Background: The impact on hospitalisations/ relapse rates of utilising long-acting antipsychotic injectable (LAIs) in a South African population suffering from chronic psychotic spectrum mental illness is poorly researched. Aim: To compare the duration and number of hospitalisation episodes 12 and 24 months before and after the initiation of a LAI. Setting: Valkenberg Hospital’s adult acute inpatient psychiatry services. Method: This was a retrospective naturalistic observational mirror-image study. Hospitalisation was utilised as a proxy for relapse. Results: Sixty-one patients were identified for the study. A comparison of the 12 months before LAI initiation to the 12 months following LAI initiation showed a reduction in the number of admissions of 44% (55 to 31), and a reduction in the number of inpatient days of 23% (1892 to 1464). There was a statistically significant reduction in the median number of hospital admissions (p = 0.005) and median inpatient days (p = 0.040). Comparing the 24 months before to the 24 months following LAI initiation, there was a reduction in the number of admissions of 30% (91 to 64) and inpatient days of 4% (3477 to 3355). There was a statistically significant reduction in the median number of hospital admissions (p = 0.014) and a non-statistically significant reduction in median days (p = 0.428). Conclusion: The prescription of a LAI reduced the duration and number of hospital admissions over a 12-month period. After 24 months, there were fewer admissions but no significant reduction in the number of inpatient days. This study supports findings of international mirror-image studies.

Includes bibliographical references. / It is recognized that the pathways patients take en route to psychiatric services vary between countries and socio-cultural groups. Delay along the pathway to care is not a mere reflection of organization of health care and referral systems but also of availability and accessibilty of services. Studies have shown associations between delay and various sociodemographic, clinical and service related factors. Understanding the pathway to psychiatric care, and recognition od delay points along the pathway, is a crucial step for the development of intervention programs geared at improving the provision of mental health care.

Generalised anxiety disorder (GAD) is a common, chronic and debilitating mental disorder impairing quality of life and functioning. The 1st line treatments for GAD include the selective serotonergic reuptake inhibitors (SSRIs) and the selective serotonergic noradrenergic reuptake inhibitors (SNRIs). However, they have rates of non-response ranging from 25 to 40%. There is justification to search for new and more efficacious GAD medication. It has hypothesised anticonvulsants possess anxiolytic properties based on animal studies and epilepsy trials. There is inconsistent evidence that anticonvulsants are efficacious in GAD. It was considered useful and timely to investigate this further. The newer anticonvulsants (felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, pregabalin, tiagabine, topiramate and zonisamide) were investigated as they were considered to have a more benign side effect profile and fewer drug interactions than older anticonvulsants. This study is a systematic review and meta-analysis of the newer anticonvulsants in the treatment of GAD. The main objective was to use randomised controlled trial (RCT) data to estimate efficacy of the newer anticonvulsants in GAD. using A search strategy was designed and three separate searches conducted by the Cochrane Depression Anxiety and Neurosis Group of the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR) and clinicaltrials.gov (the last search in May 2013). An updated, independent, search was conducted in May 2016 with no additional citations retrieved. 287 citations were retrieved and screened in total. Two independent raters assessed citations using the abstracts and selected trials that satisfied the inclusion criteria. 12 RCTs were included with eight using pregabalin and four using tiagabine. A single rater collated data from RCTs assisted by Covidence Systematic Review Software. All statistical analyses were performed using Review Manager. A random effects meta-analysis was performed expressing summary statistics as effect estimates with 95% confidence intervals (CI). There were 4001 participants in total with 2516 in the anticonvulsant group and 1485 in the placebo. Primary outcomes were reduction in symptom severity using the Hamilton Anxiety Rating Scale (HAM-A) and treatment response using the Clinical Global Impressions Scale-Improvement item (CGI-I). Secondary outcome was medication acceptability. Reduction of symptom severity on the HAM-A for: the anticonvulsant group (pregabalin and tiagabine combined) was significantly favourable with a mean difference (MD) of -2.10 ([-2.83, -1.36] 95% CI); pregabalin was significantly favourable (MD -2.86 [-3.52, -2.21] 95% CI) tiagabine was statistically insignificant (MD - 0.58 [-1.41, 0.25] 95% CI). The risk ratio (RR) of treatment response using the CGI-I (RR >1 favours the anticonvulsant) for: the anticonvulsant group was significantly favourable (RR 1.23 [1.12, 1.35] 95% CI); pregabalin was significantly favourable (RR 1.35 [1.21, 1.50] 95% CI) tiagabine was statistically insignificant (RR 1.09 [0.98, 1.22] 95% CI). The RR of treatment acceptability (RR >1 favoured placebo) for: the anticonvulsant group was significantly unfavourable (RR 1.49 [1.18, 1.88] 95% CI); pregabalin was statistically insignificant (RR 1.23 [0.92, 1.65] 95% CI) tiagabine was significantly unfavourable (RR 1.95 [1.29, 2.93] 95% CI). In conclusion, this systematic review of the newer anticonvulsants included only RCTs of pregabalin and tiagabine. The main finding was that pregabalin showed significant efficacy in reducing symptom severity and improving treatment response in GAD. Tiagabine failed to show significant efficacy in primary outcomes. Further work is needed to better clarify the place of the newer anticonvulsants in the treatment armamentarium of GAD.

Background: Medical bullying has been identified as a growing concern internationally, with multiple studies showing a high prevalence in medical students and residents However, several questions remain unanswered, including a) the prevalence of experienced bullying within our local, socioeconomic and ethnically diverse population, b) which population groups are most likely to bully medical students, c) significant demographic data which may impact on severity, frequency and type of bullying experienced, d) what is the correlation between severity, frequency and types of bullying with psychological distress in our local population. This study aims to 1) examine the association between bullying frequency and bullying types with demographic variables in this population, 2) to investigate the association of bullying severity, bullying frequency and psychological distress, and 3) to gather qualitative data on medical bullying in respondents Methods: The data for this research were collected from final year medical students. The questionnaire included the modified Quinne questionnaire assessing different types of bullying and related frequency, and the CORE-GP questionnaire assessing psychological distress. Descriptive statistics were used to analyse the quantitative data, and thematic analysis was used to assess the qualitative data. Results: There was a high prevalence of reported bullying (86.8%), with no significant differences of overall bullying across demographic variables. However, certain types of bullying were more commonly experienced by female and black students. Consultants and registrars were reported to bully students more frequently than nurses. Increased bullying frequency was significantly associated with higher levels of psychological distress. The main themes to emerge in the qualitative analysis were 1) Negative emotions relating to demographic bullying, 2)Systemised bullying within specific departments which according to the student are repetitive and expected, and 3) Feelings of academic pressure and fear associated to the bullying they have encountered Conclusion: This study suggests that the frequency of perceived bullying in South African medical students is consistent with rates reported in the literature. Bullying may follow the lines of medical hierarchies (with consultants being perceived as most likely to be the bully). Further, social disparities seem to be associated with increased bullying, with female and black students more often targeted. Specific interventions are needed to address bullying and associated psychological distress.

Background There is a consensus that psychosis confers a modest risk toward violent offending. Most research to date has shown that a statistical relationship does exist between schizophrenia and bipolar disorder, and violence and aggressive behavior In forensic mental health, state patients are rehabilitated in a general program regardless of diagnosis. It is not known whether different rehabilitation management strategies should be implemented on those with bipolar disorder as compared to those with schizophrenia. This study is an attempt to ascertain if there are differences between those diagnosed with schizophrenia and bipolar disorders, and if so, whether these have implications for their rehabilitation programs. Objectives The study aims to compare the demographic profiles and comorbidities (in terms of substance use and personality disorders) of state patients with bipolar disorder and schizophrenia who have offended violently. Methods This was a quantitative, cross sectional study. State patients who were diagnosed with schizophrenia and bipolar disorder and committed a violent crime were included in the study from the 1st January 2000 to 31st December 2014. The study population comprised a total of 93 male state patients. Of these 46 patients had a diagnosis of bipolar disorder and 47 patients had a diagnosis of schizophrenia. Results The results show that in general the differences between the schizophrenia group and the bipolar disorder group are marginal. A higher percentage of patients with schizophrenia committed murder at 17.02% and attempted murder at 12.77%. The bipolar disorder group had a significantly higher number of patients diagnosed with co morbid personality disorder at 59.57% (p value of 0.01.) Substance abuse was common in both groups. The mean age at admission was 31,23 years in schizophrenia and 36,85 years in bipolar disorder. This demonstrates an earlier onset of criminality in the group with schizophrenia. Patients with bipolar disorder were more likely to be married (13.04%), divorced (10.8%) or separated (2.17%). Conclusion There were no major differences elicited between the 2 groups of patients. Certain aspects such as therapeutic programs for personality disordered patients and social interventions in patients with poor social support would contribute to improving the quality of the rehabilitation programs currently used. The commonalities found in the 2 groups suggest that a common approach to rehabilitation would be adequate in this setting.

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