SUNScholar - Browsing by Author "Emsley, R. A."

Browsing by Author "Emsley, R. A."

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Alcohol Induced Psychotic Disorder: a comparitive study in patients with alcohol dependance, schizophrenia and normal controls
(Stellenbosch : University of Stellenbosch, 2007-12) Jordaan, Gerhard; Emsley, R. A.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Psychiatry.
Alcohol-induced psychotic disorder (also known as alcohol hallucinosis) is a complication of alcohol abuse that requires clinical differentiation from alcohol withdrawal delirium and schizophrenia. Although extensively described, few studies utilized standardized research instruments and brain-imaging has thus far been limited to case reports. The aim of this study was to prospectively compare four population groups (ie. patients with alcohol-induced psychotic disorder, schizophrenia, uncomplicated alcohol dependence and a healthy volunteer group) according to demographic, psychopathological and brainimaging variables utilizing (i) rating scales and (ii) single photon emission computed tomography (SPECT). The third component of the study was designed to investigate the (iii) effect of anti-psychotic treatment on the psychopathology and regional cerebral blood flow (rCBF) before and after six weeks of treatment with haloperidol. Effort was made to ensure exclusion of comorbid medical disorders, including substance abuse. The study provides further supportive evidence that alcohol-induced psychotic disorder can be distinguished from schizophrenia. Statistically significant differences in rCBF were demonstrated between the alcohol-induced psychotic disorder and other groups. Changes in frontal, temporal, parietal, occipital, thalamic and cerebellar rCBF showed statistically significant negative correlations with post-treatment improvement on psychopathological variables and imply dysfunction of these areas in alcohol-induced psychotic disorder. The study was unable to distinguish between pharmacological effects and improvement acccomplished by abstinence from alcohol.
Attitudes 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.
Co-occurrence of schizophrenia and obsessive compulsive disorder : a literature review
(Health & Medical Publishing Group, 1999) Emsley, R. A.; Stein, D. J.; Oosthuizen, P.
[No abstract available]
Cognitive changes in alcohol-induced psychotic disorder
(BioMed Central, 2017-04) Hendricks, Melany L.; Emsley, R. A.; Nel, D. G.; Thornton, H. B.; Jordaan, G. P.
ENGLISH SUMMARY : Aims: This study aimed to explore the neuro-cognitive deficits of alcohol-induced psychotic disorder as compared to the cognitive deficits of uncomplicated alcohol ependence. Methods: Participants were recruited from the acute psychiatric admission wards of the Department of Psychiatry, University of Stellenbosch and Stikland and Tygerberg Academic Hospitals in the Western-Cape, South Africa. Participants who met DSM IV TR criteria (American Psychiatric Association. Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington, DC, 2000) for Alcohol Dependence and for alcohol-induced psychotic disorder, respectively, were included. Participants who met criteria for another current DSM IV TR Axis I disorder were excluded. A structured interview was done prior to neuropsychological assessment to ascertain current mental state and to obtain relevant demographic detail and history. Neuropsychological assessments were performed and supervised by clinical psychologists at either Tygerberg or Stikland Hospital. Results: The groups were matched demographically with similar period of abstinence prior to assessment. The alcohol-induced psychotic disorder group experienced first psychotic symptoms at age 35. The results reflected statistically significant differences on tasks measuring immediate memory; recall upon delay; exaggeration of memory difficulty and abstract thinking. Conclusion: This study concurs with earlier literature that some cognitive deficits are greater in alcohol-induced psychotic disorder compared to uncomplicated alcohol dependence.
Computed tomography in psychiatric patients
(HMPG, 1986) Emsley, R. A.; Stander, D.; Bell, P. S. H.; Gledhill, R. F.
In a retrospective study of 100 consecutive adult psychiatric patients referred for computed tomography (CT) for suspected intracranial lesions, abnormalities were found in 61%. Of these, 23% had focal lesions significantly associated with alcohol abuse, previous craniocerebral trauma and focal neurological signs. Detection of focal lesions influenced patient management in over half the cases. No single factor was able to predict all patients with focal lesions and the correlation between electroencephalogram and CT results was weak. If criteria for CT in psychiatric patients are too restrictive, some cases of occult brain disease may escape detection.
A 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.
Establishing a neuropsychiatry clinic at Tygerberg hospital
(Health & Medical Publishing Group, 1999) La Cock, C.; Hugo, F. J.; Coetzer, R.; Van Greunen, G.; Kotze, C.; Emsley, R. A.
Objective. Neuropsychiatry is a neglected subspecialty in South Africa. The aim of this study was to assess the need for neuropsychiatry clinics by evaluating a recently established unit in South Africa and testing opinions of heads of academic psychiatry departments. Design. Three separate aspects were investigated. First, a retrospective analysis of patient records from the University of Stellenbosch neuropsychiatry and neuropsychology clinic (USNNC) was undertaken. Second, interviews were conducted with the clinical staff of the clinic, and third, questionnaires were sent to all heads of psychiatry departments in South Africa. Setting. USNNC, situated at Tygerberg Hospital. Subjects. Patients attending the USNNC, clinicians of the USNNC and heads of academic psychiatry departments in South Africa. Main outcome measures. Patients were assessed by means of a standard clinical assessment procedure and a multi-axial diagnosis was made according to the criteria of the Diagnostic nod Statistical Manual of Mental Disorders (DSM-IV), 4th ed. A semi-structured interview was conducted with the USNNC clinical staff to assess their opinions regarding the clinical importance of such a specialised clinic, possibilities for training, opportunities for research and possible improvements that could be made. The staff included a psychiatrist, a psychologist, an occupational therapist, a neurologist and a nuclear physician. An adapted questionnaire was used to assess the attitudes of heads of psychiatry departments in South Africa toward neuropsychiatry. Results. Mild neurocognitive disorder was the most common DSM-IV diagnosis. Head injuries were the most common Axis III disorder. According to USNNC clinicians, a multidisciplinary neuropsychiatric clinic provides for improved diagnosis and management of these disorders, as well as providing excellent training opportunities for psychiatry registrars and students of related disciplines. Heads of departments of psychiatry in South Africa had a clear understanding of the entity of neuropsychiatry but were divided on the question of fostering neuropsychiatry as a subspecialty. Most were confident that their graduates acquire the necessary clinical skills to evaluate and treat common neuropsychiatric disorders. Conclusions. Mild cognitive impairment, often due to head trauma, is most appropriately managed within a multidisciplinary setting. Such a facility provides good training opportunities for students in various disciplines. Much-needed research on treatment outcomes and cognitive rehabilitation can be undertaken in this setting. Improved communication between psychiatry departments in South Africa should lead to a pooling of resources and the provision of a better service to neuropsychiatric patients.
HIV/AIDS in Africa - A role for the mental health practitioner?
(Health & Medical Publishing Group, 2005) Stein, D. J.; Seedat, S.; Emsley, R. A.; Olley, B. O.
[No abstract available]
Inappropriate antidiuretic state in long-term psychiatric inpatients
(Health & Medical Publishing Group, 1990) Emsley, R. A.; Van Der Meer, H.; Aalbers, C.; Taljaard, J. J. F.; Emsley, R. A.; Van Der Meer, H.; Aalbers, C.; Taljaard, J. J. F.
To investigate the occurrence of an inappropriate antidiuretic state in a long-term psychiatric inpatient population, 690 patients underwent serum sodium determination. Forty-four patients (6.4%) had levels < 133 mmol/l. Fifteen of these patients could be investigated further and the biochemical findings in all were consistent with an inappropriate antidiuretic state. Evidence of previous episodes of water intoxication was found in 80% of these patients. Although more than one possible cause was present in most patients, the two factors most strongly incriminated in the pathogenesis of the inappropriate antidiuretic state were the drugs carbamazepine and hydrochlorothiazide.
Management of violent behaviour in acutely relapsed schizophrenics
(AOSIS Publishing, 2004-09-28) Koen, L.; Lategan, B. H.; Jordaan, E.; Niehaus, D. J. H.; Emsley, R. A.
The management of aggressive behaviour has always been a criticai issue in psychiatry. Finding measures that can be used to accurately predict the likelihood of assaultative behaviour and thus ensure timeous appropriate pharmacological management remains a dilemma. The study objective was to investigate the naturalistic, pharmacological management of inpatient aggressive behaviour in a group of 50 schizophrenic subjects with a view to determine: (1) whether a presenting history of recent violence lead to altered pharmacological management and (2) whether the NOSIE could be regarded as a useful assessment tool with regards to inpatient behaviour management. No significant difference could be demonstrated between the 2 subsets of subjects (history of violence vs none) with respect to total doses of medication administered. No statistical correlation could be found between the total NOSIE score and the dose of psychotropic medication used. The relationship between a subset of NOSIE-items and the total dose of medication was more complex and a clear linear relationship could be demonstrated for a total score of 0 to 5. In this particular ward setting a presenting history of recent violent behaviour did not influence the administration of medication and neither could the clinical judgement employed by the nursing staff to manage inpatient behaviour be captured by the NOSIE. However, a five-item subset of the NOSIE with questions relating to aggression and irritability warrants further scrutiny in this regard.
Medical research in South Africa : a psychiatric perspective
(Health & Medical Publishing Group, 1996) Stein, D. J.; Emsley, R. A.
We read the recent editorials on medical research in the new South Africa with great interest. MBewu1 argued convincingly that medical research in this country can be 'the fairy godmother who provides a brighter future for Cinderella'. In contrast, in answer to his question, 'Can we support high-tech research in South Africa', Van Rensburg2.
A new model for the pathophysiology of Alzheimer's disease : aluminium toxicity is exacerbated by hydrogen peroxide and attenuated by an amyloid protein fragment and melatonin
(Health & Medical Publishing Group, 1997) Van Rensburg, S. J.; Daniels, W. M. U.; Potocnik, F. C. V.; Van Zyl, J. M.; Taljaard, J. J. F.; Emsley, R. A.
Objectives. Although Alzheimer's disease (AD) is the leading cause of dementia in developed countries, there is an as yet unexplained lower prevalence of the disease in parts of Africa. AD is characterised by a catastrophic loss of neurons; free radicals (oxidative toxins) have been implicated in the destruction of the cells through the process of lipid peroxidative damage of cell membranes, previously aluminium (Al) and a fragment of beta amyloid (Aβ 25-35) were shown to exacerbate free-radical damage, while melatonin reduced this effect. The aim of the present study was: (i) to investigate the conditions determining the toxicity of Al and Aβ 25-35; and (ii) to assess whether melatonin could attenuate the damage done by both aluminium and the amyloid fragment, thus suggesting a pathway for the aetiology of AD. Design. An in vitro model system was used in which free radicals were generated, causing lipid peroxidation of platelet membranes, thus simulating the disease process found in the brain. Results. 1. Al and Aβ 25-35 caused lipid peroxidation in the presence of the iron (II) ion (Fe2+), Al being more toxic than Aβ 25-35. 2. Aβ 25-35 attenuated the lipid peroxidation promoted by Al. 3. Hydrogen peroxide (H2O2) greatly exacerbated the toxicity of Al and Aβ 25-35. 4. Melatonin prevented lipid peroxidation by Al and Aβ 25-35 in the absence of H2O2, but only reduced the process when H2O2 was present. Conclusions. In the light of the results obtained from the present study, the following hypotheses are formulated. 1. In AD, excessive quantities of Al are taken up into the brain, where the Al exacerbates iron-induced lipid peroxidation in the lysosomes. 2. In response, the normal synthetic pathway of amyloid protein is altered to produce Aβ fragments which attenuate the toxicity of Al. In the process of sequestering the Al and iron, immature plaques are formed in the brain. 3. Microglia are activated, in an attempt to destroy the plaques by secreting reactive oxygen species such as H2O2. At this point in the disease process, lipid peroxidation causes a catastrophic loss of brain cells. 4. Melatonin, together with other free radical scavengers in the brain, reduces the free-radical damage caused by Al and Aβ, except in the latter stages of the disease process. Since melatonin is produced by the pineal gland only in the dark, the excess of electric light in developed countries may help explain why AD is more prevalent in these countries than in rural Africa.
Obsessive compulsive disorder : prevalence in Xhosa-speaking schizophrenia patients
(Health & Medical Publishing Group, 2005) Niehaus, D. J. H.; Koen, L.; Muller, J.; Laurent, C.; Stein, D. J.; Lochner, C.; Seedat, S.; Mbanga, I.; Deleuze, J.-F.; Mallet, J.; Emsley, R. A.
Obsessive compulsive disorder (OCD) has been reported in up to 31% of schizophrenia sufferers. This study evaluated the presence of OCD in a Xhosa-speaking schizophrenia group. Xhosa patients (N = 509, including 100 sibships) with schizophrenia were recruited from hospital and community settings. The patients underwent a structured clinical interview for the presence of lifetime co-morbid schizophrenia and OCD. Only 3 patients (0.5%) fulfilled criteria for OCD. No concordance for OCD was noted in the sibship group. Our findings differ from those in other parts of the world, and if replicated, might suggest unique protective environmental or genetic factors for OCD in certain ethnic groups.
Prevalence 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.
Psychiatric manifestations of neurosyphilis
(Health & Medical Publishing Group, 1992) Roberts, M. C.; Emsley, R. A.
To investigate referral patterns, initial diagnoses and clinical features of patients with neurosyphilis who present with psychiatric manifestations, records were kept of 21 such patients admitted to an acute psychiatric ward. In none of the 12 cases referred from primary care workers was the possibility of neurosyphilis considered. In only 3 cases was this diagnosis considered on admission to the psychiatric ward before serum serological test results were known. Commonest presenting symptoms were personality change (16 patients) and memory impairment (13 patients). Neurological signs or symptoms were also common, particularly absent pupillary reaction to light (5 patients) and buccolingual masticatory movements (5 patients). A positive serological test remains the single most important factor in identifying patients with neurosyphilis.
Psychiatric 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.
Screening for syphilis and neurosyphilis in acute psychiatric admissions
(Health & Medical Publishing Group, 1992) Roberts, M. C.; Emsley, R. A.; Jordaan, G. P.
The value of blood screening for syphilis and cerebrospinal fluid (CSF) screening for neurosyphilis in acute psychiatric admissions is assessed. Of 1296 patients, 248 (19%) had evidence of previous or current syphilis as shown by a positive Treponema pallidum haemagglutination test, and 68 (5,2%) had potentially treatable syphilis as shown by a positive Venereal Disease Research Laboratory (VDRL) titre. CSF examination was performed on 169 patients with a positive blood test. Seventeen (i.e. 1,3% of all patients included in the study) met our criteria for neurosyphilis. The best predictor for neurosyphilis was the presence of a reactive serum VDRL. However, it is recommended that all patients with a positive blood test and symptoms that could possibly be ascribed to neurosyphilis undergo CSF examination.
Self-induced water intoxication : a case report
(Health & Medical Publishing Group, 1988) Emsley, R. A.; Taljaard, J. J. F.
A 19-year-old female schizophrenic with self-induced water intoxication is described. Factors of pathogenic significance included primary polydipsia and non-maximal urinary diluting capacity.
Serum phosphate and anxiety in major depression
(1990) Aalbers, C.; Emsley, R. A.; Taljaard, J. J. F.
[No abstract available]
The usefulness of cerebrospinal fluid tests for neurosyphilis
(Health & Medical Publishing Group, 1994) Russouw, H. G.; Roberts, M. C.; Emsley, R. A.; Joubert, J. J.
To determine the usefulness of cerebrospinal fluid (CSF) tests for syphilis at a large academic hospital, clinical and laboratory data on 644 patients in whom such testing was requested over a 12-month period were analysed. In 198 cases (31%) the Treponema pallidum haemagglutination (TPHA) screening test could not be performed because of insufficient fluid. Thirty-eight of the remaining patients were diagnosed as having active neurosyphilis. Examination of 22 files of patients who had a positive TPHA and fluorescent treponemal antibody absorption (FTA-Abs) test together with a negative CSF Venereal Disease Research Laboratory (VDRL) test revealed that other CSF measures indicating disease activity (CSF protein, cells or IgG index) were not utilised optimally. In 10 (45%) of these patients neurosyphilis was not diagnosed despite either abnormal or incomplete CSF biochemical analysis, indicating that if the CSF VDRL is used as the sole marker for disease activity, some cases of neurosyphilis are likely to be missed.

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