Browsing by Author "Stein, D. J."
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- ItemAssessing post-traumatic stress disorder in South African adolescents : using the child and adolescent trauma survey (CATS) as a screening tool(BioMed Central, 2005-01) Suliman, S.; Kaminer, D.; Seedat, S.; Stein, D. J.Background: Several studies have demonstrated that South African children and adolescents are exposed to high levels of violent trauma with a significant proportion developing PTSD, however, limited resources make it difficult to accurately identify traumatized children. Methods: A clinical interview (K-SADS-PL, selected modules) and self-report scale (CATS) were compared to determine if these different methods of assessment elicit similar information with regards to trauma exposure and post-traumatic stress disorder (PTSD) in adolescents. Youth (n = 58) from 2 schools in Cape Town, South Africa participated. Results: 91% of youth reported having been exposed to a traumatic event on self-report (CATS) and 38% reported symptoms severe enough to be classified as PTSD. On interview (K-SADS-PL), 86% reported exposure to a traumatic event and 19% were found to have PTSD. While there were significant differences in the rates of trauma exposure and PTSD on the K-SADS and CATS, a cutoff value of 15 on the CATS maximized both the number of true positives and true negatives with PTSD. The CATS also differentiated well between adolescents meeting DSM-IV PTSD symptom criteria from adolescents not meeting criteria. Conclusions: Our results indicate that trauma exposure and PTSD are prevalent in South African youth and if appropriate cut-offs are used, self-report scales may be useful screening tools for PTSD.
- ItemAttitudes towards and beliefs about schizophrenia in Xhosa families with affected probands(AOSIS Publishing, 2002-09-27) Mbanga, N. I.; Niehaus, D. J. H.; Mzamo, N. C.; Wessels, C. J.; Allen, A.; Emsley, R. A.; Stein, D. J.Objective: The development of effective psychoeducational programs for the management of schizophrenia requires an understanding of attitudes towards and beliefs about the disorder in families of affected probands. In order to establish the need for adaptation of Western psychoeducational programs, these variables were investigated in Xhosa speaking families in South Africa. Design: Xhosa speaking family members of patients with DSM-IV schizophrenia were recruited on a voluntary basis, and interviewed with a structured belief and attitudes questionnaire adapted from previous studies in the West. Setting: The study population was drawn from both urban and rural Xhosa communities in South Africa. Subjects: 100 Xhosa speaking family members participated in the study. Results: Family members most often recommended treatment with psychotropic medications (88%) and traditional healers (32%), and least often recommended psychotherapy (4%) and meditation (1%). Of the respondents who recommended traditional healing methods, 92% also recommended simultaneous use of allopathic treatment. Conclusion: Attitudes towards and beliefs about schizophrenia in family members of patients with schizophrenia may differ substantially from those described in previous work in the West. An understanding of local attitudes and beliefs is crucial for the successful development of local psychoeducational programs.
- ItemD8/17 in obsessive-compulsive disorder and trichotillomania(Health & Medical Publishing Group, 1999) Niehaus, D. J. H.; Knowles, J. A.; Van Kradenberg, J.; Du Toit, W. D.; Kaminer, D.; Seedat, S.; Daniels, W.; Cotton, M.; Brink, P.; Beyers, A. D.; Bouic, P.; Chapman, F.; Zabriskie, J. B.; Stein, D. J.The finding that patients with Sydenham's chorea often demonstrate obsessive-compulsive disorder (OeD) has fostered increased interest in possible neuroimmunological mechanisms in OCD.' Increased expression of the B-Iymphocyte antigen 08/17, which has been hypothesised to be a genetically inherited trait marker for susceptibility to rheumatic fever, has recently been demonstrated to be higher in OCD patients than in normal controls.2.3 To date, however, 08/17 expression has been studied in few psychiatric control populations.
- ItemDealing with post-traumatic stress disorder in general practice(Medpharm Publications, 2012) Suliman, S.; Stein, D. J.Traumatic experiences are prevalent in South Africa and may result in psychiatric disorders such as post-traumatic stress disorder (PTSD). PTSD is accompanied by a range of psychobiological alterations, including changes in brain structure and functioning. General practitioners have an important role to play in identifying and assisting those in need of help. Efficacious psychotherapies and pharmacotherapies are available for PTSD, i.e. cognitive behavioural therapy and selective serotonin reuptake inhibitors.
- ItemA double-blind placebo-controlled trial of paroxetine in the management of social phobia (social anxiety disorder) in South Africa(Health & Medical Publishing Group, 1999) Stein, D. J.; Berk, M.; Els, C.; Emsley, R. A.; Gittelson, L.; Wilson, D.; Oakes, R.; Hunter, B.Background. Social phobia, also known as social anxiety disorder, is a highly prevalent disorder with significant morbidity. Patients with social phobia frequently develop co-morbid psychiatric disorders such as depression and substance abuse, and the disorder impacts significantly on social and occupational functioning. It has been suggested that the selective serotonin reuptake inhibitors (SSRIs) are useful in the management of this disorder, but few controlled trials have been undertaken in this regard. There are also few data on the pharmacotherapy of social phobia in South Africa. Methods. A double-blind randomised placebo-controlled multi-site flexible-dose trial of paroxetine was undertaken over 12 weeks among patients with a primary diagnosis of social phobia. Primary response measures were the Global Improvement item on the Clinical Global Impression scale (CGI) and mean change from baseline in the patient-rated Liebowitz Social Anxiety Scale (LSAS) total score. Ninety-three patients participated at 9 South African sites; their data are reported here. Results. There was a significant drug effect on both the CGI Global Improvement score and the LSAS at 12 weeks. In addition, there was no significant difference in overall rate of adverse experiences between those on paroxetine and those on placebo. Conclusions. Paroxetine is both effective and safe in the acute treatment of social phobia. The findings here are consistent with those of previous controlled studies of the SSRIs as well as with previous work done in the USA on the use of paroxetine in the treatment of this disorder. Early diagnosis and treatment of social phobia should be encouraged. However, further research on long-term pharmacotherapy of social phobia is needed.
- ItemEffects of myo-Inositol versus fluoxetine and imipramine pretreatments on serotonin 5HT2A and muscarinic acetylcholine receptors in human neuroblastoma cells(2004) Brink, C. B.; Viljoen, S. L.; De Kock, S. E.; Stein, D. J.; Harvey, B. H.; Brink, C. B.; Viljoen, S. L.; De Kock, S. E.; Stein, D. J.; Harvey, B. H.myo-Inositol (mI) is a key metabolic precursor to the phospoinositide (PI) metabolic pathway as a key component of central G-protein coupled receptor signaling systems, including several subtypes of adrenergic, cholinergic, serotonergic and metabotropic glutamatergic receptors. High dose mI has also been shown to be clinically effective in the treatment of obsessive-compulsive disorder, as well as panic and depression, although its mechanism of action remains elusive. The current study aimed to investigate the possible modulatory role of mI versus fluoxetine or imipramine pretreatments on serotonin-2A receptor (5HT2A-R) and muscarinic acetylcholine receptor (mAChR) function and binding in in vitro systems. After pretreating human neuroblastoma cells with different concentrations of mI, fluoxetine, or imipramine, receptor function was measured by second messenger [3H]-IPx accumulation and [35S]-GTPγS binding to Gαq protein. Total [3H]-mI uptake into cells was measured, as well as specific receptor binding to determine receptor binding after the pretreatments. Results suggest that mI reduces 5HT2A-R function at the receptor-G protein level. While fluoxetine also reduced 5HT2A-R function, but to a lesser degree, imipramine increased 5HT2A-R function, which may explain why mI seems to be effective exclusively in selective serotonin reuptake inhibitor-sensitive disorders. In addition mI, and at high concentrations fluoxetine and imipramine, also reduces mAChR function. Furthermore the results suggest that the attenuating effect of mI on mAChRs is partially dependent on the PI metabolic pathway. The data provide novel information on understanding the mechanism of action of mI in depression and related anxiety disorders and added to the evidence suggesting a role for the cholinergic system in the pathophysiology of depression.
- ItemGeneralised anxiety disorder(AOSIS, 2013) Stein, D. J.Generalised anxiety disorder (GAD) is a common disorder witha lifetime prevalence of 6.1% and a 1-year prevalence of 2.9% inone large study.[1]It occurs most commonly in the 45 - 55-yearage group with women twice as likely as men to have GAD.
- ItemHoarding symptoms in patients on a geriatric psychiatry inpatient unit(Health & Medical Publishing Group, 1997) Stein, D. J.; Laszlo, B.; Marais, E.; Seedat, S.; Potocnik, F.Background. While collecting may be a normal behaviour, hoarding is a symptom of various psychiatric disorders, including obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD). Although anecdotal reports suggest that hoarding is not uncommon in geriatric psychiatry populations, its psychopathological correlates in such samples have not been well characterised. Methods. The presence of clinically significant hoarding symptoms was screened for in 100 consecutive patients in a geriatric psychiatry inpatient unit. Both patient and collateral histories were obtained. When hoarding symptoms were present, a detailed history of their phenomenology was obtained by means of a structured questionnaire and the response of hoarding symptoms to treatment during hospitalisation was monitored. Results. Clinically significant hoarding was found in 5/100 subjects. Four of these 5 patients met DSM-IV criteria for schizophrenia (paranoid subtype), with onset of symptoms coinciding with increased symptoms of dementia. The fifth patient met criteria for bipolar disorder (manic episode), also had symptoms of dementia, and had a lifelong history of hoarding. Hoarding behaviours responded to antipsychotic treatment in 3 of the 5 patients. Conclusions. A history of hoarding may be useful in many psychiatric patients, but psychopathological correlates of this symptom are likely to vary with age. In a geriatric psychiatry inpatient population hoarding was associated not with OCD or OCPD, but rather with paranoid schizophrenia and increasing symptoms of dementia. Dopamine blockers appeared useful in decreasing hoarding in some patients, raising interesting questions about the neurobiology of this symptom.
- ItemHow to manage obsessive-compulsive disorder (OCD) under COVID-19 : a clinician's guide from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS) and the Obsessive-Compulsive and Related Disorders Research Network (OCRN) of the European College of Neuropsychopharmacology(Elsevier Inc., 2020-07) Fineberg, N. A.; Van Ameringen, M.; Drummond, L.; Hollander, E.; Stein, D. J.; Geller, D.; Walitza, S.; Pallanti, S.; Pellegrini, L.; Zohar, J.; Rodriguez, C. I.; Menchon, J. M.; Morgado, P.; Mpavaenda, D.; Fontenelle, L. F.; Feusner, J. D.; Grassi, G.; Lochner, C.; Veltman, D. J.; Sireau, N.; Carmi, L.; Adam, D.; Nicolini, H.; Dell'Osso, B.The rapid advance of the coronavirus COVID-19 pandemic has significantly increased mortality but also has demonstrated considerable potential to negatively impact mental health, including in the young [1,2]. From a public mental health perspective, guidelines for responding to mass trauma and disaster emphasize the importance of focusing on resilience. In the immediate and ongoing response, consensus guidelines emphasize the importance of interventions that maintain calm, build community, and sustain hope [3,4].
- ItemObsessive compulsive disorder(AOSIS, 2013) Stein, D. J.This guideline focuses on the pharmacotherapy of obsessivecompulsive disorder (OCD). OCD is characterised by obsessions and compulsions. A number of other disorders are also characterised by repetitive thoughts and rituals and may also respond to modifications of standard OCD treatment. These so-called OCD spectrum disorders include body dysmorphic disorder (characterised by recurrent concerns with imagined ugliness), hypochondriasis (characterised by recurrent concerns with imagined illness), trichotillomania (characterised by recurrent hair-pulling), and obsessive-compulsive personality disorder.[1] The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition[2] has a new chapter on obsessive-compulsive and related disorders, which includes several of these conditions.
- ItemObsessive-compulsive disorder in black South Africans - A case series(Health & Medical Publishing Group, 1996) Gangdev, P. S.; Stein, D. J.; Ruzibiza, J. B.Background. Obsessive-compulsive disorder (OCD) has been shown to be highly prevalent in both developing and developed countries. Nevertheless, data on OCD in blacks, and black South Africans in particular, are limited. Method. Records of patients presenting with OCD at a tertiary hospital serving a predominantly black population were reviewed. Patient data, including demographic information, presenting symptoms and clinical course, were collated. Results. Six black South Africans had presented with OCD in the previous year. Phenomenology and psychopharmacology of the disorder were largely reminiscent of those previously reported in the international literature. Conclusion. Not surprisingly, black South Africans may suffer from OCD. Nevertheless, it is likely that such patients do not present for treatment or are underdiagnosed. Future rigorous epidemiological research on OCD in South Africa is necessary.
- ItemPica and the obsessive-compulsive spectrum disorders(Health & Medical Publishing Group, 1996) Stein, D. J.; Bouwer, C.; Van Heerden, B.Background. The concept of a spectrum of obsessive-compulsive related disorders may have clinical and research heuristic value in the approach to disorders similar to obsessive-compulsive disorder (OCD) in respect of phenomenology and psychobiology. Like other repetitive and ritualistic behaviours, pica may be postulated to fall at times on this spectrum. Methods. Five cases of pica seen at our clinics are presented here in order to test this hypothesis. Phenomenology, neurobiology (where available) and pharmacotherapy data are provided in order to consider a possible relationship with OCD and OCD spectrum disorders. Results. In 2 of the cases, pica appeared to be a compulsion and patients had additional symptoms which met diagnostic criteria for OCD. In 2 of the cases, the clinical picture and neurobiological data were reminiscent of an impulse control disorder. Four of the 5 patients responded to treatment with a serotonin re-uptake inhibitor (SRI). Conclusion. These results are consistent with a hypothesis that at least some cases of pica may usefully be conceptualised as lying within a compulsive-impulsive spectrum of symptoms and disorders.
- ItemPrevalence of obsessive compulsive disorder in first- and multi-episode male patients with schizophrenia-spectrum disorders(Health & Medical Publishing Group, 2003) Koen, L.; Oosthuizen, P. P.; Niehaus, D. J. H.; Emsley, R. A.; Muller, J. E.; Stein, D. J.; Keyter, N.; Lochner, C.; Seedat, S.Studies suggest that obsessive compulsive disorder (OCD) is a prevalent disorder (7.8 - 31.7%) in patients with schizophrenia and first-episode psychosis.1,2 Despite the varied study designs that have been employed, calculated comorbidity rates support the conclusion that this co-morbidity is not likely to be an incidental finding.
- ItemPsychiatric research in South Africa : a systematic review of Medline publications(AOSIS Publishing, 2001-09) Fourie, J.; Flisher, A. J.; Emsley, R. A.; Stein, D. J.Background - There is debate about the future path that medical and psychiatric research in South Africa should take. In particular, there have been calls to make research more relevant to the needs of the population. There is, however, little systematically collected data on the nature, strengths, and flaws of past psychiatric research in this country. Methods - We undertook a MEDLINE search to gather all manuscripts that fell under the umbrella of psychiatric research and published by South Africa-based authors during the years 1966-1997. Several kinds of data were collated from each of the articles, including information about the authors and the journal, as well as information on the focus and type of article. Results - While publications from South Africa continue to grow in number, relatively few involve collaborative research groups and few authors write more than one paper. Many papers relevant to psychiatry were published in general medical journals and many were from general medical departments. While blacks and females have been included in research, a number of important areas have received little attention. Conclusions - Psychiatry research in South Africa requires additional fostering, including additional resources for research training and arguably additional development of subspeciality focuses. Given the limited resources, and the nature of modem research, increased emphasis on collaboration seems advisable. A number of areas in psychiatry deserve particular attention from future researchers.
- ItemPsychopathology and coping in recently diagnosed HIV/AIDS patients [3](Health & Medical Publishing Group, 2004) Olley, B. O.; Seedat, S.; Stein, D. J.We thank Dr Singh for raising several issues for discussion in his letter1 in response to our paper.2 He states that there is no evidence to support the hypothesis that women with HIV/AIDS may face greater stigmatisation than men, emphasises rather social inequality and poverty as risk factors for HIV infection in women, and recommends the inclusion of a particular stigma scale. Stigmatisation may well have been interesting to include, but it was not a primary object of study in this work, and the validity of the scale recommended by Singh has not yet been demonstrated in developing world contexts. Furthermore, we would point out that HIV/AIDS stigma and gender discrimination are constructs that appear to have considerable overlap.
- ItemRisk factors for substance use in pregnant women in South Africa(HPMG, 2012-11) Vythilingum, B.; Roos, A.; Faure, S. C.; Geerts, L.; Stein, D. J.ENGLISH ABSTRACT: Objectives. To study the prevalence of alcohol and substance use in a South African antenatal population and its correlates with sociodemographic factors, depression and perceived stress. Methods. A prospective self-report study on all women presenting for their first antenatal visit who consented to the study at a midwife obstetric unit (MOU) in the East Metropole district, Cape Town, using the Alcohol Use Disorders Identification Test (AUDIT), Drug Use Disorders Identification Test (DUDIT), Edinburgh Depression Scale (EDS) and Perceived Stress Scale (PSS). Statistical analyses using the chi-square test, separate one-way analyses of variance (ANOVA) and logistic regression analyses were performed as appropriate. Outcome measures were depression, alcohol use and substance use. Results. The questionnaire was completed by 323 women. During pregnancy 36.8% of women smoked, 20.2% used alcohol and 4% used substances. Using EDS cut-off scores of 12 and 15, respectively, 48.9% and 33.6% of the sample had scores consistent with major depression. An EDS cut-off score of 12 was significantly associated with both alcohol use (25.9% v. 15.2%, p=0.019) and risky drinking (76.9% v. 36.8%, p=0.04), while an EDS cut-off score of 15 was significantly associated with substance use (8.2% v. 1.4%, p=0.004) as well as alcohol dependence (23.1% v. 3.1%). Conclusions. We found high rates of both alcohol abuse and antenatal depression, and a significant association between depression, substance use and alcohol abuse; EDS scores greater than 12 could be used to identify women at risk of alcohol dependence and/or substance abuse.
- ItemSelective serotonin reuptake inhibitors in children and adolescents(Health & Medical Publishing Group, 2006-02) Hawkridge, S.; Seedat, S.; Carey, P.; Emsley, R.; Stein, D. J.[No abstract available]
- ItemThe South African Society of Psychiatrists (SASOP) treatment guidelines for psychiatric disorders(AOSIS Publishing, 2013-08) Emsley, R.; Colin, F.; Flisher, A. J.; Grobler, G.; Hawkridge, S.; Potocnik, F. C.; Seedat, S.; Stein, D. J.; Swingler, D.; Szabo, C. P.The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric Disorders have been developed in order to address the local need for guidelines in our unique clinical setting.
- ItemViolence in the world and in South Africa - what is a doctor to do?(Health & Medical Publishing Group, 2002) Stein, D. J.; Seedat, S.; Emsley, R. A.The WHO World Report on Violence and Mental Healthl aims to raise awareness of the public health aspects of violence and to show how a public health approach can be useful in understanding and responding to violence. More specific goals of the Report include describing the magnitude and impact of violence cross-nationally, summarising information on risk factors, prevention approaches and policy responses, and making recommendations for future action and research.