Masters Degrees (Psychiatry)
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- ItemUnnatural deaths, alcohol bans and curfews : evidence from a quasi-natural experiment during COVID-19(Health & Medical Publishing Group, 2021-07) Moultrie, T. A.; Dorrington, R. E.; Laubscher, R.; Groenewald, P.; Parry, C. D. H.; Matzopoulos, R.; Bradshaw, D.Background: Coronavirus disease-19 (COVID-19) restrictions, particularly relating to the sale of alcohol and hours of curfew, have had a marked effect on the temporal pattern of unnatural deaths in South Africa. Methods: Death data were collected over 68 weeks from January 2020 to April 2021, together with information on the nature of restrictions (if any) on the sale of alcohol, and hours of curfew. Data were analysed using a simple ordinary least square (OLS) regression model to estimate the relative contribution of restrictions on the sale of alcohol and hours of curfew to the pattern of excess unnatural deaths. Results: The complete restriction on the sale of alcohol resulted in a statistically significant reduction in unnatural deaths regardless of the length of curfew. To the contrary, periods where no or limited restrictions on alcohol were in force had no significant effect, or resulted in significantly increased unnatural deaths. Conclusions: The present study highlights an association between alcohol availability and the number of unnatural deaths and demonstrates the extent to which those deaths might be averted by disrupting the alcohol supply. While this is not a long-term solution to addressing alcohol-related harm, it further raises the importance of implementing evidence-based alcohol control measures.
- ItemThe 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.
- ItemAssessing 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.
- ItemLong-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.
- ItemPrevalence 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.