Kleine-Levin syndrome as a neuropsychiatric presentation: A case report and review

Kleine-Levin syndrome (KLS) is a rare disorder characterised by hypersomnia, hyperphagia and behavioural disturbances. It typically occurs in adolescent men and may mimic a variety of neuropsychiatric conditions. Here we report what appears to be the first published case of KLS in South Africa and trace the clinical course, investigations and diagnostic difficulties encountered in the management of this condition. An overview of the literature guiding the diagnosis, differentials and treatment is discussed

SHARED PLEASURE IN EARLY INFANT INTERACTIONS

Psychiatr

Early life and infant mental health: Reshaping assumptions in a southern field

Mental health is a priority area for global health, with a particular focus on well-being in majority of the world countries. Attention to early life demonstrates the significance of infant well-being for long-term health. International organisations such as the United Nations International Children’s Emergency Fund (UNICEF), World Health Organization (WHO), and the World Bank guidelines shape interventions in the majority world. At the same time, there are severe shortages of trained mental health personnel on the African continent and growing concerns about the potentially skewed evidence base that informs the science of interventions. Scholars across a range of disciplines are calling for attention to more diverse evidence sources; for better understandings of the syndemic interactions that shape mental health and for interventions that take account of local ideals while retaining a strong evidence base. As questions of how best to secure infant well-being and the adequacy of knowledge surrounding it emerges with growing force on the global scene, it is critical that the full range of infants’ worlds are represented in scholarship. What do exposures to structural violence, interpersonal violence, social assault, and environmental insult mean for our understanding of ‘normal’ development both in our context and globally? What are the dangers of not accounting for these exposures? What evidence bases matter? How do we know? These are critical questions. They arise in the context of limited, under-resourced and often poorly supported opportunities for adequate screening, early recognition, and suitable interventions for both infants and caregivers in Africa

The Shared Pleasure Paradigm: A study in an observational birth cohort in South Africa

Mother–infant dyads in low- and middle-income countries (LMICs) may be exposed to a range of factors associated with suboptimal development. Optimal infant development is likely supported by synchronicity in the early mother–infant relationship, but limited corroborative research is available in LMICs. The Drakenstein Child Health Study (DCHS) provided an opportunity to study this synchronicity and its associations in South Africa. A South African birth cohort study investigating early-life determinants of child health in a LMIC context provided participants. The Shared Pleasure (SP) paradigm helped assess early mother–infant synchronicity in videos of a sub-set of 291 mother–infant dyads at their 14-week well baby visit. General linear regression models investigated the relationship between selected maternal and infant characteristics and the presence of Shared Pleasure moments. Out of a possible 291 dyads, 82% (n=239) yielded Shared Pleasure moments. The mean age of mothers was 27 years, while infant sex distribution comprised 54% females and 46% males. The shortest single Shared Pleasure moment lasted at least 0.5 s and the longest 28 s. Shared Pleasure moments were associated with higher gestation age at delivery (p=0.008) and higher infant birth weight (p=0.006), but were not related to mother's mental health and infant health outcomes at 14 weeks. The high frequency of positive Shared Pleasure moments in reciprocal dyadic interactions in this sample suggests that signifcant disruption in shared pleasure may be present only in extreme cases (e.g. mothers with severe mental disorders). Further work is needed to investigate the mechanisms underlying the associations between early mother–infant synchronicity and better

Cannabis use among hospitalised adolescents before and after decriminalisation in South Africa

Background: Cannabis is the most widely used substance worldwide, and its use is much higher among adolescents. However, adolescents are at higher risk of negative sequelae secondary to this use, including the possible development of mental disorders. On 31 March 2017, the South African High Court ruled that cannabis use by an adult in a private dwelling should be decriminalised. Aim: This study aimed to determine the clinical profile of adolescents who use cannabis, who use, who present to a tertiary hospital in Cape Town, South Africa, before and after the high court ruling in 2017. Setting: Folder review of adolescents admitted at Groote Schuur Hospital (GSH) in the Emergency Psychiatric Unit. Methods: This study was a retrospective folder review of adolescents admitted from April 2015 to March 2019. Results: Cannabis was the most commonly used substance in the study, with increased use seen post-ruling. The most common frequency of cannabis use reported was daily. A significantly higher proportion of patients who used cannabis pre-ruling had psychotic disorder (p  0.001) and cannabis use disorder (p = 0.01). Post-ruling, the results were statistically significant (p  0.001) for both. Conclusion: The study showed an increasing prevalence of cannabis use in adolescents admitted with mental illness after the high court ruling in 2017. This study also demonstrates that adolescents remain a vulnerable population to the effects of cannabis and highlights the need for further research. Contribution: The findings of this study call for more focussed adolescent interventions and services

“I Know That It's Something That's Creating a Bond”: Fathers' Experiences of Participating in Baby Theater With Their Infants in South Africa

Elvin Williams - ORCID: 0000-0002-1702-555X https://orcid.org/0000-0002-1702-555XIn many African countries, particularly those with largely patriarchal societies like South Africa, promoting father-child interaction can pose a challenge. An informative medium that could potentially encourage active participation in pleasurable interactions between fathers and babies may prove to be an important way in which to stimulate fathers' awareness of their infants' abilities. A Cape Town based theater company created the first ever South African baby play for care-givers and their babies between the ages of 2 weeks to 12 months. The play is performed in a contained, relaxing space and offers carers and babies time to relate to each other in a pleasurable atmosphere, while specially trained actors model sensitive and responsive interactions. Baby Theater could be a way to encourage fathers' involvement with their infants, however, no research is currently available documenting fathers' perceptions about Baby Theater experience. Aim: To explore fathers' experience of participating in Baby Theater. Method: This qualitative study involved six fathers who, with their infants, participated in the Baby Theater production. A week later the fathers were divided into two focus groups to give them the opportunity to discuss their thoughts about the experience and to reflect on whether it had any subsequent impact on their interactions with their babies. The audiotaped, transcribed material was thematically analyzed using an interpretative phenomenological approach. Results: The fathers described the experience as educative and enjoyable. They reported that the program had a positive impact on the way they interacted with their infants and also positively influenced their relationship with them. Additionally, they reported feeling more confident about coping with their babies on their own, and appreciated the connection with the other fathers in the group. Cultural, societal, and gender issues were also considered. Conclusions: The subjective experience of the fathers was positive. Further research is needed to assess the lasting effects of the Baby Theater experience.https://doi.org/10.3389/fpsyt.2020.58003811pubpub58003

Maternal shared pleasure, infant withdrawal, and developmental outcomes in a high risk setting in South Africa

Infants in lower middle income countries are often exposed to early adversities which may lead to suboptimal caregiving environments and place them at risk of not achieving their developmental potential. Synchrony and positive engagement in the mother-infant relationship plays a critical role in buffering the impact of early adversity. Shared Pleasure (SP) is considered a marker of high intensity positive interaction and may hold a promise of improving developmental outcomes

New developments in diagnosis and treatment update: Schizophrenia/first episode psychosis in children and adolescents

Childhood onset schizophrenia (COS) is diagnosed before the age of 13 years, and early onset schizophrenia (EOS) is diagnosed before the age of 18 years. EOS is considered extremely rare and its prevalence in comparison to the worldwide prevalence of schizophrenia (1%) has not adequately been studied. Patients who experience the first episode of psychosis need to be treated early and optimally to lessen the morbidity and improve the outcome of the illness. Treatment needs to be a combination of both pharmacological and non-pharmacological modalities. Pharmacological intervention is necessary for remission, improvement of positive symptoms and to aid with the efficacy of psychosocial interventions. There is a lack of efficacy and safety data of the use of antipsychotic medication in children, with most of the information available being extrapolations of adult data. An increased use of atypical antipsychotic drugs in the treatment of EOS has been accompanied by growing concern about the appropriate use and associated side effects in children and adolescents. This update highlights new developments, concepts and treatment trends in EOS.Journal of Child and Adolescent Mental Health 2014, 26(2): 109–12

Kleine-Levin syndrome as a neuropsychiatric presentation : a case report and review

CITATION: Lachman, A. 2014. Kleine-Levin syndrome as a neuropsychiatric presentation: A case report and review. South African Journal of Psychiatry, 20(2):60-62, doi:10.7196/SAJP.494.The original publication is available at http://www.sajp.org.zaKleine-Levin syndrome (KLS) is a rare disorder characterised by hypersomnia, hyperphagia and behavioural disturbances. It typically occurs in adolescent men and may mimic a variety of neuropsychiatric conditions. Here we report what appears to be the first published case of KLS in South Africa and trace the clinical course, investigations and diagnostic difficulties encountered in the management of this condition. An overview of the literature guiding the diagnosis, differentials and treatment is discussed.http://www.sajp.org.za/index.php/sajp/article/view/494Publisher's versio

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