Browsing by Author "Niehaus, Dana J. H."
Now showing 1 - 13 of 13
Results Per Page
Sort Options
- ItemA case of Ifufunyane : a Xhosa culture-bound syndrome(Lippincott, Williams & Wilkins, 2005-11) Niehaus, Dana J. H.; Stein, Dan J.; Koen, Liezl; Lochner, Christine; Muller, Jacqueline E.; Mbanga, N. Irene; Emsley, Robin A.; Gorman, Jack M.Clinicians and patients frequently have a different understanding and interpretation of the nature of an illness. While many reasons for these discrepancies can be postulated, differences in sociocultural background often play an important role—especially in the field of psychiatry. At our tertiary psychiatric hospital in South Africa, where standard Western teachings are followed, clinicians are often confronted by patients who have a markedly different interpretation of their psychiatric symptoms compared with the clinician’s perspective. For instance, “ifufunyane” (plural “amafufunyana”), a ritualized”“possession state,” often thought to result from witchcraft, is frequently reported by South African (Xhosa) patients with psychosis (including schizophrenia) and their families.
- ItemChromosome 22q11 in a Xhosa schizophrenia population(Health and Medical Publishing Group (HMPG), 2012-03) Koen, Liezl; Niehaus, Dana J. H.; Wright, Galen; Warnich, Louise; De Jong, Greetje; Emsley, Robin A.; Mall, SumayaChromosome 22q11 aberrations substantially increase the risk for developing schizophrenia. Although micro-deletions in this region have been extensively investigated in different populations across the world, little is known of their prevalence in African subjects with schizophrenia. We screened 110 African Xhosa-speaking participants with schizophrenia for the presence of micro-deletions. As further verification for the presence or absence of 22q11 microdeletions, we screened 238 Xhosa schizophrenia patients and 240 healthy Xhosa individuals from a larger schizophrenia candidate 22q11 gene study using molecular analyses. Data from molecular and cytogenetic analyses confirmed the absence of 22q11 microdeletions in the Xhosa schizophrenia samples. Although the absence of chromosome 22q11 micro-deletions in this group of patients does not exclude the possibility that it may occur in Xhosa schizophrenia patients, we concluded an extremely low prevalence. Our findings suggest that unique susceptibility loci may be present in this group.
- ItemCrisis discharges and readmission risk in acute psychiatric male inpatients(BioMed Central, 2008-06) Niehaus, Dana J. H.; Koen, Liezl; Galal, Ushma; Dhansay, Khalid; Oosthuizen, Piet P.; Emsley, Robin A.; Jordaan, EsmeBackground: Severe pressures on beds in psychiatric services have led to the implementation of an early ("crisis") discharge policy in the Western Cape, South Africa. The study examined the effect of this policy and length of hospital stay (LOS) on readmission rates in one psychiatric hospital in South Africa. Methods: Discharge summaries of adult male patients (n = 438) admitted to Stikland Psychiatric Hospital during 2004 were retrospectively examined. Each patient's clinical course was then analysed for the period between January 1st, 2004, and August 31st, 2006. Results: Although shorter LOS was associated with decreased readmission rates, the effect of crisis discharges was far more powerful. Patients discharged as usual had a far lower risk of readmission than those discharged due to bed pressures (i.e. crisis discharge). Conclusion: Increased risks associated with the early discharge policy necessitate the urgent review of the current management of bed shortages in this inpatient facility. The strengthening of community initiatives, particularly assertive outreach could be a way forward.
- ItemCross-cultural analysis of attention disengagement times supports the dissociation of faces and patterns in the infant brain(Nature Research (part of Springer Nature), 2019-10) Pyykko, Juha; Ashorn, Per; Ashorn, Ulla; Niehaus, Dana J. H.; Leppanen, Jukka M.Infants are slower to disengage from faces than non-face patterns when distracted by novel competing stimuli. While this perceptual predilection for faces is well documented, its universality and mechanisms in relation to other aspects of attention are poorly understood. We analysed attention disengagement times for faces and non-face patterns in a large sample of 6-to 9-month-old infants (N = 637), pooled from eye tracking studies in socioculturally diverse settings (Finland, Malawi, South Africa). Disengagement times were classified into distinct groups of quick and delayed/censored responses by unsupervised clustering. Delayed disengagement was frequent for faces (52.1% of trials), but almost negligible for patterns (3.9% of trials) in all populations. The magnitude of this attentional bias varied by individuals, whereas the impact of situational factors and facial expression was small. Individual variations in disengagement from faces were moderately stable within testing sessions and independent from variations in disengagement times for patterns. These results point to a fundamental dissociation of face and pattern processing in infants and demonstrate that the bias for faces can be robust against distractors and habituation. The results raise the possibility that attention to faces varies as an independent, early-emerging social trait in populations.
- ItemThe development of the visual screening tool for anxiety disorders and depression : addressing barriers to screening for depression and anxiety disorders in hypertension and/or diabetes(AOSIS, 2018-06) Ogle, Zimbini; Koen, Liezl; Niehaus, Dana J. H.Background: There is a lack of screening tools for common mental disorders that can be applied across cultures, languages and levels of education in people with diabetes and hypertension. Aim: To develop a visual screening tool for depression and anxiety disorders that is applicable across cultures and levels of education. Setting: Participants were purposively recruited from two not-for-profit organisations and two public health facilities – a maternal mental health unit and a primary health care centre. Method: This was a qualitative cross-sectional study. Thirteen drawings based on the Hospital Anxiety and Depression Scale depicting symptoms of anxiety disorders and depression were drawn. Participants described emotions and thoughts depicted in the drawings. Data were analysed through content analysis. Results: Thirty-one women (66%) and 16 men (34%) participated in the development of the visual screening tool. The mean age was 34 (standard deviation [SD] 12.46). There were 32 (68%) black participants, 11 (23%) mixed race participants and 4 (9%) white participants. Two participants (4%) had no schooling, 14 (31%) primary schooling, 8 (18%) senior schooling, 13 (29%) matric qualification and 8 (18%) had post-matric qualification. Participants correctly described 10 out of the 13 visual depiction of symptoms as associated with depression and anxiety disorders, with no differences between levels of education and cultural groups. Conclusion: Ten drawings were appropriate for inclusion in the visual screening tool for anxiety disorders and depression (VISTAD). The VISTAD will be validated against the mini international neuropsychiatric interview (MINI) in a primary care population with hypertension and/or diabetes.
- ItemFacial affect recognition and exit examination performance in medical students : a prospective exploratory study(BioMed Central, 2014-11) Roos, Tessa C.; Niehaus, Dana J. H.; Leppanen, Jukka M.; Ras, Johan; Cloete, Karen J.; Jordaan, Esme; Koen, LiezlBackground: Facial affect recognition (FAR) abilities underpin emotional intelligence (EI). The latter is suggested to predict academic success and to be important for clinician-patient interaction. It is therefore of interest to investigate the possible association between FAR and academic performance in undergraduate medical students. Methods We assessed the association between the ability to recognize emotions through facial expression and exit examination performance, a measure of clinical proficiency, in undergraduate medical students stratified by gender at a South African tertiary institution using a prospective descriptive design. Data on the perception of facial expressions and exit examination marks were obtained from 144 (61%) females and 93 (39%) males with a mean age of 24.1 ± 1.6 years. Facial affect recognition measures on the Hexagon and Animation tasks were individually correlated with academic performance indicators using Pearson correlation. Results The perceptual discrimination of anger was associated with improved performance in anaesthetics (r = .24; p = .004) and urology (r = .24; p = .001), while the recognition of happiness was associated with decreased performance in obstetrics (r = −.21, p = .002). Gender was an effect modifier in the relationship between perceptual discrimination of anger and urology performance (p = .03), with a strong positive relationship for males, but a non-significant relationship for females. Conclusion There was no overall correlation between FAR and overall academic performance or with gender. However, subject (specialty) specific findings with recognition of specific emotions and with gender as effect modifier poses interesting questions about EI and FAR and prompts further research into FAR as a useful tool. Being an objective test and offering a more focused assessment makes FAR worthy of further application.
- ItemThe impact of a psychiatry clinical rotation on the attitude of South African final year medical students towards mental illness(BMC (part of Springer Nature), 2019-04-25) De Witt, Caro; Smit, Inge; Jordaan, Esme; Koen, Liezl; Niehaus, Dana J. H.; Botha, UllaBackground: Stigmatising attitudes of health care professionals towards mental illness can impede treatment provided for psychiatric patients. Many studies have reported undergraduate training to be a critical period for changing the attitudes of medical students, and one particularly valuable intervention strategy involves time spent in a clinical psychiatric rotation. In South Africa, medical students are exposed to a clinical rotation in psychiatry but there is no evidence to show whether this has an effect on attitudes toward mental illness. Methods: This prospective cohort study involved a convenience sample of 112 South African medical students in their 5th or 6th year of undergraduate training. This sample attended a 7-week psychiatry rotation. The Attitudes to Mental Illness Questionnaire (AMIQ) was used to assess students’ attitudes toward mental illness before and after the clinical rotation which includes exposure to a number of psychiatric sub-divisions and limited didactic inputs. Results: There was a significant improvement (p < 0.01, t-test) in the students’ attitude toward mental illness following the psychiatric rotation. Females displayed a more positive attitude towards mental illness at the end of the rotation compared to males. The participants’ attitude significantly deteriorated for the non-psychiatric vignette describing diabetes (< 0.01, t-test). Conclusions: Our findings suggest that clinical training and exposure to a psychiatric setting impacts positively on medical students’ attitude towards mental illness, even when this training does not include any focused, didactic anti-stigma input.
- ItemMorphological features in a Xhosa schizophrenia population(BioMed Central, 2006-10) Koen, Liezl; Niehaus, Dana J. H.; De Jong, Greetje; Muller, Jacqueline E.; Jordaan, EsmeBackground: Demonstrating an association between physical malformation and schizophrenia could be considered supportive of a neurodevelopmental origin of schizophrenia and may offer insights into a critical period for the development of this illness. The aim of our study was to investigate whether differences in the presence of minor physical anomalies could be demonstrated between schizophrenia sufferers and normal controls in a Xhosa population with a view to identifying a means of subtyping schizophrenia for use in future genetic studies. Methods: Sixty-three subjects with schizophrenia (21 sibling pairs, 1 sibship of four and a group of probands with an affected non-participating sibling (n = 17)), 81 normal controls (37 singletons and 22 sibling pairs) of Xhosa ethnicity were recruited. Each participant was then examined for minor physical anomalies using the Modified Waldrop scale. The relationship between each of the morphological features and the presence of an affected sib was examined using the Chi-squared test, followed by an intra-pair concordance analysis in the sibling pairs. Results: Gap between first and second toes was significantly more common in the affected sib pair group when compared to the non-affected sib pair group (p = 0.019) and non-affected singleton control group (p = 0.013). Concordance analysis also revealed increased concordance for this item in the affected sib pair group. Conclusion: These findings offer an intriguing possibility that in the Xhosa population, affected sib pair status may be linked to a neurodevelopmental insult during a specific period of the fetal developmental.
- ItemObsessive-compulsive disorder and trichotillomania : a phenomenological comparison(BioMed Central, 2005-01) Lochner, Christine; Seedat, Soraya; Du Toit, Pieter L.; Nel, Daniel G.; Niehaus, Dana J. H.; Sandler, Robin; Stein, Dan J.Background: Similarities between obsessive-compulsive disorder (OCD) and trichotillomania (TTM) have been widely recognized. Nevertheless, there is evidence of important differences between these two disorders. Some authors have conceptualized the disorders as lying on an OCD spectrum of conditions. Methods: Two hundred and seventy eight OCD patients (n = 278: 148 male; 130 female) and 54 TTM patients (n = 54; 5 male; 49 female) of all ages were interviewed. Female patients were compared on select demographic and clinical variables, including comorbid axis I and II disorders, and temperament/character profiles. Results: OCD patients reported significantly more lifetime disability, but fewer TTM patients reported response to treatment. OCD patients reported higher comorbidity, more harm avoidance and less novelty seeking, more maladaptive beliefs, and more sexual abuse. OCD and TTM symptoms were equally likely to worsen during menstruation, but OCD onset or worsening was more likely associated with pregnancy/puerperium. Conclusions: These findings support previous work demonstrating significant differences between OCD and TTM. The classification of TTM as an impulse control disorder is also problematic, and TTM may have more in common with conditions characterized by stereotypical self-injurious symptoms, such as skin-picking. Differences between OCD and TTM may reflect differences in underlying psychobiology, and may necessitate contrasting treatment approaches.
- ItemOccupation and schizophrenia in a Xhosa population - A variant of the social drift theory?(Health & Medical Publishing Group, 2004) Brink, Sandra; Niehaus, Dana J. H.; Oosthuizen, Piet; Muller, Jacqueline; Koen, LiezlENGLISH SUMMARY : no abstract available.
- ItemSingle photon emission computed tomography (SPECT) of anxiety disorders before and after treatment with citalopram(BioMed Central, 2004-10) Carey, Paul D.; Warwick, James; Niehaus, Dana J. H.; Van der Linden, Geoffrey; Van Heerden, Barend B.; Harvey, Brian H.; Seedat, Soraya; Stein, Dan J.Background: Several studies have now examined the effects of selective serotonin reuptake inhibitor (SSRI) treatment on brain function in a variety of anxiety disorders including obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and social anxiety disorder (social phobia) (SAD). Regional changes in cerebral perfusion following SSRI treatment have been shown for all three disorders. The orbitofrontal cortex (OFC) (OCD), caudate (OCD), medial pre-frontal/cingulate (OCD, SAD, PTSD), temporal (OCD, SAD, PTSD) and, thalamic regions (OCD, SAD) are some of those implicated. Some data also suggests that higher perfusion pre-treatment in the anterior cingulate (PTSD), OFC, caudate (OCD) and antero-lateral temporal region (SAD) predicts subsequent treatment response. This paper further examines the notion of overlap in the neurocircuitry of treatment and indeed treatment response across anxiety disorders with SSRI treatment. Methods: Single photon emission computed tomography (SPECT) using Tc-99 m HMPAO to assess brain perfusion was performed on subjects with OCD, PTSD, and SAD before and after 8 weeks (SAD) and 12 weeks (OCD and PTSD) treatment with the SSRI citalopram. Statistical parametric mapping (SPM) was used to compare scans (pre- vs post-medication, and responders vs non-responders) in the combined group of subjects. Results: Citalopram treatment resulted in significant deactivation (p = 0.001) for the entire group in the superior (t = 4.78) and anterior (t = 4.04) cingulate, right thalamus (t = 4.66) and left hippocampus (t = 3.96). Deactivation (p = 0.001) within the left precentral (t = 4.26), right mid-frontal (t = 4.03), right inferior frontal (t = 3.99), left prefrontal (3.81) and right precuneus (t= 3.85) was more marked in treatment responders. No pattern of baseline activation distinguished responders from non-responders to subsequent pharmacotherapy. Conclusions: Although each of the anxiety disorders may be mediated by different neurocircuits, there is some overlap in the functional neuro-anatomy of their response to SSRI treatment. The current data are consistent with previous work demonstrating the importance of limbic circuits in this spectrum of disorders. These play a crucial role in cognitive-affective processing, are innervated by serotonergic neurons, and changes in their activity during serotonergic pharmacotherapy seem crucial.
- ItemUndiagnosed metabolic syndrome and other adverse effects among clozapine users of Xhosa descent(AOSIS Publishing, 2014-07) Faasen, N.; Niehaus, Dana J. H.; Koen, L.; Jordaan, E.Background. Clozapine use is known to be associated with significant side-effects, including prolongation of the QT-interval, agranulocytosis and metabolic syndrome. However, few data exist on the prevalence of clozapine side-effects in patients of Xhosa descent. Objective. To gather data from Xhosa patients with schizophrenia to establish the prevalence of clozapine side-effects in this population. Methods. Twenty-nine Xhosa patients with schizophrenia (as per the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)) who had been receiving clozapine treatment for >1 year on an outpatient basis were selected for inclusion. All patients were participating in a genetics study in the Cape Metropolitan area. The participants were evaluated for the presence of side-effects (tests including an electrocardiogram, white blood cell count (WCC) and fasting blood glucose). Results. The prevalence of metabolic syndrome was 44.8% (95% confidence interval (CI) 26.7 - 62.9) and of undiagnosed diabetes mellitus 13.8% (95% CI 1.24 - 26.34). There was a significant association between metabolic syndrome and body mass index (BMI) (p<0.01). The mean (SD) WCC was 7.8 × 109/L (2.8), with 3.4% of the subjects having a WCC <3.5 × 109/L. Sedation (82.8%; 95% CI 69.0 - 96.5), hypersalivation (79.3%; 95% CI 64.6 - 94.1) and constipation (44.8%; 95% CI 26.7 - 62.9) were common. The mean QT-interval was 373.8 (35.9) ms and 10% had a corrected QT-interval >440 ms. There was an association between the duration of clozapine treatment and QT-interval (with Bazett’s correction). Conclusion. The high prevalence of metabolic syndrome and undiagnosed diabetes mellitus in this sample points to a need to monitor glucose levels and BMI on a regular basis. A larger study should be done to accurately quantify the differences in prevalence of side-effects between population groups.
- ItemWhen apparent schizophrenia is excluded(AOSIS Publishing, 2015) Fourie, Hester F.; Koen, Liezl; Niehaus, Dana J. H.; Schoeman, Mardelle; Botha, Ulla A.Where must a clinician turn when straightforward schizophrenia suddenly turns out to be just the opposite? Fortunately, these days, there are protocols for just about everything. But how much value do these add? This article outlines the journey of our attempt to follow one such protocol.