A retrospective analysis of factors used to assess fitness to stand trial in adult male defendants referred for psychiatric observationJacobson, Candice 2017 (has links)
Background. A court orders a forensic observation of a defendant to determine a defendant's fitness to stand trial and/or ability to appreciate wrongfulness of action (criminal responsibility) at the time of the alleged offence. Fitness to stand trial is the focus of this review rather than criminal responsibility. In this instance, the court requests an expert to determine whether the defendant's current mental state would significantly impair his or her ability to participate meaningfully in his or her own trial. In South Africa, this process involves multiple assessments by a multidisciplinary forensic psychiatry team in a dedicated forensic psychiatry unit. However, at present no standardised format has been adopted for such an evaluation, the findings of which may have dire consequences for the individual being assessed. Furthermore, there is a paucity of current literature on fitness to stand trial evaluation. Objectives. To establish whether fitness to stand trial is adequately assessed in the Western Cape, South Africa. A further objective is to establish whether mental illness is the sole factor that differentiates defendants fit to stand trial from those who are found not fit to stand trial, and whether defendants with mental illness are less likely to be asked the relevant questions to determine fitness to stand trial than those without mental illness. Methods. A descriptive, retrospective review was conducted (via the application of a checklist) of clinical records of the last 100 male defendants' ≥18 years of age admitted to the Valkenberg Hospital Forensic Psychiatry Unit prior to March 2015. Results. 30 defendants (30%) were found to have a psychiatric diagnosis. Of the 30 defendants, all were noted to have a serious mental illness (mostly psychotic disorder or cognitive impairment) and were found not fit to stand trial. Seventy (70%) of the defendants were found fit to stand trial by the expert panel. From the findings, it was noted that the forensic team asked and recorded the necessary factors to determine fitness to stand trial in 56% of the study population (based on frequency of responses: n = 894), with 32% of questions not appearing to have been addressed at all (especially those pertaining to role players in court and a defendant's understanding of his rights). Furthermore, various questions appeared to have been indirectly addressed in fewer than 50% of defendants. No significant difference was noted in how the forensic team conducted its assessments between those defendants found to have a serious mental illness and those without serious mental illness. Conclusion. The results of the study suggest the need for a more in-depth review of the forensic evaluation process in the Western Cape to further ascertain the benefits of using a checklist during the evaluation process. Furthermore, additional research would assist in determining the factors contributing to a number of questions not having been addressed and the consequences thereof.
Bekele, Yilma Yitayew
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.
Heroin detoxification during pregnancy: a systematic review and retrospective study of management of heroin addiction in pregnancyGilfillan, Katherine Verne 2012 (has links)
Includes bibliographical references. There is a general consensus that methadone maintenance is the gold standard in the management of pregnant heroin users. However, in South African state hospitals, methadone withdrawal is the routine procedure offered to these patients, as methadone maintenance programmes are unavailable in the public sector.
Systematic review of imaging studies in the lateral orbitofrontal circuit in bipolar type I disorderYorke, Neil 2013 (has links)
Includes bibliographical references. The aim of this study was to review the available published structural magnetic resonance imaging (MRI) data in bipolar type I disorder, looking for any evidence of a change in size of the structures in lateral orbitofrontal circuits relative to the conceptually unaffected motor circuit. Structures in the motor circuit will thus act as an internal control. We will additionally look at healthy controls as an external control.
Includes bibliographical references. The rationale of doing thorough medical screening of all psychiatric patients is clear, because there is a relationship between medical illness and mental illness. It remains unresolved which screening tests should be performed routinely in general psychiatric patients even though the prevalence of medical illness is relatively high. Even less is known about the prevalence of medical illnesses in criminal defendants referred for observation, most of whom do not have a serious psychiatric disorder. Special investigations may be necessary in the diagnosis of these medical conditions. Within the context of psychiatry as a whole, the population referred for forensic observation may be subject to more stringent investigation as a legal requirement. However there is little information available on this group regarding the prevalence of medical illnesses and the impact that these have on the psycho-legal assessment. This study will therefore seek to assess the current practice of routine investigations in assessing criminal defendants that have been referred to the forensic observation unit in order to assess whether these findings contribute significantly to the psycho-legal assessment, and to determine the prevalence of medical illness in this population. It is hoped that it will be possible to decide whether there is utility to do routine tests, essentially by coercion, in this group.
The lived experience of persons with chronic fatigue syndrome : a qualitative phenomenological studyMayers, Patricia Margaret 2000 (has links)
Bibliography : leaves 99-111. This phenomenological study examined the lived experience of persons who suffer from Chronic Fatigue Syndrome (CFS). Research into this condition has to date concentrated on causality and coping strategies and there is limited knowledge of the experiences of sufferers of this condition. In-depth interviews were conducted with five participants who met the criteria for the diagnosis of CFS. The interviews were tape-recorded, transcribed verbatim and analysed, coding for thematic content.
Neurocognitive disorders in young adults commencing highly active anti-retroviral treatment in the Western CapeJoska, John Anton 2010 (has links)
Includes abstract. Includes bibliographical references. HIV-associated neurocognitive disorders (HAND) remain prevalent in the era of highly active anti-retroviral therapy (HAART). The aim of the study was to investigate whether HAND are as prevalent in South Africa as in other regions, and whether individuals with HAND in South Africa will respond to HAART. The literature was reviewed to elucidate potential mechanisms of the development of HIV-associated dementia (HAD), the most severe form of HAND, and to establish the effect that HAART has exerted on HAND across diverse studies. A prospective clinical cohort study was initiated in Cape Town, comprising 170 participants. The reviewed literature suggests that HAD is likely mediated by a range of HIV-related factors (including possible difference in HIV sub-type) and host-related factors.
The relationship between impulsivity, affect and a history of psychological adversity: a cognitive-affective neuroscience approachIpser, Jonathan 2011 (has links)
There is increasing evidence that trauma exposure is associated with impulsive behaviour and difficulties regulating affect. The findings of recent studies implicate the disruption of neurobiological mechanisms, particularly those involving the neurotransmitter serotonin, in both impulsivity and affect regulation.
Prevalence and patterns of medication use in children and adolescents with Autism Spectrum Disorders in the Western CapeLouw, Kerry-Ann 2012 (has links)
Includes abstract. Includes bibliographical references. The Autism Spectrum Disorders(ASD) are a group of neurobiological conditions of growing prevalence for which there is no known cure. International prevalence studies have determined that children and adolescents with ASD are a highly medicated population. This comes to light in the context of a paucity of data around the efficacy of commonly prescribed medications. There is no data around the prevalence of medication use in the ASD population in South Africa. The aim of this study is to determine the prevelance and patterns of medication use in children and adolescents with ASD in the Western Cape and to determine the relationship between demographic variables and behaviours and medication use.
Includes abstract. Includes bibliographical references (leaves 69-74). Suicide attempts are associated with an increased risk of repeat attempts, completed suicide, chronic psychiatric symptoms, and ongoing psychosocial difficulties. Data is lacking in several areas in the field of suicide prevention and it is vital that clinicians identify factors that increase treatment adherence among patients that attempt suicide. This study aims to examine adherence rates and predictors of adherence to follow-up after a suicide attempt among the patient population of the PEU of Groote Schuur Hospital, Cape Town. Underlying the study is the hypothesis that sociodemographic factors and the nature of the suicide attempt predict adherence with follow-up subsequent to a suicide attempt.
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