Pharmacological challenge with a serotonin 1D agonist in alcohol dependence

BACKGROUND: Both animal and clinical studies have implicated serotonergic dysfunction in the pathogenesis of alcohol abuse and dependence. However the exact mechanisms involved remain unknown. Theoretically, low serotonin promotes alcohol seeking behavior. Sumatriptan is a serotonin1D agonist. It is postulated that sumatriptan's agonism at this terminal autoreceptor increases negative feedback, creating a net effect of decreased serotonergic neurotransmission. Administration of sumatriptan should therefore produce a craving for alcohol and the desire to drink. METHODS: Fifteen patients with alcohol dependence who had undergone detoxification were recruited. Sumatriptan (100 mg) and placebo was administered in cross-over fashion on 2 separate days 72 hours apart. Both patients and raters were blind to all treatments. Patients were assessed on the following scales at -30, 0, 30, 90, 150 and 210 minutes: A 6-item scale designed to rate the patient's intention to drink; The Sensation Scale; a 13-item affect analog scale designed to rate the pattern and extent of emotional changes; and an 8-item scale designed to rate the patient's craving for alcohol RESULTS: No significant differences were found between the placebo and sumatriptan groups and no significant cross over effects were found. CONCLUSION: The general lack of efficacy of sumatriptan in producing alcohol-like symptoms or a desire to drink alcohol may suggest that the 5HT1D receptor plays little role in the pathophysiology of alcoholism

The treatment of alcohol dependence : new horizons

The original publication is available at http://www.samj.org.zaCITATION: Pienaar, W. 2004. The treatment of alcohol dependence: new horizons. South African Medical Journal, 94(4):264-266.No abstract available.Publisher’s versio

Developing the language of futility in psychiatry with care

CITATION: Pienaar, W. 2016. Developing the language of futility in psychiatry with care. South African Journal of Psychiatry, 22(1):1-7, doi:10.4102/sajpsychiatry.v22i1.978.The original publication is available at http://www.sajp.org.zaIn psychiatric practice, treatment success is, in many instances, not an achievable goal. Psychiatrists may often not acknowledge treatment failure in their patients and seldom consider that patients may be in situations that share similarities with end-of-life dilemmas in general somatic medicine. In such instances, futile treatment may be continued and patient suffering may be prolonged. Doctors should play a leading role in patient education, diagnosis, promoting best treatment options, motivation and support, but patients should be given the opportunity to take ownership of their illness and their future. In the discipline of psychiatry, physician-assisted suicide may be an option but warrants careful consideration. Contemporary psychiatrists may act paternalistically, refusing to accept the limitations of their scientific skills and/or struggle with the moral good of ‘letting go’ when required. It is arguably the seeming complexity of gauging patients’ understanding (competency, capacity) to make informed decisions that perpetuates futile treatment. Most patients, even in the presence of ongoing serious psychiatric illness, are able to give consent. Psychiatrists should be aware of the difference between being alive and living. Ongoing suffering cannot be condoned. The personhood of every patient and his/her bio-psycho-social and spiritual needs should, as far as possible, be respected. Psychiatrists should embrace the realisation of treatment futility and, in some cases, end-of-life decisions and take on the challenge as well as the responsibility of serving patients with mental illness in the best way possible.https://www.sajp.org.za/index.php/sajp/article/view/978Publisher's versio

16th National Congress of the South African Society of Psychiatrists (SASOP)

List of abstracts and authors: 1. Antipsychotics in anxiety disorders Christer Allgulander 2. Anxiety in somatic disorders Christer Allgulander 3. Community rehabilitation of the schizophrenic patient Orlando Alonso Betancourt, Maricela Morales Herrera 4. Dual diagnosis: A theory-driven multidisciplinary approach for integrative care David Blackbeard 5. The emotional language of the gut - when 'psyche' meets 'soma' Helen Clark 6. The Psychotherapy of bipolar disorder Franco Colin 7. The Psychotherapy of bipolar disorder Franco Colin 8. Developing and adopting mental health policies and plans in Africa: Lessons from South Africa, Uganda and Zambia Sara Cooper, Sharon Kleintjes, Cynthia Isaacs, Fred Kigozi, Sheila Ndyanabangi, Augustus Kapungwe, John Mayeya, Michelle Funk, Natalie Drew, Crick Lund 9. The importance of relapse prevention in schizophrenia Robin Emsley 10. Mental Health care act: Fact or fiction? Helmut Erlacher, M Nagdee 11. Does a dedicated 72-hour observation facility in a district hospital reduce the need for involuntary admissions to a psychiatric hospital? Lennart Eriksson 12. The incidence and risk factors for dementia in the Ibadan study of ageing Oye Gureje, Lola Kola, Adesola Ogunniyi, Taiwo Abiona 13. Is depression a disease of inflammation? Angelos Halaris 14. Paediatric bipolar disorder: More heat than light? Sue Hawkridge 15. EBM: Anova Conundrum Elizabeth L (Hoepie) Howell 16. Tracking the legal status of a cohort of inpatients on discharge from a 72-hour assessment unit Bernard Janse van Rensburg 17. Dual diagnosis units in psychiatric facilities: Opportunities and challenges Yasmien Jeenah 18. Alcohol-induced psychotic disorder: A comparative study on the clinical characteristics of patients with alcohol dependence and schizophrenia Gerhard Jordaan, D G Nel, R Hewlett, R Emsley 19. Anxiety disorders: the first evidence for a role in preventive psychiatry Andre F Joubert 20. The end of risk assessment and the beginning of start Sean Kaliski 21. Psychiatric disorders abd psychosocial correlates of high HIV risk sexual behaviour in war-effected Eatern Uganda E Kinyada, H A Weiss, M Mungherera, P Onyango Mangen, E Ngabirano, R Kajungu, J Kagugube, W Muhwezi, J Muron, V Patel 22. One year of Forensic Psychiatric assessment in the Northern Cape: A comparison with an established assessment service in the Eastern Cape N K Kirimi, C Visser 23. Mental Health service user priorities for service delivery in South Africa Sharon Kleintjes, Crick Lund, Leslie Swartz, Alan Flisher and MHaPP Research Programme Consortium 24. The nature and extent of over-the-counter and prescription drug abuse in cape town Liezl Kramer 25. Physical health issues in long-term psychiatric inpatients: An audit of nursing statistics and clinical files at Weskoppies Hospital Christa Kruger 26. Suicide risk in Schizophrenia - 20 Years later, a cohort study Gian Lippi, Ean Smit, Joyce Jordaan, Louw Roos 27.Developing mental health information systems in South Africa: Lessons from pilot projects in Northern Cape and KwaZulu-Natal Crick Lund, S Skeen, N Mapena, C Isaacs, T Mirozev and the Mental Health and Poverty Research Programme Consortium Institution 28. Mental health aspects of South African emigration Maria Marchetti-Mercer 29. What services SADAG can offer your patients Elizabeth Matare 30. Culture and language in psychiatry Dan Mkize 31. Latest psychotic episode Povl Munk-Jorgensen 32. The Forensic profile of female offenders Mo Nagdee, Helmut Fletcher 33. The intra-personal emotional impact of practising psychiatry Margaret Nair 34. Highly sensitive persons (HSPs) and implications for treatment Margaret Nair 35. Task shifting in mental health - The Kenyan experience David M Ndetei 36. Bridging the gap between traditional healers and mental health in todya's modern psychiatry David M Ndetei 37. Integrating to achieve modern psychiatry David M Ndetei 38. Non-medical prescribing: Outcomes from a pharmacist-led post-traumatic stress disorder clinic A Parkinson 39. Is there a causal relationship between alcohol and HIV? Implications for policy, practice and future research Charles Parry 40. Global mental health - A new global health discipline comes of age Vikram Patel 41. Integrating mental health into primary health care: Lessons from pilot District demonstration sites in Uganda and South Africa Inge Petersen, Arvin Bhana, K Baillie and MhaPP Research Programme Consortium 42. Personality disorders -The orphan child in axis I - Axis II Dichotomy Willie Pienaar 43. Case Studies in Psychiatric Ethics Willie Pienaar 44. Coronary artery disease and depression: Insights into pathogenesis and clinical implications Janus Pretorius 45. Impact of the Mental Health Care Act No. 17 of 2002 on designated hospitals in KwaZulu-Natal: Triumphs and trials Suvira Ramlall, Jennifer Chipps 46. Biological basis of addication Solomon Rataemane 47. Genetics of Schizophrenia Louw Roos 48. Management of delirium - Recent advances Shaquir Salduker 49. Social neuroscience: Brain research on social issues Manfred Spitzer 50. Experiments on the unconscious Manfred Spitzer 51. The Psychology and neuroscience of music Manfred Spitzer 52. Mental disorders in DSM-V Dan Stein 53. Personality, trauma exposure, PTSD and depression in a cohort of SA Metro policemen: A longitudinal study Ugashvaree Subramaney 54. Eating disorders: An African perspective Christopher Szabo 55. An evaluation of the WHO African Regional strategy for mental health 2001-2010 Thandi van Heyningen, M Majavu, C Lund 56. A unitary model for the motor origin of bipolar mood disorders and schizophrenia Jacques J M van Hoof 57. The origin of mentalisation and the treatment of personality disorders Jacques J M Hoof 58. How to account practically for 'The Cause' in psychiatric diagnostic classification C W (Werdie) van Staden POSTER PRESENTATIONS 59. Problem drinking and physical and sexual abuse at WSU Faculty of Health Sciences, Mthatha, 2009 Orlando Alonso Betancourt, Maricela Morales Herrera, E, N Kwizera, J L Bernal Munoz 60. Prevalence of alcohol drinking problems and other substances at WSU Faculty of Health Sciences, Mthatha, 2009 Orlando Alonso Betancourt, Maricela Morales Herrera, E, N Kwizera, J L Bernal Munoz 61. Lessons learnt from a modified assertive community-based treatment programme in a developing country Ulla Botha, Liezl Koen, John Joska, Linda Hering, Piet Ooosthuizen 62. Perceptions of psychologists regarding the use of religion and spirituality in therapy Ottilia Brown, Diane Elkonin 63. Resilience in families where a member is living with schizophreni Ottilia Brown, Jason Haddad, Greg Howcroft 64. Fusion and grandiosity - The mastersonian approach to the narcissistic disorder of the self William Griffiths, D Macklin, Loray Daws 65. Not being allowed to exist - The mastersonian approach to the Schizoid disorder of the self William Griffiths, D Macklin, Loray Daws 66. Risky drug-injecting behaviours in Cape Town and the need for a needle exchange programme Volker Hitzeroth 67. Neuroleptic malignant syndrome in adolescents in the Western Cape: A case series Terri Henderson 68. Experience and view of local academic psychiatrists on the role of spirituality in South African specialist psychiatry, compared with a qualitative analysis of the medical literature Bernard Janse van Rensburg 69. The role of defined spirituality in local specialist psychiatric practice and training: A model and operational guidelines for South African clinical care scenarios Bernard Janse van Rensburg 70. Handedness in schizophrenia and schizoaffective disorder in an Afrikaner founder population Marinda Joubert, J L Roos, J Jordaan 71. A role for structural equation modelling in subtyping schizophrenia in an African population Liezl Koen, Dana Niehaus, Esme Jordaan, Robin Emsley 72. Caregivers of disabled elderly persons in Nigeria Lola Kola, Oye Gureje, Adesola Ogunniyi, Dapo Olley 73. HIV Seropositivity in recently admitted and long-term psychiatric inpatients: Prevalence and diagnostic profile Christina Kruger, M P Henning, L Fletcher 74. Syphilis seropisitivity in recently admitted longterm psychiatry inpatients: Prevalence and diagnostic profile Christina Kruger, M P Henning, L Fletcher 75. 'The Great Suppression' Sarah Lamont, Joel Shapiro, Thandi Groves, Lindsey Bowes 76. Not being allowed to grow up - The Mastersonian approach to the borderline personality Daleen Macklin, W Griffiths 77. Exploring the internal confirguration of the cycloid personality: A Rorschach comprehensive system study Daleen Macklin, Loray Daws, M Aronstam 78. A survey to determine the level of HIV related knowledge among adult psychiatric patients admitted to Weskoppies Hospital T G Magagula, M M Mamabolo, C Kruger, L Fletcher 79. A survey of risk behaviour for contracting HIV among adult psychiatric patients admitted to Weskoppies Hospital M M Mamabolo, T G Magagula, C Kruger, L Fletcher 80. A retrospective review of state sector outpatients (Tara Hospital) prescribed Olanzapine: Adherence to metabolic and cardiovascular screening and monitoring guidelines Carina Marsay, C P Szabo 81. Reported rapes at a hospital rape centre: Demographic and clinical profiles Lindi Martin, Kees Lammers, Donavan Andrews, Soraya Seedat 82. Exit examination in Final-Year medical students: Measurement validity of oral examinations in psychiatry Mpogisheng Mashile, D J H Niehaus, L Koen, E Jordaan 83. Trends of suicide in the Transkei region of South Africa Banwari Meel 84. Functional neuro-imaging in survivors of torture Thriya Ramasar, U Subramaney, M D T H W Vangu, N S Perumal 85. Newly diagnosed HIV+ in South Africa: Do men and women enroll in care? Dinesh Singh, S Hoffman, E A Kelvin, K Blanchard, N Lince, J E Mantell, G Ramjee, T M Exner 86. Diagnostic utitlity of the International HIC Dementia scale for Asymptomatic HIV-Associated neurocognitive impairment and HIV-Associated neurocognitive disorder in South Africa Dinesh Singh, K Goodkin, D J Hardy, E Lopez, G Morales 87. The Psychological sequelae of first trimester termination of pregnancy (TOP): The impact of resilience Ugashvaree Subramaney 88. Drugs and other therapies under investigation for PTSD: An international database Sharain Suliman, Soraya Seedat 89. Frequency and correlates of HIV Testing in patients with severe mental illness Hendrik Temmingh, Leanne Parasram, John Joska, Tania Timmermans, Pete Milligan, Helen van der Plas, Henk Temmingh 90. A proposed mental health service and personnel organogram for the Elizabeth Donkin psychiatric Hospital Stephan van Wyk, Zukiswa Zingela 91. A brief report on the current state of mental health care services in the Eastern Cape Stephan van Wyk, Zukiswa Zingela, Kiran Sukeri, Heloise Uys, Mo Nagdee, Maricela Morales, Helmut Erlacher, Orlando Alonso 92. An integrated mental health care service model for the Nelson Mandela Bay Metro Stephan van Wyk, Zukiswa Zingela, Kiran Sukeri 93. Traditional and alternative healers: Prevalence of use in psychiatric patients Zukiswa Zingela, S van Wyk, W Esterhuysen, E Carr, L Gaauch

13th National Congress of the South African Society of Psychiatrists, 20-23 September 2004

List of abstacts and authors: 1. Integrating the art and science of psychiatry Eugene Allers 2. Chronic pain as a predictor of outcome in an inpatient Psychiatric population Eugene Allers and Gerhard Grundling 3. Recent advances in social phobia Christer Allgulander 4. Clinical management of patients with anxiety disorders Christer Allgulander 5. Do elephants suffer from Schizophrenia? (Or do the Schizophrenias represent a disorder of self consciousness?) A Southern African perspective Sean Exner Baumann 6. Long term maintenance treatment of Bipolar Disorder: Preventing relapse Charles L. Bowden 7. Predictors of response to treatments for Bipolar Disorder Charles L. Bowden 8. Aids/HIV knowledge and high risk behaviour: A Geo-graphical comparison in a schizophrenia population P Buckley, S van Vuuren, L Koen, J E Muller, C Seller, H Lategan, D J H Niehaus 9. Does Marijuana make you go mad? David J Castle 10. Understanding and management of Treatment Resistant Schizophrenia David J Castle 11. Workshop on research and publishing David J Castle 12. From victim to victor: Without a self-help book Beatrix Jacqueline Coetzee 13. The evaluation of the Gender Dysphoric patient Franco Colin 14. Dissociation: A South African model A M Dikobe, C K Mataboge, L M Motlana, B F Sokudela, C Kruger 15. Designated smoking rooms...and other "Secret sins" of psychiatry: Tobacco cessation approaches in the severely mentally ill Charl Els 16. Dual diagnosis: Implications for treatment and prognosis Charl Els 17. Body weight, glucose metabolism and the new generation antipsychotics Robin Emsley 18. Neurological abnormalities in first episode Schizophrenia: Temporal stability and clinical and outcome correlates Robin Emsley, H Jadri Turner, Piet P Oosthuizen, Jonathan Carr 19. Mythology of depressive illnesses among Africans Senathi Fisha 20. Substance use and High school dropout Alan J. Flisher, Lorraine Townsend, Perpetual Chikobvu, Carl Lombard, Gary King 21. Psychosis and Psychotic disorders A E Gangat 22. Vulnerability of individuals in a family system to develop a psychiatric disorder Gerhard Grundling and Eugene Allers 23. What does it Uberhaupt mean to "Integrate"? Jürgen Harms 24. Research issues in South African child and adolescent psychiatry S M Hawkridge 25. New religious movements and psychiatry: The Good News V H Hitzeroth 26. The pregnant heroin addict: Integrating theory and practice in the development and provision of a service for this client group V H Hitzeroth, L Kramer 27. Autism spectrum disorder Erick Hollander 28. Recent advances and management in treatment resistance Eric Hollander 29. Bipolar mixed states M. Leigh Janet 30. Profile of acute psychiatric inpatients tested for HIV - Helen Jospeh Hospital, Johannesburg A B R Janse van Rensburg 31. ADHD - Using the art of film-making as an education medium Shabeer Ahmed Jeeva 32. Treatment of adult ADHD co-morbidities Shabeer Ahmed Jeeva 33. Needs and services at ward one, Valkenberg Hospital Dr J. A. Joska, Prof. A.J. Flisher 34. Unanswered questions in the adequate treatment of depression Moderator: Dr Andre F Joubert Expert: Prof. Tony Hale 35. Unanswered questions in treatment resistant depression Moderator: Dr Andre F Joubert Expert: Prof. Sidney Kennedy 36. Are mentally ill people dangerous? Sen Z Kaliski 37. The child custody circus Sean Z. Kaliski 38. The appropriatenes of certification of patients to psychiatric hospitals V. N. Khanyile 39. HIV/Aids Psychosocial responses and ethical dilemmas Fred Kigozi 40. Sex and Psychiatry B Levinson 41. Violence and abuse in psychiatric in-patient institutions: A South African perspective Marilyn Lucas, John Weinkoove, Dean Stevenson 42. Public health sector expenditure for mental health - A baseline study for South Africa E N Madela-Mntla 43. HIV in South Africa: Depression and CD4 count M Y H Moosa, F Y Jeenah 44. Clinical strategies in dealing with treatment resistant schizophrenia Piet Oosthuizen, Dana Niehaus, Liezl Koen 45. Buprenorphine/Naloxone maintenance in office practice: 18 months and 170 patients after the American release Ted Parran Jr, Chris Adelman 46. Integration of Pharmacotherapy for Opioid dependence into general psychiatric practice: Naltrexone, Methadone and Buprenorphine/ Naloxone Ted Parran 47. Our African understanding of individulalism and communitarianism Willie Pienaar 48. Healthy ageing and the prevention of Dementia Felix Potocnik, Susan van Rensburg, Christianne Bouwens 49. Indigenous plants and methods used by traditional African healers for treatinf psychiatric patients in the Soutpansberg Area (Research was done in 1998) Ramovha Muvhango Rachel 50. Symptom pattern & associated psychiatric disorders in subjects with possible & confirmed 22Q11 deletional syndrome J.L. Roos, H.W. Pretorius, M. Karayiorgou 51. Duration of antidepressant treatment: How long is long enough? How long is too long Steven P Roose 52. A comparison study of early non-psychotic deviant behaviour in the first ten years of life, in Afrikaner patients with Schizophrenia, Schizo-affective disorder and Bipolar disorder Martin Scholtz, Melissa Janse van Rensburg, J. Louw Roos 53. Treatment, treatment issues, and prevention of PTSD in women: An update Soraya Seedat 54. Fron neural networks to clinical practice M Spitzer 55. Opening keynote presentation: The art and science of Psychiatry M Spitzer 56. The future of Pharmacotherapy for anxiety disorders Dan J. Stein 57. Neuropsychological deficits pre and post Electro Convulsive Therapy (ECT) thrice a week: A report of four cases Ugash Subramaney, Yusuf Moosa 58. Prevalence of and risk factors for Tradive Dyskinesia in a Xhosa population in the Eastern Cape Dave Singler, Betty D. Patterson, Sandi Willows 59. Eating disorders: Addictive disorders? Christopher Paul Szabo 60. Ethical challenges and dilemmas of research in third world countries Godfrey B. Tangwa 61. The interface between Neurology and Psychiatry with specific focus on Somatoform dissociative disorders Michael Trimble 62. Prevalence and correlates of depression and anxiety in doctors and teachers H Van der Bijl, P Oosthuizen 63. Ingrid Jonker: A psychological analysis L. M. van der Merwe 64. The strange world we live in, and the nature of the human subject Vasi van Deventer 65. Art in psychiatry: Appendix or brain stem? C W van Staden 66. Medical students on what "Soft skills" are about before and after curriculum reform C W van Staden, P M Joubert, A-M Bergh, G E Pickworth, W J Schurink, R R du Preez, J L Roos, C Kruger, S V Grey, B G Lindeque 67. Attention deficit hyperactivity disorder (ADHD) - Medical management. Methylphenidate (Ritalin) or Atomoxetine (Strattera) Andre Venter 68. A comprehensive guide to the treatment of adults with ADHD W J C Verbeeck 69. Treatment of Insomnia: Stasis of the Art? G C Verster 70. Are prisoners vulnerable research participants? Merryll Vorster 71. Psychiatric disorders in the gym Merryl Vorster 72. Ciprales: Effects on anxiety symptoms in Major Depressive Disorder Bruce Lydiar