Browsing by Author "Lachman, Anusha"

Now showing 1 - 5 of 5
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    Body dysmorphic disorder : a diagnostic challenge in adolescence
    (AOSIS, 2018) Thungana, Yanga; Moxley, Karis; Lachman, Anusha
    Body dysmorphic disorder (BDD) is a chronic and disabling condition that is characterised by distressing preoccupations with perceived defects in one’s own appearance, which might be slight or not observable to others. It is considered to be an obsessive–compulsive spectrum disorder and is associated with depression, feelings of shame and poor quality of life. It is primarily a disorder of childhood or adolescent onset, and sub-clinical BDD symptoms begin, on average, several years before an individual’s symptoms meet full criteria for the disorder. Here we report the case of an adolescent admitted to an inpatient psychiatric unit for treatment of psychotic symptoms that were poorly responsive to standard treatments. This challenging case of BDD in an adolescent highlights the various comorbidities of the disorder, as well as the difficulties associated with BDD diagnosis.
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    I know that it's something that's creating a bond : fathers' experiences of participating in baby theater with their infants in South Africa
    (Frontiers Media, 2020) Cowley, Brenda; Lachman, Anusha; Williams, Elvin; Berg, Astrid, 1950-
    In many African countries, particularly those with largely patriarchal societies like South Africa, promoting father-child interaction can pose a challenge. An informative medium that could potentially encourage active participation in pleasurable interactions between fathers and babies may prove to be an important way in which to stimulate fathers' awareness of their infants' abilities. A Cape Town based theater company created the first ever South African baby play for care-givers and their babies between the ages of 2 weeks to 12 months. The play is performed in a contained, relaxing space and offers carers and babies time to relate to each other in a pleasurable atmosphere, while specially trained actors model sensitive and responsive interactions. Baby Theater could be a way to encourage fathers' involvement with their infants, however, no research is currently available documenting fathers' perceptions about Baby Theater experience. Aim: To explore fathers' experience of participating in Baby Theater. Method: This qualitative study involved six fathers who, with their infants, participated in the Baby Theater production. A week later the fathers were divided into two focus groups to give them the opportunity to discuss their thoughts about the experience and to reflect on whether it had any subsequent impact on their interactions with their babies. The audiotaped, transcribed material was thematically analyzed using an interpretative phenomenological approach. Results: The fathers described the experience as educative and enjoyable. They reported that the program had a positive impact on the way they interacted with their infants and also positively influenced their relationship with them. Additionally, they reported feeling more confident about coping with their babies on their own, and appreciated the connection with the other fathers in the group. Cultural, societal, and gender issues were also considered. Conclusions: The subjective experience of the fathers was positive. Further research is needed to assess the lasting effects of the Baby Theater experience.
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    Kleine-Levin syndrome as a neuropsychiatric presentation : a case report and review
    (AOSIS Publishing, 2014-07-30) Lachman, Anusha
    Kleine-Levin syndrome (KLS) is a rare disorder characterised by hypersomnia, hyperphagia and behavioural disturbances. It typically occurs in adolescent men and may mimic a variety of neuropsychiatric conditions. Here we report what appears to be the first published case of KLS in South Africa and trace the clinical course, investigations and diagnostic difficulties encountered in the management of this condition. An overview of the literature guiding the diagnosis, differentials and treatment is discussed.
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    A retrospective chart review of the clinical and psychosocial profile of psychotic adolescents with co-morbid substance use disorders presenting to acute adolescent psychiatric services at Tygerberg Hospital
    (2012) Lachman, Anusha; Nassen, Rene; Hawkridge, Sue; Emsley, Robin A.
    ENGLISH ABSTRACT: Background. A large number of adolescents meet criteria for 'dual diagnosis' (a psychiatric disorder plus co-morbid substance use disorder (SUD)), which prolongs treatment response and complicates intervention strategies. The current service model in Cape Town divides the care of such patients into psychiatric treatment and a separate substance use intervention. Child and adolescent mental health services face the challenge of high rates of readmission of adolescents into psychiatric facilities before utilisation of community-based substance abuse services. Objective. There is a scarcity of available treatment guidelines for dual-diagnosis adolescents, and a lack of systematically documented epidemiological and clinical data in South African adolescent populations. Method. A retrospective chart review of adolescent psychiatric admissions to the Tygerberg Adolescent Psychiatric Unit during 2010 was conducted. Relevant epidemiological, clinical and demographic data for those presenting with a dual diagnosis (specifically psychotic disorders and SUD) was recorded. Results. Results suggest a high prevalence of SUD among adolescents presenting with a first-episode psychosis. Statistically significant correlations with lower levels of education were found in those with ongoing substance abuse (specifically cannabis and methamphetamine), and a significant relationship between choice of debut drug and ongoing drug use was also demonstrated. Risk factors for SUD (psychosocial adversities, childhood trauma, family and community exposure to substances, early debut drug ages), risky sexual behaviours, and clinical psychiatric profiles of adolescents with dual diagnosis are described. Conclusions. This cohort had an enhanced risk as a result of genetic vulnerability and environmental availability of substances, and the findings emphasise the differences in presentation, choice of drugs of abuse and psychosocial difficulties of adolescents with a dual diagnosis presenting to a psychiatric facility. We aim to influence role-players to provide more integrated services, and highlight the need for future prospective studies in this adolescent group to assist in improving outcomes.
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    Shared pleasure in early infant interactions
    (Stellenbosch : Stellenbosch University, 2022-12) Lachman, Anusha; Niehaus, Dana J. H.; Puura, Kaija; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
    ENGLISH SUMMARY: Infant mental health is strongly connected to the quality of caregiving relationships, specifically to the mutual adaptation of the infant and caregiver. Positive shared emotions in infant–caregiver relationships build social, intellectual and psychological resources for the infant, which facilitates optimal growth and development. Sharing positive affect fuels the organisation of early infant experiences of socialisation, and the mother–infant interaction may constitute the first environmental context to shape these abilities. Synchronised behaviours (such as mutual gaze and gaze following) between mothers and their infants are thought to create the foundation of early social connectedness and regulation. Infants are extremely sensitive to the emotional states of their mothers and shared joy is the goal for which mother and child instinctively strive. Shared pleasure (SP) moments in parent–infant interaction are defined as “the parent and the child sharing positive affect in synchrony”. This is expressed in facial expressions, such as a laugh or curving of mouth to smile, together with a direct gaze contact, and a simultaneous or synchronised beginning and ending. SP sequences are analysed from free play video recordings of mother–infant interaction situations by coding the occurrence and duration of moments, including shared eye contact and mutual, synchronous smile or laughter. Shared pleasure is considered a marker of more regulated emotions and, when absent, serves as a possible screening marker for early identification of at-risk dyads. This original study of SP in South Africa focused on mothers and their young infants in a clinical and community setting. The aims of the study were to determine the frequency and duration of SP moments in infants born to mothers with and without mental illness, to correlate SP moments with the Bayley scales of infant toddler development and to determine the presence of sustained infant withdrawal as assessed by the Alarm Distress Baby (ADBB) meausurement of infant withdrawal. The first two studies (Maternal and Infant Mental health study, n = 91) showed an overall low occurrence of SP moments (20%) in the clinical sample, although significantly more SP moments (p = 0.02) were recorded in mothers with no mental illnesses. When infants were screened for withdrawal behaviours measured by a validated tool (the Alarm Distress Baby Scale), there was a significant correlation between low occurrence of SP and higher rates of Infant withdrawal (p = 0.0002). Interestingly, in this sample of high-risk infants, those who experienced SP moments with their mothers at 6 months showed an improvement in cognitive (p = 0.052) and motor (0.007) scores at 18 months. While overall cognitive improvements were noted across the sample, further regression modelling showed stronger associations for the presence of SP moments. Additionally, having an SP moment resulted in a smaller decrease in later motor scores compared with those without an SP moment. Results of the third Drakenstein Child Health Study of SP in the community-based sample of 291 infants and mothers showed a much higher occurrence (82%) of SP. There were no associations with SP and any risk factors, including on- screens of substance use, intimate partner violence, or postpartum depression. The high frequency of SP in a sample of high exposure to risk factors may suggest that SP in reciprocal interactions may only be disrupted in extreme cases(such as severe mental illness) and so may serve as an early red flag for screening if absent early in the interaction. A significant positive quality of the mother–infant relationship and parenting capacity has potential to contribute to favourable child development, especially in mothers at risk of mental illnesses. SP as demonstrated in this study may likely be one of those protective contributors. In a lower- and middle income country such as South Africa, it is important to recognise and screen early for relational difficulties between infant and caregivers, and SP may be considered as a potential screening tool for early, culturally appropriate social connectedness.