Weskoppies Psychiatric Hospital

To elucidate the genetic architecture of familial schizophrenia we combine linkage analysis with studies of fine-level chromosomal variation in families recruited from the Afrikaner population in South Africa. We demonstrate that individually rare inherited copy number variants (CNVs) are more frequent in cases with familial schizophrenia as compared to unaffected controls and affect almost exclusively genic regions. Interestingly, we find that while the prevalence of rare structural variants is similar in familial and sporadic cases, the type of variants is markedly different. In addition, using a high-density linkage scan with a panel of nearly 2,000 markers, we identify a region on chromosome 13q34 that shows genome-wide significant linkage to schizophrenia and show that in the families not linked to this locus, there is evidence for linkage to chromosome 1p36. No causative CNVs were identified in either locus. Overall, our results from approaches designed to detect risk variants with relatively low frequency and high penetrance in a well-defined and relatively homogeneous population, provide strong empirical evidence supporting the notion that multiple genetic variants, including individually rare ones, that affect many different genes contribute to the genetic risk of familial schizophrenia. They also highlight differences in the genetic architecture of the familial and sporadic forms of the disease.

What renders some mentally disordered patients incapable of informed consent to medical interventions? It is argued that a patient is incapable of giving informed consent owing to mental disorder, if a mental disorder prevents a patient from understanding what s/he consents to; if a mental disorder prevents a patient from choosing decisively; if a mental disorder prevents a patient from communicating his/her consent; or if a mental disorder prevents a patient from accepting the need for a medical intervention. This paper holds that a patient's capacity to give informed consent should be assessed clinically by using these conditions necessary for informed consent, and should be assessed specifically for each intervention and specifically at the time when the consent has to be given. The paper considers patients' incapacity to give informed consent to treatment, to give informed consent to be examined clinically, and to give informed consent to participate in research.

We used a family-based cluster detection approach designed to localize significant rare disease-risk variants clusters within a region of interest to systematically search for schizophrenia (SCZ) susceptibility genes within 49 genomic loci previously implicated by de novo copy number variants. Using two independent whole-exome sequencing family datasets and a follow-up autism spectrum disorder (ASD) case/control whole-exome sequencing dataset, we identified variants in one gene, Fanconi-associated nuclease 1 (FAN1), as being associated with both SCZ and ASD. FAN1 is located in a region on chromosome 15q13.3 implicated by a recurrent copy number variant, which predisposes to an array of psychiatric and neurodevelopmental phenotypes. In both SCZ and ASD datasets, rare nonsynonymous risk variants cluster significantly in affected individuals within a 20-kb window that spans several key functional domains of the gene. Our finding suggests that FAN1 is a key driver in the 15q13.3 locus for the associated psychiatric and neurodevelopmental phenotypes. FAN1 encodes a DNA repair enzyme, thus implicating abnormalities in DNA repair in the susceptibility to SCZ or ASD.

BACKGROUND: NOGO Receptor 1 (RTN4R) regulates axonal growth, as well as axon regeneration after injury. The gene maps to the 22q11.2 schizophrenia susceptibility locus and is thus a strong functional and positional candidate gene. METHODOLOGY/PRINCIPAL FINDINGS: We evaluate evidence for genetic association between common RTN4R polymorphisms and schizophrenia in a large family sample of Afrikaner origin and screen the exonic sequence of RTN4R for rare variants in an independent sample from the U.S. We also employ animal model studies to assay a panel of schizophrenia-related behavioral tasks in an Rtn4r-deficient mouse model. We found weak sex-specific evidence for association between common RTN4R polymorphisms and schizophrenia in the Afrikaner patients. In the U.S. sample, we identified two novel non-conservative RTN4R coding variants in two patients with schizophrenia that were absent in 600 control chromosomes. In our complementary mouse model studies, we identified a haploinsufficient effect of Rtn4r on locomotor activity, but normal performance in schizophrenia-related behavioral tasks. We also provide evidence that Rtn4r deficiency can modulate the long-term behavioral effects of transient postnatal N-methyl-D-aspartate (NMDA) receptor hypofunction. CONCLUSIONS: Our results do not support a major role of RTN4R in susceptibility to schizophrenia or the cognitive and behavioral deficits observed in individuals with 22q11 microdeletions. However, they suggest that RTN4R may modulate the genetic risk or clinical expression of schizophrenia in a subset of patients and identify additional studies that will be necessary to clarify the role of RTN4R in psychiatric phenotypes. In addition, our results raise interesting issues about evaluating the significance of rare genetic variants in disease and their role in causation.

A hemizygous deletion of the q11 band on chromosome 22 occurs in 1 of every 5,950 live births (0.017%). The deletion is mediated by low copy repeats (LCRs) flanking this locus. Presence of the deletion is associated with variable phenotypic expression, which can include distinctive facial dysmorphologies, congenital heart disease and learning disabilities. An unusually high percentage of individuals with this deletion (25-30%) have been described to develop schizophrenia or schizoaffective disorder. In previous studies, the prevalence of the 22q11 deletion in patients with schizophrenia was found to be approximately 2% in Caucasian adults and 6% in childhood-onset cases. Both these frequencies represent a dramatic increase from the prevalence of the deletion in the general population. In this study, we investigate the occurrence of the 22q11 deletion in an independent sample of schizophrenic patients of Afrikaner origin. We first ascertained a sample of 85 patients who meet full diagnostic criteria for schizophrenia for presence of two or more of the clinical features associated with presence of the 22q11 deletion. A group of six patients (7%) met these criteria. This group was subjected to fluorescent in situ hybridization (FISH) and presence of the 22q11 deletion was confirmed for two subjects. Our study therefore confirms the previously reported rate of 2% frequency of the 22q11 deletion in adult schizophrenic patients and provides a two-stage screening protocol to identify these patients.

In this study we conducted an investigation of the background level of linkage disequilibrium (LD) in the Afrikaner population to evaluate the appropriateness of this genetic isolate for mapping complex traits. We analyzed intermarker LD in 62 nuclear families using microsatellite markers covering extended chromosomal regions. The markers were selected to allow the first direct comparison of long-range LD in the Afrikaners to LD in other demographic groups. Using several statistical measures, we find significant evidence for LD in the Afrikaners extending remarkably over a 6-cM range. In contrast, LD decays significantly beyond 3-cM distances in the other founder and outbred populations examined. This study strongly supports the appropriateness of the Afrikaner population for genome-wide scans that exploit LD to map common, multigenic disorders.

Founder populations hold tremendous promise for mapping genes for complex traits, as they offer less genetic and environmental heterogeneity and greater potential for genealogical research. Not all founder populations are equally valuable, however. The Afrikaner population meets several criteria that make it an ideal population for mapping complex traits, including founding by a small number of initial founders that likely allowed for a relatively restricted set of mutations and a large current population size that allows identification of a sufficient number of cases. Here, we examine the potential to conduct genealogical research in this population and present initial results indicating that accurate genealogical tracing for up to 17 generations is feasible. We also examine the clinical similarities of schizophrenia cases diagnosed in South Africa and those diagnosed in other, heterogeneous populations, specifically the US. We find that, with regard to basic sample descriptors and cardinal symptoms of disease, the two populations are equivalent. It is, therefore, likely that results from our genetic study of schizophrenia will be applicable to other populations. Based on the results presented here, the history and current size of the population, as well as our previous analysis addressing the extent of background linkage disequilibrium (LD) in the Afrikaners, we conclude that the Afrikaner population is likely an appropriate founder population to map genes for schizophrenia using both linkage and LD approaches.

OBJECTIVE: There is evidence of variation in the prevalence of co-morbid obsessive-compulsive disorder in schizophrenia amongst ethnic groups. This study evaluated the lifetime prevalence and clinical characteristics of obsessive-compulsive disorder (OCD)/ obsessive-compulsive symptoms (OCS) in Afrikaner schizophrenic and schizoaffective disorder patients. METHOD: An ongoing genetic study of schizophrenia is currently being conducted on the Afrikaner founder population. In this cohort of 400 subjects from the original genetic study, we identified 53 subjects with schizophrenia or schizoaffective disorder and co-morbid OCD/OCS (study group). They were matched for gender and age of onset of illness with 59 subjects who do not have OCD/OCS (control group). The diagnostic instrument used in this cohort is the Diagnostic Interview for Genetic Studies (DIGS) version 2, which has been translated into Afrikaans. In addition to the DIGS, information for the relevant clinical characteristics reported in this study was also drawn from a detailed narrative chronological summary report and clinical files. A checklist was completed. RESULTS: The prevalence of co-morbid OCD/OCS amongst 400 subjects with schizophrenia or schizoaffective disorder was 13.2% [n=53] of which 40 were male and 13 female patients. The prevalence of OCD was 10.7% and OCS was 2.5%. Contamination obsessions [n=17] were the most common type of obsession reported, followed by religious obsessions [n=8]. The most prevalent compulsions were repetitive rituals [n=32] followed by checking behaviour [n=22]. Onset of psychotic symptoms was found to be insidious in 86.8% of the study group compared to 24.6% of the control group (p<0.0001). Second-generation antipsychotic use was found to be statistically more prevalent in the study group (77.4%), compared to the control group (45.8%) (p=0.0008). 73% of the study group experienced depressive symptoms compared to 50.8% of the control group. Both groups were found to have a similar incidence of suicidal thoughts and suicide attempts. Substance abuse amongst the control group was significantly higher (35.9%) compared to the study group (19.2%) (p <0.05). Cannabis was most commonly abused in both groups, followed by alcohol. CONCLUSION: The prevalence rate of 13.2% of co-morbid OCD/OCS in Afrikaner schizophrenia and schizoaffective disorder patients differs from findings in other ethnic groups, suggesting the possible role of genetic and cultural factors in the prevalence of co-morbid OCD/OCS. Second-generation antipsychotic use amongst schizophrenia and schizoaffective disorder patients with co-morbid OCD/OCS was found to be significantly higher than in those without co-morbid OCD/OCS. Clinical characteristics of Afrikaner schizophrenics and schizoaffective disorder patients with and without co-morbid OCD/OCS are the same, both groups were associated with significant psychopathology and a poor prognosis.

OBJECTIVE: The problem of the prediction of violence in psychiatric patients has led to a proliferation of research over the last decade. This study focuses on enduring patient related risk factors of violence, and investigates which long-term patients in Weskoppies Hospital (a specialist psychiatric hospital) are the most likely to commit violent acts. METHOD: Nursing statistics on violent incidents and other security breaches were collected for 262 long-term in-patients over a six month period (April - September 2007). The 41 patients who committed violent acts were compared to the 221 non-violent patients in terms of demographic and clinical variables, using two-way tables and Chi-Square or Fisher's Exact Tests. RESULTS: The prevalence of violence among the long-term patients was 16%. Fighting among patients was the most common form of violence (58%). The most significant risk factors of violence among the long-term patients are: A diagnosis of mental retardation; first hospital admission before the age of 40 years; total hospital stay >12 years; current accommodation in a closed ward; habitual verbal aggression; absence of disorganised behaviour; and being clinically evaluated as unsuitable for community placement. CONCLUSION: The findings will help to identify those long-term patients most at risk of violence. The subgroup of patients with mental retardation is responsible for a isproportionately large number of violent acts in the hospital. The risk lies not so much in their psychiatric symptoms, but more in their cognitive ability, coping skills and inappropriate admission circumstances. Efforts should be directed - at a provincial level - towards their community placement.

OBJECTIVE: Research on HIV in South Africa has not reflected the impact of the disease on psychiatric patients. The aims of the study were: to compare the HIV prevalence among patient groups in Weskoppies Hospital; to compare psychiatric diagnoses of infected and non-infected patients; to assess intravenous drug use and high-risk sexual behaviour; to establish HIV-syphilis Association; and to investigate the rapid test performance for screening, compared to the confirmatory ELISA test. METHOD: Onehundred-and-ninety-five patients were grouped into four categories according to their duration of admission and gender. HIV rapid testing, HIV ELISA, syphilis-RPR and TPHA testing were performed. RESULTS: The HIV prevalence of 11% in the sample was significantly associated with 'gender-and-duration-of-admission' categories (p = 0.003). No significant association between HIV infection and psychiatric diagnoses or intravenous drug use was found, but a significant association existed between HIV infection and high-risk sexual behaviour (p = 0.002), and between HIV and syphilis (p = 0.012). The HIV rapid screening test had a sensitivity of 91.7% and a specificity of 98.2%. CONCLUSION: The overall HIV prevalence at Weskoppies Hospital remains lower than the national average, but has increased since a previous local study. The rapid test for HIV had a lower sensitivity than was expected, and it is recommended that HIV ELISA testing be performed as a first line test in the setting of hospitalised patients. Due to the high prevalence of HIV and syphilis in the psychiatric population it is recommended that all patients be tested for both of these diseases.

We investigate the types of childhood maltreatment and abuser-abused relational ties that best predict a dissociative disorder (DD). Psychiatric inpatients (n = 116; mean age = 35; F:M = 1.28:1) completed measures of dissociation and trauma. Abuse type and abuser-abused relational ties were recorded in the Traumatic Experiences Questionnaire. Multidisciplinary team clinical diagnosis or administration of the SCID-D-R to high dissociators confirmed DD diagnoses. Logit models described the relationships between abuser-abused relational tie and the diagnostic grouping of patients, DD present (n = 16) or DD absent (n = 100). Fisher's exact tests measured the relative contribution of specific abuse types. There was a positive relationship between abuse frequency and the presence of DD. DD patients experienced more abuse than patients without DDs. Two combinations of abuse type and relational tie predicted a DD: childhood emotional neglect by biological parents/siblings and later emotional abuse by intimate partners. These findings support the early childhood etiology of DDs and subsequent maladaptive cycles of adult abuse. Enquiries about childhood maltreatment should include a history of emotional neglect by biological parents/siblings. Adult emotional abuse by intimate partners should assist in screening for DDs.

The professional and personal impact of mandatory personal therapy (MPT) on clinical psychologists in training was explored through qualitative analysis of interviews with nine intern clinical psychologists. Participants’ reported initial resistance to treatment, but subsequently came to own and value their therapy as an indispensable professional resource. MPT reduces expectations of clinical supervision, while clinical training and personal therapy were viewed as reciprocally enhancing components of professional growth. Participants believed that they benefitted personally from their treatment and that the compulsory nature of the therapy did not compromise its positive effects. While providing containment and support during the personally challenging clinical training, MPT is itself emotionally taxing, financially stressing, and affects personal relationships in complex ways.

Objectives: The concern about elder abuse increases as the global population ages. Elder abuse is a global public health, human rights and criminal justice problem that goes beyond socioeconomic classes and regions. It remains understudied, especially in developing countries with limited resources. It is therefore timely to do a review of the available research on elder abuse in South Africa, to be able to address the gaps in the research with future projects. Methods: Publications were identified from PubMed, MEDLINE, PsychINFO, Sabinet, Africa-Wide Information, CINAHL, E-Journals, Family & Society Studies Worldwide, PsycARTICLES, Criminal Justice Abstracts and Social Work Abstracts. Fourteen articles on elder abuse in South Africa were selected for further review. This paper provides a narrative review of elder abuse in South Africa and is not a systematic review. Discussion: South Africa is a multicultural nation, plagued by HIV/AIDS, poverty and the remaining effects of the legacy of apartheid. This background sets the stage for categories of abuse that are unique to the country that are highlighted in this review. The available research on elder abuse is very limited and no reliable data about the prevalence of elder abuse in South Africa could be found. Conclusions: There is a clear need for more longitudinal research about all aspects of elder abuse in South Africa. To improve future research efforts consensus has to be reached about a universal operational definition of abuse and an elder abuse instrument with a clear cut-off for definite elder abuse.

Quantitative electroencephalographic (QEEG) changes relating to dissociative experiences have only rarely been demonstrated, and dissociative states were not quantified in those studies. The aim of this study was to explore concurrent associations between quantified dissociative states and QEEG spectral parameters, in particular theta activity, in psychiatric patients. Fifty psychiatric patients completed the State Scale of Dissociation (SSD) immediately after a 15-min EEG recording. The EEG was assessed by conventional clinical visual analysis as well as by quantitative (QEEG) spectral analysis. Canonical analysis was performed between the set of SSD subscale scores and the following QEEG parameters: alpha-theta magnitude ratios, and relative as well as absolute theta magnitude obtained from right and left mid- to posterior-temporal and parieto-occipital derivations. The SSD transferred well to the present data in terms of reliability and internal criterion-related validity. The SSD and Dissociative Experiences Scale (DES) correlated significantly (r = .73, p < .001). Conventional EEG analysis identified 29 EEGs (58%) as abnormal. The main abnormality in 23 EEGs was slowing, maximal temporally in half of these cases. Canonical analyses confirmed a statistically significant relationship between the dissociation variables (especially conversion and depersonalization symptoms) and the QEEG variables (especially relative theta magnitude in the temporal regions; R = .72, p = .03, for SSD-QEEG; and R = .66, p = .04, for DES-QEEG). Quantified dissociative mental states are positively canonically associated with decreased temporal theta activity and increased alpha-theta ratios on QEEG in psychiatric patients with a high tendency to dissociate. The potential implications of the dissociation-theta-alpha relationship for understanding normal attentional processes need to be studied further.

OBJECTIVE: The aims of this study were to determine the prevalence of metabolic disorders in long-term psychiatric patients, and the relationship between known risk factors and these metabolic disorders. METHODS: All psychiatric in-patients ≥18 years, who had been admitted ≥six months were invited to participate. Eighty-four patients participated. They were interviewed, examined, measured and blood tests conducted to determine several demographic and clinical variables including age, gender, weight, blood pressure and fasting blood glucose. RESULTS: The prevalence of the metabolic disorders were: metabolic syndrome 32%, hypertension 32%, diabetes mellitus 8%, cholesterol dyslipidaemia 32%, triglyceride dyslipidaemia 29%, low density lipoprotein (LDL) dyslipidaemia 50%, overweight 37%, and obesity 24%. Black African and female patients were more likely to have metabolic syndrome. Female patients were more likely to have cholesterol dyslipidaemia and obesity. Hypertension was associated with age. Ninety-six percent of patients with dyslipidaemia were newly diagnosed during the study. Three out of the seven previously diagnosed diabetic patients had raised fasting blood glucose levels. CONCLUSION: The prevalence of metabolic syndrome falls towards the lower limits of the expected prevalence rate. Race and gender showed a moderate statistical association with metabolic syndrome. There is a lack of screening for dyslipidaemia in this setting. Diabetic patients should be referred to specialist diabetic clinics for better monitoring and control.

Homicide committed by a person who subsequently commits suicide within one week of the homicide is a relatively rare event. The current study used an explanatory sequential design, including psychological autopsies, to identify psychiatric and other contributing factors in 35 homicide-suicide cases in northern Gauteng Province, South Africa. This research highlighted the complex multifactorial nature of these events. Identification of high-risk individuals and delineation of contributing factors is important. Early recognition and effective treatment of psychiatric illness, particularly depression and substance use problems, in people experiencing relationship issues (with pending/recent separations) and financial stressors, is an essential component in the prevention of homicide-suicide incidents. Evaluations should always include direct questioning about suicidal and homicidal ideations. Mental health practitioners have a definite role to play in offering comfort, support, and treatment to all those who remain behind after these devastating events. Urgent attention needs to be given to the availability of support and treatment for investigating police officers and surviving family and friends.

Charcot was the first to notice the occurrence of amnesia in some of his patients suffering from alcohol-neuritis. Korsakow studied this peculiar kind of amnesia more elaborately. He regarded this condition as a disease sui generis , which could arise also from other causes besides abuse of alcohol, and used the name “polyneuritic psychosis.” It was later recognised that the same mental picture could exist without accompanying neuritis. Jolly proposed the name “amnestic” or “Korsakow's” syndrome, regarding it as a modus of reaction of the nervous system to various harmful agents, viz. , head-trauma, senium, infections, poisons—alcohol being the most frequent cause of this reaction. Most later writers agree with this view. I shall deal in this paper with the cases of thirty patients, who, at some time during their illness, presented this syndrome; I have not included any cases in which alcohol could not be regarded as the principal factor.

The South African Mental Health Act of 2002 advocates the de-institutionalization of treatment of patients with mental disorders, so that the mental health care users or patients are treated in their communities. Although this approach is often used to discharge patients from hospital, no feasibility assessments are conducted to ascertain adequate care for these patients. The objective of the study was to explore the experiences of family members who provide home care for patients with serious mental disorders. A qualitative explorative design was used to interview 20 primary caregivers whose family members were readmitted to a public psychiatric hospital in Pretoria. Data were analysed using NVivo version 11. The findings are that caring for patients with serious mental illness at home is difficult, sometimes unbearable, because the families have to deal with violence perpetrated by the patients, safety concerns, financial difficulties and emotional turmoil, and wish that the patients would be kept in institutions. The absence of required skills and resources to care for the mentally ill at home exposes the patients and their families to emotional, financial and social difficulties, and results in unfavourable outcomes for both the patients and their families.

&lt;p&gt;The prevention of suicide, particularly adolescent suicide, remains one of the biggest challenges in psychiatry.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives. &lt;/strong&gt;To ascertain: (i) clinical and demographic characteristics; and (ii) possible associations between these characteristics and suicide attempt frequency in a selected patient group at Weskoppies Hospital over 4 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods.&lt;/strong&gt; Fifty adolescent outpatients aged between 13 and 17 years with a history of one or more suicide attempts were interviewed to obtain demographic and clinical features. Chi square and Fisher’s exact tests assessed associations between these features and suicide attempt frequency. &lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results.&lt;/strong&gt; Of the subjects, 79% were aged between 15 and 17 years; they were predominantly female (62%) and Caucasian (83%). Mainstream and special education schools were equally represented. Three-quarters had reached grades 8 - 10, and 14% lived with both biological parents, 33% in places of safety and 37% with one divorced parent. The minority of caregivers had a history of alcohol abuse and other substance use. Twenty-nine per cent of the subjects had attempted suicide on more than 10 occasions and 23% had made a single attempt. The most common methods were wounding (74%), tablet overdose (34%) and hanging (20%). Psychiatric diagnoses included major depressive disorder (64%), bipolar disorder (38%), alcohol abuse (18%) and other substance abuse (24%). Familial features included depression, substance abuse, antisocial behaviour and suicide. Familial suicidal behaviour included suicide attempts by parents (85%), siblings (36%), aunts and uncles (31%) and cousins (44%). Physical and sexual abuse was reported in 52% of families. Conclusion. Many findings and profiles of other studies were confirmed and point to school and home environments, family psychopathology and psychiatric diagnoses as factors associated with adolescent suicide attempts. Associations between the frequency of suicide attempts and the demographic and clinical characteristics were statistically inconclusive.&lt;/p&gt;

The current study has important implications in the South African context. The team acted as a bridge between the department of education and the school and community systems, establishing links for future negotiations between them. The ecological systems approach facilitated openness to both traditional and Western concepts of mental health by the team, the school community, and the department of education. This approach resulted in a healing method rooted in the realities of the community, realities that must be recognized if the goal is to develop effective mental health services and community outreach programs in South Africa.