SUNScholar - Browsing by Author "Seedat, S."

Browsing by Author "Seedat, S."

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Assessing post-traumatic stress disorder in South African adolescents : using the child and adolescent trauma survey (CATS) as a screening tool
(BioMed Central, 2005-01) Suliman, S.; Kaminer, D.; Seedat, S.; Stein, D. J.
Background: Several studies have demonstrated that South African children and adolescents are exposed to high levels of violent trauma with a significant proportion developing PTSD, however, limited resources make it difficult to accurately identify traumatized children. Methods: A clinical interview (K-SADS-PL, selected modules) and self-report scale (CATS) were compared to determine if these different methods of assessment elicit similar information with regards to trauma exposure and post-traumatic stress disorder (PTSD) in adolescents. Youth (n = 58) from 2 schools in Cape Town, South Africa participated. Results: 91% of youth reported having been exposed to a traumatic event on self-report (CATS) and 38% reported symptoms severe enough to be classified as PTSD. On interview (K-SADS-PL), 86% reported exposure to a traumatic event and 19% were found to have PTSD. While there were significant differences in the rates of trauma exposure and PTSD on the K-SADS and CATS, a cutoff value of 15 on the CATS maximized both the number of true positives and true negatives with PTSD. The CATS also differentiated well between adolescents meeting DSM-IV PTSD symptom criteria from adolescents not meeting criteria. Conclusions: Our results indicate that trauma exposure and PTSD are prevalent in South African youth and if appropriate cut-offs are used, self-report scales may be useful screening tools for PTSD.
Association between motor timing and treatment outcomes in patients with alcohol and/or cocaine use disorder in a rehabilitation program
(BioMed Central, 2016) Young, S. Y.; Delevoye-Turrell, Y.; Van Hoof, J. J. J.; Goudriaan, A. E.; Seedat, S.
Background: Individuals with Substance Use Disorders (SUDs) have disruptions in the brain’s dopaminergic (DA) system and the functioning of its target neural substrates (striatum and prefrontal cortex). These substrates are important for the normal processing of reward, inhibitory control and motivation. Cognitive deficits in attention, impulsivity and working memory have been found in individuals with SUDs and are predictors of poor SUD treatment outcomes and relapse in alcohol and cocaine dependence specifically. Furthermore, the DA system and accompanying neural substrates play a key role in the timing of motor acts (motor timing). Motor timing deficits have been found in DA system related disorders and more recently also in individuals with SUDs. Motor timing is found to correlate with attention, impulsivity and working memory deficits. To our knowledge motor timing, with regards to treatment outcome and relapse, has not been investigated in populations with SUDs. Methods/Design: This study aims to investigate motor timing and its relation to treatment response (at 8 weeks) and relapse (at 12 months) in cocaine and/or alcohol dependent individuals. The tested sensitivity values of motor timing parameters will be compared to a battery of neurocognitive tests, owing to the novelty of the motor task battery, the confounding effects of attention and working memory on motor timing paradigms, and high impulsivity levels found in individuals with SUDs. Discussion: This research will contribute to current knowledge of neuropsychological deficits associated with treatment response in SUDs and possibly provide an opportunity to individualize and modify currently available treatments through the possible prognostic value of motor task performance in cocaine and/or alcohol dependent individuals.
Associations between neurocognitive functioning and social and occupational resilience among South African women exposed to childhood trauma
(Taylor & Francis Open, 2017-10) Denckla, C. A.; Consedine, N. S.; Spies, Georgina; Cherner, M.; Henderson, D. C.; Koenen, K. C.; Seedat, S.
Background: Prior research on adaptation after early trauma among black South African women typically assessed resilience in ways that lacked contextual specificity. In addition, the neurocognitive correlates of social and occupational resilience have not been investigated. Objective: The primary aim of this exploratory study was to identify domains of neurocognitive functioning associated with social and occupational resilience, defined as functioning at a level beyond what would be expected given exposure to childhood trauma. Methods: A sample of black South African women, N = 314, completed a neuropsychological battery, a questionnaire assessing exposure to childhood trauma, and self-report measures of functional status. We generated indices of social and occupational resilience by regressing childhood trauma exposure on social and occupational functioning, saving the residuals as indices of social and occupational functioning beyond what would be expected given exposure to childhood trauma. Results: Women with lower non-verbal memory evidenced greater social and occupational resilience above and beyond the effects attributable to age, education, HIV status, and depressive and posttraumatic stress symptoms. In addition, women with greater occupational resilience exhibited lower semantic language fluency and processing speed. Conclusion: Results are somewhat consistent with prior studies implicating memory effects in impairment following trauma, though our findings suggest that reduced abilities in these domains may be associated with greater resilience. Studies that use prospective designs and objective assessment of functional status are needed to determine whether non-verbal memory, semantic fluency, and processing speed are implicated in the neural circuitry of post-traumatic exposure resilience.
A collaborative and evolving response to the needs of frontline workers, patients and families during the COVID-19 pandemic at Tygerberg Hospital, Western Cape Province, South Africa
(Health & Medical Publishing Group, 2021-03-23) Brocker, E.; Louw, K. A.; Hewett, M.; Burger, H.; Felix, R.; De Koker, P.; Rossouw, J.; Seedat, S.
The global devastation caused by the COVID-19 pandemic and its mental health impact is undeniable. The physical and psychological consequences are wide-ranging – affecting patients fighting the disease, frontline workers in the trenches with them, healthcare staff deployed in high-care settings, and families disconnected from their loved ones in their darkest hours. Within 6 weeks of the COVID-19 outbreak in South Africa, the Department of Psychiatry at Stellenbosch University established the TBH/SU COVID Resiliency Clinic to provide psychological support to frontline workers at Tygerberg Hospital. Identified barriers in healthcare workers accessing mental healthcare resulted in moving towards an on-site visibility to try to remove some of these barriers. This greater on-site presence enabled networking and building of relationships with frontline staff that over time highlighted other frontline needs, such as providing psychosocial and spiritual support to patients and their families. We share challenges, lessons learned and recommendations from two initiatives: the TBH/SU COVID-19 Resiliency Clinic, and an embedded COVID Care Team (CCT). We describe the establishment, roll-out and progress of the Clinic and the subsequent CCT.
D8/17 in obsessive-compulsive disorder and trichotillomania
(Health & Medical Publishing Group, 1999) Niehaus, D. J. H.; Knowles, J. A.; Van Kradenberg, J.; Du Toit, W. D.; Kaminer, D.; Seedat, S.; Daniels, W.; Cotton, M.; Brink, P.; Beyers, A. D.; Bouic, P.; Chapman, F.; Zabriskie, J. B.; Stein, D. J.
The finding that patients with Sydenham's chorea often demonstrate obsessive-compulsive disorder (OeD) has fostered increased interest in possible neuroimmunological mechanisms in OCD.' Increased expression of the B-Iymphocyte antigen 08/17, which has been hypothesised to be a genetically inherited trait marker for susceptibility to rheumatic fever, has recently been demonstrated to be higher in OCD patients than in normal controls.2.3 To date, however, 08/17 expression has been studied in few psychiatric control populations.
The diagnosis and management of depression in the era of the DSM-5
(Medpharm Publications, 2018) Thomas, E.; Seedat, S.
Depressive disorders comprise a range of conditions that can be viewed along many dimensions. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) introduced several changes to the chapter on depressive disorders largely informed by advances in neuroscience, clinical and public health needs and difficulties identified with the previous DSM-IV classification system and criteria. Clinical characteristics vary across depressive disorders, as do the corresponding treatments. Pharmacotherapy and psychotherapy should be tailored to the individual patient.
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.
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]
Hoarding symptoms in patients on a geriatric psychiatry inpatient unit
(Health & Medical Publishing Group, 1997) Stein, D. J.; Laszlo, B.; Marais, E.; Seedat, S.; Potocnik, F.
Background. While collecting may be a normal behaviour, hoarding is a symptom of various psychiatric disorders, including obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD). Although anecdotal reports suggest that hoarding is not uncommon in geriatric psychiatry populations, its psychopathological correlates in such samples have not been well characterised. Methods. The presence of clinically significant hoarding symptoms was screened for in 100 consecutive patients in a geriatric psychiatry inpatient unit. Both patient and collateral histories were obtained. When hoarding symptoms were present, a detailed history of their phenomenology was obtained by means of a structured questionnaire and the response of hoarding symptoms to treatment during hospitalisation was monitored. Results. Clinically significant hoarding was found in 5/100 subjects. Four of these 5 patients met DSM-IV criteria for schizophrenia (paranoid subtype), with onset of symptoms coinciding with increased symptoms of dementia. The fifth patient met criteria for bipolar disorder (manic episode), also had symptoms of dementia, and had a lifelong history of hoarding. Hoarding behaviours responded to antipsychotic treatment in 3 of the 5 patients. Conclusions. A history of hoarding may be useful in many psychiatric patients, but psychopathological correlates of this symptom are likely to vary with age. In a geriatric psychiatry inpatient population hoarding was associated not with OCD or OCPD, but rather with paranoid schizophrenia and increasing symptoms of dementia. Dopamine blockers appeared useful in decreasing hoarding in some patients, raising interesting questions about the neurobiology of this symptom.
Longitudinal developmental profile of children from low socio-economic circumstances in Cape Town, using the 1996 Griffiths Mental Development Scales
(Health & Medical Publishing Group, 2010) Laughton, Barbara; Springer, P. E.; Grove, D.; Seedat, S.; Cornell, M.; Kidd, M.; Madhi, S. A.; Cotton, M. F.
Background. The Griffiths Mental Development Scales (GMDS) have not been standardised in South African children. Neurodevelopmental scores of infants from deprived environments decline with age, but there is no evidence on how young South African children from such backgrounds perform on serial assessments. Aim. To describe the longitudinal developmental profile of infants from low socio-economic backgrounds at Tygerberg Children's Hospital by comparing the GMDS scores performed at 10 - 12 months and 20 - 22 months. Methods. Infants born to HIV-uninfected women attending the public service programme were recruited from a vaccine study in Cape Town, South Africa. The GMDS 0 - 2 years and a neurological examination were performed between 10 and 12 months and between 20 and 22 months. Results. Thirty-one infants (14 girls, 17 boys) were assessed. Their mean (standard deviation (SD)) age was 11.6 (0.8) months and 21.0 (0.5) months at the first and second assessments, respectively. The mean (SD) general quotient decreased significantly from 107.3 (11.7) to 95.0 (11.0) (p<0.001). All sub-quotients decreased significantly except for locomotor. The hearing and language sub-quotient was most affected, with a decrease in mean quotients from 113.0 to 93.2 (p<0.001). There was no evidence of intercurrent events to explain the decline. Interpretation. Scores on the GMDS of this group of children from low socio-economic backgrounds were normal at 11 months and, other than locomotor, decreased significantly at 21 months, with language the most affected. Further research is needed to determine the specific reasons for the decline.
Mental health services for HIV/AIDS patients are long overdue
(Health and Medical Publishing Group (HMPG), 2009-11) Andersen, L. S.; Seedat, S.
Although progress has been made since the launch of the National Antiretroviral Treatment Programme in April 2004 in providing medical treatment to people infected with HIV, their psychosocial needs have not been similarly provided for. It is imperative that efforts to ensure the provision of ART to all individuals with HIV/AIDS in South Africa continue. However, these should be complemented by psychosocial support such as mental health services. To ensure adherence to ART and improve treatment success, it is vital to correctly identify and successfully treat individuals who are suffering from mental disorders such as depression.
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.
Participants’ perspectives of weekly telephonic mood monitoring in South Africa : a feasibility study
(BioMed Central, 2018-02-22) Van der Watt, A. S. J.; Roos, T.; Beyer, C.; Seedat, S.
Background: Mood and anxiety disorders have a high lifetime prevalence, and their chronicity adds to the management burden of already scarce and strained mental health care resources, particularly in developing countries. Non-professional-assisted interventions and technology (such as weekly telephonic mood monitoring) could assist in the early identification of symptoms of relapse and hospitalization prevention. The present study aimed to determine participants’ perspectives and the feasibility of weekly telephonic mood monitoring in order to inform the development of the full study. Method: Semi-structured telephonic interviews (n = 37; 89.2% female; mean age = 33.1 years) were conducted as part of the full-scale feasibility study (N = 61; named the Bipolar Disorder Mood Monitoring (BDMM) Study). The BDMM Study was conducted to determine the viability of weekly telephonic mood monitoring, spanning 26 weeks and starting 1 week post-discharge. Frequency and descriptive statistical analyses (using SPSS version 24) were undertaken, and qualitative data were analyzed using thematic content analysis. Results: This article presents the findings from the semi-structured interview section of the BDMM Study. Participants generally expressed positive experiences and perceptions of weekly telephonic mood monitoring, stating that they would advise others to also take part in weekly telephonic mood monitoring. Nonetheless, some participants did make suggestions for improvement of mood monitoring while others expressed negative experiences of weekly telephonic mood monitoring. Conclusion: The results of the semi-structured interviews of the BDMM Study indicated that participants perceived weekly telephonic mood monitoring to be helpful in lightening the burden of mood and anxiety disorders (e.g., having someone to talk to, providing insight into their disorders). Not only did it help them, but they also perceived mood monitoring to be potentially helpful to future participants. However, weekly mood monitoring was also burdensome in itself (including being too time consuming and having to answer questions when feeling down). Importantly, the findings highlighted that participants’ and researchers’ perceptions and experiences may not be congruent (especially in terms of therapeutic misconception). The current findings may inform researchers’ future approach to study design and participant relationships.
Prevalence and correlates of probable posttraumatic stress disorder and common mental disorders in a population with a high prevalence of HIV in Zimbabwe
(Taylor & Francis Open, 2018) Verhey, R.; Gibson, L.; Brakarsh, J.; Chibanda, D.; Seedat, S.
Background: We investigated the prevalence of and factors associated with post-traumatic stress disorder (PTSD) and common mental disorders (CMDs), which include depression and anxiety disorders, in a setting with a prevalence of high human immunodeficiency virus (HIV) within a primary care clinic, using the PTSD Checklist for DSM-5 and the 14-item Shona Symptom Questionnaire, both locally validated screening tools. Methods: A cross-sectional survey was carried out with adult patients (n = 204) from the largest primary care clinic facility in Harare, Zimbabwe, in June 2016. Results: A total of 83 patients (40.7%) met the criteria for probable PTSD, of whom 57 (69.5%) had comorbid CMDs. Among people living with HIV, 42 (55.3%) had PTSD. Probable PTSD was associated with having experienced a negative life event in the past 6 months [adjusted odds ratio (OR) 3.73, 95% confidence interval (CI) 1.49–9.34] or screening positive for one or more CMD (adjusted OR 6.48, 95% CI 3.35–2.54). Conclusion: People living with HIV showed a high prevalence of PTSD and CMD comorbidity. PTSD screening should be considered when the CMD screen is positive and there is a history of negative life events.
The prevalence of mental health problems in sub-Saharan adolescents living with HIV : a systematic review
(Cambridge University Press, 2020-09) Dessauvagie, A. S.; Jorns-Presentati, A.; Napp, A. -K.; Stein, D. J.; Jonker, D.; Breet, E.; Charles, W.; Swart, R. L.; Lahti, M.; Suliman, S.; Jansen, R.; van den Heuvel, L. L.; Seedat, S.; Groen, G.
Despite the progress made in HIV treatment and prevention, HIV remains a major cause of adolescent morbidity and mortality in sub-Saharan Africa. As perinatally infected children increasingly survive into adulthood, the quality of life and mental health of this population has increased in importance. This review provides a synthesis of the prevalence of mental health problems in this population and explores associated factors. A systematic database search (Medline, PsycINFO, Scopus) with an additional hand search was conducted. Peer-reviewed studies on adolescents (aged 10–19), published between 2008 and 2019, assessing mental health symptoms or psychiatric disorders, either by standardized questionnaires or by diagnostic interviews, were included. The search identified 1461 articles, of which 301 were eligible for full-text analysis. Fourteen of these, concerning HIV-positive adolescents, met the inclusion criteria and were critically appraised. Mental health problems were highly prevalent among this group, with around 25% scoring positive for any psychiatric disorder and 30–50% showing emotional or behavioral difficulties or significant psychological distress. Associated factors found by regression analysis were older age, not being in school, impaired family functioning, HIV-related stigma and bullying, and poverty. Social support and parental competence were protective factors. Mental health problems among HIV-positive adolescents are highly prevalent and should be addressed as part of regular HIV care.
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.
Psychopathology and coping in recently diagnosed HIV/AIDS patients [3]
(Health & Medical Publishing Group, 2004) Olley, B. O.; Seedat, S.; Stein, D. J.
We thank Dr Singh for raising several issues for discussion in his letter1 in response to our paper.2 He states that there is no evidence to support the hypothesis that women with HIV/AIDS may face greater stigmatisation than men, emphasises rather social inequality and poverty as risk factors for HIV infection in women, and recommends the inclusion of a particular stigma scale. Stigmatisation may well have been interesting to include, but it was not a primary object of study in this work, and the validity of the scale recommended by Singh has not yet been demonstrated in developing world contexts. Furthermore, we would point out that HIV/AIDS stigma and gender discrimination are constructs that appear to have considerable overlap.
Rape survivors and the provision of HIV post-exposure prophylaxis
(Health and Medical Publishing Group (HMPG), 2007-08) Killian, S.; Suliman, S.; Fakier, N.; Seedat, S.
To the Editor: Rape and HIV/AIDS are two scourges of epidemic proportion in South Africa, which is known for high levels of sexual violence and one of the fastest-growing HIV epidemics in the world. While the link between rape and long-term physical and mental health problems is well established, the vast majority of rapes go unreported and only a small proportion of women attend health care services after rape, with many believing that their actions will not lead to punishment for the perpetrator. Another factor that may worsen matters even further is the latest version of the original bill on sexual offences (Criminal Law (Sexual Offences) Amendment Bill) passed in 2003. The latest version of the Bill states that the provision of post-exposure prophylaxis (PEP) is dependent on the ‘victim’ laying a charge. This is likely to have a major negative impact on rape survivors receiving PEP within 72 hours and may impede the ability of medical and police officials to obtain medical evidence that is crucial for the successful prosecution of the perpetrator.
The relationship between potentially traumatic or stressful events, HIV infection and neurocognitive impairment (NCI) : a systematic review of observational epidemiological studies
(Taylor & Francis, 2020) Spies, G.; Mall, S.; Wiele, H.; Masile, L.; Konkiewit, E. Castelon; Seedat, S.
Background: HIV/AIDS and potentially traumatic events (PTEs) or stressful life events (SLEs) and/or PTSD are independently associated with neurocognitive impairment (NCI). Literature suggests that HIV and PTE/SLE exposure independently and consistently affect various domains of cognition including language ability, working memory and psychomotor speed. There are limited data on the interaction between HIV infection and PTEs and their combined effect on NCI. Objective: In this systematic review, we synthesise evidence for the combined effect of HIV infection and PTEs and SLEs and/or post-traumatic stress disorder (PTSD) on NCI of people living with HIV/AIDS (PLWHA) from high-, middle- and low- income countries. Method: Our inclusion criteria were observational epidemiological studies (case-control, cohort and cross-sectional designs) that investigated the interaction of HIV infection, PTEs and SLEs and/or PTSD and specifically their combined effect on NCI in adults. We searched a number of electronic databases including Pubmed/Medline, PsycINFO, Scopus and Global Health using the search terms: cognition, HIV/AIDS, observational studies, trauma and permutations thereof. Results: Fifteen studies were included in the review, of which the majority were conducted in high-income countries. Ten of the fifteen studies were conducted in the United States of America (USA) and five in South Africa. Seven of these focused on early life stress/childhood trauma. The remaining studies assessed adult-onset PTEs and SLEs only. Eight studies included women only. Overall, the studies suggest that PTE and SLE exposure and/or PTSD are a significant risk factor for NCI in adults living with HIV, with impairments in memory and executive functions being the most likely consequence of PTE and SLE exposure. Conclusion: These findings highlight the need for trauma screening and for the integration of trauma-focused interventions in HIV care to improve outcomes.
Selective serotonin reuptake inhibitors in children and adolescents
(Health & Medical Publishing Group, 2006-02) Hawkridge, S.; Seedat, S.; Carey, P.; Emsley, R.; Stein, D. J.
[No abstract available]

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