Evaluation of an undergraduate psychiatric clinical rotation : exploring student perceptions

CITATION: Smit, I. M., Volschenk, M. & Koen, L. 2021. Evaluation of an undergraduate psychiatric clinical rotation : exploring student perceptions. South African Journal of Psychiatry, 27:a15,83, doi:10.4102/sajpsychiatry.v27i0.1583.The original publication is available at https://sajp.org.zaBackground: Globally, the appropriate transformation of medical training is critical to ensure the graduation of competent physicians who can address the growing health needs. Aim: To explore medical students’ perceptions of their learning experience during the undergraduate psychiatry late clinical rotation (PLCR) at Stellenbosch University (SU) and to use the findings to make possible recommendations regarding curriculum renewal. Setting: In recognition of this, the Department of Psychiatry at the Faculty of Medicine and Health Sciences of SU is reviewing its current teaching and learning practices. Methods: Data were collected from two focus groups. Results: Three main themes emerged: ‘learning in the clinical context’, ‘gaining knowledge’ and ‘generational needs’. Whilst several suggestions were made for potential improvement, the participants still endorsed that the PLCR does provide them with a good learning experience in psychiatry. Conclusions: Considering that these perceptions are from a group of millennials, the insights arising from the ‘generational needs’ theme were especially valuable. To bridge the generational gap and develop a curriculum that will not only meet the standards expected by educators but also achieve acceptance from learners, future research with a specific focus on clinical teachers’ perceptions is needed.https://sajp.org.za/index.php/sajp/article/view/1583Publisher's veriso

The validation of the visual screening tool for anxiety disorders and depression in hypertension and/or diabetes

Background: Depression and anxiety disorders remain poorly detected at primary health care, particularly in patients with hypertension and/or diabetes. A visual screening tool for anxiety disorders and depression (VISTAD) has been developed, but not validated. Aim: To validate the VISTAD in primary health care participants diagnosed with hypertension and/or diabetes. Setting: Participants were recruited from five primary health care centres in the Eastern Cape, South Africa (urban, peri-urban and rural). Methods: The study used a cross-sectional study design to validate the VISTAD. The VISTAD was validated against the International Neuropsychiatric Interview (M.I.N.I) using field testing. A demographic questionnaire was used to collect data on socio-economic variables. Results: Sixty-nine (87%) females and 10 (13%) males with a mean age of 49 (SD 8.6844) participated in the study. Fifty black people (63%), 16 mixed race people (20%) and 13 white people (16%) participated in the study. The majority of the participants (77%) did not complete high school. The area under curve score (AUC) for the VISTAD in screening for depression was 0.91, and for anxiety disorders, 0.87 post-traumatic stress disorder, 0.87 panic disorder, 0.85 social phobia, 0.88 agoraphobia, and 0.83 generalised anxiety disorder revealing acceptable psychometric properties. Conclusion: The use of the VISTAD as a screening tool at primary health care in people living with hypertension and/or diabetes is recommended. The VISTAD could, therefore, play a key role in the prevention and early treatment of individuals diagnosed with hypertension and/or diabetes across cultures and levels of education. The VISTAD needs to be validated in a large population representative of primary care patients diagnosed with hypertension and/or diabetes

London Measure of Unplanned Pregnancy for South African women with mental illness: Exploring perspectives on pregnancy

INTRODUCTION: Unplanned pregnancy is a community health concern. Research with South African women revealed the complexities surrounding pregnancy planning. Categorising pregnancies as either planned or unplanned is insufficient, as reducing a multidimensional concept to a dichotomous variable oversimplifies a complex matter. METHODS: Pregnant females, 18 years and older with a primary DSM-IV-TR (APA 2000) diagnosis of psychiatric illness, are qualified for inclusion in this quantitative descriptive study. Participants completed a structured psychiatric assessment, including the London Measure of Unplanned Pregnancy (LMUP) during care as usual visits at two Maternal Mental Health Clinics. RESULTS: Although 37.1% termed their pregnancy unplanned when asked dichotomously, the LMUP scores revealed that 50.6% of the 170 participants fell outside the ‘planned’ category. Worryingly, 73.3% of the women with unplanned or ambivalent pregnancies did not use contraception. Neither the women’s intention to fall pregnant nor their perception of the right timing for being pregnant could be predicted by the group (unplanned, ambivalent or planned) in which they fell; 82.6% of the unplanned group, 57.1% of the ambivalent group and 6.0% of the planned group indicated not wanting the baby. All the women in the ‘planned’ group agreed with their partner to have a baby. This holds true for 24.4% of the women in the other two groups. CONCLUSION: Results revealed similar findings as other studies in terms of contraception use, pregnancy timing, pregnancy intent, desire to have a baby, partner involvement and healthpromoting behaviours during pregnancy. The large size of the ambivalent category emphasises that pregnancy planning cannot be viewed in terms of two dichotomous points, but should rather be thought of as a scale or continuum.DHE

Digit ratio as an endophenotype in a schizophrenia population

CITATION: Nieuwoudt, W. D. B. et al. 2021. Digit ratio as an endophenotype in a schizophrenia population. South African Journal of Psychiatry, 27:a1587, doi:10.4102/sajpsychiatry.v27i0.1587.The original publication is available at https://sajp.org.zaBackground: Schizophrenia is a debilitating mental health condition affecting the lives of many South Africans. The origins of the heterogeneity in the presentation of the illness remain uncertain. Aim: This cross-sectional study performed a retrospective data analysis to determine the usefulness of digit ratio as an endophenotype in a South African schizophrenia population. Setting: A large genetic study in a South African schizophrenia population recruited patients from services in the Western and Eastern Cape. Methods: Complete clinical histories were captured for participants, including sets of images of the face and extremities. Software was utilised to measure the lengths of participants’ digits from said images and digit ratios (2D:4D) were calculated. Descriptive analyses were performed on the ratios and statistical differences in digit ratio means were calculated between groups characterised by sex, age of onset and the presence vs absence of positive symptoms. Linear modelling was utilised to assess for correlates between 2D:4D and positive and negative symptom severity using scores obtained from the Positive and Negative Syndrome Scale (PANSS) and Scale for the Assessment of Negative Symptoms (SANS). Results: 2D:4D in male participants did not significantly differ from female participants as in healthy populations. 2D:4D did not significantly correlate with the severity of positive or negative symptoms and 2D:4D means between groups did not significantly relate to age of onset. Conclusion: 2D:4D appears to be a possible endophenotype in schizophrenia in this population. 2D:4D, however, may not be as readily identifiable as certain minor physical anomalies and neurological soft signs significantly associated with schizophrenia in this population.https://sajp.org.za/index.php/sajp/article/view/1587Publisher's versio

Obsessive compulsive disorder- prevalence in Xhosaspeaking schizophrenia patients

Obsessive compulsive disorder (OCD) has been reported in up to 31% of  schizophrenia sufferers. This study evaluated the presence of OCD in a  Xhosa-speaking schizophrenia group. Xhosa patients (N = 509, including 100  sibships) with schizophrenia were recruited from hospital and community settings. The patients underwent a structured clinical interview for the presence  of lifetime co-morbid schizo-phrenia and OCD. Only 3 patients (0.5%) fulfilled criteria for OCD. No concordance for OCD was noted in the  sibship group. Our findings differ from those in other parts of the world, and if replicated, might suggest unique protective environmental or genetic factors  for OCD in certain ethnic groups

Chromosome 22q11 in a Xhosa schizophrenia population

Chromosome 22q11 aberrations substantially increase the risk for developing schizophrenia. Although micro-deletions in this region have been extensively investigated in different populations across the world, little is known of their prevalence in African subjects with schizophrenia. We screened 110 African Xhosa-speaking participants with schizophrenia for the presence of micro-deletions. As further verification for the presence or absence of 22q11 microdeletions, we screened 238 Xhosa schizophrenia patients and 240 healthy Xhosa individuals from a larger schizophrenia candidate 22q11 gene study using molecular analyses. Data from molecular and cytogenetic analyses confirmed the absence of 22q11 microdeletions in the Xhosa schizophrenia samples. Although the absence of chromosome 22q11 micro-deletions in this group of patients does not exclude the possibility that it may occur in Xhosa schizophrenia patients, we concluded an extremely low prevalence. Our findings suggest that unique susceptibility loci may be present in this group

Assessing the efficacy of a modified assertive community-based treatment programme in a developing country

<p>Abstract</p> <p>Background</p> <p>A number of recently published randomized controlled trials conducted in developed countries have reported no advantage for assertive interventions over standard care models. One possible explanation could be that so-called "standard care" has become more comprehensive in recent years, incorporating some of the salient aspects of assertive models in its modus operandi. Our study represents the first randomised controlled trial assessing the effect of a modified assertive treatment service on readmission rates and other measures of outcome in a developing country.</p> <p>Methods</p> <p>High frequency service users were randomized into an intervention (n = 34) and a control (n = 26) group. The control group received standard community care and the active group an assertive intervention based on a modified version of the international model of assertive community treatment. Study visits were conducted at baseline and 12 months with demographic and illness information collected at visit 1 and readmission rates documented at study end. Symptomatology and functioning were measured at both visits using the PANSS, CDSS, ESRS, WHO-QOL and SOFAS.</p> <p>Results</p> <p>At 12 month follow-up subjects receiving the assertive intervention had significantly lower total PANSS (p = 0.02) as well as positive (p < 0.01) and general psychopathology (p = 0.01) subscales' scores. The mean SOFAS score was also significantly higher (p = 0.02) and the mean number of psychiatric admissions significantly lower (p < 0.01) in the intervention group.</p> <p>Conclusions</p> <p>Our results indicate that assertive interventions in a developing setting where standard community mental services are often under resourced can produce significant outcomes. Furthermore, these interventions need not be as expensive and comprehensive as international, first-world models in order to reduce inpatient days, improve psychopathology and overall levels of functioning in patients with severe mental illness.</p