Department of Psychiatry

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10Kin1day : a bottom-up neuroimaging initiative
(Frontiers Media, 2019) Van den Heuvel, Martijn P.; Scholtens, Lianne H.; Van der Burgh, Hannelore K.; Agosta, Federica; Alloza, Clara; Arango, Celso; Auyeung, Bonnie; Baron-Cohen, Simon; Basaia, Silvia; Benders, Manon J. N. L.; Beyer, Frauke; Booij, Linda; Braun, Kees P. J.; Filho, Geraldo Busatto; Cahn, Wiepke; Cannon, Dara M.; Chaim-Avancini, Tiffany M.; Chan, Sandra S. M.; Chen, Eric Y. H.; Crespo-Facorro, Benedicto; Crone, Eveline A.; Dannlowski, Udo; De Zwarte, Sonja M. C.; Dietsche, Bruno; Donohoe, Gary; Du Plessis, Stefan; Durston, Sarah; Diaz-Caneja, Covadonga M.; Díaz-Zuluaga, Ana M.; Emsley, Robin; Filippi, Massimo; Frodl, Thomas; Gorges, Martin; Graff, Beata; Grotegerd, Dominik; Gąsecki, Dariusz; Hall, Julie M.; Holleran, Laurena; Holt, Rosemary; Hopman, Helene J.; Jansen, Andreas; Janssen, Joost; Jodzio, Krzysztof; Jancke, Lutz; Kaleda, Vasiliy G.; Kassubek, Jan; Masouleh, Shahrzad Kharabian; Kircher, Tilo; Koevoets, Martijn G. J. C.; Kostic, Vladimir S.; Krug, Axel; Lawrie, Stephen M.; Lebedeva, Irina S.; Lee, Edwin H. M.; Lett, Tristram A.; Lewis, Simon J. G.; Liem, Franziskus; Lombardo, Michael V.; Lopez-Jaramillo, Carlos; Margulies, Daniel S.; Markett, Sebastian; Marques, Paulo; Martinez-Zalacaín, Ignacio; McDonald, Colm; McIntosh, Andrew M.; McPhilemy, Genevieve; Meinert, Susanne L.; Menchon, Jose M.; Montag, Christian; Moreira, Pedro S.; Morgado, Pedro; Mothersill, David O.; Merillat, Susan; Muller, Hans-Peter; Nabulsi, Leila; Najt, Pablo; Narkiewicz, Krzysztof; Naumczyk, Patrycja; Oranje, Bob; De la Foz, Victor Ortiz-Garcia; Peper, Jiska S.; Pineda, Julian A.; Rasser, Paul E.; Redlich, Ronny; Repple, Jonathan; Reuter, Martin; Rosa, Pedro G. P.; Ruigrok, Amber N. V.; Sabisz, Agnieszka; Schall, Ulrich; Seedat, Soraya, 1966-; Serpa, Mauricio H.; Skouras, Stavros; Soriano-Mas, Carles; Sousa, Nuno; Szurowska, Edyta; Tomyshev, Alexander S.; Tordesillas-Gutierrez, Diana; Valk, Sofie L.; Van den Berg, Leonard H.; Van Erp, Theo G. M.; Van Haren, Neeltje E. M.; Van Leeuwen, Judith M. C.; Villringer, Arno; Vinkers, Christiaan H.; Vollmar, Christian; Waller, Lea; Walter, Henrik; Villringer, Arno; Vinkers, Christiaan H.; Vollmar, Christian; Waller, Lea; Walter, Henrik; Whalley, Heather C.; Witkowska, Marta; Witte, A. Veronica; Zanetti, Marcus V.; Zhang, Rui; De Lange, Siemon C.
Parkinson’s disease (PD) is a well-known neurodegenerative disease with a strong association established with systemic inflammation. Recently, the role of the gingipain protease group from Porphyromonas gingivalis was implicated in Alzheimer’s disease and here we present evidence, using a fluorescent antibody to detect gingipain R1 (RgpA), of its presence in a PD population. To further elucidate the action of this gingipain, as well as the action of the lipopolysaccharide (LPS) from P. gingivalis, low concentrations of recombinant RgpA and LPS were added to purified fluorescent fibrinogen. We also substantiate previous findings regarding PD by emphasizing the presence of systemic inflammation via multiplex cytokine analysis, and demonstrate hypercoagulation using thromboelastography (TEG), confocal and electron microscopy. Biomarker analysis confirmed significantly increased levels of circulating proinflammatory cytokines. In our PD and control blood analysis, our results show increased hypercoagulation, the presence of amyloid formation in plasma, and profound ultrastructural changes to platelets. Our laboratory analysis of purified fibrinogen with added RgpA, and/or LPS, showed preliminary data with regards to the actions of the protease and the bacterial membrane inflammagen on plasma proteins, to better understand the nature of established PD.
The 5-HTTLPR-rs25531 S-A-S-A haplotype and chronic stress moderate the association between acute stress and internalizing mental disorders among HIV+ children and adolescents in Uganda
(Frontiers, 2021-04-23) Kalungi, Allan; Womersley, Jacqueline S.; Kinyanda, Eugene; Joloba, Moses L.; Ssembajjwe, Wilber; Nsubuga, Rebecca N.; Seedat, Soraya, 1966-; Hemmings, Sian M.
Background: Internalizing mental disorders (IMDs) among HIV-positive (HIV+) children and adolescents are associated with poor disease outcomes, such as faster HIV disease progression. Although it has been suggested that the development of IMDs is moderated by interaction of stressful life events and vulnerability factors, the underlying etiology is largely unknown. Serotonin transporter gene [solute carrier family 6 member A4 (SLC6A4)] and human tryptophan hydroxylase 2 gene (TPH2) polymorphisms have been implicated in the development of IMDs. This study investigated the association between acute stress and IMDs, and moderation by chronic stress and genetic variants in SLC6A4 and TPH2. Hypothesis: Acute stress acts through genetic and environmental vulnerability factors to increase the risk of developing IMDs. Methods: Polymorphisms in SLC6A4 (5-HTTLPR, rs25531, 5-HTTLPR-rs25531, and STin2 VNTR) and TPH2 (rs1843809, rs1386494, rs4570625, and rs34517220) were genotyped in 368 HIV+ children and adolescents (aged 5–17 years) with any internalizing mental disorder (depression, anxiety disorders, or posttraumatic stress disorder), and 368 age- and sex-matched controls, who were also HIV+. Chronic and acute stress categories were derived by hierarchical cluster analysis. Logistic regression analysis was used to assess the independent moderating effect of chronic stress and each selected polymorphism on the association between acute stress and IMDs. Results: We observed a statistically significant association between severe acute stress and IMDs (p = 0.001). Children and adolescents who experienced severe acute stress were twice as likely to develop IMDs, compared to children and adolescents who experienced mild acute stress (p = 0.001). Chronic stress interacted with severe acute stress to increase the risk of IMDs (p = 0.033). Acute stress was found to interact with 5-HTTLPR-rs25531 S-A-S-A haplotype to increase the risk for IMDs among Ugandan HIV+ children and adolescents (p = 0.049). We found no evidence for a combined interaction of acute stress, chronic stress, and 5-HTTLPR-rs25531 on IMDs. Conclusion: The odds of having an internalizing mental disorder (IMD) were higher among HIV+ children and adolescents who experienced severe acute stress compared to HIV+ children and adolescents who experienced mild acute stress. Chronic stress and 5-HTTLPR-rs25531 independently moderated the association between acute stress and IMDs.
The adaptation and norming of selected psychometric tests for 12- to 15- year-old urbanized Western Cape adolescents
(Stellenbosch : Stellenbosch University, 2011-12) Ferrett, Helen Louise; Carey, Paul; Thomas, K.; Stellenbosch University. Faculty of Health Sciences. Dept. of Psychiatry.
ENGLISH ABSTRACT: The practice of psychometric testing of cognitive functioning in South Africa is hampered by the paucity of normative data that adequately characterize our ethnically, linguistically, socioeconomically, and educationally diverse population. The general aim of this study was to ascertain whether cognitive tests developed in settings outside of the Western Cape urbanized area have valid application for clinical and research purposes in that area. Strategies used to achieve that aim included: 1) translation, adaptation, and subsequent administration of a compendium of tests in a sample of typically developing, coloured and white, 12- to 15-yearold, Afrikaans- and English-speaking adolescents; 2) evaluation of the relative impact of sociodemographic factors (age, sex, language, quality of education, and race) on test performance and the consequent derivation of appropriately stratified normative data; and 3) evaluation of the cross-cultural utility of the normative data by comparing data collected from the study sample to norms derived from other populations. Results indicated that sex and language of testing impacted minimally on cognitive functioning. In contrast, the pervasive and deleterious impact of disadvantaged quality of education on cognitive performance within typically developing adolescents was clearly demonstrated. For participants with advantaged quality of education, coloured race was associated with lower performance on measures of intelligence, semantic fluency, and one measure of attention. Furthermore, the results provided evidence of age-related increments in cognitive performance, particularly after the age of 12. For cognitive measures that were significantly affected by language, race, and quality of education, trends of a downward continuum of performance were demonstrated, from highest to lowest, as follows: 1) English-white-advantaged; 2) Afrikaans-white-advantaged; 3) Englishcoloured- advantaged; 4) English-coloured-disadvantaged; 5) Afrikaans-coloured-advantaged; and 6) Afrikaans-coloured-disadvantaged. Cross-cultural comparisons of norms showed that for some tests, norms derived from other populations were suitable for use in the study sample. For other tests, however, results showed that for certain subgroups, it was essential to use the stratified norms derived from the study in order to prevent misdiagnoses.
An adapted intervention for problematic alcohol use in people living with AIDS and its impact on alcohol use, general functional ability, quality of life and adherence to HAART : a cluster randomized control trial at Opportunistic Infections Clinics in Zimbabwe
(Stellenbosch : Stellenbosch University, 2018-12) Madhombiro, Munyaradzi; Seedat, Soraya; Rusakaniko, Simba; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
ENGLISH SUMMARY : With the advent of antiretroviral therapy, the HIV pandemic has become a chronic illness requiring lifelong treatment. The 90-90-90 strategy, adopted by UNAIDS, aims for (i) 90% of HIV infected persons knowing their status, (ii) 90% on antiretroviral therapy; and (iii) 90% achieving viral suppression. The goal is to reach these aims by 2020. Alcohol use affects the attainment of the 90-90-90 goals. Research shows that people living with HIV (PLWH) drink twice as much as their HIV negative counterparts. Alcohol use disorders (AUD) in PLWH are associated with poor adherence to ART. Recommendations have been made to include interventions for AUDs in HIV prevention and treatment strategies. Brief interventions are recommended for hazardous alcohol use; however, for alcohol dependence a stepped care model incorporating behavioural/psychological treatments and pharmacological interventions may be required. Pharmacological treatments may lead to a higher pill burden and psychological interventions are, therefore, the treatment of choice. Psychological interventions have traditionally been delivered by a highly skilled workforce. However, in low and medium income countries (LMIC) where the HIV prevalence is high, there is a shortage of a skilled workforce. Task sharing has been recommended as a way of scaling up the delivery of services. The aim of this study was to adapt an evidence-based intervention for HIV and AUDs in Zimbabwe and to assess its effectiveness in a cluster randomized controlled trial (RCT). To achieve this, we first conducted a systematic review of the evidence for the effectiveness of psychological interventions. Second, a qualitative study was done to understand knowledge and perceptions of AUDs among PLWH and potential barriers and facilitators of interventions for AUDs. Third, we conducted a pilot and feasibility study in preparation for the RCT. The systematic review found limited evidence for the effectiveness of psychological interventions for AUDs, particularly on the frequency of drinking. Motivational interviewing (MI) alone and in combination with mobile technology, and cognitive behavioural therapy (CBT) were found to be effective. Additionally, MI was effective in reducing risky sexual behaviour, adherence to ART, other substance use disorders, viral load reduction, and increase in CD4 count. The qualitative study found that PLWH had adequate knowledge of the direct and indirect effects of alcohol use on HIV transmission and adherence to treatment, and were concerned about the stigma faced by PLWH who have and AUDs. Furthermore, participants were concerned about the stigma faced by PLWH who have AUDs. They called for stigma reduction strategies to be implemented and were receptive of the idea of interventions for AUDs. Following a pilot study which indicated that an intervention for AUDs was feasible, a cluster RCT was carried out at 16 HIV care clinics. The adapted intervention included motivational interviewing blended with cognitive behavioural therapy (MI/CBT). The comparator intervention was the alcohol use section of the World Health Organisation (WHO) mental health Gap Action Program Intervention Guide (mh GAP IG). The MI/CBT and mh GAP IG interventions were delivered by registered general nurses (RGN) embedded in HIV care clinics. The primary outcome was a reduction in alcohol use as measured by the Alcohol Use Disorders Identification Test (AUDIT) score. Secondary outcome measures included: (i) HIV disease parameters, as measured by the viral load and CD4 count; (ii) functionality, as assessed by the WHO Disability Assessment Schedule (WHODAS 2.0); and (iii) quality of life, as measured by the WHO Quality of Life HIV (WHOQOL HIV). The cluster RCT demonstrated that RGNs can be trained to deliver an MI/CBT intervention for AUDs in PLWH. Additionally, the MI/CBT intervention significantly reduced alcohol consumption in PLWH. While the reduction in alcohol consumption was maintained in the MI/CBT arm at 6 months, this effect was only maintained in the mh GAP IG arm up to 3 months. Additional improvements were seen in HIV treatment outcomes (especially viral load), functionality, and quality of life. Finally, it was feasible to deliver an MI/CBT intervention using a task sharing model. In terms of implementation, this can be done with a modest increase in staffing. Given the negative role AUDs play in the HIV treatment cascade, reduction in alcohol use can help in achieving the UNAIDS’ 90-90-90 goals. Further, effectiveness trials are needed in LMIC with a high prevalence of HIV. When conducting these trials, attention should be paid to patient experiences, such as the ‘double’ stigma of HIV and AUDs.
Addressing childhood trauma in a developmental context
(Taylor and Francis, 2013-06) Gregorowski, Claire; Seedat, Soraya
With the anticipated publication of the DSM-5 in May 2013, much reflection and work has been done on reviewing existing psychiatric nomenclature including, but not limited to the field of traumatic exposure. Traditionally, understanding of the psychiatric and psychological effects of trauma have been developed from studies with adults and then applied to trauma-exposed children with some modifications. While this is an important step to understanding the sequelae of trauma in children and adolescents, the adverse developmental effects of traumatic exposures on the rapidly evolving neurological, physical, social and psychological capacities of children calls for a developmentally sensitive framework for understanding, assessing and treating trauma-exposed children. The importance of early attachment relationships in infancy and childhood means that severely disrupted early caregiving relationships may have far-reaching and lifelong developmental consequences and can therefore be considered traumatic. Given the high rates of violence and trauma exposure of South African children and adolescents, the need for a developmentally based understanding of the effects of trauma on child and adolescent mental health becomes even more pronounced. In this paper, we draw on theoretical perspectives to provide a practical, clinically driven approach to the management of developmental trauma.
Addressing the intersection between alcohol consumption and antiretroviral treatment : needs assessment and design of interventions for primary healthcare workers, the Western Cape, South Africa
(BioMed Central, 2016) Schneider, M.; Chersich, M.; Temmerman, M.; Parry, C. D.
ENGLISH SUMMARY : Background: At the points where an infectious disease and risk factors for poor health intersect, while health problems may be compounded, there is also an opportunity to provide health services. Where human immunodeficiency virus (HIV) infection and alcohol consumption intersect include infection with HIV, onward transmission of HIV, impact on HIV and acquired immunodeficiency syndrome (AIDS) disease progression, and premature death. The levels of knowledge and attitudes relating to the health and treatment outcomes of HIV and AIDS and the concurrent consumption of alcohol need to be determined. This study aimed to ascertain the knowledge, attitudes and practices of primary healthcare workers concerning the concurrent consumption of alcohol of clinic attendees who are prescribed antiretroviral drugs. An assessment of the exchange of information on the subject between clinic attendees and primary healthcare providers forms an important aspect of the research. A further objective of this study is an assessment of the level of alcohol consumption of people living with HIV and AIDS attending public health facilities in the Western Cape Province in South Africa, to which end, the study reviewed health workers’ perceptions of the problem's extent. A final objective is to contribute to the development of evidence-based guidelines for AIDS patients who cons ume alcohol when on ARVs. The overall study purpose is to optimise antiretroviral health outcomes for all people living with HIV and AIDS, but with specific reference to the clinic attendees studied in this research. Methods: Overall the research study utilised mixed methods. Three group-specific questionnaires were administered between September 2013 and May 2014. The resulting qualita tive data presented here supplements the results of the quantitative data questionnaires for HIV and AIDS clinic attendees, which have been analysed and written up separately. This arm of the research study comprised two, separate, semi-structured sets of interviews: one face-to-face with healthcare workers at the same primary healthcare clinics from which the clinic attendees were sampled, and the other with administrators from the local government health service via email. The qualitative analysis from the primary healthcare worker interviews has been analysed using thematic content analysis. Results: The key capacity gaps for nurses include the definition of different patterns and volumes of alcohol consumption, resultant health outcomes and how to answer patient questions on alcohol consumption while on antiretroviral treatment. Not only did the counsellors lack knowledge regarding alcohol abuse and its treatment, but they were also they were unclear on their role and rights in relation to their patients. Docto rs highlighted the need for additional training for clinicians in diagnosing alcohol use disorders and information on the pharmacological interventions to treat alcoholism. Conclusion: Pertinent knowledge regarding patient alcohol consumption while taking ARVs needs to be disseminated to primary healthcare workers.
Adolescent and nurse perspectives of psychotherapeutic interventions for PTSD delivered through task-shifting in a low resource setting
(Public Library of Science, 2017) Van de Water, Tanya; Rossouw, Jaco; Yadin, Elna; Seedat, Soraya
Background: This investigation compared the perceived effectiveness of supportive counselling (SC) and prolonged exposure for adolescents (PE-A) by treatment users (adolescents with PTSD) and non-specialist treatment providers (supervised nurses). Method: Adolescent participants and nurse providers were purposively recruited to share their experiences of trial participation through face to face semi-structured in-depth interviews and treatment-specific focus groups (all recorded). Twelve adolescent participant transcripts (ten interviews and two focus groups) and three nurse provider transcripts were doubly transcribed. Thematic content analysis was applied using Atlas.ti software. Two emerging themes are presented in this paper: 1) Perceptions of the intervention and 2) Usefulness of the intervention. Results: Regardless of treatment arm, adolescents experienced warm counselling relationships and described the process of extending trust to the counselor. Adolescents in the PE-A arm provided clear descriptions of session structure and treatment rationale compared with adolescents receiving SC. The most helpful tools were breathing retraining and imaginal exposure for PE-A and creation of distraction strategies during non-directive SC. Adolescents in both arms continued to use the techniques acquired during treatment and reported symptom improvement. Participants who received SC acknowledged ongoing reexperiencing. Nurses perceived SC to be an immediately transferable skill, but feedback on their preference for one intervention over the other was inconclusive. Conclusion: Both PTSD treatment strategies, implemented by non-specialists, were perceived as helpful. Overall, adolescents reported warm therapeutic relationships and a reduction in PTSD symptoms. Nurses stated that they would require institutional support to ensure delivery of these interventions in a scalable and sustainable manner.
Agreement and discrepancy on emotional and behavioral problems between caregivers and HIV-infected children and adolescents from Uganda
(Frontiers Media, 2019) Van den Heuvel, Leigh L.; Levin, Jonathan; Mpango, Richard S.; Gadow, Kenneth D.; Patel, Vikram; Nachega, Jean B.; Seedat, Soraya; Kinyanda, Eugene
Background: HIV-infected children and adolescents (CA-HIV) face significant mental health challenges related to a broad range of biological and psychosocial factors. Data are scarce on the agreement and discrepancy between caregivers and CA-HIV regarding emotional and behavioral problems (EBPs) in CA-HIV. Objectives: We determined agreement between self- versus caregiver- reported EBPs and describe factors associated with informant discrepancy among caregiver–youth dyads who participated in the “Mental health among HIV-infected CHildren and Adolescents in KAmpala and Masaka, Uganda” (CHAKA) study. Methods: In a cross-sectional sample, caregiver-reported EBPs were assessed with the Child and Adolescent Symptom Inventory-5 (CASI-5), and self-reported problems were evaluated with the Youth Inventory-4 (YI-4) in 469 adolescents aged 12–17 years and the Child Inventory-4 (CI-4) in 493 children aged 8–11 years. Adolescents were questioned about experiences of HIV stigma. Caregiver psychological distress was assessed with the Self-Reporting Questionnaire (SRQ-20). Linear regression models were applied to identify variables associated with discrepancy scores. Results: Self-reported emotional problems (EPs) were present in 28.8% of adolescents and 36.9% of children, and 14.5% of adolescents self-reported behavioral problems (BPs). There was only a modest correlation (r ≤ 0.29) between caregiver- and CA-HIVreported EBPs, with caregivers reporting more EPs whereas adolescents reported more BPs. Informant discrepancy between adolescents and caregivers for BPs was associated with adolescent age and caregiver’s employment and HIV status. Among adolescents, EP discrepancy scores were associated with adolescent’s WHO HIV clinical stage, caregiver level of education, and caregivers caring for other children. Among children, EP discrepancy scores were associated with child and caregiver age, caregiver level of education, and caregiver self-rated health status. HIV stigma and caregiver psychological distress were also associated with discrepancy, such that adolescents who experienced HIV stigma rated their EPs as more severe than their caregivers did and caregivers with increased psychological distress rated EBPs as more severe than CA-HIV self-rated. Conclusions: EBPs are frequently endorsed by CA-HIV, and agreement between informants is modest. Informant discrepancy is related to unique psychosocial and HIVrelated factors. Multi-informant reports enhance the evaluation of CA-HIV and informant discrepancies can provide additional insights into the mental health of CA-HIV.
Alcohol and brain damage
(HMPG, 1993) Emsley, Robin A.
Acoholism may constitute the major health problem in many pans of the world, with its effects on morbidiry and monality grossly underestimated in world health statistics.' Alcohol-related neuropsychiatric disorders constitute a particularly large and incapacitating subset of the medical complications of alcoholism.
Alcohol Induced Psychotic Disorder: a comparitive study in patients with alcohol dependance, schizophrenia and normal controls
(Stellenbosch : University of Stellenbosch, 2007-12) Jordaan, Gerhard; Emsley, R. A.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Psychiatry.
Alcohol-induced psychotic disorder (also known as alcohol hallucinosis) is a complication of alcohol abuse that requires clinical differentiation from alcohol withdrawal delirium and schizophrenia. Although extensively described, few studies utilized standardized research instruments and brain-imaging has thus far been limited to case reports. The aim of this study was to prospectively compare four population groups (ie. patients with alcohol-induced psychotic disorder, schizophrenia, uncomplicated alcohol dependence and a healthy volunteer group) according to demographic, psychopathological and brainimaging variables utilizing (i) rating scales and (ii) single photon emission computed tomography (SPECT). The third component of the study was designed to investigate the (iii) effect of anti-psychotic treatment on the psychopathology and regional cerebral blood flow (rCBF) before and after six weeks of treatment with haloperidol. Effort was made to ensure exclusion of comorbid medical disorders, including substance abuse. The study provides further supportive evidence that alcohol-induced psychotic disorder can be distinguished from schizophrenia. Statistically significant differences in rCBF were demonstrated between the alcohol-induced psychotic disorder and other groups. Changes in frontal, temporal, parietal, occipital, thalamic and cerebellar rCBF showed statistically significant negative correlations with post-treatment improvement on psychopathological variables and imply dysfunction of these areas in alcohol-induced psychotic disorder. The study was unable to distinguish between pharmacological effects and improvement acccomplished by abstinence from alcohol.
Alcohol use, working conditions, job benefits, and the legacy of the "Dop" system among farm workers in the Western Cape Province, South Africa : hope despite high levels of risky drinking
(MDPI, 2014-07) Gossage, J. Phillip; Snell, Cudore L.; Parry, Charles D. H.; Marais, Anna-Susan; Barnard, Ronel; De Vries, Marlene; Blankenship, Jason; Seedat, Soraya; Hasken, Julie M.; May, Philip A.
This study describes alcohol consumption in five Western Cape Province communities. Cross-sectional data from a community household sample (n = 591) describe the alcohol use patterns of adult males and females, and farm workers vs. others. Data reveal that men were more likely to be current drinkers than women, 75.1% vs. 65.8% (p = 0.033); farm laborers were more likely to be current drinkers than individuals in other occupations 83.1% vs. 66.8% (p = 0.004). Group, binge drinking on weekends was the norm; men were more likely to be binge drinkers in the past week than women 59.8% vs. 48.8% (p = 0.086); farm workers were more likely to binge than others 75.0% vs. 47.5% (p < 0.001). The legacy of “Dop” contributes to current risky drinking behaviors. Farm owners or managers were interviewed on 11 farms, they described working conditions on their farms and how the legacy of “Dop” is reflected in the current use of alcohol by their workers. “Dop” was given to farm workers in the past on six of the 11 farms, but was discontinued for different reasons. There is zero tolerance for coming to work intoxicated; farm owners encourage responsible use of alcohol and assist farm workers in getting help for alcohol problems when necessary. The farm owners report some positive initiatives, were ahead of the movement to provide meaningful wages, and provide other important amenities. Further research is needed to assess whether progressive practices on some farms will reduce harmful alcohol use.
An analysis of early developmental trauma in social anxiety disorder and posttraumatic stress disorder
(BioMed Central, 2014-05) Bishop, Melanie; Rosenstein, David; Bakelaar, Susanne; Seedat, Soraya
Background: The early contributions of childhood trauma (emotional, physical, sexual, and general) have been hypothesized to play a significant role in the development of anxiety disorders, such as posttraumatic stress disorder (PTSD) and social anxiety disorder (SAD). The aim of this study was to assess childhood trauma differences between PTSD and SAD patients and healthy controls, as measured by the Early Trauma Inventory. Methods: We examined individuals (N = 109) with SAD with moderate/severe early developmental trauma (EDT) (n = 32), individuals with SAD with low/no EDT (n = 29), individuals with PTSD with EDT (n = 17), and healthy controls (n = 31). The mean age was 34 years (SD = 11). Subjects were screened with the Mini-International Neuropsychiatric Interview (MINI), Liebowitz Social Anxiety Scale (LSAS), Clinician-Administered PTSD Scale (CAPS), and Childhood Trauma Questionnaire (CTQ). Analysis of variance was performed to assess group differences. Correlations were calculated between childhood traumas. Results: Although not statistically significant, individuals with PTSD endorsed more physical and sexual childhood trauma compared with individuals with SAD with moderate/severe EDT who endorsed more emotional trauma. For all groups, physical and emotional abuse occurred between ages 6 and 11, while the occurrence of sexual abuse in individuals with PTSD was at 6–11 years and later (13–18 years) in individuals with SAD with moderate/severe EDT. For emotional abuse in all groups, the perpetrator was mostly a primary female caregiver; for sexual abuse, it was mostly a nonfamilial adult male, while for physical abuse, it was mostly a caregiver (male in PTSD and female in SAD with moderate/severe EDT). Conclusions: The contribution of childhood abuse to the development of PTSD and SAD and the differences between these groups and other anxiety disorders should not be ignored and attention should be given to the frequency and severity of these events. The relationship of the perpetrator(s) and the age of onset of childhood abuse are also important considerations as they provide a useful starting point to assess impact over the life course. This can, in turn, guide clinicians on the optimal timing for the delivery of interventions for the prevention of PTSD and SAD.
Anger and Afrophobia in South Africa : what is a health practitioner to do?
(Health and Medical Publishing Group, 2015) Long, Wahbie; Chiliza, Bonginkosi; Stein, Dan J.
The facts seem to indicate that South Africa is one of the more violent places on earth. We have been, and continue to be, a country with significant levels of political violence, criminal violence and domestic violence. And now, we are witnessing violence against fellow Africans. While many have termed this ‘xenophobia’, a more accurate term may well be ‘Afrophobia’. For clinician-scientists, many questions arise. In this editorial, we briefly consider a few of the most pertinent.
Anticholinerge intoksikasiedelirium - 'n lewensbedreigde toestand
(Health & Medical Publishing Group, 1994-01) Hugo, F. J.; Eidelman, I. J.
INLEIDING: Anticholinerge intoksikasiedelirium in pasiente met psigiatriese steurings kan 'n diagnostiese dilemma skep wanneer dit onderskei moer word van 'n akure psigotiese afbraak, 'n psigoaktiewe subsrans onttrekkingsdelirium en ander organiese breinsindrome. Hierdie problematiese differensiele diagnose word deur die volgende gevalsbeskrywing weerspieel.
Anxiety : an overlooked confounder in the characterisation of chronic stress-related conditions?
(Public Library of Science, 2020-04-16) Viljoen, Monet; Benecke, Rohan M.; Martin, Lindi; Adams, Rozanne C. M.; Seedat, Soraya; Smith, Carine
Although anxiety disorders are among the most prevalent of psychiatric disorders, childhood trauma-related studies seldom consider anxiety proneness as distinct aetiological contributor. We aimed to distinguish between trauma- and anxiety-associated physiological profiles. South African adolescent volunteers were categorised for trauma exposure (CTQ, mean score 39±11) and anxiety proneness (AP)(CASI, mean score 37±7, STAI-T, mean score 41±8). Circulating hormone and leukocyte glucocorticoid receptor levels, as well as leukocyte functional capacity, were assessed. AP was associated with lower DHEAs (P<0.05) and higher leukocyte GR expression (P<0.05). DHEAs was also negatively correlated with anxiety sensitivity (CASI, P<0.05). In conclusion, AP may have more predictive power than trauma in terms of health profile. Increased glucocorticoid sensitivity previously reported after trauma, may be a unique function of anxiety and not trauma exposure per se. DHEAs concentration was identified as potentially useful marker for monitoring progressive changes in HPA-axis sensitivity and correlated with psychological measures of anxiety.
Anxiety sensitivity in school attending youth : exploratory and confirmatory factor analysis of the 18-item CASI in a multicultural South African sample
(Frontiers, 2016-01-07) Martin, Lindi; Kidd, Martin; Seedat, Soraya
ENGLISH SUMMARY : Anxiety sensitivity (AS) is a risk factor for the development of anxiety disorders in youth. To date, the applicability of the Childhood Anxiety Sensitivity Index (CASI) in youth from a low or middle income country (LMIC) setting on the African continent has not been assessed. A representative sample of 1149 secondary school learners from 29 schools in Cape Town, South Africa, participated in the study. Participants completed the CASI on a single occasion. One-, two-, and four-factor models of the CASI were assessed. A one-factor solution that comprised items predominantly represented by physical concerns appeared to provide the best fit to our data, however, relatively low variance (26%) was explained. Subsequent item deletion resulted in a 9-item ‘physical concerns’ factor that showed good construct reliability (0.83) but also explained a low amount of variance (35%). In terms of gender, a one-factor model provided the best fit, however, low variance was explained (i.e., 25%). Configural, metric and scalar invariance of the CASI by gender was determined. Our results suggest that the 18-item CASI is not applicable to our target population and may require adaptation in this population; however, replication of this study in other multicultural adolescent samples in South Africa is first needed to further assess the validity of the AS construct as measured by the CASI.
Appetitive and reactive aggression are differentially associated with the STin2 genetic variant in the serotonin transporter gene
(Nature Research (part of Springer Nature), 2018-04) Hemmings, Sian M. J.; Xulu, Khethelo; Sommer, Jessica; Hinsberger, Martina; Malan-Muller, Stefanie; Tromp, Gerard; Elbert, Thomas; Weierstall, Roland; Seedat, Soraya
Appetitive aggression is a sub-category of instrumental aggression, characterised by the primary intrinsic enjoyment of aggressive activity. Aggression is heritable, and serotonergic and monoaminergic neurotransmitter systems have been found to contribute to the underlying molecular mechanisms. The aim of this study was to investigate the role that genetic variants in the serotonin transporter (SLC6A4) and monoamine oxidase A (MAOA) genes play in the aetiology of appetitive aggression in South African Xhosa males (n = 290). SLC6A4 5-HTTLPR, rs25531, and STin2 variants, as well as MAOA-uVNTR were investigated for their association with levels of appetitive aggression using Poisson regression analysis. The STin2 VNTR12 allele was found to be associated with increased levels of appetitive aggression (p = 0.003), but with decreased levels of reactive aggression (p = 7 × 10−5). This study is the first to investigate genetic underpinnings of appetitive aggression in a South African population, with preliminary evidence suggesting that SCL6A4 STin2 variants play a role in its aetiology, and may also be important in differentiating between appetitive and reactive aggression. Although the results require replication, they shed some preliminary light on the molecular dichotomy that may underlie the two forms of aggression.
Application of data pooling to longitudinal studies of early post-traumatic stress disorder (PTSD) : the International Consortium to Predict PTSD (ICPP) project
(Taylor & Francis Open, 2018) Qi, Wei; Ratanatharathorn, Andrew; Gevonden, Martin; Bryant, Richard; Delahanty, Douglas; Matsuoka, Yutaka; Olff, Miranda; DeRoon-Cassini, Terri; Schnyder, Ulrich; Seedat, Soraya; Laska, Eugene; Kessler, Ronald C.; Koenen, Karestan; Shalev, Arieh
Background: Understanding the development of post-traumatic stress disorder (PTSD) is a precondition for efficient risk assessment and prevention planning. Studies to date have been site and sample specific. Towards developing generalizable models of PTSD development and prediction, the International Consortium to Predict PTSD (ICPP) compiled data from 13 longitudinal, acute-care based PTSD studies performed in six different countries. Objective: The objectives of this study were to describe the ICPP’s approach to data pooling and harmonization, and present cross-study descriptive results informing the longitudinal course of PTSD after acute trauma. Methods: Item-level data from 13 longitudinal studies of adult civilian trauma survivors were collected. Constructs (e.g. PTSD, depression), measures (questions or scales), and time variables (days from trauma) were identified and harmonized, and those with inconsistent coding (e.g. education, lifetime trauma exposure) were recoded. Administered in 11 studies, the Clinician Administered PTSD Scale (CAPS) emerged as the main measure of PTSD diagnosis and severity. Results: The pooled data set included 6254 subjects (39.9% female). Studies’ average retention rate was 87.0% (range 49.1–93.5%). Participants’ baseline assessments took place within 2 months of trauma exposure. Follow-up durations ranged from 188 to 1110 days. Reflecting studies’ inclusion criteria, the prevalence of baseline PTSD differed significantly between studies (range 3.1–61.6%), and similar differences were observed in subsequent assessments (4.3–38.2% and 3.8–27.0% for second and third assessments, respectively). Conclusion: Pooling data from independently collected studies requires careful curation of individual data sets for extracting and optimizing informative commonalities. However, it is an important step towards developing robust and generalizable prediction models for PTSD and can exceed findings of single studies. The large differences in prevalence of PTSD longitudinally cautions against using any individual study to infer trauma outcome. The multiplicity of instruments used in individual studies emphasizes the need for common data elements in future studies.
Assessing cognition in children with prenatal methamphetamine exposure in South Africa
(Elsevier, 2019) Roos, Annerine; Stein, Dan J.; Donald, Kirsten A.
No abstract available.
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, Sharain; Kaminer, Debra; Seedat, Soraya; Stein, Dan 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 cut-off 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.

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