Freeman, Carla Patricia
Includes abstract. Includes bibliographical references. Myasthenia gravis (MG) is an acetylcholine receptor antibody- mediated disease targeting the neuromuscular junction resulting in fatigable muscle weakness. A number of reports have suggested a high prevalence of psychiatric symptoms amongst MG patients. Approximately 10% of MG subjects are found to have an associated thymoma and despite thymomectomy, the MG persists. The presence of thymoma may lead to other antibody-mediated neuropsychiatric manifestations including limbic encephalitis. We hypothesized that the prevalence of neuropsychiatric symptoms may be higher in MG subjects with thymoma-associated MG when compared with those who have non-thymoma MG. This study aims to compare the prevalence of neuropsychiatric symptoms in a South African population of non-thymoma MG and thymoma-associated MG.
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.
The diagnostic yield of computerised tomography in human immunodeficiency virus (HIV) positive psychiatric patients at a tertiary hospital in the Western CapeBerwers, Juan 2017 (has links)
Background. HIV infection increases the risk for mental illness. Neuroimaging is an important part of the diagnostic workup in HIV+ psychiatric patients; CT is the primary neuroimaging modality available in resource limited settings. Despite advances in neuroimaging no clear guidelines exist for the use of CT in psychiatric settings. Objective. To determine the diagnostic yield of CT brain (CTB) scans in HIV+ psychiatric patients and to describe these abnormalities as well as demographic and clinical variables associated with abnormal CT scans. Methods. A retrospective study was conducted at the Department of Psychiatry and Mental illness at Groote Schuur Hospital, Cape Town, South Africa. Clinical and radiological data for HIV+ psychiatric patients who received a CTB scan during admission were analysed for the period January 2013 - June 2015. Results. A total of 65 patients met the inclusion criteria. The mean age of the participants in this study was 36.2 years (range 18 - 64). The most common presenting psychiatric symptoms were psychosis (81.54%), cognitive deficits (72.41%) and mood symptoms (69.23%). CT scans results consisted of 29 (44.62%) normal scans and 36 (55.38%) abnormal scans. Atrophy was the most common (72%) radiological finding in abnormal CT scans. No associations were found between current proposed CT guidelines in psychiatric patients, although a history of previous traumatic brain injury (TBI) approached significance (p = 0.054). There was a significant correlation between abnormal CT scans and past or current substance use (X² = 5.9508 P = .015). Abnormal CT findings increased with the Centers for Disease Control and Prevention (CDC) HIV immunological stage progression. The management of 9 patients changed; 7 of these CT scans were abnormal. Conclusion. In this study of CTB scans in HIV+ psychiatric inpatients, previously suggested criteria proposed in guidelines for imaging were not associated with significantly higher rates of abnormal CT findings. Current or previous substance use correlated with significant higher rates of abnormal CT findings. Due to the high yield of abnormal CT scans in this study, it is suggested that HIV+ psychiatric inpatients with previous or current substance use, a history of TBI or HIV immunological stages B or C, are considered for imaging. It is recommended that further studies with larger sample sizes, consisting of inpatient and outpatient populations, with control groups be conducted to investigate current or previous substance use as an indication in guidelines for CTB scan in HIV+ psychiatric patients.
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