Includes abstract. Includes bibliographical references. The co-occurrence of problematic substance use and non-substance use psychopathology is very common in psychiatry, and is generally referred to as comorbidity. The phenomenon has been the subject of debate and widespread research, yet remains poorly understood. The thesis aimed to examine the association between psychopathology and substance use in young people in South African settings, to determine the nature and prevalence of comorbidity, and to identify sociodemographic factors that might influence the associations, as well as the influence of comorbidity on substance use treatment outcomes.
Includes bibliographical references. Intimate relationships in adolescence play an important role in psychosocial development and can impact on relationships during adulthood. There is a need for evidence-based interventions to prevent intimate partner violence (IPV), promote sexual and reproductive health, and equitable, enjoyable relationships during adolescence. A nuanced understanding of contemporary adolescents' intimate relationships is needed to inform intervention development. A series of studies was undertaken to explore (a) contemporary adolescents' ideas about and experiences of relationships; (b) young adolescents' sexual behaviour and dating; (c) adolescents' conceptions of a good relationship; and (d) published-evidence guidelines for developing school-based violence prevention interventions. For study (a), qualitative data were collected during focus group discussions and in-depth interviews with 14-18 year olds. Survey data from 13-16 year olds (for study b) and 15-18 year olds (for study c) were analysed using regression analyses. Adolescentsâ€™ intimate relationships are fluid and unstructured, highly gendered, and greatly influenced by peer relationships; however, experience with relationships and sex are varied. For girls, good relationships were associated with having a mutual main partnership with an older, educated boyfriend in which there was good, open communication particularly about sexual and reproductive health. For boys, a mutual main partnership and very little quarrelling were associated with good relationships. Young adolescents' reported engaging in a variety of sexual behaviours ranging from kissing to sexual intercourse with the former more common than the latter. These findings indicate a need for early interventions that are carefully adapted and acceptable to adolescents who have varying levels of experience with relationships, sex, and violence. Adolescents would benefit from developing gender equitable attitudes; critically reflecting on their ideas and practices related to good and poor relationships; building sexual decision-making skills to better prepare them to develop and maintain good, healthy relationships and end poor or abusive ones. Interventions should incorporate adolescents' perspectives and balance evidence-based best practice and resource availability.
Includes bibliographical references. The HIV/AIDS epidemic in South Africa is characterised mainly by heterosexual transmission and an extremely rapid spread among adolescents and young adults in their early twenties, indicating the need for an increased focus on preventive efforts aimed at this age group. Apart from the development of a cure or vaccine to prevent HIV transmission, preventive programmes clearly offer the best chance of halting the spread of HIV, and these need to be based on behavioural change to modify or prevent risk behaviours. The challenge is to develop suitable theory-based programmes that address and promote safer sex behaviour, taking into account the local social and cultural environment. This cross-sectional study focused on a key HIV preventive behaviour, namely condom usage, and used as its research target adolescents, a key risk group for HIV infection in South Africa. It aimed to investigate the key variables that influence condom usage among adolescents in the Cape Town metropolitan area. The study was based on an integrated theoretical model using constructs from 5 of the most common social cognitive behavioural theories, namely, the Health Belief Model, Bandura’s Social Cognitive Theory, the Theory of Reasoned Action, the Theory of Planned Behaviour and the Theory of Subjective Culture and Interpersonal Relations. In addition, variables from Basch’s construct availability model were included. The sample comprised a representative three-stage sample of grade 11 adolescents from 36 schools in the Cape Town Metropolitan area (n = 1931). Formative research, in the form of an elicitation study using to focus group interviews with a purposive sample of adolescents, was used to develop the theory-based self-completion questionnaire used in this study. Twelve constructs were included in the questionnaire as potential correlates of condom use, namely: intention, self-standards, self-efficacy, affect, attitude, beliefs, norms, condom availability, health concern, worry about AIDS, construct availability and condom availability. The dependent variable was condom use on the last coital episode.
Kaliski, Sean Z
Bibliography leaves 309-337. Aims: to determine which static and dynamic risk factors contributed to the commission of violent offences, and to habitual violence in offenders that had been referred for pre-trial psychiatric assessment. b. to assess, by logistic regression modelling, the relative importance of the significant risk factors. All defendants admitted to the Forensic Psychiatry Unit at Valkenberg Hospital for 30 day pre-trial assessments over a 6 month period were entered. All subjects were assessed by 2 psychiatrists and a clinical psychologist, who used semi-structured interviews A forensic social worker interviewed family members. Court documentation provided information about the events of the offence and conviction record. A psychometrist administered Barrat's Impulsivity Scale (BIS), Zuckerman's Sensation Seeking Scale (ZSS), and Annett's Handedness Test (Zuckerman et al. 1964). Nursing staff and occupational therapists compiled daily reports on the subjects' behaviour in the ward.
Quested, Digby John
Bibliography: leaves 221-270. Serotonin neurones have been implicated in the pathophysiology and treatment of clinical depression to a greater degree than any other neurotransmitter. Additionally, serotonin pathways may playa role in the pathophysiology and treatment of eating disorders, anxiety states and schizophrenia. Molecular biological studies have confirmed pharmacological evidence suggesting the existence of multiple serotonin receptor subtypes and the genes for these receptors, as well as that of the serotonin transporter, have common polymorphic variants. To investigate the effect of repeated treatment with selective serotonin fe-uptake inhibitors (SSRI's) on the function of central 5-HT2C receptors. To assess the effect of polymorphic variation in the 5-HT2c receptor and serotonin transporter on functional responses to selective pharmacological challenge. To determine whether polymorphic variation in the 5-HT receptor and serotonin transporter influence the clinical response of patients with major depression to treatment with serotonergic antidepressants. To assess the effect of repeated treatment with selective serotonin re-uptake inhibitors (SSRI's) on the function of central 5-HT2c receptors I used the 5-HT2C receptor agonist, m-chlorophenylpiperazine (m-CPP) as a 5-HT2c probe in a neuroendocrine challenge paradigm. I used the same approach to assess whether polymorphic variation in the 5-HT2c receptor (serine vs cysteine substitution) was associated with differences in functional response to 5-HT2C receptor challenge. I then studied whether polymorphic variation in the serotonin transporter promotor region (long versus short form) was associated with differing functional responses to acute challenge with clomipramine, a tricyclic antidepressant with a high affinity for the serotonin transporter. Finally, I studied whether either of these polymorphic variants influenced the clinical response of patients with major depression to treatment with SSRI's and clomipramine. SSRI treatment significantly lowered the sensitivity of 5-HT2c receptors as predicted from animal experimental studies. However polymorphic variation in the 5-HTzc receptor did not significantly influence functional responses to m-CPP challenge. In contrast polymorphic variation in the serotonin transporter was associated with differing neuroendocrine responses to acute clomipramine challenge with greater prolactin release being seen in subjects with the long polymorphic variant. Neither the 5-HTzc nor the transporter polymorphisms correlated with clinical response to SSRI and clomipramine treatment in patients with major depression. The ability of SSRI's to produce a functional down-regulation of 5-HTzc receptors may be relevant to certain of their therapeutic effects. Polymorphic variation in the 5-HT2c receptor (serine vs cysteine) seems unlikely to explain functional differences in responses to 5-HTzc receptor challenge or antidepressant responses to SSRI treatment. In contrast variation in the serotonin transporter promotor is associated with differing functional responses to acute serotonin re-uptake blockade. However, this did not correlate with clinical response to longer-term SSRI treatment.
Observational analysis study on the influence of the physical hospital environment on aggressive behaviour and the management thereof in an adult acute psychiatric admission unitVan den Berg, Marietta 2008 (has links)
Includes bibliographical references (leaves 81-96). Aggression is a complex phenomenon that is influenced by a range of factors including individual patient factors, social-interactive factors and envirnmental factors. Many studies have tried and failed to demonstrate that changes such as physical environmental change, intensive case management, increased staff training or skills reduce the levele of violence, as captures by number of incidents accuring in in-patient units.
Van der Westhuizen, Claire
Includes bibliographical references. Mental disorders and violence-related injuries make significant contributions to the global disease burden, mostly affecting young people. In emergency centres, mental disorders and violence-related injuries are commonly seen and, according to international data, violently injured patients are at-risk for mental disorders. Despite the scale of this problem, little evidence exists, especially from low- and middle-income-countries, regarding predictors of mental disorder and violence-related injuries, and data concerning interventions have not been synthesised.
Joska, John A
The mental health needs of patients entering the program at ward one, Valkenberg Hospital, are not routinely measured. Their presenting problems are frequently complicated by basic and social needs, which impact on recovery and re-integration into the community. The Camberwell Assessment of Need is a valid and reliable instrument used to measure the mental health needs of psychiatric patients. In this study, this instrument was used with some modifications to assess the needs of patients on admission to ward one. At discharge, these needs were explored to measure the extent to which services and interventions were useful in meeting those needs. Where not, questions aimed at elucidating impediments to care were asked. All 60 patients completing the program agreed to participate. The average number of total needs on admission was 9.2, which included an average of 6.7 unmet needs. Psychiatric needs were the most commonly reported, with a need in the area of "depression" being declared in 59 patients. Help received prior to admission was scant, and patients had high expectations of ward one. Help received from ward one was highest in areas of psychiatric needs, with 89.8% of patients receiving moderate or high help in the area of depression. More than two-thirds of patients reported receiving low help in basic areas such as accommodation, self-care, and sexual expression. The services most often regarded as useful were organised group activities and therapies. Paired t-tests revealed that the patients without borderline personality had more unmet needs on admission. Regression analysis suggests that younger age and lower level of education confer a greater risk of unmet needs on admission and discharge. The routine use of a needs assessment instrument is recommended as an aid to guide clinicians. Attention needs to be given to basic and social needs, such as accommodation, daily activities and company, prior to admission to hospital. Where these needs persist, the active involvement of a social worker and occupational therapist is suggested. The high numbers of unmet needs in domains other than psychiatric problems, requires the input of the multidisciplinary team.
A comprehensive literature study on the effect of cannabis use on cognition and aggressiveness, including a small study to explore these variablesFanshawe, Nigel Charles 1997 (has links)
Twenty seven consecutive black male patients who were admitted as acute admissions to FEH were examined in this thesis. The following demographic information characterized the sample group. a) Age: Bimodal distribution with peaks at 21-25 years and 31-35 years. Five patients were older than 35 years. b) Marital Status: In the sample. 59.2% were single. 11.1 % married and 29.6% the marital status was unknown. c) Number of Children: In the sample. 75% did not know how many children they had. Numbers ranged from no children (14.3%) to 2 children (7.1% of the sample). d) Employment Status: In the sample 81 .1 % were unemployed. e) Level of Schooling: In one third of cases, level of schooling was unknown. Most men did reach secondary level of education.
Background: Comorbid anxiety disorders in psychotic illness are reported in the international literature as highly prevalent and have a significant negative impact on patient outcomes. Local literature describing such comorbidity in the South African population is limited and clinically, anxiety symptoms are seldom recognised or treated in patients with psychotic disorders. More data on prevalence rates across psychotic disorder diagnoses, as well as sociodemographic correlates would aid recognition, diagnosis, and treatment, and potentially improve clinical outcomes in this population. Method: We performed a secondary analysis of an existing database which comprised data from participants of three previous studies. The sample was made up of patients from Valkenberg Hospital and healthcare facilities in its catchment area. All patients had a diagnosis of a psychotic disorder. Socio-demographic information was collected using a structured questionnaire. Clinical information and diagnosis was determined using the Structured Clinical Interview for DSM (SCID-I). Rates of comorbid anxiety disorders were compared across various sociodemographic categories. Results: The overall prevalence of any anxiety disorder in the entire sample (N=226) was 14.6% (n=33), 95% CI [10.27-19.89%]. The most common anxiety disorder comorbidities were, in descending order, panic disorder (n=12, 5.31%; 95% CI [2.77-9.09%]), PTSD (n=9, 3.98%; 95% CI [1.84-7.42%]), specific phobia (n=7, 3.10%; 95% CI [1.25-6.28%]), anxiety disorder not otherwise specified (n=7, 3.10%; 95% CI [1.25-6.28%]), social phobia (n=4, 1.77%; 95% CI [0.48%-4.47%]), generalised anxiety disorder (n=4, 1.77%; 95% CI [0.48-4.47%]), substance-induced anxiety disorder (n=4, 1.77%; 95% CI [0.48-4.47%]) and obsessive compulsive disorder (n=2, 0.88%; 95% CI [0.11-3.16%]). There was a significant association between diagnosis and the presence of post-traumatic stress disorder (PTSD), with the schizoaffective disorder group having a higher rate of PTSD (13.3% vs. 3.3% in schizophrenia, 3.2% in substance-induced mood/psychotic disorder and 0% in bipolar I disorder) (Fisher's exact test, p=0.039). In turn, there was a trend level association between diagnosis and the presence of panic disorder (PD), with schizoaffective disorder patients having higher rates of PD (16.6% vs. 4.1% in schizophrenia spectrum, 3.2% in substance-induced mood/psychotic disorder and 2.2% in bipolar I disorder) (Fisher's exact test, p=0.052). A significant association was found between level of education and the presence of PTSD, with higher rates of PTSD in patients with seven or less years of education (8.8%) compared to lower rates in those with 8-12 years of education (5.3%) and > 12years of education (0%) (Fisher's exact test, p=0.020). Conclusion: The overall prevalence of anxiety disorders in psychotic illness was lower than what has been described in previous literature. Prevalence rates of individual anxiety disorders were also lower than previously published literature. Possible reasons for this include use of the SCID which utilises a strict diagnostic hierarchy, that the majority of the sample were in-patients, no use of self-report questionnaires or other anxiety-specific diagnostic instruments, or possible geographical and/or ethnic differences in South African patients. The most frequent comorbid anxiety disorders in our study were panic disorder and PTSD. This is out of keeping with other literature which has mostly found obsessive compulsive disorder and social anxiety disorder to be the most common anxiety comorbidities in psychotic illness. Further research into comorbid anxiety in psychotic disorders is needed, particularly amongst South African populations.
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