Masters Degrees (Psychiatry)

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Assessing the revised clinical institute withdrawal for alcohol scale (CIWA-Ar) use at Stikland Hospital
(Stellenbosch : Stellenbosch University, 2022-12) Muddapah, Creeshen Pillay; Weich, Lize; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
ENGLISH SUMMARY: Background: Alcohol use disorder is a major public health concern in South Africa. Abrupt cessation or reduction of alcohol intake in the chronic user can result in withdrawal symptoms. Benzodiazepines are recognised as the treatment of choice but need to be used cautiously in patients with a lifetime history of substance abuse given their highly addictive potential. Symptom-triggered prescription of benzodiazepines during alcohol withdrawal using the Revised Clinical Institute Withdrawal for Alcohol Scale (CIWA-Ar) has been associated with improved safety and reduced benzodiazepines use. Aim: To investigate if implementation of the CIWA-Ar during alcohol detoxification impacted the amount of benzodiazepines used and withdrawal-related outcomes in a specialized alcohol rehabilitation unit at Stikland Psychiatric Hospital in the Western Cape, South Africa. Methods: We conducted a retrospective cohort study of 135 admissions over a six month period before (2015) and after (2017) implementation of the CIWA-Ar. Results: We noted no differences in sociodemographic and alcohol-associated variables at admission between the two groups and there were no recorded complications in either group. The 2017 group had a lower percentage of patients that required benzodiazepines (33.8% vs 51.4%, p=0.04) and a lower median total amount of benzodiazepines used during alcohol withdrawal (0mg vs 5mg, p=0.01). Conclusions: The findings indicate that using the CIWA-Ar rating scale to determine benzodiazepines requirements in the specialised alcohol rehabilitation unit was a safe and effective alternative to pro re nata benzodiazepines prescribing in the South African setting and decreased the amount of benzodiazepines used during alcohol withdrawal.
Associations between exposure to community violence, symptoms of psychological distress, and school performance in high-risk peri-urban communities
(Stellenbosch : Stellenbosch University, 2024-03-01) Smith, Matthew James; Naidoo, Anthony Vernon; Rabie, Stephan; Stellenbosch University. Faculty of Arts and Social Sciences. Department of Psychology.
ENGLISH ABSTRACT: Research has shown that masculinities are socially and culturally constructed. How one particular social group constructs what it means to be a man varies depending on changing cultural values and beliefs. By unpacking how individuals understand their own masculinity as well as the masculinity of those around them, more can be learned about these cultural values and beliefs. This is important as these beliefs and norms that are tied to masculine identity can influence behaviour. There is considerable evidence finding that strict adherence to masculine norms results in limited help-seeking behaviour and poorer mental health outcomes. There is limited research in the South African context regarding young adolescent men’s mental health and help-seeking behaviours. Adolescence is a formative development period as this is when internalised masculine norms become entrenched within their masculine identity and can have long term impacts on their behaviour. By exploring personal constructions and understandings of masculinity by adolescent males, more can be learnt about the masculine norms that are endorsed and internalised by young men within the geographical location of the Stellenbosch district. The extent to which these norms influence help-seeking behaviour will allow for the identification of social norms that have a detrimental impact on health behaviours and can be targeted in future interventions. This qualitative study adopted a constructivist approach to meaning making, framing the research question, analysing the data, and reporting the research findings. A combined grounded theory and narrative inquiry methodology and case study design were used. The combined grounded theory and narrative inquiry approach worked well given the research aims of making sense of the participants’ personal understandings of masculinity, while still respecting their unique story and situation. The case study design was necessary given the sample size of the study. Qualitative data that were collected from individual interviews and a focus group were transcribed analysed using Braun and Clarke’s (2006) six phase framework for conducting a thematic analysis. Data from the individual interviews were presented separately from the data from the focus groups, as the focus group data was used to back up and validate the themes identified during the individual interviews. Findings indicated that traditional masculine gender norms associated with hegemonic masculinity were present and endorsed within this sample of young men. The participants stated that these masculine norms manifested as expectations on themselves, and they felt a great deal of pressure to meet these expectations. This pressure to maintain what they perceived as the norm for men would influence behaviour. For instance, practicing stoicism, crying in private, and emphasising emotional control were all behaviours undertaken by the participants so as to not jeopardise their status as a man. Help-seeking behaviour was viewed as a gendered behaviour, being seen as feminine. Other factors, such as perceived financial inaccessibility of therapy and lack of mental health knowledge were identified as playing a role in limited help-seeking behaviour. This research serves as a good snapshot of the masculine norms that are endorsed by young men in the Stellenbosch district, as well as how these masculine norms influence help-seeking behaviour.
Barefoot vs running shoes – Comparing 20m sprint performance, spatiotemporal variables and foot strike patterns in schoolchildren in the Western Cape
(Stellenbosch : Stellenbosch University, 2017-03) Murphy, Ian Desmond; Venter, Ranel; Stellenbosch University. Faculty of Education. Dept. of Sport Science
ENGLISH ABSTRACT : A short anaerobic sprint test such as a 20m sprint test forms part of many fitness test batteries used by sports teams and in schools during physical education classes for fitness testing. Some of these short sprint tests are done on a hard running surface and some of the protocols do not specify or standardise the type of footwear that should be worn and participants have a choice to sprint either barefoot (BF) or in running shoes. Similarly, many children and adolescents in South African schools participate in athletics competitions that are sometimes held on synthetic athletics tracks and since most children and adolescents do not own spikes, they have to choose between competing BF or in their running shoes. In some countries such as South Africa, which has a BF culture, sprinting BF is common. Currently, there is limited research available to answer whether it is faster to sprint BF or shod. The aim of the current study was to determine the acute effects of sprinting BF and in running shoes on 10m and 20m sprint performance, spatiotemporal variables and foot strike pattern (FSP). 115 Girls and 161 boys (N=276) aged 8-19 years from randomly selected schools in the Western Cape Province were recruited for the study. Children performed two 20m maximal effort sprints from a standing start on a hard running surface in both a BF and running shoes condition in random order. For each sprint, 10m and 20m sprint times, step frequency (StepF), stride length (SL), flight time (FT), ground contact time (GCT) and swing time (SwT) were measured and FSP was determined. Sprint times were measured with electronic photocells (Brower Timing Systems, Salt Lake City, UT) and spatiotemporal variables were measured with the OptoGait system (Microgate S.r.I, Bolzano, Italy). High-speed video footage was taken with a GoPro camera (GoPro HD Hero 4, GoPro Inc., San Mateo, California, USA) at 240Hz and was analysed with video analysis software (Kinovea 0.8.15) to determine FSPs. The data of the fastest sprint in each footwear condition was used for further statistical analysis. Statistically significant differences as well as small to medium practically significant differences were found between the BF and shod conditions for children and adolescents’ 10m and 20m sprint performance and all the measured spatiotemporal variables. When BF, children and adolescents’ 10m and 20m sprint performances were significantly faster (p<0.001) but with only small effect sizes (d=0.24 and d=0.25 respectively). The faster sprint performances when BF were due to a significantly higher StepF (p<0.001) with a medium effect size (d=0.42) despite being accompanied by a significantly shorter SL (p<0.001) with a medium effect size (d=0.73). The significantly higher StepF when BF was due to a significantly shorter FT (p=0.022) with a small effect size (d=0.16), a significantly shorter GCT (p<0.001) with a medium effect size (d=0.69) and a significantly shorter SwT (p<0.001) with a medium effect size (d=0.56). All differences in sprint performance and spatiotemporal variables were due to the shoe mass effect and not due to FSP differences caused by the footwear effect. Changing from the shod to the BF condition caused a significant decrease in the occurrence of a rearfoot strike (RFS) from 57% to 27% and a significant increase in the occurrence of a forefoot-/midfoot strike (FFS/MFS) from 43% to 73% (p<0.001). The shod condition, therefore, encouraged a significantly higher rate of RFS and the BF condition a significantly higher rate of FFS/MFS. In conclusion, changing from running shoes to BF has a significant acute effect on short anaerobic sprint performance, spatiotemporal variables and FSPs of schoolaged children. Sprinting BF is only marginally faster than sprinting in running shoes over 10m and 20m but this may potentially only be applicable to habitually BF children and adolescents. Sprinting BF or in running shoes is, therefore, almost the same speed and children and adolescents can choose either footwear condition for sprint tests of fitness batteries and for athletics competitions held on synthetic athletics tracks. Caution should be taken when acutely changing to sprinting BF since it increases the risk of plantar surface injuries.
The epidemiology of major depression in South Africa : results from the South African Stress and Health study
(Health and Medical Publishing Group (HMPG), 2009) Tomlinson, Mark; Grimsrud, Anna T.; Stein, Dan J.; Williams, David R.; Myer, Landon
Background. Mental disorders are a major contributor to the burden of disease in all regions of the world. There are limited data on the epidemiology of major depressive disorder in South Africa. Methods. A nationally representative household survey was conducted between 2002 and 2004 using the World Health Organization Composite International Diagnostic Interview (CIDI) to establish a diagnosis of depression. The dataset analysed included 4 351 adult South Africans of all racial groups. Results. The prevalence of major depression was 9.7% for lifetime and 4.9% for the 12 months prior to the interview. The prevalence of depression was significantly higher among females than among males. The prevalence was also higher among those with a low level of education. Over 90% of all respondents with depression reported global role impairment. Conclusion. In comparison with data from other countries, South Africa has lower rates of depression than the USA but higher rates than Nigeria. The findings are broadly consistent with previous findings in South Africa. These findings are the first step in documenting a level of need for care in a context of significant under-funding of mental health services and research in South Africa.
Experiences of Xhosa women providing kangaroo mother care in a tertiary hospital in the Western Cape, South Africa
(Stellenbosch : Stellenbosch University, 2023-12) Mpongwana-Ncetani, Sibongile; Lachman, Anusha; Roomaney, Rizwana; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
ENGLISH SUMMARY: Kangaroo mother care (KMC) has been recognized as one of the interventions to improve preterm birth outcomes by the World Health Organization. KMC requires high user engagement and consists of continuous skin‐to‐skin contact between the mother and infant and exclusive breastfeeding. We conducted a qualitative study of Xhosa women (n=10) practicing KMC in a tertiary hospital in the Western Cape, South Africa. All interviews were conducted in IsiXhosa, audio recorded, and transcribed. The transcribed data were analysed using thematic analysis. Four themes emerged: (1) KMC, a beneficial but foreign concept; (2) distress in the KMC ward; due to factors like poor milk supply, uncomfortable nursing positions and sleep deprivation; (3) themissing umbilical cord: experiences ofmothers in theKMC ward reflecting on respect for cultural and traditional practices but having limited knowledge of its significance themselves; and (4) the KMC village: interpersonal relations in the ward that oscillates between staff and fellow patient mothers. Our study showed that cultural practices still pose a challenge to fully accepting KMC. We suggest more studies on cultural sensitivity to encourage acceptance of interventions that affect culturally diverse groups.
The experiences, concerns, and receptivity in accessing digital health information and resources in caregivers of older adults with major neurocognitive disorder seen in a private psychogeriatric practice in Cape Town, South Africa.
(Stellenbosch : Stellenbosch University, 2023-03) Nhlabathi, Sihle; Niehaus, Dana; Nepgen, Nicolize; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
ENGLISH SUMMARY: Introduction: The financial and human resources needed for the development and maintenance of an internet-based cognitive disorder resource are significant. These resources may aid in improving caregiver burden and patient quality of life. Exploring the reasons for the apparent underutilization of these resources can lead to a targeted internet-based resources that are accessible, service user friendly and utilized efficiently. Methodology: This was a qualitative study using an interpretive methodology. A purposive heterogeneous sampling method was used to select 12 caregivers of patients who met the inclusion criteria in the research setting at a private psychogeriatric practice in Cape Town, South Africa. Data were collected through semi-structured interviews that were guided by a leading question and a set list of conversational prompts. The semi-structured interviews were digitally recorded, transcribed verbatim and analysed in a 6-step thematic analysis approach. Results: The verification sessions revealed the following main themes: i) lack of resources and the cost of accessing internet, ii) knowledge deficits, iii) information requirements and iv) receptiveness or perceptions. Conclusion: This study provides the valuable points of departure for internet-based resources. Caregivers in our study were enthusiastic about utilising these resources. They are also willing to provide feedback in terms of the type of information that would be helpful to them. Whilst caregivers see the value of internet-based resources, there is still a need for human contact or interactions e.g., with health professionals and through support groups. Perceptions were positive towards utilising mHealth psychiatric resources in the care of their family member that suffers from NCD. Barriers to accessing these resources include high data costs. Free data access to trustworthy, internet-based caregiver support tools should be explored in future.
Feasibility of a mindfulness-based intervention for stress reduction and resilience for medical students at a large teaching hospital and medical campus in the western cape : a randomised controlled, comparative trial with supportive counselling
(Stellenbosch : Stellenbosch University, 2021-12) Boyd, Nicola Lindy; Alexander, Debra Whiting; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
ENGLISH SUMMARY : The high levels of stress experienced by medical students is cause for concern due to the negative academic and emotional consequences both for themselves, as well as their future patients and professional careers. South Africa’s context contributes additional unique stressors for South African medical students. Research is showing that mindfulness-based interventions are effective for the treatment of psychological issues as well as of benefit to healthy individuals. Online delivery of such interventions increase accessibility for time-constrained participants. There is limited information about the potential of online mindfulness-based interventions to increase medical students’ wellbeing, self-compassion and to address perceived stress. This feasibility study aimed to provide information by investigating the effects of a six-week online, teacher-facilitated mindfulness-based intervention for medical students in comparison to supportive counselling. An evaluative, experimental, mixed-methods design included the randomisation of 45 self-selected participants to one of two groups. Quantitative data was collected online at pre-, post- and 8-week follow up. A post-course completed feedback questionnaire, provided qualitative data to provide an understanding of participants’ experience of the programmes. Results indicated significant positive changes in both groups’ wellbeing, decreased perceived stress and self-reported, enhanced stress management. Unexpectedly, a significant change in decreased self-compassion was noted over the time period. Mindfulness reflected as a statistically significant treatment effect in the mindfulness group at post-course analysis. Based on the findings, an introduction of a stress management programme for medical students is recommended – one which includes mindfulness and stress- related psychoeducational components as part of a wider mental health strategy. A main study would contribute further information to this area and whether findings could be widened to benefit tertiary students in South Africa.
The impact of perinatal trauma and HIV exposure on maternal mental health and infant social-emotional development in Khayelitsha, South Africa.
(Stellenbosch : Stellenbosch University, 2023-12) Motingoe, Kediemetse; Lachman, Anusha; Laughton, Barbara; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
ENGLISH SUMMARY: There is limited knowledge on the impact of HIV and trauma exposure on maternal mental health and infant social-emotional development. This study investigated pregnant women living with HIV, with either late or early initiation of antiretroviral therapy, and those not living with HIV and their infants. These mother-child dyads were followed up for 12 months postnatally. Maternal trauma levels, infant social withdrawal and symbolic play were evaluated using the Harvard Trauma Scale, Alarm distress baby scale, and the Belsky tests, respectively. This study showed low rates of PTSD compared to previous studies in this setting, with HIV status not showing significant differences in trauma exposure. There was insignificant impact of maternal HIV and trauma causing infant withdrawal and poor symbolic play. Larger, longer-term studies are necessary for further exploration.
Infant malnutrition and maternal mental health in home based care
(Stellenbosch : Stellenbosch University, 2021-03) Jacobs, Moezna; Lachman, Anusha; Van Niekerk, Evette; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
ENGLISH SUMMARY : Background: Maternal mental health is of critical importance in the early years of childhood due to its impact on the short and long term outcomes of the child and the caregiver. The combination of women’s vulnerability to depression and their responsibility of childcare suggests that maternal mental health could have a significant effect on the growth of children. Objectives: This study sought to describe the mental health status of mothers receiving home based care in the Nomzamo area in the Helderberg basin of the Cape Metropole, and to determine whether there were higher rates of malnutrition in infants 0-24 months amongst mentally-ill mothers compared to well mothers Design:A descriptive, quantitative, cross-sectional study was conducted and included mothers taking care of 0-24 month old infants, receiving home based care. Outcome measures: Maternal Mental health was screened using the PHQ 9, GAD 7 and 3 CPMD questionnaire. Infant weight-for-age, height-for-age and weight-for-height z-scores were measured. Results: 14% of mothers experienced symptoms of anxiety, 22% experienced symptoms of depression and 18% of mothers had a suicide risk. The majority of infants (86%) had a normal weigh-for-age, and a normal height-for-age (90%). We found no association between malnutrition and maternal health. There were significant associations between depression and male infant gender, marital status, accommodation and level of education of the mothers. Conclusions: Maternal mental health rates were consistent with previous studies done in Western Cape and LMICs. The rates of malnutrition were lower than expected and this could be attributed to the support given by community health workers. There were no positive associations found between maternal mental health and malnutrition in this sample. Further research is needed in this area.
Intimate partner violence and its association with substance use disorder : a qualitative study
(Stellenbosch : Stellenbosch University, 2023-12) Ferreira, Luzette; Roos, Annerine; Lochner, Christine; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
ENGLISH SUMMARY: Intimate partner violence (IPV) is a serious public health and social problem affecting a large proportion of women in both developed and developing countries. South Africa has one of the highest prevalence rates of IPV compared to other countries, with significant negative effects on the well-being and mental health of the victims. IPV has been significantly associated with substance use disorder (SUD) and victims of IPV are significantly more prone to abuse multiple substances. There is a lack of rich narrative information within a South African context with regards to women’s experiences of IPV and SUD. My aim was to qualitatively investigate the experiences and challenges of women present with both SUD and IPV. Twelve participants with ages ranging between 18 and 43, in an inpatient unit offering rehabilitation services, were interviewed using a semi-structured interview and several questionnaires to assess type, severity and history of IPV and SUD; to identify risk factors such as mental health symptoms and childhood abuse. After transcription of audiotaped interviews, thematic analysis was used to derive from participants’ narratives three primary themes: i) Substance abuse and relationship development, ii) The relationship became abusive, and iii) Becoming sober and leaving the relationship. Under each primary theme, four subthemes were identified. A history of abuse and mental health problems contributed to increased vulnerability in these participants. Mental health consequences of IPV were mostly undiagnosed and participants identified symptoms of depression, anxiety, and trauma. IPV often went untreated as the primary treatment was for SUD. These findings describe the complexity of IPV and SUD in women within treatment centres as well as the escalation and severity of these two problems when they occur simultaneously. This study adds to the limited literature on South African women’s daily experiences of living with both IPV and SUD. Participants’ narratives provide valuable information that provide a foundation for future investigations among larger populations of women with IPV and SUD; to determine their unique experiences, difficulties and needs for targeted treatment.
Investigating inflammation in neuropsychiatric disorders
(Stellenbosch : Stellenbosch University, 2021-03) Moodley, Allegra; Hemmings, S. M. J.; Swart, P. C.; Womersley, J. S.; Seedat, S; Stellenbosch University. Faculty of Medicina and Health Sciences. Dept. of Psychiatry.
ENGLISH ABSTRACT: Chronic systemic inflammation, characterised by the elevated production of pro-inflammatory cytokines, has been implicated in the pathophysiology and severity of neuropsychiatric disorders (NPDs), such as posttraumatic stress disorder (PTSD), Parkinson’s disease (PD) and schizophrenia (SCZ). However, the exact role pro-inflammatory cytokines play in NPDs has yet to be fully established, with several studies reporting inconsistent findings. The current study aimed to measure the association between levels of interferon gamma (IFN), interleukin one beta (IL-1), interleukin six (IL-6), tumour necrosis factor alpha (TNF) and C-reactive protein (CRP), and PTSD, PD and SCZ. Serum samples were previously collected as part of a parent cohort study (SHARED ROOTS Flagship Project). Diagnoses of PTSD, PD and SCZ were made by clinicians and assessed according to the Diagnostic and Statistical Manual of Mental Disorders-5th edition (DSM-5) for PTSD and PD. Severity of the disorders were evaluated using the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) for PTSD, the Unified Parkinson’s Disease Rating Scale (UPDRS) for PD and the Positive and Negative Syndrome Scale (PANSS) for SCZ. Pro-inflammatory cytokines, IFN, IL-1, IL-6, TNF and CRP were measured in serum samples of participants (PTSD cohort: 139 cases, 179 controls; PD cohort: 46 cases, 21 controls; 31 SCZ cohort: 18 first-episode cases, 13 chronic cases, 39 controls) using multiplex and immunoturbidimetric assays. Statistically significant lower levels of IL-1 were found to be associated with PTSD status after controlling for age, smoking and metabolic syndrome (OR = 0.24; p = 0.0146), whilst PD status was associated with statistically significant elevated levels of IL-6 (OR = 34.97; p = 0.0254) and lower levels of CRP (OR = 0.57; p = 0.0401), after adjusting for sex. Increased levels of TNF were significantly associated with chronic SCZ diagnosis after controlling for metabolic syndrome (OR = 5.52; p = 0.0218). The findings observed in this study contributes to the evidence that immune processes are dysregulated in NPDs, however future studies are required to provide further insight into the relationship between pro-inflammatory markers and NPDs.
Long-term outcomes of an assertive community treatment (ACT) intervention : a 10-year follow-up
(Stellenbosch : Stellenbosch University, 2022-12) Coetzee, Danell; Botha, Ulla; Koen, Liezl; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
ENGLISH SUMMARY: Background: Assertive community treatment (ACT) is an intervention implemented in many countries to manage the effects of deinstitutionalization, with studies in South Africa demonstrating decreased admissions at 12 and 36-month follow-up for patients receiving modified ACT compared to standard care. Whilst shown to be effective, costs associated with the intervention has raised the question of its feasibility in developing countries. Aim: This study aimed to describe the demographic and clinical outcomes of a group of patients included in an ACT interventional study, 10 years after inclusion. Methods: This is a retrospective description of the 10-year outcomes of a group of 55 highfrequency psychiatric users (HFUs) included in the first ACT intervention in South Africa. The group either received follow-up with a modified ACT program or at a community care centre. Demographics, admissions, social functioning and adverse events were outcomes reviewed. Results: Nine patients remained in ACT for the full 10 years, 16 were never included and 30 patients spent some time in ACT. Five participants died, 2 were admitted to long-term wards and 12 were never re-admitted. The group had an overall low level of education, a mean age of 43 years and most were single (82%). The mean number of admissions were 3.73 and the mean number of admission days was 261.11. Conclusions: This was the first study looking at the long-term outcomes of a group of HFUs in an under-resourced setting receiving a modified ACT intervention. Correlation with the poor psychosocial outcomes often associated with schizophrenia were found in this group, but overall, the study findings suggest increased stabilization, service utilization and quality of life for patients exposed to ACT at some stage in their treatment.
Maternal perinatal risk factors for adolescent mood disorders in an inpatient setting
(Stellenbosch : Stellenbosch University, 2021-03) Ndlela, Nhlanhla Lucky; Adams, Amy S.; Lachman, Anusha; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
ENGLISH SUMMARY : Background: One of the major factors known to affect the psychological wellbeing of youth is the mental health of their caregivers. Women/mothers are typically the primary caregivers in South Africa. Previous studies have highlighted a positive relationship between maternal mental disorders and poor adolescent outcomes. This study aimed to identify the possible risk factors that are associated with the development and progression of mood disorders in an adolescent population from the Western Cape, South Africa. Methods: This descriptive study involved a retrospective record review of all patients admitted to Tygerberg adolescent psychiatric inpatient unit during the period 2015 to 2017. The study sample consisted of 10 male and 27 female research participants. Continuous variables were summarized as mean and standard deviation, while nominal variables were summarized as counts and percentages. Results: The research findings identified a number of possible maternal risk factors associated with the development of adolescent mood disorders. These risk factors include a history of maternal psychiatric illness, maternal postpartum depression, domestic violence, adolescent bereavement and maternal substance use during and after pregnancy. Conclusion: Mothers with a history of psychiatric disorders need further psycho-education regarding the possible impact of these risk factors on the mental health of their children.
Medical management of opioid dependence in South Africa
(Health and Medical Publishing Group (HMPG), 2008) Weich, Lize; Perkel, Charles; Van Zyl, Nicolette; Rataemane, S. T.; Naidoo, Lochan
Medical practitioners in South Africa are increasingly confronted with requests to treat patients with opioid use disorders. Many do not possess the required knowledge and skills to deal with these patients effectively. This overview of the medical treatment of opioid dependence was compiled by an elected working group of doctors working in the field of substance dependence. Recommendations are based on current best practice derived from scientific evidence and consensus of the working group, but should never replace individual clinical judgement.
The mental health of caregivers of children with atopic dermatitis at Tygerberg hospital
(Stellenbosch : Stellenbosch University, 2023-12) Suresh, Shwetha; Lachman, Anusha; Kannenberg, Suretha; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
ENGLISH SUMMARY: Background: Atopic dermatitis (AD) is a chronic and often debilitating illness for children but also has a significant effect on caregiver quality of life (QOL) and mental health. Aim: To explore the relationship between AD in children on the QOL and the mental health of their caregivers. Methods: We conducted a cross-sectional study of patients and their caregivers attending the Dermatology Clinic at Tygerberg Hospital in Cape Town, South Africa. Participants were recruited between February 2021 and August 2021. Results: Most of the children in this study experienced mild AD symptoms. Almost 90% of the children had an identifiable trigger, with the most common triggers being an environmental temperature change (66.7%) and stress (57.4%). We noted a weak but significant correlation between QOL and AD severity (rs = 0.395, p = 0.003) and a strong positive correlation between the caregivers’ QOL and their mental health (rs = 0.650, p < 0.001). Conclusions: The use of uncomplicated and rapid screening tools for caregiver mental health and QOL should be implemented when treating patients with AD. Understanding the burden and allowing room for mitigation of these modifiable factors will play a large role in ensuring a better therapeutic outcome for those children with a chronic illness like AD.
Parents’ practices and beliefs about their infants play at two state infant mental health clinics in Cape Town
(Stellenbosch : Stellenbosch University, 2021-03) Domingo, Marchelle; Berg, Astrid; Mpinda, Bulelwa; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
ENGLISH SUMMARY : Background: Insight into local beliefs about play, which is highly under studied within the first three years of life, could inform clinical practice in that clinicians and parents might have different views about play. Aim: The study aimed to explore and describe parents’ practices and beliefs about their infants play. Methods: Qualitative study using individual semi structured interviews with six purposefully selected parents, who attended an Infant Mental Health Clinic at either Tygerberg or Lentegeur state hospitals in Cape Town, over the last twelve months. Results: All parents were birth parents, with a mean age of 33 years. Most parents (83.3%) were female. Two-thirds (66.7%) were unemployed at the time of the interview. Infants were predominantly male (83.3%). Most parents had never considered play as something of significance in their own or their children’s lives. Several transgenerational subthemes emerged, suggesting that parents’ experiences and beliefs about play impacted their interaction and the messages they conveyed about play behaviours. Most parents appeared motivated to give their children the best opportunities for play, but some found it difficult to balance daily demands and demonstrated a reliance on expert guidance. Conclusions: There is a need for parental guidance – to allow for a space for parents to explore what they understand by ‘play’ and what their childhood experiences might have been, before the clinician can give information, examples, and guidance as to the importance of play so that it can be meaningful for the parent.
Prevalence and associated factors of depression among older adults in rural Tanzania
(Stellenbosch : Stellenbosch University, 2022-12) Mlaki, Damas Andrea; Laila, Asmal; Walker, Richard; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
ENGLISH SUMMARY: Objectives: Depression is the commonest mental disorder in older adults worldwide, affecting 7% of the world’s older population and accounting for 5.7% of years lived with disability among adults aged over 60 years. We conducted a secondary data analysis to determine the point prevalence, associated risk factors and treatment gap for DSM-IV depression among older adults in the Hai District, rural Tanzania. Methods: The primary data source was a cross-sectional two-stage community-based dementia study where older adults aged ≥70 years (n=296) were fully-assessed for dementia and depression in the second stage. Age-adjusted prevalence of depression was determined based on the WHO standard population using the Direct Method. Univariate and multivariate logistic regression models were performed. Results: Of the 296 older adults assessed for depression, 48 were diagnosed with depression based on Diagnostic and Statistical Manual of Mental Disorders-IV criteria. The median (Inter Quartile Range) (IQR) age was 80 (75–88) years. Age-adjusted point prevalence of depression was 21.2% (95%CI: 16.6–21.9) and the treatment gap for depression was 100%. There was reduced odds of depression in older adults who rated their physical health as good or very good (AOR=0.22; 95%CI: 0.10–0.46; p<0.001), or moderate (AOR 0.26; 95%CI: 0.10–0.66; p=0.005). Conclusions: Depression in older adults is associated with physical health status and there is an alarmingly high treatment gap. Future research on depression in older adults should focus on effective interventions to address physical morbidity, psychosocial factors and the treatment gap.
Prevalence of vitamin B12 deficiency in psychogeriatric patients in private practice in Cape Town
(Stellenbosch : Stellenbosch University, 2023-03) Gabriels, Charnotte; Niehaus, Dana; Potocnik, Felix; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
ENGLISH SUMMARY: Background: The elderly population in South Africa is growing and it is estimated that 5.4 million (9.1%) of the population is aged 60 years or older (nearly 1 in 10 elderly). Quality of life and physical wellbeing are important to maintain optimal function and independence in the later years of life. Malnutrition is one risk factor that increases morbidity and mortality in the elderly, where suboptimal vitamin B12 levels, one form of malnutrition, has been shown to impair cognition and immune status. Prevalence studies on vitamin B12 deficiency in the elderly in South Africa are limited. This study will provide information on the prevalence of vitamin B12 deficiency and if this deficiency is associated with selected demographic, medical and cognitive variables. Objective: To determine the prevalence (95% CI) of vitamin B12 deficiency in patients, 60 years and older and to investigate if vitamin B12 deficiency is associated with any sociodemographic, medical or cognitive factors in this population group. Methods: We conducted a retrospective cohort study of all first-time patients (≥60 years old) attending their first consult at a Psychogeriatric Private Practice in Durbanville, Cape Town between January 2017 and January 2020. Patients who had their vitamin B12 levels assessed at intake were included in the study, where participants with B12 levels of <148 pmol/L were categorised as having a deficiency, 148-221 pmol/L as having low levels, and >221 pmol/L as having adequate levels. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), Mini Mental State Examination (MMSE) and the Repeatable Battery for Neuropsychological Status (RBANS).
Problematic feeding behaviours in infants and the mental health of their caregivers : a descriptive study at two public health care facilities in the Western Cape
(Stellenbosch : Stellenbosch University, 2021-03) Subramoney, Jeannine; Lachman, Anusha; Van Niekerk, Evette; Berg, Astrid
ENGLISH SUMMARY : Background: Maternal mental health (MMH) is considered a risk factor for feeding difficulties in young children. Problematic eating behaviour may not pose an immediate physical health threat; however, long-term poor dietary intake is a known contributor towards poor developmental outcomes. Objectives: To describe the common mental health symptomatic status of mothers of children (1-3 years old) that present with problematic feeding behaviours at government health sites in Atlantis and a nonprofit organization – Courage-to-Care in the Western Cape. Methods: Using a cross-sectional study design with purposive sampling, 16 mother-child dyads were recruited. Problematic feeding behaviours were screened for using the Montreal Children’s Hospital feeding scale and anthropometric measurements were used for growth development. MMH was assessed using the Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-item and the Common Perinatal Mental Disorders screening tools. Results: Infants had a current median (IQR) age of 22 (18.00-36.00) months. Most infants had normal growth development. However, 43% of infants scored as having severe feeding difficulties. Mothers had a mean (SD) age of 28.40 (7.03) years with 18% reporting severe anxiety symptoms and 25% with severe depressive symptoms. Suicide risk was high (50%). Infants with severe feeding difficulties were noted for 25% of mothers with severe depression and 32% of the mothers that screened in the suicidal risk category. Conclusions: The findings suggest that MMH screenings should be integrated at baby wellness clinics to help mothers who may be experiencing common mental health disorders to seek early intervention at primary health care settings.
Problematic use of the internet and family functioning : a quantitative investigation
(Stellenbosch : Stellenbosch University, 2022-04) Van Den Berg, Gizela; Lochner, Christine; Coetzee, Bronwyne; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
ENGLISH SUMMARY: The internet is intertwined with most aspects of our daily lives and contribute considerably to the progression of humankind. Nevertheless, the excessive and maladaptive use of the internet are linked to serious health concerns and has subsequently been termed problematic use of the internet. Problematic use of the internet (PUI) is widely considered a behavioural addiction and is frequently linked to various psychological, social, academic, and/or professional problems. Many people with PUI present with psychiatric comorbidities such as obsessive-compulsive disorder, obsessive-compulsive personality disorder, autism spectrum disorder, and attention deficit/hyperactivity disorder. Moreover, there are many reports suggesting that young people are at particular risk for PUI. Existing literature, mainly conducted in Asia, implicate family functioning in PUI. According to the premise of family systems theory (FST), PUI can only be appraised by examining the complex interactions of family members. The relationship between PUI and family functioning is shown to be reciprocal in nature: PUI may result in unhealthy family functioning, marked by conflict, low levels of cohesion, and poor communication. In turn, unhealthy family functioning may reinforce PUI when members excessively engage with the internet as a coping mechanism. Little research has been done on PUI in general, and none in youth in South Africa (SA). To our knowledge, this is the first study to investigate the relationship between PUI and family functioning in South African youth between the ages of 18 and 30. There were four research objectives to the present study. The first objective was to determine the demographic profile of our sample of 18-to-30-year-old South Africans with PUI (including PUI prevalence rates). The second objective was to investigate whether there is a relationship between PUI and family functioning. The third objective was to explore whether there is a relationship between time spent on various online activities (e.g., online gaming, online gambling, and online pornography) and family functioning. The fourth objective was to determine whether there is an interaction effect between PUI and comorbid psychiatric disorders (e.g., obsessive-compulsive disorder, autism spectrum disorder, and attention deficit/hyperactivity disorder) on family functioning. Cross-sectional survey data was collected from 814 South Africans between the ages of 18 and 30 years. Among our sample of 814 respondents (𝑛𝑓𝑒𝑚𝑎𝑙𝑒𝑠 = 531; 𝑛𝑚𝑎𝑙𝑒𝑠 = 278; 𝑛𝑡𝑟𝑎𝑛𝑠𝑔𝑒𝑛𝑑𝑒𝑟/𝑜𝑡ℎ𝑒𝑟 = 5), the prevalence rate of PUI was 15%, indicating that PUI may be a significant mental health issue among our sample. Potential risk factors to PUI in our sample included: being single, having completed high school (grade 12), having some college/university education, and being a university/college student. Results showed that as scores on the JEG internet addiction test (IAT) 10-item instrument increased, scores on the general functioning scale of the family assessment device (GF-FAD) increased linearly, indicating that increased severity of PUI was associated with increased severity of unhealthy family functioning (r = .33, p < .001). There was a significant difference in the GF-FAD scores for individuals with PUI (M = 2.57, SD = .51) and those without PUI (M = 2.13, SD = .61); t(812) = -7.52, p < 0.001, suggesting that individuals with PUI experienced unhealthier family functioning than individuals without PUI. The increased frequency of all but one of the PUI symptoms (i.e., symptom six: “Do you snap, yell, or act annoyed if someone bothers you while you are on-line?”) correlated significantly with severity of unhealthy family functioning. Section B of the internet severity and activities addiction questionnaire (ISAAQ), i.e., the internet activities scale (IAS), indicated that as time spent on social networking (r = .11, p = .003), online pornography (r = .20, p < .001), streaming media (r = .11, p = .003), and cyberbullying (r = .17, p < .001) increased, the severity of unhealthy family functioning increased. No interaction effects of PUI and comorbidities on family functioning were found (p > .05). In conclusion, the current findings suggest that PUI is common in South African youth. This study also sheds light on the nature of the relationship between PUI and unhealthy family functioning among young South Africans. This relationship demands sustained attention and effort from role-players such as parents, schools, clinicians and policymakers alike, to mitigate it and therefore promote the optimal development of youth.

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