Research Articles (Psychiatry)

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Psychiatric nurses' knowledge of COVID-19 within a patient care context : a qualitative study
(AOSIS, 2025-01) Dyonase, Sandisiwe; Swanepoel, Isabelle; Lippi, Gian
BACKGROUND : Coronavirus disease 2019 (COVID-19) infection caused unparalleled hastening of the transmission of infection worldwide, commonly affecting healthcare workers’ well-being. Nursing staff spend most hours caring for patients and are the first contact that patients utilise when reporting symptoms or receiving treatment. AIM : This study aims to evaluate the knowledge of COVID-19 among psychiatric nurses at a tertiary psychiatric hospital. SETTING : Weskoppies Hospital, Gauteng, South Africa. METHODS : We conducted a qualitative study comprising 14 semi-structured interviews with nurses working at Weskoppies Hospital in South Africa. We used open-ended questions to facilitate the discussion and provide some structure for the interview while still allowing the participants to elaborate freely. The recordings were later transcribed into text. RESULTS : Twenty nurses working full time at the hospital, were recruited for the study. The nurses’ knowledge about COVID-19 was summarised into five major themes, each with subthemes: signs and symptoms of COVID-19, risk of contracting the virus, the spread of COVID-19, prevention, and complications. In this study, the majority of participants had relatively good knowledge regarding COVID-19. CONCLUSION : The majority of nurses at the hospital had adequate knowledge about COVID-19 but limited knowledge about the mode of transmission of the infection. Consistently improving healthcare workers’ knowledge about infection control measures through training, supplying information and identifying areas for improvement can ultimately enhance patient care and outcomes. CONTRIBUTION : This study sheds light on the value of nurses’ understanding of COVID-19, particularly in a psychiatric setting.
Mental health literacy among secondary school learners in Tshwane region 1 : a quantitative study
(AOSIS, 2025-04) Madlala, Dumisile P; Joubert, Pierre M.; Mokoena, Oratilwe P.
BACKGROUND : Mental health literacy (MHL) is one of the crucial factors in the prevention and maintenance of youth mental health. Despite this fact, there is limited research on MHL in this age group. AIM : To determine the MHL in a sample of secondary schoolgoing learners. SETTING : Five schools in Tshwane, South Africa. METHODS : A quantitative cross-sectional study was done. Three fictive vignettes depicting individuals having symptoms of major depressive disorder (MDD), substance-induced psychotic disorder (SIPD) and social anxiety disorder (SAD) were presented to participants. The ability to recognise the disorder, knowledge of the best form of help to address the symptoms, and the ability to provide psychological first aid support were assessed. A comparison of MHL between township school learners and urban school learners was conducted. The association between MHL and demographic factors was also assessed. RESULTS : The ability to recognise symptoms and connect them to a particular disorder was high (80.71% for MDD, 61.96% for SIPD and 67.91% for SAD). Correct knowledge on who would best address the symptoms was 52.55% for MDD, 63.83% for SIPD and 23.86% for SAD with a sizable number choosing informal help for the cases of MDD and SAD. There was good psychological first aid knowledge for both MDD and SIPD cases but poor for SAD case. CONCLUSION : Even though the results are promising regarding the recognition of all three disorders, there is still room for improving MHL in this group, especially in the areas of help-seeking and knowledge about anxiety disorders in general. CONTRIBUTION : The findings highlight key areas of focus during mental health awareness campaigns to learners.
Medication non-adherence in re-admitted patients at a psychiatry hospital : a qualitative study
(AOSIS, 2025-02) Zwide, Gopolang E.; Dewet, Zukiswa Tsolekile; Sokudela, Funeka Brenda
BACKGROUND : Medication non-adherence is a significant public health concern and is prevalent among mental healthcare users. Approximately 65% of patients with severe mental illness do not adhere to their prescribed medication. Medication nonadherence may worsen mental illness and result in poorer clinical outcomes, including frequent relapses and rehospitalisation rates, as well as long time to remission, which may contribute to increased cost of care. AIM : We explored perspectives regarding reasons for medication non-adherence among readmitted psychiatric patients. SETTING : Weskoppies Psychiatric Hospital, Pretoria, South Africa. METHODS : We adopted the social constructivism paradigm for this exploratory qualitative study. Purposive sampling was used to select 15 re-admitted patients, who were nonadherent to their medication. Data were collected through individual semi-structured interviews. The interviews were audio recorded and transcribed. The data were thematically analysed, using the principles of grounded theory. RESULTS : Substance abuse, a lack of family support and poor health literacy were the most common reasons for non-adherence to medication. Other reasons included medication side effects, healthcare system drawbacks and a lack of finances to access healthcare. Some patients did not adhere to their medication because they believed that their mental illnesses were spiritual in origin. CONCLUSION : Multiple factors contributed to patients not adhering to their medication, ultimately resulting in their relapse and readmission. Clinicians should be cognisant of these factors when trying to prevent relapse and readmission. CONTRIBUTION : Clinicians also ought to identify patients who are at risk of not adhering to medication. Targeted interventions should be established for tackling medication non-adherence.
Exploration of psychiatric inpatients' experience of adapting to the COVID-19 pandemic
(AOSIS, 2025-06) Magwabeni, Muimeleli Prudence; Swanepoel, Isabelle; Joubert, Marinda
BACKGROUND : The coronavirus disease 2019 (COVID-19) pandemic has changed life globally and significantly disrupted psychiatric inpatient care, with infection control measures altering therapeutic environments and exacerbating patient distress. Both staff and inpatients had to quickly adapt to new norms while maintaining care in an already vulnerable setting. AIM : This study aimed to explore psychiatric inpatients' experience of adapting to the COVID-19 pandemic. SETTING : The study was conducted in Weskoppies Psychiatric Hospital, Tshwane, Gauteng. METHODS : We conducted a qualitative study comprising 15 semi-structured interviews with psychiatric inpatients admitted to Weskoppies Hospital in South Africa during the COVID-19 pandemic, using purposive sampling. Open-ended questions encouraged detailed responses and guided the conversation. Recordings were later transcribed for analysis. RESULTS : Our study showed that psychiatric inpatients displayed an engagement strategy, rather than a disengagement approach, in adapting to a crisis. They actively tried to control, manage, and change stressful situations by accepting the hospital infrastructure and new COVID-19 rules, seeking social support, and holding on to their faith. CONCLUSION : Psychiatric inpatients at Weskoppies Hospital adapted to the COVID-19 pandemic through support from staff, family, hospital systems, and personal coping strategies. These findings highlight the need for holistic, patient-centred care that includes psychosocial and spiritual support during times of crises. CONTRIBUTION : This study provided insights into psychiatric inpatients' experiences and can help mental healthcare practitioners to ensure a more positive experience during rehabilitation and reintegration of psychiatric patients into society.
A psychiatrist in training encounters a traditional healer
(AOSIS, 2025-06) Singh, Raksha; Joubert, Pierre M.; pierre.joubert@up.ac.za
BACKGROUND : Traditional healers play a significant role in healthcare seeking in South Africa. Many South Africans often seek healthcare services from both medical practitioners and traditional healers simultaneously for the same condition. Despite this, many medical practitioners seem ignorant about the practices of traditional healers. AIM : This study aimed to explore the similarities and differences between the practices of a traditional healer (TH) and a psychiatrist in training (PIT) regarding an inpatient mental healthcare user (MHCU). SETTING : This study was conducted at an inpatient ward at Weskoppies Hospital, Pretoria. METHODS : An autoethnographic method was utilised in this study. RESULTS : The TH and PIT evaluated the same MHCU. While doing so, the PIT used participant observation, field notes, and finally a qualitative content analysis. The findings of the content analysis were validated with the TH. Two previously unpublished findings in South African traditional healing emerged: the use of a doll (effigy) and calling on angels. CONCLUSION : The TH and PIT followed the same basic steps in evaluating and treating the MHCU, but there were notable differences in the details (subcategories) of those steps. These differences reflect very different epistemologies about mental illness: the PIT used an evidence-based, naturalistic (or positivistic) model, while the TH used a model that can best be designated as transcendent. CONTRIBUTION : This study contributes towards an understanding of a TH’s approach to a mentally disordered patient.
Maladaptive daydreaming should be included as a dissociative disorder in psychiatric manuals : position paper
(Cambridge University Press, 2025) Soffer-Dudek, Nirit; Somer, Eli; Spiegel, David; Chefetz, Richard; O'Neil, John; Dorahy, Martin J.; Cardena, Etzel; Mamah, Daniel; Schimmenti, Adriano; Musetti, Alessandro; Boon, Suzette; Van Dijke, Annemiek; Ross, Colin; Nijenhuis, Ellert; Krause-Utz, Annegret; Dell, Paul; Gold, Steven N.; Pietkiewicz, Igor; Silberg, Joyanna; Steele, Kathy; Moskowitz, Andrew; Draijer, Nel; Thomson, Paula; Barach, Peter; Kinsler, Philip; Maves, Peter; Sar, Vedat; Kruger, Christa; Middleton, Warwick
Maladaptive daydreaming is a distinct syndrome in which the main symptom is excessive vivid fantasising that causes clinically significant distress and functional impairment in academic, vocational and social domains. Unlike normal daydreaming, maladaptive daydreaming is persistent, compulsive and detrimental to one’s life. It involves detachment from reality in favour of intense emotional engagement with alternative realities and often includes specific features such as psychomotor stereotypies (e.g. pacing in circles, jumping or shaking one’s hands), mouthing dialogues, facial gestures or enacting fantasy events. Comorbidity is common, but existing disorders do not account for the phenomenology of the symptoms. Whereas non-specific therapy is ineffective, targeted treatment seems promising. Thus, we propose that maladaptive daydreaming be considered a formal syndrome in psychiatric taxonomies, positioned within the dissociative disorders category. Maladaptive daydreaming satisfactorily meets criteria for conceptualisation as a psychiatric syndrome, including reliable discrimination from other disorders and solid interrater agreement. It involves significant dissociative aspects, such as disconnection from perception, behaviour and sense of self, and has some commonalities with but is not subsumed under existing dissociative disorders. Formal recognition of maladaptive daydreaming as a dissociative disorder will encourage awareness of a growing problem and spur theoretical, research and clinical developments.
Schneiderian first rank symptoms significantly predict a dissociative disorder diagnosis in psychiatric in-patients
(Taylor and Francis, 2025) Kruger, Christa; Fletcher, Lizelle; christa.kruger@up.ac.za
Previous empirical studies on the relationship between psychotic symptoms and dissociative disorders focused on auditory hallucinations only or employed limited statistical analyses. We investigated whether the frequency of Schneiderian first rank symptoms (FRS) predicts the presence or absence of a dissociative disorder (DD). Psychiatric in-patients (n = 116) completed measures of dissociation, FRS and general psychological distress (GPD). DD diagnoses were confirmed by multidisciplinary teams or administering the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised (SCID-D-R). The FRS were recorded in the Multidimensional Inventory of Dissociation (MID) and a mean score obtained for 35 relevant items: Voices arguing, voices commenting, made feelings, made impulses, made actions, influences on body, thought withdrawal, and thought insertion. A global severity index (GSI) of GPD was obtained from the Symptom Checklist–90–Revised (SCL-90- R). Logistic regression models examined whether FRS predict diagnostic classification of patients under a DD (n = 16) or not (n = 100), controlling for GSI. The overall fit of the model was significant (p = .0002). DD was correctly classified using frequency of FRS, controlling for GSI. The latter was moderately associated with FRS (r = 0.56). FRS more than doubled the odds of a DD diagnosis (odds = 2.089; 95% CI = 1.409–3.098; correct classification rate 87.1%). The study provides convincing evidence that FRS are closely related to DDs. FRS should alert clinicians to consider DDs in differential diagnosis of psychiatric in-patients. Future research should analyze whether FRS also predict a diagnosis of schizophrenia or other psychiatric disorders.
Vigour as a marker of positive mental health among social media respondents
(Elsevier, 2024-10) Dlagnekova, Antonia; Van Staden, Werdie; werdie.vanstaden@up.ac.za
BACKGROUND : Quantitative research on vigour as a therapeutically responsive marker of positive mental health, has become possible by virtue of the validation of the Vigour Assessment Scale (VAS). Considering that its validation and therapeutic responsiveness were examined in an avolitional schizophrenia population, using the VAS outside these constraints requires that its psychometric properties be investigated in a more general non-clinical population. METHOD : Social media respondents (n = 787) were recruited on social media through snowball sampling and data were obtained for statistical analyses through an online questionnaire comprising the VAS and measures of work-place vigour, active involvement in personal growth, behavioural activation, procrastination, and fatigue. RESULTS : Convergent validity was confirmed in moderate to strong positive correlations between the VAS and measures approximate to vigour including physical strength (r = 0.805), cognitive liveliness (r = 0.676), planfulness (r = 0.61), and intentional behaviour (r = 0.595). Discriminant validity was evident in negative correlations with procrastination (r = −0.593) and fatigue (r = −0.786). The VAS showed good internal consistency (Cronbach α = 0.951), split-half reliability (r = 0.892), test-retest reliability (r = 0.861), and a low standard error of measurement of 3.73 within a theoretical range of 82 points. Exploratory factor analysis yielded a clear two-factor structure. LIMITATIONS : Results are limited to willing participants who responded through social media. CONCLUSIONS : Vigour may now be measured clinically as an indication of positive mental health and well-being. It may also be further investigated for its relations to other parameters of health, personality, and the efficacy of professional and self-enhancing interventions that aim for the cultivation of vigour.
Agentive steadfastness as trait marker in relation to temperament and character
(Elsevier, 2024-09) Vosloo, Cristel; Van Staden, Werdie; werdie.vanstaden@up.ac.za
BACKGROUND : Agentive steadfastness was identified as a potential trait marker with which to anticipate prognostically that a patient will persevere steadfastly and take congruent action in facing the demands of living. Taken as an enduring expression of personality, this study investigated agentive steadfastness among adult social media respondents (n = 511) in relation to temperament and character as captured in Cloninger's psychobiological model of personality. METHODS : Participants recruited though snowball sampling on social media platforms, applied the 27-item Agentive Steadfastness Index (ASI) and the 240-item Temperament and Character Inventory (TCI-R-240). RESULTS : Agentive steadfastness was statistically predicted by the Self-directedness (β = 0.634), Self-transcendence (β = 0.119), Harm Avoidance (β = -0.142) and the Reward Dependence (β = 0.071) scales, accounting for 63.3 % of the variance in one stepwise regression model. In another stepwise model for the TCI-R-240 subscales, the Purposeful (β = 0.359), Anticipatory Worry (β = -0.353), and the Responsibility (β = 0.259) subscales accounted for respectively 56.8 %, 11.2 % and 2.8 % of the variance in ASI scores. LIMITATIONS : Results are limited to adult social media respondents who were willing to participate. CONCLUSIONS : Agentive steadfastness may serve as a trait marker of well-being and the good prognostic associations that have been established for high self-directedness, low harm avoidance, as well as resilience, and character strengths. It may be assessed clinically to anticipate prognostically the extent to which a patient will persevere steadfastly and take congruent action in facing the demands of living and adversity.
The effects of inpatient suicide on nurses at Weskoppies Hospital : a qualitative study
(AOSIS, 2024-05-21) Zola, Nomthandazo; Mtetwa, Thandazile G.; Khamker, Nadira
BACKGROUND : Inpatient suicide is a serious adverse event in psychiatric wards. Suicide can cause severe trauma to both patients and health professionals, who may develop maladaptation with poor coping skills. Healthcare practitioners are the second victims and historically, this concept has been overlooked. The psychological effects and lack of support have not been sufficiently explored. AIM : The emotional well-being and clinical practice of nurses who experienced inpatient suicide at Weskoppies Psychiatric Hospital was explored. SETTING : Weskoppies Psychiatric Hospital, South Africa. METHODS : In this qualitative case study, 12 nurses who had lost a patient to inpatient suicide some time during their employment were purposefully selected. Data were collected through individual in-depth interviews, which were audio recorded and transcribed. The data were thematically analysed. RESULTS : Nurses were negatively affected by inpatient suicide resulting in a range of emotional and psychological effects, including fear, anger, sadness, flashbacks, guilt, and difficulty in coping. Clinical practice factors included being doubtful and extra vigilant. Although nurses received psychological support from the institution, they recommended in-service training with periodic reviews to prevent and manage inpatient suicide. CONCLUSION : Inpatient suicide is a serious adverse event, and mental health practitioners become second victims. These events do not only impact the psychological well-being of nurses but also influence the clinical practice. Mental health practitioners should receive adequate training and support in preventing and handling inpatient suicide. CONTRIBUTION : This study provided insights into nurse’s perspectives on the effects of inpatient suicide and how they can be supported.
Factors associated with long hospitalisation for psychotic disorder patients in an acute ward : tertiary care hospital
(AOSIS, 2024-04-23) Paliweni-Zwane, Tshepiso I.; Modisane, Lucas N.; Grobler, Gerhard Paul
BACKGROUND : The average length of stay is often used to indicate health system efficiency; shorter stays are associated with reduced costs. In South Africa, mental healthcare expenditure is spent on inpatient care. AIM : To identify factors associated with a long stay in an acute psychiatric unit. SETTING : A tertiary hospital. METHODS : A case-control study review of inpatients diagnosed with psychotic symptoms was used. Sample was divided into two groups, length of stay (LOS) (LOS greater than 21 days, LOS less than 14 days). Total of 82 patients were divided into short stay group (SSG, n = 23) and long stay group (LSG) (n = 59). A comparison of demographic, clinical and system variables was conducted. RESULTS : In demographics, LSG had fewer men compared to SSG (78.3%) and differed statistically from LSG with p = 0.05. Long stay groups were older in comparison to SSG with a p = 0.02. Illicit substance use in LSG was 44.1% and statistically less than SSG (73.91%; p = 0.02). A high proportion of LSG had medical or surgical and psychiatric comorbidities (67.8%) compared to SSG (43.5%) (p = 0.04). A total of 95% patients in SSG had family support. CONCLUSION : Longer stay was found to be associated with older females with primary psychotic disorders. Comorbidities with less availability of family support were associated with younger males presenting with psychotic symptoms that may be related to illicit substances that respond to rapid stabilisation. CONTRIBUTION : Active surveillance of medical comorbidities amongst older female patients is necessary for early liaison services to reduce their length of stay.
Comparing the medication costs of treating patients with schizophrenia who use cannabis with those who do not
(AOSIS, 2024-04-15) Nowbath, Nikhil; Abdelatif, Nada; Lippi, Gian; gian.lippi@up.ac.za
BACKGROUND: Cannabis use is more prevalent among people with schizophrenia than in the general population. This usage detrimentally impacts disease prognosis, contributing to escalated admissions, heightened severity of psychotic symptoms, and reduced medication response. The recent decriminalisation of cannabis in South Africa may lead to an upsurge in usage, consequently intensifying the strain on mental healthcare services. AIM : This study aimed to compare the medication costs of patients with schizophrenia depending on cannabis use. SETTING : Weskoppies Hospital, Pretoria, South Africa, 2018–2019. METHODS : Data pertaining to medication expenses during the 2018–2019 period were acquired from the hospital pharmacy. Data were collected from 114 patient records to form two equal cohorts: one exposed to cannabis and the other non-exposed, as indicated by urine drug screens or admission of cannabis use. Medications prescribed from admission to time of being ready for discharge were recorded and corresponding costs were calculated. RESULTS : Patients who were exposed to cannabis had higher medication costs (R 516.47) than patients who were non-exposed (R 328.69) (p = 0.0519), over the whole admission period. CONCLUSION : Cannabis exposure escalates the financial burden of treating schizophrenia at Weskoppies Hospital. This might be attributed to failure of cost-effective, first-line medications prompting the prescription of costlier, second-line alternatives or higher prescribed dosages. CONTRIBUTION : This study contributes to findings that it is more expensive to treat patients with schizophrenia who have relapsed, if they are using cannabis. This finding has future cost implications when budgeting for pharmacotherapeutic treatment.
Validity and reliability of the agentive steadfastness index
(Wiley, 2024-06) Vosloo, Cristel; Van Staden, Werdie; werdie.vanstaden@up.ac.za
Agentive steadfastness is a hitherto unarticulated and unmeasured construct, although clinicians may have drawn intuitively on it in anticipating clients' prognosis and anticipated responsiveness to adverse events. Following the conceptualisation and articulation of the agentive steadfastness construct and a measure thereof, the current study examined the validity and reliability of the agentive steadfastness index (ASI) among responding adult social media users (n = 511). Results confirmed convergent validity between agentive steadfastness and closest related psychological constructs, which were resilience (r = .715) and character strength (r = .704). Its discriminant validity was observed with other related but notably distinct psychological constructs, which were anxiety (r = −.599) and ego-strength (r = −.244). Temporal stability was confirmed over a period of 6 months (r = .763). The ASI showed good internal (Cronbach alpha = .937) and split-half reliability (r = .838) and a low standard error of measurement of 7.57 points within a theoretical range of 190 points. These results suggest that the ASI is a valid and a reliable measure of agentive steadfastness. Equipped with the ASI, further research is enabled on agentive steadfastness as a psychotherapeutic target and its relations with various aspects of personality, prognosis and adversity.
Ethical principles, challenges and opportunities when conducting genetic counselling for schizophrenia
(Frontiers Media, 2023-06-21) Zingela, Zukiswa; Sokudela, Funeka Brenda; Thungana, Yanga; Van Wyk, Stephan
Ethical challenges of genetic counselling for schizophrenia include effective communication of critical scientific information in an easily understood manner by patients and relatives, and the ability to ensure communication is unencumbered by medical jargon. Levels of literacy in the target population may limit this process, making it difficult for patients to attain the desired levels of informed consent to make crucial decisions during genetic counselling. Multilingualism in target communities may further complicate such communication. This paper outlines the ethical principles, challenges and opportunities facing clinicians when conducting genetic counselling for schizophrenia and how these might be met, drawing on lessons from South African studies. The paper draws on reflections of clinician and researcher experiences gained from clinical practice or research on the genetics of schizophrenia and psychotic disorders in South Africa. The context of genetic studies in schizophrenia is used to illustrate the ethical challenges in genetic counselling for schizophrenia, both in clinical and research settings. Attention is also drawn to multicultural and multilingual populations, particularly where the preferred language lacks a well-developed scientific language of communication for some of the genetic concepts that have to be presented during the genetic counselling process. The authors describe the ethical challenges and how to address these to empower patients and relatives to make well-informed decisions despite these obstacles. Principles applied by clinicians and researchers during the genetic counselling are described. Potential solutions, including the establishment of community advisory boards to address potential ethical challenges inherent to the genetic counselling process, are also shared. Genetic counselling for schizophrenia still faces ethical challenges which require a balance of principles of beneficence, autonomy, informed consent, confidentiality and distributive justice, while striving to present accuracy in the science that guides the process. Evolution in language and cultural competency therefore needs to occur alongside scientific advances in genetic research. Key stakeholders need to partner and build capacity and expertise in genetic counselling through the provision of funding and resources. The goal of partnerships is to empower patients, relatives, clinicians and researchers to share scientific information in a manner guided by empathy while retaining scientific accuracy.
Readmission of adolescent psychiatric patients to a specialised unit in Gauteng, South Africa
(Health and Medical Publishing Group, 2023-07-27) Brown, Sarah-Anne; Moeketsi, Tshepiso D.; Musekiwa, Alfred; Moodley, Saiendhra Vasudevan
BACKGROUND : Readmission rates to child and adolescent psychiatric units among the youth have been reported to be increasing. AIM : The study aimed to determine the readmission rate and factors associated with readmission of adolescent psychiatric patients at a child and adolescent psychiatric unit. SETTING : A specialised psychiatric hospital in Gauteng province, South Africa. METHODS : This retrospective cohort study utilised data from the records of patients admitted to the adolescent inpatient unit over a period of five years. The cumulative incidence and incidence rate of readmission within one year of discharge from the index admission was calculated using survival analysis methods. Characteristics significantly associated with readmission were determined by applying the multivariable Cox proportional hazards regression model. RESULTS : Among the 189 patients included in the analysis, the cumulative incidence of readmission within one year of discharge was 17.5%. The incidence rate was 5.31 readmissions per 10 000 person-days. The final multivariable model showed that a diagnosis of schizophrenia (p = 0.015), a diagnosis of attention deficit hyperactivity disorder (p = 0.039), and coming from a child and youth care centre or temporary safe care (p = 0.018) increased the risk of readmission while having a medical condition (p = 0.008) reduced the risk. CONCLUSION : Psychiatric diagnosis and residential care could be potential risk markers for readmission. Improving the collaboration between health and social services in residential care would be beneficial. CONTRIBUTION : Identifying factors that predispose adolescent psychiatric patients to readmission can inform and improve management and risk assessments.
Factors affecting readmission of adolescent mental healthcare users to a psychiatric hospital
(AOSIS, 2023-11-15) Eichstadt, Stephanie A.; Chetty, Shren; Magagula, T.G.; Swart, Xan
BACKGROUND : Adolescent mental illness is increasing worldwide, leading to more admissions to psychiatric institutions. Many adolescents may require multiple readmissions, which is disruptive to their holistic well-being and costly for the healthcare sector. Identifying especially modifiable risk factors for readmission remains an important step in providing potential areas for improving patient care. AIM : This study investigated the risk factors associated with the readmission of adolescent mental healthcare users to a specialist psychiatric unit. SETTING : The specialist adolescent unit at Weskoppies Psychiatric Hospital. METHODS : In this retrospective study, the clinical files of 345 adolescents admitted between 2015 and 2019 were reviewed. The primary outcome variable was readmission, that is, whether a patient was readmitted to Weskoppies Hospital (n = 98) compared to those with no recorded readmission (n = 247). RESULTS : Readmitted adolescents were significantly younger on first admission compared to the non-readmitted group (13.46 vs 14.26, p = 0.016). Bivariate analysis showed that the readmitted group had a much higher rate of non-adherence to treatment (38.1% vs 10.5%, p = < 0.001). Patients with a family history of mental illness had a significantly higher risk of readmission (52.2% vs 37.5%, p = 0.015). CONCLUSIONS : Adolescents were more likely to be readmitted if they had first admission at a younger age, a family history of mental illness or non-adherence to treatment. CONTRIBUTION : Identifying especially modifiable risk factors for readmission of adolescents to improve patient care, particularly in the South African context where there is a paucity of research on this topic.
Attitudes of medical students regarding legalisation of cannabis and cannabis-education
(AOSIS, 2023-11-07) Eiselen, Evan; Naidu, Kalai; Viljoen, Maryn
BACKGROUND : Recreational and medicinal use of cannabis is topical in the light of more permissive legislation regarding the substance worldwide. AIM : The primary purpose of this study is to determine the attitudes that final-year medical students at the University of Pretoria (UP) hold about recreational and medicinal use of cannabis, as well as determining if they feel they are being adequately trained in this regard. SETTING : The research was conducted at Weskoppies Psychiatric Hospital, affiliated with the UP. METHODS : The study follows a cross-sectional, comparative, quantitative design. Data were collected by means of a structured questionnaire. Final-year medical students were identified as participants via a convenience sampling technique. Participation was voluntary and anonymous. RESULTS : A total of 57 valid responses were recorded. The study shows that most medical students had permissive views about cannabis and that the majority feel that they are not being adequately trained to advise patients about medical cannabis in a lecture setting (64.9%, n = 37) or clinical setting (68.4%, n = 38). Results also show that previous personal experience with cannabis led to more permissive views. CONCLUSION : This study illustrates the need for academic research regarding medicinal cannabis but interestingly shows that medical students want more guidance from their training institution about the topic. CONTRIBUTION : This research shows that the conversation surrounding cannabis in medicine is continuous and universities should make a conscious effort to familiarise students with the topic.
Pathophysiological aspects of exposure to dampness-associated indoor mould and mycotoxins : a mini-overview
(Elsevier, 2023-02) Viljoen, Margaretha; Claassen, Nicolaas
Indoor mould growth presents a potential health risk. The aim of this writing is to provide an overview on the pathophysiological aspects of exposure to dampness-associated indoor mould and mycotoxins. The paper briefly deals with the host’s defence against mould invasion; mechanisms by which moulds can override the host’s de- fence mechanisms; potential adverse health effects posed by moulds, as well as symptoms and disorders associated with exposure to indoor moulds, including respiratory disorders, and non-respiratory disorders. References to re- cent in-depth reviews on specific aspects of the subject are provided. The prominent role of the inflammatory response, both as a defence mechanism against mould invasion and as the basis for mould-associated pathology is pointed out.
The validity of a therapeutic invigoration task in avolitional schizophrenia outpatients
(Wiley, 2024-01) Dlagnekova, Antonia; Van Staden, Werdie; werdie.vanstaden@up.ac.za
BACKGROUND AND OBJECTIVES : Avolition is associated with much morbidity and functional impairment in schizophrenia patients. Vigor may be taken as, in part, the inverse of avolition, but it has not been investigated as a therapeutic pursuit before. To this end, a therapeutic invigoration task was developed drawing on cognitive-behavioral and guided imagery therapies. This study investigated the validity and reliability of a therapeutic invigoration task in avolitional residual phase schizophrenia outpatients. METHODS : In a proof-of-concept quasi-experimental one-group sequentially repeated pretest/posttest study design, patients (n = 76) participated in a structured invigoration task that was repeated after 1 month (n = 70). RESULTS : Patients' vigor during the preceding 7 days measured on the Vigor Assessment Scale increased highly significantly in anticipation of the subsequent 7 days on both occasions with respectively very large (Cohen's δ with Hedges' correction [δ] = 1.46) and large (δ = 1.04) effect sizes. The anticipated vigor after the first occasion was partially consummated during the subsequent month in that vigor during the 7 days preceding the second occasion was lower than participants had anticipated but still significantly higher than at baseline (p < 0.001; δ = 0.70). Repeating the task a month later, together with homework, had a cumulative effect as indicated by a very large effect size (δ = 1.61). CONCLUSION : Results suggest that the invigoration task did what it was supposed do, and did so consistently, in patients with avolitional residual schizophrenia. These results warrant a subsequent randomized controlled trial to establish the efficacy of the invigoration task.
Twelve weeks of additional fish intake improves the cognition of cognitively intact, resource-limited elderly people : a randomized control trial
(Springer, 2022-02) Kühn, Lizette; MacIntyre, Una Elizabeth; Kotze, Carla; Becker, Piet J.; Wenhold, Friedeburg Anna Maria
INTRODUCTION : Dietary omega 3 polyunsaturated fatty acids (PUFA) may reduce the risk of dementia. Many studies have investigated PUFA supplementation in high-income countries, yet food-based randomized control trials using omega 3 PUFA rich fish in lower to middle income countries, are lacking. OBJECTIVE : To determine the effect on cognition of adding either fish or non-fish foods for twelve weeks to an enhanced diet of cognitively intact, independently living, resource-limited elderly people. DESIGN : Randomized control trial (National Health Trial register: DOH-27-061-6026) SETTING : Retirement center in urban South Africa. PARTICIPANTS : Fifty-seven (74% female, mean age: 72±7 years) elderly participants with cognitive function exceeding 22 on the Mini Mental State Examination were randomized into an intervention (n=31) and control (n=26) group. INTERVENTION : The usual diets of both groups were enhanced with context-appropriate foods to mimic elements of the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet. The intervention group additionally received canned pilchards and fish spread every week amounting to an additional (theoretical) intake of 2.2g omega 3 PUFA daily. The control group received canned meatballs and texturized soya every week. MEASUREMENTS : Cognition was measured twice before and once after the intervention phase using the Cognitive Abilities Screening Instrument (CASI). Adherence was assessed by a study-specific food frequency questionnaire and red blood cell (RBC) PUFA biomarkers. Data were analyzed using a non-parametric analysis of covariance (ANCOVA) with, and without, bootstrap imputation. RESULTS : Participants in the intervention group had a significantly higher post intervention (P=0.036) CASI score than the control group, when the model was fitted with imputation and controlled for baseline scores. Participants in the intervention group also had a significantly higher intake of calculated dietary omega 3 PUFA and higher levels of RBC eicosapentaenoic acid and docosapentaenoic acid content than the control group (P < 0.05). CONCLUSION : Twelve weeks of fish intake in the context of a modified MIND diet may improve the cognition of cognitively intact, resource-limited elderly people.

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