Cannabis use predicts shorter duration of untreated psychosis and lower levels of negative symptoms in first-episode psychosis: a South African study

Objective: Cannabis use/abuse is a common co-morbid problem in patients experiencing a first episode of psychotic illness (FEP). The relationship between the clinical presentation of FEP and cannabis abuse is complex and warrants further investigation; especially within the South African context. Method: We tested associations between recent/current cannabis use and duration of untreated psychosis (DUP); age of onset (AO); PANSS-rated (Positive and Negative Syndrome Scale) positive; negative and general psychopathology symptoms and depressive symptoms (Calgary Depression Scale for Schizophrenia) in a sample of 54 patients with FEP. Results: Mean DUP was 34.4 weeks; while mean AO was 24.7 years. Co-morbid cannabis use occurred in 35of the sample and was significantly associated with shorter DUP (Mann-Whitney U; p=0.026). While not significant; there was also a trend association between cannabis use and lower negative symptoms (Mann-Whitney U; p=0.051). Conclusion: Current/recent cannabis use was associated with clinical features of psychosis onset that previously have been associated with better outcome. Medium and long-term outcome for cannabis users however; is likely to depend on whether or not cannabis use is ongoing

Implementation of the Mental Health Care Act (2002) at District Hospitals in South Africa : Translating Principles into Practice

Legislation prior to 2002 tended to reinforce the alienation; stigmatisation and disempowerment of mentally ill patients in South Africa. In line with international develop- ments in mental health legislation; the Mental Health Care Act (2002) was promulgated in South Africa. Its core principles - human rights for users; decentralisation and integration of mental health care at primary; secondary and tertiary levels of care; and a focus on care; treatment and rehabilitation - are progressive and laudable. However; the task of implementing the requirements of the Act at community and district hospital levels is fraught with problems. Lack of infrastructure; inadequate skills and poor support and training undermine its successful implementation.Health workers already burdened with enormous workloads and inadequate resources struggle to manage mentally ill patients at district hospitals. The 72- hour observation is a particular area of difficulty throughout the country. This paper outlines the rationale and sense behind this legislation; discusses the problems encountered at the 'rock face'; and offers solutions to the problem of translating principles into practice