Assessing the efficacy of a modified assertive community-based treatment programme in a developing country

<p>Abstract</p> <p>Background</p> <p>A number of recently published randomized controlled trials conducted in developed countries have reported no advantage for assertive interventions over standard care models. One possible explanation could be that so-called "standard care" has become more comprehensive in recent years, incorporating some of the salient aspects of assertive models in its modus operandi. Our study represents the first randomised controlled trial assessing the effect of a modified assertive treatment service on readmission rates and other measures of outcome in a developing country.</p> <p>Methods</p> <p>High frequency service users were randomized into an intervention (n = 34) and a control (n = 26) group. The control group received standard community care and the active group an assertive intervention based on a modified version of the international model of assertive community treatment. Study visits were conducted at baseline and 12 months with demographic and illness information collected at visit 1 and readmission rates documented at study end. Symptomatology and functioning were measured at both visits using the PANSS, CDSS, ESRS, WHO-QOL and SOFAS.</p> <p>Results</p> <p>At 12 month follow-up subjects receiving the assertive intervention had significantly lower total PANSS (p = 0.02) as well as positive (p < 0.01) and general psychopathology (p = 0.01) subscales' scores. The mean SOFAS score was also significantly higher (p = 0.02) and the mean number of psychiatric admissions significantly lower (p < 0.01) in the intervention group.</p> <p>Conclusions</p> <p>Our results indicate that assertive interventions in a developing setting where standard community mental services are often under resourced can produce significant outcomes. Furthermore, these interventions need not be as expensive and comprehensive as international, first-world models in order to reduce inpatient days, improve psychopathology and overall levels of functioning in patients with severe mental illness.</p

Crisis discharges and readmission risk in acute psychiatric male inpatients

<p>Abstract</p> <p>Background</p> <p>Severe pressures on beds in psychiatric services have led to the implementation of an early ("crisis") discharge policy in the Western Cape, South Africa. The study examined the effect of this policy and length of hospital stay (LOS) on readmission rates in one psychiatric hospital in South Africa.</p> <p>Methods</p> <p>Discharge summaries of adult male patients (<it>n </it>= 438) admitted to Stikland Psychiatric Hospital during 2004 were retrospectively examined. Each patient's clinical course was then analysed for the period between January 1^st, 2004, and August 31^st, 2006.</p> <p>Results</p> <p>Although shorter LOS was associated with decreased readmission rates, the effect of crisis discharges was far more powerful. Patients discharged as usual had a far lower risk of readmission than those discharged due to bed pressures (i.e. crisis discharge).</p> <p>Conclusion</p> <p>Increased risks associated with the early discharge policy necessitate the urgent review of the current management of bed shortages in this inpatient facility. The strengthening of community initiatives, particularly assertive outreach could be a way forward.</p

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