Browsing by Author "Kilian, Sanja"

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    Associations of premorbid adjustment with type and timing of childhood trauma in first-episode schizophrenia spectrum disorders
    (AOSIS, 2021-06) Smit, Anna M.; Kilian, Sanja; Emsley, Robin A.; Luckhoff, Hilmar K.; Swartz, Leslie; Seedat, Soraya; Asmal, Laila
    Background: Childhood trauma may contribute to poorer premorbid social and academic adjustment which may be a risk factor for schizophrenia. Aim: We explored the relationship between premorbid adjustment and childhood trauma, timing of childhood trauma’s moderating role as well as the association of clinical and treatment-related confounders with premorbid adjustment. Setting: We conducted a secondary analysis in 111 patients with first-episode schizophrenia (FES) disorders that formed part of two parent studies, EONKCS study (n =73) and the Shared Roots study (n =38). Methods: Type of childhood trauma was assessed with the Childhood Trauma Questionnaire, short-form and premorbid adjustment using the Premorbid Adjustment Scale. Timing of childhood trauma was assessed using the Life Events Checklist and life events timeline. Linear regression analyses were used to assess the moderating effect of timing of childhood trauma. Clinical and treatment-related confounders were entered into sequential hierarchical regression models to identify independent predictors of premorbid adjustment across key life stages. Results: Childhood physical neglect was associated with poorer premorbid academic functioning during childhood and early adolescence, and poorer premorbid social functioning during early and late adolescence. By hierarchical regression modelling (r2 = 0.13), higher physical neglect subscale scores (p = 0.011) independently predicted poorer premorbid social adjustment during early adolescence. Timing of childhood trauma did not moderate the relationship between childhood trauma and premorbid functioning. Conclusion: In patients with FES, childhood physical neglect may contribute to poorer premorbid social functioning during early adolescence. This may provide us with an opportunity to identify and treat at-risk individuals earlier.
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    Cognitive insight is associated with perceived body weight in overweight and obese adults
    (BMC (part of Springer Nature), 2021-03-19) Suliman, Sharain; L. Van Den Heuvel, Leigh; Kilian, Sanja; Brocker, Erine; Asmal, Laila; Emsley, Robin; Seedat, Soraya
    Background: Accurate perception of body weight is necessary for individuals with a high body mass index (BMI) to initiate strategies to improve their health status. Furthermore, identifying factors that influence accurate body weight perception can assist in designing appropriate educational and weight management programs. We therefore aimed to investigate whether levels of cognitive functioning and insight influence the ability to correctly judge body weight. Methods: One hundred and eighty four overweight and obese adults who participated in a cross- sectional casecontrol study and were controls in the aforementioned study were included. The study was conducted in Cape Town, South Africa. Demographic, weight-related, neuropsychiatric, neurocognitive and cognitive insight measures were administered. Regression analysis was conducted to determine the factors associated with correct weight perception. Results: The final regression model explained 52.3% of variation in accurate perception of body weight and was significant (p ≤ 0. 001). The model correctly classified 79.3% of individuals who were able to correctly and incorrectly judge their weight. Adults with higher BMI, and lower self-certainty, those who reported that they had gained weight in the previous year and those who were told by a healthcare professional to lose or maintain a healthy weight were more likely to correctly judge their weight. Conclusion: Some aspects of cognitive insight (self-certainty) but not cognitive functioning were associated with perception of body weight in this sample. Awareness of recent weight changes, higher BMI and advice from of health care professionals were also significantly associated with perception of body weight, while demographic variables were not. Understanding the factors that contribute to the correct perception of weight is important in identifying appropriate health interventions that may address the burden of associated non-communicable diseases in overweight and obese individuals.
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    Cognitive-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, Martin
    Background: 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.
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    Doing 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, Bonginkosi
    Background 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.
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    Efficacy and safety profile of paliperidone palmitate injections in the management of patients with schizophrenia : an evidence-based review
    (Dove Medical Press, 2018) Emsley, Robin A.; Kilian, Sanja
    The course of schizophrenia is characterized by multiple relapses, incomplete remission of symptoms, enduring cognitive deficits, and social and occupational functional impairments. Nonadherence to antipsychotic medication is a major determinant of this poor outcome. Long-acting injectable antipsychotics were developed specifically to address the nonadherence problem and are increasingly considered as an early treatment option, in an attempt to prevent accruing morbidity. This review focuses on paliperidone palmitate, the long-acting injectable (LAI) formulation of paliperidone. After considering the pharmacology of paliperidone palmitate, we review the randomized controlled trials, as well as pertinent observational, pragmatic studies for paliperidone once-monthly injections in schizophrenia. Finally, we review the recently introduced 3-monthly formulation of paliperidone palmitate. Taken together, the studies indicate that paliperidone palmitate (PP) has good efficacy compared with placebo and comparable with other antipsychotics including risperidone. The tolerability profile of PP is similar to that of risperidone, with the most important side effects being prolactin elevation, weight gain, and extrapyramidal symptoms. Advantages of PP include the extensive research database and clinical experience with paliperidone and its parent compound risperidone, the availability of different LAI formulations (once-monthly, 3-monthly, and perhaps even longer acting formulations in future), and the novel dose initiation procedure that provides rapid onset of action without the need for oral antipsychotic supplementation.
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    Factors moderating the relationship between childhood trauma and premorbid adjustment in first-episode schizophrenia
    (Public Library of Science, 2017-01-20) Kilian, Sanja; Burns, J. K.; Seedat, S.; Asmal, L.; Chiliza, B.; Du Plessis, S.; Du Plessis, M. R.; Kidd, Michael; Emsley, Robin A.
    Childhood trauma is a recognised risk factor for schizophrenia. It has been proposed that childhood trauma interferes with normal neurodevelopment, thereby establishing a biological vulnerability to schizophrenia. Poor premorbid adjustment is frequently a precursor to schizophrenia, and may be a manifestation of neurodevelopmental compromise. We investigated the relationship between childhood trauma and premorbid adjustment in 77 patients with first-episode schizophrenia spectrum disorders. We also investigated possible mediating roles for other selected risk factors in the relationship. We found several significant correlations between different trauma types and both social and academic premorbid adjustment from childhood to late adolescence. There were no significant moderating effects for family history of schizophrenia or family history of psychiatric disorder. History of obstetric complications, substance abuse and poor motor coordination weakened some of the associations between childhood trauma and premorbid adjustment, while poor sequencing of motor acts strengthened the association. Our results confirm previous studies indicating an association between childhood trauma and premorbid adjustment. Results indicate a general rather than specific association, apparent with different types of trauma, and affecting both social and academic components of premorbid adjustment across childhood, early and late adolescence. Further, our results suggest a complex interplay of various risk factors, supporting the notion of different pathways to psychosis.
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    Instruments 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.
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    Interpreting practices in a psychiatric hospital : interpreters' experiences and accuracy of interpreting of key psychiatric terms
    (Stellenbosch : University of Stellenbosch, 2007-12) Kilian, Sanja; Swartz, Leslie; University of Stellenbosch. Faculty of Arts and Social Sciences. Dept. of Psychology.
    The main objective of this study was to investigate interpreting practices within the psychiatric hospital San Marco1, in the Western Cape. More specifically, the aim was to determine what factors might lead to the obstruction of accuracy by asking employees that act as official and unofficial interpreters to report on certain issues relating to interpreting practices. The second objective of the study was to gain some understanding of what interpreters experience when doing interpreting especially since unofficial interpreters (nurses, cleaners and administrative staff) are often used to act as interpreters within South Africa’s public health services and this may not only have implications for accuracy but also for interpreters’ own mental health. A cross-sectional qualitative interview design was used. The research participants consisted of eight employees of San Marco, (including two administrative clerks/ interpreters, two bilingual security guards, and four bilingual nurses), and two bilingual psychiatrists, who, though not being employees of San Marco, yet have experience in interpreting while working as psychiatrists within psychiatric institutions in South Africa. Participants were asked to respond to semi-structured questions. In addition, participants took part in a structured task in which they were asked to translate and back-translate commonly-used diagnostic questions. Content analysis was used to analyse data collected from semi-structured interviews and participants’ translations and back-translations were checked for inaccuracies. The analysis of interviews revealed the following information: • not all of the participants who act as interpreters are in fact functionally bilingual in the context with which they work • none of the interpreters are trained in interpreting; and • a clear distinction could be drawn between interpreters who have training in mental health compared to those who lack training in mental health or psychiatry. Furthermore participants’ translations of the nine questions were approximately right. Participants’ translations conveyed more or less the same messages as what was intended with the original English questions. In fact the translations were fairly accurate for untrained interpreters. However, participants were not always specific as to what they were asking about. Interpreters need to translate questions in such a way that it is diagnostically specific in order for the clinician to make an accurate diagnosis. It is crucial that patients have a clear understanding about what the interpreter are asking them and this was not always evident in participants’ translations. The abovementioned results may for obvious reasons lead to the obstruction of accurate interpretation however it should not be attributed to a lack of competence on the interpreters part but should rather be attributed to challenges in a health system which has inherited a history of discrimination and continues to discriminate against certain patients, even when clinicians and interpreters alike may be doing their best not to discriminate. The problem is structural rather than individual, and needs to be addressed as such, and in the context of competing demands in public health care. Although the interviews did reveal valuable information regarding the obstruction of accuracy it should be kept in mind that an analysis of actual recorded interpreting sessions between the clinician, patient and interpreter is necessary for a more in depth understanding of the obstruction of accuracy as investigated in this study and such a study is currently in the planning phase.
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    Interpreting within a South African psychiatric hospital : a detailed account of what happens in practice
    (Stellenbosch : Stellenbosch University, 2013-03) Kilian, Sanja; Swartz, Leslie; Dowling, Tessa; Dlali, Mawande; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
    ENGLISH ABSTRACT: It is more than 18 years since South Africa became a democratic country. However, many South Africans are still discriminated against when accessing state services, such as healthcare services (Drennan, 1999). The problem is that healthcare practitioners, in the higher positions of the healthcare system, are commonly made up of professionals who speak only one or at most two of South Africa’s official languages (Swartz, 1998). Due to the lack of funding ad hoc arrangements are made for interpreter-services (Drennan, 1999). Anyone available that can speak even a fragment of the patient’s language, such as nurses, household aides and security guards are called to act as interpreters (Drennan, 1999; Smith, 2011). In many clinical settings, although not ideal, it is possible to treat patients even if there are minimal shared communicative resources (Anthonissen & Meyer, 2008). However, in psychiatric care, language is the primary diagnostic tool, and is one of the central instruments through which patients voice their symptoms (Westermeyer & Janca, 1997). In the Western Cape (one of the nine provinces in South Africa), clinicians working in psychiatric care are mainly fluent in English and Afrikaans. Many Black isiXhosa-speaking patients are not proficient in these languages. The aim of this dissertation is to gain a better understanding of the language barriers facing isiXhosa-speaking patients by focusing on natural conversations, which take place during psychiatric interviews within a particular psychiatric institution in the Western Cape. I made video-recordings of interpreter-mediated psychiatric interviews (n=13) as well as psychiatric interviews (n=12) conducted without the use of an interpreter. In addition, I had discussions (i.e. through semi-structured interviews) with registrars, interpreters and patients to understand their views about issues related to language barriers and interpreting practices. I used an ethnographic approach and the method of Conversation Analysis to understand the study findings. The findings, derived from the psychiatric interviews that were not interpreter-mediated, suggest that the Limited English Proficient (LEP) patients had great difficulty communicating with the registrars. The findings (emerging from the interpreter-mediated encounters and semi-structured interviews), strongly suggest that the haphazard use of hospital employees, who are not trained and employed to act as interpreters, have a significant impact on the goals of the psychiatric interview. In some instances, the use of ad hoc interpreters positively contributed to the successful achievement of the goals of the psychiatric interview. In most instances, the use of ad hoc interpreters inhibited the successful achievement of the goals of the psychiatric interview. One of the most significant findings was that interpreters’ interpretations of patients’ words at times suggest that patients appear to be more psychiatrically ill (increasing the risk for over-diagnosis) than it appears when looking at patients’ original responses. In essence, the lack of language services is unjust towards patients, clinicians, hospital staff acting as ad hoc interpreters, and LEP patients caught in a system, which construct them as voiceless, dependent, powerless, healthcare users.
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    Language, 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, Bonginkosi
    Language 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