Charles Bonnet Syndrome; Presenting as “Innocent Spirits Within’: A Case Report

Charles Bonnet syndrome (CBS) is an under-recognized and under-reported disorder that involves visual hallucinations in visually impaired individuals. These patients have intact cognition, do not have hallucinations in any other sensory modalities, and retain insight into the unreal nature of their hallucinations. In most developing countries like  Botswana where mental health and ophalmology professionals are  scarce, cases like  Charles Bonnet Syndrome are likely to be misdiagnosed for psychosis/’madness’ with consequent  inappropriate biological interventions . Our patient, a 90 year old blind widow pensioner, with no prior psychiatric history, complained to family members that she was seeing people without heads and sometimes without limbs following her. She felt tortured as these people followed her everywhere. She consulted her pastor about these visual hallucinations, and was told not to worry about them as ‘’they were harmless spirits within her’. When she was eventually brought to the Hospital she was given a diagnosis of Charles Bonnet Syndrome and showed marked improvement after being given assurance about her sanity and antidepressants.There is need to increase awareness of rare psychiatric syndromes in the elderly like the Charles Bonnet Syndrome amongst clinicians since they can be easily missed or inappropriately managed more so since the population of the elderly is increasing in Botswana and many other sub-Sahara countries Keywords: Charles Bonnet Syndrome, Hallucinations, Botswan

Assessment of Voluntary HIV Counseling and Testing Service Utilization and Associated Socio-Demographic among Secondary School Teachers in Nyando, Kisumu County Kenya: A Descriptive Cross Sectional Survey

Voluntary HIV counseling and testing (VCT) is one of the key tools in the HIV/AIDS prevention and control programs in Kenya. But utilization of VCT services among out secondary school teachers in Kenya is low.  The aim of this study was to assess Voluntary HIV Counseling and Testing Service utilization and associated socio-demographic factors among secondary school teachers since most school-based HIV interventions in sub-Saharan Africa rely on teachers as behavior formation and behavior-change agents to deliver prevention messages to school children. The study sample consisted of 255 secondary school teachers (36% females and 64% males) out of a total of 753 teachers from 73 secondary schools in the seven divisions in Nyando district. Stratified sampling was used to select the number of schools per division to be included in the study while simple random sampling was used to select schools in each division.Self-administered questionnaires and focus group discussions were used to estimate the prevalence of VCT service utilization and to assess associated socio-demographic factors among the secondary school teachers.Cross tabulation was used to show relationships between the independent and the dependent variables, and chi-square was used to test for existence of relationships between the variables, p<0.05 was considered statistically significant. Information from in-depth discussions was analyzed manually using qualitative methods. The data was presented descriptively and through the use of frequency tables and bar graphs. The study found significant relationships between utilization of VCT services and gender (p=0.003) and age (p=0.004), but not level of education, marital status, religious affiliation or area of residence. Spousal approval of VCT utilization emerged as the most significant social factor affecting utilization of VCT services (p=0.019). HIV/VCT utilization among secondary school teachers in Nyando County remain low especially among male teachers. HIV/AIDS prevention and control programs among secondary school teachers in Nyando County should focus on the above areas. Key words: HIV testing, VCT utilization, Knowledge, Secondary school teachers, Nakuru Kenya

Neuropsychological profile following suicide Attempt by hanging in Botswana: Three case reports

Botswana police suicide statistics reported a total of 783 cases of both attempted and completed suicide in one year. Attempted hanging usually results in severe memory disturbances but that these amnesic states usually are only temporary. While  there is a considerable amount of early German-language literature on the neurological and neuropsychological consequences of unsuccessful attempts by hanging ,by the early 1990’s , only two cases of attempted hanging had been reported In the  English language as the cause of a persistent anterograde amnestic syndrome resembling that seen in Korsakoffs syndrome. We present three cases we believe to be the first reported cases of amnesic syndromes in Botswana following unsuccessful attempts by hanging in three male adults. Key words: Attempted suicide, Amnesic states, Botswana, Korsakoff ’s syndrom

Assessment of Voluntary HIV Counseling and Testing Service Utilization and Associated Psychosocial Factors Among Secondary School Teachers in Nyando, Kisumu County Kenya: A Descriptive Cross Sectional Survey

Voluntary HIV counseling and testing (VCT) is one of the key tools in the HIV/AIDS prevention and control programs in Kenya. But utilization of VCT services among out secondary school teachers in Kenya is low. The aim of this study was to assess Voluntary HIV Counseling and Testing Service utilization and associated psychosocial factors among secondary school teachers since even though  most school-based HIV interventions in sub-Saharan Africa rely on teachers as behavior formation and behavior-change agents to deliver prevention messages to school children, their utilization of HIV VCT services has been low. The study sample consisted of 255 secondary school teachers (36% females and 64% males) out of a total of 753 teachers from 73 secondary schools in the seven divisions in Nyando district. Stratified sampling was used to select the number of schools per division to be included in the study while Simple random sampling was then used to select schools in each division. Self-administered questionnaires and focus group discussions were used to estimate the prevalence of VCT service utilization and to assess associated psychosocial factors among the secondary school teachers. Cross tabulation was used to show relationships between the independent and the dependent variables, and chi-square was used to test for existence of relationships between the variables, p<0.05 was considered statistically significant. Information from in-depth discussions was analyzed manually using qualitative methods. The data was presented descriptively and through the use of frequency tables and bar graphs. This study found that less than half (48%) of the respondents had utilized VCT services. The majority of teachers (38%), who had utilized the VCT services did so “in order to know their HIV status/plan their future”. The study also found a positive association between utilization of VCT services, and perception of the importance of VCT as an HIV/AIDS control strategy (p=0.039). Spousal approval of VCT utilization emerged as the most significant social factor affecting utilization of VCT services (p=0.019). HIV/VCT utilization among secondary school teachers in Nyando County remain low especially among male teachers. HIV/AIDS prevention and control programs among secondary school teachers in Nyando County should focus on the above areas. Keywords: HIV testing, VCT utilization, Knowledge, Secondary school teachers, Nakuru Kenya

Post-traumatic stress disorder among the staff of a mental health hospital: Prevalence and risk factors

Background: Mental health service providers are frequently exposed to stress and violence in the line of duty. There is a dearth of data concerning the psychological sequelae of the frequent exposure to stress and violence, especially among those who work in resource-limited countries such as Botswana. Aim: To determine the prevalence and predictors of post-traumatic stress disorder (PTSD) among mental health workers in a tertiary mental health institute in Botswana. Setting: The study was conducted in Sbrana Psychiatric Hospital, which is the only referral psychiatric hospital in Botswana. Methods: The study used a descriptive cross-sectional design. A total of 201 mental health workers completed a researcher-designed psycho-socio-demographic questionnaire, which included one neuroticism item of the Big Five Inventory, and a PTSD Checklist-Civilian Version (PCL-C), which was used to assess symptoms of PTSD. Results: Majority of the study participants were general nurses (n = 121, 60.5%) and females (n = 122, 60.7%). Thirty-seven (18.4%) of the participants met the criteria for PTSD. Exposure to violence in the past 12 months (AOR = 3.26; 95% CI: 1.49–7.16) and high neuroticism score (AOR = 2.72; 95% CI: 1.19–6.24) were significantly associated with the diagnosis of PTSD among the participants. Conclusion: Post-traumatic stress disorder could result from stressful events encountered in the course of managing patients in mental health institutes and departments. Pre-placement personality evaluation of health workers to be assigned to work in psychiatric units and post-incident trauma counselling of those exposed to violence may be beneficial in reducing the occurrence of PTSD in mental hospital health care workers

Early-onset psychosis in an adolescent with DiGeorge syndrome: A case report

DiGeorge syndrome (DGS) was first described in 1829 by Dr Angelo DiGeorge. DGS is a cluster of symptoms because of a defect in the development of the pharyngeal pouch. Evidence from cytogenetic studies has linked the pathogenesis of DGS with a deletion of a gene located in chromosome 22-band 22q11. In most affected individuals, the deletion is de novo; however, inheritance has been reported in 10% – 25% of patients. DGS commonly presents with a classical triad of conotruncal cardiac anomalies, hypoplastic thymus and hypocalcaemia. DGS may be of focus to a psychiatrist as it is associated with cognitive deficits, high rates of schizophrenia and anxiety disorders. Patients may also present to mental health care workers with learning disabilities, developmental delay and behavioural disorders such as attention-deficit or hyperactivity disorder. Mental health workers therefore play an invaluable role in the diagnosis and timely treatment of the disorder. In a resource-limited area such as Botswana, with scarce mental health professionals, paediatricians and neurologists, DGS may be frequently misdiagnosed with consequent inappropriate interventions that may increase morbidity. Herein, we present a case to raise awareness and demonstrate one of the varied ways the syndrome may present. The multifaceted nature of DGS presentation underscores the need for a multidisciplinary approach to treatment

Caregiver burden and correlates among caregivers of children and adolescents with psychiatric morbidity: a descriptive cross sectional study

Objective: To determine levels and correlates of caregiver burden among caregivers of children and adolescents with psychiatric morbidity.Method: Over a period of four months, a total of 252 caregivers of children and adolescents with psychiatric morbidity were recruited. Data on socio-demographic factors, psychiatric morbidity among caregivers, and level of caregiver burden was collected using a researcher-designed socio-demographic questionnaire, Mini International Neuropsychiatric Interview, and Zarit burden interview, respectively. Data was analysed using statistical package for social sciences (SPSS) version 21.Results: Females (n = 211, 83.7%) and mothers (n = 182, 72.2%) accounted for the majority of the study participants. The majority of caregivers reported moderate to severe caregiver burden; (n = 100, 39.7%). Being single or separated (B = −6.91, p = 0.001, β = −0.18) and presence of psychiatric morbidity (B = 7.44, p = 0.009, β = 0.22) in the caregiver significantly contributed to the high levels of caregiver burden.Conclusion: Caregivers of children and adolescents with psychiatric morbidity suffer high levels of caregiver burden. A multidisciplinary approach to management of children with psychiatric morbidity to address challenges faced by the caregivers may alleviate the burden; thereby improving clinical outcomes of children and adolescents with psychiatric morbidity

A culturally adapted brief intervention for post-traumatic stress disorder in people with severe mental illness in Botswana: protocol for a randomised feasibility trial.

BackgroundResearch consistently reports elevated rates of exposure to traumatic events and post-traumatic stress disorder (PTSD) in people with severe mental illness (SMI). PTSD may be adequately managed with psychotherapy; however, there is a gap when it comes to management in culturally diverse settings like Botswana. This paper describes a study protocol whose aim is to culturally adapt the BREATHE intervention, a brief psychological intervention for people living with comorbid PTSD and SMI that was developed and tested in the USA; assess the feasibility and acceptability of the adapted BREATHE intervention and explore its efficacy.MethodsThe study will be conducted in three phases using a mixed methods approach. The first phase will identify and describe the most common traumatic experiences and responses to traumatic experiences, amongst patients with SMI, and patients' and mental health care providers' perceptions about suitable PTSD interventions for Botswana. The second phase will entail cultural adaption of the intervention using findings from phase 1, and the third phase will be a pilot trial to assess the feasibility and acceptability of the culturally adapted intervention and explore its efficacy. Quantitative and qualitative data will be analysed using basic descriptive statistics and thematic analysis, respectively.DiscussionLiterature highlights cultural variations in the expression and management of mental illness suggesting the need for culturally adapted interventions. The findings of this feasibility study will be used to inform the design of a larger trial to assess the efficacy of an adapted brief intervention for PTSD in patients with SMI in Botswana.Trial registrationClinicaltrials.gov registration: NCT04426448 . Date of registration: June 7, 2020