This study investigated whether illness progression and treatment refractoriness emerge after relapse in schizophrenia. We compared outcomes in a cohort treated with a standardized protocol for the ...first and second episodes of illness. The sample comprised 31 participants who (1) had successfully completed a 2-year open-label treatment phase with risperidone long-acting injection (RLAI) for a first episode of schizophrenia; (2) underwent an intermittent treatment extension phase up to 3 years or until recurrence, and (3) entered a further 2-year treatment phase with RLAI for a recurrence episode. For the patients who remained in treatment (n = 14 45%), Positive and Negative Syndrome Scale score reductions, response rates, remission rates, time to response, time to remission, functional outcome scores, and modal RLAI doses were similar for the 2 treatment periods. However, 17 (55 %) of the 31 patients discontinued the study in the second episode compared with 14 (28%) of 50 patients in the first episode, suggesting reduced effectiveness of antipsychotics when reintroduced after illness recurrence. Most notably, emergent treatment nonresponsiveness was observed in 5 participants (16%), consistent with the hypothesis that relapse may be biologically harmful in a subset of patients.
Background Assertive community treatment (ACT) is an intervention implemented to manage the effects of deinstitutionalisation. South African studies have reported decreased admissions at 12 and 36 ...months when a modified ACT intervention is compared with standard care. However, costs associated with the intervention have raised the question of its feasibility in developing countries.Aim This study aimed to describe the long-term demographic and clinical outcomes of a group of psychiatric high-frequency users (HFUs) included in the first South African ACT study.Setting Stikland Psychiatric Hospital, Cape Town, South Africa.Methods Data from 55 HFUs participating in the first South African ACT trial, including both the intervention and control groups, were retrospectively reviewed 10 years after the patients’ inclusion.Results Of the 55 HFUs initially included, nine remained in the formal ACT programme whilst 16 received standard care over the full 10 years. Five patients died and two were admitted to long-term wards. The mean number of admissions was 3.73 and the mean number of admission days was 261.11 over the 10 years. Twelve patients were never re-admitted; of these, nine came from the original study intervention group.Conclusions This was the first study looking at the long-term outcomes of a group of psychiatric HFUs in an under-resourced setting receiving either a modified ACT intervention or standard outpatient care. Reflecting broadly on the group, there were a larger number of patients in the original ACT group who had no re-admissions and a comparatively higher utilisation of available services during the 10-year follow-up period.
Background Emotional dysregulation in psychiatric disorders contributes to morbidity, mortality and healthcare costs. Dialectical behaviour therapy (DBT) is effective in addressing this, but is ...complex and costly to implement. Recent literature indicates that DBT can be modified for use in resource-limited settings, but little is known about its implementation in African settings.Aim To describe the demographic and clinical characteristics of participants in a modified DBT-ST (skills training) programme at a South African psychiatric hospital.Setting The study was conducted at Stikland Hospital, a public psychiatric hospital in the Western Cape province, South Africa.Methods A retrospective, cross-sectional chart review of patients included in a modified inpatient DBT-ST programme between 30 June 2014 and 30 June 2019 was conducted. Descriptive analyses were performed on the data both as a complete set and after division into several subgroups.Results We included 349 records. Two-thirds of the patients completed the programme. Major depressive disorder, borderline personality disorder and substance use disorder were the most prevalent diagnoses. Most patients had psychiatric comorbidities. A total of 90.61% (n = 309) of the patients were exposed to at least one traumatic event and three-quarters (n = 261) had attempted suicide at least once before.Conclusions The demographics of our sample did not differ markedly from the international literature. Rather, what stood out was that modified DBT-ST could be a choice in resource-limited settings for a diagnostically heterogeneous group that displayed significant clinical complexity and high levels of emotional dysregulation. Our findings might suggest that the intervention was well tolerated and possibly most appropriately delivered at the first admission, although further research is required.
Stigmatising attitudes of health care professionals towards mental illness can impede treatment provided for psychiatric patients. Many studies have reported undergraduate training to be a critical ...period for changing the attitudes of medical students, and one particularly valuable intervention strategy involves time spent in a clinical psychiatric rotation. In South Africa, medical students are exposed to a clinical rotation in psychiatry but there is no evidence to show whether this has an effect on attitudes toward mental illness.
This prospective cohort study involved a convenience sample of 112 South African medical students in their 5th or 6th year of undergraduate training. This sample attended a 7-week psychiatry rotation. The Attitudes to Mental Illness Questionnaire (AMIQ) was used to assess students' attitudes toward mental illness before and after the clinical rotation which includes exposure to a number of psychiatric sub-divisions and limited didactic inputs.
There was a significant improvement (p < 0.01, t-test) in the students' attitude toward mental illness following the psychiatric rotation. Females displayed a more positive attitude towards mental illness at the end of the rotation compared to males. The participants' attitude significantly deteriorated for the non-psychiatric vignette describing diabetes (< 0.01, t-test).
Our findings suggest that clinical training and exposure to a psychiatric setting impacts positively on medical students' attitude towards mental illness, even when this training does not include any focused, didactic anti-stigma input.
Background Deinstitutionalisation refers to the process of transferring most of the psychiatric care provision from inpatient state-run institutions to community-based care. However, it has proven ...difficult to implement and failed to reach its desired targets. New Beginnings (NB) is a transitional care facility that facilitates the transition from in- to outpatient care. To date, no data exist as to whether the intervention provided at NB is effective in reducing psychiatric readmissions.Aim To determine if completing a psychosocial rehabilitation (PSR) programme reduces acute inpatient service utilisation and if this is influenced by sociodemographic or clinic factors.Setting New Beginnings transitional care facility in South Africa.Methods A record review of all NB admissions between January 2011 and December 2015. Demographic and clinical data were collected, including readmissions and days-in-hospital (DIH), 36 months pre- and postindex admission. Patients were divided into a completer group (CG) and a noncompleter group (NCG) for the eight-week PSR programme, and comparative statistical analysis was performed.Results Completion of the 8-week voluntary inpatient PSR programme led to a significant decrease (p = 0.017) (CG vs. NCG) in DIH during the 36-month period postindex admission. In addition, both groups showed significantly decreased (p<0.001) DIH postindex in comparison to pre-index admission.Conclusions This study’s findings support that transitional care facilities offering an inpatient PSR programme may reduce inpatient service utilisation for all attendees but especially for those who complete the program. This highlights the need for such facilities that offer interventions tailored for patients with mental illness.Contribution This is the first local study highlighting the potentially important role transitional care facilities could play in reducing readmissions.
There is a paucity of research on the clinical profile of women living with human immunodeficiency virus (HIV) (WLWH) admitted with acute mental health illness. Existing studies are small and did not ...look at factors that could have an impact on medication adherence. As a first step to inform service delivery for this vulnerable population, a thorough understanding of the composition and needs of these patients should be identified.
To describe the socio-demographic and clinical profile that could have an influence on the antiretroviral therapy (ART) adherence of WLWH at an inpatient psychiatric unit.
In this retrospective audit, the medical records of all WLWH (18-59 years of age), discharged from the acute unit at Stikland Psychiatric Hospital, were reviewed over a 12-month period.
Of the 347 female patients discharged, 55 patients were positive for HIV (15.9%). The majority of them were unmarried (78.2%), unemployed (92.7%), had a secondary level of education (Grade 8-10) (58.2%), lived with a family member (83.6%) and had children (61.8%). The most common psychiatric diagnosis on discharge was substance use disorder with 78.2% of patients being categorised as substance users. Interpersonal violence was only reported by 5.5% of patients. Although most patients performed poorly on the Montreal Cognitive Assessment (MoCA) and International HIV Dementia Scale (IHDS), only 12% of patients received a diagnosis of HIV-associated neurocognitive disorder (HAND) upon discharge. Antiretroviral therapy (ART) was initiated in 21.8% of patients. Only eight patients had a viral load of < 200 copies/mL, indicating viral suppression.
Our findings may inform service planning and emphasise the need for targeted intervention strategies to improve treatment outcomes in this vulnerable group.
Psychiatric nurses constitute a fundamental part of the mental health care system in South Africa. However, high levels of burnout and job dissatisfaction among nursing staff have been associated ...with reduced empathy and quality of care, and poor service delivery. Stikland Psychiatric Hospital is a state psychiatric hospital situated in Belville and provides all levels of psychiatric care to a large part of the Cape metro region. To our knowledge, no previous studies have examined burnout and job satisfaction among nurses in this setting.
We assessed the relationship between burnout and job satisfaction among the nursing staff.
The study was conducted at Stikland Psychiatric Hospital, Cape Town, South Africa.
This cross-sectional study used the Copenhagen Burnout Inventory and an established job satisfaction questionnaire to assess burnout and job satisfaction among 127 staff members associated with psychiatric nursing.
In this population comprising mostly female (83.5%) nurses, scores for personal, work-related and client-related burnout were relatively high, but job satisfaction was also high. Higher levels of burnout were significantly associated (Pearson's linear correlation,
= -0.077,
< 0.01) with lower levels of job satisfaction. There were no significant associations between burnout or job satisfaction and gender, rank or years of experience.
If mental health service delivery is to be optimised, supportive or preventative processes should be implemented to reduce the prevalence of burnout in psychiatric nurses. This study adds to the scarce local knowledge and provides information that can be used to inform the development of supportive strategies for psychiatric nursing staff in South Africa.
Introduction
Deinstitutionalization has led to a dramatic reduction of inpatient beds and subsequent increase in pressure on available beds. Another consequence of deinstitutionalization has been the ...phenomenon of the revolving door patient; high-frequency users (HFUs) admitted to hospital repeatedly, remaining well for only short periods of time. The purpose of the study was to determine factors that contribute to HFU of inpatient psychiatric services by schizophrenia and schizo-affective disorder subjects in a developing country with a view to understanding this phenomenon better.
Methods
Subjects were divided into HFU and low-frequency user (LFUs) groups for comparison with regard to selected variables.
Results
HFUs had higher PANSS scores (
p
< 0.01), were more likely to admit to lifetime substance use (
p
= 0.01), be on mood stabilizers (
p
< 0.01) and also to have been crisis (premature) discharges (
p
< 0.01). LFUs were more likely to have been treated with depot medication (
p
< 0.01). Multivariate analysis showed crisis discharge (
p
= 0.03) and depot use (
p
= 0.03) to be the only remaining significant predictors of HFU versus LFU status.
Discussion
Our findings suggest HFUs’ characteristics to be similar across different settings, with under-utilization of depot antipsychotics and early discharge from hospital as particular contributors to high-frequency use of services in our sample.
Conclusion
Results seem to indicate that HFU-specific interventions are vital to addressing these issues.
Background Schizophrenia is a debilitating mental health condition affecting the lives of many South Africans. The origins of the heterogeneity in the presentation of the illness remain uncertain.Aim ...This cross-sectional study performed a retrospective data analysis to determine the usefulness of digit ratio as an endophenotype in a South African schizophrenia population.Setting A large genetic study in a South African schizophrenia population recruited patients from services in the Western and Eastern Cape.Methods Complete clinical histories were captured for participants, including sets of images of the face and extremities. Software was utilised to measure the lengths of participants’ digits from said images and digit ratios (2D:4D) were calculated. Descriptive analyses were performed on the ratios and statistical differences in digit ratio means were calculated between groups characterised by sex, age of onset and the presence vs absence of positive symptoms. Linear modelling was utilised to assess for correlates between 2D:4D and positive and negative symptom severity using scores obtained from the Positive and Negative Syndrome Scale (PANSS) and Scale for the Assessment of Negative Symptoms (SANS).Results 2D:4D in male participants did not significantly differ from female participants as in healthy populations. 2D:4D did not significantly correlate with the severity of positive or negative symptoms and 2D:4D means between groups did not significantly relate to age of onset.Conclusion 2D:4D appears to be a possible endophenotype in schizophrenia in this population. 2D:4D, however, may not be as readily identifiable as certain minor physical anomalies and neurological soft signs significantly associated with schizophrenia in this population.
Abstract Background: Few studies have compared long-acting injectable second-generation antipsychotics with oral antipsychotics. Long-acting injectable antipsychotics—developed specifically to ...address the problem of adherence—might have an important role to play in treating early psychosis. Objective: The effects of oral antipsychotics versus risperidone long-acting injection (RLAI) were compared between 2 similar studies lasting 2 years each that were conducted at our site in South Africa. Methods: Results of an open-label study in which patients were treated with flexible doses of RLAI were compared with the results of a randomized controlled trial of flexible doses of oral risperidone or haloperidol. Inclusion criteria for both studies were age 16 to 45 years; confirmed diagnosis of schizophrenia, schizophreniform disorder, or schizoaffective disorder; ≤2 hospitalizations for psychosis; and lifetime exposure to ≤12 weeks of antipsychotic medication. The dose of RLAI was 25 mg every 2 weeks, which could be increased to 50 mg. Doses of oral risperidone or haloperidol began at 1 mg/d and were increased if necessary up to a maximum dose of 4 mg/d (8 mg/d in exceptional cases). Study assessments included the Positive and Negative Syndrome Scale (PANSS), the Extrapyramidal Symptom Rating Scale (ESRS), and body mass index (BMI). Results: The RLAI group included 50 patients (32 men and 18 women; mean SD age, 25.4 7.4 years; BMI, 20.6 4.6 kg/m2 ). The oral risperidone or haloperidol group included 47 patients (27 men and 20 women; mean SD age, 25.9 5.8 years; BMI, 20.1 3.4 kg/m2 ). Compared with patients treated with oral risperidone or haloperidol, RLAI-treated patients had significantly fewer all-cause discontinuations (26.0% 13/50 vs 70.2% 33/47 at 24 months; P < 0.005), greater reduction on the PANSS total score (-39.7 vs -25.7; P = 0.009), higher remission rate (64.0% 32/50 vs 40.4% 19/47; P = 0.028), and lower relapse rate (9.3% 4/43 vs 42.1% 16/38; P = 0.001) among the responders. Extrapyramidal symptoms were significantly lower in the RLAI group than in patients treated with oral risperidone or haloperidol, as measured by the maximum change in the mean SD ESRS total score (1.40 2.60 vs 5.61 5.21 vs 9.04 6.21, respectively; P ≤ 0.001). The increase in BMI after 6 months was significantly greater in the RLAI group than in oral haloperidol-treated patients (mean SD, 3.9 1.9 vs 2.2 1.3 kg/m2 ; P = 0.001) but not significantly different from oral risperidone (3.4 2.0 kg/m2 ; P = NS). Four patients in the RLAI group had adverse events that were possibly related to prolactin, compared with 1 each in the oral risperidone and haloperidol groups. Conclusions: The findings of this post hoc analysis suggest that there were advantages in terms of efficacy, fewer extrapyramidal symptoms, and more weight gain with long-acting injectable second-generation antipsychotics as compared with oral antipsychotic treatment in early-episode psychosis.
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