South African Psychiatry - February 2022

REPORT

A REPORT OF
SELECTED
SESSIONS

Lisa Selwood

T he second South African Multidisciplinary outcomes, as was shown in a
Congress took place from 1st – 4th September Danish prospective cohort study
2021. The program was varied and included with a 32 year follow up.
sessions on psychiatric co-morbidities, medical
co-morbidities, technology, practical approaches to ADULTS WITH ADHD HAD
the use of medication and a lively ethical debate DOUBLE THE RISK OF
on the scheduling of methylphenidate. Owing to the MORTALITY AND WERE
virtual nature of the congress, it was possible to host THREE TIMES MORE LIKELY TO
many world class international speakers, in addition DEVELOP MDD THAN THEIR
to the local speakers. NON-ADHD COUNTERPARTS.

Below are brief summaries of selected sessions Lisa Selwood
attended:
Symptoms may overlap between ADHD and
PSYCHIATRIC CO-MORBIDITY IN ADHD comorbidities – restlessness, agitation or difficulty
(EXCLUDING SUBSTANCE ABUSE) concentrating may be indicative of ADHD, but
Dr Larry Klassen may also be symptoms of MDD. Some patients
with psychiatric illnesses may have untreated
When diagnosing ADHD, clinicians should remember ADHD and have developed compensatory skills
that co-morbidities are the rule and not the which may delay or prevent diagnosis. Untreated
exception. Psychiatric co-morbidities can complicate ADHD is also associated with poor treatment
identification and diagnosis and adversely affect response, noncompliance and a perceived lack of
improvement in symptoms

ADHD and Depression ADHD and BMD ADHD and Anxiety

Shared Irritability Restlessness Inattention and fidgeting
features Difficulty completing tasks Poor Distractibility Insomnia
concentration and memory Fidgeting
Talkativeness

Differences Depression is associated with BMD has a depressive phase, and ADHD may have insomnia as
an enduring depressive affect, episodic course of symptoms. thoughts can’t be turned off.There
changes in appetite and sleep Symptoms are not episodic with may be insomnia in anxiety –
and suicidality, which is not ADHD. related to rumination due to worry
usually present in ADHD.
BMD – decreased need for sleep vs Physical symptoms in ADHD are
insomnia in ADHD independent of emotional state

Treatment Most impairing disorder first. Treat BMD first, with mood stabilizers Stabilize most severe condition first
ADHD medications are and antipsychotics
acceptable in MDD patients Stabilize before adding ADHD
medication

SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022 * 51

REPORT

In addition to pharmacological treatment, should be started first, or a long acting stimulant
psychological options are also indicated, and with caution after considering all the risks and
cardiovascular exercise should be encouraged. benefits, including the risk of misuse. Bupropion,
MANAGEMENT OF ADHD IN PATIENTS WITH venlafaxine and clonidine may be other options.
COMORBID SUBSTANCE USE DISORDER (SUD) In conclusion:
Dr Lize Weich • Diagnose and treat ADHD as early as possible
SUDs are complex disorders with multifactorial • Suspect ADHD in the SUD population and vice
aetiology, that often first present in adolescents.
A typical pattern follows, which may be mild, versa
moderate or severe: • Always screen for other co-morbidities
Experimenting  occasional controlled use, • Maintain a good therapeutic alliance
recreational use  Harmful use, misuse, abuse  • Above all remember: SKILLS RATHER THAN PILLS!
Addiction, dependence
The risk of developing a SUD is higher in patients with ADHD IN THE GERIATRIC POPULATION
ADHD because both disorders are hereditary. There Dr L Thela
is a shared genetic risk, amongst multiple genes,
and the gene-environment interaction may also Does ADHD persist into the geriatric age? ADHD has
play a role. Also, both disorders share neurobiology a 6-9% prevalence rate in children and adolescents
in terms of the same circuits involved with reward, and a third will not outgrow the symptoms,
cognition and behaviour. particularly the inattentive component. 5% of adults
Clinicians must be careful not to underestimate have ADHD.
the lived experiences of those with ADHD. These
patients experience increased levels of stress and ADHD has a 75% heritability, is polygenic, and the
emotions, struggle to cope with the demands gene environment interaction plays a significant
placed on them as adults, have a higher tendency role in the aetiology. There are also epigenetic
towards job losses and unemployment and this may factors to consider, such as perinatal experience,
lead to substance use. Unfortunately, when the two exposure to environmental toxins and psychosocial
conditions co-occur, medications tend to be less adversity.
effective, and quality of life remains decreased.
Red flags to look out for – a positive family history
THE AGE-OLD CONTROVERSY OF ‘DO of ADHD, a history of poor performance at school,
STIMULANTS CAUSE SUD?’ STILL EXISTS, drug abuse, relationship problems, forgetfulness,
DESPITE RESEARCH SHOWING THAT frequent trouble with the law, unable to keep a job
USING STIMULANTS AT A YOUNG AGE and those patients who may have a depression or
AND FOR LONG ENOUGH MAY ACTUALLY anxiety diagnosis that is continually unresponsive
BE PROTECTIVE AGAINST DEVELOPING A to treatment.
SUD.
It is also important in this population to distinguish
Typically, patients will present for help with SUD, between ADHD and Mild Cognitive Impairment
and not ADHD, therefore it is important to screen (MCI). A retrospective report on onset and duration
all patients, and to have a high index of suspicion will show that the onset of behavioural symptoms
for co-morbid ADHD in a SUD population and is earlier in ADHD. In terms of symptoms, MCI
vice versa. The goal of treatment is to improve the symptoms will worse whereas ADHD patients usually
patient’s ability to cope with both disorders and to report a static course of symptoms. Imaging may
live a wholesome life. be of some use as dementia brains may change
Treatment options include psychoeducation, over time
motivational enhancement therapy, peer support
and potentially pharmacotherapy. CBT works well Stimulants, including methylphenidate, OROS
for both disorders in terms of modifying problematic methylphenidate and mixed amphetamine salts,
thoughts and behaviours. It is important to note that are first line treatment. However, stimulants have
the SUD needs to be stabilized first and may require been associated with CV events, and mixed
brief residential treatment. Emphasis should be amphetamine salts have shown a clinically small
placed on a healthy lifestyle, encompassing nutrition, difference in diastolic blood pressure.
sleep, exercise, a structured day, mindfulness
exercises, coaching and parenting advice. ATOMOXETINE IS GIVEN ONLY ONCE
When adding pharmacotherapy, the guidelines A DAY, BUT MAY BE ASSOCIATED WITH
vary as to the best approach. A non-stimulant LIVER TOXICITY.

52 * SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022 Alternatives include bupropion, modafinil, clonidine,
guanfacine and nortriptiline. Psychotherapies and
behavioural therapies include CBT, mindfulness,
cognitive remediation and DBT.

When ADHD occurs with another co-morbidity the
following medications are preferential:

REPORT

• ADHD and severe anxiety: Atomoxetine In terms of safety, there is no need for a dosage
• ADHD and a SUD: Atomoxetine or bupropion reduction for patients in renal failure. In hepatic
• ADHD and depression: Bupropion or combine deficiency start with a lower dose and don’t go
high, and in cardiac disease be aware of possible
SSRI/SNRI with a stimulant arrythmias.
ADHD AND PALLIATIVE CARE
Dr Michelle King ADHD AND EPILEPSY
Prof Renata Schoeman
Experience with Covid-19 has taught us now more
than ever that psychiatrists should be involved in ADHD EPILEPSY
palliative care. Psychiatrists have the sensitivity, the
training and the knowledge of pharmacology. In children: 2-16% In children: 3.2-5.5/1000
Of these, 1.2 – 14% have Of these, 20 – 40% have ADHD
CURRENTLY THERE IS VERY LITTLE epilepsy
RESEARCH LOOKING AT THE LINK
BETWEEN ADHD AND PALLIATIVE CARE. In adults: 2.5 – 4.3% In adults: 4-10/1000
FATIGUE, WEAKNESS AND A LACK OF Of these, 15-20% have ADHD
ENERGY ARE THE THREE MOST REPORTED
SYMPTOMS IN PALLIATIVE CARE PATIENTS Increased risk of 3.94 to Increased risk of 2.54 to
AND CAN BE DISTRESSING AND develop epilepsy develop ADHD
DISABLING.
Epileptiform EEG Significant ADHD symptoms in
Causes can include the illness itself, side effects abnormalities more common up to 82% of children before
from treatment, poor sleep and low calorie intake. in children with ADHD without onset of first seizure.
Fatigue affects quality of life from all perspectives clinical seizures than controls
– physical, psychological, social and spiritual.
Medications traditionally used to treat ADHD may Genetic predisposition: The underlying brain
be valuable for these patients. pathologyindicatesthatbothconditionsare network
disorders, are associated with abnormal excitatory
Opioid induced fatigue: Good pain control is of glutaminergic function and monoaminergic
the utmost importance when it comes to treating dysfunction and both are associated with structural
patients with opioid induced fatigue, and the lesions.
response to methylphenidate (MPH) ranges from 80
– 88%. Improvements in drowsiness, confusion and Psychosocial: Attentional impairment is secondary
cognitive functioning have been observed, and to several factors in epilepsy:
one study showed an improvement in both daytime • Brain pathology
sedation and in night time sleeping. • Seizures themselves
• Seizure localisation
Depression: The prevalence of depression in • Certain seizure types
palliative care cancer patients is between 15 – • Interictal EEG phenomena which often results in
47%. The challenge arises as antidepressants take
weeks before an effect may be seen, and this disrupted attention
could be time the patient doesn’t have. MPH is • Certain anti-epileptic drugs (AEDs)
effective in improving depressive symptoms as well
as cognition. An improvement in mood could also Effects of AEDs on ADHD
lead to an improved appetite. A response usually
occurs within 2 days. AEDs with negative effects on Phenobarbital
behaviour Valproic acid
Cognitive dysfunction: This may occur in many Topiramate (neutral or
palliative care patients including those with cancer, negative)
paediatric patients, patients living with HIV and
patients with Multiple Sclerosis (MS). MPH has been AEDs with positive effects on Carbamazepine
shown to improve cognitive dysfunction in all these behaviour Lamotrigine
groups.
AEDs with neutral, uncertain Oxcarbazepine
Delirium: More than 80% of cancer patients will or conflicting evidence on
report delirium in their final days. Delirium is a behaviour
disturbance of consciousness and attention with
a change in cognition or perception, but 50% of Medications for ADHD may also influence seizures.
delirium cases are reversible. The clinician needs to The labelling warns of a lowered seizure threshold
identify the reversible causes and treat them, and
some methods include opioid rotation, hydration or
a change of medication(s).

SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022 * 53

REPORT

in patients with a history of seizures or EEG • Cost effective
abnormalities and to discontinue in the setting of • May decrease stigma in obtaining treatment
seizures. However, this warning is based on case • Useful for observing parent-child interactions in
reports, with no control groups. A more recent study
(2021), examined a Hong Kong database showed a more naturalistic setting
only 69/29,604 (0.2%) developed new onset seizures • Fewer ‘no shows’
after MPH treatment, and all occurred within the • Options for future innovation
first thirty days. A Swedish registry of 995 paediatric • Traditional forms of treatment may be used
patients showed no increase in seizure frequency.
The impact of MPH on an EEG is variable, with 32% online, such as parent management training,
showing increased abnormalities, and 28% showing as telepsychiatry doesn’t influence the
electrographic improvements. effectiveness, there is a high fidelity, it can help
create a good therapeutic alliance and is
MOST STUDIES SUGGEST THAT MPH associated with high parent stisfction
DOESN’T INCREASE SEIZURE RISK IN
CHILD AND ADOLESCENTS WITH ADHD BUT
AND EPILEPSY. • Reimbursement issues
• Confidentiality may be at stake
Children with both disorders have a decreased • More difficult to engage with a younger child
quality of life so it is recommended that there is
careful screening for psychiatric co-morbidities online
in children with epilepsy. Epilepsy is common • Some don’t have access to technology
and one third of patients have ADHD symptoms, • Issues around intellectual property
which are frequently underestimated and hence
undertreated. During the hard lockdown during the COVID-19
pandemic, increased recreational screen time
PROS AND CONS OF TECHNOLOGY IN ADHD was observed, and this has persisted, even when
Dr Brendan Belsham lockdown ended. There lie several risks in that this
may deter from other developmentally important
There has recently been an increase in the use of activities, may lead to sleep disturbances and
digital technology to assess attention, including: may lead to an increase in cyber bullying.
• The MOXO d-CPT, which is a clinician decision There is a bi-directional relationship between
problematic use of the internet (PUI) and ADHD.
support tool for diagnosing attentional PUI is a risk factor for and aggravates ADHD and
difficulties. However, there is uncertain sensitivity ADHD is a risk factor for and aggravates excessive
and specificity. screen use. PUI and ADHD have a shared biology
• In 2013, the FDA approved marketing of the of the dopaminergic system – the brain is biased
Neuropsychiatric Electroencephalogram (EEG)- towards reward dependency and immediate
Based Assessment Aid (NEBA) system — which gratification.
calculates the ratio of the power of EEG theta
and beta bands over the Cz electrode to OTHER PROBLEMS ASSOCIATED
supplement clinical evaluation for ADHD. WITH INCREASED SCREEN TIME ARE
• Games based assessment tools SOCIAL DEFICITS, SOCIAL ISOLATION,
• Head mounted virtual classroom SLEEP DEPRIVATION, OBESITY DUE TO
DECREASED EXERCISE.
However, none of the above is a substitution for a
clinical evaluation. Digital technology has the potential to improve cost
effective management of ADHD in several ways,
There are many areas in which digital technology and may be a useful intervention to established
can be helpful: treatments, but a stronger evidence base is
required. The dangers of problematic media use
Improving adherence via SMS reminders, social must be guarded against.
media interventions or via the use of apps (eg
FOCUS) COMPLEXITIES OF EMOTIONAL DYSREGULATION
IN ADHD
Other issues can also be addressed – smartphones Dr Rene Nassan
can facilitate social support, ensure accurate
tracking of symptoms and assist with improving Emotional Dysregulation (ED) has numerous
organisational skills and time management definitions. It can be described as the
difficulties. decreased capacity to regulate affect and
sustain attention. It has also been described as
Telepsychiatry the inability to modulate emotional responses
• Accessible resulting in extreme responses of an internalizing/
• Overcomes geographical location limitations externalizing nature inappropriate for age or
developmental stage.

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This multi-dimensional process affects 40-50% of PROS AND CONS OF CONTINUOUS
children with ADHD, manifesting in impairments PSYCHOSTIMULANT TREATMENT
relating to anger and irritability, and results in rapid, Dr Chris Schuler
intense and disproportional emotional reactions. It ADHD is the most studied and diagnosed psychiatric
is more prevalent in those who display combined condition in children, with a short-term treatment
features of ADHD. success rate of 68 – 80%. There are concerns that
longer-term studies are lacking. There are two
TEMPERAMENT IS DEFINED AS THREE different medication patterns – the ‘school time
DISPOSITIONAL DIFFERENCES IN ATTENTION, only’ medication pattern and the ‘all the time’
REGULATION AND MOTOR AND medication pattern.
ATTENTIONAL REACTIVITY. IT IS PRESENT
IN INFANCY AND REMAINS STABLE WHAT ARE DRUG HOLIDAYS? DRUG
THROUGH THE LIFESPAN. HOLIDAYS REFER TO A SPECIFIC PERIOD
WHEN A PARTICULAR MEDICATION IS
Temperament is predictive of externalizing and STOPPED FOR A SPECIFIC PURPOSE,
internalizing psychopathology, and comprises of WHICH MAY BE TO PREVENT TOXIC BUILD-
three dimensions – negative affect, surgency and UP OF A MEDICATION (E.G. LITHIUM), TO
effortful control. ENSURE EFFECTIVENESS OCCURS AGAIN
In order to measure and assess temperament, (E.G. L-DOPA) OR TO ALLEVIATE SIDE
the clinician needs to examine physiological EFFECTS ASSOCIATED WITH LONG TERM
aspects, use rating scales, as well as parent and TREATMENT (E.G. ANTIPSYCHOTICS OR
child self-reported measures. Patients with ADHD ADHD MEDICATION).
are significantly poorer in identifying emotional
expressions due to deficits in motivation reward In particular, when referring to ADHD, the following
systems. It is important to tease out if the core deficits may be instances where a drug holiday may be
of ED are related to ADHD vs being a symptom of a considered:
co-morbid disorder. Tolerance refers to a decreased response to the
same dose which occurs with repeated use over
THERE ARE CERTAIN RED FLAGS, FOR time. Larger doses are needed to achieve the
EXAMPLE, ADHD BOYS TEND TO BE LESS same response and there are various reasons for
EMPATHETIC, WITH DECREASED ACCESS this, including (a) a change in pharmacokinetic
TO INTERNAL EMOTIONS. parameters – larger children have less exposure to
the same dose as smaller children; (b) progression
Patients with the combined subtype tend to show of the disorder as the course of the illness may
greater dysregulation and increased aggression, be worsening; (c) new environmental changes,
whereas those with the predominantly inattentive with more demands on attention that may
subtype tend to display a decreased social unmask hidden symptoms and (d) paradoxical
knowledge and social passivity. decompensation, where the medication itself
Impairments in executive functioning worsens the ADHD.
Deficits linked with impairments in executive Growth retardation – two review studies looked
functioning are commonly associated with ADHD, at the effect of stimulant treatment on weight and
and patterns of impairments are varied for different height after one year, and a third study looked at
comorbidities due to specific subtypes, specific the effect on weight and height after three years
disorders and the severity of the disorder. of treatment. These studies showed a low but not
As mentioned before, there is no single definition significant reduction.
for ED, and no gold standard assessment for ED Sleep disturbances may be associated with
occurring in patients with ADHD. The functional ADHD and may lead to significant distress due to
impairment is significant but may not fulfil criteria for problems with mood, attention and behaviour.
a distinct comorbid disorder, therefore measuring In addition, symptoms from sleep problems may
and defining becomes a key priority. mimic ADHD symptoms and result in a misdiagnosis
In terms of treatment: of ADHD. However, sleep difficulties relating to the
Adults: Both MPH and atomoxetine showed medication are usually limited to the first few weeks
improvement in patients with ED associated with of treatment.
ADHD, but not as much as those with core ADHD However, there are opposing cons associated with
symptoms alone. The effect size for MPH was small drug holidays:
to moderate, and for atomoxetine was small. Other • ADHD is not just a disorder of academic life but
interventions may include parenting measures,
games. CBT and mindfulness. affects all aspects of life. The biggest risk factor

SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022 * 55

REPORT

may be the domain of impulsivity as this is concentrations, hence leading to an effect which
present in affect, cognition, sexual activities and lasts 24 hours and facilitating once daily dosing.
life events. This also means there is less stigma attached than
• ADHD may also result in relationship impairment that associated with stimulants.
with rates of divorce and separation higher It doesn’t bind to receptors associated with abuse
in those with ADHD vs those who did not have potential and is not considered addictive. In self-
ADHD. This also extends to the parent-child administration studies it was found to be non-
relationships and the relationships with peers or reinforcing. There were significant improvements
colleagues. in all three subtypes of ADHD, and improvements
• Untreated ADHD may also result in social and in functional outcomes as measured by the Child
occupational impairment – untreated patients Health Questionnaire (CHQ).
with ADHD have a higher risk of tobacco, alcohol The side effects are mainly mild – children and teens
and illicit drug use, as well as increased rates of may experience nausea and vomiting, an upset
criminality. stomach, loss of appetite and dizziness. Adults may
experience constipation, dry mouth, insomnia and
Recommendations if the decision to take a drug dizziness.
holiday is chosen:
ATOMOXETINE IS A SCHEDULE FIVE,
Carefully consider the timing – during school MEANING A SCRIPT MAY BE GIVEN FOR
holidays a drug holiday may be appropriate, SIX MONTHS.
however stressful times such as Christmas and the
beginning of new school years should be avoided It can safely be combined with methylphenidate
in regard to timing. (MPH) for treatment resistance or where there are
side effects associated with MPH. Clinicians should
IT IS THE PARENT’S CHOICE IF THEY WANT note that that it can take 12 weeks to reach full
TO INVOLVE THE SCHOOL WHEN THERE effectiveness.
IS A DRUG HOLIDAY. THE PRACTICAL POSITIONING OF
METHYLPHENIDATE (MPH)
The drug holiday should be at least a week in length, Dr Karen Vukovic
if the behaviour is manageable, and should only
considered after two years of continuous treatment, MPH is a CNS stimulant which is FDA approved
followed by an annual review. Drug holidays are for children, adolescents and adults, and the
independent of age but are generally more advisable therapeutic effect occurs through the blockade
in older children as they can self-assess. Drug holidays of the reuptake of dopamine and norepinephrine.
are most successful in stable cases of ADHD where the There are short, intermediate and longer acting
child has been symptom free for a reasonable period preparations. The shorter acting preparations have
of time; those who are showing signs of remission and a short half-life which may lead to social stigma
those with a supportive environment. and inconveniencing when dosed multiple times
A PRACTICAL APPROACH TO THE TREATMENT throughout the day. In these cases, a longer acting
OF ADHD preparation can be used to enhance compliance.
THE PRACTICAL POSITIONING OF ATOMOXETINE Long acting formulations may avoid having to dose
Dr Frans Korb multiple times throughout the day.

Current pharmacotherapy for ADHD has several MPH HAS DIFFERING TIME ACTION
limitations: PROFILES AND AN INDIVIDUALISED
• Interrupted symptom relief – short duration of APPROACH SHOULD BE USED FOR EACH
PATIENT, BASED ON THEIR NEEDS.
action, rebound effects, side effects leading to
patients taking drug holidays This can be assessed using the Dundee Difficult
• Tolerability in certain patients – insomnia, Times of the Day scale. The individualised approach
appetite suppression, perceived personality can therefore be made using adequate titration for
changes a morning response and to achieve good symptom
• Controlled substance concerns – prescribing control throughout the day.
inconveniencies, diversion and abuse No one MPH is superior to another, but each has its
protentional. own profile, which will be discussed below:
• Ritalin® IR – Unimodal curve, onset of action
Atomoxetine is a molecule which overcomes
many of these limitations. It is a highly selective within 30 – 60 minutes, 2 – 5 hours duration of
norepinephrine reuptake inhibitor, with two action
major metabolites that are rapidly absorbed, not
affected by food and has a half-life of 5 hours. The
therapeutic effects may persist after clearance, as
the brain concentrations may differ from the plasma

56 * SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022

REPORT

• Ritalin® LA – Spheroidal Oral Drug Absorption It can be used for these patients as add on or
System (SODAS) formulation, with bead filled monotherapy, but patients should be monitored for
capsules It is a racemic mixture of IR and ER, serotonin syndrome. It can also be used in patients
which means 50% is released immediately. with Bipolar Mood Disorder and cyclothymia, with
Two strong peaks occur four hours apart, and or without an ADHD diagnosis. A mood stabilizer
duration of effect is 8 – 12 hours. should be initiated first, whilst monitoring for mania
or psychosis. However, Vyvanse® has been shown
• Concerta® (Clone: Neucon®; Generic: to have less of a switch effect than SSRIs.
Mefedinel®) – Osmotic Release Oral System TREATMENT OF ADHD DURING PREGNANCY
(OROS) which is a racemic mixture and typically AND LACTATION
displays a biphasic and bimodal curve, with Dr Lavinia Lumu
22% released in the first hour and 78% over the
rest of the day. It is effective for 10 – 12 hours 3 – 7% of the adult population have ADHD, of which
38% are women. ADHD is associated with significant
• Contramyl® XR – Multi Unit Pellet System (MUPS), co-morbidities. In the previous FDA pregnancy risk
which contains two types of beads, with 21% categories, psychotropics fell into Category C
MPH released immediately and the other 79% which was defined as ‘Animal reproduction studies
over the rest of the day. have shown an adverse effect on the foetus and
there are no adequate and well-controlled studies
• Acerta® – Core release technology with 25% in humans, but potential benefits may warrant use
released immediately and 75% over the rest of of the drug in pregnant women despite potential
the day risks.’ In 2015, this classification system was replaced
with narrative sections and subsections which
• Transdermal patch (not available in SA) – included (a) pregnancy (labour and delivery), (b)
provides continuous delivery over 12 hours lactation (including nursing mothers) and (c) males
and displays a monophasic pattern. The onset and females of reproductive potential.
of action takes two hours and the patch is
associated with decreased abuse potential, CLINICIANS NEED TO TAKE A RISK-RISK
enhanced adherence and less side effects. ANALYSIS APPROACH IN ORDER TO
DETERMINE THE RISK OF UNTREATED ADHD
THE PRACTICAL POSITIONING OF VYVANSE® VS THE RISK OF USING MEDICATION. THE
(LIS-DEXAMFETAMINE) FOCUS SHOULD BE ON INDIVIDUALISED
MANAGEMENT AND CARE. TREATMENT
Dr Suntheren Pillay NEEDS TO BE MANAGED AND OPTIMIZED,
POLYPHARMACY SHOULD BE AVOIDED,
Vyvanse® is indicated as second line treatment THERE SHOULD BE ADEQUATE WEIGHT
for ADHD in South Africa, with five available doses GAIN DURING THE PREGNANCY, AND
worldwide, and three doses available in South THE MULTI-DISCIPLINARY TEAM (MDT) IS
Africa – 30mg, 50mg and 70mg. The inactive ESSENTIAL FOR MANAGEMENT.
prodrug is converted to the active moiety via
hydrolysis. The prodrug technology showed In 2020, a large study by Anderson et al examined
low inter- and intra- subject variability on PK the association of ADHD medication use before and
parameters. The bioavailability is not significantly during pregnancy and the risk of 12 selected birth
affected by food, gastric pH and method of defects. Medication use during early pregnancy
administration. It is the least addictive of all was associated with 3/12 of the selected birth
ADHD stimulant medication and snorting the defects
contents does not produce a pleasurable high. Pharmacokinetic and pharmacodynamic
The maintenance of symptom control lasts the considerations need to be considered. In
entire day and showed significant improvement pregnancy, gastric emptying may be prolonged,
of executive functioning when compared with and the hormonal changes and increased
placebo. but does not have a significant impact plasma volume may make the treatment effects
on sleep. unpredictable.
Medications levels less than 10% in breast milk are
THE SAFETY PROFILE IS CONSISTENT WITH deemed to be safe. Breast milk is more acidic and
OTHER LONG ACTING STIMULANTS, contains more lipids and proteins than plasma.
AND MOST SIDE EFFECTS WERE MILD Safety also depends on the age of the infant as
TO MODERATE IN SEVERITY. COMMON metabolism and clearance are decreased in the
SIDE EFFECTS INCLUDE DECREASED neonate. Breastfeeding immediately prior to taking
APPETITE, INSOMNIA, DRY MOUTH AND the next dose is recommended.
HEADACHE.
SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022 * 57
In other countries, Vyvanse® is indicated for Binge
Eating Disorder (BED).

It is a product best used in patients with co-
morbidities, including Major Depression and
dysthymia, with or without an ADHD diagnosis.

REPORT

Psychostimulant use during the first trimester of Other: CBT is effective, as is working on strategies
pregnancy was associated with a minor risk of associated with scheduling and self-management.
miscarriage and use during the second and third
trimesters could lead to pre-eclampsia, pre-term 1. Confirm diagnosis of ADHD
birth and small for age infants. 2. Review symptoms, triggers and current treatment
In terms of specific interventions: 3. Review co-morbidities and optimize treatment
4. Optimise non-pharmacological treatment, such as
METHYLPHENIDATE LEVELS IN BREAST
MILK WERE LOW AND UNDETECTABLE CBT and self-management strategies
IN INFANT BLOOD, HENCE THERE IS 5. Trial of ADHD treatment
NO REASON TO DISCONTINUE MPH IF
BREASTFEEDING. Useful websites:
The Lactmed website contains information on
Atomoxetine showed no higher risk for pregnancy drugs and other chemicals to which breastfeeding
complications, and there were no adverse events mothers may be exposed and includes information
in the two breastfed infants studied. of such substances in breast milk and infant blood
and the possible adverse effects in the nursing
THE NUMBER OF BIRTH DEFECTS infant. All data are derived from the scientific
ASSOCIATED WITH BUPROPION WAS literature and fully references.
SIMILAR TO THE GENERAL POPULATION.
https://www.ncbi.nlm.nih.gov/books/NBK501922/
Risperidone was associated with increased weight www.mothertobaby.org offers expert information
gain during pregnancy, and an increased risk for about medications and other exposures during
gestational diabetes. There was a minor risk for low pregnancy and breastfeeding.
birth weight babies. It is undetectable in breast
milk and was not associated with developmental Lisa Selwood is the Medical Affairs Manager (Lundbeck);
abnormalities. she is also a Medical Writer. Correspondence: liew@
lundbeck.com

• Virtual format – from the convenience and safety For further information, please contact:
of your home/office Congress Secretariat: Sonja du Plessis
Tel: +27 82 455 7853
• Earn CPD Points (clinical and ethical) E-mail: [email protected]
• Reduced registration fees Congress Convenor: Prof Renata Schoeman:
• World-class local- and international speakers [email protected]
• Competition prizes and live entertainment

58 * SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022

QUETIAPINE FUMARATE TRUST is
EARNED

Treatment with

PROVEN EFFICACY

For the treatment of schizophrenia
and manic episodes associated
with bipolar disorder1

HARMONY in MENTAL HEALTH2

Dr. Reddy’s HELPLINE : 0800 21 22 23 Dr. Reddy’s
www.sadag.org

References: 1. Dopaquel Package Insert. Dr. Reddy’s Laboratories (Pty) Ltd. June 2017. 2. Galderisi S, Heinz A, Kastrup M et al. Toward a new
definition of mental health. World Psychiatry, 2015;14(2): 231-233.

S5 Dopaquel 25/100/200/300. Each tablet contains quetiapine fumarate equivalent to quetiapine 25 mg/100 mg/200 mg/300 mg.

Reg No’s 43/2.6.5/0429;0430;0431;0432. Dr. Reddy’s Laboratories (Pty) Ltd. Reg no. 2002/014163/07. Block B, 204 Rivonia Road,

Morningside, Sandton. 2057. www.drreddys.co.za. ZA/03/2021-23/Dop/005.

For full prescribing information refer to the professional information approved by the medicines regulatory authority.

This content is for HCPs only and the intended recipient should not share or forward it.

CMSA UPDATE

PRESIDENTIAL
PONDERINGS ON

THE PANDEMIC…

Suvira Ramlall

G reetings and best wishes for a fresh and The rigid structural boundaries
optimistic start to the New Year, 2022. of universities became more
The last two years have been a surreal fluid online, and students had
experience; apart from the health and greater access to and comfort
economic impact of the pandemic, every aspect with virtual teaching, training,
of how we live, and work has had to be revisited and assessment/examination
and, in many instances, completely revolutionized. platforms.
As good psychiatrists we must of course look for
the silver linings around those dark Covid clouds. DESPITE THIS, TRAINING AND
The famous definition of insanity is ‘doing the same FORMAL TEACHING WERE Suvira Ramlall
thing and expecting a different result.’ While the INEVITABLY COMPROMISED, President, College of
pandemic has left us with profound lessons for Psychiatrists
change on many fronts, it is prudent to highlight
a few that resonate with the postgraduate training FOR SOME MORE THAN
programme and platform, and the vision, of the OTHERS, AS WE WERE TOSSED FROM
College of Psychiatrists. WAVE TO WAVE, TRYING TO CATCH OUR
1. UNITY IS STRENGTH BREATHS AND IMPROVISE IN AN EVER-
The pandemic has painfully driven home the CHANGING WORLD.
point that ‘no man is an island’; we are a global
village, and it is in our interdependence and Given the huge discrepancies in the quantity and
selfless sharing of resources that our strength and quality of resources available across our country’s
survival depend. It was heartwarming to see many medical schools, and the limited and progressively
educational resources being made available shrinking specialist population in the public sector,
where, pre-pandemic, paid access was the norm. serious consideration must be given to the creation
Conferences-local and international- that would of a national e-repository of educational resources
normally only be accessed by those who received for both our undergraduate and postgraduate
sponsorships or could afford the steeply rising costs, medical trainees. South Africa is small enough to
were more readily accessible and affordable online. have a core national undergraduate curriculum
as it does for postgraduate specialist and sub-
specialist trainees. There is room within such a model

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to accommodate university-specific creativity The clinical and academic public-private
and innovativeness to ensure that a healthy, boundaries should also become bi-directionally
necessary and competitive edge is still possible permeable, if not dissolve altogether post-
and maintained between universities. It would be pandemic.
cost-efficient for clinicians/medical educators to
pool their resources and create a national med-e- GRADUATES ARE EXPOSED SOLELY TO
learning resource. PUBLIC HEALTH TRAINING PLATFORMS
Towards this end, the Colleges of Medicine of YET (A MAJOR IT Y ) IMMEDIATELY
South Africa is exploring the creation of such an PRACTICE IN THE PRIVATE SECTOR UPON
e-platform for its candidates; this is prudent given QUALIFICATION (FOR A VARIETY OF
the different and discrepant training exposures VALID YET CONCERNING REASONS).
that candidates receive despite sitting a common,
national exit examination. The CMSA project will be They are often poorly equipped to function
piloted in the College of Psychiatrists. Of course, its clinically and professionally in the private health
success depends on the generosity of spirit of those setting which is significantly different in all respects
willing to contribute to the platform. to practicing in the public sector. Given the scarcity
of specialists and sub-specialists in our country, a
WHILE A MAJORITY HAVE EMBRACED hybrid training experience will strengthen both our
THE INVITATION TO BE PART OF THIS academic and clinical objectives, strengthen our
INITIATIVE WITH ENTHUSIASM, SOME health systems, and take us closer to the goal of
UNIVERSITY TERRITORIAL BOUNDARIES global health: health equity for all people on the
REMAIN RIGID AND RESISTANT TO A planet that transcend arbitrary social, institutional,
CULTURE OF SHARING. provincial, national, and international borders
and boundaries. Discussions have been initiated
Late last year, I reached out to Neuropsychiatrists in to expand the postgraduate training platform to
Australia, who unhesitatingly and unquestioningly include private hospitals, but much policy and
welcomed the overture, without pre-conditions, politics will have to be navigated before this is a
and also invited our clinicians to join their Global reality. Advocacy from clinicians will certainly help
Neuropsychiatrist Platform’s monthly academic the cause.
forum. They also offered ten local registrars 2. CURRICULA: TRAINING FOR RELEVANCE
free attendance at their RANZCP Symposium’s One of many revelations of the pandemic has
Neuropsychiatry Session in November. been the need to practice ‘learning-on-the-
Collaborations and links were also shared with job’ medicine. The corona virus was novel and
other international Colleges, which I am exploring. required the creation /discovery of new knowledge,
Ensuring an optimum, common educational treatments and strategies which were time-sensitive
experience can only benefit the quality of our and without the luxury of strong evidence bases
graduates and the calibre of the sub/specialists and longitudinal data; knowledge and practices
we, as a country, produce. Relieving (mostly) had to evolve and be implemented in real-time as
clinicians from repetitive didactic duties frees them the pandemic unfolded. Medicine is often criticized
to engage in much-needed on-site clinical training, for its reliance on rote-learning; indeed, our
supervision, and workplace-based assessments. curricula leave little room for critical thinking and
With the exponentially increasing knowledge base registrars often struggle with research because of
in medicine, curriculum content grows, and there the ‘higher order thinking skills’ required. Published
is a progressive erosion on the focus on teaching, 21 years ago, Frenk et al’s Health professionals for a
learning and assessing clinical and other essential new century: transforming education to strengthen
‘soft-skills. Of course, this is also driven by an health systems in an interdependent world (Lancet,
increasing reliance on medical investigations to 2010), speaks to the heart of what ails our medical
diagnose patients, high patient -to-staff ratios that education and which Covid has exposed. The
threaten quality consultation time and competing world had a plethora of experts (informative
demands on the time of specialist-trainers. Just learning-information, skills) who worked tirelessly
as the global medical and scientific community to address the pandemic yet, what was needed in
is required to competently address the Covid-19 equal if not greater measure, were change agents
pandemic, the national medical fraternity (public (transformative learning-leadership attributes).
and private) can unite to review and strengthen the The pandemic highlighted that a biomedical
postgraduate medical training experience in the training model does not necessarily equip medical
new era that is dawning for earthlings.

SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022 * 61

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CMSA

practitioners to deal effectively in time-sensitive opposed to academic curricula. Also highlighted
health crises requiring both right and left-brain during the pandemic was the need for a public
skills and in which the practitioners themselves health approach to health and safety; skills we
are as much affected and at risk as the patients. have relegated to public health specialists who
Deficiencies were evident: much needed, simple are not only few in number, but who function at
health-promotion, versus treating illnesses, when the periphery of the mainstream curative-biased
there is no magic pill on the horizon (e.g. basic medicine. The need for a multi-disciplinary and
yet effective measures such as wearing a mask, task-shifting/sharing models were exemplified when
properly!!!); addressing grief and vaccine hesitancy even the richest countries’ medical personnel were
(which requires psychosocial/humanistic skills); or insufficient to cope with the Covid case load.
coping with personal care (stress, fear, anxiety,
uncertainty, burnout, compassion fatigue, grief) YOU MAY ARGUE THAT THESE LESSONS
which require soft skills that are stigmatized by the ARE ONLY RELEVANT FOR PANDEMICS;
scientific community. I BELIEVE THAT THE PANDEMIC MERELY
The pandemic highlighted the need to be locally EXPOSED THE WEAK LINKS IN OUR HEALTH
responsive and globally connected. Fortunately, SYSTEM AND WHICH OUR TRAINING
the widespread acceptability of on-line PLATFORMS NEED TO ADDRESS POST-
engagements also opened the doors of our local PANDEMIC IF GLOBAL HEALTH IS TO
classrooms to international institutions; this cross REMAIN A COMMON GOAL.
pollination and sharing will not only strengthen our
learning experiences but also open the minds of 3. IQ IS NOT ENOUGH!
local trainees and trainers to the wider world and
to diverse standards of clinical and academic What is learning…a journey, not a destination
practices in a local climate where a progressive What is discovery…questioning the answers, not
dwindling of resources pose a real threat to the answering the questions
maintenance of optimum academic and clinical What is the process…discovering ideas, not
practices. covering content
Importantly, the pandemic spotlighted the health What is the goal… open minds, not closed issues
of healthcare workers internationally; not only were What is the test…being and becoming, not
self-care resources shared globally, but the need for remembering and reviewing
equipping them with more than just technical skills AA GLATTHORN
and crisis support exposed the need for self-care to
be an integral and essential component of medical Medical schools historically attracted the ‘cleverest’
curricula. Expecting stressed, burdened frontline matriculants. Yet the skills that we should be seeking
workers to learn afresh selfcare skills while in the in our trainees, to create a responsive (scientific
midst of saving lives, and while trying themselves to and humanistic) health force, need to evolve
survive, is unrealistic. beyond that of IQ. Increasingly, the health sector
is becoming a business. While running the service
A CULTURE OF SELFCARE MUST BE using sound business principles could address the
ENTRENCHED AS AN ESSENTIAL financial constraints health services labour under,
COMPONENT OF MEDICAL EDUCATION, the increasing chasm between the caring health
AB INITIO, IF WE ARE TO CREATE A HEALTHY professional and the medical super-specialist/
WORKFORCE, IMPROVE THE QUALITY OF technical expert poses a real threat to the ethos
LIFE OF OUR TRAINEES AND GRADUATES of the medical profession. Patients are seeking
AND REDUCE THE SIGNIFICANT COST OF out traditional, complementary, and alternate
THE PSYCHOLOGICAL AND PSYCHIATRIC health practitioners to meet their need, not just
MORBIDITY OF DOCTORS ON HEALTH for treatment, but for practitioners who listen to,
SYSTEMS. care for, and heal the person, not just the disease.
International medical schools have come to value
Frenk et al also emphasise the need for a shift from the contribution of the humanities and spirituality
problem-based learning to competency-based in creating healthy health care practitioners
curricula that are informed by health education and have adapted and evolved their curricula
systems; teaching content should be sensitive to in a move designed to benefit both patient and
and driven by healthcare needs on the ground as practitioner wellbeing. Emotional literacy is essential

62 * SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022

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for medical graduates: to capacitate them to care students and the nature of the world we all live
for themselves as burnout and stress have become and function in have changed so considerably
endemic and synonymous with medical careers; that it is insane that archaic teaching practices still
to provide quality patient care, and to become prevail. To make learning both joyful and effective,
compassionate, competent managers, teachers/ responsive and evolving, should be the aspiration
trainers and leaders. To achieve these, we need to of every educator. To achieve this and to bridge the
start with how we teach, what we teach and how generational, epistemological, andragogical and
we model medicine to our trainees on all platforms: technologic divide between our cohort of teachers
academic, clinical, research and administrative. and learners requires will, effort and a vision that
4. FROM DOING TO BEING…PROMOTING goes beyond the ‘if it was good enough for me…..’
PROFESSIONAL IDENTITY
A NEW YEAR, NEW BEGINNINGS, NEW
THE CMSA HAS WORKED CONSISTENTLY CHALLENGES, NEW OPPORTUNITIES. NO
TOWARDS STRENGTHENING EXAMINATION SUFFERING SHOULD BE IN VAIN AND IT
METHODS TO IMPROVE THE VALIDITY IS MY HOPE THAT THE MANY LESSONS
AND OBJECTIVITY OF THEIR HIGH STAKES’ WE HAVE BEEN EXPOSED TO DURING
EXAMINATIONS. THE PANDEMIC CAN BE TRANSLATED
INTO A NEW VISION AND MISSION FOR
However, exit examinations should not be a POSTGRADUATE MEDICAL EDUCATION
once-off stellar Oscar-worthy display of brushed- AND TRAINING.
up-just-before-the-examinations clinical skills.
The development and formative feedback that Towards this end, the College is working
is necessary throughout the years of training continually to develop a robust, vibrant, valid,
are arguably more important in the journey to inclusive and responsive assessment platform
specialization. Miller’s triangle placed ‘does’ as that is comparable to international Colleges of
the apical training accomplishment and yardstick, Psychiatrists. Further, our focus is not restricted to
arguing that the traditional assessment methods the setting and conducting of examinations. We
focused too much on knowledge, and not enough intend to also capacitate examiners as medical
on behaviour in real-life consultations. Continual educators (this is foundational to becoming good
workplace-based assessments therefore must examiners!), to enhance the teaching and learning
be the focus in strengthening our training quality skills of examination candidates and to provide
and outputs. Not only will it be a more authentic candidates with support with academic resources
assessment of doctors’ application of knowledge and opportunities for clinical skills development.
and clinical skills, but provides real-life opportunities Most importantly, we would like to create a national
to develop and display their humanistic skills and platform for multi-specialty communication and
CANMED competencies. It has been proposed collaboration. This should address the holistic
that the ultimate competency of ‘does’ should development of professionals who will not only offer
be replaced by ‘Is’; a more reliable indicator of excellent clinical services to their patients, but who
professional behaviour should be the incorporation can also be experts in their personal wellbeing, be
and integration of the values and attitudes of the proficient medical educators (didactic and clinical
professional into the identity of the aspiring specialist. skills), who will embrace the ethos and universal
For this to become a reality requires a paradigm shift values of a changing, evolving world and usher in
in what we value in our training and trainees and the a new era in medical education that embodies the
adoption of a holistic and comprehensive definition spirit and excellence of a caring profession-for its
of what constitutes education. members and its patients.
5. DOCTORS AS TEACHERS: ‘SEE ONE, DO
ONE, TEACH ONE’ What kind of doctor do you want to be treating your
Medicine is still taught using the apprentice children and grandchildren? Start growing them
model. Medical education as a formal practice now!
has been slow to be adopted by local universities
even though doctors all engage either in formal Together, we can be the change….!
teaching or do so informally through the behaviour
they model to patients, subordinates and peers. January 2022
Not only has there been significant developments
in educational theory, but the nature of our Suvira Ramlall is the current President: College of
Psychiatrists, Colleges of Medicine of South Africa (CMSA)
Correspondence: [email protected]

SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022 * 63

DULOXETINE HCI PITCH

for PERFECT

HARMONY

TOGETHER we are

STRONGER

Dual serotonin and noradrenaline
reuptake inhibitor1

HARMONY in MENTAL HEALTH2

Dr. Reddy’s HELPLINE : 0800 21 22 23 Dr. Reddy’s
www.sadag.org

References: 1. Yelate 30/60 package insert. Dr. Reddy’s Laboratories (Pty) Ltd. January 2020. 2. Galderisi S, Heinz A, Kastrup M et al.
Toward a new definition of mental health. World Psychiatry, 2015;14(2): 231-233.

S5 Yelate 30/60. Each capsule contains duloxetine hydrochloride equivalent to duloxetine 30/60 mg. Reg No’s 44/1.2/0114;0115. Dr.
Reddy’s Laboratories (Pty) Ltd. Reg no. 2002/014163/07. Block B, 204 Rivonia Road, Morningside, Sandton. 2057. www.drreddys.co.za.
ZA/03/2021-23/Yel/003

For full prescribing information refer to the professional information approved by the medicines regulatory authority.

MAMA CONFERENCE 2021

T he International Marcé Society for a platform to allow for speakers
Perinatal Mental Health is an international, from various African countries
interdisciplinary organization dedicated to present aspects of perinatal
to supporting research and assistance mental health in Africa and
surrounding prenatal and postpartum mental hopefully result in the development
health for mothers, fathers, and their babies. The of Marcé Africa regional group.
overall mission of the International Marcé Society is The webinar created a continental
to sustain an international perinatal mental health virtual network of perinatal
community to promote research and high-quality mental healthcare professionals
clinical care around the world. and showcased the developing
expertise in perinatal psychiatry Lavinia Lumu
THE SOCIETY AIMS TO PROMOTE,
FACILITATE, AND COMMUNICATE ABOUT and the research opportunities that Africa has to
RESEARCH INTO ALL ASPECTS OF THE offer. Due to the great success of the webinar, a
MENTAL HEALTH OF WOMEN, MEN/ face-to-face conference in 2022 is definitely on the
PARTNERS, INFANTS, AND THEIR FAMILIES cards.
THROUGHOUT PREGNANCY AND THE
FIRST TWO YEARS AFTER CHILDBIRTH. Dr Lavinia Lumu
Correspondence: [email protected]
This involves a broad range of research activities _____________________________________________
ranging from basic science through to health
services and development of best practice care #THEMAMACONFERENCE2021
and prevention. The Society is multidisciplinary
and encourages involvement from all THURSDAY 16 SEPTEMBER (17:00 – 20:00)
disciplines including psychiatrists, psychologists,
paediatricians, obstetricians, midwives, nurses, SCIENTIFIC PROGRAMME
early childhood specialists.
As one of the board members of the executive Introduction and opening
committee, the vision was to expand the society Dr Lavinia Lumu (South Africa)
and develop a regional group on the African
continent. The development of the Marcé Africa Women’s health and Mental health - Providing
regional group would be in line with existing regional integrated care
groups in Europe, North and South America and Prof Salome Maswime (South Africa)
would be part of the overall mission of establishing
international multidisciplinary perinatal mental Maternal mental health screening
health care for all. Prof Simone Honikman (South Africa)
In line with this mission, an online webinar was
organised on the 16th September 2021, to create EPDS screening in Kiswahili: Overcoming the
language and cultural barrier
Dr Linnet Ongeri (Kenya)

Common perinatal mental disorders -The
depressed mother
Dr Bibilola Oladeji (Nigeria)

SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022 * 65

MAMA CONFERENCE 2021

The Gambia Women’s Music Group (RAPiD), a randomized controlled trial that evaluated
Dr Katie Rose Sanfilippo the effectiveness of a psychosocial intervention
Outcomes of group problem solving therapy package delivered by frontline primary care
on maternal depression in primary health care providers to treat adolescent perinatal depression.
settings in rural Uganda: An interventional cohort Both of the projects were funded by the International
study Development Research Centre, Canada. He
Dr Juliet Nakku (Uganda) is the recipient of several undergraduate and
What about the fathers? - Paternal perinatal postgraduate scholarship awards and honours,
mental health including the World Bank Scholarship, Heller School
Dr Olatunde Ayinde (Nigeria) Merit Scholarship, Chevron-NNPC scholarship and
Psychopharmacology in pregnancy: Keynote Federal Government of Nigeria Scholarship.
speaker from The International Marcé Society
Prof Saira Kalia (University of Arizona College of Dr Juliet Nakku (MD) is a Consultant
Medicine) (Arizona, USA) Psychiatrist and Executive Director at
Discussion & Close Butabika National Referral Teaching
INVITED FACULTY hospital and a lecturer in Psychiatry
at Makerere University college of
Keynote speaker: Assistant health sciences (MUCHS). She
Professor Saira Kalia, MD, holds an MBChB (MUCHS) and
University of Arizona College of Master of Medicine in Psychiatry of
Medicine, USA Makerere University. She teaches mainly Psychiatry
Dr. Saira Kalia, is the Adult residents in the maternal mental health module
Psychiatry Outpatient Medical and does research in this and other areas of mental
Director at Banner - University health. She was Principal investigator in the recently
Medical Center South. She is also concluded PRIME study where she led the maternal
a perinatal psychiatrist, an educator, and serves as mental health component in Uganda. In this study
the Associate Training Director for the Department she was evaluated the impact of integrating of
of Psychiatry Residency program at the University evidence-based interventions in a primary care in low
of Arizona College of Medicine – Tucson. She resource settings. Currently she is a co-investigator
currently runs the Psychiatry Department’s Perinatal in the MDEPTH project which is a trial of Problem-
Psychiatry Track. Dr. Kalia is well regarded in the Solving Therapy (PST) for maternal depression in
Tucson community and has earned numerous Central Uganda. Dr Nakku has published a number
accolades for her role as an educator and for her of papers in maternal as well as other areas omental
patient-centered care. Most recently, she earned health particularly in primary care settings. She is also
the Arizona Psychiatric Society’s Howard E. Wuslin a leader in Psychiatry in the Africa region as World
Excellence in Education Award. Psychiatric Association (WPA) Zonal Representative
Dr Olatunde Olayinka Ayinde and President of the Uganda Psychiatric Association.
(MBBS, MS, FWACP) is a Lecturer Dr Katie Rose Mahon Sanfilippo
and Consultant Psychiatrist at is currently a postdoctoral fellow in
the University of Ibadan and psychology at Goldsmiths, University
University College Hospital, of London. She is also an associated
Ibadan, respectively. Dr Ayinde’s lecturer in music at university of
work focuses on the epidemiology Cambridge. Her overall research
of mental disorders in different interests concern the perception,
sub-populations as well as on scaling up mental function and application of music.
health services for persons with psychosis, perinatal She has undergraduate degrees in psychology and
women and college students in low- and middle- music from Loyola Marymount University, an MSc in
income countries. He is currently an investigator Music Mind and Brain and a PhD in psychology from
at the WHO Collaborating Centre for Research Goldsmiths, University of London. Her PhD, under the
and Training in Mental Health, Neurosciences supervision of Prof Lauren Stewart and Prof Vivette
and Substance Abuse, Department of Psychiatry, Glover, investigated the potential of a community-
University of Ibadan, Nigeria. Dr Ayinde was an based music intervention to reduce anxiety and
investigator on two recently completed studies depression symptoms in pregnant women from The
focused on perinatal depression: Scaling up Care Gambia, West Africa. Her current research is exploring
for Perinatal Depression in primary care (SPECTRA), the application of music-based interventions to
a hybrid Implementation study that aimed at support maternal mental health across different
using cascade training model to skill up primary cultural contexts in Africa and the UK. She has worked
care providers to identify and respond to perinatal with various policymakers, charities and health
depression in primary care setting, and Responding organisations to promote maternal mental health in
to the challenge of Adolescent Perinatal Depression the educational and health policy agendas in The
Gambia. She also has experience working in the
charity sector in the UK. She has helped to design and
conduct evaluations for organizations that use music
to aid in the well-being of different marginalized
populations.

66 * SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022

MAMA CONFERENCE 2021

Professor Salome Maswime is an in Cape Town. She is actively involved with the
associate professor, Obstetrician International Marcé Society for Perinatal Mental
and Gynaecologist, and Head of Health, the Global Alliance for Maternal Mental
Global Surgery at the University of Health and the African Alliance for Maternal Mental
Cape Town. She is the President Health and has contributed to several World Health
of the South African Clinician Organisation initiatives.
Scientists Society, vice-president of
the Women in Global Health South Dr Bibilola Oladeji (MBBS, MSc,
Africa, trustee of the Board of the Health Systems FWACP) is a Senior Lecturer,
Trust in South Africa, member of the leadership College of Medicine, University
team of UNITARs Global Surgery Foundation and of Ibadan, and a Consultant
Associate editor of the South African Journal of Psychiatrist to the University College
Obstetrics and Gynaecology. Salome completed Hospital, Ibadan and is currently
her MBChB at the University of KwaZulu Natal, and the head of the Department.
qualified as Fellow of the Colleges of Obstetrics Her main research interest is in
and Gynaecology South Africa at the University Psychiatric Epidemiology and Implementation
of the Witwatersrand, and thereafter completed Research. She has special interest in Maternal
her Masters in Medicine and PhD also at Wits. Mental Health and is a member of the Marce
She was awarded the prestigious Discovery MGH Society. She has been involved with trials exploring
fellowship in 2018 and did postdoctoral research the integration of mental health care with primary
at the Harvard Medical School and Massachusetts and maternal and child health care using a task
General Hospital in the United States. Maswime has sharing approach with funding from the Fogarty
worked in various hospitals in South Africa, including International Centre, Grand Challenges Canada
Chris Hani Baragwanath Academic Hospital and and the IDRC. In the context of this work, she has
currently Groote Schuur Hospital. She is currently a trained hundreds of frontline healthcare providers
Next Einstein fellow and a World Economic Forum to identify and provide evidenced based care for
Young Scientist. Maswime’s research interests are common mental disorders. She has several peer
obstetric surgery and placental causes of stillbirths. reviewed publications in high impact journals.
She has published her work and presented in Dr Linnet Ongeri is a researcher in
numerous conferences internationally. She has the field of mental health working
served in numerous international committees, at the Centre for Clinical Research
boards, and technical working groups. She was in the Kenya Medical Research
recognized as a trailblazer and young achiever Institute (KEMRI). She recently
by the President of South Africa in 2017, Destiny completed her postdoctoral
magazine for Excellence and Tenacity in public fellowship in the Global Initiative
service in 2017; and Contribution to maternal health for Neuropsychiatric Genetics
by Africa Forbes, CNBC Africa and Africa Business Education in Research (GINGER) program, hosted
News in 2018, and received the Research in Health jointly by the Harvard T.H. Chan School of Public
Award in 2020 from the OneAfrica organization. Health and the Stanley Center for Psychiatric
Associate Professor Simone Research. She is currently pursuing her PhD studies
Honikman is the Director, Perinatal examining suicidality in Kenya. Having worked in
Mental Health Project and Kenya for the last 10 years as a medical doctor
Associate Professor, University and later as a psychiatrist, she believes innovative
of Cape Town (Ashoka Fellow). programs that tap into already existing physical and
Simone has a medical degree and human resources can go a long way to addressing
an MPhil in Maternal and Child the mental health treatment gap. It is for this same
Health from the University of Cape reason that she has been drawn to research
Town (UCT). She has worked as a medical officer in approaches that strive to design culturally and
psychiatry, paediatrics, obstetrics and gynaecology regionally appropriate models of integrating mental
and HIV medicine. In 2002, she founded the health care in primary health care. In her prior
Perinatal Mental Health Project, currently located research work she was the principal investigator of
within the Alan J Flisher Centre for Public Mental a study on postpartum depression, which sought
Health, Department of Psychiatry and Mental to establish the magnitude of late pregnancy and
Health at UCT. She has collaborated in several postpartum depression among women seeking
global mental health research consortia and has care at maternal and child health clinics (MCH)
published journal papers and book chapters on in Nairobi and validated a postpartum depression
maternal mental health. Simone is actively involved screen in the local language. Most recently, she has
in policy writing, advocacy work and multi-media served as site-PI for an effectiveness-implementation
resource development for maternal mental health hybrid type I study of Interpersonal Therapy (IPT)
in low resource settings. She conducts trainings delivered by non-specialists for HIV-positive women
and develops capacity building resources for a facing gender-based violence. Aside from her
wide range of service providers and organisations. research role, Dr. Ongeri is additionally engaged
She offers executive oversight of an integrated in policy work. She is a member of the presidential
and comprehensive mental health service model mental health national task force as well as various
that operates at a community-based midwife unit technical working group at the Ministry of Health.

SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022 * 67

MAMA CONFERENCE 2021

SCREENING WOMEN FOR COMMON MENTAL However, screening levels remain low and
DISORDERS IN THE PERINATAL PERIOD: responses by women do not reflect the high
DEVELOPING A TOOL FOR SOUTH AFRICA AND prevalence of depression and anxiety. Key factors
PRACTICAL CONSIDERATIONS underpinning these challenges include: women
Simone Honikman; Thandi van Heyningen, Sally receiving no preparation for mental health
Field, Zulfa Abrahams, Marguerite Schneider, engagement, limited resources for referral and
Mark Tomlinson, Landon Myer the manner in which the tool is administered
Email: [email protected] by staff who are reluctant to engage in mental
In South Africa, approximately one in five women health matters due to a lack of confidence and
experience depression and a similar proportion skill, fear of being overwhelmed or unaddressed
experience an anxiety disorder during pregnancy personal mental health challenges. These may
or in the first year postpartum. be overcome through training, supervision and
support for screeners, development of referral
MATERNITY SERVICE PROVIDERS FACE sources and care pathways and including
LARGE WORKLOADS WITH RUDIMENTARY screening into health information systems.
TRAINING IN MENTAL HEALTH. HOWEVER,
THEY REPRESENT AN IMPORTANT ENTRY UNDERSTANDING MUSIC’S ROLE IN MATERNAL
POINT TO CARE FOR WOMEN WITH MENTAL HEALTH IN THE GAMBIA
PSYCHOLOGICAL DISTRESS.
Katie Rose Sanfilippo*1, Bonnie McConnell#2,
There was a need for a brief, culturally appropriate Hajara Huma§3, Buba Darboe5, Hassoum
yes/no screening tool for common perinatal mental Ceesay§6, Paul Ramchandani‡7, Ian Cross‡8,
disorders to be routinely integrated into maternity Victoria Cornelius†9, Vivette Glover†10, Lauren
care. Stewart*11
The Perinatal Mental Health Project undertook a
screening tool development and validation study. *Psychology Department, Goldsmiths, University of London, UK
At a Midwife Obstetric Unit in Cape Town, 376 women # The Australian National University, Australia
attending their first antenatal visit were screened for §The National Centre for Arts and Culture, The Gambia
depression or anxiety using five tools. Additionally, The Ministry of Health and Social Welfare, The Gambia
a structured diagnostic interview was conducted, ‡University of Cambridge, UK
the MINI Neuropsychiatric Interview Plus. Multiple †Imperial College London, UK
logistic regression generated four items that were
most strongly psychometrically predictive of a Email: [email protected]
diagnosis of depression or any anxiety disorder.
Thereafter, cognitive interviewing was conducted Mental health problems in the perinatal period
for the tool in English, Afrikaans and isiXhosa to are a particular challenge in low- and middle-
assess the degree of match between intent of the income countries (LMICs). It is thus of high priority
questions and respondent interpretation. A two- to develop new low-cost, non-stigmatising and
phase iterative adjustment approach revealed culturally appropriate approaches to support
that 1) the item relating to anhedonia was poorly maternal mental health.
understood and 2) there was cognitive coherence
with the remaining three rephrased items (one MUSIC-CENTERED APPROACHES MAY BE
each for depressive symptoms, anxiety symptoms PARTICULARLY USEFUL IN THE GAMBIA
and suicidality) and a modified recall period of two SINCE A RANGE OF MUSICAL PRACTICES
weeks. Psychometrically, at a cut-point of 2, the tool THAT SPECIFICALLY ENGAGE PREGNANT
had a sensitivity of 85.7% and a specificity of 92.9% WOMEN AND NEW MOTHERS ALREADY
against the Edinburgh Depression Scale. EXIST AND MUSICAL PRACTICES
SURROUNDING HEALTH AND SOCIAL
THE TOOL, TOGETHER WITH A SCRIPTED RELATIONSHIPS ARE COMMONPLACE.
PREAMBLE AND REFERRAL ADVISORY, HAS
BEEN INTEGRATED INTO THE STANDARD First discussed was a research study which aimed
MATERNITY CARE STATIONERY USED to investigate the feasibility of implementing a
NATIONALLY. community health intervention through music
engagement to reduce symptoms of perinatal
common mental disorders in The Gambia. Women
in the intervention group (n = 50) participated in
a weekly hour-long music session with their local
Kanyeleng group (all female fertility societies) while

68 * SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022

MAMA CONFERENCE 2021

the control group (n = 74) received standard care. be a period of increased paternal stress, and
Results showed that this type of approach was not this has been associated with the development
only enjoyable, culturally acceptable, and feasible of overt psychopathology. Paternal perinatal
but also showed signs of a beneficial effect through depression occurs in 10.4% of perinatal men,
the reduction of antenatal anxiety and depression while the prevalence of anxiety ranges from 2.4%
symptoms. to 51%. PPMHC in men is likely underestimated
Second was a public engagement project which due to cultural and gender factors, and often go
was undertaken to commission popular local male unidentified and untreated, because of poor help-
musicians (Jaliba Kuyateh and Martin Lyrix King) to seeking among men.
create and perform new musical material to inform
the wider community about the importance of AETIOPATHOGENESIS OF PPMHC IS NOT
maternal mental health and the role that partners COMPLETELY UNDERSTOOD, BUT SOME
can have in supporting women during pregnancy OF THE KNOWN RISK FACTORS INCLUDE
and after birth. MATERNAL PERINATAL DEPRESSION,
MARITAL DISTRESS, PARENTING AND
THE MUSICIANS SHARED THE SONGS ON GENDER ROLE STRESS, LACK OF SOCIAL
A CARAVAN TOUR, A POPULAR RADIO SUPPORT AND STRESSFUL LIFE EVENTS.
STATION AND THE LOCAL TV STATIONS.
A THEMATIC ANALYSIS OF FOCUS PPMHC impact negatively fathers’ ability to cope
GROUP DISCUSSIONS HELD AFTER THE with fatherhood and can lead to increased risk
PERFORMANCES (N = 50) ILLUSTRATED of marital conflict and domestic violence. PPMHC
THAT THE MESSAGES WERE IMPORTANT are also associated with decreased positive father-
AND RELEVANT, THE MUSIC ALLOWED infant interaction and a slew of child internalising
FOR DIFFICULT SUBJECTS AROUND and externalising behavioural problems, up to the
MENTAL HEALTH AND RELATIONSHIPS age of 21 years. The proposed mechanisms of risk
TO BE DISCUSSED MORE OPENLY, AND transmission between fathers and their children
THE USE OF WELL-RESPECTED MUSICIANS include via increased couple conflict, impaired
WAS IMPORTANT. parenting and effects on maternal psychological
health.
Overall, this talk gave two examples of the potential Existing perinatal services are not tailored to new
ways that music-based activities might be used to fathers’ experiences. New interventions need to
support maternal mental health across The Gambia be “father-inclusive” and “father-specific”, focus
and potentially Africa on the whole family, engage men early in the
perinatal period, and should include psychosocial
WHAT ABOUT THE FATHERS? - PATERNAL interventions for a broad range of problems. There
PERINATAL MENTAL HEALTH are a number of barriers to access that also must
Dr Olatunde O Ayinde be overcome, including improving identification
Department of Psychiatry, College of Medicine, of symptoms and help seeking among men, and
University of Ibadan, Nigeria designing perinatal services that accept men and
Email: [email protected] respond to their concerns.
There is a dearth of PPMHC research in Africa.
THERE IS POOR AWARENESS OF PATERNAL There is only one study from Nigeria which found
PERINATAL MENTAL HEALTH CONDITIONS the prevalence of paternal perinatal depression of
(PPMHC) AMONG THE LAY PUBLIC AS 3% at birth and 8.8% six weeks postpartum, with
WELL AS AMONG HEALTH WORKERS. unemployment being the only identified risk factor.
There is an urgent need for PPMHC research on the
Becoming a new father is associated with intense continent
emotions as well as marital, social and cultural
pressures. The perinatal period can therefore

SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022 * 69

Beethoven Recovery Centre, a well-established, private Psychiatric
Hospital and substance abuse Rehabilitation Centre, has an
opportunity for a general Psychiatrist to join our team.

60- bed Psychiatric Hospital
20- bed Substance Abuse Rehabilitation Centre
Voluntary admissions
16+ years of age
Located in Hartbeespoort, at the foot of the tranquil Magaliesberg mountains,
Beethoven Recovery Centre is a short drive from Johannesburg, Pretoria and Rustenburg.

Contact: Henri Gastrow (Hospital Manager) | 083 441 6224 | [email protected]

www.beethovenrecovery.co.za

PERSPECTIVE

OF TOOLBOXES

AND TALKING

Claudia Campbell

T he way I understand it, diagnosis often itself in an almost entirely
alludes to the point of departure for effective psychiatric/psychological way.
treatment. On the other hand, ‘relapse’ The physiological event was
indicates a resurfacing of diagnosed heavily experienced through
symptoms after improvement. Aside from medical the awfulness of PTSD. A big
intervention, diagnosis requires a patient to begin a challenge is that the physiological
process of building their own psychological toolbox cause/diagnosis will take months
to cope. to confirm and treat, however
My psychological toolbox includes many things, the ‘mind’ symptoms need to
with cognitive understanding of my illness playing be addressed immediately. How
a key role. This understanding has often been should my psychiatrist treat me Claudia Campbell
the launch-pad from which I have developed
practical skills to cope with symptoms and other when the cause of my symptoms is endocrinological?
diagnosis related experiences. It has also helped
navigate boundaries and limitations to keep me EVEN MORE CONCERNING IS, HOW
safe. My toolbox is an integral part of who I am now. DOES MY PSYCHIATRIST TREAT ME
Because of it, the gap between episodes of illness WHEN I AM INTOLERANT TO ALMOST
have become longer and longer. However, during ALL MEDICATIONS WHICH WOULD
periods of relapse I need to reach into the deepest ORDINARILY BE USED TO DEAL WITH THE
part of my toolbox for tools which may have been MANIFESTING SYMPTOMS?
lying unused for years.
Although some tools are used daily and others Besides desperately hanging onto my own logic
infrequently, it is a pretty comprehensive toolbox, and reasoning, whose responsibility is it to calm my
and over time I have built confidence in it, as fear? My endocrinologist or my psychiatrist?
have those who treat me. My treatment team
have also added a few Claudia-specific tools to As a patient, it is a terrifying place to find myself
their own toolboxes to deal with a patient who, in – confused and under-equipped, experiencing
many instances, exists on the fringes of the bell- unrelenting symptoms night and day. The hope
curve. In recent times, there have not been too that a way forward will eventually be found, can at
many situations where I or my doctors have found times, be totally surpassed by the desperateness
ourselves ‘toolless’. Recently that changed, in a big to get through the current day, sometimes just the
way. current hour. I know the suspected physiological
An unexpected medical event became the catalyst cause needs extended time to confirm and then
for a startling firestorm. A purely physiological and to treat medically. Right now I am acutely aware
previously undiagnosed problem manifested of dwindling internal reserves, even so, I realise my
own misfiring brain is the ‘safest’ tool to rely on in
order to avoid a possible catastrophic fallout from
incorrect treatment. It is a crushing ask at times. I

SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022 * 71

PERSPECTIVE

know my treatment team is working their utmost to from a diagnostic and treatment perspective, it is
find the best way forward, but in the moment the probably important for you to know if things really
misfiring ricochets can feel unbearable. Knowing go pear-shaped before a pre-booked consultation?
diagnostic and treatment accuracy is dependent
on time, and that survival depends on a broken I am viewed as privileged to be on the receiving
mind seemingly unable to grasp tools, can feel like end of private healthcare. It goes without saying
a terminal situation. that private healthcare is usually viewed as
superior healthcare. However, at times I think it is
DESPONDENCY IS DESOLATE. DESPONDENCY inferior. Having been treated by countless doctors
NEEDS TO BE COUNTERED BY COURAGE over many years I have found that aside from
AND HOPE. BUT HOW? my surgeon and anesthetist, in private practice
business each doctor works in their own silo.
To me, simply talking to those treating me is Separate appointment books, separate rooms,
generally the most effective treatment in these separate hospitals, separate working hours,
types of situations. But I know that I am one of many, separate invoices – these things are not conducive
many patients who also require time and attention. I to working as a well synchronized team. It’s risky.
see the appointment books overflowing for months. As your patients, we are more than the sum of our
Dozens and dozens of patients crammed in every individual systems. I am not a psychiatric patient,
week, so how could I ever expect more time than or an endocrinological patient, or a neurological
my scheduled appointment? And so, we face a patient. No, I am a singular patient who requires
conundrum. Often, the practice of medicine can medical care. It so happens that my care requires
be expedient and effective when diagnoses are the involvement of a psychiatrist, an endocrinologist,
clear and patients respond to pharmaceuticals. a neurologist etc.
Appointment, tests, script, follow-up appointment
– effective treatment is underway. But, what about WHEN THERE ARE MULTIPLE DISCIPLINES
when diagnoses are not clear, and symptoms INVOLVED, PLEASE, PLEASE COMMUNICATE
cannot be effectively treated by a script; when WITH EACH OTHER, AND GIVE US
time is needed to confirm suspected diagnoses, FEEDBACK.
but intensely intrusive symptoms are immediately
present? What then? Is that not the ethical thing to do? I’m not sure
Communication, that’s what. Please figure out a truly effective, multidisciplinary treatment can be
way to ‘talk’ to us, your patients, continuously – don’t dependent on the patient needing to play the role
wait for the weeks to pass until you get all the tests of intermediary.
you need. Silence is not just empty, blank space for
your patient, it’s full of churning. Acknowledge that Unfortunately, and inconveniently for us all, is the
your patient is not just waiting for time to pass, they fact that illness and symptoms don’t always adhere
are living an illness every day. I know it’s a lot to ask, to business hours. Illness tends to ignore schedules,
maybe too much. But perhaps your secretary could symptoms have little regard for punctuality and
help you out? Perhaps you could ask your secretary order, they certainly don’t care how many people
to regularly send a one-line email to say: “Dear should consult with each other before treatment.
Patient (use their name), doctor would like to know I like to believe though, that in tackling the issue
how you are coping this week”. That’s it, a 12-word of treatment, joint toolboxes, consideration and
email. Is that really too much to ask? Your patient communication can be far more powerful than the
will most likely reply “Thanks so much for checking stubborn inconsiderateness of illness. I hope you
in. I’m okay” – we are probably not great, but I can believe that too.
guarantee you the email will give us a little more
fuel for our depleted tanks. Additionally, it makes it Claudia Campbell holds a post-graduate degree in
much easier for us to feel comfortable in letting you psychology and has 10 years experience in the field of
know when we really are not okay, without feeling corporate transformation strategy. Claudia works in a
we will only be able to speak to you at our next voluntary capacity as a psychosocial facilitator, public
scheduled appointment (which we may have tried speaker, and consultant. Due to various health challenges,
to move forward, but probably couldn’t because Claudia’s personal life includes many experiences from the
of the state of the appointment book and length patient’s side of the consultation room. Correspondence:
of the cancellation list). Additionally, I’m guessing, [email protected]

72 * SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022

KETAMINE CLINICS OF SA - LATEST NEWS AND VIEWS

THE NEW WAY TO TREAT DEPRESSION, ANXIETY AND CHRONIC NEUROPATHIC PAIN

ALARMING DEPRESSION AND SUICIDE YET ANOTHER MEDICAL PROFESSIONAL
RATES IN THE LGBTQ+ COMMUNITY EXPERIENCED A DRAMATIC TURNAROUND
AFTER KETAMINE INFUSIONS...
A survey conducted in the USA in 2020 polled 40 000 In our last newsletter we reported that physicians
LGBTQ+ youth between the ages of 13 and 24 and are twice as likely to commit suicide than the
discovered that 40% had seriously contemplated general population. We featured a testimonial from
suicide in the preceding year. More than half a gynaecologist, whose life was turned around
suffered with major depression and almost 70% after ketamine infusions.
reported symptoms of Generalized Anxiety Disorder. KCSA has since received wonderful feedback from
The situation has worsened since the start of the yet another medical professional who says it has
COVID pandemic. taken her 10-years to finally find a solution for her
depression and anxiety. Ketamine.
AN LGBTQ+ TEENAGER IS SIX-TIMES MORE Read Candace's quirky and encouraging account
LIKELY TO SUFFER DEPRESSION THAN of her treatment at our Cape Town clinic:
THEIR HETEROSEXUAL OR CISGENDERS
PEERS. ht t p s://keta m i n e c l i n i c s.c m a i l19.c o m/t/y - l - bz t h d t -
idfkyurm-t/
These numbers can reasonably be extrapolated
to the South African context where the overall rate ANOTHER STUDY DEMONSTRATING THAT
of suicide now places this country second on the LOW-DOSE KETAMINE COMBINED WITH CBT
world list after Russia. IMPROVES ABSTINENCE IN ALCOHOLICS
KCSA was approached by the editorial staff of SA
Gay Pages, a quarterly magazine, following the This study demonstrates that treatment with three
tragic suicide of yet another high profile gay man, infusions of low-dose ketamine in patients with
former Mr. Gay SA, DA Counsellor and psychologist, alcohol use disorder was associated with more days
Lance Weyers, late last year. They were encouraged of abstinence from alcohol at 6-month follow-up.
to hear of ketamine's success in treating resistant In a previous newsletter, we linked to an article
depression and reversing suicidality. Read the describing how ketamine infusions can rewrite
article in the SA Gay Pages magazine, and the
testimonial from a gay KCSA patient by folloing the
link below:
ht tps://g a y p a g essa.c om/2 022/02/0 4/al arm - ove r-
suicides-and-mental-health-in-sas-lgbt-community/

SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022 * 73

KETAMINE CLINICS OF SA - LATEST NEWS AND VIEWS

maladaptive reward memories (MRMs) to reduce COMPLEX REGIONAL PAIN SYNDROME
harmful drinking: (CRPS) - NICKNAMED: 'THE SUICIDE
DISEASE'.
ht t p s://keta m i n e c l i n i c s.c m a i l19.c o m/t/y - l - bz t h d t -
idfkyurm-k/ CRPS is ranked amongst the most painful of all
medical conditions. Activation of NMDA-receptors
Dr F. Perry Wilson of the Yale School of Medicine is linked to neuropathic pain and CRPS, so little
suggests that "Ketamine learns a new trick" in wonder ketamine infusions can offer significant
his short Medscape video discussing the paper relief to many sufferers.
appearing in the American Journal of Psychiatry:

https://www.medscape.com/viewarticle/966270

KCSA OFFERS OUTPATIENT KETAMINE
INFUSIONS AT THE FOLLOWING
LOCATIONS:

• Bedfordview (GP) NMDAR activation also leads to reduced opioid
• Constantia (WC) receptor sensitivity which, coupled with the potential
• Umhlanga (KZN) for paradoxical opioid induced hyperalgaesia (OIH)
• Hilton (KZN) makes outpatient ketamine infusion an elegant
solution for patients seeking ever increasing opioid
Contact a KCSA branch: doses.
https://ketamineclinics.co.za/contact-us/

KETAMINE IMPROVES SEVERAL COGNITIVE A registered nurse from Rhode Island shares her CRPS
FUNCTIONS - A NEW DOMAIN IN SUICIDE RISK & Ketamine story in Practical Pain Management,
REDUCTION and describes how her pain intensity reduced by
50% after ketamine.
Professor John Mann is Director
of Research and Molecular AT KCSA CLINICS, WE ADOPT A VERY
Imaging at the New York State SIMILAR PROTOCOL FOR MANAGEMENT
Psychiatric Institute. He is past OF CRPS AND OTHER NEUROPATHIC
President of the International PAIN CONDITIONS.
Academy of Suicide Research.

Prof. Mann's research employs
functional brain imaging,
neurochemistry and molecular Read Nurse Beth's story:
Professor John Mann

genetics to probe the causes of depression and ht t p s://w w w.p ra ct i c a l p a i n m a n a g e m e nt.c o m/p a t i e nt/
suicide. c o n di t i o ns/c r ps - r sd/c o m p l ex- re g i o n a l - p a in - sy nd ro m e -

Prof. Mann is lead author of a study published in when-nurse-becomes-patient
The Journal of Clinical Psychiatry that demonstrates
ketamine's ability to rapidly improve several HOW DID KCSA START IN SOUTH
cognitive functions linked to suicide attempts. AFRICA?

While ketamine is well known to rapidly improve Ketamine Clinics of South
symptoms of depression (and this accounts in Africa (KCSA) was founded by
part for reduction in suicidal ideation), the study Dr Alan Howard, a Consultant
notes specific improvement in reaction time in Emergency Medicine who
and cognitive control / interference processing, returned home permanently
domains associated with previous suicide attempts to his native South Africa from
in depressed patients. Ireland in 2019.

"BEING ABLE TO THINK MORE CLEARLY To read more about Dr
CAN MAKE SOMEONE FEEL LESS Howard and KCSA's flagship
SUICIDAL" clinic in the Natal Midlands
in two informative articles
Dr Alan Howard published in South African

Link to Medscape's review of the study: Psychiatry visit the link below:

ht t p s://keta m i n e c l i n i c s.c m a i l19.c o m/t/y - l - bz t h d t - ht t p s://keta m i n e c l i n i c s.c m a i l19.c o m/t/y - l - bz t h d t -
idfkyurm-b/ idfkyurm-c/

74 * SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022

Introducing

with TRIPEL (Tri-layered pellet) technology1,2

Drug layer
Barrier layer
Outer enteric layer

Multi-layer benefits1,2

Drug Features Benefits
layer
Suspension coating Greater amount
technique for greater of drug available

bioavailability at the site
Ensures optimal
Barrier Protects Duloxetine from
layer acidic layer of enteric coating absorption
Avoids
Outer Protects Duloxetine
enteric layer from gastric acid Sub-therapeutic dose

When depression hurts…

SIYAENZA

References: 1. Chen Kuang, Yinghua Sun, Bing Li, Rui Fan, Jing Zhang, Yumin Yao, Zhonggui He. Preparation and evaluation of duloxetine hydrochloride enteric-coated pellets with different enteric polymers,
Asian Journal of Pharmaceutical Sciences, Volume 12, Issue 3, 2017, Pages 216-226. 2. Jawahar, N. & Anilbhai, P.H.. (2012). Multi unit particulates systems (MUPS): A novel pellets for oral dosage forms. Journal of

Pharmaceutical Sciences and Research. 4. 1915-1923.
*For full prescribing and dosage information, please refer to registered package insert. S5 DULEVE 30 mg Capsules. Each capsule contains 30 mg Duloxetine (as Hydrochloride). Reg No.: A49/1.2/1198. S5 DULEVE
60 mg Capsules. Each capsule contains 60 mg Duloxetine (as Hydrochloride). Reg No.: A49/1.2/1199. Zydus Heathcare SA (Pty) Ltd, Block B, Southdowns Office Park, 22 Karee Street, Centurion, 0157. Tel. No.: +27

(0)12 748 6400. 04/DUL/09/21/AD.

NEWS

DPESPYA CR T MHEINATTS ROYF

Compiled by Prof. Ugash Subramaney Correspondence: [email protected]

DIVISION OF CLINICAL PSYCHOLOGY process of acquiring a higher qualification.Tejil Morar
(psychiatrist at Sterkfontein Hospital), Tsholofelo Jood
Yael Kadish was promoted to Adjunct Professor in (clinical psychologist at Tara Hospital) and Ntokozo
the School of Clinical Medicine   Gqweta (clinical psychologist at Tara Hospital)
from the Department of Psychiatry completed the
MMED DEGREES programme in 2021.The programme consisted of the
following:
The following doctors received their degrees in
December 2021: 1. a mandatory 1-day ECAD opening workshop
2. a choice of 4 research and teaching workshops
Dr Ladawa Goga
and courses selected from the CLTD Prospectus
Dr Gagu Matsebula 3. 3 communities of practice meetings
4. a 4-day virtual facilitated writing retreat
Dr Thabo Tlolane 5. access to a mentor
6. the ECAD closing ceremony on successful
(the above 3 have all been appointed as psychiatrists
at Sterkfontein Hospital) completion

Dr Stacey Osche (appointed at CMJAH as a specialist)

Dr Liesel Aldrich (appointed at CMJAH as a specialist)

DPr BSotYo PCheHto (IsuApeTrnRumYeraryHregOistraDr fromNBoEtswWanaS) aInnpdreCvioonussuylteaatiros,na-LniaaiswoanrdPsoyfcRh2ia5tr0y0;0cwoallas bgoivraentintgo
wpThaitehrticrmeipsaeajoanrrtictsyhbeourfst lwuanisttfhoiynrteuaannra’sdtepolyurot2gs0irda2e1mSlmaocuekthetodAoffkruicnpadl.aincge.
Dr Thato Kalane Hviertuias llya dreuceiptioenttheofCtOheVIDJo-1h9npHaanmdeiltmonic,Ahwoawrdeveinr,
DDrr.TNaoiwkhouAthkuinladipMeawviaesSahpibpaonindtaed as Chief Specialist CKtThheoiesymHdmopidnruoonnguitorryastmMSdomeecdteireaictciynttaaeuftrog(U2mhC0tT0;t0aha)en;spdareiacmchfteosmccaooblnfeptreoanoinctf taGspdhoeaelrdmrseoedinnc.
DSaernCfdalakioHreeMLaoawdkgniaeothf o PHseyaclthhiSactireyncDeseUpnaivretrmsiteyn(St MaU)t fspsoeelartrtvTnineRngEsinA.agITtsNafeEanTlt,dNaliskoteUnraN-aateOlhcgDeoyClhpthoipnalirgctoijsThernacuontsttd(et2aew0u1hfgo4ihlr-e2tt0ihon1en7teh)Ae.ilsHccoeulihnnaiodclsleaiocrl

APreNtoNriaU, wAithL efAfecWt fAromR DNoSv:ember 2020.

•aH et tPDrheosreygbciTtUsahetnriijaaniilverterMdfyro,soritahyr2ani0sord2fu1wIgnloaodrsitenr,hgaNirwsaigadFerMudriaeaCtdePinsytm2hc0eeh0d0aoic.vnHaedelradtFlrlWaegibAnreCeesdePt Aathdnemonipnyrmiestsorsauutosrer(,AleoAcf)tubgrearorl,aucnplicn. iincgianbaenindgmaanny academic,
in other roles.
TTahiewreo wias s iantewreasrmtedseninse tohfecoinmtemrpuhnaitysethrboeutgwheoeunt
•q uaDlirficJaatdioensBoinuwe2r00w9/a1s0nominfroamted thaes tNheatiobneastl sthuebsyteaanrc. Weeuhsaed athnedopopthoertrunmityentotaclritdicisaollrydaenrsa. lyHsee
PosptgerrafodrumaitnegMMeMdEicDasl tCudolelengt eino2f0N21ig.eShriae wasillwbeellthaes aoudrvostcraatteegsiefos rwahneninittecgormateivsetoaapcparodaecmhictoteasecrhviincge
therWeceisptieAnfrticoaf nthCeo2ll0e2g1eLoofuPishFyrsaicnikailnns.Freed prize. diasnenecedloimvmereereyds,ectatoroarbcuinhnei,tnirnaigeessff.awencedtllivaeres.Wspeerauarnclsehothihnaedlosttwroartaeefnglediecstmowindhtdihclhee
type of mentors we wanted to be and how to meet
• Dr Jade Bouwer was also noted for the Kurt Gillis
He pirsizeafnor athluembneusts poefrfoUrmniivnegrsFitCy PsoyfchCcaapnediTdoawtne
wheinre20h2e1.obtained MPhil (Addiction psychiatry) in
•CiDn eaAcpDpederrimdAzTeiosbchwetiloenr  in.g2H0hPe1sP1ysr.ipcohHer inewatathrtsyhaaedawftoahGlrliosdrwoesodiuntbteghseptSwecpochsyiuyacuelthrayorHstthora(es2ipnr0aii1tnpa2gyl-, “thIne naenedhsisotofrisctuadllyendtsisiandtvhaenatacgaeddeminicstistuetttioinng. lWikee
(EK2e0EA1nCR3siL)AnYgDptrCo)onvAPiTdRRreinEOagEtmGRcelRiAnnAtiCcCMaAel DMnstuErEepMp(IKoCTrCt D)t,oECVdarEpuLegOTouPwsMenr.EsNaTt SpwtoMseyraUce,chcamiahdytaerylmlmedniicsegspieroeadnsrtetmoiaserqctnuohteitsanrtaniotnadnsnfofodourecmrmupsaawonriatndhditsrgheemebttirsnnagerneedlacdltsetinhaogerf
agoparelsvitohurosulygmh athrgeinwarliitsiendg preotpreualat.tTiohne”writing retreat
introduced a lot of concepts about writing which
“wIearemnopvuetlt,inugsefmulyannodsneetcoestshaerygtroinednsgtoangee wwiitthh. my
sjAoleinelovmteeswrooanlslethdgisuatpirnaetiondoafcfrcochmoamnptghliees.h” EthC isADmispsiroong.raPlmeamsee
BPYrioTrEtJoILthMisOcRuArrRe,nTtSaHpOpLoOiFnEtLmOenJOt, OheD hAaNdDwNoTrOkeKdOZaOs which will surely be taken forward in the context of
aGQSWpeETcAialist Psychiatrist and Senior Lecturer on the
THjaohoniennstpuUaiatnaplilvEpeaaornrsilnydittyCmSaMoerfneUtt.ehoreAf cDWar.itdGweaemoteircrgserDaeMnvdeulko(hWpamitrsie)Anchtao(EdsCtesAmaDinc)
self-development and our working environment.
Professional relationships formed spanned across
different faculties and will surely endure as we
iTPaOnarnoftifwdihgceoreaDa.hmTeraehvmaseeelsaop,ouprrfuotmShnguoerbabrnesymtdtatm(hnpCeeceLTeeCiDsrue-)rsaneevtiamrideeneiwdsodoef rtdLdaheetesarc,arDniWceuinanitasgtdilf,eidcRTmeieaaasigcerctnahicsoritnlcasegihfssf progress through our academic careers. The ECAD
was a refreshing window into the possibilities in
academia and what Wits is able to offer  
who have a PhD for 5 years or less, or are still in the

76 * SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022

NEWS

Compiled by Delcia Liedeman-Prosch, Correspondence: [email protected]

TRIBUTE TO DR ROBIN SCHEEPERS (7 FEBRUARY 1980
– 25 OCTOBER 2021)

BY CANDICE JACOBSON
It is challenging to describe in only a few words this humble doctor who
touched so many lives with his grace, kindness, and patience.
Robin completed his undergraduate degree at UCT and after a period
exploring the Far East teaching English and obtaining a black belt in
Taekwondo Robin then returned to UCT as a psychiatry registrar. After
qualifying as a psychiatrist in 2018, he ventured into private practice
working at both Milnerton Akeso Clinic and Life Vincent Pallotti Hospital.
He rapidly developed a thriving practice along with a reputation that
befitted his personality. He had a true zest for life, and it was rare to not see
his warm smile or hear the enthusiastic tone in his voice  

WELCOME TO NEW STAFF

DR AMY ADAMS completing her Masters Degree
in Clinical Psychology at UNISA in
A warm welcome to Dr Amy Adams, who will be Pretoria, Hayley gained her forensic
taking up a position as Senior Lecturer in the experience working at Sterkfontein
Division of Addiction Psychiatry. Amy completed Psychiatric Hospital in 2019 during
her undergraduate degree at UCT and then her internship.
honours and master’s degrees from the University She worked in the observation
of the Western Cape. and state patient wards during this year. Inspired
by her newfound passion for forensic work, Hayley
Her doctoral study at Stellenbosch University completed her Community Service at Pollsmoor
looked at the relationship between PTSD, reflective Prison performing risk assessments for parole
functioning and caregiving sensitivity amongst considerations and ‘lifers’, as well as conducting
mothers misusing substances. Her research individual therapy and group psychoeducation
interests include resilience, Foetal Alcohol Spectrum for rehabilitative purposes. She is thrilled to have
Disorders and mentalisation-based treatment for joined the Valkenberg Hospital team  
substance-abusing mothers.

She was previously a Clinical Psychologist at DR LERATO MAJARA
Stikland hospital working in the Outpatient and
Female Acute Units, as well as a lecturer in the SU BY NASTASSJA KOEN
Department of Psychiatry   I am delighted to welcome Dr
Lerato Majara (left) as Co-Head
DR YANGA VAVA of the Psychiatric Genetics Group
of the Brain-Behaviour Unit (BBU),
Yanga (left) qualified with an Neuroscience Institute.
undergraduate degree in 2010 Lerato has a background in Medical
at Walter Sisulu University. After Microbiology, having completed a
internship in Port Elizabeth, he
worked in Fort England Hospital BSc degree at the University of the Free State, as well
Grahamstown where his love for as an MSc degree at UCT in this field. Thereafter, she
Forensics started. completed a PhD in Human Genetics, studying the
Yanga then started registrar time in 2017 under genetics of schizophrenia in the South African Xhosa.
Stellenbosch University and completed his training She is currently pursuing a Postdoctoral Fellowship
in July 2021. He has always wanted to do Forensic on the Neuropsychiatric Genetics in African
Psychiatry and when the opportunity to join the Populations (NeuroGAP) project, a collaborative
Department came, he jumped at it   study between UCT and the Stanley Centre at the
Broad Institute of Harvard and MIT.
HAYLEY SHANNON She is also a senior fellow of the Global Initiative of
Neuropsychiatric Genetics Education and Research
Hayley Shannon (above left) joined the Forensic (GINGER) programme at the Harvard T.H. Chan
team in November as a contract Clinical School of Public Health; and a current member of
Psychologist working on observation cases in the Cross-Population Special Interest Group of the
Ward 20 and the Outpatients department. After Psychiatric Genomics Consortium  

SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022 * 77

NEWS

MELODY KNIGHT AND ALUTA KIBI/ LIESL HERMANUS
DR SYBRAND DE VAAL
BY SIMONE HONIKMAN AND RITA STOCKHOWE
BY SHARON KLEINTJES Liesl Hermanus (left), the Perinatal
The Division: Intellectual Disability Mental Health Mental Health Project’s (PMHP)
welcome new staff members who have recently Clinical Services Co-ordinator, was
joined the psychology team at Alexandra hospital, recently awarded the 2021 UCT
Melody Knight and Aluta Kibi; and Dr Sybrand de Vice-Chancellor’s Excellence Award
Vaal, a Psychiatrist based at Lentegeur Hospital.   for Global Citizenship.
This is in recognition of her
C O N G R AT U L AT I O N S commitment to the Hanover Park
community, providing essential
A/PROF GOODMAN SIBEKO
support and leadership during the current difficult
Goodman Sibeko, Head of the times. The PMHP team is extremely proud of her
Division of Addictions Psychiatry, achievement and delighted that this honour has
who moved from the University of been bestowed by UCT  
Kwazulu-Natal to UCT 10 years ago,
began his PhD in work that included REGISTRARS
capacity building of primary care
clinicians, and subsequently Congratulations to Drs Rosalind Adlard, Gillian
focused on addictions. Booysen, Nerisha Pillay and Bailee Romberg on
passing the FC(Psych) Part II exams.
He was recently promoted to Associate Professor. Drs Keagan Clay, Christine Kopsch, Michelle
As Director of the only International Technology Swartz, Bongi Brenda Tyhala and Rushil Devraj are
Transfer Centre (ITTC) in Africa he has played a congratulated on passing the FCPsych (SA) Part 1
national and international leadership role in policy exams in the second semester  
development and in education, enabling the
training of thousands in Motivational Interviewing/ PROF JACKIE HOARE’S
Screening, Brief Intervention and Referral to INAUGURAL LECTURE
Treatment/Mental Health across the country and
region   Prof Hoare (left) and Vice-Chancellor Mamokgethi Phakeng celebrate the
moment together.
ADELE MARAIS
Prof Hoare presented her inaugural lecture on
Adele Marais (left), a Senior Clinical Mental Health in the frontline on the 2nd December
Psychologist on Joint Appointment 2021.
in the Department, was recently Prof Hoare wears many hats. She is a
promoted to Associate Professor. neuropsychiatrist, Head of the Division, research
Adele is now nationally and scientist, co-director of the UCT Mental Health Unit,
internationally recognized for her work Senior Consultant Psychiatrist at Groote Schuur
done in the fields of Intimate Partner Hospital and chairs the Adolescent Clinicians
Violence, as well as Transgender and Group and Better Together Adolescent service at
Gender-affirming care   the hospital.
She has been the principal or co-investigator
HETTA GOUSE of NIH USA federal funded research projects in
SA on mental health, neurocognitive disorders,
Hetta Gouse (left), a Chief Research neuroimaging, epigenetics and development of
Officer in the Department, who adherence interventions for adolescents living with
trained in neuropsychology at UCT, HIV  
was also promoted to Associate
Professor. Hetta works in the area
of NeuroHIV and has obtained
national and international
recognition for her scientific and
social responsivity work on neurocognition in HIV  

YANGA THUNGANA

Yanga Thungana is congratulated on obtaining
his Certificate in Neuropsychiatry. He joins a select
group of sub-specialists who have trained with
Prof Joska, and who are leading the continent in
services, teaching, and research in this key area of
work  

78 * SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022

NEWS

LANCET PSYCHIATRY - Louise was also a founding member of the UCT
Division of Psychotherapy and together with
A LETTER FROM SOUTH AFRICA colleagues, developed the Postgraduate Diploma
in Psychotherapy (PGDip).
A letter from South Africa She then moved to GSH in 2010 and pursued her
by Jackie Hoare and interests in pain management and consultation-
Louise Frenkel (pictured liaison (CL), joining the Division of CL. Louise - along
together, right) describes the with Prof. Jackie Hoare – has created a thriving
experiences of supporting consultation-liaison service that is valued and that
doctors during the COVID-19 makes a difference to the lives of patients and staff  
pandemic and was recently
published in The Lancet. You INTELLECTUAL DISABILITY MENTAL HEALTH
can view the article on the following link:
h t t p://w w w. p s y c h i a t r y.u c t.a c. za/s i t e s/d e fa u l t/ BY SHARON KLEINTJES
files/image_tool/images/71/Lancet%20letter%20 Last year saw us say farewell to three of our team
COVID%20mental%20health%20.pdf   members who had moved to new adventures,
Charlotte Capri who has left to work in the field in
FAREWELL TO COLLEAGUES the UK, Siyabulela Mkabile who will shortly join the
Department of Psychology at UCT and Jenna-Lee
DR ROB ALLEN Proctor who is now in private practice. We wish
them well in their new work!  
BY JOHN PARKER
Rob Allen (left) retired in October SYMPOSIA
2021 after a long and memorable
career with the UCT Department RESEARCH IN IDD IN AFRICA
of Psychiatry and Mental Health.
A relative latecomer to psychiatry, Rob joined the BY SHARON KLEINTJES
Registrar Program in 1997 after 10 years working as A first virtual symposium on Intellectual and
a Medical Officer at Day Hospitals and a further 8 Developmental Disabilities (IDD) in Africa hosted
years as a General Practitioner in Private Practice by the Division of ID in December 2020 provided
(he had also previously qualified with a BSc in participants with opportunity to share common
Computer Science). challenges faced by families and service providers
After completing his training and obtaining his across several countries on the continent.
FCPsych (SA) in 2001, Rob came to Lentegeur Hospital, A second half day conference was organised
where he worked as a Consultant in the Child and on 16th November 2021 at the request of the 2020
Adolescent Mental Health Services between 2001 participants. This latter conference saw presentations
and 2009, when he was appointed as head of on a variety of service development issues, including a
Clinical Services, a position he held until retiring. presentation by a divisional member, Toni Abrahams,
True to form, however, he continued to further on preliminary findings of her doctoral study focused
his studies, completing an MBA, with distinction, on respite care for persons with ID.
at the UCT GSB in 2009, where he also obtained Dr Callista Kahonde’s presentation on making
certification as a Development Coach, in October research accessible to people with intellectual
of this year. disabilities as the meeting’s keynote address
He always displayed a phenomenal understanding highlighted ethical issues in conducting research
of governance processes and a keen interest in with people with ID from lessons learnt in the
developing effective leadership, which he ably conduct of her own research in this area  
shared with those around him and huge energy for
service development   TRAUMA INFORMED CARE IN SERVICES
FOR PEOPLE WITH IDD
LOUISE FRENKEL
BY SHARON KLEINTJES
BY LAMEZE ABRAHAMS Our division’s mental health awareness
Louise Frenkel retired from her symposium held on the 26th October this year
position as Principal Psychologist included presentations on cultural incongruence
(PP) at Groote Schuur Hospital as a parental stressor in service access and
at the end of December 2021, utilisations, support to parents with complex PTSD,
having worked in the Department organisational responses to addressing staff
of Health for 20 years! trauma, and services for clients with ID who have
Louise (above) is a stalwart of the psychology experienced trauma in various settings.
internship program, with the 2021 intern clinical The seminar concluded with a fascinating
psychology group having been Louise’s 20th group presentation on low arousal approaches to
of interns that would benefit from her expertise. supporting people with ID presented by Dr
Nashareen Morris  

SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022 * 79

BOOK REVIEW

THE WAY OF

INTEGRITY

FINDING THE PATH TO YOUR TRUE SELF

Koffi Kouakou

accuracy of one's actions". The
key notion that links them is
“truthfulness”. But she lifts hers to
the spiritual realm and makes it
almost missionary, apostolically
and religiously appealing.

To help us find our true self, Dr. Beck
takes us on the journey from hell to
paradise. She shares her personal
way into the journey of integrity
Koffi Kouakou

and how she managed to traverse
the valleys of darkness to the mountains of paradise
in the end. However, she warns the pilgrims of the
journey of integrity about the challenges and fears
on the road to inner Eden – the true self. But she also
offers them practical ways to the embrace of their
inner guides.

Title: The Way of INTEGRITY Finding the OF COURSE, SHE STARTS THE JOURNEY
Path to Your True Self WITH THE USUAL ENTICING CLICK-AND-
BAIT BUFFET-STYLE, NEW AGE SPIRITUALITY
Publisher: Piatkus WITH THE FOLLOWING HEADINGS
“LOST IN THE WOODS”, “DESPERATE
Author: Martha Beck FOR SUCCESS”, “MEETING WITH THE
TEACHER”, “THE ONLY WAY OUT” AND
ISBN: ISBN: 978-0-34942-602-0 “RECLAIMING EDEN” AMONG OTHERS.

T he subtitle of the book tells it all “Finding the But most important, Dr Beck, a life coach,
Path to Your True Self”, our own true self, who sociologist, a mother of three, and holder of
we are, and our integrity. That’s the daring three degrees, a BA, MA, and PhD, from Harvard
subject matter here – finding the self. It’s University, tries to convince us to start living our own
already a challenging journey to find oneself in truth. She reminds us on how to become undivided
daily life. So how can a book claim to help do just and whole. That’s The Way of Integrity “if you want
that in 327 pages? to be happy”, she asserts. She also makes a simple
case: “integrity, being in harmony with ourselves, is
I am always suspicious about such lofty claims, and the key to a meaningful and joyful life”.
rightly so. Here, Dr Martha Beck’s understanding and
offered definitions of integrity seem slightly different In the chapter on Meeting the Teachers, she shares
from the traditional definitions in our dictionaries her experience on meeting her own teachers
where it is the practice that combines honesty while telling us that the famous Italian author
and showing a consistent and uncompromising Dante Alighieri first “met” his teacher Virgil by
adherence to strong moral and ethical principles reading his poetry. And she commented rightly
and values... of incorruptibility. In ethics, integrity
is regarded as the "honesty and truthfulness or

80 * SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022

BOOK REVIEW

so, that “reading is the way I‘ve met most of my appearances and conversations with Oprah Winfrey
life teachers…Sometimes we meet our teachers who called her “one of the smartest women I know.”
because someone sees we need help and
drags us to therapy, rehab, yoga, or some other While I was a bit sceptical about another fashionable
environment where we can meet wise guides.” This book by a famous new age guru, I became fond of
a very interesting way to meet spiritual teachers but the book’s easy flow and usefulness on the meanders
also to meet oneself on the way of integrity. of the self. Dr Beck made it fun and engrossing to
The strength of this book resides in the four-stage learn about our self, take charge of it and make it
process, inspired by The Divine Comedy, a work our own, wholly and fully. The Way to Integrity is a
of medieval epic poetry, that Dr Beck proposes to nice intellectual and spiritual weekend read.
her audience to “find integrity, a sense of purpose,
emotional healing, and a life free of mental “INTEGRITY IS A CURE FOR UNHAPPINESS
suffering”. She makes use of Dante’s classic hero’s AND PSYCHOLOGICAL SUFFERING.
journey as a manageable framework to attaining PERIOD.” THAT’S MY FAVOURITE QUOTE
personal integrity. Through the spiritual notions of FROM THE BOOK.
Inferno, Purgatory and Paradise, she demonstrates
how to understand and accept “our internal signals Koffi Kouakou is a senior lecturer at the Wits School of
that lead us towards our true path”. Governance, where he teaches strategic government
The integrity techniques she provides, are time communications and scenario planning. He is the former
tested spiritual practices packaged into easier director of the Unilever Mandela Rhodes Academy for
modern offerings with numerous practical exercises Communications and Marketing (UMRA), a Storyteller,
and examples. Interestingly, the birth and practices Social Commentator, Business Strategist, Author and
in this book have their sparks and origins in South Futurist. He specialises in information communications
Africa. As such, Dr Martha Beck’s journey took her to technologies for development and telecommunications
rural villages to Londolozi and the Kruger National adapted to environmental issues in Africa. He has been
Park in South Africa. a regular contributor to international, local media and
She is best known for her many bestselling books business magazines on the BBC, VOA, Deutsche Welle, The
such as The Joy Diet, Finding Your Own North Star People Daily, eNCA, Africa 360 degrees, SAFM, 702 Radio,
and Expecting Adam, and also for her many media Power FM, China, Brainstorm, The Media, CIO.COM and
Intelligence in South Africa. He co-authored a book titled
AfricaDotEdu: IT Opportunities and Higher Education in
Africa, 2003. Correspondence: [email protected]

NO ONE SEES NO ONE SEES
HER ADHD HER ADHD

BUT EVERYONE BUT EVERYONE
SEES HER POTENTIAL SEES HER SUCCESS

VYVANSE® offers sustained improvement in adult ADHD symptoms for up to 14 hours 1

VYVANSE® is the FIRST prodrug stimulant 2,3 NEW

• Offers improvement in real-life executive function deficits
and self-reported quality of life 3,4

• Convenient once-daily dosing with a well-established
safety profile 3,5,6

References: 1. Wigal T, Brams M, Gasior M, Gao J, Squires L, Giblin J, for 316 Study Group. Randomized, double-blind, placebo-controlled, crossover study of the efficacy and safety of lisdexamfetamine dimesylate in adults with attention-deficit/hyperactivity disorder:
novel findings using a simulated adult workplace environment design. Behav Brain Funct. 2010;6:34. Available from: http://www.behavioralandbrainfunctions.com/content/6/1/34 [Accessed 18th August 2021]. 2. Pennick M. Absorption of lisdexamfetamine dimesylate and
its enzymatic conversion to d-amfetamine. Neuropsychiatr Dis Treat. 2010;6:317-327. 3. Frampton JE. Lisdexamfetamine: A Review in ADHD in Adults. CNS Drugs 2016: 30(4):343-54.DOI 10.1007/s40263-016-0327-6. 4. Adler LA, Dirks B, Deas PF, Raychaudhuri A, Dauphin
MR, Lasser RA, et al. Lisdexamfetamine Dimesylate in Adults With Attention-Deficit/ Hyperactivity Disorder Who Report Clinically Significant Impairment in Executive Function: Results From a Randomized, Double-Blind, Placebo-Controlled Study. J Clin Psychiatry.
2013;74(7):694-702. 5. VYVANSE® 30,50,70. SAHPRA approved professional information. Takeda (Pty) Ltd. 24 July, 2020. 6. Coghill DR, Caballero B, Sorooshian S, Civil R. A Systematic Review of the Safety of Lisdexamfetamine Dimesylate. CNS Drugs 2014;28:497–511.
S6 VYVANSE® 30. Each capsule contains 30 mg lisdexamfetamine dimesilate. Reg. No: 48/1.6/0407. S6 VYVANSE® 50. Each capsule contains 50 mg
lisdexamfetamine dimesilate. Reg. No: 48/1.6/0408. S6 VYVANSE® 70. Each capsule contains 70 mg lisdexamfetamine dimesilate. Reg. No: 48/1.6/0409. For
full prescribing information, refer to the Vyvanse Professional Information as approved by SAHPRA. Takeda (Pty) Ltd, Reg. No.: 1982/011215/07, Building A,
Monte Circle, 64 Montecasino Boulevard, Fourways 2191. Tel: +2711 514 3000. Marketed by Acino Pharma (Pty) Ltd. Reg. No: 1994/008717/07. No 106, 16th Road,
Midrand, 1686, Gauteng, South Africa. (011) 516 1700. www.acino.co.za C-APROM/ZA/Vyv/0024.

SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022 * 81

POEM

ON THERAPY...

Oupa Habib

S trange but true, Emotional place!
Is it not? This is the real essence ,
Almost unbelievable: Secret and mystery of Therapy!
Yet possible! At one level : so simply
That us: And yet so complicated!
Real imperfect I have been on both sides of this
Humans: Fence:
Sometimes: Professionally a therapist at times
When we Not uncommonly also : a client!
Genuinely, honestly talk Whichever side of the fence;
To a total stranger Often stumbling , uncertain
About matters Searching and seeking!
Deeply Bothering us : Attempting to clear
Then: The fog and mist ;
We really hear ourselves ; Often discover
(We have taken ourselves Only when dig deeper
Seriously : And am courageous
Are really in the presence And if lucky:
Of ourselves ) might lead
And therefore are bound to feel our To some rewards!
Unmistakable authentic emotions ; But It :
Arriving at a different Ain’t Easy

Dr Habib (nickname “Oupa”) is the Principal Psychiatrist at Port Shepstone Regional Hospital in Southern KwaZulu Natal. He
has a professional interest in the issues of psychotherapy. [email protected]

82 * SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022

WINE FORUM

THE EVOLUTION

OF KLEIN CONSTANTIA

SAUVIGNON BLANC

T he talk was technical – petrol-head We repaired to this cellar – so clean David Swingler
technical – as we trundled up the slopes you could literally have eaten off
of Constantiaberg. Host Craig Harris, Klein the floor – to consider the evolution
Constantia’s viticulturist, was punting the of Klein Constantia Sauvignon
torque of the Land Rover while fellow guest Francois Blanc in celebration of its 40th
Rautenbach, Sommelier and General Manager vintage in the modern era. There
of prestigious Singita Premier Wine, batted for the have been two owners and three
Land Cruiser. He had noted wheel rim markings winemakers in this time, a
on our vehicle which identified the original source remarkable consistency amidst
as the Londolozi fleet. Which I thought was pretty the seminal socio-political, global
impressive. economic and market dynamics it
Not as pretty or as impressive as the vistas that has paralleled over that time.
greeted us at the top dam. From here the expanse
of 70 hectare of vines planted on the 146ha spread Duggie Jooste resuscitated the derelict property
– a full half destined for the Estate Sauvignon Blanc from 1980, installing veteran icon Ross Gower as the
– shimmered in their 42 blocks on south-southeast winemaker who shot the lights out to announce a
slopes at varying altitudes with a range of N-S renewed quality world player with the early wines.
and E-W aspects, on decomposed granite and We tasted his 1996; old gold certainly, but with a
Table Mountain sandstone. The breezes off False vivacity, low alcohol and bone dry finish that still
Bay – scintillating just 7km away – were the aircon bristled with vigour.
in Summer while those coming over the neck from
Hout Bay, 5km away, did the job in Winter. And
a cellar housing one million litres of tank space
ranging from 500L to 30 000L in capacity for a 4 000
ton harvest means winemaker Matt Day can keep
all the intricate pieces of the puzzle separate until
the composite is crafted

Klein Constantia Sauvignon Blanc bush vines with view Vineyard above the cloud

THE EARLY ‘GREEN’ STYLING APED NEW
ZEALAND’S AWARD WINNERS LIKE
CLOUDY BAY IN THE EARLY DAYS AND
CONTINUED WHEN LOWELL TOOK OVER
FROM FATHER DUGGIE AND ROSS
MOVED TO HIS OWN FARM IN 2003.

SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022 * 83

WINE FORUM

Adam Mason held the cellar baton and his maiden And wine anoraks who can discuss nuances in fluid
2004 was especially ‘leesy’ from roto-tank practices as avidly as the gentlemen had earlier compared
of the day. It was the last bottling under cork. motor vehicles don’t bat an eyelid paying R350 for
Klein Constantia found new foreign owners in 2011 a bottle of Jocelyn Hogan’s old vines chenin blanc,
and assistant Matt Day assumed cellar control with would gag on R200 for a ‘savvy’. That the latest
2012. 2021 Klein Constantia Sauvignon Blanc is only R165
reflects this perhaps, and is astounding value.
THE DIRECTION WAS NOW FIRMLY SET
ON A BROADER, TEXTURED DRY WHITE Klein Constantia Manor House
WINE STYLE RATHER THAN THE TINGLING
GREEN SAUVIGNON DISTINCTION THAT IN SPITE OF ROSS GOWER WINNING THE
CAN, WELL, GET TIRESOME. BEST WINE ON THE NATIONAL WINE
SHOW WITH CABERNET SAUVIGNON IN
Grapes are farmed for their white stone fruit character, 1988,AND HIS CABERNET-MERLOT BLEND
harvesting now commences at 04h00 to prevent sun DOING THE SAME THE NEXT YEAR, KLEIN
damage, all semillon has been removed, 100% wild CONSTANTIA IS WHITE WINE COUNTRY.
yeast fermentation, oxygen is no longer the enemy,
and a saline core has become the new grail. It’s refreshing to me to hear management talking
about Klein Constantia as a quality white wine
Klein Constantia Sauvignon Blanc bush vines with mountain view producer; it’s just the dry white wine is about one
tenth the price of the ‘natural sweet’ one!
The package also needed to change with the times.
The sloping shoulder bottle, name font style and [email protected]
trademark cellar arch motif have remained, but the www.kleinconstantia.com
rest gets a fresh perspective in 2021: new ‘Klein David Swingler is a writer and taster for Platter’s South
Constantia’ embossing of the shoulder (rather than African Wine Guide for over 21 years to date. Dave
the older regional Constantia identity), a premium Swingler has over the years consulted to restaurants,
Stelvin screw cap that tucks the thread away inside, game lodges and convention centres, taught wine
a far superior textured label paper and cleaner courses and contributed to radio, print and other
design lines all doff the cap to the environment. 60% media. A psychiatrist by day, he’s intrigued by language
recycled glass helps reduce the carbon footprint by in general, and its application to wine in particular.
20% and less board in the box assists too. Correspondence: [email protected]
Over lunch on the sumptuous lawns – simple snoek
pate, roast free-range chicken and cheese (with Vin
de Constance) – talk turned to the perception (and
pricing) of sauvignon blanc.

IT’S WELL KNOWN THAT WINE WRITERS
GENERALLY VIEW SAUVIGNON BLANC
AND MERLOT AS LESSER BEINGS AND
SELDOM DRINK THEM,WHILE THE PUNTERS
– THAT’S YOU THE CONSUMERS – GLUG
BOTH, NOT ABLE TO GET ENOUGH!

84 * SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022

SASOP

SOUTH AFRICAN SOCIETY OF
PSYCHIATRISTS

SAVE THE DATE

SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022 * 85

SASOP

SOUTH AFRICAN SOCIETY OF
PSYCHIATRISTS

P O S I T I O N:

SUB-SPECIALIST, CHILD &

ADOLESCENT PSYCHIATRY

TYGERBERG ACADEMIC HOSPITAL

JOB INFORMATION SUMMARY

Job Title Sub-Specialist Child & Adolescent Psychiatrist, Department of Psychiatry,
Tygerberg Hospital
Rank of Current Post Holder Sub-Specialist
Core Medical Science and Support Personnel
Post Level 12
Post Level of Current Post Holder 12
Location Tygerberg Academic Hospital Complex, Tygerberg
Component Health
Post Reports To Head of Child & Adolescent Unit/ Head of Department of Psychiatry

JOB PURPOSE INHERENT REQUIREMENTS FOR THE JOB

To provide clinical assessment and management PREREQUISITES:
to child & adolescent patients referred to the • Specialist registration with the HPCSA to
outpatient CAP (Child and Adolescent Psychiatry)
services and including the adolescent and practise as a Sub-Specialist Child & Adolescent
neuropsychiatric inpatient ward at Tygerberg Psychiatrist
Hospital and in-service training and supervision in • FC(Psych)SA, MMed(Psych) or equivalent
child psychiatry of primary, secondary and tertiary recognised by HPCSA with the sub-specialist
level health workers in relevant disciplines. Certificate in Child & adolescent Psychiatry from
the Colleges of Medicine of South Africa
To teach child psychiatry to under- and postgraduate • Clinical teaching and/or research and
students in relevant degrees and diplomas. communication skills
• Ability to serve patients in at least two of three
To generate relevant research and publications official languages of the Western Cape
and to supervise the research of junior colleagues.
EXPERIENCE:
To render support to the Head of the Clinical Unit • At least one year’s post-registration experience
of Child & Adolescent Psychiatry with respect to
clinical, management, teaching and administrative in clinical child and adolescent psychiatry and
matters. management of a CAP mental health care team
• At least one year’s post-registration experience
KEY PERFORMANCE AREAS in undergraduate and/or postgraduate
teaching and training and/or research in child
1. Rendering of a comprehensive and quality and adolescent psychiatry
clinical service to patients.
Please email your interest and CV to:
2. Performance and management of relevant Dr A Lachman: [email protected] and
clinical areas and support to head of clinical Ms V Meyer: [email protected]
unit.
Closing Date: 3 December 2021
3. Conducting appropriate training and teaching.
4. Conducting and supervising clinical research in

psychiatry.

86 * SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022

SASOP

SOUTH AFRICAN SOCIETY OF
PSYCHIATRISTS

NOTICE OF REQUEST FOR COMMENT
ON THE STANDARD TREATMENT
GUIDELINES & ESSENTIAL MEDICINES
LIST FOR PRIMARY HEALTHCARE &
ADULT HOSPITAL LEVEL OF CARE

T he ministerially appointed National Essential • N D o H _ E M L _ B u p re n o r p h i n e _O S T_ P H C - Ad u l t s _
Medicines List (EML) Committee has Review_30November2021_v2.0.docx:
reviewed the evidence for Opioid Substitution
Therapy (OST) and Tuberculosis Preventive https://healthman.evlink9.net/servlet/link/1774/
Therapy (TPT) to inform the recommendations for 671191/1886150/2747670
the respective sections of the Standard Treatment
Guidelines (STGs) and Essential Medicines List (EML) • N D o H _ EM L _ M et h a d o n e _OST_ PH C - Adu l t s _
for Primary Healthcare (PHC) and Adult Hospital Review_19August2021_v2.0.docx:
Levels of care:
The Primary Health Level STGs and EML are https://healthman.evlink9.net/servlet/link/1774/
aimed for use by doctors and nurse prescribers 671191/1886150/2747671
providing care at primary healthcare facilities,
whilst the Adult Hospital Level STGs and EML • PHC-AdultHosp_ MHC- OST_ R4C_9December
are aimed for use by doctors providing care 2021.docx:
at district and regional level hospitals; to
provide access to pharmaceuticals to manage https://healthman.evlink9.net/servlet/link/1774/
common conditions at the respective levels of 671191/1886150/2747672
care.
Kindly circulate the request for comment to It would be appreciated if comments can be
relevant healthcare professionals at your received by 9 February 2022.
institutions. Constructive comment regarding Comments may be submitted via e-mail to:
the identification of major errors, particularly the Trudy Leong
relevance of clinical evidence that may have E-mail: [email protected]
been missed, will be appreciated. Please include Essential Drugs Programme
a short motivation to substantiate any comment Private Bag X828
made. PRETORIA
The following documents are available to download: 0001
• PHC-Adult Hosp_NoticeForComment_OST TPT_9 Your co-operation in this regard is appreciated.
Kind regards,
December2021.pdf: Assoc Prof. Ag Parrish
https://healthman.evlink9.net/servlet/link/1774/ Co-Chair:
National Essential Medicines
671191/1886150/2747668 List Committee (NEMLC)
• DRAFT_MHC_OST STG_4C_9December2021.docx: Dr R De Waal
https://healthman.evlink9.net/servlet/link/1774/6 Co-Chair:
National Essential Medicines
71191/1886150/2747669 List Committee (NEMLC)

SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022 * 87

SASOP

SOUTH AFRICAN SOCIETY OF
PSYCHIATRISTS

AVA I L A BL E POS I TION

MEDICAL SPECIALIST
POST OF THE CLINICAL
UNIT PSYCHIATRY

Post 01/50 care, including 72-hours observations). After hours
Ref: SBAH 002/2022 service as per contract. Delivering of consulting
Directorate: Psychiatry liaison psychiatry service to all departments of the
SALARY Steve Biko Academic Hospital and the Department
Grade 1: R 1 122 630 per annum, plus benefits of Family Medicine at Tshwane District Hospital.
Grade 2: R 1 283 592 per annum, plus benefits Involvement in undergraduate and post-graduate
Grade 3: R 1 489 665 per annum, plus benefits training of medical students as well as students
CENTRE from other disciplines.
Steve Biko Academic Hospital Participation in academic research and
REQUIREMENTS publication of the clinical unit and academic
MBChB with either Mmed (Psych) or FC Psych department. Additional service delivery as
qualifications. Registration with the HPCSA as an decided upon by the unit from time to time.
independent specialist practitioner is compulsory. ENQUIRIES
This is a joint-appointment position with both Prof. GP Grobler
the Gauteng Department of Health (Steve Biko Tel No: 012 354 3191
Academic Hospital) and the Faculty of Health APPLICATIONS
Sciences at the University of Pretoria. Compliances Steve Biko Academic Hospital
with the minimum requirements for appointment Private Bag X169, Pretoria, 0001
as a lecturer/senior lecturer, as per the University or hand delivered to
of Pretoria's clinical joint appointments criteria, will cnr Malherbe & Steve Biko Road, Main Entrance,
include evidence of a minimum of 1 accredited Level 3.
scientific publication and/or presentation(s) at NOTE
scientific conferences. Engagement in Master's Applications must be submitted with a Z83 form
supervision is recommended. Teaching portfolio with relevant attachments. Steve Biko Academic
must be provided. Community engagement is Hospital is committed to the pursuit of diversity
recommended. An interest in neuropsychiatry and redress. Candidates whose appointment will
and consultation-liaison psychiatry will be viewed promote representivity in terms of race, disability
favorably. and gender will receive preference.
DUTIES CLOSING DATE
Service delivery at the Psychiatry Unit, Ward 2.1 Steve 31 January 2022
Biko Academic Hospital (inpatient and outpatient

88 * SOUTH AFRICAN PSYCHIATRY ISSUE 30 2022

INSTRUCTIONSTO AUTHORS

South African Psychiatry publishes original contributions that relate to South African Psychiatry.The aim of the
publication is to inform the discipline about the discipline and in so doing, connect and promote cohesion.

The following types of content are published, noting that the list is not prescriptive or limited and potential
contributors are welcome to submit content that they think might be relevant but does not broadly conform to
the categories noted:

LETTERS TO THE EDITOR
* Novel experiences
* Response to published content
* Issues

FEATURES
* Related to a specific area of interest
* Related to service development
* Related to a specific project
* A detailed opinion piece

REPORTS
* Related to events e.g. conferences, symposia, workshops

PERSPECTIVES
* Personal opinions written by non-medical contributors
NEWS
* Departments of Psychiatry e.g. graduations, promotions, appointments,
events, publications

ANNOUNCEMENTS
* Congresses, symposia, workshops
* Publications, especially books

The format of the abovementioned contributions does not need to conform to typical scientific papers.
Contributors are encouraged to write in a style that is best suited to the content. There is no required word count
and authors are not restricted, but content will be subject to editing for publication. Referencing - if included -
should conform to the Vancouver style i.e. superscript numeral in text (outside the full stop with the following
illustration for the reference section: Other AN, Person CD. Title of article. Name of Journal, Year of publication;
Volume (Issue): page number/s. doi number (if available). Where referencing is not included, it will be noted
that references will be available from the author/authors. All content should be accompanied by a relevant
photo (preferably high resolution – to ensure quality reproduction) of the author/authors as well as the event or
with the necessary graphic content.A brief biography of the author/authors should accompany content, including
discipline, current position, notable/relevant interests and an email address. Contributions are encouraged and
welcome from the broader mental health professional community i.e. all related professionals, including industry. All
submitted content will be subject to review by the editor-in-chief, and where necessary the advisory board.

REVIEW / ORIGINAL ARTICLES
Such content will specifically comprise the literature review or data of the final version of a research report
towards the MMed - or equivalent degree - as a 5000 word article

* A 300 word abstract that succinctly summarizes the content will be required.
* Referencing should preferably conform to the Vancouver style i.e. superscript numeral in text (outside the full
stop with the following illustration for the reference section: Other AN, Person CD. Title of article. Name of

Journal, Year of publication; Volume (Issue): page number/s. doi number (if available); Harvard style or

variations of either will also be acceptable

* The submission should be accompanied by the University/Faculty letter noting successful completion of the
research report.

Acceptance of submitted material will be subject to editorial discretion

All submitted content will be subject to review by the editor-in-chief, and where necessary the advisory board.
All content should be forwarded to the editor-in-chief, Christopher P. Szabo - [email protected]

Cingulate 16046 Live Today.
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Introducing NEW Bupropion XR 150 ADCO

• Simple and convenient morning dosing.1
• Treats major depressive disorder and associated symptoms.1-3
• Offers a therapeutic advantage over serotonergic

antidepressants with dual action on monoaminergic receptors.#*2,4
• 58 % monthly cost saving vs. originator.5

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XR - extended release; *Dual action refers to inhibition of neuronal noradrenaline and dopamine re-uptake in the synaptic cleft;2 #Therapeutic advantage is gained by dual action on noradrenaline and dopamine neurotransmission causing enhanced
monoaminergic effects and a reduction in the noradrenergic symptom cluster (decreased positive effect) which include loss of energy and fatigue, loss of self-care and motivation and decreased concentration.4
References: 1. Bupropion XR 150 ADCO Professional Information Leaflet. January 2021. 2. Stahl SM, Pradko JF, Haight BR, et al. A Review of the Neuropharmacology of Bupropion, a Dual Norepinephrine and Dopamine Reuptake Inhibitor. Prim Care
Companion J Clin Psychiatry 2004;6(4):159-166. 3. Fava M, Rush AJ, Thase ME, et al. 15 Years of Clinical Experience With Bupropion HCl: From Bupropion to Bupropion SR to Bupropion XL. Prim Care Companion J Clin Psychiatry 2005;(3):106-113.
4. Bupropion. Medline Plus Information. Available at: https://medlineplus.gov/druginfo/meds/a695033.html. Last accessed: August 2021. 5. Generics Dictionary [online]. Available at: <http://www.generic.co.za/frontend/generics?utf8=%E2%9C%93&q%5Bactive_
ingredient_name_eq%5D=BUPROPION> [Accessed 30 August 2021].
For full prescribing information please refer to the professional information approved by SAHPRA (South African Health Products Regulatory Authority).
S5 Bupropion XR 150 Adco. Each extended-release tablet contains bupropion hydrochloride 150 mg. Reg. No.: 50/1.2/0967.965.
Adcock Ingram Limited. Reg. No.: 1949/034385/06. 1 New Road, Midrand, 1685. Private Bag X69, Bryanston, 2021. Tel.: +27 11 635 0000. www.adcock.com
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