South African Journal of Psychiatry

A call for SASOP to review their position on the care of ‘transgender and non-binary youth’

Allan Donkin — 2025-05-15

No abstract.

Changes in schizophrenia symptoms, tryptophan metabolism, neuroinflammation and the GABA-glutamate loop: A pilot study

Estmia Van der Walt — 2025-05-15

No abstract.

The SASOP/PsychMg child and adolescent attention-deficit/hyperactivity disorder guidelines

Brendan Belsham — 2025-05-15

No abstract.

Diagnostic difficulty in an adolescent with dissociative identity disorder

Kajal M. Patel — 2025-05-15

Introduction: Dissociative identity disorder (DID) is a complex and controversial psychiatric condition characterised by the presence of two or more distinct identities, personality states, or identities that recurrently take control of an individual’s behaviour. The identities or personality states may have distinct characteristics, memories, and behaviours, making identifying and differentiating them challenging. We describe a complex case that presented diagnostic challenges because of the fluctuations in psychiatric presentations associated with DID, and we outline a multidisciplinary and biopsychosocial intervention.

Patient presentation: A 15-year-old transgender female presented with psychosis, suicidal ideation, a history of self-harm and aggressive behaviour, and panic attacks. She had a diary with excerpts that she could not remember writing and a history of forgetting certain parts of her day. She displayed extreme variations of psychiatric presentations, including depression, mania, panic, and aggression.

Management and outcome: The patient’s alters were individually treated based on their psychiatric presentation and theme. Management followed the phased approach of the International Society for the Study of Trauma and Dissociation (ISSTD guidelines), which included establishing safety and symptom reduction, integration of traumatic memories and identity as well as rehabilitation.

Conclusion: In this case report, we present an adolescent with a myriad of psychiatric presentations and describe her management. We summarise key difficulties that a clinician can encounter in diagnosing DID.

Contribution: We bring awareness to the complexity of this diagnosis. Lastly, we propose an Multidisciplinary team (MDT) biopsychosocial approach that helps to manage the condition.

COVID-19 in patients with severe mental illness: An analysis of in-patients at a psychiatric hospital in Cape Town

Haseena B. Sablay — 2025-05-15

Background: Psychiatric patients in specialist units are more vulnerable to infections such as SARS-COV-2 (severe acute respiratory syndrome coronavirus 2) because of hospital infrastructure and patients’ mental health.

Aim: This study aimed to describe the psychiatric and medical profile, and the risk factors associated with more severe disease and clinical outcomes of coronavirus disease 2019 (COVID-19) in patients with severe mental illness (SMI) admitted to a specialist psychiatric hospital in South Africa between 01 April 2020 and 30 September 2021.

Setting: The study was executed at the Vàlkenberg Hospital (VBH), which is a government-funded, specialised psychiatric hospital. The hospital comprises 370 beds made up of 145 forensic service beds and 225 acute service beds. It provides in-patient and out-patient services.

Methods: Demographic and clinical information were collected for all VBH in-patients who tested positive for SARS-COV-2 from 01 April 2020 to 30 September 2021.

Results: A total of 254 participants tested positive for SARS-COV-2. The sample comprised 75% (n = 191) males with a mean age of 35.7 years. Most patients were diagnosed with schizophrenia (37%, n = 94), bipolar disorder (21%, n = 54) and schizoaffective disorder (19%, n = 49). Reported comorbidities included nicotine use (71%, n = 181), hypertension (11%, n = 28) and human immunodeficiency virus (7%, n = 18). Most patients (62%, n = 156) were symptomatic for COVID-19. Seven per cent (n = 17) required transfer to a medical ward. Almost all patients (99%, n = 252) recovered and 1% (n = 2) died.

Conclusion: Contrary to early fears of high mortality among institutionalised SMI patients, most experienced mild COVID-19 illness and recovered.

Contribution: This descriptive study provided information on in-patients with COVID-19 disease at a specialised psychiatric hospital during the pandemic.

Psychiatric nurses’ knowledge of COVID-19 within a patient care context: A qualitative study

Sandisiwe Dyonase — 2025-05-15

Background: Coronavirus disease 2019 (COVID-19) infection caused unparalleled hastening of the transmission of infection worldwide, commonly affecting healthcare workers’ well-being. Nursing staff spend most hours caring for patients and are the first contact that patients utilise when reporting symptoms or receiving treatment.

Aim: This study aims to evaluate the knowledge of COVID-19 among psychiatric nurses at a tertiary psychiatric hospital.

Setting: Weskoppies Hospital, Gauteng, South Africa.

Methods: We conducted a qualitative study comprising 14 semi-structured interviews with nurses working at Weskoppies Hospital in South Africa. We used open-ended questions to facilitate the discussion and provide some structure for the interview while still allowing the participants to elaborate freely. The recordings were later transcribed into text.

Results: Twenty nurses working full time at the hospital, were recruited for the study. The nurses’ knowledge about COVID-19 was summarised into five major themes, each with subthemes: signs and symptoms of COVID-19, risk of contracting the virus, the spread of COVID-19, prevention, and complications. In this study, the majority of participants had relatively good knowledge regarding COVID-19.

Conclusion: The majority of nurses at the hospital had adequate knowledge about COVID-19 but limited knowledge about the mode of transmission of the infection. Consistently improving healthcare workers’ knowledge about infection control measures through training, supplying information and identifying areas for improvement can ultimately enhance patient care and outcomes.

Contribution: This study sheds light on the value of nurses’ understanding of COVID-19, particularly in a psychiatric setting.

The profile of long-stay patients in a psychiatric hospital in KwaZulu-Natal, South Africa

Siziphiwe Y. Myeni — 2025-05-15

Background: South African psychiatric hospitals’ inpatient average length of stay is approximately 220 days. Inpatient care accounts for over 80% of the mental national healthcare budget. However, there is limited research on factors associated with length of stay (LOS) in tertiary psychiatric hospitals.

Aim: To determine the threshold for long-stay and describe the socio-demographic and clinical profile of long-stay patients admitted to a tertiary psychiatric hospital.

Setting: Townhill Hospital: a tertiary psychiatric hospital in Pietermaritzburg, KwaZulu-Natal, South Africa.

Methods: A retrospective review of clinical records of admissions between January 2019 and January 2020 was conducted. Information on LOS, sociodemographic and clinical factors was collected. The interquartile range (IQR) of LOS in days was calculated, with patients above 75th percentile classified as long-stay patients.

Results: In total, 326 records were included. The 75th percentile LOS was 120 days. Eighty-three patients (25.46%) had a stay of 120 days or longer. The median LOS was 73 (IQR 49–120) days. Factors associated with long-stay included being male (p < 0.001), a psychotic disorder diagnosis (p = 0.019), receiving a disability grant (p = 0.050), involuntary admission (p = 0.010) and multiple readmissions (p = 0.010).

Conclusion: Psychotic disorders and associated factors are key contributors to long-stay hospitalisations.

Contribution: This study highlights the burden of inpatient care for psychotic disorders and the need for interventions that optimise care and promote remission. To reduce the economic impact of prolonged hospitalisations, early intervention and enhanced community-based mental healthcare services focused on psychotic disorders are recommended.

Assessing the mental health literacy of healthcare workers at a Johannesburg tertiary hospital

Carla A. Smit — 2025-05-15

Background: Good mental health literacy (MHL) has proven to aid in providing adequate and timely care, promote positive attitudes towards mental health and assist in the integration of mental healthcare with other services. Studies have shown that enhancing the MHL of healthcare workers (HCWs) can help alleviate the burden of mental illness.

Aim: The study aims to explore the MHL of HCWs at a tertiary hospital in Johannesburg.

Setting: The study was conducted at Helen Joseph Hospital.

Methods: A quantitative, descriptive, cross-sectional study via a self-administered questionnaire consisting of: (1) a demographic, work and exposure to mental illness and mental healthcare services questionnaire and (2) the Mental Health Literacy Scale (MHLS) was employed. The MHLS identifies people with low MHL who could benefit from further interventions.

Results: Two hundred and fifty-two HCWs participated in the study. The overall median MHLS score was 129, in keeping with a previous study conducted in SA and Zambia. Younger HCWs with less than 5 years of experience scored higher. Among the various professions, doctors scored highest and nurses lowest. The anaesthetic and psychiatric departments obtained the highest MHLS scores. Personal exposure to mental illness and mental health services was associated with higher MHLS scores.

Conclusion: This study highlighted areas where mental health awareness and education are lacking, which are crucial for improving MHL. Targeted interventions to fill these identified gaps are therefore recommended.

Contribution: To our knowledge, this was the first South African study to assess MHL among tertiary-level HCWs across various professions.

Mental health and substance use among rehabilitation sciences students during the COVID-19 pandemic

Itumeleng Ntatamala — 2025-05-15

Background: An increase in mental health problems have been documented in health sciences students globally during the coronavirus disease 2019 (COVID-19) pandemic.

Aim: This study aimed to determine the prevalence and correlates of mental health problems and substance use among health and rehabilitation sciences (HRS) students during the pandemic.

Setting: The study was conducted at the University of Cape Town, Health Sciences Faculty.

Methods: A cross-sectional study of 113 voluntary undergraduate participants was conducted. Participants completed self-administered electronic questionnaires. Multiple logistic regression analysis was performed to explore the sociodemographic and COVID-19-related determinants of mental health diagnoses.

Results: Substance use was common, including alcohol (54.05%), cigarettes and/or tobacco (17.27%), and illicit drugs (5.56%). Below a quarter (23.85%) self-reported a mental health condition in their lifetime and 14.81% in the past 12 months. Diagnoses included major depressive disorders (13.27%) and anxiety disorders (11.50%). A mental health diagnosis in the past 12 months was significantly associated with alcohol use (AOR [adjusted odds ratio] = 4.02, 1.06–15.23), prescription medication used to manage academic/social stress (AOR = 5.74, 1.68–19.69), COVID-19 diagnosis (AOR = 5.51, 1.60–18.92) and physiotherapy programme (AOR = 12.35, 1.21–126.44). Barriers to accessing mental health support included academic commitments (61.90%) and the lack of time to attend student wellness services (36.19%).

Conclusion: The self-reported prevalence of mental health problems and substance use among HRS students was high during the pandemic.

Contribution: Institutional and public health measures should address modifiable risk factors and barriers to accessing mental health support amongst students.

Medication non-adherence in re-admitted patients at a psychiatry hospital: A qualitative study

Gopolang E. Zwide — 2025-05-15

Background: Medication non-adherence is a significant public health concern and is prevalent among mental healthcare users. Approximately 65% of patients with severe mental illness do not adhere to their prescribed medication. Medication nonadherence may worsen mental illness and result in poorer clinical outcomes, including frequent relapses and rehospitalisation rates, as well as long time to remission, which may contribute to increased cost of care.

Aim: We explored perspectives regarding reasons for medication non-adherence among readmitted psychiatric patients.

Setting: Weskoppies Psychiatric Hospital, Pretoria, South Africa.

Methods: We adopted the social constructivism paradigm for this exploratory qualitative study. Purposive sampling was used to select 15 re-admitted patients, who were nonadherent to their medication. Data were collected through individual semi-structured interviews. The interviews were audio recorded and transcribed. The data were thematically analysed, using the principles of grounded theory.

Results: Substance abuse, a lack of family support and poor health literacy were the most common reasons for non-adherence to medication. Other reasons included medication side effects, healthcare system drawbacks and a lack of finances to access healthcare. Some patients did not adhere to their medication because they believed that their mental illnesses were spiritual in origin.

Conclusion: Multiple factors contributed to patients not adhering to their medication, ultimately resulting in their relapse and readmission. Clinicians should be cognisant of these factors when trying to prevent relapse and readmission.

Contribution: Clinicians also ought to identify patients who are at risk of not adhering to medication. Targeted interventions should be established for tackling medication non-adherence.

Seasonal trends in methylphenidate use: A mirror of misuse or compliance?

Renata Schoeman — 2025-05-15

Background: A steady growth in the use of medication for the treatment of attention-deficit hyperactivity disorder (ADHD) has been evident over the past few decades. While growth attests to increased awareness of ADHD and improved access to diagnosis and treatment, concerns have been raised about poor adherence to treatment and diversion of medication.

Aim: This current study explored the seasonal and/or temporal use of methylphenidate (MPH) in South Africa.

Setting: The study was conducted in South Africa.

Methods: A retrospective database analysis was conducted to examine unit sales of MPH over a 9-year period. The unit sales of MPH were compared to those of atomoxetine for the same period.

Results: Unit sales for MPH peaked in May and October, which coincided with the academic high-pressure periods for school learners and university students. This was most evident for MPH immediate release 10 mg. There was a noticeable decrease in unit sales for MPH during December. Atomoxetine demonstrated much less seasonal variation.

Conclusion: The seasonal and/or temporal use of MPH fluctuates following the academic calendar. These changes are driven by both temporary interruptions of treatment, such as ‘drug holidays’, and the misuse and diversion of MPH for non-medical use. This holds significant implications for interventions to improve ADHD outcomes. It is crucial to balance accessibility to treatment with the prevention of misuse of MPH.

Contribution: Our findings highlight the need to reconsider current policies and regulations regarding the appropriate diagnosis and management of ADHD and the scripting, dispensing and monitoring of MPH.

Changes in cannabis use post decriminalisation in mental health care users in South Africa

Rachel Moshori — 2025-05-15

Background: Personal cannabis use was decriminalised in South Africa in 2018. Cannabis use increases the risk of mental illness (MI) and worsens prognosis in patients with MI. The impact of decriminalisation on cannabis use remains unclear.

Aim: To examine cannabis use patterns by self-report and urine multidrug screening (UMDS) among psychiatric inpatients at Chris Hani Baragwanath Academic Hospital (CHBAH).

Setting: CHBAH, Soweto, South Africa.

Methods: A retrospective review of clinical records comparing patients admitted to CHBAH psychiatry pre- and post-decriminalisation.

Results: A total of 244 patients were included, with 57% using cannabis based on self-report and/or UMDS. Although not significant, overall cannabis use was higher post-decriminalisation (63.1%) than pre-decriminalisation (50.8%). Self-reported use increased slightly post-decriminalisation (56.6% vs. 50.0%), while UMDS-confirmed use was significantly higher (32.8% vs. 17.2%). Cannabis use was associated with male gender and younger age, with younger admissions post-decriminalisation.

Conclusion: Decriminalisation did not significantly increase overall or self-reported cannabis use; however, more patients tested positive on UMDS post-decriminalisation. Young males remain at higher risk of cannabis use.

Assessing sleep using the Pittsburgh Sleep Quality Index (PSQI) among comorbid HIV and psychiatric outpatients

Ahmad Peerbhay — 2025-05-15

Background: Sleep is an essential component of physical and mental health. HIV and mental illness are both risk factors for developing sleep problems. There is a paucity of sleep research in a population with comorbid HIV and mental illness.

Aim: This research study aimed to determine the prevalence of sleep disturbances among comorbid HIV and psychiatric outpatients using the Pittsburgh Sleep Quality Index (PSQI). A further aim was to identify socio-demographic and clinical variables that may significantly correlate with results of their PSQI scores.

Setting: Luthando Neuropsychiatric Clinic at Chris Hani Baragwanath Academic Hospital in Johannesburg.

Methods: This was a cross-sectional study assessing the sleep of comorbid HIV and psychiatric outpatients using the PSQI. A global score of 5 or greater is indicative of poor sleep quality. Eligible participants completed the self-administered PSQI, and socio-demographic and clinical data were obtained from their records.

Results: A total of 71.6% of participants had an overall PSQI score of ≥ 5, indicating poor sleep quality. HIV-related factors were not predictors of poor sleep outcomes. Female gender, unemployment, absence of alcohol use and selective psychiatric diagnoses were associated with poor sleep quality. None of the participants had a sleep disorder formally diagnosed.

Conclusion: Sleep disturbances are highly prevalent in patients with comorbid HIV and mental illness. Actively screening this population, training of psychiatrists in diagnosing sleep disturbances and interventions to improve the quality of sleep are needed.

Contribution: This research highlights the prevalence of sleep disturbances in patients with HIV and mental illness.

Attitudes of Christian leaders and congregants in South Africa towards mental illness and the mentally ill

Zamahlubi T. Dlamini — 2025-05-15

Background: Mental illness and substance use disorders significantly contribute to the global disease burden, and limited access to mental health services exacerbates this problem. Initially, many individuals seek help from religious leaders and traditional healers. Given that 80% of South Africa’s (SA) population identifies as Christian, churches may influence mental health help-seeking behaviour.

Aim: This study aimed to determine the attitudes of Christian leaders and congregants towards the mentally ill using the Community Attitudes Towards the Mentally Ill (CAMI) scale.

Setting: The study was conducted in Soweto, a diverse peri-urban settlement in Johannesburg.

Methods: This was a cross-sectional survey where participants completed a demographics questionnaire and the CAMI scale, which measures attitudes across four sub-scales: Authoritarianism (AU), Benevolence (BE), Social Restrictiveness (SR), and Community Mental Health Ideology (CMHI). Low AU and SR scores and high BE and CMHI scores indicated low stigma towards mental illness.

Results: There were 51 participants, predominantly female (80.4%), aged 25–35 years (58.8%) and possessing tertiary education (82.4%). No significant differences emerged between leaders and congregants. Participants with a personal history of mental illness exhibited more positive attitudes, while familiarity with affected individuals did not significantly influence attitudes.

Conclusion: The study highlights the importance of collaboration between mental healthcare providers and the Christian community in South Africa, emphasising the need for cross-denominational engagement and further research to improve culturally relevant mental healthcare.

Contribution: These findings underscore the church’s potential role in promoting mental health support.

Mental health literacy among secondary school learners in Tshwane region 1: A quantitative study

Dumisile P. Madlala — 2025-05-15

Background: Mental health literacy (MHL) is one of the crucial factors in the prevention and maintenance of youth mental health. Despite this fact, there is limited research on MHL in this age group.

Aim: To determine the MHL in a sample of secondary schoolgoing learners.

Setting: Five schools in Tshwane, South Africa.

Methods: A quantitative cross-sectional study was done. Three fictive vignettes depicting individuals having symptoms of major depressive disorder (MDD), substance-induced psychotic disorder (SIPD) and social anxiety disorder (SAD) were presented to participants. The ability to recognise the disorder, knowledge of the best form of help to address the symptoms, and the ability to provide psychological first aid support were assessed. A comparison of MHL between township school learners and urban school learners was conducted. The association between MHL and demographic factors was also assessed.

Results: The ability to recognise symptoms and connect them to a particular disorder was high (80.71% for MDD, 61.96% for SIPD and 67.91% for SAD). Correct knowledge on who would best address the symptoms was 52.55% for MDD, 63.83% for SIPD and 23.86% for SAD with a sizable number choosing informal help for the cases of MDD and SAD. There was good psychological first aid knowledge for both MDD and SIPD cases but poor for SAD case.

Conclusion: Even though the results are promising regarding the recognition of all three disorders, there is still room for improving MHL in this group, especially in the areas of help-seeking and knowledge about anxiety disorders in general.

Contribution: The findings highlight key areas of focus during mental health awareness campaigns to learners.

Psychiatric nurses’ experiences of using a model to improve relationships of couples with borderline personality disorder

Andile G. Mokoena-de Beer — 2025-05-15

Background: Individuals with borderline personality disorder (BPD) struggle with relationships because of impulsivity and emotional regulation difficulties. Specialised skills are needed for care, but existing models are lacking. A new model was developed to help psychiatric nurses support couples with one partner having BPD. This innovative psychiatric nursing model emphasises the need for implementation and evaluation in care.

Aim: To explore the psychiatric nurses’ experiences of implementation of a model to facilitate constructive intra- and interpersonal relationships for couples in a relationship where one is living with BPD.

Setting: The study was conducted at a mental health institution in Gauteng province where the one partner with BPD receives treatment.

Methods: The study adopted a qualitative, exploratory design conducting in-depth interviews with psychiatric nurses who implemented the model, triangulated with observations and field notes and analysed thematically.

Results: Four themes emerged, namely: (1) the model served as a helpful tool for empowerment; (2) the positive results yielded by the model; (3) challenges related to using the model; and (4) suggestions for expanding the model’s reach. The psychiatric nurses found the model acceptable and feasible to facilitate the relationships of couples where one is living with BPD.

Conclusion: Psychiatric nurses need guidelines to enhance care for individuals with BPD, highlighting the importance of implementing supportive models to improve relationships in various settings.

Contribution: Implementation of this model is unique in the care of persons living with BPD making it a valuable tool for psychiatric nurses in mental health care provision.

Expanding mental health support: Empowering medical professionals with greater resilience

Yilin Jiang — 2025-05-15

No abstract.