Schizoaffective Disorder remains poorly understood. Experts still disagree on whether it is a discrete disorder; whether it exists on a spectrum between Bipolar Disorder and Schizophrenia or whether it even exists. Objectives: The study aimed to describe the demographic, clinical and treatment profile of mental health care users (MHCUs) diagnosed with Schizoaffective Disorder at a regional hospital (Helen Joseph Hospital) in Johannesburg, Gauteng. It also aimed to determine the degree of agreement between the clinicians‟ diagnosis and Operational Criteria (OPCRIT). Methods: All MHCUs at Helen Joseph Hospital psychiatric unit with a discharge diagnosis of Schizoaffective Disorder between January 2004 and December 2010 were included. The demographic, clinical and treatment profiles as well as data required for OPCRIT were extracted from hospital records and discharge summaries. Results: The main findings were that most MHCUs diagnosed with Schizoaffective Disorder were female with a mean age of illness onset of 25 years; had impaired social, occupational and interpersonal functioning; had a family history of mood disorders; were non-adherent on admission and were treated with at least 1 antipsychotic and 1 mood stabiliser. Also, there was no agreement between the clinicians‟ diagnosis and OPCRIT. Conclusion: More rigorous research is needed to accurately describe the profile of MHCUs diagnosed with Schizoaffective Disorder to improve understanding and management of their condition.

No description available.

The ICD is currently under revision and this study is the first phase of the electronic field trials for ICD-11 for psychotic disorders. The present study compared ICD-10 and ICD-11 with regards to changes made to the diagnostic guidelines and changes amongst specific disorders. Of specific interest was clinicians’ ability to accurately diagnose disorders that can present with overlapping features. We found that both diagnostic systems were accurate in differentiating disorders that have the potential to be easily confused. For some of the diagnostic guidelines that were undergoing substantial changes from ICD-10 to ICD-11, we did find improvements in the proposed guidelines. Subsequent studies will expand on our findings prior to the release of ICD-11. However, based on our initial findings, the proposed changes do appear to be increasing clinical utility of the diagnostic guidelines.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Occupational Therapy Johannesburg, 2014. / Background: Individuals suffering from both a psychotic disorder and a substance abuse disorder have shown to have poorer occupational outcomes. This study aimed at determining the exact consequences of substance abuse on occupational performance in order to tailor more specific treatment interventions in the future. Methodology: A non-experimental design and observational study was used. This involved a once off occupational therapy assessment using the Activity Participation Outcome Measure (APOM) as the recoding tool. The participants were divided into three groups: Alcohol abuse, cannabis abuse and no substance abuse. Methodology: A non-experimental design and observational study was used. This involved a once off occupational therapy assessment using the Activity Participation Outcome Measure (APOM) as the recoding tool. The participants were divided into three groups: Alcohol abuse, cannabis abuse and no substance abuse. Results: A statistically significant difference was noted between the alcohol and cannabis groups. The alcohol group achieved a higher level of activity participation in all eight APOM domains (Role performance, life skills, communication, motivation, process skills, self esteem, balanced lifestyle, and affect). The no substance abuse group (individuals diagnosed with schizophrenia) showed the lowest level of activity participation. Conclusion: Cannabis adolescent abuse/dependence appears to have a more negative impact on activity participation when compared to alcohol abuse.

A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Doctor of Philosophy Johannesburg, 2016 / Oral drug delivery is acknowledged by many as the idyllic method of drug delivery due to its versatility and convenience of administration. Nevertheless, the bioavailability of drugs delivered via the oral route remains disputed. Classically, conventional marketed drug delivery systems release drugs in inconstant and unpredictable manners, leading to sub-therapeutic and in some cases toxic drug doses. Consequently, patient compliance is compromised, in turn having an effect on the success of the therapeutic intervention in question. One such limitation occurs in the treatment of Schizophrenia, with patients unable to comply with treatment due to multiple administration requirements. Sulpiride, an antipsychotic agent, displays notable efficiency in reducing both positive and negative symptoms of Schizophrenia. However, sulpiride has a low bioavailability and thus therapy requires the use of large doses, and hence multiple administrations. In addition, a large percentage of Schizophrenic patients present with concomitant mood disorders, namely ‘Schizoaffective’ disorder, which further necessitates the use of mood stabilizing agents. As a result, patients end up with a huge pill burden and are unable to comply with therapy and this leads to reduced clinical outcomes. A dual layered, xerogel-bioadhesive intestinal patch drug delivery system (ODLS) was thus designed, formulated, and evaluated for the site-specific delivery of two bioactives in the treatment of Schizophrenia with concomitant mood disorders in a time controlled-idiosyncratic manner. Ultimately easing compliance to complicated treatment regimens, enhancing bioavailability and improving patient compliance. The ODLS essentially comprises of a bi-layered tablet, layer one comprised of a sustained release semi-interpenetrating polymer network (s-IPN) xerogel and a layer two of embedded pulsatile release bioadhesive intestinal patches, with the system as a whole enteric coated for protection. Intestinal patches encompassed in layer two are fabricated of a backing layer, a drug loaded layer, a mucoadhesive layer, and a mucus cleaving layer. The ODLS employs a combination of sustained and pulsatile drug release mechanisms, in addition to intestinal retentive mechanisms. Furthermore, the system physically protects the drug delivery system from acidic or proteolytic degradation within the human gastro-intestinal tract. The present study utilized the use of bioadhesion for site-specific and gastro retentive drug delivery, with crosslinking being employed for rate-modulated drug delivery. Sulpiride and sodium valproate were selected as model drugs for the sustained release xerogel layer and the pulsatile bioadhesive patch layer respectively in this study as sulpiride is an antipsychotic with low bioavailability yet good antipsychotic activity and sodium valproate is the mainstay drug treatment for mood disorders in schizophrenia. Therefore, sulpiride would profit from the sustained release as it would improve bioavailability and hence patient compliance, whereas sodium valproate would benefit from the pulsatile release so as to avoid the well-known resistance to therapy due to prolonged exposure to drug. Thus these drugs would gain benefit from the site-specific controlled drug delivery offered by the ODLS. The primary aim of the sustained release s-IPN xerogel was to ensure delayed release of drug over 24 hours thus decreasing the need for multiple administrations and to maintain a steady state drug concentration. Film casting, a versatile technique was utilized in the fabrication of polymeric films to develop the bioadhesive intestinal patches. Preliminary in vitro investigations led to identification of a combination of polymers and crosslinking agent best suited to develop the system. A central composite design was employed for system optimization. The xerogel layer demonstrated that zero-order drug release was achieved after the crosslinking procedure. Delayed drug release fundamentally decreases the number of doses required daily and thus patient compliance and clinical efficacy is improved. The pulsatile release layer displayed distinct triphasic drug release after assembly of the intestinal patches, pulsatile release of drugs fundamentally reduced resistance to drug therapy as well as reducing pill burden. Furthermore, in vitro analysis of the ODLS showed that the xerogel layer behaved superiorly in terms of controlling drug delivery in a site-specific and prolonged fashion in comparison to a marketed gold standard. There exists no gold standard for pulsatile delivery of sodium valproate hence the pulsatile layer was tested against the marketed standard administered as a single dose. In vitro findings were substantiated by in vivo analysis in a white pig model. Results indicated that the systemic bioavailability of sulpiride was higher than the gold standard and drug release was prolonged in a zero-order fashion over 24 hours. Sodium valproate released in a triphasic manner over 24 hours thus reducing the risk of treatment resistance and decreased pill burden. To summarize, the ODLS was able to overcome the many challenges associated with oral drug delivery in schizoaffective disorder, by simplification of complicated treatment regimens, and hence improving bioavailability of drug delivery orally. The benefits associated with oral drug delivery have evidently been exploited by the present study, producing a versatile drug delivery system which can successfully deliver two bioactives simultaneously via individualistic release patterns, thus treating both conditions with a single oral dosage form with a single daily administration. / MT2016

MMed, Psychiatry, University of the Witwatersrand, Faculty of Health Sciences / Introduction Antipsychotics are used for the treatment of psychotic disorders, most commonly schizophrenia, as well as mood disorders e.g. bipolar mood d isorder. The efficacy of the newer second generation (atypical) antipsychotics is equivalent to first generation antipsychotics. The apparent advantage of the second generation antipsychotics is related to their purported reduced side effect profile, thus making them more desirable due to improved compliance and relapse prevention. The limiting factor with this class of drugs, especially in the state sector in South Africa, has been the cost. However, reports of treatment-emergent adverse events such as diabetes mellitus, diabetic ketoacidosis, hyperglycaemia and dyslipidaemia in patients receiving second generation antipsychotics have increased in recent times. This has lead to growing concern about the link between metabolic complications and their use, with consequent reconsideration of the implications of prescribing. Aims The study aimed to establish the extent to which metabolic and cardiovascular screening and monitoring has been undertaken on patients who have been prescribed olanzapine, a second generation antipsychotic. Specifically the extent to which the American Diabetes Association Consensus Conference monitoring protocols were being implemented in a specialist psychiatric South African setting i.e.: at Tara: The H. Moross Centre’s outpatient department. Objectives The study objectives were to describe the demographic profile, clinical diagnosis and risk factors for metabolic complications in a sample of patients receiving olanzapine. Further, to establish the extent to which metabolic and cardiovascular screening and monitoring has been undertaken on patients prescribed olanzapine as well as to what extent the patients’s demographics, diagnosis and metabolic risk factors influenced the treating doctor’s adherence to screening guidelines. Method This study was undertaken at Tara: The H. Moross Centre (outpatient department). A convenience sample of patients prescribed olanzapine were selected as the study group. The study involved a review of case records. It was a retrospective descriptive study. Relevant data was entered on a data sheet, designed for the study in accordance with the objectives and adapted from the American Diabetes Association Consensus Development Conference on Antipsychotic Drugs, Obesity and Diabetes. The data sheet is based on an existing protocol for monitoring metabolic status. v Frequencies for the presence or absence of evidence of screening or monitoring for metabolic complications were established, as per American Diabetes Association monitoring protocol requirements. Although the study involved outpatients, not all patients were intiated on olanzapine as outpatients i.e. some of the prescribing was inpatient initiated. Results The sample comprised of 19 females and 20 males. 48.72% female and 51.28% male. The mean age of females in the sample was 52.38 years (SD=16.20) and the mean age of males was 41.28 (SD=17.05) years. The sample were predominantly single ( 61.54% n=24 ) with the majority being white (79.49% n=31 ); most had either tertiarty (43% n=17 ) or secondary (53.85% n =21 ) level of education. Only 2.56% (n=1) had only primary level education. With regards to the diagnoses of patients in the sample, 17,95% (n=7) were diagnosed with bipolar 1 disorder, 7.69% (n=3) with major depressive disorder with psychosis, 20,51% (n=8) schizoaffective disorder and 53,84% (n=21) with schizophrenia. The percentage of screening for all the parameters was generally less than 20% and it continued to decline to less than 20% until 4 months. The exception was weight, where frequency increased slightly over time. Comparing inpatient vesus outpatient initiated treatment there were apparent differences in the extent of screening i.e. greater for inpatient initiated treatment, specifically with respect to weight and blood pressure. Conclusion The current study was conducted in a very specific setting, but the findings demonstrated an area requiring attention i.e. adherence to acceptable clinical guidelines. Whilst one can only speculate on the basis for non-adherence, having established the status quo, there is a requirement for an appropriate strategy to address the deficit, given the implications of inadequate monitoring.

The purpose of this thesis was to synthesize evidence on symptoms of psychosis in post-secondary students, including participant characteristics, prevalence, risk factors, interventions, and reported experiences. The design was a mixed-methods systematic review, modeled on the Joanna Briggs Institute and PRISMA guidelines, with all standard systematic review procedures followed. A search in nine databases yielded 26 (published between 2006 and 2018) articles for inclusion. Data were analyzed according to objectives and reported using synthesis tables and narrative summaries. Average age of participants was 21 years and most identified as female and Caucasian. Prevalence of psychosis across the included studies was inconclusive. Risk factors associated with symptoms of psychosis included substance use, depression, and younger age. There were five interventions with mixed results and three studies about experiences. While five promising interventions exist, inadequate testing and replication limits confidence in their effectiveness. There is a notable deficit in qualitative evidence exploring the experiences of students with symptoms of psychosis.

Diss. (sammanfattning) Uppsala : Univ., 2003. / Härtill 5 uppsatser.

Afhandling--Københavns universitet. / Summaries in Danish and German. Bibliography: p. 153-156.

Orientador: Paulo Dalgalarrondo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Medicas / Made available in DSpace on 2018-08-08T11:26:57Z (GMT). No. of bitstreams: 1 Teixeira_EduardoHenrique_M.pdf: 2378711 bytes, checksum: 73d59583c19a26a22f8da5b55f2524c8 (MD5) Previous issue date: 2007 / Resumo: Introdução: Aspectos da psicopatologia do delírio e do perfil dos pacientes delirantes parecem relacionados à ocorrência de crime violento. Objetivo: Descrever o perfil sócio-demográfico e psicopatológico de sujeitos delirantes que cometeram crimes violentos. Métodos: Estudo retrospectivo do tipo caso-controle, comparando dois grupos de trinta pacientes delirantes. Todos pacientes apresentaram transtorno psicótico com atividade delirante definida. Os pacientes do grupo caso cometeram crimes violentos e foram selecionados da Casa de Custódia do município de Franco da Rocha-SP, nos anos de 2004 a 2006. Os pacientes do grupo controle foram selecionados de enfermaria psiquiátrica do Hospital das Clínicas da Unicamp, do Hospital e Maternidade Celso Pierro (Puc-Campinas) e do Instituto Américo Bairral do município de Itapira-SP. Foram utilizadas as escalas PANSS (Escala das Síndromes Positiva e Negativa), MINI (Entrevista Neuropsiquiátrica Mini-Internacional) e MMDAS (Escala de Avaliação de Delírio Macarthur-Maudsley). Resultados: Os dois grupos foram muito parecidos em relação ao perfil sócio-demográfico, história da doença, comorbidade de substâncias psicoativas e conteúdo do delírio. Os pacientes do grupo caso apresentaram mais antecedentes criminais, embora tenham cometido menos freqüentemente agressões leves. As vítimas dos crimes foram com mais frequência parentes ou conhecidos. Em relação às dimensões do delírio, o grupo caso teve menor pontuação em â?¿inibição de açãoâ?? e â?¿afeto negativoâ??. Conclusões: Fatores intrínsecos do delírio parecem ser mais relevantes do que o perfil sócio-demográfico nos sujeitos delirantes que cometem crimes. Delírios que induzem a inibição de ações aparentemente também reduzem o potencial de ações violentas. Ao contrário do que se afirma correntemente, pacientes delirantes assustados e com outros afetos negativos associados ao delírio parecem cometer menos atos violentos / Abstract: Introduction: Some aspects of the psychopathology of delusion and the profile of the delirious patients seem to be related to the occurrence of violent crime. Objective: To describe the social-demographic and psychopathologic profile of delirious patients who have committed violent crimes. Methods: Retrospective case-control study, comparing two groups of thirty delusional patients. All patients had presented psychotic disorders with definite delusion activity. The patients of the case group had committed violent crimes and have been selected out of the criminal-psychiatric ward Franco da Rocha-SP, from 2004 to 2006. The patients of the control group have been selected out of psychiatric ward of the Hospital das Clínicas da Unicamp, of the Hospital e Maternidade Celso Pierro (PUC-Campinas) and of the Instituto Américo Bairral of the city of Itapira-SP. Scales PANSS (Positive and Negative Syndrome Scale), MINI (Mini International Neuropsychiatric Interview) and MMDAS (Macarthur-Maudsley Delusion Assessment Scale) have been used. Results: The two groups were very similar as far as social-demographic profile, history of the illnesses, substance abuse and content of the delusion. The patients of the case group had greater criminal records, although a smaller frequency of light aggressions. The victims of the crimes had been more often acquaintances or relatives. In relation to the dimensions of the delusion, the patients in the study group scored less in "action inhibition" and "negative affection". Conclusions: Intrinsic factors of the delusion seem to be more relevant than social-demographic profile in the delusional patients who commit crimes. Delusions that induce action inhibition apparently also reduce the potential for violent actions. In contrast to what is commonly said, delusional patients with fear and other negative affection associated to the delusion seem to commit less violent acts / Mestrado / Saude Mental / Mestre em Ciências Médicas