South African Psychiatry - November 2021

SASOP CONGRESS - POSTER ABSTRACTS SASOP CONGRESS - POSTER ABSTRACTS

Presenter: Dr Usha Chhagan ‘UNHEARD,’ ‘UNCARED FOR’ AND ‘UNSUPPORTED’:
Aim: According to the Global Burden of Disease THE MENTAL HEALTH IMPACT OF COVID -19 ON
Study 2013 mental disorders are among the main FRONTLINE HEALTHCARE WORKERS IN KWAZULU-
contributors to the increase in years lived with NATAL PROVINCE, SOUTH AFRICA
disability (YLD) rates per person. Importantly, HIV Bilkis Dawood, Postgraduate Programme (Master
was also identified as especially contributing to of Medicine), Discipline of Psychiatry, School of
increasing YLDs in sub-Saharan Africa. Women are Clinical Medicine, College of Health Sciences,
more vulnerable to HIV in South Africa (SA). University of KwaZulu-Natal, Durban, South Africa
There is a need to understand the interrelationship Andrew Tomita, KwaZulu-Natal Research Innovation
between gender, HIV, and mental illness in a and Sequencing Platform (KRISP), College of Health
region with a high HIV prevalence. We examined Sciences, University of KwaZulu-Natal, Durban, South
the nature of psychotic, cognitive symptoms, Africa; Centre for Rural Health, School of Nursing
and duration of untreated psychosis in people and Public Health, College of Health Sciences,
with first episode psychosis (FEP) living with and University of KwaZulu-Natal, Durban, South Africa
without HIV. Suvira Ramlall, Discipline of Psychiatry, School
Secondly, we reviewed the preliminary data for of Clinical Medicine, College of Health Sciences,
associations between gender, HIV and clinical University of KwaZulu-Natal, Durban
features of FEP. PRESENTER: Dr Bilkis Dawood
Methodology: The study was conducted at 5 Aim: Frontline healthcare workers (HCWs) are at a
hospitals in the province of KwaZulu-Natal, South high risk of both infection and death due to excessive
Africa. Male and female patients, aged between exposure during the Covid-19 pandemic. The focus
18 to 45 years, with first presentation for a psychotic of attention has been on their physical needs with
disorder, were invited to participate. relatively much less attention directed towards their
The study utilized a clinical interview, physical psychological needs. Studies consistently show the
examination, and several psychiatric tools, negative impact of chronic stress on both mental
including the MINI to confirm psychosis diagnosis, and physical health, with potential implications for
International HIV Dementia Scale (IHDS) and the immunity and vaccine response.
PANSS (Positive and Negative Syndrome Scale) The main objective was to measure the psychological
to measure variables. Measures were carried out impact of the Covid-19 pandemic on public sector
within 6 weeks of first presentation. HCWs in KwaZulu-Natal (KZN) Province, South Africa
Results: Of the 134 participants, ninety-four were (SA). The secondary objective was to ascertain their
males (median age = 24 years) and 40 females perceptions of institutional psychosocial support.
(median age = 30 years) with FEP. There were 22 Methodology: This cross-sectional electronic
females and 11 males living with HIV. survey was conducted among public sector HCWs
There were no statistically significant gender employed in KZN from August to October 2020, and
differences between all males and females for included 312 (N = 312) participants. Data captured
PANSS or DUP score or those males compared to were socio-demographic, clinical and responses
females with HIV. related to institutional support. The depression,
The females with FEP and HIV had a higher total anxiety and stress (DAS) symptoms were assessed
PANSS score (p=0.04) and a higher PANSS negative with the Depression Anxiety and Stress Scale – 21
subgroup score (p=0.01), compared to the females item (DASS 21), and subjective psychological
without HIV. There was no statistically significant trauma was measured by the Impact of Events
difference in the DUP or other variables amongst Scale- Revised version (IES-R).
males based on HIV status. Results: The participants’ mean age was 36.6±
Conclusion: The high prevalence (more than 50%) 9.3 years with three quarters being male (n = 234,
of HIV amongst females compared to males with 75.0%). Majority (n = 196, 70.8%) were employed
FEP is concerning. in the eThekwini Health District and most (n = 214,
72.3%) were medical doctors. Majority (63.0%) felt
Living with HIV has a negative impact on the severity that their concerns were not ‘heard’, 75.1% did
of FEP symptoms particularly among females with not feel ‘cared for’; 81.1% did not feel ‘physically’
HIV compared to those without HIV. or ‘psychologically’ (74.0%) supported by the
employer. Frequencies of DAS symptoms, ranging
from mild to extremely severe, were 51.6%, 47.3 % and

51 * SOUTH AFRICAN PSYCHIATRY ISSUE 29 2021

SASOP CONGRESS - POSTER ABSTRACTS SASOP CONGRESS - POSTER ABSTRACTS

44.3% for DAS respectively; severe and extremely be reported using Preferred Reporting Items for
severe symptoms ranged from 16.2% - 21.3%. On Systematic Reviews and Meta-Analyses [PRISMA]
the IES-R, 87.1 % were symptomatic, and 47.2% had extension for Scoping Reviews (PRISMA-ScR)
moderate-severe symptoms. guidelines. Literature will be searched for the
Conclusion: High levels of DAS and distress were period January 1999 to March 2021. Two reviewers
detected amongst public sector HCWs in KZN will independently screen titles/abstracts and full-
employed during the first surge of the Covid-19 texts in two consecutive screening stages. Eligible
pandemic in 2020, and their subjective perceptions studies will be independently reviewed to ensure
of support were consistently rated poorly. Mental that inclusion criteria are met. Cohen’s Kappa (k)
health literacy and skills should be included in will be used to calculate inter-rater agreement.
the training of HCWs and in the action plans of a A third reviewer will resolve any disagreements.
pandemic response as they have implications for The Joanna Briggs Institute (JBI) Appraisal Tools
both mental and physical wellbeing. will be used for quality appraisal of included
________________________________________ studies. Findings will be reported by means of a
THE USE OF MAGNETIC RESONANCE IMAGING narrative overview, tabular presentation of study
TECHNIQUES IN ASSESSING THE EFFECTS OF characteristics and quality assessment, and a
ALCOHOL CONSUMPTION AND HEAVY DRINKING thematic analysis of major themes. This scoping
ON THE ADOLESCENT BRAIN: A SCOPING REVIEW review has been registered with the Open Science
Nancy Hornsby, Alcohol, Tobacco and Other Drug Framework (https://osf.io/n5xud).
Research Unit, South African Medical Research Results: Expected findings: MRI studies will show
Council that adolescents who engage in heavy episodic
Soraya Seedat, Department of Psychiatry, Faculty drinking have (a) decreased volume in white and
of Medicine and Health Sciences, Stellenbosch grey matter brain structures; and (b) reduced
University, Cape Town, South Africa functional activation in brain regions of interest.
Eric Westman, Division of Clinical Geriatrics, Conclusion: Heavy episodic drinking during
Department of Neurobiology, Care Sciences and adolescence is associated with brain region deficits.
Society, Karolinska Institutet Current findings contribute to understanding the
Lars-Olof Wahlund, Division of Clinical Geriatrics, mechanisms of the brain-behaviour axis in problem
Department of Neurobiology, Care Sciences and drinking among adolescents and has the potential
Society, Karolinska Institutet to strengthen treatment strategies.
Nandi Siegfried, Alcohol, Tobacco and Other Drug ________________________________________
Research Unit, South African Medical Research METABOLIC SYNDROME ASSOCIATIONS WITH
Council CORTICAL THICKNESS AND SUBCORTICAL BRAIN
Leslie-Ann Erasmus-Claassen, Alcohol, Tobacco VOLUMES IN FIRST-EPISODE SCHIZOPHRENIA
and Other Drug Research Unit, South African PATIENTS AND CONTROLS
Medical Research Council Hilmar Luckhoff, Department of Psychiatry, Faculty
Bronwyn Myers, Alcohol, Tobacco and Other Drug of Medicine and Health Sciences, Stellenbosch
Research Unit, South African Medical Research University, Cape Town, South Africa
Council; and Division of Psychiatry, Department of Laila Asmal, Department of Psychiatry, Faculty
Psychiatry and Mental Health, University of Cape of Medicine and Health Sciences, Stellenbosch
Town University, Cape Town, South Africa
Presenter: Mrs Nancy Hornsby Stefan du Plessis, Department of Psychiatry, Faculty
Aim: Alcohol consumption, specifically heavy of Medicine and Health Sciences, Stellenbosch
drinking during adolescence has been shown to be University, Cape Town, South Africa
accompanied by adverse structural brain changes Freda Scheffler, Department of Psychiatry, Faculty
in adolescent drinkers. This scoping review aims to of Medicine and Health Sciences, Stellenbosch
quantify and evaluate the quality of studies in which University, Cape Town, South Africa
magnetic resonance imaging (MRI) techniques Lebogang Phahladira, Department of Psychiatry,
are used to assess regional brain deficits among Faculty of Medicine and Health Sciences,
adolescents who consume alcohol. Stellenbosch University, Cape Town, South Africa
Methodology: This scoping review will be Retha Smit, Department of Psychiatry, Faculty
conducted following the Arksey and O’Malley of Medicine and Health Sciences, Stellenbosch
scoping review methodology framework and will University, Cape Town, South Africa
Chanelle Buckle, Department of Psychiatry, Faculty
of Medicine and Health Sciences, Stellenbosch
University, Cape Town, South Africa

52 * SOUTH AFRICAN PSYCHIATRY ISSUE 29 2021

Introducing

with TRIPEL (Tri-layered pellet) technology1,2

Drug layer
Barrier layer
Outer enteric layer

Multi-layer benefits1,2

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

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

When depression hurts…

SIYAENZA

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

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

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

SASOP CONGRESS - POSTER ABSTRACTS SASOP CONGRESS - POSTER ABSTRACTS

Soraya Seedat, Department of Psychiatry, Faculty long-term BMI and lipid profile changes with
of Medicine and Health Sciences, Stellenbosch antipsychotic efficacy and tolerability, as well as
University, Cape Town, South Africa how this is related to changes in the connectivity of
Robin Emsley, Department of Psychiatry, Faculty a proposed “eating network”.
of Medicine and Health Sciences, Stellenbosch ________________________________________
University, Cape Town, South Africa DEMOGRAPHIC AND CLINICAL PROFILE OF HIV
Presenter: Dr Hilmar Luckhoff INFECTED AND NON-INFECTED CHILDREN AND
Aim: Brain structural changes implicated in first- ADOLESCENTS ATTENDING TWO COMMUNITY
episode schizophrenia, including widespread PSYCHIATRIC CLINICS IN GAUTENG PROVINCE
cortical thinning and subcortical volume loss, Lerato Makofane, University of Witwatersrand,
overlap with those reported for the metabolic Department of Psychiatry
syndrome (METS). The aim of our study was to Lesley Robertson, University of Witwatersrand,
examine the associations of metabolic syndrome Department of Psychiatry
(METS) with brain structure in first-episode Presenter: Dr Lerato Makofane
schizophrenia spectrum disorder (FES) patients Aim: A limited district-based child and adolescent
(n=110) compared to controls (n=113). psychiatric service is provided in Gauteng province.
Methodology: For our main objectives, Mental disorders are common in children and
hierarchical linear regressions were used to model adolescents living with HIV. There is a bidirectional
the effects of FES caseness and BMI, as well as relationship between mental health and HIV.
their interactions, on a) global cortical thickness, We aimed to ascertain the prevalence of HIV
as well as b) subcortical gray matter volumes for among children and adolescents attending two
the ventral diencephalon (VD), hippocampus clinics in the Sedibeng district and to compare
(HC), and basal ganglia (BG), and c) white matter those infected with HIV with those non-infected.
volumes for the anterior corpus callosum (CC). Methodology: A retrospective record review was
Other cortical (frontal cortex, orbitofrontal cortex, conducted at two community health centres in
anterior cingulate cortex, parahippocampal Sedibeng ('Zone 12 Clinic' in Sebokeng township
gyrus, superior temporal gyrus, insula) and and 'Johan Heyns' in a suburban area of
subcortical (brainstem, thalamus, amygdala, Vanderbijlpark). All clinical files at the two clinics as
nucleus accumbens) regions-of-interest (ROI) of 28 February 2019 were reviewed.
were selected based on their involvement in the Results: A total of 370 clinical files were retrieved; 232
regulation of food intake. (63%) from Johan Heyns Clinic and 138 (37%) from
In FES patients, secondary objectives included Zone 12 Clinic. Five (1.4%) were HIV infected users. All
the relationships of other clinical (duration of five were male and Black African with an age range
untreated psychosis, psychopathology) and METS of 9- 22 years (two were young adults still attending
(lipid profiles, fasting glucose) risk factors with brain school). Three had one deceased parent and two
structures for which BMI had a main effect. had lost both parents. Psychiatric diagnoses were
Results: FES caseness predicted thinner global intellectual disability (n=3), epilepsy (n=3), attention
cortical thickness, adjusting for BMI, while increased deficit hyperactivity disorder (ADHD) (n=1), autistic
BMI predicted larger BG volumes, as well as thinner spectrum disorder (n=1), depression (n=1) and
left and right frontal pole, parahippocampal gyrus, traumatic brain injury (n=1).No comparison could
and anterior cingulate cortex (ACC), adjusting be made between users with HIV and those without
for caseness. There were significant FES*BMI HIV.
interactions for the VD, HC, and anterior CC, with The study however, showed interesting differences
illness-specific and differential effects across these between the two clinics. Compared to Zone 12
outcomes. Clinic, those attending Johan Heyns Clinic were
In FES patients, we noted multiple correlations more often male (p=0.028), White (p=0.001),
of these structural outcomes with other clinical living with their parents (p=0.001), attending a
and METS risk factors, including increased waist mainstream school (p=0.015) and less often on a
circumference (ACC, HC), elevated triglycerides care dependency or foster care grant (p0.001).
(HC), and a higher triglyceride/HDL ratio (HC, VD), Those attending Zone 12 Clinic were more often
but also lower LDL cholesterol levels (anterior CC). diagnosed with intellectual disability (p=0.003)
Conclusion: Our research supports an association and autistic spectrum disorder (p=0.016) and less
between METS risk factors, and brain structure, frequently with ADHD (p=0.001), anxiety (p=0.001),
consistent with a proposed “lipid paradox” or conduct disorder (p=0.001).
described for treatment-naïve FES. Future studies
would do well to examine the associations of

54 * SOUTH AFRICAN PSYCHIATRY ISSUE 29 2021

BudepXR

Bupropion 150 / 300 mg

A first-line treatment for major depression1

Consistent efficacy in major depressive disorder2,3
Lower incidence of sexual dysfunction vs. SSRIS1,2
Little or no weight gain4
Effective in MDD patients with decreased energy,
pleasure and interest5

Bioequivalent to the originator6

MDD – major depressive disorder; SSRI – selective serotonin reuptake inhibitor
References: 1. Davidson JRT, Connor KM. Bupropion sustained release: A therapeutic overview. J Clin Psychiatry 1998;59 (Suppl 4):25-31. 2. Clayton AH, Croft HA, Horrigan JP, et al. Bupropion
extended release compared with escitalopram: effects on sexual functioning and antidepressant efficacy in 2 randomized, double-blind, placebo-controlled studies. J Clin Psychiatry 2006;67(5):736-
746. 3. Data on file. Wellbutrin® XL Monograph. 2017. 4. Fava M, Rush J, Thase ME, et al. 15 years of clinical experience with bupropion HCl: From bupropion to bupropion SR to bupropion XL. Prim
Care Companion J Clin Psychiatry 2005:7:106-113. 5. Jefferson JW, Rush AJ, Nelson C, et al. Extended-release bupropion for patients with major depressive disorder presenting with symptoms of
reduced energy, pleasure, and interest: Findings from a randomized, double-blind, placebo-controlled study. J Clin Psychiatry 2006 67:865-873. 6. Data on file. Bioequivalence study of bupropion XR.
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.
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.
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

SASOP CONGRESS - POSTER ABSTRACTS SASOP CONGRESS - POSTER ABSTRACTS

Conclusion: Very few HIV infected users attend FNH for a 30-day inpatient forensic assessment,
either clinic. The sample highlights different while 43% were not recommended for referral.
communities access and help-seeking priorities Those recommended for inpatient assessment
regarding mental health. Research regarding were significantly more likely to have a lower
unmet mental health needs among children and level of education (p=0.02), to be on a disability
adolescents is recommended. grant (p0.01), and to have been diagnosed
________________________________________ with intellectual disability (p0.01), than those not
THE PROFILE OF SUSPECTED CRIMINAL OFFENDERS recommended for referral.
REFERRED FOR PSYCHIATRIC EVALUATION ON AN Conclusion: Identifying the characteristics of
OUTPATIENT BASIS AT NGWELEZANA HOSPITAL suspected criminal offenders who are most likely to
Lerato Makofane, Department of Psychiatry at the be recommended for referral to FNH will potentially
University of the Witwatersrand reduce the number of unnecessary referrals. The
Sithembisile Mngadi, Department of Psychiatry, assessing psychiatrists recommended alternative
Nelson R. Mandela School of Medicine, Durban, referral methods for 43% of the suspected criminal
South Africa offenders, which will prevent trial delays and
Andrew Tomita, KwaZulu-Natal Research Innovation congested waiting lists.
and Sequencing Platform (KRISP), College of Health ________________________________________
Sciences, University of KwaZulu-Natal, Durban, EXPLORING BURNOUT AMONG PSYCHIATRIC
South Africa TRAINEES AT A SOUTH AFRICAN UNIVERSITY
Vusi Khanyile, Madadeni Provincial Hospital, Tejil Morar, Department of Psychiatry at the
Department of Psychiatry University of the Witwatersrand
Bonginkosi Chiliza, Nelson R. Mandela School of Presenter: Dr Tejil Morar
Medicine, Department of Psychiatry, Durban, South Introduction: The mental health of doctors is
Africa increasingly topical, internationally and locally.
Presenter: Dr Sithembisile Mngadi Of importance is the phenomenon of burnout, a
Introduction: Some suspected criminal offenders far-reaching repercussion of chronic work-related
in South Africa are required to undergo forensic stress. Psychiatrists are more vulnerable to stress,
psychiatry assessments before or during the trial, burnout and suicide in comparison to other medical
which can be delayed due to the shortage of specialities. There is a void in published research
psychiatrists and inpatient forensic psychiatry beds. relating to South African psychiatric trainees.
In KwaZulu-Natal (KZN) Province, only one hospital Aim: To investigate burnout and associated factors
(Fort Napier Hospital (FNH)) is designated for the 30- among psychiatric registrars at a South African
day inpatient forensic psychiatry assessments and University.
there is a long waiting list for suspected criminal Methodology: A cross-sectional study, via an
offenders awaiting assessment. There is a need to anonymous self-administered questionnaire.
find ways of alleviating the backlog in the waiting The questionnaire comprised three sections:
list, with the use of outpatient forensic assessments demographics, the Maslach Burnout Inventory
being a possible adjunctive method. Human Services Survey (MBI-HSS) and questions
Aim: To determine the demographic, clinical and relating to contributing factors, protective factors
forensic profile of suspected criminal offenders and consequences of burnout. The MBI-HSS is
referred for outpatient preliminary assessment to recognised as the leading measure of burnout,
Ngwelezana Hospital, and identify the profile of The MBI-HSS consists of three subscales: emotional
those who most likely require referral to FNH for a exhaustion (EE), depersonalisation (DP) and
30-day inpatient assessment. personal accomplishment (PA).
Methodology: We conducted a retrospective chart Results: The questionnaire was completed by 33
review of 207 suspected criminal offenders referred out of 55 psychiatric registrars (60.0% response
for outpatient forensic assessment from January rate). Data from 31 registrars were used in the
2009 to June 2015. analyses, as two registrars did not provide informed
Results: The majority of the participants were males consent. Among participants, EE was the most
(94.2%), with a diagnosis of substance use disorder commonly affected, followed by DP and lastly PA.
(28.2%), intellectual disability (23.4%) or psychotic The majority (67.78% or n=21) had scores in the
disorders (21.8%). Forty three percent were charged high category for any one of the three subscales
with sexual crimes and 10.7% with murder. Fifty (EE/DP/PA). Significant factors associated with
seven percent were recommended for referral to burnout included poor work and non-professional
life balance (p=0.017), utilising annual leave days
for work-related tasks (p<0.001), irregular holidays

56 * SOUTH AFRICAN PSYCHIATRY ISSUE 29 2021

SASOP CONGRESS - POSTER ABSTRACTS SASOP CONGRESS - POSTER ABSTRACTS

(p=0.003) and financial debt (p=0.026). A possible testing revealed significant impairment in multiple
protective factor was an amicable relationship with domains: memory and psychomotor processing
fellow psychiatric registrars. (82.5%), concentration (18%), language (96.7%),
Conclusion: There is evidence of some degree of and executive function (15.2%). While gender,
burnout in more than two-thirds of participants. employment, medical comorbidity, depression and
Associated factors lie largely at an organisational CD4 counts showed no association with NP, higher
level, and while optimising individual resilience is educational attainment and CR categories were
important, systemic support plays a key role. predictive of higher composite cognitive scores. CR
________________________________________ was the only significant predictor of NPI across all
COGNITIVE HEALTH AND RESERVE IN ANTI- neurocognitive tests.
RETROVIRAL THERAPY NAÏVE HIV-POSITIVE ADULTS
Kalpesh Narsi, Department of Psychiatry, University Conclusion: Despite the advent of ARVs, HIV-related
of KZN cognitive burden remains a considerable concern.
Suvira Ramlall, Department of Psychiatry, University We found a high degree of sub-optimal CR, which
of KZN was significantly associated with poor NP across
Andrew Tomita, KwaZulu-Natal Research Innovation various domains, in a relatively young cohort of
and Sequencing Platform , University of KwaZulu- ART-naïve PLWH. Early intervention focusing on
Natal increasing CR, especially in socioeconomically
Presenter: Dr Kalpesh Narsi vulnerable populations, is needed to promote
Aim: As people living with HIV (PLWH) live longer with healthy lifestyle, mitigate NPI, and maintain long-
improved physical health and a lower incidence termindependent functioning in PLWH.
of HIV-associated dementia, milder forms of ________________________________________
neuropsychological impairment (NPI) persist,
which have a less robust response to antiretroviral ANTIPSYCHOTIC DOSE REDUCTION/
therapy (ART). Cognitive reserve (CR), the brain’s DISCONTINUATION ON METABOLIC SYNDROME IN
capacity to resist the clinical manifestations of PATIENTS WITH FIRST EPISODE PSYCHOSIS TREATED
pathology, plays an essential role in preserving WITH A LONG-ACTING INJECTABLE ANTIPSYCHOTIC
cognitive health. Despite growing literature on the
role of CR in mitigating NPI in PLWH, its association Ziyanda Ndlangisa, University of KwaZulu Natal
with baseline neuropsychological performance
(NP) has not been studied in a newly diagnosed Prof Musa Mabandla, University of KwaZulu Natal
South African cohort.To describe the CR profile and
NP, and its association with socio-demographic Prof Robin Emsley, Stellenbosch University
and clinical factors in a clinical population of ART-
naïve HIV-positive adults. Prof Bonginkosi Chiliza, University of KwaZulu Natal
Methodology: In this cross-sectional study, socio-
demographic and clinical data was collected on Presenter: Ms Ziyanda Ndlangisa
211 ART-naïve participants from two peri-urban
clinics. Depression, CR, and NP were assessed Aim: The introduction of antipsychotics has
using the MINI – Depression Module, the Cognitive been a significant milestone in the treatment of
Reserve Index Questionnaire (CRIq) and a battery schizophrenia. However, these agents have several
of neuropsychological tests to assess the domains important side effects, such as the propensity
of memory, psychomotor processing, attention, to cause metabolic syndrome. Options to curb
language, executive and visuo-spatial function these adverse effects include a change in the
Multiple regression models assessed the socio- treatment option, changes in patients’ lifestyle,
demographic and clinical determinants of CR, and the addition of other medications such as
and the relationship between CR and clinical risk metformin. Thus, this study investigated whether
predictors of NP on composite cognitive scores and dose reduction/discontinuation of an injectable
individual neuropsychological tests. antipsychotic, flupenthixol decanoate, would result
Results: CRIq scores were concentrated in the low- in improvement of metabolic syndrome parameters
medium (52.6%) and medium (47.4%) functioning in a cohort of first-episode schizophrenia patients in
range with no individual in the extreme-low or South Africa.
high CR-functioning group. Higher CR scores were
significantly associated with older age, higher Methodology: The study included 33 participants
education, and being employed. Using standard recruited at the Tygerberg and Stikland Hospitals
cut-off values, performance on neuropsychological in the Western Cape Province, South Africa. The
metabolic syndrome profiles of all 33 participants
were compared at baseline and at point of relapse.
All participants were given a monthly dose of an
injectable antipsychotic, flupenthixol decanoate,
which was gradually reduced until the participant
relapsed or was off treatment. Adherence to
treatment was guaranteed as all participants
had to visit the healthcare facility to receive their
injectable.

57 * SOUTH AFRICAN PSYCHIATRY ISSUE 29 2021

SSRI = selective serotonin-reuptake inhibitor

References: 1. Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments analysis. Lancet
2009;373(9665): 746-758. 2. Cipriani A, La Ferla T, Furukawa TA, et al. Sertraline versus other antidepressants for depression. Cochrane Database Syst Rev 2014;(4):CD006117.
Doi:10.1002/14651858.CD006117.pub4. 3. Parissis J, Fountoulaki K, Paraskevaidis I, et al. Sertraline for the treatment of depression in coronary artery disease and heart failure.
Expert Opin Pharmacother 2007;8(10):1529-1537. 4. Muijsers RB, Plosker GL, Noble S. Sertraline: a review of its use in the management of major depressive disorder in elderly
patients. Drugs Aging 2002;19(5):377-392. 5. Data on file. Bioequivalence study of sertraline.

S5 SERLIFE® 50 mg (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 mg (Film-coated tablets). Reg. No.: 36/1.2/0273. Each film-coated tablet contains sertraline hydrochloride equivalent to sertraline 100 mg.
Sugar free. Pharmacological classification: A 1.2 Psychoanaleptics (Antidepressants). Applicant: Ranbaxy (S.A.) (Pty) Ltd., a Sun Pharma company. Ground Floor, Tugela
House, Riverside Office Park, 1303 Heuwel Avenue, Centurion, 0046. Tel: +27 12 643 2000. Fax: +27 12 643 2001. www.sunpharma.com.

For full prescribing information please refer to the package inserts approved by the South African Health Products Regulatory Authority.

SASOP CONGRESS - POSTER ABSTRACTS SASOP CONGRESS - POSTER ABSTRACTS

Results: The study participants were aged ACEs, PHQ-9 for depressive symptoms and a socio-
between 21-25 years (39.4%). Most (64%) of the demographic and clinical questionnaire. The
participants were overweight. The mean time to study was conducted between September and
relapse was 39.2 weeks, and by week 32, almost December 2020, after the first wave of the COVID-19
half of the participants had relapsed. A significant pandemic in South Africa.
change was observed for weight (p = 0.018), waist Results: The most common types of ACEs
circumference (p = 0.006) and fasting glucose (p experienced were having one or no parent, parental
= 0.045). There were no significant changes in the separation or divorce (n=131,66.8%), exposure to
lipid parameters following the antipsychotic dose collective violence (n=57,29.1%) and community
reduction. violence (n=55,28.1%) with 79 (40.3%) experiencing
Conclusion: Antipsychotic dose reduction resulted 3 or more types of ACEs. The most commonly used
in weight loss; however, the majority of patients substances were alcohol (n=34,17.3%), tobacco
relapsed, some having important consequences. (n=33,16.8%) and cannabis (n=13,6.6%). Thirty-
Further studies are needed to understand eight (19.4%) participants screened positive for
the dynamics of treatment discontinuation in depressive symptoms. Linear regression analyses
schizophrenia patients. Clinicians should closely indicated greater alcohol use (adj β=2.84, p0.01),
monitor patients taking antipsychotics as metabolic tobacco use (adj β=3.64, p0.01) and cannabis
syndrome negatively impacts on the patients’ use risk scores (adj β=2.39, p0.01) for individuals
quality of life and the syndrome is difficult to reverse. experiencing 3 or more types of ACEs. Similarly,
________________________________________ depressive risk (adjusted OR=9.39,95% CI 4.78-23.51)
THE PREVALENCE OF ADVERSE CHILDHOOD was also greater for individuals experiencing 3 or
EXPERIENCES, SUBSTANCE USE AND DEPRESSION more types of ACEs based on logistic regression.
IN PEOPLE WITH HIV INFECTION DURING THE Conclusion: The prevalence of depression in this
COVID-19 PANDEMIC study population was consistent with the pre-
Nikita Prosad Singh, Department of Psychiatry, COVID literature, however the findings highlight
Nelson R. Mandela School of Medicine, University the high prevalence of ACEs in PLWHIV and the
of KwaZulu-Natal association of ACEs with greater risk of substance
Vuyokazi Ntlantsana, Department of Psychiatry, use and depressive symptoms suggesting the need
Nelson R. Mandela School of Medicine, University for improved screening strategies for ACEs and the
of KwaZulu-Natal triple burden of HIV, substance use and depressive
Andrew Tomita, Centre for Rural Health, School of symptoms as outcomes may be modified by
Nursing and Public Health, University of KwaZulu- addressing potential risk factors.
Natal, Durban, South Africa / KwaZulu Natal ________________________________________
Research Innovation and Sequencing Platform A COMPARISON OF GAUTENG PROVINCE
(KRISP), College of Health Sciences, University of PSYCHOTROPIC MEDICINE PROCUREMENT
KwaZulu-Natal, Durban, South Africa AND EXPENDITURE DURING 2017-2018 BETWEEN
Saeeda Paruk, Department of Psychiatry, Nelson R. DISTRICTS AND FACILITIES AT EACH SERVICE LEVEL
Mandela School of Medicine, University of KwaZulu- Lesley Jane Robertson, Department of Psychiatry,
Natal School of Clinical Medicine, University of the
Presenter: Dr Nikita Prosad Singh Witwatersrand, Johannesburg, South Africa
Aim: The association of adverse childhood Jade Bouwer, Department of Psychiatry, School of
experiences (ACEs) with substance use and Clinical Medicine, University of the Witwatersrand,
depressive symptoms has been investigated Johannesburg, South Africa
but the triple burden of HIV, substance use and Shereen Govender, Previously Pharmaceutical
depressive symptoms and its association with ACEs Policy Specialist, Affordable Medicines Directorate,
requires further exploration as comorbid ACEs are National Department of Health, South Africa
associated with poorer mental and physical health Presenter: Prof Lesley Robertson
outcomes. Aim: Gauteng province spent 3.7% of total
To determine the prevalence of ACEs, substance medicine expenditure on medicines for mental,
use and depressive symptoms in people living with neurological, and substance use (MNS)
HIV (PLWHIV) attending an outpatient HIV service at disorders in the 2017/18 financial year. Analysis of
a hospital and assess the association of ACEs with procurement and expenditure may provide an
substance use and depressive symptoms. indirect indication of equitable service provision
Methodology: 196 participants completed a and prescribing practices. This study aimed to
self-report written survey comprising of the WHO compare procurement of MNS medicines between
ASSIST V3.0 for substance use, WHO ACE-IQ for districts at each service level, hypothesising
there would be no significant difference for each
medicine class.

59 * SOUTH AFRICAN PSYCHIATRY ISSUE 29 2021

SASOP CONGRESS - POSTER ABSTRACTS SASOP CONGRESS - POSTER ABSTRACTS

Methodology: A secondary analysis of the 2017/18 (MNS) disorders. This study aimed to compare
Gauteng Medical Stores Administration System medicine procurement for MNS disorders at each
database was conducted using the World Health service level, hypothesising that there would be no
Organization’s Anatomical Therapeutic Chemical/ significant difference between the five districts.
Defined Daily Dose (ATC/DDD) methodology. The Methodology: A secondary analysis of the
study population comprised medicines in ATC Gauteng Medical Stores Administration System
classes N03A (antiepileptics), N05A (antipsychotics), database was conducted using the World
N05B (anxiolytics), N06A (antidepressants), and Health Organization’s Anatomical Therapeutic
N06B (psychostimulants) procured for the public Chemical/Defined Daily Dose (ATC/DDD)
health sector. Medicines procured for contracted methodology. The study population comprised
care were excluded. Procurement at District MNS medicines in ATC classes N03 (antiepileptics),
Clinic and District, Regional, Tertiary, Central and N04 (anticholinergics and dopaminergics),
Specialised Hospital service levels was analysed. N05 (antipsychotics and anxiolytics), N06
Results: The DDDs procured and costs per 1000 (antidepressants and psychostimulants) and N07
population served differed significantly between (medicines in addiction disorders). Medicines
districts for each ATC class at District, Regional, procured for contracted care and specialised
Central, and Specialised Hospital service levels. neurological conditions were excluded. The DDD
At District Clinic level, anxiolytic procurement did for each was obtained from the WHO Collaborating
not differ between districts in terms of DDDs/1000 Centre for Drug Statistics Methodology website.
population served (p=0.064), although it differed The population served was derived from the
in cost/1000 population (p<0.001). Conversely, District Health Information System.
for antidepressants, the cost/1000 did not differ Results: A total of R132 323 280.26 was spent on MNS
between districts (p=0.13) while the DDD/1000 did medicines in 2017/18. Of the total DDDs, 93.7% were
differ (p<0.001). At Tertiary Hospitals, the DDDs /1000 procured for general health settings, accounting for
population for anxiolytics and psychostimulants did 89.7% of total expenditure. There was no significant
not differ between districts (p=0.134 and p=0.055, difference between the five districts regarding total
respectively) although the cost/1000 differed headcount or proportion of population served in
(p<0.001) for all ATC classes. general health settings. Tshwane spent the most
Conclusion: Procurement and expenditure differed per 1000 population served (range R3 131 to R5
between districts for all ATC classes at each service 049; p<0.001), whereas Sedibeng procured the
level, suggesting different patient populations and most DDD per 1000 population served (range 1491
prescribing practices. Further research evaluating to 2349; p<0.001), while there was no difference
medicine procurement, utilisation and patient level between districts in cost per DDD (range R1.96 to
outcomes at the various service levels may inform R2.84, p=0.994). The three specialised psychiatric
future practice. hospitals together procured 5.9% of total DDDs, at an
________________________________________ average cost of R4.24 per DDD, accounting for 10%
GAUTENG PROVINCIAL PSYCHOTROPIC MEDICINE of total expenditure. Two specialised rehabilitation
PROCUREMENT IN GENERAL AND SPECIALISED centres accounted for 0.3% of total expenditure
HEALTHCARE SETTINGS DURING 2017-2018 and DDDs procured, at R2.21 per DDD.
Lesley Jane Robertson, Department of Psychiatry, Conclusion: The pattern of MNS medicine
School of Clinical Medicine, University of the procurement indicates mental healthcare is
Witwatersrand, Johannesburg, South Africa integrated into general health settings in Gauteng
Jade Bouwer, Department of Psychiatry, School of province. Differences between districts in terms of
Clinical Medicine, University of the Witwatersrand, expenditure and DDDs procured warrant further
Johannesburg, South Africa exploration.
Shereen Govender, Previously Pharmaceutical ________________________________________
Policy Specialist, Affordable Medicines Directorate, PREVALENCE OF VITAMIN B12 DEFICIENCY IN
National Department of Health, South Africa PSYCHIATRIC INPATIENTS IN NELSON MANDELA
Presenter: Prof Lesley Robertson BAY
Aim: South African mental health legislation Megan Schultz, Walter Sisulu University
advocates for treatment of mental illness close to Zukiswa Zingela, Walter Sisulu University
the person’s home, in general healthcare settings, Stephan Van Wyk, Walter Sisulu University
with specialist referral as needed. Pharmaco- Presenter: Dr Megan Schultz
epidemiology may provide an indirect assessment Introduction: B12 deficiency is an increasing
of service provision. During 2017/18, Gauteng problem. Research of the subject, especially related
Department of Health spent approximately 3.73% to mental illness is scarce, particularly in Africa. This
of total pharmaceutical expenditure on medicines is a descriptive study on B12 deficiency.
for mental, neurological, and substance use

60 * SOUTH AFRICAN PSYCHIATRY ISSUE 29 2021

BRoeofsMdtoBryieanltahdnec&e

Significant reduction in depressive
symptoms;1 comparable to SSRIs2

More effective in major depressive disorder
with painful physical symptoms, than SSRIs2

Guideline-recommended first-line therapy for
diabetic peripheral neuropathic pain3

Well-balanced inhibitor of serotonin and
noradrenaline reuptake4

Bioequivalent to
the originator5

SSRI – selective serotonin reuptake inhibitor
References: 1. Harada E, Tokouka H, Fujikoshi S, et al. Is duloxetine’s effect on painful physical symptoms in depression an indirect result of improvement of depressive symptoms: Pooled
analyses of three randomized controlled trials. Pain 2016;157:577-584. 2. Kuga A, Tsuji T, Hayashi S, et al. An observational study of duloxetine versus SSRI monotherapy for the treatment
of painful physical symptoms in Japanese patients with major depressive disorder: primary analysis. Neuropsychiatric Disease & Treatment 2017;13:2105-2114. 3. Iqbal Z, Azmi S, Yadav R,
et al. Diabetic peripheral neuropathy: epidemiology, diagnosis, and pharmacotherapy. Clinical Therapeutics 2018;40(6):828-849. 4. Muneoka K. Pharmacotherapy of major depressive
disorder: Focus on duloxetine. Clinical Medicine: Therapeutics 2009;1:1541-1556. 5. Data on file. Bioequivalence study of duloxetine.
S5 DUZELA 30 mg hard gastro-resistant capsules. Each capsule contains 30 mg duloxetine (as hydrochloride). Contains sugar (sucrose and mannitol). 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 and mannitol). 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

SASOP CONGRESS - POSTER ABSTRACTS SASOP CONGRESS - POSTER ABSTRACTS

AIM: Investigate and describe the prevalence of Oscar Motswage, Department of Clinical
B12 deficiency in a mental health unit in Nelson Psychology, School of Medicine, Sefako Makgatho
Mandela Bay. Review validity of the local cut- Health Sciences University, Pretoria, South Africa
off value. Describe clinical and demographic Soraya Seedat, Department of Psychiatry,
correlates associated with B12 deficiency. Stellenbosch University, South Africa
Methodology: The study was conducted at the Christiane Eichenberg, Medical Faculty, Institute of
Dora Nginza Mental Health Unit (MHU) in Nelson Psychosomatic, Sigmund Freud University, Vienna,
Mandela Bay, as a retrospective chart review of Austria
all admissions to the MHU over a 3-month period, Presenter: Dr Georgina Spies
June - August 2017. B12 levels were documented AIM: Serious games are computer or video games
and classified based on B12 values. Data was from that are developed for learning and instructional
three sources: (a) MHU admissions register, (b) NHLS purposes. Serious games are increasingly being
online results (c) clinical notes from patient folders. applied within healthcare, but their integration in
A data collection sheet designed by the researcher psychotherapeutic settings is less well documented.
was utilized to capture data. Clinical correlates Existing knowledge and experience of serious
are compared for each subgroup. Data includes games, as well as readiness to integrate serious
housing, income and dietary info. Information such games in the treatment of psychological conditions,
as DSM-5 diagnosis, comorbidity and neurological requires investigation. The present study sought
symptoms was captured. Data was collated and to identify the attitudes of psychotherapists and
analysed applying descriptive and inferential patients towards serious games in psychotherapy
statistics. in the South African context.
Results: The study showed a large proportion of Methodology: Online surveys assessed
people admitted for mental illness suffer from B12 acceptance, experience, and requirements for the
deficiency across various age groups and clinical utilisation of serious games in therapeutic contexts.
diagnoses. 245 records were reviewed; 122 (49,8%) Two stakeholder groups completed these online
had questionable levels requiring further testing; surveys, namely clients utilising mental health
44 (18%) had clear deficiency. These deficiencies services (n = 209) and psychotherapists delivering
were not limited to elderly people or people with mental health services (n = 156) in South Africa.
dietary exclusions. Megaloblastic anaemia was not Results: Current knowledge about serious games is
evident. limited with only 15% of clients and 16% of therapists
Conclusion: B12 deficiency is a complex disorder reporting knowledge of the existence and
with multiple causes and effects. There is limited application of serious games. Use of serious games
research within the South African context, especially is even more infrequent with only 1% of therapists
in psychiatric settings. This study highlights the fact and 6% of clients currently using serious games as
that our longstanding knowledge on B12 deficiency an intervention.
is not adequate in our setting. We will have to review Although knowledge and use of serious games
our diagnostic procedures, treatment approaches is still limited, our findings highlight an apparent
and guidelines. Study findings suggest that all demand for their use, with 71% of therapists
patients admitted for psychiatric illness should have indicating that serious games would be a suitable
routine B12 testing. It may be advisable to review the adjunct treatment modality for their patients.
cutoff values and the possibility of cascade testing The majority of participants agreed that South
to better identify B12 deficiency. Africans could benefit from serious games more if
Further studies are needed to determine if this is a they are tailored to be more culturally specific and
general problem requiring food fortification and applicable.
whether it is specific to psychiatric settings. Conclusion: Our results show a general openness
________________________________________ toward the use of serious games in psychotherapy,
ATTITUDES OF PATIENTS AND MENTAL HEALTH although therapists were more reluctant to
PROFESSIONALS TOWARDS SERIOUS GAMES IN consider the application of serious games for more
PSYCHOTHERAPY severe disorders. The use of serious games as an
Georgina Spies, DSI/NRF South African Research e-mental health treatment modality is conceivable
Chairs Initiative, PTSD Program, Department of for both patients and therapists, particularly as a
Psychiatry, Stellenbosch University, South Africa complementary strategy to traditional face-to-face
Jessica Huss, Department of Psychology, University psychotherapy.
of Kassel, Kassel, Germany

62 * SOUTH AFRICAN PSYCHIATRY ISSUE 29 2021

SASOP CONGRESS - POSTER ABSTRACTS SASOP CONGRESS - POSTER ABSTRACTS

PATTERNING OF INDIVIDUAL VARIABILITY IN by severity of childhood maltreatment in tests of
NEUROCOGNITIVE HEALTH AMONG SOUTH information processing speed (Trail Making Test)
AFRICAN WOMEN EXPOSED TO CHILDHOOD and executive function (Color Trails 2 and Stroop
MALTREATMENT Color-Word), in the absence of mean differences.
Georgina Spies, DSI/NRF South African Research Exploratory results suggest that the presence of
Chairs Initiative, PTSD Program, Department of individual-level heterogeneity in neurocognitive
Psychiatry, Stellenbosch University, South Africa performance among women exposed to childhood
Christy Denckla, Department of Social and maltreatment warrants further exploration.
Behavioral Sciences, Harvard T. H. Chan School of Conclusion: The methods presented here may be
Public Health, Boston, USA used in a person-centered framework to better
Sun Yeop Lee, Department of Social and Behavioral understand vulnerability to the toxic neurocognitive
Sciences, Harvard T. H. Chan School of Public effects of childhood maltreatment at the individual
Health, Boston, USA level, ultimately informing personalized prevention
Rockli Kim, Interdisciplinary Program in Precision and treatment.
Public Health, Department of Public Health ________________________________________
Sciences, Graduate School of Korea University, CUT IT OUT OR WAIT IT OUT? CASE SERIES OF
Seoul, Republic of Korea; Division of Health Policy MIDDLE FOSSA ARACHNOID CYSTS PRESENTING
and Management, College of Health Science, WITH PSYCHIATRIC SYMPTOMS AND THE ETHICS OF
Korea University, Seoul, Republic of Korea NEUROSURGICAL MANAGEMENT
Jennifer Vasterling, Boston University School of Petrus Johannes Steyn, Department of Psychiatry,
Medicine, Boston, USA Stellenbosch University
S. V. Subramanian, Harvard Center for Population and Leigh Luella van den Heuvel, Department of
Development Studies, Cambridge, USA; Department Psychiatry, Stellenbosch University
of Social and Behavioral Sciences, Harvard T. H. Chan Presenter: Dr Petrus Steyn
School of Public Health, Boston, USA AIM: Although the neuropscyhiatry of arachnoid
Soraya Seedat, Department of Psychiatry, cysts are controversial, they have been linked to
Stellenbosch University, South Africa mental health morbidity.
Presenter: Dr Georgina Spies There have been case reports of psychiatric illness
AIM: There are individual differences in health which improves with drainage of arachnoid cysts
outcomes following exposure to childhood or where surgery was withheld and psychopatholoy
maltreatment, yet constant individual variance is proves resistant; as well as studies which failed to
often assumed in analyses. show such associations. This impedes treatment
Methodology: Among 286 Black, South African planning.
women, the association between childhood Methodology: We describe two patients who
maltreatment and neurocognitive health, defined presented to a neuropsychiatry service with
here as neurocognitive performance (NP), was arachnoid cysts and acute psychiatric symptoms.
first estimated assuming constant variance. Then, Results: Our patients were males in their early
without assuming constant variance, we applied twenties who presented with dissociative and
Goldstein’s method (Encyclopedia of statistics manic symptoms with atypical features, believed
in behavioural science, Wiley, 2005) to model to be associated with middle fossa arachnoid
“complex level-1 variation” in NP as a function of cysts. They were managed medically and remitted
childhood maltreatment. eventually, but symptoms were resistant.
Results: Mean performance in some tests of Conclusion: We present a brief review of the
information processing speed (Digit-symbol, literature to indicate mechanisms by which these
Stroop Word, and Stroop Color) lowered with cysts could cause symptoms and consider whether
increasing severity of childhood maltreatment, neurosurgical management would be appropriate.
without evidence of significant individual variation. Although neurosurgery can be considered, its
Conversely, we found significant individual variation role is currently limited by practical and ethical
considerations.

63 * SOUTH AFRICAN PSYCHIATRY ISSUE 29 2021

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64 * SOUTH AFRICAN PSYCHIATRY ISSUE 29 2021