South African Psychiatry - November 2023

SHARPEN THEIR COGNITION VORTIOXETINE’S NOVEL MULTIMODAL MECHANISM OF ACTION OFFERS IMPROVEMENT IN COGNITIVE IMPAIRMENT & EMOTIONAL BLUNTING.1 NEW BRIVOR 5, 10, 20 mg. Each film coated tablet contains vortioxetine hydrobromide equivalent to 5, 10, 20 mg vortioxetine respectively. S5 A55/1.2/0105, 6, 7. For full prescribing information, refer to the professional information approved by SAHPRA, February 2023. 1) Evren, C., 2021. Vortioxetine: a comprehensive update on a new generation antidepressant. Dusunen Adam, 34(1), pp.1-13. BVRB905/09/2023 www.pharmadynamics.co.za CUSTOMER CARE LINE +27 21 707 7000

PRODYNA 150 mg 300 mg XR BUPROPION HYDROCHLORIDE PATIENTS EXPERIENCING SYMPTOMS OF LOSS OF POSITIVE AFFECT CAN BE RETURNED TO NORMAL FUNCTIONING WITH AN AGENT THAT HAS A DOPAMINERGIC AND/OR NORADRENERGIC COMPONENT.1 PRODYNA 150, 300 mg XR. Each tablet contains 150, 300 mg bupropion hydrochloride respectively. S5 A54/1.2/0181,0182. For full prescribing information, refer to the professional information approved by SAHPRA, March 2023. 1) Nutt, D.J., 2008. Relationship of neurotransmitters to the symptoms of major depressive disorder. The Journal of clinical psychiatry, 69, pp.4-7. PDAA914/10/2023 www.pharmadynamics.co.za CUSTOMER CARE LINE +27 21 707 7000 NEW

ABOUT ABOUT the discipline the disciplineFORFOR the discipline the disciplineissue 37 • NOVEMBER 2023 ISSN 2409-5699 www.southafricanpsychiatry.co.za ABSTRACTS PUBLISHED IN ASSOCIATION WITH THE SOUTH AFRICAN SOCIETY OF PSYCHIATRISTS 21ST NATIONAL CONGRESS OF THE SOUTH AFRICAN SOCIETY OF PSYCHIATRISTS CENTURY CITY CONFERENCE CENTRE, CAPE TOWN SHIFTING THE PARADIGM TOWARDS COMMUNITY CARE AND THE UNHEARD VOICES IN MENTAL HEALTH 19TH – 23RD NOVEMBER 2023

THAT FINAL PIECE HELP THEM TO UNLOCK Unlocking potential S6 CONTRAMYL XR 18 mg (Extended Release Tablets). Reg. No. 49/1.2/1137. Each extended release tablet contains 18 mg methylphenidate hydrochloride. Contains sugar (sucrose). S6 CONTRAMYL XR 27 mg (Extended Release Tablets). Reg. No. 49/1.2/1138. Each extended release tablet contains 27 mg methylphenidate hydrochloride. Contains sugar (sucrose). S6 CONTRAMYL XR 36 mg (Extended Release Tablets). Reg. No. 49/1.2/1139. Each extended release tablet contains 36 mg methylphenidate hydrochloride. Contains sugar (sucrose). S6 CONTRAMYL XR 54 mg (Extended Release Tablets). Reg. No. 49/1.2/1140. Each extended release tablet contains 54 mg methylphenidate hydrochloride. Contains sugar (sucrose). For full prescribing information, refer to the Professional Information approved by the Regulatory Authority. Mylan (Pty) Ltd. Reg. No.: 1949/035112/07. 4 Brewery Street, Isando, Kempton Park, 1601. Tel: (011) 451 1300. Fax: (011) 451 1400. www.viatris.co.za. MET-2023-0034 EXP: 04/2025 “ADHD SHOULD NOT BE A BARRIER TO REALISING MY POTENTIAL.”

SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 * 5 NOVEMBER 2023 * PLEASE NOTE: Each item is available as full text electronically and as an individual pdf online. Disclaimer: No responsibility will be accepted for any statement made or opinion expressed in the publication. Consequently, nobody connected with the publication including directors, employees or editorial team will be held liable for any opinion, loss or damage sustained by a reader as a result of an action or reliance upon any statement or opinion expressed. © South African Psychiatry This magazine is copyright under the Berne Convention. In terms of the South African Copyright Act No. 98 of 1978, no part of this magazine may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without the permission of the publisher and, if applicable, the author. COVER IMAGE: AdobeStock image Design and layout: The Source 7 SASOP PRESIDENT’S WELCOME 8 CONVENING COMMITTEE WELCOME 10 SASOP CONGRESS ORAL PRESENTATION ABSTRACTS 25 SASOP CONGRESS POSTER ABSTRACTS 46 SPONSORS AND EXHIBITORS 50 SASOP NOTICE OF AGM Acknowledgement: Thanks to Lisa Selwood for assistance with proof reading Design and Layout: Rigel Andreoli Web: www.southafricanpsychiatry.co.za Contact Person: Vanessa Beyers - [email protected] Editor-in-Chief: Christopher P. Szabo - Department of Psychiatry, University of the Witwatersrand Associate Editor: Renata Schoeman - University of Stellenbosch Business School Advisory Board: Ugash Subramaney - Head, Department of Psychiatry, University of the Witwatersrand Soraya Seedat - Head, Department of Psychiatry, Uiversity of Stellenbosch Dan Stein - Head, Deprtment of Psychiatry and Mental Health, University of Cape Town Taiwo Akindipe - Head, Department of Psychiatry, Sefako Makgatho Health Sciences University Funeka Sokudela - Head, Department of Psychiatry, University of Pretoria Janus Pretorius - Head, Department of Psychiatry, University of The Free State Zuki Zingela - Head, Department of Psychiatry, Walter Sisulu University Bonga Chiliza - Head, Department of Psychiatry UKZN; President South African Society of Psychiatrists "The views expressed in individual articles are the personal views of the authors and are not necessarily shard by the editor, associate editor, advisory board, advertisers or the publisher." CONTENTS SOUTH AFRICAN SOCIETY OF PSYCHIATRISTS

AN SNRI WITH THE SAME RECOMMENDED STARTING AND MAINTENANCE DOSE1 For further product information contact PHARMA DYNAMICS Email [email protected] CUSTOMER CARE LINE +27 21 707 7000 EXLOV XR 50, 100 mg. Each extended release tablet contains desvenlafaxine benzoate equivalent to 50, 100 mg desvenlafaxine respectively. S5 A51/1.2/0009, 0010. For full prescribing information, refer to the professional information approved by SAHPRA, August 2020. 1) Lourenco, M.T.C., et al, 2009. Desvenlafaxine in the treatment of major depressive disorder. Neuropsychiatric disease and treatment, 5, pp.127- 136. EVA899/08/2023. www.pharmadynamics.co.za

SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 * 7 Dear Colleagues, it is my singular honour to welcome you all to the South African Society of Psychiatrists (SASOP) biennial conference. Welcome to Cape Town, eKapa, the Mother City. From the 1600s, sailors used Cape Town as a pit stop, gaining the name, The Tavern of the Seas. SASOP is the biggest psychiatry society in Africa and its membership is not limited to psychiatrists. In addition, the society is open to psychiatrists beyond our borders, so it stands to reason that it will host the biggest biennial conference. The theme of this conference is Shifting the Paradigm toward Community Care and the unheard voices in Mental health. It therefore means that we need to ensure that the community at large can access the appropriate mental health care, at the appropriate time and location. We cannot effectively address community mental health needs without addressing the social determinants of health. If we say those are not in our immediate jurisdiction, then we must accept that we are not going to move the needle in advancing better mental health for the community. Looking at a community and listening to all members means we must make sure that particular attention is paid to diversity, including but not limited to minority groups, like women, children, LGBTI-plus and any other grouping that is being marginalised. The practice of psychiatry and mental health must be culture-sensitivity in training, treatment, dissemination of information, policies and all other aspects of our lives and work as psychiatrists. We can’t be psychiatrists and not be advocates for the patients. We must get involved with mental health issues, we must be front and centre in formulating policies, guidelines, and all other issues of mental health, so as to obviate a situation where decisions are made for us and yet we are the experts. This conference is a great opportunity to share, exchange and debate ideas, gain information and knowledge, upskill ourselves as well as vicariously our colleagues and the communities we serve. It is an opportunity to become more familiar with new emerging treatment modalities and to be appraised of the amazing research our colleagues are involved in. We are also going to connect with colleagues, meet old friends and make new ones. We collectively owe a great debt of gratitude to Professor Laila Asmal, the convenor of this conference and her team and all the partners for putting together this conference. Welcome all. Dr Sebolelo Seape President, South African Society Of Psychiatrists [email protected] WELCOME MESSAGES S A S O P PRESIDENT’S WELCOME Sebolelo Seape SOUTH AFRICAN SOCIETY OF PSYCHIATRISTS

8 * SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 WELCOME MESSAGES CONVENING C O M M I T T E E WELCOME I t is with immense pleasure that I welcome you to the South African Society of Psychiatrists Congress, taking place from the 19th to the 23rd of November 2023 at the Century City Conference Centre in Cape Town. Our theme for this year, "Shifting the Paradigm towards Community Health and the Unheard Voices in Mental Health," speaks to the urgent need to expand our perspectives and inclusively integrate diverse voices in our collective journey of enhancing mental health care in South Africa. This commitment to inclusivity is reflected in our robust program, featuring over 15 keynote addresses, 6 workshops, and more than 25 parallel sessions. SASOP 2023 presents a unique opportunity for psychiatrists to receive updates from leading experts about the latest knowledge, actionable insights, and emerging data in our field. It is a chance to connect with a dynamic community of psychiatrists ensuring you leave not only wellequipped and energized but also inspired to bring fresh vigour to your profession. With representation from various regions across South Africa, Africa, and the global community, we aim to provide a truly international viewpoint that is at its core locally relevant. While SASOP primarily focuses on psychiatry, we deeply value the essential contributions from multiple stakeholders in shaping the landscape of clinical care, research, policymaking, and training in mental health. In line with this, our congress this year warmly welcomes presentations by NGOs, individuals with lived experiences, occupational therapists, nurses, and psychologists. The future of psychiatry in South Africa must reflect this representation - one marked by inclusivity, interdisciplinarity, and attunement to community needs. I warmly invite you to dive into the valuable learning experiences, cultivate impactful collaborations, and actively participate in the pivotal discussions to help direct the course for mental health care in our nation. Laila Asmal Chair, Congress Convening Committee [email protected] Laila Asmal SOUTH AFRICAN SOCIETY OF PSYCHIATRISTS

Dopaquel is indicated for the treatment of adult patients with schizophrenia or for the treatment of manic episodes associated with bipolar disorder.3 Quetiapine is recommended as a first-line treatment in the management of acute mania associated with bipolar disorder4 HELPLINE: 0800 21 22 23 www.sadag.org THIS INFORMATION IS INTENDED FOR HEALTHCARE PROFESSIONALS ONLY HEALTH CARE PROFESSIONALS PATIENTS 5 1. https://toronto.cmha.ca/documents/balancing-your-life/ [Accessed February 2023] 2. Quetiapine. 7 things you should know. https://www.drugs.com/tips/quetiapine-patient-tips#/[Accessed February 2023] 3. Dopaquel [Professional Information]. Sandton, South Africa. Dr. Reddy’s Laboratories (Pty) Ltd; 2017. 4. Yatham LN, Kennedy SH, Parikh SV et al. Canadian Network for Mood and Anxiety Treatment (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 2018; 97-170. 5. EFPIA Patient Think Tank. Working Together with Patient Organisations White Paper. June 2019. S5 Dopaquel 25 (tablet), Dopaquel 100 (tablet), Dopaquel 200 (tablet) and Dopaquel 300 (tablet). Registration numbers: Dopaquel 25: 43/2.6.5/0429. Dopaquel 100: 43/2.6.5/0430. Dopaquel 200: 43/2.6.5/0431. Dopaquel 300: 43/2.6.5/0432. Dopaquel 25: Each tablet contains quetiapine fumarate equivalent to quetiapine 25 mg. Dopaquel 100: Each tablet contains quetiapine fumarate equivalent to quetiapine 100 mg. Dopaquel 200: Each tablet contains quetiapine fumarate equivalent to quetiapine 200 mg. Dopaquel 300: Each tablet contains quetiapine fumarate equivalent to quetiapine 300 mg. For full prescribing information refer to the professional information approved by the medicines regulatory authority. Dr. Reddy’s Laboratories (Pty) Ltd. Reg no. 2002/014163/07. Tel: +27 11 324 2100. www.drreddys.co.za R1146479-ZA-CO-25022023-0709-31 Mar 2 Dr. Reddy’s

10 * SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 S A S O P C O N G R E S S ORAL PRESENTATION ABSTRACTS A STRUCTURAL ANALYSIS OF MANAGING INSOMNIA IN SOUTH AFRICAN PRIMARY HEALTH Mrs Michelle Baker UKZN, department of clinical medicine (Psychiatry) [email protected] Mrs Michelle Baker1 1 UKZN, department of clinical medicine (Psychiatry) INTRODUCTION The standards of practice in sleep medicine in South Africa has been reviewed by the South African Society for Sleep Health. Whilst global gold standards serve as a good scaffold to ensure ethical guidelines are adhered to, South Africa is often considered unique in its diversity, requiring special adaption. Institutional issues around advocacy and training programmes in sleep medicine are leaving healthcare practitioners under resourced and uncertain of how to conceptualise treatment protocols and manage sleep disorders appropriately. Coveney et al., 2019). These authors question whether the management simply reverts to medicalisation and pharmaceuticalisation of sleeplessness? General Practitioners report commonly assessing insomnia and often feel that patients coerce them into prescribing hypnotics, when they are aware of behavioural interventions, such as Cognitive Behavioural Therapy for Insomnia (CBT-I) as a better option (Cheung et al.,2013). The aim of this situational analysis is to highlight the standards of sleep medicine, with the lens on insomnia, and compare South Africa to other countries - to ask what is going on in South Africa regarding the management of insomnia? METHODS This is a structural analysis of the current status of managing insomnia globally, and in South Africa. The method of gathering information for critical analysis of the opinions of doctors managing insomnia in the United Kingdom and Australia, with the final lens on South Africa is as follows: 1. Mixed methods study - A pilot study in a clinical setting in South Africa focusing on symptom recognition and management of insomnia. 2. A qualitative analysis of two focus groups exploring the lived experience of insomnia in South African women, using Interpretive Phenomenological Analysis (IPA). 3. A review of literature investigating primary health care practitioner perspectives and opinions on the management of insomnia. RESULTS 1. Symptom expression of insomnia is different, yet similar when comparing questionnaires and the intake narratives in a clinical setting in South Africa. This information assists efficient conceptualisation of the problem and guides appropriate treatment for insomnia. 2. Employed professional women are able to define good and bad sleep and the consequences. They ruminate about sleep quality and quantity when sleep is bad and focus on performance at work the following day. Unemployed women have no definition for insomnia, using narratives to describe fears about vulnerability, safety, loneliness and poverty. 3. Primary health care practitioners' perspectives in the UK and Australia on managing insomnia are reviewed against the backdrop of the standards of practice in managing insomnia according to the American College of Physicians guidelines (ACP, 2017). CONCLUSION Health care practitioners in other countries experience a limitation within the health care system in the management of insomnia. They cite a lack of training, resources and guidelines. They feel coerced by patients to prescribe hypnotics, when they would rather use more conservative, evidence-based behavioural interventions such as CBT-I. Are perspectives the same in South Africa? in a clinical setting in South Africa, intake narratives prove as useful as a long questionnaire cueing criterion-based symptoms. This suggests that succinct intake narratives alone on intake, can be used to expediate and guide treatment for insomnia. Understanding the diversity of the socio-economic fabric in South Africa through SASOP CONGRESS - ORAL PRESENTATIONS

SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 * 11 SASOP CONGRESS - ORAL PRESENTATIONS the lived experiences of women with good and bad sleep, provides a baseline for understanding South African diversity and formulating guidelines for defining, assessing and treating insomnia in South Africa, against the scaffold of global trends for standards of practice in sleep medicine. ________________________________________ THE PSYCHOSOCIAL WORK CONDITIONS AND MENTAL WELL-BEING OF INDEPENDENT SCHOOL HEADS IN SOUTH AFRICA Dr Jozef Breedt University of the Witwatersrand [email protected] Jozef Erasmus Breedt1, Belinda Marais1 , Jonathan Patricios1 1 University of the Witwatersrand INTRODUCTION Numerous international studies have investigated the well-being of school Heads. Studies have shown imbalances in psychosocial work conditions with increases demands and depletion of resources, leading to burnout and stress, negatively impacting on mental well-being. Investigating and understanding psychosocial work conditions and the impact on well-being of Heads will assist in identifying individuals at risk and highlight factors that could be addressed in intervention programs. This has not yet been explored in South African research. This study aimed to determine the psychosocial work conditions and mental wellbeing of South African Independent School Heads. METHODS This study adopted a quantitative research approach, using an anonymous cross-sectional questionnaire design, distributed to Heads of independent schools in South Africa (N=817; n=296). A demographic questionnaire, the COPSOQ IIImiddle version and MHC-SF were used to collect data. Spearman correlation, analysis of variance and univariate linear regression were used to describe associations. RESULTS This study demonstrated fair correlation between various psychosocial work conditions and mental well-being e.g., higher Emotional Demands had a negative impact on mental well-being whereas Job Satisfaction had a positive impact. Furthermore, two demographic groups were identified as being most at risk for poorer well-being: younger and female Heads. CONCLUSION The well-being of Heads in South Africa is an under-researched field. This cohort is burdened by a multitude of job and personal demands, requiring emotional and physical resources. This study illustrated much room for improvement in the mental well-being and psychosocial work conditions of Heads and identified specific vulnerable groups and factors in the workplace that could be addressed through improved policy and strengthening resources. More research is required to identify specific factors in vulnerable groups that can be addressed. ________________________________________ THE PREVALENCE OF DEPRESSIVE SYMPTOMS IN ADOLESCENTS LIVING WITH HUMAN IMMUNODEFICIENCY VIRUS (HIV) ATTENDING HIV CLINICS IN THE WEST RAND HEALTH DISTRICT, JOHANNESBURG, SOUTH AFRICA Dr Vuyiswa Gantsho University of the Witwatersrand [email protected] Vuyiswa Gantsho1, Mvuyiso Talatala1 , Nokuthula Mdaka1 1 University of the Witwatersrand INTRODUCTION Adolescents living with HIV (ALWHIV) are more vulnerable to developing depressive symptoms. This is linked to the bidirectional relationship between the Human Immunodeficiency Virus (HIV) and depression with one exacerbating the other. Despite this knowledge the screening of depression is not routinely integrated into HIV treatment programmes. METHODS This was a cross-sectional study of 125 adolescents living with HIV. The modified Patient Health Questionnaire for Adolescents (PHQ-A) was used to screen for depressive symptoms with a score of ≥ 5 deemed significant. A distress protocol was used for immediate psychological intervention. RESULTS The prevalence of depressive symptoms was 44.8%. This prevalence was higher among female participants (58.9%), albeit not statistically significant, and among the older age group of 15-19 years (87.5%). The majority of the adolescents reported mild-moderate symptoms (88.5%) and academic difficulties (61.6%). Overall, 36.8% adolescents had suicidal behaviours. Most participants with symptoms of depression had full viral suppression (66%). In overall, the majority of participants had either one or both parents as caregivers (69.6%) and had no opportunistic infections (68.5%). CONCLUSION High prevalence of depressive symptoms was found in ALWHIV. This finding emphasize the need for integrating mental healthcare into routine HIV/AIDS and programme as recommended by WHO and the SA national ART guidelines. This integration will address the high unmet treatment needs for ALWHIV and comorbid depression by facilitating entry onto onsite mental health screening and psychosocial support services for further assessment and referral to specialized psychiatric care if needed.

YELATE is indicated for the treatment of depression, as defined by DSM-IV Criteria, and diabetic peripheral neuropathic pain (DPNP). 2 HELPLINE: 0800 21 22 23 www.sadag.org Reference: 1. Peterson, T. (2019, July 4). Declare Independence from Your Anxiety, Celebrate Freedom, Healthy Place. https://www.healthyplace.com/blogs/anxiety-schmanxiety/2019/7/ declare-independence-from-your-anxiety-celebrate-freedom [Accessed February 2023] 2. Yelate [Professional lnformation]. Sandton, South Africa: Dr. Reddy’s Laboratories (Pty) Ltd; 2021. 3. EFPIA Patient Think Tank. Working Together with Patient Organisations White Paper. June 2019. S5 Yelate 30 (capsule), 60 (capsule). Registration numbers: Yelate 30: 44/1.2/0114. Yelate 60: 44/1.2/0115. Yelate 30. Each capsule contains duloxetine hydrochloride equivalent to duloxetine 30 mg. Contains sugar. Yelate 60. Each capsule contains duloxetine hydrochloride equivalent to duloxetine 60 mg. Contains sugar. For full prescribing information refer to the professional information approved by the medicines regulatory authority. Dr. Reddy’s Laboratories (Pty) Ltd. Reg no. 2002/014163/07. Tel: +27 11 324 2100. www.drreddys.co.za. R1146516-ZA-CO-25022023-0743-31 Mar 25 HEALTH CARE PROFESSIONALS PATIENTS 3 THIS INFORMATION IS INTENDED FOR HEALTHCARE PROFESSIONALS ONLY. Dr. Reddy’s

SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 * 13 SASOP CONGRESS - ORAL PRESENTATIONS THE VALPROATE PRESCRIPTION PATTERN FOR FEMALE MENTAL HEALTH CARE USERS OF REPRODUCTIVE AGE Dr Phumla Gasa Discipline of Psychiatry, School of Clinical Medicine, College of Health Sciences, University of KwaZuluNatal, Durban [email protected] Phumla Gasa1, Andrew Tomita2,3, Vidette Juby1 , Saeeda Paruk1 1 Discipline of Psychiatry, School of Clinical Medicine, College of Health Sciences, University of KwaZuluNatal, Durban 2KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa 3Centre for Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa INTRODUCTION Sodium valproate (valproate) is used both as an anti-epileptic and a mood stabiliser is teratogenic in pregnancy. A Dear Health Care Professional Letter (DHCPL) issued in December 2015 recommended the avoidance of sodium valproate prescription in women of childbearing age (WOCBA) and pregnant women. This study aimed to describe the prescription pattern of valproate in female mental health care users (MHCUs). METHODS This was a descriptive, retrospective chart review of female in- and out-patient aged 12- 55 years who were receiving a valproate prescription for mental illness between 1 January 2018 and 31 December 2020 in a regional hospital psychiatry department in King Dinizulu Hospital Complex, Durban, KwaZulu-Natal. The data was extracted from the patient files by a medical doctor with clinical psychiatry experience. Statistical Package for Social Sciences (SPSS version 25.0) was used for data analysis RESULTS Of the 158 females who received valproate during the study period, 15 (9.5%) had it tapered off while 143 (90.5%) were continued. Only 19% of all the patients had documented counselling regarding valproate, 19(12%) had documented contraceptive use, and six (3.8%) continued its use during pregnancy. The most frequently prescribed dose range was 800mg-1499mg/day (n=111, 70.7%) and the most common psychiatric indication was a psychotic disorder. CONCLUSION This study showed that prescription of valproate in female mental health care users still occurs in practise in South Africa despite the guidelines outlining management of those of reproductive age on valproate. Use was poorly documented, as was overall monitoring. ________________________________________ SEX VERSUS GENDER ASSOCIATIONS WITH BRAIN STRUCTURE Dr Hilmar Luckhoff Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University [email protected] Hilmar Luckhoff1, Retha Smit1 , Laila Asmal1 , Lebogang Phahladira1 , Robin Emsley1 , Stefan du Plessis1 1 Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University INTRODUCTION Sexual dimorphism in brain structure is welldescribed, but effect sizes are often limited, and few regions of interest (ROIs) have shown reproducible associations. In contrast to sex (a biological distinction), little is known about the associations between gender (a societal construct) and brain structure in the general population. METHODS We examined the associations of sex vs. gender with FreeSurfer-generated cortical thickness and subcortical brain volume ROIs in adults screened for general medical comorbidities, mental illness, and substance use (n = 88). Gender role endorsement was assessed using the Bem Sex Role Inventory. For our main outcomes, we calculated an androgyny score as the difference between the femininity and masculinity scores (F – M). Post-hoc testing was performed to determine possible sexspecific associations of masculinity vs. femininity scores with brain structural measures in males vs. females. RESULTS For the global neuroimaging outcomes, we found that sex, but not gender, predicted larger subcortical gray matter volumes, while gender, but not sex, predicted thicker global cortical thickness. Sex and gender were independent predictors of cerebral white matter volumes. Hierarchical regression revealed that higher androgyny scores predicted thicker cortical thickness for the prefrontal cortical ROIs. Post-hoc testing showed sex-specific associations between higher femininity scores and thicker prefrontal cortical thickness in females, but not males. CONCLUSION Sex and gender showed semi-independent associations with brain structure in a general population sample. Our research supports the disaggregation of sex and gender to provide a more nuanced perspective on brain structural differences between men and women.

14 * SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 SASOP CONGRESS - ORAL PRESENTATIONS DISCLOSING YOUR HIV STATUS TO FAMILY, FRIENDS AND HEALTH CARE WORKERS, A DAUNTING TASK Dr Sibongile Mashaphu UKZN [email protected] Sibongile Mashaphu1, Suntosh Pillay1 1 UKZN INTRODUCTION Understanding the dynamics of disclosure versus non-disclosure in serodiscordant couples within the SA context has implications in the management of the HIV epidemic, which continues to affect black South Africans disproportionately. Research in this area is necessary to inform the design of future risk-reduction interventions targeted at serodiscordant couples, to pay specific attention to the complexities of disclosure in collectivist cultures, where disclosure has ripple effects on multiple levels of the couples’ psycho-social and relational systems. METHODS Using a subset of data, this study aimed to improve our understanding of how disclosure of HIV is perceived and experienced by serodiscordant couples. The data was extracted from two focus group discussions with five couples and is further informed by other instances of disclosurerelated conversations that emerged through the intervention. A thematic analysis of the data was conducted. RESULTS Three main types of disclosure emerged: disclosure within the relationship; disclosure to family; disclosure to health care workers and disclosure to children. Each type of disclosure further contained a core psycho-social conflict that impacted on couples’ decisions to disclose or not disclose their serodiscordant status. These included conflicts between protecting versus weakening the couples’ relationship; gaining support versus being stigmatized by family; and empowering children versus creating emotional instability in their lives. CONCLUSION The findings reported in this study suggest that couples experience various psycho-social conflicts about whether or not to disclose the HIV status of the infected partner to other people. ________________________________________ THE ULTIMATE BETRAYAL- INTIMATE PARTNER VIOLENCE IN FEMALE MENTAL-HEALTH-CAREUSERS DURING THE COVID-19 PANDEMIC Dr Lynette Moodley Department of Psychiatry, Nelson.R.Mandela School of Medicine, University of KwaZulu-Natal [email protected] Dr Lynette Moodley1, Dr Vuyokazi Ntlantsana1 , Andrew Tomita2, Professor Saeeda Paruk1 1 Department of Psychiatry, Nelson.R.Mandela School of Medicine, University of KwaZulu-Natal 2Centre for rural health School of Nursing and Public Health, University of KwaZulu-Natal INTRODUCTION Background: Adverse childhood experiences (ACEs) and interpersonal violence (IPV) in mentally ill women is often neglected and needs to be reviewed in light of the suggested increase in IPV during the COVID-19 pandemic. Aim: We investigated the prevalence of ACEs and IPV in women living with severe mental illness (SMI) attending an outpatient psychiatry service at a public hospital in KwaZulu-Natal, South Africa during the COVID-19 pandemic. We also described the association of ACEs with later IPV. METHODS A written survey comprising of socio-demographic and clinical questionnaire, WHO Adverse Childhood Experiences International Questionnaire (ACE-IQ) for ACEs and the Women abuse screening tool (WAST) for IPV, was completed by the 154 women with SMI. The inclusion criteria were women aged 18 and older with severe mental illness who received out-patient mental health services and were able to read and write in English. Stata version 15 was used for data analysis. RESULTS 141 (91.6%) participants scored positive for ACEs and 104 (67.5%) had experienced three or more ACEs. The most prevalent forms of ACEs were, emotional neglect 72 (46.8%), one or no parents, parental separation, or divorce 104 (67.5%), contact sexual abuse 67 (43.5%) and witnessing a household member treated violently 67 (43.5%). Sixty-one (46.6%) participants reported IPV with scores ≥ 13 (indicative of abuse). On logistic regression, experience of three or more ACEs was significantly associated with IPV in adulthood (aOR 3.3, 95% CI: 1.2-9.6). CONCLUSION The high prevalence of IPV and association of IPV with cumulative ACEs reflects firstly the hidden epidemic of intimate partner violence and secondly the vulnerability of those with ACEs to become victims of abuse later which is often missed in the care of women with SMI. ________________________________________ ADVERSE CHILDHOOD EXPERIENCES, MENTAL ILLNESS, HIV AND VIOLENT OFFENDING AMONG FEMALE INMATES IN DURBAN, SA Dr Samantha Naidoo Vista Clinic [email protected] Samantha Naidoo1, Saeeda Paruk2, Liezel Ferreira3, Ugasvaree Subramaney3 1 Vista Clinic

Redilev is indicated in adults and adolescents (from 16 years of age) as • Monotherapy for the treatment of newly diagnosed partial onset seizures with or without secondary generalisation • Adjunctive therapy to treat partial onset seizures, with or without secondary generalisation Dr. Reddy’s HEALTH CARE PROFESSIONALS PATIENTS 3 HELPLINE: 0800 21 22 23 www.sadag.org REDILEV INDICATIONS:1 Redilev is also indicated as adjunctive therapy in the treatment of: • Myoclonic seizures in adults and juvenile myoclonic epilepsy in adolescents (from 12 years of age), • Primary generalised tonic-clonic seizures in adults, and • Idiopathic generalised epilepsy in adolescents (from 16 years of age) References: 1. Redilev [Professional Information]. Sandton, South Africa: Dr. Reddy’s Laboratories (Pty) Ltd; November 2016. 2.https://www.mayoclinic.org/ drugs-supplements/levetiracetam-oral-route/side-effects/drg-20068010?p=1 3. EFPIA Patient Think Tank. Working Together with Patient Organisations White Paper. June 2019. S3 Redilev 250/500/750. Each tablet contains levetiracetam 250 mg/500 mg/750 mg. Reg. No’s: 41/2.5/0460; 0461; 0462. Dr. Reddy’s Laboratories (Pty) Ltd Reg no. 2002/014163/07. Block B, 204 Rivonia Road, Morningside, Sandton, 2057. www.drreddys.co.za. For full prescribing information refer to the professional information approved by the medicines regulatory authority. This content is for HCPs only. The intended recipient should not share or forward it. R1164079-ZA-CO-02052023-001-31 May 2025

16 * SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 SASOP CONGRESS - ORAL PRESENTATIONS 2Discipline of Psychiatry, Colleges of Health Sciences, University of KwaZulu-Natal 3Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University Of the Witwatersrand INTRODUCTION Childhood adversities and adult trauma are common among female inmates. Associations have been documented with childhood adversities and mental illness, personality disorders, human immuno-deficiency virus (HIV) and violent offending. However, no such studies have been conducted in South Africa, which has a high prevalence of trauma and the largest HIV epidemic globally. METHODS Aim: To measure the prevalence of childhood adversities and adult trauma; and to determine if there is a relationship between childhood adversities, mental illness, personality disorders, HIV and violent offending among female inmates. Setting:The study was conducted at the largest correctional centre in Durban, KwaZulu-Natal, South Africa. Methods: This cross-sectional, descriptive study randomly recruited 126 female inmates. The World Health Organisation’s Adverse Childhood Experiences- International Questionnaire (WHO ACE-IQ) was used to measure childhood adversities; the Structured Clinical Interview for the Diagnostics and Statistical Manual-5 Research Version (SCID 5-RV) was used to diagnose mental illness; and a structured questionnaire was used to measure adult trauma. HIV data was confirmed from prison medical records. RESULTS Elevated rates of individual childhood adversities and adult trauma were found. Associations were found between cumulative childhood adversities and post-traumatic stress disorder, alcohol use disorder, substance use disorder, borderline personality disorder and HIV. CONCLUSION Female inmates are a highly traumatised population. Prison mental health services should provide trauma-informed and trauma-focused care to improve inmates’ mental health outcomes and decrease recidivism. This study contributes to the emerging literature on ACEs and their associations among incarcerated female populations, in a low and middle-income, South African setting SOCIO-DEMOGRAPHIC, FORENSIC AND CLINICAL CORRELATES IN FEMALE OBSERVANCE REFERRED FOR NON-VIOLENT CRIMES. Dr Muthumuni Nemavhola University of the Witwatersrand Johannesburg [email protected] Muthumuni Nemavhola1, Ora Gerber-Schutte1 , Daniel Hoffman1 , Tando Melapi1 University of the Witwatersrand Johannesburg1 , INTRODUCTION Globally, research into female criminality is scarce as criminal behaviour is highly masculinised. In South Africa, no research has been published that specifically focuses on the social, forensic and clinical characteristics of females observandi referred for non-violent crimes. The study aimed to describe the socio-demographic, clinical and forensic correlates in females referred to Sterkfontein Hospital for forensic psychiatric observation following a non-violent criminal charge. The study also sought to establish the relationship, if any, between the correlates and observation outcomes: fitness to stand trial and criminal responsibility. METHODS A retrospective record review of all cases referred to the Sterkfontein psychiatric hospital forensic unit for a single observation over a 10-year period was conducted. RESULTS Sixty-five cases were identified and included in the study. Most female observandi referred for nonviolent crimes were found to be single (84.6%), unemployed (67.7%), abused (55.4%)with a high prevalence of mental illness (90.8%) and substance use. Non-adherence to psychotropic medication and substance use were identified in approximately a third of the study population respectively. The most common charges were theft or shoplifting (64.6%). A majority of the sample was found fit and responsible (57%). Bipolar (21%) and primary psychotic disorders (35.7%)were associated with statistically significant outcomes of trial incompetence and lack of criminal responsibility (p=0.005 and 0.028 respectively). CONCLUSION From the findings of the study female observandi referred for non-violent crimes can be described as single, unemployed and abused with a high prevalence of mental illness and substance use and more likely to be charged with theft or shoplifting. It is thus, recommended that the correlates observed ORAL PRESENTATION ABSTRACTS

SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 * 17 SASOP CONGRESS - ORAL PRESENTATIONS in this study be included (in a standardised manner) in the standard of care in forensic assessments of female observandi. It is further recommended that future prospective studies are conducted that include comparisons with males who are referred for non-violent crimes and females referred for violent crimes. ________________________________________ THE OCCURRENCE OF HYPONATRAEMIA AMONGST PATIENTS WITH SEVERE MENTAL ILLNESS ADMITTED AT SOLOMON STIX MOREWA MEMORIAL HOSPITAL, JOHANNESBURG Dr Natsai Nhiwatiwa University of the Witwatersrand [email protected] Dr. Natsai Nhiwatiwa1, Prof. Yosuf Veriava1 , Dr. Mvuyiso Talatala1 University of the Witwatersrand1 INTRODUCTION Morbidity in patients with severe mental illness is known to be higher than in the general population. In addition to the mental illness, patients with severe mental illness are vulnerable to commonly occurring medical conditions. Numerous factors contribute to this, including the propensity to have comorbid conditions and the effects of long-term treatment with psychotropics. Hyponatraemia, the most common electrolyte abnormality encountered in hospitalised patients (Adrogue and Madias, 2000, Spasovski et al., 2014), may be overlooked in patients with severe mental illness (Sivaraman and Manivel, 2016, Sawant et al., 2019). Patients with severe mental illness are vulnerable to the development of hyponatraemia due to psychogenic polydipsia, comorbid conditions and the long-term use of psychotropics. Current guidelines do not emphasise the need for longterm electrolyte monitoring in patients with severe mental illness. METHODS This was a retrospective records review that quantified the exact number of cases of hyponatraemia in a sample that consisted largely of former Life Esidimeni patients admitted at Solomon Stix Morewa Memorial Hospital. In addition, the associated demographic variables and testing trends were analysed. RESULTS 32% of the patients had hyponatraemia on admission to Solomon Stix Morewa Memorial Hospital, significantly higher than that of the general population. Female patients and patients on antihypertensive medications were more likely to have hyponatraemia. Other medical conditions such as hypertension, type 2 diabetes mellitus and chronic obstructive pulmonary disease were significant predictors for the development of hyponatraemia. Patients on combination antipsychotics (first- and second-generation antipsychotics) were also more likely to develop hyponatraemia than those not on combination antipsychotics. CONCLUSION Hyponatraemia was found in a significant proportion of the study participants. Patients with severe mental illness are more likely to have comorbid illnesses that can be overlooked. More recognition of hyponatraemia as a significant adverse effect of comorbid illness, psychiatric illness and chronic medication is required in patients with severe mental illness. ________________________________________ THE GUT MICROBIOME AND NEUROPSYCHIATRIC DISORDERS IN A SOUTH AFRICAN POPULATION: THE SANEUROGUT INITIATIVE Ms Michaela O'Hare 1 Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa. 2 South African Medical Research Council / Genomics of Brain Disorders Research Unit, Cape Town, South Africa. 3Department of Biomedical Sciences, Division of Molecular Biology and Human Genetics, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa. [email protected] Michaela O'Hare1.2.3, Patricia C. Swart1.2, Stefanie Malan-Müller1 , Yolandi Espach1.2, Leigh L. van den Heuvel1.2, Erine Bröcker1.2, Soraya Seedat1.2, Sian M.J. Hemmings1.2 1 Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa 2South African Medical Research Council / Genomics of Brain Disorders Research Unit, Cape Town, South Africa 3Department of Biomedical Sciences, Division of Molecular Biology and Human Genetics, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa INTRODUCTION Neuropsychiatric disorders (NPDs) are chronic disorders that are among the most prevalent causes of global years lived with disability and global disability-adjusted life years. In South Africa, only a small proportion of patients diagnosed with NPDs have access to affordable and effective treatments. Understanding the underlying mechanisms of NPDs may aid in developing novel treatments. Recent research suggests that the gut microbiome can be altered by traumatic experiences and stress, and that it also plays a role in the development of NPDs. However, most of this research has been conducted in either animal models, or human populations from the Global North. Therefore, as part of the saNeuroGut study, we aimed to assess the associations between gut microbial composition and self-reported symptom severity of anxiety, depression, and posttraumatic stress (PTS) among South African adults.

Depression can make keeping on top of daily tasks a struggle ® References: 1. Baune BT et al. Int J Neuropsychopharmacol 2018; 21 (2):97-107.2. Fagiolini A et al. Journal of Affective Disorders. Nov 2020. S5 Vortioxetine 5 mg, 10 mg and 20 mg Lundbeck Film-coated Tablets. ® Each film-coated tablet contains vortioxetine hydrobromide equivalent to 5 mg, 10 mg or 20 mg vortioxetine. Reg No.: 5 mg 55/1.2/0580; 10 mg 55/1.2/0581; 20 mg 55/1.2/0583 S5 Brintellix (vortioxetine) film coated tablets. Each tablet contains vortioxetine hydrobromide - equivalent to vortioxetine. Reg No. 5 mg: 48/1.2/0429; 10 mg 48/1.2/0430; 20 mg 48/1.2/0432 H. Lundbeck (Pty) Ltd. Office A1002 Knightsbridge, 33 Sloane Street, Bryanston, 2190 Tel: +27 11 699 1600. For full prescribing information refer to the professional information approved by the medicines regulatory authority. ZA-VOR-0073 February 2023 ® Vortioxetine Lundbeck can help with her mood, concentration and fatigue, so she is able to 1,2 organise her day again

SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 * 19 SASOP CONGRESS - ORAL PRESENTATIONS METHODS Eighty-six participants completed online self-report questionnaires to assess anxiety, depression and PTS. Stool samples were self-collected, after which microbial DNA extraction was performed and samples underwent 16S rRNA (V4) sequencing. Linear regression models were generated to assess associations between symptom severity and alpha diversity estimates (intra-sample diversity), as well as the former with clr-transformed individual taxa abundances. Permutational analyses of variance were used to assess beta diversity (inter-sample diversity). RESULTS No alpha diversity estimates were significantly associated with anxiety, depression or PTS symptom severity. Overall gut microbial composition between samples significantly differed based only on PTS scores. No individual genera showed significant association with psychiatric symptom severity following correction for multiple testing. However, suggestive findings imply Paraprevotella is differentially abundant for anxiety, and many genera for PTS, including Alistipes, Bacteroides and Faecalibacterium which have previously been associated with other NPDs. Of note, Odoribacter and Catenibacterium are suggestively differentially abundant (p = 0.009, p-adjusted = 0.126 and p = 0.002, p-adjusted = 0.082, respectively) based on PTS scores, which is congruent with a previous PTS study in South Africa. CONCLUSION This study is the first of its kind in South Africa, with results providing insight into the relationship between the human gut microbiome and NPDs in a South African population. ________________________________________ WHITE MATTER MICROSTRUCTURAL CHANGES IN CHILDREN WITH PRENATAL ALCOHOL EXPOSURE IN A SOUTH AFRICAN BIRTH COHORT: NEONATES TO 6 YEARS Dr Annerine Roos University of Cape Town, Stellenbosch University [email protected] Kirsten Donald1.2, Chanelle Hendrikse1 , Annerine Roos2.3.4, Catherine Wedderburn1.2, Sivinesi Subramoney1 , Jessica Ringshaw1 , Layla Bradford1 , Nadia Hoffman2.3, Katherine Narr5, Roger Woods5, Tiffany Burd4.6, Heather Zar4.6, Shantanu Joshi7 , Dan Stein2.3.4 1 Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa 2Neuroscience Institute, University of Cape Town, Cape Town, South Africa 3Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa 4SAMRC, Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa 5Department of Neurology & Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA 6Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa 7 Department of Neurology & Department of Bioengineering, University of California, Los Angeles, California, USA INTRODUCTION Prenatal alcohol exposure (PAE) affects white matter development in early life. Nevertheless, few studies investigated the trajectory of white matter development in low-and middle-income countries. This study explored white matter trajectories during the pre-school years in a South African birth cohort, aiming to examine windows of maximal impact of PAE on the developing brain. METHODS Diffusion weighted images (DWI) were acquired on a 3T MRI scanner over time on children in the Drakenstein Child Health study (DCHS). Information on maternal alcohol use and other antenatal variables were collected from 28-32 weeks’ gestation. A total of 342 quality diffusion datasets were included: n=82 neonates (30 PAE, 52 controls; 55% male), n=121 2-3-year-olds (27 PAE, 94 controls; 59% male), and n=139 6-7-year-olds (45 PAE, 94 controls; 52% male). Diffusion data was analysed using Tortoise software, and fractional anisotropy (FA) was derived using Tract-based Spatial Statistics. A-priori tracts known to associate with PAE were callosal, brain stem, projection, association, callosal and limbic tracts. Mixed effects models determined the effect of time and PAE X time interaction with sex and maternal education as covariates. RESULTS We found significant PAE X time interaction in the corpus callosum genu, superior longitudinal fasciculus (SLF), superior cerebellar peduncle (SCP), and the fornix, suggesting altered white matter development trajectories for PAE compared to control children. For PAE compared to unexposed children at 2 years, the SCP-L and SLF-R showed significant PAE by time interactions, whereas the SLF-L and SCP-R showed significantly increased FA. CONCLUSION Our data suggest that PAE continually influence maturational processes during early brain development, which is critical for early intervention. PAE effects in the SLF (language, visuospatial functioning) and SCP (motor regulation, learning, memory) coincide with previous research, but here we also describe detectable change in early life white matter development compared to the pre-school years. Alterations in FA trajectories across these tracts in PAE suggest altered glial cell proliferation or migration in utero, disturbing normal myelin development and tract organization, with greatest impact in the first 3 years of life. Findings show critical need to acquire early intermediate time points in longitudinal studies of PAE.

20 * SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 SASOP CONGRESS - ORAL PRESENTATIONS THE RELATIONSHIP BETWEEN NUTRIENT INTAKE AND EXECUTIVE FUNCTION IN ADULTS WITH POST-TRAUMATIC STRESS DISORDER Dr Kirsten Rowe Psychiatry Registrar, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa; Honorary Postdoctoral Researcher, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa. [email protected] Kirsten Rowe1, Erine Bröcker2, Sharain Suliman3, Renée Blaauw4, Soraya Seedat5, Leigh Luella van den Heuvel6 1 Psychiatry Registrar, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa; Honorary Postdoctoral Researcher, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa 2Doctoral Researcher, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa 3Postdoctoral Fellow, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa 4Professor, Division of Human Nutrition, Department of Global Health, Stellenbosch University, Cape Town, South Africa 5Distinguished Professor of Psychiatry and Executive Head of Department, Department of Psychiatry, University of Stellenbosch, South Africa; South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa 6Consultant Psychiatrist and Associate Professor, Department of Psychiatry, University of Stellenbosch, South Africa; South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa INTRODUCTION Executive function (EF) deficits are common in adults with post-traumatic stress disorder (PTSD) and may predict re-experiencing and hyperarousal symptom severity, and functional outcomes. Dietary intake of nutrients is associated with deficits in EF, however this has not been systematically evaluated in adults with PTSD. Macro- and micronutrient intake are potential modifiable factors that may influence EF in PTSD. This study’s objective was to explore the relationship between the daily dietary (foodonly) intake of ω-3 and ω-6 polyunsaturated fatty acids (PUFAs), antioxidants vitamin C and vitamin E, vitamin D, vitamin B12 and folate, and EF in adults with PTSD. METHODS This was a cross-sectional observational nested study of adults with PTSD without significant comorbidities who completed neurocognitive assessments (n = 201). Digit span backwards, spatial span backwards, Stroop test and the Ruff Figural Fluency Task were used to assess EF and calculate a global EF score. FoodFinder nutrient intake based on 24-hour dietary recalls were used to calculate average food-only daily nutrient intake. Multivariable linear regression models were used to regress EF on the nutrient variables. Adjusted models controlled for age, sex, education, and body mass index. RESULTS More than 80% of the sample were below the Dietary Reference Intake for daily intake of vitamin C, vitamin E, ω-3 PUFAs, vitamin D and folate. Intake of vitamin E, ω-3 PUFAs, and ω-6 PUFAs were all positively associated with planning, with vitamin E (adjusted β = 0.20, p = 0.004) and ω-6 (adjusted β = 0.17, p = 0.01) remaining significantly positively associated with planning ability after adjustment for potential confounders. Vitamin D intake was negatively associated with interference (adjusted β = -0.21, p = 0.01). Vitamin C, vitamin B12 and folate intake were not associated with EF. CONCLUSION Dietary intake of vitamins E, ω-3 and ω-6 may be important modifiable factors affecting EF in adults with PTSD. Randomised controlled trials are needed to investigate whether micro- and macronutrient interventions can improve EF and other outcomes in PTSD. ________________________________________ INVESTIGATING THE GUT MICROBIOME IN PATIENTS WITH SCHIZOPHRENIA Ms Carlien Rust Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa [email protected] Carlien Rust1, Robin Emsley1 , Laila Asmal1 , Soraya Seedat1 , Etheresia Pretorius2, Sian Hemmings1 1 Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa 2Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa INTRODUCTION Growing evidence suggests a complex interplay between the gut microbiome and schizophrenia

Introducing Drug layer Barrier layer Outer enteric layer When depression hurts… 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). (0)12 748 6400. 04/DUL/09/21/AD. Multi-layer benefits1,2 Drug layer Barrier layer Outer enteric layer Suspension coating technique for greater bioavailability Protects Duloxetine from acidic layer of enteric coating Protects Duloxetine from gastric acid Greater amount of drug available at the site Ensures optimal absorption Avoids Sub-therapeutic dose Features Benefits with TRIPEL (Tri-layered pellet) technology1,2

22 * SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 SASOP CONGRESS - ORAL PRESENTATIONS (SCZ) through the microbiome-gut-brain axis. Dysbiosis of the gut microbiome has been observed in SCZ patients, indicating potential associations between specific microbial profiles and disease severity. This study aims to investigate the intricate connections between the gut microbiome and SCZ. METHODS 16S rRNA (V4) sequence data for 41 patients with SCZ (first-episode psychosis, FEP, n = 24; chronic patients n = 17) and 48 controls from the Shared Roots of Neuropsychiatric Disorders and Cardiovascular Disease Project (SR) were analysed. Patients were recruited from general and psychiatric hospitals and community clinics. The diagnosis of SCZ was based on the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (SCID-IV). Data analysis was done in R studio (dada2 pipeline) and QIIME2 (diversity and composition plugins) to assess diversity (PCoA and adonis PERMANOVA) and differential abundances (ANCOM and ANCOMBC). Covariates included in the analyses were casecontrol status, sex, and current smoker status. RESULTS We found no significant results for cases versus controls or FEP versus chronic cases. The results did suggest that Alistipes (p = 0.064) were enriched in SCZ cases versus controls. Moreover, the results suggested the differential abundance of Methanobrevibacter (p = 0.068) and Butyrivibrio (p = 0.083) were depleted in FEP cases, whereas Gemmiger (p = 0.098) was enriched in chronic cases compared to controls. CONCLUSION This is an exploratory study done on a South African population and larger studies are needed to confirm the findings of the gut microbiome's association with case-control statuses and Methanobrevibacter, Butyrivibrio, Gemmiger and Alistipes. ________________________________________ MATERNAL MENTAL HEALTH AND FILICIDE IN SOUTH AFRICA: AN OPPORTUNITY FOR MINIMIZING STIGMA AND IMPROVING OUTCOMES Prof Ugash Subramaney Department of Psychiatry, School of Clinical Medicine, University of the Witwatersrand, Johannesburg [email protected] Dr Yumna Minty Department of Psychiatry, School of Clinical Medicine, University of Witwatersrand; Psychiatric Department, Chris Hani Baragwanath Academic Hospital [email protected] Ugasvaree Subramaney1 1 Wits University INTRODUCTION Filicide, the act of a parent killing their offspring, is rare, varying between 0.6–2.1 per 100,000 children under 15. Research on the mental health correlates of filicide allude to a complex interplay of factors, including mental illness, childhood trauma, victimization from violence and unstable marital relationships. This talk reflects the fundamental issues traversing two important clinical psychiatric subdisciplines - forensic psychiatry and women’s mental health. On the background of recent infanticide cases that has caused much public discussion, the authors will discuss pertinent issues related to perinatal mental health and filicide, specifically neonaticide. METHODS Yumna Minty will present current literature on perinatal mental health, as well as observations and preliminary data on the prevalence of psychiatric disorders and associated factors from the Seketela maternal mental health clinic at Chris Hani Baragwanath Academic Hospital. The focus will be on commonly occurring mental health symptoms and disorders, as well as psychosocial and environmental factors which are of concern in a perinatal population. The interplay between these aspects (and how they relate to the possible occurrence of filicide) will be discussed, as well as factors unique to the South African context (e.g., high rates of gender-based violence and substance use). Ugash Subramaney, forensic psychiatrist, will review findings from the forensics neurosciences unit spanning twenty-two years of filicide cases referred for forensic psychiatric observation. Two cases will be discussed in depth. RESULTS 31 cases of maternal filicide were referred to the forensic unit for observation. Two case reports reveal gaps in the system leading to tragedy in the form of neonaticide. Case 1 (GH) a woman with treatment resistant schizophrenia who smothered her son and Case 2 (IM) a young woman with bipolar disorder that stabbed her baby were both found not fit to stand trial and not criminally responsible for the offences, due to psychosis at the time of the offence. The scope of mental health problems seen at Seketela Clinic include depression, anxiety and psychotic disorders. The conglomerate of interacting factors will illustrate how they might lead to neonaticide. CONCLUSION Filicide due to severe maternal mental illness is avertible. Accessing services, early recognition and management of risk factors are important,. Sensationalism of filicide by the media, whilst noting important issues of fitness and responsibility at the time of the offence serves to promote stigma of mental illness in the peripartum period.

SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 * 23 SASOP CONGRESS - ORAL PRESENTATIONS BIOMEDICAL ETHICS’ WORSHIP OF AUTONOMY Dr Mvuyiso Talatala University of the Witwatersrand [email protected] Mvuyiso Talatala1 1 University of the Witwatersrand INTRODUCTION It has been argued that respect for autonomy is the moral justification for the objection to coercive treatment in psychiatry. Christman (2020:1) describes “[i]ndividual autonomy [as] an idea that is generally understood to refer to the capacity to be one’s own person, to live one’s life according to reasons and motives that are taken as one’s own and not the product of manipulative or distorting external forces”. In addition to the objections to coercive treatment that are based on moral arguments some legal arguments have been recently advanced by civil society in South African courts with the Constitutional Court of South Africa (2023) making some pronouncements. Civil society is therefore quite engaged in moral, ethical and legal aspects of coercive treatment in South Africa. The presenter intends to explore the use of the principle of autonomy as an objection to coercive treatment and counterargue that coercive treatment reinforces one’s autonomy in the long term. A brief update on the recent court pronouncements on the sections of the Mental Health Care Act that deal with involuntary mental health care will also be provided. METHODS A review of the literature on the arguments for and against coercive treatment was undertaken with particular emphasis on arguments that deal with the principle of respect for autonomy. The recent legal adjudication on matters raised by civil society about involuntary mental health care was also reviewed. RESULTS There is extensive philosophical argumentation on moral permissibility of coercive treatment including the guidance by the World Psychiatric Association on “implementing alternatives to coercion” (WPA 2020). CONCLUSION The argument that autonomy benefits from coercive treatment in psychiatry should caution biomedical ethicists from “worshiping” autonomy and allow for judicious use of coercion instead of abolishing it. ________________________________________ THE CLINICAL IMPLICATIONS OF SWITCHING SMOKERS TO COMBUSTION-FREE PRODUCTS Prof Praneet Valodia Praneet Valodia Consulting Pty Ltd [email protected] Praneet Valodia INTRODUCTION Cigarette smoke increases the metabolism of selected medicines by inducing cytochrome P450 enzymes in the liver. Therefore, cigarette smoke may reduce the clinical effect of medicines used to treat mental disorders. Switching from smoking cigarettes to combustion-free products (e.g., heat-not-burn, snus and e-cigarettes) is likely to have an impact on the metabolism of selected medicines. The absence of tobacco combustion in these smoke-free products reduces the production of the chemicals that induce the metabolism of selected medicines. In this study, phenytoin was used as an example to determine whether combustion-free products have a role to play in epileptic patients who take phenytoin and continue to smoke cigarettes. Similarly, the same principles could be used to determine whether combustion-free products have a role to play in the treatment of mental disorders. The secondary objectives were to assess: (1) the influence of cigarette smoke on phenytoin metabolism (2) the influence of nicotine on phenytoin metabolism including the metabolic pathways involved, and (3) the influence of nicotine on epilepsy in humans, if any. METHODS The literature review was conducted. The potential mechanisms underlying the effects of cigarette smoke and nicotine on phenytoin metabolism and the pathways for phenytoin metabolism were evaluated to determine overlapping mechanisms/pathways. RESULTS Thirty-five studies were reviewed. Cigarette smoke influenced the metabolism of phenytoin by increasing the maximum metabolism rate of phenytoin by an average of 16% in humans. Cigarette smoke is known to contain several polycyclic aromatic hydrocarbons (PAHs), which can lead to faster elimination of numerous medicines, including phenytoin. The metabolic pathways of phenytoin and nicotine do not overlap indicating that nicotine does not influence the metabolism of phenytoin. Hence, complete switching to combustion-free products with similar nicotine concentrations to cigarettes, may reduce the influence smoking has on phenytoin metabolism in epileptic patients who take phenytoin and smoke. CONCLUSION The literature showed that the increase in metabolic rate of phenytoin due to tobacco smoke is probably attributable to PAHs and not nicotine. The reduced levels of PAHs in combustion-free products indicate that there is a role for combustion-free products in epileptic patients who take phenytoin and smoke.

SASOP CONGRESS - ORAL PRESENTATIONS HIV, MENTAL ILLNESS AND SUBSTANCE ABUSE: THE EXPERIENCES OF PERSONS DIAGNOSED WITH TRIPLE DIAGNOSIS AT CHRIS HANI BARAGWANATH ACADEMIC HOSPITAL Dr Sibulele Zuma University of Witswatersrand Psychiatry Department [email protected] Sibulele Zuma1, Gregory Jonsson1 , Laila Paruk1 1 University of Wits Watersrand INTRODUCTION The term triple diagnosis is used to refer to patients with mental illness, substance use disorder as well as HIV infection. Not only is this group clinically complex to manage optimally, but it is also faced with unique challenges that have both predisposed them to having this condition as well as those that are the sequalae of living with multiple co-morbidities.This study looked at the subjective experiences of people living with and being managed for a triple diagnosis. METHODS This is a descriptive qualitative study using the convenience sampling method. Semi-structured in-depth interviews with 12 open ended questions were conducted with 10 participants from the Triple Diagnosis clinic at Chris Hani Baragwanath Hospital, Soweto, South Africa. The study was done in July-December 2018. The participants were questioned about awareness of their condition, the experience of the clinic where they receive health care, the experience of disclosing their diagnoses, their general life challenges and their perception of the level of difficulty that the triple diagnosis may or may not pose in their lives. RESULTS The study participants were most knowledgeable about their HIV diagnosis and seek health care primarily for it. Many were aware of their psychiatric diagnoses and their substance use disorders but were less forthcoming due to feelings of guilt and shame. Participants felt more support for HIV and mental illness diagnoses than substance use disorders from those in their lives. The areas of greatest difficulty included financial difficulties, stigma for having HIV, poor social support and coping with childhood stressors that preceded the triple diagnosis. For many participants having three chronic conditions was burdensome in itself. Participants experienced the triple diagnosis clinic as a supportive base for dealing with the challenges the three diagnoses pose. While triple diagnosis has unique difficulties the participants hopeful. CONCLUSION A specialised multidisciplinary triple diagnosis is beneficial for the physical and mental health of this population. The therapeutic environment of this specialised clinic assists patients to cope with their multiple hardships and reduces harmful coping strategies VYVANSE® offers sustained improvement in adult attention deficit hyperactivity disorder (ADHD) symptoms for up to 14 hours 1 NO ONE SEES HER ADHD BUT EVERYONE SEES HER SUCCESS NO ONE SEES HER ADHD BUT EVERYONE SEES HER POTENTIAL 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. VYVANSE® is the FIRST prodrug stimulant 2,3 • 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 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/0039.

SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 * 25 SASOP CONGRESS POSTER ABSTRACTS EVALUATING THE PERFORMANCE OF POLYGENIC RISK SCORE- & MACHINE LEARNING-BASED CLASSIFICATION FOR THE PREDICTION OF PTSD IN A SOUTH AFRICAN POPULATION Mr Morne Du Plessis (1) Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa (2) South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa [email protected] Morne Du Plessis1.2, Jacomine Grobler3, Leigh van den Heuvel1.2, Soraya Seedat1.2, Sian Hemmings1.2 1 Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa 2South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa 3Department of Industrial Engineering, Faculty of Engineering, Stellenbosch University, Stellenbosch, South Africa INTRODUCTION Post traumatic stress disorder (PTSD) is a complex psychiatric disorder characterized by symptoms of intrusive thoughts, avoidance behaviors, hyperarousal and negative alterations in cognition and mood. PTSD is unique among psychiatric disorders in that its identification is conditional upon exposure to a traumatic incident. While 50-85% of individuals are expected to encounter at least one traumatic event in their lifetime, the prevailing prevalence of PTSD is estimated to lie between 3.9 and 5.6% globally. This discrepancy serves to highlight the existence of factors granting individuals contingent resilience or vulnerability to developing PTSD. While the biological underpinnings elemental to PTSD remain largely unknown, prior heritability estimates have suggested that the disorder presents a genetic component that interacts with non-genetic factors to confer risk of or resilience to PTSD. METHODS This study aims to elucidate the molecular mechanisms underlying PTSD by comparing the predictive performance of a series of PTSDrisk proxies in a uniquely admixed South African population. Polygenic risk score- and machine learning-based predictive approaches will be used to construct, optimize, and subsequently validate models tailored to assess genetic risk in our sample. In addition, we will explore the utility of genetically supported predictor variables by utilizing transcriptome analysis to test the generated risk proxies against potential molecular contributors. RESULTS Data will be presented on preliminary polygenic risk score models attempting to identify the optimal method to predict PTSD status in our sample population. CONCLUSION These findings will add to the growing knowledge base on polygenic risk score- and machine learning-based methods in psychiatric studies, supplement our current research on the genetic mechanisms underlying PTSD, as well as help improve existing analytical capabilities associated with interrogating complex datasets in resourcelimited environments. ________________________________________ AN EXPLORATORY CROSS-SECTIONAL SURVEY OF FACTORS ASSOCIATED WITH UNIVERSITY STUDENTS’ UTILISATION OF DIGITAL MENTAL HEALTH SOLUTIONS IN SOUTH AFRICA Dr Elton Fayiah Gbollie Stellenbosch University [email protected] Dr. Elton Fayiah Gbollie1, Dr. Lucy Jarvis1 , Prof. Jason Bantjes2 1Stellenbosch University 2 Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council SASOP CONGRESS - POSTER ABSTRACTS

26 * SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 INTRODUCTION Digital mental health interventions such as apps and web-based tools aim to promote mental wellbeing. Studies have shown that they can bridge treatment gaps and reduce costs. However, there is limited research from South Africa on the usage of these resources and factors associated with the intention to use them for mental health promotion among university students. The study aims to understand usage, intentions and factors that influence the usage of digital mental health solutions among university students, to develop targeted strategies for the implementation of these solutions. METHODS This study used an exploratory cross-sectional design, recruiting a self-selected sample (n=17,838) of undergraduate and post-graduate university students from three South African universities via email. Participants completed an anonymous online self-report survey administered using REDCap. Data was analysed using SPSS. Data analysis consisted of descriptive statistics, chisquare tests of significance, and univariate and multivariate ordinal regression analysis. RESULTS Positive attitudes towards digital interventions were found, but concerns about privacy and security, as well as the quality of the interventions, were also expressed. The intention to use digital mental health interventions was positively associated with perceptions about accessibility, affordability, privacy, and user-friendliness. CONCLUSION South African University students believe digital solutions may be an acceptable way to increase access to mental health support and improve campus counselling services, but they also would like these interventions to be controlled by legislation and regulations to protect users. More research is needed to assess the uptake and feasibility of integrating digital technologies into existing student support services, including the development of rigorous evaluation methods to assess their effectiveness, as well as willingness to use digital solutions among students with mental health challenges. ________________________________________ IDENTIFYING MICRORNAS ASSOCIATED WITH ANXIETY PRONENESS IN A COHORT OF SOUTH AFRICAN ADOLESCENTS Prof Sian Hemmings Stellenbosch University [email protected] Danielle Jansen van Rensburg1, Jacqueline Samantha Womersley2, Patricia Cathrine Swart2, Soraya Seedat2, Sian Megan Joanna Hemmings2 1 Division of Molecular Biology and Human Genetics, Department of Biomedical Science, Faculty of Medicine and Health Science, Stellenbosch University 2SU/SAMRC Genomics of Brain Disorders Unit, Stellenbosch University; Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University INTRODUCTION Anxiety proneness (AP) is the tendency to react fearfully to stressors due to the belief that they have harmful consequences. High AP individuals are at higher risk of developing anxiety disorders later in life. Biological mechanisms underlying AP remain unclear, although epigenetic mechanisms, such as microRNAs, may explain how the combined genetic variation and environmental risk factors (e.g., childhood trauma [CT]), can increase the risk of developing anxiety disorders. MicroRNAs affect the expression of mRNA targets by inhibiting their gene expression. Insight into biological processes could potentially allow for mechanisms contributing to anxiety disorders to be identified/ targeted. This study aimed to investigate APassociated differences in microRNA expression from South African adolescents with variable exposure to CT. METHODS Total RNA was extracted from PAXgene-stored blood samples (n=88), and were sequenced using the NEXTFLEX Small RNA-sequencing Kit v4 with UIDs, according to the manufacturer’s instructions. Differential microRNA expression analysis was conducted with DESeq2 in R. mRNA target prediction analysis was performed using TargetScan (https:// www.targetscan.org/vert_80/) and DIANAmicroT (http://diana.imis.athena-innovation.gr/ DianaTools/index.php). Using DIANA mirPATH tool for KEGG pathway analysis, to investigate the functional role of predicted mRNA targets, only significant (p<0.05) pathways were included. RESULTS The majority of adolescents were female (75.86%) with an average age of 15 (± 1.20) years. hsamiR-28-5p was upregulated (padj = 0.036), hsamiR-500a-3p (padj = 0.042) and hsa-miR-502-3p (padj = 0.042) were downregulated in high-AP individuals, irrespective of CT. Four pathways (amphetamine addiction, dopamine synapse, nicotine addiction, and long-term potentiation) were associated with high-AP, where more than 10% of the pathways genes were present in each pathway, respectively. CONCLUSION This study found a link between hsa-miR-28-5p, hsamiR-500a-3p and hsa-miR-502-3p, and AP in South African adolescents. Based on potential target genes (GRIN2B, GRIA1, GRIA2, GRIA4, PPP3CA and PPP3CC), these results suggest a correlation between AP and calcineurin and glutamate signalling. SASOP CONGRESS - POSTER ABSTRACTS

28 * SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 THE INTERACTION BETWEEN THE GUT MICROBIOME AND HOST GENOME IN POSTTRAUMATIC STRESS DISORDER Prof Sian Hemmings Stellenbosch University [email protected] Sian Hemmings1, Catharina Rust1 , Stefanie MalanMuller2, Patricia Swart1 , Christopher Lowry3, PGCPTSD Microbiome Workgroup4, Soraya Seedat1 1 Stellenbosch University Department of Psychiatry; SU/SAMRC Genomics of Brain Disorders Unit 2Department of Pharmacology and Toxicology, Faculty of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain 3Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States 4 The Psychiatric Genomics Consortium Posttraumatic Stress Disorder Microbiome Workgroup INTRODUCTION Post traumatic stress disorder (PTSD) can develop following exposure to a traumatic event. However, not all individuals exposed to trauma will develop PTSD, indicating that there must be a degree of susceptibility/resilience among individuals. This is partly explained by underlying genetic risk. Recently, alterations in gut microbial composition have been observed in relation to psychiatric disorders, which may also explain some of the variation in susceptibility to PTSD. In addition, the host genome has been found to regulate certain aspects of the gut microbiome. This study aims to provide insight into the interaction between the gut microbiome and host genome in the context of PTSD. METHODS Genome-wide genotype data and 16S rRNA gut microbiome data from 53 trauma-exposed controls and 74 PTSD patients was utilised in an exploratory analysis to examine the association between host genotype of 143 gut microbiome-related SNPs and the summed relative abundance of 4 genus-level taxa (Mitsuokella, Odoribacter, Catenibacterium, and Olsenella), found in a previous study of ours to positively correlate with the severity of PTSD symptoms. GWAS summary statistics from the Psychiatric Genomics Consortium were used to calculate the polygenic risk score (PRS) for PTSD to investigate if the genetic predisposition towards developing PTSD is associated with gut microbial composition. RESULTS Exploratory analysis revealed associations between 10 SNPs and the summed relative abundance of the 4-genus level taxa. For the top two SNP associations (CNTNAP2 rs2710119 and PROM2 rs2278067), the summed relative abundance decreased with every copy of the CNTNAP2 rs2710119 T allele (p = 0.0025) and increased with every copy of the PROM2 rs2278067 T allele (p = 0.0081). In addition, rs2278067 interacted with PTSD case/control status (p < 0.0139) to influence the summed relative abundance of the genus-level bacteria. The polygenic risk for PTSD was not found to be predictive of gut microbial composition in this cohort. CONCLUSION Our preliminary findings indicate a genetic association between host genetic components and gut microbial composition providing valuable insight into the complex relationship between the gut microbiome and host genome. These results should be replicated in a larger sample set. ________________________________________ VIRTUAL REALITY AS A TOOL FOR PHYSIOLOGICAL BIO-MARKER EXPLORATION IN POST-TRAUMATIC STRESS DISORDER IN A SOUTH AFRICAN POPULATION: A FOCUS ON FKBP5 METHYLATION Ms Catherine Lohrentz (1) South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa. (2) Division of Molecular Biology and Human Genetics, Department of Biomedical Science, Faculty of Medicine and Health Science, Stellenbosch University Catherine Lohrentz1.2, Jacqueline Womersley1.3, Patricia Swart31.3, Robin Emsley3, Laila Asmal3, Soraya Seedat1.3, Sian Hemmings1.3, Stefan Du Plessis1.3 1 South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa 2Division of Molecular Biology and Human Genetics, Department of Biomedical Science, Faculty of Medicine and Health Science, Stellenbosch University 3Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa INTRODUCTION Trauma, interpersonal violence, and chronic stress significantly contribute to poor mental health status in South Africa. Despite chronic stress and trauma exposure, adverse psychiatric outcomes, such as the development of posttraumatic stress disorder (PTSD), is not guaranteed. Research is required to identify the neurobiological and molecular mechanisms underlying relative risk to traumarelated adverse psychiatric outcomes. PTSD assessments are typically questionnaire-based, or use experience sampling methods, which are time consuming and only capture subjective verbal responses. Virtual reality (VR) provides a potential solution, whereby behavioural and physiological responses can be captured. Genetic studies examining the link between stressful events and psychiatric disorders have focused on genes involved in the hypothalamic-pituitaryadrenocortical (HPA) axis, which coordinates the SASOP CONGRESS - POSTER ABSTRACTS

SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 * 29 stress response. FK06 binding protein 5 (FKBP5) is a target of interest, as when bound to the glucocorticoid receptor, it reduces their sensitivity to cortisol, prolonging elevated circulating cortisol levels. DNA methylation, an epigenetic modification characterised by the addition of methyl groups to DNA, may alter gene expression. Evidence suggests that FKBP5 methylation both influences and can be influenced by the stress response. Therefore, methylation-associated alterations to FKBP5 may produce stress response dysregulation. We aim to investigate the association between the stress response, assessed with VR, and FKBP5 methylation in healthy adult participants. METHODS Environmental cues will be used to generate physiological stress responses, without explicit trauma-related cues, using two novel VR paradigms assessing fear of heights and implicit fear. Electrodermal activity (EDA) will be assessed as a measure of physiological arousal across different stress periods within the virtual paradigms. RESULTS (Data analysis is currently underway, results will be available by October 2023.) CONCLUSION This will also allow us to confirm the efficacy of our VR paradigm in eliciting a stress response and establish a baseline methylation profile for HPA-axis functioning in a non-clinical South African cohort. Our research will lay the groundwork for future studies, including in participants with PTSD, and may also inform VR-based therapeutic interventions. ________________________________________ ASSESSING THE PREVALENCE OF PSYCHOTIC SYMPTOMS IN EPILEPTIC PATIENTS AT A TERTIARY CLINIC Dr Michelle Hungwe University of the Witwatersrand [email protected] Michelle Hungwe1, Karishma Lowton1 1 University of the Witwatersrand INTRODUCTION The International League against epilepsy (ILAE) defines epilepsy as a brain disorder characterised by an enduring risk to generate seizures with neurobiological, cognitive, psychological, and social consequences. Psychotic disorders in epilepsy are a serious psychiatric complication affecting prognosis, morbidity, and mortality of patients. There is a paucity in literature with regards to the prevalence of psychotic symptoms in epileptic patients in low to middle income countries. METHODS Aim: This study aimed to look at the prevalence of psychotic symptoms in epileptic patients at an outpatient clinic using the prodromal questionnaire 16(PQ-16) Setting: The study was conducted at the epilepsy clinic at Charlotte Maxeke Academic Hospital (CMJAH), a tertiary hospital located in Johannesburg, South Africa. Methods: The PQ 16 was distributed to consenting patients attending the epilepsy clinic at CMJAH who then independently completed the questionnaire before their appointment. RESULTS The study consisted of 121 participants. The prevalence of patients found to be at high risk for psychosis (i.e., PQ-16 score > 6) was 61.2% (95% LCI: 0.53, UCI: 0.70). None of the demographic variables showed significant associations in the percentage of patients found to be high risk. No association was found between any anti-epileptic drug and high risk for psychosis. CONCLUSION The high prevalence of psychotic like experiences found suggests it is imperative to screen for psychotic disorders in epileptic patients and if required to involve neuropsychiatrists in their management. Contribution: This study highlights the importance of assessing for psychotic symptoms in epileptic patients and the importance of a multi-disciplinary approach in managing these complex patients. ________________________________________ A PATHWAY TO GREATER MEANING IN LIFE AND WELL-BEING FOR SENIOR EXECUTIVES BESET BY ANTI-MEANING Dr Juanmari Kruger University of Stellenbosch Business School, South Africa [email protected] Juanmari Kruger1, Jeremias J. De Klerk2 1 University of Stellenbosch Business School, South Africa 2Stellenbosch University, South Africa INTRODUCTION This study was undertaken to gain an understanding of how conceptualising meaning in life as a bipolar construct, consisting of both meaning and anti-meaning, could impact on senior executives’ sense of life meaning and well-being. Although work is a significant source of meaning for most people, the role of senior executive generates different meaning and wellbeing complexities than those experienced or faced by general employees. This study explored how meaning and anti-meaning components affect senior executives’ experiences of meaning in life and well-being. The findings enabled devising a pathway to enhance senior executives’ net experiences of meaning in life and well-being. METHODS A cross-sectional, semi-structured interview study SASOP CONGRESS - POSTER ABSTRACTS

SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 * 31 design was used to gather rich qualitative data. Eight participants from southern and eastern Africa, who had held the position of chief executive officer or managing director for at least five years, were interviewed RESULTS This study highlighted several important findings. (1) Senior executives’ work or role provided a significant source of life meaning but also contained elements of unavoidable anti-meaning (time constraints, stress and pressure, loneliness); (2) Multidimensionally sourced meaning, spousal support and healthy coping mechanisms lessened the impact of unavoidable anti-meaning; (3) When unavoidable anti-meaning was addressed insufficiently or unhealthily it led to the generation of additional anti-meaning, negatively impacting on several wellness domains; and (4) Senior executives expressed a need for support in addressing their specific well-being and meaning in life needs, but several barriers prevented them from receiving such support. CONCLUSION The findings demonstrated that senior executives’ work roles provide a significant source of meaning. However, the roles are accompanied by unavoidable anti-meanings, which are likely to generate additional anti-meanings if not tempered sufficiently, thus reducing the net meaning experienced. From the results, a practical pathway was devised to assist top executives to deal with the bipolar relationship between meaning and anti-meaning. Consulting and counselling practitioners can utilise the pathway to guide, support, and counsel senior executives towards improved meaning, temper anti-meaning and improve well-being. ________________________________________ THE NEUROPSYCHIATRIC AND PERSONAL COST OF POST-COVID SYNDROME Dr Kim Laxton Private practice [email protected] Kim Laxton1 1 Private Practice INTRODUCTION We now find ourselves in a post-Covid-world with the conversations centred around the "Post-Covid Syndrome". Our minds are consumed with questions regarding the intermediate effects of Covid-19. As medical practitioners we are confronted by the fatigue-plagued illness and "brain fog" - one patient described this as "trying to think through butter in one's mind". METHODS Mr A, a 52 year old male, COO of his own company, came to me in April 2023 for an Independent Psychiatric Assessment to determine impairment on mental and behavioural grounds. In June 2021 Mr A was diagnosed with a severe form of Covid-19. Mr A's timeline is described from the infection onwards. From August 2021 up until now, Mr A had developed clear symptoms and signs of Bipolar Spectrum Disorder. However, his main concern, for which he was to be assessed, was his significant neurocognitive fallout. This cognitive fallout saw a man sitting opposite me struggling to find words, complete sentences, focus and concentrate. His identity as a company owner and as a husband and father was tarnished by this syndrome which is still difficult to understand. RESULTS Post-Covid Syndrome appears to affect the brain in ways which we still cannot clearly describe. In Mr A's case, and his road to the impairment assessment, we journey through his story and come to empathise with a man whose functional decline was significant and devastating. And we ask ourselves the questions: What are the signs and symptoms of Post-Covid Syndrome? How do we describe it when diagnosing a patient in the clinical space? And how does its consequences come to affect the patients themselves and those who form part of his/her world? CONCLUSION With these questions in mind we look at the Independent Medical Examination, Post-Covid Syndrome and a real story of a life now lived with neurocognitive impairment. In conclusion, this opens doors for many more questions which will possibly become dilemmas for further conversations. ________________________________________ EVALUATING THE EFFECTIVENESS OF MENTAL HEALTH TRAINING ON THE KNOWLEDGE AND ATTITUDES OF NON-SPECIALIST HEALTH WORKERS IN SOUTH AFRICA Dr Mpho Mahlakametsa University of Cape Town [email protected] Mpho Mahlakametsa1, Goodman Sibeko1 1 University of Cape Town INTRODUCTION Mental disorders are a leading cause of disability worldwide. Economic data has shown that mental disorders reduce productivity and contribute to a loss of income to individuals and families. Given a significant shortage of health professionals in low-and middle-income countries and the unequal distribution of resources, a task-shifting approach has been proposed to broaden access to services through the use of less specialised health care providers . Studies have shown that this is a feasible option that may improve mental health outcomes. This study expanded on a pilot intervention study done by Sibeko and colleagues, which showed that the positive impact of mental health training on non-specialized health workers’ (NSHW) knowledge, confidence, and attitudes in the Western Cape province of South Africa. SASOP CONGRESS - POSTER ABSTRACTS

32 * SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 METHODS This was analysis of data collected as part of quality assurance of mental health training provided to NSHW in various centres across South Africa. The mental health knowledge schedule (MAKS) and community attitudes towards mental illness (CAMI) tests were administered before and after the training was provided. The test scores were analysed using regression models to determine which of the demographic characteristics had an impact on the scores. RESULTS A majority of the training recipients were women, with nearly 97% reporting a minimum education level of grade 8. The median age was 36 and median duration of working as a NSHW was 6 years. Hypertension and HIV were the most reported physical conditions, while the only disclosed psychiatric illness was depression. There was an overall statistically significant increase in the knowledge score (pre-training mean 40.69, post-training mean 45.79, p-value < 2.2E -16). Attitude scores wereas follows: authoritarianism (pre-training mean 30.78, post-training mean 31.24, p-value 0.097), benevolence (pre-training mean 28.25, post-training mean 28.38, p-value 0.941), community mental health ideology (pre-training mean 31.49, post-training mean 31.28, p-value 0.636) and a statistically significant change in social restiveness scores (pre-training mean 28.22, post-training mean 27.13, p-value 9.63E-06). CONCLUSION The mental health training provided to the NSHW had a positive impact on their knowledge and attitude scores. The limitations included missing information, as such, investigation under strict research conditions may be necessary in the future. ________________________________________ INVESTIGATING GENETIC VARIANTS IN ADCYAP1, ADCYAP1R1, AND BRSK2 IN RELATION TO THE TRAJECTORY OF POSTTRAUMATIC STRESS SYMPTOMS Mr Kabelo Maloka Stellenbosch University [email protected] Kabelo Mabokane Simon Maloka1.2, Jani Nöthling1.2.3, Carl Lombard4.5, Naeemah Abrahams3, Soraya Seedat1.2, Sian Megan Joanna Hemmings1.2 1 Department of Psychiatry, Stellenbosch University, South Africa 2South African Medical Research Council/ Stellenbosch University Genomics of Brain Disorders Research Unit, Stellenbosch University, South Africa 3Gender and Health Research Unit, South African Medical Research Council 4Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa 5Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa INTRODUCTION Rape and sexual assault are associated with a high risk for developing post-traumatic stress disorder (PTSD) in comparison to other forms of trauma. Genetic variations within genes encoding components of the hypothalamic-pituitary-adrenal axis, particularly the adenylate cyclase-activating polypeptide 1 (ADCYAP1) gene and its receptor 1 (ADCYAP1R1) gene, could potentially contribute to the susceptibility of PTSD development. An epigenome-wide association study conducted using the parent cohort of the current study found that a CpG site in ADCYAP1 was differentially methylated in relation to PTSD at 3 months postrape. Additionally, they reported that decreased methylation of a CpG site in brain serine/threonine kinase 2 (BRSK2) gene was associated with increased PTSD scores at 3 months post-rape. To build on these findings, we investigated variants within ADCYAP1 (rs1893154 and rs2856966), ADCYAP1R1 (rs2267735), and BRSK2 (rs4963048) in relation to posttraumatic stress symptom (PTSS) scores over 12 months post-rape. METHODS The study involved 450 rape-exposed black South African women, who were recruited as part of the Rape Impact Cohort Evaluation Study in KwaZulu Natal province. PTSS was assessed using the Davidson Trauma Scale. The four SNPs were genotyped using Kompetitive AlleleSpecific PCR. Quantile regression models were used to model the median PTSS scores for each SNP at baseline, 3-, 6-, and, 12-months post-rape. Additionally, the study assessed the genotypetime interaction effect of each SNP on PTSS scores over the course of 12 months. The models were adjusted with baseline age and childhood trauma scores. RESULTS We did not identify any significant genotype-time interaction effects on PTSS scores over 12 months for each SNP. However, the GG genotype of ADCYAP1 rs1893154 was significantly associated with a decrease in PTSS scores at 3 months post-rape (β = -13.01, p = .024). Furthermore, the AA genotype of BRSK2 rs4963048 was significantly associated with an increase in PTSS scores at 6 months post-rape (β = 20.72, p = .016). CONCLUSION This study provides evidence for the potential involvement of ADCYAP1 and BRSK2 variants in PTS post-trauma. Although our results are preliminary and require replication, they justify follow-up efforts with a larger sample size to characterize how these genes relate to PTS posttrauma. SASOP CONGRESS - POSTER ABSTRACTS

Life Path Health is a group of private mental health hospitals with inpatient facilities in the Western Cape, Soweto and Kwazulu-Natal. We assist psychiatrists in launching their private practices to meet the high demand for quality mental health care in South Africa. To find out more, please contact COO Dr Karen Olckers at [email protected] www.lifepathgroup.co.za

34 * SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 THE VIEWS OF SOUTH AFRICAN MENTAL HEALTHCARE PROVIDERS REGARDING EXERCISE FOR PEOPLE WITH MENTAL ILLNESS Dr Belinda Marais Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand [email protected] Belinda Marais1 1 Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand INTRODUCTION There has been increasing interest regarding exercise and mental health, including exercise for people living with mental illness. This study aimed to evaluate the views of South African mental healthcare providers (MHCPs), regarding exercise for people with a mental illness (PWMI). METHODS This was a cross-sectional descriptive study. MHCPs working in public sector specialised psychiatric units in Gauteng were invited to complete the Exercise in Mental Illness Questionnaire- Health Professionals Version (EMIQ-HP). RESULTS Most of the participants were nurses (49.1%) and doctors (26.2%). The majority (79.4%) reported no prior formal training in exercise prescription. Overall MHCPs knowledge was good regarding the benefits of exercise, particularly in terms of cardiometabolic diseases and depression. The majority of MHCPs believed that exercise is equally beneficial for both in- and out-patients, and that the benefits are long-lasting. However, beliefs were mixed as to whether PWMI know that exercise is beneficial for their mental health (36.4% agreed vs. 36.9% disagreed) and whether PWMI will adhere to exercise prescription (25.7% vs. 22.4%). The most common barriers to exercise participation for PWMI, as perceived by MHCPs were: stigma around having a mental illness (56.5%), medication side-effects (56.5%), and uncertainty regarding what to do (50.9%). Regarding barriers to exercise prescription, the majority of MHCPs disagreed that: exercise might worsen the condition of PWMI (87.4%), that they were not interested in prescribing exercise (86.9%), that exercise prescription for PWMI is not part of their job (71.5%), and that PWMI are unable to participate in exercise due to their physical health (70.6%). The majority (76.2%) of MHCPs reported that they prescribe exercise for PWMI at least “occasionally”. The method most frequently used was personal discussion (77.3%) and the type of exercise most frequently recommended was aerobic exercise (81.0%). Most (92.1%) of MHCPs indicated that they would be interested in further training for prescribing exercise for PWMI. CONCLUSION MHCPs were supportive of exercise for PWMI. Efforts to address stigma regarding mental illness and medication side-effects, further training for MHCPs regarding exercise prescription and collaboration with exercise professionals are recommended. ________________________________________ SPECIES-LEVEL PROFILING OF THE MATERNAL VAGINAL BACTERIOME USING FULL-LENGTH 16S RRNA AMPLICON SEQUENCING WITH APPLICATION TO FETAL ALCOHOL SPECTRUM DISORDER Ms Lauren Martin (1) Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, (2) Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, (3) South African Medical Research Council Genomics of Brain Disorders Extramural Unit (SA-MRC GBD EMU), Faculty of Medicine and Health Sciences, Stellenbosch University [email protected] Lauren Martin1.2.3, Natasha Kitchin2.3, Anna-Susan Marais2, Marlene M. de Vries2, Phillip A. May4, Soraya Seedat2.3, Sian M.J. Hemmings2.3 1 Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University 2Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University 3South African Medical Research Council Genomics of Brain Disorders Extramural Unit (SA-MRC GBD EMU), Faculty of Medicine and Health Sciences, Stellenbosch University 4Department of Nutrition, Gillings School of Global Public Health, Nutrition Research Institute, University of North Carolina, United States of America INTRODUCTION Affecting approximately 16-31% of children in the Western Cape of South Africa, Fetal Alcohol Spectrum Disorder (FASD) describes varying severities of physical, neurodevelopmental, and behavioural deficits associated with prenatal alcohol exposure. Exposure to vaginal microbes during delivery results in the acquisition of intestinal bacteria which, via the microbiome-gut-brain axis, have been found to play a significant role in neurodevelopment. Alcohol-associated vaginal microbial alterations may therefore increase FASD risk in infants. Species-level classifications provide greater insight into the bacterial dynamics of the microbiome. However, hypervariable sequencing data hinders species-level bacterial classification as data are derived from regions of the 16S ribosomal RNA (rRNA) gene, limiting insight into the microbiota composition. We aimed to improve species-level resolution of the maternal vaginal bacterial communities through long and short-read sequencing of the full-length 16S rRNA amplicon using the PacBio Sequel IIe and SASOP CONGRESS - POSTER ABSTRACTS

SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 * 35 Illumina iSeq 100 instruments and comparing their performance with on-hand V1-V2 hypervariable data and assess these data in relation to the FASD outcomes of the infants. METHODS Pregnant women (n=28) provided vaginal swab samples on the day of birth. Alcohol use was assessed via Alcohol Use Disorders Identification Test questionnaire. FASD diagnoses were made through triangulation of maternal interviews and infant assessments. Following amplification, library preparation, and sequencing of 16S rRNA amplicons on the iSeq100, libraries were re assembled using a custom-built pipeline, “16S amplicon seq”. Microbial composition was also assessed through targeted hypervariable sequencing and long-read 16S rRNA amplicon sequencing on the Illumina MiSeq and the PacBio Sequel IIe instrument, respectively. Microbiome-related analyses were performed using various R packages for all datasets. RESULTS Of the three platforms, the PacBio-generated dataset had the highest species-level assignments. Significant associations between the abundance of various bacterial genera and species in relation to FASD status were identified. CONCLUSION Additional investigation into the development of cost-effective sequencing techniques with high species level resolution on instruments with low capital investment is required to improve the usefulness of generated sequencing data. Furthermore, the exploratory nature of this study necessitates replication in a larger cohort, in which true associations between the maternal vaginal microbiota and FASD may be unveiled. ________________________________________ ASSESSING HIV TRANSMISSION KNOWLEDGE IN PSYCHIATRIC PATIENTS IN JOHANNESBURG, SOUTH AFRICA Hangwani J. Matodzi Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa [email protected] Hangwani J. Matodzi1, Karishma Lowton1 , Prinesh Miseer1 1 Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa BACKGROUND The bidirectional relationship between human immunodeficiency virus (HIV) and psychiatric illnesses is well documented. Misinformation about HIV transmission and prevention is associated with high rates of HIV-related risky behaviours, and therefore, HIV infection risk. The aim of this study was to assess basic HIV transmission knowledge in psychiatric patients. METHODS This cross-sectional, quantitative study was conducted at the outpatient psychiatric clinic at Tara Psychiatric Hospital, Johannesburg, South Africa. A 18- item HIV knowledge questionnaire (HIV-KQ18) was utilised to assess basic HIV transmission knowledge in psychiatric patients. Consent, demographic, and clinical profile information were obtained from participants meeting the selection criteria. RESULTS This study indicated a mean knowledge score of 12.6 (69.7%) out of 18, and therefore good knowledge. The highest HIV-KQ18 mean scores were found in patients with personality disorders (78.9%), anxiety disorders (75.6%) and bipolar and related disorders (71.1%). Participants with schizophrenia, depressive disorders and substance use disorders had scores ranging between 66.1% and 69.4%. Statistically significant differences in knowledge were evident based on age, marital status, level of education and employment status. Interestingly, participants who used substances had higher average basic HIV transmission knowledge scores compared to those who did not use substances. CONCLUSION Good overall HIV transmission knowledge was found in this population, albeit lower than in the general population. Statistically, correlates were found between psychiatric diagnosis, substance use, age, marital status, level of education, and employment status and basic level of HIV knowledge. HIV knowledge remains lower in psychiatric patients than in the general population, with correlates between demographic and clinical factors, calling for psychoeducation efforts to take all these into consideration. ________________________________________ PREVALENCE OF DEPRESSION, ANXIETY AND BURNOUT IN MEDICAL STUDENTS AT THE UNIVERSITY OF NAMIBIA (UNAM) Dr Nelao Mhata Discipline of Psychiatry, School of Clinical Medicine, College of Health Sciences, University of KwaZuluNatal, Durban, South Africa [email protected] Nelao Mhata1, Vuyokazi Ntlantsana1 , Andrew Tomita2.3, Kissah Mwambene4, Shamima Saloojee1 1 Discipline of Psychiatry, School of Clinical Medicine, College of Health Sciences, University of KwaZuluNatal, Durban, South Africa 2Discipline of Psychiatry, KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZuluNatal, Durban, South Africa 3Discipline of Psychiatry, Centre for Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa 4Mental Health Centre, Windhoek Central Hospital, Windhoek, Namibia SASOP CONGRESS - POSTER ABSTRACTS

XR Bupropion 150 / 300 mg Budep S5 DUZELA 30 mg hard gastro-resistant capsules. Each capsule contains 30 mg duloxetine (as hydrochloride). Contains sugar (sucrose: 64,2 mg and mannitol: 6,7 mg). Pharmacological classification: A 1.2 Psychoanaleptics (antidepressants). Reg. No. 48/1.2/0680. S5 DUZELA 60 mg hard gastro-resistant capsules. Each capsule contains 60 mg duloxetine (as hydrochloride). Contains sugar (sucrose: 128,4 mg and mannitol: 13,4 mg). Pharmacological classification: A 1.2 Psychoanaleptics (antidepressants). Reg. No. 48/1.2/0681. Applicant: Ranbaxy Pharmaceuticals (Pty) Ltd, 14 Lautre Road, Stormill, Ext.1, Roodepoort, 1724. Tel: +27 11 495-0100. Fax: +27 12 495-0150. www.sunpharma.com S5 SERLIFE® 50 (Film-coated tablets). Reg. No.: 36/1.2/0272. Each film-coated tablet contains sertraline hydrochloride equivalent to sertraline 50 mg. Sugar free. S5 SERLIFE® 100 (Film-coated tablets). Reg. No.: 36/1.2/0273. Each filmcoated tablet contains sertraline hydrochloride equivalent to sertraline 100 mg. Sugar free. Pharmacological classification: A 1.2 Psychoanaleptics (Antidepressants). For full prescribing information, refer to the Professional Information Leaflet approved by the Regulatory Authority. Applicant: Ranbaxy Pharmaceuticals (Pty) Ltd, 14 Lautre Road, Stormill, Ext.1, Roodepoort, 1724. Tel: +27 11 495-0100. Fax: +27 12 495-0150. www.sunpharma.com S5 BUDEP XR 150 (Extended Release Tablets). Reg. No.: 48/1.2/0114. Each extended release tablet contains 150 mg bupropion hydrochloride. Contains sugar: lactose monohydrate 4,76 mg per extended release tablet. S5 BUDEP XR 300 (Extended Release Tablets). Reg. No.: 48/1.2/0115. Each extended release tablet contains 300 mg bupropion hydrochloride. Contains sugar: lactose monohydrate 9,73 mg per extended release tablet. Pharmacological classification: A. 1.2. Psycho-analeptics (antidepressants). For full prescribing information, refer to the Professional Information Leaflet approved by the Regulatory Authority. Applicant: Ranbaxy Pharmaceuticals (Pty) Ltd, 14 Lautre Road, Stormill, Ext.1, Roodepoort, 1724. Tel: +27 11 495-0100. Fax: +27 12 495-0150. www.sunpharma.com CNS PORTFOLIO

SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 * 37 INTRODUCTION There is an increased prevalence of depression, anxiety, and burnout among medical students worldwide, with no information from Namibia. This study aimed to determine the prevalence and factors associated with depression, anxiety, and burnout among medical students at UNAM. METHODS A quantitative descriptive cross-sectional survey was conducted on 229 medical students at UNAM, utilizing a specially designed questionnaire for the study and standardized instruments to evaluate depression, anxiety, and burnout. Descriptive statistics were used to summarize the sociodemographic characteristics, the clinical characteristics, and the depression, anxiety and burnout scores from the PHQ-9, GAD-7, and MBI-SS scores, respectively. Sociodemographic and clinical characteristics associated with depression, anxiety and burnout were analysed using bivariate analysis. Multivariate linear regression was used to assess mental health outcomes controlling for sociodemographic and clinical variables. A p value of < 0.05 was considered to be statistically significant. RESULTS Of the 229 students in this study, 71.6% were female and 28.4% were male. Prevalence of depression, anxiety, and burnout was 43.6%, 30.6%, and 36.2%, respectively. Prevalence of emotional exhaustion (EX), cynicism (CY), and professional efficacy (EF) was 68.1% (n = 156), 77.3% (n = 177) and 53.3% (n = 122), respectively. In the final regression model, participants with a current psychiatric illness were more likely to screen positive for depression (adjusted odds ratio [aOR] 4.06, confidence interval [CI] 1.28–12.91; p = 0.02) and anxiety (aOR: 3.63, CI: 1.17–11.23; p = 0.03). Emotional exhaustion and cynicism were significantly associated with female gender (EX: aOR, 0.40, CI: 0.20–0.79; p = 0.01) (CY: aOR, 0.42, CI: 0.20–0.91; p = 0.03). Older participants were less likely to experience high levels of EX (aOR: 0.75, CI: 0.61–0.93) and CY (aOR: 0.81, CI: 0.66–0.98) compared with younger participants. CONCLUSION More than one in three medical students at UNAM were either depressed or burnt out. This is the first study to highlight the mental health needs of medical students at UNAM. ________________________________________ LONGITUDINAL ASSOCIATIONS BETWEEN PITUITARY ADENYLATE-CYCLASE-ACTIVATING POLYPEPTIDE PLASMA CONCENTRATION AND SYMPTOMS OF POST-TRAUMATIC STRESS DISORDER AND DEPRESSION IN SOUTH AFRICAN RAPE-EXPOSED WOMEN Ms Lianna Kapp Department of Psychiatry, Stellenbosch University, South Africa; South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Stellenbosch University, South Africa [email protected] Lianna Kapp1.2, Jani Nöthling1.2.3, Carl Lombard4.5, Naeemah Abrahams3, Soraya Seedat1.2, Sian Hemmings1.2 1 Department of Psychiatry, Stellenbosch University, South Africa 2South African Medical Research Council/ Stellenbosch University Genomics of Brain Disorders Research Unit, Stellenbosch University, South Africa 3Gender and Health Research Unit, South African Medical Research Council 4Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa 5Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa INTRODUCTION Rape is associated with an increased risk of post-traumatic stress disorder (PTSD) and depression development. One biological mechanism involved in this risk is dysregulation of the stress response. The adenylate-cyclaseactivating polypeptide 1 gene (ADCYAP1) and its protein product, pituitary adenylate-cyclaseactivating polypeptide (PACAP), are master regulators of this response. In an epigenomewide analysis study, we found that a CpG site in ADCYAP1 (chr18:905177-905180) was differentially methylated in relation to PTSD status in the Rape Impact Cohort Evaluation (RICE) study. This aligns with previous findings where PACAP levels have been positively associated with PTSD symptoms in women. As a second step, we aimed to investigate longitudinal changes in PACAP concentration in relation to PTSD symptom scores in a subset of RICE participants. Given the high comorbidity between rape, PTSD, and depression, we also aimed to assess the longitudinal relationship between PACAP concentration and depression symptom scores. METHODS PACAP plasma concentration was investigated using an enzyme-linked immunosorbent assay in a subset of 30 rape-exposed women. Selfreported PTSD symptoms were measured using the Davidson Trauma Scale and self-reported depression symptoms were measured using the Center for Epidemiologic Studies Depression Scale. PACAP concentration and symptom scores were assessed at baseline (within 20 days postrape), 3-, 6-, and 12-months post-rape. Joint models were used to investigate the relationship between PACAP concentration and symptom scores over time. RESULTS Preliminary results indicate that PACAP concentration is positively associated with PTSD and depression over time. The expected value of square root PACAP concentration is marginally positively associated with square root PTSD (β = 0.48; 95% CI: -0.06, 1.03; p = .082) and significantly positively associated with depression (β = 3.62; 95% CI: 0.80, 6.44; p = .012). SASOP CONGRESS - POSTER ABSTRACTS

38 * SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 CONCLUSION Few previous studies have investigated the trajectory of post-traumatic and depression symptoms following rape exposure. Our preliminary results support the hypothesis that increased PACAP levels are associated with increased PTSD and depression symptoms in women. Future studies with larger cohorts are needed to confirm these findings. This study may contribute to understanding the role of PACAP in the development of these disorders and provide support for PACAP as a biomarker of PTSD and depression pathogenesis. ________________________________________ THE CLINICAL AND SOCIODEMOGRAPHIC CORRELATES OF POLYPHARMACY IN A SAMPLE OF OUTPATIENTS WITH SEVERE MENTAL ILLNESS AT A TERTIARY HOSPITAL Dr Tendani Netshilata [email protected] Dr Tendani Netshilata INTRODUCTION Polypharmacy is rapidly increasing and is associated with various factors. Although proven necessary at times, it is not without consequences. Little is known about the factors associated with polypharmacy. The study aimed to investigate and describe the clinical and socio-demographic factors associated with polypharmacy in patients with severe mental illness. METHODS The study design was a retrospective crosssectional descriptive study. A total of 171 patient records of outpatients who were diagnosed with severe mental illness and satisfied the inclusion criteria were retrieved. The socio-demographic and clinical data collected from the patient’s files were recorded on a data collection form designed by the researcher. The demographic and clinical characteristics of the patients were summarized descriptively. All the statistical analyses were done on SAS (SAS Institute Inc, Carey, NC, USA). RESULTS The overall prevalence rate for polypharmacy was found to be 76.6%. On logistic regression analysis, only three statistically significant predictors were found, namely gender, a negative history of substance abuse, and a history of non-adherence. Males were found to be 9.52 times more likely to be on polypharmacy compared to females. Patients not abusing substances were 5.81 times more likely to be on polypharmacy compared to patients abusing substances. Patients with a history of non-adherence were 11.24 times more likely to be on polypharmacy compared to patients without a history of non-adherence. Other variables, such as a history of hospitalisation at first presentation, a diagnosis of MDD, and the type of polypharmacy, were also found to be associated with polypharmacy. CONCLUSION The prevalence of polypharmacy among patients with severe mental illness is high. Although some of these variables are independent, the dependent variables (such as non-adherence and drug availability) are factors that can be looked into to see how best they can be improved. ________________________________________ FREQUENCY AND FACTORS ASSOCIATED WITH PROLONGED LENGTH OF STAY AMONG PATIENTS WITH CANNABIS-INDUCED PSYCHOTIC DISORDERS ADMITTED TO THE PSYCHIATRIC UNIT Dr Nonhlanhla Ntumbe Sefako Makgatho Health Science university: Dr George Mukhari Academic hospital Psychiatry department [email protected] Nonhlanhla Ntumbe1 1 Sefako Makgatho Health Science university: Dr George Mukhari Academic hospital Psychiatry department INTRODUCTION Prolonged hospital length of stay refers to patients treated in an acute psychiatry facility for more than 28 days (Barnett et al.,2020). It's common among patients with serious mental disorders and it has been a major challenge in resource-limited environments. A better understanding of the prolonged length of stay, particularly its associated factors, may provide the basis for intervention and break the chain in the prolonged length of stay in patients admitted for cannabis-induced psychotic disorders. The aim of the study is to determine the incident and factors associated with prolonged length of stay in patients with cannabis-induced psychotic disorders at a psychiatry unit. METHODS A cross-sectional study was conducted which comprised 279 study population and a sample size of 156 patients diagnosed with cannabisinduced psychotic disorder according to DSM-5 criteria admitted at DGMAH psychiatry unit from 01 January to 31 December 2021. A self-administered questionnaire eliciting socio-demographic and clinical-related factors was used. Ethical approval was obtained from Sefako Makgatho Health Science University. RESULTS There was a 36% prevalence of prolonged length of stay. A statistically significant association was found with the following socio-demographic factors (unemployment, living status and family support) and clinical factors (hospital admissions, secondary substance use, treatment combination and side effects). SASOP CONGRESS - POSTER ABSTRACTS

40 * SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 CONCLUSION Prolonged length of stay was significant amongst patients with poor socioeconomic status, family support and clinical factors such as treatment response and comorbid secondary substance use. This highlights the importance of not only clinical Intervention but also incorporating social interventions to decrease prolonged length of stay ________________________________________ CAREGIVER BURDEN AND ITS DETERMINANTS IN RELATIVES OF PATIENTS WITH SCHIZOPHRENIA ATTENDING A PSYCHIATRIC TERTIARY HOSPITAL IN SOUTH AFRICA Dr Chioma Obiageli Onyia Department of Psychiatry, School of Medicine, Sefako Makgatho Health Sciences University, GaRankuwa, Pretoria, South Africa. [email protected] Chioma Obiageli Onyia1, Julia Lethole1 1 Department of Psychiatry, School of Medicine, Sefako Makgatho Health Sciences University, Ga- Rankuwa, Pretoria, South Africa. INTRODUCTION Schizophrenia affects activities of daily living, making the services of caregivers necessary in the management of the illness. We aimed to determine the caregiver burden and its predictors in family caregivers of patients with schizophrenia who attend a Psychiatry Outpatient Department in a tertiary hospital METHODS In a cross-sectional study conducted from June to August 2023, the socio-demographic profile of 300 consecutive family caregivers of schizophrenic patients who attended the psychiatry outpatient was ascertained. The 22-item Zarit Burden Interview (ZBI), which has a score of 0 - 88, was administered to the family caregivers. The ZBI score was grouped into an ordinal scale: 88 - 61 (severe), 60 - 41 (moderate to severe), 40 - 21 (mild to moderate), and 20 - 0 (none to low). Linear and ordinal logistic regression analyses were performed to identify the predictors of total and severe burdens, respectively. RESULTS The majority of the family caregivers were aged 46.0 ± 14 years old, of low-income status (93.7%), resided with the patient (87%), had secondary education (70%), females (62%), parents (39%), and assisted with troublesome activities of daily living mostly financial, psychological, and physical support (64.7%). The median (and interquartile range) of the ZBI score was 19.0 (13.0 - 30.5). The predictors of severe and total caregiver burden were caregivers aged 50 years and above, increasing caregiving duration, residing farther away from the hospital, and providing support for another family member requiring care. CONCLUSION Seamless access to a mental health care facility and improving the socio-economic support for family caregivers aged 50 years and above who provide long-term care, particularly those supporting multiple family members, are necessary interventions to reduce caregiver burden. ________________________________________ ATTENTION DEFICIT/HYPERACTIVITY DISORDER (ADHD) WITHIN THE CAPE METROPOLE Mrs Marguerette Monique Osborne Psychometrist [email protected] Marguerette Osborne1, Claire Tobin2, Ronel Aylward3, Miche Moodley1 , Joanne Beley4, Prof Renata Schoeman5 1 Psychometrist 2Senior Psychometrist/ Operations Manager 3Registered Nurse/Mental health screener 4 Administrator 5Goldilocks and The Bear Foundation / Stellenbosch Business School INTRODUCTION ADHD is one of the most common psychiatric disorders in children and it’s affecting 2 to 16% of the school-age population. In South Africa, the literature indicates that research is lacking, and access to care and effective treatment for ADHD is extremely limited. Consequently, the majority of children from underprivileged communities who suffer from ADHD remain undiagnosed, and if they are diagnosed, they not not receive adequate treatment. The Goldilocks and The Bear Foundation (hereafter referred to as the Foundation) provides screening and early intervention services for ADHD and other mental health disorders to learners at a primary school level. We will be presenting the statistics from the establishment of the Foundation until mid-2023. METHODS The population focus of the Foundation is on underprivileged primary school children. We gather our statistics from forms that are completed, and data is captured into a custom-made database. Informed consent is obtained from the parents prior to the mental health screening of the child. Trained professionals do the basic physical screening and behavioral observations for each child. All information is collated and controlled by a trained healthcare practitioner, who determines the possible diagnosis and refers accordingly (either to the community clinic, school doctor, optometrist, audiologist, educational psychologist, or occupational psychologist). This means that a multidisciplinary team collaborates in order to provide the child with the best possible interventions. SASOP CONGRESS - POSTER ABSTRACTS

SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 * 41 RESULTS A case study will be presented to show how the Foundation together with the clinic/hospital (Department of Health), volunteers and Department of Education has worked together to successfully implement the necessary interventions. CONCLUSION Although mental health clinics and hospitals exist in the public sector, children with ADHD often never reach this point of diagnosis and treatment, due to a lack of awareness and knowledge in their communities as well as the stigma attached to ADHD. Improved outcomes are possible to achieve if patients suffering from ADHD are diagnosed as such early, and receive a multi-modal intervention – which would include psychopharmacological interventions, behavioral interventions, and continuous support. ________________________________________ CORRELATION BETWEEN SERUM INFLAMMATORY CYTOKINES AND CLINICAL PROFILES IN THE FIRST-TIME PSYCHOSIS: EXPLORATORY ANALYSIS OF DATA COLLECTED FROM THE HIV FIRST-EPISODE PSYCHOSIS LONGITUDINAL STUDY, IN DURBAN Dr Noxolo Qwabe University of KwaZulu-Natal, School of Clinical Medicine, Psychiatry Discipline [email protected] Noxolo Qwabe1, Saeeda Paruk1 , Andrew Tomita2, Enver Karim1 , Usha Chhagan1 , Vuyokazi Ntlantsana1 , Bonginkosi Chiliza1 , Nathlee Abbai3, Fazana Dessai3, Lindokuhle Thela1 1 University of KwaZulu Natal, School of Clinical Medicine, Psychiatry Discipline 2Centre for Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu Natal, KwaZulu Natal Research Innovation and Sequencing, Nelson R Mandela School of Medicine 3University of KwaZulu Natal, School of Clinical Medicine Laboratory INTRODUCTION Inflammatory dysregulation has been reported in people living with schizophrenia. Inflammatory cytokines may be helpful surrogate biomarkers in the diagnosis, treatment response, and prognosis of first-episode psychosis (FEP). This study aimed to describe the relationship between interleukins (IL)- 6, 8 and 10; and clinical profile of treatment naïve FEP patients. METHODS We conducted a secondary exploratory analysis of the data collected from a longitudinal FEPHIV study. Inclusion criteria were both genders, 18 – 45-year-olds, confirmed diagnosis of primary psychotic disorder, < 6 weeks of antipsychotic treatment, and no current use of anti-inflammatory drugs. We explored the correlation between lL- 6, 8, 10 (analysed by Multiplex ELISA assay) with; sociodemographic profile, body mass index (BMI), PANNS, PHQ-9 and cognitive screening and HIV. The Wilcoxon rank-sum test was used for association between non-parametric and continuous data and Pearson's correlation for associations between continuous variables. RESULTS Seventy participants were included, of which 55 (74%) were male, and 12 (17%) were living with HIV. There was no significant association between clinical variables such as psychosis symptom severity (PANSS scores), cognitive screen, depression score, HIV status, and ILs. Participants currently using alcohol had statistically significantly high IL-8 levels (p=0.01). IL-10 was statistically significantly high in participants with higher BMI and those who reported lifetime and current alcohol use (p=0.04, p=0.04, and p=0.05, respectively). A sensitivity analysis was conducted, testing for associations between ILs and clinical variables, after excluding participants living with HIV yielded no difference in the findings CONCLUSION In this study, high IL-8 was associated with alcohol use, while high IL-10 was associated with higher BMI and comorbid alcohol use in FEP patients. The expression of ILs was not influenced by HIV status. Further studies using larger sample sizes and the inclusion of CSF interleukins are required. ________________________________________ EPIGENETIC PROFILES OF NEUROPSYCHOLOGICAL FUNCTION IN SOUTH AFRICAN WOMEN LIVING WITH HIV AND VARIABLE EXPOSURE TO CHILDHOOD TRAUMA Ms Aqeedah Roomaney Roomaney (1) Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University; (2) South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University [email protected] Aqeedah Abbas Roomaney1.2, Georgina Spies1.2, Soraya Seedat1.2, Sian Megan Joanna Hemmings1.2, Jacqueline Samantha Womersley1.2 1 Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University 2South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University INTRODUCTION HIV-associated neurocognitive impairment persists in 15-55% of people living with HIV. Thirty to fifty percent of people living with HIV report depressive symptoms, with a two-fold higher risk of developing depression compared to the general population. Epigenetic regulation, such as DNA methylation, influences gene expression and functions as a molecular interface between the genome and SASOP CONGRESS - POSTER ABSTRACTS

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SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 * 43 the environment. Differentially methylated genes are associated with CT and HIV-related cognitive impairment, and may mediate the effects of social stressors such as childhood adversity associated with depression and neurocognitive function. Research demonstrates the potential influence of epigenetic factors on neurological, cognitive and behavioural outcomes in the context of HIV and childhood trauma. METHODS This study aims to elucidate the multidirectional interactions between HIV, CT and DNA methylation by determining their effects on depression, neurocognition, and structural brain volumes in a longitudinal (5-year) cohort of South African women (baseline n = 225; nHIV- = 112, nHIV+ = 113). Neurocognitive functioning was ascertained using the HIV Neurobehavioral Research Centre International Neurobehavioral battery; CT scores were determined via the Childhood Trauma Questionnaire; lifetime trauma exposure was determined by the Life Events Checklist; and depressive symptoms were ascertained using the Centre for Epidemiologic Studies Depression Scale. A subset of participants underwent structural magnetic resonance imaging. Using DNA methylation data sequenced on the Illumina EPIC Bead Chip kit, we will conduct epigenetic region and network analysis using methylation-based inference of regulatory activity and weighted correlation network analysis approaches, respectively. We will use linear regression models to determine the association between HIV status and CT scores and epigenetic profiles. We will then determine the interactive effects of HIV, CT, and epigenetic profiles on structural brain volumes and longitudinal neuropsychiatric characteristics, including cognitive functioning and symptoms of depression. RESULTS This research is currently ongoing and the results will be presented at the conference. CONCLUSION This is the first study to demonstrate the intersecting effects of DNA methylation profiles, HIV and childhood trauma on depression, neurocognition, and structural brain volumes in a South African cohort. Understanding these multidirectional interactions will provide insight into factors driving impaired cognition and depression in HIV. ________________________________________ OUTCOME TRAJECTORIES BETWEEN RELAPSE AND NON-RELAPSE GROUPS IN FIRST-EPISODE SCHIZOPHRENIA Mrs Retha Smit Faculty of Medicine and Health Sciences, Department of Psychiatry, Stellenbosch University [email protected] Retha Smit1, Anna Margaretha Smit1 , Hilmar Klaus Luckhoff1 , Lebogang Phahladira1 , Robin Alexander Emsley1 , Laila Asmal1 1 Faculty of Medicine and Health Sciences, Department of Psychiatry, Stellenbosch University INTRODUCTION Relapse in schizophrenia is a frequent phenomenon and the early warning signs for relapse remain unclear and sometimes abrupt with very little warning signs. Here we investigated the outcome trajectories between patients who relapsed versus those who did not in first episode schizophrenia (FES) (n= 107), who received assured long-acting injectable antipsychotic (LAI) over 24 months. METHODS Clinical and socio-demographic data were collected using valid instruments. Relapse was operationally defined using modified Csernansky criteria. Substance use was assessed based on collateral family interviews and urine toxicology. In a linear mixed model repeated measures (MMRM) analysis we compared the patients who relapsed with those who did not with visit wise trajectories over time. RESULTS Significant group*time interaction effects were found for quality of life (QOL) in social relations F(3, 142) = 5.536, p = 0.001; PANSS factor hostility/ excitement F(8, 215) = 2.481, p = 0.01; QOL in environmental health F(3, 135) = 3.640, p = 0.014; Speed of processing (SOP) F(3, 113) = 3.456, p = 0.019; and QOL in physical health F(3, 120) = 3.330, p = 0.022 adjusting for age, sex, educational level, duration of untreated psychosis, age of illness onset, and cannabis dose. QOL in social relations was the only variable that survived Benjamini Hochberg post-hoc correction for multiple testing. CONCLUSION Overall, there were few differences in outcome trajectories between individuals who relapsed and those who didn’t. Poor social relationships may be an important early warning sign for relapse. Future qualitative studies may provide a better understanding of whether better QOL can serve as a buffer against relapse. ________________________________________ REVIEW OF CANNABIS USE AMONGST ADOLESCENTS IN A TERTIARY PSYCHIATRIC UNIT IN CAPE TOWN, BEFORE AND AFTER THE HIGH COURT RULING IN 2017 TO DECRIMINALIZE CANNABIS Dr Michelle Catherine Swartz Department of Psychiatry and mental health, University of Cape Town [email protected] Dr Michelle Catherine Swartz1, Dr Lisa Dannatt1 , Dr Anusha Lachman2 1 Department of Psychiatry and mental health, University of Cape Town 2Department of Child and adolescent Psychiatry, Stellenbosch University SASOP CONGRESS - POSTER ABSTRACTS

44 * SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 INTRODUCTION Cannabis is the most widely used substance worldwide and its use is much higher amongst adolescents. However, adolescents are at higher risk of negative sequelae secondary to this use, including poorer developmental outcomes and the possible development of mental disorders. On 31 March 2017, the South African High Court ruled that cannabis use by an adult in a private dwelling should be decriminalized. The aim of this study is to determine the clinical profile of adolescents who use cannabis, that present to a tertiary hospital in Cape Town, South Africa, before and after the high court ruling in 2017. METHODS The study was conducted reviewing folders of adolescents admitted at Groote Schuur Hospital (GSH) in the Emergency Psychiatric Unit, Ward C23 in Cape Town, South Africa. This study was a retrospective folder review of adolescents admitted from April 2015 to March 2019. RESULTS The study included 266 participants and the total number of adolescents using cannabis admitted during the study period was 116. Cannabis use was the most commonly used substance in the study, with increased use seen post-ruling (n = 75; 65%). The most common frequency of cannabis use reported was daily use (n = 43; 57%). When comparing psychiatric diagnoses between cannabis users and non-cannabis users, a significantly higher proportion of patients who used cannabis pre-ruling had psychotic disorder (p < 0.001) and substance use disorder (p = 0.01). Post– ruling, the significance was p < 0.001 for psychotic and substance use disorders. The most common DSM-5 diagnoses in cannabis users pre-ruling were psychotic disorders (n = 27; 65.9%); post-ruling, it was psychotic disorders (n = 36; 48%) and trauma and stressor-related disorders (n = 31; 41.3%). CONCLUSION The study showed an increasing prevalence of cannabis use in adolescents admitted with mental illness after the high court ruling in 2017. This study also demonstrates that adolescents remain a vulnerable population to the effects of cannabis. This highlights the need for more focused adolescent interventions and services. ________________________________________ ADVERSE DRUG REACTIONS REPORTED AT THREE PSYCHIATRIC HOSPITALS IN THE WESTERN CAPE, SOUTH AFRICA Dr Thumeka Tonjeni Department of Psychiatry and Mental Health, University of Cape Town [email protected] Thumeka Tonjeni1, Deirdre Pieterse1 , Qhama Cossie1 1 Department of Psychiatry and Mental Health, UCT INTRODUCTION Adverse drug reactions (ADR) to psychotropic medications are common in outpatients and hospitalised patients. They are associated with increased morbidity and mortality and a socioeconomic burden on the patients and the healthcare system. Adverse drug reporting remains poor, and there is a paucity of data on adverse drug reactions in psychiatric hospitals in South Africa. Adverse drug detection and prevention is essential in safe patient care and good clinical practice. This study is aimed to identify the patterns of adverse drug reactions reported in psychiatric hospitals and the medications frequently implicated. METHODS This study reviewed adverse drug reactions reported over two years at the three state psychiatric hospitals in Cape Town, Western Cape. Data were collected from all the adverse drug reaction forms submitted during the study period. Psychotropic medications were further categorised into drug classes, and adverse drug reactions were categorised into body systems affected. The descriptive analysis included the presentation of frequencies for categorical data and means and standard deviations for continuous variables. Chi-square tests were used to determine any categorical associations between the adverse drug reactions and implicated drugs. RESULTS A total of 403 adverse drug reactions were reported. Lentegeur Hospital only represented 6.4% of the reports. Antipsychotic medications, particularly second-generation antipsychotics, accounted for the most frequently implicated drugs (90.3%). Risperidone was the most common antipsychotic reported (38.5%), followed by longacting depot antipsychotics (20.3%). Furthermore, risperidone was primarily associated with extrapyramidal and endocrine effects, particularly hyperprolactinemia. Most patients were on more than one psychotropic agent (81.7%), meaning more than one drug could be implicated in the ADR. CONCLUSION Despite the evidence in the literature, firstgeneration antipsychotics were not most frequently reported to cause extrapyramidal side effects. This may be due to underreporting by clinicians. Adverse drug reactions are commonly reported in patients receiving antipsychotic medications, especially those with more than one antipsychotic agent. This is influenced by the high prevalence of psychotic disorders in the psychiatric inpatient population in our context. Underreporting remains a concern, especially at Lentegeur Hospital. Further studies are recommended to determine the causality and preventability of adverse drug reactions in this population SASOP CONGRESS - POSTER ABSTRACTS

Anxiety Other indications Pre- and postoperative adjunctive medication IDICATIONS Short-term management of anxiety, tension and psychomotor agitation in conditions of emotional stress Alleviating the manifestations of anxiety and tension in situations in which the causative stress is temporary, as in the preparation for dental and other minor surgical procedures and in acute emotional problems Adjunctive therapy in allergic conditions with strong emotional overlay, as in urticaria and pruritus Adjunctive pre and postoperative sedative medication due to its ability to allay anxiety, control emesis, and reduce the amount of opioid analgesic required ADULTS 50 mg to 100 mg four times daily 25 mg to 100 mg four times daily. For pruritus an initial dose of 25 mg may be given at night, increased to 25 mg three or four times daily 50 mg to 100 mg CHILDREN Over 6 years 15 mg to 25 mg daily, increased if necessary, to 50 mg to 100 mg daily in divided doses Over 6 years 15 mg to 25 mg daily, increased if necessary, to 50 mg to 100 mg daily in divided doses 0,6 mg/kg body weight Under 6 years 5 mg to 15 mg daily, increased if necessary, to 50 mg daily in divided doses Under 6 years 5 mg to 15 mg daily, increased if necessary, to 50 mg daily in divided doses

46 * SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 SASOP CONGRESS - SPONSORS & EXHIBITORS SPONSORS AND EXHIBITORS

SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 * 47 SASOP CONGRESS - SPONSORS & EXHIBITORS SPONSORS AND EXHIBITORS

48 * SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 SASOP CONGRESS - SPONSORS & EXHIBITORS SPONSORS AND EXHIBITORS

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50 * SOUTH AFRICAN PSYCHIATRY ISSUE 37 2023 SOUTH AFRICAN SOCIETY OF PSYCHIATRISTS ANNUAL GENERAL MEETING FOR THE FOLLOWING PURPOSES: 1. To approve the minutes of the previous Annual General Meeting that took place on 16 September 2022. 2. To receive and consider the financial statements for the period ended 31 December 2022. 3. To elect directors: In compliance with the Memorandum of Incorporation (MOI) of the company the following directors will remain in office as previously elected: o Dr Seape (Past President 2023-2025) o Dr A Lachman (President 2023-2025) The following directors will retire, but have indicated that they are eligible and available for re-election: • Dr A Pillay (President Elect (2023-2025) • Dr A Porter (Honorary Secretary 2023-2025) The following directors will retire and are not available for re-election: • Dr K Maaroganye • Dr K Roux The following members were nominated as Directors and available for election: • Dr T Mdaka (Public Sector Convener 2023- 2025) • Dr M van Zyl (Private Practice Convener 2023-2025) • Dr T Seshoka (Honorary Treasurer 2023- 2025) 4. To appoint Messrs Integritas Auditors, as Auditors of the Company. 5. To transact any other business which may be transacted at an Annual General Meeting Any member entitled to attend and vote at the above mentioned meeting is entitled to appoint one or more proxies to attend and speak out and, on a poll, vote in his/her stead. A proxy need not be a member. Proxy forms must be delivered by email as a legible scanned document to: [email protected] or [email protected] or [email protected] by no later than Friday 17 November 2023. BY ORDER OF THE BOARD Dr A Porter Honorary Secretary 26 October 2023 NOTICE IS HEREBY GIVEN THAT THE ANNUAL GENERAL MEETING WILL BE HELD ON WEDNESDAY,22 NOVEMBER 2023, AT THE CENTURY CITY CONFERENCE CENTRE, CENTURY CITY, WESTERN CAPE TIME: 9:45 to 10:45 SASOP