Browsing by Author "Chiliza, Bonginkosi"
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- ItemAnger and Afrophobia in South Africa : what is a health practitioner to do?(Health and Medical Publishing Group, 2015) Long, Wahbie; Chiliza, Bonginkosi; Stein, Dan J.The facts seem to indicate that South Africa is one of the more violent places on earth. We have been, and continue to be, a country with significant levels of political violence, criminal violence and domestic violence. And now, we are witnessing violence against fellow Africans. While many have termed this ‘xenophobia’, a more accurate term may well be ‘Afrophobia’. For clinician-scientists, many questions arise. In this editorial, we briefly consider a few of the most pertinent.
- ItemCognitive-perceptual deficits and symptom correlates in first-episode schizophrenia(AOSIS Publishing, 2017) Olivier, Riaan M.; Kilian, Sanja; Chiliza, Bonginkosi; Asmal, Laila; Oosthuizen, Petrus P.; Emsley, Robin A.; Kidd, MartinBackground: Thought disorder and visual-perceptual deficits have been well documented, but their relationships with clinical symptoms and cognitive function remain unclear. Cognitive-perceptual deficits may underscore clinical symptoms in schizophrenia patients. Aim: This study aimed to explore how thought disorder and form perception are related with clinical symptoms and cognitive dysfunction in first-episode schizophrenia. Setting: Forty-two patients with a first-episode of schizophrenia, schizophreniform or schizoaffective disorder were recruited from community clinics and state hospitals in the Cape Town area. Methods: Patients were assessed at baseline with the Rorschach Perceptual Thinking Index (PTI), the Positive and Negative Syndrome Scale (PANSS) and the MATRICS Cognitive Consensus Battery (MCCB). Spearman correlational analyses were conducted to investigate relationships between PTI scores, PANSS factor analysis-derived domain scores and MCCB composite and subscale scores. Multiple regression models explored these relationships further. Results: Unexpectedly, poor form perception (X- %) was inversely correlated with the severity of PANSS positive symptoms (r = -0.42, p = 0.02). Good form perception (XA%) correlated significantly with speed of processing (r = 0.59, p < 0.01), working memory (r = 0.48, p < 0.01) and visual learning (r = 0.55, p < 0.01). PTI measures of thought disorder did not correlate significantly with PANSS symptom scores or cognitive performance. Conclusions: Form perception is associated with positive symptoms and impairment in executive function during acute psychosis. These findings suggest that there may be clinical value in including sensory-perceptual processing tasks in cognitive remediation and social cognitive training programmes for schizophrenia patients.
- ItemDoing their best : strategies used by South African clinicians in working with psychiatric inpatients across a language barrier(Co-Action Publishing, 2015-10-26) Kilian, Sanja; Swartz, Leslie; Chiliza, BonginkosiBackground and objectives: South Africa has 11 official languages, but most psychiatrists can speak only English and Afrikaans and there are no formal interpreter posts in the mental healthcare system. As a result clinicians communicate with patients who have limited English language proficiency (LEP) without the use of interpreters. We present case material, constituting recordings of interactions between clinicians and LEP patients in a public psychiatric institution. The aim is to have a better understanding of how these clinical encounters operated and what communicative strategies clinicians used. Design: We used the Roter interaction analysis system (RIAS) to evaluate clinicians’ conversational strategies and to analyze interactions between clinicians and patients. Results: Clinicians showed a high degree of tenacity in trying to engage patients in the clinical conversation, build rapport, and gather crucial diagnostic information. However, patients often responded briefly and monosyllabically, or kept quiet. In psychiatry where commonality of language cannot be assumed, it is not possible to determine the clinical significance of these responses. Discussion: Clinicians went to great lengths to understand LEP patients. It is also clear that patients were often not optimally understood. Clinicians would try to gain valid information in a polite manner, but would abandon these attempts repeatedly as it became clear that proper communication was not possible. Conclusions: Our findings suggest that in the absence of interpreter services, the communication between clinicians and LEP patients is sparse and yields limited clinical information. The lack of proper language services stands in the way of optimal clinical care and requires urgent attention.
- ItemFactors affecting specialist psychiatry training in South Africa : bullying during specialist psychiatric training?(2021) Beath, Natalie; Moxley, Karis; Subramaney, Ugasvaree; Zingela, Zukiswa; Chiliza, Bonginkosi; Joska, John; Kotzé, Carla; Seedat, Soraya, 1966-As many of us served as members of the Council of Psychiatrists, Colleges of Medicine of South Africa, for the triennium 2017 - 2020, we were keen to understand how workplace experiences and supervision could affect training and examination outcomes in South African (SA) centres. We conducted a cross-sectional, descriptive study of registrar trainees in psychiatry at the University of the Witwatersrand, the University of Cape Town, the University of KwaZulu-Natal, the University of Pretoria, the University of the Free State, Stellenbosch University, the University of Limpopo, and Walter Sisulu University between 1 June and 30 November 2019. We made use of an online survey that included questions on bullying/discrimination. All questions were closed-ended.
- ItemIncidence of anxiety and depression in a predominantly HIV-infected population with severe adverse drug reactions(BioMed Central, 2014-07) Zitha, Eddy; Chiliza, Bonginkosi; Muloiwa, Rudzani; Lehloenya, RannakoeBackground Little is known on the short-term or medium-term psychological and psychiatric sequelae following Stevens Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS). Based on this we did a prospective study designed to assess anxiety and depression in patients with severe cutaneous adverse drug reactions by indicating higher Hospital anxiety and depression scale (HADS).
- ItemInstruments measuring blunted affect in schizophrenia : a systematic review(Public Library of Science, 2015-06) Kilian, Sanja; Asmal, Laila; Goosen, Anneke; Chiliza, Bonginkosi; Phahladira, Lebogang; Emsley, Robin A.Blunted affect, also referred to as emotional blunting, is a prominent symptom of schizophrenia. Patients with blunted affect have difficulty in expressing their emotions. The work of Abrams and Taylor and their development of the Rating Scale for Emotional Blunting in the late 1970’s was an early indicator that blunted affect could indeed be assessed reliably. Since then, several new instruments assessing negative symptoms with subscales measuring blunted affect have been developed. In light of this, we aim to provide researchers and clinicians with a systematic review of the different instruments used to assess blunted affect by providing a comparison of the type, characteristics, administration and psychometric properties of these instruments. Studies reporting on the psychometric properties of instruments assessing blunted affect in patients with schizophrenia were included. Reviews and case studies were excluded. We reviewed 30 full-text articles and included 15 articles and 10 instruments in this systematic review. On average the instruments take 15–30 minutes to administer. We found that blunted affect items common across all instruments assess: gestures, facial expressions and vocal expressions. The CAINS Self-report Expression Subscale, had a low internal consistency score. This suggests that this sub-scale does not reliably assess patients’ self-reported blunted affect symptoms and is likely due to the nature of blunted affect. Instruments correlated minimally with instruments measuring positive symptoms and more importantly with depression suggesting that the instruments distinguish between seemingly similar symptoms.
- ItemLanguage, culture, and task shifting - an emerging challenge for global mental health(Co-Action Publishing, 2014-02) Swartz, Leslie; Kilian, Sanja; Twesigye, Justus; Attah, Dzifa; Chiliza, BonginkosiLanguage is at the heart of mental health care. Many high-income countries have sophisticated interpreter services, but in low- and middle-income countries there are not sufficient professional services, let alone interpreter services, and task shifting is used. In this article, we discuss this neglected issue in the context of low- and middle-income countries, where task shifting has been suggested as a solution to the problem of scarce mental health resources. The large diversity of languages in low- and middle-income countries, exacerbated by wide-scale migration, has implications for the scale-up of services. We suggest that it would be useful for those who are working innovatively to develop locally delivered mental health programmes in low- and middle-income countries to explore and report on issues of language and how these have been addressed. We need to know more about local challenges, but also about local solutions which seem to work, and for this we need more information from the field than is currently available
- ItemThe nature of relapse in schizophrenia(BioMed Cenral, 2013-02) Emsley, Robin; Chiliza, Bonginkosi; Asmal, Laila; Harvey, Brian, H.Background Multiple relapses characterise the course of illness in most patients with schizophrenia, yet the nature of these episodes has not been extensively researched and clinicians may not always be aware of important implications. Methods We critically review selected literature regarding the nature and underlying neurobiology of relapse. Results Relapse rates are very high when treatment is discontinued, even after a single psychotic episode; a longer treatment period prior to discontinuation does not reduce the risk of relapse; many patients relapse soon after treatment reduction and discontinuation; transition from remission to relapse may be abrupt and with few or no early warning signs; once illness recurrence occurs symptoms rapidly return to levels similar to the initial psychotic episode; while most patients respond promptly to re-introduction of antipsychotic treatment after relapse, the response time is variable and notably, treatment failure appears to emerge in about 1 in 6 patients. These observations are consistent with contemporary thinking on the dopamine hypothesis, including the aberrant salience hypothesis. Conclusions Given the difficulties in identifying those at risk of relapse, the ineffectiveness of rescue medications in preventing full-blown psychotic recurrence and the potentially serious consequences, adherence and other factors predisposing to relapse should be a major focus of attention in managing schizophrenia. The place of antipsychotic treatment discontinuation in clinical practice and in placebo-controlled clinical trials needs to be carefully reconsidered.
- ItemA prospective study of clinical, biological and functional aspects of outcome in first episode psychosis(Stellenbosch : Stellenbosch University, 2015-12) Chiliza, Bonginkosi; Emsley, Robin; Stellenbosch University. Faculty of Health Sciences. Dept. of Psychiatry.ENGLISH ABSTRACT: Prospective, longitudinal clinical studies in first-episode schizophrenia have become relatively commonplace over the past two decades or more and have provided a wealth of useful information regarding the clinical presentation, treatment, course and outcome of the illness. However, there remain several unanswered questions. The majority of the studies have been conducted in upper income countries using often costly medication with heterogeneous samples. While the overall outcome of patients showed some progress, there is room for improvement yet. The overall aim of the dissertation was to study the clinical, biological and functional aspects of outcome in first episode schizophrenia in a resource constrained setting. We conducted a prospective, non-comparative, longitudinal study over 12 months assessing the efficacy and tolerability of a cost effective, long-acting injectable antipsychotic (LAI; flupenthixol decanoate) combined with an assertive monitoring program (AMP) among first-episode schizophrenia patients. Efficacy was measured by examining rates of response, remission and relapse, as well as quality of life and social and occupational functioning. Tolerability of our intervention was assessed by measuring extrapyramidal symptoms, and weight and metabolic changes. We also examined the evolution of treatment refractoriness by studying the rates of non-response, and other associated predictor and outcome features. We found high rates of acceptance and adherence to the LAI and AMP. Seventy percent of our patients completed the 12 months of treatment. Treatment response was achieved by 82% of the participants and 60% achieved remission. Although 19% of our patients relapsed, the majority of the relapses were mild and did not require hospitalisation. Patients experienced significant quality of life and social and occupational functioning improvements. We found mild rates of extrapyramidal effects, present in only a third of our cohort. The majority of the extrapyramidal effects were treated with anticholinergics or propranolol. Only 3% of our patients developed transient dyskinesia over the duration of the study. However, our cohort gained considerable weight, with statistically significant increases in BMI (p< .0001) and waist circumference (p=0.0006). Our cohort also experienced significant deleterious changes to their lipid profiles. Of particular concern was the increase in triglycerides (p=0.03) and a significant decrease in high density lipoprotein (p=0.005) leading to a 91% increase in the triglyceride/high density lipoprotein ratio. With regards to emerging treatment refractoriness, 12% of our patients met our pre-defined criteria for non-response. Non-responders were younger and at baseline showed more prominent disorganised symptoms, poorer social and occupational functioning, poorer quality of life for psychological, social and environmental domains, more prominent neurological soft signs (NSS), and lower BMI. At endpoint the non-responders were characterised by higher levels of symptomatology in all domains; poorer functional outcome, poorer quality of life and greater cognitive impairments. They also had more prominent NSS and a lower BMI. The strongest predictors of non-response were prominent baseline NSS and poor early (7 weeks) treatment response. In conclusion, the combination of an LAI with an AMP may be an effective and safe intervention in firstepisode schizophrenia, and may be particularly suitable for resource-constrained settings. The risk of weight gain and metabolic syndrome associated with antipsychotic treatment in first-episode schizophrenia are not restricted to second generation antipsychotics and low-potency first-generation antipsychotics. Ensuring effective treatment for first episode schizophrenia patients is a global problem, and likely to be under-recognised in LMICs.
- ItemRace trouble : experiences of black medical specialist trainees in South Africa(BioMed Central, 2016-12-03) Thackwell, Nicola; Swartz, Leslie; Dlamini, Sipho; Phahladira, Lebogang; Muloiwa, Rudzani; Chiliza, BonginkosiENGLISH SUMMARY : Background: This research aimed to identify and explore the experiences of Black registrars in their training in the Western Cape’s academic hospitals in order to identify structures, practices, attitudes and ideologies that may promote or impede the advancement of Black doctors into specialist medicine. This is justified by the requirement for universities to work towards monitoring and evaluating efforts to create non-discriminatory and inclusive training environments. Methods: This study employed qualitative research methods. Ten Black African medical specialists were interviewed about their training experiences in two university training hospitals in the Western Cape Province, South Africa. Interview data was collected using open-ended questions and coded and analysed using thematic and critical discursive analysis techniques. Results: Four experiential themes emerged from the interview data, they included: 1) experiences of everyday racism during work hours, 2) the physical and psychological effects of tokenism and an increased need to perform, 3) institutional racism as a result of inconsistent and unclear methods of promotion and clinical competence building, and 4) an organisational culture that was experienced as having a race and gender bias. Conclusion: This is a pilot study and there are limits on the generalizability of the data due to the small sample. What is clear from our participants, though, is the strong experiential component of finding it challenging to be a Black trainee in a White-dominated profession. We are undertaking further research to explore the issues raised in more detail.
- ItemSniffing out olfactory reference syndrome(AOSIS Publishing, 2017) Thomas, Eileen; Voges, Juane; Chiliza, Bonginkosi; Stein, Dan J.; Lochner, ChristineOlfactory reference syndrome is characterised by the erroneous belief that one emits an unpleasant body odour. This results in significant distress and is often accompanied by repetitive behaviour such as frequent showering in an attempt to camouflage the perceived odour. The body odour concerns may have a delusional quality and do not respond to simple reassurance or counterexample. Herein, we report the case of an olfactory reference disorder (ORD) patient who had received multiple medical interventions and undergone polysurgery prior to an accurate diagnosis being established. ORD may lead to significant disability, yet often goes unrecognised for many years. For many patients, poor insight will contribute to their reluctance to consider psychiatric treatment. This case demonstrated that a multimodal treatment approach comprising judicious medication use, combined with cognitive behavioural therapy, in the context of a therapeutic alliance yielded therapeutic success.