Course of psychotic experiences and disorders among apprentice traditional health practitioners in rural South Africa:3-year follow-up study

Background: Culture is inevitably linked with the experience, interpretation and course of what modern biomedicine understands to be psychotic symptoms. However, data on psychoses in low- and middle-income countries are sparse. Our previous study showed that psychotic and mood-related experiences, symptoms and disorders are common among individuals who had received the ancestral calling to become a traditional health practitioner (THP) in rural KwaZulu-Natal, South Africa. Our related ethnographic study suggested that ukuthwasa (the training to become a THP) may positively moderate these calling-related symptoms. As far as we know, no research has been conducted into the course of psychiatric symptoms among apprentice THPs. Objective: We studied the course of psychotic experiences, symptoms and disorders among apprentice THPs. We also assessed their level of functioning and expanded our knowledge on ukuthwasa. Materials and methods: We performed a 3-year follow-up of a baseline sample of apprentice THPs (n = 48). Psychiatric assessments (CAPE, SCAN), assessment of functioning (WHODAS) and a semi-structured qualitative questionnaire were completed for 42 individuals. Results: At 3-year follow-up, psychotic experiences were associated with significantly less distress and there was a reduction in frequency of psychotic symptoms compared to baseline. The number of participants with psychotic disorders had decreased from 7 (17%) to 4 (10%). Six out of seven participants (86%) with a psychotic disorder at baseline no longer had a psychiatric diagnosis at follow-up. Although the mean level of disability among the (apprentice) THPs corresponded with the 78th percentile found in the general population, 37 participants (88%) reported no or mild disability. Forty-one participants (98%) reported that ukuthwasa had positively influenced their psychiatric symptoms. Conclusion: In rural KwaZulu-Natal, psychotic experiences, symptoms and disorders have a benign course in most individuals who are undergoing the process of becoming a THP. Ukuthwasa may be an effective, culturally sanctioned, healing intervention for some selected individuals, potentially because it reframes distressing experiences into positive and highly valued experiences, reduces stigma, and enhances social empowerment and identity construction. This implies that cultural and spiritual interventions can have a positive influence on the course of psychosis

Cultural differences in the perceptions of fear and efficacy in South Africa

Contains fulltext : 67720.pdf (publisher's version ) (Closed access) Contains fulltext : 285785.pdf (publisher's version ) (Closed access

Perceptions of quality of life and disability in homeless persons with schizophrenia and persons with schizophrenia living in non-institutional housing

Background: Homelessness is common in persons with schizophrenia. It is unclear how housing conditions and homelessness affect their quality of life and their disability. Aims: To explore the self-perceived quality of life and disability of homeless persons with schizophrenia and of those of persons with schizophrenia living in non-institutional housing. Methods: Seventy-six not-homeless and 50 homeless persons with schizophrenia were assessed using the World Health Organization's Quality of Life - short version (WHOQOL-Bref) and Disability Assessment Schedule (WHO-DAS-II). Univariate comparisons of the two groups were made for sociodemographic variables, clinical characteristics, perceived quality of life and disability. A regression model was used to adjust for potential confounding factors between quality of life, disability and housing. Results: After controlling for age, gender, marital status and age of first hospital admission, homeless persons had more positive scores for the quality of life domain 'health', for the disability domain 'getting along with people' and for the total disability score than persons in non-institutional housing. Conclusion: Contrary to our expectations, the persons in non-institutional housing reported a lower quality of life and more disability than the homeless people. Future research should clarify whether non-institutional housing in and of itself can improve the well-being of people with schizophrenia

Does cognitive behavioral therapy strengthen the effect of bariatric surgery for obesity? Design and methods of a randomized and controlled study

Multivariate analysis of psychological dat