South African Journal of Psychiatry

Ten game-changers in mental health for South Africa

Dan J. Stein — 2024-02-07

No abstract

Electroconvulsive therapy (ECT) with ketamine induction for catatonia in an HIV positive patient

Yvette Nel — 2024-02-07

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

A case of schizophrenia refuting mind-body dualism

Mohlalefi C. Letuka — 2024-02-07

Introduction: The case report depicts the complex interplay between mental and physical illness and contests the notion of mind-body dualism in medicine. It emphasises the importance of holistic management of patients and the misnomer of schizophrenia as a purely mental illness.
Patient presentation: Mr S is a 35-year-old male who presented to a South African specialist psychiatric hospital via the forensic system. He had multiple physical symptoms involving the abdominal, haematological, dermatological and neurological systems, in addition to an eight year duration of untreated psychosis with a marked decline in cognition and functioning.
Management and outcome: An extensive medical examination during his admission excluded conditions such as early onset dementia, Huntington’s disease, pellagra, Wilson’s disease, autoimmune encephalitis and substance-related complications. A definitive diagnosis of schizophrenia was made, and both physical and psychiatric symptoms responded well to the administration of an antipsychotic resulting in an eventual discharge from the hospital.
Conclusion: Mind-body dualism can result in a delayed diagnosis of schizophrenia and subsequent increased duration of untreated psychosis and other complications.
Contribution: This case emphasises the flaws of mind-body dualism, and the interplay of mental and physical illness.

Prevalence of depression, anxiety and burnout in medical students at the University of Namibia

Nelao T. Mhata — 2024-02-07

Background: There is an increased prevalence of depression, anxiety, and burnout among medical students worldwide with no information from Namibia.
Aim: This study aimed to determine the prevalence and factors associated with depression, anxiety, and burnout among medical students at the University of Namibia (UNAM).
Methods: A quantitative descriptive cross-sectional survey was conducted utilising a specially designed questionnaire for the study and standardised instruments to evaluate depression, anxiety, and burnout.
Results: Of the 229 students in this study, 71.6% were female and 28.4% were male. The prevalence of depression, anxiety, and burnout was 43.6%, 30.6%, and 36.2%, respectively. The prevalence of emotional exhaustion (EX), cynicism (CY), and professional efficacy (EF) was 68.1% (n = 156), 77.3% (n = 177) and 53.3% (n = 122), respectively. In the final regression model, participants with a current psychiatric illness were more likely to screen positive for depression (adjusted odds ratio [aOR] 4.06, confidence interval [CI] 1.28–12.91; p = 0.02) and anxiety (aOR: 3.63, CI: 1.17–11.23; p = 0.03). Emotional exhaustion and cynicism were significantly associated with female gender (EX: aOR, 0.40, CI: 0.20–0.79; p = 0.01) (CY: aOR, 0.42, CI: 0.20–0.91; p = 0.03).
Conclusion: More than one in three medical students at the UNAM were either depressed or burnt out.
Contribution: This is the first study to highlight the mental health needs of medical students at the University of Namibia.

Routine investigations for patients with mental and behavioural disturbances

Solomon M.K.K. Jere — 2024-02-07

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.

Mental health education for physiotherapists: A scoping review

Marilyn Hooblaul — 2024-02-07

Background: Physiotherapists play an integral role in the management of people living with a mental illness, yet little is known about their knowledge, attitudes and perceptions about mental health globally and particularly in South Africa.
Aim: The purpose of the study is to map global evidence on mental health education for physiotherapists, including their knowledge, attitude and perceptions, with the goal of using this information to design an improved undergraduate curriculum for physiotherapy in South Africa.
Setting: The search was focused on the South African and global context, with the participants as physiotherapists and physiotherapy students.
Methods: The methodical framework proposed by Arksey and O’Malleys guided the scoping review. The online search used five electronic databases. An expert librarian assisted in the search strategy. English language, primary research articles that investigated
physiotherapist or physiotherapy students’ knowledge, attitude and perceptions towards mental health were sought.
Results: The search strategy extracted 226 published studies and 15 studies were included in the analysis. The results indicated that globally physiotherapists and physiotherapy students had limited knowledge about mental health. Improved attitudes were noted with a mental health training intervention. Negative perceptions were associated with limited knowledge.
Conclusion: There was limited literature on the influence of education on mental health in physiotherapy on attitudes and perceptions. Physiotherapists desired more knowledge about mental health because of the prevalence of mental health disorders.
Contribution: Because of the increasing prevalence of mental illness globally, the findings of this review suggest the necessity of integrating mental health content in the physiotherapists’ undergraduate programme to provide high-quality care physiotherapy management for people with mental illnesses.

A review of recent treatments for adults living with attention-deficit/hyperactivity disorder

Candice Wakelin — 2024-02-07

Background: Attention-deficit/hyperactivity disorder (ADHD) is a neuro-developmental disorder prevalent among children and adults. Adults living with ADHD can experience significant distress affecting their daily functioning on emotional, physical, interpersonal, familial and financial levels. Intervention programmes may be a way to mitigate these challenges.
Aim: This review identified good evidence-based intervention studies for adults with ADHD and described the usefulness of these interventions.
Method: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, articles were searched from 2009 to 2019 across four medical- and psychological-focused electronic databases using EBSCOhost. All articles selected for the review’s thematic meta-synthesis were appraised by attaining a threshold score of at least 61%, using the Smith-Franciscus- wartbooi appraisal tool. Two autonomous reviewers engaged in the review process. The study adhered to all ethical principles pertaining to systematic review practice.
Results: Forty studies were identified for summation, including pharmacological, nonpharmacological and neuro-stimulation approaches. Most interventions used a multimodal approach. Results indicated the most effective stimulant and non-stimulant as methylphenidate and atomoxetine, respectively. Effective non- pharmacological approaches to treatment were identified as cognitive-behavioural treatment, mindfulness-based approaches, psychoeducation and dialectical-focused therapies. Bright light treatment and neurofeedback were reported as the most efficacious neuro-stimulatory methods.
Conclusion: Pharmacological and non-pharmacological approaches, as well as neurostimulation or a blend of these approaches were acknowledged as the most effective recent modalities in the treatment of adult ADHD.
Contribution: This review reported on the most current approaches to treat adult ADHD. This will facilitate a better understanding and informed decisions with regard to dealing with adult ADHD.

Strengthening a mental illness management questionnaire for clinical associates through expert validation and cognitive interviews

Saiendhra V. Moodley — 2024-02-07

The supply and distribution of specialist mental health professionals is a significant barrier to providing access to mental health services in South Africa (SA).1,2 Clinical associates are a clinically trained cadre that could be utilised in mental health service provision in underserved areas. There is a lack of data on clinical associates’ training in mental health, their knowledge and confidence to manage mental health conditions, attitudes towards mental illness, and the mental health services that they currently provide in SA. The authors developed a questionnaire to assist us to obtain this information. With the exception of the attitudes component of the
questionnaire, which used the validated 16-item Mental Illness Clinicians’ Attitudes version 4 scale (MICA v4),3 the questions were developed by the authors. Expert validation and cognitive interview processes were used in the final stages of development of the questionnaire. The purpose of this scientific letter is to outline the expert validation and cognitive interview processes followed and to reflect on their value in developing a mental illness management questionnaire for clinical associates.

HIV prevalence and access to HIV testing and care in patients with psychosis in South Africa

Mbalenhle P. Mwelase — 2024-02-07

Background: Human immunodeficiency virus (HIV) and psychosis share a complex bidirectional relationship, with people living with HIV being at increased risk of psychosis and those with psychosis at increased risk of HIV. However, people living with severe mental
illness often have limited or reduced access to HIV testing and care.
Aim: This study aimed to determine the prevalence of HIV and describe the access to HIV testing and care among adult patients with recent-onset psychosis who were admitted to a psychiatric hospital in KwaZulu-Natal (KZN) province, South Africa. Setting: A psychiatric hospital in Pietermaritzburg, KZN province, South Africa.
Method: A retrospective chart review of 294 patients with recent-onset psychosis admitted between May 2018 and November 2020.
Results: A total of 291 (99%) patients had access to HIV testing during the study period, with the HIV seroprevalence rate being 21.5% among the 294 patients; HIV seropositivity was associated with the 25–49 age category (adjusted odds ratio [aOR] = 3.09, 95% confidence interval [CI] 1.27–7.50), female gender (aOR = 9.55, 95% CI 4.40–20.74), current alcohol and cannabis use (aOR = 3.43, 95% CI 1.01–11.62), family history of psychosis (aOR = 3.22, 95% CI 1.03–10.02) and no tertiary education (aOR = 3.7, 95% CI 0.14–0.99). All those living with HIV were on antiretroviral treatment.
Conclusion: This study showed that HIV testing and care was accessible at a psychiatric hospital but the prevalence of HIV in people living with recent onset psychosis remains high.
Contribution: The study findings suggest the importance of integrating mental health and HIV management.

Assessing the revised Clinical Institute Withdrawal for Alcohol Scale use at Stikland Hospital

Creeshen P. Muddapah — 2024-02-07

Background: Alcohol use disorder (AUD) is a major public health concern in South Africa (SA). Abrupt cessation or reduction of alcohol intake in chronic users can result in withdrawal symptoms. Benzodiazepines are the treatment of choice but need to be used cautiously in patients with a lifetime history of substance abuse given their highly addictive potential. Symptom-triggered prescription of benzodiazepines during alcohol withdrawal using the Revised Clinical Institute Withdrawal for Alcohol Scale (CIWA-Ar) has been associated with improved safety and reduced benzodiazepines use.
Aim: To investigate if implementation of the CIWA-Ar during alcohol detoxification impacted the dose of benzodiazepines used and withdrawal-related outcomes.
Setting: Alcohol rehabilitation unit (ARU) at Stikland Psychiatric Hospital.
Methods: A retrospective cohort study of 135 admissions over a six-month period comparing two groups: before (2015) and after (2017) the implementation of the CIWA-Ar.
Results: The study noted no differences in sociodemographic and alcohol-associated variables between the two groups, and there were no recorded complications in either group. The 2017 group had a lower percentage of patients that required benzodiazepines (33.8% vs. 51.4%, p = 0.04) and a lower median total amount of benzodiazepines used during alcohol withdrawal (0 mg vs. 5 mg, p = 0.01).
Conclusions: The CIWA-Ar rating scale was an effective alternative to prescribing benzodiazepines pro re nata and decreased the total dose of benzodiazepines used during alcohol withdrawal.
Contribution: The use of a symptom triggered regime, like the CIWA-Ar rating scale, during withdrawal can be implemented safely in a SA treatment setting for patients with low-risk AUD.

Trauma survivors’ perceptions and experiences of prolonged exposure for PTSD at a psychology clinic

Duane D. Booysen — 2024-02-07

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 f or 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.

A retrospective data analysis of psychiatric cases in Hargeisa, Somaliland between 2019 and 2020

Hassan Abdulrahman — 2024-02-07

Background: In Somaliland, an estimated one person in every two households suffers from psychiatric disorders. Despite this, access to mental health care is limited because of shortages n facilities, human resources, funding and stigma.
Aim: To present the proportion of psychiatric disorders encountered in outpatient psychiatry clinics.
Setting: The University if Hargeisa (UoH), Hargesisa, Somaliland.
Methods: De-identified data on patients accessing psychiatric care from doctor trainees in the dual psychiatry–neurology residency program at UoH from January 2019 to June 2020 were included in the analysis. The Institutional Review Board from UoH approved data collection and analysis. The most common psychiatric diagnoses were summarised overall and by sex and age.
Results: A total of 752 patients were included in the analysis. Most were male (54.7%), with an average age of 34.9 years. The most common psychiatric diagnoses were schizophrenia (28.0%), major depressive disorder (MDD) (14.3%) and bipolar disorder type 1 (BD1) (10.5%). When stratified by sex, patients with schizophrenia and BD1 were more likely to be male (73.5% and 53.3%, respectively), and those with MDD were more likely to be female (58.8%). Trauma- and stressor-related disorders accounted for 0.4% of cases, while 0.8% of patients presented with substance use disorders (alcohol and khat), which is an underestimate of the widespread use in Somaliland.
Conclusion: Additional research using structured clinical interviews is needed to determine the epidemiology of psychiatric disorders and promote policies aiming to decrease neuropsychiatric mortality and morbidity.
Contribution: This work presents the first data collection related to neuropsychiatric disorders in Somaliland.

Provision of HIV services to psychiatric inpatients in Botswana: Challenges and recommendations

Maria A. Qambayot — 2024-02-07

Background: The high prevalence of HIV among psychiatric inpatients is well-documented,yet little is known about the provision of HIV services for these patients.
Aim: This qualitative study aimed to explore and understand healthcare providers’ challenges with providing HIV services to psychiatric inpatients.
Setting: This study was conducted at the national psychiatric referral hospital in Botswana.
Methods: The authors conducted in-depth interviews with 25 healthcare providers serving HIV-positive psychiatric inpatients. Data analysis was performed using a thematic analysis approach.
Results: Healthcare providers reported challenges with transporting patients to access off-site HIV services, longer waiting periods for antiretroviral therapy (ART) initiation, patient confidentiality, fragmented services for treatment of comorbidities, and a lack of patient data integration between the national psychiatric referral hospital and other facilities such as the Infectious Diseases Care Clinic (IDCC) at the nearby district hospital. Providers’ recommendations for addressing these challenges included the establishment of an IDCC at the national psychiatric referral hospital, connecting the psychiatric facility to the patient data management system to ensure integration of patient data, and provision of HIV-related inservice training to nurses.
Conclusion: Psychiatric healthcare providers advocated for on-site integration of care for psychiatric illness and HIV among inpatients to address the challenges of ART provision.
Contribution: The findings suggest the need to improve the provision of HIV services in the psychiatric hospitals in order to ensure better outcomes for this often-overlooked population. These findings are useful in improving clinical practice for HIV in psychiatric settings.

Lived experiences of adolescents admitted for first-episode psychosis in South Africa

Luzuko Magula — 2024-02-07

Background: First-episode psychosis is common in adolescents and can be distressful to the person experiencing it for the first time. However, there is limited research globally and specifically in Africa about the lived experiences of adolescents admitted into a psychiatric facility for first-episode psychosis.
Aim: To understand the adolescents’ experiences of psychosis and receiving treatment in a psychiatric facility.
Setting: Adolescent Inpatient Psychiatric Unit, Tygerberg Hospital, Cape Town, South Africa.
Methods: This was a qualitative study that used purposive sampling to recruit 15 adolescents with first-episode psychosis and admitted to the Adolescent Inpatient Psychiatric Unit, Tygerberg Hospital in Cape Town, South Africa. Individual interviews were audio recorded, transcribed and analysed using thematic analysis consisting of both inductive and deductive coding.
Results: The participants described negative experiences of their first episode psychosis, provided varying explanations for their first episode psychosis and had the insight that cannabis precipitated their episodes. They described both positive and negative interactions with both the other patients and staff. They did not wish to return to the hospital again following their discharge. Participants stated that they wanted to change their lives, return to school and try to prevent a second episode of psychosis.
Conclusion: This study provides insights into the lived experiences of adolescents presenting with first-episode psychosis and calls for future research to delve deeper into factors that support or enable recovery among adolescents with psychosis.
Contribution: The findings of this study call for improving the quality of care in the management of first-episode psychosis in adolescents.

Study of burnout and depressive symptoms in doctors at a central level, state hospital

Ariefdien Nazeema — 2024-02-07

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.

Illness-perception in adolescent attention-deficit/ hyperactivity disorder: A qualitative study

Wanita Botha — 2024-02-07

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.

Development and validation of the Redeemer’s University Suicidality Scale

Bede C. Akpunne — 2024-02-07

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.

Effects of personality traits on mindful self-care practices of healthcare workers

Iram Osman — 2024-02-07

Background: Coronavirus disease 2019 (COVID-19) placed healthcare professionals (HCPs) at a higher risk for stress-related conditions. Implementing a brief online mindfulness-based intervention (MBI) was hypothesised to transform the HCPs’ ability to cope with stress by enhancing their self-care.
Aim: This study aimed to explore the impact of an online MBI on HCPs’ self-care practices and determine if personality traits were a moderating variable.
Setting: An online MBI was implemented for HCPs working in South Africa during the COVID-19 pandemic lockdowns.
Methods: A quantitative study design included a pre-assessment and post-assessment component, which allowed paired comparison and regression analysis to confer correlations. Data were collected via two validated instruments: the Mindful Self-Care scale-2018 and the Big Five Personality test.
Results: Forty-nine HCPs participated in the study. Significant improvements were found in all the major self-care subscales post-intervention (p < 0.05). No significant associations were found between the personality traits and self-care except for neuroticism, which appeared to be an essential moderating variable.
Conclusion: An online MBI significantly impacted health professionals’ ability to care for themselves, despite their personality styles.
Contribution: The impact of an online MBI on HCPs’ self-care during the most intense time of stress and with a cohort of people known to be the most vulnerable to stress, namely those with neuroticism to date, has not been commented on.

South Africa’s Psychiatric training capacity in 2008 and in 2018. Has training capacity improved?

Natalie Beath — 2024-02-07

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.

Psychiatric morbidity in children involved in bullying treated at the Free State Psychiatric Complex

Mosa Masakala — 2024-02-07

Background: Bullying is a multifaceted problem with many consequences.
Aim: This study aimed to determine the psychiatric morbidity of children involved in bullying, either as bullies or victims, treated at the Child and Adolescent Mental Health Care Centre of the Free State Psychiatric Complex (FSPC).
Setting: Free State Psychiatric Complex, Bloemfontein, South Africa.
Methods: This retrospective cross-sectional study included children under 18 years treated at the FSPC Care Centre between January and September 2017. Information was extracted from patient files.
Results: Of 288 patients, 98 (34.0%) were involved in bullying: 66 were bullies, 28 victims, 3 bully-victims, and 1 unspecified. For gender and family structure, there were no statistically significant differences between children involved and those not involved in bullying and between bullies and victims. Almost all bullies (95.4%) had aggression as presenting complaint compared with 39.3% of the victims (p < 0.01). Statistically significantly more victims, than bullies, reported sadness (21.4%, 4.6%, p = 0.02). Attention deficit/hyperactivity disorder (ADHD) was diagnosed in most children, both involved (73.5%) and not involved (63.2%). Statistically significant differences for the presence of conduct disorder were found between children involved and those not involved in bullying (31.6%, 10.0%, p < 0.01) and between bullies and victims (39.4%, 14.3%, p = 0.02).
Conclusion: The prevalence of conduct disorder diagnosis was more common in bullies than in victims and those involved in bullying as opposed to those not involved.
Contribution: Psychiatric information of bullying victims and perpetrators in the Free State, which had a high prevalence of bullying in a national survey.

Assessing attitudes of fourth year medical students towards psychiatry and mental illness

Stacey L. Ochse — 2024-02-07

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.

Clozapine use at a specialised psychiatric hospital in JohannesburgClozapine use at a specialised psychiatric hospital in Johannesburg

Katherine L. Ord — 2024-02-07

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.

Preparedness of final year medical students in caring for lesbian, gay, bisexual, and transgender patients with mental illness

Ahmed Badat — 2024-02-07

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.

Costs of adult functional neurological disorders at a tertiary hospital in central South Africa

Leonriche L.C. Christopher — 2024-02-07

Background: Functional neurological disorders (FND) lead to increased care requirements and costs, negatively impacting healthcare budgets. Healthcare expenditure in FND has escalated beyond other neurologic disorders during the past decade.
Objectives: To assess inpatient costs in adults admitted to the neurology ward at Universitas Academic Hospital (UAH) in central South Africa.
Methods: A retrospective observational study with a comparative component was conducted on patients admitted during 2018 and 2019. All FND cases (n = 29) and a systematic sample of other neurological disorders were included in the comparison group (n = 29). Data were obtained from the Meditech billing system and clinical records.
Results: FND patients accounted for 5.5% of 530 admissions in the neurology ward during the study period. No significant differences regarding daily median cost, age categories, gender or medical comorbidity were observed between FND and the comparison group. However, the length of stay was significantly shorter for the FND patients (median of four versus eight days), translating to approximately half the total costs of patients admitted for other neurological disorders.
Conclusion: The daily median cost was similar for FND and other neurology-related admissions. The lower overall inpatient costs for FND patients were only related to significantly shorter durations of stay, which may reflect new diagnostic approaches resulting from changes in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnostic criteria. The prevalence of FND was similar to those reported in previous studies conducted at neurology clinics.
Contribution: The study contributes towards better understanding the prevalence and cost of FND in local neurology inpatient care settings.

Positive mental health of patients at a psychiatric hospital, Gauteng province, South Africa

Satya Sai Ram Kumar Gulla — 2024-02-07

Background: Positive mental health (PMH) forms the basis of well-being and positive mind set, which includes a range of cognitive-emotional attributes and coping skills of an individual towards the family and society. Assessment of PMH in psychiatric patients is critical in understanding their needs, improving mental health and the treatment of their illnesses.
Aim: To investigate the levels of PMH among patients attending the outpatient department at a public sector tertiary referral psychiatric hospital using the multidimensional PMH instrument.
Setting: Adult psychiatric patients attending the outpatient department at a public sector tertiary referral hospital, Gauteng province, South Africa.
Methods: A quantitative, cross-sectional and descriptive study was conducted using a multidimensional PMH instrument with a convenient sample of 346 outpatients who provided consent.
Results: Females reported significantly high PMH scores (3.86 vs 3.6; p = 0.018) compared to males. Patients with higher education (Gr. 0–7 vs Gr. 8–12 vs Tertiary education, PMH scores 3.34 vs 3.75 vs 4.18; p < 0.001), being married (single vs married, 3.67 vs 3.81, p = 0.342) and
employed (unemployed vs employed, 3.62 vs 3.97, p = 0.005) reported significantly high total PMH score and across various domains.
Conclusion: The results of the study highlighted the multi- dimensionality of mental health and justified importance of evaluating the domains of PMH in mental health care users. Identifying the reasons for the deficits in the PMH domains and implementing coping strategies will improve the emotional and psychological well-being of patients.
Contribution: Examining the PMH domains will assist healthcare workers intervene to improve the mental health of patients.

Predictors of burnout among resident doctors in a Nigerian teaching hospital

Mumeen O. Salihu1 Salihu — 2024-02-07

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.

Assessing HIV transmission knowledge in psychiatric patients in Johannesburg, South Africa

Hangwani J. Matodzi — 2024-02-07

Background: The bidirectional relationship between human immunodeficiency virus (HIV) and psychiatric illnesses is well documented. Misinformation about HIV transmission and prevention is associated with high rates of HIV-related risky behaviours, and therefore, HIV infection risk.
Aim: To assess basic HIV transmission knowledge in psychiatric patients.
Setting: Outpatient psychiatric clinic at Tara Psychiatric Hospital, Johannesburg, South Africa.
Methods: A cross-sectional, quantitative study was conducted employing a self-administered HIV knowledge questionnaire, the 18-item HIV knowledge questionnaire (HIV-KQ18). Consent, demographic, and clinical profile information were obtained from participants meeting the selection criteria.
Results: This study indicated a mean knowledge score of 12.6 (69.7%) out of 18, and therefore good knowledge. The highest HIV-KQ18 mean scores were found in patients with personality disorders (78.9%), anxiety disorders (75.6%) and bipolar and related disorders (71.1%). Participants with schizophrenia, depressive disorders and substance use disorders had scores ranging between 66.1% and 69.4%. Statistically significant differences in knowledge were evident based on age, marital status, level of education and employment status. Interestingly, participants who used substances had higher average basic HIV transmission knowledge scores compared to those who did not use substances.
Conclusion: Good overall HIV transmission knowledge was found in this population, albeit lower than in the general population. Statistically, correlates were found between psychiatric diagnosis, substance use, age, marital status, level of education, and employment status and basic level of HIV knowledge.
Contribution: HIV knowledge remains lower in psychiatric patients than in the general population, with correlates between demographic and clinical factors, calling for psychoeducation efforts to take all these into consideration.

Experiences of family members of relatives admitted as state patients in a psychiatric hospital

Seipati Malebye — 2024-02-07

Background: Family members play an important role in caring for state patients during their admission to a psychiatric hospital. They receive limited support from the multidisciplinary team because they do not have a relationship that will promote the families to verbalise their thoughts, rather the interaction that the multidisciplinary team and family members share is about the admitted state patient.
Aim: This article explored and described the experiences of family members who have a relative admitted as a state patient in a psychiatric hospital. Based on the findings, specific recommendations were provided to facilitate the mental health of state patients’ family members in the future.
Setting: The study was conducted in participants’ homes; only one interview took place in the psychiatric hospital when the family member came to meet the multidisciplinary team.
Methods: The study employed a qualitative, exploratory and contextual research design. Family members’ lived experiences were explored using in-depth phenomenological interviews and later analysed.
Results: The findings indicated family members experienced negative feelings, a sincere desire to support their relatives and a great need to share information and knowledge about mental illness.
Conclusion: The study indicated that state patients’ family members’ mental health should be focused on to improve their understanding of mental illness.
Contribution: The findings of this study call for collaboration between the family members, the police and multidisciplinary teams from the hospitals, the mental health awareness and counselling for families.

Readmission of adolescent psychiatric patients to a specialised unit in Gauteng, South Africa

Sarah-Anne Brown — 2024-02-07

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.

HIV associated psychiatric comorbidity among attendees at a tertiary hospital, North-Eastern Nigeria

Akinbola R. Oyedun — 2024-02-07

Background: There are a wide range of neuropsychiatric conditions associated with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). These mental disorders may be unrecognised yet their presence can significantly affect outcome.
Aim: This study aimed to determine psychiatric comorbidity associated with HIV and AIDS.
Setting: The HIV clinic of a tertiary hospital in North-Eastern Nigeria.
Methods: A cross-sectional descriptive study consecutively recruiting 328 adult persons living with HIV. The Mini International Neuropsychiatric Interview and a sociodemographic questionnaire were administered to the participants.
Results: Two-thirds of the respondents were females. The mean age (±s.d.) was 42 years (±11.24). Majority of the participants had World Health Organization stage 1 HIV disease. The prevalence of psychiatry comorbidity among our respondents was 82.9%. Social phobia was the leading disorder (69.8%). Others were mixed depression anxiety disorder (49.4%) and post-traumatic stress disorder (36.6%). Current psychosis was 27.7%, while major depressive disorder was 12.2%. Psychiatric comorbidity was significantly associated with male gender, religion, ethnicity, marital status and being unemployed with p < 0.01. Human immunodeficiency virus stage was related to panic disorder with p < 0.01, while viral load was significantly associated with depressive disorder with p = 0.001.
Conclusion: Majority of our HIV patients attending the clinic have undetected psychiatric morbidity. Clinicians need to be aware of the features of major psychiatric disorders and refer appropriately for improved overall outcome.
Contribution: This study contributes to the body of work on unrecognised psychiatric comorbidity in people living with HIV and AIDS, especially in North-Eastern Nigeria, identifying issues which are relevant to clinical practice and buttressing the need for integration of mental healthcare services into HIV treatment and prevention services.

Psychosocial effects of gender-based violence among women in Vhembe district: A qualitative study

Rodney Rikhotso — 2024-02-07

Background: The phenomenon of gender-based violence is a pertinent social problem in South Africa. The fear of reporting gender-based violence contributes to its continuation, marginalisation and silencing of victims.
Objectives: The study sought to explore the psychosocial effects of gender-based violence among women in Vhembe district.
Methods: An exploratory phenomenological research design was used and sampling was performed purposively from a population of women who experienced gender-based violence in a low-resource, rural setting of Vhembe district. Semi-structured telephonic interviews were used as the main method of data collection after permissions and informed consent were sought for conducting the study. Thematic content analysis was applied to convert the participants’ statements into a meaningful framework to derive the findings.
Results: A total of 15 participants aged from 19 to 35 years participated in the study. Their psychosocial experiences of gender-based violence were depression, worthlessness, social isolation and anger directed towards children.
Conclusion: This research confirms that gender-based violence remains one of the most challenging problems associated with mental health problems in Vhembe district. It affirms the need to focus on awareness in rural areas afflicted by patriarchal attitudes, norms and stereotypes. Gender-based violence should to be viewed as human rights violation for victims’ protection.
Contribution: The study contributes to the body of knowledge on the experiences of gender-based violence among marginalised women from rural areas.

Assessing the prevalence of psychotic symptoms in epileptic patients at a tertiary clinic

Michelle M. Hungwe — 2024-02-07

Background: The International League against Epilepsy (ILAE) defines epilepsy as a brain disorder characterised by an enduring risk to generate seizures with neurobiological, cognitive, psychological and social consequences. Psychotic disorders in epilepsy are a serious psychiatric complication affecting the prognosis, morbidity and mortality of patients. There is a paucity in literature with regard to the prevalence of psychotic symptoms in epileptic patients in low- to middle-income countries.
Aim: This study aimed to look at the prevalence of psychotic symptoms in epileptic patients at an outpatient clinic using the prodromal questionnaire 16 (PQ-16).
Setting: The study was conducted at the epilepsy clinic at Charlotte Maxeke Academic Hospital (CMJAH), a tertiary hospital located in Johannesburg, South Africa.
Method: The PQ-16 was distributed to patients at the epilepsy clinic at CMJAH.
Results: The study consisted of 121 participants. The prevalence of patients found to be at high risk of psychosis (i.e., PQ-16 score > 6) was 61.2% (95% lower confidence interval (LCI): 0.53, upper confidence interval (UCI): 0.70). None of the demographic variables showed significant associations in the percentage of patients found to be at high risk. No association was found between any antiepileptic drug and high risk of psychosis.
Conclusion: The high prevalence of psychotic like experiences found suggests it is imperative to screen for psychotic disorders in epileptic patients and if required to involve neuropsychiatrists in their management.
Contribution: This study highlights the importance of assessing psychotic symptoms in epileptic patients and the importance of a multidisciplinary approach in managing these complex patients.

Neurocognitive improvement in HIV-positive patients treated with dolutegravir-based regimens

Janine Rodrigues — 2024-02-07

Background: Neurocognitive disorders due to human immunodeficiency virus (HIV) remain highly prevalent, specifically mild forms despite effective antiretroviral therapy (ART). Dolutegravir-based regimens are the first line of treatment for adult HIV-positive patients. Controversies exist regarding the neurocognitive effects of dolutegravir. Evidence regarding the neurocognitive effects of dolutegravir is important, in support of its use in patients with HIV-associated neurocognitive disorders (HAND).
Aim: This study aimed to describe the change in cognitive function using the International HIV Dementia Scale (IHDS) and Brief Neuropsychological Cognitive Examination (BNCE) in HIV positive, treatment naïve patients before and 3 months after initiation of ART using a dolutegravir-based regimen.
Setting: The HIV initiation clinic of Hillbrow Community Health Centre in Johannesburg.
Methods: This prospective, quantitative cohort study assessed adult HIV-positive patients who were ART naïve being initiated on a dolutegravir-based regimen, using the BNCE and IHDS at baseline and after 3 months of treatment.
Results: Neurocognitive test results of 26 participants showed significant improvements for IHDS (Z = 1.84, p = 0.033) and time to complete BNCE (Z = 2.47, p = 0.007). BNCE total results showed improvements that were not significant (Z = 1.44, p = 0.075); however, Part 2 of the BNCE reflecting that of executive function showed significant improvements (Z = 66.5, p = 0.043).
Conclusion: The trend of neurocognitive function is towards improvement in HIV-positive treatment naïve patients who receive 3 months of dolutegravir-based ART.
Contribution: The findings support the use of dolutegravir-based regimens in the treatment of patients with HIV-associated neurocognitive disorders.

Attention deficit hyperactivity disorder: Insights into underfunding in the private healthcare sector in South Africa

Johan J. Botha — 2024-02-07

Background: Although the prevalence of attention deficit hyperactivity disorder (ADHD) has remained stable, the number of patients diagnosed with ADHD has increased in recent years owing to increased awareness. Despite this increase, medical schemes in South Africa have not improved their funding models for this condition.
Aim: The study aimed to provide an account of the funding that medical schemes provisioned for treating ADHD in South Africa during 2022.
Setting: All the South African medical schemes that were registered with the Council of Medical Schemes during 2022 (n = 72) and all their listed options were evaluated (n = 279).
Methods: The study analysed secondary data published on the medical schemes’ websites in the public domain. Statistical minimum, average, maximum and correlation analyses were performed using Excel version 16.58.
Results: Attention deficit hyperactivity disorder is not regarded as a prescribed minimum benefit (PMB) condition and therefore each medical scheme used its own approach to providing its beneficiaries with some or no benefits for ADHD. It was evident that ADHD was underfunded and lacked structured or standardised funding approaches.
Conclusion: Attention deficit hyperactivity disorder is underfunded in the private healthcare sector in South Africa. Better funding models are needed or ADHD needs to be registered as a PMB condition.
Contribution: Findings from this study highlight the urgency for structured and sufficient ADHD-specific funding by medical schemes. Considerations based on these findings may be applied in the National Health Insurance and in other countries around the world.

Clozapine monitoring at a specialised psychiatric hospital: A retrospective chart review

Michelle V. Daniels — 2024-02-07

Background: Clozapine is the only Food and Drug Administration (FDA) and National Institute for Care and Excellence (NICE) approved drug for treatment-resistant schizophrenia (TRS). Its potentially life-threatening haematological side effects of neutropaenia and agranulocytosis mandate rigorous monitoring of neutrophil counts, presenting unique, Third-World population challenges.
Aim: To describe the Clozapine white blood cell monitoring practice and outcomes in a local psychiatric hospital.
Setting: At a specialist Psychiatry unit in Durban, KwaZulu-Natal, which follows a modified algorithm of the South African Standard Treatment Guidelines for Clozapine monitoring.
Methods: A retrospective chart review composed of 120 patients on Clozapine treatment from 01 July 2018–31 December 2020. Demographic and clinical information was captured in a Redcap database. Descriptive statistics using categorical variables were used.
Results: The study population was from a low socioeconomic background, with low levels of education and employment. A baseline neutrophil count was recorded in 58 files (48.3%). Clozapine was stopped in 6 out of the 120 patients due to ‘neutropaenia’ (absolute neutrophil counts ranging from 1.18 to 1.6); none developed agranulocytosis. Their duration of Clozapine treatment ranged from 2 weeks–15 years.
Conclusion: Haematological monitoring frequency and documentation of patients receiving Clozapine were not in compliance with the hospital’s adapted guidelines and may have resulted in the termination of treatment before true neutropaenia developed. Patients developed neutropaenia at low doses of Clozapine and after many years of treatment.
Contribution: These results suggest local Clozapine monitoring guidelines should be more strictly adhered to.

Caregiver burden among caregivers of children with autism spectrum disorder

Karli van Niekerk — 2024-02-07

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder with deficits in social communication and interaction, restricted and repetitive patterns of behaviour, interests and activities. Autism spectrum disorder is associated with multiple comorbidities. As a result, caregivers of children with ASD experience increased levels of burden and poor quality of life. However, there is a paucity of information on the burden.
Aim: The study aimed to describe the sociodemographic profiles and determine the extent of the burden experienced by caregivers of children and adolescents with ASD.
Setting: The Child, Adolescent and Family Unit (CAFU) outpatient services at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH).
Methods: A quantitative, descriptive, cross-sectional study was done. Two self-administered questionnaires were used: a socio-demographic questionnaire and the 12-item Zarit Burden Interview questionnaire.
Results: The questionnaires were completed by 77 caregivers, of which the majority were female (n = 56 or 72.3%), mothers to children with ASD (n = 49 or 64.3%) and identified as Christian (p < 0.001). Most had completed secondary school or had a tertiary education (p = 0.003) and were employed (p < 0.001). Among the caregivers, 41.6% experienced mild to moderate burden, 33.8% experienced high burden and only 24.9% reported no to mild burden.
Conclusion: Caregivers of children and adolescents with a diagnosis of ASD are mostly mothers and experience mild to moderate levels of caregiver burden, suggesting the need for improved screening and psychosocial support programmes.
Contribution: This study highlights the burden experienced by primary caregivers of children with ASD and is one of the few comprehensive studies on this issue within the context of South Africa.

Factors associated with longer hospital admission in elderly patients with major neurocognitive disorder

Tarina Steenkamp — 2024-02-07

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 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.

Burnout in emergency department staff: The prevalence and barriers to intervention

Reshen Naidoo — 2024-02-07

Background: Burnout impacts patient care and staff well-being. Emergency department (ED) staff are at an elevated risk for burnout. Despite an acceleration in burnout research due to the coronavirus disease 2019 (COVID-19) pandemic, there is limited data on the nature and prevalence of burnout in the South African emergency medicine setting.
Aim: This study determined the prevalence of burnout in ED staff (doctors, nurses and non-clinical staff) at Tygerberg Hospital and explored staff awareness and utilisation of interventions.
Setting: The study was conducted at Tygerberg Hospital, South Africa.
Methods: This cross-sectional study used the Maslach Burnout Inventory to assess burnout via a self-administered electronic survey in a convenience sample of 109 ED staff. Quantitative data were analysed with descriptive and inferential statistics. Qualitative data were analysed using thematic analysis.
Results: A total of 46 participants (45.10%) experienced burnout, with 73 participants (71.57%) at high risk for emotional exhaustion or depersonalisation. The prevalence of burnout in doctors was 57.89%, non-clinical staff was 25.93%, and nursing staff was 50.00%. Burnout was higher in doctors and nursing staff compared to non-clinical staff, with high emotional exhaustion and depersonalisation found in interns and specialist professional nurses. The level of intervention awareness was 41.8% and the level of intervention utilisation was 8.82%. Thematic analysis identified awareness, accessibility and reactive utilisation as barriers to utilisation with opportunities to reduce burnout and enhance resilience.
Conclusion: Coordinated health system and organisational efforts are required to optimise intervention strategies to reduce burnout.
Contribution: Guidance on the design and planning of intervention strategies considering at risk groups, intervention-related factors, and non-clinical staff.

Post-traumatic stress symptoms in mental healthcare workers during the COVID-19 outbreak

Allison K. Human — 2024-02-07

Background: In the context of disease outbreaks, healthcare workers are exposed to multiple physical and psychological stressors, which may result in severe mental health outcomes. Although existing literature explores this impact, it is focused on frontline workers, with limited evidence exploring the mental well-being of mental healthcare workers (MHCWs).
Aim: To explore post-traumatic stress symptoms (PTSS) and associated factors among MHCWs within the context of the coronavirus disease 2019 (COVID-19) pandemic.
Setting: Four academic hospitals in the Gauteng province, South Africa, with specialised psychiatric units.
Methods: A cross-sectional study design was used. Participants were selected using a simple random sampling technique and invited to participate in structured interviews. Measurement tools included a demographic questionnaire, the post-traumatic stress disorder checklist for DSM-5 and the Brief Resilient Coping Scale.
Results: A total of 120 MHCWs participated. The prevalence of PTSS was 11.7%. The MHCWs’ profession was a significant predictor of the occurrence of PTSS (p = 0.046), with nurses being the most affected. Other socio-demographic, employment, COVID-19-related factors and coping skills were not predictors of PTSS.
Conclusion: An elevated prevalence of PTSS has been found and was significantly associated with the profession of the MHCW. It is recommended that existing employee wellness programmes be strengthened to promote mental well-being and improve resilience among MHCWs, particularly vulnerable employee groups.
Contribution: This study provides insight into the prevalence of PTSS among MHCWs following the COVID-19 outbreak, as well as associated factors.

Knowledge, confidence, and practices of clinical associates in the management of mental illness

Saiendhra V. Moodley — 2024-02-07

Background: Additional human resources are needed to provide mental health services in underserved areas in South Africa (SA). Clinical associates, the mid-level medical worker cadre in SA, could potentially be used to deliver these services.
Aim: The study explored the self-reported knowledge, confidence, and current practices of clinical associates related to mental health assessment and management.
Setting: South Africa.
Methods: A cross-sectional study was conducted. The link to the electronic questionnaire was distributed to clinical associates via databases and social media. Data were analysed with Stata v17.
Results: Of the 209 participants, 205 (98.1%) indicated they had training on management of patients with mental illness during their undergraduate degree and 192 (91.9%) had a mental health rotation. Few (10.7%) had any additional mental health training. Most participants rated their knowledge of priority mental disorders as ‘good’ or ‘excellent’. Only 43.2% of the participants felt quite or very confident to perform a mental health examination. Participants who felt quite or very confident to manage patients presenting with suicide risk, aggression, and confusion were 44.9%, 46.9% and 53.1%, respectively. Factors associated with a confidence score of 75% and higher were male gendered, working in Gauteng or Northern Cape provinces, and in a rural area. The majority of participants were already involved in mental health assessment and management in their current work.
Conclusion: Clinical associates have a contribution to make in mental health service provision, but this may need to be supplemented by additional practical training.
Contribution: Potential gaps in training have been identified.

Knowledge, attitudes, and help-seeking behaviour for mental illness in a Christian community

Nomthandazo Hlongwane — 2024-02-07

Background: Christian beliefs have a role in conceptualising mental illness, which determines help-seeking behaviour and treatment choices. The topic of mental illness is controversial in many Christian circles and is often avoided because of the beliefs and teachings stemming from the Christian faith. Inadequate and inaccurate knowledge about mental illness and its causes negatively impacts the attitudes towards mental illness, the mentally ill, and ultimately help-seeking behaviour.
Aim: This study aimed to explore knowledge, attitudes, and help-seeking behaviour for mental illness in a Christian community.
Setting: A descriptive, quantitative cross-sectional survey was conducted, comprising 300 congregants from a Pentecostal Christian charismatic church – Assemblies of God in KwaZulu- Natal.
Methods: A socio-demographic tool was used to capture the relevant social, demographic, and religious information. Existing self-administered questionnaires were used to collect information in four areas: Mental Health Knowledge Schedule, the Reported and Intended Behaviour Scale, Community Attitudes Towards Mentally Ill scale and the Dimensions of Religiosity Scale to determine the degree of religiosity.
Results: The population studied demonstrates high levels of mental health knowledge and a tolerant attitude towards persons who have mental illness. There is a high preference for professional treatment.
Conclusion: The high knowledge in this Christian community is associated with a reduction in stigma and a positive attitude towards mental illness. If mental health awareness is encouraged, it helps to encourage positive help-seeking practices tolerance, and treatment outcomes.
Contribution: This study highlights levels of knowledge and its influence on help-seeking practices and stigma in a Christian community.

Attitudes of medical students regarding legalisation of cannabis and cannabis-education

Evan Eiselen — 2024-02-07

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 hows 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.

Neurological and neuropsychiatric manifestations in hospitalised patients with COVID-19

Gondah Lekpeh — 2024-02-07

Background: Although literature globally indicates varied neurological and/or neuropsychiatric manifestations (NNM) and complications associated with coronavirus disease 2019 (COVID-19), information about NNM in infected hospitalised patients on the African continent remains limited.
Aim: To describe the presentation of NNM and compare patients with and without NNM considering demographic and clinical profiles, treatment, and outcomes.
Setting: Tygerberg Hospital, Cape Town, South Africa.
Methods: Retrospective medical record review of the first 100 consecutively admitted COVID-19 patients (64 females, mean age 47.6 years) between March and June 2020.
Results: Of the 98 patients included in the analysis, 56.1% had at least one NNM. The most common NNM were myalgia (32.7%), headache (21.4%), loss of smell and/or taste (15.3%), and delirium (10.2%). Patients with and without NNM did not differ with respect to demographic characteristics. Patients with NNM had significantly more constitutional symptoms (p = 0.017) and were more likely to have neurological and/or neuropsychiatric comorbid conditions (10.9% vs. 0.0%, p = 0.033) than those without NNM. Patients without
documented NNM were more likely to have abnormalities on chest X-ray (p = 0.009) than those with NNM. Coronavirus disease 2019 related treatment and mortality did not differ between the groups.
Conclusion: Neurological and/or neuropsychiatric manifestations were common in hospitalised patients with COVID-19. The results suggest that while COVID-19 patients with NNM may have less of a respiratory phenotype they nonetheless have equivalent mortality rates.
Contribution: This study highlights the common NNM in patients with COVID-19 admitted to Tygerberg Hospital early in the pandemic and adds to the growing evidence of COVID-19 NNM.

An initiative to reduce psychiatric boarding in a Cape Town emergency department

Clint A. Hendrikse — 2024-02-07

Background: Psychiatric boarding in Emergency Departments (ED) is a global challenge which results in long ED length of stays (LOS) with significant consequences on patient care and staff safety.
Aim: This study investigated the impact of an initiative to reduce psychiatric boarding on LOS and readmission rate, as well as explored the relationship between boarding times and LOS.
Setting: This study was conducted at Mitchells Plain Hospital, a large district-level hospital in Cape Town.
Methods: This cross-sectional study collected data for 24 months, which included a 9-month period prior to the initiative and 16 months thereafter. Data were collected retrospectively from official electronic patient registries. The initiative comprised of inpatient hallway boarding as a full-capacity protocol with the accompanying capacitation of psychiatric wards to accommodate the additional burden.
Results: The initiative was associated with a decrease of 95% (p < 0.001) in boarding time, 13% (p < 0.001) in ward LOS and 25% (p < 0.001) in hospital LOS. Ward LOS were found to be independent of ED boarding times. The readmission rate increased from 12% to 18% post intervention.
Conclusion: The initiative resulted in a sustainable improvement in boarding times and LOSs. The observational nature of this study precludes concrete conclusions and further investigations into psychiatric inpatient hallway boarding are recommended.
Contribution: Inpatient hallway boarding could be a feasible option to reduce the risk. Psychiatric boarding times in the ED are independent of ward LOS, rendering it devoid from any value from a lean and economic perspective.

Factors affecting readmission of adolescent mental healthcare users to a psychiatric hospital

Stephanie A. Eichstadt — 2024-02-07

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.

Psychosis screening questionnaire: Exploring its factor structure among South African adults

Yanga Thungana — 2024-02-07

Background: Early detection of psychosis improves treatment outcomes, but there is limited research evaluating the validity of psychosis screening instruments, particularly in lowresourced countries.
Aim: This study aims to assess the construct validity and psychometric properties of the psychosis screening questionnaire (PSQ) in South Africa.
Setting: This study was conducted at several health centres in the Western and Eastern Cape provinces in South Africa.
Methods: The sample consisted of 2591 South African adults participating as controls in a multi-country case-control study of psychiatric genetics. Using confirmatory factor analysis and item response theory, we evaluated the psychometric properties of the PSQ.
Results: Approximately 11% of the participants endorsed at least one psychotic experience on the PSQ, and almost half of them (49%) occurred within the last 12 months. A unidimensional model demonstrated good fit (root mean square error of approximation [RMSEA] = 0.023, comparative fit index [CFI] = 0.977 and Tucker–Lewis Index [TLI] = 0.954). The mania item had the weakest association with a single latent factor (standardised factor loading = 0.14). Model fit improved after removing the mania item (RMSEA = 0.025, CFI = 0.991 and TLI = 0.972). With item response theory analysis, the PSQ provided more information at higher latent trait levels.
Conclusion: Consistent with prior literature, the PSQ demonstrated a unidimensional factor structure among South Africans. In our study, the PSQ in screening for psychosis performed better without the mania item, but future criterion validity studies are warranted.
Contribution: This study highlights that PSQ can be used to screen for early psychosis.

Sleep quality of adult psychiatric outpatients at Chris Hani Baragwanath Academic Hospital

Celeste M. Harlies — 2024-02-07

Background: Sleep disorders are increasingly prevalent among the general population and individuals with mental disorders. However, little research has focused on the sleep quality of psychiatric patients beyond depression, despite its relevance in diagnostic criteria.
Aim: This study aimed to assess overall sleep quality in psychiatric outpatients and to assess for an association with socio-demographic variables.
Setting: This study took place at the adult psychiatric outpatient department of Chris Hani Baragwanath Academic Hospital.
Methods: A cross-sectional study design was employed to evaluate overall sleep quality using the self-administered Pittsburgh Sleep Quality Index (PSQI), a validated tool. The PSQI yields a global score ranging from 0 to 21, with scores of 5 or greater indicating poor sleep quality. Eligibility was determined through structured clinical interviews and data obtained from participant records.
Results: Poor sleep quality was found in 50% of participants. Sleep quality did not differ significantly based on sex or age. Subscale analysis revealed reduced sleep duration and efficiency, nocturnal disturbances and daytime dysfunction. Additionally, 38% of participants required pharmacological intervention for sleep issues, despite lacking a diagnosis of primary or comorbid sleep disorders.
Conclusion: Half of the psychiatric outpatients experienced poor sleep quality, irrespective of socio-demographic factors, psychiatric diagnosis, symptom remission or medication type.
Contribution: This study highlights the importance of addressing sleep disturbances as comorbid conditions in psychiatric patients. Comprehensive evaluation and management of sleep quality can lead to improved patient outcomes and quality of life.

Access and use of digital technology by patients with psychosis at a hospital in South Africa

Smitha Sharma-Misra — 2024-02-07

Background: There is growing interest in the use of digital information and communication technology (ICT) for mental health care purposes. Information and communication technology tools may enhance mental health literacy and help-seeking behaviour.
Aim: To describe the access to, use and perception of ICT in people with schizophrenia and other psychotic disorders.
Setting: The study was conducted at an urban psychiatric hospital in Durban, KwaZulu-Natal (KZN) province, South Africa.
Methods: Participants completed questionnaires on their socio-demographic characteristics and access to, use and perception of ICT. Multiple ordinal logistic regressions were used to test the association between socio-demographic factors and ICT use and perception.
Results: Of the 165 participants (mean age = 41 years ± 14.2), 54.5% were male, 37.6% were employed, and most (93.3%) lived in an urban area. Most participants (93%) had access to the internet in past 3 months and a smartphone (89.8%). Age (AOR 0.94, p = 0.06, CI = 0.88–1.00) and marital status (AOR = 0.26, p 0.02, CI = 1.62–253.74) were
associated with internet use, while age (AOR = 0.95, p 0.03, CI = 0.9–1.00), marital status (AOR = 3.64, p = 0.05, CI = 1.03–12.90), income (AOR = 4.02, p < 0.01, CI = 1.69–9.54), employment status (AOR = 0.16, p < 0.01, CI = 0.06–0.44), and living with HIV (AOR = 5.41, p < 0.01, CI = 1.39–21.07) were associated with frequency of internet use. Older participants had lower odds of using a mental health care app (AOR = 0.93, p = 0.02, CI= 0.88–0.99). Those with higher incomes had increased odds of seeking mental health information digitally (AOR = 4.33, p = 0.03, CI = 1.13–7.54).
Conclusion: People living with psychosis do have access to digital technology although pattern of use maybe influenced by sociodemographic factors.
Contribution: This study provides baseline data on digital technology use in Africa.

Relationship between physical activity and behaviour challenges of adolescents in South Africa

Kwabena Asare — 2024-02-07

Background: Four out of five adolescents worldwide are physically inactive based on recommended standards.
Aim: We determined whether physical activity is associated with lower behavioural challenges in adolescents to promote buy-in from stakeholders.
Setting: KwaZulu-Natal province, South Africa, from January 2020 to March 2020.
Methods: A cross-sectional study was conducted among 187 adolescent learners (12–18 years) from three government schools in KwaZulu-Natal Province, South Africa, from January to March 2020. We fitted linear regression models between the Strengths and Difficulties Questionnaire scores (total, internalising, externalising, and prosocial) and hours of physical activity exposure, adjusting for demographic covariates, and depression history.
Results: The median age was 14.4 years (interquartile range = 1.36) and 75.9% of the participants were females. Overall average and weekday physical activity were each associated with lower total and externalising but higher pro-social scores. Depression was associated with higher inactivity scores (total, internalising and externalising).
Conclusions: The article shows that physical activity can reduce the behavioural and emotional problems in adolescents.
Contribution: Physical activity is critical for a healthy adolescent hood and needs to be actively included in childhood development.

The profile of adolescent patients presenting to a tertiary maternal mental health clinic

Luzaan M. Cooke — 2024-02-07

Background: Between March 2021 and April 2022, there were 90 037 documented adolescent pregnancies in South Africa. Statistics SA reports that this number is growing. Pregnancy places adolescents at greater risk of psychiatry-related morbidity and may have far- reaching consequences for their children. To date, there is no published data describing the patient profile of adolescent pregnancies in Gauteng Province, South Africa.
Aim: To describe the patient profile (demographics, schooling history and type of accommodation), pregnancy-related factors, substance use habits and contraceptive use in pregnant adolescents seen at a tertiary care maternal mental health clinic (MMHC).
Setting: The MMHC at Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa.
Methods: A retrospective file review of all pregnant adolescents referred to the MMHC between January and June 2022.
Results: The mean age of the patients was 15.2 years; 72% attended school and 97.4% planned to return. Most pregnancies were unplanned (97.9%), wanted (84%) and presented in the second (41.24%) and third (51.55%) trimesters. Most did not report using substances (76.7%). Fifty percent of the participants met the criteria for a major depressive disorder. Repeating a grade was an identifiable risk factor for an increased Edinburgh depression score. An unplanned pregnancy was associated with a higher risk factor assessment.
Conclusion: Pregnant adolescents represent a vulnerable population group. A greater understanding of this patient profile may inform early psychiatric and psychosocial interventions, improved service delivery and help-seeking behaviour.
Contribution: This study gives significant insights into the challenges faced, as well as the health and social needs of pregnant adolescents. This contributes to wholistic care and opportunities for early intervention, including awareness of contraceptive use and the risks of substance use and adolescent pregnancy on mental health, benefiting all South African adolescents.

Alcohol, Smoking and Substance Involvement Screening Test validity in bipolar and psychotic disorders

Rosalind J. Adlard — 2024-02-07

Background: Patients with multi-episode bipolar and psychotic disorders have a high prevalence of substance use disorders, with negative consequences. A brief, easily administered screening test such as the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is needed to identify those at risk in order to intervene appropriately. However, the ASSIST has not yet been validated in this population.
Aim: This article aims to determine the validity and reliability of the ASSIST in detecting substance use disorders in patients with multi-episode bipolar and psychotic disorders.
Setting: Western Cape Province, South Africa.
Methods: The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Health Disorders, 4th Edition (DSM-IV) Axis I Disorders (SCID-I) was used as the gold standard for detecting substance abuse and dependence. Cronbach’s alpha was used to determine the internal consistency of the ASSIST, and receiver operating characteristic analysis was used to evaluate its screening properties. Optimal cut off scores were calculated to maximise sensitivity and specificity.
Results: A total substance involvement lifetime score of ≥13 was found to have optimal sensitivity and specificity of just over 74%. The optimal cutoff score for alcohol was ≥4 and for cannabis, methamphetamine, and ‘other drugs’ was ≥3. The area under the curve was 0.7 or above for both the total and specific substance involvement scores.
Conclusion: The ASSIST is a psychometrically sound screening test for substance use disorders in patients with multi-episode bipolar and psychotic disorders.
Contribution: This is the first study to validate the ASSIST in this population.