scholarly journals A profile of adult acute admissions to Lentegeur Psychiatric Hospital, South Africa

Author(s):  
Herman Franken ◽  
John Parker ◽  
Robin Allen ◽  
Robert A. Wicomb

Background: The Western Cape province has the highest documented lifetime prevalence of common mental disorders in South Africa. To ensure the efficient, equitable and effective distribution of current resources, there is a need to determine the profile of patients requiring psychiatric admission.Aim: To describe patients admitted to the acute adult admissions unit at Lentegeur Hospital.Setting: Lentegeur Psychiatric Hospital is situated in Mitchells Plain, Cape Town, and serves about 1 million people from nearby urban and rural areas.Methods: This retrospective study involved an audit of all patients (18–60 years of age) admitted between 01 January 2016 and 30 June 2016. The clinical records of 573 adult patients were examined.Results: The median age of the cohort was 29 years. Most patients (63%) were educated to the secondary level. Only 12% of the patients were employed, and 37% received disability grants. More than 90% of the patients presented with psychotic symptoms. Of these, 28% presented with a first-episode of psychosis. Of all patients, 20% were referred with manic symptoms and 7% with depressive symptoms. Many patients (62%) used substances concurrently in the period leading up to admission. Significantly more males (73%) used substances compared to females (38%). Cannabis was the most widely used substance (51%), followed by methamphetamine (36%). Recent violent behaviour contributed to 37% of the current admissions. A total of 70 patients (13%) tested positive for human immunodeficiency virus (HIV), and 49 (9%) tested positive for syphilis.Conclusion: Substance use and a history of violence contributed to admissions in this population.

2013 ◽  
Vol 44 (3) ◽  
pp. 499-506 ◽  
Author(s):  
J. M. Stone ◽  
H. L. Fisher ◽  
B. Major ◽  
B. Chisholm ◽  
J. Woolley ◽  
...  

BackgroundCannabis use has been reported to be associated with an earlier onset of symptoms in patients with first-episode psychosis, and a worse outcome in those who continue to take cannabis. In general, studies have concentrated on symptoms of psychosis rather than mania. In this study, using a longitudinal design in a large naturalistic cohort of patients with first-episode psychosis, we investigated the relationship between cannabis use, age of presentation to services, daily functioning, and positive, negative and manic symptoms.MethodClinical data on 502 patients with first-episode psychosis were collected using the MiData audit database from seven London-based Early Intervention in psychosis teams. Individuals were assessed at two time points – at entry to the service and after 1 year. On each occasion, the Positive and Negative Syndrome Scale, Young Mania Rating Scale and Global Assessment of Functioning Scale disability subscale were rated. At both time points, the use of cannabis and other drugs of abuse in the 6 months preceding each assessment was recorded.ResultsLevel of cannabis use was associated with a younger age at presentation, and manic symptoms and conceptual disorganization, but not with delusions, hallucinations, negative symptoms or daily functioning. Cannabis users who reduced or stopped their use following contact with services had the greatest improvement in symptoms at 1 year compared with continued users and non-users. Continued users remained more symptomatic than non-users at follow-up.ConclusionsEffective interventions for reducing cannabis use may yield significant health benefits for patients with first-episode psychosis.


2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Aaron J. Roberto ◽  
Subhash Pinnaka ◽  
Abhishek Mohan ◽  
Hiejin Yoon ◽  
Kyle A. B. Lapidus

Catatonia is especially concerning in children and adolescents. It leads to significant impairment, including emotional distress, difficulty communicating, and other debilitating symptoms. In this case report, we discuss a patient with no previous history of neuroleptic medication or psychotic symptoms, presenting with first-episode catatonia in the presence of disorganized, psychotic thoughts. We then review the catatonia syndrome, citing examples in the literature supporting its underdiagnosis in children and adolescents, and discuss successful treatment modalities. It is important to diagnose and treat catatonia as efficiently as possible, to limit functional and emotional distress to the patient.


1998 ◽  
Vol 172 (S33) ◽  
pp. 134-136 ◽  
Author(s):  
Jean Addington ◽  
Donald Addington

Background Studies examining the temporal relationship between substance use and the onset of psychotic symptoms in schizophrenia are inconclusive.Method Three groups of out-patients with schizophrenia were compared on onset of illness, symptoms and quality of life. Fifty-one subjects had no past or present history of substance misuse, 29 subjects had a history of past substance misuse occurring around the onset of their illness, and 33 subjects were currently misusing substances.Results Current substance misusers had poorer quality of life scores and less negative symptoms than the non-users. Those who had a past history of substance misuse had a significantly earlier age of onset than those with no substance use.Conclusions Attention should be paid to substance misuse present at the first episode. Treatment for schizophrenia should begin even though a diagnosis of drug-induced psychosis cannot be ruled out.


Author(s):  
Mary-Louise Penrith

The histories of the two swine fevers in southern Africa differ widely. Classical swine fever (hog cholera) has been known in the northern hemisphere since 1830 and it is probable that early cases of ‘swine fever’ in European settlers’ pigs in southern Africa were accepted to be that disease. It was only in 1921 that the first description of African swine fever as an entity different from classical swine fever was published after the disease had been studied in settlers’ pigs in Kenya. Shortly after that, reports of African swine fever in settlers’ pigs emerged from South Africa and Angola. In South Africa, the report related to pigs in the north-eastern part of the country. Previously (in 1905 or earlier) a disease assumed to be classical swine fever caused high mortality among pigs in the Western Cape and was only eradicated in 1918. African swine fever was found over the following years to be endemic in most southern African countries. Classical swine fever, however, apart from an introduction with subsequent endemic establishment in Madagascar and a number of introductions into Mauritius, the last one in 2000, had apparently remained absent from the region until it was diagnosed in the Western and subsequently the Eastern Cape of South Africa in 2005. It was eradicated by 2007. The history of these diseases in the southern African region demonstrates their importance and their potential for spread over long distances, emphasising the need for improved management of both diseases wherever they occur.


2018 ◽  
Vol 146 (16) ◽  
pp. 2107-2115 ◽  
Author(s):  
T. N. Mann ◽  
H. S. Schaaf ◽  
R. N. Dunn ◽  
S. Dix-Peek ◽  
K. du Preez ◽  
...  

AbstractThe aim of this retrospective review was to assess the overall burden and trend in spinal tuberculosis (TB) at tertiary hospitals in the Western Cape Province of South Africa. All spinal TB cases seen at the province's three tertiary hospitals between 2012 and 2015 were identified and clinical records of each case assessed. Cases were subsequently classified as bacteriologically confirmed or clinically diagnosed and reported with accompanying clinical and demographic information. Odds ratios (OR) for severe spinal disease and corrective surgery in child vs. adult cases were calculated. A total of 393 cases were identified (319 adults, 74 children), of which 283 (72%) were bacteriologically confirmed. Adult cases decreased year-on-year (P = 0.04), however there was no clear trend in child cases. Kyphosis was present in 60/74 (81%) children and 243/315 (77%) adults with available imaging. Corrective spinal surgery was performed in 35/74 (47%) children and 80/319 (25%) adults (OR 2.7, 95% confidence interval 1.6–4.5, P = 0.0003). These findings suggest that Western Cape tertiary hospitals have experienced a substantial burden of spinal TB cases in recent years with a high proportion of severe presentation, particularly among children. Spinal TB remains a public health concern with increased vigilance required for earlier diagnosis, especially of child cases.


1997 ◽  
Vol 171 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Jan Volavka ◽  
Eugene Laska ◽  
Sheryl Baker ◽  
Morris Meisner ◽  
Pal Czobor ◽  
...  

BackgroundInformation on patterns and correlates of the violent behaviour of individuals with schizophrenia is largely limited to populations in developed countries. Data from a World Health Organization epidemiological study of schizophrenia and related disorders, the Determinants of Outcome of Severe Mental Disorders (DOSMD), presented an opportunity to study patterns of violence across multinational settings.MethodCentres in 10 countries participated in the DOSMD study. An incidence sample of 1017 patients with schizophrenia who had their first-in-lifetime contact with a helping agency as a result of their psychotic symptoms was obtained. Data were available on their history of violent behaviour, substance use, and demographics.ResultsThe occurrence rate of assault in the entire cohort was 20.6 per hundred, but the rate was three times higher in the developing countries (31.5 per hundred) than in the developed countries (10.5 per hundred). History of assault was associated with positive symptoms, such as excitement and auditory hallucinations, and with serious alcohol problems.ConclusionsThe cultural context and the specific characteristics of the disease in individuals with schizophrenia may interactively affect rates of violent behaviour.


2016 ◽  
Author(s):  
◽  
Candice Ann Owen

Echthrodesis lamorali Masner 1968 (Hymenoptera: Platygastridae, Scelioninae) is an intertidal parasitoid wasp that uses the eggs of the maritime spider, Desis formidabilis O.P. Cambridge 1890 (Araneae: Desidae), as a host. This species is one of only three known maritime parasitoids globally, and is the only known spider egg parasitoid that attacks its host within the intertidal region in southern Africa. Originally described from ‘The Island’, Kommetjie (Western Cape, South Africa), this shore was the only known locality of the species at the commencement of this thesis. Furthermore, the extent of the parasitism pressure the wasp exerts on D. formidabilis was largely unknown, along with its basic biology (drivers of its broad-scale and fine-scale distribution patterns; parasitism incidence; and sex ratios) and morphological and physiological adaptations for living within the frequently saltwater-inundated environment. This thesis unravelled these aspects, as well as experimentally provided data for many components of the life history of E. lamorali that had only been hypothesized by other authors, at a variety of scales, from the country-wide ecosystem, to single shores, and finally to the scale of the individual. While the distribution of E. lamorali was found to be much wider than previously thought, it remained restricted to the shores of the Cape Peninsula (Western Cape, South Africa). The host spiders were located throughout a much wider distributional range than the wasp, from East London in the east to the Peninsula, but some behavioural and morphological differences were found between those within and outside of the range of the parasitoid, suggesting range-limitation imposed by the host on E. lamorali. This limitation may be strengthened by the general lack of suitable shore types within the close vicinity of the Peninsula. Modelling using macro-climatic conditions suggested that maximum temperatures and humidities were also largely limiting to E. lamorali, although these patterns were not observable in the micro-climates in which the species survives. The wasp populations and spiders within the range of E. lamorali as identified in Chapter 2 were assessed to determine any preferences for local conditions, including location along the Peninsula, nesting sites and intertidal zones within single shores, using AICc modelling, which detected parasitism patterns in D. formidabilis and E. lamorali populations, as well as the sex ratios in the latter species. The models showed that the spider population size and distribution was more influenced by bottom-up factors such as abiotic components of the shore than by parasitism, which only showed density dependence with the host at certain scales. Both host and parasitoid populations illustrated a preference for the middle zone on single shores. Observed spider nest characteristics suggested opportunistic nesting behaviour in the species, although preference was shown for construction along an east-west orientation and in locations with low sun exposure. Along with larger population sizes on the west coast over the east coast (not reflected by E. lamorali), these observations suggest that D. formidabilis prefers cooler environments. Spider brood success was 50% in unparasitized egg-sacs, but this figure halved when E. lamorali gained access to the eggs (of which 100% within a single compartment were parasitized each time). Encapsulation of the embryo was found to be positively correlated with parasitism, indicating some form of host resistance. Resultant parasitoid broods illustrated a strong female bias in the species, as is common for this group of insects. The life history of E. lamorali was then assessed at a smaller scale, that of the individual. Scanning electron microscopy of whole E. lamorali specimens and light microscopy of sectioned specimens demonstrated no morphological adaptations in the trachea and spiracles to cope with saltwater inundation. On the other hand, respirometry experiments categorically demonstrated that the species copes with inundation through the formation of a physical gill over the full habitus, and the induction of a state of torpor to reduce metabolic needs, when submerged. This precludes the need for any further morphological adaptations. Determination of the wasp’s critical thermal tolerance illustrated a wide temperature range with a particularly cold lower limit of -1.1ºC ± 0.16, suggesting the presence of related genera or ancestors in much colder environments. With a much broader distribution than previously thought, and the inclusion of the distributional range of E. lamorali within the Table Mountain National Park, this species is being effectively conserved and managed through the umbrella-conservation of the park. Links to the host proved to vary at differing scales, proving the need for scale considerations to be included in other similar biological and ecological studies. Finally, the species showed a physiological adaptation to its intertidal existence. Echthrodesis lamorali, the only discovered maritime spider egg parasitoid in Southern Africa, displayed unusual characteristics at every scale of its life history and as such, warrants further investigation.


Sign in / Sign up

Export Citation Format

Share Document