The challenges faced by mental health care users in a primary care setting : a qualitative study

Over the past two decades, the value and benefits of integrated mental health care services have been increasingly recognised. Despite the potential benefits, barriers exist at primary care level to receiving mental health care services, interfering with continuity of care. We conducted semi-structured interviews with mental healthcare users at a primary care clinic in South Africa, to explore their experiences of receiving mental health care services. A convenience sample of 15 participants identified challenges such as limited infrastructure, organisation, medication, services in local communities, allied mental health care services, communication and long waiting times. Mental health care users felt uncared for and disrespected, especially if they were treated by unskilled and overworked staff. Mental health care users described clinic visits as stressful and frustrating. Mental health care users described marked challenges in mental health care service provision in a South African primary health care setting.http://link.springer.com/journal/105972021-05-31hj2020Psychiatr

CLINICAL PRESENTATION OF HIV-INFECTED PATIENTS IN A PSYCHIATRIC HOSPITAL IN SOUTH AFRICA

Background: Africa is profoundly stricken by the HIV pandemic. People living with HIV/AIDS are more likely to be diagnosed with psychiatric disorders than the general population. We describe the prevalence of different mood and psychiatric disorders in HIV/AIDS infected patients with serious mental illness. Materials and Methods: We retrospectively sourced data from 105 patient files, at Weskoppies Hospital, between January 2012 and December 2016. Results: 56 patients had a psychotic disorder; 27 patients had a mood disorder and three patients had a cognitive disorder. Multiple diagnoses were observed in seven patients with a mood and psychotic disorder; ten patients with a psychotic and cognitive disorder and one patient with a mood and cognitive disorder. One patient had all three diagnoses. The most common medical co-morbidities were hypertension (15.24%) and tuberculosis (13.33%). Conclusion: Mentally ill patients who are HIV positive mostly present with mood and psychotic disorders. Clinicians need to be vigilant to detect neuropsychiatric manifestations of HIV infection to effectively manage and optimise treatment. This study highlights the need for further intervention in these vulnerable patients

Attitudes of medical students regarding legalisation of cannabis and cannabis-education

DATA AVAILABILITY : The authors confirm that the data supporting the findings of this study are available within the article.BACKGROUND : Recreational and medicinal use of cannabis is topical in the light of more permissive legislation regarding the substance worldwide. AIM : The primary purpose of this study is to determine the attitudes that final-year medical students at the University of Pretoria (UP) hold about recreational and medicinal use of cannabis, as well as determining if they feel they are being adequately trained in this regard. SETTING : The research was conducted at Weskoppies Psychiatric Hospital, affiliated with the UP. METHODS : The study follows a cross-sectional, comparative, quantitative design. Data were collected by means of a structured questionnaire. Final-year medical students were identified as participants via a convenience sampling technique. Participation was voluntary and anonymous. RESULTS : A total of 57 valid responses were recorded. The study shows that most medical students had permissive views about cannabis and that the majority feel that they are not being adequately trained to advise patients about medical cannabis in a lecture setting (64.9%, n = 37) or clinical setting (68.4%, n = 38). Results also show that previous personal experience with cannabis led to more permissive views. CONCLUSION : This study illustrates the need for academic research regarding medicinal cannabis but interestingly shows that medical students want more guidance from their training institution about the topic. CONTRIBUTION : This research shows that the conversation surrounding cannabis in medicine is continuous and universities should make a conscious effort to familiarise students with the topic.http://www.sajpsychiatry.orgam2024PsychiatrySDG-03:Good heatlh and well-beingSDG-04:Quality Educatio

Severity of psychotic episodes in predicting concurrent depressive and anxiety features in acute phase schizophrenia

BACKGROUND: Considering that depressive and anxiety symptoms are common in schizophrenia, this study investigated whether the severity of a psychotic episode in an acute phase schizophrenia cohort is predictive of concurrent depressive and anxiety features. METHOD: Fifty one recently hospitalised patients suffering from acute phase schizophrenia participated prospectively in a cross-sectional study. The severity of the psychotic episode, the depressive features and the anxiety features were measured by the Structured Clinical Interview for Positive and Negative Syndrome Scale (SCI-PANSS), the Calgary Depression Scale for Schizophrenia (CDSS), the Hamilton Anxiety Rating Scale (HAM-A) and the Staden Schizophrenia Anxiety Rating Scale (S-SARS). The total SCI-PANSS-scores were adjusted to exclude appropriately the depression or anxiety items contained therein. To examine akathisia as potential confounder, the Barnes Akathisia Scale was also applied. The relationships were examined using linear regressions and paired t-tests were performed between lower and higher scores on the SCI-PANSS. RESULTS: A higher adjusted total SCI-PANSS-score predicted statistically significantly higher scores for depressive features on the CDSS (p < 0.0001) and for anxiety features on the HAM-A (p = 0.05) and the S-SARS (p < 0.0001). The group that scored more or equal to the median (=99) of the adjusted total SCI-PANSS, scored significantly higher (p < 0.0001) on the CDSS, the HAM-A and the S-SARS than the group scoring below it. Akathisia measured distinctly different (p < 0.0001) from both the anxiety measures. CONCLUSION: The study suggests that the severity of a psychotic episode in acute phase schizophrenia predicts the severity of concurrent depressive and anxiety features respectively.http://www.biomedcentral.com/1471-244X/14/166am201

Are female bipolar patients of reproductive age aware of the teratogenic risk of sodium valproate? A qualitative study

BACKGROUND : Sodium valproate is considered the most teratogenic of all anticonvulsant drugs. Internationally, new regulations require women to sign risk assessment forms if initiated on it. AIM : This study aimed to explore patients’ awareness of the teratogenic risk of sodium valproate. SETTING : Weskoppies Psychiatric Hospital, Tshwane, Gauteng. METHODS : We conducted a qualitative study comprising 23 semi-structured interviews with female bipolar patients of reproductive age at a tertiary psychiatric hospital in South Africa. RESULTS : Patient psychoeducation and self-education is improving as many patients were aware of the risk of teratogenicity of sodium valproate either by being educated or by searching online after developing an interest. Our study identified the need for female patients to be educated about contraceptive use when starting on sodium valproate to avoid pregnancy. CONCLUSION : Our study shows that patients are becoming more aware of the teratogenic risk of sodium valproate. This suggests that consultations focusing on the issues of conception and the use of sodium valproate in women of childbearing potential has improved.A.U.S. was the principal investigator of the project in the context of her master’s in psychiatry. She wrote the research protocol, gathered and analysed the data, interpreted the findings and wrote the final manuscript. M.J. was the supervisor and K.N. the co-supervisor of the master’s study and they assisted with the formulation of the research question, the analysis and interpretation of the data and contributed to the writing of the manuscript.http://www.sajpsychiatry.orgam2023Psychiatr

Validity and reliability of the Staden Schizophrenia Anxiety Rating Scale

In schizophrenia, none of the standard anxiety measures exhibit strong psychometric properties, and all performed poorly against quality assessment criteria. Developed for the schizophrenia population, this study examined the validity and reliability of the Staden Schizophrenia Anxiety Rating Scale (S-SARS) that measures both specified and undifferentiated anxiety. Among 353 schizophrenia patients, strong correlations with anxiety parameters supported the S-SARS’s convergent validity. Criterion-related validity testing yielded accuracy, sensitivity, and specificity rates of around 95%. Its discriminant validity was observed for measures of depression, psychosis, akathisia, fatigue, vigour, procrastination, behavioural inhibition and activation, and personal growth and initiative. Structural validity was found in a single-factor unidimensional model with a 0.953 factor score. Excellent results were found for internal consistency (Cronbach’s alpha = 0.931; Spearman–Brown coefficient = 0.937; Guttman split-half coefficient = 0.928) and inter-rater reliability (Krippendorff’s alpha = 0.852). It incurred no more than a small error of measurement whereby the observed scores were within 1.54 to 3.58 of a true score on a zero to 50 scale. These strong psychometric properties suggest that the S-SARS is a valid and reliable instrument for measuring specified and undifferentiated anxiety in schizophrenia, providing the means for the accurate measurement of anxiolytic treatment effects.Supplementary Materials: Form S1: Staden Schizophrenia Anxiety Rating Scale (S-SARS)https://www.mdpi.com/journal/diagnosticsdm2022Psychiatr

Discerning undifferentiated anxiety from syndromal anxiety in acute-phase schizophrenia

BACKGROUND : Literature on anxiety in schizophrenia is confined to well-established diagnostic syndromes and the diagnostic category of unspecified anxiety disorder has not been quantitatively verified in this population. This study examined whether anxiety that is not differentiated into the well-established syndromes is empirically discernible from syndromal anxiety and no anxiety in acute-phase schizophrenia. METHODS : After sampling 111 acute-phase schizophrenia patients, they were stratified into three groups: syndromal anxiety; undifferentiated anxiety; and without anxiety disorder. The groups were compared statistically in two data sets on measures for anxiety, psychotic severity, depressive features, akathisia and medication use. RESULTS : On two measures of anxiety and for both data sets, the groups were significantly different without evidence of a confounding influence by akathisia, medication, or psychotic severity. The undifferentiated group was different from the syndromal group on the Staden Schizophrenia Anxiety Rating Scale (S-SARS) for both data sets (mean difference = 7.46, p < 0.001; mean difference = 7.69, p < 0.002) and on the Hamilton Anxiety Rating Scale for the one data set (mean difference = 14.68, p < 0.001) but not for the replicative data set (mean difference = 1.49, p = 0.494). The undifferentiated anxiety group was different from the no anxiety group for the respective data sets on both anxiety scales (S-SARS: mean difference = 8.67, p < 0.001; mean difference = 8.64, p < 0.001)(HAM-A: mean difference = 6.05, p < 0.001; mean difference = 8.67, p = 0.002). When depressive features had a confounding effect, it was small relative to the group differences. CONCLUSIONS : The results suggest some patients in acute-phase schizophrenia present with undifferentiated anxiety that is discernible from both syndromal anxiety and those without an anxiety disorder. This finding may serve as empirical grounds for clinicians to recognise undifferentiated anxiety in acute-phase schizophrenia, and for further research into the clinical importance of undifferentiated anxiety in this population.https://annals-general-psychiatry.biomedcentral.comhj2020PsychiatryStatistic

Severity of psychotic episodes in predicting concurrent depressive and anxiety features in acute phase schizophrenia

BACKGROUND: Considering that depressive and anxiety symptoms are common in schizophrenia, this study investigated whether the severity of a psychotic episode in an acute phase schizophrenia cohort is predictive of concurrent depressive and anxiety features. METHOD: Fifty one recently hospitalised patients suffering from acute phase schizophrenia participated prospectively in a cross-sectional study. The severity of the psychotic episode, the depressive features and the anxiety features were measured by the Structured Clinical Interview for Positive and Negative Syndrome Scale (SCI-PANSS), the Calgary Depression Scale for Schizophrenia (CDSS), the Hamilton Anxiety Rating Scale (HAM-A) and the Staden Schizophrenia Anxiety Rating Scale (S-SARS). The total SCI-PANSS-scores were adjusted to exclude appropriately the depression or anxiety items contained therein. To examine akathisia as potential confounder, the Barnes Akathisia Scale was also applied. The relationships were examined using linear regressions and paired t-tests were performed between lower and higher scores on the SCI-PANSS. RESULTS: A higher adjusted total SCI-PANSS-score predicted statistically significantly higher scores for depressive features on the CDSS (p < 0.0001) and for anxiety features on the HAM-A (p = 0.05) and the S-SARS (p < 0.0001). The group that scored more or equal to the median (=99) of the adjusted total SCI-PANSS, scored significantly higher (p < 0.0001) on the CDSS, the HAM-A and the S-SARS than the group scoring below it. Akathisia measured distinctly different (p < 0.0001) from both the anxiety measures. CONCLUSION: The study suggests that the severity of a psychotic episode in acute phase schizophrenia predicts the severity of concurrent depressive and anxiety features respectively

Psychiatric and other contributing factors in homicide-suicide cases, from northern Gauteng, South Africa over a six-year period

Homicide committed by a person who subsequently commits suicide within one week of the homicide is a relatively rare event. The current study used an explanatory sequential design, including psychological autopsies, to identify psychiatric and other contributing factors in 35 homicide-suicide cases in northern Gauteng Province, South Africa. This research highlighted the complex multifactorial nature of these events. Identification of high-risk individuals and delineation of contributing factors is important. Early recognition and effective treatment of psychiatric illness, particularly depression and substance use problems, in people experiencing relationship issues (with pending/recent separations) and financial stressors, is an essential component in the prevention of homicide-suicide incidents. Evaluations should always include direct questioning about suicidal and homicidal ideations. Mental health practitioners have a definite role to play in offering comfort, support, and treatment to all those who remain behind after these devastating events. Urgent attention needs to be given to the availability of support and treatment for investigating police officers and surviving family and friends.http://www.tandfonline.com/toc/ufmh202019-01-30hj2018Psychiatr