First-episode psychosis and substance use in an acute mental health unit

Background: Substance use is frequent among first-episode psychosis (FEP) patients, and it has prognostic implications. There is a dearth of locally published literature in the Eastern Cape, South Africa, on the prevalence of substance use amongst FEP patients, especially among inpatient populations. This study has been undertaken to fill this gap with the aim being to yield further knowledge which could be applicable to the Eastern Cape psychiatric inpatient population. The research site is a 35-bed designated mental health unit (MHU) in a regional hospital in Port Elizabeth, South Africa. Method: This was a cross-sectional, retrospective and descriptive study. Case notes of patients admitted to the MHU with first-episode, non-affective psychosis over a 12-month period – from November 2016 to October 2017 – were analysed using a pre-designed data capturing sheet to gather demographic, clinical and other relevant information. A total of 331 patients were identified to have presented with first time psychosis and 206 of them were excluded based on the inclusion and exclusion criteria. Results: Of the 331 cases, 125 met the inclusion criteria. The majority of those presenting with FEP were predominantly males (92 of 125, 73.6%). The median age of the 125 participants was 25 years with a mean age of 28 years (SD 11), and 74% aged between 18 and 35 years. The majority of the 125 subjects were unemployed (62%) and single (84%), with only high school education or less (81%), and were brought to hospital by family members (57%). Of the 125 participants presenting with FEP, 83% had a current or lifetime history of substance use. Cannabis was the most commonly used substance (64%), followed by alcohol (60%), stimulants (42%), mandrax (12.5%) and opioids (7.5%). Cannabis use was associated with a younger age (mean 25 years, SD 7) compared to alcohol (mean 29 years, SD 11) use. The cannabis and stimulant use were disproportionally higher in males with FEP (76% and 47%, respectively vs. 26% and 23% in females) compared to alcohol use (62% in males vs. 55% in females). Conclusion: In keeping with national and international literature, the study results showed a strong association between FEP and a history of current or lifetime substance use. The strongest association is with the use of cannabis and alcohol followed by stimulants. The study findings highlight the need for mental health services in the Eastern Cape to focus on dual diagnosis in order to address the challenge of substance abuse and its association with FEP. Preventative strategies focusing on substance use disorder could also assist in addressing the growing burden of mental disorders

An Evaluation of the Psychometric Properties of the Montreal Cognitive Assessment Tool when Administered in a Memory Clinic At Groote Schuur Hospital, Cape Town, South Africa

Worldwide, the population is aging, and the prevalence of neurocognitive disorders is expected to rise exponentially. Therefore, early detection of dementia is favorable for the patient and may even be of greater significance if disease-modifying treatments are discovered. The Montreal Cognitive Assessment (MoCA) is a reliable and valid cognitive screening tool but is sensitive to several sociodemographic factors, including language, culture, and quality of education. This underscores the need for cognitive screening scales validated in the culturally diverse South African setting. Aim. The purpose of this study was to investigate the utility of the MoCA as a brief cognitive screening tool in a specialized clinical South African sample. Methods. A retrospective medical folder review of 162 patients seen at Groote Schuur Hospital Memory Clinic for the first time between January 2014 and August 2021. Results. The median age of participants was 67 years (IQR 58-73). Most were females (63%, n =102), and had dementia (58%, n = 94); more than half (51%, n = 78) had at least 12 years of formal education. Older age and lower levels of education were associated with lower MoCA scores (p < 0.001). Conclusion. In a specialized South African clinical setting, the MoCA demonstrated good psychometric properties as a screening tool for evaluating different levels of cognitive impairment. However, to our knowledge, this is the first South African study to assess the factor structure of the MoCA in a clinical setting. More comprehensive and larger studies should evaluate the validity of our findings

Body dysmorphic disorder : a diagnostic challenge in adolescence

CITATION: Thungana, Y., Moxley, K. & Lachman, A. 2018. Body dysmorphic disorder : a diagnostic challenge in adolescence. South African Journal of Psychiatry, 24:a1114, doi:10.4102/sajpsychiatry.v24i0.1114.The original publication is available at http://www.sajp.org.zaBody dysmorphic disorder (BDD) is a chronic and disabling condition that is characterised by distressing preoccupations with perceived defects in one’s own appearance, which might be slight or not observable to others. It is considered to be an obsessive–compulsive spectrum disorder and is associated with depression, feelings of shame and poor quality of life. It is primarily a disorder of childhood or adolescent onset, and sub-clinical BDD symptoms begin, on average, several years before an individual’s symptoms meet full criteria for the disorder. Here we report the case of an adolescent admitted to an inpatient psychiatric unit for treatment of psychotic symptoms that were poorly responsive to standard treatments. This challenging case of BDD in an adolescent highlights the various comorbidities of the disorder, as well as the difficulties associated with BDD diagnosis.https://sajp.org.za/index.php/sajp/article/view/1114Publisher's versio

Cross-country variations in the reporting of psychotic symptoms among sub-Saharan African adults: A psychometric evaluation of the Psychosis Screening Questionnaire

Background: Self-reporting of psychotic symptoms varies significantly between cultures and ethnic groups. Yet, limited validated screening instruments are available to capture such differences in the African continent. Methodology: Among 9,059 individuals participating as controls in a multi-country case-control study of the genetic causes of psychosis, we evaluated the psychometric properties of the Psychosis Screening Questionnaire (PSQ). We applied multi-group confirmatory factor analysis and item response theory to assess item parameters. Results: The overall positive endorsement of at least one item assessing psychotic symptoms on the PSQ was 9.7%, with variability among countries (Uganda 13.7%, South Africa 11%, Kenya 10.2%, and Ethiopia 2.8%). A unidimensional model demonstrated good fit for the PSQ (root mean square error of approximation = 0.009; comparative fit index = 0.997; and Tucker-Lewis Index = 0.995). Hypomania had the weakest association with single latent factor (standardized factor loading 0.62). Sequential multi-group confirmatory factor analysis demonstrated that PSQ items were measured in equivalent ways across the four countries. PSQ items gave more information at higher levels of psychosis, with hypomania giving the least discriminating information. Limitations: Participants were recruited from general medical facilities, so findings may not be generalizable to the general population. Conclusion: The PSQ demonstrated a unidimensional factor structure in these samples. Items were measured equivalently across all study settings, suggesting that differences in prevalence of psychotic symptoms between countries were less likely to represent measurement artifact. The PSQ is more reliable in screening for psychosis in individuals with higher degrees of psychotic experiences-hypomania excluded-and might decrease the false-positive rate from mild nonspecific psychotic experiences

Young people's data governance preferences for their mental health data: MindKind Study findings from India, South Africa, and the United Kingdom.

Mobile devices offer a scalable opportunity to collect longitudinal data that facilitate advances in mental health treatment to address the burden of mental health conditions in young people. Sharing these data with the research community is critical to gaining maximal value from rich data of this nature. However, the highly personal nature of the data necessitates understanding the conditions under which young people are willing to share them. To answer this question, we developed the MindKind Study, a multinational, mixed methods study that solicits young people's preferences for how their data are governed and quantifies potential participants' willingness to join under different conditions. We employed a community-based participatory approach, involving young people as stakeholders and co-researchers. At sites in India, South Africa, and the UK, we enrolled 3575 participants ages 16-24 in the mobile app-mediated quantitative study and 143 participants in the public deliberation-based qualitative study. We found that while youth participants have strong preferences for data governance, these preferences did not translate into (un)willingness to join the smartphone-based study. Participants grappled with the risks and benefits of participation as well as their desire that the "right people" access their data. Throughout the study, we recognized young people's commitment to finding solutions and co-producing research architectures to allow for more open sharing of mental health data to accelerate and derive maximal benefit from research

Young people’s data governance preferences for their mental health data: MindKind Study findings from India, South Africa, and the United Kingdom

Funder: Wellcome Trust; funder-id: http://dx.doi.org/10.13039/100010269Mobile devices offer a scalable opportunity to collect longitudinal data that facilitate advances in mental health treatment to address the burden of mental health conditions in young people. Sharing these data with the research community is critical to gaining maximal value from rich data of this nature. However, the highly personal nature of the data necessitates understanding the conditions under which young people are willing to share them. To answer this question, we developed the MindKind Study, a multinational, mixed methods study that solicits young people’s preferences for how their data are governed and quantifies potential participants’ willingness to join under different conditions. We employed a community-based participatory approach, involving young people as stakeholders and co-researchers. At sites in India, South Africa, and the UK, we enrolled 3575 participants ages 16–24 in the mobile app-mediated quantitative study and 143 participants in the public deliberation-based qualitative study. We found that while youth participants have strong preferences for data governance, these preferences did not translate into (un)willingness to join the smartphone-based study. Participants grappled with the risks and benefits of participation as well as their desire that the “right people” access their data. Throughout the study, we recognized young people’s commitment to finding solutions and co-producing research architectures to allow for more open sharing of mental health data to accelerate and derive maximal benefit from research

Young people's data governance preferences for their mental health data: MindKind Study findings from India, South Africa, and the United Kingdom.

Mobile devices offer a scalable opportunity to collect longitudinal data that facilitate advances in mental health treatment to address the burden of mental health conditions in young people. Sharing these data with the research community is critical to gaining maximal value from rich data of this nature. However, the highly personal nature of the data necessitates understanding the conditions under which young people are willing to share them. To answer this question, we developed the MindKind Study, a multinational, mixed methods study that solicits young people's preferences for how their data are governed and quantifies potential participants' willingness to join under different conditions. We employed a community-based participatory approach, involving young people as stakeholders and co-researchers. At sites in India, South Africa, and the UK, we enrolled 3575 participants ages 16-24 in the mobile app-mediated quantitative study and 143 participants in the public deliberation-based qualitative study. We found that while youth participants have strong preferences for data governance, these preferences did not translate into (un)willingness to join the smartphone-based study. Participants grappled with the risks and benefits of participation as well as their desire that the "right people" access their data. Throughout the study, we recognized young people's commitment to finding solutions and co-producing research architectures to allow for more open sharing of mental health data to accelerate and derive maximal benefit from research

Young people’s data governance preferences for their mental health data: MindKind Study findings from India, South Africa, and the United Kingdom

Mobile devices offer a scalable opportunity to collect longitudinal data that facilitate advances in mental health treatment to address the burden of mental health conditions in young people. Sharing these data with the research community is critical to gaining maximal value from rich data of this nature. However, the highly personal nature of the data necessitates understanding the conditions under which young people are willing to share them. To answer this question, we developed the MindKind Study, a multinational, mixed methods study that solicits young people’s preferences for how their data are governed and quantifies potential participants’ willingness to join under different conditions. We employed a community-based participatory approach, involving young people as stakeholders and co-researchers. At sites in India, South Africa, and the UK, we enrolled 3575 participants ages 16–24 in the mobile app-mediated quantitative study and 143 participants in the public deliberation-based qualitative study. We found that while youth participants have strong preferences for data governance, these preferences did not translate into (un)willingness to join the smartphone-based study. Participants grappled with the risks and benefits of participation as well as their desire that the “right people” access their data. Throughout the study, we recognized young people’s commitment to finding solutions and co-producing research architectures to allow for more open sharing of mental health data to accelerate and derive maximal benefit from research