https://sajp.org.za/index.php/sajp/issue/feedSouth African Journal of Psychiatry2024-03-02T11:38:21+01:00AOSIS Publishingsubmissions@sajp.org.zaOpen Journal Systems<a id="readmorebanner" href="/index.php/sajp/pages/view/journal-information" target="_self">Read more</a> <img style="padding-top: 2px;" src="/public/web_banner.svg" alt="" />https://sajp.org.za/index.php/sajp/article/view/2190Prior trauma experiences among state patients charged with murder: A retrospective records review2024-03-02T11:38:21+01:00Ugasvaree Subramaneyugasvaree.subramaney@wits.ac.zaNasiha Mintynasihaminty007@gmail.comChad M. Himlokchadhimlok@gmail.comDamilola Adetibadadetiba@gmail.comHamza Ahmedahmedhamza864@gmail.comElouise Barnardelo1barnard@gmail.comYolanda R. Mahachiyolandamahachi@gmail.comKoketso Selekanakoketso.selekana@gmail.comJenna R. Smithjenna.rene.smith@gmail.comSamantha Iyaloosamantha.iyaloo@gmail.com<p><strong>Background:</strong> Trauma experiences, particularly in childhood, have been associated with criminality and mental illness. There is a paucity of research into the crime of murder, trauma and mental illness.</p><p><strong>Aim:</strong> This research study focused on state patients charged with murder and sought to determine associations with prior trauma experiences, and specific types of traumas (sexual, physical and emotional).</p><p><strong>Setting:</strong> The study was conducted at a forensic psychiatric hospital in Johannesburg, South Africa.</p><p><strong>Methods:</strong> The records of state patients admitted over a 21-year period on a charge of murder were reviewed and analysed with respect to sociodemographic variables, clinical profiles, trauma experience and victim characteristics.</p><p><strong>Results:</strong> Experience of trauma in this population, with a much higher number of males compared with females, was lower than previous studies. Neurocognitive disorder was significantly associated with physical trauma. Physical trauma was found to have a significantly negative association with psychotic disorders, compared with other mental disorders.</p><p><strong>Conclusion:</strong> Although trauma is common in psychiatric patients, the study’s findings are lower than previous studies. Noting the male bias in state patients that commit murder, greater sample sizes are needed to adequately address issues of specific types of traumas, the development of mental illness and murder.</p><p><strong>Contribution:</strong> Exploring and managing prior trauma in state patients who commit murder is important while considering rehabilitation efforts, such that reintegration into the community and non-recidivism are encouraged.</p>2024-03-01T06:00:00+01:00Copyright (c) 2024 Ugasvaree Subramaney, Nasiha Minty, Chad M. Himlok, Damilola Adetiba, Hamza Ahmed, Elouise Barnard, Yolanda R. Mahachi, Koketso Selekana, Jenna R. Smith, Samantha Iyaloohttps://sajp.org.za/index.php/sajp/article/view/2176Ketamine for depressive symptoms: A retrospective chart review of a private ketamine clinic2024-03-01T13:21:03+01:00Vidette M. Jubyvidette.juby@gmail.comSaaeda Parukparuks4@ukzn.ac.zaMitsuaki Tomitatomita@ukzn.ac.zaBonga Chilizachilizab@ukzn.ac.za<p><strong>Background:</strong> There is currently no published evidence demonstrating the effectiveness and safety of subanaesthetic doses of ketamine, when administered intravenously as an adjunct treatment for depressive symptoms, in a real world setting in South Africa.</p><p><strong>Aim:</strong> This retrospective chart review reports the clinical response (change in Patient Health Questionnaire – 7 score) to an initial infusion series of ketamine added to usual treatment, and the pattern of its subsequent maintenance use, for depressive symptoms.</p><p><strong>Setting:</strong> A private ketamine clinic in Hilton, KwaZulu-Natal.</p><p><strong>Methods:</strong> The medical records of all patients who attended a private ketamine clinic between August 2019 and 31 May 2021 were retrospectively analysed. Depression symptoms were evaluated using the Patient Health Questionaire-9 (PHQ-9) administered immediately before and 24 h after each treatment. Response was defined as a score decrease of more than 50%.</p><p><strong>Results:</strong> Among the 154 patients who received ketamine infusions for depression, 67 completed a six infusion initial series, with a response rate of 60.6% and remission rate of 32.4%. Of the 154, 50% no longer experienced any suicidal ideation after treatment and adverse events were uncommon, with 6.2% of infusions requiring intervention for adverse events, mostly nausea. In addition, 48.5% of those who completed the initial series continued to receive maintenance infusions, with no evidence of escalating use or abuse.</p><p><strong>Conclusion:</strong> Incorporating intravenous ketamine into the existing treatment regimens at a private clinic was associated with reduced acuteness of depression severity and suicidal ideation. This approach appeared safe and tolerable, showing no signs of abuse or dependence.</p><p><strong>Contribution:</strong> This is the first known naturalistic study reporting on ketamine use for depressive symptoms in South Africa.</p>2024-02-19T06:00:00+01:00Copyright (c) 2024 Vidette M. Juby, Saaeda Paruk, Mitsuaki Tomita, Bonga Chilizahttps://sajp.org.za/index.php/sajp/article/view/2087The test-retest reliability of the Opiate Treatment Index in nyaope users in Johannesburg2024-03-01T13:21:03+01:00Kelebogile Pitsoanekeleptsn@yahoo.comNirvana Morgannirvana.morgan0@gmail.comSumaya Mallsumaya.mall@wits.ac.za<p><strong>Background:</strong> Epidemiological studies suggest that nyaope, a heroin-based drug, is widely used in South Africa. Yet few reliable research tools are available to assess treatment outcomes of users. The Opiate Treatment Index (OTI), a tool developed in Australia, could potentially facilitate research on context-specific South African treatment outcomes. However, we know little of its test-retest reliability.</p><p><strong>Aim:</strong> This study aimed to assess the test-retest reliability of the OTI among a sample of nyaope users in Johannesburg.</p><p><strong>Setting:</strong> This study was conducted across three substance use treatment facilities in Johannesburg.</p><p><strong>Methods:</strong> The OTI was administered to 53 nyaope users at baseline and one week later. To determine the test-retest reliability of the OTI, the intra-class correlation coefficients (ICC) and the Brennan–Prediger coefficients of the two interviews were calculated.</p><p><strong>Results:</strong> The ICC of the Q-scores from the data sets along with the Brennan–Prediger coefficient for the substance use domain were calculated. The ICC for nyaope was 0.38. Brennan–Prediger coefficients were as follows: alcohol – 0.96, crack-cocaine – 0.89, cannabis – 0.92, methaqualone – 0.85 and crystal methamphetamine – 0.89.</p><p><strong>Conclusion:</strong> A significant positive finding was the excellent test-retest reliability of the injecting and sexual behaviour domains and moderate reliability of the criminality, general health and social functioning domains.</p><p><strong>Contribution:</strong> The results of this study provide insight into the reliability of this tool and for its use in future studies in the South African context.</p>2024-02-16T06:00:00+01:00Copyright (c) 2024 Kelebogile Pitsoane, Nirvana Morgan, Sumaya Mallhttps://sajp.org.za/index.php/sajp/article/view/2133Antipsychotics-related hyperprolactinaemia among patients with schizophrenia in Maiduguri2024-02-02T11:29:04+01:00Falmata B. Shettimafalshetty@gmail.comMusa A. Wakilbamusa@gmail.comTaiwo L. Sheikhlatshe1@gmail.comMohammed Abdulazizzizo922000@yahoo.comIbrahim A. Wakawaibrahimabdu55@gmail.comOmeiza Beidaomeizabeida@gmail.com<p><strong>Background:</strong> Hyperprolactinaemia among patients on antipsychotic medications is generally overlooked due to lack of outwardly visible symptoms, patient resistance to reporting because the symptoms are perceived as shameful, or to clinician’s insufficient knowledge.</p><p><strong>Aim:</strong> The study aimed to evaluate the patterns and correlates of hyperprolactinemia among patients with schizophrenia on antipsychotic medications.</p><p><strong>Setting:</strong> The study was conducted in a psychiatric facility in Maiduguri, Northeastern Nigeria.</p><p><strong>Methods:</strong> A total of 209 patients with schizophrenia were evaluated through a cross-sectional design and assayed for serum prolactin with ELISA Kits. Frequencies and percentages were tabulated for categorical variables. Variables with significant associations with hyperprolactinaemia on chi-square (<em>p</em> < 0.05) were subjected to logistic regression analysis.</p><p><strong>Results:</strong> The prevalence of hyperprolactinaemia was 45.9% in all patients on antipsychotic medication. The prevalence because of the use of typical and atypical antipsychotics was 51.5% and 25.0%, respectively. Hyperprolactinaemia was significantly associated with typical antipsychotics (β = 0314, <em>p</em> = 0.002), high overall drug dosage (β = 2.340, <em>p</em> = 0.003), high-dose typical antipsychotics (β = 3.228, <em>p</em> = 0.000), twice daily dosing frequency (β = 2.751, <em>p</em> = 0.001) and polypharmacy (β = 1.828, <em>p</em> = 0.0024).</p><p><strong>Conclusion:</strong> The findings support that patients on typical, high-dose antipsychotic medications and polypharmacy have a high prevalence of hyperprolactinaemia. As hyperprolactinaemia is often undetectable, screening and patient psycho-education on the significance of the signs and symptoms of hyperprolactinaemia is required for necessary clinical intervention.</p><p><strong>Contribution:</strong> The study provides evidence for the rational use of antipsychotic medications in sub-Saharan Africa.</p><p> </p>2024-02-01T06:00:00+01:00Copyright (c) 2024 Falmata B. Shettima, Musa A. Wakil, Taiwo L. Sheikh, Mohammed Abdulaziz, Ibrahim A. Wakawa, Omeiza Beidahttps://sajp.org.za/index.php/sajp/article/view/2198Substance use patterns in an adolescent psychiatric unit in Johannesburg, South Africa2024-02-01T13:19:33+01:00Vuyani W. Nxumalowvuyani@yahoo.comYvette M. Nelyvette.nel@wits.ac.za<p><strong>Background:</strong> Substance use among adolescents carries a significant public health and socioeconomic burden with potential long-term consequences for the adolescent substance user (SU). Adolescents with mental health challenges are vulnerable to substance use and substance use worsens outcomes in this population.</p><p><strong>Aim:</strong> This study aimed to describe the substance use patterns among inpatients admitted to a specialised tertiary adolescent inpatient unit in Johannesburg over a 4-year period.</p><p><strong>Setting:</strong> This study was conducted at the Tara H. Moross Centre (Tara Hospital), in Johannesburg in the Gauteng province of South Africa.</p><p><strong>Methods:</strong> This was a retrospective comparative record review of all patients admitted to the adolescent unit over the 4 years.</p><p><strong>Results:</strong> A lifetime history of substance use was documented in 44.1% (<em>n</em> = 52) of the 118 patient’s records included in the final analysis. Cannabis was the most frequently used substance (<em>n</em> = 36, 69.2%). There were significant differences between the SU and substance nonuser groups regarding family structure (<em>p</em> = 0.012), family history of substance abuse (<em>p</em> = 0.046) and conflict within the family (<em>p</em> < 0.001).</p><p><strong>Conclusion:</strong> The high prevalence of substance use in this sample demonstrates the dual burden of mental health disorders and substance use in an adolescent treatment programme in Johannesburg. Primary caregiver burden and relational difficulties within the family unit should be observed for planned multidisciplinary interventions.</p><p><strong>Contribution:</strong> The findings of this review provide an update on the pattern and prevalence of substance use among this adolescent mental healthcare user group, highlighting potential therapeutic targets.</p>2024-01-31T08:25:00+01:00Copyright (c) 2024 Vuyani W. Nxumalo, Yvette M. Nelhttps://sajp.org.za/index.php/sajp/article/view/2138Family Psycho-Social Involvement Intervention for severe mental illness in Uganda2024-02-01T13:19:33+01:00Racheal Alinaitwerarukiri@gmail.comMusisi Segganesegganemusisi@yahoo.caAndrew Turihoturiho@mail.comVictoria Birdv.j.bird@qmul.ac.ukStefan Priebes.priebe@qmul.ac.ukNelson Sewankambosewankam@infocom.co.ug<p><strong>Background:</strong> Treatment rates for severe mental illness (SMI) are low in low- and middle-income countries because of limited resources. Enlisting family support could be effective and low cost in improving patient outcomes.</p><p><strong>Aim:</strong> The article assess the feasibility, acceptability and estimates of efficacy of Family Psychosocial Involvement Intervention (FAPII) for patients with SMI.</p><p><strong>Setting:</strong> Masaka Regional Referral Hospital and Mityana District Hospital in Uganda.</p><p><strong>Methods:</strong> This was a controlled pilot study with two sites randomly assigned as intervention and control. Thirty patients each with one or two family members and six mental health professionals were recruited at the intervention site. Five patients, their family members and two mental health professionals met monthly for 6 months to discuss pre-agreed mental health topics. Patient outcomes were assessed at baseline, 6- and 12-months and analysed using paired t-tests. The trial was prospectively registered (ISRCTN25146122).</p><p><strong>Results:</strong> At 6 and 12 months, there was significant improvement in the QoL in the intervention group compared to the control (<em>p</em> = 0.001). There was significant symptom reduction in the intervention group at 6 and 12 months (<em>p</em> < 0.001). Family Psychosocial Involvement Intervention affected better treatment adherence at 6 and 12 months (<em>p</em> = 0.035 and <em>p</em> < 0.001, respectively) compared to the control arm.</p><p><strong>Conclusion:</strong> Family Psychosocial Involvement Intervention improved QoL, medication adherence, reduced stigma and symptoms among patients with SMI. The authors recommend involving families in the care of patients with SMI in Uganda, with FAPII employing culturally sensitive psychotherapy.</p><p><strong>Contribution:</strong> The results support involvement of family in the care of patients with SMI.</p>2024-01-30T07:59:00+01:00Copyright (c) 2024 Racheal Alinaitwe, Musisi Seggane, Andrew Turiho, Victoria Bird, Stefan Priebe, Nelson Sewankambohttps://sajp.org.za/index.php/sajp/article/view/2153Contraceptive use in women with mental illness in Soweto, South Africa2024-02-01T13:19:33+01:00Lisa J. Galvinpixienoggin@gmail.comYvette M. Nelyvette.nel@wits.ac.za<p><strong>Background:</strong> The psychosocial and medical implications of unplanned pregnancy in women with mental illness (MI) are vast. International guidelines make clear recommendations about family planning for women with MI, particularly those exposed to known human teratogens; however, there is limited research related to contraceptive usage among women with MI.</p><p><strong>Aim:</strong> The aim of this study was to investigate the prevalence of consistent contraceptive use and family planning education (FPE) among a population of women of childbearing age with MI.</p><p><strong>Setting:</strong> This quantitative cross-sectional study was conducted at Chris Hani Baragwanath psychiatric unit in Soweto, South Africa.</p><p><strong>Methods:</strong> A convenience sample comprising 190 eligible women of childbearing age with MI was employed for the study. The women were invited to participate by means of a structured questionnaire which was administered by the researcher. Clinical information was obtained from the patients’ medical records.</p><p><strong>Results:</strong> Consistent contraceptive usage occurred in 44.7% of participants. Family planning education was low (26.8%). Relationship status was associated with using contraception consistently (<em>p</em> = 0.0229). Teratogen exposure was not associated with either contraceptive use or FPE. Family planning education was not associated with contraceptive use.</p><p><strong>Conclusion:</strong> Women with MI may have increased risk for unplanned pregnancy if they are not in a relationship because of perceived lack of need for contraception.</p><p><strong>Contribution:</strong> Family planning education must be prioritised in women with MI, especially among women prescribed teratogenic medication, highlighting the risks associated with unplanned pregnancy.</p>2024-01-25T06:00:00+01:00Copyright (c) 2024 Lisa Jane Galvin, Yvette Margaret Nelhttps://sajp.org.za/index.php/sajp/article/view/2108Adverse childhood experiences, mental illness, HIV and offending among female inmates in Durban, South Africa2024-02-01T13:19:33+01:00Samantha Naidoodrsnaidoo@hotmail.comSaeeda Paruksaeedaparuk@gmail.comLiezel Ferreiralfpsych@gmail.comUgasvaree SubramaneyUgasvaree.Subramaney@wits.ac.za<p><strong>Background:</strong> Childhood adversities and adult trauma are common among female inmates. Associations have been documented with childhood adversities and mental illness, personality disorders, human immunodeficiency virus (HIV) and violent offending. However, no such study had been conducted in South Africa (SA), despite the high prevalence of HIV and trauma in SA.</p><p><strong>Aim:</strong> To measure the prevalence of childhood adversities and adult trauma; and to determine if there is a relationship between childhood adversities, mental illness, personality disorders, HIV and violent offending among female inmates.</p><p><strong>Setting:</strong> The study was conducted at the largest correctional centre in Durban, KwaZulu-Natal, South Africa.</p><p><strong>Methods:</strong> This cross-sectional, descriptive study randomly recruited 126 female inmates. The World Health Organization’s Adverse Childhood Experiences- International Questionnaire (WHO ACE-IQ) was used to measure childhood adversities; the Structured Clinical Interview for the Diagnostics and Statistical Manual-5 Research Version (SCID 5-RV) was used to diagnose mental illness; and a structured questionnaire was used to measure adult trauma. Human immunodeficiency virus data was confirmed from prison medical records.</p><p><strong>Results:</strong> Elevated rates of individual childhood adversities and adult trauma were found. Associations were found between cumulative childhood adversities and post-traumatic stress disorder (PTSD), alcohol use disorder, substance use disorder, borderline personality disorder, and HIV.</p><p><strong>Conclusion:</strong> Female inmates are a highly traumatised population. Prison mental health services should provide trauma-informed and trauma-focussed care to improve inmates’ mental health outcomes and decrease recidivism.</p><p><strong>Contribution:</strong> This study contributes to the emerging literature on adverse childhood experiences (ACEs) and their associations among incarcerated female populations, in a low- and middle-income, South African setting.</p>2024-01-24T06:00:00+01:00Copyright (c) 2024 Samantha Naidoo, Saeeda Paruk, Liezel Ferreira, Ugasvaree Subramaneyhttps://sajp.org.za/index.php/sajp/article/view/2109Alcohol, Smoking and Substance Involvement Screening Test validity in bipolar and psychotic disorders2024-01-10T13:11:09+01:00Rosalind J. Adlardrosalind.adlard@hse.ieTessa Roostessa.roos@uct.ac.zaHenk Temminghhenk.temmingh@uct.ac.za<p><strong>Background:</strong> Patients with multi-episode bipolar and psychotic disorders have a high prevalence of substance use disorders, with negative consequences. A brief, easily administered screening test such as the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is needed to identify those at risk in order to intervene appropriately. However, the ASSIST has not yet been validated in this population.</p><p><strong>Aim:</strong> This article aims to determine the validity and reliability of the ASSIST in detecting substance use disorders in patients with multi-episode bipolar and psychotic disorders.</p><p><strong>Setting:</strong> Western Cape Province, South Africa.</p><p><strong>Methods:</strong> The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Health Disorders, 4th Edition (DSM-IV) Axis I Disorders (SCID-I) was used as the gold standard for detecting substance abuse and dependence. Cronbach’s alpha was used to determine the internal consistency of the ASSIST, and receiver operating characteristic analysis was used to evaluate its screening properties. Optimal cut off scores were calculated to maximise sensitivity and specificity.</p><p><strong>Results:</strong> A total substance involvement lifetime score of ≥13 was found to have optimal sensitivity and specificity of just over 74%. The optimal cutoff score for alcohol was ≥4 and for cannabis, methamphetamine, and ‘other drugs’ was ≥3. The area under the curve was 0.7 or above for both the total and specific substance involvement scores.</p><p><strong>Conclusion:</strong> The ASSIST is a psychometrically sound screening test for substance use disorders in patients with multi-episode bipolar and psychotic disorders.</p><p><strong>Contribution:</strong> This is the first study to validate the ASSIST in this population.</p>2023-12-21T08:02:00+01:00Copyright (c) 2023 Rosalind J. Adlard, Tessa Roos, Henk Temminghhttps://sajp.org.za/index.php/sajp/article/view/2185The profile of adolescent patients presenting to a tertiary maternal mental health clinic2024-01-10T13:11:09+01:00Luzaan M. Cookeluzaan.cooke@gmail.comSanushka Moodleysanushka86@gmail.comLaila Paruklaila.paruk@gmail.com<p><strong>Background:</strong> Between March 2021 and April 2022, there were 90 037 documented adolescent pregnancies in South Africa. Statistics SA reports that this number is growing. Pregnancy places adolescents at greater risk of psychiatry-related morbidity and may have far-reaching consequences for their children. To date, there is no published data describing the patient profile of adolescent pregnancies in Gauteng Province, South Africa.</p><p><strong>Aim:</strong> To describe the patient profile (demographics, schooling history and type of accommodation), pregnancy-related factors, substance use habits and contraceptive use in pregnant adolescents seen at a tertiary care maternal mental health clinic (MMHC).</p><p><strong>Setting:</strong> The MMHC at Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa.</p><p><strong>Methods:</strong> A retrospective file review of all pregnant adolescents referred to the MMHC between January and June 2022.</p><p><strong>Results:</strong> The mean age of the patients was 15.2 years; 72% attended school and 97.4% planned to return. Most pregnancies were unplanned (97.9%), wanted (84%) and presented in the second (41.24%) and third (51.55%) trimesters. Most did not report using substances (76.7%). Fifty percent of the participants met the criteria for a major depressive disorder. Repeating a grade was an identifiable risk factor for an increased Edinburgh depression score. An unplanned pregnancy was associated with a higher risk factor assessment.</p><p><strong>Conclusion:</strong> Pregnant adolescents represent a vulnerable population group. A greater understanding of this patient profile may inform early psychiatric and psychosocial interventions, improved service delivery and help-seeking behaviour.</p><p><strong>Contribution:</strong> This study gives significant insights into the challenges faced, as well as the health and social needs of pregnant adolescents. This contributes to wholistic care and opportunities for early intervention, including awareness of contraceptive use and the risks of substance use and adolescent pregnancy on mental health, benefiting all South African adolescents.</p>2023-12-20T07:00:00+01:00Copyright (c) 2023 Luzaan M. Cooke, Sanushka Moodley, Laila Paruk