Comparing the medication costs of treating patients with schizophrenia who use cannabis with those who do not.

Background: Cannabis use is more prevalent among people with schizophrenia than in the general population. This usage detrimentally impacts disease prognosis, contributing to escalated admissions, heightened severity of psychotic symptoms, and reduced medication response. The recent decriminalisation of cannabis in South Africa may lead to an upsurge in usage, consequently intensifying the strain on mental healthcare services. Aim: This study aimed to compare the medication costs of patients with schizophrenia depending on cannabis use. Setting: Weskoppies Hospital, Pretoria, South Africa, 2018-2019. Methods: Data pertaining to medication expenses during the 2018-2019 period were acquired from the hospital pharmacy. Data were collected from 114 patient records to form two equal cohorts: one exposed to cannabis and the other non-exposed, as indicated by urine drug screens or admission of cannabis use. Medications prescribed from admission to time of being ready for discharge were recorded and corresponding costs were calculated. Results: Patients who were exposed to cannabis had higher medication costs (R 516.47) than patients who were non-exposed (R 328.69) (p = 0.0519), over the whole admission period. Conclusion: Cannabis exposure escalates the financial burden of treating schizophrenia at Weskoppies Hospital. This might be attributed to failure of cost-effective, first-line medications prompting the prescription of costlier, second-line alternatives or higher prescribed dosages. Contribution: This study contributes to findings that it is more expensive to treat patients with schizophrenia who have relapsed, if they are using cannabis. This finding has future cost implications when budgeting for pharmacotherapeutic treatment.

Nanoscatterer-Assisted Fluorescence Amplification Technique.

Weak fluorescence signals, which are important in research and applications, are often masked by the background. Different amplification techniques are actively investigated. Here, a broadband, geometry-independent and flexible feedback scheme based on the random scattering of dielectric nanoparticles allows the amplification of a fluorescence signal by partial trapping of the radiation within the sample volume. Amplification of up to a factor of 40 is experimentally demonstrated in ultrapure water with dispersed TiO2 nanoparticles (30 to 50 nm in diameter) and fluorescein dye at 200 µmol concentration (pumped with 5 ns long, 3 mJ laser pulses at 490 nm). The measurements show a measurable reduction in linewidth at the emission peak, indicating that feedback-induced stimulated emission contributes to the large gain observed.

Corrigendum: Do medical students feel career ready after their psychiatry clinical rotation?

[This corrects the article DOI: 10.4102/sajpsychiatry.v25i0.1397.].

Nanolasers with Feedback as Low-Coherence Illumination Sources for Speckle-Free Imaging: A Numerical Analysis of the Superthermal Emission Regime.

Lasers distinguish themselves for the high coherence and high brightness of their radiation, features which have been exploited both in fundamental research and a broad range of technologies. However, emerging applications in the field of imaging, which can benefit from brightness, directionality and efficiency, are impaired by the speckle noise superimposed onto the picture by the interference of coherent scattered fields. We contribute a novel approach to the longstanding efforts in speckle noise reduction by exploiting a new emission regime typical of nanolasers, where low-coherence laser pulses are spontaneously emitted below the laser threshold. Exploring the dynamic properties of this kind of emission in the presence of optical reinjection we show, through the numerical analysis of a fully stochastic approach, that it is possible to tailor some of the properties of the emitted radiation, in addition to exploiting this naturally existing regime. This investigation, therefore, proposes semiconductor nanolasers as potential attractive, miniaturized and versatile future sources of low-coherence radiation for imaging.

Methodological investigation into the noise influence on nanolasers' large signal modulation.

Nanolasers are considered ideal candidates for communications and data processing at the chip-level thanks to their extremely reduced footprint, low thermal load and potentially outstanding modulation bandwidth, which in some cases has been numerically estimated to exceed hundreds of GHz. The few experimental implementations reported to date, however, have so-far fallen very short of such predictions, whether because of technical difficulties or of overoptimistic numerical results. We propose a methodology to study the physical characteristics which determine the system's robustness and apply it to a general model, using numerical simulations of large-signal modulation. Changing the DC pump values and modulation frequencies, we further investigate the influence of intrinsic noise, considering, in addition, the role of cavity losses. Our results confirm that significant modulation bandwidths can be achieved, at the expense of large pump values, while the often targeted low bias operation is strongly noise- and bandwidth-limited. This fundamental investigation suggests that technological efforts should be oriented towards enabling large pump rates in nanolasers, whose performance promises to surpass microdevices in the same range of photon flux and input energy.

Thermal, Quantum Antibunching and Lasing Thresholds from Single Emitters to Macroscopic Devices.

Starting from a fully quantized Hamiltonian for an ensemble of identical emitters coupled to the modes of an optical cavity, we determine analytically regimes of thermal, collective anti-bunching and laser emission that depend explicitly on the number of emitters. The lasing regime is reached for a number of emitters above a critical number-which depends on the light-matter coupling, detuning, and the dissipation rates-via a universal transition from thermal emission to collective anti-bunching to lasing as the pump increases. Cases where the second order intensity correlation fails to predict laser action are also presented.

Acoustofluidic phase microscopy in a tilted segmentation-free configuration.

A low-cost device for registration-free quantitative phase microscopy (QPM) based on the transport of intensity equation of cells in continuous flow is presented. The method uses acoustic focusing to align cells into a single plane where all cells move at a constant speed. The acoustic focusing plane is tilted with respect to the microscope's focal plane in order to obtain cell images at multiple focal positions. As the cells are displaced at constant speed, phase maps can be generated without the need to segment and register individual objects. The proposed inclined geometry allows for the acquisition of a vertical stack without the need for any moving part, and it enables a cost-effective and robust implementation of QPM. The suitability of the solution for biological imaging is tested on blood samples, demonstrating the ability to recover the phase map of single red blood cells flowing through the microchip.

Suicide risk of male State patients with antisocial personality traits.

BACKGROUND: Suicide mortality rates are higher in people with personality disorders, especially those who have antisocial personality traits. These mortality rates are also higher in people who have committed offences. Antisocial personality traits are very common in populations who have committed offences and in forensic psychiatric patients. AIM: To determine if male State patients with antisocial personality traits had a higher risk of suicide compared with patients with no antisocial personality traits. We tried to identify other risk factors for attempted suicide in this population. SETTING: Weskoppies Hospital's Forensic Unit, Pretoria, South Africa. METHODS: Of the 275 male State patients, 37 had antisocial personality traits and were included in the study. Of the remaining State patients, we randomly selected 37 control group participants, who had no antisocial personality traits. For each participant, we completed a data capturing sheet and a Beck's Suicide Ideation Scale (BSIS). We compared suicide risk and associated factors between study and control group participants. RESULTS: Study group and control group participants had the same current suicide risk. Overall, 63 participants (85.14%) had no current suicide risk. Of the 11 (14.86%) remaining participants with current suicide risk, 5 had antisocial personality traits. Eighteen had previous suicide attempts, 13 of whom had antisocial personality traits. CONCLUSION: State patients with and without antisocial personality traits had similar current suicide risk. Although antisocial personality disorder is an identified risk factor for suicide, it was not the case in this study. Assessment of other risk factors for suicide should be prioritised.

Do medical students feel career ready after their psychiatry clinical rotation?

BACKGROUND: In the South African healthcare system, mentally ill patients first come into contact with primary care physicians who then refer these patients for specialised care if needed. Medical students therefore need to acquire the knowledge, skills and confidence to treat mentally ill patients. AIM: To evaluate the perceptions of medical students regarding their career readiness as doctors after their clinical rotation in psychiatry. SETTING: The University of Pretoria, South Africa. METHODS: Data were collected retrospectively from questionnaires completed by final year medical students from 2011 to 2015. These data were analysed overall and by year using Chi-square tests and regression analyses (N = 770). RESULTS: Overall, 93.10% of medical students felt adequately prepared for their role as medical practitioners after their clinical rotation in psychiatry. The proportion of medical students exposed to post-traumatic stress disorder (p = 0.012), obsessive-compulsive disorder (p = 0.006) and alcohol-use disorder (p = 0.046) was found to vary significantly by year. Exposure to any one psychiatric condition did not influence perceptions of career preparedness. Students perceived themselves to be career ready if they had sufficient exposure to mentally ill patients, knowledge about prescribing appropriate psychiatric medication and especially psychiatric interviewing skills. CONCLUSION: Students who completed practical and clinical training in psychiatry perceived themselves to be career ready.

Erratum: Identifying factors associated with the discharge of male State patients from Weskoppies Hospital.

[This corrects the article DOI: 10.4102/sajpsychiatry.v23i0.1083.].

The psycho-social and clinical profile of women referred for psycho-legal evaluation to forensic mental health units in South Africa.

BACKGROUND: There is a paucity of research on women offenders in the South African context, particularly those referred for forensic psychiatric observation. Little is known about their life histories, the nature of their offences or the psycho-social contexts that enable, or are antecedents to, women's criminal offending. AIMS: This research study, the largest of its kind in South Africa, examined the psycho-social contexts within which women offenders referred for psychiatric evaluation come to commit offences. The profiles of both offenders and victims, as well as reasons for referral and forensic mental health outcomes, were investigated. METHODS: A retrospective record review of 573 cases, spanning a 12-year review period, from six different forensic psychiatric units in South Africa, was conducted. RESULTS: The findings describe a population of women offenders who come from backgrounds of socio-demographic and socio-economic adversity, with relatively high pre-offence incidences of being victims of abuse themselves, with significant levels of mental ill-health and alcohol abuse permeating their life histories. The majority of index offences which led to court-ordered forensic evaluations were for violent offences against the person, with murder being the single most common index offence in the sample. Most victims of violence were known to the accused. There were also relatively high rates of psychotic and mood-spectrum disorders present, with relatively low rates of personality disorders. The majority of women were deemed to be trial competent and criminally responsible in relation to their index offences. CONCLUSION: It is recommended that more standardised and gender-sensitive forensic mental health assessment approaches, documentation and reporting be employed throughout the country. Future research should compare male and female offending patterns and forensic mental health profiles.

The psycho-social and clinical profile of women referred for psycho-legal evaluation to forensic mental health units in South Africa

Background: There is a paucity of research on women offenders in the South African context, particularly those referred for forensic psychiatric observation. Little is known about their life histories, the nature of their offences or the psycho-social contexts that enable, or are antecedents to, women's criminal offending. Aims: This research study, the largest of its kind in South Africa, examined the psycho-social contexts within which women offenders referred for psychiatric evaluation come to commit offences. The profiles of both offenders and victims, as well as reasons for referral and forensic mental health outcomes, were investigated. Methods: A retrospective record review of 573 cases, spanning a 12-year review period, from six different forensic psychiatric units in South Africa, was conducted. Results: The findings describe a population of women offenders who come from backgrounds of socio-demographic and socio-economic adversity, with relatively high pre-offence incidences of being victims of abuse themselves, with significant levels of mental ill-health and alcohol abuse permeating their life histories. The majority of index offences which led to court-ordered forensic evaluations were for violent offences against the person, with murder being the single most common index offence in the sample. Most victims of violence were known to the accused. There were also relatively high rates of psychotic and mood-spectrum disorders present, with relatively low rates of personality disorders. The majority of women were deemed to be trial competent and criminally responsible in relation to their index offences. Conclusion: It is recommended that more standardised and gender-sensitive forensic mental health assessment approaches, documentation and reporting be employed throughout the country. Future research should compare male and female offending patterns and forensic mental health profile

Stigmatization towards the mentally ill: Perceptions of psychiatrists, pre-clinical and post-clinical rotation medical students.

BACKGROUND: Stigma towards the mentally ill is a well-known phenomenon and it is not restricted to certain communities or countries. Stigma, be it self-stigma or public stigma, has a major influence in mental health care. AIM: The aim of this study was to determine whether stigmatizing attitudes towards the mentally ill differ according to the level of knowledge about psychiatric illnesses and whether the level of exposure towards the mentally ill plays a role in stigmatizing attitudes. METHOD: This study was carried out by assessing psychiatrists ( n = 68), pre-clinical ( n = 194) and post-clinical ( n = 354) medical students' attitudes towards the mentally ill using the Mental Illness: Clinicians' Attitudes (MICA) scale. The scale is scored on a Likert scale with higher scores indicating higher levels of stigmatization. RESULTS: Participants in the three groups had statistical significant different levels of stigma with a decline in scores as you are more exposed to psychiatry. Familiarity with mental illness was associated with less stigma. Participants who had friends or family members who suffered from mental illness or they themselves suffered from a mental illness had less stigma. CONCLUSION: More exposure to mental health-related issues are needed not only in communities but also in medical schools. Medical students need to be targeted for educational intervention because they are the future doctors who might pursue psychiatry as their field of choice. Stigma against psychiatry as a medical profession should also be addressed. If psychiatry is to be respected as a medical profession, mental illness-related stigma interventions need to be put in place to raise awareness about the negative impact of stigma.

Neuropsychiatric symptoms and diagnosis of grey matter heterotopia: A case-based reflection.

Neuropsychiatric symptoms can be related to less common underlying neuropsychiatric conditions - in this case report, the condition discussed is that of grey matter heterotopia (GMH). The patient presented with a history of prominent aggression, impulsivity and manipulative and attention-seeking behaviour. Episodes of depression and incidents of deliberate self-harm and suicide attempts had been reported. Neuropsychiatric symptoms included anxiety, a labile mood, delusional thinking and auditory hallucinations. Testing revealed some cognitive difficulties and severe impairment of frontal lobe functions. A magnetic resonance imaging (MRI) scan of his brain revealed the presence of GMH, which had previously been misdiagnosed as tuberous sclerosis. An MRI scan of the brain is the special investigation of choice for the correct diagnosis of GMH. The pathognomonic finding is that of heterotopic grey matter abnormally located within areas of white matter. Defective foetal neuronal migration between the third and fifth month of pregnancy can lead to GMH, which can present later on in childhood or adolescence with epilepsy, intellectual impairment or reading difficulties. During the late teenage years or early adulthood, a wide variety of neuropsychiatric symptoms may be present, which can lead to diagnostic difficulties.

The use of cyproterone acetate in a forensic psychiatric cohort of male sex offenders and its associations with sexual activity and sexual functioning.

BACKGROUND: Cyproterone acetate (CPA) is a steroidal anti-androgenic medication used in the field of psychiatry for the treatment of paraphilic disorders, hypersexuality, and inappropriate sexual behaviour which may be present in patients with disorders such as mild and major neurocognitive disorders. In the forensic psychiatric population, it is prescribed for these indications especially for patients with a history of committing a sexual offence or who are at moderate to high risk of recidivism. OBJECTIVES: To investigate the use of CPA in a forensic psychiatric cohort of male sex offenders and its associations with sexual activity and sexual functioning. METHODS: Seventy-six forensic psychiatric patients from Weskoppies Hospital in Pretoria, South Africa, participated in the study which measured their sexual functioning. A specifically designed questionnaire was used to capture relevant background information. The use of CPA was studied. The Changes in Sexual Functioning Questionnaire, Male Clinical Version (CSFQ-M-C) was used to measure sexual functioning of participants. The CSFQ-M-C scores, and those of all its subscales, of participants on CPA were compared to those not on the drug. Relevant statistical analyses were performed. RESULTS: Thirteen out of the 76 participants were being treated with CPA (17.11%). In total, 53.85% of the participants on CPA and 65.08% not on CPA had scores indicating the presence of sexual dysfunction. The total CSFQ-M-C scores for participants on CPA (mean = 40.54; median = 42) were not statistically significantly lower than those not on the drug (mean = 41.22; median = 41). More notable is that the use of CPA in this population was associated with lower levels of desire, frequency of and pleasure from sexual activity. There was an association between having intellectual disability and being treated with CPA. CONCLUSION: That all the participants were being treated with psychotropic medication could account for the high percentage of sexual dysfunction in any or all areas of sexual functioning and contribute to the small difference in CSFQ-M-C scores between the two groups. Only a tentative conclusion can be made that CPA may be more effective in decreasing levels of desire, frequency and pleasure related to sexual activity than other areas of sexual functioning. The indication for the use of CPA in this population should be assessed clinically according to patient circumstances and risk assessment.

Identifying factors associated with the discharge of male State patients from Weskoppies Hospital.

BACKGROUND: Designated psychiatric facilities are responsible for the care, treatment and reintegration of State patients. The necessary long-term care places a considerable strain on health-care resources. Resource use should be optimised while managing the risks that patients pose to themselves and the community. Identifying unique factors associated with earlier discharge may decrease the length of stay. Factors associated with protracted inpatient care without discharge could identify patients who require early and urgent intervention. AIM: We identify socio-economic, demographic, psychiatric and charge-related factors associated with the discharge of male State patients. METHODS: We reviewed the files of discharged and admitted forensic State patients at Weskoppies Psychiatric Hospital. Data were captured in an electronic recording sheet. The association between factors and the outcome measure (discharged vs. admitted) was determined using chi-squared tests and Fischer's exact tests. RESULTS: Discharged State patients were associated with being a primary caregiver (p = 0.031) having good insight into illness (p = 0.025) or offence (p = 0.005) and having had multiple successful leaves of absences. A lack of substance abuse during admission (p = 0.027), an absence of a diagnosis of substance use disorder (p = 0.013) and the absence of verbal and physical aggression (p = 0.002 and p = 0.016) were associated with being discharged. Prolonged total length of stay (9-12 years, p = 0.031) and prolonged length of stay in open wards (6-9 years, p = 0.000) were associated with being discharged. A history of previous offences (p = 0.022), a diagnosis of substance use disorder (p = 0.023), recent substance abuse (p = 0.018) and a history of physical aggression since admission (p = 0.017) were associated with continued admission. CONCLUSION: Discharge of State patients is associated with an absence of substance abuse, lack of aggression, multiple successful leave of absences and length of stay in hospital.

Schizophrenia in a member of the family: Burden, expressed emotion and addressing the needs of the whole family.

How often do we find ourselves concentrating so much on treating a patient with schizophrenia that we forget about the needs and difficulties of the family members who take care of that patient? This article highlights the global and specific difficulties that families and caregivers experience in having to care for chronically ill family members with schizophrenia with a backdrop of continuing global deinstitutionalisation of such patients. Matters such as burden and expressed emotion are explored, family-specific interventions are discussed and areas of service delivery and resource inadequacies are identified.

Treated for psychosis and presenting with prominent speech and language abnormalities: A case report of an adult with a frontal lobe teratoma.

We report on a rare case of an adult presenting with psychotic symptoms, including prominent thought form disorder and an aphasia. Further investigation revealed the presence of a mature teratoma in the left frontal lobe, which could have played a pathophysiological role in the development of both the psychosis and the language impairment.

Optimization of the switch-on and switch-off transition in a commercial laser.

The response of a Class B laser to a rapid change in one of its parameters is known to be accompanied by delay and ringing. It has been theoretically and numerically shown that the transition can be modified by using adequate functional shapes for the control parameter (e.g., the laser pump) in order to steer the laser from one point of operation to another. Here we experimentally show the implementation of these ideas in a commercial device: a semiconductor laser. We establish a procedure for optimizing a controlled switch-on and switch-off and obtain a clean, fast, and reliable square pulse, either in a single shot or in a repetitive sequence. The generality of this procedure promises a wide field of application for a variety of laser systems.