South African Psychiatry - August 2021

PERSPECTIVE

ARE YOU SURVIVING OR THRIVING?

BUILDING YOUR

RESILIENCE

Renata Schoeman

2 020…do we need to say more? COVID-19 Prevention includes a wide
has flipped our world upside down and range of activities — known
changed a world that was safe, secure as “interventions” — aimed at
and known, even with all its life challenges, reducing risks or threats to health.
overnight to one of unfamiliarity, chaos and an Primary prevention specifically
enormous amount of discomfort and additional refers to preventing disease or
stressors. injury before it occurs. In the
The pandemic, and the significant impact it has context of resilience, primary
had, and continues to have, on all aspects of our prevention refers to limiting
lives, contributes to many feelings of uncertainty exposure to work-related hazards
and anxiety. We have all had to adapt at rapid Renata Schoeman
speed. The past couple of months, whilst facing
adversity, we have been working from home, that contribute or cause disease
physically distancing, tolerating financial hardships, (workplace intervention), altering unhealthy and
embracing technology, or even dealing with illness unsafe behaviours (improving selfcare and healthy
and loss related to health, finances. This has become lifestyle choices), and increasing resistance to
our ‘new normal’. These overnight changes and illness, should exposure occur.
challenges have left most people despondent.
However, despite facing similar stressors, there are The most effective prevention is therefore building
many who seem to have “glided” through it all, resilience through strengthening your internal
unaffected. How is that possible, you might ask. resources and focussing on selfcare.

“THE TRUTH IS THAT OUR FINEST MOMENTS TEN HABITS OF RESILIENT PEOPLE
ARE MOST LIKELY TO OCCUR WHEN WE
ARE FEELING DEEPLY UNCOMFORTABLE, 1. Be optimistic
UNHAPPY, OR UNFULFILLED. FOR IT IS Optimism is a future-oriented attitude, involving
ONLY IN SUCH MOMENTS, PROPELLED BY hope and confidence that things will turn out well.
OUR DISCOMFORT, THAT WE ARE LIKELY Positive emotions reduce physiological arousal
TO STEP OUT OF OUR RUTS AND START and broaden our visual focus, our thoughts, and
SEARCHING FOR DIFFERENT WAYS OR our behaviour. Although we may feel overwhelmed
TRUER ANSWERS.” (PECK, 1978). by the current situation and our anxieties (health,
financial, etc.), our thinking is more creative, flexible,
The message here is that we should not shy away holistic, effective and future-focussed, when we are
from stress – stress can be a powerful motivator and optimistic.
fertiliser for growth. However, we need to manage
our stress and build our resilience. According to 2. Face your fear
the American Psychological Association (2014), Mandela said “I learned that courage was not the
resilience is “the process of adapting well in the absence of fear, but the triumph over it. I felt fear
face of adversity, trauma, tragedy, threats or even myself more times than I can remember, but I hid
significant sources of threat”. it behind a mask of boldness. The brave man is not
But what makes some more resilient than others? he who does not feel afraid, but he who conquers
that fear”.

Fear can be a warning and a guide – it helps us to
focus on what we need to address and to master
the skills necessary for conquering the “enemy”.

SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 * 51

PERSPECTIVE happiness, joy and pleasure) and concentration,
but it also creates new cells in the hippocampus
3. Have moral courage which underlies learning and memory. Aim to
Actively identifying your core values, assessing the exercise five times per week for at least 30 minutes.
degree to which you are living by these values, and
challenging yourself to adopt a higher standard 8. Sleep regularly
can strengthen character and build resilience. To Various studies have confirmed the health benefits
be morally courageous, we must be willing to do of sleep. It improves your immunity, stabilises
what we know to be right, even if it means loss, hormones directly linked with metabolism, improves
disapproval, or shame. emotional resilience and is necessary to consolidate
information during learning for memory formation.
Kidder (2006) describes moral courage as the
“willingness to take a tough stand for right in the 9. Cultivate a growth mind set and never stop
face of danger…the courage to do the right thing… learning.
the quality of mind and spirit that enables one to The more we think, the better our brain functions
face up to ethical challenges firmly and confidently – regardless of age. An active brain produces
without flinching or retreating”. new connections between neurons, so-called
neuroplasticity. Even if we train one cognitive skill,
4. Have faith it can improve performance of other cognitive skills
Religion and spirituality draw on faith. Not only is and protect us against cognitive decline later in life.
faith associated with better physical and mental However, it is important that we cultivate a growth
health, but also with longevity. In a meta-analysis mindset in which we see failure and challenges as
of 42 studies (n = 126000), those who actively opportunities for growth – both at personal and
practiced a religious faith lived slightly longer than organisational levels. Resilience also requires us to
those who did not (McCullough et al., 2000). think creatively and with flexibility.

We can include the practice of meditation and 10. Find meaning
mindfulness here. Mindfulness is a state of active, Nietschze famously said “He who has a why
open attention on the present - observing your can endure almost any how”. In Man’s search
thoughts and feelings from a distance, without for meaning, Frankl (2008) emphasised that
judging them as good or bad. Mindfulness means finding meaning is an active pursuit: “It must be
living in the moment and awakening to the searched for, found and discovered in the concrete
experience. Mindfulness has been associated with experiences of our daily lives”.
an increase in the areas of the brain regulating
mood, anxiety, memory and wellness – through We need to make sense of our circumstances and
increasing the size of the hippocampus and believe that we have the ability to exert influence
reducing the size of the amygdala. over it. This underlies one of the core requirements of
resilience: our consistent and deliberate practice of
5. Get social support resilience and the engaging in work that is “excellent
Social connectedness decreases perceived stress, in quality, socially responsible, and meaningful to its
depression, ischaemic heart disease and mortality. practitioners” (Gardner, Csikszentmihalyi, & Damon
The effect of social support on life expectancy may 2001). This will help us to translate the benefit of the
be as strong as the effects of obesity, cigarette inner work we are doing to the external challenges
smoking, hypertension, or level of physical activity we are facing.
(Salpolsky, 2004).
SIEBERT (2005) STATED THAT “WE ARE
Fowler and Christakis (2008) have also found that MOST RESILIENT WHEN WE SCAN NEW
social connectedness improves our happiness by CIRCUMSTANCES WITH CURIOSITY,
up to 40%. This is one of the biggest challenges for us NOT KNOWING IN ADVANCE WHAT WE
during the current COVID-19 pandemic and the call WILL DO, BUT CONFIDENT THAT WE WILL
for social distancing. I would strongly recommend INTERACT IN WAYS THAT LEAD TO THINGS
that we replace “social distancing” with “physical WORKING WELL.”
distancing” – and ensure that we remain socially
connected. The COVID-19 pandemic has transformed our
lives – and it has the potential to transform us. It is
6. Find role models crucial that we accept and embrace change as
The mirror neurons in our brain enable us to learn part of living, and that we avoid seeing crises as
through observation. Identify resilient role models insurmountable problems. Stress can be good for
and imitate and practice their best qualities. Rosen you. It can compel you to thrive and not merely
(2014) and Sharma (2018) give good examples of survive if you commit to setting aside time to work
resilient people and their practices. on your resilience, keep things in perspective, focus
on your goals and take care of yourself.
7. Train diligently
Physical exercise directly benefits the brain. Not only
does it improve immunity, positive emotions (e.g.

Renata Schoeman is a psychiatrist in private practice; Associate Professor, Leadership, University of Stellenbosch Business
School. Correspondence: [email protected]

52 * SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021

PERSPECTIVE

FREEDOM IN A

7 LETTER

PRISON

Claudia Campbell

E very month I hand over a fairly regular weight – not just diagnostically,
looking script to my pharmacist. My scripts but emotionally. It’s a word I try
have been written at the hand of the same not to look at too much, because
doctor for a dozen years – unusually, his it can feel like a 7-letter prison. The
writing is fairly legible. Collecting my medication, twice-daily procedure of spit-the-
bringing it home, and packing it into 28 days’ worth toothpaste -swallow-the-tablets
of little pill organizers has become a tedious ritual. feels quite devoid of emotion. But,
I feel that after packing out 4380 days’ worth of the script and a bag of blister-
capsules and tablets it should feel like nothing more packs make the spot behind my
than a requisite, dull routine. However, every month gut, underneath my lungs, close
I find myself avoiding it, and I mean, really, really to my heart thud uncomfortably. Claudia Campbell
avoiding it.
One might link this to the droning, monotonous Fortunately, for the most part, once the blackcurrant
popping of blister packs and counting of hundreds yoghurt whiff has drifted away and the blister packs
of dispersible tablets that have a faux blackcurrant- are little void plastic shapes, the thud dissipates
yoghurt whiff to them, but this is not the cause of my and my gut, lungs and heart begin to idle along
avoidance. The reason is linked to one word on my fairly contentedly again.
script: chronic.
A COUPLE OF WEEKS AGO I WENT
‘CHRONIC’, IT’S A SIMPLE TERM AND AT FOR MY REGULAR, COMPREHENSIVE
ITS CORE IT REALLY JUST MEANS ‘TIME’. PANEL OF BLOOD TESTS. GETTING MY
MEDICATION INTO THE THERAPEUTIC
However, written on a script it carries so much more RANGE TOOK YEARS. IT WAS A HARD
SLOG, BOTH FOR MY DOCTORS AND ME.

SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 * 53

PERSPECTIVE

7 LETTER P RIS O N

The gruelling process gradually gave way to persistent and very real part of me, it is merely a
the much longed for sustained stability and part, and all of me is so much more than just one
functionality. part. The things that, without doubt, make my life
After my initial arrival at the haloed ground of The worth living need to take up most of my mind’s eye,
Therapeutic Level, every blood test that came because they are plentiful and beautiful.
back in range felt like a celebration. However,
a half-dozen blood tests later I simply expected THAT SAID, I AM REQUIRED TO ADMIT THAT
good results, the sparkle had worn off and I CHRONIC ILLNESS IMPOSES LIMITATIONS
stopped my continual doubt that I was about to AND DEFINES NUMEROUS BOUNDARIES
slip backwards. However, my last result was not THAT MUST, AT ALL TIMES, BE RESPECTED.
so good, still in range but only just in range. The
‘chronic’ churn began again. However, ‘chronic’ Boundaries and limitations sound so very
also provides a plan and the plan effectively deals restricting. However, for the most part, it is these
with the churn. Because in its ‘chronic-ness’ my very restrictions that allow me, a person with
illness is not an unknown now, we know how it a chronic illness, to experience freedom too. I
behaves and we understand what needs doing to learnt, often the hard way, to stop trying to break
get back to where we need to be. It’s truly not a through my limitations – to conquer boundaries,
big deal anymore. but instead embrace the freedom that exists within
those precincts. I began to stop feeling restricted
PERHAPS A MONTHLY MOOD OVER and realise how freely I can live within a safe
HAVING A CHRONIC ILLNESS MIGHT space. Boundaries: the frontiers to freedom! Well,
SEEM DRAMATIC - IT DOES TO ME relative freedom.
ANYWAY, BUT IT HAS AN OFF-BEAT
PURPOSE TOO. A DOZEN YEARS AGO IF I DON’T CROSS THE BOUNDARY
I WAS SO ILL AND DYSFUNCTIONAL. LINES, THEN I REMAIN HEALTHY AND
HOSPITAL ADMISSIONS CAME AND WENT FUNCTIONAL - SO MUCH SO THAT FOR
MORE FREQUENTLY THAN THE SEASONS. MOST OF EACH MONTH I CAN ALMOST
EVERY TIME I FELT LIKE I WAS GAINING FORGET I HAVE A CHRONIC ILLNESS.
HEALTHY MOMENTUM SOMETHING THAT IS, UNTIL I HAVE TO PACK MY
WOULD KNOCK ME BACK. MEDICATIONS OUT AGAIN.

Getting up each time required a certain stick-at-it- So somehow, every 28 days, when my freshly filled
ness, and this led to the start of understanding that I pill organisers and empty blister packs are scattered
needed to figure out how life could happen and be around me, I need to force my self-pitying mind to
joyful within, or perhaps, around a chronic illness. muscle its way to gratitude. ‘Chronic illness’ and
To do that I had to stop overanalysing it, fighting it, its offspring, ‘chronic prescription’, can be terms of
I needed to stop searching for a permanent fix and incarceration or gateways to boundaried freedom.
I had to start simply walking next to it. I stopped I choose the latter.
focusing solely on treatment and started focusing
on living. I managed to lift my head, look up and Claudia Campbell holds a post-graduate degree in
plan my next steps. psychology and has 10 years experience in the field of
Thus, the process of acknowledging the limitations corporate transformation strategy. Claudia works in a
of having a chronic illness began. Because of the voluntary capacity as a psychosocial facilitator, public
7-letter word ‘chronic’ I began to accept that I was speaker, and consultant. Due to various health challenges,
not separate from my illness. Even though it’s a Claudia’s personal life includes many experiences from the
patient’s side of the consultation room. Correspondence:
[email protected]

54 * SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021

Live life in colour

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2021041310117912

PERSPECTIVE

K E TA M I N E
CLINICS

BEYOND THE HILLS

Alan Howard

I n the August 2020 edition of South African Throughout lockdowns, and more
Psychiatry, I penned two articles titled Ketamine recently the riots and unrest,
COVID & Suicidality – a perfect fit for a perfect infusion days have been limited
storm and A Ketamine Clinic in the Hills, the and most clinics operational two-
latter describing the establishment of our flagship days a week. Still, in 18-months, our
outpatient ketamine infusion clinic in the Natal clinics have administered almost
Midlands. 2000-ketamine infusions.
Ketamine Clinics of South Africa (KCSA) currently has
three established outpatient clinics in KZN (Hilton Most of our patients are referred
and Umhlanga) and Gauteng (Bedfordview), with a with a diagnosis of Treatment
new clinic opening shortly in Cape Town and further Resistant Depression (TRD), many Alan Howard
branches planned for Pretoria and the Garden Route.
with established suicidal ideation. We also treat
ACCEPTANCE OF NMDA ANTAGONISTS several patients with anxiety disorders and PTSD
LIKE KETAMINE, AS AN EFFECTIVE AND and have seen remarkable results in OCD. Wherever
NO LONGER REALLY ‘NOVEL’ APPROACH possible, a ‘successful outcome’ is quantified using
TO TREATING AN ARRAY OF MOOD a subjective scale (PHQ-9, GAD-2 or 7, YBOCS) and
DISORDERS, CHIEF AMONG THEM patients provide feedback after an infusion series.
TREATMENT RESISTANT DEPRESSION
(TRD) AND SUICIDALITY, IS GAINING OUTPATIENT KETAMINE INFUSIONS ARE
TRACTION AND MORE UNIVERSAL INCREASINGLY BEING USED TO TREAT
ACCEPTANCE. REFRACTORY NEUROPATHIC PAIN.

That the launch of our clinics in early 2020 We have also noticed more acceptance amongst
coincided with the start of the COVID pandemic physicians, neurologists, neurosurgeons, and
and lockdowns was a bitter blow yet, inevitably oncologists who increasingly turn to ketamine as
(as discussed in a prior article), the prevalence of an outpatient option to treat refractory neuropathic
suicidality, newly diagnosed mood disorders and pain, the role of NMDARs in chronic pain states
exacerbations in patients with existing diagnoses being more clearly understood. In this regard,
have given new impetus and significance to the progress is monitored using the Defense and
treatment we offer. Veterans Pain Rating Scale (DVPRS), as this focuses
not only on an analogue pain scale, but on four
other biopsychosocial parameters. It is not unusual
to see oncology patients with Cancer related
Neuropathic Pain (CNP), either neoplastic in origin
or related to chemotherapy, reduce their DVPRS

56 * SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021

PERSPECTIVE

score to single digits after only a few ketamine ketamine infusions for depression that guidelines
infusions, as well as concurrently reducing their have yet to be issued by The South African Society
opioid requirement. of Psychiatrists (SASOP), something that would be
THE APA HAS PUBLISHED INTERNATIONAL welcomed, particularly following the recent APA
GUIDELINES ON KETAMINE USE FOR release.
DEPRESSION. KCSA has partnered with the Department of
At last, the American Psychiatric Association (APA) Psychiatry at the University of KwaZulu Natal Nelson
has published international guidelines on Ketamine R Mandela School of Medicine in research on
use for depression (American Journal of Psychiatry, outpatient ketamine infusion for depression, for
March 17, 2021). Only intravenous or intranasal which ethics approval was obtained in May 2021.
ketamine is advocated by the panel and it is The Principal Investigator (a specialist psychiatrist)
pertinently noted that insufficient evidence exists for is conducting retrospective chart reviews from our
administration by other routes. The likelihood that Hilton clinic, collating data from several hundred
the intravenous route is superior to the intranasal outpatient infusions.
route is also pointed out. The requirement for a safe Further exciting research in which KCSA is involved
clinical environment is stressed. is our collaboration with Inkosi Albert Luthuli
Shortly after the release of the APA Guidelines, Academic Hospital Burns Unit. An RCT is planned to
the South African Society of Anaesthesiologists investigate the effect on major depressive symptoms
(SASA) released a statement on outpatient in severe burns victims (60% of whom are clinically
ketamine infusions. Their comment, they say, depressed one-year post trauma), by substituting
was necessitated by the fact that ketamine is a traditional sedation cocktails used for dressings
registered anaesthetic drug and its outpatient changes (usually opiates and benzodiazepines)
use consequently led to legitimate patient safety with ketamine.
concerns, concerns echoed by the APA in the
aforementioned guidelines. (The statement can be INCREASINGLY, MEDICAL AID SCHEMES
accessed on our website). ARE RECOGNIZING THE BENEFIT OF
SASA HAS RELEASED A STATEMENT ON OUTPATIENT KETAMINE INFUSIONS FOR
OUTPATIENT KETAMINE INFUSIONS. THEIR MEMBERS AND AUTHORIZING
KCSA is proud of our commitment to patient safety FUNDING. PARTICULARLY IN PATIENTS WITH
first. In our clinics, ketamine is only administered CONCERNING LEVELS OF SUICIDALITY,
by anaethetists and doctors with life-support skills, HOSPITALIZATION CAN FREQUENTLY BE
and in a clinical environment with resuscitation AVOIDED FOLLOWING REVERSAL OF
equipment and experienced nurses immediately SUICIDAL IDEATION IN UP TO 80% OF
on hand. All of our doctors are members of CASES FOLLOWING A SINGLE KETAMINE
SOSPOSA (Society of Sedation Practitioners of South INFUSION.
Africa), a special interest group of SASA, and we
apply for accreditation of our clinics by this group, In the recent past, patients referred for ketamine
as recommended by SASA. infusions (often in desperation), were consigned
to noisy ECT-theatres, day clinics, ill-equipped
THE DICHOTOMY THAT EXISTS BETWEEN consulting rooms and denied the added benefit
THE FIELDS OF PSYCHIATRY AND of a milieu that undoubtedly enhances outcomes.
ANAESTHESIOLOGY WHERE KETAMINE IS Still they benefitted. Associated expense was
CONCERNED IS OFTEN AN UNFORTUNATE high, often driven by the requirement for formal
STUMBLING BLOCK BUT NOT, I BELIEVE, ‘admission’ to such a facility and a fee for specialist
AN INSURMOUNTABLE PROBLEM. anaesthetic services. Patients have (and still do)
endure administration of ketamine by intramuscular
Administration of outpatient ketamine in ‘nurse- injection while in a ‘bean-bag’, intravenous
run’ clinics or via the intramuscular route in an blousing of ketamine in a chair in a GP’s surgery,
unmonitored environment, are practices starkly ketamine infusions while seated in a room with four
at odds with the recommendations of both the other patients receiving ketamine. (A KCSA patient
APA and SASA, but sadly a reality. These practices described to me how he would take toilet paper
should be roundly condemned. along to such sessions, to stick in his ears, as no
ADMINISTRATION OF OUTPATIENT KETAMINE headphones were provided to reduce ambient
MUST BE IN ACCORDANCE WITH ESTABLISHED noise and mitigate potential negative effects of
PATIENT SAFETY GUIDELINES. synesthesia.)
SASA makes specific mention in its statement on Strange indeed are the experiences of most patients
receiving this remarkable drug. Strange too is the
fairly sudden requirement for synergy between two

SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 * 57

PERSPECTIVE

most diverse medical specialities, psychiatry
and anaesthesiology, in the dawn of a new
psychedelic era. As an emergency physician

I AM NEITHER ONE NOR THE OTHER
AND CAN THEREFORE, ATOP MY
FENCE, CLEARLY UNDERSTAND
AND APPRECIATE THE RELEVANCE
AND IMPORTANCE OF BOTH. THEY
ARE NOT MUTUALLY EXCLUSIVE YET
PATIENT SAFETY CLEARLY REMAINS
THE FOREMOST CONCERN.

KETAMINE CAN BE A TURNING POINT IN
A PATIENT’S JOURNEY TOWARDS MENTAL
WELLNESS.

Teams at KCSA clinics around the country
stand ready to partner with our psychiatry
colleagues by offering their patients safe,
regulated, and affordable outpatient
ketamine infusions. Ketamine is a remarkable
adjunct to traditional medication and
therapeutic techniques and in no way
replaces these or obviates the need for
continued monitoring and therapy by
treating psychiatrists and other mental
health specialists. Ketamine is a treatment,
not a cure – but it can be a turning point in
a patient’s journey towards mental wellness.

“Ketamine is the best decision I have ever
made. I feel my life is worth living again”
(KCSA patient July 2021)

Alan Howard is an Emergency Physician who
returned permanently to South Africa at the end of
2019 after working as a Consultant in Emergency
Medicine in Donegal, Ireland for 12-years. He
is author of the medical textbook ‘Emergency
Management of Acute Poisoning’.1 Dr Howard
has served as an instructor and examiner for the
American College of Surgeons Advanced Trauma
Life Support Course (ATLS) for over 25-years and was
published by the BMJ in their subsidiary journal the
Emergency Medicine Journal (EMJ) following his
pioneering work in pre-transfer cranial trephination
for traumatic extradural haemorrhages in the
Emergency Department.2

Dr Howard founded Ketamine Clinics of South
Africa (KCSA) in August 2019 and is president of
the Society of Ketamine Practitioners of South Africa
(SOKePSA). He is a member of the American Society
of Ketamine Physicians (ASKP).

1 Van Schaik Publishers 2006 ISBN 0 627 0263 1 1
2 Howard A,et al,Cranial burr holes in the Emergency
Department: to drill or not to drill? Emerg Med J
2019;0:1–4. doi:10.1136/emermed-2019-208943

www.ketamineclinics.co.za
[email protected]

58 * SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021

PERSPECTIVE

BEND DON’T BREAK:

COVID-19 INFECTION PREVENTION AND
CONTROL STRATEGIES FOR THE INPATIENT
PSYCHIATRIC POPULATION AT CHRIS HANI
BARAGWANATH ACADEMIC HOSPITAL, SOWETO.

Moodley S, Maisto A, Jeenah FY, Moosa MYH

ABSTRACT and remains a rapidly evolving
The psychiatric inpatient setting presents unique situation worldwide. The psychiatric
challenges regarding COVID-19 environmental population’s susceptibility and
controls for infection and prevention controls. The vulnerability to COVID-19 infection
increased risk of transmission in this setting is due requires particular consideration.
to multiple factors. There is a dearth of evidence Mental illness adversely affects
regarding potential strategies to navigate infection outcomes of various medical
control measures in the psychiatric inpatient conditions because individuals
population within resource limited settings. We with mental illness are less likely
discuss lessons learnt and the implementation of to undergo screening for medical
a practical strategy at Chris Hani Baragwanath comorbidities, have a higher Sanushka Moodley
Academic Hospital’s acute inpatient psychiatric
unit. We hope that in sharing this strategy we are mortality and a poorer prognosis compared to the
able to facilitate the development of generalisable general population.7,8
psychiatric guidelines for resource limited settings
by way of encouraging information sharing. Thus THERE IS A PAUCITY OF EVIDENCE
improving patient outcomes and service delivery REGARDING SUSCEPTIBILITY TO SARS-
challenges whilst navigating the ever-changing COV-2 INFECTION AND CLINICAL
milieu of the COVID-19 pandemic. OUTCOMES AFTER INFECTION AMONGST
INDIVIDUALS WITH SEVERE MENTAL
O n 11 March 2020, the Director-General ILLNESS. IN ADDITION TO SUSPECTED
of the World Health Organization (WHO) IMMUNE MEDIATED BIOLOGICAL
declared coronavirus disease 2019 MECHANISMS OF VIRUS SUSCEPTIBILITY
(COVID-19) as a pandemic.1 COVID-19 is IN SEVERE MENTAL ILLNESS9; THERE ARE
caused by the novel beta coronavirus SARS-CoV-2, INCREASED RISKS OF TRANSMISSION
which is genetically similar to but distinct from other SECONDARY TO POSSIBLE COGNITIVE
coronaviruses responsible for global outbreaks.2 On IMPAIRMENT AND A REDUCED
5 March 2020, The Minister of Health, Dr Z Mkhize, AWARENESS OF RISKS.10
reported the first case of COVID-19 in South Africa.3
In response to a growing concern of a possible Individuals with mental illness are more vulnerable
local pandemic, the South African Government to the impact of lockdown restrictions such as the
responded by enacting a State of Disaster on 15 socio-economic effects of job losses, reduced
March 2020.4 On 14 July 2021, the National Health educational opportunities, psychosocial effects
Institute for Communicable Diseases reported that of isolation, challenges regarding accessing
2 236 805 cases of COVID-19 have been identified in healthcare and reduced social support.11 Further,
South Africa, with a positivity rate of 31.0% and total discrimination and stigma associated with mental
fatalities of 65 595.5 illness affects timeous access to health services as
The emergence of COVID-19 has created a great well as the quality of care received.12,13 Further, there
deal of stress and uncertainty for many patients, are concerns over risk of relapse or exacerbation
families, communities and healthcare providers6

SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 * 59

PERSPECTIVE

of an existing mental illness secondary to the infrastructural inadequacies.18,19,20 The additional
heightened stress response to the COVID-19 burden of the COVID-19 pandemic has exacerbated
pandemic compared with the general public.14 these deficiencies in most psychiatric facilities and
placed it under further pressure, whilst also testing
INDIVIDUALS WITH ACUTE SERIOUS the resilience of healthcare providers.21
MENTAL ILLNESS MAY STILL NECESSITATE Similar to most psychiatric wards in the country,
INPATIENT PSYCHIATRIC CARE; HOWEVER, the psychiatric wards at CHBAH are dormitory
THE PREPAREDNESS OF INPATIENT style and designed to hold as many patients as
FACILITIES DURING THE COVID-19 possible.22 There is limited opening of windows
PANDEMIC HAVE GENERALLY BEEN resulting in less than adequate ventilation within
OVERLOOKED. PSYCHIATRIC WARDS ARE the wards and no open outdoor areas, leading
AT HIGH RISK FOR OUTBREAKS AND NEED to an increased risk of transmission.23 In addition,
CONTINGENCY PLANS TO DETECT AND the average length of in-patient stay is 42 days,
CONTAIN OUTBREAKS IF THEY OCCUR.6,15 with new admissions daily. The average length of
stay of psychiatric patients in South African tertiary
Chris Hani Baragwanath Academic Hospital psychiatric facilities is generally much longer than
(CHBAH) is a tertiary hospital in Soweto, that of other disciplines at 54.8 days.24 Infection
Johannesburg and serves a large catchment area control is more challenging due to the prolonged
in Southern Gauteng. The psychiatry department interpatient contact and results in a higher risk of
offers acute adult, adolescent and child in-patient infectious disease outbreaks.15 In addition to the
services, as well as general and specialist outpatient crowded ward conditions, there are communal
clinics. The acute inpatient bed capacity is 165 dining areas and ablution facilities, which further
beds. Admissions are on a referral basis from district increases the risk of spread of infection.6 There are
hospitals and specialized psychiatric clinics in the no designated and fully equipped cubicles for
catchment area, as well as “walk in” patients from isolation against infectious respiratory illness and
the community. The aim of this report is to describe there is a lack of proper training on the correct use
the challenges associated with providing inpatient of personal protective equipment.25
psychiatric services at Chris Hani Baragwanath Due to the nature of their illness, patients may
Academic Hospital in the face of the COVID-19 have altered mental states, impaired insight, poor
pandemic and to discuss some of the measures judgement, poor self-care and self-control that
implemented to manage these challenges. may render them unable to appreciate the risk of
DISCUSSION infection and vulnerable.6 Important preventative
a) Challenges associated with providing inpatient measures such as social distancing, avoiding close
psychiatry services physical contact, wearing of masks and regular
The NICD has made recommendations regarding hand washing is difficult to implement.
environmental controls for infection and prevention
control in an inpatient setting.16 Some of these THERE IS OFTEN A DELAY IN THEM
recommendations include natural ventilation REPORTING SYMPTOMS OF COVID-19
(providing 17-40 air exchanges per hour) or well- DUE TO ALTERED MENTAL STATE. PATIENTS
functioning mechanical ventilation (providing 12 WITH MENTAL ILLNESS ARE ALSO AT
air exchanges per hour); sufficient space in these INCREASED RISK OF CHRONIC DISEASES
areas to minimize transmission whilst allowing for SUCH AS HYPERTENSION, DYSLIPIDAEMIA,
workflow activities (no more than 6-8 beds per unit CHRONIC OBSTRUCTIVE AIRWAY
with at least 1.2m2 of unobstructed space between DISEASE AND DIABETES MELLITUS26,27,28
beds); at least two isolation/single rooms with en- WHICH MAY AFFECT THE PROGRESSION,
suite ablution facilities per 24 beds; shared ablution SEVERITY AND PROGNOSIS OF COVID-19
facilities to be cleaned every 2-4 hours and all INFECTION.25,28
consultation rooms to have a hand wash basin.
However, these recommendations do not take The nature of the multidisciplinary team approach
into cognisance the unique and inappropriate to the inpatient management of our patients
infrastructure design of the country’s psychiatric include psychology groups, occupational
inpatient wards.17 therapy groups and multidisciplinary team ward
Inpatient psychiatric settings present unique rounds. These activities, which are crucial to the
challenges due to open space ward design, biopsychosocial management of our patients,
nature of the illness and the need for close contact result in prolonged close contact and increased
treatment. Prior to the COVID-19 pandemic, risk of transmission between patients.6 Additionally,
published reports highlighted the complex nature the staff are not allocated to a single ward but
and the systemic neglect of mental health services rather on shift rotations between wards, increasing
in South Africa, which include lack of access, the risk of cross-contamination and are specialised
underfunding, inadequate human resources and in providing psychiatric care and not always on
early detection and management of infectious
60 * SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 diseases.29

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The previously metioned challenges make quarantine period required. The consequences
complying with the NICD’s COVID-19 prevention of which were far reaching as the demand for
strategies difficult, if not near impossible to inpatient psychiatric beds remained unchanged in
implement. the face of the pandemic.
In the face of the third wave, it became apparent that
b) Measures implemented by CHBAH to overcome there would need to be a review of above strategies
these challenges to mitigate against some of these outcomes. On 25
June 2021, the psychiatry COVID-19 team revised
The first step was to establish a dedicated psychiatry their plan to include the reorganisation of the
COVID-19 team to provide appropriate guidance existing wards into a dedicated COVID-19 positive
and support to manage the overall process. During ward only for the isolation of positive patients, a
the first and second wave, the team implemented dedicated cubicle within this COVID-19 positive
measures that were similar to those of psychiatric ward for persons under investigation (PUI) for
hospitals and psychiatric units in general hospitals COVID-19 and COVID-19 negative wards. This was
in other countries.6,21,30 complemented with a more efficient redistribution
of available human resources within these wards
THE CRITERIA FOR ADMISSION INTO and with appropriate levels of PPE and the training
THE PSYCHIATRIC WARDS WERE MADE of the use thereof.
STRICTER AND ONLY VERY ILL PATIENTS In addition, all patients were now subjected to the
WHO COULD NOT BE MANAGED AS OUT point of care PanbioTM COVID-19 Antigen Rapid
PATIENTS WERE ADMITTED. test (nasopharyngeal swab) prior to admission.
The PanbioTM COVID-19 Antigen Rapid test has a
Aggressive management of patients by the reported 100% specificity and a 72.6% sensitivity,
multidisciplinary mental health professionals which is appropriate for use as a screening test.31
was instituted to shorten the length of hospital Benefits of utilizing point of care testing included:
stay. Daily, and if possible twice-daily, screening use of a portable instrument, rapid results available
and symptom monitoring of all inpatients was within 15-20 minutes and decreasing the burden on
conducted. If a patient screened positive, then a laboratory testing and sample processing.32 If the
formal nasopharyngeal PCR swab was performed antigen rapid test is positive, the patient is cared
and the patient isolated from other patients whilst for in the dedicated COVID-19 ward. If the antigen
awaiting results. If the patient tested positive, the rapid test is negative and the patient had no
patient remained in isolation and all other patients symptoms of COVID-19 then they were admitted to
in that ward, and who may have had contact with COVID-19 negative wards. If the antigen rapid test
the COVID positive patient, were subject to a formal was negative and the patient had any symptoms
nasopharyngeal PCR swab after 5-7 days. Close of COVID-19, then they underwent a formal
collaboration with the hospital’s COVID-19 medical nasopharyngeal swab PCR test and admitted to
teams was established for the urgent transfer of any the PUI cubicle whilst awaiting results. All patients
positive patient who became medically unstable are screened daily for symptoms of COVID-19
and required specialist care including oxygen regardless of which ward they were admitted to.
support. In addition, all group activities in the ward Both patients and health care professionals
were suspended and all patients were educated experience the negative psychological
with regards to prevention measures and health ramifications of the COVID-19 pandemic, resulting
promotion. in increased rates of anxiety, depression, post-
traumatic stress disorder and psychological
ALL STAFF WERE TRAINED ON COVID-19 distress.33 Health care workers may experience
PROTOCOLS AND APPROPRIATE USE psychological distress from providing direct care to
OF PERSONAL PROTECTIVE EQUIPMENT patients with COVID-19, knowing someone who has
(PPE) WHILST ALL OTHER NON-ESSENTIAL contracted or died of the disease, or being required
TRAINING WAS SUSPENDED. THE WARDS to undergo quarantine or isolation.34,35,36 They
WERE CLOSED TO VISITORS, AND also experience stress due to the high workload,
WEEKEND LEAVE OF ABSENCE WERE frequent shift changes, inadequate sleep and rest,
HALTED. PATIENTS WERE ONLY PERMITTED which can lead to fatigue, discomfort, helplessness,
TO LEAVE THE WARD ON DISCHARGE. and anxiety.37

IT IS VITAL TO ENSURE PSYCHOLOGICAL
Despite these measures, the first and second wave WELLNESS AND IN TURN ENSURE A
saw multiple outbreaks within the wards. In total, HEALTHY AND ROBUST CLINICAL
from June 2020-June 2021 there have been 12 WORKFORCE.
outbreaks in the psychiatric wards. One positive
patient quickly snowballed into dozens of patients It was therefore also important for the dedicated
testing positive and being symptomatic – some team to address the psychological impact of a
requiring transfer to medical wards for further care.
This resulted in the closure of entire wards for the

SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 * 61

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pandemic on the hospital’s health care workers, GIVEN THE PAUCITY OF EVIDENCE
patients and their families. The team established REGARDING POTENTIAL STRATEGIES
a hospital psychosocial team, comprising a wide TO NAVIGATE INFECTION CONTROL
range of disciplines and skills. Psychological MEASURES IN THE PSYCHIATRIC
counselling and supportive therapy groups were INPATIENT POPULATION IN RESOURCE
implemented for healthcare professionals to LIMITED SETTINGS; WE HOPE TO SHARE
identify early, support and treat these potentially A PRACTICAL STRATEGY THAT HAS BEEN
long term and persistent psychopathological APPLIED WITH SPECIFIC CONSIDERATIONS
sequale.37 Unfortunately, no psychological support FOR THE PSYCHIATRIC SERVICES IN THE
was provided to patients and their families because SOUTH AFRICAN CONTEXT.
of resource constraints. However, psychiatric
nurses who are trained in counselling skills will be We recommend that similar strategies be considered
earmarked to address this going forward. and information on the successes and difficulties
This revised plan precludes the need to close entire be shared. Thus, facilitating the development of
wards for the period of quarantine, as was found generalisable psychiatric guidelines that will help
in the first and second waves. This limited any improve patient outcomes and service delivery
further impact on the already insufficient number challenges whilst navigating the ever-changing
of available inpatient beds in the province. milieu of the COVID-19 pandemic.

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Impact of COVID-19 Pandemic on Health
Care Workers: A Systematic Review and Meta- AUTHORS’ AFFILIATION:
Analysis. Frontiers in Psychology. 2021; 12, 2382. S Moodley: Department of Psychiatry, School of Clinical
doi: 10.3389/fpsyg.2021.626547 Medicine, Faculty of Health Sciences, University of
34. Lai J, Ma S, Wang Y, et al. Factors associated Witwatersrand, Johannesburg, South Africa.
with mental health outcomes among health A Maisto: Department of Psychiatry, School of Clinical
care workers exposed to coronavirus disease Medicine, Faculty of Health Sciences, University of
2019. JAMA Netw Open. 2020;3:e203976 Witwatersrand, Johannesburg, South Africa.
35. Styra R, Hawryluck L, Robinson S, et al. Impact on FY Jeenah: Department of Psychiatry, School of Clinical
health care workers employed in high-risk areas Medicine, Faculty of Health Sciences, University of
during the Toronto SARS outbreak. J Psychosom Witwatersrand, Johannesburg, South Africa.
Res. 2008;64:177-83 MYH Moosa: Department of Psychiatry, School of
36. Brooks SK, Webster RK, Smith LE, et al. The Clinical Medicine, Faculty of Health Sciences, University
of Witwatersrand, Johannesburg, South Africa.

Sanushka Moodley works as a consultant psychiatrist at Chris Hani Baragwanath Academic Hospital where she runs the
consultation liaison psychiatry and outpatient services. She oversees the COVID-19 psychiatry logistic team and has been

involved in the national vaccination rollout at Chris Hani Baragwanath Academic Hospital.Her special interest is in consultation
liaison psychiatry. Correspondence: [email protected]  

The smart choice for all your ECT needs

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HCEAOLINGM TBHEA HTEAI LNER G–

C O M PA S S I O N
FATIGUE

AMONGST MENTAL
HEALTH PRACTITIONERS

Elmarie Du Plessis

"C ompassion is not a relationship the World Health Organization Elmarie Du Plessis
between the healer and the wounded (WHO) on 11 March 2020 declared
It’s a relationship between equals. COVID-19 a pandemic, it has had
Only when we know our own darkness well an immense impact on the way
Can we be present with the darkness of others. we live and work. Add to the mix
Compassion becomes real when we recognize adjusting to consulting on-line;
our shared humanity.” Pema Chodron ensuring POPIA compliance and
Promoting and caring empathetically for the coding challenges; as well as
wellbeing of others are amongst the reasons we increased case-loads and the
chose this profession in the first place. We are lack of PPE and support for a lot of
passionate about improving the quality of living health care practitioners working
for the patients we treat and are wholeheartedly in hospital and clinic settings.
invested in finding solutions to unbind our patients
from what holds them back from living abundantly. FURTHER SOME OF US HAVE HAD TO
Patients rely on us to be sincerely interested, to show COPE WITH FINANCIAL LOSS AND THE
empathy, to listen attentively, to be always available LOSS OF COLLEAGUES AND FAMILY
and unfailingly consistent in our caretaking. We MEMBERS DUE TO THE PANDEMIC -
are expected to be perfectly knowledgeable, to IT MAKES FOR A PERFECT STORM TO
diagnose quickly and prescribe accurately, to BECOME COMPLETELY EMOTIONALLY
be their unfailing experts and wave an imaginary AND PHYSICALLY DEPLETED.
magic wand that would secure their long-term
mental and overall health instantly. In some ways our training and profession also often
lacks the awareness and acknowledgement that
PATIENTS ALMOST EXPECT US TO BE we are in fact at times facing the same challenges
SUPERHUMAN AND IN SOME WAY as the patients we serve and that caring too much
ABOVE AND IMMUNE TO THE DAY-TO- for too long can become dangerous to ourselves
DAY STRUGGLES OF LIFE IN 2021. and our patients. Unfortunately, mental health
concerns can be heavily stigmatized in the medical
Let us be frank – some of us are completely burnt out field, whereby admitting our own need for help is
and mentally and emotionally exhausted. Since challenging and often pushed aside for fear of
seeming weak.

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The reality is that as mental health practitioners ranges from 21.8% to 44.8% depending on the
we are highly susceptible to burnout, secondary setting (Jin et al. 2021) Settings with fewer resources
traumatic stress and compassion fatigue. The work pose higher risk (Sprang et al. 2017). A 2020 study by
of helping requires us to open our hearts and minds Summers et al. reports that psychiatrists experience
to our patients and it is this very process of empathy burnout and depression at a substantial rate. The
that make us vulnerable to being profoundly presence of depressive symptoms; female gender;
affected and even harmed by our work. an inability to control one’s work schedule and work
Compassion Fatigue has been described as the setting were associated with significantly higher
“cost of caring” for other’s emotional pain and is levels of burnout.
a term coined to describe the phenomenon of
stress resulting from exposure to a traumatized WE CAN EXPECT THAT THE LEVELS OF
individual rather than exposure to the trauma COMPASSION FATIGUE AMONGST
itself (Figley,1982). The term further refers to the MENTAL HEALTH CARE PRACTITIONERS
disengagement of caregivers from their patients, WILL RISE SIGNIFICANTLY POST COVID-19.
which culminates in a reduction or inability to feel
empathy and compassion towards patients and Compassion Fatigue includes experiences of
an inability to provide the patient care deemed both burnout and secondary traumatic stress.
appropriate. It leads to a loss of meaningful and (Maila et al. 2021) and fatigued healers might
purposeful interactions between care-givers and display the following symptoms:
patients (Coetzee & Klopper, 2010; Ledoux, 2015). Emotional symptoms: irritability, anxiety, dread
at having to care for another person and a
THE TERM, COMPASSION FATIGUE diminished sense of fulfillment in helping another.
IS OFTEN USED INTERCHANGEABLY Mental health practitioners might feel detached
WITH VICARIOUS TRAUMATIZATION, apathetic and depressed. Physical symptoms
SECONDARY TRAUMATIC STRESS AND include insomnia, headaches, weight loss,
BURNOUT. overeating and substance abuse. Compassion
fatigue can also lead to a decline in the quality
Vicarious traumatization according to McCann & of the care we provide, more errors can occur
Pearlman (1991) refers to the transformation in one’s and judgment and discernment might be poor,
cognitive schema and beliefs systems resulting from leading to less desirable interactions with
empathetic engagement with a client’s traumatic patients.
experiences that may result in significant disruptions So, it seems that we as mental health practitioners
in one’s sense of meaning, connection, identity are caught in a conundrum - empathy and
and world-view, as well as affecting one’s affect compassion is argued as necessary to form a
tolerance, psychological needs, beliefs about the therapeutic relationship and it seems inevitable that
self and the other, interpersonal relationships, and we at some point during our careers could become
sensory memory. fatigued, but not all practitioners do. According to
Figley (1995) defines Secondary Traumatic Stress Stamm (2002), many practitioners continue to be
as the natural and consequent behaviours committed to the work and find that trauma work
and emotions resulting from knowing about a sustains and nourishes them.
traumatizing event experienced by a significant
other – the stress resulting from helping or wanting THESE PRACTITIONERS ARE MOTIVATED
to help a traumatized or suffering person. With the BY A SENSE OF SATISFACTION DERIVED
exception that the traumatic exposure is indirect, it FROM HELPING OTHERS – AN EXPERIENCE
is nearly identical to post traumatic stress disorder LABELED COMPASSION SATISFACTION.
(PTSD).
According to WHO, Burnout is characterized Empirical studies have been equivocal in linking
by "feelings of energy depletion or exhaustion; empathy to either the development of or protection
increased mental distance from one's job, or from compassion fatigue (Turgoose & Maddox,
feelings of negativism or cynicism related to one's 2017). Figley (1995) and Stamm (2002) proposed
job; and reduced professional efficacy." Burnout a continuum of responses that range from
is now according to the International Disease Compassion Satisfaction to Compassion Stress and
Classification (ICD-11) categorized as a “syndrome” Compassion Fatigue. It is postulated that there is
that results from “chronic workplace stress that has a balance between the two polar experiences
not been successfully managed.” (Stamm, 2002).
A 2013 cross-sectional study reported that 70% So now, how do we as mental health practitioners
of psychotherapists employed by the UK’s NHS keep a balance, an internal equilibrium and
were vulnerable to chronic levels of secondary continue to experience Compassion Satisfaction?
traumatic stress and average levels of burnout. It Here are some ideas on how to be an effective
is further alarming that the estimated prevalence healer in the face of others adversity:
of Compassion Fatigue among healthcare workers

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TAKE RESPONSIBILITY FOR YOUR OWN SELF-CARE Acknowledge that is not possible to “save” everyone
Lombardo & Eyre (2011) identify healthy nutrition, and be mindful of your professional boundaries i.e.,
sleep, and exercise as important ways to recover availability to patients outside of consultation times,
from compassion fatigue, suggesting as we know, set a clear limit to work hours and the number of
that negative health related behaviours may patients you take on. Sprang et al. (2007) revealed
coexist with the presence of compassion fatigue. that the case-load of PTSD patients predicted
Therefore, create a plan for what recharges you - the levels of compassion fatigue and burnout in
regular exercise, a healthy balanced eating plan practitioners.
and sufficient hydration and good sleep hygiene. Boundaries become blurred when health
Practice regular mindfulness or meditation, practitioners step in for patients in tasks that they
spend time in nature. Remember to breathe. are capable and age-appropriately should be
Spend quality time with loved ones and pursue doing for themselves. It is about learning when
a hobby. Schedule time off, away from work and how to say: “No!”, which is according to Ann
responsibilities. Basically, set a good example for Lamott a complete sentence. Brene Brown states
the patients under your care by practicing what that “Daring to set boundaries is about having
you preach. the courage to love ourselves even when we risk
disappointing others”
BE MINDFUL OF WHAT YOU ALLOW IN ACTIVELY MAKE TIME FOR PROFESSIONAL
With so much information and news that is CONNECTIONS
constantly available it is pivotal to be mindful of how Realizing that you are not alone will increase a
much time you spend on social platforms, groups sense of solidarity, curb feelings of isolation and
and on-line-reading. reduce emotional exhaustion. Peer review and
support groups can be invaluable to help keep
WE CAN ONLY TAKE SO MUCH BAD you accountable to solid clinical practice and
NEWS. DECIDE WHEN TO SWITCH IT OFF. adequate self-care. Sprang et al. (2007) found that
ALSO INTENTIONALLY CHOOSE WHAT specialized trauma training enhanced Compassion
TO FOCUS ON, WHAT YOU READ AND Satisfaction and reduced levels of burnout. This
LISTEN TO. suggests that trauma knowledge and training might
provide some protection to the deleterious effects
Some people might find engaging in spiritual of trauma exposure, as it cultivates more effective
activities sustaining. According to Phelps et al. assessment and treatment of the trauma and thus
(2009) beliefs in a higher power and that of a practitioners might have better treatment outcomes.
shared religious community may have an influence Supervision and / or personal psychotherapy can
on how we cope with compassion fatigue. provide a space for personal growth and building
resilience and compassion satisfaction.
FOCUS ON WHAT YOU CAN CONTROL To conclude, in 2021 more so than maybe ever
Especially in the current situation most mental before, it is pivotal that we as mental health
health practitioners are overbooked and it seems practitioners acknowledge our own humanity and
as if the need for mental health assistance far out- develop more self-compassion. Our own sorrow and
weighs the availability of practitioners. wounds are healed only when we touch them with
compassion. So, we’d be wise to follow the words
WE KNOW FOR CERTAIN, THAT THE of Mahatma Ghandi, “You must be the change you
MENTAL HEALTH FALL-OUT FROM wish to see in the world”. We can emerge from this
COVID-19 WILL CONTINUE WAY immensely stressful and challenging time as more
BEYOND THE ACTUAL CURBING AND effective and valuable healers, when we realize
MEDICAL MANAGEMENT HEREOF. that “Healing is an inside job “ (Dr BJ Parker).
THIS CAN BECOME EXCEPTIONALLY REFERENCES:
OVERWHELMING. Brian, E.; Radey, M. & Figley, C.R. (2007). Measuring
Compassion Fatigue. Clinical Social Work Journal,
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Coetzee, S.K. & Klopper, H.C. (2010). Compassion
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“good fences make good neighbors” and a lack of
boundaries invites a lack of respect.

SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 * 67

PERSPECTIVE

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among Healthcare Workers. An Umbrella Systematic

68 * SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021

FEATURE

ADVERSE INCIDENTS,

COMPLAINTS
& APOLOGIES

Volker Hitzeroth

In this article, the second of a medicolegal series of articles, Dr Volker Hitzeroth will clarify how
a healthcare practitioner should respond when they receive correspondence from a patient
expressing dissatisfaction about an aspect of the treatment and care that they received. The
article will also address common misconceptions about apologizing to a patient in the event of
an adverse incident occurring.

H ealthcare Practitioners (HCP) are, after all, themselves from future complaints Volker Hitzeroth
only human and delays, misunderstandings by being aware of potential risks
and errors can occur despite their best and taking steps to mitigate these
efforts, particularly when they are working before an incident occurs. Most
under pressure in a stressful environment. When a patient complaints relate to one or
patient or their family believe their needs have not more of the following areas:
been addressed, their expectations have not been 1. Competence
met and their experience has been disappointing they 2. Communication
may choose to raise the issues with the HCP directly 3. Consent
in order to discuss their concerns. Whilst this might 4. Confidentiality
be done informally during a clinical consultation it is 5. Conduct
more frequent that a patient will email their complaint
directly to the HCP and invite them to respond to their Being aware and knowledgeable about potential
grievance and clarify the issues. Most patients, in the risk will have a positive impact on a HCP’s behaviour
event of an adverse event or outcome, will usually and clinical performance.
attempt to reach out to their HCP in some way to alert
them to their plight and request an explanation and Here are some further suggestions:
appropriate follow up care.
Many HCPs will have to deal with a complaint 1. Stay up to date: keep abreast of the latest
during their professional career; some of these developments in healthcare, such as new
could come from a patient, their family or even treatments and medication regimes, news,
an employer and could relate to any aspect of policy announcements and important changes
clinical practice. Complaints against HCPs have to regulations and legislation.
unfortunately become more common in South
Africa in recent years. 2. Work on your “soft” skills: are your organizational
and administrative skills up to scratch? It is
THIS IS LIKELY DUE TO THE INCREASING common for medicolegal cases to involve poor
COMPLEXITY OF MEDICINE AND AN record-keeping, for example.
EMERGING COMPLAINTS CULTURE
AMONGST THE PUBLIC, RATHER 3. Do you communicate effectively? Patients will
THAN ANY DECREASE IN DOCTORS’ usually appreciate honest, open doctors who
PERFORMANCE. communicate effectively, explain issues clearly
and apologize appropriately when things don’t
go to plan. It’s also key that you communicate
clearly and fully with colleagues at all levels.

WHAT IF A HCP MAKES A MISTAKE?

PREVENTING COMPLAINTS: Sometimes prevention isn’t enough and even the
“Prevention is better than cure”. It's a well-known phrase best, most diligent doctors find themselves facing
in medicine, and it’s also true where medicolegal complaints and possible legal action. At this early
issues are concerned. HCPs can help protect stage there are still steps that a HCP can take to
protect themself.

SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 * 69

FEATURE

1. Recognize and report early: contact your Medical 9. Review your response prior to sending it to the
Defence Organization (MDO) as soon as possible complainant – Confide in a senior colleague,
as they may be able to prevent the matter from supervisor or mentor and request them to
escalating to a more serious problem. comment on the situation and your written
response.
2. Rectify the mistake and prevent further harm:
take appropriate responsibility for what’s APOLOGIES:
happened and do what you can to rectify the Unfortunately, things do go wrong in healthcare and
situation. While you may not be able to undo sometimes patients are dissatisfied, disappointed,
the mistake entirely, you may be able to prevent or upset with the care that they have received. In
the patient coming to any further harm. general, open communication, and an apology
where things have gone wrong, regardless of fault,
3. Speak to the patient and family: be open and is appropriate, welcomed and accepted.
honest, listen carefully and respond to their An apology, expressing regret about the patient’s
concerns. experience or emotions, is not an admission of
liability and is appropriate when a patient has
4. Learn from mistakes: resilience and continuous suffered harm from their healthcare or experienced
development are part and parcel of being a disappointment. It is an acknowledgement that
HCP. Use negative experiences as learning something has gone wrong and a way of expressing
opportunities and take steps to ensure the empathy. Contrary to popular belief, apologies tend
same errors are not repeated. to prevent formal complaints rather than the reverse.

RESPONDING TO A COMPLAINT: IT IS BEST TO OFFER AN APOLOGY AS
SOON AS IT BECOMES APPARENT THAT
Many minor concerns and complaints may be AN ADVERSE INCIDENT HAS OCCURRED,
addressed merely by explaining the facts of the OR THE PATIENT EXPRESSES THEIR
matter and taking steps to rectify any mistakes. DISSATISFACTION WITH THE CARE THEY
If the issues escalate it may be best to send a RECEIVED.
written response, either in reply to a letter or email
of complaint or following a meeting with the It is important that patients, or their families, receive a
complainant. meaningful and timely apology. It may be sometime
1. Consider sending an initial “holding response” before all the facts are understood. Until these are
established, speculation should be avoided as this is
– It may be appropriate to acknowledge receipt unhelpful to all involved. However, this consideration
of the complaint and inform the complainant should not hinder a prompt apology being
you aim to respond within a particular forthcoming. At such an early stage the doctor may
timeframe. Diarize this timeframe and ensure not have all the answers to the patient’s concerns. If
any updates are sent in a timely manner. so, the doctor should say so, but commit to establish
2. Identify and respond – Identify the concerns the facts and report back to the patient.
that have been raised and respond to the The culture in a hospital, GP or specialist practice, day
complaint. It is often helpful to set out an clinic and so forth, should permit doctors the freedom
account of what took place, even if this is to apologise. It is ethically and professionally the right
background information, but do not lose sight thing to do – irrespective of the cause. An appropriate
of the issues. apology should be tailored to the situation – reflecting
3. Be courteous, objective and professional – The the patient’s perception of the issue. It should also
purpose of your response is to try and resolve be put into context, so all parties understand the
the complaint, not to perpetuate further purpose of the apology. Fundamentally, an apology
correspondence. should be offered willingly, and not perceived to have
4. Establish the facts – Take time to present a been given reluctantly.
measured, considered, and considerate It is always good practice to discuss an unintended
response, bearing in mind the timescales. adverse outcome with a senior colleague, your
Familiarize yourself with all relevant medical supervisor or mentor as well as your MDO prior to
records before you draft your letter. Do not refer meeting with the patient and their family.
to another colleagues’ contribution unless this On occasions it may be appropriate to waive the
is relevant in which case you should do so in a consultation fees or follow up costs as a gesture of
factual and non-judgmental manner. good will.
5. Respect patient confidentiality – Not all
complaints are made by the patient personally. Volker Hitzeroth is Medicolegal Consultant at Medical
Where a complaint is made about the Protection Society in London, United Kingdom.
service provided to a patient who has the Correspondence: [email protected]
capacity to give a valid consent, that patient’s
confidentiality must be respected.
6. Try to be sympathetic and understanding –
Offer condolences if these are due. Do not be
afraid of apologizing if an error has been made.
7. Avoid blaming or judging others – Do not cast
aspersions on the character or conduct of a
fellow HCP, the patient or family members.
8. Avoid jargon – Use plain language that a non-
medical professional would understand.

70 * SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021

desvenlafaxine

Medication with a high risk
for drug - drug interactions
can have a negative impact
on the successful treatment
of MDD.1

S5 EXSIRA, 50 mg and 100 mg extended-release tablets.

QUALITATIVE AND QUANTITATIVE COMPOSITION: Each EXSIRA 50 mg extended-release consequences. For patients who experience a sustained increase in blood pressure while receiv-

film-coated tablet contains desvenlafaxine succinate equivalent to 50 mg desvenlafaxine. Each ing EXSIRA, either dose reduction or discontinuation should be considered.Caution should be ex-

EXSIRA 100 mg extended-release film-coated tablet contains desvenlafaxine succinate equiv- ercised in treating patients with underlying conditions that might be compromised by increases in
blood pressure. Postural hypotension (see Use in elderly patients). Cardiovascular/cerebrovascu-
alent to 100 mg desvenlafaxine. Sugar free. PHARMACEUTICAL FORM: Extended-release lar. Caution is advised in administering EXSIRA to patients with cardiovascular, cerebrovascular,
tablets. EXSIRA 50 mg extended-release tablets are light pink, square (pyramid, one sided),

film coated tablets, debossed “W” over “50” on the flat side. EXSIRA 100 mg extended-release or lipid metabolism disorders. Increases in blood pressure and heart rate were observed in clinical

tablets are reddish-orange, square (pyramid, one sided), film-coated tablets, debossed “W” over trials with EXSIRA. EXSIRA has not been evaluated systematically in patients with a recent histo-

“100” on the flat side.CLINICAL PARTICULARS:Therapeutic Indications: Major depressive ry of myocardial infarction, unstable heart disease, uncontrolled hypertension, or cerebrovascular

disorder EXSIRA tablets are indicated for the treatment of major depressive disorder (MDD). disease. Patients with these diagnoses, except for cerebrovascular disease, were excluded from
Posology and method of administration: Major depressive disorder. The recommended dose clinical trials.Serum lipids, Dose-related elevations in fasting serum total cholesterol, LDL (low

for EXSIRA is 50 mg once daily, with or without food, with a maximum dose of 100 mg per density lipoprotein) cholesterol, and triglycerides were observed in clinical trials. Measurement
day. The dose increase should occur gradually and at an interval of not less than 7 days. Dis- of serum lipids should be considered during treatment with EXSIRA.Seizures, Cases of seizure

continuing EXSIRA: Symptoms associated with discontinuation of EXSIRA, other SNRIs and were reported in pre-marketing clinical trials with EXSIRA. EXSIRA has not been systematically

SSRIs have been reported. Patients should be monitored for these symptoms when discontin- evaluated in patients with a seizure disorder. Patients with a history of seizures were exclud-

uing treatment. A gradual reduction in the dose rather than abrupt cessation is recommended ed from pre-marketing clinical trials. EXSIRA should be prescribed with caution in patients with
whenever possible. If intolerable symptoms occur following a decrease in the dose or upon dis- a seizure disorder. Discontinuation effects, During marketing of SNRIs (Serotonin and Norepi-

continuation of treatment, then resuming the previously prescribed dose may be considered. nephrine Reuptake Inhibitors), and SSRIs (Selective Serotonin Reuptake Inhibitors) such as

Subsequently, the medical practitioner may continue decreasing the dose but at a more grad- SE5XESXISRIAR,At,h5e0remhgavaendb1e0e0n mspgoenxtatennedoeuds-rreelpeoarstes toafbaledtsv.erse events occurring upon discontinu-
ual rate. Switching patients from other antidepressants to EXSIRA: Discontinuation symptoms QaUtiAonLIToAf TthIVesEeAmNeDdicQinUeAsN, pTaITrtAicTuIVlaErlyCwOhMePn OaSbrIuTpIOt,Nin:cEluadcihngEtXhSeIRfoAllo5w0inmg:gdeyxstpehnodreicd-mreoleoads, eir- consequences. For patients who experience a sustained increase in blood pressure while receiv-
have been reported when switching patients from other antidepressants, including venlafaxine, filrmita-cboilaityte, dagtaitbalteiot nc,odnitzazininsedses,svseennlsaofaryxindeistsuurcbcainncaetes e(eq.ugiv. apleanratetsoth5e0smiasg sduecshveanslaefalexcintreic. Esahcohck ing EXSIRA, either dose reduction or discontinuation should be considered.Caution should be ex-
to EXSIRA. Tapering of the initial antidepressant may be necessary to minimise discontinua- EsXeSnIsRaAtio1n0s0),magnxeiexttey,ndceodn-fureslieoans,ehfeilamd-accohaete, dlettahbalregtyc, oenmtaointisondaelslvaebnilliatyf,axininseomsunciac,inhaytepoemquainvi-a,
tion symptoms. Special populations: Use in patients with renal impairment. The recommended alteinnntittuos,1a0n0dmsegizdueressv.enWlahfialexitnhee.seSuegvaerntfsreaer.ePgHenAeRraMllAyCsEelUf-TlimICitAinLg,FthOeRreMh: aEvxetebnedeendr-ereploeratsseof ercised in treating patients with underlying conditions that might be compromised by increases in
blood pressure. Postural hypotension (see Use in elderly patients). Cardiovascular/cerebrovascu-
starting dose in patients with severe renal impairment (24-hr CrCl < 30mL/min) or end-stage tasbeleritosu.sEdXiSscIRonAtin5u0amtiogn esxytmenpdtoemd-sr.ePleaatiseenttsabslheotsuldarbeeligmhotnpitionrke,dsqwuhaerne d(pisycroanmtiindu, inognetresiadtemde),nt lar. Caution is advised in administering EXSIRA to patients with cardiovascular, cerebrovascular,
renal disease (ESRD) is 50 mg every other day. Because of individual variability in clearance filwmithcoEaXteSdIRtaAb.leAts,grdaedbuoaslsreeddu“Wct”ioonveinr “th5e0” doonsetheraftlhaet rsitdhea.nEaXbSruIRpAt c1e0s0samtigonexistenredceodm-rmeleenadseed or lipid metabolism disorders. Increases in blood pressure and heart rate were observed in clinical
in these patients, individualisation of dosage may be desirable. Supplemental doses should tawbhleetnseavreerrpeodsdsisibhl-eo.raIfnigneto,lseqraubalrees(ypmyrpatmomids, ooncecusridfeodllo),wfiilnmg-caodaetecdretaasbeleitns,tdheebdoossseedor“Wup”oonvdeirs-
not be given to patients after dialysis. Use in patients with hepatic impairment. No dosage ad- d“1iAcs0obo0nnr”dtoineormurnaEatthliXobeSnleIfRloeafdAt itnsrteagidab,etlMem.CteseLdnIiactN,rienItCehiAsenndLthicraPeatAstienuRdhmTibfIinoCitgrUstLethhrAeeoRttoprSenr:eaiTnvtmhiuoeepurntsaatlpkyoeepfuirnmteicpsacljaoIrntirbedeldeicdetsapdtrmieoossanseysivl:meeaMaddyaistjooboreraddbceenorpon(rrsMemisdDaselDiirvtei)ee.ds. trials with EXSIRA. EXSIRA has not been evaluated systematically in patients with a recent histo-
justment is necessary for patients with hepatic impairment. Use in elderly patients. No dosage ry of myocardial infarction, unstable heart disease, uncontrolled hypertension, or cerebrovascular
disease. Patients with these diagnoses, except for cerebrovascular disease, were excluded from
fPooborfesEpouXllasoStegeIdRlyeActaaaniusgdtgio5mrue0esgtlmayhtgoiiondnop.noaAcftesiaedwndmtaistihilynp,oirsetwhtdrietiashrtpimoooresned:wdiMcitihtnaooejousbrtletdhfeoeadoptidrnien,gsh.wsibiHivtihteypsadoeinsrmooatartordxaneieimrn.m-uTrimeahu,epdCrtoaeaskcseeoe,msoEfmoXf1eS0hnI0ydRpeAmodngsdahotporseauereld-
damyi.aTahnedd/oorsteheincSryenadsreomsheouolfdInoacpcpurrogprraiadtueaAllyntaidniudreatticanHoinrtmerovnael o(Sf InAoDt Hle)sssetchraentio7ndhaayvse. Dbeise-n
uScoideaSnnendgRtsdiIncptsrureaeihibotnaiaesegtmvidnnetEeoswnXpb,ithteS.ihnieIlAiRcncSlAugNrpder:RnaipnSedIosgyuurmmtaaeelnpodldrdtn.eoeiPdmaSrlua.ySsctIiRtnepaiotInasesntts,rsiesoiintnsncithictiastalohutleuedadllidnunddnwgobgsieptEehdaXmitrsdSiaoeeitIsnnhRacitestsAooern,rtettauahidnksnauiudnfnaoagtraeliloybtodhnrsieiuuninospreoeftvtpocEischleXyusislmm.SiscpIIaeRnptt-otidAnoemeen,rspusotilmisettwhitaoerehelndrecilanuoSonmrNdagidsmRssecIdeoshoinscyndaeidtaeniarntaddes-ted-
wwheithnevveenrlapfoasxsinibele(.thIfeinptoalreernatblmeesdyimcipnteomofsEoXccSuIRr Afo)llothweirnagpay dheacvreeabseeeninrtehpeodrtoesde. Torheuppoonssdiibsi-li-
metabolic properties of desvenlafaxineadjustment is required solely on the basis of age; however, possible reduced renal clearance
of EXSIRA should be considered when determining dose.Paediatric populations: Safety and
efficacy in patients less than 18 years of age has not been established. Method of administra-
tion: For oral use. Contraindications:.• Hypersensitivity to EXSIRA, venlafaxine hydrochloride
or to any excipients in the EXSIRA formulation.• EXSIRA is an inhibitor of both norepinephrine

and serotonin reuptake. EXSIRA must not be used in combination with a monoamine oxidase

inhibitor (MAOI), or within at least 14 days of discontinuing treatment with an MAOI. Based on
The simple clinical trials.Serum lipids, Dose-related elevations in fasting serum total cholesterol, LDL (low
density lipoprotein) cholesterol, and triglycerides were observed in clinical trials. Measurement
of serum lipids should be considered during treatment with EXSIRA.Seizures, Cases of seizure
were reported in pre-marketing clinical trials with EXSIRA. EXSIRA has not been systematically
evaluated in patients with a seizure disorder. Patients with a history of seizures were exclud-
ed from pre-marketing clinical trials. EXSIRA should be prescribed with caution in patients with
a seizure disorder. Discontinuation effects, During marketing of SNRIs (Serotonin and Norepi-
the half-life of EXSIRA, at least 7 days should be allowed after stopping EXSIRA before starting cotyntoinfutahteiosne aodf vterersaetmeevnetn, ttshesnhoruelsdubmeincgonthseideprreedvioinusplaytipernetssctrriebaetdeddowsiteh mEXaySIbReAcwohnosidpereresde.nt nephrine Reuptake Inhibitors), and SSRIs (Selective Serotonin Reuptake Inhibitors) such as
an MAOI. Severe adverse reactions have been reported when therapy is initiated with SSRI/ Swubitshepqruoegnrtelys,sitvhee dmyesdpinceaal ,pcraocutgithio,noerr cmheasyt cdoisnctionmuefodrte. cSreuachsinpgattiehnetsdossheoubludtuantdaermgoorae pgrroamd-pt EXSIRA, there have been spontaneous reports of adverse events occurring upon discontinu-
SNRI medicines such as EXSIRA soon after discontinuation of an MAOI and when an MAOI uhaaUmlvseeredabitcienea.eleSneldwvreaeitrlpculyhoairntptieogadntip,ewaanhtntiseed.nndNtssisowfcriodotcnomhtsiinanouggthaepetiaaor dtnaijeunonstftitdsEmeXfeprSonremItRsissAoatrshnehetqsoruutaiorldnetdEbidXeseSopclIoreRenlsyAss:iodaDnenritsesthc,deo.innSbctipalnuesudicasinitaigoolfnvpaeosgnpyelmau; flpahatxotoiiwonmenes,sv-.
is initiated soon after discontinuation of SSRI/SNRI medicines. These reactions have included ation of these medicines, particularly when abrupt, including the following: dysphoric mood, ir-
ritability, agitation, dizziness, sensory disturbances (e.g. paraesthesias such as electric shock
toerE, XpSosIRsiAb.leTraepdeurcinegd oref nthael cilneiatiraalnacnetidoef pErXeSssIRanAt smhoauyldbebeneccoensssidaeryredtowmhiennimdiseeterdmisicnoinngtinduoas-e.
tioOnf sthyem7pt7o8m5s.pSatpieenctisalinpporpeu-mlaatiroknetsin: gUcsleiniincaplattriieanlstswwithithErXeSnaIRl Aim, p5a%irmoefnpt.aTtiehnetsrewcoemrem6e5nydeeadrs
stoafrtaingge doorsoeldiner.pNatoienotvserwailtlhdisffeevreerneceresnianl simafpeatyirmorenetffi(c2a4c-yhrwCerreClo<bs3e0rvmeLd/mb ient)woerenent hde-ssteagpea-
retnieanltsdisaenadseyo(uEnSgRerD)paistie5n0tsm; ghoewveevryero, tihnetrhdeasy.hoBret-ctearumsepolafcienbdoiv-icdounatlrovlaleridabtriliiatyls,inthcelerearawnacsea
inhitghheesreinpcaidtieenntcse, oinfdsivyisdtuoaliclisoarttiohnosotaftidcohsyapgoetemnsaiyonbein dpeastiieranbtsle.treSautpepdlewmitehnEtaXl SdIoRsAeswhsohowueldre
no≥t 6b5e ygeivaersn otof apgaetie(n8ts%a)ftceormdpiaalyresdis.toUspeatiinenptsati<en6t5s wyeitahrsheopf aatigceim(0p,9air%m)e.nItn. Nadodditoiosna,gien abdo-th
suggest a minimal likelihood of clinically significanttremor, myoclonus, diaphoresis, nausea, vomiting, flushing, dizziness, hyperthermia with fea-
tures resembling neuroleptic malignant syndrome, seizures and death.• Children less than 18
years of age, as safety and efficacy have not been established. • Pregnancy and lactation.
Special warnings and precautions for use: SSRIs/SNRIs may increase the risk of postpartum
haemorrhage (see section 4.6 and 4.8). Clinical worsening of depressive symptoms, unusual
changes in behaviour, and suicidality. Patients with major depressive disorder may experience
sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania,
tinnitus, and seizures. While these events are generally self-limiting, there have been reports of
serious discontinuation symptoms.Patients should be monitored when discontinuing treatment
with EXSIRA. A gradual reduction in the dose rather than abrupt cessation is recommended
whenever possible. If intolerable symptoms occur following a decrease in the dose or upon dis-
continuation of treatment, then resuming the previously prescribed dose may be considered.
worsening of their depression and/ or the emergence of suicidal ideation and behaviour, whether jusshtmoret-ntet rims naencdeslosnagry-teformr ppaltaiecnetbsow-citohnthroelpleadtictriimalsp,aitrhmeerentw. eUrseeinincreeladseerlsy ipnastiyesnttosl.icNbolodoodsapgrees- Abnormal bleeding, Medicines that inhibit serotonin uptake in platelets may lead to abnormalities
S5 EXSIRA, 50 mg and 100 mg extended-release tablets. or not they are taking antidepressant medicines. This risk may persist until significant remission adsjuursetminepnat tiisenrtesq≥ui6re5dyseoalreslyofoangtehecobmapsaisreodf taogpea; thieonwtsev<e6r,5pyoesasrisbleof raegdeuctreedatreednawlitchleEaXraSnIcReA. of platelet aggregation. As with other medicines that inhibit serotonin-reuptake, EXSIRA should

QUALITATIVE AND QUANTITATIVE COMPOSITION: Each EXSIRA 50 mg extended-release occounrsse.qAuecnacuessa.l Froolre,pahtoiewnetvsewr,hfooreaxpnetidriepnrceesasasnutsmtaeindeicdininecirneainsdeuicninbglosoudcphrebseshuarveiowuhrilhearsecneoitv- ofPEaeXdSiIaRtrAicshpooupludlabteiocno.nSsaidfeertyedanwdheenfficdaecteyrimnicnhinilgdrdeonsuen.Pdaeerd1i8atyriecarpsoopfualagteiohnass: nSoatfebteyeanneds- be used cautiously in patients predisposed to bleeding. Hyponatraemia, Cases of hyponatrae-
beinegnEeXsStaIbRlAis,heeidth. ePradtioesnetsrebdeuincgtiotrneoarteddiswcoitnhtiEnXuaStIiRonAsshhoouulldd,bneecvoenrsthideeleressd,.Cbaeuotibosnesrvheodulcdlobseeelyx- eftfaicbalicsyheind p(saetieenstsecletiossnsth4a.n3 1a8ndye4a.r8s).oIfnacgleinihcaasl tnroiatlsbeoef nSeSsRtaIsblaisnhdedS.NMReItshiondmoafjoardmdeipnriesstrsaiv-e
CYP-mediated DDIs.1film-coated tablet contains desvenlafaxine succinate equivalent to 50 mg desvenlafaxine. Each mia and/or the Syndrome of Inappropriate Antidiuretic Hormone (SIADH) secretion have been
described with SNRIs and SSRIs, including EXSIRA, usually in volume-depleted or dehydrat-
EXSIRA 100 mg extended-release film-coated tablet contains desvenlafaxine succinate equiv- ed patients, including elderly patients and patients taking diuretics. Interstitial lung disease
alent to 100 mg desvenlafaxine. Sugar free. PHARMACEUTICAL FORM: Extended-release and eosinophilic pneumonia. Interstitial lung disease and eosinophilic pneumonia associated
tablets. EXSIRA 50 mg extended-release tablets are light pink, square (pyramid, one sided), with venlafaxine (the parent medicine of EXSIRA) therapy have been reported. The possibili-
film coated tablets, debossed “W” over “50” on the flat side. EXSIRA 100 mg extended-release ty of these adverse events should be considered in patients treated with EXSIRA who present
tablets are reddish-orange, square (pyramid, one sided), film-coated tablets, debossed “W” over with progressive dyspnea, cough, or chest discomfort. Such patients should undergo a prompt
“100” on the flat side.CLINICAL PARTICULARS:Therapeutic Indications: Major depressive medical evaluation, and discontinuation of EXSIRA should be considered. Special populations.
disorder EXSIRA tablets are indicated for the treatment of major depressive disorder (MDD). Use in elderly patients. No dosage adjustment is required solely on the basis of age; howev-
Posology and method of administration: Major depressive disorder. The recommended dose
foerrcliisneicdailnwtroerasteinginpgaatinedntssuwiciitdhaulintyd, eerslypinegciaclolyndaittitohnesbtheagtinmningghtobfeaccoomuprsroemoifstehderbaypiyncoreaatsaensyin tiodins:orFdoerr,otrhael ruesew.eCreonintrcareinadsiecdatrieopnosr:t.s• oHfyhpoesrstielintysiativnidtystuoicEidXeS-rIRelAat,evdenaldavfaexrsineeehvyednrtoschsulocrhideas
timbleooodf pdroessesucrhea.nPgoesstu, reaitlhheyrpiontcernesaiosens(soeredUescereianseelsd.eBrlyecpaautiseentosf).thCearpdoiosvsaibsiclituylaorf/cceor-embroorvbaidsictyu- orsutoiciadnayl iedxecaiptioienntasnidn stheelf-EhaXrSmIR. AIntfeorrmacutliaotnionw.•ithEXoSthIReAr miseadnicininheibsitoarndofobtohtehrnfoorrempsineopfhirninteer-
belatrw. eCeanumtioanjoisr daedpvriesessdivine addismorindiesrtearnindgoEthXeSr IpRsAycthoiaptaritcieanntsdwnoithn-cpasrydcihoivaatrsicudlaisro, rcdeerresb,rtohveassacmulear, atiaSnhnnoaSlPNhiesdfc-eiRMebghtbrsidIiolaotoAyeotmlctnboOfrrh-ooy:nelI(iptf.CiMdMoCneriSnYocAYosoiteiPnnyeOnPfvon2ieE2nIeradD)seDXr,mreu6to6Sosrpima,urnaaItRncMaednwehsAkvd,eiopete,EdhaxoC.raiitsisrcndhEYtteieaanElXPaersner,XtS3aeeosASlsIaLleR,itm4IncaaRPA7,thbseioAoMitotdbmatnr1eaiesabtsu4nyoodtossotrohilitdcsiarnassiyanln(evhyMofeaedoosttsfeArutbbbesolEOmdyeterfXIeeCdbd)iuSnn.tieiYassstICeRcbecPraeeorodoAl3alpnnlnoAiciozttttwnrioti4ernianote,ducealundMoidfnansbfmeetaeg,yiwocrfdbtvEtnthCeiirocnoeerlYeiuoatnnashcsPftettitemoo1trsashropnAyneemmcps2nrwoiMtea,entenitpdtg2AwmavhyiAubcOiEta6i(lohinsXICs,lieimSvaasN2isennneIoCSRiddMtnM)8itAa-oheb,waAtaedybe2chmOriedtCcaaeifvIiipno9nn.wceyreeBoeiaa,mtsmahnnosFsmedxbtSeeMadiiedn2rdSriActtataCaiiRionsOlntb1iineIgote/Io9yns-,,
proercliapuidtiomnestaoboselisrvmediwsohrednertsre. aInticnrgeapsaetisenintsbwloiothdmpraejossr udreeparensdshiveeadrtisraotredewresrsehoobuslderbveedobinsecrlivneicdal ispirneitgiantaendcsyooanndafltaecrtdaitsioconn: tEinXuSatIiRonA omfuSsSt RnoI/tSbNeRaI dmmeindiisctineeresd. Ttohepsreegrneaancttioonr slahcatavteingincwluodmeedn.
wthrieanlstwreitahtinEgXSpIaRtiAen. tEsXwSiItRh Aothhaesr npostybcheieantreicvalnudatneodns-pystyecmhiaattircicalldyisinorpdaetriesn.Ttshewiftohllaowreincgenstyhmispt-o-
tormy osf hmayvoecabredeianl irnefpaorcrteiodn,inunpsatatiebnletshebaeritndgistereaastee,dunwcitohntaronltlieddephryepsesratenntssifoonr, moracjoerredberporveasssciuvelar
didsiosredaesrea. sPawteiellnatsswfoitrhotthheesreinddiaicgantoiosness,,beoxtchepst yfocrhciaetreicbaronvdasncounl-aprsdyicsheiastreic,:waenrxeieetxy,claugdietadtiforno,m
paclninicicalttatrciaklss,.Sinesruommnliiap,idisrr,itDaboisliety-,rehlaotsetdilitye,leavgagtiroensssiivnenfaesstsin, gimspeurulsmivitoy,taalkcahthoilseisat,erhoylp, oLmDaLn(ilao,w

for EXSIRA is 50 mg once daily, with or without food, with a maximum dose of 100 mg per anddenmsiatynialip. oApltrhooteuignh) achcoaleustaelrloinl,kabnedtwtreigelnyctheerideemsewrgeernecoebosfesrvueicdidianl cimlinpiuclasletsriahlass. nMoetabseuernemese-nt trSemafoert,y mduyroincglonhuusm,adniapprheogrneasnisc,y naanudsleaac,tavtioomnihtinags,nfolut sbheienng,edsitzazbilnisehsesd, .hOypbesertrhveartmioinaalwditahtafeinad-i- er, possible reduced renal clearance of EXSIRA should be considered when determining dose.
day. The dose increase should occur gradually and at an interval of not less than 7 days. Dis- taobflissehreudm, cliopnidssidsehraotuioldn bsehocuoldnsbideegreivdendutorincghatrnegaintmgetnhtewthitehraEpXeSuItRicAr.eSgeimizeunre,sin, cCluadsiensgopfossesizbulyre tucraetse raenseinmcbreliansgenderuisrkol(elepstisc tmhaanlig2n-afonltd)syonf dproosmtpea,rtsuemizuhraeesmaonrdrhadgeeatfho.l•loCwhinildgrSenSRleIs/SsNtRhaI nex1p8o- Of the 7 785 patients in pre-marketing clinical trials with EXSIRA, 5 % of patients were 65 years

continuing EXSIRA: Symptoms associated with discontinuation of EXSIRA, other SNRIs and diwsceorentrienpuoinrgteEdXinSIpRreA-minapraketietingtscfloinriwcahlotmriaslsucwhithsyEmXpStoIRmAs. aErXeSsIeRvAerhea, sabnroutpbt einenonssyest,eomrawtiecarelly yesaurrse wofithaignet,heasmsoanftehtypraionrdtoefbfiicrtahc.yUhnadveesinraobt lbeeeefnfeecststa: bMlisehtaebdo. li•smPraengdnannuctyritiaonndal ldaicstoartdioenr.s: of age or older. No overall differences in safety or efficacy w ere o bserved b etween t hese pa-
SSRIs have been reported. Patients should be monitored for these symptoms when discontin- noetvaplaurattoefdthine ppaattiieenntts’swpirtehsaensteinizgusreymdpistomrdse.r.IfPtahteiednetsciswioitnh ias hmisatdoerytoofdsiseciozunrtiensuewetrreeatemxecnlutd, - SCpeocmiamlowna: rDneincrgesasaenddapprpeectaituet.iPosnyscfhoiarturicsed:isSoSrdReIrss/:SVNeRryIscmomaymionnc:reInassoemthneiar.isCkoomfmpoosnt:pAanrtxuiemty, tients and younger patients; however, in the short-term placebo-controlled trials, there was a
uing treatment. A gradual reduction in the dose rather than abrupt cessation is recommended EeXdSIfRroAmsphroeu-mldabrekettainpgercelidn.icSahl otrita-tles.rmEXtrSiaIRlsAdsidhonuoltdsbheowpraenscirnibceredawseithincathuetiorinskinopf astuieicnidtsalwityith haaebmnoorrmrhaalgdere(asmees,sneecrtvioonus4n.e6ssa,ndde4c.r8e)a.sCedlinliibcaidlow, oarnsoerngiansgmoiaf .dNeeprrveosussivesyssytemmptdoimsosr,deurnsu:sual
whenever possible. If intolerable symptoms occur following a decrease in the dose or upon dis- waithseainztuidrepdriessosradnetrs. Dcoismcopnatrienduatotiopnlaeceffbeoctsin, aDduurilntsgbmeyaorknedtitnhge oafgeSNofR2Is4 (ySeearrost;otnhienreanwdasNaorreep-i- chVaenrygecsominmboenh:aDviiozuzri,neasnsd, shueiaciddaaclihtye..PCaotimenmtsonw:itShommanjoolrendceep,retrsesmivoer,dipsaorradeesrthmeasyiae, xdpyesrgieenucseia, higher incidence of systolic orthostatic hypotension in patients treated with EXSIRA who were
≥ 65 years of age (8 %) compared to patients < 65 years of age (0,9 %). In addition, in both
continuation of treatment, then resuming the previously prescribed dose may be considered. duncetpiohnrininethReeuripsktaokfesuInichiidbaitloitrys)w, itahnadntSidSeRpIrses(sSaenletsctcivoempSaerreodtotnoinplaRceeubpotainkeadInuhltsibaitogres)65suyceharsas wdoirssteunrbinagncoef tihneairttdeenptiroens,svieorntigaon.d/Eoyrethdeisoermdeerrgs:eCncoemomf osnu:icBidluarlrieddeavtiisoionna,nmdybderihaasvisio. uEra, rwahnedthlearb- short-term and long-term placebo-controlled trials, there were increases in systolic blood pres-
Subsequently, the medical practitioner may continue decreasing the dose but at a more grad- Sa5nEEdXXSoSlIdRIeRArA., T,th5e0remhgaavnedbb1ee0ee0nnmresgpoenrxttsaenoedf oehudos-rteirlelietypa,ossretusitcaoidbfalealtdisdv.eearstieoneavnedntseolfc-hcaurmrinwg ituhpuosnedoisf cSoSnRtinIsu- oryrninotththdeisyoardreertsa:kCinogmamntoidne: pTrinenssitauns.t Cmaerddiicaincedsis. oTrhdiesrrsi:skCommamy opne:rsPisatlpuintatitliosnigsn, itfaiccahnytcraermdiias.sVioans-
ual rate. Switching patients from other antidepressants to EXSIRA: Discontinuation symptoms QinUacAtihoLinlIdTorAefTntIhVuenEsdeAermNtDheedQicaUigneAesNo,fTp1IaT8ArtyiTceIuaVlraEsr.lyCMOwaMnhieaPn/OhaySbpITroumIOpatN,n:iinaEc.laIuncdhcinliEgnXicthSaelIRtfroAialllo5sw0, minmaggn: ideayxwstepanhsdorereidcp-ormertloeoaddsf,eorir- occcocunulsarersq.duAiseocnarcdueessra.slF: roCorloepm,ahmtioeownnte:svHweorh,toffoleurxsaphne.trRiideeenspcpreeirsastsoaurnyst,tmathineoedradicciinnicecareinnadisnemdiuencdbiinalogsotsidnuapclhrdebsisseouhrradeveiwroshu:irClehoramescmneooivnt-: sure in patients ≥ 65 years of age compared to patients < 65 years of age treated with EXSIRA.
Paediatric population. Safety and efficacy in children under 18 years of age has not been es-
fi0lm,r0it-3acbo%ialitoeyf,dpataagtbitealenttitoscnto,rnedtaaiztienzdisnwedsietshs,vEesXenSnlasIfRoaArxyi.nAdecissttiuvucarbctiaionnactoefsmeq(aeun.igvia.a/lpheaynprtaotemosat5hn0eiasmihagassdseauslcsvhoenbalesaefaenxlerineceptr.oicrEtesadhcohinck bineYgeanwEXneisSntIgaR.bAlGis,aheseitdhro.eiPrndtaeotsiseteinntraselbddeuisicnotgirodntereorsar:tdeVidsecwroyintchtionEmuXamStioIoRnn:AsNhsahouosuldeldab,,endcerovynemsrtihodeueltrehes,dsc.C,obaneustoipobanstesiorhvnoe.udCldcolbmoesmeeolxyn- :
have been reported when switching patients from other antidepressants, including venlafaxine, EaXssSemInRasAalltpi1or0no0sp)om,rtagionnexxioeteftynp,dacetioednn-rfteuslsewioaitnshe, mhfiealmajod-rcaoacafhfetec,dtilvetaethbdaleisrtgoycr,doenertmawionhtsioodnweaeslrveleatnbrleialiatfyate,xdinwesoitshmuoncctiahin,earhtmeypaeorqkmueaitven-dia, bftlbeioameCsDlrrrockt.oiewcoaiesCmldrelioeenraemfhdptiucanodrotaielenoimnolssas:ntwsate,riuejRfoiofvscranrareoshteasdi.meansdhPenngsiv.ptoig.iinpnrsMseegRaegtsustd.ea,isrsepaneSiicvnnrldiukoetthhsalidsonydeduuwspirmscikaoictoiteninthindevrldcdeieaunsretlensatsirestiadluyo,yarse,binsnncerectldg(oseysusnimpotEenoanetegrXhnecadeSUeccinaerotIsidlRcpvulneyresAsdbeiyaniratttcttieoiioesshstaenhlspsidsassueuaett.eerttrbidihBlecyeiaadnesagpntiotcsnisadmnaroddtnwuiriebegndisinnorthoeehsgtntnrs:soecbo-):Cpfa.efdsCrtoVahcdyimaseoeiccoorrmhmodyvpriudiapaooocresrtsnvsrorcsia:escmuis:bElodciamisCrlfiuriseet,otolyocahdcnmrtreeo:idb/lrmcerfeyaHeecropbdisryonneyr,yp-co:btsmeorhvrferMrouaeohaavnsruissbdatcsaeirustadcoimscolnuiastunieyylirnos-,*-,. tablished (see sections 4.3 and 4.8). In clinical trials of SSRIs and SNRIs in major depressive
aalentinntitdneittoupsr1e, 0sas0nadmntsgse.idzEueXrseSvseIR.nWAlahfsaihlxeoinutehld.esSbeeueguvaserendftrsecea.ruePtiogHueAsnRleyrMainAllyCpasEetUielfT-nliItmCs AiwtiLnitghF, aOthRheirMset:ohrEayvxoeterbnfedaemndil-yrehpleiosartsotseryof disorder, there were increased reports of hostility and suicide-related adverse events such as
Abbreviations: MDD: Major depressive disorder, DDIs: Drug-Drug Interactionsto EXSIRA. Tapering of the initial antidepressant may be necessary to minimise discontinua- taobfslemertiaso.nuiEsaXdoSirsIchRoyAnpto5inm0uaamntiigoan.eSxsteyemrnopdtoteondmi-nrses.lPyenadtsieronmtaseb.slehTtoshuealdrdeebveliegmlhotpomnpitneoknr,tedosqf wuaahpreeont(edpniystricaolmlnytidilni,fueoi-ntnhgeretsraeitdaeetnmdin)e,gnt suicidal ideation and self-harm. Interaction with other medicines and other forms of inter-
tion symptoms. Special populations: Use in patients with renal impairment. The recommended action: Monoamine oxidase inhibitors (MAOI). Central nervous system (CNS)-active medicines
starting dose in patients with severe renal impairment (24-hr CrCl < 30mL/min) or end-stage Serotonin syndrome, Ethanol, Potential for EXSIRA to affect other medicines Medicines metabo-

References: renal disease (ESRD) is 50 mg every other day. Because of individual variability in clearance
fislmewriocthtooanEtieXndSsItyRanbAdle.rotAsm, gedremabdaouysasol ecrdceud“ruWwc”tiitohnvEeiXrnS“5tIhR0e”Aodtnroestahetemraefltanhte,srpidatherta.icnEuXlaaSbrlrIyRupwAtit1hc0ec0sosmnactgoiomenxitiaesnrtdeuecsdoe-mroemfleoeatnshdeerd pordreelcilpaaiyudetmidoneestajaobcbouslilesarmtvioedndi*sw,ohredejaencrsutr.leaIantitcoinrnegafpsaaeiltusierienn*tb.slow(*oiFtdhrepmqreuasejosnrucdryeepaisrnedcsashliecvuaelradt triesaodterdbweaerssreesdhoobousneldrmvbeeednoinbosnceliyrnv)i.ecNadol t
tasbewlrehotetsonnaeerveregriecpdomdsisehdib-icloeirn.aeInfsgine(ti,noscleqluruadabirnleeg(spSyySmraRpmItsoi,dm,SsoNnoRecIcsuidraefnoddl)lo,trwfilpimntag-cnaosa)dtaendcdrteaawbsiltehtsinm, dtehedebicodisnosesesedtoh“rWaut”pimoonvpeadrirs- wtrkhianelosnwwtnrie:tPhaotEinsXtgpSapIRratutAiem.nEthsXaSweIimRthAoorhrtahagesern*po**st.ybc(e*he*i*naTterhivcisaaleunvadetenndtonshy-apsssteybmcehaeiatnictraricellpydoiinsrtoeprdadteifeorsnr.tTtshhweeittfhhoelalorarwepiceneugntitschymicsltapos--s
in these patients, individualisation of dosage may be desirable. Supplemental doses should lised by CYP2D6, Medicines metabolised by CYP3A4, Medicines metabolised by a combination
not be given to patients after dialysis. Use in patients with hepatic impairment. No dosage ad- of both CYP2D6 and CYP3A4, Medicines metabolized by CYP1A2, 2A6, 2C8, 2C9 and 2C19,
justment is necessary for patients with hepatic impairment. Use in elderly patients. No dosage P-glycoprotein transporter, Laboratory test interactions, Electroconvulsive therapy, Fertility,
adjustment is required solely on the basis of age; however, possible reduced renal clearance pregnancy and lactation: EXSIRA must not be administered to pregnant or lactating women.
of EXSIRA should be considered when determining dose.Paediatric populations: Safety and Safety during human pregnancy and lactation has not been established. Observational data indi-
efficacy in patients less than 18 years of age has not been established. Method of administra-
cate an increased risk (less than 2-fold) of postpartum haemorrhage following SSRI/SNRI expo-
tablets (Reg. nos.: 42/1.2/0935, 41/1.2/0427). Each tablet contains desvenlafaxine succinate equivalent to 50 mg and 100 mg desvenlafaxine respectively.tion: For oral use. Contraindications:.• Hypersensitivity to EXSIRA, venlafaxine hydrochloride
sure within the month prior to birth. Undesirable effects: Metabolism and nutritional disorders:
or to any excipients in the EXSIRA formulation.• EXSIRA is an inhibitor of both norepinephrine Common: Decreased appetite. Psychiatric disorders: Very common: Insomnia. Common: Anxiety,

Reg. No. 1954/000781/07. 85 Bute Lane, Sandton, 2196, South Africa. Tel. No.: 0860 PFIZER (734937). Please refer to detailed package insert for full prescribing information.and serotonin reuptake. EXSIRA must not be used in combination with a monoamine oxidase abnormal dreams, nervousness, decreased libido, anorgasmia. Nervous system disorders:

inhibitor (MAOI), or within at least 14 days of discontinuing treatment with an MAOI. Based on Very common: Dizziness, headache. Common: Somnolence, tremor, paraesthesia, dysgeusia,
1. DeMaio et al. J Bioequiv Availab 2011, 3:7 Metabolism Studies of DesvenlafaxineS5 EXSIRA 50 mg and 100 “1m0ce0ot”natboinonulisathmtieonofflaostfesrtroidetoean.tCminLeI(nNint,IcCtluhAdeLinngPreAMsRuATmOICiInsUg).LtSAheRroSpt:roTenhviineorusasyplnyeduprotriemcsecInrsidbyiemcdapttdiooomnsse:mmMaaayyjoinbrcedluecdpoernemssidseeinvrteeadl . troyomfosfSmhSayRovIecsa/SbrdeNieaRnlIisnr)ef.aprGocrettioennde,raiunlnspdtaiastboielrendtehsresbaeratinnddgisetaraedsametei,nduisntwcraoittnhiotranon:llteCiddoehmpyrmpeesosrntae:nnFtssaiotfinog,ruoemr,accejohrreillbdsre,opvarasestshcseuivnlaeiar ,
dsistAaobtrudnseorrcmhEaaXnl SbgIleeRseAd(eitn.aggb.,leaMtgseitdaaitcrieoinnei,nshdatichllautceiindnhafitobioritntsshe,eraotntrodenacitnommuepant)ta,koaefutminonapojloamrteidcleintpssremtasabsyilvitleyea(dedis.gtoo.rdtaaebcrnho(yMrcmaDarDdlii)tai.e,s pdcdiafdliseisnneoeiicrccladiranesealgearttt.sraajeiPitacstdaeklswtsrwi.ye,Se,enlielniitgrrsasruhisotwmtam.fibotOhlniirlpiivatoiyhde,t.ehsriIdsr,enreoriDvtsaiedonebsisda:iteliigicgtT-nyarah,eotteiilshooareonnetessss,dti,:sielbiCetxloyilocme,tehmvaiptamgpettgsdifooyornneccr:sslhcinsiIeainiinvcrtcerearifbcnelareaseaotssxnvinsepad,gdesnricmsiwoeueepnnlraiu-cugrpelmhssdityiwv,stcioeitihtyntha,aicaslraEterckXi,achawSs:otheeIalReidrnsseAxiatbieee,loorxtovhyocel,yld,urpadLdopgoDemritsedLaaastfg(insroloueoinamrw,,ein,
LICENCE HOLDER: Pfizer Plaoobsfiolpelloabgtleoyloeadtnadpgrgemrsesgtuharoetio,dnao.nfAdasdhwympitiehnritoshttehrraemtriioman)e,:dnMiceaiunjroeorsmdtuehspacrteuinslashrivbaeitbdseiersrroaorttdioenris.nT-(rheee.ugp.rethacykopeme, mrEreXfnSledIxReidaA,dsionhscoeou-ld atdoanhBefbduenslimscesmhairatuayeunmndssliei,a.plc.iNoopoApfoindlrtsossthhitpodeseeuehincgrmoa)ihfuoitcilaodhaneocbnrlasaeetuhitsdecsotoeoauvtrnleloodlssillnui,bdfkmaoeenrbregedeEidovtXwtferdSiendguIeilRsrtynoitncAritegcbhahrueitradrteeineeoagkmsntnimnewoogrefewgntrtenhhetn.eiwscoInteibmhtdhseoueerfEcdarstvXipicuoeSeiinndcuIeiRtodii,ncAfafelo.crSeimrlmicegneepiiizmcsduuaieslrdsleneiituss,rsir,ianenhCloscsaaitl.sussrM,denedicenosioaagtomslbypfuemsosreieessenms,inziehdbuesaelrnye-dt-.
mg extended–release foorrbdeEinXuaSstieIoRdnA)caisuntd5io/0oursmlgygaisnotrnpocaientitednsatisilny,aplrwesidtyhimspoportoswemditshtoo(eub.tglfe.oenodadinu, gswe.iatHh,yvapoomnaiattixrnaigme,umaminad,dCodsaiaesrerohsfooe1fa0h)0.yTpmhoegnacptoernar-e- dwimsecoroepnerterinfpuuosirniotgend,EiaXnnSpdIrReeA-xmcinhaarpknaegttieienngttrsacnlfionsrifcuwaslhiotornmiaalssreuwcuihthnsliEykmeXlSyptIoRtomAbs. eEaXroeSf sIbReeAvneehrfeait,s.Tanrbeoratutpbmteeiennntosnyhssoeteut,mldoarctwoicneasrleliyst
Laboratories (Pty) Ltd. dcaomym.iaTithaaenntddu/oossreetohifnecESrXeySansIdRerAosmhweoituholdfseIonrcaocptuoprnriognprapridraeutceaulAlrysnoatirndsdiu(sraeuttciachnHaisnotrtemrryvopantolepo(hfSanInAotDsluHeps)pssleethmcareenntit7osn)diashyansvo.etDrbiesec-e-n neoovtfaptluhaaorttseeodfgitnehnepeparaatieltienmntset’aswspiuthrreesaseesnmetiinzpgulorsyeyemdipsinotortmdheesr.. mIPf aathntieaegndetesmcwiesniitothnoafisohmviseatroddreoystoaofgdesieswiczoiuthnretiansnuwyeeStrrSeeaRetImx/ScelNundRt,-I.
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To report an adverse event, please contact ZAF.AEReporting@pathnfiezMhaeAlOfr-.lIicf.eoSoemfvEe.XreSIfaIRdyAvoe, raustelewraesiastc7htiodntasoyshcasvhoeonubltdeaebcnetraelPlpoowfirtezeddearwftheferonsrtothapepnrianypgyEoiXsthSinIeRitiAratbpeedufowrrepithsotSasrSetiRn,gI/ please use contact details below. +2711 320 6000 or 0860 734 937 (SA Only). Monday-Friday 09h00-17h00.caoltnytisinocufhatahteieomsneiao,afdmtvryeoarsctmearednviate,lntithnsefasnrhcorteiuoslndu,mbaeingdcotcnhoseriodpnerareervydiooiuncscplylautspieiroennstscrretirbqeeuaditreindgowsreiethvmaEsaXcyuSlbaIReriAscaowtniohsnoid; petrheesdse.ent dnuleacprtghioerni-nbienortReheeourropisgtakaksoetfrisIcnuhticuibidietaolwirtsyit)h,waithnpdparnoStpiSdriReapItserea(sSisrewalnaetycstipcvroeomteSpceatriroentdo,ntiofinnpeRlaeecdueepbdto,amkineaayIdnbuhelitbsiintaodgrisce)a6tse5udyciehfaparessr- disturbance in attention,vertigo. Eye disorders: Common: Blurred vision, mydriasis. Ear and lab-
Spuawbtistehenqptusreohngatrldey,smsthivueeltimpdlyesdpuicnaedlaep,rrlycaiocnutgigtiohcn,aerodrriamcchaerysistckodnfisatcinotuomersfo.dreMt.corSerueacsphinapgtiaettnhietesntdesoxspheeorbiueulndt cauetnddatehmregosoreeaegpvrreaondmt-spt aEnfXodrSmoIRleddAer,s. otThohenereraefhtheaarvvienegbbeeeseetinonnsrepoporoninrttassnyoemfohpuotsosmtrielaiptytoi,crstpsuaicotiifednaatldsiv.deAeracstteiivoaentveaednndctshsaeorlcfc-cohuaarlrrimsnhgwouitlphdoubnseediosfcoSnStRinIus- yrinth disorders: Common: Tinnitus. Cardiac disorders: Common: Palpitations, tachycardia. Vas-
SNRI medicines such as EXSIRA soon after discontinuation of an MAOI and when an MAOI udauml rreiandtgeicE.aXSl eSwvIiRtaclAhuiantrtgieoanpt,maateinendnttdsaissfrcoomnmtiponatuhraetrdioatnonotpifdlaEecpXerSbeIosRs.DAainsstchsootnuotlidnEubXaeSticIoRonnAss:yidDmeipsrectodom.nStsin.puAeadctviaoelnrspseoyprmeuaplactotiimoonsnss. ianaticdohmnildionrfiestntheeuresnded.emPr HethdAeicRainMgeeAsoC, fpO1aL8rtOiycGeualIaCrrsAl.yLMwPahnReiOan/PhayEbprRuoTpmItE,aSnini:acP.luIhdnaincrmglinatihccaeolloftorgilailcolasw,licnmlgaa:sndsiaiyfiscwpaahtsioorrniec:pAmo1rot.e2odd,foirr- cular disorders: Common: Hot flush. Respiratory, thoracic and mediastinal disorders: Common:
is initiated soon after discontinuation of SSRI/SNRI medicines. These reactions have included hraeUvpesoerbteindeneinlrdeeaprsolsyrotpecadiatitweionhntesnw. iNsthwoiatdcbohrsiunapggt epdaiastidceojnuntssttimnfureoanmttioionst,hrdeorqsuaeinretridedesupocrleteisolysnaonontrst,haiepnecblruaindsginsgoofvfteraengalaetmf;ahexoninwteei,nv- 0ri,Pt0as3byi%clihtyoo,faapngaaittlieaeptniottiscns,trde(aiazntzetidndewspisrthe, sEsseXanSnstIosR)rAyP.dHAisActtuRivrMabtaAionCncEeosUf mT(eIaC.ngAi.aLp/haPyrApaoeRmsTthaICenUsiaiLahsAaRssuSac:lshLoiabsset eeonlferceetxrpiccoirptseihedonictnks: Yawning. Gastrointestinal disorders: Very common: Nausea, dry mouth, constipation. Common:

PP-EXS-ZAF-0145 tremor, myoclonus, diaphoresis, nausea, vomiting, flushing, dizziness, hyperthermia with fea- toMeDEr,XDpScoIlRsinsAicb.aleTl atrpeiaedlrsuincagetdaorfreatnhteaeloicfnl≥eitiaa2rla%anncinetidcoleufpdEreeX:sSdsiIazRnzAtinmsehsaosy,uwlbdeitbhnedercacoewnsasliadsryeynredtodrowmmhiene,inmnaidsueesteedraimscainonindntgihneduaoads--e. asEesnXmsSaaIltRliopAnro5sp)0,omratingoxneiexotfye,pnadctoeiendnf-urtessliewoanits,hehmteaaabjdoleartcashfTfeea,cbtlievtehcadorirsgeoy:,rdHeeymrpworothimoonewallloesrleaeb,triMleitaya,tgenidneswsoiiumthmnoisatht,eeahrrymaptaoerm,kMeatnieciardo,- Diarrhoea, vomiting. Skin and subcutaneous tissue disorders: Very common: Hyperhidrosis.
tures resembling neuroleptic malignant syndrome, seizures and death.• Children less than 18 tiaocOnhfsety.hmeInp7tgo7em8ns5e.rpSaalp,tieedcnisitascloipnotpinprueua-lmatitoaionrknessyt:imnUgpstceolimniniscpaoalcttirceiuanrltsrsewwdiittmhhoErreXenSafIrlReimqAu,pe5anir%tmlyeownf tipt.haTthileoentrgseecwroedmruemra6et5niodyneedoafrs atincntrniydisteutpasrl,leinasensdacnestleslui.zloEusrXeSs, .ITRaWAlch.silFheioltmuhle-dcsoebaeetivnuegsn:etMds acacarreuotgioeounl/sPelyrEaGilnly3ps3ae5tlif0e-,lnimPtsoitlwiynvigtih,ntyahleahrliecsothoharoyvleo(prbaefraetmnhyilryderphooilsyrttssoerodyf), Common: Rash. Musculoskeletal, connective tissue and bone disorders: Common: Musculo-
years of age, as safety and efficacy have not been established. • Pregnancy and lactation. stthaoerftrianpgye.doAsrdeovelidnresrep.aNrteioeancottsvioewnrasitlhlledsaiefdfveineregrentcoreesdniaisnlciosmnaptfieantiuyrmaoteironnetffo(i2cf4at-chhyerrwaCperyCre.l To<hbe3se0mrmvoeLsd/tmbcinoe)mtwomereoenntdah-desvtsaeegrspeea- osfRemreiodaunirsioandoisorcxhoidynepti,onmuTaatlncio,ianT.istSayenmriuopmttoonmdiinso.xsPiydanetid,erYnoetmslloesw.hToirhuoeldn dobexevidemelo.opEnmiXtoeSrnIeRtdoAfw1ah0e0pnomtdeginsetcixaotlnelytnindliufeeidn-t-ghrertelreeaaatestmenientangbt- skeletal stiffness. Reproductive system and breast disorders: Common: Erectile dysfunction*,

Special warnings and precautions for use: SSRIs/SNRIs may increase the risk of postpartum rerentiaaeclnttdiosisnaelneadasedyino(EguSntogRedDris)pcioasnti5eti0nutmsa;gtihoeonvwienervyaetorl,ethainesrtt2hdea%ys.ohBfoterhtc-eateEursXmeSpIoRlfaAicn-etdrbievoai-dtceuodanlptrvaoatlilreiandbtsitlriitnayltsihn,etchslehroaerta-wnteacresma sweleirtothst:oETnXainSblsIeRytnAcd.orAroem:geHraymdpuaroaymlorceecldluourscewt,iiotMhnaEignXnStehIsReiuAdmotrseseatetmarareathntet,,rpMtahiractrincoucalrabyrrsluytapwltliincthesccsoeanltlcuioolonmsiietsa, nTretaculcos.meFmoilfmeon-tcdhoeeadrt- delayed ejaculation*, ejaculation failure*. (*Frequency is calculated based on men only).Not
haemorrhage (see section 4.6 and 4.8). Clinical worsening of depressive symptoms, unusual intrhiatihglseh,seuerpipntaoctiid1ee2nntswc,eeienokdfsisv, yiwdsuatoaslicnsaoutirosthenoaso(tfa2tdi%cos)h;ayignpeotthmeenaslyoionbnge-itnedrpemasitsriaetubndltesie. tsrS,euauptpepdtloemw1i1ethnmtEaolXndSthoIRss,eAnsowshehovoeuwnldetsre sweinhroget:noMenveaercrgriopcgoomsls/ePibdEliecG.inIef3s3in5t(o0inl,ecPrluaodblyilnevgisnySmlSapRltcIoosm,hosSlNo(cpRcaIusrtr ahfonylddlorwotrliiypnstgaendas)d,) eRacenrdedaiwrsoeitnhinomxthiededei,dcoiTnaseelcs,otTrhiautatpnoiminumpdaisidr-i- known:Postpartum haemorrage***. (***This event has been reported for the therapeutic class
changes in behaviour, and suicidality. Patients with major depressive disorder may experience nloe≥tadb6e5togydievisaecrnosntotifnpauagatieteion(n8tsin%aaf)tteclreoadmsiaptla2yrs%eisd.otUfotshpeeaiptniaeptnieatsntiet<snat6sn5dwyaiethtaarhsreaoptefatagicgreeiamt(ep0ra,9tirhm%ane)n.ptIl.naNcaeodbddoiotinsoanthg, eindaobduo--th msActomoaebxnttnouaitdonisbnertohmuc,lsahiYas,taelimoSnbllngpoloeeewfoescsfdii(eraitenorrl.eogngpat,.ortoMamnexgeicinedidatnea(iucti,tntiionicFtonehlDun,sed&shntihCnafragolleutYrsMcienusilAnhmltooaOibwitrniIiaotsg#gns).6esthS/,:rSeoaeSutnroptnoodnrstreoicenevnotiuiaomnYptueatssoal)ylr,kyoneawbdpueirrntolFeoomCpswncloeFar2mtisbeA5yielclemu°dtCimsnpd.stimnootKaimsauebeymseillipmetmyLawaaa(dyeyekt.elolgbin..ecacSltolbauchsncodeeohneldryfsm.cmildaDiaeferleodnirt:eiiteaand2s,lo.4t of SSRIs/SNRIs). General disorders and administration: Common: Fatigue, chills, asthenia,
worsening of their depression and/ or the emergence of suicidal ideation and behaviour, whether jubslsethm-oberlitnn-tdeisrpmhnaeascneed.sAslodanvrgye-rftsoeermrpeapatilceatncioetnsbsowr-iecthopnohtrertoepldlaetwdicitthirmiaopltsha,eirtrmhSeerNneRt.wIUse.srAeeltiihnnoceurelgdahesrgelyasspitnarotsiienyntsettsso.tlincNaobl lbodloedseadpgirneegs- feeling jittery, irritability. Investigations: Common: Increased weight, increased blood pressure,

S5 EXSIRA, 50 mg and 100 mg extended-release tablets. or not they are taking antidepressant medicines. This risk may persist until significant remission aidssjuunsroettmicneonpntasitisideernerteqsdu≥ira6en5d aysdeovalerslrysoeofnraegtahecetciobnmaspfiosarroeEfdXatSogIeRp;aAht,ioeiwnt teissv<earn,65paoydsevsaeibrrssleeofrreeadagucectietordenarfteoenrdaowlthcitlheeraErSXaNSnRcIReIsA. olobarrEfebdeXipimlnuelSaasoItbetvReioldeolAenocbt)dalaiausgpnttgeirdoer/uesocsgsraluayrgrtdieaion,sfnrtapo.ronamAidtnsietthhewnyestistpthicnepaarortrleththodeseniyrsrmmpumionpaestt)io,edl mdirnceseitqnouue(reisobr.emlgetdh.euadnsftocianriunugulhsa.seirbHeaia.ty,bpNsveoeoarnrmtrouaatittrotriieoannnegiansm,n-rad(ieaenu,.cdgpCo.tdanahiktsayeerpn,rsehtEsroorXefeoSafhlf)eIyR.cxTpAoiohanne,stahianctoriocnauoneeld---r: decreased weight. Overdose: There is limited clinical experience with EXSIRA overdosage in
QUALITATIVE AND QUANTITATIVE COMPOSITION: Each EXSIRA 50 mg extended-release occocnusresq. uAecnacuessa. lFroorlep,ahtioewntesvwerh,ofoerxapnetriideenpcreesassaunsttamineeddiciinnecreinasinediuncbinlogosdupcrhesbseuhraevwiohuirlehraesceniovt- oaf nPEdaXemSdaIiRaytArailcsshopooucpldcuublraetwiocitonhn.EsSiXdaSeferIRetydAa.wnEhdfefeencfftidsceaotcenyrmaincintciivnhigtiileddsreornseequ.uPnidarienrdg1ica8otrnyicceeapnrostrpaoutfiolaangtieaonnhdsa:speSnraofofterbmtyeaeannncdees. - cmo(dimaeistaavnnedtn/uolasrfeathxoeinf eESXysnuSdcIRcroiAnmaweteit)ohef sxInetearonptdpoernodinp-rrepialreteeacsuAernsttoaidrbsilue(rtsesutiaccrheHaaosvrmatriyolapnbteolep(ShaasIAnfDoslHluo)pwpsslee: cAmreectaniortstno)nhisacvonenottabrieenecinn-g humans. No specific antidotes for EXSIRA are known. Induction of emesis is not recommended.
film-coated tablet contains desvenlafaxine succinate equivalent to 50 mg desvenlafaxine. Each binegenEXesStIaRbAlis, heeithde. rPdaotiseentrsedbuecintigontreoar tdeidscwointhtinEuXaStioIRnAshsohuoludldb,enceovnesrtihdeelreesds.C, baeutoiobnsesrhvoeudldclboeseelxy- eIfnftitacebarlcfiesyrheienndcpea(stwieeeinthtsseclcoetgsionsnittsihvae4n.3a1na8dnydmeao4rt.os8r)o.pfIenargfcoelirnmhiacaasnlcnteori.taTblsheoefnrSeesSsutRaltIbssliosafhneaddcS.lMiNnRiectIahsloitnrdiamol fathajoadrtmdaiesnspiersestsrase-idve
Because of the moderate volume of distribution of this medicine, forced diuresis, dialysis, hae-
feorrccisliendicianl twreoarstiennginpgataienndtsswuiicthiduanlitdye, relysipnegcciaolnlydaittiotnhse tbheagt imnniginhgt boef acocmouprrsoemoisfetdhebryapinycoreraasteasniyn titohdneis:eoFfrfoderecrto,srtaohlfeurEseXew.SCeIRroeAnitonrnacrinebadeshiceaadvtiioroeunprsao:lr.t•pseHoryffophremorsaetnilncitseyitioavfnitdyhetsoaultiEchiXydSein-IRrdeiAvla,idtevuedanlsaladrfvaeexvriensaelehedyvdenrnootcschlislnouircidahellyas omtedahmoHndeaendsOmr(eecpaLefreaooniDnbotrrgideeEselmeeid,nRnd-potocsw.aOrNpl,eotihFtiasiehcnirulnClircecrSotleEsauwNprRdgw-RnpialTniaeItlnIashguuFgscmrIalteCaoeincolimAdsd/ngaeeTaillaaSrduE)l.uymSsicOnIhRnioptnoFrtImaaiesuutRo,ralimdescE.itnnuibMGftctloiesaalIyiuSrllmddabpTlrinulonirRiaesdnngsAtsgietispTsEorudarIXshOeritsetSiaderNeisI.onpRaI:srtssbsPActeechhf,ieotoazauanneseksntermiaurdneLiaaigncpaeltilonbyorcdirgosasitiurenikr7nadrde,otoivoat1pfioinrcc4haileusicaalosm.iudcsr(tIesve2nPpoe-8tdtnncreyseieatr)aeaspurLtbrtlimieeoottldeivtwnaoe,telns-d8wnail5aetnuiostaghnBr.aclgIeudshEntse.gXedcohliSalscLyineuIiadaRiacnrctaAoesaete-d;l,-
EXSIRA 100 mg extended-release film-coated tablet contains desvenlafaxine succinate equiv- tbimloeodofpdreossseurceh.aPnogsetsu,raelithhyeproitnecnrseiaosne(sseoer Udescereinaesledse.rlByepcaatuiesnetso).f Cthaerdpioosvsaisbciluitlyaro/cf ecroe-bmroovrbaisdcituy- osrisgtuoniicaficdnaynletidximceiaptiaieoinrnmtsaeninndt tohsfeplfE-shyXacSrhmIoR.mAIonftotoerrmr,acucoltagiotnionitnivw.•ei,EthoXrSoctIoRhmeArpilsmexaendbieicnhihnaievbisiotouarrnopdfebrofoothtrhmernaofnorceremp.insHeoopwfheriinvneteer,r- twriSaitalhsn,dvtethonenlra,ef2aw1x9ein6ree, S(utonhucetohpmAamrfreoicnnat ,rmeTepdlo:irc+tsi2n7oe(f0oi)sf1c1EhX3a2eS0mIR6icA0)c0a0thrd/ei0raa8cp6ya0dh7va3ev4res9eb3ee7ve(entonlrtlesf,preoinercteSludod.uinTthghAemfrpyicooasc)sa.irbdilii-- moperfusion, and exchange transfusion are unlikely to be of benefit.Treatment s hould consist
alent to 100 mg desvenlafaxine. Sugar free. PHARMACEUTICAL FORM: Extended-release blaert.wCeaeuntimonajiosraddevpisreesdsiinveaddimsoinrdiseter rainngd oEtXhSerIRpAsytcohpiaattriiecnatnsdwnitohnc-pasrdyicohviaastrciculdairs,ocredreerbsr,othvaesscaumlaer, atylRiEosfcGhtIhaSeeTsmReiAaaT,dImvOeyNrosceNaUerdMvieaBnl EtisnRfs(ahSroc):tuioEldnX,bSeaIRncdAonc5so0irdomenrgae:rdy4i2no/c1pc.a2lut/is0ei9no3tns5,rterEeqXautSierIidnRgAwir1teh0v0EasmXcSguI:lRa4rA1is/aw1t.hi2oo/n0;p4r2teh7se.esnet of those general measures employed in the management of overdosage with any SSRI/SNRI.
tablets. EXSIRA 50 mg extended-release tablets are light pink, square (pyramid, one sided), porrelcipaiudtmionestaobbosliesmrveddisworhdeenrstr.eInactirnegapsaetsieinntbslowoitdhpmreasjosrudreeparnedshsievaertdrisaoterdweersresohbosueldrvbeedoinbscelirnviecadl asniadnccsteieoarnon:tyoMCnioNnnSore-aaumcptitnvaekemo.xeEidXaicSsineIReiAnmhmaibyuitisomtrspnao(iMtr jAbueOdgIu)e.smeCdeennintt,rtachloinmkebirnvingoa,utosior nsmyowstioethrmsak(iCmllsNo,Snp)oa-atimecntinvtsesmohxoeiudlaidcsibnees pwaRittEiheFnpEtrsoRghEraNedsCsmEiv:ueAltdippyplesrpounvneddae,Prclryooiunfeggshsc,iaoornrdaicalhcInefsroitsrkdmisafacticootmnorfdsoa.rtM.eSoourfecphupbapltaiicetainettnisotnse(sx1hp4oeurMiledanrcucenhdd2e0trh2ge1os)e.a epvroemntpst Ensure an adequate airway, oxygenation, and ventilation. Monitor cardiac rhythm and vital signs.
film coated tablets, debossed “W” over “50” on the flat side. EXSIRA 100 mg extended-release wtrhiaelsn wtriethatEinXgSpIRatAie.nEtsXSwIiRthAohtahsernpost ybceheinaterivcaalunadtendosny-pssteymchaitaictraicllydiinsopradteiersn.tTshweitfholalorwecinegntshymistpo-- inchaSiubetiritoontroe(ndMinaAbsOyoInu),dt rooprmeweriat,htEiinntghahtnalozelaa, rsPdtoo1tue4sndmtiaaalycfsohrionEfedXryiSs, cIiRnocnAltuitndouinaingffgeacutrtteooamthtmoebreinmletesw,diuitchnintiael ntshMeMyAeadOriceI.inrBeeassmeodneatoabnblyo- drUmeuPpserLeoidnErigtciAenaEdSleXEeilndSvReaIaRrElulsyAFasEotptirocRaeintaaiT,ettmiOanontnesDdn.wEtdNaiTitsohsAccIodaLonobEmtsriDunappugaPtaerRtediaodOisdncFtjouooEsnfpSttElmiaSnXceIuOeSnabItNtRiooiAs.AnDL,rsiesIhdNqcoooFuusniOerldteiRndrbeMuesdaAoutciTlocoeItnnlOiyossNniodymneForrOpethttdRoae.mpCSbesOpar.iesnMAicgsdPiavooLleffEprtsaTroeegEpaeruet;mlahaceotitnwoiotnenisvns-. General supportive and symptomatic measures are also recommended.Gastric lavage with a
tablets are reddish-orange, square (pyramid, one sided), film-coated tablets, debossed “W” over troymosf mhayovecabrdeieanl inrefaprocrtitoend, iunnsptaatbielenthsebaertindgisetraesaete, udnwcoitnhtraonllteiddehpyrpeessrtaenntssiofno,r omr caejorrebdreopvraesscsuivlaer thcelisrhteaadilnf-bltiyhfeaCtoYEfPEX2XSDSI6RI,RAMAteh, deairtcaliepnayessdtmo7eedstaanybosotlsiashedodvuelbdrysbeCelyYaaPllf3ofeAwc4et,dthMaeefitrdeiarcbisnitleoitspypmtionegetanEbgXoaSlgisIeRedAinbbsyeufacohrceoamscttbaivirnittiainetgsio.n large-bore orogastric tube with appropriate airway protection, if needed, may be indicated if per-
“100” on the flat side.CLINICAL PARTICULARS:Therapeutic Indications: Major depressive ddiissoeradseer.aPsawtieenlltsaswfitohr tohtehseer idnidaigcnaotisoenss,, ebxoctehpptsfoycr hciearteribcroavnadsncounla-rpdsyiscehaiaster,icw: earnexieextyc,luadgeitdatfiroonm, aAnobMfubsAeoOthaI.nCSdYedPvee2prDee6nadadenvndecrCes.eYPreh3ayAsc4itci,oaMnl seadnhidacivnpeessbycemheeontloargbeiopcloaizrlteedddebpwyehnCedYnePnthc1eeA.r2aA,pl2ythAois6u,gin2hiCtiaE8t,Xe2SdCIRw9AitahnhSdasS2RCnIo1/ t9, formed soon after ingestion or in symptomatic patients. Activated charcoal should be
disorder EXSIRA tablets are indicated for the treatment of major depressive disorder (MDD). pcalinniiccaal tttraiaclkss.S, einrsuommlnipiaid, si,rrDitaobsielit-yr,elhaotesdtilietyle, vaagtgiornesssiinvefansetsinsg, imsepruulmsivtiotyta, lackhaothleissitae,rohly, pLoDmLa(nloiaw, SbNePRe-gnI lymscyeosdptiercominteaeitsnicsaturllaycnhsstpauosdritEeedXr,SinLIRapAbroesrcaolitononircyaalfttoeersrtcdliinnstciceoarnal tcitnrtiiuoaanlstsio,fonEr olietfscatprnooctMeonnAtvOiauIllsfaiovnredatbwhuheserean,pyan,no FMinedArtiOcilaiIt-y, administered. PHARMACOLOGICAL PROPERTIES: Pharmacological classification: A1.2
Posology and method of administration: Major depressive disorder. The recommended dose istiopinnrietiogafntedadrnucsgoy-osaneneadkfitnleagrcdtbaiesthcioaonvn:itoinEuurXaSwtiIoaRnsAosmfeeSunsStRinIo/StthNbeRecIalimndimceadinlicistirntieaerlsse..dTCthooe-psaerdemgreninaaicsnttiroaontrsiolanhcaotvafetimningecdwluicodimneedesn. Psychoanaleptics (antidepressants) PHARMACEUTICAL PARTICULARS: List of excipients:

for EXSIRA is 50 mg once daily, with or without food, with a maximum dose of 100 mg per adnednsmitaynliiap.oAprltohtoeuing)hcahoclaeusstearloliln, kanbdetwtriegelyncethreideesmewregreenocebsoefrsvueidcidinalcilminpicuallsetrsiahlsa.sMneoat sbuereenmeesn-t trceoSmnaotfaer,itnymindyguorcvinleognnlhuausfam,xdaininaephraeongrden/saoinrsc,EynXaSnuIdsRelAa.c, tvaEotXimoSniItRihnaAgs, insfloutshbheeinemgn,aedjosizrtazabincliestishvse,dhm. yOepbteasrbethorevlitaremtioioanfawvl iedthnaltafefaianx-d-i- MePrD,RDpEocSslisCnibiRclaIeBl rItNeridaGulscINeadtFaOreRranMtaelAocTlfeIO≥arN2a.n%ceinoclfuEdeX:SdIRizAzinsehsosu,ldwibthedcraownsaildseyrneddrowmheen, ndaeuteserma iannindghdeoasde-. EXSIRA 50 mg extended-release tablets Tablet core: Hypromellose, Magnesium stearate, Micro-
day. The dose increase should occur gradually and at an interval of not less than 7 days. Dis- toafbslieshruemd, lcipoindssidsehroautilodnbsehcoounldsibdeergeidvednurtoingchtarenagtimngentht ewtihtherEaXpSeuIRticA.rSeegiizmuerens, ,inCcalusdeisngofposessizibulrye tuinrceas,teareamsneeimdnicbcrlieinnaegseundseeurdirsoktloe(plettrisecsamthamalinagjno2ar-fnodtledsp)yronefdspsrooivmsete,p,agrseteunimezruahrleaisseemdanoadrrnhxdaieegateyth,f.os•lolCocwihailndgarenSnxSielRetysI/sSaNnthdRaInpea1xn8pico- aOcfhteh.eIn7 7g8e5nepraatli,ednitsscionnptirneu-amtiaornkestiynmgpctloinmicsalotcricaulsrrewdithmEoXreSIfRreAq,u5en%tlyofwpitahtielonntsgewredreur6a5tioyneaorsf crystalline cellulose, Talc. Film-coating: Macrogol/PEG 3350, Polyvinyl alcohol (part hydrolysed),
dwisecroenrteinpuoirntegdEiXnSpIrReA-minarpkaettiienngtsclfionricwalhtorimalssuwcihthsEymXSpItRomA.sEaXreSsIReAvehrea,sanbortubpet einnosnyssetet,moar twicearlely ydeisasurosrredoewfristah.gineE,XthaSesIRmsAaofnesthtyopuarlnidodrnteoftfbicbiraetchy.uUshenaddvecsonirnoactboblmeeieteanfnfetelcysttsaw:biMltihsehpteardbo.od•luiscPmtsreagcnnodanntacuiyntriinatigonndvaelandcliatsafoatrixodinen.res: tohferaagpey.oAr dovldeersr.eNroeaocvtieornasll ldeiaffdeirnegncteosdiinscsoanfetintyuaotrioenffiocfacthyewraeprye. oTbhseermveodstbceotwmemeonnt haedsveerpsae-
continuing EXSIRA: Symptoms associated with discontinuation of EXSIRA, other SNRIs and neovtapluaartteodf itnhepaptaietinetnst’swipthresaesnetiinzgurseymdispotordmesr.. IPf athtieendtescwisiitohnaishmisatodrey toof dsiesiczounretisnuweetrreeaetmxcelundt,- ShpyCedocrmoiacmlhwolonar:irdnDeienocgrseoatahsnedrdpparrpoepdceuatciuttesti.ocPnosnsytcafohinriainutrgsiceEd:XiSsSoSIrRRdAIes.r/sSI:nNVcRreerIaysscmeosamyinminboclnor:eoIadnsspeormethsnesiuarir.seCkwoomef rpmeooosntbp:saAernrtvuxemiedty, rteieancttsionanledadyoinugntgoedr ispcaotinetnintsu;athioonwienvaetr,leinastth2e%shoofrtth-teeErmXSpIlRacAe-btroe-actoendtrpoallteiednttsriainlst,hethsehreortw-taesrma Red iron oxide, Talc, Titanium dioxide, Yellow iron oxide. EXSIRA 100 mg extended-release tab-
SSRIs have been reported. Patients should be monitored for these symptoms when discontin- EeXdSfrIoRmA pshreo-umldarbkeettinagpecrleindi.caSlhtorirat-lste. rEmXStriIaRlsA dsihdonuoldt bsheopwreasncriinbcerdeawsiteh incatuhteionrisikn opfatsieunictisdawliittyh hianaesbmonomorrermhpaagl tedieren(satsemeinss,cenlicentriicvoaonlut4srn.ia6elssa,snp,dadre4tci.c8rue).laasCrleylidnwilciibtahildhowi,goahrsneeornrdginoagssemosfi.aPd. erNepe-rerevxsoisuitvisnegsyshsyytmepmeprtotdeminsso,irodunenrsushs:ouualld thriiaglhse, rupinctoid1e2ncweeoefkss,yswtaoslicnoarutsheoasta(2tic%h)y; pinottehneslioonngi-nteprmatiestnutdsietrse,autepdtow1it1h mEXonStIhRsA, nwoheovwenetrse lets: Tablet core: Hypromellose, Magnesium stearate, Microcrystalline cellulose, Talc. Film-coat-
uing treatment. A gradual reduction in the dose rather than abrupt cessation is recommended waitsheaiznutrideedpirseosrsdaenr.tsDcisocmopnatirneudattoionplaecffeebcotsi,nDaudruinltgs bmeayroknedtintgheoaf gSeNoRfI2s4(Syeearorsto; nthineraenwdaNsoarerpei-- cbheVaencrgoyensctrooinmllembdeobhnea:fvoDiorieuzzrt,rineaeanstdms,seuhnietcawiddiatahlcitEhy.eX.PSCaIRtoieAmn.mtPsoawntii:ethnStomsmarenjocoreleidvneincpegr,eEstrXseiSvmIeRordA,ispsoharordaueelrdsmthaevyseiaer,xepdgeyusrliagerenucseia, l≥ea6d5toyedaisrcsoonftinaugaetio(8n %in)atcloemaspta2re%d otof tphaetpieanttiesn<ts6a5ndyeaat rasroafteaggreea(0te,9r th%a)n. pInlaacedbdoitioinnt,hien dboouth- ing: Macrogol/PEG 3350, Polyvinyl alcohol (part hydrolysed), Red iron oxide, Talc, Titanium di-
whenever possible. If intolerable symptoms occur following a decrease in the dose or upon dis- oxide, Yellow iron oxide, FD&C Yellow #6/Sunset Yellow FCF Aluminium Lake. Shelf life: 24
continuation of treatment, then resuming the previously prescribed dose may be considered. dnuecpthiorninien Rtheeurpistakkoef sInuhicibiditaolirtsy),waitnhdanStiSdRepIsre(sSsealnetcsticvoemSpearroetdontoinpRlaecuepbtoakineaIdnuhlitbsitaogrse)6s5uycehaarss wmodorissnetiutnorirbninaggnocofefthibneloiarotdtdeenptrieosns,vuioernert.iagCnoad.s/ eEosyr etohfdeeiseleomvrdaeetregrsde:nbCclooeomodmf psoruenics: isBdualurlerirderedqavutiioisrninogann,imd mbydeerhdiaiasvtisoe.utEr,eawarthmaenetdhnetlarb- bslheo-brtl-intedrmphaansed. lAondgve-tresremrepalacctieobnos-rceopnotrrotelldedwittrhiaolst,hethreSreNRwIesr.eAlitnhcoruegahsegsasintrosyinstteoslitcinballoboledepdriensg- months, Special precautions for storage: Store at or below 25 °C. Keep well closed. Do not
SQaiaEn5UntXicAEdoShXnLoiIlISRldoTdIrAAfeRe,rTtnA.hItTeVh,uhse5nEeer0derAeemmrNhhegtaDhadvaeviecnQeaidnUbgbee1eAese0eN,on0nfpTm1sarIeTp8rgtApoiycoeTneurxtItaalVtsaernErsnoely.dfoCMehwuOdoash-sMnerrtieienaPllip/etOhyaoa,ySbrssptrIesuuTopimItcoOatif,adbNnaialne:idlactisvEld.u.eaeIdnrcasihntceigoliEnentXivhcaeSeannlIdRfttosrAsilaleool5lscwf0-,cihnumamgrarr:gimnndigeaywxsuwitptephahnosoudnrsreieecddpi-osmorfcerootSleeonSaddtRis,nfeoIuisrr-- ohraynrvoienttbhthedeeiysnoarrredepeotrasrtk:eiCndgowmaitnmhtioEdneX:pSTrIeiRnsnAsia.tunSstu.msCteaadirndiceiiadncebsdlo.isoTodhrdipsereriss:skCumroeamiynmcporeenra:ssiPsetaslupcniottaiultlisdoinghsna,ifvitceaacanhdtyvcrearmrsdeiisas.ioVnas- issunreotincopnastiiednetrsed≥ 6a5n yaedavresrsoef argeeacctoiomnpfaorredEXtoSpIRaAtie, nittsis<a6n5 aydevaersrsoef aregaecttiroenatefodr woitthheEr XSSNIRRIAs.
Subsequently, the medical practitioner may continue decreasing the dose but at a more grad- occounlrsaser.qdAuiseconarcudesesar.lsF:rooClreo,pmahmtoiewonnet:vseHwro,htfooflreuaxspnhet.idrRieepnsrcpeeisraasatsonurtys,mtatheinodericadicninieccairnenaidnsdemuiecndinbiaglossotiudncaphlrdebsiesshouarrdveeiowrsuh:riClheaorsmecnmeooitvn-: aPnademdiaaytraiclspooopcucluartiwointh. SEaXfSeItRy Aa.nEd fefeffcictsacoyn iancctihviiltdiersenreuqnudireinrg18coynecaernstroaftiaogneahnadspneorftobrmeeanncees.- remove blister card from the carton until required for use. Nature and contents of container:
ual rate. Switching patients from other antidepressants to EXSIRA: Discontinuation symptoms EXSIRA
have been reported when switching patients from other antidepressants, including venlafaxine, fi0lrmi,t0a-3cboi%laitytoe, fdapgtaaittbiaelteniottsnc,tordneitazatzienindsewdsiesth,svsEeeXnnSlsaIofRaryAxi.ndAeisctstuiuvrcabctaiionncaetoesf me(eqa.ugni.viaap/lhaeyrnapteotsmotha5en0siaimahsgassdueacslshvoeanbsleaeefanlexrcinetrepic.orEsteahdcohcink beinYeganwEeXnsiStnaIgbR.lAiGs,haeesidtthr.oePirnadtteioessnteitnsraebldeduinscgotirotdrneoarsrte:ddVisewcroiytnhctiEonmXuaSmtIioRonnA:ssNhhaoouuuslldde,abn,eedcvroyenrmsthiodeueletrhes,sd,c.Cboaenusottiibposanetsirovhneo.duClcdolobmseemelyoxn- : Itnatbelrifsehreednc(eseweitsheccotigonnistiv4e.3aannddm4o.8to)r. Ipnercfloinrmicaalnctreia.lsThoef SreSsRulItss aonfdaScNlinRicIsalintrimalatjhoar tdaespsreesssseivde (desvenlafaxine succinate) extended-release tablets are available as follows: A carton containing
to EXSIRA. Tapering of the initial antidepressant may be necessary to minimise discontinua- EasXesSnmIsRaaAltliop1nr0os0p),omratginoxneiexotyef,npdaceotiednn-furtesslieowanits,hehmfeialamjdo-arccoahaffeete,cdtlievttaehbadlreigstoyc,rdoeenmrtawointhisoondwaelesrlvaeebtnirlleiatayf,atexidninsweoimtshunociacth,ineharytmepoaemrqkuaeintvei-ad, foerDrcialiisnrerihcdaoilenwat,roervasoteimngintipngagat.ineSdnktssinuwicaiitdnhadulintsydu,ebercslyupitneagcniaecloolyunsdaitttitioshnsesubetheagdtinsmnoirngdghetrosbf:eaVcceoormyuprscroeommoimfsteohdne:rbayHpiynpcoererhaaitsdaeronssyiins. tdhiesoerfdfeecr,tsthoefreEXwSeIrReAinocnrebaesheadvrioeuproarltspeorffohromsatinlitcyeaonfdhseuailcthidyei-nredliavtideudaalsdvreevrseealeedvennotscsliuncichalalys one or more clear plastic/aluminium foil blister strips containing 7, 14 or 28 tablets each.
tion symptoms. Special populations: Use in patients with renal impairment. The recommended ataaoltsebifnnenltmenritidtiotasetuuo.npssiEr,a1edaX0soinsSs0rdcaIhRomnsynAtegsptii.onz5dumEu0eraXaestmSnisvo.iegIanRWn.eAlsaShxyfsiteamleehrxnopoitdnttuhooeelenmdd.si-nseSbr.eeuPselygevaunaaetsidrsneeretndfosrtmestcaaeearbs.e.uhlePtTogitosHuheulenAdaseRrldyrbeeaMeivlnllAiyegmlCphsooateEpntlmpUifiet-iolTnenimrknIteCs,tidtAiwosnqwLfigtuahh,FaetpahrOneoeRhtrd(eeiMpsinstyh:ctoriaoaraEyvnlmlxeytoitinedrbliun,fefeidaneo-emgtnnhdeirrtl-eyrereseaphialtdoeeitsermanttdsoien)er,ongyft timbCleoooomdfmpdroensse:suRcrhaeas.nhPg.oeMsstu,urseacitluhhleoyrspkionetcelernetsailos,encs(osonerneedUcetscivereiantsieselssdu.eeBrlyeacpnaadutisebenotnosef).tdhCieasorpdrodiosevsraisbs:icliCtuyloaomrf/cmceor-enmb: roMorvbuaisdscictuyulo-- ssiuginciifdicaalnidt eimatpioanirmaenndt soeflfp-hsyacrmho. mInotteorra, cctoiognnitwiveit,hoor tchoemr pmleexdbiceihnaevsioaunr dpeortfhoremr afoncrme.sHoofwienvteerr,-
starting dose in patients with severe renal impairment (24-hr CrCl < 30mL/min) or end-stage fislwmeirthoctooEanXtienSdsIRtyanAbd.lerAotsmg, erdaemdbuaoayslsorecedcduu“rWcwti”oitohnvEeinXr S“th5IeR0”Adootnrseetahtermaeftlhanett,rspitdaherat.nicEuaXlabSrrluIyRpwAt ict1he0sc0soamntcigoonmexiisttaennretdcueosdme-rmoefleonatdsheedr belastrwk. eeCleantuamtliosantjiofifsrndeaesdpsvr.iesRessdeipvinreoaddiusmcotriindviesrtesayrnisndtgeomEthXeaSrnIpdRsAybcrtehoaiapstatritcideiansnotsdrdwneoirthns:-cpCasryodcmihomivaaotrsnic:udElaisrreo, crcdteileerresbd,rytohsvefuasnsaccmutioleanr,*, bsccAaSolPiaeiesbncf-eureegucttbrtiandolesiooyoietnctanbosnhonyy:neatpshyCidMnCnrtaCedYoaYotsmtNPbnyePEdoon2aSie2XnuadDt-pDiStacmr6eto6oacIrnRima,ptlnalidynvAMeeneeesrd,esnatophmEtdctxoCuieientiercddhYrt.gdiaieaanePipPrhsnced,3yeaihosnAziLyldne,im4ansaoP,mirhbpecedoMiortabasoatereliyeuabctnnoadslitooimotrnnilimcstiardispiycalna(eaaMfdepcdoitlrvsehsArobjeysiuEnOmryrctdseXhIcegCe)rioSln.tyeilYanyl,tIComeRbiPicngaeroeA3aacifnlcnfAilclezttuatrott4,ceiadlrot,tidalihadnnMtfnilehsgbfnseeep,eykacrfdeiivornuEtCinocrgtoaldYoeiu,tnibetmhcsPoseinlte1riorsstcrpoyAmbyemomcsi2.tolotetoe,eeetnAsotnd2maev,lrtitAubnciuhsa6i(lognoknslC,latuiieilfvisNlgl2ogsseeteCrSh,hdMp)8eati-Enhaeb,ybaetXdyu2cisaeriSstCucaraineeviIcp9ntRce,hsyreoeAa,nmssmaanohFchmesdboteoiadiinuevn2rnsidcltitaCdataiiiilntncebb1iiboateoslo9eyyn-st.-,, HOLDER OF CERTIFICATE OF REGISTRATION: Pfizer Laboratories (Pty) Ltd, 85 Bute Lane,
renal disease (ESRD) is 50 mg every other day. Because of individual variability in clearance taswbehlreoettnsoenavererrgripecodmsdsiseibhdl-ieco.irnaIfensignet(oi,nlescqrluaudbailrneegs(ypSmySrpaRtmoIsmi,ds,SoNoncRecIussridafeondldlo),wtrfiilnpmgta-cnaosda) etaecndredtaawsbeiltehitnsm,thdeedbidcooisnsseeesdotrh“Wautp”oimonvpdeairsir- proedrcelialpauiydtieomdnesetaojabcosuelilsravmteiodni*ws,ohreedjnaecrtsrue.laInticonrngeapfsaeitliusernient*sb. wlo(*iotFhdrmepqraeujosesrnudcreyepairsensdcsahivleceuadlratistreaodtredbewaressresehdoobousnlderbmveeedonbinosencrlliyvn)ei.cNdaol t Sandton, 2196, South Africa, Tel: +27(0)11 320 6000 / 0860 734 937 (toll free South Africa).
in these patients, individualisation of dosage may be desirable. Supplemental doses should “1mc0oe0nt”atibnoounlaisthimoenoffolafstetsrreoidatoetmn.CienLnI(tNi,nIctChluAednLinrgPeAsMuRAmTOiInCIgsU).LthSAeeRrpoSrt:eoTvnhiioneurssaylpynedpurroteimcsceIrnibsdyeimdcapdttiooosmness:mmMaayayjobinrecdluceodpnersemisdseeinrveteadl. wthrkieannloswtwrnei:taPhtionEsgXtpSpaIaRrtiuAemn. tEshXawSeiItmRh Aoorthrhaaegsrenp*o*s*ty.bc(he*ie*a*ntTreihcvisalneudvaetnenodtnsh-pyasstyecbmheiaeatntircicarelldpyiosinroterpddaetrifeson.rTttshheweiftothhlleaorwareipncegeuntsitcyhmicsplta-os-s
not be given to patients after dialysis. Use in patients with hepatic impairment. No dosage ad- dsiAstabotnrudosermrchEaalXnbSgleIeResdA(ient.gag,b.Mleatgesidtaiactriienoenis,nhdthaicallauttcienidnhaibftoiiotr nstesh,reoattnordenainctomumpeatna)tk, oeafuintmopnalojaomtreildceetisnpsrmetasabsyiilvlieteyad(eist.ogo.radtbaencroh(ryMmcaDarlDditii)ea.s, tormyofosfShmSayRvoeIcsa/bSredNeiaRnlIirsne)f.paorGcrteeiondne,rinaulnpsdatiatsiebonlredtsehrebsaeraitnndgdisteraeadasmteei,dnuisnwtcritaohtniotarnon:ltliedCdeophmryempseosranten: ntsFsaifotoingr,umoera,cjocehrreidllbser,porvaeassstshcieuvnelaiar , REGISTRATION NUMBER(S): EXSIRA 50 mg: 42/1.2/0935, EXSIRA 100 mg: 41/1.2/0427.
justment is necessary for patients with hepatic impairment. Use in elderly patients. No dosage didsfieoseredlaiensrgea.jsiPttawetreiyel,lniatrsrsitwafoibtrhiloittythh.eeIsnrevineddsiaitcigganatoitoisonensss,,:beCoxtochempmst yfoocnrh:ciaIentrceicrbearaonsvdeadsncowunel-apigrshdytic,sheiniacstreeic,a:wsaeendrxeibeeltoxyo,cldaugdpietraedtsifosrnou,mre, REFERENCE: Approved Professional Information date of publication (14 March 2021).

adjustment is required solely on the basis of age; however, possible reduced renal clearance Ploaofbsipolellaotbgelolyeotadangdpgremresegstauhtrioeo,dna.onAfdsadhwymitphienoritsthhtererarmtmiioaen)d,: inMceinauejrosormtdhueasptcrieunslhasirbiviatebsdeeirsrrooatrtodionenirns.-Tr(eheue.gp.rtaehkcyeop,meEmrrXeeSfnlIedRxeAida,sdhionoscueold- pacdlnineiciccraeltatatsrceiakdlss,w.Sieneisgruohmt. nOliapv,ideisrdr,itoDasboeisl:ietyT-,rhehelaoretsetdiilsityel,ilmeavigtaegtdiroencsslsiniivinceanflaesestxsinp, geimrsiepenurculsemivwitoyit,thaalEkcaXhtShoIilsReisaAt,eorhovyelp,rodLmoDsaLang(ilaeo,win tpiornegonf adnrcuyg-asenedkilnagctabteihoanv:ioEuXrSwIRaAs mseuesnt ninotthbee caldinmicianlisttreiarelsd. tCoop-aredgmniannisttroartiloanctaotfinmgewdoicmineens. PLEASE REFER TO DETAILED PROFESSIONAL INFORMATION FOR COMPLETE
of EXSIRA should be considered when determining dose.Paediatric populations: Safety and foobrredEiunXsaSetiIdoRncA)aaiusntido5/u0osrlmyggainsotprnoacitenietendstastiilnyp,arlewdsitiyshmpoprstoewmditshtoo(eub.tlgef.eodnoiadnu,gs.weHiathy, pvaoonmmaiattrixaniegmm,uaiman,ddCodasisaeerrsohfooef1a0h)0y.Tpmohnegactproeanre-- andhdeunmmsiaatynnisali.p. NoApoltrhosotpeueignch)ifiacchcaoanleutisdtaoeltreloinsl,kfaobnredEtwXtreSigeIlRnycAtheaerirdeemksenwrogewernne.coIenbdosufecsrtvuioeicndidoianfl ecimmlinpeiucslaissleitsriahnlaosst. rnMeocetoabmseumerneemnedsee-ndt . cSoanfteatiynidnugrinvgenhlaufmaxainnepreagnnda/onrcyEaXnSdIRlaAc.taEtiXonSIhRaAs nisottbheeenmeasjotar balicsthiveed.mOebtsaebrovlaitteionoaf lvdeantalaifnadxi-- PRESCRIBING INFORMATION.
SucdcotmoiaademShnomnyendaegRim.tasdmriI(neTcptisatraeufrehaaeoninnhiboetnnargiddaeseetgtld/meveidn,uonoed-tpEsroecsws.aepnXNl,bteoithhtteSiaos.iheeniierfunlIAniRrcncSrcESotlesAurgNwXyrepder:gwnSR-anaipaldnSisaeIdItonRrsgheuyuorgAmcmtamralseaoelnphowdleimdrsdton.geioeetaouilPhdmaaSrd)flluda.uySsssIictcnneIihRotneoptaariocrotIonmapsaecunttsp,oruosailedsorcnii.ontnnscuiibgMtnphcitliasetaralrohyuatpirlaeuemdddarptdlleriudnueonirdcaadnengwouAbslgsilsrietiynsptEsosehutdaorXamihderitrrsndeSiaasidoeuediItss.nor(RhaIcessitraestbsAoucotttereihnhcc,rateetohtaauahinHndnseksnaaeuomiiudrnfnsnaoeraagimttrcpteaeltirlooyorybtorcdhvnirpnrsasitaeiuuteniekrnolosprddeopfoot(viaStphffoicEinscchaIalneAuXysincaoaslmm.DiSucdstsspItIHeasvluRenepto-et)potidAsnonecrpmsesein,araleespeusrtottcrlihmimieseoottrwahietvwnaeoernehetelnn-idrewonacti7lansntunoSiost)dnghmrN.dahiaglsIiedsamREsnysevncsIgXdeoscehoo.linSalscyntiDdanbeiuIdtarReniieiaecrncstaddAeeosca--tned--;l- taobBfliesscehareuudms,eclioopnfidsstidhsehramotuioolddnebsraehtoecuovldnoslbuidemegreeivdoefnddutiosritnrcighbautrnteioganintmgoeftnhthteiwsthimtehreaEdpXiceSiunIteRic,Afro.eSrgceiemizdeunrde,iusinr,ecCsluaisds,iendsgiaoplyfosssiess,izbhulyaree- icnaet,eaanmiendcirceinaeseudsreisdkto(letsresatthamna2jo-frodlde)poref spsoisvtep,agrteunmerhaaliesmedorarhnaxigeetyf,oslloocwiainlgaSnxSiRetIy/SaNnRdI peaxnpioc-
efficacy in patients less than 18 years of age has not been established. Method of administra- diwsmceorenpterienrfpuuoisnrigotenEd,XianSnIpdRreAe-xminchaparaknetgieteingttsracfnloinsrifwcuashliotmrniaaslsruecwhuithnslyiEkmeXplSytoIRtmoAsb. aeErXeoSfsIbeRevAenrehefai,ts.aTbnrerouatptbmt eienennotnsssyhesot,euomldracwtoiecnarselliyst dsiusroerdweirtsh.inEtXheSImRoAntshhopurilodr tnootbirbteh. uUsneddesciornacbolemeitfafnetclyts:wMithetapbroodliusmctsancdonntuatinriitniognavlednislaofradxeinrse:
tion: For oral use. Contraindications:.• Hypersensitivity to EXSIRA, venlafaxine hydrochloride noeotvfaptlauhraottsoeefdtghineenpeparaattiielenmnttse’sawspiurtehresasenestmeinizgpulosryeemddpistinomrtdhsee.r.ImfPtaahnteiaedgnetscmisweinoittnhoiasf ohmvisaetdroderoytsooafgdesisecwioziunthrtienasunewy etSrreSeaRtemIx/SecnlNutdR, -I. hCyodmromcholno:riDdeecorreoatsheedr appropdeutictets. Pcsoynctahiinaitnrigc EdiXsoSrIdReArs. :InVcerreyacsoems minobnlo: Iondsopmrensisau.rCeowmemreoonb: Asenrxvieedty,
or to any excipients in the EXSIRA formulation.• EXSIRA is an inhibitor of both norepinephrine EeXEdSnIfsRrouAmrespahrnoeua-mldeabqrekueattatienpgearicrewlidna.icyS,ahol oxtryitag-tleesn.rmaEtXiotrSniaI,RlsaAnddsidhveonnuotltdilasbhtieonwp.rMaensocnirniibtcoerredcaawsreidthiianccathruhetyiotrhinsmkinaonpf dastuvieiictnaidtlsaslwiigtyinths. ianbsnoomrme apladtireenatms sin, ncelinrvicoaulstnrieaslss,,pdaerctirceualaserldy wlibitihdoh,igahneorrgdaossmesia. .PNree-revxoiusstinsgyshtyepmerdteisnosridoenrss:hould

and serotonin reuptake. EXSIRA must not be used in combination with a monoamine oxidase
inhibitor (MAOI), or within at least 14 days of discontinuing treatment with an MAOI. Based on wtwrhiaeitlhnse,vvtehenerlrapefoaswxsienibreele(.uthnIfecionpmtoamlreeornantblmreeepsdoyirmctsinpetoofmoisfscEhoXacSecumIRricAfo)cllaothrwdeiirnaagcpyaaddhveaecvrreseeabseeeeveninnrtteshp,eoinrdctoelusdde. inToghr eumppyooonscsdaiirbsdi-lii-- waitGhseeaninzeturidarel psdruiespsopsroadrnetitrvs.eDcoaismncdopnastryienmdupatottoiopmnlaaectiefcfbemoctesin,asaDudurureilntssgabmreeyaoarknlsedotitnhrgecoaofgmeSmNoefRn2Ids4e(ydSe.eGarraosst;ottrnhicienrleaavnwadagseNaowrreiethp-i-a bVeercyonctoromllmedonb:eDfoirzezitnreeastsm, ehnetawdaitchhEeX. SCIoRmAm. Poant:ieSnotsmrneocleeinvcineg, tEreXmSoIRr,Apsahraoeusldthheasviae,rdeygsuglaerusia,
the half-life of EXSIRA, at least 7 days should be allowed after stopping EXSIRA before starting caotylntiosinfcuhthaaeteiosmeniaao,df vmteryerosaectmaeredvnieatn,l ttsihnefsanhrocrtueiolsdnu,bmeainncgdontchsoeirdoepnrraeerdvyiionoucspclaylutisepinroetnscrtreiebqaeutdieridndgowsirteehvmEasXacySuIlbRaerAiscwaothnioosnid;pertehresedes.net dunlceatprigohenri-nibneotrhReeeourriopskgtaaoksfetsriuIcnichtuiidbbaietloitwrysit)wh, itaahnpadpnrotSipdSreRiapItrsesa(sSiraewnlaetsyctcipvoremotpeSacertrieoodnto,tnoifinpnleaRecedeuebpdot,ainmkeadyInubhltesibiaintogdreisc)a6t5seuydceihaf rpsaesr- mdiosntuitrobrainngceofinblaototednptiroens,svuerreti.gCo.asEeyseodfiseolervdaetresd: Cbolomodmporne:sBsluurrererdeqvuisirioinng, mimymdreiadsiaiste. Etraeraatmndenlat b-
uSdpamwuaulbietrtrsihideaneintgpcqetarusE.oleXSgehnrSwvaetladIiysRtl,csumAhitavhiutnteeirolgetdinmappy,tlesemapdtneiuniedcnnenatddatlsaie,spsrccfrlrycaoooiocnunmmttggiitnhipoouc,atnaahorerteeridrordicnamahtconoeatfspryiidtElsacedkXcopiSesnfracbeItRicoosntmsA.uoDaerfssionsh.rdtcstoe.MouctnSoolrdtuerineEcabuhsXepaiSnapctigIotaoRientnitAneshsitn:edsytDemsderiopsesxscthdpoeoo.emnuSrbitslepidun.netuAuccaaednittadvdioaleentprrhmsgoeseoopysrrmueaeelapaepgcttvroritoeoaimomndnnst-pssst. iannaEafcdtXoidhorSomimnlldIdRieorneedAfirsn.,tsthTeuotehrnoesednderee.armPfhtteHhearedAviiecnaRiggbnMbeeeeeAsesoet,CnifnopO1rnesa8LportOyoricenrGiuntatsalIraCssnory.AelfmyMohLpwuoaPtsnhoRtiemiarlOeni/tahypPt,ayoicEbsprturoRpsuimacTpotiIatdiEfe,nanSaiilnatd:iscd.vP.leIueAnhadrcastcinitreoliimgvnnaeiacttavhceaneeodldnltofctrosighaelilalcoolsfracw-,chlcmoiancuaalrgalmrn:issnidshawgiyofwiisutuchpalapdhsutoiobosnrreenicpd:ooiAsmfr1ctSoeo.S2odndRtfi,onIsruir-- hyarivnethbdeiesnorrdeeprosr:teCdomwimthoEnX: TSiInRnAitu. sS.uCstaaridnieadc bdliosoodrdperress: sCuorme mincorne:aPsaelspictaotuioldnsh,atvaechaydcvaerrdsiea. Vas-
an MAOI. Severe adverse reactions have been reported when therapy is initiated with SSRI/ cular disorders: Common: Hot flush. Respiratory, thoracic and mediastinal disorders: Common:
SNRI medicines such as EXSIRA soon after discontinuation of an MAOI and when an MAOI
is initiated soon after discontinuation of SSRI/SNRI medicines. These reactions have included hraUevpseeorbtineedeenlidnreearplsyosroptecaditaietwinohtnse.nwNistohwidatcobhsriuanpggtepdaaisdticjeuonsnttstminfeuronamttioisont,rhedeqorusairenetdriedsdeouplcreetliysosnoannotrsth,taeipnbecalruisndigsingooffvtaergeneala;tmfahexoniwntei,vn- 0,r0iPt3asby%iclihtoyof, apanagatitleeanptitotsicnts,red(aaiztneztdiindweespitshre,EsssXeaSnnsItRosAr)y.PAdHcisAttivuRarMbtiaoAnCcoEefsUmT(aeICn.giAa. /LphayPprAaoeRmsTathInCeiaUsiLhaasAsRsauSlcs:hoLbaisesteeonlfereceptxroiccritpesidheoninctks: Yawning. Gastrointestinal disorders: Very common: Nausea, dry mouth, constipation. Common:
tremor, myoclonus, diaphoresis, nausea, vomiting, flushing, dizziness, hyperthermia with fea- toMerDE, XDpoScsIlRsiniAbicl.eaTlraterpidaeulrscineagdt aorefrnathateel coilfne≥iatira2aln%acneintiodclfeupEdrXee:SsdsIRiaznAztinsmehsoasuy,ldwbeibthendecraocewnsasildaseryryenddtorowmmhieenn,imndaiesueteserdmaisicanoninndgtihndeuoaasd-e-. assEemnXasSallItRpioArnos5p)0o,rmtaiongnxeioexfttyep,nacdtioendnf-turseswlieoiatnhs, emhteaaajbodlreaatcsfhfeTeac,tbilvleeetthdcaiosrrgoeyr:,dHeerympworhotiomonwealelloreslaetb,reiMliatyate,gdninewssoitiuhmmontisaht,eerahmryapatoerkm, eMatenicdiaro,- Diarrhoea, vomiting. Skin and subcutaneous tissue disorders: Very common: Hyperhidrosis.
stitaotOohacnferfhtrastieanhgy.pgemeyIn7.dpootAr7gos8demoe5vnldseeip.enrrasSra.eptlpi,Neaerndtoecietiasisonaccvtilotnseiponrpowntairnpsiletluuh-ldmaelaistafaifteoedirvonkrineengsrntseiycn:tmegorUsepcsdntileoniiasnmlicinsciosmaapnflopeatticantrtyiiceiuarunmalosrttrrseiweoenwdnifttfhiitmo(ch2Efao4rcXtre-hyehSnerwaIrfRralCeeApimrqye,Cu.p5loeaTn<%bihrtsmle3yeo0erfmwvmnpetoiatL.dhst/Ttimbehlocneienontts)wrmgeeeowmcrereoondremneuntmhrd6aaee-5dtssnivotyedaeneegrpasdeoaresf- aofntsiRcnetmirdnreyiaeiodstnuputiasrsraeol,lisdnonasirensoadchxcnoiyetdsnspleel.touii,nzmElouuTXsaraaeeSntlcis,iIoa,R.Tn.TWaASilstchasey.inhmrlFeoiouiptlutommthlonde-midcnsbioseoesa.xPeytiuidnvanseedtgei,ner:doYtnMsmetcsalaelcor.suerwhtoTioogghiruueoeolsnldn/ldPeyoerbEaixvenGlieldymlpeo3as.po3etEmn5ielfi0Xte-no,lSintmrsPtIeRoidwotliAfyniwtvgah1ih,n0paety0honlhemtaeirdslegncitstoehicahrxaoyloltvnyeloetn(irlnpidbfufaeeeair-dnemtth-gnhrirleyertdlreaeehrptaoaeiossltnyrtmeotisnsreetgyaondbft)-, Common: Rash. Musculoskeletal, connective tissue and bone disorders: Common: Musculo-
tures resembling neuroleptic malignant syndrome, seizures and death.• Children less than 18 skeletal stiffness. Reproductive system and breast disorders: Common: Erectile dysfunction*,
years of age, as safety and efficacy have not been established. • Pregnancy and lactation.
Special warnings and precautions for use: SSRIs/SNRIs may increase the risk of postpartum rerteineaanclttsdioisanenleadasyedoin(uEgnStgoRedrDisp)caiostine5tni0ntsum;aghtiooenwveienvryaetr,oletihnaestrth2dea%syh.ooBfrteth-cteearEumsXeSpIolRafcAien-btdroiev-aicdtoeundatlrpovalalteiredianbttsriliiaitnylst,ihnethcselhereoarrtwa-ntaecsrema sewlreiotthtso:nETiXnaSbslIyeRntAdc.rooArme:geHrmaydpauryaoolmcreceludloruswcetii,tohMnEaiXgnSnteIhRseiAudmtroessaettemaraeratnhttee, ,rpMathritacicrnouclaarbyrlrsyutapwltiltinhceecsocsneacltluoiolmonsitieas,nTrteauclscoe.mFomiflmoetn-hcdeoeradt- delayed ejaculation*, ejaculation failure*. (*Frequency is calculated based on men only).Not
haemorrhage (see section 4.6 and 4.8). Clinical worsening of depressive symptoms, unusual inthriiatghlhsee,sruepinpctaoidti1e2nctswe,eoienfkdssiv,yiswdtuoaalsiclinsoaaruttiohsenoasota(f2tidc%ohs)y;apignoettehmnesailyoonnbgei-ntedpremastiesrantubtsdleiet.rseS,auutpeppdtloewm1it1henmEtaXolnSdtIhoRssA,enswohseohvoweuneldtrse sewirnhogeto:nnMeevaregcrircopgomosels/dPibiEcleiGn. eIf3s3in(5tino0cl,elPuradobilnylegvisnSyySml RaplItcsoo,mhSosNlo(RcpIcasurtrahfnoydldlortrwoipliyntsagenads)d, aeRncerddeawirsiotehninmoxtehideeicd,inoTesaselc,tohTraiutapinmoinupmadirsd-i- known:Postpartum haemorrage***. (***This event has been reported for the therapeutic class
changes in behaviour, and suicidality. Patients with major depressive disorder may experience njublos≥eslhtaet6mod-bb5reettl-oinyntgeteddirvaiimsspercshnnoaaeontnsocftdeiena.pslugAaosaetndaitegivr(oyn-e8nttrefss%oirnemra)afrptectpeaoallrteaimceadctnispeioattabnsl2yrosesw-%dcirsieot.hoptnoUfothrtrsphoeteeaelpldetaiipnedtwaincpttititrseahiamnt<ioletspst,nha6ateti5srhnrmedywSreeeaiNntahtRtwra.shIeUsreora.sepftAeeaailnttgighinccreoereeiuam(lag0dtepsh,e9reargstliyrh%amaisnp)tne.arnsoptIinytieln.asntNatceotdesosldib.tcidionNtiobaoionsllnoabdt,ohglodeieensepaddabrgoidoeneu-tsgh-- mceootxnaitbdinoeul,isaYmtieolnloofwosfeirrtoroentoantomixnied(neint,,cFtluhDde&innCgreMYseuAlmlOowiInsg)#. 6tSh/eSruopntrosenevitinoYusesylllnyodwprorFemCsecFrsibAyemludpmtdoinomisusemmmLaaayykienb.celSuchdoenlfmsildeifenert:eadl2.4 of SSRIs/SNRIs). General disorders and administration: Common: Fatigue, chills, asthenia,
worsening of their depression and/ or the emergence of suicidal ideation and behaviour, whether stAambtunosonrtchmhsa,nlSbgpleeesecd(ieian.lgg.p, arMegecitdaiutciotininoe,nshsathlflaoutrciinsnhtaoitbiroiatngssee, r:aoSntodtoncrineomuaptat)oa,rkaebuetinolonpwolam2tei5cle°intCss.mtaKabeyileitlpyea(wede.gtlol.ctaalobcsnheoydrcm.aDardloiitaien,sot feeling jittery, irritability. Investigations: Common: Increased weight, increased blood pressure,

or not they are taking antidepressant medicines. This risk may persist until significant remission aoeaiIffdtPssnfanuijEtaucbdenreaXsleroidmtcfsStmeiyhinaIraceReeiytopndnnrAnaiatcpc(stlessisaiespdheotnwieoertoeruispntecsqhltudd≥cesuluccaib6lraoretteei5nigoswdonsnycinatisesohttd.ihoanv4vSEalrseee.sani3XldryafosSe1anefotrI8ndyReandrdygAeametea4n.hwaoc.dEec8rthtosofi)eofb.rmeofnnafIcpifpnsctdefaasiaosercgrcfroetloeieyonndErrfmihimcXantaaoaacSigscnltnpIiehivtRcnnar;iieilogtAtadihi.etelr,odsTesbniwonthetorsseeeeifuesvq<nSn.reuPeade6Srisan,res5RiuentrpaaIyldgot1sbesdis8calavaisosoternyirfshbnrdieseclacoeaedeSfrpc.nsrNarloetMiegnroRdpaaeiefucIutcstaiactotlhriaeglonieontdetnairdaoitmharnefnoeoalddasnfrstj:hoapwaonarleSditottrhcdhmaftlaeoefebeEisrrpanmtesXryrSieeeasaSNssnantnIrssnRRccaeeiedveIA-sdse.-. laobrfeilpemlaobtvleoeloedbt laipsgrtgerrsescguaarretdi,ofnaro.nmAdshthwyepitehcratohrttehorenmr uiman)et,idlnirceiuqnrueoisrmetudhsafctourinlauhrsibeai.tbNeserarratouttiroenisann-(rede.ugcp.othanyktepene, rtErseXfoSlefIxRciaAo,nsitnhacoinou-eldr: decreased weight. Overdose: There is limited clinical experience with EXSIRA overdosage in
occurs. A causal role, however, for antidepressant medicine in inducing such behaviour has not titdohines:oerFfdfoeercr,tostrhaoelfrueEsXew.SeCIrReoAnintocrnareinbadesheicadavtriioeoupnrosar:lt.s•peoHrfyfohproemsrsatielnintcyseiationvfidtyhsetuoailctEhidXyeS-inrIeRdliAavt,iedvdueanalsldavrfaeexvrsieneaeleehvdyednnrotoscchsliulnocirchidaelalys orbdEeiXnuaSstIieRodnA)cauntdio/ourslgyaisntrpoaintitenstsinaplresdyimsppotosemds to(e.bgle. endaiunsge. aH,yvpoomnaittinrage,mainad, Cdaiasrerhsooefah).yTphoenactorna-e- humans. No specific antidotes for EXSIRA are known. Induction of emesis is not recommended.
been established. Patients being treated with EXSIRA should, nevertheless, be observed closely osrsiugtoinciiafdicnaayl niedt xeimcaitppioiaeninrmtasneidnntstohefelfp-EhsayXcrSmhIoR. mIAnotfteoorram, ccutoliaogtnnioitnwiv.•iet,hEoXorStchIoRemAr pmilseexadnbiceiinhnhaeivbsiiotaounrrdopfeobrtfohoterhmr nafonrrcemep.sinHeoopfwhiernivnteeerr,- octmhomaedmae(oHmndedmrina(dsOeeiaetcpefasLoanreanvoniDrngbotdeertidleEseen,mu/idn-Rolnpsacot.roaesNlfwOroapt,teiaoihsxehFtihrfuecininrlrClEiotceeceSsSwlXEauNysgwprS-RdnualRnipaITtdcnnRehIlucrIasgguFAocirslnmaoemIateCwaiimncosletgAdied/etnaalheTa)odi)laSruuEefsls.iymScnxeIhOnoIttRroinerpoanmFautInatpiesouoaldtRpd,ricmn.eesrEuiibotndnMnilGftepac-toisyrpalrrIeiumdiSlrlapldearbeTotliricnuealaennRiusdnssgiAArttigesseosnpTEuorrttdhaerIaXirsOediastdbstSiiersN.lueo(ieIInpssrRar:btetsucsstsPAethhceicaefc,ohaiotrznaseuaenHaeekmsnrtsraoiaeudnaivLricpatgnmtraaeolyirlcinbyoolirpdaastgonsteikrbiourniedd7nalproeie,oat(hvfioSnt1apcoaairc4shIilncaeaAusiuflodssm.Disoctrsvuel(IHeloe2Pnopp-nc)r8twdptnseyiasaeleestre)raestp:rumiLeobtcolAmietvtrwlnedeietceaoen,-ttawnlansidt8osrtniil5tasetn)uoogh.aniBnrlsahIecEgnudsahcngXtseov.ceodloSehnaltiiscLnytuIraRbeiadecacieanArnoctaaeesei--;lntned,-g Because of the moderate volume of distribution of this medicine, forced diuresis, dialysis, hae-
for clinical worsening and suicidality, especially at the beginning of a course of therapy or at any asnaidncctiseoenaron: tyMoCnoiNnoSrae-amucpitntivaeekoemx.iedEdaXiscSeinIRienAmhibmaiytuoismrtspn(aMoitrAjbuOedIg)u.esCmeedennitntr,atclhoninmekrbivniongua,stoiorsnmysowtetiotmhr sa(kCimlNlsoS, np)-oaaatcimetinvintesemsohexodiudicladisnbees moperfusion, and exchange transfusion are unlikely to be of benefit.Treatment s hould consist
time of dose changes, either increases or decreases. Because of the possibility of co-morbidity of those general measures employed in the management of overdosage with any SSRI/SNRI.
between major depressive disorder and other psychiatric and non-psychiatric disorders, the same Ensure an adequate airway, oxygenation, and ventilation. Monitor cardiac rhythm and vital signs.

precautions observed when treating patients with major depressive disorders should be observed incShaeiubrtioitootonrne(idMn aAsbyOonIud),trooompr eewr,iatEhtitinnhgaahntaolzle,aaPrsdotote1un4stidmaalayfcoshr ioEnfeXdrSyis,IRcinoAcnltuoinduainifnfgegacturoteotahmtemorbeminleetsdw,iciutihnnteialsnthMMeeyAdaOicreIin. reBesaamsseoedntaaobbnloy- trwiaSiltsah,ndtvhetoennrlea, f2wa1xe9irn6ee, uS(ntohcueothmpAmarforeincatr,emTpeeoldr:ti+csi2no7ef(0ios)fc1h1EaX3e2Sm0IRic6A0c)0a0trhd/eia0rac8p6ay0dvh7ea3rv4see9b3ee7vee(ntnotlsrle,fprienoecrtleuSdo.iunTtghhmAefyrpiococasa)s.ridbii-li- General supportive and symptomatic measures are also recommended.Gastric lavage with a
when treating patients with other psychiatric and non-psychiatric disorders.The following symp- thclieesrehtadailnbf-yltihfCeaYtoPEf 2EXDXS6SIR,IRMAAeth,deaicrtianlepeayssdmt o7eetdsaabnyoosltissaehddovubelydrsCbeelYyPaa3llfofAew4ce,t dMthaeefditreicarinbseitloistpymptioentgaebnEogXlaiSsgeIeRdAinbybseuafcochroemascbttaiivnritatiinteigosn. altyRisEocfGhtaIhSeeTmsReiaA,aTdmIvOyeNorsceNarUedMviaeBlniEtnsRfas(rhSco)ti:uoElndX, bSaenIRdcAocn5os0riodmnearger:yd4oi2nc/1cpl.au2ts/i0eio9nn3ts5r,etrEqeuXaitSreinIdRgAwrie1thv0a0EsmXcuSglaI:Rr4iAs1a/w1ti.oh2no/0; p4trh2ee7ss.eent large-bore orogastric tube with appropriate airway protection, if needed, may be indicated if per-

Register now

Early bird registration closes 31 July

www.adhdcongress.co.za

2nd Southern Africa Multidisciplinary ADHD Congress

Wednesday 1 September – Saturday 4 September 2021

presented by in partnership with

present the

• Virtual format – from the convenience and safety of2ynodurShooumteh/eofrfniceAfrica
• Earn CPD Points (clinical and ethical)
Multidisciplinary Virtual
• Reduced registration fees

• World-class local- and international speakers ADHD Congress

• Competition prizes and live entertainment Wednesday 1 September

Programme Outline: – Saturday 4 September

Wednesday 1 September – Friday 3 September: 2021

08:00 – 09:00 Trade sponsored morning symposia

12:30 – 13:30 Trade sponsored afternoon symposia

14:00 – 18:00 Scientific Sessions

19:30 – 20:30 Trade sponsored evening symposia

Saturday 4 September:

08:30 – 09:30 Trade sponsored morning symposium

10:00 – 13:00 Scientific Sessions

14:00 – 16:00 Parallel Sessions

18:00 – 19:00 Ethics panel discussion

19:00 – 20:00 Live Entertainment

Congress Convenor: Prof Renata Schoeman: [email protected]
Congress Organiser: Sonja du Plessis: [email protected]

ADHD CONGRESS

2ND SOUTHERN AFRICA

MULTIDISCIPLINARY
VIRTUAL ADHD
CONGRESS -

LETTER FROM THE COVENOR

Renata Schoeman

D ear Delegate Through a strong partnership,
We are excited to welcome you to the state of the art IT infrastructure
2nd Southern African Multidisciplinary and support from the University of
ADHD Congress, which aims to bring together Stellenbosch Business School, this
psychiatrists, paediatricians, general practitioners, will again be a live and interactive
psychologists, and occupational therapists – the virtual event. On registration,
whole team involved with the optimal management delegates will receive detailed
of ADHD across the lifespan. log in instructions for the event.
It is estimated that ten to twenty percent of You will also receive details for
children and adolescents experience mental downloading the congress app
health problems worldwide, while in Sub-Saharan where you will be able to find all
Africa, epidemiological studies indicated that the relevant information about the Renata Schoeman
40.8% of adolescents struggles with emotional and programme, speakers, and sponsors.
behavioural problems. Last year’s inaugural congress was attended by
more than 300 delegates representing seven
INTERNATIONAL STUDIES ESTIMATE THE countries. We hope that you will participate in this
PREVALENCE OF ADHD AS FIVE PERCENT year’s event and are looking forward to welcoming
OF SCHOOL-AGED CHILDREN, WITH 65% you to the 2nd Southern Africa Multidisciplinary
OF PATIENTS HAVING SYMPTOMS THAT ADHD Congress.
PERSIST INTO ADULTHOOD. HOWEVER, IT Please do not hesitate to contact us should you
IS POSSIBLE THAT THE PREVALENCE RATES require any further information or assistance.
IN SOUTHERN AFRICA MAY BE HIGHER.
Prof Renata Schoeman
Furthermore, access to care remains a challenge, Convenor
and care delivery – in both the public and private
sector – remains fragmented.

SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 * 73

DISRUPTS THEIR LIVES
AND FUNCTIONING

BUILD THEM
UP AGAIN WITH

Restoring order to their lives1,2,3

References: 1. De Bruyckere K, Bushe C, Bartel C, Berggren L, Kan C, Dittmann R. Relationships Between Functional Outcomes and Symptomatic Improvement in Atomoxetine-Treated Adult Patients with Attention-Deficit/
Hyperactivity Disorder: Post Hoc Analysis of an Integrated Database. CNS Drugs 2016; 30:541–558. 2. Young JL, Sarkis E, Qiao M, Wietecha L. Once-Daily Treatment With Atomoxetine in Adults With Attention-Deficit/Hyperactivity
Disorder: A 24-Week, Randomized, Double-Blind, Placebo-Controlled Trial. Clin Neuropharm 2011; 34:51–60. 3. Lenzi F, Cortese S, Harris J, Masi G. Pharmacotherapy of emotional dysregulation in adults with ADHD: A systematic
review and meta-analysis. Neurosci Biobehav Rev 2018; 84:359–367.
For full prescribing info please refer to package insert approved by the South African Health Products Regulatory Authority (SAHPRA.) S5 INIR 10. Reg. No.: 43/1.2/0809. Each capsule contains atomoxetine hydrochloride equivalent
to atomoxetine 10 mg. S5 INIR 18. Reg. No.: 43/1.2/0810. Each capsule contains atomoxetine hydrochloride equivalent to atomoxetine 18 mg. S5 INIR 25. Reg. No.: 43/1.2/0811. Each capsule contains atomoxetine hydrochloride
equivalent to atomoxetine 25 mg. S5 INIR 40. Reg. No.: 43/1.2/0812. Each capsule contains atomoxetine hydrochloride equivalent to atomoxetine 40 mg. S5 INIR 60. Reg. No.: 43/1.2/0813. Each capsule contains atomoxetine
hydrochloride equivalent to atomoxetine 60 mg. Dr. Reddy’s Laboratories (Pty) Ltd. Reg. No. 2002/014163/07. Tel: +27 11 324 2100 www.drreddys.co.za ZA/08/2020-22/INIR/072

ADHD CONGRESS

2RNDeSgOisUtTeHErRnNoAwFRICA MULTIDISCIPLINARY

AEaDrlyHbDird reCgiOstrNatiGonRclEosSesS31 JuPlyRELIMINARY PROGRAMME

www.adhdcongress.co.za Speaker TBC

WED2NnEd SSoDuAthYer1n SAfErPicTaEMMuBltEidRisc2ip0li2n1ary ADHD Congress

08:00 -W09e:d0n0e sdMayO1RSNeINpGtemSYbMePrO–SSIUaMtur-dDaRyR4ESDeDpYt'eSmber 2021

Topic TBC

12:30p-r1e3se:3n0te d byAFTERNOON SYMPOSIUM - ACINinOpaSrWtnIeSrSship with Speaker TBC
Topic TBC

14:00 - 16:10 SCIENTIFIC SESSION 1 - GENERAL

14:00 - 14:10 Official Welcome & Opening Prof Mark Smith (USB)

14:10 - 14:15 Introduction of speakers present the Prof Renata Schoeman
(Convenor)

11•••44::1555RVE-aei-rr1dt1nu4u5aCc::5le0Pf5dD0o rr PemogaiinstttQK–rsaef(trc&yioolinmnnAoicftetaheelesaAcnoddnedvterhneiciseasnl):ceInatnedrsnaafettiyoMonfua2ylnlotdiCudrSoihosnocumsitpeehln/ieonsfrufanicsreyAStfVariitrcetamuaelnt on ADHD Prof Steve Faraone (USA)

ADHDPro 11g••55ra::30m00mWCo--eom11rO5l5pdu::e-33tctl5i0litan i soesn:lopcrQaAaiznnle-&dsaunaAptndhddienlaitveptereoneasontitinteoiornttahnalieinsnpmggeeaenoknteferpsthicasW–rmaeSnadadtncuonersegddueaarnyoyeb4t1CiicoSoSselneopgpgtrtyeeemosmsfbbAeeDrrHD – Dr Suntheran Pillay (SA)

We1d5n:e3s5da-y116S:0e5pt embTehr e– Fbriidgaya3nSdepstmemabllero:f ADHD (weight re20la2t1ed matters) Dr Richard Sykes (SA)

08:0106:–0059-:0106:10T radeQsp&onAsored morning symposia

12:3106:–1103-:3106:35T radeBsrpeoansko/redNaefwtesrnforoonmsytmhpeossipaonsors
14:00 – 18:00 Scientific Sessions
19:3106:–3250:-3108:00Tr adeSsCpoIEnsNoTreIFdICeveSnEinSgSsIOymNpo2si-aPSYCHIATRIC COMORBIDITY

Satu1r6d:3ay54- S1e6p:4te0m ber:Introduction of speakers Dr Lerato Dikobe-Kalane (SA)
08:30 – 09:30 Trade sponsored morning symposium Dr Larry Klassen (Canada)
10:0106:–4103-:0107:20S cientTifhiceSepsssyiocnhs iatric comorbidity in ADHD (excluding SUD)

14:0107:–2016-:0107:25 ParallQel S&esAsions Dr Lize Weich (SA)
1198::00 1007:––252190-::001007:55 ELitvheicEssTnpuhtaebenrtseamtliandaminsncecuanestgsiuoesnmeednist oorfdAeDrsH(DSUinDp) atients with comorbid

17:55 - 18:00 Q & A

19:30 - 20:30 EVENING SYMPOSIUM - VIATRIS Speaker TBC
Topic TBC

Congress Convenor: Prof Renata Schoeman: [email protected]
Congress Organiser: Sonja du Plessis: [email protected]

THURSDAY 2 SEPTEMBER 2021

08:00 - 09:00 MORNING SYMPOSIUM - SANDOZ Assoc. Prof Jason Kilmer
Cannabis, Cognitive Effects, and Clinical Considerations: (USA)
Approaching the Treatment of ADHD in a Changing Legal
Climate

12:30 - 13:30 AFTERNOON SYMPOSIUM - LIFE PATH HEALTH Speaker TBC
Topic TBC

14:00 - 16:10 SCIENTIFIC SESSION 3 - GENERAL

14:00 - 14:05 Introduction of speakers Dr Karen Vukovic (SA)

14:05 - 14:45 New pharmacological developments and alternative delivery Prof Jeffrey Newcorn
strategies for ADHD (USA)

14:45 - 14:50 Q & A

14:50 - 15:30 ADHD and sleep disorders Dr Andreia Hazewinkel
(Netherlands)

15:30 - 15:35 Q & A

*Subject to change

SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 * 75

ADHD CONGRESS

THURSDAY 2 SEPTEMBER 2021 (continued)

15:35 - 16:05 Exercise as treatment for ADHD Dr Eileen Africa (SA)
16:05 - 16:10 Q&A
16:10 - 16:35 Break / News from the sponsors Dr Frans Korb (SA)
16:35 - 18:00 SCIENTIFIC SESSION 4 - CONTROVERSIES Assoc. Prof Jason Kilmer (USA)
16:35 - 16:40 Introduction of speakers Dr Francois Esterhuizen (SA)
16:40 - 17:20 The diversion of stimulants and the prevention thereof Speaker TBC
17:20 - 17:25 Q&A
17:25 - 17:55 The non-medical use of stimulants
17:55 - 18:00 Q&A
19:30 - 20:30 EVENING SYMPOSIUM - CIPLA
Topic TBC

FRIDAY 3 SEPTEMBER 2021

08:00 - 09:00 MORNING SYMPOSIUM - PHARMA DYNAMICS Speaker TBC
Strategies for improving ADHD medication adherence

14:00 - 16:00 SCIENTIFIC SESSION 5 - MEDICAL COMORBIDITY

14:00 - 14:05 Introduction of speakers Dr Jacobus Roux (SA)

14:05 - 14:40 ADHD in the geriatric population Dr Lindokuhle Thela (SA)

14:40 - 14:45 Q & A

14:45 - 15:20 The management of ADHD during palliative care (incl HIV) Dr Michelle King (SA)

15:20 - 15:25 Q & A

15:25 - 15:55 ADHD and epilepsy Prof Renata Schoeman (SA)

15:55 - 16:00 Q & A

16:00 - 16:30 Break / News from the sponsors

16:30 - 18:00 SCIENTIFIC SESSION 6 - TECHNOLOGY

16:35 - 16:40 Introduction of speakers Dr Sebo Seape (SA)

16:40 - 17:20 A review of neuromodulation for the treatment of ADHD Prof Katya Rubia (UK)

17:20 - 17:25 Q & A

17:25 - 17:55 The pros and cons of technology in the management of ADHD Dr Brendan Belsham (SA)

17:55 - 18:00 Q & A

19:30 - 20:30 EVENING SYMPOSIUM - NOVARTIS Speaker TBC
Topic TBC

SATURDAY 4 SEPTEMBER 2021 Dr Sebolelo Seape (SA)

08:30 - 09:30 MORNING SYMPOSIUM - SANOFI Dr Mvuyiso Talatala (SA)
The presentation of Adult ADHD Dr Yumna Dhansay
10:00 - 13:10 SCIENTIFIC SESSION 7 - THE CASE FOR EARLY INTERVENTION (Australia)
10:00 - 10:05 Introduction of speakers
10:05 - 10:45 ADHD and juvenile offenders Claire Tobin and Tawni
Voges (SA)
10:45 - 10:55 Q & A
10:55 - 11:25 A diagnostic journey of misunderstood children through the
Goldilocks and The Bear Foundation
11:25 - 11:30 Q & A
11:30 - 11:55 Break / News from the sponsors

76 * SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021

ADHD CONGRESS

SATURDAY 4 SEPTEMBER 2021 (continued)

11:55 - 12:00 Introduction of speakers

12:00 - 12:30 Complexities of emotional dysregulation in ADHD Dr Rene Nassen (SA)

12:30 - 12:35 Q & A Dr Chris Schuler (SA)

12:35 - 13:05 The pros and cons of extended versus interrupted treatment Dr Anersha Pillay (SA)
of ADHD Berenice Daniels (SA)

13:05 - 13:10 Q & A Dr Merryn Young (SA)
Elize Janse van Rensburg (SA)
SCIENTIFIC SESSION 8: PARALLEL SESSIONS Marele Venter (SA)

13:55 - 16:00 EDUCATION Dr Michelle King (SA)
13:55 - 14:00 Introduction of speakers Dr Lerato Dikobe-Kalane (SA)
14:00 - 14:25 Inclusive versus specialised education for pupils with Dr Derine Louw (SA)
learning disorders Jessica Cheesman (SA)
14:25 - 14:30 Q&A Linda Hiemstra (SA)
14:30 - 14:55 ADHD/Autism: the overlap and differentiating features
14:55 - 15:00 Q&A Dr Eleanor Holzapfel (SA)
15:00 - 15:25 Classroom tips for educators relating to ADHD Dr Leon Morales-
15:25 - 15:30 Q&A Quezada (USA)
15:30 - 15:55 Social skills training for children with ADHD Dr Diana Martinez-Huerta
15:55 - 16:00 Q&A (USA)
Dr Hugo Theron (SA)
13:55 - 16:00 THERAPY
13:55 - 14:00 Introduction of speakers Dr Kali Tricoridis (SA)
14:00 - 14:25 ADHD, marriage and interpersonal violence Dr Karen Vukovic (SA)
14:25 - 14:30 Q&A Dr Frans Korb (SA)
14:30 - 14:55 Parenting with ADHD Dr Suntheran Pillay (SA)
14:55 - 15:00 Q&A Dr Lavinia Lumu (SA)
15:00 - 15:25 Parenting for ADHD
15:25 - 15:30 Q&A Prof Renata Schoeman (SA)
15:30 - 15:55 Workplace interventions for ADHD Prof Christopher Szabo (SA)
15:55 - 16:00 Q&A Dr Chris Verster (SA)

13:55 - 16:05 NEW TECHNOLOGIES
13:55 - 14:00 Introduction of speakers
14:00 - 14:40 Non-invasive neuromodulation in ADHD (part 1)

14:40 - 14:45 Q & A
14:45 - 15:25 Non-invasive neuromodulation in ADHD (part 2)

15:25 - 15:30 Q & A
15:30 - 15:55 Apps and Games for managing ADHD
15:55 - 16:00 Q & A

13:55 - 16:00 A PRACTICAL APPROACH TO THE TREATMENT OF ADHD
13:55 - 14:00 Introduction of speakers
14:00 - 14:20 The practical positioning of methylphenidate
14:20 - 14:30 Q&A
14:30 - 14:50 The practical positioning of atomoxetine
14:50 - 15:00 Q&A
15:00 - 15:20 The practical positioning of lisdexamphetamine
15:20 - 15:30 Q&A
15:30 - 15:55 Treatment of ADHD during pregnancy and lactation
15:55 - 16:00 Q&A

18:00 - 19:00 SCIENTIFIC SESSION 9: ETHICS (PANEL DISCUSSION)

18:00-18:05 Introduction of speakers

18:05-19:00 Should the scheduling of methylphenidate be changed?


19:00 - 20:00 CLOSING OF CONGRESS & LIVE ENTERTAINMENT

SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 * 77

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Brought to you by Sandoz, a division of Novartis – the trusted pioneer of the MPH molecule7

ADHD = attention deficit hyperactivity disorder; MPH = methylphenidate HCI;
OROS = Osmotic Release Oral System

OROS

PPrroololonnggeedd--rreeleleaasseettaabblelettss1188mmgg,,2277mmgg,,3366mmgg,,5544mmgg

References: 1. Sandoz SA (Pty) Ltd. TPM/IMS data; January, 2021, and data on file; March, 2021. 2. Who we are | sandoz. Accessed February 24, 2021. https://www.sandoz.com/about-us/who-we-are. 3. Mefedinel™. Professional Information.
Sandoz SA (Pty) Ltd; 2021. 4. Schapperer E, Daumann H, Lamouche S, et al. Bioequivalence of sandoz methylphenidate osmotic-controlled release tablet with Concerta® (Janssen-Cilag). Pharma Res Per. 2015;3(1), e00072:1-8. 5. Katzmann MA, Sternat
T. A review of OROS methylphenidate (Concerta®) in the treatment of attention-deficit/hyperactivity disorder. 2014;28(11):1005-1033. 6. Sandoz SA (Pty) Ltd. Data on file. March, 2021. 7. Dettwiler W for Novartis. How a leader in healthcare was
created out of Ciba, Geigy and Sandoz. Profile Books; 2014.

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(prolonged-release tablet) contains 54 mg methylphenidate hydrochloride. ACTIVE INGREDIENT: methylphenidate hydrochloride. PHARMACOLOGICAL CLASSIFICATION: N06BA04 Centrally Acting Sympathomimetics. For full prescribing information refer
to the Sandoz Professional Information approved by the South African Health Products Regulatory Authority.

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Customer Call Centre: 0861 726 225. SAN.MEF.2021.03.01

NEWS

DPESPYA CR T MHEINATTS ROYF

HIGHER DEGREES Eklektos, Omphemetse Mahuma, Sharne O'Brien,
Sibongile Mondlana, Priscilla Vythilingham, Rebone
The Department had a record 18 MMeds graduating Sebothoma, Nabila Veyej  
in July 2021 and one PhD.
DEPARTMENTAL RESEARCH DAY
PhD: Amanda Edge
The 32nd annual Research Day took place on
MMeds: Tando Melapi, Jade Bouwer, Tejil Morar, Wednesday 23rd June 2021 (as per the full report
Bianca Hart, Annette Antwi Anyimadu, Sibulele which appears on page 7 of this issue)  
Zuma, Felicity Marcus, Jessica Meddows Taylor,
Kabo Letseli, Caroline Serebro, Stacey Lintnaar, Nikki

SEFAKO MAKGATHO HEALTH SCIENCES UNIVERSITY

PSYCHIATRY HOD NEWS joint appointment of Dr. George Mukhari Academic
Hospital and SMU.
Dr. Taiwo Akindipe was Taiwo has authored peer-reviewed scientific articles
appointed as Chief Specialist in the areas of Substance use disorder,Dual diagnosis
and Head of Psychiatry and Consultation-Liaison Psychiatry; collaborating
Department at Sefako with researchers within and outside South Africa.
Makgatho Health Sciences He is a recipient of the John Hamilton Award in
University (SMU) Pretoria, with Community Medicine (2000); a member of Golden
effect from November 2020. Key Honours Society at UCT; and a focal point person
for TREATNET, a UNODC project (2014-2017). He also
He obtained his undergraduate serves as a Non-alcoholic Trustee for the Alcoholic
medical degree at the University Anonymous (AA) group.
of Ilorin, Nigeria in 2000. He Taiwo is interested in the interphase between
Taiwo Akindipe trained in Psychiatry, and got substance use and other mental disorders. He
advocates for an integrative approach to service
his FMCPsych and FWACP qualifications in 2009/10 delivery, training and research in low and middle
from the National Postgraduate Medical College income countries.
of Nigeria as well as the West African College of “In an historically disadvantaged institution like
Physicians. SMU, my mission is to transform and rebrand the
psychiatry department in tandem with the needs of
He is an alumnus of University of Cape Town a previously marginalised population”
where he obtained MPhil (Addiction psychiatry) in “I am putting my nose to the grindstone with my
December 2011. He had his subspecialty training sleeves rolled up to accomplish this mission. Please
in Addiction Psychiatry at Groote Schuur Hospital, join me on this train of change.”  
Cape Town. He spent the following two years (2012-
2013) providing clinical support to drug users at
Kensington Treatment Centre (KTC), Cape Town.

Prior to this current appointment, he had worked as
a Specialist Psychiatrist and Senior Lecturer on the

SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 * 79

NEWS

IN MEMORIAM: PROF JULIAN LEFF

Her interest in neurodevelopmental disorders was
central to the development of a neurodevelopmental
clinic at the Red Cross Children’s Hospital. Wendy’s
interest in autism and working with others to arrive
at a diagnosis, particularly for girls where it had
been missed, was a knack often remarked on!

Sadly, on 23rd February 2021, Prof Julian Leff (pictured Wendy Vogel
above) passed away at the age of 82 years.
Prof Leff, an emeritus professor in the department, 3. Dr Kate Mawson has moved to Tygerberg
was prominently known for his innovative work as a Hospital/Stellenbosch University to head up the
psychiatrist in the treatment of schizophrenia, where Eating Disorders unit. Drs Mawson and Nisaar
he pioneered group and individual sessions with Dawood both worked tirelessly on the frontlines in
patients. He was also known for his classic research district services remain champions for patients in
and work on expressed emotion to prevent relapse. the community. We thank them for their efforts and
Post retirement, he invented the highly effective wish them well for their next endeavours.
avatar therapy, in which patients create computer 4. Shareefa Dalvie, with a keen interest in
avatars of their auditory hallucinations to be able to neuropsychiatric genetics research in South Africa,
engage with the voices   has published a host of high-impact papers and
book chapters on psychiatric genomics; and is
WELCOME on the editorial board of the journals, “Complex
Psychiatry” and “Frontiers in Psychiatry “.
The Alan J Flisher Centre for Public Mental Health She has also led multiple international
would like to welcome Mirriam Mkhize and Chesney collaborations, including with the Psychiatric
Ward-Smith, the first two Sue Struengmann Initiative Genomics Consortium, in which she co-heads the
(SSI) PhD Fellows. The purpose of the Initiative is to Systems Biology Working Group. In recognition of
address the mental health implications of childhood her work and contributions, she was promoted ad
and adolescent adversity and trauma by providing hominem to a Senior Lecturer in 2019.
a base for research, capacity building and policy We wish Shareefa well in her new position as
development   Specialist Scientist in the Biomedical Research and
Innovation Platform at the South African Medical
GOODBYE TO COLLEAGUES Research Council.
5. Maggie Marx, a Communications Specialist
WE BID FAREWELL TO THE FOLLOWING COLLEAGUES: who joined CPMH in 2015 as part of the Programme
for Improving Mental Health Care (PRIME) project,
1. Prof Sean Kaliski (pictured quickly made her mark at CPMH and rapidly
right) was a longstanding increased the visibility of CPMH projects.
member of the department, Maggie is passionate about mental health research
a stalwart in the Forensic and specifically how research evidence translates
Psychiatry field and a into policy. We are excited for Maggie in her new
charismatic personality, known position at the central Research Office at UCT  
for his interesting ties and even
more interesting talks. He will
be hugely missed by those who
worked with him. Sean Kaliski
will stay on as Emeritus and continue to supervise
MMed students.
2. Dr Wendy Vogel recently retired as Head of
the Division of Child and Adolescent Psychiatry
(DCAP), a position she held since 2011. She was,
among others, the National Chairperson of the
South African Association of Child and Adolescent
Psychiatry (SA-ACAPAP) between 1999-2001.

80 * SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021

NEWS

C O N G R AT U L AT I O N S

1. Dr Papani Gasela is congratulated on being that will support persons with intellectual disabilities
appointed as Head of Division for Child and to self-advocate for inclusion of their priorities in
Adolescent Psychiatry. She takes the reigns from social and health related policy in South Africa.
Wendy Vogel and we wish her and the Division all 5. Congratulations to Drs Idorenyin Akpabio,
the best going forward. Sybrand de Waal, E.J. Smith, Imraan Tayob, Jasper
2. Prof Jackie Hoare is the first and only doctor van Zyl, Elizabeth Vogts and Allanah Wilson who
to be registered on the General Medical Council have been successful in passing their FC Psych(SA)
(GMC) UK register as a Neuropsychiatrist. Part II exit examinations. We wish them well with
The Royal College of Psychiatrists have extended their future career plans.
their congratulations and have published an 6. Congratulations to Drs Charles Crookes,
interview with Prof Hoare in their Summer 2021 Lisa Dondashe, Mpho Mahlakametsa, Tinashe
edition of RCPsych Insight. It can be accessed on Mangozho, Devina Nair, Haseena Sablay, Inette
the following link: Swart and Joshu Tippoo, who have been successful
https://www.rcpsych.ac.uk/docs/default-source/ in their CMSA FCPsych (SA) Part 1 exams in the First
m e m b e r s/rc p s yc h - i n s i g ht - m a g a z i n e/rc p s yc h - semester and are due to start 1st August 2021.
insight-16---summer-2021.pdf?sfvrsn=4c99894_8 7. Mirriam Mkhize and Simphiwe Simelane
3. We congratulate Dr Nyameka Dyakalashe are congratulated on being selected for the
(pictured below) on being appointed as Head accelerated transformation programme of the
of Division of Forensic Psychiatry. No doubt the Faculty of Health Sciences, which aims to identify
division will thrive under her leadership and we wish and nurture highly talented Black South African
her and the division all the best going forward. students, and to support them with mentoring
throughout their academic careers. We wish them
4. Babalwa Tyabashe-Phume, a Social Worker by every success for their studies.
profession, was awarded 3-year funding for her 8. Siyabulela Mkabile has been awarded substantial
doctoral degree from the Bongani Mayosi Fund. Her funding this year (a SAMRC Bongani Mayosi National
study intends to develop a conceptual framework Health Scholars Program Scholarship; funding
from Kings College, for a four-month PhD Student
Fellowship, London; and an UCT Research and
Development Grant) to support the completion of his
PhD entitled: “Explanatory models of child intellectual
disability: Views of caregivers, spiritual healers and
traditional healers in Khayelitsha, Cape Town”.
9. Hayley Julius received an award from the review
committee. The award was granted for her research
project that explores disability grant utilisation,
and barriers to access for patients with personality
pathology through the use of a mixed-methods
study. The topic demonstrates how research and
clinical service delivery objectives work best when
both are fully aligned with the other  

THE 2021 LOREN LECLEZIO LECTURE

Prof Lionel Green-Thompson (pictured right), Dean of the
Health Sciences Faculty, was invited to speak and share with
us his thought-provoking presentation “To Whom shall we
account”, at this year’s annual ‘Loren Leclezio Lecture’.
Prof Green-Thompson reflected on how we hold stakeholders
accountable and how to shorten the gap between ordinary
people and the institutions they wish to hold accountable.
He highlighted the challenge in defining community, while
sharing reflections on his doctoral study focusing on social
accountability and medical doctors. He also reminded us
of the importance of equity underpinning all thinking around
global health  

SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 * 81

NEWS

PUBLICATION: LECTURE: THE NEEDS OF
AUTISTIC PEOPLE IN AFRICA
PROBLEMS OF LIVING
Extracted from UCT News article
More than a decade ago, Dan Stein published a Prof De Vries delivered the opening lecture at the
volume, “Philosophy of Psychopharmacology”, in International Society of Autism Research (INSAR) global
which he addressed some of the “hard problems” conference in May 2021. He is the founding director of
faced by mental health clinicians, with a particular the Centre for Autism Research in Africa (CARA).
focus on philosophical issues raised or addressed
by advances in psychiatric medication. Prof de Vries (front middle) and the CARA team (Photograph by Izak de Vries ©
This year he has published his second volume CARA)
at the intersection of psychiatry and philosophy,
“Problems of Living”, in which he looks at a range Prof De Vries focused his lecture on the question of
of “hard problems” raised by life as a whole, with a what research should be done and where it should
particular focus on philosophical issues raised or be done, highlighting that the vast majority of people
addressed by advances in the cognitive-affective with autism and other developmental disabilities live
sciences including psychology and neuroscience. in low-to middle-income countries in the context of
“Philosophy of Psychopharmacology” argues that inadequate services, expertise and research.
psychiatry is precisely the sort of field that should He encouraged socially responsive research which
on the one hand acknowledge its own fallibility, should be done in collaboration with families and
while at the same time try to make a positive community stakeholders and where their needs
difference - even though we have still so much to could drive meaningful, relevant and innovative
learn about the brain-mind and its disorders, and research. He also challenged the autism research
even though our interventions are far from ideal. community to address research inequities by
“Problems of Living” argues that any answers to the building improved research capacity in these
problems of living can only be partial and tentative, countries.
but that we should nevertheless persist in trying to The full article can be accessed on https://www.
live meaningful lives – even though we have still so news.uct.ac.za/  
much to learn about human nature and the world,
and despite life’s apparent absurdity   MINDFULNESS AT VALKENBERG HOSPITAL

RAPID AND AUTOMATIC Mindfulness is everywhere and has been promoted
SCREENING FOR DEMENTIA in almost every setting although it is not yet part
of formal medical or psychiatry training in South
The poorly resourced South African healthcare Africa. A useful definition is ‘the awareness that
system is concerned by what appears to be steadily arises from paying attention, on purpose in the
increasing rates of dementia. Therefore, a brief present moment, non-judgmentally.’ (Kabat-Zinn J,
cognitive assessment tool that can be administered Full Catastrophe Living, 1990, 2013).
by non-experts or lay providers to improve clinical Tessa Roos (psychiatrist and member of the UCT
care and outcomes. department of Psychiatry and Mental Health) and
An interdisciplinary team, headed by Dr Hetta Jacqui Wigg (teacher working in educational
Gouse (Division of Neuropsychiatry, UCT) and program research) have completed the two
Prof Reuben Robbins (HIV Center for Clinical and year post graduate certification in Mindfulness
Behavioral Studies, Columbia University), has Interventions through Stellenbosch University.
launched a research study (Alzheimer’s Disease As part of their training, they needed to teach a
NeuroScreen; ADiNS) that is designed to adapt mindfulness course. Tessa and Jacqui chose to
and investigate the validity of a brief, tablet- teach Mindfulness Based Stress Reduction (MBSR)
based neuropsychological test battery for use in as the original program developed by one of the
the assessment of older South African adults with founders of secular mindfulness, Jon Kabat-Zinn,
suspected cognitive decline and/or dementia. at the University of Massachusetts Medical school
The app, NeuroScreen, takes approximately 30 in the 1970’s. The online mindfulness course has
minutes to administer and has previously been worked well during the pandemic and both Tessa
validated for use in South African adults with HIV. and Jacqui are now planning a pilot mindfulness
It assesses cognition in six cognitive domains. programme as an elective to fourth year students
NeuroScreen is portable, self-contained and during their psychiatry rotation later in 2021  
highly automated; it has standardized audio-visual
instructions, requires minimal training to administer,
and can yield test results immediately.
The ADiNS study is the first step in addressing the
need for a culturally acceptable, reliable, and valid
tablet-based cognitive screening tool for use in
older South African adults  

82 * SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021

TpalRipeEridoVneIpCalmTitaAte®

prolonged release suspension for injection

THE
TREVICTA® PLAN*

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living with schizophrenia?

Help your patients to 4 PER YEAR
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schizophrenia with the
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* The TREVICTA® Plan is the initiation of XEPLION® then moving to TREVICTA® when stabilised - in line with the approved indications for both treatments.7 XEPLION® is indicated for maintenance treatment of schizophrenia and
for the prevention of recurrence of symptoms of schizophrenia. 8 TREVICTA®, a 3-monthly injection is indicated for the maintenance treatment of schizophrenia in adult patients who are clinically stable on 1-monthly paliperidone
palmitate injectable product. 7
References: 1. Schreiner A, Bergmans P, Cherubin P, et al. A Prospective Flexible-Dose Study of Paliperidone Palmitate In Nonacute But Symptomatic Patients With Schizophrenia Previously Unsuccessfully Treated With Oral
Antipsychotic Agents. Clinical Therapeutics 2014;36(10):1372-1388e1. 2. Berwaerts J, Liu Y, Gopal S, et al. Efficacy and Safety of the 3-Month Formulation of Paliperidone Palmitate vs Placebo for Relapse Prevention of Schizophrenia.
A Randomized Clinical Trial. JAMA Psychiatry 2015;72(8):830-839. 3. Savitz A, Xu H, Gopal S, et al. Efficacy and Safety of Paliperidone Palmitate 3-Monthly Formulation for Patients with Schizophrenia: A Randomized, Multicenter,
Double-Blind, Noninferiority Study. International Journal of Neuropharmacology 2016;19(7):1-14. 4. Hargarter L, Bergmans P, Cherubin P, et al. Once-monthly paliperidone palmitate in recently diagnosed and chronic non-acute
patients with schizophrenia. Expert Opinion on Pharmacology 2016;17(8):1043-1053. 5. Caroli F, Raymondet P, Izard I, et al. Opinions of French patients with schizophrenia regarding injectable medication. Patient Preference and
Adherence 2011;5:165-171. 6. Gopal S, Vermeulen A, Nandy P, et al. Practical Guidance for Dosing and Switching from Paliperidone Palmitate 1-Monthly to 3-Monthly Formulation in Schizophrenia. Current Medical Research and
Opinion 2015;31(1):2043-2054. 7. TREVICTA® Professional Information Leaflet. December 2020. 8. Xeplion Professional Information Leaflet. May 2019. 9. INVEGA® Professional Information Leaflet. January 2010.
S5 TREVICTA® 175 mg, 263 mg, 350 mg, 525 mg prolonged release suspension for injection. 175 mg prolonged release suspension for injection: Each pre-filled syringe contains 273 mg paliperidone palmitate equivalent to 175 mg
paliperidone. 263 mg prolonged suspension for injection: Each pre-filled syringe contains 410 mg paliperidone palmitate equivalent to 263 mg paliperidone. 350 mg prolonged release suspension for injection: Each pre-filled syringe
contains 546 mg paliperidone palmitate equivalent to 350 mg paliperidone. 525 mg prolonged release suspension for injection: Each pre-filled syringe contains 819 mg paliperidone palmitate equivalent to 525 mg paliperidone.
Marketing Authorisation Number/s: EU/1/14/971/007; EU/1/14/971/008; EU/1/14/971/009; EU/1/14/971/010. For full prescribing information, refer to the latest professional information leaflet. December 2020.
S5 XEPLION® 50, 75, 100 or 150mg Prolonged release suspension for intramuscular injection. Each pre-filled syringe contains sterile paliperidone palmitate equivalent to 50, 75, 100 or 150mg of paliperidone respectively. Reg.
Nos.:44/2.6.5/0866; 44/2.6.5/0867; 44/2.6.5/0868;44/2.6.5/0870. For full prescribing information, refer to the latest professional information insert. May 2019.

JANSSEN PHARMACEUTICA (PTY) LTD, (Reg. No. 1980/011122/07), No 2, Medical Street, Halfway House, Midrand, 1685. www.janssen.com. Medical Info Line: 0860 11 11 17.
CP-243117

M.A.M.A UPDATE

THE 1ST MARCÉ AFRICA

MATERNAL MENTAL HEALTH

(M.A.M.A)

VIRTUAL CONFERENCE

THURSDAY 16 SEPTEMBER 2021
17:00 – 20:00 CENTRAL AFRICAN TIME

INVITATION FROM THE CONVENOR America and would be part of the overall mission of
establishing international multidisciplinary perinatal
T he International Marcé Society for mental health care for all.
Perinatal Mental Health is an international,
interdisciplinary organisation dedicated In line with this mission, and to ensure safety for all
to supporting research and assistance during the COVID-19 pandemic, a virtual conference
surrounding prenatal and postpartum mental will be held on Thursday 16 September to allow for
health for mothers, fathers, and their babies. speakers from various African countries to present
aspects of perinatal mental health in Africa and
THE OVERALL MISSION OF THE hopefully result in the development of a Marcé-
INTERNATIONAL MARCÉ SOCIETY IS TO Africa regional group. The conference will be an
SUSTAIN AN INTERNATIONAL PERINATAL excellent platform for information exchange and
MENTAL HEALTH COMMUNITY TO exposure to the latest developments in perinatal
PROMOTE RESEARCH AND HIGH- mental health from an African perspective.
QUALITY CLINICAL CARE AROUND THE
WORLD. The virtual conference is free for any health care
provider with an interest in Perinatal Mental Health.
The Society aims to promote, facilitate, and Please see registration details below and attached
communicate about research into all aspects of scientific programme.
the mental health of women, men/partners, infants,
and their families throughout pregnancy and the We hope you will join us.
first two years after childbirth. This involves a broad
range of research activities ranging from basic Yours sincerely,
science through to health services and development
of best practice care and prevention. The Society is Dr Lavinia Lumu
multidisciplinary and encourages involvement from Board member, Executive committee
all disciplines including psychiatrists, psychologists, The International Marcé Society for Perinatal Mental Health
paediatricians, obstetricians, midwives, nurses, [email protected]
early childhood specialists.
As one of the board members of the executive Registration is free for any health care provider with
committee, the current vison is to expand the an interest in Perinatal Mental Health
society and develop a regional group on the
African continent. The development of the Marcé For any further information, please contact the
Africa regional group would be in line with existing congress secretariat:
regional groups in Europe, North and South Sonja du Plessis on e-mail [email protected] or
cell: +27 82 455 7853
You will receive a zoom link and further instructions
from the congress secretariat  

84 * SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021

M.A.M.A UPDATE

M.A.M.A V I RT UA L C O N F E R E N C E

INVITED FACULTY

Keynote speaker: Assistant based interventions in primary care in low resource
Professor Saira Kalia, MD settings. Currently she is a co-investigator in the
University of Arizona College of MDEPTH project which is a trial of Problem-Solving
Medicine, USA Therapy (PST) for maternal depression in Central
Dr. Saira Kalia, is the Adult Uganda. Dr Nakku has published a number of
Psychiatry Outpatient Medical papers in maternal as well as other areas of mental
Director at Banner - University health particularly in primary care settings.
Medical Center South. She is
also a perinatal psychiatrist, an SHE IS ALSO A LEADER IN PSYCHIATRY
educator, and serves as the Associate Training IN THE AFRICA REGION AS THE WORLD
Director for the Department of Psychiatry Residency PSYCHIATRIC ASSOCIATION (WPA) ZONAL
program at the University of Arizona College of REPRESENTATIVE AND PRESIDENT OF THE
Medicine – Tucson. She currently runs the Psychiatry UGANDA PSYCHIATRIC ASSOCIATION.
Department’s Perinatal Psychiatry Track. Dr. Kalia
is well regarded in the Tucson community and Dr Katie Rose Mahon Sanfilippo
has earned numerous accolades for her role as is currently a postdoctoral fellow
an educator and for her patient-centered care. in psychology at Goldsmiths,
Most recently, she earned the Arizona Psychiatric University of London. She is also
Society’s Howard E. Wuslin Excellence in Education an associated lecturer in music at
Award. The University of Cambridge.
Her overall research interests
Dr Olatunde Olayinka Ayinde concern the perception, function
(MBBS, MS, FWACP) is a Lecturer and application of music. She
and Consultant Psychiatrist at has undergraduate degrees in psychology and
the University of Ibadan and music from Loyola Marymount University, an MSc
University College Hospital, in Music Mind and Brain and a PhD in psychology
respectively. He is a recipient from Goldsmiths, University of London. Her PhD,
of several undergraduate and under the supervision of Prof Lauren Stewart and
postgraduate scholarship Prof Vivette Glover, investigated the potential
awards, including the World of a community-based music intervention to
Bank Scholarship, Heller School Merit Scholarship, reduce anxiety and depression symptoms in
Chevron-NNPC scholarship and Federal pregnant women from The Gambia, West Africa.
Government of Nigeria Scholarship. His research Her current research is exploring the application
interest is in global mental health with particular of music-based interventions to support maternal
emphasis on scaling up services for persons with mental health across different cultural contexts
mental disorders in low- and middle-income in Africa and the UK. She has worked with various
countries. In the last few years, his research has policymakers, charities and health organisations
focused on scaling up services for perinatal to promote maternal mental health in the
depression in Nigeria. educational and health policy agendas in The
Gambia. She also has experience working in the
Dr Juliet Nakku (MD) is a Consultant charity sector in the UK. She has helped to design
Psychiatrist and Executive and conduct evaluations for organizations that
Director at Butabika National use music to aid in the well-being of different
Referral Teaching hospital and a marginalized populations.
lecturer in Psychiatry at Makerere Professor Salome Maswime is an
University college of health associate professor, Obstetrician
sciences (MUCHS). She holds and Gynaecologist, and Head of
an MBChB (MUCHS) and Master Global Surgery at the University of
of Medicine in Psychiatry of Cape Town. She is the President
Makerere University. She teaches mainly Psychiatry of the South African Clinician
residents in the maternal mental health module Scientists Society, vice-president
and does research in this and other areas of mental of the Women in Global Health
health. She was Principal investigator in the recently South Africa, trustee of the Board
concluded PRIME study where she led the maternal
mental health component in Uganda. In this study
she evaluated the impact of integrating evidence-

SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 * 85

M.A.M.A UPDATE

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

86 * SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021

M.A.M.A UPDATE

M.A.M.A V I RT UA L C O N F E R E N C E

SCIENTIFIC
PROGRAMME

#THEMAMACONFERENCE

THURSDAY 16 SEPTEMBER 2021
17:00 – 20:00 CENTRAL AFRICAN TIME

17:00 – 17:05 Introduction and opening
Dr Lavinia Lumu (South Africa)

17:05 – 17:25 Women’s health and Mental health - Providing integrated care
Prof Salome Maswime (South Africa)

17:25 – 17:45 Screening women for common mental disorders in the perinatal period: Developing a
tool for South Africa and practical considerations
Prof Simone Honikman (South Africa)

17:45 – 18:05 Edinburgh Postnatal Depression Scale (EPDS) screening in Kiswahili: Overcoming the
language and cultural barrier
Dr Linnet Ongeri (Kenya)

18:05 – 18:25 Common perinatal mental disorders -The depressed mother
Dr Bibilola Oladeji (Nigeria)

18:25 – 18:35 Understanding Music’s Role in Maternal Mental Health in The Gambia
Dr Katie Rose Sanfilippo

18:35 – 18:55 Outcomes of group problem solving therapy on maternal depression in primary health
care settings in rural Uganda: An interventional cohort study
Dr Juliet Nakku (Uganda)

18:55 – 19:15 What about the fathers? - Paternal perinatal mental health
Dr Olatunde Ayinde (Nigeria)

19:15 – 19:45 Psychopharmacology in pregnancy: Keynote speaker from The International Maré Society
Assistant Professor Saira Kalia (University of Arizona College of Medicine) (Arizona, USA)

19:45 – 20:00 Discussion & Close

HOW TO REGISTER:

Registration is free for any health care provider with an interest in Perinatal Mental Health
For any further information, please contact the congress secretariat:
Sonja du Plessis on e-mail [email protected] or cell: +27 82 455 7853

You will receive a zoom link and further instructions from the congress secretariat

SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 * 87

Depression can
make keeping
on top of daily
tasks a struggle

Brintellix® can help with her mood,
concentration and fatigue, so she is
able to organise her day again1,2

®
10 mg once daily
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. South Africa: S5 Brintellix® 10 mg film-coated tablets. Each tablet contains vortioxetine hydrobromide
equivalent to 10 mg vortioxetine. Reg No. 48/1.2/0430 Namibia: NS3:15/1.2/0071 Botswana: S2: BOT 1502705 Mauritius: PB/13008/04/2018. Lundbeck SA (Pty) Ltd. Unit 9, Blueberry Office Park, Apple Street, Randpark Ridge Extension 114
Tel: +27 11 699 1600. For full prescribing information refer to the professional information approved by the medicines regulatory authority.
ZA-BRIN-0143 July 2021

UPDATE

RESET EXPECTATIONS

WITH REXULTI®

(BREXPIPRAZOLE)

Lisa Selwood

L Lundbeck is proud to announce REXULTI® supported in a 52-week open
(brexpiprazole) tablets are now available in label safety study, where patients
South Africa. REXULTI® is indicated in adult demonstrated a sustained/
patients for the treatment of schizophrenia. continued improvement of their
Two virtual launch events were streamed live from symptoms of schizophrenia.
a studio to a combined audience of over three
hundred psychiatrists. Prof Leslie Citrome, a Clinical In addition, a good safety
Professor of Psychiatry and Behavioural Sciences at and tolerability profile was
New York Medical College, New York, USA, provided demonstrated in both the short-
insight into the brexpiprazole molecule, the clinical and long-term studies and
trial development program and prescribing brexpiprazole was associated Lisa Selwood
practicalities.
REXULTI® is a distinct chemical entity; it is not a with a low rate of discontinuation due to adverse
precursor, a metabolite or an enantiomer of another events. Of importance is the effect on metabolic
product. It has a unique mode of action - it acts as a parameters, as patients with schizophrenia have
partial agonist at serotonin 5-HT1A and dopamine an increased propensity for metabolic problems as
D2 receptors, which contributes to its antipsychotic they age. However, REXULTI® had only a small effect
activity. It is an antagonist at serotonin 5-HT2A and on metabolic parameters and was associated with
noradrenaline α1B/α2C receptors and differs from a mean weight gain of 1.2kg over six weeks, and
all other antipsychotics in its pharmacologic profile 2.1kg over 52 weeks versus placebo. There was a low
and intrinsic activity. incidence of EPS related adverse events and a low
incidence of activating and sedating side effects.
ITS PHARMACOLOGIC PROFILE
INDICATES A LOW PROPENSITY TO The recommended dose titration of REXULTI® is as
INDUCE SIDE EFFECTS ASSOCIATED follows:
WITH DOPAMINE ANTAGONISM. PROF Day 1 – 4: 1 mg/day
CITROME HIGHLIGHTED THAT PARTIAL Day 5 – 7: 2 mg/day
AGONISM DOSE NOT EQUATE TO PARTIAL Day 8+: 2 – 4mg/day
EFFICACY!
Peak plasma concentration occurs within four
REXULTI® is backed by a robust clinical development hours of a single dose, and steady state is reached
program. In two six-week, fixed dose studies in within 10 to 12 days. It can be given without regard
patients with acute schizophrenia, brexpiprazole for meals, at any time of the day.
improved symptoms of schizophrenia, as measured
by the change in the Positive and Negative Syndrome Patients who have symptoms that are not fully
Scale (PANSS). The Number Needed to Treat (NNT) controlled, or those who continue to experience
in the short-term trials for brexpiprazole was 7. bothersome side effects from their antipsychotic
In a 52-week maintenance study, brexpiprazole medication, may not be functioning at their
demonstrated superiority over placebo on the potential and may become non-adherent over time.
time to impending relapse. The time to impending REXULTI® offers an alternative option with clinically
relapse was significantly delayed compared to proven efficacy in schizophrenia, without tolerability
placebo, and the risk of impending relapse was trade-offs. Isn’t it time you reset your expectations of
significantly reduced by 71% versus placebo. what a medication for schizophrenia could - and
Furthermore, the long-term efficacy was further should - offer?

Lisa Selwood is the Medical Affairs Manager at Lundbeck,
South Africa. Correspondence: [email protected]

SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 * 89

RESET EXPECTATIONS WITH NEW ®

NEW ®

REXULTI® is indicated in adult patients for treatment of schizophrenia

South Africa: S5 REXULTI® film coated tablets. Each tablet contains brexpiprazole. Reg No. 0,5 mg: 51/2.6.5/0501;1 mg: 51/2.6.5/0502; 2 mg: 51/2.6.5/0503; 3 mg: 51/2.6.5/0504; 4 mg: 51/2.6.5/0505.
Lundbeck SA (Pty) Ltd. Unit 9, Blueberry Office Park, Apple Street, Randpark Ridge Extension 114 Tel: +27 11 699 1600. For full prescribing information refer to the professional information approved by
the medicines regulatory authority. ZA-REXU-0093 July 2021

BOOK REVIEW

PROBLEMS

OF LIVING

PERSPECTIVES FROM PHILOSOPHY, PSYCHIATRY,
AND COGNITIVE-AFFECTIVE SCIENCE

Sean Baumann

aperback | 15mm spine Stein and misperceptions in the general
public about the nature and
MS OF LIVING scope of psychiatric practice.

Philosophy, Psychiatry, and The neurosciences are too often
e Science relegated to a burdensome
PROBLEMS OF LIVING requirement of post-graduate
atry, University of Cape Town and Groote Schuur Hospital, training, a necessity for the
understanding of basic
s from Philosophy, Psychiatry, and Cognitive- psychopharmacology, and as a
losophical questions related to problems of separate discipline rather than
ut the nature of the brain-mind, reason and Sean Baumann
ng, goodness and truth, and the meaning of
atic, and embodied realism as well as moral intrinsic to clinical psychiatry. This
ts from metaphysics, epistemology, and ethics disjunction contributes to a lag or failure to translate
tive-affective science. This multidisciplinary, research findings into practice, perhaps especially
novel framework for considering not only the PROBLEMS OF LIVING outside academic settings.
also broader issues in mental health, such as
life. Perspectives THE LACK OF INTEGRATION OF
from Philosophy, PHILOSOPHY, THE NEUROSCIENCES AND
cts of polar positions in philosophy and Psychiatry, CLINICAL PRACTICE IMPOVERISHES
mportant perennial debates in these fields and Cognitive-Affective PSYCHIATRY. IT ALSO IN ALL LIKELIHOOD
en early philosophical work and current Science CONTRIBUTES TO THE UNCERTAIN STATUS
OF PSYCHIATRY, BOTH WITHIN AND
including neuroscience and psychology Dan J. Stein BEYOND THE CONFINES OF MEDICINE.
ern cognitive-affective science to rethink

philosophy and psychiatry
w mind is embodied in the brain, and
vide an integrated conceptual framework
nd the limitations of cognitive-affective

g questions and hard problems of living

ISBN 978-0-323-90239-7

9 780323 902397

Title: Problems of Living

Publisher: Academic Press

Author: Dan Stein Psychiatry is perceived as philosophically
incoherent, fraught with conflicts and controversies,
ISBN: eBook ISBN: 9780323904391 and lacking an adequate scientific foundation.
In these, and many other, respects Dan Stein’s
Paperback ISBN: 978032390239 Problems of Living makes an important, and timely
contribution.
P hilosophy is largely neglected in the
practice of clinical psychiatry and this has As indicated in the subtitle, the book addresses
problematic consequences. Divisions arise perspectives from philosophy, psychiatry and
and false dichotomies distract from the cognitive-affective sciences. An early chapter on
need to examine the underlying assumptions in the brain-mind problem examines one that is central
the way psychiatric disorders are conceptualized to psychiatry, how to define the mind and how to
and treated. Reductive biomedical models might explain the relation of mind to brain. A perhaps
claim to bring psychiatry into the fold of orthodox rather gruesome metaphor of wet-ware is proposed,
medicine yet neglect social, economic and reaching beyond a more familiar distinction
cultural factors that have an important bearing between hard –ware and soft-ware models. Stein
on symptom formation and management. These throughout the text makes an interesting argument
various tensions, between limited and broader for the usefulness of metaphors in making sense
models, and of the shifting boundaries between of difficult concepts. That the mind is embodied in
psychiatric illness and what might be described the brain and is embedded in a social context is
as problems of living are philosophical issues a recurrent motif. The tension between reason and
that are rarely addressed explicitly and too often
contribute to arid conflicts within the profession

SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 * 91

BOOK REVIEW

passion is considered: a dichotomous formulation two thousand references give an indication of the
is inadequate and both emotion and reason are breadth and depth of his reading. The text makes
necessary for optimal decision making. A chapter a valuable contribution in integrating perspectives
on the pleasures of life discusses contributions from clinical psychiatry and philosophy and the
from Aristotle to Wittgenstein and proposes that neurosciences to foster a more creative and helpful
happiness entails both pleasure and purpose. way of addressing problems of living and human
A thoughtful and critical evaluation of the problem suffering.
of addiction emphasizes the need for public health
interventions. A chapter on pain and suffering stresses This is an ambitious undertaking. In the breadth
the importance of both meanings and mechanisms: of its scope, the clarity of its exposition and in its
science is theory bound and value laden. Pain, and modest and humane tone it is also a remarkable
in particular chronic pain is problematic in that achievement. The book elaborates on some of the
both in medicine and in the general public a false themes of a previous, perhaps more provocative
dichotomy as to whether the problem is physical or work, ‘Philosophy of Pharmacology’, subtitled ‘Smart
psychological is very often unthinkingly imposed, Pills, Happy Pills and Pep Pills’. In this text he raised
which is unhelpful and harmful, and neglectful of questions about the philosophy of pharmacology,
valuable philosophical and neuroscientific insights. but also addressed a range of perspectives on
Pain is inherently subjective, and therefore the more science, language and medicine.
open and constructive notion of human suffering is
invoked. A chapter on the good and the bad includes GIVEN THE IMPRESSIVELY WIDE RANGE IT
a discussion on the vexed issue of psychopathy, and IS UNDERSTANDABLE THAT A NUMBER OF
the extent to which the medicalization of badness ISSUES ARE NOT ADDRESSED THAT ARE
confuses ways of dealing with the problem in a NEVERTHELESS IMPLICIT IN THE AREAS
helpful and just way. This chapter also addresses in OF INTEREST UPON WHICH STEIN PLACES
an imaginative way a theme that is unusual for a text FOCUS.
of this nature, but of special relevance to this country,
being that of forgiveness and reconciliation. The The tone is optimistic, and there is a perhaps
nature of human nature is investigated in a further cautious optimism that in integrating these
chapter, a subject that most clinicians probably different perspectives it can be expected that the
do not consider explicitly, or take for granted, but difficult problems described should be resolved. It
which has important implications for psychiatric is perhaps then not appropriate to this project to
practice. Throughout history philosophy has been draw attention to controversies, but the very title of
grounded in science, but addresses issues that the the book raises a number of questions including
sciences sometimes cannot. Psychiatry needs to be whether or not psychiatry should be concerned
understood as a bridge between the sciences and with the problems of living, and whether or not in
the humanities. doing so problems of living are medicalized with
A concluding chapter considers the meaning the assumption that there is some medical solution,
of life, and includes a review of the fraught but or cure. These difficulties are described rather
critically important problem of free will. Beauty, than critically addressed, and this is consistent
goodness spirituality and generativity, or creativity, with the general aim of finding a middle ground.
are imaginatively and insightfully discussed in This is commendable but can at time seem
this final section. Both objectivist and subjectivist rather predictable, and at least in some areas
approaches are described. A balance needs to a more polemical approach might have struck
be found between vagueness and imponderability, another kind of balance. A concluding reference
and rigidity and reductiveness, reflected both in is made to the aphorism ‘everything in moderation
eastern philosophy as the middle path and in including moderation’. The lack of progress in the
western philosophy in Aristotle’s golden mean. understanding and treatment of the schizophrenia
The text is organized in a taut and rigorous structure. spectrum disorders, for example, is not dealt with,
For the most part the psychiatric, philosophical and and again it is possibly not within the remit of this
neuroscientific or cognitive- affective perspectives work, but attending to the neuroscientific and the
are articulated, followed dialectically by concluding philosophical perspectives does provide a basis
remarks which seek to “sharpen” our ways of for the hope of the better understanding and
thinking about these centrally important subjects. A treatment of these and many other complex and
number of tables describing classical, critical and enigmatic psychiatric disorders.
integrative approaches may be considered over-
schematic but provide useful summaries of the For further information : https://www.elsevier.com/
subjects under discussion. Stein throughout adopts books/problems-of-living/stein/978-0-323-90239-7
a non-technical, lucid style of writing that is free of
jargon. He admirably renders accessible at times Sean Baumann worked for 25 years as a consultant to
difficult and controversial topics. Personal accounts the male acute service at Valkenberg Hospital and was a
of the development of his thinking, and recurrent senior lecturer in the department of Psychiatry and Mental
reference to the South African context add interest Health where he holds an honorary position. He is the editor
and depth to what might otherwise have become a of Primary Care Psychiatry: A Practical Guide for Southern
formidably academic study. Importantly he inspires Africa 1988, 2007, 2015). His cantata Madness: Songs of
interest in dimensions of psychiatry that are too often Hope and Despair was performed at the Baxter Theatre in
either neglected of insufficiently addressed. Over Cape Town in 2017. His book Madness: Stories of Uncertainty
and Hope was published by Jonathan Ball Publishers in
92 * SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 2020. Correspondence: [email protected]

BOOK REVIEW

THINK LIKE A MONK:

TRAIN YOUR MIND FOR PEACE
AND PURPOSE EVERY DAY

A BOOK REVIEW Q&A CONVERSATION
WITH MY DAUGHTER, NIANKA KOUAKOU

Koffi Kouakou

Why did you choose this book?
Who is Jay Shetty and why should
we care about his message,
today?

Jay Shetty is a well-renowned
podcaster, former monk, motivational
speaker and life coach. Having
been an avid listener to his
podcast On Purpose, I was curious
to see if he would articulate his
message as well in writing as he Koffi Kouakou

does in speech. I learned a lot, reflected on many
topics and discussions on his podcast.

I ALSO VALUE A DIFFERENT PERSPECTIVE,
MORE IN-DEPTH TOPICS AND ESPECIALLY
ON HOW TO TRAIN MY MIND FOR PEACE
AND PURPOSE EVERY DAY.

Title: Think Like a Monk: Train Your Mind for His message carries a lot of value because he
Peace and Purpose Every Day speaks about subjects that affect us daily and talks
about the power of meditation, the breath, creating
Publisher: Thorsons, HarperCollins Publishers healthy routines, having a deep understanding of
compassion and giving back through service.
Author: Jay Shetty
ISBN: 978-0-00-838642-9 What’s its main message for you?
ISBN: ISBN: 978-0-00-835556-2
Jay Shetty’s Think Like a Monk delves into how any
ordinary person, with no desire to become a monk
DISCLOSURE: can learn from and practice valuable principles
that knowledgeable experts in peace, purpose
My daughter enjoyed this book and suggested and calm have dedicated their lives to. Here are
I consider reviewing it. I did. But I thought I would 10 things I’ve learnt from the book and the reasons
ask her to share her take on the book. Below is the why you should read it:
summary of our Q&A conversation

SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 * 93

BOOK REVIEW

• Understanding oneself, one’s reality and how What does it mean to be a modern monk like Jay
perspective plays an important role in dealing Shetty in times of crises and trauma?
with one’s hardships. Being a modern monk involves implementing these
monk morals, values and principles mentioned
• How one’s viewpoints on fear and negativity above into one’s daily life. It’s not just about
affect one’s lived experiences. ”lighting up candles in your home, walking around
barefoot and posting pictures of yourself doing tree
• Understanding the meaning of purpose and pose on a mountaintop.” It entails adopting certain
exploring one’s deeper reason for being and elements of a mindset that bring great value, deep
asking oneself “Why?” meaning, purposeful routines and an enriched life.

• How to define oneself by our intentions, services, AS HUMAN BEINGS, WE ARE FACED
understanding, compassion and growth rather WITH TRAUMA, TRAGEDY AND DESPAIR
than our achievements. DAILY, AND THINKING LIKE A MONK
CAN PROVIDE US WITH NOT ONLY
• The importance of failures, healthy habits and KNOWLEDGEABLE INFORMATION ON
routines, the power of meditation and the value THESE SKILLS BUT ALSO PRACTICAL TIPS
of challenges in our lives. TO ACHIEVING CONTENTMENT.

• Discovering one’s purposes which are What is your favourite part of the book and why?
interlinked with passions, skills, usefulness and It is undoubtedly the practicality, succinctness
compassion. and clarity of its message that are my favourite.
Shetty doesn’t dawdle with his words. Every section,
• The profoundness in being present and living chapter and page are relevant.
life, as opposed to just existing. (Practicing
being present with tools such as meditation, MANY SELF-HELP BOOKS TELL YOU WHAT
writing gratitude lists, being compassionate YOU NEED TO DO TO LIVE A BETTER
letting go of ego through service). LIFE BUT OFTEN EXCLUDE THE MOST
SIGNIFICANT PART, WHICH IS HOW TO
• The role of the ego and humility in one’s life. ACTUALLY HAVE THE MINDSET AND
• The beauty of coexisting paradoxes that one PRACTICE TO ACHIEVE THAT. SHETTY
CUTS STRAIGHT TO THE CHASE TO
experiences and how one’s life journey is not PROVIDE PRACTICAL EXAMPLES AND
linear and is unexpected at times. TOOLS TO LIVE A MEANINGFUL LIFE WITH
PURPOSE.
• THE GREAT VALUE THAT PRACTICING
GRATITUDE AND FORGIVENESS CAN What are your takeaways from the book?
ADD TO ONE’S LIFE. IT GENERATES Overall, the most important takeaway for me is letting
PRESENCE, CLARIFIES PERSPECTIVES go of fear, negativity and understanding oneself
AND GARNERS COMPASSION, RESPECT, while creating an intention through everything you
LOVE, APPRECIATION AND IN TURN, do with deep meaning. In addition, by harnessing
SERVICE TO MAKE A POSITIVE IMPACT one’s power of the mind, creating healthy routines,
SOMEWHERE IN THE WORLD. realising one’s purpose, understanding one’s ego,
engaging in mindful breathwork and meditation,
Define thinking like a monk, and how can it be peace can be achieved. Finally, by practicing
applied to our modern world? What does it take gratitude and being compassionate to all, one can
to think like a monk? live a meaningful life.

To me, thinking like a monk means implementing
healthy, sustainable and wholesome ways into
your everyday life. This includes doing breathwork,
letting go, growing, giving, understanding fear,
realising the ego, understanding personal purpose,
respecting and dedicating parts of our life to
service, while being fully present. We can learn
something great from the happiest and calmest
people on earth.

Koffi Kouakou is a senior lecturer at the Wits School of Governance, where he teaches strategic government communications
and scenario planning. He is the former director of the Unilever Mandela Rhodes Academy for Communications and
Marketing (UMRA), a Storyteller, Social Commentator, Business Strategist, Author and Futurist. He specialises in information
communications technologies for development and telecommunications adapted to environmental issues in Africa. He has
been a regular contributor to international, local media and business magazines on the BBC,VOA, Deutsche Welle,The People
Daily, eNCA, Africa 360 degrees, SAFM, 702 Radio, Power FM, China, Brainstorm,The Media, CIO.COM and Intelligence in South
Africa. He co-authored a book titled AfricaDotEdu: IT Opportunities and Higher Education in Africa, 2003. Correspondence:
[email protected]  

94 * SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021

MOVIES

MOVIES

Title: Black Widow Title: Cry Macho
Release Date: 13-Aug-21 Release Date: 17-Sep-21
Avenger Natasha Romanoff (Scarlett Johansson) A one-time rodeo star
becomes separated from the rest of her crime- and washed-up horse
fighting team in the wake of a significant battle. breeder takes a job to
Natasha must reconnect with her former allies bring a man's young son
Yelena Belova (Florence Pugh) home and away from his
alcoholic mom. On their
Title: Old journey, the horseman
Release Date: 06-Aug-21 finds redemption through
This summer, visionary teaching the boy what it
filmmaker M. Night means to be a good man.
Shyamalan unveils a
chilling, mysterious new Title: Off the Rails
thriller about a family on Release Date: 24-Sep-21
a tropical holiday who Now in their 50's, four
discover that the secluded friends recreate an inter-
beach where they are rail journey across Europe,
relaxing for a few hours is but this time 18-year-old
somehow causing them Maddie is taking her
to age rapidly - reducing mother's place, fulfilling
their entire lives into a single day. her dying wish.

Title: Ice Road Title: Summer of Soul
Release Date: 27-Aug-21 Release Date: 01-Oct-21
After a remote diamond Summer Of Soul (...Or,
mine collapses in the When The Revolution
far northern regions of Could Not Be Televised)
Canada, an ice driver is a feature documentary
leads an impossible about the legendary 1969
rescue mission over a Harlem Cultural Festival
frozen ocean to save the which celebrated African
lives of trapped miners American music and
despite thawing waters culture, and promoted
and a threat they never Black pride and unity.
see coming. Title: Respect
Release Date: 13-Aug-21
This film follows the rise of legendary R&B singer,
Aretha Franklin, from a child singing in her father's
church's choir to her international superstardom

SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 * 95

TRAVEL

REVIVAL & RESURGENCE

IN THE TOURISM LANDSCAPE OF

THE EASTERN CAPE

CO FFEE BAY - PAT ERSO N - G Q EB ERH A

T he Eastern Cape is yours to explore. We invite Mandisa Magwaxaza
you to do so to contribute to your well-being
and the well-being of the tourism industry. Once we navigated safely beyond the adventurous
SOULFUL ADVENTURES IN WILD COAST terrain, the green valleys, sandy shores, black rock
My first trip in 2021 was a road trip from Gqeberha faces and frothy ocean ahead of me affirmed my
to Coffee Bay. As the odometer rolled into the 500s, being. I was present and my holiday was a real
I was deep in the old Transkei. The villages are thing. At last. As I took in the scene of children
vast grasslands dotted with homesteads that tell running along the side of the road towards the fields
of educated hard workers in the cities that send and recalled former President Thabo Mbeki’s poem
money back home so they can return to modern about being an African. Indeed, I owe my being to
conveniences in December. Herds of livestock are this land that holds the secrets of my ancestors.
ushered along the N2 and given right-of-way as the Waking up at the Ocean View Hotel in Coffee Bay,
valuable commodity securities that they are. I sat at the table in front of my room which was
perched on a hill. I had a cinematic view of the
IT’S NOT LIKE ANYBODY CAN SPEED rising sun as it filled in the space between the sea
THROUGH THESE PARTS IN ANY CASE AS and the sky. The resort-like hotel is sprawled out on
THE POTHOLES CAUSE LONGER TRAFFIC
JAMS THAN THE GOATS. THE SLOW-
PACED DRIVE THROUGH MQANDULI
TOWARDS COFFEE BAY PUTS YOU
STRAIGHT INTO HOLIDAY GEAR.

96 * SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021

TRAVEL

the edge of a cove – giving the appearance that Mantis, together with a highly qualified medical
the hotel has a private beach. It sure felt like it does team, has developed a revitalising burnout
because the only people I saw on our beach strolls treatment programme for executive-level individuals
were the faces I met at breakfast. and couples. Hosted in the Eastern Cape at No5
The Ocean View Hotel has direct access to the Boutique Art Hotel (Gqeberha) and Founders
beach cove through a small gate in the garden Lodge, adjacent to Shamwari, Resurgence through
where you will find a games room, wellness centre, Nature with Mantis will be offering 4 programmes
an outdoor play area and a swimming pool. These that focus on the treatment and prevention of
facilities were all closed because the hotel was burnout and a lifestyle reset program focusing on
operating according to the Tourism Industry safety weight loss.
protocols for Covid19. PROGRAMMES CURRENTLY AVAILABLE:
The restaurant serves a la carte lunches, buffet The Twofold Burnout Prevention Programme:
dinners and cold and hot breakfasts fit for Two connected programmes that are run
royalty. Packed lunches are made on request for consecutively, but separately. The first programme
those who want to spend the day exploring the is a 6-day burnout prevention programme: The
surroundings. Hole in the Wall is a 5-minute drive Lifestyle Enrichment Programme. The second,
from the hotel, and there are guided hikes and and follow-up programme is The Immersion and
kayaking experiences operated by locals from the Maintenance Programme, a 5-day programme
surrounding villages. that is a more focused psychological process that
Bashing about in a 4x4, trekking my wanderlust aims to enhance and develop the initial programme
down steep escarpments, and gliding across the learnings and way of being. During both processes,
Mthatha river are my bucket list activities in the doctors and psychologists guide you through the
Wild Coast of the Eastern Cape. I had intermittent programme to develop a unique individualised
connectivity, which I came to appreciate and used process that creates the right experience to feel re-
to reset my mind and my priorities to the here-and- connected and re-vitalised. As part of the nature
now. experiences, you are shown how to use nature to
re-connect to yourself and feel re-vitalised. Nature
THE WILD COAST’S CHARM IS IN ITS walks and animal experiences will anchor you into
PEOPLE’S HUMILITY AND THE DOMINANT an enhanced awareness of your relationships to
ROLE OF THE NATURAL WORLD IN self, and others.
EVERYDAY LIFE. NOTHING EXPLAINS
THIS BETTER THAN HAVING MY PERFECT SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 * 97
BEACH VIEW ANIMATED BY A PIGLET
CHASING CATTLE ACROSS THE SHORE.

Book the Ocean View Hotel while exploring Coffee
Bay: https://www.oceanview.co.za/
RESURGENCE THROUGH NATURE WITH MANTIS
As the world emerges from covid induced
bafflement, many people need to heal the battle
scars left by financial, social, and emotional stress.
For some people, a holiday would be enough to
defog the mind. However, this particular perplexity
calls for a double dose of whatever it takes for high-
functioning people to evolve from so many ‘new
normals’.

TRAVEL

The Lifestyle Enrichment Programme: provide time to get to know you and what brought
The Lifestyle Enrichment Programme is the initial you to this place of exhaustion, fatigue, and stress
and targeted wellness process that takes key in your life.
aspects of the 14-day Resurgence through Nature With this, we will be able to understand, plan and
Programme to treat and prevent ‘executive guide you to your healing process. From Mantis No5
burnout’ and corporate fatigue, as well as lifestyle you will leave to spend 4 nights at Mantis’ Founders
stresses. The Lifestyle Enrichment Programme is Lodge in the Eastern Cape Bushveld to engage with
an individual 6-day process using psychological nature and be guided by experienced psychologists
processes, nature-based interactions and rest- and eco-therapists towards an experience that will
enhancing activities. Together, these applications leave you re-connected to yourself, rested, and re-
assist the person or couple to become emotionally vitalised.
and physically enriched. The programme will
leave you better equipped to manage stress, feel THE PROCESS AT FOUNDERS LODGE AIMS
relieved of fatigue and be able to walk back into TO HELP YOU BECOME MORE AWARE
your day-to-day lives with confidence. As part of the OF THE CAUSES OF YOUR TIREDNESS
process, the medical team uses the latest medical AND STRESSES AND, PROVIDE BASIC
advances to assist in ongoing lifestyle resetting and CHANGES TO YOUR WAY OF BEING THAT
weight-management issues that often play a role WILL LEAD YOU TO FEEL MORE ENRICHED
in physical fatigue and psychological confidence, IN YOUR LIFE. RETURNING TO MANTIS NO5
enriching the potential for growth and re-energising. FOR THE FINAL NIGHT, WHERE YOU WILL
The Lifestyle Enrichment Programme begins with BE EQUIPPED TO USE THE EXPERIENCE TO
a day at Mantis No5 Boutique Art Hotel in Nelson MAINTAIN YOUR NEWFOUND VITALITY
Mandela Bay. Here, you will be introduced to the AND RE-CONNECTED SENSE OF SELF.
programme, undergo basic medical screening
included to see where you are physically and The Immersion and Maintenance Programme:
The Immersion and Maintenance Programme is a
5-day follow-up that deepens the experience of
the Lifestyle Enrichment Programme. This essential
process of emotional growth affirms your sense of
self in the world. This 5-day programme strengthens
your awareness of your relationship with self, nature
and others. Starting at Mantis No5, you will spend
a day under the guiding hand of our medical
professionals assessing your current physical and
psychological processes and needs. From Mantis
No5, you will head to Founders Lodge for three
nights. This portion of your resurgence journey is
a psychological process that is unique to your
needs. On your final night at Mantis No5, you will be
equipped with tools to maintain the process as a
way of being in your day-to-day life. Confident and
re-connected
CONTACT:
Web: https://resurgencethroughnature.co.za
e-mail: [email protected]

98 * SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021

SASOP SASOP

SOUTH AFRICAN SOCIETY OF
PSYCHIATRISTS

SASOP NATIONAL CONGRESS 2021

REGISTER NOW

T he 20th National Congress will be held DELEGATES WHO DO NOT RECEIVE
from 20 – 24 October 2021 at Champagne SPONSORSHIP FROM A COMPANY, MAY
Sports Resort. At this stage, the organizing QUALIFY FOR THE SASOP DISCOUNTED
committee is confident that an in-person REGISTRATION FEES THAT ARE ONLY
congress will be possible. If we need to postpone AVAILABLE TO SASOP MEMBERS WHO
the congress (due to a change in Covid legislation), ARE FULLY PAID UP FOR THE PRECEDING
you will be notified immediately. 24 MONTHS AND MAY ONLY BE UTILIZED
If you are interested to apply for POSSIBLE ONCE PER 2 YEAR CYCLE.
sponsorship from the trade, you may give sonja@
londocor.co.za permission to circulate your name Those who have utilized their discount in 2019 for the
to the participating trade for sponsorship. Once Biological Psychiatry Congress, will not be eligible
Londocor receives confirmation from a company, for the SASOP Discounted Registration Fees in 2021.
you will be notified in writing of the extent of such If you are unsure of your discounted registration fee,
sponsorship (e.g. registration, accommodation then please contact [email protected]
and/or travel) - which may often also be partial Should you wish to have your details circulated to
sponsorship. If you have already registered and the trade for possible sponsorship, please e-mail
paid your registration fee by the time you receive the following information to: [email protected]
sponsorship, then Londocor will contact you to • Title, First Name and Surname
obtain your banking details for a refund. Please • State or Private Practice
note that no guarantee can be provided that you • Profession: Psychiatrist or Registrar
will receive sponsorship. We look forward to seeing you at SASOP 2021.
To register for SASOP 2021, go to: https://medmail. Eugene Allers & Kobus Roux
med-bay.com/servlet/link/235762/1119384/9961349 On behalf of the SASOP 2021 Organising Committee
5/5753044
SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021 * 99

SASOP

SOUTH AFRICAN SOCIETY OF
PSYCHIATRISTS

SASOP NATIONAL
CONGRESS 2021
INVITATION FROM THE ORGANISING COMMITTEE

D ear SASOP member, discussion following each presentation.
The 20th National Congress will be held from
20 – 24 October 2021 at Champagne Sports A dedicated CPD accredited “Art & Culture”
Resort. At this stage, the organizing committee is programme related to psychiatry, has also
confident that an in-person congress (with safety been included. This will include presentations &
protocols) will be possible. If we need to postpone discussion relating to movies, poetry, music, art, etc
the congress (due to a change in Covid legislation), with a psychiatric theme.
you will be notified immediately.
The hotel has also given us a written undertaking The aim of the SASOP 2021 Congress is to drastically
(available on the website www.sasop2021. reduce its’ carbon and plastic footprint, and
co.za) that there will be no penalties (including enhance future sustainability. We have launched a
paid accommodation) should the congress be project with great enthusiasm from our sponsors to
postponed. Registration fees will also be refunded suggest novel ideas of building sustainable, non-
(or transferred) should the congress be postponed plastic stands, with the aim of re-using the materials
due to a change in Covid legislation. in a building project of school classrooms at a local
The organisers are planning an event designed for community. Without “letting the cat out of the bag”,
the needs of psychiatrists in the academic sector, this alone would be an inspiration to attend the
the public sector, the private sector, for psychiatric conference.
registrars, general practitioners with an interest in
psychiatry and the rest of the psychiatric multi- To further reduce our paper footprint, we are
professional team. planning to move to more digitally inspired
marketing and poster presentation areas.
WE DO NOT SIMPLY WANT TO COPY AND
PASTE FROM PREVIOUS CONGRESSES, The organising committee warmly invites you and
BUT REALLY WANT TO ASSESS THE NEEDS is looking forward to hosting you for this event. We
OF THE PARTICIPANTS OF THE NATIONAL have therefore also created special tariffs for early
CONGRESS. bird registrations with a marked reduction off the
normal registration fee. We want you to make use
Results from a survey have shown that 90% of SASOP of the time created to fulfil not only your academic
members would prefer an in-person congress. needs but the need to spend some time with your
We are also planning an event around networking colleagues.
with colleagues. The daily program will start at 07:30
in the morning with breakfast symposia and will We hope to see you in the Berg in October!
end at approximately 14:00 or 15:00 every day to
give time for delegates to relax, network and enjoy Eugene Allers
their surroundings. The international faculty will
join the congress virtually with an interactive Q&A The Organising Committee:
Dr Eugene Allers (Convenor) & Dr Kobus Roux (Co-
Convenor) Dr Connie Mataboga, Prof Gerhard Grobler
(Chair of Scientific Committee) Prof Bonga Chiliza (SASOP
President) Dr Hoepie Howell, Dr Marius Pretorius, Dr Matlala
Mabeba, Dr Mvuyiso Talatala & Dr Kim Laxton

100 * SOUTH AFRICAN PSYCHIATRY ISSUE 28 2021