Psychiatry

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Browsing Psychiatry by Subject "Depression"

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    Prevalence of comorbid psychiatric illness and quality of life in adults with inherited bleeding disorders in central South Africa
    (University of the Free State, 2019-10) Koekemoer, Heinrich Tertius; Nichol, Richard J.; Joubert, Jaco; Coetzee, Marius J.
    Introduction: Inherited bleeding disorders (IBDs) appear to be relatively uncommon, but they pose unique health-related challenges. IBDs are acquired through inheritance of mutations that cause abnormal bleeding. Due to their chronic nature, one would expect similar psychosocial problems as seen in other chronic diseases. The purpose of this study was to obtain information about the psychiatric comorbidities of patients with inherited bleeding disorders in order to be able to sensitize health workers and to promote holistic care in order to better patients’ health-related quality of life (HR-QoL). Aim: To achieve this, the researchers aimed to establish the prevalence of psychiatric comorbidities in patients with IBDs, as well as their QoL. Furthermore, risk factors associated with psychiatric comorbidity and HR-QoL were evaluated. Methods: A quantitative, cross-sectional, observational study was conducted using a questionnaire, the EQ-5D assessment tool, the Mini International Neuropsychiatric Interview - M.I.N.I. 7.0.2 (8/8/16 version), a functional assessment with the aid of the Functional Independence Score in Hemophilia (FISH) tool and also from patients’ clinical records. At the Bloemfontein and the Kimberley Haemophilia Treatment Centres respectively there were 57 and 12 adult patients who attended regularly. Forty adult patients were consecutively sampled from these two sites. Results: The median age of the sample was 29.5 years (range 18 to 65). The majority were male (83%), unemployed (75%), receiving a disability grant (53%) and had never been married (65%). The majority of patients had haemophilia (73%), followed by hereditary haemorrhagic telangiectasia (HHT) (23%), Von Willebrand Disease (VWD) (2.5%) and Bernard-Soulier syndrome (BSS) (2.5%). The prevalence of both hepatitis C virus (HCV) and human immunodeficiency virus (HIV) was 10%. Twenty-three percent of patients reported bleeding more than three times per month. The lifetime prevalence of comorbid psychiatric illness in patients with IBDs was high - 43% had one or more psychiatric comorbidity. Major depressive disorder (MDD) was particularly common, with a lifetime prevalence of 30%. The prevalence of anxiety disorders and substance use disorders were both 15%, followed by post-traumatic stress disorder (PTSD), schizophrenia and suicidality, all present in 2.5% of the sample. The group of patients with severe haemophilia carried most of the burden of psychiatric illness (53%) when compared to mild/moderate haemophilia, HHT and the other IBDs. The total sample had greater impairment in HR-QoL in all domains, but anxiety/depression compared to normative data. The severe haemophilia subgroup was the only subgroup with worse anxiety/depression when compared to normative data. The deficit in HR-QoL was more pronounced in all domains (except pain/discomfort) in the severe haemophilia group when compared to the mild/moderate group. Functional assessments showed that actions such as squatting, stair climbing, and running are the most severely affected domains of functionality. No significant risk factors could be established for the development of psychiatric illness, but patients with a higher level of education were less likely to develop a mental illness compared to patients with lower levels of education. Higher bleeding frequencies, as well as perceiving family as unsupportive were significant risk factors for impaired HR-QoL. Never having been married was associated with the development of psychiatric illness in the haemophilia subgroup. Conclusion: Patients with IBDs in central South Africa have a high prevalence of psychiatric illnesses, especially MDD (30%), compared to the 9.8% in the general population of South Africa. No demographic or clinical characteristics were associated with the development of psychiatric illness but optimizing measures to limit the bleeding frequency and educating and supporting family members might improve functioning and HR-QoL. Screening for comorbid psychiatric illness in patients with IBDs is recommended.
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    Prevalence of mood symptoms in patients with cannabis use admitted to the acute wards at Free State psychiatry complex with schizophrenia spectrum and related disorders
    (University of the Free State, 2021-02) Pooe, M. T.; Van Niekerk, J. S. S.
    Background: Cannabis is the most commonly used drug among psychotic patients. Literature shows that the frequency and intensity of cannabis use, is a risk-factor for the development of schizophrenia-related psychosis. However, evidence for causality of mood disorders remain conflicting. Aim: The purpose of this study was to compare the prevalence and severity of mood symptoms in patients with schizophrenia spectrum and related disorders with comorbid cannabis use and those that does not use cannabis. Setting: This study was conducted in patients with schizophrenia spectrum and related disorders admitted at the acute wards at the Free State Psychiatric complex. Methods: A prospective study was conducted among 30 non- cannabis users and 40 cannabis users. The Young Mania Rating Scale (YMRS) and Hamilton Depression (HAM-D) rating scale for depression was administered within three days of admission and repeated after 7-14 days. Results: Among cannabis users, symptoms compatible with mania like symptoms was significantly more prevalent shortly after admission with (p<0.01). However, this difference declined to non-significance after 7 – 14 days with no clinical separation between the groups. Conclusion: Seventy-five percent of schizophrenia spectrum and related disorders patients that used cannabis, scored ≥18 on the YMRS shortly after admission. Mania like symptoms were of mild-moderate severity. The study indicated a possible association between cannabis use and higher scores on the YMRS rating scale during the early phase of treatment. A causal link between mood symptoms and cannabis use could not be established and confounding factors were not excluded.