Browsing by Author "Seedat S."
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- ItemA comparison of the effects of citalopram and moclobemide on resting brain perfusion in social anxiety disorder.(2006) Warwick, James M.; Carey P.; Van der Linden G.; Prinsloo C.; Niehaus D.; Seedat S.; Dupont P.; Stein D.J.INTRODUCTION: The serotonin specific reuptake inhibitor (SSRI) citalopram and the reversible mono-amine oxidase-A inhibitor (RIMA) moclobemide have both been used successfully for the treatment of social anxiety disorder (SAD). In this study we investigate the effects of these compounds on resting brain function using single photon emission computed tomography (SPECT). METHODS: Subjects meeting DSM-IV criteria for SAD underwent regional cerebral blood flow (rCBF) SPECT using Tc-HMPAO at baseline and after 8 weeks of treatment with either citalopram or moclobemide. Using statistical parametric mapping brain SPECT studies were analysed to determine the effects of treatment on rCBF, to compare the effects of citalopram and moclobemide, and to detect correlations between changes in rCBF and clinical response. RESULTS: Subjects received citalopram (n=17) or moclobemide (n=14) as therapy. Subjects in both treatment groups demonstrated a significant improvement of SAD symptoms as measured by the Liebowitz Social Anxiety Scale total score. All subjects demonstrated a decrease in rCBF in the insulae post therapy. Subjects receiving citalopram had decreased superior cingulate rCBF after therapy compared to those receiving moclobemide. CONCLUSION: Both SSRI's and RIMA's decreased rCBF in the insulae during treatment of SAD; an effect that may be consistent with the role of these regions in processing internal somatic cues evoked by emotional stimuli. Citalopram had a greater effect on superior cingulate perfusion, an effect that is consistent with evidence of high levels of 5-HT transporters in this region.
- ItemA treatment algorithm for generalised anxiety disorder(2001) Stein D.J.; Seedat S.; Niehaus D.J.N.; Pienaar W.; Emsley R.A.[No abstract available]
- ItemAdjunctive quetiapine for serotonin reuptake inhibitor-resistant obsessive-compulsive disorder: A meta-analysis of randomized controlled treatment trials(2006) Fineberg N.A.; Stein D.J.; Premkumar P.; Carey P.; Sivakumaran T.; Vythilingum B.; Seedat S.; Westenberg H.; Denys D.Small studies have shown positive effects from adding a variety of antipsychotic agents in patients with obsessive-compulsive disorder who are unresponsive to treatment with serotonin reuptake inhibitors. The evidence, however, is contradictory. This paper reports a meta-analysis of existing double-blind randomized placebo-controlled studies looking at the addition of the second-generation antipsychotic quetiapine in such cases. Three studies fulfilled the inclusion criteria. Altogether 102 individuals were subjected to analysis using Review Manager (4.2.7). The results showed evidence of efficacy for adjunctive quetiapine (<400 mg/day) on the primary efficacy criterion, measured as changes from baseline in total Yale-Brown Obsessive Compulsive Scale scores (P=0.008), the clinical significance of which was limited by between-study heterogeneity. The mechanism underlying the effect may involve serotonin and/or dopamine neurotransmission. © 2006 Lippincott Williams & Wilkins, Inc.
- ItemAn open trial of citalopram in adolescents with post-traumatic stress disorder(2001) Seedat S.; Lockhat R.; Kaminer D.; Zungu-Dirwayi N.; Stein D.J.In this preliminary, 12-week open-label study, eight adolescents with moderate to severe post-traumatic stress disorder (PTSD) were treated with citalopram the most selective of the selective serotonin reuptake inhibitors) in a fixed daily dose of 20 mg, and rated at 2-week intervals. The Clinician-Administered PTSD Scale (Child and Adolescent Version) was the primary measure used to assess treatment outcome. Core PTSD symptoms (re-experiencing, avoidance, and hyperarousal symptoms) showed statistically significant improvement at week 12 on the Clinician-Administered PTSD Scale (Child and Adolescent Version) (CAPS-CA), with a 38% reduction in total CAPS scores between baseline and endpoint. Citalopram failed to effect improvement on self-reported depressive symptoms. All seven adolescent completers were rated as much improved or very much improved on Clinical Global impression improvement scores. Citalopram was well-tolerated overall with reported adverse experiences being relatively benign. However, larger, controlled trials are needed to consolidate these preliminary, results. © 2001 Lippincott Williams & Wilkins.
- ItemAntidepressants and suicide in children and adolescents: A storm in a teacup?(2004) Seedat S.So have the regulatory authorities overstated the risks and underestimated the benefits of antidepressants in the treatment of depression in youth? Considering that existing data from clinical trials on suicidality appear contradictory and incomplete, more careful scrutiny of the risks and benefits is clearly needed. Better data and a cleaner, more systematic approach toward adverse event data reporting may be able to answer the question at hand. Risk benefit analyses in paediatric trials may be more complicated because of high placebo response rates which make it difficult to show statistically and clinically significant drug-placebo differences. For example, in two recent randomised controlled trials of sertraline in children and adolescents (aged 6 - 17) with DSM-IV defined major depressive disorder, undertaken at the request of the FDA, 69% of those who were taking sertraline were classified as responders compared with 59% of patients taking placebo. While these differences were statistically significant, the mean change in scores from baseline to endpoint on the primary outcome measure, the Children's Depression Rating Scale-Revised, between the groups was so small so as to be of minimal clinical significance. In addition to high placebo response rates, other problems include non-publication of negative findings, withholding of unfavourable data and under-reporting of adverse events. For now, monitoring child, adolescent, and adult patients closely for suicidal ideation during the first weeks of antidepressant therapy and during dose titrations of their medication should always be part of the armamentarium and standard of care of any good clinician.
- ItemBarriers to mental health care and predictors of treatment dropout in the South African stress and health study(2011) Bruwer B.; Sorsdahl K.; Harrison J.; Stein D.J.; Williams D.; Seedat S.Objective: This study used data from the South African Stress and Health Study (SASH) to examine both structural and attitudinal barriers to treatment initiation among South Africans with mental disorders and to investigate predictors of treatment dropout. Methods: Face-to-face interviews were conducted with 4,315 adult South Africans living in households or hostel quarters. The interview included a core diagnostic assessment of past-12-month mental disorders and assessments of disorder severity, service use, and barriers to treatment. Multivariate logistic regression models were used to determine predictors of not seeking treatment in relation to disorder severity and sociodemographic characteristics, as well as factors that were predictive of premature treatment discontinuation by participants who had received mental health treatment in the previous 12 months. Predictors of dropout were identified by cross-tabulation and discrete-time survival analysis. Results: Of the 4,315 adults, 729 (16.9% weighted) met criteria for a mental disorder in the past 12 months. Across all levels of severity, the most frequently cited reason for not seeking professional treatment was a low perceived need for treatment. Among those who recognized the need but did not access treatment during the past 12 months (7.2%), attitudinal barriers to treatment seeking were reported more commonly than structural barriers (100% and 34%, respectively). Of the 182 respondents who received treatment (25% weighted), 20% discontinued prematurely. Various factors, such as substance use disorders and absence of health insurance, increased the odds of treatment dropout. Conclusions: Low rates of treatment seeking and high treatment dropout rates for common mental disorders among South Africans are a major concern. Public health efforts to improve treatment of mental disorders should consider the multiple influences on treatment initiation and discontinuation.
- ItemChild and adolescent cognitive behaviour therapy in South Africa: An editorial review(2011) Rosenstein D.; Seedat S.The evidence base for cognitive behaviour therapy (CBT) 1 and other psychotherapeutic interventions in child and adolescent populations in low to middle income countries such as in South Africa is almost non-existent. In this review we explored the transportability of cognitive behaviour therapy interventions into the South African mental health care environment. Further investigations of CBT's effectiveness for children and adolescents and its cultural adaptability in South Africa are needed. 1When using cognitive behaviour therapy in this article we refer to all iterations and therapies that support the basic principles of CBT and that are evidenced based. © 2011 Copyright NISC Pty Ltd.
- ItemClinical presentations and diagnostic issues in dual diagnosis disorders(2012) Morojele N.K.; Saban A.; Seedat S.Purpose of Review: The co-occurrence of mental disorders and substance use disorders (SUDs) is very common, and associated with substantial psychiatric morbidity, functional and quality of life impairments, and societal costs. However, dual disorders are often underdetected, misdiagnosed and inadequately treated in both substance abuse and mental health settings. Recent Findings: Individuals with dual or multiple disorders generally have worse clinical features and long-term outcomes than those with single disorders. However, findings can vary depending on factors such as type(s) of psychiatric disorder(s) and substance(s) involved, and whether the mental disorder is primary or secondary, or substance-induced or independent. Underdiagnosis or misdiagnosis of dual disorders may occur due, in part, to the use of measurement instruments and diagnostic approaches that have uncertain clinical utility. Summary: Routine, thorough, and integrated screening and diagnosis of dual disorders are needed to facilitate implementation of appropriate treatment. Results suggest that forthcoming revisions to the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases should categorize and define mental and SUDs such that clinicians can more readily detect and diagnose all types of substance use and mental health comorbid conditions. Adoption and widespread use of appropriate screening, assessment and diagnostic instruments, and more thorough diagnostic (clinimetric) approaches are recommended. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.
- ItemComorbid obsessive-compulsive personality disorder in obsessive-compulsive disorder (OCD): A marker of severity(2011) Lochner C.; Serebro P.; Van der Merwe, L.; Hemmings, Sian M. J.; Kinnear C.; Seedat S.; Stein D.J.Introduction: Comorbid obsessive-compulsive personality disorder (OCPD) is well-described in obsessive-compulsive disorder (OCD). It remains unclear, however, whether OCPD in OCD represents a distinct subtype of OCD or whether it is simply a marker of severity in OCD. Materials and methods: The aim of this study was to compare a large sample of OCD subjects (n = 403) with and without OCPD on a range of demographic, clinical and genetic characteristics to evaluate whether comorbid OCPD in OCD represents a distinct subtype of OCD, or is a marker of severity. Results: Our findings suggest that OCD with and without OCPD are similar in terms of gender distribution and age at onset of OC symptoms. Compared to OCD. -OCPD (n = 267, 66%), those with OCD. +. OCPD (n = 136, 34%) are more likely to present with the OC symptom dimensions which reflect the diagnostic criteria for OCPD (e.g. hoarding), and have significantly greater OCD severity, comorbidity, functional impairment, and poorer insight. Furthermore there are no differences in distribution of gene variants, or response to treatment in the two groups. Conclusion: The majority of our findings suggest that in OCD, patients with OCPD do not have a highly distinctive phenomenological or genetic profile, but rather that OCPD represents a marker of severity. © 2011 Elsevier Inc.
- ItemComparison of 2 dementia screeners, the test your memory test and the mini-mental state examination, in a primary care setting(2012) Van Schalkwyk G.; Botha H.; Seedat S.Dementia is an important cause of morbidity but is often neglected in primary care settings. This relates, in part, to perceived difficulties with diagnosis and the need to focus on more pressing physical complaints. Screening provides a potential first-step solution. Existing screening measures are regarded as either too time consuming or insufficiently sensitive and specific. The Test Your Memory (TYM) questionnaire was recently developed in response to this problem. Its utility as a cognitive screener has not been assessed in primary care settings. In this study, we measured and compared the performance of an adapted English as well as Afrikaans translation of the self-administered TYM to the Mini-Mental State Examination, the current accepted standard screening instrument for dementia, in 100 older primary care patients in South Africa. We found a strong positive correlation of total scores between the measures, with a higher internal consistency for the TYM. The TYM was also easily self-administered. Our results, in conjunction with previous validation findings and diagnostic accuracy for the TYM, suggest that it has clinical utility and potential as a cognitive screener in this context. © The Author(s) 2012.
- ItemDeterminants of unprotected sex among HIV-positive patients in South Africa(2005) Olley B.O.; Seedat S.; Gxamza F.; Reuter H.; Stein D.J.This study examined the prevalence of unprotected sex, other sexual risk behaviours, and factors associated with unprotected sex among men and women recently diagnosed with HIV in South Africa. One hundred and forty-nine outpatients (44 males and 105 females) were assessed, of whom 101 were sexually active at least 6 months prior to study entry. Subjects were asked about sexual risk behaviours with reference to their most recent sexual encounter. Logistic regression analysis was employed to determine the predictors of condom use, with independent variables selected from five general categories: (1) sociodemographic characteristics; (2) situational characteristics regarding sexual intercourse (i.e. alcohol or drugs used before intercourse); (3) clinical diagnoses; (4) negative life events; and (5) coping styles. Fifty-five patients (19 males and 36 females), representing 54.4% of those sexually active in the 6 months preceding the study, had not used a condom during the most recent intercourse. Compared with those who used condoms, participants who did not significantly reported shorter duration of HIV infection (t = -2.7, p < 0.001), have a current partner (χ2 = 3.98, p = 0.005), and lack knowledge of their partner's HIV status (χ2 = 4.78, p = 0.004). Also they were significantly more likely to engage in denial (t = 3.2, p < 0.002) and to use substances (t = 1.98, p < 0.05) as a means of coping. Logistic regression showed that shorter duration of illness (odds ratio (OR) = 1.2, 95% confidence interval (CI) = 1.01-1.41) and coping styles characterized by denial (OR = 0.6, 95% CI = 0.45-0.96) were significantly associated with unprotected sex. These data suggest the need for interventions to further reduce sexual risk behaviours in HIV-positive patients in South Africa.
- ItemDouble-blind, placebo-controlled assessment of combined clonazepam with paroxetine compared with paroxetine monotherapy for generalized social anxiety disorder(2004) Seedat S.; Stein M.B.Background: Generalized social anxiety disorder (GSAD) is a pervasive form of social anxiety that affects approximately 5% of persons in the community. Among evidence-based pharmacologic treatments for the disorder, selective serotonin reuptake inhibitors (SSRIs) have become widely used and are known to be efficacious. Monotherapy with the benzodiazepine clonazepam is also efficacious for GSAD, but the adjunctive use of clonazepam with an SSRI to potentially improve outcomes has not been studied to date. Method: Twenty-eight patients (22 men and 6 women) with DSM-IV-defined GSAD were randomly assigned to receive double-blind clonazepam (or placebo), 1.0 to 2.0 mg/day (divided b.i.d.) along with open-label paroxetine, 20 to 40 mg/day, for 10 weeks. A 2-week taper of double-blind medication was followed by an additional 8 weeks of open-label paroxetine treatment (during which the dose of paroxetine could be increased to a maximum of 50 mg/day). Twenty-three patients (82%) met DSM-IV criteria for avoidant personality disorder. The patients' mean ± SD age was 31.2 ± 7.7 years, and their mean duration of illness was 12.1 ± 5.8 years. Data were gathered from August 2001 to April 2002. Results: Nineteen (68%) of 28 patients completed treatment. At the end of the 10-week double-blind treatment, there was a trend (p < .06) favoring the paroxetine/clonazepam group, who had a 79% response rate (Clinical Global Impressions-Global Improvement scale [CGI-I] score of 1 or 2) compared with a 43% response rate for the paroxetine/placebo group. However, no significant differences on other outcome measures were noted between the 2 groups in an intent-to-treat analysis, in terms of either very early (2-4 weeks) or not as early (5-10 weeks) responses during treatment. Dropout rates due to adverse events were rare (1 patient in each group), indicating that the paroxetine/clonazepam combination was well tolerated. Conclusion: Coadministration of clonazepam with an SSRI, in contrast to findings in panic disorder, did not lead to more rapid resolution of symptoms in GSAD. On the other hand, there is some evidence that the clonazepam-added group had superior global outcomes (e.g., as measured on the CGI-I), although power to detect such differences in this study was small. These observations suggest that a role for adjunctive benzodiazepines in patients with GSAD (e.g., for augmenting SSRI partial response or nonresponse) is deserving of further controlled investigation. © Copyright 2004 Physicians Postgraduate Press, Inc.
- ItemEscitalopram in the treatment of multisomatoform disorder: A double-blind, placebo-controlled trial(2008) Muller J.E.; Wentzel I.; Koen L.; Niehaus D.J.H.; Seedat S.; Stein D.J.Despite the prevalence of multisomatoform disorder (MSD), there are few controlled trials of its pharmacotherapy. The aim of this study was to compare the efficacy and safety of escitalopram (10-20 mg/day) with that of placebo in treating patients with MSD over a 12-week period. Fifty-one outpatients aged from 18 to 65 years, with multiple medically unexplained symptoms, were recruited. The primary efficacy measure was a change on the Patient Health Questionnaire-15 scores from baseline to endpoint. Secondary efficacy endpoints included the Clinical Global Impression-Improvement score, the psychic and somatic subscales of the Hamilton Anxiety Scale, Montgomery-Asberg Depression Rating Scale, the Visual Analogue Pain Rating Scale, the Scale for the Assessment of Illness Behaviour and the Sheehan Disability Scale. On the primary analysis of covariance, escitalopram-treated patients had significantly greater reductions in Patient Health Questionnaire scores (P<0.0001) compared with placebo at week 12. Significant separation from placebo occurred from week 6 onwards. Escitalopram was superior to placebo on all secondary outcome endpoints, with the exception of the Scale for the Assessment of Illness Behaviour. The medication was well tolerated. In conclusion, in this 12-week, randomized, placebo-controlled study, escitalopram (10-20 mg/day) was both effective and well tolerated in the treatment of patients with MSD. Compared with placebo, escitalopram was associated with lower symptom scores, increased response and remission rates, and improved functioning. © 2008 Lippincott Williams & Wilkins, Inc.
- ItemEvidence for fractional anisotropy and mean diffusivity white matter abnormalities in the internal capsule and cingulum in patients with obsessive-compulsive disorder(2012) Lochner C.; Fouche J.-P.; du Plessis S.; Spottiswoode B.; Seedat S.; Fineberg N.; Chamberlain S.R.; Stein D.J.Background: There is evidence to suggest that obsessive-compulsive disorder (OCD) is associated with structural abnormalities in cortico-striato-thalamic circuits, yet the extent of white matter abnormalities is not well established. In this study, we used diffusion tensor imaging (DTI) to examine white matter integrity in specific regions of interest (ROIs) in patients with OCD. Methods: Patients with OCD and sex-, age- and IQ-matched healthy controls underwent DTI. The primary objective was to explore whether patients with OCD had white matter abnormalities in the anterior limb of the internal capsule (ALIC), the uncinate fasciculus, the genu of the corpus callo-sum and the cingulum. The secondary objective was to evaluate the relation between fractional anisotropy and mean diffusivity in these ROIs and other clinical variables (including age at onset of OCD, OCD severity and levels of depressive and anxiety symptomatology) in patients with OCD. Results: There were 15 patients and 17 controls enrolled in our study. Compared with healthy controls, patients with OCD showed increased fractional anisotropy in bilateral regions of the ALIC adjacent to the body of the caudate, as well as decreased fractional anisotropy in the right anterior limb near the head of the caudate. Patients also had decreased mean diffusivity in the body of the right cingulum and the left anterior cingulum compared with controls. Correlational analyses revealed significant associations of fractional anisotropy and mean diffusivity in select circuits with OCD, depression and anxiety severity scores. Limitations: Inclusion of patients with OCD receiving pharmacotherapy may have been a limitation. In addition, the patients were heterogeneous in terms of their obsessive-compulsive symptom profiles; we did not distinguish between different obsessive-compulsive symptom dimensions. Conclusion: The study results provide further evidence for OCD-related white matter abnormalities in the ALIC and cingulum, consistent with a cortico striatal model of OCD. © 2012 Canadian Medical Association.
- ItemGender differences in risk for intimate partner violence among south african adults(2011) Gass J.D.; Stein D.J.; Williams D.R.; Seedat S.Despite a high prevalence of intimate partner violence in South Africa, few epidemiological studies have assessed individual risk factors and differential vulnerability by gender. This study seeks to analyze gender differences in risk for intimate partner violence victimization and perpetration according to childhood and adult risk factors in a national sample of South African men and women. Using data from the cross-sectional, nationally representative South Africa Stress and Health Study, the authors examine data from 1,715 currently married or cohabiting adults on reporting of intimate partner violence. Our analysis include (a) demographic factors, (b) early life risk factors (including exposure to childhood physical abuse, witnessing parental violence, parental closeness, and early onset DSM-IV disorders), and (c) adult risk factors (including experiencing the death of a child and episodes of DSM-IV disorders after age 20). Although prevalence rates of intimate partner violence are high among both genders, women are significantly more likely than men to report being victimized (29.3% vs. 20.9%). Rates of perpetrating violence are similar for women and men (25.2% and 26.5%, respectively). Men are more likely to report predictive factors for perpetration, whereas women are more likely to report predictors for victimization. Common risk factors among men and women reporting perpetration include exposure to childhood physical abuse, witnessing parental violence, and adult onset alcohol abuse/dependence. However, risk factors in male perpetrators are more likely to include cohabitation, low income, and early and adult-onset mood disorders, whereas risk factors in female perpetrators include low educational attainment and early onset alcohol abuse/dependence. The single common risk factor for male and female victims of partner violence is witnessing parental violence. Additional risk factors for male victims are low income and lack of closeness to a primary female caregiver, whereas additional risk factors for female victims are low educational attainment, childhood physical abuse, and adult onset alcohol abuse/dependence and intermittent explosive disorder. Intimate partner violence is a significant public health issue in South Africa, strongly linked to intergenerational cycling of violence and risk exposure across the life course. These findings indicate that gender differences in risk and common predictive factors, such as alcohol abuse and exposure to childhood violence, should inform the design of future violence-prevention programs and policies. © The Author(s) 2011.
- ItemHIV as an index stressor for PTSD: Challenges and pitfalls in applying DSM criteria(2011) Bakelaar S.Y.; Rosenstein D.; Kagee A.; Seedat S.[No abstract available]
- ItemHoarding behaviour in Xhosa patients with schizophrenia - Prevalence and clinical presentation(2007) Ameer T.; Niehaus D.J.H.; Koen L.; Seller C.; Seedat S.Objective. Hoarding is commonly defined as the acquisition of and failure to discard possessions of little use or value, and is included as a symptom in the diagnostic criteria for obsessive compulsive personality disorder (OCPD) and obsessive compulsive disorder (OCD). However, it has also been observed in other clinical syndromes including schizophrenia. This study was conducted to investigate the prevalence and clinical presentation of hoarding behaviour in schizophrenia among Xhosa patients. Method. The sample consisted of 102 patients, recruited as part of a larger genetic study in the Cape Town metropole between November 2004 and January 2005, diagnosed with schizophrenia or schizoaffective disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. They were screened for clinically significant hoarding symptoms. If these were present, additional information on the phenomenology was obtained by means of a structured questionnaire. The Mini International Neuropsychiatric Interview (MINI) (screen and full version), the Yale Brown Obsessive Compulsive Scale (Y-BOCS) Checklist, Y-BOCS, Clutter Image Rating Scale (CIRS) and a structured questionnaire on hoarding were administered. Results. Only four patients with schizophrenia were classified as hoarders. Although their clinical presentation resembled that of hoarders described elsewhere in the literature, they had low Y-BOCS scores and did not report other obsessive-compulsive symptoms. Conclusion. Our results suggest that hoarding behaviour is not common in Xhosa patients with schizophrenia. Further investigation of protective factors for hoarding behaviour in the Xhosa population is warranted.
- ItemHoarding in obsessive-compulsive disorder: Clinical and genetic correlates(2005) Lochner C.; Kinnear C.J.; Hemmings, Sian M. J.; Seller C.; Niehaus D.J.H.; Knowles J.A.; Daniels W.; Moolman-Smook J.C.; Seedat S.; Stein D.J.Objective: Hoarding may be an important symptom dimension in obsessive-compulsive disorder (OCD). Hoarding in OCD has been associated with poor insight, poorer response to selective serotonin reuptake inhibitors than other OCD symptom dimensions, and a distinctive psychobiological profile. The clinical and genetic correlates of hoarding in OCD therefore deserve additional investigation. Method: Adult OCD patients (N = 315) underwent a comprehensive clinical assessment that included the Structured Clinical Interview for DSM-IV Axis I Disorders (Patient Edition) and for Diagnosis of Obsessive-Compulsive Spectrum Disorders. DNA extracted from venous blood (10-30 mL) in a Caucasian subset of the interviewed OCD patients (N = 204) and Caucasian controls (N = 169), including patients (N = 94) and controls (N = 138) of Afrikaner descent, was genotyped to investigate polymorphisms in genes involved in monoamine function and previously hypothesized to be relevant to OCD. Data were collected from 1998 through 2004. Results: OCD patients with hoarding made up 18.1% of the total sample. Compared with nonhoarding OCD, OCD with hoarding was associated with a number of comorbid Axis I disorders, obsessive-compulsive personality disorder, significantly higher OCD severity scores, and more functional impairment. In subjects of Afrikaner descent, the L/L genotype of the COMT Val158Met polymorphism was significantly more common in the OCD hoarding group, with a preponderance of low activity alleles, compared with nonhoarding patients and controls. Conclusions: These data are consistent with the hypothesis that hoarding represents a unique symptom subtype in OCD with a distinctive clinical and psychobiological profile. Further work is needed to determine the psychobiological mechanisms responsible for hoarding and to replicate the genetic findings noted here.
- ItemHousehold food insufficiency and mental health in South Africa(2011) Sorsdahl K.; Slopen N.; Siefert K.; Seedat S.; Stein D.J.; Williams D.R.Background: Both mental illness and food insufficiency are common in low and middle income countries. However, there are limited data on the relation between food insufficiency and mental disorders, despite the potential relevance of such data for the development of policy-level interventions. The relationship between food insufficiency and mental disorders within a nationally representative sample of South African adults was examined. Methods: A national survey of 4185 South African adults was conducted using the WHO Composite International Diagnostic Interview to generate psychiatric diagnoses. The survey included a widely used single-item measure of household food insufficiency. The independent effects of food insufficiency and demographic characteristics on 12-month and lifetime DSM-IV diagnosis were assessed using logistic regression. Results: 29% of respondents reported that their household 'sometimes' did not have enough to eat while 9% reported that they 'often' did not have enough to eat. After controlling for conventional socioeconomic and sociodemographic variables, food insufficiency was associated with having any 12-month (OR 1.44, 95% CI 1.1 to 1.9) and lifetime (OR 1.35, 95% CI 1.1 to 1.7) DSM-IV disorder. Conclusions: In South Africa the prevalence of household food insufficiency is very high compared with studies conducted in the developed world, and is independently associated with having a 12-month and lifetime DSM-IV diagnosis. The relationship between food insufficiency and mental health has implications for reducing the burden of common mental disorders in South Africa since, unlike a number of major risk factors for mental illness, food insufficiency may be relatively amenable to intervention.
- ItemInositol augmentation of serotonin reuptake inhibitors in treatment-refractory obsessive - compulsive disorder: An open trial(1999) Seedat S.; Stein D.J.Inositol, an isomer of glucose and precursor in the phosphatidylinositol cycle, may be effective in a number of psychiatric disorders, including obsessive - compulsive disorder (OCD). There is little data, however, on inositol as an augmenting agent of serotonin reuptake inhibitors (SRIs) in treatment-refractory patients. Ten OCD patients who had failed to respond to current and previous trials of serotonin reuptake inhibitors participated in open-label trial of inositol (18 mg/day) augmentation for 6 weeks. Symptoms were rated at 2-weekly intervals using the Yale-Brown Obsessive - Compulsive Scale, the Montgomery - Asberg Depression Rating Scale, and the Clinical Global Impressions (CGI) Scale. The majority of patients (n = 7) did not respond to treatment with inositol augmentation on the CGI improvement item. However, a small number of patients (n = 3) did report a clinically significant response on the CGI improvement item. OCD patients who fail to respond to a number of trials of SRIs may be a particularly treatment-refractory group of subjects. Unfortunately, inositol augmentation of a SRI did not lead to significant improvement in the majority of such cases. Nevertheless, further research on the mechanism of inositol efficacy in some patients with anxiety and mood disorders is warranted.
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