South African Journal of Psychiatry最新文献

Background: Colorectal cancer is one of the most common types of cancer worldwide, including in Indonesia, and has a significant impact on patients' quality of life. In addition to the physical burden it causes, colorectal cancer patients often experience psychological disorders such as depression and anxiety, which worsen their quality of life.

Aim: Although many studies have assessed the physical impact of cancer, the relationship between psychological disorders and quality of life still requires further attention.

Setting: This study was conducted at H. Adam Malik General Hospital in Medan, Sumatra.

Methods: This study used a correlative analytical design with a cross-sectional approach, involving 300 colorectal cancer patients. Data were collected using the Patient Health Questionnaire-9 (PHQ-9), Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) and World Health Organization Quality of Life-Brief (WHOQOL-BREF) questionnaires to evaluate depression syndrome, anxiety levels and quality of life. Spearman's test, logistic regression and linear regression model were used in this study.

Results: The results of the study show that 41% of patients experienced severe depression, while 58% of patients experienced severe anxiety. There was a strong negative correlation between symptoms of depression (PHQ-9) and anxiety (HADS-A) and quality of life (WHOQOL-BREF), with a p-value < 0.001 for both. Clinical factors such as stage IV and metastasis, as well as socioeconomic status such as employment and education, were also found to have a significant association.

Conclusion: Psychological disorders, particularly depression and anxiety, significantly affect the quality of life of colorectal cancer patients. Psychological interventions, such as cognitive behavioural therapy (CBT), are essential to reduce symptoms of depression and anxiety and improve patients' quality of life.

Contribution: Strong social support has also been shown to play an important role in improving patients' psychological well-being and treatment outcomes.

Background: South Africa is considered as the epicentre of rape. Despite the establishment of hospital-based post-rape centres, uptake remains limited. Within the context of medical pluralism, many individuals utilise both biomedical and traditional healing systems, which are often perceived as culturally congruent and accessible. This study explored post-rape care services provided by traditional health practitioners (THPs) when survivors seek care outside the formal healthcare system.

Aim: The study aimed to demystify traditional healing methods used in post-rape care by describing treatment approaches and formulations.

Setting: The study was conducted in KwaZulu-Natal, South Africa, which is a province with high rates of gender-based violence and rape.

Methods: A qualitative descriptive design was used. Fifteen THPs, including faith healers, diviners, and herbalists, participated in one-on-one interviews conducted in isiZulu and translated into English. Data were analysed using thematic analysis and the healthworlds framework.

Results: Findings indicated that rape was often understood as spiritual contamination affecting both survivors and their bloodline. Healing practices therefore focused on addressing this perceived spiritual transgression.

Conclusion: The results of this study highlight the importance of culture and spirituality in shaping understandings of rape, treatment formulation, and holistic post-rape care.

Contribution: The study demonstrates the significance of traditional healing methods in providing holistic post-rape care.

Background: Bipolar disorder (BD) is associated with unfavourable reproductive health outcomes. Evidence-based treatment guidelines advocate for reproductive safe prescribing, including family planning, avoidance of teratogenic medication and documentation of risk acknowledgement. However, there is poor adherence to the prescribed guidelines in clinical practice.

Aim: To describe the range of psychotropic medications prescribed to women of reproductive age (WRA) with BD at a tertiary psychiatric unit.

Setting: Helen Joseph Hospital, Johannesburg, South Africa.

Methods: A retrospective record review of females aged 18-49 years treated for BD between January 2016 and December 2023 was conducted. A convenience sample of 141 files was reviewed. Data were collected from the latest clinical notes and prescription charts.

Results: A combination of mood stabilisers (MS) and atypical antipsychotics was predominantly prescribed (81.6%). Of the MS, valproate use was most common (50.6%), followed by lithium (29.3%). Risperidone was the most prescribed antipsychotic (39.0%), followed by olanzapine (24.7%) and quetiapine (20.5%). Antidepressants were combined with MS or antipsychotics in 10.6% of cases. Documented contraception counselling (5%) and contraception use (9.2%) were low. None of the records had documented risk acknowledgement for valproate use (100%).

Conclusion: Prescribing guidelines for teratogenic MS were not consistently followed. Therefore, WRA diagnosed with BD may be at an increased risk of teratogenic drug exposure in pregnancy.

Contribution: This study highlights the need for improved documentation of medication risk discussions, family planning and informed consent at every visit.

Background: Despite advances in diagnostics and pharmacological interventions, adults with attention-deficit/hyperactivity disorder (ADHD) experience poor mental health outcomes in South Africa. Patient involvement in psychiatric care remains inconsistent, and co-production has yet to be explored for improved continuity, adherence, and satisfaction.

Aim: This study explored how adults with ADHD perceive their involvement in psychiatric care to inform co-production practices for clinicians.

Setting: Participants were recruited via the South African Society of Psychiatrists (SASOP) ADHD Special Interest Group (SIG).

Methods: This qualitative study explored how adults with ADHD perceive their involvement in psychiatric care. Thirteen adults formally diagnosed with ADHD were purposively sampled. Semi-structured interviews, guided by the SERVPERF model, were conducted online and analysed thematically using ATLAS.ti (version 24.2.1 [32295]; ATLAS.ti Scientific Software Development GmbH, Berlin, Germany).

Results: The proposed patient-centred care framework is based on four identified themes: (1) patient agency enhances engagement when decision-making is shared and treatment options are clearly explained; (2) trust in provider expertise and empathy influence adherence and comfort with treatment plans; (3) satisfaction increases with personalised, responsive care, particularly during medication adjustments and follow-up; and (4) continuity of care and timely access foster sustained engagement, while inconsistent communication leads to frustration and dropout. Together, these dynamics form a relational framework for the co-production of care.

Conclusion: Patient involvement in ADHD care is relational and influenced by trust, effective communication, and continuity of care. Where co-production was present, patients experienced improved outcomes.

Contribution: This study emphasises integrating co-production into psychiatric practice through structured involvement strategies, improved continuity, and relational training for healthcare providers.

Background: Harmful substance use (HSU) poses a significant global health challenge, impacting social, economic, and healthcare systems. Low- and middle-income countries (LMICs) are particularly burdened as a result of limited infrastructure for managing substance-related issues. While evidence-based brief interventions like motivational interviewing (MI) are widely used in high-income countries, research on their effectiveness in LMICs is limited.

Aim: This systematic review aims to evaluate studies employing MI as part of interventions for adults with HSU in LMIC settings.

Setting: This review focused on studies within low- and middle-income countries which include settings characterised by constrained mental health resources, high treatment gaps for substance use disorders (SUDs), and diverse service delivery contexts.

Methods: Following Cochrane and PRISMA guidelines, we searched PubMed, EBSCOhost, Web of Science, Cochrane Library, clinicaltrials.gov and GSK Clinical Study Register for publications from 2010 to 2022. A narrative analysis was conducted, and the Joanna Briggs Institute Critical Appraisal Tools assessed study quality.

Results: Out of 518 publications, 11 studies from five countries met our inclusion criteria. Most were randomised controlled trials, with some using qualitative or mixed methods. The interventions targeted alcohol, opioids, and other drugs. Different strategies were used, including MI-blended with other interventions (such as cognitive-behavioural therapy, behavioural activation, and imaginal desensitisation) or using MI-informed approaches.

Conclusion: Overall, MI-informed interventions were shown to improve substance use outcomes in six of the 11 studies, with a significant reduction in substance use. However, further high-quality research with larger samples and rigorous designs is needed to strengthen the evidence base and address potential sources of bias.

Contribution: Findings suggest that MI-informed approaches, as a brief intervention, can improve substance use outcomes in resource-constrained environments within LMICs.

[This corrects the article DOI: 10.4102/sajpsychiatry.v32i0.2543.].

Background: Adjustment disorder (AjD) is a significant yet often underdiagnosed condition in workplace mental health. The International Adjustment Disorder Questionnaire (IADQ) has shown promise as a screening tool, but its clinical utility within South African (SA) occupational settings remains unexplored.

Aim: To assess the psychometric validity and clinical utility of the IADQ in an educated SA workplace population.

Setting: The research was conducted across various occupational sectors in South Africa.

Methods: A cross-sectional survey included the IADQ alongside validated measures of depression, anxiety, post-traumatic stress disorder and psychological resilience. Confirmatory factor analysis assessed structural validity, while performance of the IADQ algorithm was evaluated against clinical interviews. A grey zone approach was considered to refine screening thresholds.

Results: Adjustment disorder point prevalence was 4.3% in this sample. Confirmatory factor analysis supported the two-factor model of AjD symptoms, with measurement invariance observed across gender and language groups. The IADQ algorithm demonstrated good diagnostic accuracy for screening purposes, with sensitivity and specificity values exceeding 0.95. Psychological resilience was associated with lower odds of AjD.

Conclusion: The IADQ demonstrated good psychometric properties and clinical utility for comparable workplace mental health screening. The grey zone approach may offer a practical framework for graduated triage in resource-limited settings.

Contribution: Our study supported the global applicability of the two-factor AjD symptom model, provided updated AjD prevalence rates for a SA workplace sample, and considered a refined screening method for use in occupational mental health services.

Background: Chronic low-grade systemic inflammation is implicated in the pathophysiology of schizophrenia, particularly in its early stages. Pro-inflammatory and anti-inflammatory cytokines have been implicated, particularly interleukin (IL) 6, 8 and 10.

Aim: To investigate the association between serum inflammatory cytokines (IL-6, IL-8 and IL-10) and first-episode psychosis (FEP).

Setting: The study was at five clinical sites in KwaZulu-Natal, South Africa.

Methods: This study was an observational, cross-sectional sub-analysis of data derived from a larger longitudinal cohort study of individuals with FEP. In this analysis, we included HIV-negative participants who were 18 years to 45 years old and had less than 6 weeks of antipsychotic exposure. Measures included socio-demographics (age, sex), body mass index (BMI), psychiatric diagnosis (Mini International Neuropsychiatric Interview, MINI), psychosis severity (Positive and Negative Syndrome Scale, PANSS), depressive symptoms (Patient Health Questionnaire-9, PHQ-9), substance use (WHO Alcohol, Smoking and Substance Involvement Screening Test, WHO-ASSIST), childhood trauma (Childhood Trauma Questionnaire, CTQ), and serum cytokines (Multiplex ELISA).

Results: The sample comprised 58 participants, predominantly men (83%), with high rates of lifetime alcohol use (88%) and at least one type of childhood trauma (66%). There was a statistically significantly higher cytokine expression with current alcohol use: IL-6 (p = 0.04), IL-8 (p = 0.01) and IL-10 (p = 0.03). There was also a statistically significant association between lifetime alcohol and tobacco use and elevated IL-10 (p = 0.00 and p = 0.04, respectively). There was no statistically significant association between PANSS, PHQ-9, CTQ, BMI or cannabis and interleukins.

Conclusion: The study concludes that there is some evidence of immunological dysfunction at baseline in treatment-naïve persons diagnosed with FEP.

Contribution: This study contributes novel data on inflammatory cytokine profiles in individuals with FEP in a South African context, an under-represented population in psychoneuro-immunology research.