Mental health leadership and patient access to care: a public-private initiative in South Africa.

Background: Mental health leadership is a critical component of patient access to care. More specifically, the ability of mental health professionals to articulate the needs of patients, formulate strategies and engage meaningfully at the appropriate level in pursuit of resources. This is not a skill set routinely taught to mental health professionals.

No health without mental health: establishing psychiatry as a major discipline in an African Faculty of Health Sciences.

Psychiatry has not always been a major clinical discipline in medical schools. Although the Faculty of Health Sciences of the University of Cape Town (UCT) celebrates its Centenary in 2012, a closely aligned major psychiatric hospital is older than the Medical School, while the Department of Psychiatry is only 50 years old. These differing dates reflect the history of and challenge for psychiatry; mental disorders contribute a major portion of the burden of disease, while appropriate recognition and resourcing of services and training has been delayed.

More doctors and dentists are needed in South Africa.

BACKGROUND. An aim of the Colleges of Medicine of South Africa (CMSA) project 'Strengthening Academic Medicine and Specialist Training' was to research the number and needs of specialists and subspecialists within South Africa. METHODS.

Traditional healers and mental health in South Africa.

Psychiatric patients access both indigenous healers and services rendered by psychiatric facilities in South Africa. The various groups of healers which are available are clearly not all acceptable to the whole population and variable experiences are reported with different categories of healer and the different treatments provided. An increasing collaboration between psychiatric services and indigenous healers is becoming evident, as in other health services.

A structured assessment of newly qualified medical graduates.

Introduction: While there is extensive published experience with the assessment of procedural skills in undergraduate students, this is limited in newly qualified medical graduates at the time of entry to the pre-registration (internship) year. The few studies that have been published suggest that these skills are frequently deficient when objectively tested. We therefore chose to assess the competence of a group of South African medical graduates on entry to their pre-registration year.

Current ethical issues for African psychiatry.

One of the challenges of medical practice is to resolve the conflicts that arise when a professional is required to choose between competing ethical principles. This is especially true in psychiatry. The answers to ethical issues are not necessarily right or wrong.

Forensic psychiatric evaluation: clinical, ethical and procedural issues in South Africa.

Evaluations done by the Forensic Psychiatrist take place in relation to various situations and in circumstances of a statutory nature and include clinical assessments for treatment, management and rehabilitation. Numerous issues in the field of legal process and ethical dilemmas are discussed. Conflicts with the traditional role occur and continued awareness of this is relevant for the maintenance of standards in the whole of psychiatry.

Violence, sensation seeking, and impulsivity in schizophrenics found unfit to stand trial.

Many studies have confirmed an association between violent behavior, impulsivity, and sensation seeking in nonpsychotic subjects. Schizophrenic patients (n = 49) who had been found unfit to stand trial were investigated for violence, according to index offenses and longitudinal histories (before and after admission) for violence. Those charged with violent offenses were significantly more often married with children, and were equally likely to direct their assaultiveness to strangers, acquaintances, and family members.

South African psychiatrists' criteria for predicting dangerousness.

The prediction of dangerousness has emerged as one of the most controversial issues in forensic psychiatry. It is a value-laden and ambiguous concept which has not been adequately defined and operationalized by the law or psychiatry. The validity and reliability of psychiatric predictions of dangerousness have been brought seriously into question in the past few decades.

Psychiatric evidence in extenuation: assessment and testimony in homicide defendants.

The role of psychiatric evaluation and testimony on 202 cases demonstrates the participation of mental health experts in the legal process. The majority of these cases fall outside the mental abnormal groupings of 'incompetent to stand trial' or 'criminal insane'. A finding of diminished responsibility on account of mental illness provides for a finding of extenuating circumstances on account of mental illness.

Physical disease in the chronic mentally ill.

A group of 196 institutionalized patients with chronic mental illness was studied to determine the prevalence of unrecognized physical disease. Sixty per cent of the patients were found to have previously undiagnosed minor or major disorders, the most prevalent being scabies and fungal infections (24%), peripheral vascular disease (13%), dyskinetic movements (11%) and anaemia (5,5%). Forty-six per cent of the physical disorders were considered to be minor, and only 21% of the major disorders were likely to respond to treatment.

Clinical vampirism. A presentation of 3 cases and a re-evaluation of Haigh, the 'acid-bath murderer'.

Clinical vampirism is named after the mythical vampire, and is a recognizable, although rare, clinical entity characterized by periodic compulsive blood-drinking, affinity with the dead and uncertain identity. It is hypothetically the expression of an inherited archaic myth, the act of taking blood being a ritual that gives temporary relief. From ancient times vampirists have given substance to belief in the existence of supernatural vampires.

A psychophysiological investigation of the long-term effects of clozapine upon sleep patterns of normal young adults.

A 25-night single-blind cross over design was employed to determine the long-term effects of clozapine on the sleep patterns of six normal young adults. Subjects received 12.50 mg placebo on the first and last five nights, whereas on the intermediate 15 nights 12.

A psychophysiological investigation of the short-term effects of clozapine upon sleep parameters of normal young adults.

A nine consecutive night, double-blind design was used to assess the effects of a psychotropic agent (clozapine) upon sleep parameters as well as measures of mood and performance in a group of seven normal, young adults. Placebo was administered to a control group of seven subjects. EEGs and EOGs were monitored throughout the night in a laboratory environment and were scored according to standardized criteria.

An investigation of clozapine in the treatment of acute and chronic schizophrenia and gross behaviour disorders.

Fifty-two mental hospital cases of acute and chronic schizophrenia and gross behaviour disorders were investigated and observed for 6-12 months during treatment with clozapine. Three-quarters of the acute cases recovered with full occupation capacity. Two-thirds of the chronic cases improved markedly.

The effect of prolonged lithium carbonate administration on the thyrotrophin and prolactin response to thyrotrophin-releasing hormone.

Thyrotrophin (TSH) and prolactin (PRL) responses to intravenous thyrotrophin-releasing hormone (TRH) were measured in euthyroid patients suffering from psychiatric disease on long-term lithium carbonate (LC) and phenothiazine therapy. These responses were retested after oral tri-iodothyronine (T3) 120 mug/day had been given for a week. The raised basal TSH and the suppression of the exaggerated responses to TRH by T3 found in some of the patients suggest a mild disturbance of thyroid function in patients on long-term LC therapy, even in the face of clinical euthyroidism and otherwise normal thyroid function.