Dementia in intellectual disability: a review of diagnostic challenges

The evaluation of dementia in individuals with intellectual disability (ID), which will guide subsequent intervention, care and management depends on the systematic review of a number of factors: (1) the individual historical context, obtained from multiple sources, (2) evaluation of the pre-existing cognitive, behavioural, psychiatric, medical and adaptive skill profile, (3) the constellation, and pattern of evolution, of presenting signs and symptoms, (4) results of focused investigations, and (5) refinement of the differential diagnosis. In patients with ID, standard clinical methods need to be supplemented by careful, longitudinal behavioural observations, and individually tailored assessment techniques. Co-morbidity, multiple biological, psychological and socioenvironmental factors, and complex interactions among events, are the reality for many ageing people with ID. Determining the various influences is often a formidable clinical task, but should be systematically carried out using medical, cognitive, behavioural, neuropsychiatric and psycho-social frameworks.Key words: Dementia; Intellectual disability; Mental retardatio

The adjustment of the deaf to a hearing world

The writer wishes to thank the staff of the Dominican School for the Deaf at Wittebome with whose ample assistance she was able to write the thesis. They allowed her to be present during lessons, attend staff discussions, consult the records of pupils and borrow books and pamphlets. In addition, it was through their help that she was able to visit the homes of past and present pupils. The parents of the deaf pupils and the deaf adults with whom the writer came into contact were very helpful and for this she is grateful. The writer wishes to thank the branch secretary of the National Council for the Deaf at Woodstock who allowed her to attend the social evenings. She also wishes to express thanks to managers of the Cape Footwear Industry whose workers she interviewed. Finally, it is although the generous co-operation of many deaf children and adults that she was able to have an insight into their problems and difficulties

The forensic mental health profile of women offenders in the Eastern Cape, South Africa

Introduction There is a dearth of research on mental health issues in women offenders in South Africa, especially regarding their socio-demographic backgrounds, offence characteristics, and forensic mental health profiles. Objectives This study examined the psychosocial and forensic mental health profile of women offenders referred by eastern Cape courts for forensic evaluation. A range of socio-demographic, criminological, clinical and forensic mental health variables were systematically explored. Methods A bi-phasic, mixed methods study design was adopted. The clinical and forensic records of all women referred for forensic evaluation to Fort England forensic psychiatric hospital in the Eastern Cape, South Africa were retrospectively reviewed, comprising 173 individual cases in the study period of 1993-2017. Inferential statistical analyses (chi-squared and multivariate logistic regression) were applied to explore relationships between variables and offending outcomes of nterest. Detailed semi-structured interviews were subsequently conducted with a sub-sample of 8 women with mental disorder and violent offending ackgrounds. Interview transcripts thematically analysed. Results Most women came from impoverished and disadvantaged backgrounds. Whilst the majority were first offenders, a high proportion had violent index offences, with murder, attempted murder and assault with intent to do grievous bodily harm accounting for over half of cases. The majority of victims of violence were well known to the perpetrator, especially as biological children, intimate male partners or close family members. Biological children in their first year of life were particularly vulnerable to being victims of homicidal violence. Disproportionately high rates of pre-offence mental illness, alcohol misuse, HIV infection and prior abuse of the offender (especially by intimate male partners) were present. High rates of severe mental disorders (especially psychiatric comorbidity and psychotic-spectrum disorders), and relatively low rates of personality disorders and substance disorders were diagnosed. The majority of women were declared to lack trial competence and criminal capacity, respectively, following forensic evaluation. Women who had backgrounds of prior abuse themselves had over three mes the odds of subsequent violent offending in general, and almost six times the odds of homicidal offending in particular. Homicidal offences were significantly more commonly committed by women with no prior psychiatric history and no psychiatric comorbidity. Women who committed homicide had over eleven times of killing children as opposed to adults. Women over the age of 30 years, and those without psychiatric comorbidity, were significantly less likely to have killed children. Thematic analysis of interviews emphasized the important roles played by gender, self-image, and mental health in violent offending pathways. Conclusions A complex array of socio-demographic, criminological, clinical and forensic variables interact in women offenders of the Eastern Cape referred by courts for forensic evaluation. Exploration of these factors improves understanding of the broader psychosocial context of female offending, and of the personal experiences of the women themselves. This in turn provides an enhanced gender-focus to guide the progressive changes required in policy, legislative, clinical and research endeavours in this field

The relationship between a selection battery and the academic performance of students on an MBA programme

The study is a quantitative analysis into the selection process of the Masters in Business Administration (MBA) programme at the Tshwane University Technology (TUT). The selection battery used at TUT to select the MBA applicants is comprised of the Situation Specific Evaluation Expert (SpEEx), the English Literacy Skills Assessment (ELSA), and the 15 Factor Questionnaire (15FQ+). This test battery aims to obtain information on an applicant with regards to his/her cognitive potential (verbal and non-verbal ability), language proficiency, and personality. Therefore, the aim of the study was to investigate the relationship between the selection battery and the academic performance of those students selected into the MBA programme at TUT by examining the differences between the scores of the psychometric selection batteries and the academic performance of those students selected. Upon analyses and interpretation of the data it was determined that there were no statistically significant differences between the scores of the different components of the selection batteries used and the academic performance of those selected.Dissertation (MEd)--University of Pretoria, 2011.Educational Psychologyunrestricte

How to Carry Out Bathymetric and Elevation Surveys on a Tight Budget: Basic Surveying Techniques for Sustainabilty Scientists

Sustainability scientists often face a difficult task to conduct research or carry out preliminary investigations around coastal areas in developing countries, due to the limitation in the availability of topographical and bathymetry data. These limitations can be particularly important for the case of ports, on which the livelihoods of many fishing communities depend on. Often, cost is cited as a reason regarding the absence of any such data. However, in the present technical note the authors highlight how existing “low-level” surveying methods can be inexpensive and allow sustainability scientists to conduct a reasonably accurate survey for less than 1,000 USD, provided that researchers possess a reasonable knowledge of mathematics and geometry (high-school equivalent)

Endovascular embolisation of a cervical spinal AVF in a patient with NF1

Vascular abnormalities associated with neurofibromatosis type 1 (NF1) are well described. Spinal arterio-venous fistula (AVF), however, is a rare finding in NF1 and may present with neurological symptoms that require treatment. Management of spinal AVFs can be endovascular or surgical. We present a patient with known NF1 and neurological symptoms owing to a spinal AVF demonstrated by imaging, who required a combination of endovascular and surgical management

The gendered context of women charged with violent offences in the forensic psychiatric setting

Background: Women charged with violent offences may be referred by courts for forensic psychiatric assessment to determine whether mental disorder or intellectual disability impacts their fitness to stand trial and/or criminal responsibility. The profile of these women is a poorly researched area in South Africa. Aim: This study examined the socio-demographic, offence-related, and clinical profile of South African women charged with violent offences referred for forensic assessment. Setting: Fort England Hospital (FEH), a forensic psychiatric institution in the Eastern Cape. Methods: The clinical records of 173 women referred by courts for forensic psychiatric evaluation over a 24-year period (1993–2017) to FEH were systematically reviewed. Results: Most women were single, black mothers with dependent children, who were unemployed and socio-economically impoverished. Many had backgrounds of pre-offence mental illness, alcohol use and alleged abuse. The majority were first-time offenders whose victims were known to them. Most child victims were biological children killed by their mothers. Likely primary motives for violence were related to psychopathology in half of cases, and interpersonal conflict in a third. Forensic assessment most frequently confirmed psychotic disorders and dual diagnoses. Half the cases were fit to stand trial and under half were criminally responsible. Conclusion: Violent female offending occurs within a gendered context, with high rates of prior trauma, alcohol use and psychosocial distress in perpetrators. An emphasis on gender-sensitive psychosocial interventions is required. Contribution: This study highlights the nature and context of violent offending by women referred for forensic psychiatric assessment in South Africa

Evaluating Community Engagement Strategies to Manage Stigma in Two African Genomics Studies Involving People Living with Schizophrenia or Rheumatic Heart Disease

In global health research and genomics research specifically, community engagement has gained prominence in enhancing ethical conduct, particularly in managing the risk of stigmatization, but there is minimal scientific evidence on how to do this effectively. This article reports on community engagement evaluation strategies in two African genomics studies: the Stigma in African Genomics Research study and the Genomics of Schizophrenia in South African Xhosa People (SAX) study. Within the Stigma in African Genomics Research study, a self-report rating scale and open-ended questions were used to track participant responses to an experiential theatre workshop. The workshop focused on participant experiences of living with schizophrenia or rheumatic heart disease (RHD). While the schizophrenia group reported more alienation and less stigma resistance than the RHD group, both groups demonstrated increased stigma resistance over time, after participating in the workshops. Hearing from others living with and managing the same illness normalised participants’ own experiences and encouraged them. Within the SAX study, a short rating scale and qualitative feedback methods were used to evaluate a Mental Health Literacy Day targeting mental health stigma. Information talks about (i) the symptoms of schizophrenia and treatment options and (ii) the illness experiences of a patient in recovery were rated as the most helpful on the day. Audience members reported that these talks challenged negative perceptions about severe mental illness. Three important learnings emerged from these evaluations: firstly, integration of evaluation strategies at the research study planning phase is likely to promote more effective community engagement. Secondly, a combination of quantitative and qualitative methods that draw on simple descriptive statistics and thematic analysis can provide nuanced perspectives about the value of community engagement. Thirdly, such evidence is necessary in establishing and promoting the science of community engagement in genomics research and health research more broadly

The content of delusions in a sample of South African Xhosa people with schizophrenia

Background: Although the relationship between cultural beliefs and schizophrenia has received some attention, relatively little work has emerged from African contexts. In this study we draw from a sample of South African Xhosa people with schizophrenia, exploring their cultural beliefs and explanations of illness. The purpose of the article is to examine the relationship between this cultural context and the content of delusions. Methods: A sample comprising 200 Xhosa people with schizophrenia participating in a South African schizophrenia genomics study were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Participant delusions were thematically analyzed for recurring themes. Results: The majority of participants (n = 125 72.5%) believed that others had bewitched them in order to bring about their mental illness, because they were in some way jealous of the participant. This explanation aligns well with the understanding of jealousy-induced witchcraft in Southern African communities and highlights the important role that culture plays in their content of delusions. Conclusions: Improved knowledge of these explanatory frameworks highlights the potential value of culturally sensitive assessment tools and stigma interventions in patient recovery. Furthermore such qualitative analyses contribute towards discussion about aspects of delusional thought that may be more universally stable, and those that may be more culturally variable

Rekeningkundige Studies 100

Exam paper (Additional Assessment) for second semeste