South African Journal of Psychiatry最新文献

Background: Despite mental illness being a major burden in South Africa, there is a shortage of psychiatrists compared to global rates. By understanding final-year medical students' attitudes towards psychiatry, new recruitment strategies can be implemented to overcome this hurdle.

Aim: This study aimed to assess final-year medical students' attitudes toward psychiatry and to identify demographic and experiential factors that influence the intention to specialise in psychiatry.

Setting: The University of the Witwatersrand.

Methods: A cross-sectional, quantitative survey was conducted among final-year medical students between July 2024 and October 2024 using the Mental Illness: Clinicians' Attitudes (MICA-2) Scale.

Results: Among 171 students, the overall mean MICA-2 score was 40.43 (standard deviation = 8.16), indicating moderately positive attitudes. Females demonstrated significantly more favourable attitudes (mean = 39.35) than males (mean = 43.08, p = 0.022). Older students (> 33 years, n = 8, 4.7%) had slightly more positive attitudes than younger age groups, but these findings were not significant (p = 0.268). Exposure to a psychiatry clinical rotation did not positively influence students' attitudes (p = 0.257), and personal fulfilment and work-life balance were the predominant deciding factors with regard to specialisation choice.

Conclusion: There is no significant stigmatisation towards psychiatry across all cohorts. The study instead reflects differing levels of positive attitudes towards psychiatry. However, this did not translate to students pursuing psychiatry as a specialty, as they feel it does not offer personal fulfilment and work-life balance.

Contribution: Future strategies must focus on work-life balance and personal fulfilment when attempting to increase the recruitment rate into psychiatry.

Background: Inpatient psychiatric services in South Africa are faced with challenges such as high demand for beds, rapid discharges, limited community services upon discharge and high readmission rates.

Aim: To provide a profile of the demographic and clinical characteristics of the mental health users of inpatient male acute psychiatric services.

Setting: The male acute unit at Stikland Hospital.

Methods: A retrospective folder review of all patients discharged (n = 693) from the male acute psychiatric unit at Stikland Hospital between 01 February 2022 and 31 January 2023, and followed up for 1 year post-discharge.

Results: Most of the admissions were young males (29 [23-35] years), single (89%) and unemployed (80.8%), with no secondary-level education (65.4%). Thirty per cent of admissions were admitted directly to the unit, and most patients presented with a diagnosis of schizophrenia (42.1%). Almost half (47.8%) of all admissions were patients previously admitted to Stikland Hospital, and more than one quarter (27.6%) were readmitted within 1 year following discharge. Most admissions had a short length of stay (36 [27-53] days) and were crisis-discharged (63.5%). The use of long-acting injectables (LAI) was highly prevalent (73.4%).

Conclusion: Current inpatient psychiatric services are functioning as crisis intervention units. The study provides a foundation for developing context-specific, tailored strategies to be integrated into the discharge planning processes within the existing healthcare system.

Contribution: Current system-related factors, such as bed shortages, lead to short length-of-stays (LOS) and crisis discharges, which likely contribute to a higher rate of readmissions.

Background: Aggression and violence remain persistent challenges in healthcare settings, particularly in psychiatric and emergency units. Security personnel serve as frontline responders but frequently lack structured training in de-escalation techniques, increasing the risk of harm.

Aim: This study aimed to assess and improve security personnel's attitudes towards the causes and management of aggression through a structured de-escalation training programme.

Setting: The study was conducted at Cecilia Makiwane Hospital, a regional academic facility in the Eastern Cape province of South Africa, housing the only public-sector mental health unit in Buffalo City Municipality.

Methods: A quasi-experimental single-group pre-test-post-test design was used. Security personnel completed an interactive educational programme incorporating discussions, role-play, and scenario-based exercises. The Management of Aggression and Violence Attitude Scale (MAVAS) was administered before and after the intervention. Data were analysed using paired-samples t-tests and multiple regression at a 5% significance level.

Results: Baseline MAVAS domain scores indicated moderate agreement with all four domains. Following the intervention, significant improvements were observed across all MAVAS domains (p ≤ 0.01), reflecting more positive attitudes towards aggression management. Female participants showed greater changes in environmental and interpersonal causes of aggression (B = -0.259, p = 0.003), while longer work experience predicted increased recognition of patient-related causes. Job rank and age were not significant predictors.

Conclusion: Structured de-escalation training effectively improved security personnel's attitudes towards managing aggression and violence in a hospital setting.

Contribution: This study provides empirical evidence that context-specific de-escalation training for security personnel may support workplace safety and strengthen multidisciplinary collaboration in the South African setting.

Introduction: Rasmussen's encephalitis (RE) is a rare, progressive inflammatory neurological disorder characterized by treatment-resistant epilepsy, progressive hemiplegia, and cognitive decline. Although its pathogenesis remains incompletely understood, immune-mediated mechanisms are thought to play a central role. RE predominantly affects children, with only approximately 10% of cases occurring in adults. Diagnosis relies on the combination of clinical features, serial neuroimaging, and electroencephalographic findings. Early recognition is essential, as treatment options are limited and outcomes are improved with timely intervention. Atypical adult-onset presentations are particularly uncommon and may present significant diagnostic challenges.

Patient presentation: We report a case that presented with atypical, adult-onset RE with major neurocognitive disorder.

Management and outcome: The patient's diagnosis was made with neuroimaging 10 years following seizure onset. Findings indicated moderate generalised atrophy, with asymmetric involvement of the left cerebral hemisphere. Interventions required a multidisciplinary team, and pharmacological management included sodium valproate and lamotrigine for seizure control, as well as quetiapine and fluoxetine for behavioural disturbances. The patient's prognosis remains poor because of generalised brain atrophy limiting treatment options.

Conclusion: There is a need to raise awareness of RE to assist with early detection and treatment. Late diagnosis may have contributed to the patient's poor prognosis.

Contribution: Despite the need for further research, early neuroimaging of patients with new adult-onset seizures may help decrease morbidity associated with RE.

Background: Childbirth has been associated with post-traumatic stress disorder (PTSD) in women, affecting mother-child bonding, foetal growth, cognitive development and marital relationships. However, there is a dearth of literature on postpartum PTSD in Africa.

Aim: The study aimed to investigate the occurrence of postpartum PTSD among women.

Setting: The study was conducted within Johannesburg metropolitan clinics.

Methods: The study included 88 women attending postnatal clinics in the metropolitan area. A questionnaire was used to collect data on their characteristics, obstetric and neonatal factors and perceived social support. The City Birth Trauma Scale was used to screen for postpartum PTSD symptoms. Data were analysed using R software with a significance level of 0.05.

Results: Almost half of the participants (48.9%) perceived their most recent childbirth as a traumatic event. One participant (1.1%; 95% CI: 0.0003-0.06) endorsed all symptoms required to diagnose PTSD. Endorsing childbirth as a traumatic event was significantly associated with reporting intrusion and/or re-experiencing symptoms (OR = 3.7) and avoidance symptoms (OR = 3.3). There was no association between the mode of childbirth and PTSD symptom scores. There is no association between the presence or absence of neonatal complications and PTSD symptom scores.

Conclusion: Although the occurrence was relatively low, our findings highlight the importance of routine screening and early intervention in maternal health services.

Contribution: There is need for further research to inform culturally relevant prevention and treatment strategies.

Background: Mental healthcare service provision is challenging and becomes more complex when users are students. Students are more vulnerable to experiencing mental health challenges. Therefore, higher education institutions (HEIs) must offer effective mental healthcare services to meet the mental health needs of students.

Aim: To understand the experiences of mental health practitioners (MHPs) who work for a HEI providing mental healthcare services.

Setting: The study was conducted in South Africa within the context of higher education.

Methods: A qualitative, exploratory, descriptive and contextual research design, incorporating the Appreciative Inquiry 5D Model, was used. This method allowed for the exploration and description of the experiences of MHPs working in a higher education setting who are tasked with providing mental healthcare services to students.

Results: Five themes emerged from the analysis of data: (1) mental healthcare services are viewed as a source of holistic support, (2) mental healthcare provision is experienced as fulfilling and challenging, (3) mental healthcare services should be student-centred and engaging, (4) services should be available, accessible and responsive to address students' needs, (5) mental healthcare services should integrate monitoring and evaluation strategies.

Conclusion: Resource challenges and the rising demand for mental healthcare services by students remain an enormous burden on the already-burdened healthcare system. Higher education institutions must commit to funding these services, and then MHPs will be able to provide effective mental healthcare services to the students.

Contribution: Strategies to guide the facilitation of students' mental health were developed.

Background: Childhood traumatic experiences are known to have profound and lasting effects on mental health; however, there are limited data on the relationship between types of childhood trauma and social anxiety in non-clinical populations.

Aim: This study aimed to explore the associations between types of childhood trauma and social anxiety symptoms in non-clinical young adults.

Setting: The study was conducted at the Faculty of Health Sciences of a university in Istanbul, Turkey.

Methods: This cross-sectional study included 486 university students. Sample size was determined via G*Power analysis to ensure statistical power. Participants completed the Liebowitz Social Anxiety Scale (LSAS) and the Childhood Trauma Questionnaire (CTQ) to assess childhood trauma types and social anxiety symptoms. Data were analysed using stepwise multiple regression.

Results: The mean age of the participants was 21.8 ± 4.0 years, and 81% were female, with emotional abuse and neglect scoring highest in both genders. The sample's LSAS total mean score was 63.87 ± 11.68. When the subscales were compared by gender, females had significantly higher mean fear and avoidance scores than males (p < 0.05). The results show that childhood abuse and neglect were significant predictors of social anxiety and explained 23% of the social anxiety variance.

Conclusion: Childhood abuse and neglect are clearly associated with social anxiety symptoms. Interventions and treatments for individuals with social anxiety should incorporate a detailed assessment of childhood trauma history, with a particular focus on emotional abuse and neglect.

Contribution: This study contributes to the literature by clarifying the associations between specific types of childhood trauma and social anxiety symptoms in a non-clinical young adult population.

Background: Anaesthesia trainees are at increased risk of burnout and depression - with occupational stress recognised as a trigger for both. Previous South African single-site studies have assessed these outcomes separately, but not within the same study.

Aim: This study aimed to describe a composite mental well-being profile of South African anaesthesia trainees, focusing on burnout, depression screening, occupational stress and associated risk factors.

Setting: The study was conducted among South African anaesthesia trainees from nine university-affiliated public teaching hospitals.

Methods: Participants were recruited via convenience sampling through engagement with study representatives. Burnout, depression screening and occupational stress were measured using the abridged Maslach Burnout Inventory-Human Services Survey for Medical Personnel, the Harvard Department of Psychiatry National Depression Screening Day Scale and the Effort-Reward Imbalance questionnaire. The response rate was 37%.

Results: Of the 194 trainees, 54 (28%) met burnout criteria, 88 (45%) screened positive for depression and 144 (74%) demonstrated chronic occupational stress. Forty-one (21%) trainees simultaneously met criteria for all three study outcomes, representing a distinctly vulnerable subcohort. Risk factors included: previous and/or current treatment for psychiatric illness, registrars in their second year of training and self-prescribing anxiolytics and antidepressants.

Conclusion: Burnout rates in this population closely approximate international estimates; however, both depressive symptoms and occupational stress prevalence exceed international figures.

Contribution: This first-of-its-kind study provided a composite insight into the mental well-being profile of South African anaesthesia trainees, identifying a bigger cohort at risk of burnout and/or depression in the near future.

Background: Lactate dehydrogenase (LDH) plays a crucial role in glucose metabolism by catalysing the conversion of pyruvate to lactate and facilitating lactate utilisation. Given LDH's central role in energy metabolism, it may serve as a promising biomarker for anxiety disorders.

Aim: This study aimed to compare serum LDH levels between patients with generalised anxiety disorder (GAD) and healthy controls (HC) and to examine the associations between LDH levels and clinical features.

Setting: Bursa City Hospital: A tertiary hospital in Bursa, Turkey.

Methods: This study included 113 participants with GAD and 90 HC. Group comparisons were conducted using an independent samples t-test. Correlations between LDH levels and clinical variables were assessed using the Pearson rank correlation coefficient. To control for the impacts of possible confounding factors on LDH levels, an analysis of covariance (ANCOVA) was conducted.

Results: Serum LDH levels were significantly lower in the GAD compared to the HC (157.7 ± 18.7 vs. 173.2 ± 23.3; p: <0.001, t: -5.249, d Cohen: 0.733). The ANCOVA analysis revealed that there was a statistically significant difference in adjusted LDH levels between the control and GAD groups (p < 0.001; mean difference: -15.607; 95% confidence interval [CI]: -21.180 to -9.975). Additionally, LDH levels were negatively and significantly correlated with HAM-A scores (r = -0.218, p = 0.021) and psychic subscale scores (r = -0.250, p = 0.008).

Conclusion: These findings support the hypothesis that LDH may represent a potential biomarker and therapeutic target in the clinical management of anxiety.

Contribution: This study is the first to report significantly reduced LDH levels in individuals with GAD, highlighting a potential link between altered lactate metabolism and anxiety pathogenesis.

Background: The increasing prevalence of autism spectrum disorder (ASD) highlights the importance of understanding caregivers' experiences in accessing mental healthcare for their children, particularly given the demanding nature of supporting children with ASD in resource-constrained settings.

Aim: This study aimed to explore the experiences of caregivers of children with ASD when accessing mental healthcare services in South Africa.

Setting: This qualitative study was conducted at the Child and Adolescent Psychiatric Unit at Weskoppies Hospital, a tertiary-level hospital in Pretoria West, Gauteng province, South Africa.

Methods: This qualitative case study purposively sampled 15 caregivers of children with ASD at a tertiary psychiatric facility in South Africa. Data were gathered through in-depth interviews and analysed using a Grounded Theory-informed thematic analysis approach.

Results: Five main themes emerged: (1) challenges in accessing mental health care services, (2) delays in screening and early diagnosis, (3) limited ongoing education and knowledge-sharing, (4) the need for emotional support and counselling, and (5) facilitating referrals to specialised schools and allied health care services.

Conclusion: The study identified significant barriers to mental health service utilisation, underscoring the urgent need for improved service accessibility, caregiver support and increased public awareness.

Contribution: The findings advocate for strengthened mental healthcare access and targeted caregiver support for families of children with ASD in South Africa.