South African Journal of Psychiatry

Introducing the ‘Lived Experience’ section of the South African Journal of Psychiatry

Laila Asmal — 2025-02-03

No Abstract

Lived experience narrative: My journey with schizophrenia

Name withheld by request — 2025-02-03

No Abstract

Lived experience narrative: My bipolar odyssey

Samukelisiwe J. Ngcobo — 2025-02-03

No Abstract

A call for communication, compassion and care

Marenet Jordaan — 2025-02-03

No Abstract

The intersection of depression and disability: A personal and professional perspective

Jean E. Augustyn — 2025-02-03

No Abstract

Lived experience narrative: My journey with schizophrenia

Name withheld by request — 2025-02-03

No Abstract

A call for communication, compassion and care

Marenet Jordaan — 2025-02-03

No Abstract

The intersection of depression and disability: A personal and professional perspective

Jean E. Augustyn — 2025-02-03

No Abstract

Corrigendum: A culturally congruent approach to trauma symptom evaluation improves detection of PTSD in people with a first-episode of psychosis in South Africa

Vuyokazi Ntlantsana — 2025-02-03

No Abstract

Nigeria mental health law: Challenges and implications for mental health services

Gerald O. Ozota — 2025-02-03

Background: The Nigerian mental health law titled the Lunacy Act of 1958 has been under scrutiny for violating the human rights of people with mental illness. The call to reform the obsolete Lunacy Act has garnered attention from the government, as the law has been unamended for over 60 years.

Aim: This study presents the challenges and implications of the new mental health law to the mental health services of Nigeria.

Methods: ScienceDirect, PubMed, and Google Scholar were used to find pertinent material. The implications and difficulties facing the new mental health law examined from the literature were discussed. Recommendations were made following an exploratory search for literature on mental health legislation in Nigeria.

Results: The new Law in Section 5(6) saw the introduction of mental health services in primary and secondary healthcare. It also addresses critical issues such as non-discrimination, fundamental human rights, standards of treatment, access to information, confidentiality and autonomy, and the employment rights of persons with mental health and substance abuserelated disorders. The Law failed to include mental health services in the country’s health insurance system.

Conclusion: There is a need for legislation to meet people’s mental health needs and encourage them to seek treatments, such as regulations that protect against discrimination and harsh treatment of people with mental illness.

Contribution: Nigerian mental health services would benefit from the new mental health law if the key issues raised in this review are addressed.

Adverse childhood experiences, mental illness, HIV and offending among female inmates in Durban, South Africa

Samantha Naidoo — 2025-02-03

Background: 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.

Aim: 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.

Setting: The study was conducted at the largest correctional centre in Durban, KwaZuluNatal, South Africa.

Methods: 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.

Results: 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.

Conclusion: 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.

Contribution: This study contributes to the emerging literature on adverse childhood experiences (ACEs) and their associations among incarcerated female populations, in a lowand middle-income, South African setting

Contraceptive use in women with mental illness in Soweto, South Africa

Lisa J. Galvin — 2025-02-03

Background: 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.

Aim: 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.

Settings: This quantitative cross-sectional study was conducted at Chris Hani Baragwanath psychiatric unit in Soweto, South Africa.

Methods: 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.

Results: Consistent contraceptive usage occurred in 44.7% of participants. Family planning education was low (26.8%). Relationship status was associated with using contraception consistently (p = 0.0229). Teratogen exposure was not associated with either contraceptive use or FPE. Family planning education was not associated with contraceptive use.

Conclusion: 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.

Contribution: Family planning education must be prioritised in women with MI, especially among women prescribed teratogenic medication, highlighting the risks associated with unplanned pregnancy

Family Psycho-Social Involvement Intervention for severe mental illness in Uganda

Racheal Alinaitwe — 2025-02-03

Background: Treatment rates for severe mental illness (SMI) are low in low- and middleincome countries because of limited resources. Enlisting family support could be effective and low cost in improving patient outcomes.

Aim: The article assess the feasibility, acceptability and estimates of efficacy of Family Psychosocial Involvement Intervention (FAPII) for patients with SMI.

Setting: Masaka Regional Referral Hospital and Mityana District Hospital in Uganda.

Methods: 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).

Results: At 6 and 12 months, there was significant improvement in the QoL in the intervention group compared to the control (p = 0.001). There was significant symptom reduction in the intervention group at 6 and 12 months (p < 0.001). Family Psychosocial Involvement Intervention affected better treatment adherence at 6 and 12 months (p = 0.035 and p < 0.001, respectively) compared to the control arm.

Conclusion: 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.

Contribution: The results support involvement of family in the care of patients with SMI.

Substance use patterns in an adolescent psychiatric unit in Johannesburg, South Africa

Vuyani W. Nxumalo — 2025-02-03

Background: 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.

Aim: 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.

Settings: This study was conducted at the Tara H. Moross Centre (Tara Hospital), in Johannesburg in the Gauteng province of South Africa.

Methods: This was a retrospective comparative record review of all patients admitted to the adolescent unit over the 4 years.

Results: A lifetime history of substance use was documented in 44.1% (n = 52) of the 118 patient’s records included in the final analysis. Cannabis was the most frequently used substance (n = 36, 69.2%). There were significant differences between the SU and substance nonuser groups regarding family structure (p = 0.012), family history of substance abuse (p = 0.046) and conflict within the family (p < 0.001).

Conclusion: 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.

Contribution: 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.

Antipsychotics-related hyperprolactinaemia among patients with schizophrenia in Maiduguri

Falmata B. Shettima — 2025-02-03

Background: 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.

Aim: The study aimed to evaluate the patterns and correlates of hyperprolactinemia among patients with schizophrenia on antipsychotic medications.

Setting: The study was conducted in a psychiatric facility in Maiduguri, Northeastern Nigeria.

Methods: 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 (p < 0.05) were subjected to logistic regression analysis.

Results: 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, p = 0.002), high overall drug dosage (β = 2.340, p = 0.003), high-dose typical antipsychotics (β = 3.228, p = 0.000), twice daily dosing frequency (β = 2.751, p = 0.001) and polypharmacy (β = 1.828, p = 0.0024).

Conclusion: 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.

Contribution: The study provides evidence for the rational use of antipsychotic medications in sub-Saharan Africa

The valproate prescription pattern for female mental healthcare users of reproductive age

Phumla S. Gasa — 2025-02-03

No Abstract

Social, forensic, and clinical correlates in female observandi referred for non-violent crimes

Muthumuni Nemavhola — 2025-02-03

Background: Globally, crime is highly masculinised and research into female criminality is scarce. In South Africa, no research specifically investigating the characteristics of female observandi referred for non-violent crimes has been published.

Aims: The study aimed to describe the socio-demographic, clinical, and forensic correlates in women referred to Sterkfontein Hospital for forensic psychiatric observation following a nonviolent criminal charge between 2010 and 2019. It also sought to establish the relationship between the correlates and fitness to stand trial and criminal responsibility, as well as the relationship between the socio-demographic characteristics and the different non-violent criminal charges.

Setting: Sterkfontein Hospital.

Methods: A retrospective record review of all cases referred to Sterkfontein Hospital for a single observation over 10 years was conducted.

Results: Sixty-five cases were included in the study. Most observandi referred for nonviolent crimes were found to be single (84.6%), unemployed (67.7%), reported abuse (55.4%), and had a high prevalence of mental illness (90.8%). Non-adherence to treatment was identified in 59.1% and substance use was identified in 72.2% of the study sample. The most common charge was theft (64.6%). The majority of the sample was found fit and responsible (57%). Bipolar (21%) and Primary Psychotic Disorders (35.7%) were associated with statistically significant outcomes of trial incompetence (p = 0.005) and lack of responsibility (p = 0.028).

Conclusion: It is recommended that prospective studies are conducted which include comparisons with male counterparts and females referred for violent crimes.

Contribution: The study identified correlates that should be included in the standard of care in forensic assessments of female observandi.

Health effects of caregiving and coping with severe mental disorders: A caregivers’ experience

Olindah Silaule — 2025-02-03

Background: Informal caregivers are an essential health resource in the care of persons with severe mental disorders, particularly in South Africa where access to mental healthcare services is limited.

Aim: The study aimed to explore and describe the coping strategies used by informal caregivers and the specific health impacts they face in the context of severe mental disorders in South Africa.

Setting: The study was conducted in Bushbuckridge municipality situated in the northeastern parts of Mpumalanga province, South Africa.

Methods: A descriptive qualitative methodology was used to conduct semi-structured interviews with 12 purposefully selected participants. Audio-recorded interviews were translated, transcribed and analysed inductively on NVivo12 using reflexive thematic analysis.

Results: The themes identified were caregivers’ experience of consequences of caregiving and caregivers’ experience of coping with their caregiving role. Participants experienced negative consequences on their emotional, mental and physical health. The participants use internal and external resources to cope with the challenges they face, and many highlighted using emotion-focused coping strategies.

Conclusion: The findings revealed an urgent need to develop support strategies to strengthen informal caregivers’ coping and promote good health particularly in rural South Africa where informal caregivers play a crucial role in the management of severe mental disorders.

Contribution: The finding demands that policymakers and healthcare providers prioritise the health and well- being of the informal caregivers. There should be policies targeted specifically at developing and implementing caregiver-orientated healthcare services.

The gendered context of women charged with violent offences in the forensic psychiatric setting

Mohammed Nagdee — 2025-02-03

Background: Women charged with violent offences may be referred by courts for forensic psychiatric assessment to determine whether mental disorder or intellectual disability impacts their fitness to stand trial and/or criminal responsibility. The profile of these women is a poorly researched area in South Africa.

Aim: This study examined the socio-demographic, offence-related, and clinical profile of South African women charged with violent offences referred for forensic assessment.

Setting: Fort England Hospital (FEH), a forensic psychiatric institution in the Eastern Cape.

Methods: The clinical records of 173 women referred by courts for forensic psychiatric evaluation over a 24-year period (1993–2017) to FEH were systematically reviewed.

Results: Most women were single, black mothers with dependent children, who were unemployed and socio-economically impoverished. Many had backgrounds of pre-offence mental illness, alcohol use and alleged abuse. The majority were first-time offenders whose victims were known to them. Most child victims were biological children killed by their mothers. Likely primary motives for violence were related to psychopathology in half of cases, and interpersonal conflict in a third. Forensic assessment most frequently confirmed psychotic disorders and dual diagnoses. Half the cases were fit to stand trial and under half were criminally responsible.

Conclusion: Violent female offending occurs within a gendered context, with high rates of prior trauma, alcohol use and psychosocial distress in perpetrators. An emphasis on gendersensitive psychosocial interventions is required.

Contribution: This study highlights the nature and context of violent offending by women referred for forensic psychiatric assessment in South Africa.

Prevalence and determinants of burnout among South African doctors during the COVID-19 pandemic

Saajida Khan — 2025-02-03

Background: Burnout, resulting from chronic workplace stress that has been unsuccessfully managed, has previously been documented in doctors. The coronavirus disease 2019 (COVID-19) pandemic has increased occupational challenges faced by doctors, potentiating their risk for burnout.

Aim: This study aimed to determine the prevalence and determinants of burnout among medical doctors during the COVID-19 pandemic.

Setting: Three public sector hospitals in Gqeberha, South Africa.

Methods: A cross-sectional study of 260 voluntary participants was conducted. Participants completed self-administered electronic questionnaires. Logistic regression analysis was performed to explore the determinants of burnout.

Results: The prevalence of burnout in this study was 78%. Burnout was significantly associated with being a medical intern or community-service medical officer (adjusted odd ratio [AOR] = 6.72, 1.71–26.40), being in the lowest income band (AOR = 10.78, 2.55–45.49), and using alcohol to manage work-related stress (AOR = 3.01, 1.12–8.04). Job- related factors associated with burnout were experiencing high conflict at work (AOR = 5.04, 1.92–13.20) and high role ambiguity and role conflict (AOR = 4.49, 1.98–10.18). Low support at work (AOR = 9.99, 3.66–27.23), medium job satisfaction (AOR = 5.38, 2.65–10.93) and medium support at work (AOR = 3.39, 1.71–6.73) were positively associated with burnout. Participants with medium (AOR = 0.28, 0.10– 0.80) and high levels of resilience (AOR = 0.08, 0.03–0.25) were protected against burnout. Coronavirus disease 2019-related factors were not significantly associated with burnout.

Conclusion: The burnout prevalence among South African medical doctors at public hospitals during the COVID-19 pandemic was high and strongly associated with job stress factors.

Contribution: Given the increased prevalence of burnout among doctors and the strong associations with job stress factors, mitigation of burnout requires targeted organisational interventions.

COVID-19 experience of people with severe mental health conditions and families in South Africa

Carrie Brooke-Sumner — 2025-02-03

Background: People with severe mental health conditions, such as schizophrenia, and their family caregivers are underserved in low- and middle-income countries where structured psychosocial support in the community is often lacking. This can present challenges to recovery and for coping with additional strains, such as a pandemic.

Aim: This study explored the experiences and coping strategies of people with lived experience of a severe mental health condition, and family caregivers, in South Africa during the initial stages of the coronavirus disease 2019 (COVID-19) pandemic.

Setting: This qualitative study was conducted in the Nelson Mandela Bay District, Eastern Cape, South Africa, in the most restrictive period of the COVID-19 lockdown.

Methods: Telephonic qualitative interviews were conducted with people with lived experience (n = 14) and caregivers (n = 15). Audio recordings were transcribed and translated to English from isiXhosa. Thematic analysis was conducted with NVivo 12.

Results: Participants described negative impacts including increased material hardship, intensified social isolation and heightened anxiety, particularly among caregivers who had multiple caregiving responsibilities. Coping strategies included finding ways to not only get support from others but also give support, engaging in productive activities and taking care of physical health. The main limitation was inclusion only of people with access to a telephone.

Conclusion: Support needs for people with severe mental health conditions and their families should include opportunities for social interaction and sharing coping strategies as well as bolstering financial security.

Contribution: These findings indicate that current support for this vulnerable group is inadequate, and resource allocation for implementation of additional community-based, recovery-focused services for families must be prioritised.

Comparing the medication costs of treating patients with schizophrenia who use cannabis with those who do not

Nikhil Nowbath — 2025-02-03

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.

Demographic and mental health profile of youth in a gender service: An African case series

Simon D. Pickstone-Taylor — 2025-02-03

Background: Despite a massive global increase in research on gender-diverse youth, there have been no studies in Africa on gender- diverse children and adolescents presenting to health services.

Aim: This study aimed to present the first African findings of the demographic and mental health profile of youth who have presented at a gender service in South Africa.

Setting: A specialist mental health outpatient service, consisting of psychiatry, psychology and nursing input, for gender-diverse child and adolescent patients in the Western Cape.

Methods: All consenting youth seen at a gender service, consisting of psychiatry, psychology and nursing input, in state and by the same clinician in private practice between January 2012 and May 2019 were participants of a retrospective, sequential case series study. Data of interest, including gender identity and sexuality, mental health history and social information, were extracted from the psychiatry files of participants.

Results: Thirty-nine participants were part of the registry and qualified for the study: 72% selfidentified as white, 15% as coloured and 13% as black African. The rate of co- occurring psychopathology was high (64%) and included high rates of autism, particularly in trans males (26%), suicidal ideation in 31% and a history of suicide attempt(s) in 10%.

Conclusions: This first study describing gender-diverse youth seeking support relating to their gender identity in Africa showed they had remarkable similarities to those studied internationally.

Contribution: Establishing that transgender youth of all major racial groups in the province with similar demographic profiles to other parts of the world are presenting to services in South Africa and in need of mental health support and interventions.

Schizophrenia and schizoaffective disorder: Length of stay and associated factors

Ladawa Y. Goga — 2025-02-03

Background: Patients with schizophrenia and schizoaffective disorder often require longer admissions.

Aim: To explore length of stay (LOS) and associated factors of patients with schizophrenia and schizoaffective disorder, admitted to a public sector specialised psychiatric hospital, over a 4-year period.

Setting: The study was conducted at Tara Hospital in Johannesburg.

Methods: A retrospective record review of 367 adult schizophrenia and schizoaffective disorder patients admitted between 01 January 2015 and 31 December 2018. Average LOS was calculated and the proportion of short-stay (< 30 days), medium-stay (31–90 days) and longstay (> 90 days) admissions determined. Sociodemographic, clinical and admission outcome data were collected and analysed from a randomly selected subset of patients in each LOS category.

Results: Mean LOS was 128 days (median 87, interquartile range [IQR] 49–164, range 0–755 days). A significantly greater proportion had long-stay admissions (p < 0.001). Male gender (p = 0.018), being unmarried (p = 0.006), treatment resistant (p < 0.001) and on clozapine (p = 0.009) were factors found to have a significant association with long-stay admissions. Rates of unemployment (> 80%), comorbid substance use disorders (> 40%), medical illnesses (> 40%), antipsychotic polypharmacy (> 40%) and readmissions (> 80%) were high. Most (> 80%) were discharged.

Conclusion: Long-stay admissions were frequently required for patients with schizophrenia and schizoaffective disorder admitted to Tara Hospital.

Contribution: This study highlights factors associated with long-stay admissions in patients with schizophrenia and schizoaffective disorder. More research is needed into whether increased access to community-based services, such as residential and daycare facilities, outpatient substance rehabilitation programmes and dual diagnosis clinics, could translate into shorter admissions, less frequent relapses and improved outcomes in this population.

Nurses’ practice of metabolic monitoring for patients on antipsychotics in Lesotho

Relebohile P. Matete — 2025-02-03

Background: Severe mental illness is associated with higher physical health morbidities and reduced life expectancy, with an estimated 14.3% of global deaths attributed to mental disorders. Antipsychotic medications (APs) used in treatment contribute to physical health issues, including metabolic and cardiovascular effects.

Aim: The aim of this study was to assess nurses’ practices regarding metabolic monitoring for patients prescribed antipsychotic medications at Mohlomi Hospital in Lesotho.

Setting: The study was conducted at Mohlomi Hospital, the primary psychiatric facility in Lesotho.

Methods: Using a cross-sectional design, 44 nurses from Mohlomi Hospital participated in the study. A structured questionnaire assessed nurses’ metabolic monitoring practices.

Results: Most of the respondents were female (n = 30, 75%), and minority were male (n = 10, 25%). The academic qualifications of respondents were distributed as follows: 40% (16) held a nursing assistant certificate and 22.5% (9) held an advanced nursing diploma, among others. The average age of all respondents was 39.05 (s.d. 8.9), with an average of 8 years of experience in psychiatry (s.d. 7.6). The overall rate of nurses’ practices of metabolic monitoring for patients taking antipsychotic medications showed variability, with a mean score of 2.83 (s.d. 0.524). However, only 20% performed ECG tests, 22.5% measured blood pressure, 27.5% tested for glucose abnormalities and 17.5% conducted lipid profile testing.

Conclusion: Results revealed a significant gap in the practice of metabolic monitoring among nurses with various aspects of metabolic monitoring, not being adequately monitored.

Contribution: The study’s findings shall inform policy and guidelines for monitoring patients on antipsychotic medications while guiding future research.

Suicidal behaviour among patients with congestive cardiac failure in a Nigerian teaching hospital

Tomilola O. Shofu-Akanji — 2025-02-03

Background: Suicidal behaviour is an established psychiatric complication of congestive cardiac failure (CCF), contributing significantly to morbidity and death by suicide. The magnitude and risk factors for suicidal behaviour among patients with CCF are yet to be unpacked, especially in developing nations such as Nigeria.

Aim: To determine the prevalence of suicidal behaviour and the risk factors associated with suicidal behaviour, among patients with CCF in Nigeria.

Setting: Cardiology outpatient clinic of Lagos State University Teaching Hospital, Lagos, Nigeria.

Methods: A cross-sectional study was conducted among 98 randomly selected patients with a diagnosis of CCF. Participants were assessed with a socio-demographic and clinical factors questionnaire and Beck Scale of Suicidal Ideation. Chi-square test, t-test and logistic regression were used to analyse data.

Results: The prevalence of suicidal ideation and suicidal attempt among patients with CCF was 52% and 1%, respectively. No socio-demographic factor was significantly associated with suicidal ideation. Clinical factors associated with suicidal ideation were age at diagnosis ( p = 0.042), aetiology of CCF (p = 0.001) and severity of CCF (p = 0.032). Only the severity of CCF (odds ratio [OR] = 20.557, p = 0.014) predicted suicidal ideation among patients with CCF.

Conclusion: Suicidal behaviour constitutes a huge burden among the outpatient CCF population. The identification of clinical risk factors for suicidal ideation (age at diagnosis, aetiology and severity of CCF) further illuminates a pathway to mortality among patients with CCF.

Contribution: The findings lend a voice to the need for screening for suicidal behaviour, suicide prevention programmes, surveillance systems and government policies that support mental health for patients with CCF.

Factors associated with long hospitalisation for psychotic disorder patients in an acute ward: Tertiary care hospital

Tshepiso I. Paliweni-Zwane — 2025-02-03

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

South African mental healthcare providers’ views about exercise for people with mental illness

Belinda S. Marais — 2025-02-03

Background: People living with mental illness (PWMI) have significantly reduced life expectancy compared to the general population, yet mental healthcare providers (MHCPs) do not regularly prescribe exercise, despite its proven health benefits.

Aim: This study aimed to evaluate South African MHCPs’ views regarding exercise for PWMI.

Setting: A cross-sectional descriptive study conducted across five public sector specialised psychiatric units in Gauteng.

Methods: Mental healthcare providers were surveyed using the Exercise in Mental Illness Questionnaire – Health Professionals Version.

Results: Most participants were nurses (49.1%) and doctors (26.2%) and reported no prior formal training in exercise prescription (79.4%). The vast majority (up to 89.7%) agreed regarding the physical benefits of exercise, particularly cardiometabolic benefits. The most common barriers, as perceived by MHCPs, to exercise participation for PWMI were: stigma (56.5%) and medication side effects (56.5%). The majority (76.2%) reported prescribing exercise for PWMI at least ‘occasionally’. The method most frequently used was personal discussion (77.3%) and aerobic exercise was most frequently recommended (81.0%). Specific instructions regarding physical activity recommendations however were often not provided. Regarding MHCPs personal exercise habits, only a third (34%) met physical activity guidelines. Most MHCPs (92.1%) indicated an interest in further training regarding exercise for PWMI.

Conclusion: Mental healthcare providers were supportive of exercise for PWMI. Strategies to address the stigma around mental illness and medication side- effects, to improve training regarding exercise prescription, as well as the exercise habits of MHCPs themselves, and collaboration with exercise professionals and organisations are recommended.

Contribution: This study provides insight into the views of South African MHCPs regarding exercise for PWMI.

Psychiatric nurses advocating for the human rights of mental health care users in Gauteng

Nompumelelo Ntshingila — 2025-02-03

Background: Psychiatric nurses play an important role in advocating for mental health care users such as advocating for the care, treatment and rehabilitation of mental health care users (MHCUs). Psychiatric nurses face various challenges while advocating for the human rights of MHCUs, particularly those unable to protect their rights because of the severity of their mental health conditions.

Aim: This study aimed to explore and describe psychiatric nurses’ lived experiences in advocating for the human rights of MHCUs in the Gauteng province.

Setting: The study was conducted within the primary healthcare (PHC) setting’s mental health services, Sedibeng District, Gauteng province.

Methods: The study employed a qualitative, exploratory, descriptive and contextual research design. Three phenomenological focus group interviews were conducted, and audio recorded to collect data. Data were analysed using Tesch’s method.

Results: Three themes emerged: (1) advocating for human rights was a strong push and an exhausting plea for psychiatric nurses in their attempts to voice and protect MHCUs’ rights; (2) MHCUs and mental health services were discriminated against and excluded by various stakeholders; mental health awareness should be raised and (3) training needs to be conducted as a matter of urgency in order to destigmatise mental illness from government to societal level.

Conclusion: Psychiatric nurses experienced feelings of disempowerment, frustration and helplessness in advocating for MHCUs’ human rights.

Contribution: The study’s findings will contribute to the body of knowledge in clinical psychiatric mental health practice on advocating for the human rights of MHCUs

Long-term benzodiazepine prescriptions in community psychiatry clinics

Machipi A. Tau — 2025-02-03

Background: Anecdotal evidence indicates that the prevalence of long-term benzodiazepine prescription is high and not in accordance with accepted prescribing guidelines.

Aim: To determine the prevalence of long-term prescriptions of benzodiazepines and associations thereof in community psychiatry clinics.

Setting: Of the 27 community psychiatry clinics, 5 were randomly selected.

Methods: A descriptive, retrospective, and cross-sectional record review of files of 126 adult patients was conducted, to obtain sociodemographic and clinical characteristics. Descriptive statistics were presented as proportions and percentages. Fisher’s exact test was used to determine any associations between long-term benzodiazepines use and demographic and clinical variables. Regression analyses were performed to determine the significance of any such associations.

Results: Approximately one out of every four patients were prescribed benzodiazepines. Most of the patients were males aged between 18 and 50 years, single and unemployed. The most common psychiatric diagnoses were bipolar disorders and psychotic disorders, and the majority had no comorbid medical illnesses or substance use. Ninety- three per cent of the patients were prescribed long-term (more than 180 days) benzodiazepines. There were no statistically significant associations between prescribing patterns and any sociodemographic and clinical characteristics (p > 0.05).

Conclusion: This study found that nearly all the benzodiazepine prescriptions were long-term (over 180 days) and no statistically significant associations between this practice and any sociodemographic and clinical characteristics could be established.

Contribution: There is high prevalence rate of long- term benzodiazepine prescription in community psychiatry clinics, and as such clinical monitoring systems need to be established and enforced.

Views held by South African primary health care nurses on caring for people living with mental illness

Nokukhanya Phungula — 2025-02-03

Background: Primary healthcare is the first point of entry into the healthcare system. Scaling up primary mental healthcare is recommended in South African mental health policy. However, there is a paucity of data exploring the views of primary healthcare nurses (PHCNs) with regards to caring for people living with mental illness (PLWMI) in South Africa.

Aim: To explore the views of PHCNs around caring for PLWMI and task shifting.

Setting: A community health centre in Gauteng province, South Africa.

Methods: A qualitative study design using the framework approach was employed. Semi-structured individual interviews were conducted among a convenient sample of PHCNs in a community health centre in Gauteng. Interviews were transcribed and data analysed thematically.

Results: Eight PHCNs were interviewed in June 2022. Five themes emerged: (1) participants highlighted their current practice which excludes mental healthcare; (2) participants described feeling fearful of caring for PLWMI; (3) participants ascribed their lack of confidence in caring for PLWMI largely due to insufficient under- and post-graduate mental healthcare training. (4) task shifting was not welcome due to inadequate mental healthcare training and preexisting challenges in the healthcare system; and (5) recommendations to prioritise mental healthcare training prior to implementing task shifting were made.

Conclusion: Primary healthcare nurses, although empathic towards PLWMI, expressed discomfort with caring for them. This is influenced by multiple factors, some of which may be addressed by improved training and support.

Contribution: This study provides insight into how PHCNs feel about caring for PLWMI and task shifting

Clinical profile of children and adolescents with autism spectrum disorder in Durban, South Africa

Manisharani Gangai — 2025-02-03

Background: There are often delays in accessing care and diagnosing autism spectrum disorders (ASDs), with little data from Southern Africa on the clinical profile of affected children and adolescents.

Aim: To describe the socio-demographic and clinical variables of children and adolescents with ASD attending psychiatric services at two state hospitals in eThekwini Municipality, KwaZulu-Natal province, South Africa.

Setting: Two state hospitals in KwaZulu-Natal province, South Africa.

Methods: The retrospective chart review examined patient records for the period 01 January 2018 to 31 December 2021. Data were collated using a structured data questionnaire on birth and family history, current presentation, comorbid conditions, medications, and nonpharmacological interventions.

Results: Of the 67 children and adolescents accessing care for ASD during the study period (including the coronavirus disease 2019 [COVID-19] pandemic lockdown period), most were males (89%), with a mean age standard deviation (s.d.) of 10.69 (s.d. 2.64) years. There was a delay between recognition of first symptoms and an ASD diagnosis of approximately three years. The most common reasons for referral were behavioural problems and speech delay, with 57 patients having delayed milestones (85%). Comorbid attention deficit hyperactivity disorder was reported in 55.2% (n = 37) of the patients and intellectual disability in 50.7% (n = 34), and the commonest comorbid medical condition was epilepsy (n = 20; 29.8%). All participants were on psychotropic medications, with 40 (59%) being on more than one agent.

Conclusion: The delay in diagnosing ASD, high rates of comorbidity, and need for polypharmacy are concerning.

Contribution: The study highlights the need for greater awareness of ASD in communities and health care workers to expedite diagnosis and facilitate prompt psychosocial support and rehabilitation.

The effects of inpatient suicide on nurses at Weskoppies Hospital: A qualitative study

Nomthandazo Zola — 2025-02-03

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.

Caregiver burden and its sociodemographic determinants in family caregivers of patients with schizophrenia attending a psychiatric tertiary hospital in South Africa

Chioma O. Onyia — 2025-02-03

Background: Chronic mental illnesses such as schizophrenia affect patients’ functioning, making caregiving necessary although burdensome.

Aim: This study aimed to determine caregiver burden and its sociodemographic determinants in family caregivers of patients with schizophrenia attending a Psychiatric Outpatient Department (POD).

Setting: Tertiary hospital in Northern Pretoria, South Africa.

Methods: In this cross-sectional study conducted over 3 months, 300 consecutive family caregivers who attended the POD were administered a 22-item Zarit Burden Interview (ZBI-22), which has a score of 0–88, with higher values indicating more burden. Their sociodemographic characteristics were ascertained. Linear and ordinal logistic regression analyses were performed to identify determinants or predictors of total and severe burdens, respectively.

Results: Most caregivers were aged 46.0 ± 14 years, females (62%), parents (39%), of low-income status (93.7%), had secondary education (70%), resided with the patient (87%), and helped with all troublesome activities (95.3%). The median ZBI-22 score was 19.0 (interquartile range: 13.0–30.5). The determinants of both total and severe burdens were: caregiver age ≥ 50 years adjusted odds ratio (aOR): 2.55, confidence interval (CI): 1.49–4.36; residential area farther away from the hospital aOR: 1.76, CI: 1.3–2.99; increasing months of caregiving aOR: 1.0, CI: 1.001– 1.009, p = 0.006; and not having another family member that needs care aOR: 0.43, CI: 0.24–0.78.

Conclusion: Having mental healthcare facilities close to residential areas and assisting caregivers aged ≥ 50 years who have multiple family members who need care may alleviate the burden.

Contribution: Predicting total and severe caregiver burdens contemporaneously is effective for identifying potential burden interventions

Demographic and clinical correlates of depression among older adults with arthritis in Nigeria

Yesiru A. Kareem — 2025-02-03

Background: Older adults have a high prevalence of chronic conditions like arthritis with morbidities, especially depression ranging up to 40% – 70%. Therefore, it is important to explore depression in older adults with arthritis.

Aim: This study aimed to determine if any demographic and clinical factors are associated with depression in older adults aged ≥ 60 years with arthritis attending a rheumatology clinic

Setting: This is a cross-sectional study conducted over 6 months among 127 older adults on follow-up care in a university teaching hospital in the North-Eastern region of Nigeria.

Methods: A clinical proforma with information about the type of arthritis, duration of illness, hospitalisation, use of medications, co- morbidity was utilised for the data collection. The Geriatric Depression Scale (GDS-30), sociodemographic questionnaire and clinical proforma were administered. Data were analysed using Statistical Product and Service Solutions (SPSS) version 26.0 with the level of significance set as 0.05.

Results: The mean age (± standard deviation [s.d.]) was 66.6 (± 5.5) years, with males constituting 57.5%. The prevalence of depression was 57.8%. Osteoarthritis 30.2%, while 69.8% had rheumatoid arthritis. Sociodemographic factors associated with depression include age (p = 0.049), marital status (p = 0.001), and level of education (p = 0.001). Duration of illness (p = 0.02), hospitalisation (p = 0.03), and number of medications (p = 0.01) were clinical factors associated with depression score.

Conclusion: The prevalence of depression in older people with arthritis is high and was associated with females, the widowed, no formal education; and those with long duration of illness, those using multiple medications, and those with repeated hospitalisation.

Contribution: This finding can enhance the suspicion index for depression to establish standard operating procedures, which will help to improve therapeutic practice for caring for the older adult age group.

A description of COVID-19 related delusional content in admissions to an acute psychiatric unit

Marc D. Stopford — 2025-02-03

Background: The COVID-19 pandemic had a profound global impact, affecting individuals, including those with mental illness, through early and widespread information dissemination. Although the neurobiological basis of delusions remains unclear, external stimuli and historical events are known to influence them. The pandemic provided a unique opportunity to explore this phenomenon.

Aim: To determine the prevalence of COVID-19-related delusional content, among individuals presenting for treatment of psychosis during the peak of the COVID-19 pandemic and investigate associated clinical and demographic factors.

Setting: Chris Hani Baragwanath Academic Hospital in-patient psychiatry department.

Methods: Data were extracted retrospectively from adult psychiatric admissions spanning April to September 2020 on patients whose presenting complaints included delusions. Demographic factors, symptoms, psychiatric, medical and substance use history, and a documented Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnosis by the attending psychiatrist were collected.

Results: The prevalence of COVID-19-related delusional content was 25.5%. Significant demographic association was observed with education level of Grade 12 and above (p = 0.000338). The odds of a diagnosis of schizophrenia and related disorders were 2.72 times greater than mood and psychotic disorder due to another medical condition in those with COVID- 19-related delusional content (OR 2.19, 95% CI: [1.4-3.4]).

Conclusion: The presence of COVID-19-related delusional content in patients admitted to hospital with psychosis provides further evidence of the role of external stimuli in the formation of delusions.

Contribution: This study underscores the influence of socio-cultural factors on delusions and advocates for interventions and expanded research to address mental health outcomes.

The prevalence of anxiety in pregnant women at Chris Hani Baragwanath Academic Hospital

Lisha Narayan — 2025-02-03

Background: Non-psychotic mental disorders are common during the perinatal period. In South Africa, there are few studies on antenatal anxiety and these results vary. Antenatal anxiety does not only add to the burden of perinatal co-morbidity but has subsequent immediate and long-term effects on the mother, birth outcomes and her offspring.

Aim: The aim of this study was to determine the prevalence of anxiety symptoms in pregnant women during the antenatal period and to determine associated factors.

Setting: The study was conducted at an antenatal clinic located in Chris Hani Baragwanath Academic Hospital (CHBAH), Soweto, Johannesburg. Data were collected from March to December 2022.

Methods: This was a prospective, cross-sectional study in which 200 pregnant women were interviewed. A biographical questionnaire and the generalised anxiety disorder questionnaire (GAD-7) were administered.

Results: The prevalence of anxiety symptoms in pregnant women attending the antenatal clinic was 33%. Participants with anxiety were younger, employed and had lower perceived social support. Women with planned and wanted pregnancies had a lower prevalence of anxiety.

Conclusion: One-third of the pregnant women screened positive for anxiety symptoms on the GAD-7. This is significantly higher compared to other studies carried out in the same facility previously. High-risk groups should be screened for anxiety.

Contribution: This study prompts further studies and guiding policies on routine screening of pregnant women for anxiety and other mental illnesses during pregnancy.

Antipsychotics and chronic dystonia at a Botulinum Toxin clinic

Mahlatse Thosago — 2025-02-03

Background: Chronic dystonia, characterised by sustained muscle contractions and abnormal postures, poses clinical challenges, especially when associated with antipsychotic medication use.
Aim: To delineate the demographic and clinical profiles of adults with dystonia and examine the association with antipsychotic medication.
Setting: Botulinum Toxin Clinic at Tygerberg Hospital, Cape Town, South Africa.
Methods: We conducted a retrospective cohort study of adult patients seen at the Botulinum Toxin Clinic between January 2018 and June 2022.
Results: Of the 119 patients studied, those assessed with antipsychotic-induced dystonia (32.69%) presented at a younger age (p < 0.001), were more likely female (p = 0.04), received higher average dose of Botulinum toxin (p < 0.001), and incurred a higher estimated Botulinum toxin treatment cost (p = 0.01) compared to those with primary dystonia. Logistic regression identified age and Botulinum toxin dose as factors associated with psychotropic-related dystonia (p = 0.005 and p = 0.012, respectively).
Conclusion: Clinical and demographic factors are associated with dystonia in adults taking antipsychotic medication. These patients generally manifested symptoms at an earlier age, had a higher male prevalence, and required prolonged treatment with Botulinum toxin, leading to increased costs. In those assessed with antipsychotic-induced dystonia, a comorbid diagnosis of a mood disorder was more common than that of a psychotic disorder.

Contribution: By identifying the demographic and clinical profile of individuals with dystonia because of antipsychotic medication, this study provides a basis for preventative strategies and enhanced patient care.

Scheduling of methylphenidate: Preventing misuse or impeding ADHD treatment adherence?

Renata Schoeman — 2025-02-03

Background: Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, with a chronic, and potentially debilitating course if untreated. Medication adherence is poor – negatively affecting emotional, social, educational and employment outcomes. The current Schedule 6 status of methylphenidate (MPH) drives healthcare resource utilisation and costs – a potential barrier to care.

Aim: This study explored stakeholders’ understanding and perceptions of the potential impact of a regulatory shift in the scheduling of MPH on treatment accessibility and adherence for ADHD.

Setting: Participants from multiple stakeholder groups, involved in ADHD management in South Africa, were recruited via professional networks.

Methods: A qualitative analysis of semi-structured interviews with 23 stakeholders was conducted to explore their views on the utility, benefits and risks associated with rescheduling MPH.

Results: Six key themes emerged from the interviews: ‘adherence’, ‘accessibility’, ‘affordability’, ‘stigma’, ‘rescheduling of MPH’ and ‘risk mitigation’. Core to these themes is the role of the scheduling of MPH – which can have a protective societal role, but also acts as a barrier to care for individuals with ADHD.

Conclusion: The current Schedule 6 status of MPH is not an effective strategy to prevent misuse and diversion but negatively impacts on treatment adherence. The positive outlook from stakeholders on rescheduling MPH holds significant implications for the ADHD landscape in South Africa.

Contribution: It is crucial to address stigma, facilitate fundamental change in service delivery and remove structural and practical barriers to care to improve outcomes for individuals with ADHD. A framework for ADHD treatment adherence is provided.

Changes in patient-reported outcomes during admission to a South African psychiatric facility

Lerato Motshudi — 2025-02-03

Background: Patient-reported outcome measures (PROMs) are used as part of clinical practice to determine the impact of the condition and treatment interventions on a patient’s health and quality of life. The Patient Health Questionnaire-9 (PHQ-9) is a self-administered diagnostic tool that has been widely adopted for the detection and monitoring of depression.

Aim: This analysis reports the change in PHQ-9 scores from admission to discharge in patients admitted for depression to a South African acute psychiatric facility and aims to quantify the treatment effect of the admission using the PHQ-9 as the measurement tool. Setting: South African acute psychiatric facility.

Methods: This was a retrospective observational study of all patients admitted to Netcare Akeso acute psychiatric facilities from 01 January 2018 to 31 October 2022. Patients were included if they were ≥ 18 years of age, admitted with a primary International Classification of Disease (ICD)-10 code for depression (i.e. F32–F33) and fully completed both an admission and discharge PHQ-9 questionnaire. We excluded facilities focusing only on the treatment of patients with specialised conditions such as addiction or eating disorders.

Results: This analysis included 13308 patients admitted for depression at 10 different facilities. The median PHQ-9 score on admission was 19 (interquartile range [IQR] 14–23) and 5 (IQR 2–11) on discharge, with a median change of -12 (IQR -5 to -18). A minimal clinically important difference was seen in 87.6% patients (n = 10 091/11515); a treatment effect was seen in 74.5% of patients and a clinically significant improvement was seen in 72.1% of patients.

Conclusion: With the average patient reporting a four-fold reduction in the severity of their depression scores, PROMs provide a critical patient-centred window into the benefit that an inpatient admission has on those suffering with depression.

Contribution: These changes are consistent with those seen internationally and provide a baseline for understanding the treatment efficacy of an inpatient admission for the treatment of depression

Youth exposure to violence and victimization in a South African community sample

Lingum G. Pillay — 2025-02-03

Background: Studies show that youth in low socioeconomic communities suffer significant disturbances in mental and emotional health because of exposure to violence and peer victimisation, manifesting in internalising disorders such as depression, anxiety and traumatic stress.

Aim: To examine the relation between risks and exposure to community violence and peer victimisation.

Setting: Low socioeconomic communities in Durban, KwaZulu-Natal.

Methods: Data were collected via school and home interviews with youth and maternal caregivers using standardised schedules and instruments. These included the Demographics and Questions about Child’s Health schedule, the Family History of Risk Questionnaire, the Child Behaviour Checklist, the Social Experiences Questionnaire and the Survey of Children’s Exposure to Violence. Youth sample comprised 256 participants, with age range from 9 to 18 years, and 65% being female.

Results: Sociodemographic risks were significantly associated with lifetime witnessing violence, victimisation and hearing about violence. Low maternal education was associated with overt peer victimisation and cyber-victimisation. Internalising conditions such as worry and oversensitivity, fear and concentration, youth anxiety and maternal anxiety were also significantly associated with violence exposure and peer victimisation.

Conclusion: Predisposing risks for exposure to violence and victimisation occur in all domains, suggesting that interventions should target these domains to minimise their impact. Cooccurring experience of violence at the personal, proximal and distal levels perpetuate a cyclical loop of violence, intersecting and influencing each other.

Contribution: Risk factors such as anxious attachment, avoidant attachment and anxiety, conceptually often seen as maladaptive outcomes, also serve as predisposing risks for violence exposure.

Exploring South African Indian men’s understanding of depression

Vashnie Sithambaram — 2025-02-03

Background: Depression is reported as one of the most common mental disorders. Research on Indian men’s understandings of depression is limited.
Aim: The authors aimed to explore South African Indian men’s understanding of depression in a community, and how this guides help-seeking behaviour.
Setting: Community dwelling participants in Gauteng, South Africa.
Methods: An exploratory qualitative design was employed and a purposive sampling method was used to recruit participants. Semi-structured interviews were conducted with seven Indian adult men and analysed using thematic analysis.
Results: The findings of this study yielded a total of six themes. These included understanding of depression, depression is taboo, diverging gender role expectations and depression, helpseeking behaviour, barriers to help-seeking, and mental health community support.
Conclusion: The findings suggest a lack of understanding and awareness of depression among participants and discussions around mental illness being regarded as taboo. Gender roles and societal expectations were considered as one of the contributors to depression onset. Coping and help-seeking behaviour included adaptive and maladaptive coping mechanisms with professional psychological help being least prioritised. Self-stigmatisation and fear of discrimination were highlighted as barriers to help-seeking behaviours.
Contribution: This study contributed to the limited body of knowledge on understanding of depression among Indian men in South Africa and highlighted the importance of mental health awareness campaigns and professional help-seeking behaviour.

Retrospective review: Factors impacting length of stay in Bipolar Disorder at a tertiary hospital

Nomsa C. Mkhwebane — 2025-02-03

Background: Bipolar disorder (BD) is a chronic, disabling mental illness that may require recurrent hospitalisation. The length of hospital stay (LOS) for BD patients is variable, and literature suggests that this is because of clinical and socio-demographic factors.

Aim: To determine the average LOS for patients admitted for BD at a hospital and its relation to clinical and socio-demographic factors.

Setting: A public tertiary hospital in South Africa.

Methods: Clinical and socio-demographic data were obtained from a retrospective record review of patient admissions at a hospital over 1 year. Length of hospital stay, defined as the duration between admission and discharge date, and other variables were retrieved.

Results: A total of 215 patients were admitted during the study period. The mean LOS was 30 days. The mean age of the patients was 35.9 years (standard deviation [s.d.] = 12.4, range 18–72 years). There were similar numbers of males and females admitted. Significantly more patients were not married (p < 0.001), unemployed (p < 0.001), and had a history of substance use (p < 0.001). Employed patients were 2.5 times more likely to have a short stay than those unemployed (p = 0.03). There was a statistically significant association between the number of comorbidities and LOS.

Conclusion: The study findings align with the literature’s results. The median length of stay was 25 days and was impacted by socio-demographic but not clinical factors.

Contribution: The study provided insight into the impact of variable factors in LOS for BD patients

Childhood trauma, substance use and depressive symptoms in people with HIV during COVID-19

Nikita Prosad Singh — 2025-02-03

Background: Adverse childhood experiences (ACEs), substance use, depressive symptoms, and HIV outcomes in people living with HIV (PLWHIV) have not been comprehensively investigated within a single study.

Aim: The aim of this study was to investigate the prevalence and association of ACEs, substance use, depressive symptoms and human immunodeficiency virus (HIV) outcomes in PLWHIV accessing HIV care during the coronavirus disease 2019 (COVID-19) pandemic.

Setting: District hospital HIV clinic in South Africa.

Methods: A total of 196 PLWHIV completed a socio-demographic and clinical questionnaire; an adapted World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test; WHO ACEs International Questionnaire, and Patient Health Questionnaire.

Results: The most common ACEs were having one or no parent, parental separation or divorce (n = 131, 66.8%), exposure to collective (n = 57, 29.1%) and community violence (n = 55, 28.1%), with 40.3% (n = 79) experiencing ≥ 3 ACEs. The most commonly used substances were alcohol (n = 34, 17.3%), tobacco (n = 33, 16.8%), and cannabis (n =13, 6.6%). The prevalence of depressive symptoms was 19.4% (n = 38). Linear regression analyses indicated greater alcohol (adj β = 2.84, p < 0.01), tobacco (adj β = 3.64, p < 0.01) and cannabis use risk scores (adj β = 2.39, p < 0.01) were associated with ≥ 3 ACEs. Logistic regression indicated depressive risk (adjusted odds ratio [OR] = 9.39, 95% confidence interval [CI] 4.78–23.51) was associated with ≥ 3 ACEs.

Conclusion: A high prevalence of ACEs, substance use and depressive symptoms exists among PLWHIV, along with an association between cumulative ACEs and both substance use and depressive symptoms.

Contribution: Enhanced screening and management services are recommended to address this triple burden in PLWHIV.

Depression, anxiety and coping mechanisms among mental healthcare practitioners during COVID-19

Yolandi Stals — 2025-02-03

Background: The coronavirus disease 2019 (COVID-19) pandemic has placed the psychological functioning of mental healthcare practitioners under severe strain. Coping methods may affect mental health outcomes.

Aim: The study examined the relationship between depression, anxiety, stress, and coping styles utilised by mental healthcare practitioners during the COVID-19 pandemic.

Setting: Three private and one public mental healthcare facility in Bloemfontein, South Africa.

Methods: Respondents completed the Depression, Anxiety and Stress Scale (DASS-21) and Brief Coping Orientation to Problems Experienced (Brief-COPE) inventories. An ordinal regression model was used to assess the relationship between coping styles, anxiety and depression.

Results: A total of 212 practitioners were included in the analysis. According to DASS-21 measures, approximately 41% and 28% of respondents had moderate to severe depressive and anxiety symptoms, respectively, with the highest prevalence among younger female respondents and nurses. The association between stress severity, anxiety and depression was significant. Avoidant coping methods and two approach coping strategies (planning and acceptance) were associated with depression and anxiety. Anxiety was linked to an increased likelihood of transitioning to higher avoidant categories, while participants with depression were less likely to move to higher avoidant or approach categories.

Conclusion: Mental healthcare practitioners, especially nurses, experienced significant COVID-19-related psychological distress during the pandemic. Avoidant coping mechanisms may increase the risk of poor mental health outcomes.

Contribution: This study added data on the mental health effects of COVID-19 on mental healthcare practitioners, as well as psychological methods used to cope during the pandemic.

Descriptive study of mental health care users 12 months pre- and post-COVID-19 lockdown

Noluthando A. Hlongwane — 2025-02-03

Background: Coronavirus disease 2019 (COVID-19) has impacted on a range of physical, mental and societal health indices. Increased levels of psychological stress are often reported following pandemics.

Aim: To describe and compare the presentations of mental health care users pre- and postinitiation of the lockdown, with an emphasis on demographic profiles and final diagnoses.

Setting: The study was conducted as a retrospective record review over the predetermined period at a large public hospital in Johannesburg and included all mental health care users requiring psychiatry consultation during the study period.

Methods: Clinical records were traced via the emergency department registration desk, and information pertaining to demographics, presenting complaints, date of presentation and diagnosis was extracted.

Results: A significant increase was seen in patients with psychotic disorders from preCOVID-19 to post-COVID-19. There was a reduction in presentations of mood disorders and substance-related disorders. Patients presenting in the post-COVID-19 time period were significantly younger than in the pre-COVID-19 time period.

Conclusion: Pandemics result in notable negative mental health sequelae. Policies aimed at mitigating the spread of infective agents should be implemented with consideration of the burden of psychological distress following the pandemic.

Contribution: This study provides insights into clinical and demographic variables in a mental health care population serviced at a government hospital pre- and post-COVID-19 lockdown regulations.

Autonomic response and attachment style in disruptive mood dysregulation disorder

Michelle Leal — 2025-02-03

Background: Disruptive mood dysregulation disorder (DMDD) is characterised by severe emotion regulation difficulties, particularly anger and irritability, in children. Despite the impact of attachment on emotional and behavioural regulation, the link between attachment style and DMDD is under-researched.

Aim: This study investigated whether attachment style and parasympathetic regulation differentiate the response profiles to frustrating conditions between children diagnosed with DMDD and controls.

Setting: Participants were assessed at schools in Johannesburg, Gauteng, South Africa. Methods: Thirty participants were divided into two matched groups (nDMDD = 15; nControl = 15) and assessed. Respiratory sinus arrhythmia (RSA) and heart period were measured during an Affective Posner Task, inducing frustration. Attachment style was assessed using the Attachment Style Classification Questionnaire for children. Parents of children with DMDD completed a social interaction problems questionnaire.

Results: The DMDD group showed a higher prevalence of avoidant attachment style (p = 0.013) compared to controls. Both groups displayed adaptive vagal withdrawal and recovery during the task (p = 0.005; p = 0.021). Controls had significantly higher heart period throughout the assessment (game 1: p = 0.006; game 2: p = 0.013; game 3: p = 0.007). In the DMDD group, lower vagal tone during frustration correlated with more social interaction problems (p = 0.049).

Conclusion: The study demonstrates a potential link between attachment style and altered physiological state in children with DMDD.

Contribution: The findings provide insight into possible atypical vagal regulation of the heart and avoidant attachment styles in DMDD, highlighting potential therapeutic and intervention targets.

Attitudes of primary healthcare nurses towards people living with mental illness in Botswana

Selebogo M. Moremi — 2025-02-03

Background: The global disease burden attributable to mental and neurological disorders has been increasing over the years. World Health Organization (WHO) recommends the integration of mental health services into existing primary healthcare framework as one strategy for dealing with the burden. Understanding the attitudes of nurses towards people with mental illness is important for a successful integration and management outcome of patients.
Aim: This study aimed to determine primary healthcare nurses’ attitudes towards people with mental illness.
Setting: The study was conducted at Greater Lobatse health district, one of the primary healthcare districts in Botswana.
Methods: A cross-sectional study was conducted among 202 nurses working in the greater Lobatse health district from 01 May 2023 to 30 November 2023. Convenience sampling was used. Data were collected using a structured self-administered questionnaire.
Results: The prevalence of negative attitudes was 51.5%. The mean age (standard deviation [s.d.]) of respondents was 33.4 (8.0) years. Being a non-specialised nurse (B= –0.184; p = 0.014), having a personal history of mental illness (B = –0.215; p = 0.002), and having poor knowledge about mental illness (B = –0.149; p = 0.032) were associated with negative attitudes.
Conclusion: More than half of the respondents have negative attitudes towards people with mental illness. This justifies the need for training and educational programmes and anti-stigma campaigns among primary healthcare nurses to mitigate negative attitudes.
Contribution: This study provides insight into primary healthcare nurses’ attitudes towards people with mental illness.

Prevalence of depressive symptoms in adolescents living with HIV in Johannesburg, South Africa

Vuyiswa Gantsho — 2025-02-03

Background: Adolescents living with HIV (ALWHIV) are more vulnerable to developing depressive symptoms. Despite this knowledge, the screening for depression is not routinely integrated into HIV treatment programmes.

Aim: The study aimed to determine the prevalence of depressive symptoms among ALWHIV.

Setting: The study was carried out in the primary healthcare clinics and an antiretroviral clinic situated in a district hospital, West Rand District, Johannesburg.

Methods: This was a cross-sectional study of 125 ALWHIV. The modified Patient Health Questionnaire for Adolescents (PHQ-A) was used to screen for depressive symptoms with a score of ≥ 5 deemed significant. A distress protocol was used for immediate psychological intervention.

Results: The prevalence of depressive symptoms was 44.8% and the majority of ALWHIV reported mild-moderate symptoms (36.8%). Overall, 25.6% of adolescents had suicidal behaviours. Those with psychosocial difficulties and those who reported a previous suicide attempt were 3.6 (adjusted odds ratio [aOR] 3.59, 95% confidence interval [CI]:1.17–11.03) and 6.9 (aOR 6.93, 95% CI:1.39–34.55) times likely to develop depressive symptoms, respectively.

Conclusion: A high prevalence of depressive symptoms was found in ALWHIV. Psychosocial difficulties and previous suicide attempts were predictive factors for depressive symptoms. This highlights the unmet need for the integration of mental health screening and overall mental health services into adolescent HIV programmes.

Contribution: This study emphasises an urgent need for routine mental health screening and prompt psychosocial support in ALWHIV .

Safety and effectiveness of methylphenidate ER multi-unit pellet system in ADHD patients: An open label study

Anne-Marie Nel — 2025-02-03

Background: Attention deficit hyperactive disorder (ADHD) is a neurodevelopmental disorder occurring in children and adults. Pharmacotherapy remains the cornerstone of ADHD treatment. Stimulants such as methylphenidate are effective and have been one of the best studied and most frequently used treatment for ADHD. However, different delivery mechanisms and devices may potentially impact patient experience and real-life outcomes.

Aim: This study evaluated the effectiveness of Multiple-Unit Pellet System Delivered Extended-Release Methylphenidate (Contramyl XR) on symptom control and reported outcomes in ADHD patients, in a real-world setting.

Setting: A phase IV, open label, flexible dose, prospective, observational study conducted at six sites covering five provinces of South Africa.

Methods: About 119 participants with ADHD (both newly diagnosed [treatment-naïve] and methylphenidate-treated [switch-over] patients) were enrolled and initiated either on Contramyl XR or switched over from methylphenidate to Contramyl XR. Primary efficacy was assessed by Weiss Functional Impairment Rating Scale (WFIRS) over 12 weeks.

Results: In all, 117 participants completed the study (treatment-naïve patients: 46% [n = 55] and switch-over patients: 54% [n = 64]). Mean change from baseline in total WFIRS (95% confidence interval) was –17.7 (–21.1, –14.3; p < 0.001) at week 4 and –29.3 (–33.5, –25.2; p < 0.001) at week 12. At week 12, there was significant improvement in WFIRS scores, with treatment satisfaction reported by treatment-naïve patients. Switch-over patients also demonstrated comparable effectiveness.

Conclusion: Contramyl XR was found to be clinically effective either as de novo or as switch therapy. It was well tolerated, and all patients chose to continue with the treatment option.

Contribution: Despite distinct and different delivery mechanism of Contramyl XR, this study provides evidence for using it as an alternate treatment option versus reference methylphenidate, in both treatment-naïve and switch-over ADHD patients. Study participants willingness to continue Contramyl XR therapy post study, further strengthens the confidence on the effectiveness of Contramyl XR in managing ADHD patients.

An in depth review of body shaming phenomenon among adolescent: Trigger factors, psychological impact and prevention efforts

Fitrio Deviantony — 2025-02-03

Background: Body shaming, a pervasive issue, has severe psychological and societal repercussions, particularly for early adolescents. This study addresses the gap in understanding body shaming in smaller urban settings such as Jember City, often overlooked in favour of larger metropolitan areas.

Aim: The study aimed to investigate the psychological effects, trigger factors and potential preventive measures of body shaming among junior high school students in Jember City.

Setting: The study was conducted in junior high schools in Jember City, East Java, Indonesia.

Methods: An observational, cross-sectional design with both quantitative and qualitative approaches was used. Data were collected through self-administered questionnaires and in-depth interviews. The quantitative analysis was performed using the Spearman’s rank test.

Results: The study included 320 adolescents aged between 12 and 15 years. Of these, 6.3% were 12 years old, 31.2% were 13, 31.6% were 14, and 30.9% were 15. Additionally, 56.2% of the participants were female. The majority (95%) identified as Muslim, and 72.8% had parents with bachelor’s degrees. Parental occupations ranged from private business to civil service. In terms of body mass index, 34.7% were classified as very thin, 18.1% as thin, 40.9% as normal, and 3.1% as fat or obese. Body shaming was widespread, with 73.1% criticized for their clothing, 59.9% for their speech, and 66.7% compared to others. The main sources of body shaming were family, peers, media, and personal insecurities. There was also a significant correlation between body shaming and stress (ρ = 0.404, p < 0.01).

Conclusion: Body shaming affects mental health, particularly among adolescents. It stems from societal norms and media perpetuation.

Contribution: This study provides insights into body shaming in smaller urban settings, highlighting the need for targeted prevention efforts to mitigate its effects and promote healthier self-esteem and body image.

Teaching transference focused psychotherapy to South African mental health practitioners

Henk S. Temmingh — 2025-02-03

Background: Personality disorders (PDs) are estimated to occur in 6.8% of South Africans and in 45% to 80% of clinical populations. Mental health practitioners often harbour negative attitudes and lack confidence in working with such patients. Brief training in transference focused psychotherapy (TFP) has been shown to improve attitudes and confidence in the management of clinical encounters with PD.

Aim: This study aimed to describe the characteristics of attendees at a brief TFP training workshop and determine the impact of training on attitudes and clinical confidence towards patients with PD.

Setting: We conducted two 3 h online workshops, spaced 1 week apart to staff at South African University training hospitals.

Methods: At baseline, participants (N = 41) completed questionnaires on demographics, perceived need for training, supervision adequacy and perceived confidence. At baseline and after the second session, the Attitude to Personality Disorder Questionnaire (APDQ) and the Clinical Confidence in Personality Disorder Questionnaire (CCPDQ) were completed. Longitudinal data were analysed using linear mixed- effects regression.

Results: In the completer sample (N = 13), there were significant improvements in the APDQ enthusiasm subscale (p = 0.029) and in clinical confidence (CCPDQ) (p = 0.032). The APDQ total and other subscales also showed improvements. Participants with higher baseline confidence were more likely to drop out.

Conclusion: Brief training in TFP can lead to significant improvements in attitude and confidence in managing patients with PD.

Contribution: This is the first study in the South African context demonstrating the potential value of brief teaching in TFP.

Knowledge and attitudes towards electroconvulsive therapy in an academic psychiatric department

Lerato L. Masenya — 2025-02-03

Background: Negative attitudes towards electroconvulsive therapy (ECT) among health professionals have been attributed to a lack of knowledge, despite advancements in its administration and evidence of its efficacy in certain psychiatric conditions.

Aim: This study assesses knowledge and attitudes towards ECT among psychiatry and clinical psychology professionals.

Setting: The University of the Witwatersrand, Department of Psychiatry, Johannesburg, South Africa.

Methods: A quantitative cross-sectional design was used. All psychiatry and clinical psychology professionals associated with the university were invited to participate in an anonymous online survey from 01 September 2022 to 30 June 2023.

Results: The response rate was 49.6% (n = 58) among psychiatrits and 22.2% (n = 22) among clinical psychology professionals. Psyhiatrists had greater knowldge and more favourable attitudes than psychologists. Only 45.5% of psychologists had exposure to ECT, compared to 93.1% of psychiatrists. Knowledge and attitude scores were significanly correlated (p = 0.009, OR 6.7). Most psychologists (86.4%) recommended ECT theory be included in their curriculum.

Conclusion: Greater knowledge correlates with improved attitudes towards ECT. Increased training could enhance attitudes, particularly among psychology professionals.

Contribution: This study offers insights into knowledge and attitudes towarss ECT in a Johannesburg psychiatry department.

Mortality rate in patients in a long-term psychiatric care facility in Johannesburg

Mokgokong Mathekga — 2025-02-03

Background: Limited research exists on mortality rates and contributing factors among
individuals with severe mental illness (SMI) in long-term psychiatric care, especially in lowand middle-income countries (LMICs).
Aim: To analyse mortality rates and associated factors at Solomon Stix Morewa Memorial
Hospital (SSMMH), a long-term psychiatric care facility in Johannesburg, South Africa.
Setting: SSMMH, a private facility in Selby Park, Johannesburg, has been contracted by
the Gauteng Department of Health since March 2017 to provide inpatient care for SMI
patients.
Methods: A retrospective analysis was conducted on records of 406 SMI patients
admitted to SSMMH from March 2017 to February 2022. Mortality rates were calculated,
and associated factors were analysed using descriptive statistics and logistic regression.
Results: Of the 406 participants, 34 (8%) died over five years, yielding a standardised
mortality ratio (SMR) of 1.28 (95% CI: 0.85–1.71). Mortality was highest in the 60–69 years
age group (SMR 2.7), with most deaths occurring in 2020–2021, likely due to COVID-19.
Cardiovascular conditions were the leading cause of death (53%). Age at admission (OR: 2.35,
95% CI: 1.55–3.58) and transfer site (OR: 0.58, 95% CI: 0.42–0.81) were significant predictors
of mortality.
Conclusion: Individuals with SMI face elevated mortality rates, with age, diagnosis, and
comorbidities as key factors.
Contribution: This study provides insights into the comprehensive management of people
with SMI to reduce mortality. Further research is needed to guide psychosocial and palliative
care approaches.

The lifeworld of families of mental health care users in rural South Africa: A phenomenological study

Takalani E. Mbedzi — 2025-02-03

Background: In recovery-oriented mental health care, family members of mental health care users form part of the caring team. Families are expected to care for mental health care users without support in the under-resourced rural Vhembe district in South Africa. Aim: This study aims to describe the lifeworld of family members caring for mental health care users in rural areas to inform the development of a support programme.
Setting: Purposive sampling was used to select 16 family members from eight community health centres in the Vhembe district.
Methods: A qualitative approach, using a descriptive phenomenological design, was adopted to conduct unstructured interviews that were transcribed, translated and analysed using a descriptive method.
Results: Family members continuously contemplate their responsibilities. Endless concerns and stress result in forgetfulness and physical problems such as insomnia, hypertension and pain. Family members feel powerless and helpless when there is no improvement and support from community resources. Fear of being violated, embarrassed and stigmatised by community members results in social isolation and depression.
Conclusion: Caregiving is burdensome in poorly resourced areas. Feelings of helplessness and hopelessness Psychosomatic and depressive symptoms relate to the lack of effective community support which are likely to result in compromising the care they provide.
Contribution: The results call for the Department of Health to strengthen community mental health services and for health care professionals to provide supportive interventions based on the needs of mental health care users and their families.

From stroke to depression: The need for systematic screening for post-stroke depression

Mundih N. Njohjam — 2025-02-03

Background: Post-stroke depression (PSD) negatively impacts the physical and mental wellbeing of stroke survivors. However, data on the prevalence and risk factors of PSD in African countries such as Cameroon are limited.

Aim: This study aims to determine the prevalence and factors associated with PSD among stroke survivors at a hospital in Cameroon and inform clinical practice.

Setting: The study was carried out in the Nkwen Baptist Hospital in the North West region of Cameroon.

Methods: This was a hospital-based cross-sectional study. Stroke patients were systematically screened for PSD using the patient health questionnaire (PHQ-9). PSD was present if a patient scored ≥ 4 points on the scale. The multidimensional scale of perceived social support was used to assess the level of social support, the modified Rankin tool and Barthel index were used to assess functional independence, and the Fatigue assessment tool was used to assess post-stroke fatigue. A multivariate analysis was performed to identify factors associated with PSD.

Results: A total of 103 patients were included in the study. The mean age was 55.55 ± 12.15. Most patients were males (58.25%). The mean depression score was 5.17 ± 6.26. The overall prevalence of PSD was 36.89%. A higher functional impairment, post-stroke fatigue, perceived social support, recent stroke and being divorced were all associated with high PSD scores.

Conclusion: In this study, we found a high prevalence of PSD using a systematic screening approach, suggesting that systematic screening for PSD can lead to early detection and management.

Contribution: Systematic screening for PSD in stroke patients can lead to early diagnosis and, consequently, early initiation of treatment. Integration of mental health support and care as part of the routine stroke is warranted.

Lithium-induced cognitive dysfunction assessed over 1-year hospitalisation: A case report

Yuji Murase — 2025-02-03

Introduction: Lithium-induced neurotoxicity is almost always reversible but can cause irreversible neurological sequelae, namely the syndrome of irreversible lithium-effectuated neurotoxicity (SILENT). As there is no definitive treatment for SILENT, caution is required when administering lithium. Reports on the effect of lithium-effectuated neurotoxicity on cognitive function are limited. We report a case in which high cognitive function was lost after lithium overdose and hardly recovered, as evaluated using multiple neuropsychological tests during a 1-year hospitalisation period.

Patient presentation: A 52-year-old man on lithium medication with bipolar disorder was admitted to the intensive care unit because of lithium overdose. The patient achieved lucid consciousness after continuous haemodiafiltration. However, he could not move his body as desired or produce appropriate verbal expressions; thus, he was moved to our psychiatric ward, where his treatment continued. Management and outcome: After several months, the patient was diagnosed with SILENT owing to persistent motor and cognitive dysfunctions. Multiple neuropsychological tests were performed, and cognitive function was evaluated. The Neurobehavioural Cognitive Status Examination showed a worsening trend, and the full intelligence quotient of the Wechsler Adult Intelligence Scale-Third Edition was in the mild intellectual disability range.

Conclusion: This is a clear case of cognitive dysfunction due to SILENT and is difficult to treat. Thus, it is crucial to prevent the onset of SILENT.

Contribution: This report is valuable because it is one of the few to track changes in cognitive function over time in a patient with SILENT using objective measures over 1 year of hospitalisation.

The SASOP/PsychMg guidelines for psychiatric independent medical examinations

Renata Schoeman — 2025-02-03

These guidelines, developed by the South African Society of Psychiatrists (SASOP) and the Psychiatry Management Group (PsychMg) offer a comprehensive framework for conducting psychiatric independent medical examinations (IMEs) in South Africa. They serve as a valuable resource for psychiatrists involved in evaluating disability claims, providing a standardised approach to psychiatric assessment and reporting. These guidelines address the challenges inherent in determining psychiatric impairment, including premature determinations of permanent inability to work and inconsistencies in diagnosis and prognosis. They emphasise the importance of objectivity, avoiding conflicts of interest and maintaining professional ethics in the IME process. By providing a structured methodology and reporting format, these guidelines aim to facilitate informed decision-making by third parties, such as insurance companies and the courts, in assessing mental health-related disability claims.

Corrigendum: A culturally congruent approach to trauma symptom evaluation improves detection of PTSD in people with a first-episode of psychosis in South Africa

Vuyokazi Ntlantsana — 2025-02-03

No Abstract

Introducing the ‘Lived Experience’ section of the South African Journal of Psychiatry

Laila Asmal — 2025-02-03

No Abstract