SUNScholar - Browsing by Author "Stein, D. J."

Browsing by Author "Stein, D. J."

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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.
Attitudes towards and beliefs about schizophrenia in Xhosa families with affected probands
(AOSIS Publishing, 2002-09-27) Mbanga, N. I.; Niehaus, D. J. H.; Mzamo, N. C.; Wessels, C. J.; Allen, A.; Emsley, R. A.; Stein, D. J.
Objective: The development of effective psychoeducational programs for the management of schizophrenia requires an understanding of attitudes towards and beliefs about the disorder in families of affected probands. In order to establish the need for adaptation of Western psychoeducational programs, these variables were investigated in Xhosa speaking families in South Africa. Design: Xhosa speaking family members of patients with DSM-IV schizophrenia were recruited on a voluntary basis, and interviewed with a structured belief and attitudes questionnaire adapted from previous studies in the West. Setting: The study population was drawn from both urban and rural Xhosa communities in South Africa. Subjects: 100 Xhosa speaking family members participated in the study. Results: Family members most often recommended treatment with psychotropic medications (88%) and traditional healers (32%), and least often recommended psychotherapy (4%) and meditation (1%). Of the respondents who recommended traditional healing methods, 92% also recommended simultaneous use of allopathic treatment. Conclusion: Attitudes towards and beliefs about schizophrenia in family members of patients with schizophrenia may differ substantially from those described in previous work in the West. An understanding of local attitudes and beliefs is crucial for the successful development of local psychoeducational programs.
Co-occurrence of schizophrenia and obsessive compulsive disorder : a literature review
(Health & Medical Publishing Group, 1999) Emsley, R. A.; Stein, D. J.; Oosthuizen, P.
[No abstract available]
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.
Dealing with post-traumatic stress disorder in general practice
(Medpharm Publications, 2012) Suliman, S.; Stein, D. J.
Traumatic experiences are prevalent in South Africa and may result in psychiatric disorders such as post-traumatic stress disorder (PTSD). PTSD is accompanied by a range of psychobiological alterations, including changes in brain structure and functioning. General practitioners have an important role to play in identifying and assisting those in need of help. Efficacious psychotherapies and pharmacotherapies are available for PTSD, i.e. cognitive behavioural therapy and selective serotonin reuptake inhibitors.
A double-blind placebo-controlled trial of paroxetine in the management of social phobia (social anxiety disorder) in South Africa
(Health & Medical Publishing Group, 1999) Stein, D. J.; Berk, M.; Els, C.; Emsley, R. A.; Gittelson, L.; Wilson, D.; Oakes, R.; Hunter, B.
Background. Social phobia, also known as social anxiety disorder, is a highly prevalent disorder with significant morbidity. Patients with social phobia frequently develop co-morbid psychiatric disorders such as depression and substance abuse, and the disorder impacts significantly on social and occupational functioning. It has been suggested that the selective serotonin reuptake inhibitors (SSRIs) are useful in the management of this disorder, but few controlled trials have been undertaken in this regard. There are also few data on the pharmacotherapy of social phobia in South Africa. Methods. A double-blind randomised placebo-controlled multi-site flexible-dose trial of paroxetine was undertaken over 12 weeks among patients with a primary diagnosis of social phobia. Primary response measures were the Global Improvement item on the Clinical Global Impression scale (CGI) and mean change from baseline in the patient-rated Liebowitz Social Anxiety Scale (LSAS) total score. Ninety-three patients participated at 9 South African sites; their data are reported here. Results. There was a significant drug effect on both the CGI Global Improvement score and the LSAS at 12 weeks. In addition, there was no significant difference in overall rate of adverse experiences between those on paroxetine and those on placebo. Conclusions. Paroxetine is both effective and safe in the acute treatment of social phobia. The findings here are consistent with those of previous controlled studies of the SSRIs as well as with previous work done in the USA on the use of paroxetine in the treatment of this disorder. Early diagnosis and treatment of social phobia should be encouraged. However, further research on long-term pharmacotherapy of social phobia is needed.
Effects of myo-Inositol versus fluoxetine and imipramine pretreatments on serotonin 5HT2A and muscarinic acetylcholine receptors in human neuroblastoma cells
(2004) Brink, C. B.; Viljoen, S. L.; De Kock, S. E.; Stein, D. J.; Harvey, B. H.; Brink, C. B.; Viljoen, S. L.; De Kock, S. E.; Stein, D. J.; Harvey, B. H.
myo-Inositol (mI) is a key metabolic precursor to the phospoinositide (PI) metabolic pathway as a key component of central G-protein coupled receptor signaling systems, including several subtypes of adrenergic, cholinergic, serotonergic and metabotropic glutamatergic receptors. High dose mI has also been shown to be clinically effective in the treatment of obsessive-compulsive disorder, as well as panic and depression, although its mechanism of action remains elusive. The current study aimed to investigate the possible modulatory role of mI versus fluoxetine or imipramine pretreatments on serotonin-2A receptor (5HT2A-R) and muscarinic acetylcholine receptor (mAChR) function and binding in in vitro systems. After pretreating human neuroblastoma cells with different concentrations of mI, fluoxetine, or imipramine, receptor function was measured by second messenger [3H]-IPx accumulation and [35S]-GTPγS binding to Gαq protein. Total [3H]-mI uptake into cells was measured, as well as specific receptor binding to determine receptor binding after the pretreatments. Results suggest that mI reduces 5HT2A-R function at the receptor-G protein level. While fluoxetine also reduced 5HT2A-R function, but to a lesser degree, imipramine increased 5HT2A-R function, which may explain why mI seems to be effective exclusively in selective serotonin reuptake inhibitor-sensitive disorders. In addition mI, and at high concentrations fluoxetine and imipramine, also reduces mAChR function. Furthermore the results suggest that the attenuating effect of mI on mAChRs is partially dependent on the PI metabolic pathway. The data provide novel information on understanding the mechanism of action of mI in depression and related anxiety disorders and added to the evidence suggesting a role for the cholinergic system in the pathophysiology of depression.
Generalised anxiety disorder
(AOSIS, 2013) Stein, D. J.
Generalised anxiety disorder (GAD) is a common disorder witha lifetime prevalence of 6.1% and a 1-year prevalence of 2.9% inone large study.[1]It occurs most commonly in the 45 - 55-yearage group with women twice as likely as men to have GAD.
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.
How to manage obsessive-compulsive disorder (OCD) under COVID-19 : a clinician's guide from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS) and the Obsessive-Compulsive and Related Disorders Research Network (OCRN) of the European College of Neuropsychopharmacology
(Elsevier Inc., 2020-07) Fineberg, N. A.; Van Ameringen, M.; Drummond, L.; Hollander, E.; Stein, D. J.; Geller, D.; Walitza, S.; Pallanti, S.; Pellegrini, L.; Zohar, J.; Rodriguez, C. I.; Menchon, J. M.; Morgado, P.; Mpavaenda, D.; Fontenelle, L. F.; Feusner, J. D.; Grassi, G.; Lochner, C.; Veltman, D. J.; Sireau, N.; Carmi, L.; Adam, D.; Nicolini, H.; Dell'Osso, B.
The rapid advance of the coronavirus COVID-19 pandemic has significantly increased mortality but also has demonstrated considerable potential to negatively impact mental health, including in the young [1,2]. From a public mental health perspective, guidelines for responding to mass trauma and disaster emphasize the importance of focusing on resilience. In the immediate and ongoing response, consensus guidelines emphasize the importance of interventions that maintain calm, build community, and sustain hope [3,4].
Medical research in South Africa : a psychiatric perspective
(Health & Medical Publishing Group, 1996) Stein, D. J.; Emsley, R. A.
We read the recent editorials on medical research in the new South Africa with great interest. MBewu1 argued convincingly that medical research in this country can be 'the fairy godmother who provides a brighter future for Cinderella'. In contrast, in answer to his question, 'Can we support high-tech research in South Africa', Van Rensburg2.
Obsessive compulsive disorder
(AOSIS, 2013) Stein, D. J.
This guideline focuses on the pharmacotherapy of obsessivecompulsive disorder (OCD). OCD is characterised by obsessions and compulsions. A number of other disorders are also characterised by repetitive thoughts and rituals and may also respond to modifications of standard OCD treatment. These so-called OCD spectrum disorders include body dysmorphic disorder (characterised by recurrent concerns with imagined ugliness), hypochondriasis (characterised by recurrent concerns with imagined illness), trichotillomania (characterised by recurrent hair-pulling), and obsessive-compulsive personality disorder.[1] The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition[2] has a new chapter on obsessive-compulsive and related disorders, which includes several of these conditions.
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.
Obsessive-compulsive disorder in black South Africans - A case series
(Health & Medical Publishing Group, 1996) Gangdev, P. S.; Stein, D. J.; Ruzibiza, J. B.
Background. Obsessive-compulsive disorder (OCD) has been shown to be highly prevalent in both developing and developed countries. Nevertheless, data on OCD in blacks, and black South Africans in particular, are limited. Method. Records of patients presenting with OCD at a tertiary hospital serving a predominantly black population were reviewed. Patient data, including demographic information, presenting symptoms and clinical course, were collated. Results. Six black South Africans had presented with OCD in the previous year. Phenomenology and psychopharmacology of the disorder were largely reminiscent of those previously reported in the international literature. Conclusion. Not surprisingly, black South Africans may suffer from OCD. Nevertheless, it is likely that such patients do not present for treatment or are underdiagnosed. Future rigorous epidemiological research on OCD in South Africa is necessary.
Olfactory reference syndrome in DSM-V
(Health and Medical Publishing Group (HMPG), 2009-09) Flegar, S. J.; Vythilingum, B.; Stein, D. J.; Lochner, C.
To the Editor: We read with interest Dr A Lawrence’s recent SAMJ case report of a young man who presented with persistent preoccupation with personal body odour in the absence of any physical abnormalities
Pica and the obsessive-compulsive spectrum disorders
(Health & Medical Publishing Group, 1996) Stein, D. J.; Bouwer, C.; Van Heerden, B.
Background. The concept of a spectrum of obsessive-compulsive related disorders may have clinical and research heuristic value in the approach to disorders similar to obsessive-compulsive disorder (OCD) in respect of phenomenology and psychobiology. Like other repetitive and ritualistic behaviours, pica may be postulated to fall at times on this spectrum. Methods. Five cases of pica seen at our clinics are presented here in order to test this hypothesis. Phenomenology, neurobiology (where available) and pharmacotherapy data are provided in order to consider a possible relationship with OCD and OCD spectrum disorders. Results. In 2 of the cases, pica appeared to be a compulsion and patients had additional symptoms which met diagnostic criteria for OCD. In 2 of the cases, the clinical picture and neurobiological data were reminiscent of an impulse control disorder. Four of the 5 patients responded to treatment with a serotonin re-uptake inhibitor (SRI). Conclusion. These results are consistent with a hypothesis that at least some cases of pica may usefully be conceptualised as lying within a compulsive-impulsive spectrum of symptoms and disorders.
Post-menopausal panic disorder
(Health & Medical Publishing Group, 1996) Stein, D. J.; Bouwer, C.
[No abstract available]
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.

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