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Childhood trauma is a recognised risk factor for schizophrenia. It has been proposed that childhood trauma interferes with normal neurodevelopment, thereby establishing a biological vulnerability to schizophrenia. Poor premorbid adjustment is frequently a precursor to schizophrenia, and may be a manifestation of neurodevelopmental compromise. We investigated the relationship between childhood trauma and premorbid adjustment in 77 patients with first-episode schizophrenia spectrum disorders. We also investigated possible mediating roles for other selected risk factors in the relationship. We found several significant correlations between different trauma types and both social and academic premorbid adjustment from childhood to late adolescence. There were no significant moderating effects for family history of schizophrenia or family history of psychiatric disorder. History of obstetric complications, substance abuse and poor motor coordination weakened some of the associations between childhood trauma and premorbid adjustment, while poor sequencing of motor acts strengthened the association. Our results confirm previous studies indicating an association between childhood trauma and premorbid adjustment. Results indicate a general rather than specific association, apparent with different types of trauma, and affecting both social and academic components of premorbid adjustment across childhood, early and late adolescence. Further, our results suggest a complex interplay of various risk factors, supporting the notion of different pathways to psychosis.

List of Abstract Titles and authors: 1. Psychosis: A matter of mental effort? M Borg, Y Y van der Zee, J H Hsieh, H Temmingh, D J Stein, F M Howells 2.In search of an affordable, effective post-discharge intervention: A randomised control trial assessing the influence of a telephone-based intervention on readmissions for patients with severe mental illness in a developing country U A Botha, L Koen, M Mazinu, E Jordaan, D J H Niehaus 3. The effect of early abstinence from long-term methamphetamine use on brain metabolism using 1H-magnetic resonance spectro-scopy (1H-MRS) A Burger, S Brooks, D J Stein, F M Howells 4. The effect of in utero exposure to methamphetamine on brain metabolism in childhood using 1H-magnetic resonance spectroscopy (1H-MRS) A Burger, A Roos, M Kwiatkowski, D J Stein, K A Donald, F M Howells 5. A prospective study of clinical, biological and functional aspects of outcome in first-episode psychosis: The EONKCS Study B Chiliza, L Asmal, R Emsley 6. Stimulants as cognitive enhancers - perceptions v. evidence in a very real world H M Clark 7. Pharmacogenomics in antipsychotic drugs Ilse du Plessis 8. Serotonin in anxiety disorders and beyond Ilse du Plessis 9. HIV infection results in ventral-striatal reward system hypo-activation during cue processing S du Plessis, M Vink, J A Joska, E Koutsilieri, A Bagadia, D J Stein, R Emsley 10. Disease progression in schizophrenia: Is the illness or the treatment to blame? R Emsley, M J Sian 11. Serotonin transporter variants play a role in anxiety sensitivity in South African adolescents S M J Hemmings, L I Martin, L van der Merwe, R Benecke, K Domschke, S Seedat 12. Iron deficiency in two children diagnosed with multiple sclerosis: Report on whole exom sequencing S Janse van Rensburg, R van Toorn, J F Schoeman, A Peeters, L R Fisher, K Moremi, M J Kotze 13. Benzodiazepines: Practical pharmacokinetics P Joubert 14. What to consider when prescribing psychotropic medications G Lippi 15. Current prescribing practices for obsessive-compulsive disorder in South Africa: Controversies and consensus C Lochner, L Taljaard, D J Stein 16. Correlates of emotional and behavioural problems in children with preinatally acquired HIV in Cape Town, South Africa K-A Louw, N Phillips, JIpser, J Hoare 17. The role of non-coding RNAs in fear extinction S Malan-Muller, L Fairbairn, W M U Daniels, M J S Dashti, E J Oakleley, M Altorfer, J Harvey, S Seedat, J Gamieldien, S M J Hemmings 18. An analysis of the management og HIV-mental illness comorbidity at the psychiatric unit of the Dr George Mukhari Academic Hospital M L Maodi, S T Rataemane, T Kyaw 19. The identification of novel genes in anxiety disorders: A gene X environment correlation and interaction study N W McGregor, J Dimatelis, S M J Hemmings, C J Kinnear, D J Stein, V Russel, C Lochner 20. Collaborations between conventional medicine and traditional healers: Obstacles and possibilities G Nortje, S Seedat, O Gureje 21. Thought disorder and form perception: Relationships with symptoms and cognitive function in first-episode schizophrenia M R Olivier, R Emsley 22. Investigating the functional significance of genome-wide variants associated with antipsychotic treatment response E Ovenden, B Drogemoller, L van der Merwe, R Emsley, L Warnich 23. The moral and bioethical determinants of "futility" in psychiatry W P Pienaar 24. Single voxel proton magnetic resonance spectroscopy (1H-MRS) and volumetry of the amylgdala in social anxiety disorder in the context of early developmental trauma D Rosenstein, A T Hess, J Zwart, F Ahmed-Leitao, E Meintjies, S Seedat 25. Schizoaffective disorder in an acute psychiatric unit: Profile of users and agreement with Operational Criteria (OPCRIT) R R Singh, U Subramaney 26. The right to privacy and confidentiality: The ethics of expert diagnosis in the public media and the Oscar Pistorius trial C Smith 27. A birth cohort study in South Africa: A psychiatric perspective D J Stein 28. 'Womb Raiders': Women referred for observation in terms of the Criminal Procedures Act (CPA) charged with fetal abduction and murder U Subramaney 29. Psycho-pharmacology of sleep wake disorders: An update R Sykes 30. Refugee post-settlement in South Africa: Role of adjustment challenges and family in mental health outcomes L Thela, A Tomita, V Maharaj, M Mhlongo, K Jonathan 31. Dstinguishing ADHD symptoms in psychotic disorders: A new insight in the adult ADHD questionnaire Y van der Zee, M Borg, J H Hsieh, H Temmingh, D J Stein, F M Howells 32. Oscar Pistorius ethical dilemmas in a trial by media: Does this include psychiatric evaluation by media? M Vorster 33. Genetic investigation of apetite aggression in South African former young offenders: The involvement of serotonin transporter gene K Xulu, J Somer, M Hinsberger, R Weierstall, T Elbert, S Seedat, S Hemmings 34. Effects of HIV and childhood trauma on brain morphemtry and neurocognitive function G Spies, F Ahmed-Leitao, C Fennema-Notestine, M Cherner, S Seedat 35. Measuring intentional behaviour normative data of a newly developed motor task battery S Bakelaar, J Blampain, S Seedat, J van Hoof, Y Delevoye-Turrel 36. Resilience in social anxiety disorder and post-traumatic stress disorder in the context of childhood trauma M Bship, S Bakelaar, D Rosenstein, S Seedat 37. The ethical dilemma of seclusion practices in psychiatry G Chiba, U Subramaney 38. Physical activity and neurological soft signs in patients with schizophrenia O Esan, C Osunbote, I Oladele, S Fakunle, C Ehindero 39. A retrospective study of completed suicides in the Nelson Mandela Bay Metropolitan Area from 2008 to 2013 - preliminary results C Grobler, J Strumpher, R Jacobs 40. Serotonin transporter variants play a role in anxiety sensitivity in South African adolescents S M J Hemmings, L I Martin, L van der Merwe, R Benecke, K Domschke, S Seedat 41. Investigation of variants within antipsychotic candidate pharmacogenes associated with treatment outcome F Higgins, B Drogmoller, G Wright, L van der Merwe, N McGregor, B Chiliza, L Asmal, L Koen, D Niehaus, R Emsley, L Warnich 42. Effects of diet, smoking and alcohol consumption on disability (EDSS) in people diagnosed with multiple sclerosis S Janse van Rensburg, W Davis, D Geiger, F J Cronje, L Whati, M Kidd, M J Kotze 43. The clinical utility of neuroimaging in an acute adolescnet psychiatric inpatient population Z Khan, A Lachman, J Harvey 44. Relationships between childhood trauma (CT) and premorbid adjustment (PA) in a highly traumatised sample of patients with first-episode schizophrenia (FES) S Kilian, J Burns, S Seedat, L Asmal, B Chiliza, S du Plessis, R Olivier, R Emsley 45. Functional and cognitive outcomes using an mTOR inhibitor in an adolescent with TSC A Lachman, C van der Merwe, P Boyes, P de Vries 46. Perceptions about adolescent body image and eating behaviour K Laxton, A B R Janse van Rensburg 47. Clinical relevance of FTO rs9939609 as a determinant of cardio-metabolic risk in South African patients with major depressive disorder H K Luckhoff, M J Kotze 48. Childhood abuse and neglect as predictors of deficits in verbal auditory memory in non-clinical adolescents with low anxiety proneness L Martin, K Martin, S Seedat 49. The changes of pro-inflammatory cytokines in a prenatally stressed febrile seizure animal model and whether Rhus chirindensis may attenuate these changes A Mohamed, M V Mabandla, L Qulu 50. Influence of TMPRSS6 A736v and HFE C282y on serum iron parameters and age of onset in patients with multiple sclerosis K E Moremi, M J Kotze, H K Luckhoff, L R Fisher, M Kidd, R van Toorn, S Janse van Rensburg 51. Polypharmacy in pregnant women with serious mental illness E Thomas, E du Toit, L Koen, D Niehaus 52. Infant attachment and maternal depression as predictors of neurodevelopmental and behavioural outcomes at follow-up J Nothling, B Laughton, S Seedat 53. Differences in abuse, neglect and exposure to community violence in adolescents with and without PTSD J Nothling, S Suliman, L Martin, C Simmons, S Seedat 54. Assessment of oxidative stress markers in children with autistic spectrum disorders in Lagos, Nigeria Y Oshodi, O Ojewunmi, T A Oshodi, T Ijarogbe, O F Aina, J Okpuzor, O C F E A Lesi 55. Change in diagnosis and management of 'gender identity disorder' in pre-adolescent children S Pickstone-Taylor 56. Brain network connectivity in women exposed to intimate partner violence A Roos, J-P Fouche, B Vythilingum, D J Stein 57. Prolonged exposure treatment for PTSD in a Third-World, task-shifting, community-based environment J Rossouw, E Yadin, I Mbanga, T Jacobs, W Rossouw, D Alexander, S Seedat 58. Contrasting effects of early0life stress on mitochondrial energy-related proteins in striatum and hippocampus of a rat model of attention-deficit/ hyperactivity disorder V Russell, J Dimatelis, J Womersley, T-L Sterley 59. Attention-deficit hyperactivity disorder in adults: A South African perspective R Schoeman, M de Klerk, M Kidd 60. Cognitive function in women with HIV infection and early-life stress G Spies, C Fennema-Notestine, M Cherner, S Seedat 61. Changes in functional connectivity networks in bipolar disorder patients after mindfulness-based cognitic therapy J A Starke, C F Beckmann, N Horn 62. Post-traumatic stress disorder, overweight and obesity: A systematic review and meta-analysis S Suliman, L Anthonissen, J Carr, S du Plessis, R Emsley, S M J Hemmings, C Lochner, N McGregor L van den Heuvel, S Seedat 63. The brain and behaviour in a third-trimester equivalent animal model of fetal alcohol spectrum disorders P C Swart, C B Currin, J J Dimatelis, V A Russell 64. Irritability Assessment Model (IAM) to monitor irritability in child and adolescent psychiatric disorders. D van der Westhuizen 65. Outcome of parent-adolescent training in chilhood victimisation: Adaptive functioning, psychosocial and physiological variables D van der Westhuizen 66. The effect of ketamine in the Wistar-Kyoto and Sprague Dawley rat models of depression P J van Zyl, J J Dimatelis, V A Russell 67. Investigating COMT variants in anxiety sensitivity in South African adolescents L J Zass, L Martin, S Seedat, S M J Hemmings

List of abstracts and authors: 1. Bipolar disorder not otherwise specified -overdiagnosed or underdiagnosed? E Allers 2. The prognosis of major depression untreated and treated: Does the data reflect the true picture of the prognosis of this very common disorder? E Allers 3. Can we prolong our patients' life expectancy? Providing a better quality of life for patients with severe mental illness O A Betencourt 4. The scope of ECT practice in South Africa J Benson-Martin, P Milligan 5. Biomarkers for schizophrenia: Can we evolve like cancer therapeutics? P Buckley 6. Relapse in schizophrenis: Major challenges in prediction and prevention P Buckley 7. Informed consent in biological treatments: The right to know the duty to inform I Chetty 8. Effectiveness of a long-acting injectable antipsychotic plus an assertive monitoring programme in first-episode schizophrenia B Chiliza, L Asmal, O Esan, A Ojagbemi, O Gureje, R Emsley 9. Name, shame, fame P Cilliers 10. Can we manage the increasing incidence of violent raging children? We have to! H Clark 11. Serotonin, depression and antidepressant action P Cowen 12. Prevalence and correlates of comorbid psychiatris illness in patients with heroin use disorder admitted to Stikland Opioid Detoxification Unit L Dannatt, K J Cloete, M Kidd, L Weich 13. Investigating the association between diabetes mellitus, depression and psychological distress in a cohort of South African teachers A K Domingo, S Seedat, T M Esterhuizen, C Laurence, J Volmink, L Asmal 14. Neuropeptide S -emerging evidence for a role in anxiety K Domschke 15. Pathogenetics of anxiety K Domschke 16. The effects of HIV on the fronto-striatal system S du Plessis, M Vink, J Joska, E Koutsilieri, C Scheller, B Spottiswoode, D Stein, R Emsley 17. Effects of acute antipsychotic treatment on brain morphology in schizophrenia R Emsley, L Asmal, B Chiliza, S du Plessis, J Carr, A Goosen, M Kidd, M Vink, R Kahn 18. Development of a genetic database resource for monitoring of breast cancer patients at risk of physical and psychological complications K Grant, F J Cronje, K Botha, J P Apffelstaedt, M J Kotze 19. Unipolar mania reconsidered: Evidence from a South African study C Grobler 20. Antipsychotic-induced movement disorders: Occurence and management P Haddad 21. The place of observational studies in assessing the effectiveness of long-acting injectable antipsychotics P Haddad 22. Molecular mechanisms of d-cycloserine in fear extinction: Insights from RNS sequencing S Hemmings, S Malan-Muller, L Fairbairn, M Jalali, E J Oakeley, J Gamieldien, M Kidd, S Seedat 23. Schizophrenia: The role of inflammation DC Henderson 24. Addictions: Emergent trends and innovations V Hitzeroth 25. The socio-cultural-religious context of biological psychiatric practice B Janse van Rensburg 26. Biochemical markers for identifying risk factors for disability progression in multiple sclerosis S Janse van Rensburg, M J Kotze, F J Cronje, W Davis, K Moremi, M Jalali Sefid Dashti, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus 27. Alcohol-induced psychotic disorder: Brain perfusion and psychopathology - before and after antipsychotic treatment G Jordaan, J M Warwick, D G Nel, R Hewlett, R Emsley 28.'Pump and dump': Harm reduction strategies for breastfeeding while using substances L Kramer 29. Adolescent neuropsychiatry - an emerging field in South African adolescent psychiatric services A Lachman 30. Recovery versus remission, or what it means to be healthy for a psychiatric patient? B Latecki 31. Holistic methods utilised to normalise behaviours in youth diagnosed with neuro-biochemical disorders P Macqueen 32. Candidate genes and novel polymorphisms for anxiety disorder in a South African cohort N McGregor, J Dimatelis, S M J Hemmings, C J Kinnear, D Stein, V Russel, C Lochner 33. Higher visual functioning A Moodley 34. The effects of prenatal methylmercury exposure on trace element and antioxidant levels in rat offspring following 6-hydroxydopamine-induced neuronal insult Z M Moosa, W M U Daniels, M V Mabandla 35. Paediatric neuropsychiatric movement disorders L Mubaiwa 36. The South African national female offenders study M Nagdee, L Artz, C de Clercq, P de Wet, H Erlacher, S Kaliski, C Kotze, L Kowalski, J Naidoo, S Naidoo, J Pretorius, M Roffey, F Sokudela, U Subramaney 37. Neurobiological consequences of child abuse C Nemeroff 38. What do Stellenbosch Unviversity medical students think about psychiatry - and why should we care? G Nortje, S Suliman, K Seed, G Lydall, S Seedat 39. Neurological soft skins in Nigerian Africans with first episode schizophrenia: Factor structure and clinical correlates A Ojagbemi, O Esan, O Gureje, R Emsley 40. Should psychiatric patients know their MTHFR status? E Peter 41. Clinical and functional outcome of treatment refractory first-episode schizophrenia L Phahladira, R Emsley, L Asmal, B Chiliza 42. Bioethics by case discussion W Pienaar 43. Reviewing our social contract pertaining to psychiatric research in children, research in developing countries and distributive justice in pharmacy W Pienaar 44. The performance of the MMSE in a heterogenous elderly South African population S Ramlall, J Chipps, A I Bhigjee, B J Pillay 45. Biological basis addiction (alocohol and drug addiction) S Rataemane 46. Volumetric brain changes in prenatal methamphetamine-exposed children compared with healthy unexposed controls A Roos, K Donald, G Jones, D J Stein 47. Single voxel proton magnetic resonance spectroscopy of the amygdala in social anxiety disorder in the context of early developmental trauma D Rosenstein, A Hess, S Seedat, E Meintjies 48. Discussion of HDAC inhibitors, with specific reference to supliride and its use during breastfeeding J Roux 49. Prevalence and clinical correlates of police contact prior to a first diagnosis of schizophrenia C Schumann, L Asmal, K Cloete, B Chiliza, R Emsley 50. Are dreams meaningless? M Solms 51. The conscious id M Solms 52. Depression and resilience in HIV-infected women with early life stress: Does trauma play a mediating role? G Spies, S Seedat 53. State of affairs analysis for forensic psychiatry in SA U Subramaney 54. Escitalopram in the prevention of post-traumatic stress disorder: A pilot randomised controlled trial S Suliman, S Seedat, J Pingo, T Sutherland, J Zohar, D J Stein 55. Epigenetic consequences of adverse early social experiences in primates S Suomi 56. Risk, resilience, and gene x environment interactions in primates S Suomi 57. Biological aspects of anorexia nervosa C Szabo 58. Agents used and profiles of non-fatal suicidal behaviour in East London H Uys 59. The contributions of G-protein coupled receptor signalling to opioid dependence J van Tonder 60. Emerging trend and innovation in PTSD and OCD J Zohar 61. Making the SASOP treatment guidelines operational E Allers Poster Presentations 62. Neuropsychological deficits in social anxiety disorder in the context of early developmental trauma S Bakelaar, D Rosenstein, S Seedat 63.Social anxiety disorder in patients with or without early childhood trauma: Relationship to behavioral inhibition and activation and quality of life S Bakelaar, C Bruijnen, A Sambeth, S Seedat 64. Exploring altered affective processing in obssessive compulsive disorder symptom subtypes E Breet, J Ipser, D Stein, C Lochner 65. To investigate the bias toward recognising the facial expression of disgust in obsessive compulsive disorder as well as the effect of escitalopram E Breet, J Ipser, D Stein, C Lochner 66. A fatal-case of nevirapine-induced Stevens-Johnson's syndrome in HIV mania A Bronkhorst, Z Zingela, W M Qwesha, B P Magigaba 67. Association of the COMT G472A (met/met) genotype with lower disability in people diagnosed with multiple sclerosis W Davis, S J van Rensburg, L Fisher, F J Cronje, D Geiger, M J Kotze 68. Homocycsteine levels are associated with the fat mass and obesity associated gene FTO(intron 1 T>A) polymorphism in MS patients W Davis, S J Van Rensburg, M J Kotze, L Fisher, M Jalali, F J Cronje, K Moremi, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus 69. Analysis of the COMT 472 G>A (rs4680) polymorphism in relation to environmental influences as contributing factors in patients with schizophrenia D de Klerk, S J van Rensburg, R A Emsley, D Geiger, M Rensburg, R T Erasmus, M J Kotze 70. Dietary folate intake, homocysteine levels and MTHFR mutation detection in South African patients with depression: Test development for clinical application D Delport, N vand der Merwe, R Schoeman, M J Kotze 71. The use ofexome sequencing for antipsychotic pharmacogenomic applications in South African schizophrenia patients B Drogmoller, D Niehaus, G Wright, B Chiliza, L Asmal, R Emsley, L Warnich 72. The effects of HIV on the ventral-striatal reward system S du Plessis, M Vink, J Joska, E Koutsilieri, C Scheller, B Spottiswoode, D Stein, R Emsley 73. Xenomelia relates to asymmetrical insular activity: A case study of fMRI S du Plessis, M Vink, L Asmal 74. Maternal mental helath: A prospective naturalistic study of the outcome of pregancy in women with major psychiatric disorders in an African country E du Toit, L Koen, D Niehaus, B Vythilingum, E Jordaan, J Leppanen 75. Prefrontal cortical thinning and subcortical volume decrease in HIV-positive children with encephalopathy J P Fouche, B Spottiswoode, K Donald, D Stein, J Hoare 76. H-magnetic resonance spectroscopy metabolites in schizophrenia F Howells, J Hsieh, H Temmingh, D J Stein 77. Hypothesis for the development of persistent methamphetamine-induced psychosis J Hsieh, D J Stein, F M Howells 78. Culture, religion, spirituality and psychiatric practice: The SASOP Spirituality and Psychiatry Special Interest Group Action Plan for 2012-2014 B Janse van Rensburg 79. Cocaine reduces the efficiency of dopamine uptake in a rodent model of attention-deficit/hyperactivity disorder: An in vivo electrochemical study L Kellaway, J S Womersley, D J Stein, G A Gerhardt, V A Russell 80. Kleine-Levin syndrome: Case in an adolescent psychiatric unit A Lachman 81. Increased inflammatory stress specific clinical, lifestyle and therapeutic variables in patients receiving treatment for stress, anxiety or depressive symptoms H Luckhoff, M Kotze, S Janse van Rensburg, D Geiger 82. Catatonia: An eight-case series report M Mabenge, Z Zingela, S van Wyk 83. Relationship between anxiety sensitivity and childhood trauma in a random sample of adolescents from secondary schools in Cape Town L Martin, M Viljoen, S Seedat 84. 'Making ethics real'. An overview of an ethics course presented by Fraser Health Ethics Services, BC, Canada JJ McCallaghan 85. Clozapine discontinuation rates in a public healthcare setting M Moolman, W Esterhuysen, R Joubert, J C Lamprecht, M S Lubbe 86. Retrospective review of clozapine monitoring in a publica sector psychiatric hospital and associated clinics M Moolman, W Esterhuysen, R Joubert, J C Lamprecht, M S Lubbe 87. Association of an iron-related TMPRSS6 genetic variant c.2007 C>7 (rs855791) with functional iron deficiency and its effect on multiple sclerosis risk in the South African population K Moremi, S J van Rensburg, L R Fisher, W Davis, F J Cronje, M Jalali Sefid Dashti, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus, M Kidd, M J Kotze 88. Identifying molecular mechanisms of apormophine-induced addictive behaviours Z Ndlazi, W Daniels, M Mabandla 89. Effects of lifestyle factors and biochemistry on the major neck blood vessels in patients with mutiple sclerosis M Nelson, S J van Rensburg, M J Kotze, F Isaacs, S Hassan 90. Nicotine protects against dopamine neurodegenration and improves motor deficits in a Parkinsonian rat model N Ngema, P Ngema, M Mabandla, W Daniels 91. Cognition: Probing anatomical substrates H Nowbath 92. Chronic exposure to light reverses the effects of maternal separation on the rat prefrontal cortex V Russel, J Dimatelis 93. Evaluating a new drug to combat Alzheimer's disease S Sibiya, W M U Daniels, M V Mabandla 94. Structural brain changes in HIV-infected women with and without childhood trauma G Spies, F Ahmed, C Fennema-Notestine, S Archibald, S Seedat 95. Nicotine-stimulated release of hippocampal norepinephrine is reduced in an animal model of attention-deficit/ hyperactivity disorder: the spontaneously hypertensive rat T Sterley 96. Brain-derive neurotrophic factor (BDNF) protein levels in anxiety disorders: Systematic review and meta-regression analysis S Suliman, S M J Hemmings, S Seedat 97. A 12-month retrospective audit of the demographic and clinical profile of mental healthcare users admitted to a district level hospital in the Western Cape, South Africa E Thomas, K J Cloete, M Kidd, H Lategan 98. Magnesium recurarization: A comparison between reversal of neuromuscular block with sugammadex v. neostigmine/ glycopyrrolate in an in vivo rat model M van den Berg, M F M James, L A Kellaway 99. Identification of breast cancer patients at increased risk of 'chemobrain': Case study and review of the literature N van der Merwe, R Pienaar, S J van Rensburg, J Bezuidenhout, M J Kotze 100. The protective role of HAART and NAZA in HIV Tat protein-induced hippocampal cell death S Zulu, W M U Daniels, M V Mabandla

1. How can we maintain a sustainable private practice in the current political and economic climate? Eugene Allers 2. SASOP Clinical guidelines, protocols and algorithms: Development of treatment guidelines for bipolar mood disorder and major depression Eugene Allers, Margaret Nair, Gerhard Grobler 3. The revolving door phenomenon in psychiatry: Comparing low-frequency and high-frequency users of psychiatric inpatient services in a developing country U A Botha, P Oosthuien, L Koen, J A Joska, J Parker, N Horn 4. Neurophysiology of emotion and senses - The interface between psyche and soma Eugene Allers 5. Suicide prevention: From and beyond the psychiatrist's hands O Alonso Betanourt, M Morales Herrera 6. Treatment of first-episod psychosis: Efficacy and toleabilty of a long-acting typical antipsychotic B Chiliza, R Schoeman, R Emsey, P Oosthuizen, L KOen, D Niehaus, S Hawkridge 7. Treatment of attention deficit hyperactivity disorder in the young child Helen Clark 8. Holistic/ Alternative treatment in psychiatry: The value of indigenous knowledge systems in cllaboration with moral, ethical and religious approaches in the military services J Dill 9. Treating Schizophrenia: Have we got it wrong? Robin Emsley 10.Terminal questions in the elderly Mike Ewart Smith 11. Mental Health Policy development and implementation in Ghana, South Africa, Uganda and Zambia Alan J Flisher, Crick Lund, Michelle Frank, Arvin Bhana, Victor Doku, Natalie Drew, Fred N Kigozi, Martin Knapp, Mayeh Omar, Inge Petersen, Andrew Green andthe MHaPP Research Programme Consortium 12. What indicators should be used to monitor progress in scaling uo services for people with mental disorders? Lancet Global Mental Health Group (Alan J Flisher, Dan Chisholm, Crick Lund, Vikram Patel, Shokhar Saxena, Graham Thornicroft, Mark Tomlinson) 13. Does unipolar mania merit research in South Africa? A look at the literature Christoffel Grobler 14. Revisiting the Cartesian duality of mind and body Oye Gureje 15. Child and adolescent psychopharmacology: Current trends and complexities S M Hawkridge 16. Integrating mental illness, suicide and religion Volker Hitzeroth 17. Cost of acute inpatient mental health care in a 72-hour assessment uniy A B R Janse van Rensburg, W Jassat 18. Management of Schizophrenia according to South African standard treatment guidelines A B R Janse van Rensburg 19. Structural brain imaging in the clinical management of psychiatric illness F Y Jeenah 20. ADHD: Change in symptoms from child to adulthood S A Jeeva, A Turgay 21. HIV-Positive psychiatric patients in antiretrovirals G Jonsson, F Y Jeenah, M Y H Moosa 22. A one year review of patients admitted to tertiary HIV/Neuropsychiatry beds in the Western Cape John Joska, Paul Carey, Ian Lewis, Paul Magni, Don Wilson, Dan J Stein 23. Star'd - Critical review and treatment implications Andre Joubert 24. Options for treatment-resistent depression: Lessons from Star'd; an interactive session Andre Joubert 25. My brain made me do it: How Neuroscience may change the insanity defence Sean Kaliski 26. Child andadolescent mental health services in four African countries Sharon Kleintjies, Alan Flisher, Victoruia Campbell-Hall, Arvin Bhana, Phillippa Bird, Victor Doku, Natalie, Drew, Michelle Funk, Andrew Green, Fred Kigozi, Crick Lund, Angela Ofori-Atta, Mayeh Omar, Inge Petersen, Mental Health and Poverty Research Programme Consortium 27. Individualistic theories of risk behaviour Liezl Kramer, Volker Hitzeroth 28. Development and implementation of mental health poliy and law in South Africa: What is the impact of stigma? Ritsuko Kakuma, Sharon Kleintjes, Crick Lund, Alan J Flisher, Paula Goering, MHaPP Research Programme Consortium 29. Factors contributing to community reintegration of long-term mental health crae users of Weskoppies Hospital Carri Lewis, Christa Kruger 30. Mental health and poverty: A systematic review of the research in low- and middle-income countries Crick Lund, Allison Breen, Allan J Flisher, Ritsuko Kakuma, Leslie Swartz, John Joska, Joanne Corrigall, Vikram Patel, MHaPP Research Programe Consortium 31. The cost of scaling up mental health care in low- and middle-income countries Crick Lund, Dan Chishlom, Shekhar Saxena 32. 'Tikking'Clock: The impact of a methamphetamine epidemic at a psychiatric hospital in the Western Cape P Milligan, J S Parker 33. Durban youth healh-sk behaviour: Prevalence f Violence-related behaviour D L Mkize 34. Profile of morality of patients amitted Weskoppies Psychiatric Hospital in Sout frican over a 5-Year period (2001-2005) N M Moola, N Khamker, J L Roos, P Rheeder 35. One flew over Psychiatry nest Leverne Mountany 36. The ethical relationship betwe psychiatrists and the pharmaceutical indutry Margaret G Nair 37. Developing the frameor of a postgraduate da programme in mental health R J Nichol, B de Klerk, M M Nel, G van Zyl, J Hay 38. An unfolding story: The experience with HIV-ve patients at a Psychiatric Hospital J S Parker, P Milligan 39. Task shifting: A practical strategy for scalingup mental health care in developing countries Vikram Patel 40. Ethics: Informed consent and competency in the elderly Willie Pienaar 41. Confronting ommonmoral dilemmas. Celebrating uncertainty, while in search patient good Willie Pienaar 42. Moral dilemmas in the treatment and repatriation of patients with psychtorders while visiting our country Duncan Ian Rodseth 43. Geriatrics workshop (Psegal symposium): Medico-legal issuess in geriatric psyhiatry Felix Potocnik 44. Brain stimulation techniques - update on recent research P J Pretorius 45. Holistic/Alternative treatments in psychiatry T Rangaka, J Dill 46. Cognitive behaviour therapy and other brief interventions for management of substances Solomon Rataemane 47. A Transtheoretical view of change Nathan P Rogerson 48. Profile of security breaches in longerm mental health care users at Weskoppies Hospital over a 6-month period Deleyn Rema, Lindiwe Mthethwa, Christa Kruger 49. Management of psychogenic and chronic pain - A novel approach M S Salduker 50. Childhood ADHD and bipolar mood disorders: Differences and similarities L Scribante 51. The choice of antipsychotic in HIV-infected patients and psychopharmacocal responses to antipsychotic medication Dinesh Singh, Karl Goodkin 52. Pearls in clinical neuroscience: A teaching column in CNS Spectrums Dan J Stein 53. Urinary Cortisol secretion and traumatics in a cohort of SA Metro policemen A longitudinal study Ugash Subramaney 54. Canabis use in Psychiatric inpatients M Talatala, G M Nair, D L Mkize 55. Pathways to care and treatmt in first and multi-episodepsychosis: Findings fm a developing country H S Teh, P P Oosthuizen 56. Mental disorders in HIV-infected indivat various HIV Treatment sites in South Africa Rita Thom 57. Attendanc ile of long-term mental health care users at ocupational therapy group sessions at Weskoppies Hospital Ronel van der Westhuizen, Christa Kruger 58. Epidemiological patterns of extra-medical drug use in South Africa: Results from the South African stress and health study Margaretha S van Heerden, Anna Grimsrud, David Williams, Dan Stein 59. Persocentred diagnosis: Where d ps and mental disorders fit in the International classificaton of diseases (ICD)? Werdie van Staden 60. What every psychiatrist needs to know about scans Herman van Vuuren 61. Psychiatric morbidity in health care workers withle drug-resistant erulosis (MDR-TB) A case series Urvashi Vasant, Dinesh Singh 62. 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Multiple factors play a role in determining the outcome of schizophrenia. However, the role of these factors is poorly understood, and research findings so far have been inconclusive and sometimes contradictory. Various demographic and baseline clinical factors have been reported to be associated with treatment outcome. Also, early symptom reduction after initiation of antipsychotic therapy is closely related to later treatment response. However, associations as such do not necessarily imply predictive value, and none of these factors can be regarded as clinically useful in predicting treatment outcome. This article discusses selected aspects of treatment outcome and its prediction in schizophrenia, focusing particularly on early treatment response, ethnicity, neurological soft signs, and the predictive value of a discriminant functional analysis model utilising a combination of putative predictors. Such a model holds promise, and it is to be hoped that future refinements will lead to a clinically useful model for predicting outcome.

Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Resilience refers to the ability to employ a collection of protective factors to return to or maintain positive mental health following an experience of disadvantage or adversity. Understanding why some children do well despite early adverse experiences is crucial because it can inform more effective policies and programs that help more children reach their full potential. This study aimed to explore and explain the development of resilience within an ecological-transactional framework. A qualitative case study approach was used recruiting participants with history of childhood adversity: six patients with a diagnosis of first-episode psychosis from the main referral psychiatric hospital in Kenya and eight healthy controls from a neighbouring community in Nairobi. The findings indicate that children and their contexts mutually influenced each other. Using the systemic perspective of the ecological-transactional model, our participants identified the home environment (microsystem) as an important enabler of trauma to children. Available social support at both the micro-and exosystem levels, including good caregiver-child relationships, acted as buffers to alleviate the negative influence of adversity, leading to successful adaptation. Our study highlights the significant impact of adversities during childhood and adolescence. In addition, it emphasizes the influence of multiple contexts, supporting the need for appropriate interventions at each level to mitigate the negative consequences., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Pregnancy and puerperium are critical points in women's health, and various psychiatric emergencies may worsen or manifest (for the first time) during this period. In the presence of a psychiatric emergency, the pregnancy and puerperium outcomes may be compromised. In addition to the mother being at risk, the health of the fetus and the newborn may also be compromised if the psychiatric emergency is not managed appropriately. Early detection and collaborative approaches between mental health practitioners and obstetricians are of utmost importance in women who are at risk and those living with psychiatric illnesses during pregnancy and puerperium. Practitioners should also ensure that women with impaired capacity due to psychiatric disease are treated in a non-judgmental and respectful manner, even if their autonomies have been overridden., Competing Interests: Declaration of competing interest B.C. has received honoraria for speaking at educational events and/or being part of the advisory boards of Adcock Ingram, Dr Reddys, Janssen, and Pfizer. L.T, S.P and B. D declared no conflict of interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Aim: Mental disorders and HIV are the main contributors to the increase in years lived with disability rates per person in sub-Saharan Africa. A complex inter-relationship exists between HIV and mental illness, especially in a region with a high HIV prevalence. We examined the duration of untreated psychosis (DUP), and the nature of psychotic and cognitive symptoms in people with first episode psychosis (FEP) living with and without HIV., Methods: Adults aged between 18 and 45 years were assessed using a clinical interview, physical examination and several psychiatric tools. These included the Mini International Neuro-psychiatric Interview to confirm psychosis, Positive and Negative Syndrome Scale, International HIV Dementia Scale and other scales to measure symptom variables. HIV ELISA was used for HIV serology testing, with measures being carried out within 6 weeks of the first presentation., Results: Of the 172 people presenting with FEP, 36 (21%) had comorbid HIV, those with both being older and more likely to be female (p < .001). Clinically, participants with FEP and HIV scored lower on the positive subscale (p = .008). There were no statistically significant differences for DUP or cognitive screening. Of those living with HIV and FEP (n = 36) comorbidity, nine were newly diagnosed with HIV at the time of the study., Conclusion: Individuals presenting with FEP and comorbid HIV were older, female and reported more mood symptoms. The identification of nine new HIV infections also reflects the ongoing need to test for HIV in people presenting with severe mental illness., (© 2024 The Author(s). Early Intervention in Psychiatry published by John Wiley & Sons Australia, Ltd.)

Aim: Exposure to adversity during childhood is associated with elevated risk for commonly occurring forms of psychopathology, especially psychotic disorders. Despite the noteworthy consequences associated with adverse childhood experiences, an inconsistent and unpredictable number of at-risk populations present with remarkably good physical and mental health outcomes that can be attributed to resilience. This study aimed to qualitatively explore the experience of childhood adverse events and coping strategies employed by individuals that promote resilience and better mental health outcomes., Methods: Fourteen individuals with a history of childhood adversity were recruited to participate using a case-study approach. A semi-structured interview guide was developed based on empirical evidence and theoretical background, and the interviews were analysed using a reflexive thematic approach., Results: Our findings showed that the type of adversity impacted the experience of trauma, for example, the death of a caregiver versus emotional abuse or witnessing violence at home. Five coping strategies were identified (social support, religious coping, problem or emotion-focused coping, and meaning-making), with healthy controls found to identify and use these resources more than the psychosis group to promote individual well-being and better mental health outcomes., Conclusions: Our findings provide insights into experiences in the aftermath of childhood adversity, emphasising the need to assess the history of trauma systematically. They further underscore the importance of mental health prevention programmes bolstering individual-level coping strategies and the resources available within our environments to help them manage adversity, improve overall outcomes, and promote resilience., (© 2024 The Author(s). Early Intervention in Psychiatry published by John Wiley & Sons Australia, Ltd.)

Background: The COVID-19 pandemic and the lockdown experience may have not only precipitated or exacerbated mental illness but also influenced access to care and the nature and content of the psychotic symptomatology of people with psychosis., Aim: This study aimed to evaluate the association of the COVID-19 pandemic and lockdown experience on clinical presentation and quality of life of people (QOL) with first episode psychosis (FEP)., Method: Two first episode psychosis cohorts from the same epidemiological area collected prior to, and during the COVID-19 pandemic and lockdown were compared in terms of clinical symptomatology, substance use and QOL. All adult in- and outpatients with FEP at five clinical units in KwaZulu-Natal, South Africa, aged between 18 and 45 years, were assessed with the MINI interview for psychosis, Positive and Negative Symptoms Scale, WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and the WHO QOL scales., Results: Eighty-eight FEP participants were recruited between 2019 and 2020 (cohort 1) before the pandemic. Study recruitment was suspended in March 2020 due to the pandemic. On study resumption from November 2020 to November 2022, 95 new participants (cohort 2) were recruited. There were no sociodemographic differences between the two cohorts, except unemployment status (57% vs. 65%) and household income. The cohort presenting post-COVID-19 pandemic onset had significantly more positive psychotic symptoms (21.9 vs. 23.7), lower PANSS domain depressive score, more lifetime use of tobacco, cannabis and alcohol. However, they reported improved QOL (196 vs. 239)., Conclusion: Following the pandemic and lockdown experience participants presented with more severe psychotic symptoms and concomitant substance use but improved perceived QOL. This suggests the need to explore individual and social factors that may influence the clinical presentation., (© 2023 The Authors. Early Intervention in Psychiatry published by John Wiley & Sons Australia, Ltd.)

Background: There is currently no published evidence demonstrating the effectiveness and safety of subanaesthetic doses of ketamine, when administered intravenously as an adjunct treatment for depressive symptoms, in a real world setting in South Africa., Aim: This retrospective chart review reports the clinical response (change in Patient Health Questionnaire - 7 score) to an initial infusion series of ketamine added to usual treatment, and the pattern of its subsequent maintenance use, for depressive symptoms., Setting: A private ketamine clinic in Hilton, KwaZulu-Natal., Methods: The medical records of all patients who attended a private ketamine clinic between August 2019 and 31 May 2021 were retrospectively analysed. Depression symptoms were evaluated using the Patient Health Questionaire-9 (PHQ-9) administered immediately before and 24 h after each treatment. Response was defined as a score decrease of more than 50%., Results: Among the 154 patients who received ketamine infusions for depression, 67 completed a six infusion initial series, with a response rate of 60.6% and remission rate of 32.4%. Of the 154, 50% no longer experienced any suicidal ideation after treatment and adverse events were uncommon, with 6.2% of infusions requiring intervention for adverse events, mostly nausea. In addition, 48.5% of those who completed the initial series continued to receive maintenance infusions, with no evidence of escalating use or abuse., Conclusion: Incorporating intravenous ketamine into the existing treatment regimens at a private clinic was associated with reduced acuteness of depression severity and suicidal ideation. This approach appeared safe and tolerable, showing no signs of abuse or dependence., Contribution: This is the first known naturalistic study reporting on ketamine use for depressive symptoms in South Africa., Competing Interests: The authors have declared that no competing interest exists., (© 2024. The Authors.)

The purpose of this study was to characterize healthcare use for general care and mental health one year before suicidal behavior among individuals with fatal and non-fatal suicidal behavior (NFSB) in Cape Town, South Africa. We linked electronic health records of 484 participants from a case series of 93 completed suicides on whom forensic autopsies were performed at a mortuary in Cape Town, between August 2014 and January 2016; and 391 patients admitted to hospital following NFSB between June 2014 and March 2015, and between August 2015 and August 2017. Time from last healthcare visit to date of suicidal behavior (fatal or non-fatal) was calculated, and Kaplan Meier curves were used to compare the differences by psychiatric diagnoses and study group. Overall, 64.5% of completed suicides and 65.9% of NFSB patients sought general healthcare in the year before suicidal behavior. Most of these visits occurred at hospital outpatient clinics (40.8%) and primary healthcare facilities (31.3%). The prevalence of preexisting psychiatric diagnoses and the use of mental healthcare services was lower for individuals who completed suicide compared to NFSB patients. Common reasons for a healthcare visit among individuals who completed suicide were chronic disease and assault; and psychiatric illness (depression, bipolar, and/or substance use disorders), chronic disease and HIV among NFSB patients. A large proportion of individuals with fatal and NFSB interacted with the healthcare system before suicidal behavior. These findings suggest opportunities for suicide prevention at primary healthcare facilities, antiretroviral treatment centers and emergency departments.HIGHLIGHTSHealthcare access is common among individuals with fatal and NFSB in the year before suicidal behavior.The prevalence of mental disorder diagnoses is higher among NFSB patients than among individuals who completed suicide.A greater proportion of NFSB patients accessed mental healthcare services compared to individuals who completed suicide.

Opioid use disorder causes significant burden of disease and treatment comprises pharmacotherapy and psychosocial treatment. Cognitive behavioral therapy is an effective psychosocial intervention used in substance use disorders treatment and can be delivered using digital approach. There is limited use of digital treatment among individuals with opioid use disorder in Kenya. This study aimed to describe the experiences and feedback from participants with opioid use disorder enrolled in a text-message intervention in Kenya. Qualitative data was collected from participants in the intervention arm of a feasibility trial testing a text-message intervention based on cognitive behavioral therapy. Data was collected using open-ended questions in a questionnaire and structured in-depth interviews amongst those who received the intervention. Framework method was applied for analysis. Twenty-four participants (83.3% males) were enrolled with a mean age of 32.5 years (SD9.5). Five themes were identified namely: (1) Gain of cognitive behavioral therapy skills which included: identification and change of substance use patterns; drug refusal skills; coping with craving and self-efficacy; (2) Therapeutic alliance which included: development of a bond and agreement on treatment goals; (3) Feedback on intervention components and delivery such as: frequency, and duration of the text message intervention; (4) Challenges experienced during the intervention such as: technical problems with phones; and barriers related to intervention delivery; (5) Recommendations for improvement of intervention in future implementations. The findings demonstrated participants' satisfaction with intervention, gain of skills to change substance use patterns, highlighted challenges experienced and suggestions on improving the intervention among individuals with opioid use disorder. The feedback and recommendations provided by the participants can guide implementation of such interventions to allow acceptability, effectiveness and sustainability. Trial registration: This study was part of a randomized feasibility trial. Clinical trial registration: Pan African Clinical Trial Registry: Registration number: PACTR202201736072847. Date of registration: 10th January 2022., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Kiburi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Cannabis use has been linked to psychotic disorders but this association has been primarily observed in the Global North. This study investigates patterns of cannabis use and associations with psychoses in three Global South (regions within Latin America, Asia, Africa and Oceania) settings., Methods: Case-control study within the International Programme of Research on Psychotic Disorders (INTREPID) II conducted between May 2018 and September 2020. In each setting, we recruited over 200 individuals with an untreated psychosis and individually-matched controls (Kancheepuram India; Ibadan, Nigeria; northern Trinidad). Controls, with no past or current psychotic disorder, were individually-matched to cases by 5-year age group, sex and neighbourhood. Presence of psychotic disorder assessed using the Schedules for Clinical Assessment in Neuropsychiatry and cannabis exposure measured by the World Health Organisation Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)., Results: Cases reported higher lifetime and frequent cannabis use than controls in each setting. In Trinidad, cannabis use was associated with increased odds of psychotic disorder: lifetime cannabis use (adj. OR 1.58, 95% CI 0.99-2.53); frequent cannabis use (adj. OR 1.99, 95% CI 1.10-3.60); cannabis dependency (as measured by high ASSIST score) (adj. OR 4.70, 95% CI 1.77-12.47), early age of first use (adj. OR 1.83, 95% CI 1.03-3.27). Cannabis use in the other two settings was too rare to examine associations., Conclusions: In line with previous studies, we found associations between cannabis use and the occurrence and age of onset of psychoses in Trinidad. These findings have implications for strategies for prevention of psychosis.

Objective: We aimed to compare antiretroviral non-adherence in the behaviourally infected (BIAs) and congenitally infected adolescents (CIAs) and explore its associations with depression, cognitive impairment, and alcohol use disorder (AUD) in adolescents living with HIV(ALWHIV) in Botswana., Methods: This study was a cross-sectional, comparative, multi-center research that involved collecting samples from different HIV clinics in Botswana. Of the 622 ALWHIV, 223 were identified as BIAs and 399 as CIAs. They were evaluated using various tools such as MINI-KID for psychiatric disorders, DSM-5 for AUD, CAT-rapid for cognitive assessment, and Visual Analogue Scale (VAS) for non-adherence (the outcome). The data were analysed using both bivariate and multivariate regression analyses., Results: The participants' mean age (SD) was 17.7(1.60). The CIAs were more likely to have cognitive impairment (t -7.25; p < 0.01), while the BIAs had more depression (χ2 = 5.86; p = 0.016) and AUD (χ2 = 4.39; p = 0.036) and were more likely to be non-adherent (t = 3.14; p = 0.002). In the CIA group, cognitive impairment (AOR = 2.86; 95% CI:1.77-4.64) (AOR = 2.79; 95%CI:1.73-4.48) and depression (AOR = 2.69; 95%CI:1.48-4.90 were associated with ART non-adherence. In the BIA group, depression (AOR = 2.55; 95%CI:1.27-5.16), AUD (AOR = 2.58; 95%CI:1.21-5.49) and struggling to accept status (AOR = 2.54; 95%CI:1.41-4.56) predicted non-adherence to treatment., Conclusion: The two groups of adolescents differ regarding ART non-adherence and associated psychosocial issues, indicating the need for differentiated care to address non-adherence in the ALWHIV, especially in high-burden, resource-constrained settings, such as Botswana., (© 2023. The Author(s).)

Purpose of Review: This review summarizes the current literature on the role of traditional and faith-based healthcare in the management of psychotic disorders in Africa., Recent Findings: In contemporary Africa, individuals with psychosis and traditional and faith healers (TFH) are pluralistic towards their understanding of psychosis and their help-seeking behaviour. Traditional healing is perceived to be helpful to patients with psychotic disorders and their family members and may have a positive influence on the course of psychosis in some selected individuals. Studies show that potentially harmful practices are commonly used by African TFH, but that these are associated with a lack of resources and are susceptible to training. Although various TFH and biomedical practitioners are open to collaboration, the many identified obstacles hinder actual partnerships. However, the few studies that have been conducted on collaborative care for patients with psychotic disorders on the continent, show positive outcomes., Summary: Rather than harmonizing the two healing paradigms, synergistic collaboration between traditional/faith-based and biomedical mental healthcare in the management of individuals with psychosis seems to be possible within certain limits. Synergistic collaboration is more culturally syntonic and may actually contribute to bridging the treatment gap for mental disorders in present-day Africa., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Progressive brain structural MRI changes are described in schizophrenia and have been ascribed to both illness progression and antipsychotic treatment. We investigated treatment effects, in terms of total cumulative antipsychotic dose, efficacy and tolerability, on brain structural changes over the first 24 months of treatment in schizophrenia., Methods: A prospective, 24-month, single-site cohort study in 99 minimally treated patients with first-episode schizophrenia, schizophreniform and schizoaffective disorder, and 98 matched healthy controls. We treated the patients according to a fixed protocol with flupenthixol decanoate, a long-acting injectable antipsychotic. We assessed psychopathology, cognition, extrapyramidal symptoms and BMI, and acquired MRI scans at months 0, 12 and 24. We selected global cortical thickness, white matter volume and basal ganglia volume as the regions of interest., Results: The only significant group × time interaction was for basal ganglia volumes. However, patients, but not controls, displayed cortical thickness reductions and increases in white matter and basal ganglia volumes. Cortical thickness reductions were unrelated to treatment. White matter volume increases were associated with lower cumulative antipsychotic dose, greater improvements in psychopathology and cognition, and more extrapyramidal symptoms. Basal ganglia volume increases were associated with greater improvements in psychopathology, greater increases in BMI and more extrapyramidal symptoms., Conclusions: We provide evidence for plasticity in white matter and basal ganglia associated with antipsychotic treatment in schizophrenia, most likely linked to the dopamine blocking actions of these agents. Cortical changes may be more closely related to the neurodevelopmental, non-dopaminergic aspects of the illness.

Background: There is a deficit of psychiatrists in South Africa, and to our knowledge, there is no situational analysis of training posts for psychiatrists in the country., Aim: To compare the number of specialists and subspecialists in training and training posts available in 2008 and 2018., Setting: South African medical schools with departments of psychiatry., Methods: A situational analysis involving data collection through a survey completed by eight heads of academic psychiatric departments followed by a comparative analysis of the two aforementioned years., Results: Data shows an 11% increase in funded and unfunded posts combined and a 9.3% increase in funded posts. The occupancy of funded posts decreased (92% in 2008 to 82% in 2018). When considering both funded and unfunded posts, only three more psychiatrists were being trained in 2018. Supernumeraries appointed in unfunded posts can be expected to return to their countries of origin. As such, a decrease in filled funded posts likely reflects a decrease in training psychiatrists destined to work in South Africa. While child and adolescent psychiatry was the only sub-speciality with accredited training posts in 2008, all sub-specialities included on the questionnaire had accredited training posts in 2018, and the number of accredited training posts in child and adolescent psychiatry doubled. That said, many of the posts were unfunded and vacant., Conclusion: While there was an increase in posts from 2008 to 2018, many posts remained unfilled. As such, not only are additional funded training posts required but also strategies to increase post-occupancy and successful completion of training., Contribution: This study is the first situational analysis of specialist and subspecialist training posts in Psychiatry in South Africa, at two time points over a 10 year period, that draws on academic heads of departments of psychiatry as respondents. The study highlights the nominal increase in funded training posts over this period, especially subspecialist training posts. The majority of Health Professions Council of South Africa (HPCSA) accredited subspecialities in Psychiatry have no funded training posts which is particularly concerning., Competing Interests: The authors declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this article., (© 2023. The Authors.)

Substance use is a major obstacle to preventing and managing HIV among adolescents, who account for 30% of new infections in many parts of the world, including Botswana. Unfortunately, there is a paucity of data on adolescent substance use, especially in the region. Therefore, this study aimed to determine the pattern of psychoactive substance use in adolescents living with HIV (ALWHIV). It also aimed to compare and explore the pattern of substance use disorders and associated factors between congenitally infected adolescents (CIAs) and behaviorally infected adolescents (BIAs). Six hundred and thirty-four ALWHIV were interviewed using a sociodemographic questionnaire, the WHO drug questionnaire, and DSM-5 criteria for substance use disorder. The participants' mean age (SD) was 17.69 (1.6) years, with a male predominance (n = 336, 53%), and the majority (n = 411, 64.8%) were CIAs. Alcohol was the most used substance among the participants, with 15.8% admitting to its current use. The BIAs were more likely to have SUD (χ 2  = 17.2, P  < .01), use more than one substance (χ 2  = 20.3, P  < .01), and more likely to use all psychoactive substances except for inhalants. In the CIAs, regular participation in religious activities was negatively associated with SUD (AOR = 0.36; 95% CI: 0.17-0.77), while struggling with HIV status acceptance was positively associated with SUD (AOR = 2.54; 95% CI: 1.15-5.61) in the BIAs. This study showed a huge burden and similar pattern of substance use disorders among the ALWHIV in Botswana, as reported elsewhere. It also identified the dissimilarities between the BIAs and CIAs regarding substance-related issues and suggested the need for differentiated care., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: Human immunodeficiency virus (HIV) and psychosis share a complex bidirectional relationship, with people living with HIV being at increased risk of psychosis and those with psychosis at increased risk of HIV. However, people living with severe mental illness often have limited or reduced access to HIV testing and care., Aim: This study aimed to determine the prevalence of HIV and describe the access to HIV testing and care among adult patients with recent-onset psychosis who were admitted to a psychiatric hospital in KwaZulu-Natal (KZN) province, South Africa., Setting: A psychiatric hospital in Pietermaritzburg, KZN province, South Africa., Method: A retrospective chart review of 294 patients with recent-onset psychosis admitted between May 2018 and November 2020., Results: A total of 291 (99%) patients had access to HIV testing during the study period, with the HIV seroprevalence rate being 21.5% among the 294 patients; HIV seropositivity was associated with the 25-49 age category (adjusted odds ratio [aOR] = 3.09, 95% confidence interval [CI] 1.27-7.50), female gender (aOR = 9.55, 95% CI 4.40-20.74), current alcohol and cannabis use (aOR = 3.43, 95% CI 1.01-11.62), family history of psychosis (aOR = 3.22, 95% CI 1.03-10.02) and no tertiary education (aOR = 3.7, 95% CI 0.14-0.99). All those living with HIV were on antiretroviral treatment., Conclusion: This study showed that HIV testing and care was accessible at a psychiatric hospital but the prevalence of HIV in people living with recent onset psychosis remains high., Contribution: The study findings suggest the importance of integrating mental health and HIV management., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2023. The Authors.)

Background: This study aimed to explore the effectiveness of psychological interventions (PI): psychoeducation, problem-solving, and rehearsal strategies on depression and adherence in HIV-infected adolescents in Botswana., Methods: Fifty adolescents living with HIV were randomized into control (n = 25) and intervention groups (n = 25), the latter being exposed to five weeks of PI sessions. The PHQ-9 and visual analog scale (VAS) were used to measure the outcomes: depression and adherence at pre-intervention, 5- and 24 weeks post-intervention., Results: The participants' mean age (SD) was 17.38 years (1.1), the two groups being similar in socio-demographic variables: gender (χ 2  = 2.22; p = 0.135) and age (U = 285, z =  - 0.55, p = 0.579). The intervention group scored significantly lower on depressive symptoms (PHQ-9 [F (1,50) = 12.0, p = 0.001, ƞ p 2  = 0.20]) and higher on adherence score (VAS [F (1,50) = 13.5, p = 0.001, ƞ p 2  = 0.22]) than the control group after 5 weeks. The post-hoc analysis showed that the significant improvements in depressive symptoms (z =  - 4.03, p < 0.01, r [effect size] = 0.88) and adherence (z =  - 4.05, p < 0.01, r = 0.88) at post-test in the intervention group were maintained at 24 weeks. This project was registered with ClinicalTrials.gov (NCT05482217)., Conclusion: The 5-week PI showed promising effectiveness in addressing depression and adherence in adolescents living with HIV in Botswana., (© 2023. The Author(s).)

Background: As children living with HIV transition from adolescence into adulthood, they face a considerable burden of psychiatric disorders (PDs) which may vary between the perinatally and behaviorally infected. The knowledge of the pattern of these PDs in relation to the varying needs of the adolescents living with HIV (ALWHIV) is unclear but necessary for maximizing their linkage to care and improving their quality of life in Botswana.  AIM: To determine the pattern of PDs in ALWHIV in Botswana; to compare and explore the differences in the pattern and their associated factors between congenitally infected adolescents (CIAs) and behaviorally infected adolescents (BIAs)., Methods: A cross-sectional survey of 622 ALWHIV (399 CIA and 223 BIA) with the Mini International Neuropsychiatric Interview-Kid Screen., Results: The participants' mean age (SD) was 17.71 (1.60) years, with more males (54%), of whom 52.9% had at least one PD, with depression (23.6%) and generalised anxiety disorder (18.0%) being the most prevalent. The externalising disorders were associated with being CIA (OR = 3.99; 95% CI:1.87-8.54), male gender (OR = 3.93; 95% CI:2.02-7.64), and a viral load of 400 and above copies (OR = 3.53; 95%CI:1.92-6.48). Internalising disorders were associated with being BIA (OR = 3.64; 95%; CI: 2.39-5.56), females (OR = 2.59; 95% CI:1.75-3.83), poor counselling (OR = 2.23; 95% CI: 1.42-3.51) and struggling to accept HIV status (OR = 1.73; 95% CI:1.14-2.62)., Conclusions: Depression and anxiety disorders were the most prevalent PDs in ALWHIV, who differed in psychiatric presentations, the BIAs being more likely to present with internalizing disorders, while the CIAs had more externalizing disorders. Due to the varying needs of ALWHIV, individualized management plans that consider gender, mode of infection, and other psycho-social needs, should be further studied and encouraged., (© 2022. The Author(s).)

Introduction: Opioid use disorders are associated with a high burden of disease and treatment gap. Digital interventions can be used to provide psycho-social treatment for opioid use disorders, as an alternative to or together with face-to-face interventions. This review aimed to assess the application and effectiveness of digital interventions to treat opioid use disorder globally., Methods: The study team searched four electronic databases (PubMed, Psych INFO, Web of Science and Cochrane Central register of controlled trials). The inclusion criteria were: randomized controlled trials, assessment for opioid use before and at least once following intervention, and use of digital interventions. The primary outcomes were opioid use and/or retention in treatment, with data being summarized in tables and a narrative review presented., Results: The initial database search yielded 3542 articles, of which this review includes 20. Nineteen were conducted among adults in the United States. The digital interventions used included web-based, computer-based, telephone calls, video conferencing, automated self-management system, mobile applications and text messaging. They were based on therapeutic education systems, community reinforcement approaches, cognitive behavior therapy, relapse prevention, brief interventions, supportive counselling and motivational interviewing. The studies had mixed findings; of the 20 studies, 10 had statistically significant differences between the treatment groups for opioid abstinence, and four had significant differences for treatment retention. Comparisons were difficult due to varying methodologies. Participants rated the interventions as acceptable and reported high rates of satisfaction., Conclusion: The use of digital interventions for opioid use disorder treatment was acceptable, with varying levels of effectiveness for improving outcomes, which is influenced by participant and intervention delivery factors. Further studies in different parts of the world should compare these findings, specifically in low- and middle-income countries., Competing Interests: Declaration of competing interest None., (Copyright © 2022. Published by Elsevier Inc.)

Importance: Less than 10% of research on psychotic disorders has been conducted in settings in the Global South, which refers broadly to the regions of Latin America, Asia, Africa, and Oceania. There is a lack of basic epidemiological data on the distribution of and risks for psychoses that can inform the development of services in many parts of the world., Objective: To compare demographic and clinical profiles of cohorts of cases and rates of untreated psychoses (proxy for incidence) across and within 3 economically and socially diverse settings in the Global South. Two hypotheses were tested: (1) demographic and clinical profiles of cases with an untreated psychotic disorder vary across setting and (2) rates of untreated psychotic disorders vary across and within setting by clinical and demographic group., Design, Setting, and Participants: The International Research Program on Psychotic Disorders in Diverse Settings (INTREPID II) comprises incidence, case-control, and cohort studies of untreated psychoses in catchment areas in 3 countries in the Global South: Kancheepuram District, India; Ibadan, Nigeria; and northern Trinidad. Participants were individuals with an untreated psychotic disorder. This incidence study was conducted from May 1, 2018, to July 31, 2020. In each setting, comprehensive systems were implemented to identify and assess all individuals with an untreated psychosis during a 2-year period. Data were analyzed from January 1 to May 1, 2022., Main Outcomes and Measures: The presence of an untreated psychotic disorder, assessed using the Schedules for Clinical Assessment in Neuropsychiatry, which incorporate the Present State Examination., Results: Identified were a total of 1038 cases, including 64 through leakage studies (Kancheepuram: 268; median [IQR] age, 42 [33-50] years; 154 women [57.5%]; 114 men [42.5%]; Ibadan: 196; median [IQR] age, 34 [26-41] years; 93 women [47.4%]; 103 men [52.6%]; Trinidad: 574; median [IQR] age, 30 [23-40] years; 235 women [40.9%]; 339 men [59.1%]). Marked variations were found across and within settings in the sex, age, and clinical profiles of cases (eg, lower percentage of men, older age at onset, longer duration of psychosis, and lower percentage of affective psychosis in Kancheepuram compared with Ibadan and Trinidad) and in rates of untreated psychosis. Age- and sex-standardized rates of untreated psychoses were approximately 3 times higher in Trinidad (59.1/100 000 person-years; 95% CI, 54.2-64.0) compared with Kancheepuram (20.7/100 000 person-years; 95% CI, 18.2-23.2) and Ibadan (14.4/100 000 person-years; 95% CI, 12.3-16.5). In Trinidad, rates were approximately 2 times higher in the African Trinidadian population (85.4/100 000 person-years; 95% CI, 76.0-94.9) compared with the Indian Trinidadian (43.9/100 000 person-years; 95% CI, 35.7-52.2) and mixed populations (50.7/100 000 person-years; 95% CI, 42.0-59.5)., Conclusions and Relevance: This analysis adds to research that suggests that core aspects of psychosis vary by historic, economic, and social context, with far-reaching implications for understanding and treatment of psychoses globally.

Introduction: Access to mental health services is a challenge, especially for young people who are over-represented in the unemployment and poverty index in South Africa. Therefore, continuing care is a problem after hospital discharge for young people with first-episode psychosis (FEP) due to a lack of clinical engagement and follow-up, for which they need support, including financial, to improve their outcomes. This pilot randomised control trial (RCT) aims to assess the feasibility and acceptability of financial support, in the form of an unconditional cash transfer (UCT), among young patients with FEP to prevent relapse., Methods and Analysis: This study will use a 1:1 ratio two-arm open-label pilot RCT of 60 young participants (18-29 years) with FEP in remission, who will be recruited from specialised psychiatric facilities in KwaZulu-Natal Province, South Africa. This study will implement an UCT and assess its feasibility, acceptability and preliminary clinical outcomes (ie, medication adherence, relapse, quality of life, personal and social function). The follow-up time will be 3 months, the outcomes being measured at baseline, months 1 and 3. Descriptive and conventional content analysis will be done for quantitative and qualitative data, respectively., Ethics and Dissemination: The study obtained provisional approval from the Biomedical Research Ethics Committee at the University of KwaZulu-Natal(#BREC/00004117/2022). Also is registered on the South African National clinical trial registry (#DOH-27-092022-5894) and approved by the KwaZulu-Natal department of health (#NHRD Ref: KZ&#95;2002209&#95;033). The results from this investigation will be actively disseminated through peer-reviewed journal publications, conference presentations and stakeholder engagement., Trial Registration Number: DOH-27-092022-5894., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: There is limited research on the use of digital interventions among individuals with opioid use disorders (OUD) in low-and-middle income countries. This study aimed to assess mobile phone ownership, digital technology use and acceptability of digital interventions for treatment among individuals on treatment for OUD in Nairobi, Kenya., Methods: A cross-sectional study was conducted among individuals with OUD. Structured questionnaires were used to collect data on socio-demographic and clinical characteristics, use of mobile phones and other digital technology and acceptability of digital interventions for treatment., Results: One hundred and eighty participants were enrolled comprising 83.3% males with mean age of 31.5 years (SD 8.6). Mobile phone ownership was reported by 77.2% of participants of which 59.7% used smartphones. One hundred and sixty-six (92.2%) used phones to call, 82.8 and 77.2% used phones to send and receive text messages respectively; 30% used the internet; 57.2% had replaced the phone in past year and 51.1% of participants reported use of at least one social media platform, of these 44.4% had searched social media for information on drug use. Acceptability to receive treatment by phone was 95% and computer 49.4% with majority (88.1%) preferring a text message-based intervention. The preferred approach of delivery of a text message-based intervention were: one text message per day once a week, message to be personalized and individuals allowed to choose time and day to receive the message. Factors associated with acceptability of digital interventions were education level, being single, smartphone ownership and employment., Conclusion: Majority of individuals on treatment for OUD had access to mobile phones but with high device turnover and limited access to computers and internet. There was high acceptability of digital interventions to provide treatment for OUDs, mostly through phones. These findings highlight factors to consider in the design of a digital intervention for this population., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Kiburi, Paruk and Chiliza.)

Introduction and Objective: Neuropsychiatric disorders like schizophrenia are heterogeneous in that they occur because of the interaction of factors. These factors include but are not limited to genetic, epigenetic, neurobiological and environmental factors. Methylation of DNA, like other erpigenetic modifications, is risk factors for neuropsychiatric disorders. Candidate gene approach projects have produced contradictory results to find candidate gene methylation. The current genome-wide studies have limitations., Search Strategy: An exhaustive search strategy was designed to recover studies on genome-wide DNA methylation in schizophrenia patients or schizophrenia rat models. The Medline (PubMed), SCOPUS and Web of Science, databases were searched, giving 4077 references in total., Screening and Annotation: Studies will undergo two phases of screening, title and abstract screening and article screening, for inclusion by two reviewers. A third reviewer will resolve any disagreements in the article screening phase. Data will be collected using the Systematic Review Facility (http://syrf.org.uk/) tool. All included studies will undergo study quality and risk of bias assessment., Data Management and Reporting: Data will be extracted and used to calculate effect sizes. For the purpose of this meta-analysis, a random effects model will be used to combine effect sizes. Heterogeneity will be assessed, and the sources identified. A risk-of-bias assessment will be carried out to assess the quality of the studies. An assessment of publication bias will also be carried out., Ethics and Dissemination: No ethical approval is required as there are no participants in the study. We will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines and disseminate the findings through publication and conference presentation., Prospero Registration Number: CRD42021283159., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Background: Depression and suicidal behavior are the main causes of disability and morbidity, especially in adolescents living with HIV (ALWHIV). Data regarding these are lacking in Botswana, a country with a predominantly youthful population and ranked among the top four in the world most affected by HIV. Therefore, the present study aimed to estimate the prevalence of depression and suicidal behavior and explore their associated factors in Botswana ALWHIV., Methods: Responses were obtained from 622 ALWHIV using the DSM-5 and the Mini-International Neuropsychiatric Interview for Children and Adolescents., Results: The mean age (SD) of the participants was 17.7 (1.60) years and more males (54.3%) participated than females. Depression and suicidal behavior rates among adolescents were 23% and 18.9%, respectively. Female participants were more likely to be depressed (AOR = 1.96; 95% CI 1.11-3.45) and have suicidal behaviour (AOR = 6.60; 95% CI 3.19-13.7). Loss of mother (AOR = 2.87; 95% CI 1.08-7.62) and viral load of 400 copies and above (AOR = 5.01; 95% CI 2.86-8.78) were associated with depression. Alcohol use disorder (AOR = 3.82; 95% CI 1.83-7.96) and negative feelings about status (AOR = 8.79; 95% CI 4.62-16.7) were associated with suicidal behavior. Good support (AOR = 0.42; 95% CI 0.23-0.76) and increased frequency of religious activities were protective (AOR = 0.33; 95% CI 0.14-0.79) against depression and suicidal behaviour, respectively., Conclusion: Therefore, routine psychologic screening, which includes identifying psychological stressors and maladaptive coping, family and caregiver support services, and psychosocial support platforms, should be integrated into the management package for ALWHIV in Botswana., (© 2022. The Author(s).)

Research indicates that most people with Schizophrenia from low to middle-income countries do not receive adequate healthcare. Inadequate policies, lack of funding, poor service planning and neglect are some barriers to adequate care. Intrinsic barriers to care include stigma, lack of insight, and pathways to care that are often driven by cultural beliefs, and many systemic challenges. South Africa was not spared from the scourge of COVID-19, hosting a third of all reported cases in Africa. In a country with disparities, it would be of interest to get insight into the situation concerning the healthcare needs of people with Schizophrenia during the pandemic. A pandemic such as COVID-19 placed enormous strains on already limited and unequally distributed health care resources. In this paper, we discuss: (1) The South African healthcare system (with respect to Schizophrenia care). (2) COVID-19 policies related to the care of people with Schizophrenia (testing, access to vaccine). (3) Managing people with Schizophrenia amid the COVID-19 pandemic. (4) Recommendations., (© The Author(s) 2022. Published by Oxford University Press on behalf of the University of Maryland's school of medicine, Maryland Psychiatric Research Center.)

Background: Despite the high proportion of adolescents living with mental health issues in low- to middle-income countries (LMICs), especially in Botswana, there is a significant deficit of local research to guide an increase in prevention and treatment. We, therefore, aimed to assess the prevalence and associated risk factors of psychiatric disorders (PD) in a sample of secondary school students in Botswana., Methods: This cross-sectional study included 750 students from the 13 public secondary schools in Gaborone using a multi-stage sampling technique. The Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) was used to screen for PDs., Results: The participant's mean age was 15.26 and SD 1.57 years, with 53.6% being female. Approximately 34% had a PD, with depression being the commonest, of whom 35% were neither receiving treatment nor aware of the available services. Perinatal complications (AOR = 4.29; 95%CI: 1.04-17.70), a family history of mental illness (AOR = 2.19; 95%CI: 1.17-4.11) and substance-related problems (AOR = 1.80; 95% CI:1.22-2.65) predicted the likelihood of developing PD., Conclusions: Our findings revealed that adolescents in Botswana have many mental health issues which may affect their developmental phases. A multi-sectoral collaboration is needed for the timely detection of identified risk factors and initiation of the necessary prevention and treatment measures., (© 2022. The Author(s).)

Background: Recent studies suggest a two-factor structure for negative symptoms as assessed by the Positive and Negative Syndrome Scale (PANSS) in schizophrenia, namely experiential and expressive subdomains. Little is known about their clinical correlates and treatment trajectories., Objectives: We sought to replicate the two factor-analysis derived subdomains for PANSS negative symptoms in schizophrenia and to assess their independent demographic, premorbid and treatment-related characteristics., Methods: This was a longitudinal study of 106 minimally treated participants with a first episode of a schizophrenia spectrum disorder who received treatment with flupenthixol decanoate 2-weekly injections over two years. Factor analysis was used to characterize the PANSS negative symptom subdomains and linear mixed-effect models for continuous repeated measures were constructed to assess the temporal relations between the negative symptom subdomains and premorbid and treatment related variables., Results: Factor analysis confirmed a two-factor solution for experiential and expressive subdomains of negative symptoms, although they were strongly correlated. The treatment response trajectories for the two subdomains did not differ significantly, and neither subdomain was significantly associated with our premorbid variables. We found significant main effects for disorganised symptoms and extrapyramidal symptoms on the expressive subdomain, and for disorganised symptoms and depressive symptoms on the experiential subdomain. Post-hoc testing indicated that reductions in HDL-cholesterol levels were associated with less improvement in both expressive and experiential subdomain scores., Conclusion: The two negative symptom subdomains are closely related, have similar premorbid correlates and respond similarly to antipsychotic treatment. Depression affects the experiential subdomain, whereas extrapyramidal symptoms affect the expressive subdomain., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: It has been proposed that sex and gender differences described in schizophrenia can be explained from a neurodevelopmental perspective., Aim: In this study, we examined the associations of biological sex and gender role endorsement with putative indicators of neurodevelopmental compromise., Methods: We used the Bem Sex Role Inventory to calculate masculinity scores in 77 patients with a first episode of a schizophrenia spectrum disorder, and selected the following indicators of neurodevelopmental compromise: family history of schizophrenia, obstetric complications, premorbid functioning, neurological soft signs, and cognitive function. Secondary objectives included the moderating effects of age of onset of illness, substance use and negative symptoms on these associations., Results: There were no significant sex differences across any of the indicators of neurodevelopmental compromise. However, lower masculinity scores correlated significantly with poorer premorbid adjustment, sensory integration deficits and worse overall cognitive performance. Stepwise linear regression identified poorer premorbid adjustment in early adolescence and lower verbal learning scores as independent predictors of lower masculinity scores. In contrast to sex, gender showed several associations with indicators of neurodevelopmental compromise., Conclusions: Lower masculinity scores may represent part of a phenotype for a neurodevelopmental anomaly that places some individuals on a pathway to schizophrenia., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Introduction: Untreated post-traumatic stress disorder (PTSD) results in considerable morbidity and higher risk of mortality. However, little is being done to treat PTSD in sub-Saharan Africa (SSA) settings where rates of PTSD are likely to be elevated due to mass exposure of the population to traumatic events. This systematic review aims to summarise available evidence on the efficacy of psychological therapies for PTSD in SSA., Methods and Analysis: A systematic search of the literature will be conducted in four electronic databases: PubMed, PsychInfo, EMBASE and Cochrane Register of Controlled Trials using keywords and synonyms related to 'PTSD', 'psychological therapies' and 'SSA'. Studies will be included if they were conducted in SSA and used a randomised controlled trial design. Two researchers will screen the studies for eligibility to be included, and data on intervention types, population, comorbidities, comparison group intervention and PTSD outcomes will be extracted from those included. Risk of bias will be assessed using Cochrane risk-of-bias tool for randomised trials (version 2). Narrative synthesis of data will be conducted and pooled effect estimates calculated., Ethics and Dissemination: Ethical approval is not required as this is a protocol of a systematic review of available data. Findings will be disseminated to the scientific community through peer-reviewed publications and presentation at conferences., Prospero Registration: CRD42020181638., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Pesticides are a commonly used agent for suicide in many Low- and Middle-Income countries (LMICs). However, accumulating evidence suggests that exposure to organophosphate (OP) pesticide may also increase the risk of suicide. We conducted a hospital-based case-control study to investigate whether prior household, garden or occupational OP exposure were associated with attempted suicide using conditional logistic regression modeling. Participants who attempted suicide with any means and were admitted to two Western Cape Province hospitals in South Africa were compared to a sample of controls matched by age, sex and time of admission with unrelated conditions, between August 2015 and August 2017. The means of attempted suicide was not recorded. OP exposure was determined by dialkyl phosphate (DAP) metabolites detected in hair and by environmental and occupational history. Approximately 85% of participants reported using pesticides in the home or garden and 15% of participants reported current or past occupational exposure while working on a farm. Attempted suicide was not associated with reported home or garden OP use (Odds ratio [OR] = 0.59, 95%CI 0.33-1.04), hair DAP metabolites (OR = 1.00, 95%CI 0.98-1.02) or current or past agricultural work (OR = 1.08, 95%CI 0.62-1.87), but was associated with hazardous drinking and unemployment with no household income. We found no evidence that attempted suicide was associated with environmental or occupational pesticide use in an urban South African population attending an emergency center.

Background: There is a need to retain medical doctors in rural areas to ensure equitable access to healthcare for rural communities. Burnout, depression and anxiety may contribute to difficulty in retaining doctors. Some studies have found high rates of these conditions in medical doctors in general, but there is little research available on their prevalence among those working in the rural areas of South Africa (SA)., Objectives: To determine the prevalence of burnout, depression and anxiety in doctors working in rural district hospitals in northern KwaZulu-Natal (KZN) Province, SA, and to explore the associated sociodemographic and rural work-related factors., Methods: We performed a quantitative descriptive cross-sectional study in three districts in northern KZN among medical doctors working at 15 rural district hospitals during August and September 2020. The prevalences of burnout, depression and anxiety were measured using the Maslach Burnout Inventory, the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder 7-item questionnaire, respectively. The sociodemographic and rural occupational profiles were assessed using a questionnaire designed by the authors. Descriptive statistics were used to analyse the data., Results: Of 96 doctors who participated in the study, 47.3% (n=44) were aged between 24 and 29 years and 70.8% (n=68) had worked in a rural setting for &lt;5 years. Of the participants, 68.5% (n=61) were considered to have burnout. The screening tests for depression and anxiety were positive for 35.6% (n=31) and 23.3% (n=20) of participants, respectively. Burnout alone was significantly associated with female gender (84.8%; n=39) (χ2=11.65, df=1, p=0.01). Burnout (χ2=8.14, df=3, p=0.04) and anxiety (χ2=12.96, df=3, p&lt;0.01) were both significantly associated with occupational rank, with 85.2% (n=23) of community service medical officers (CSMOs) reporting the former and 29.6% (n=8) screening positive for generalised anxiety disorder. Burnout (χ2=7.61, df=1, p=0.01), depression (χ2=5.49, df=1, p=0.02) and anxiety (χ2=4.08, df=1, p=0.04) were all shown to be significantly associated with doctors planning to leave the public sector in the next 2 years., Conclusions: Our study found high rates of burnout, depression and anxiety in rural doctors in northern KZN, all of which were associated with the intention to leave the public sector in the next 2 years. Of particular concern was that CSMOs as a group had high burnout and anxiety rates and female gender was associated with burnout. We recommend that evidence-based solutions are urgently implemented to prevent burnout and retain rural doctors.

Objective: The authors investigated South African psychiatry residents' satisfaction with their training, physical, and mental health to inform the development of a strategy to improve the quality and experiences of training., Method: A cross-sectional online survey was undertaken to assess the factors affecting residents' satisfaction with their current training program. The authors conducted a comparative analysis of residents across the training institutions in South Africa., Results: Of 179 psychiatry residents in the country, 70 responses were received (39.1% response rate). Most were satisfied with the overall quality of their training, various aspects of training, and access to training resources. However, significant differences across universities were identified with regard to residents' perception of the quality of their training, quality of their experiences, access to training resources, quality of supervision, and clinical workload. More than a quarter were dissatisfied with their mental and/or physical health. The top four factors contributing to stress were all training-related., Conclusion: While most residents were satisfied with their specialist training, institutional differences in access to training and training resources, quality of training, and availability of quality supervision were evident and need to be addressed to ensure equitable training. There is a need to actively address staff shortages not only for clinical cover during protected academic time but also to meet training needs. A centralized examination process should remain in place to ensure that there is a national standard. Workplace-based assessments could facilitate standardization across institutions, should these assessments be standardized and accompanied by rigorous training of supervisors., (© 2021. Academic Psychiatry.)

Schizophrenia is a neuropsychiatric disorder characterized by dissociation of thoughts, idea, identity, and emotions. It has no central pathophysiological mechanism and precise diagnostic markers. Despite its high heritability, there are also environmental factors implicated in the development of schizophrenia. Epigenetic factors are thought to mediate the effects of environmental factors in the development of the disorder. Epigenetic modifications like DNA methylation are a risk factor for schizophrenia. Targeted gene approach studies attempted to find candidate gene methylation, but the results are contradictory. Genome-wide methylation studies are insufficient in literature and the available data do not cover different populations like the African populations. The current genome-wide studies have limitations related to the sample and methods used. Studies are required to control for these limitations. Integration of DNA methylation, gene expression, and their effects are important in the understanding of the development of schizophrenia and search for biomarkers. There are currently no precise and functional biomarkers for the disorder. Several epigenetic markers have been reported to be common in functional and peripheral tissue. This makes the peripheral tissue epigenetic changes a surrogate of functional tissue, suggesting common epigenetic alteration can be used as biomarkers of schizophrenia in peripheral tissue.

Background: Research consistently reports elevated rates of exposure to traumatic events and post-traumatic stress disorder (PTSD) in people with severe mental illness (SMI). PTSD may be adequately managed with psychotherapy; however, there is a gap when it comes to management in culturally diverse settings like Botswana. This paper describes a study protocol whose aim is to culturally adapt the BREATHE intervention, a brief psychological intervention for people living with comorbid PTSD and SMI that was developed and tested in the USA; assess the feasibility and acceptability of the adapted BREATHE intervention and explore its efficacy., Methods: The study will be conducted in three phases using a mixed methods approach. The first phase will identify and describe the most common traumatic experiences and responses to traumatic experiences, amongst patients with SMI, and patients' and mental health care providers' perceptions about suitable PTSD interventions for Botswana. The second phase will entail cultural adaption of the intervention using findings from phase 1, and the third phase will be a pilot trial to assess the feasibility and acceptability of the culturally adapted intervention and explore its efficacy. Quantitative and qualitative data will be analysed using basic descriptive statistics and thematic analysis, respectively., Discussion: Literature highlights cultural variations in the expression and management of mental illness suggesting the need for culturally adapted interventions. The findings of this feasibility study will be used to inform the design of a larger trial to assess the efficacy of an adapted brief intervention for PTSD in patients with SMI in Botswana., Trial Registration: Clinicaltrials.gov registration: NCT04426448 . Date of registration: June 7, 2020., (© 2021. The Author(s).)

Abstract: A systematic review and meta-analysis was conducted to synthesize data on HIV prevalence in individuals with first-episode psychosis (FEP) and to provide an overview of the association of HIV with clinical variables of FEP. Electronic databases were searched for quantitative studies published from January 1986 to November 2019. Meta-analyses were undertaken to calculate the pooled HIV/FEP proportion based on random effects modeling with inverse variance method. Seven HIV/FEP studies from sub-Sahara Africa (SSA) met inclusion criteria. The prevalence of HIV in FEP ranged from 24% to 40%, and FEP in people living with HIV (PLWHIV) ranged from 17% to 29%. The pooled proportion of HIV in FEP was 26% (95% confidence interval [CI], 10%-43%), with significant heterogeneity (n = 3, I2 = 89%, p < 0.01), and of FEP in PLWHIV was 23% (95% CI, 15%-32%), without significant heterogeneity (n = 3, I2 = 0%, p = 0.43). There are concerning levels of HIV and FEP comorbidity in SSA, necessitating an integrated health care service., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Some suspected criminal offenders in South Africa are required to undergo forensic psychiatry assessments before or during the trial, which can be delayed as a result of the shortage of psychiatrists and inpatient forensic psychiatry beds. In KwaZulu-Natal (KZN) province, only one hospital (Fort Napier Hospital [FNH]) is designated for the 30-day inpatient forensic psychiatry assessments and there is a long waiting list for suspected criminal offenders awaiting assessment. There is a need to find ways of alleviating the backlog in the waiting list, with the use of outpatient forensic assessments being a possible adjunctive method., Aim: To determine the demographic, clinical and forensic profile of suspected criminal offenders referred for outpatient preliminary assessment to Ngwelezana Hospital, and identify the profile of those who most likely require referral to FNH for a 30-day inpatient assessment., Setting: The study was conducted at Ngwelezana Tertiary Hospital, in KZN, South Africa., Methods: We conducted a retrospective chart review of 207 suspected criminal offenders referred for outpatient forensic assessment from January 2009 to June 2015., Results: The majority of the participants were males (94.2%), with a diagnosis of substance use disorder (28.2%), intellectual disability (23.4%) or psychotic disorders (21.8%). Forty three per cent were charged with sexual crimes and 10.7% with murder. Fifty seven per cent were recommended for referral to FNH for a 30-day inpatient forensic assessment, whilst 43% were not recommended for referral. Those recommended for inpatient assessment were significantly more likely to have a lower level of education ( p = 0.02), to be on a disability grant ( p < 0.01), and to have been diagnosed with intellectual disability ( p < 0.01), than those not recommended for referral., Conclusion: Identifying the characteristics of suspected criminal offenders who are most likely to be recommended for referral to FNH will potentially reduce the number of unnecessary referrals., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2021. The Authors.)

It is understandable that the challenges of living through a severe contagious outbreak, like the coronavirus disease 2019 (COVID-19), cannot be tolerated for long and that some individuals may require emotional, psychological, and spiritual support in order to strengthen their resilience to navigate this difficult period. As clinicians and researchers in the field of mental health, we need to appreciate the roles that culture, spirituality, and religion play in comforting people who survive such an outbreak and provide possible solutions for public health authorities on how to promote wellness. This appreciation should direct us to seek a deeper understanding of how culture, spirituality, and religion can be used to endure an outbreak of this magnitude and how the interruption of common practices can impact the coping skills of those who are affected. Our understanding of the roles that customs, beliefs, and values of South Africans play in building resilience will help inform and strengthen interventions that are aimed at controlling the spread of COVID-19., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Mashaphu, Talatala, Seape, Eriksson and Chiliza.)

In sub-Saharan Africa (SSA), a systematic approach to exploring the prevalence of psychiatric disorders (PDs) and adherence to antiretroviral treatment (ART) in adolescents living with HIV (ALWHIV) is lacking. This study aimed to systematically review the studies conducted in SSA on the prevalence of PDs among ALWHIV and their association with ART adherence. A systematic search of all English studies assessing PDs among ALWHIV using the Web of Science, PubMed, and EBSCO databases was conducted between March 1 and September 30, 2019. Forty-two studies published between 2009 to 2019 met the inclusion criteria, of which 15 were included in the meta-analysis. The most common PDs were depression (0.24, 95% CI 0.14-0.36) and anxiety disorder (0.26, 95% CI 2-0.44). The available evidence could not conclude on the definitive association between PDs and ART adherence; therefore, further research is required. However, the need for mental health integration in the care for ALWHIV is evident.

Competing Interests: The authors declare that they have no competing interests.

Introduction: South Africa (SA) has a high HIV prevalence and limited mental healthcare resources. Neuropsychiatric complications such as psychosis onset in people living with HIV (PLWHIV) remains poorly understood. The study aims to compare the socio-demographic, clinical, substance use, cognitive and trauma profile of PLWHIV presenting with first episode psychosis (FEP) to those with the condition but without HIV., Methods and Analysis: This study will compare presentation, course, and outcome of a cohort of PLWHIV and FEP with a control group recruited over a 3-year period. We will prospectively test the hypothesis that the 2 groups are socio-demographically, clinically and cognitively distinct at illness presentation, with higher trauma burden and poorer outcomes in those with the dual burden of HIV and FEP. FEP participants, confirmed by a structured neuropsychiatric interview, will have their socio-demographic, psychosis, mood, motor, trauma and substance use variables assessed. A neuropsychological battery will be completed to assess cognition, while quality of life, psychotic symptoms and HIV markers will be measured at 3, 6 and 12 months., Ethics and Dissemination: The study protocol has been reviewed and ethics approval obtained from the Biomedical Research Ethics Committee (BC 571/18) of the University of KwaZulu-Natal. The results from this investigation will be actively disseminated through peer-reviewed journal publications and conference presentations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

Sex (a biological distinction) and gender (a social construct) are inter-related, but semi-independent measures. The aim of our research was to compare gender role endorsement between first-episode schizophrenia spectrum disorder patients (n=77) and matched controls (n=64). The Bem Sex Role Inventory (BSRI) was used to assess masculinity and femininity scores as separate linear measures. This well-known research instrument also allowed us to examine gender as a categorical measure based on sex-specific cut-off scores calculated for controls as our normative reference sample using a median-split technique. First, we found that both masculinity and femininity scores differed between patients and controls. The distribution of gender as a categorical measure also differed between the two groups. Post-hoc testing with correction for multiple comparisons identified masculinity scores in particular as being lower in both male and female patients compared to controls of the corresponding sex. In conclusion, lower masculinity scores reported for chronic schizophrenia also affects first-episode patients with minimal prior treatment exposure irrespective of their biological sex. Future studies would do well to examine the associations of sex and gender with clinical and treatment outcomes from the perspective of the neurodevelopmental model of schizophrenia as a proposed "disorder of the self"., (Copyright © 2021 Elsevier B.V. All rights reserved.)