Opinions of medical students at the University of Cape Town on emigration, conscription and compulsory community service

A study was conducted to determine emigration intentions of medical students at the University of Cape Town. Students from 1st to 5th year completed a self-administered questionnaire. A response rate of 86% was achieved. Over half the students (54%) were considering emigration. The most frequently selected motivating factors were moral dissatisfaction with the present government and career opportunities abroad. Men who were eligible for military conscription rated this factor as an important deterrent to remaining in South Africa, and 81% stated objections to national service. However, 71% would be less likely to emigrate were an alternative national service (ANS) instituted. Should a compulsory community service be implemented, 41% of those eligible would be more inclined to emigrate. Recommendations include the implementation of ANS; a re-evaluation of the compulsory community service proposal; and further investigation of emigration trends and of ways to curb emigration. Suggestions offered are a reappraisal of both selection criteria and medical education; and the provision of incentives for doctors to work in rural areas

Updated European Consensus Statement on diagnosis and treatment of adult ADHD

Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness. Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated. Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated? Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD. (c) 2018 The Author(s). Published by Elsevier Masson SAS.Peer reviewe

Bright light therapy versus physical exercise to prevent co-morbid depression and obesity in adolescents and young adults with attention-deficit/hyperactivity disorder: study protocol for a randomized controlled trial

Background: The risk for major depression and obesity is increased in adolescents and adults with attention-deficit / hyperactivity disorder (ADHD) and adolescent ADHD predicts adult depression and obesity. Non-pharmacological interventions to treat and prevent these co-morbidities are urgently needed. Bright light therapy (BLT) improves day– night rhythm and is an emerging therapy for major depression. Exercise intervention (EI) reduces obesity and improves depressive symptoms. To date, no randomized controlled trial (RCT) has been performed to establish feasibility and efficacy of these interventions targeting the prevention of co-morbid depression and obesity in ADHD. We hypothesize that the two manualized interventions in combination with mobile health-based monitoring and reinforcement will result in less depressive symptoms and obesity compared to treatment as usual in adolescents and young adults with ADHD. Methods: This trial is a prospective, pilot phase-IIa, parallel-group RCT with three arms (two add-on treatment groups [BLT, EI] and one treatment as usual [TAU] control group). The primary outcome variable is change in the Inventory of Depressive Symptomatology total score (observer-blinded assessment) between baseline and ten weeks of intervention. This variable is analyzed with a mixed model for repeated measures approach investigating the treatment effect with respect to all three groups. A total of 330 participants with ADHD, aged 14 – < 30 years, will be screened at the four study centers. To establish effect sizes, the sample size was planned at the liberal significance level of α = 0.10 (two-sided) and the power of 1-β = 80% in order to find medium effects. Secondary outcomes measures including change in obesity, ADHD symptoms, general psychopathology, health-related quality of life, neurocognitive function, chronotype, and physical fitness are explored after the end of the intervention and at the 12-week follow-up. This is the first pilot RCT on the use of BLT and EI in combination with mobile health-based monitoring and reinforcement targeting the prevention of co-morbid depression and obesity in adolescents and young adults with ADHD. If at least medium effects can be established with regard to the prevention of depressive symptoms and obesity, a larger scale confirmatory phase-III trial may be warranted.The trial is funded by the EU Framework Programme for Research and Innovation, Horizon 2020 (Project no. 667302). Funding period: January 2016–December 2020. This funding source had no role in the design of this study and will not have any role during its execution, analyses, interpretation of the data, or decision to submit results. Some local funds additionally contributed to carry out this study, especially for the preparation of the interventions: FBO research activity is by the Spanish Ministry of Economy and Competitiveness – MINECO (RYC-2011-09011) and by the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Unit of Excellence on Exercise and Health (UCEES)

Updated European Consensus Statement on diagnosis and treatment of adult ADHD

Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness. Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated. Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated? Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD. (c) 2018 The Author(s). Published by Elsevier Masson SAS

The 15th Biannual National Congress of the South African Society of Psychiatrists, 10-14 August 2008, Fancourt, George, W Cape

1. How can we maintain a sustainable private practice in the current political and economic climate? Eugene Allers 2. SASOP Clinical guidelines, protocols and algorithms: Development of treatment guidelines for bipolar mood disorder and major depression  Eugene Allers, Margaret Nair, Gerhard Grobler 3. The revolving door phenomenon in psychiatry: Comparing low-frequency and high-frequency users of psychiatric inpatient services in a developing country U A Botha, P Oosthuien, L Koen, J A Joska, J Parker, N Horn 4. Neurophysiology of emotion and senses - The interface between psyche and soma Eugene Allers 5. Suicide prevention: From and beyond the psychiatrist's hands O Alonso Betanourt, M Morales Herrera 6. Treatment of first-episod psychosis: Efficacy and toleabilty of a long-acting typical antipsychotic B Chiliza, R Schoeman, R Emsey, P Oosthuizen, L KOen, D Niehaus, S Hawkridge 7. Treatment of attention deficit hyperactivity disorder in the young child Helen Clark 8. Holistic/ Alternative treatment in psychiatry: The value of indigenous knowledge systems in cllaboration with moral, ethical and religious approaches in the military services J Dill 9. Treating Schizophrenia: Have we got it wrong? Robin Emsley 10.Terminal questions in the elderly Mike Ewart Smith 11. Mental Health Policy development and implementation in Ghana, South Africa, Uganda and Zambia Alan J Flisher, Crick Lund, Michelle Frank, Arvin Bhana, Victor Doku, Natalie Drew, Fred N Kigozi, Martin Knapp, Mayeh Omar, Inge Petersen, Andrew Green andthe MHaPP Research Programme Consortium 12. What indicators should be used to monitor progress in scaling uo services for people with mental disorders? Lancet Global Mental Health Group (Alan J Flisher, Dan Chisholm, Crick Lund, Vikram Patel, Shokhar Saxena, Graham Thornicroft, Mark Tomlinson) 13. Does unipolar mania merit research in South Africa? A look at the literature Christoffel Grobler 14. Revisiting the Cartesian duality of mind and body Oye Gureje 15. Child and adolescent psychopharmacology: Current trends and complexities S M Hawkridge 16. Integrating mental illness, suicide and religion Volker Hitzeroth 17. Cost of acute inpatient mental health care in a 72-hour assessment uniy A B R Janse van Rensburg, W Jassat 18. Management of Schizophrenia according to South African standard treatment guidelines A B R Janse van Rensburg 19. Structural brain imaging in the clinical management of psychiatric illness F Y Jeenah 20. ADHD: Change in symptoms from child to adulthood S A Jeeva, A Turgay 21. HIV-Positive psychiatric patients in antiretrovirals G Jonsson, F Y Jeenah, M Y H Moosa 22. A one year review of patients admitted to tertiary HIV/Neuropsychiatry beds in the Western Cape John Joska, Paul Carey, Ian Lewis, Paul Magni, Don Wilson, Dan J Stein 23. Star'd - Critical review and treatment implications Andre Joubert 24. Options for treatment-resistent depression: Lessons from Star'd; an interactive session Andre Joubert 25. My brain made me do it: How Neuroscience may change the insanity defence Sean Kaliski 26. Child andadolescent mental health services in four African countries Sharon Kleintjies, Alan Flisher, Victoruia Campbell-Hall, Arvin Bhana, Phillippa Bird, Victor Doku, Natalie, Drew, Michelle Funk, Andrew Green, Fred Kigozi, Crick Lund, Angela Ofori-Atta, Mayeh Omar, Inge Petersen, Mental Health and Poverty Research Programme Consortium 27. Individualistic theories of risk behaviour Liezl Kramer, Volker Hitzeroth 28. Development and implementation of mental health poliy and law in South Africa: What is the impact of stigma? Ritsuko Kakuma, Sharon Kleintjes, Crick Lund, Alan J Flisher, Paula Goering, MHaPP Research Programme Consortium 29. Factors contributing to community reintegration of long-term mental health crae users of Weskoppies Hospital Carri Lewis, Christa Kruger 30. Mental health and poverty: A systematic review of the research in low- and middle-income countries Crick Lund, Allison Breen, Allan J Flisher, Ritsuko Kakuma, Leslie Swartz, John Joska, Joanne Corrigall, Vikram Patel, MHaPP Research Programe Consortium 31. The cost of scaling up mental health care in low- and middle-income countries Crick Lund, Dan Chishlom, Shekhar Saxena 32. 'Tikking'Clock: The impact of a methamphetamine epidemic at a psychiatric hospital in the Western Cape P Milligan, J S Parker 33. Durban youth healh-sk behaviour: Prevalence f Violence-related behaviour D L Mkize 34. Profile of morality of patients amitted Weskoppies Psychiatric Hospital in Sout frican over a 5-Year period (2001-2005) N M Moola, N Khamker, J L Roos, P Rheeder 35. One flew over Psychiatry nest Leverne Mountany 36. The ethical relationship betwe psychiatrists and the pharmaceutical indutry Margaret  G Nair 37. Developing the frameor of a postgraduate da programme in mental health R J Nichol, B de Klerk, M M Nel, G van Zyl, J Hay 38. An unfolding story: The experience with HIV-ve patients at a Psychiatric Hospital J S Parker, P Milligan 39. Task shifting: A practical strategy for scalingup mental health care in developing countries Vikram Patel 40. Ethics: Informed consent and competency in the elderly Willie Pienaar 41. Confronting ommonmoral dilemmas. Celebrating uncertainty, while in search  patient good Willie Pienaar 42. Moral dilemmas in the treatment and repatriation of patients with psychtorders while visiting our country Duncan Ian Rodseth 43. Geriatrics workshop (Psegal symposium): Medico-legal issuess in geriatric psyhiatry Felix Potocnik 44. Brain stimulation techniques - update on recent research P J Pretorius 45. Holistic/Alternative treatments in psychiatry T Rangaka, J Dill 46. Cognitive behaviour therapy and other brief interventions for management of substances Solomon Rataemane 47. A Transtheoretical view of change Nathan P Rogerson 48. Profile of security breaches in longerm mental health care users at Weskoppies Hospital over a 6-month period Deleyn Rema, Lindiwe Mthethwa, Christa Kruger 49. Management of psychogenic and chronic pain - A novel approach M S Salduker 50. Childhood ADHD and bipolar mood disorders: Differences and similarities L Scribante 51. The choice of antipsychotic in HIV-infected patients and psychopharmacocal responses to antipsychotic medication Dinesh Singh, Karl Goodkin 52. Pearls in clinical neuroscience: A teaching column in CNS Spectrums Dan J Stein 53. Urinary Cortisol secretion and traumatics in a cohort of SA Metro policemen A longitudinal study Ugash Subramaney 54. Canabis use in Psychiatric inpatients M Talatala, G M Nair, D L Mkize 55. Pathways to care and treatmt in first and multi-episodepsychosis: Findings fm a developing country H S Teh, P P Oosthuizen 56. Mental disorders in HIV-infected indivat various HIV Treatment sites in South Africa Rita Thom 57. Attendanc ile of long-term mental health care users at ocupational therapy group sessions at Weskoppies Hospital Ronel van der Westhuizen, Christa Kruger 58. Epidemiological patterns of extra-medical drug use in South Africa: Results from the South African stress and health study Margaretha S van Heerden, Anna Grimsrud, David Williams, Dan  Stein 59. Persocentred diagnosis: Where d ps and mental disorders fit in the International classificaton of diseases (ICD)? Werdie van Staden 60. What every psychiatrist needs to know about scans Herman van Vuuren 61. Psychiatric morbidity in health care workers withle drug-resistant erulosis (MDR-TB) A case series Urvashi Vasant, Dinesh Singh 62. Association between uetrine artery pulsatility index and antenatal maternal psychological stress Bavanisha Vythilingum, Lut Geerts, Annerine Roos, Sheila Faure, Dan J Stein 63. Approaching the dual diagnosis dilemma Lize Weich 64. Women's mental health: Onset of mood disturbance in midlife - Fact or fiction Denise White 65. Failing or faking: Isses in the fiagnosis and treatment of adult ADHD Dora Wynchan