Browsing by Author "Stein D.J."
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- Item1H-MRS in autism spectrum disorders: A systematic meta-analysis(2012) Ipser J.C.; Syal S.; Bentley J.; Adnams C.M.; Steyn B.; Stein D.J.We conducted a systematic review and metaanalysis of proton magnetic resonance spectroscopy (1HMRS) studies comparing autism spectrum disorder (ASD) patients with healthy controls, with the aim of profiling ASD-associated changes in the metabolites N-acetylaspartate (NAA) and Creatine (Cr). Meta-regression models of NAA and Cr levels were employed, using data from 20 eligible studies (N0852), to investigate age-dependent differences in both global brain and region-specific metabolite levels, while controlling for measurementmethod (Cr-ratio versus absolute concentrations). Decreased NAA concentrations that were specific to children were found for whole-brain grey and white matter. In addition, a significant decrease in NAA was evident across age categories in the parietal cortex, the cerebellum, and the anterior cingulate cortex. Higher levels of Cr were observed for ASD adults than children in global grey matter, with specific increases for adults in the temporal lobe and decreased Cr in the occipital lobe in children. No differences were found for either NAA or Cr in the frontal lobes. These data provide some evidence that ASD is characterized by age-dependent fluctuations in metabolite levels across the whole brain and at the level of specific regions thought to underlie ASD-associated behavioural and affective deficits. Differences in Cr as a function of age and brain region suggests caution in the interpretation of Cr-based ratio measures of metabolites. Despite efforts to control for sources of heterogeneity, considerable variability in metabolite levels was observed in frontal and temporal regions, warranting further investigation. © Springer Science+Business Media, LLC 2012.
- ItemAdjunctive quetiapine for serotonin reuptake inhibitor-resistant obsessive-compulsive disorder: A meta-analysis of randomized controlled treatment trials(2006) Fineberg N.A.; Stein D.J.; Premkumar P.; Carey P.; Sivakumaran T.; Vythilingum B.; Seedat S.; Westenberg H.; Denys D.Small studies have shown positive effects from adding a variety of antipsychotic agents in patients with obsessive-compulsive disorder who are unresponsive to treatment with serotonin reuptake inhibitors. The evidence, however, is contradictory. This paper reports a meta-analysis of existing double-blind randomized placebo-controlled studies looking at the addition of the second-generation antipsychotic quetiapine in such cases. Three studies fulfilled the inclusion criteria. Altogether 102 individuals were subjected to analysis using Review Manager (4.2.7). The results showed evidence of efficacy for adjunctive quetiapine (<400 mg/day) on the primary efficacy criterion, measured as changes from baseline in total Yale-Brown Obsessive Compulsive Scale scores (P=0.008), the clinical significance of which was limited by between-study heterogeneity. The mechanism underlying the effect may involve serotonin and/or dopamine neurotransmission. © 2006 Lippincott Williams & Wilkins, Inc.
- ItemAn open trial of citalopram in adolescents with post-traumatic stress disorder(2001) Seedat S.; Lockhat R.; Kaminer D.; Zungu-Dirwayi N.; Stein D.J.In this preliminary, 12-week open-label study, eight adolescents with moderate to severe post-traumatic stress disorder (PTSD) were treated with citalopram the most selective of the selective serotonin reuptake inhibitors) in a fixed daily dose of 20 mg, and rated at 2-week intervals. The Clinician-Administered PTSD Scale (Child and Adolescent Version) was the primary measure used to assess treatment outcome. Core PTSD symptoms (re-experiencing, avoidance, and hyperarousal symptoms) showed statistically significant improvement at week 12 on the Clinician-Administered PTSD Scale (Child and Adolescent Version) (CAPS-CA), with a 38% reduction in total CAPS scores between baseline and endpoint. Citalopram failed to effect improvement on self-reported depressive symptoms. All seven adolescent completers were rated as much improved or very much improved on Clinical Global impression improvement scores. Citalopram was well-tolerated overall with reported adverse experiences being relatively benign. However, larger, controlled trials are needed to consolidate these preliminary, results. © 2001 Lippincott Williams & Wilkins.
- ItemAn open trial of valproate in borderline personality disorder(1995) Stein D.J.; Simeon D.; Frenkel M.; Islam M.N.; Hollander E.Background: Target symptoms in pharmacotherapy of borderline personality disorder include mood instability, anxiety, and impulsivity. Valproate appears useful for the treatment of these target symptoms in several disorders, and carbamazepine has been found effective for such symptoms in borderline personality disorder. We therefore conducted a preliminary open- label trial of valproate in borderline personality disorder. Method: Eleven patients who met DSM-III-R criteria for borderline personality disorder were entered into an 8-week study of valproate. Exclusion criteria included current major depression or major medical disorder. All patients were in psychotherapy at least once a week for a minimum of 8 weeks prior to starting medication. Valproate was increased as tolerated to reach blood levels of 50 to 100 μg/mL. Clinician- and self-rated scales were completed each week. Results: Three patients did not complete the study. Of completers, 4 of 8 patients were responders ('much less' or 'less') on clinician-rated change scores for overall pathology and for mood. Three of 8 patients were responders on change scores for anxiety, anger, impulsivity, and rejection sensitivity. There was a significant (p = .03) decrease in total Symptom Checklist-90 scores between the start and end of the trial. On the Overt Aggression Scale (Modified), total other-directed assault did not significantly decrease, but there was a significant (p = .02) decrease in global subjective irritability. Conclusion: Valproate led to overall improvement in 50% of a small sample of borderline personality disorder patients who completed an 8-week open trial. The medication was modestly helpful for mood and irritability as well as for anxiety, anger, rejection sensitivity, and impulsivity, but specific therapeutic effects varied from patient to patient. More extensive controlled trials of anticonvulsants for impulsive personality disorders are warranted.
- ItemBarriers to mental health care and predictors of treatment dropout in the South African stress and health study(2011) Bruwer B.; Sorsdahl K.; Harrison J.; Stein D.J.; Williams D.; Seedat S.Objective: This study used data from the South African Stress and Health Study (SASH) to examine both structural and attitudinal barriers to treatment initiation among South Africans with mental disorders and to investigate predictors of treatment dropout. Methods: Face-to-face interviews were conducted with 4,315 adult South Africans living in households or hostel quarters. The interview included a core diagnostic assessment of past-12-month mental disorders and assessments of disorder severity, service use, and barriers to treatment. Multivariate logistic regression models were used to determine predictors of not seeking treatment in relation to disorder severity and sociodemographic characteristics, as well as factors that were predictive of premature treatment discontinuation by participants who had received mental health treatment in the previous 12 months. Predictors of dropout were identified by cross-tabulation and discrete-time survival analysis. Results: Of the 4,315 adults, 729 (16.9% weighted) met criteria for a mental disorder in the past 12 months. Across all levels of severity, the most frequently cited reason for not seeking professional treatment was a low perceived need for treatment. Among those who recognized the need but did not access treatment during the past 12 months (7.2%), attitudinal barriers to treatment seeking were reported more commonly than structural barriers (100% and 34%, respectively). Of the 182 respondents who received treatment (25% weighted), 20% discontinued prematurely. Various factors, such as substance use disorders and absence of health insurance, increased the odds of treatment dropout. Conclusions: Low rates of treatment seeking and high treatment dropout rates for common mental disorders among South Africans are a major concern. Public health efforts to improve treatment of mental disorders should consider the multiple influences on treatment initiation and discontinuation.
- ItemCharacterization of South African Adolescents With Alcohol Use Disorders but Without Psychiatric or Polysubstance Comorbidity(2011-05-25) Ferrett H.L.; Cuzen N.L.; Thomas K.G.F.; Carey P.D.; Stein D.J.; Finn P.R.; Tapert S.F.; Fein G.Background: Individuals who begin drinking during early adolescence and exhibit externalizing pathology and disinhibitory/dysregulatory tendencies are more vulnerable to developing alcohol use disorders (AUDs) in adulthood. Previous research has focused on in-treatment populations with substantial comorbid psychopathology and polysubstance use. Here, we characterize a unique sample of treatment-naïve adolescents without such comorbidity to help identify vulnerable youth who may benefit from early intervention. Methods: We compared externalizing propensity, disinhibitory characteristics, and school performance in adolescents with AUDs (but without comorbid psychopathology or other substance use; n=70) to those of demographically matched controls (n=70). Within the AUD group, we compared measures of substance use and the disinhibitory syndrome between boys and girls with differing severity of externalizing propensity. Results: Adolescents with AUDs demonstrated more externalizing propensity and disinhibitory personality traits (impulsivity, novelty seeking, and excitement seeking), poorer self-monitoring and response inhibition, more bullying and sexual risk-taking behavior, poorer first-language performance, and greater use of alcohol, cannabis, and nicotine (p<0.05). Within the AUD group, participants with higher externalizing propensity began drinking earlier, more frequently, and for a longer duration than those with lower externalizing symptoms (p<0.05). Disinhibitory features (personality, cognition, and behavior) were, however, not stronger in those with higher externalizing propensity. Conclusions: We suggest that the constructs of externalizing propensity and disinhibitory syndrome are useful in characterizing treatment-naïve adolescents with AUDs but without comorbid psychopathology or polysubstance use. These results support the importance of these constructs in understanding adolescent AUDs, even when the frank externalizing diagnoses of childhood (oppositional defiant disorder and conduct disorder) are excluded. Copyright © 2011 by the Research Society on Alcoholism.
- ItemCitalopram 20 mg, 40 mg and 60 mg are all effective and well tolerated compared with placebo in obsessive-compulsive disorder(2001) Montgomery S.A.; Kasper S.; Stein D.J.; Hedegaard K.B.; Lemming O.M.Serotonin reuptake inhibitors appear to be uniquely effective treatments for obsessive-compulsive disorder (OCD). This double-blind, placebo-controlled study was the first trial to assess the efficacy of the most selective of the serotonin reuptake inhibitors, citalopram, in OCD. A total of 401 patients were randomized to receive citalopram 20, 40 or 60 mg/day or placebo for 12 weeks. All three doses of citalopram were significantly more effective than placebo measured on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) change score (P < 0.01). The highest response rate, defined as 25% improvement in Y-BOCS entry score, was observed in the 60 mg group (65%). This compared with 52% and 57.4% in the 40 mg and 20 mg groups. Response rate on placebo was 36.6% (P < 0.05 for all three doses of citalopram compared to placebo). There was no significant difference between the individual doses of citalopram. An advantage was seen for citalopram on the Sheehan Disability Scale compared with placebo (P < 0.05 on all three citalopram groups versus placebo for both the work situation and the family life and home responsibilities and P < 0.05 on citalopram 60 mg and 20 mg versus placebo for the social life and home activities). Citalopram was well tolerated; only 4 to 6 patients in each dose group discontinued the study prematurely due to adverse events. © 2001 Lippincott Williams & Wilkins.
- ItemCognitive-affective neuroscience of somatization disorder and functional somatic syndromes: Reconceptualizing the triad of depression-anxiety-somatic symptoms(2008) Stein D.J.; Muller J.Somatization disorder is a somatoform disorder that overlaps with a number of functional somatic syndromes and has high comorbidity with major depression and anxiety disorders. Proposals have been made for revising the category of somatoform disorders, for simplifying the criteria for somatization disorder, and for emphasizing the unitary nature of the functional somatic syndromes in future classifications. A review of the cognitive-affective neuroscience of somatization disorder and related conditions suggests that overlapping psychobiological mechanisms mediate depression, anxiety, and somatization symptoms. Particular genes and environments may contribute to determining whether symptoms are predominantly depressive, anxious, or somatic, and there are perhaps also overlaps and distinctions in the distal evolutionary mechanisms that produce these symptoms.
- ItemDepression and anxiety in the developing world: Is it time to medicalise the suffering?(2004) Stein D.J.; Gureje O.[No abstract available]
- ItemDepressive and anxiety symptoms in patients with schizophrenia and schizophreniform disorder(1999) Emsley R.A.; Oosthuizen P.P.; Joubert A.F.; Roberts M.C.; Stein D.J.Background: Symptoms of depression and anxiety are frequently encountered in the course of schizophrenia and are of considerable clinical importance. They may compromise social and vocational functioning, and they are associated with an increased risk of relapse and suicide. Various treatment approaches have been reported to be successful. Method: The sample comprised 177 patients with DSM-III-R or DSM-IV schizophrenia or schizophreniform disorder who were participants in multinational clinical drug trials at our academic psychiatric unit over a 7-year period and who were assessed by means of the Positive and Negative Syndrome Scale (PANSS). Analysis was performed on baseline PANSS scores. The depression/anxiety score was compared in the men and women, first-episode and multiple-episode patients, and those with predominantly positive and negative syndromes. Correlations were sought between depression/anxiety scores and age, total PANSS score, positive score, negative score, general psychopathology score, and treatment outcome. Multivariate analysis was applied to determine contributions of individual variables toward depression/anxiety and outcome scores. Results: Depression and anxiety symptoms were more severe in women (p = .007), first-episode patients (p = .02), and those with predominantly positive symptoms (p < .0001). Depression/anxiety scores were significantly correlated to age (r =-0.31, p < .0001), PANSS positive scores (r = 0.39, p < .0001), and treatment outcome (r = 0.25, p = .006). Multivariate analysis bore out these results, with the exception that first episode was not a significant predictor of depression and anxiety scores. Conclusion: PANSS depressive/anxiety scores were generally low in our sample, perhaps because patients with schizoaffective disorder were excluded. The finding that these symptoms were more prominent in women and first-episode patients is in keeping with previous literature. The higher scores in first-episode patients are likely due to the higher positive symptom scores in these patients. The association between depressive/anxiety scores and positive symptoms but not with negative symptoms points to a specific relationship between affective symptoms and the positive symptom domain of schizophrenia. The presence of depressive and anxiety symptoms may predict a more favorable outcome to treatment, although this may only apply to the acute exacerbations of the illness.
- ItemDifferential effects of escitalopram challenge on disgust processing in obsessive-compulsive disorder(2012) Lochner C.; Simmons C.; Kidd Michael; Chamberlain S.R.; Fineberg N.A.; van Honk J.; Ipser J.; Stein D.J.
- ItemDopamine transporter binding in social anxiety disorder: The effect of treatment with escitalopram(2012) Warwick, James M.; Carey P.D.; Cassimjee N.; Lochner C.; Hemmings, Sian M. J.; Moolman-Smook H.; Beetge E.; Dupont P.; Stein D.J.Social anxiety disorder (SAD) is characterised by fear of social or performance situations where the individual is exposed to unfamiliar people or to possible scrutiny by others. The literature on dopamine ligands and dopamine genotypes in SAD is however inconsistent. In this study we measured the effects of SSRI pharmacotherapy on dopamine transporter (DAT) binding in patients with SAD, also addressing variability in DAT genotype. Adult subjects meeting DSM-IV criteria for generalised SAD were studied before and after 12 weeks of pharmacotherapy with the selective serotonin reuptake inhibitor (SSRI) escitalopram. DAT single photon emission computed tomography (SPECT) using 123I-FP-CIT was performed at baseline, and repeated at 12 weeks. Striatal DAT binding was analysed for changes following therapy, and for correlations with clinical efficacy, in the whole group as well as for a subgroup with the A10/A10 DAT genotype. The study included 14 subjects (9 male, 5 female) with a mean (SD) age of 41 (±13) years. The subjects' Liebowitz Social Anxiety Scale (LSAS) score was significantly decreased following pharmacotherapy. In the combined group the left caudate and left putamen showed clusters of increased DAT binding after therapy. The left caudate changes were also observed in the subgroup of 9 A10/A10 homozygotes. However no correlation was found between improved symptoms and DAT binding. The changes found in DAT binding in the caudate and putamen may be due to serotonergic activation of dopamine function by SSRI therapy. This is consistent with previous work indicating decreased DAT binding in SAD, and increased DAT binding after SSRI administration. © Springer Science+Business Media, LLC 2012.
- ItemEarly maternal separation followed by later stressors leads to dysregulation of the HPA-axis and increases in hippocampal NGF and NT-3 levels in a rat model.(2006) Faure J.; Uys J.D.; Marais L.; Stein D.J.; Daniels W.M.Early adverse life events, followed by subsequent stressors, appear to increase susceptibility for subsequent onset of psychiatric disorders in humans. The molecular mechanisms that underlie this phenomenon remain unclear, but dysregulation of the HPA axis and alterations in neurotrophic factors have been implicated. The present study investigated the effects in rodents of early maternal separation, followed by stress in adolescence and adulthood on later HPA-axis activity and hippocampal neurotrophin levels (brain-derived neurotrophic factor, nerve growth factor, and neurotrophin-3). Animals subjected to repeated stressors showed a significant decrease in basal ACTH (p < 0.05) and CORT (p < 0.05) levels when compared to controls, as well as significantly increased levels of NGF in the dorsal (p < 0.001) and ventral hippocampus (p < 0.01), and of NT-3 in the dorsal hippocampus (p < 0.01). Dysregulation of the HPA axis after multiple stressors is consistent with previous preclinical and clinical work. Given that neurotrophins are important in neuronal survival and plasticity, it is possible to speculate that their elevation reflects a compensatory mechanism.
- ItemEating disorder and superior mesenteric artery syndrome [4](2000) Jordaan G.P.; Muller A.; Greeff M.; Stein D.J.[No abstract available]
- ItemEscitalopram in the treatment of multisomatoform disorder: A double-blind, placebo-controlled trial(2008) Muller J.E.; Wentzel I.; Koen L.; Niehaus D.J.H.; Seedat S.; Stein D.J.Despite the prevalence of multisomatoform disorder (MSD), there are few controlled trials of its pharmacotherapy. The aim of this study was to compare the efficacy and safety of escitalopram (10-20 mg/day) with that of placebo in treating patients with MSD over a 12-week period. Fifty-one outpatients aged from 18 to 65 years, with multiple medically unexplained symptoms, were recruited. The primary efficacy measure was a change on the Patient Health Questionnaire-15 scores from baseline to endpoint. Secondary efficacy endpoints included the Clinical Global Impression-Improvement score, the psychic and somatic subscales of the Hamilton Anxiety Scale, Montgomery-Asberg Depression Rating Scale, the Visual Analogue Pain Rating Scale, the Scale for the Assessment of Illness Behaviour and the Sheehan Disability Scale. On the primary analysis of covariance, escitalopram-treated patients had significantly greater reductions in Patient Health Questionnaire scores (P<0.0001) compared with placebo at week 12. Significant separation from placebo occurred from week 6 onwards. Escitalopram was superior to placebo on all secondary outcome endpoints, with the exception of the Scale for the Assessment of Illness Behaviour. The medication was well tolerated. In conclusion, in this 12-week, randomized, placebo-controlled study, escitalopram (10-20 mg/day) was both effective and well tolerated in the treatment of patients with MSD. Compared with placebo, escitalopram was associated with lower symptom scores, increased response and remission rates, and improved functioning. © 2008 Lippincott Williams & Wilkins, Inc.
- ItemEvidence for fractional anisotropy and mean diffusivity white matter abnormalities in the internal capsule and cingulum in patients with obsessive-compulsive disorder(2012) Lochner C.; Fouche J.-P.; du Plessis S.; Spottiswoode B.; Seedat S.; Fineberg N.; Chamberlain S.R.; Stein D.J.Background: There is evidence to suggest that obsessive-compulsive disorder (OCD) is associated with structural abnormalities in cortico-striato-thalamic circuits, yet the extent of white matter abnormalities is not well established. In this study, we used diffusion tensor imaging (DTI) to examine white matter integrity in specific regions of interest (ROIs) in patients with OCD. Methods: Patients with OCD and sex-, age- and IQ-matched healthy controls underwent DTI. The primary objective was to explore whether patients with OCD had white matter abnormalities in the anterior limb of the internal capsule (ALIC), the uncinate fasciculus, the genu of the corpus callo-sum and the cingulum. The secondary objective was to evaluate the relation between fractional anisotropy and mean diffusivity in these ROIs and other clinical variables (including age at onset of OCD, OCD severity and levels of depressive and anxiety symptomatology) in patients with OCD. Results: There were 15 patients and 17 controls enrolled in our study. Compared with healthy controls, patients with OCD showed increased fractional anisotropy in bilateral regions of the ALIC adjacent to the body of the caudate, as well as decreased fractional anisotropy in the right anterior limb near the head of the caudate. Patients also had decreased mean diffusivity in the body of the right cingulum and the left anterior cingulum compared with controls. Correlational analyses revealed significant associations of fractional anisotropy and mean diffusivity in select circuits with OCD, depression and anxiety severity scores. Limitations: Inclusion of patients with OCD receiving pharmacotherapy may have been a limitation. In addition, the patients were heterogeneous in terms of their obsessive-compulsive symptom profiles; we did not distinguish between different obsessive-compulsive symptom dimensions. Conclusion: The study results provide further evidence for OCD-related white matter abnormalities in the ALIC and cingulum, consistent with a cortico striatal model of OCD. © 2012 Canadian Medical Association.
- ItemEvidence-based pharmacotherapy of panic disorder: An update(2012) Batelaan N.M.; Van Balkom A.J.L.M.; Stein D.J.The evidence-based pharmacotherapy of panic disorder continues to evolve. This paper reviews data on first-line pharmacotherapy, evidence for maintenance treatment, and management options for treatment-refractory patients. A Medline search of research on pharmacotherapy was undertaken, and a previous systematic review on the evidence-based pharmacotherapy of panic disorder was updated. Selective serotonin reuptake inhibitors remain a first-line pharmacotherapy of panic disorder, with the serotonin noradrenaline reuptake inhibitor venlafaxine also an acceptable early option. Temporary co-administration of benzodiazepines can be considered. Maintenance treatment reduces relapse rates, but further research to determine optimal duration is needed. For patients not responding to first-line agents several pharmacotherapy options are available, but there is a notable paucity of data on the optimal choice. © 2011 CINP.
- ItemExecutive summary of the report by the WPA section on pharmacopsychiatry on general and comparative efficacy and effectiveness of antidepressants in the acute treatment of depressive disorders(2011) Baghai T.C.; Blier P.; Baldwin D.S.; Bauer M.; Goodwin G.M.; Fountoulakis K.N.; Kasper S.; Leonard B.E.; Malt U.F.; Stein D.J.; Versiani M.; Moller H.-J.
- ItemExercise normalizes altered expression of proteins in the ventral hippocampus of rats subjected to maternal separation(2012-01-18) Daniels W.M.U.; Marais L.; Stein D.J.; Russell V.A.Many studies have reported on the detrimental effects of early life adversity and the beneficial effects of exercise on brain function. However, the molecular mechanisms that underpin these various effects remain poorly understood. The advent of advanced proteomic analysis techniques has enabled simultaneous measurement of protein expression in a wide range of biological systems. We therefore used iTRAQ proteomic analysis of protein expression to determine whether exercise counteracts the detrimental effects of early life adversity in the form of maternal separation on protein expression in the brain. Rat pups were subjected to maternal separation from postnatal day 2 to 14 for 3 h day -1 or normally reared. At 40 days of age, half of the rats in each group (maternal separation and normally reared) were allowed to exercise voluntarily (access to a running wheel) for 6 weeks and the remainder kept as sedentary control animals. At 83 days of age, rats were killed and the ventral hippocampus was dissected for quantitative proteomic (iTRAQ) analysis. The iTRAQ proteomic analysis identified several proteins that had been altered by maternal separation, including proteins involved in neuronal structure, metabolism, signalling, anti-oxidative stress and neurotransmission, and that many of these proteins were restored to normal by subsequent exposure to voluntary exercise in adolescence. Our data show that a broad range of proteins play a role in the complex consequences of adversity and exercise. © 2011 The Authors. Experimental Physiology © 2012 The Physiological Society.
- ItemGender differences in risk for intimate partner violence among south african adults(2011) Gass J.D.; Stein D.J.; Williams D.R.; Seedat S.Despite a high prevalence of intimate partner violence in South Africa, few epidemiological studies have assessed individual risk factors and differential vulnerability by gender. This study seeks to analyze gender differences in risk for intimate partner violence victimization and perpetration according to childhood and adult risk factors in a national sample of South African men and women. Using data from the cross-sectional, nationally representative South Africa Stress and Health Study, the authors examine data from 1,715 currently married or cohabiting adults on reporting of intimate partner violence. Our analysis include (a) demographic factors, (b) early life risk factors (including exposure to childhood physical abuse, witnessing parental violence, parental closeness, and early onset DSM-IV disorders), and (c) adult risk factors (including experiencing the death of a child and episodes of DSM-IV disorders after age 20). Although prevalence rates of intimate partner violence are high among both genders, women are significantly more likely than men to report being victimized (29.3% vs. 20.9%). Rates of perpetrating violence are similar for women and men (25.2% and 26.5%, respectively). Men are more likely to report predictive factors for perpetration, whereas women are more likely to report predictors for victimization. Common risk factors among men and women reporting perpetration include exposure to childhood physical abuse, witnessing parental violence, and adult onset alcohol abuse/dependence. However, risk factors in male perpetrators are more likely to include cohabitation, low income, and early and adult-onset mood disorders, whereas risk factors in female perpetrators include low educational attainment and early onset alcohol abuse/dependence. The single common risk factor for male and female victims of partner violence is witnessing parental violence. Additional risk factors for male victims are low income and lack of closeness to a primary female caregiver, whereas additional risk factors for female victims are low educational attainment, childhood physical abuse, and adult onset alcohol abuse/dependence and intermittent explosive disorder. Intimate partner violence is a significant public health issue in South Africa, strongly linked to intergenerational cycling of violence and risk exposure across the life course. These findings indicate that gender differences in risk and common predictive factors, such as alcohol abuse and exposure to childhood violence, should inform the design of future violence-prevention programs and policies. © The Author(s) 2011.
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