Identification of patients with recent-onset psychosis in KwaZulu Natal, South Africa: a pilot study with traditional health practitioners and diagnostic instruments.

PURPOSE: There is considerable variation in epidemiology and clinical course of psychotic disorders across social and geographical contexts. To date, very little data are available from low- and middle-income countries. In sub-Saharan Africa, most people with psychoses remain undetected and untreated, partly due to lack of formal health care services. This study in rural South Africa aimed to investigate if it is possible to identify individuals with recent-onset psychosis in collaboration with traditional health practitioners (THPs). METHODS: We developed a strategy to engage with THPs. Fifty THPs agreed to collaborate and were asked to refer help-seeking clients with recent-onset psychosis to the study. At referral, the THPs rated probability of psychosis ("maybe disturbed" or "disturbed"). A two-step diagnostic procedure was conducted, including the self-report Community Assessment of Psychic Experiences (CAPE) as screening instrument, and a semi-structured interview using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Accuracy of THP referrals, and test characteristics of the THP rating and the CAPE were calculated. RESULTS: 149 help-seeking clients were referred by THPs, of which 44 (29.5%) received a SCAN DSM-IV diagnosis of psychotic disorder. The positive predictive value of a THP "disturbed" rating was 53.8%. Test characteristics of the CAPE were poor. CONCLUSION: THPs were open to identifying and referring individuals with possible psychosis. They recognized "being disturbed" as a condition for which collaboration with formal psychiatric services might be beneficial. By contrast, the CAPE performed poorly as a screening instrument. Collaboration with THPs is a promising approach to improve detection of individuals with recent-onset psychosis in rural South Africa.

Factors Moderating the Relationship Between Childhood Trauma and Premorbid Adjustment in First-Episode Schizophrenia.

Childhood trauma is a recognised risk factor for schizophrenia. It has been proposed that childhood trauma interferes with normal neurodevelopment, thereby establishing a biological vulnerability to schizophrenia. Poor premorbid adjustment is frequently a precursor to schizophrenia, and may be a manifestation of neurodevelopmental compromise. We investigated the relationship between childhood trauma and premorbid adjustment in 77 patients with first-episode schizophrenia spectrum disorders. We also investigated possible mediating roles for other selected risk factors in the relationship. We found several significant correlations between different trauma types and both social and academic premorbid adjustment from childhood to late adolescence. There were no significant moderating effects for family history of schizophrenia or family history of psychiatric disorder. History of obstetric complications, substance abuse and poor motor coordination weakened some of the associations between childhood trauma and premorbid adjustment, while poor sequencing of motor acts strengthened the association. Our results confirm previous studies indicating an association between childhood trauma and premorbid adjustment. Results indicate a general rather than specific association, apparent with different types of trauma, and affecting both social and academic components of premorbid adjustment across childhood, early and late adolescence. Further, our results suggest a complex interplay of various risk factors, supporting the notion of different pathways to psychosis.

Spinal Muscular Atrophy: More than a Disease of Motor Neurons?

Spinal muscular atrophy (SMA) is the most common genetically inherited neurodegenerative disease resulting in infant mortality. SMA is caused by genetic deletion or mutation in the survival of motor neuron 1 (SMN1) gene, which results in reduced levels of the survival of motor neuron (SMN) protein. SMN protein deficiency preferentially affects α- motor neurons, leading to their degeneration and subsequent atrophy of limb and trunk muscles, progressing to death in severe forms of the disease. More recent studies have shown that SMN protein depletion is detrimental to the functioning of other tissues including skeletal muscle, heart, autonomic and enteric nervous systems, metabolic/endocrine (e.g. pancreas), lymphatic, bone and reproductive system. In this review, we summarize studies discussing SMN protein's function in various cell and tissue types and their involvement in the context of SMA disease etiology. Taken together, these studies indicate that SMA is a multi-organ disease, which suggests that truly effective disease intervention may require body-wide correction of SMN protein levels.

Poverty, inequality and a political economy of mental health.

The relationship between poverty and mental health is indisputable. However, to have an influence on the next set of sustainable global development goals, we need to understand the causal relationships between social determinants such as poverty, inequality, lack of education and unemployment; thereby clarifying which aspects of poverty are the key drivers of mental illness. Some of the major challenges identified by Lund (2014) in understanding the poverty-mental health relationship are discussed including: the need for appropriate poverty indicators; extending this research agenda to a broader range of mental health outcomes; the need to engage with theoretical concepts such as Amartya Sen's capability framework; and the need to integrate the concept of income/economic inequality into studies of poverty and mental health. Although income inequality is a powerful driver of poor physical and mental health outcomes, it features rarely in research and discourse on social determinants of mental health. This paper interrogates in detail the relationships between poverty, income inequality and mental health, specifically: the role of income inequality as a mediator of the poverty-mental health relationship; the relative utility of commonly used income inequality metrics; and the likely mechanisms underlying the impact of inequality on mental health, including direct stress due to the setting up of social comparisons as well as the erosion of social capital leading to social fragmentation. Finally, we need to interrogate the upstream political, social and economic causes of inequality itself, since these should also become potential targets in efforts to promote sustainable development goals and improve population (mental) health. In particular, neoliberal (market-oriented) political doctrines lead to both increased income inequality and reduced social cohesion. In conclusion, understanding the relationships between politics, poverty, inequality and mental health outcomes requires us to develop a robust, evidence-based 'political economy of mental health.'

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 35% of 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.

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 developments 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.

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

Maternal recall bias, obstetric history and schizophrenia.

BACKGROUND: This study sought to clarify the role of obstetric complications (OCs) and maternal recall bias for patients with first episodes of schizophrenia and those at increased risk of the disorder. METHOD: Subjects at high risk of schizophrenia were compared with people with first-episode schizophrenia and with healthy volunteers. Consenting mothers of subjects were interviewed using a standardised questionnaire for the recall of OCs, and OCs were also measured from records collected at the time of pregnancy and delivery. RESULTS: High-risk subjects and first-episode patients had higher rates of OCs recalled by their mother than controls, but hospital records showed no differences in OCs between groups. The number of OCs recalled by mothers of the high-risk group was not related to whether the mother had schizophrenia or not, but was related to the maternally rated abnormal childhood behaviour as measured by the Child Behaviour Checklist. CONCLUSIONS: These results suggest that studies that rely on maternal recall alone are susceptible to bias. The excess of OCs recalled by the mother could be related to abnormal behaviour in their child rather than maternal illness, family history or psychotic symptoms.

Capillary electrophoresis analysis of orange juice pectinesterases.

Pectinesterase (PE) was extracted from orange juice and pulp with 1 M NaCl, desalted, and separated using capillary electrophoresis (CE) gel procedures (CE-SDS-CGE) and isoelectric focusing (CE-IEF). PE resolved as a single peak using noncoated fused silica columns with CE-SDS-CGE. CE-IEF separation of PE required acryloylaminoethoxyethanol-coated columns, which had limited stability. Thermal stability of PE extracts before and after heating at 75 degrees C for 30 min and at 95 degrees C for 5 min established heat labile and heat stabile fractions with identical PE migration times by CE-SDS-CGE or CE-IEF. Peak magnitude decreased to a constant value as heating time increased at 75 degrees C. Regression analysis of CE-SDS-CGE peak migration times of molecular weight (MW) standards estimated both heat labile and heat stable PE at MW approximately 36 900. Traditional SDS-PAGE gel separation of MW standards and active PE isolated by IEF allowed estimation of MW approximately 36 000. CE-SDS-CGE allowed presumptive, but not quantitative, detection of active PE in fresh juice.

The effect of surfactant on eustachian tube function in a gerbil model of otitis media with effusion.

The relationship of eustachian tube surfactant and otitis media with effusion on eustachian tube opening pressure was studied in a gerbil model. Injection of killed Streptococcus pneumoniae bacteria created a serous effusion that increased eustachian tube opening pressure. The introduction of exogenous surfactant to this system resulted in a dramatic decrease in eustachian tube opening pressure in both normal ears and those with effusion. Identifying means to increase surfactant in the eustachian tube could be beneficial in reducing persistent otitis media with effusion.

Continuing education in genetics for Adoption workers in Wisconsin.

In response to 1982 legislation and 1984 changes in the Wisconsin Adoption Records Laws requiring the collection of a medical-genetic history at the time of termination of parental rights, a continuing education program in genetics was conducted for adoption workers in 1984 and 1985. The education program provided 14 workshops in five locations throughout the state and consisted of a variety of formats and levels of training. In all, 164 participants were trained at least at the introductory level with approximately 40 of these individuals taking part in the advanced levels of training. Evaluations of the training by participants and by a sample of the agency supervisors of trainees ranked the program very highly. A review of genetic history forms completed in post-training sessions verified the expectation that training was beneficial. Trained workers completing the medical-genetic history forms scored somewhat higher than untrained workers and much higher than parents who completed the forms without professional guidance. Medical-genetic history forms completed by birth fathers as part of step-parent adoptions contained little to no useful information about the birth father's genetic background.

Vacuolar Acid hydrolysis as a physiological mechanism for sucrose breakdown.

Sucrose breakdown in mature acidic ;Persian' limes (Citrus aurantifolia [Christm.] Swing.) occurred at a rate of 30.6 picomoles per milliliter per day during 9 weeks storage at 15 degrees C. Neither enzyme of sucrose catabolism (sucrose synthase or acid/alkaline invertase) was present in extracts of mature storage tissue. The average vacuolar pH, estimated by direct measurement of sap from isolated vacuoles and by the methylamine method, was about 2.0 to 2.2. In vitro acid hydrolysis of sucrose at physiological concentrations in a buffered solution (pH 2.2) occurred at identical rates as in matured limes. The results indicate that sucrose breakdown in stored mature acidic limes occurs by acid hydrolysis.

Impact of PKU on the reproductive patterns in collaborative study families.

Factors that relate to reproductive patterns in 129 families after the birth of a child with phenylketonuria (PKU) include birth order of the index child, age of the parents at the birth of the index child, and expressed intentions of the parents whether or not to have additional children. Factors that do not correlate with reproductive histories include knowledge of the genetic and metabolic nature of PKU, the relationship of PKU to mental retardation and special diet, parental upset about the diagnosis, sex of the affected child, parental IQ, religion, education, and social class. Correlations found related to the question, "Is PKU the reason you don't want more children?" include stress factors in family functioning, mother's upset with the diagnosis, father's concerns about being a carrier, sex of the child with PKU, and degree of knowledge about PKU. Many of the Collaborative Study clinics tend to be more concerned about the consequences of PKU on the family than on society, and feel that families should receive genetic counseling to determine their reproductive risks and future plans. Upon self-report, many clinics declare their counseling to be either "completely nondirective" or making a "conscious effort to be nondirective."

Bone cells: a serum-free medium supports proliferation in primary culture.

Bone-cells isolated from embryonic rat calvaria increase in number two-to threefold when cultured at high, but not at low, population densities in a serum-free medium that contains albumin. Cultured cells respond to parathyroid hormone and exhibit a marked rise in alkaline phosphatase activity during proliferation, which suggests the progressive differentiation or preferential growth of osteoblast-like cells.

PKU as a factor in the development of self-esteem.

Self-esteem of ten children with phenylketonuria was compared with that of seven unaffected siblings of children with PKU in a total of 11 families. Ages of the nine girls and eight boys ranged from 8 to 15 years. The study examined several variables that might affect self-esteem. From this study, it appears that PKU status and lowered IQ together contribute to lowered self-concept and that PKU status alone (i.e. with the effects of IQ removed) has a strong tendency to influence self-esteem.