Treating depression in HIV-positive patients affects adherence

Aim. To determine changes in adherence to antiretroviral therapy (ART) in HIV-positive patients with depression, following treatment with an antidepressant or psychotherapy.Methods. The study was prospective, randomised and controlled. Consenting volunteers aged .18 years and stable on ART for .6 months were included in the study. Sociodemographic data were obtained, and a clinical diagnostic evaluation and the Hamilton Depression rating scale (HAMD) were performed on all subjects at entry to and at the end of the study. Participants found to be depressed were randomly assigned antidepressant treatment (20 mg citalopram) or interpersonal psychotherapy (IPT) (5 sessions). Medication was dispensed at each visit and patients were asked to return all unused medication todetermine ART adherence. The study was approved by the University of the Witwatersrand. Results. Sixty-two HIV-positive persons receiving ARTparticipated; 30 were not depressed (control group) and 32 were depressed (patient group). No significant differences in demographic characteristics existed between the control and patient groups. Mean ART adherence at the start of the study was 99.5% (standard error (SE) }0.46) and 92.1% (SE }1.69) in the control and patients groups, respectively.Mean ART adherence at the end of the study changed marginally in the control group (99.7%; SE }0.46) and increased significantly in the patient group (99.5%; SE} 0.13) (p>0.05). The mean ART adherence rate of patients who received pharmacotherapy increased from 92.8% to99.5%, and of those who received psychotherapy increased from 91.1% to 99.6% (p>0.05). There was no significant association between the increased adherence in the patient group and baseline demographic and clinical characteristics, irrespective of antidepressant therapy or IPT (p>0.05). Conclusion. Successful treatment of depression withan antidepressant or psychotherapy was associated with improved ART adherence, independent of the type of treatment and sociodemographic factors. It is necessary to identify HIV-positive patients at risk of depression, to initiate antidepressant treatment which may prevent ARTnon-adherence, and subsequent disease progression and increased morbidity

The assessment of undergraduate psychiatry training: a paradigm shift

No Abstract.South African Psychiatry Review Vol. 10 (2) 2007: pp.88-9

Knowledge, attitudes and personal beliefs about HIV and AIDS among mentally ill patients in Soweto, Johannesburg

Aim. The aim of the study was to determine knowledge, attitudes and personal beliefs regarding HIV and AIDS in a group of mentally ill patients attending outpatient clinics in Soweto, Johannesburg. Method. All patients attending four randomly chosen clinics in Soweto were invited to complete a self-administered questionnaire after obtaining informed written consent. The 63-item questionnaire, developed from others specifically for this study, included questions on socio-demographic and clinical characteristics; knowledge on how HIV is acquired and spread; attitudes and beliefs regarding HIV and AIDS; and condom usage. The statements in the knowledge sections were used to calculate a composite score, which if greater than or equal to 75% was defined as ‘adequate knowledge’. Results. A total of 1 151 patients with mental illness participated in the study. The mean age was 41.9 years (standard deviation 11.6) and the majority were males (50%); single (55%), and had achieved only a secondary level of education (53.3%). Overall, most of the study population did not believe in the myths surrounding the spread and acquisition of HIV and AIDS. There were however, significant associations between a low level of education and the belief that HIV is acquired from mosquito bites (odds ratio (OR) 1.61; 95% CI 1.19 - 2.18; p=0.002) and through masturbation or body rubbing (OR 1.76; 95% CI 1.34 - 2.33; p=0.000). Although more than 90% of the patients were aware of the facts regarding the spread of HIV, approximately 40% did not believe that one could acquire HIV through a single sexual encounter. The composite scoring for knowledge showed that less than half the patients had adequate knowledge of HIV/AIDS. This was significantly associated with gender and level of education: females were 1.6 times (p<0.0004) and patients with Grade 8 or higher education 1.5 times more knowledgeable (p=0.002). Conclusion. Among mentally ill patients there is both a lack of knowledge about most aspects of HIV and AIDS and a belief in some of the myths associated with the acquisition and spread of the disease, especially among older, less educated patients. It is imperative that a targeted strategy be developed for this vulnerable group, taking into cognisance their inherent lower level of education and the cognitive impairment associated with mental illness, to educate them on all aspects of HIV and AIDS and to improve access to services

The outcome of Mental Health Care Users admitted under Section 40 of the South African Mental Health Care Act (No 17 of 2002)

Objective: To determine the outcomes of mental health care users (MHCU’s) admitted in terms of Section 40 of the South African Mental Health Care Act (No 17 of 2002) (MHCA) and the factors, if any, that are associated with these outcomes. Method: The study was a retrospective record review of MHCU’s, 18 years and older, referred by the South African Police Service (SAPS) to Chris Hani Baragwanath Hospital (CHBH). All mental health care users handed over to CHBH by SAPS with completed MHCA form 22’s during the period July 2007 to December 2007 were included in the study. The outcomes, demographics and clinical characteristics of these referrals were obtained from hospital records. Results: During the six-month study period, 718 MHCU’s were referred by members of SAPS to the CHBH Emergency Department. Associations were found between discharged MHCU’s and i) being male, ii) being less than 35 years of age, iii) being unemployed, iv) having a lower level of education, v) having a past history of substance abuse and/or vi) a past psychiatric illness. Females were twice as likely to be unemployed and admitted to hospital (either to a psychiatric or general medical ward). MHCU’s diagnosed with delirium were more likely to be admitted intoa medical ward as compared to a psychiatric ward. Conclusion: As has been the case in most countries where police services have been incorporated into mental health acts, South Africa’s new Mental Health Care Act (No 17 of 2002) has resulted in a large number of referrals by the police to mental health services. However, many of these referrals may not be necessary as most MHCU’s end up not being admitted. The characteristics of police referrals suggest that the receiving facility should have thecapacity to identify factors that favour outpatient care (especially substance abuse problems) and divert MHCU’s presenting with such factors to appropriate treatment facilities without admitting them to the hospital.Keywords: Mental Health Care Act; Outcome; Police services; Mental illness, South Afric

Feelings of hopelessness in stable HIV-positive patients on antiretrovirals

Aim. The coping skills and styles individuals utilise to deal with the stress of HIV infection greatly influence the psychological impact of this illness and potential consequent feelings of hopelessness. The aim of this study was to describe levels of hopelessness in a group of stable, non-depressed HIV-positive patients receiving antiretroviral therapy, and factors associated with hopelessness. Method. Thirty randomly selected non-depressed patients (according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria) were included in this study. Demographic and other data were obtained from all subjects, who also completed the Beck’s Hopelessness Scale (BHS). The 20 true-false items of the BHS (29) measured three major aspects of hopelessness, which was interpreted on the total scale score as follows: ≤3 minimal, and >3 significant. Results. The study population comprised 30 patients with a mean age of 37.9 years (standard error (SE) 1.18) (range 28 - 51 years). The mean BHS score was 4.03 (SE 0.55), with a range from 0 to 12. There were no statistically significant correlations between BHS scores of the study population and gender, marital status, employment status, level of education, years since the diagnosis of HIV, or number of children (p>0.05). Eighteen subjects (60%) scored 3 or less on the BHS, considered minimal levels of hopelessness. However, 12 (40%) scored more than 3, which is considered significant; of these 23% had scores of 7 or more. There was no statistically significant association between BHS scores and gender, employment status, level of education, number of children or number of years since diagnosis (p>0.05). However, patients who were married or living with partners were statistically more likely to score higher on the hopelessness scale compared with those who were single (p<0.05). Conclusion. Hopelessness is a psychological distress reaction that is common but largely undetected in stable HIV-positive patients on antiretrovirals. Feelings of hopelessness may result in increase in risk-taking behaviour (e.g. unprotected sex, drug use, sharing needles) and attempted suicide

Anxiety associated with colposcopy at Chris Hani Baragwanath Hospital, Johannesburg

Given the high incidence of cervical cancer in South Africa and the distress it causes, we aimed to determine the extent of anxiety in patients undergoing colposcopy at Chris Hani Baragwanath (CHB) Hospital, Johannesburg. Method. A descriptive and cross-sectional study design was applied on a convenient sample of patients from the waiting area of the colposcopy clinic at CHB Hospital. Females attending a first colposcopy appointment were invited to participate by completing the State-Trait Anxiety Inventory (STAI) after written informed consent had been obtained. Results. Among a total of 31 women, the mean STAI score for state anxiety was 46.77 (SD=12.92) and the mean STAI score for trait anxiety was 46.81 (SD=9.50); 51.6% of the patients had a STAI state anxiety score of >50, while 41.9% of the patients had a STAI trait anxiety score >50. There was no significant association between either elevated STAI state or trait anxiety scores and age group ( χ 2 =1.77; p= 0.18 and χ 2 =0.001; p= 0.98, respectively); marital status ( χ 2 =0.301; p= 0.58 and χ 2 =0.834; p= 0.36); level of education ( χ 2 =0.444; p= 0.51 and χ 2 =2.40; p= 0.12); employment status ( χ 2 =1.78; p= 0.18 and χ 2 =0.001; p= 0.98); monthly income ( χ 2 =1.15; p= 0.28 and χ 2 =0.03; p= 0.86) or using stimulants ( χ 2 =0.416; p= 0.52 and χ 2 =0.394; p= 0.53). There was a significant negative correlation between age and STAI state anxiety scores ( r 2 =0.004; p= 0.017) and a positive correlation between age and STAI trait anxiety scores ( r 2 =0.004; p= 0.019). Conclusion. This study reported significantly elevated trait anxiety scores relating to colposcopy and emphasises the need to identify the anxiety and institute a plan to ameliorate it with information booklets, leaflets, video colposcopy and educational counselling