Provider-initiated HIV counselling and testing (PICT) in the mentally ill

The prevalence of HIV infection is substantially higher in mentally ill individuals than in the general population. Despite this, HIV testing is not yet standard practice among the mentally ill population, and many mental health settings do not encourage HIV testing. This paper discusses provider-initiated HIV counselling and testing (PICT) and some of the ethical dilemmas associated with it, on the basis that PICT may be used to increase the number of mentally ill persons tested for HIV. The authors conclude that PICT should be promoted to all psychiatric admissions and mentally ill individuals receiving outpatient services, and that this is within the parameters of existing policies and legislations in South Africa

Strengthening of district mental health services in Gauteng Province, South Africa

In response to the Life Esidimeni tragedy, the Gauteng Department of Health established a task team to advise on the implementation of the Health Ombud’s recommendations and to develop a mental health recovery plan. Consistent with international human rights and South African legislation and policy, the plan focused on making mental healthcare more accessible, incorporating a strategy to strengthen district mental health services to deliver community-based care for people with any type and severity of mental illness. The strategy included an organogram with three new human resource teams integrated into the district health system: a district specialist mental health team to develop a public mental health approach, a clinical community psychiatry team for service delivery, and a team to support non-governmental organisation governance. This article discusses the strategy in terms of guiding policies and legislation, the roles and responsibilities of the various teams in the proposed organogram, and its sustainability

Cladistic analysis of the apolipoprotein AI-CIH-AIV gene cluster using a healthy French Canadian sample. I. Haploid analysis

A cladistic analysis was carried out to identify haplotypes hypothesized to differ for functional DNA sequence variations within the apolipoprotein (apo) AI-CIII-AIV gene cluster that affect plasma lipid, lipoprotein and apolipoprotein levels. A sample of unrelated healthy French Canadians was studied. First, a cladogram of the observed apo AI-CIII-AIV haplotypes was estimated. Then this cladogram was used to define a statistical analysis of the association between haplotype variation and variation in plasma lipid, lipoprotein and apolipoprotein levels. Three haplotypes were identified which were associated with small (5–12% of the total sum of squares) pleiotropic effects on plasma lipid, lipoprotein and apolipoprotein traits and these effects were context, i.e. gender, dependent.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66070/1/j.1469-1809.1995.tb00742.x.pd

The South African society of psychiatrists (SASOP) and SASOP State Employed Special Interest Group (SESIG) position statements on psychiatric care in the public sector

Executive summary. National mental health policy: SASOP extends its support for the process of formalising a national mental health policy as well as for the principles and content of the current draft policy. Psychiatry and mental health: psychiatrists should play a central role, along with the other mental health disciplines, in the strategic and operational planning of mental health services at local, provincial and national level. Infrastructure and human resources: it is essential that the state takes up its responsibility to provide adequate structures, systems and funds for the specified services and facilities on national, provincial and facility level, as a matter of urgency. Standard treatment guidelines (STGs) and essential drug lists (EDLs): close collaboration and co-ordination should occur between the processes of establishing SASOP and national treatment guidelines, as well as the related decisions on EDLs for different levels. HIV/AIDS in children: national HIV programmes have to promote awareness of the neurocognitive problems and psychiatric morbidity associated with HIV in children. HIV/AIDS in adults: the need for routine screening of all HIV-positive individuals for mental health and cognitive impairments should also be emphasised as many adult patients have a mental illness, either before or as a consequence of HIV infection, constituting a ‘special needs’ group. Substance abuse and addiction: the adequate diagnosis and management of related substance abuse and addiction problems should fall within the domain of the health sector and, in particular, that of mental health and psychiatry. Community psychiatry and referral levels: the rendering of ambulatory specialist psychiatric services on a community-centred basis should be regarded as a key strategy to make these services more accessible to users closer to where they live. Recovery and re-integration: a recovery framework such that personal recovery outcomes, among others, become the universal goals by which we measure service provision, should be adopted as soon as possible. Culture, mental health and psychiatry: culture, religion and spirituality should be considered in the current approach to the local practice and training of specialist psychiatry, within the professional and ethical scope of the discipline. Forensic psychiatry: an important and significant field within the scope of state-employed psychiatrists, with 3 recognised groups of patients (persons referred for forensic psychiatric observation, state patients, and mentally ill prisoners), each with specific needs, problems and possible solutions. Security in psychiatric hospitals and units: it is necessary to protect public sector mental healthcare practitioners from assault and injury as a result of performing their clinical duties by, among others, ensuring that adequate security procedures are implemented, appropriate for the level of care required, and that appointed security staff members are appropriately trained and equipped.Dr Reddy’s Laboratorieshttp://www.sajp.org.za/index.php/sajpam2013ay201

Community psychiatry: An audit of the services in southern Gauteng

Aim. To audit the community psychiatric services in southern Gauteng with a view to determining whether the objectives of the country’s mental health legislation and policies are being achieved. Results. Although southern Gauteng’s community psychiatric clinics are situated in a primary health setting, primary health clinicians play no active role in the management of mentally ill patients. Care is supplied mainly by specialist psychiatrists, psychiatric registrars (in training) and psychiatric nurses. For first appointments, a mean of 2 patients are seen per doctor per clinic day for a mean duration of 30 minutes. For follow- up appointments, a mean of 17 patients are seen per doctor per clinic day for a mean duration of 8 minutes. The waiting time for new patient appointments is a mean of 6 months. Follow-up patients are seen once a month by nursing staff and approximately once every 4 months by doctors. An average of 1 in 5 patients is treated with oral atypical antipsychotics; in the majority of clinics, this is the total extent of care. However, where psychologists, social workers and occupational therapists are present, only 0.2% of all users have access to them. Conclusion. The community psychiatric services, although better than those in some other countries, fall short of what is required by South African legislation and policies. General community health services ought to play an active role in the structure and delivery of psychiatric services by developing and strengthening the current limited services, with an emphasis on cost-effective and preventive approaches. Existing community psychiatric services, if so transformed, could serve as a model for other countries in Africa

HIV in South Africa - depression and CD4 count

Objective. Published studies on the prevalence of depressive symptoms using rating scales and the relationship between depression and immune status offer inconsistent results. Depressive symptoms are common and impact on functioning, quality of life, and health status, highlighting the importance of diagnosis and treatment of patients with HIV infection. The aim of the study was to determine the occurrence of depression among HIV-positive patients using the Beck's Depression Inventory (BDI) and to determine a relationship, if any, between depressive symptoms and CD4 count. Method. Forty-one patients aged 18 years or more were recruited from the HIV outpatient clinic. All the subjects completed the 21-item BDI and their CD4 counts were determined. Patients who had a score of 10 or more on the BDI were considered positive for a depressive disorder. Results. More than half (56%) of the study sample had a BDI of ≥ 10 indicating significant symptoms of depression. There was no significant difference in the CD4 counts between the depressed and non-depressed groups (p > 0.05), and no correlation between CD4 counts and BDI scores in the total study sample (r = 0.27, p > 0.05). The affective components of the BDI contributed significantly to the overall BDI score compared with the somatic component (p < 0.05). Conclusion. The evidence from the study supports the BDI as a suitable measure for identifying those patients who meet the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for minor or major depression. The HIV epidemic is the most serious health challenge in South Africa and it is imperative that HIV-infected patients who complain of fatigue or insomnia be screened routinely for major depression, followed by a structured interview to confirm the diagnosis

Repeat non-fatal suicidal behaviour at Johannesburg Hospital

Objective. To describe the characteristics of non-fatal suicide behaviour (NFSB) in a group of patients and to determine factors, if any, that may be associated with repetition of this behaviour. Method. The study included all patients treated for NFSB at Johannesburg Hospital during the period August 2002 - October 2002. The information was gathered by means of a structured questionnaire designed to evaluate characteristics of the behaviour. Results. The study sample comprised 43 patients with NFSB (mean age 29.7 years, range of 16 - 75 years), of whom 26 (60%) were female. Sixty-three per cent of the patients overdosed with medication and 33% ingested household poisons. Events that precipitated the event included relationship problems (70%), illness (12%), financial difficulties (9%), and depressed mood (9%). In 65% of patients the behaviour was impulsive. Factors associated with non-fatal repetition included being in the 18 - 30-year age group (76%) (χ2 = 6.74, p < 0.05); being female (90%) (χ2 = 4.75, p < 0.05); having children (90%) (χ2 = 4.72, p < 0.05); a past psychiatric history (50%) (χ2 = 4.08, p < 0.05); and the current attempt deemed medically serious (50%) (χ2 = 6.67, p < 0.05). Conclusions. NFSB is a major problem in South Africa and the incidence is still increasing. Hospital-based interventions following admission are recommended to reduce repeat attempts in such patients. Significant factors associated with non-fatal repetition include among others, a history of a previous medically serious attempt and/or a known psychiatric illness