Psychiatric classification, stigma, and mental health

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Psychiatry and mental health research in South Africa: National priorities in a low and middle income context

The recent National Mental Health Summit included discussion of research priorities for South Africa. This paper reviews some of the background literature that is relevant to this key issue. It draws attention to one contested question, the extent to which research in low and middle income countries should address questions about fundamental mechanisms and clinical treatments versus focusing on questions about implementation and systems research? In addressing this question, the paper argues that the boundary between good clinical practice and good academic scholarship is not nearly as distinct as is often assumed (the “research fallacy”); prospective rigorous assessments, retrospective clinical audits, evidence-based medicine, and useful information systems all point to the mutual interdependence of good practice and good scholarship. Finally, some general conclusions that the majority of summit delegates participating in the discussion on research agreed to, are presented

Psychiatric Contributions from South Africa: Ex Africa Semper Aliquid Novi

Given that humans originated in Africa, it is likely that many seminal psychological observations and interventions originate in the continent. Relatively little attention has been paid, however, to more recent African contributions to the scientific fields of psychiatry and clinical psychology. This article notes that a number of major contributions to the understanding of brain-mind disorders have emerged from South Africa in particular. It briefly covers seminal contributions in evolutionary theory, psychotherapy, andneuroscience, as well as conceptual and practical contributions to reconciliation

Dealing with substance use disorders in general practice

Substance use disorders are highly prevalent in South Africa. General practitioners are often the first point of contact and play an essential role in correctly identifying the substance use problem. This article provides an overview of the importance of screening for and assessing substance use disorders and identifying the severity of the substance use disorder, so that the right level of management can be ensured. It also examines associated co-morbidities and provides a general overview of the management of substance use disorders.S Afr Fam Pract 2012;54(5):404-40

Differences in the association between childhood trauma and BMI in black and white South African women

Objective: Childhood trauma has previously been associated with adult obesity. The aim of this study was to determine if ethnicity altered the relationship between childhood trauma and obesity in South African women. Methods: Forty-four normalweight (BMI<25kg/m2) and obese (BMI>30kg/m2), black and white premenopausal women completed the Childhood Trauma Questionnaire (CTQ), which retrospectively assessed emotional and physical neglect, and emotional, physical and sexual abuse in childhood. Results: Body composition did not differ by ethnicity in the normal-weight and obese groups. However,independent of BMI group, there were significant differences in socioeconomic status (SES) between black and white women (P<0.01). Total CTQ score, as well as the sub-scales, physical and emotional neglect, and physical and sexual abuse were higher in black than white women (all P<0.05), but these scores did not differ between BMI groups. Apart from the sexual abuse score, the differences in physical and emotional neglect and physical abusescores were no longer significant after adjusting for ethnic differences in age and SES. For sexual abuse, there was a significant interaction between ethnicity and BMI group(P=0.04), with scores in normal weight women being higher in black than white women, but scores in obese women not differing by ethnicity. Conclusion: Ethnicity alters the association between childhood sexual abuse and BMI status. Larger studies are required to verify this finding, including measures of body image and body size satisfaction that may explain these findings.Keywords: Childhood trauma questionnaire; Body fat; Body image; Sexual abuse; Ethnicity, Socioeconomic statu

Mental Health Services in South Africa: Scaling up and future directions

“No health without mental health” has become a rallying call for the World Health Organization and numerous service providers, training institutions, health researchers, and advocacy groups around the world. It is timely to consider the implications of this call for South Africa. We review key evidence regarding the burden and risk factors for mental disorders in South Africa and crucial challenges for local mental health services and research. We emphasize that mental disorders are more impairing but less treated than physical disorders, and that existing services need to be scaled up and adapted to the local context. New research is needed to determine what interventions work best in the South African context.Keywords: Mental Health; Health; South Africa; Service

Predicting referral practices of traditional healers of their patients with a mental illness: An application of the Theory of Planned Behaviour

Objective: Although many studies indicate that traditional healers are willing to collaborate with Western practitioners in South Africa, none focus specifically on mental health care, and none use a theory of health behaviour to explain their findings. The present study applies the Theory of Planned Behaviour (TPB) to predict traditional healer referral practices of patients with a mental illness.Method: One hundred traditional healers were first interviewed to assess the TPB variables and were contacted again 5 months later to measure self-reported behaviour.Results: Herbalists were less likely than other types of healers to referpatients with a mental illness to Western health professionals. From the TPB application, the following cognitive variables were found to predict intentions: attitudes (ß = 0.612, p< 0.01); perceived behavioural control (ß = 0.355, p< 0.01); and past behaviour (ß = 0.704, p< 0.01). Subjective norms and knowledge of mental illness did not predict intentions. Finally, past behaviour (ß = 0.297, p = 0.040) and intentions to refer patients (ß = 0.758, p< 0.01) predicted greater self-reported behaviour.Conclusion: The TPB may be a useful theoretical model for predicting the referral practices of traditional healers. The empirical data here may be useful for future work designing interventions to provide traditional healers with the information and skills they require to appropriately refer patients with mental illness.Keywords: Medicine, African traditional; Referral and Consultation; Decision Analyses; South Afric

Adjunctive quetiapine for serotonin reuptake inhibitor-resistant obsessive-compulsive disorder: A meta-analysis of randomised controlled treatment trials

Small studies have shown positive effects from adding a variety of antipsychotic agents in patients with obsessive–compulsive disorder who are unresponsive to treatment with serotonin reuptake inhibitors. The evidence, however, is contradictory. This paper reports a meta-analysis of existing double-blind randomized placebo-controlled studies looking at the addition of the second-generation antipsychotic quetiapine in such cases. Three studies fulfilled the inclusion criteria. Altogether 102 individuals were subjected to analysis using Review Manager (4.2.7). The results showed evidence of efficacy for adjunctive quetiapine (< 400 mg/day) on the primary efficacy criterion, measured as changes from baseline in total Yale–Brown Obsessive Compulsive Scale scores (P = 0.008), the clinical significance of which was limited by between-study heterogeneity. The mechanism underlying the effect may involve serotonin and/or dopamine neurotransmission

The prevalence and correlates of hallucinations in a general population sample: findings from the South African Stress and Health Study

Objective: Large epidemiological surveys conducted in the developed world have found rates of psychotic symptoms in the general population to be as high as 10-28%. However, there are few data available from developing countries, including African countries, on the prevalence and correlates of psychotic symptoms. This study investigates the prevalence and correlates of psychotic symptoms (ie hallucinations) in a general population sample of South African adults. Method: As part of the South African Stress and Health Study the prevalence of auditory and visual hallucinations was determined in a large community based sample of 4250 participants utilizing the Composite International Diagnostic Interview (CIDI). In addition, socio-demographic and clinical correlates as well as indicators of service utilization and functional impairment were determined. Results: The prevalence of any reported hallucination was 12.7%, a rate comparable to that found in studies from the developed world. Multivariate analyses revealed a significant association between role impairment, service utilisation, suicidality and reported auditory or visual hallucinations. No significant association was found between urbanicity and reported psychotic symptoms. Conclusion: Our finding that psychotic symptoms (ie hallucinations) are significantly associated with functional impairment and service utilization supports the potential clinical significance of such symptoms, even in the African context.Key Words: Prevalence; Psychosis; Population groups; Epidemiology; South Afric