONTRIBUTION : This study is the first situational analysis of specialist and subspecialist training posts in Psychiatry in South Africa, at two time points over a 10 year period, that draws on academic heads of departments of psychiatry as respondents. The study highlights the nominal increase in funded training posts over this period, especially subspecialist training posts. The majority of Health Professions Council of South Africa (HPCSA) accredited subspecialities in Psychiatry have no funded training posts which is particularly concerning.
Development of a mobile application for detection of adolescent mental health problems and feasibility assessment with primary health care workers
(Taylor and Francis, 2022) Groen, Gunter; Joerns-Presentati, Astrid; Dessauvagie, Anja; Seedat, Soraya; Van den Heuvel, Leigh L.; Suliman, Sharain; Grobler, G.P.; Jansen, Ronelle; Mwape, Lonia; Mukwato, Patricia; Chapima, Fabian; Korhonen, Joonas; Stein, Dan J.; Jonker, Deborah; Mudenda, John; Turunen, Timo; Valtins, Karlis; Beinarovica, Anete; Grada, Leva; Lahti, Mari
INTRODUCTION : There has been a sharp increase in the use of digital health interventions in global health, particularly mobile health applications, in recent years. The extreme shortage of health care providers trained in mental health screening and intervention in low- and middle-income countries raises questions about the applicability of mobile applications to deliver these services due to their accessibility and availability. This exploratory paper describes the development and feasibility assessment of a mobile screening application for the detection of mental disorders among adolescents in Zambia and South Africa. METHODS : Eighty-two health care workers (HCW) working in primary care evaluated the acceptability and practicality of the mobile screening application after receiving brief training. The evaluation included questions from the Mobile Application Rating Scale (MARS) as well as open-ended questions. RESULTS : The acceptability of the screening app was high and study participants were positive about using the app in routine care. Problems with internet connectivity, and time and staff constraints were perceived as the main barriers to regular use. CONCLUSION : HCW in primary care were able and willing to use a mobile screening app for the detection of mental health problems among treatment-seeking adolescents. Implementation in clinical practice needs to be further evaluated.
Reflections on pellagra, the then and the now
(Mattioli1885, 2022-12) Viljoen, Margaretha; Claassen, Nico
By the mid-20th century, pellagra had virtually been eradicated from the USA and Europe. In contrast, outbreaks of pellagra, as diagnosed by skin lesions, today still occur in sub-Saharan Africa. We argue that outbreaks of pellagra in sub-Saharan regions are not only maintained by food insecurity, but that it is further aggravated by the burden of communicable diseases and excessive alcohol consumption. In addition, we argue from a historical point of view, that the prevalence of pellagra is underestimated when based only on dermatological symptoms.

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