About 30.00% of schizophrenic patients fail to respond to conventional antipsychotics. Clozapine shows superior efficacy, for both the positive and negative symptoms of schizophrenia, over conventional antipsychotics. The reputation of clozapine lies mainly with its repeated proven efficacy in the treatment of refractory schizophrenia. However, clozapine has quite a severe side effect profile. Patients receiving clozapine therapy may develop serious adverse effects such as agranulocytosis, neutropenia and metabolic syndrome. Therefore guidelines are required which recommend that regular haematological and metabolic monitoring be performed. These monitoring guidelines should assist medical practitioners in the early detection and reporting of serious adverse effects associated with clozapine therapy. South Africa lacks uniform provincial or national guidelines regulating practices in the treatment of mental disorders. International guidelines may be considered, which are not specifically adapted for the South African setting. These guidelines recommend both the haematological and metabolic monitoring of clozapine. At present there are no South African guidelines recommending the metabolic monitoring of clozapine. The general aim of the study was to determine the prescribing and monitoring patterns of clozapine at Elizabeth Donkin Hospital in the Nelson Mandela Metropole. Due to the absence of specific South African guidelines and the severe side effect profile of clozapine, some of the research objectives were to determine whether the initiation of clozapine, as well as the haematological and metabolic monitoring performed, was compliant with international clinical guidelines. In this pharmacoepidemiological study a retrospective drug utilisation review was performed. The study was observational in design and included quantitative data. Data were collected from the files of 65 patients (N=65) discharged on clozapine between 1 December 2010 and 29 February 2012. Follow-up investigations were performed at the clinics and long-term care centres both three months and six months after discharge. In 52.30% (n=34) of the cases clozapine was previously prescribed. Compliance with the National Institute for Health and Clinical Excellence (NICE) guidelines for the appropriate initiation of clozapine was 63.10% (n=41). Compliance with the Standard Treatment guidelines for the initiation of clozapine by a psychiatrist was 63.10% (n=41). Noncompliance with the recommended guidelines for haematological monitoring occurred in 77.40% of patients in the hospital setting (n=48) as well as in 95.70% of patients during the three-month follow-up at the clinics (n=44). Non-compliance with the guidelines for metabolic monitoring occurred in all the observed patients in the hospital setting (n=62) as well as in 45.70% of patients in the clinic setting (n=21). It was found that 71.00% (n=46) of patients were still on clozapine three months after discharge and 65.00% (n=42) were still on clozapine six months after discharge from hospital, resulting in discontinuation rates of 29.00% and 35.00% respectively. It was found that clozapine was inadequately monitored although in most cases the initiation of clozapine was compliant with the recommended guidelines. However, practitioners should be trained on the existing prescribing and monitoring guidelines to promote the rational use of clozapine in the public health sector of South Africa. / MPham (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

About 30.00% of schizophrenic patients fail to respond to conventional antipsychotics. Clozapine shows superior efficacy, for both the positive and negative symptoms of schizophrenia, over conventional antipsychotics. The reputation of clozapine lies mainly with its repeated proven efficacy in the treatment of refractory schizophrenia. However, clozapine has quite a severe side effect profile. Patients receiving clozapine therapy may develop serious adverse effects such as agranulocytosis, neutropenia and metabolic syndrome. Therefore guidelines are required which recommend that regular haematological and metabolic monitoring be performed. These monitoring guidelines should assist medical practitioners in the early detection and reporting of serious adverse effects associated with clozapine therapy. South Africa lacks uniform provincial or national guidelines regulating practices in the treatment of mental disorders. International guidelines may be considered, which are not specifically adapted for the South African setting. These guidelines recommend both the haematological and metabolic monitoring of clozapine. At present there are no South African guidelines recommending the metabolic monitoring of clozapine. The general aim of the study was to determine the prescribing and monitoring patterns of clozapine at Elizabeth Donkin Hospital in the Nelson Mandela Metropole. Due to the absence of specific South African guidelines and the severe side effect profile of clozapine, some of the research objectives were to determine whether the initiation of clozapine, as well as the haematological and metabolic monitoring performed, was compliant with international clinical guidelines. In this pharmacoepidemiological study a retrospective drug utilisation review was performed. The study was observational in design and included quantitative data. Data were collected from the files of 65 patients (N=65) discharged on clozapine between 1 December 2010 and 29 February 2012. Follow-up investigations were performed at the clinics and long-term care centres both three months and six months after discharge. In 52.30% (n=34) of the cases clozapine was previously prescribed. Compliance with the National Institute for Health and Clinical Excellence (NICE) guidelines for the appropriate initiation of clozapine was 63.10% (n=41). Compliance with the Standard Treatment guidelines for the initiation of clozapine by a psychiatrist was 63.10% (n=41). Noncompliance with the recommended guidelines for haematological monitoring occurred in 77.40% of patients in the hospital setting (n=48) as well as in 95.70% of patients during the three-month follow-up at the clinics (n=44). Non-compliance with the guidelines for metabolic monitoring occurred in all the observed patients in the hospital setting (n=62) as well as in 45.70% of patients in the clinic setting (n=21). It was found that 71.00% (n=46) of patients were still on clozapine three months after discharge and 65.00% (n=42) were still on clozapine six months after discharge from hospital, resulting in discontinuation rates of 29.00% and 35.00% respectively. It was found that clozapine was inadequately monitored although in most cases the initiation of clozapine was compliant with the recommended guidelines. However, practitioners should be trained on the existing prescribing and monitoring guidelines to promote the rational use of clozapine in the public health sector of South Africa. / MPham (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

This study focuses on the following schizophrenic related elements to be found in the postmodern society and to be represented in selected contemporary video artworks: 1) creation of an alternative world and 2) disturbance in meaning. To confirm that the creation of an alternative world and disturbance in meaning is present in postmodern society, the following elements are investigated as symptoms of schizophrenia and characteristics present in contemporary society: 1) fragmentation, 2) withdrawal from reality, 3) misinterpretation of memories and 3) the creation of 'word salad'. In order to draw a parallel between schizophrenia and the postmodern society, the postmodern theories of Simon Gottschalk, Fredric Jameson, Kenneth Gergen, Jean Baudrillard, Andreas Huyssen, Gilles Deleuze en Paul Virilio as well as the medical studies involving schizophrenia by the Schizophrenia Foundation of South Africa, the University of Iowa se Department of Healthcare and D Sue, DW Sue en S Sue are used. In both conditions of schizophrenia and postmodern society, reality and meaning are altered. This study concludes that schizophrenic related elements are present in the postmodern society and therefore these elements are represented in the selected video artworks of the artists Eija-Liisa Ahtila and myself.AFRIKAANS : Hierdie studie fokus op die skisofrenie-verwante elemente wat voorkom in die postmoderne samelewing naamlik: 1) alternatiewe wêreldskepping en 2) versteuring in betekenisgewing en wat uitgebeeld word in geselekteerde kontemporêre videokunswerke. Fragmentering, onttrekking van realiteit, waninterpretasie van herinneringe en die skepping van 'woordslaai' word as simptome van skisofrenie en as kenmerkende eienskappe in die postmoderne samelewing ondersoek om die argument te versterk dat alternatiewe wêreldskepping en versteuring in betekenisgewing teenwoordig is in die postmoderne samelewing. Die postmoderne teorieë van Simon Gottschalk, Fredric Jameson, Kenneth Gergen, Jean Baudrillard, Andreas Huyssen, Gilles Deleuze en Paul Virilio sowel as die mediese studies deur die Schizophrenia Foundation of South Africa, die University of Iowa se Department of Healthcare en D Sue, DW Sue en S Sue aangaande skisofrenie, word gebruik om parallelle tussen die postmoderne samelewing en die mediese toestand van skisofrenie in hierdie studie te trek. Daar word vasgestel dat realiteit en betekenis in beide toestande van skisofrenie en die postmoderne samelewing verbuig en hervorm word. Die gevolgtrekking van hierdie studie is dat skisofrenie-verwante elemente wel voorkom in die kontemporêre samelewing en dus uitgebeeld word in die geselekteerde videokunswerke van die kunstenaars Eija-Liisa Ahtila en myself. / Dissertation (MA)--University of Pretoria, 2006. / Visual Arts / unrestricted