Kleine-Levin syndrome as a neuropsychiatric presentation: A case report and review

Kleine-Levin syndrome (KLS) is a rare disorder characterised by hypersomnia, hyperphagia and behavioural disturbances. It typically occurs in adolescent men and may mimic a variety of neuropsychiatric conditions. Here we report what appears to be the first published case of KLS in South Africa and trace the clinical course, investigations and diagnostic difficulties encountered in the management of this condition. An overview of the literature guiding the diagnosis, differentials and treatment is discussed

SHARED PLEASURE IN EARLY INFANT INTERACTIONS

Psychiatr

The Shared Pleasure Paradigm: A study in an observational birth cohort in South Africa

Mother–infant dyads in low- and middle-income countries (LMICs) may be exposed to a range of factors associated with suboptimal development. Optimal infant development is likely supported by synchronicity in the early mother–infant relationship, but limited corroborative research is available in LMICs. The Drakenstein Child Health Study (DCHS) provided an opportunity to study this synchronicity and its associations in South Africa. A South African birth cohort study investigating early-life determinants of child health in a LMIC context provided participants. The Shared Pleasure (SP) paradigm helped assess early mother–infant synchronicity in videos of a sub-set of 291 mother–infant dyads at their 14-week well baby visit. General linear regression models investigated the relationship between selected maternal and infant characteristics and the presence of Shared Pleasure moments. Out of a possible 291 dyads, 82% (n=239) yielded Shared Pleasure moments. The mean age of mothers was 27 years, while infant sex distribution comprised 54% females and 46% males. The shortest single Shared Pleasure moment lasted at least 0.5 s and the longest 28 s. Shared Pleasure moments were associated with higher gestation age at delivery (p=0.008) and higher infant birth weight (p=0.006), but were not related to mother's mental health and infant health outcomes at 14 weeks. The high frequency of positive Shared Pleasure moments in reciprocal dyadic interactions in this sample suggests that signifcant disruption in shared pleasure may be present only in extreme cases (e.g. mothers with severe mental disorders). Further work is needed to investigate the mechanisms underlying the associations between early mother–infant synchronicity and better

“I Know That It's Something That's Creating a Bond”: Fathers' Experiences of Participating in Baby Theater With Their Infants in South Africa

Elvin Williams - ORCID: 0000-0002-1702-555X https://orcid.org/0000-0002-1702-555XIn many African countries, particularly those with largely patriarchal societies like South Africa, promoting father-child interaction can pose a challenge. An informative medium that could potentially encourage active participation in pleasurable interactions between fathers and babies may prove to be an important way in which to stimulate fathers' awareness of their infants' abilities. A Cape Town based theater company created the first ever South African baby play for care-givers and their babies between the ages of 2 weeks to 12 months. The play is performed in a contained, relaxing space and offers carers and babies time to relate to each other in a pleasurable atmosphere, while specially trained actors model sensitive and responsive interactions. Baby Theater could be a way to encourage fathers' involvement with their infants, however, no research is currently available documenting fathers' perceptions about Baby Theater experience. Aim: To explore fathers' experience of participating in Baby Theater. Method: This qualitative study involved six fathers who, with their infants, participated in the Baby Theater production. A week later the fathers were divided into two focus groups to give them the opportunity to discuss their thoughts about the experience and to reflect on whether it had any subsequent impact on their interactions with their babies. The audiotaped, transcribed material was thematically analyzed using an interpretative phenomenological approach. Results: The fathers described the experience as educative and enjoyable. They reported that the program had a positive impact on the way they interacted with their infants and also positively influenced their relationship with them. Additionally, they reported feeling more confident about coping with their babies on their own, and appreciated the connection with the other fathers in the group. Cultural, societal, and gender issues were also considered. Conclusions: The subjective experience of the fathers was positive. Further research is needed to assess the lasting effects of the Baby Theater experience.https://doi.org/10.3389/fpsyt.2020.58003811pubpub58003

Maternal shared pleasure, infant withdrawal, and developmental outcomes in a high risk setting in South Africa

Infants in lower middle income countries are often exposed to early adversities which may lead to suboptimal caregiving environments and place them at risk of not achieving their developmental potential. Synchrony and positive engagement in the mother-infant relationship plays a critical role in buffering the impact of early adversity. Shared Pleasure (SP) is considered a marker of high intensity positive interaction and may hold a promise of improving developmental outcomes

New developments in diagnosis and treatment update: Schizophrenia/first episode psychosis in children and adolescents

Childhood onset schizophrenia (COS) is diagnosed before the age of 13 years, and early onset schizophrenia (EOS) is diagnosed before the age of 18 years. EOS is considered extremely rare and its prevalence in comparison to the worldwide prevalence of schizophrenia (1%) has not adequately been studied. Patients who experience the first episode of psychosis need to be treated early and optimally to lessen the morbidity and improve the outcome of the illness. Treatment needs to be a combination of both pharmacological and non-pharmacological modalities. Pharmacological intervention is necessary for remission, improvement of positive symptoms and to aid with the efficacy of psychosocial interventions. There is a lack of efficacy and safety data of the use of antipsychotic medication in children, with most of the information available being extrapolations of adult data. An increased use of atypical antipsychotic drugs in the treatment of EOS has been accompanied by growing concern about the appropriate use and associated side effects in children and adolescents. This update highlights new developments, concepts and treatment trends in EOS.Journal of Child and Adolescent Mental Health 2014, 26(2): 109–12

Kleine-Levin syndrome as a neuropsychiatric presentation : a case report and review

CITATION: Lachman, A. 2014. Kleine-Levin syndrome as a neuropsychiatric presentation: A case report and review. South African Journal of Psychiatry, 20(2):60-62, doi:10.7196/SAJP.494.The original publication is available at http://www.sajp.org.zaKleine-Levin syndrome (KLS) is a rare disorder characterised by hypersomnia, hyperphagia and behavioural disturbances. It typically occurs in adolescent men and may mimic a variety of neuropsychiatric conditions. Here we report what appears to be the first published case of KLS in South Africa and trace the clinical course, investigations and diagnostic difficulties encountered in the management of this condition. An overview of the literature guiding the diagnosis, differentials and treatment is discussed.http://www.sajp.org.za/index.php/sajp/article/view/494Publisher's versio

Body dysmorphic disorder : a diagnostic challenge in adolescence

CITATION: Thungana, Y., Moxley, K. & Lachman, A. 2018. Body dysmorphic disorder : a diagnostic challenge in adolescence. South African Journal of Psychiatry, 24:a1114, doi:10.4102/sajpsychiatry.v24i0.1114.The original publication is available at http://www.sajp.org.zaBody dysmorphic disorder (BDD) is a chronic and disabling condition that is characterised by distressing preoccupations with perceived defects in one’s own appearance, which might be slight or not observable to others. It is considered to be an obsessive–compulsive spectrum disorder and is associated with depression, feelings of shame and poor quality of life. It is primarily a disorder of childhood or adolescent onset, and sub-clinical BDD symptoms begin, on average, several years before an individual’s symptoms meet full criteria for the disorder. Here we report the case of an adolescent admitted to an inpatient psychiatric unit for treatment of psychotic symptoms that were poorly responsive to standard treatments. This challenging case of BDD in an adolescent highlights the various comorbidities of the disorder, as well as the difficulties associated with BDD diagnosis.https://sajp.org.za/index.php/sajp/article/view/1114Publisher's versio

Iron deficiency in South African children and adolescents with attention deficit hyperactivity disorder

Objective: Iron deficiency may play a role in the pathophysiology of attention deficit hyperactivity disorder (ADHD) by causing dopamine dysfunction, but there is conflicting evidence in the literature regarding this relationship. This study investigates the possible correlation between iron deficiency and ADHD in children and adolescents attending a South African child and adolescent psychiatry outpatient service.Method: In this retrospective study, we gathered data from 245 outpatient children and adolescents who had their serum ferritin and/or iron levels tested between February 2011 and January 2016. Relevant statistical methods were used to test for correlations between ADHD and various demographic and clinical factors, including iron deficiency.Results: Out of 245 patients, 88 (35.9%) had iron deficiency, 156 (63.7%) had ADHD and 55 (22.4%) had both iron deficiency and ADHD. Variables found to be significantly correlated with ADHD included gender, age, and methylphenidate treatment, but there was no significant correlation between ADHD and iron deficiency.Conclusions: Our study emphasizes the great complexity involved in understanding ADHD. Comparisons between mentally-ill paediatric patients and matched healthy controls from the same communities are required to further explore the possible association between iron deficiency and ADHD