Search

Abstract Background A number of recently published randomized controlled trials conducted in developed countries have reported no advantage for assertive interventions over standard care models. One possible explanation could be that so-called "standard care" has become more comprehensive in recent years, incorporating some of the salient aspects of assertive models in its modus operandi. Our study represents the first randomised controlled trial assessing the effect of a modified assertive treatment service on readmission rates and other measures of outcome in a developing country. Methods High frequency service users were randomized into an intervention (n = 34) and a control (n = 26) group. The control group received standard community care and the active group an assertive intervention based on a modified version of the international model of assertive community treatment. Study visits were conducted at baseline and 12 months with demographic and illness information collected at visit 1 and readmission rates documented at study end. Symptomatology and functioning were measured at both visits using the PANSS, CDSS, ESRS, WHO-QOL and SOFAS. Results At 12 month follow-up subjects receiving the assertive intervention had significantly lower total PANSS (p = 0.02) as well as positive (p < 0.01) and general psychopathology (p = 0.01) subscales' scores. The mean SOFAS score was also significantly higher (p = 0.02) and the mean number of psychiatric admissions significantly lower (p < 0.01) in the intervention group. Conclusions Our results indicate that assertive interventions in a developing setting where standard community mental services are often under resourced can produce significant outcomes. Furthermore, these interventions need not be as expensive and comprehensive as international, first-world models in order to reduce inpatient days, improve psychopathology and overall levels of functioning in patients with severe mental illness.

Abstract Background Severe pressures on beds in psychiatric services have led to the implementation of an early ("crisis") discharge policy in the Western Cape, South Africa. The study examined the effect of this policy and length of hospital stay (LOS) on readmission rates in one psychiatric hospital in South Africa. Methods Discharge summaries of adult male patients (n = 438) admitted to Stikland Psychiatric Hospital during 2004 were retrospectively examined. Each patient's clinical course was then analysed for the period between January 1st, 2004, and August 31st, 2006. Results Although shorter LOS was associated with decreased readmission rates, the effect of crisis discharges was far more powerful. Patients discharged as usual had a far lower risk of readmission than those discharged due to bed pressures (i.e. crisis discharge). Conclusion Increased risks associated with the early discharge policy necessitate the urgent review of the current management of bed shortages in this inpatient facility. The strengthening of community initiatives, particularly assertive outreach could be a way forward.

Abstract Background Demonstrating an association between physical malformation and schizophrenia could be considered supportive of a neurodevelopmental origin of schizophrenia and may offer insights into a critical period for the development of this illness. The aim of our study was to investigate whether differences in the presence of minor physical anomalies could be demonstrated between schizophrenia sufferers and normal controls in a Xhosa population with a view to identifying a means of subtyping schizophrenia for use in future genetic studies. Methods Sixty-three subjects with schizophrenia (21 sibling pairs, 1 sibship of four and a group of probands with an affected non-participating sibling (n = 17)), 81 normal controls (37 singletons and 22 sibling pairs) of Xhosa ethnicity were recruited. Each participant was then examined for minor physical anomalies using the Modified Waldrop scale. The relationship between each of the morphological features and the presence of an affected sib was examined using the Chi-squared test, followed by an intra-pair concordance analysis in the sibling pairs. Results Gap between first and second toes was significantly more common in the affected sib pair group when compared to the non-affected sib pair group (p = 0.019) and non-affected singleton control group (p = 0.013). Concordance analysis also revealed increased concordance for this item in the affected sib pair group. Conclusion These findings offer an intriguing possibility that in the Xhosa population, affected sib pair status may be linked to a neurodevelopmental insult during a specific period of the fetal developmental.

Background: Psychiatric nurses constitute a fundamental part of the mental health care system in South Africa. However, high levels of burnout and job dissatisfaction among nursing staff have been associated with reduced empathy and quality of care, and poor service delivery. Stikland Psychiatric Hospital is a state psychiatric hospital situated in Belville and provides all levels of psychiatric care to a large part of the Cape metro region. To our knowledge, no previous studies have examined burnout and job satisfaction among nurses in this setting. Aim: We assessed the relationship between burnout and job satisfaction among the nursing staff. Setting: The study was conducted at Stikland Psychiatric Hospital, Cape Town, South Africa. Methods: This cross-sectional study used the Copenhagen Burnout Inventory and an established job satisfaction questionnaire to assess burnout and job satisfaction among 127 staff members associated with psychiatric nursing. Results: In this population comprising mostly female (83.5%) nurses, scores for personal, work-related and client-related burnout were relatively high, but job satisfaction was also high. Higher levels of burnout were significantly associated (Pearson's linear correlation, r = -0.077, p < 0.01) with lower levels of job satisfaction. There were no significant associations between burnout or job satisfaction and gender, rank or years of experience. Conclusions: If mental health service delivery is to be optimised, supportive or preventative processes should be implemented to reduce the prevalence of burnout in psychiatric nurses. This study adds to the scarce local knowledge and provides information that can be used to inform the development of supportive strategies for psychiatric nursing staff in South Africa. [ABSTRACT FROM AUTHOR]