Review Article: Medical management of opioid dependence in South Africa

Medical practitioners in South Africa are increasingly confronted with requests to treat patients with opioid use disorders. Many do not possess the required knowledge and skills to deal with these patients effectively. This overview of the medical treatment of opioid dependence was compiled by an elected working group of doctors working in the field of substance dependence. Recommendations are based on current best practice derived from scientific evidence and consensus of the working group, but should never replace individual clinical judgement.South African Medical Journal Vol. 98 (4) 2008: pp. 280-28

An approach to heroin use disorder intervention within the South African context: A content analysis study

<p>Abstract</p> <p>Background</p> <p>The field of heroin use disorder intervention has been in transition in South Africa since the outbreak of the heroin epidemic. Yet despite growing evidence of an association between heroin users' use of supplementary intervention services and intervention outcomes, heroin use disorder intervention programmes in South Africa generally fail to meet international research-based intervention standards.</p> <p>Methods</p> <p>Semi-structured interviews with ten heroin use disorder specialists were conducted and the interviews were subjected to content analysis.</p> <p>Results and Discussion</p> <p>In terms of theory and practice, findings of the study suggest that the field of heroin use disorder intervention in South Africa remains fragmented and transitional. Specifically, limited strategic public health care polices that address the syndromes' complexities have been implemented within the South Africa context.</p> <p>Conclusions</p> <p>Although many interventions and procedures have begun to be integrated routinely into heroin use disorder clinical practice within the South African context, comorbidity factors, such as psychiatric illness and HIV/AIDS, need to be more cogently addressed. Pragmatic and evidence-based public health care policies designed to reduce the harmful consequences associated with heroin use still needs to be implemented in the South African context.</p

The South African society of psychiatrists (SASOP) and SASOP State Employed Special Interest Group (SESIG) position statements on psychiatric care in the public sector

Executive summary. National mental health policy: SASOP extends its support for the process of formalising a national mental health policy as well as for the principles and content of the current draft policy. Psychiatry and mental health: psychiatrists should play a central role, along with the other mental health disciplines, in the strategic and operational planning of mental health services at local, provincial and national level. Infrastructure and human resources: it is essential that the state takes up its responsibility to provide adequate structures, systems and funds for the specified services and facilities on national, provincial and facility level, as a matter of urgency. Standard treatment guidelines (STGs) and essential drug lists (EDLs): close collaboration and co-ordination should occur between the processes of establishing SASOP and national treatment guidelines, as well as the related decisions on EDLs for different levels. HIV/AIDS in children: national HIV programmes have to promote awareness of the neurocognitive problems and psychiatric morbidity associated with HIV in children. HIV/AIDS in adults: the need for routine screening of all HIV-positive individuals for mental health and cognitive impairments should also be emphasised as many adult patients have a mental illness, either before or as a consequence of HIV infection, constituting a ‘special needs’ group. Substance abuse and addiction: the adequate diagnosis and management of related substance abuse and addiction problems should fall within the domain of the health sector and, in particular, that of mental health and psychiatry. Community psychiatry and referral levels: the rendering of ambulatory specialist psychiatric services on a community-centred basis should be regarded as a key strategy to make these services more accessible to users closer to where they live. Recovery and re-integration: a recovery framework such that personal recovery outcomes, among others, become the universal goals by which we measure service provision, should be adopted as soon as possible. Culture, mental health and psychiatry: culture, religion and spirituality should be considered in the current approach to the local practice and training of specialist psychiatry, within the professional and ethical scope of the discipline. Forensic psychiatry: an important and significant field within the scope of state-employed psychiatrists, with 3 recognised groups of patients (persons referred for forensic psychiatric observation, state patients, and mentally ill prisoners), each with specific needs, problems and possible solutions. Security in psychiatric hospitals and units: it is necessary to protect public sector mental healthcare practitioners from assault and injury as a result of performing their clinical duties by, among others, ensuring that adequate security procedures are implemented, appropriate for the level of care required, and that appointed security staff members are appropriately trained and equipped.Dr Reddy’s Laboratorieshttp://www.sajp.org.za/index.php/sajpam2013ay201

Attention-deficit/hyperactivity disorder - co-morbidity and differential diagnosis

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Medical management of opioid dependence in South Africa

The original publication is available at http://www.samj.org.zaMedical practitioners in South Africa are increasingly confronted with requests to treat patients with opioid use disorders. Many do not possess the required knowledge and skills to deal with these patients effectively. This overview of the medical treatment of opioid dependence was compiled by an elected working group of doctors working in the field of substance dependence. Recommendations are based on current best practice derived from scientific evidence and consensus of the working group, but should never replace individual clinical judgement.Publishers' versio

Alternative psychosis (forced normalisation) in epilepsy

Abstract Forced normalization is a paradoxical relationship between seizure activity and behavioural problems. A 20 year old male with recurrent refractory tonic clonic epilepsy experienced forced normalization, whilst on medication with multiple anti- epileptic drugs (AEDs).(Valproate Sodium, Carbamazepine, and Topiramate). A reduction in the seizure burden correlated with sudden behavioural changes manifesting with aggressive outbursts and violence.. The present case may help clarify the mechanism of forced normalization whilst providing some helpful hints regarding the diagnosis and treatment of symptoms observed in recurrent refractory seizures

Ethnicity and treatment response in schizophrenia: A comparison of 3 ethnic groups

Background: Numerous cultural and ethnic factors may directly and indirectly influence treatment outcome in schizophrenia. The present study compared the response to antipsychotic treatment in 3 ethnic groups of patients with schizophrenia. Method: Fifty black, 63 mixed descent, and 79 white patients with DSM-IV-diagnosed schizophrenia or schizophreniform disorder who were participants in multinational clinical drug trials were assessed by means of the Positive and Negative Syndrome Scale (PANSS). Treatment response was measured by the change in PANSS total scores and the change in positive, negative, and general psychopathology subscale scores from baseline to 6 weeks. Also, the percentage of responders (defined as ≥ 40% reduction in PANSS total scores) was calculated for each group. Results: Baseline PANSS scores differed significantly, being higher for black and mixed descent patients. Mixed descent patients showed the greatest mean ± SD percentage reduction in PANSS total score (29.4 ± 21.6) followed by black (28.4 ± 14.7) and white (11.4 ± 27.6) patients. Analysis of covariance revealed a significant effect of ethnicity on the reduction in PANSS total scores (p < .0001). The numbers of responders were 20 mixed descent (32%), 12 black (24%), and 7 white (9%) patients (p = .002). Conclusion: Significant ethnic differences in acute antipsychotic treatment response are demonstrated by this study. Factors such as diet, nutritional status, body mass, and substance use could be important, as well as genetically determined ethnospecific pharmacokinetic and pharmacodynamic differences. Delayed help-seeking may account for the higher baseline scores in the black and mixed descent patients.Articl

The South African Society of Psychiatrists (SASOP) and SASOP State Employed Special Interest Group (SESIG) position statements on psychiatric care in the public sector

Geneeskunde en GesondheidswetenskappePsigiatriePlease help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected]