18 research outputs found
The South African Society of Psychiatrists (SASOP) treatment guidelines for psychiatric disorders
The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric Disorders have been developed in order to address the local need for guidelines in our unique clinical setting. The need for treatment guidelines has frequently been expressed by South African psychiatrists and other medical practitioners, as well as by other role players such as medical scheme and other funding body advisors and the pharmaceutical industry. While several well-developed international treatment guidelines are readily accessible and are indeed extensively utilised in South Africa, they are not always applicable to our own circumstances. There are often important differences, not only regarding the availability of various psychotropic medications, but also in healthcare settings and availability of resources that need to be considered when selecting particular medications. For example, prescribing compounds that require regular monitoring such as lithium and clozapine may not always be feasible in certain rural settings in South Africa.http://www.sajp.org.za/index.php/sajpam201
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
ENIGMA and global neuroscience: A decade of large-scale studies of the brain in health and disease across more than 40 countries
This review summarizes the last decade of work by the ENIGMA (Enhancing NeuroImaging Genetics through Meta Analysis) Consortium, a global alliance of over 1400 scientists across 43 countries, studying the human brain in health and disease. Building on large-scale genetic studies that discovered the first robustly replicated genetic loci associated with brain metrics, ENIGMA has diversified into over 50 working groups (WGs), pooling worldwide data and expertise to answer fundamental questions in neuroscience, psychiatry, neurology, and genetics. Most ENIGMA WGs focus on specific psychiatric and neurological conditions, other WGs study normal variation due to sex and gender differences, or development and aging; still other WGs develop methodological pipelines and tools to facilitate harmonized analyses of "big data" (i.e., genetic and epigenetic data, multimodal MRI, and electroencephalography data). These international efforts have yielded the largest neuroimaging studies to date in schizophrenia, bipolar disorder, major depressive disorder, post-traumatic stress disorder, substance use disorders, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, autism spectrum disorders, epilepsy, and 22q11.2 deletion syndrome. More recent ENIGMA WGs have formed to study anxiety disorders, suicidal thoughts and behavior, sleep and insomnia, eating disorders, irritability, brain injury, antisocial personality and conduct disorder, and dissociative identity disorder. Here, we summarize the first decade of ENIGMA's activities and ongoing projects, and describe the successes and challenges encountered along the way. We highlight the advantages of collaborative large-scale coordinated data analyses for testing reproducibility and robustness of findings, offering the opportunity to identify brain systems involved in clinical syndromes across diverse samples and associated genetic, environmental, demographic, cognitive, and psychosocial factors
Novel genetic loci associated with hippocampal volume
The hippocampal formation is a brain structure integrally involved in episodic memory, spatial navigation, cognition and stress responsiveness. Structural abnormalities in hippocampal volume and shape are found in several common neuropsychiatric disorders. To identify the genetic underpinnings of hippocampal structure here we perform a genome-wide association study (GWAS) of 33,536 individuals and discover six independent loci significantly associated with hippocampal volume, four of them novel. Of the novel loci, three lie within genes (ASTN2, DPP4 and MAST4) and one is found 200 kb upstream of SHH. A hippocampal subfield analysis shows that a locus within the MSRB3 gene shows evidence of a localized effect along the dentate gyrus, subiculum, CA1 and fissure. Further, we show that genetic variants associated with decreased hippocampal volume are also associated with increased risk for Alzheimer's disease (rg =-0.155). Our findings suggest novel biological pathways through which human genetic variation influences hippocampal volume and risk for neuropsychiatric illness
Integrated analysis of environmental and genetic influences on cord blood DNA methylation in new-borns
Epigenetic processes, including DNA methylation (DNAm), are among the mechanisms allowing integration of genetic and environmental factors to shape cellular function. While many studies have investigated either environmental or genetic contributions to DNAm, few have assessed their integrated effects. Here we examine the relative contributions of prenatal environmental factors and genotype on DNA methylation in neonatal blood at variably methylated regions (VMRs) in 4 independent cohorts (overall n = 2365). We use Akaike’s information criterion to test which factors best explain variability of methylation in the cohort-specific VMRs: several prenatal environmental factors (E), genotypes in cis (G), or their additive (G + E) or interaction (GxE) effects. Genetic and environmental factors in combination best explain DNAm at the majority of VMRs. The CpGs best explained by either G, G + E or GxE are functionally distinct. The enrichment of genetic variants from GxE models in GWAS for complex disorders supports their importance for disease risk
Partitioning the Heritability of Tourette Syndrome and Obsessive Compulsive Disorder Reveals Differences in Genetic Architecture
The direct estimation of heritability from genome-wide common variant data as implemented in the program Genome-wide Complex Trait Analysis (GCTA) has provided a means to quantify heritability attributable to all interrogated variants. We have quantified the variance in liability to disease explained