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Item Open Access A comparative cost analysis of functional neurological disorder with other neurological disorders in patients admitted at Universitas Academic Hospital Neurology Ward(University of the Free State, 2021-05) Christopher, Leonriche Leonard Christo; Pretorius, P. J.; Moodley, A.Background: There is a lack of published data about functional neurological disorder and related costs incurred on the health care system in South Africa. Aim: To compare the health care costs of functional neurological disorder (FND) to those of other neurological conditions admitted in an inpatient setting. Setting: Universitas Tertiary Academic Hospital, Neurology Department, Free State, South Africa. Method: Secondary data was collected from Meditech for the period of 1 January 2018 until 31 December 2019. All neurology patient records were reviewed to ensure that patients with FND admitted during the study period were correctly identified. A descriptive data analysis was performed with means and standard deviations calculated for all patients included in the analysis. Categorical variables were summarised by frequencies and percentages. P-values were reported as a measure of significance for the main outcome variable, namely cost. Results: A total of 530 patients were admitted during the study period. Every 12th patient with a diagnosis other than FND were chosen as the comparator group. Of the 58 patients included in the study, 29/58 (50%) had a diagnosis of FND and 29/58 (50%) were admitted for other neurological disorders. A median age of 28 years IQR (19-36) was reported for the patients diagnosed with FND and 34 years IQR (25-45) for admissions with comparable neurological diagnoses. Both groups had similar gender representations with 11/29 (37.9%) being male, and 18/29 (62.1%) females. The median length of stay was significantly shorter (p value 0.007) for patients diagnosed with FND. Patients with FND most commonly (41.4%) presented with paraplegia. The average cost for the FND patients was significantly less (p value 0.008) than other neurological disorders. The majority (72.4%) of patients admitted for FND was from a low-income category. Conclusion: Patients admitted at the neurology ward with FND incurred lower costs and had fewer medical comorbidities than patients diagnosed with other neurological disorders.Item Open Access 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.Item Open Access The prevalence of mental disorders among offenders admitted at health facilities in Bizzah Makhate Correctional Service Centre, Kroonstad, South Africa(University of the Free State, 2019-11) Modupi, Mosa Bonolo; Mosotho, N. L.Mental disorders are reportedly more prevalent in prisons than expected. The aim of this study was to determine the prevalence of mental disorders among offenders admitted at the health establishments in Bizzah Makhathe Correctional Centre, Kroonstad, South Africa. Structured psychiatric interviews were conducted to elicit the information. The majority of the participants were young males, black Africans with low educational levels, coming from low socio-economic backgrounds. Crimes against human beings were jointly the most common ones committed by the offenders. The lifetime prevalence of mental disorders was 54.7%. Personality disorders, followed by substance and addictive disorders were the most prominent disorders among the study sample. Other psychiatric disorders noted were depressive disorders, schizophrenia spectrum, intellectual disabilities and neurocognitive disorders, etc. It is agreed that a notable number of prisoners suffering from mental disorders goes undetected, undiagnosed and untreated. Constructs of competency to stand trial and criminal responsibility should always be observed. There is a need to conduct more empirical studies on the prevalence and incidences of mental disorders in correctional service centres in South Africa.Item Open Access 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.Item Open Access Exploring the appropriateness of the Montreal Cognitive Assessment as a culturally sensitive screening test in the Sesotho-speaking population(University of the Free State, 2020-04) Mienie, Jan Konig; Nel, C.; Potgieter, M. F.Neurocognitive disorder (NCD) or dementia, is a progressive neurodegenerative syndrome that causes severe impairment in function. The disease burden of NCD is increasing in middle- and low-income countries as life expectancy increases. Early detection and intervention is essential in the management of NCD. In countries with severe resource constraints, low-cost screening tools to diagnose cognitive impairment is imperative, as extensive neurocognitive batteries are rarely feasible. The Montreal Cognitive Assessment (MoCA) is one of these screening tools designed for the diagnosis of mild cognitive impairment. Limited information on the validity of the MoCA in a South African population is available, as it was initially validated for English- and French-speaking populations. We conducted a descriptive study that explored the appropriateness of the MoCA in screening for cognitive impairment in a Sesotho-speaking population. The study was conducted in Bloemfontein in the Free State Province, South Africa. Participants were recruited from National District Hospital and Pelonomi Academic Hospital. Ninety-three Sesotho-speaking healthcare users between 18 and 62 years of age were recruited. All participants were screened for mental and other illnesses that could impair cognitive function prior to the administration of the MoCA. Using the normed MoCA cut-off score of 26. The MoCA yielded a false positive screen with a total score of 25 or less in 63 (67.7%) of the participants. Although participants with a tertiary level of education did perform better than the participants with lower educational attainment, their mean total score of 23.9 was still below the recommended cut-off score. Significant concerns regarding cultural bias in the MoCA emerged in the sample, regardless of the level of education of participants. This might indicate that some items may not be culturally appropriate for the Sesotho-speaking population and might lead to false positive screening for cognitive impairment. Future research should focus on collecting normative data in the population in an attempt to suggest more appropriate substitutes for these items.