Liezl Koen

• Stellenbosch University

Background: Deinstitutionalisation refers to the process of transferring most of the psychiatric care provision from inpatient state-run institutions to community-based care. However, it has proven difficult to implement and failed to reach its desired targets. New Beginnings (NB) is a transitional care facility that facilitates the transition from...

Background: Assertive community treatment (ACT) is an intervention implemented to manage the effects of deinstitutionalisation. South African studies have reported decreased admissions at 12 and 36 months when a modified ACT intervention is compared with standard care. However, costs associated with the intervention have raised the question of its...

Background: Emotional dysregulation in psychiatric disorders contributes to morbidity, mortality and healthcare costs. Dialectical behaviour therapy (DBT) is effective in addressing this, but is complex and costly to implement. Recent literature indicates that DBT can be modified for use in resource-limited settings, but little is known about its...

Background: Globally, the appropriate transformation of medical training is critical to ensure the graduation of competent physicians who can address the growing health needs. Aim: To explore medical students’ perceptions of their learning experience during the undergraduate psychiatry late clinical rotation (PLCR) at Stellenbosch University (SU)...

Objective The authors investigated South African psychiatry residents’ satisfaction with their training, physical, and mental health to inform the development of a strategy to improve the quality and experiences of training.MethodA cross-sectional online survey was undertaken to assess the factors affecting residents’ satisfaction with their curren...

Background: Clozapine may cause life-threatening hematological side effects (HSEs). Hematological side effect incidence data from Sub-Saharan Africa are lacking. Furthermore, clozapine reduces cellular immunity, and it is unknown whether clozapine is a risk factor for tuberculosis or whether HIV is a risk factor for developing HSEs. We assessed th...

Background: There is a paucity of research on the clinical profile of women living with human immunodeficiency virus (HIV) (WLWH) admitted with acute mental health illness. Existing studies are small and did not look at factors that could have an impact on medication adherence. As a first step to inform service delivery for this vulnerable populati...

Background: Schizophrenia is a debilitating mental health condition affecting the lives of many South Africans. The origins of the heterogeneity in the presentation of the illness remain uncertain. Aim: This cross-sectional study performed a retrospective data analysis to determine the usefulness of digit ratio as an endophenotype in a South Afric...

Background: The World Health Organization’s action plan for 2020 has identified the need for service-based data to motivate for more appropriate community-based services. To date, there is no published data from step-up or step-down facilities in South Africa. Aim: To describe the demographic and clinical profile of all patients admitted to New Be...

Background: Maternal Mortality is a global health concern. The lack of suicide data, particularly in low and middle income countries, is concerning and needs to be addressed. Aim: This study assessed suicidality and associated factors during pregnancy and the postpartum period amongst women with known psychiatric diagnoses. Setting: The study sam...

Background: Psychiatric nurses constitute a fundamental part of the mental health care system in South Africa. However, high levels of burnout and job dissatisfaction among nursing staff have been associated with reduced empathy and quality of care, and poor service delivery. Stikland Psychiatric Hospital is a state psychiatric hospital situated in...

Objectives: Results from multinational WHO studies suggest that schizophrenia patients in developing countries may have more favorable prognoses and morbidity outcomes than those in developed settings. This study serves to establish whether mortality outcomes in South African Xhosa-speaking schizophrenia patients are more favorable than in the gene...

Background: Globally, the number of older people is rising. As a consequence of greater longevity, an increased burden on both medical and mental health care is expected. As a first step towards developing strategies to provide quality mental health care for this growing population, practitioners need to have a thorough understanding of the composi...

Background Stigmatising attitudes of health care professionals towards mental illness can impede treatment provided for psychiatric patients. Many studies have reported undergraduate training to be a critical period for changing the attitudes of medical students, and one particularly valuable intervention strategy involves time spent in a clinical...

Background: Depression and anxiety disorders remain poorly detected at primary health care, particularly in patients with hypertension and/or diabetes. A visual screening tool for anxiety disorders and depression (VISTAD) has been developed, but not validated. Aim: To validate the VISTAD in primary health care participants diagnosed with hypertens...

Introduction: Unplanned pregnancy is a community health concern. Research with South African women revealed the complexities surrounding pregnancy planning. Categorising pregnancies as either planned or unplanned is insufficient, as reducing a multidimensional concept to a dichotomous variable oversimplifies a complex matter. Methods: Pregnant fem...

Background: There is a lack of screening tools for common mental disorders that can be applied across cultures, languages and levels of education in people with diabetes and hypertension. Aim: To develop a visual screening tool for depression and anxiety disorders that is applicable across cultures and levels of education. Setting: Participants w...

Pregnant women in general are at an increased risk of experiencing symptoms of mental illness, and those living in a developing country are even more vulnerable. Research points towards a causal relationship between unplanned pregnancy and perinatal mental illness and suggests that pregnancy planning can aid in reducing the negative impact of menta...

Purpose: The aim of this study was to determine whether attendance at an occupational therapy-led day treatment centre for mental health care users affects the use of inpatient services in South Africa. Methods: A retrospective pre-test/post-test quasi-experimental study design was used to compare admissions and days spent in hospital during the 24...

Introduction Pressure on inpatient beds often results in premature discharges, which may precipitate early readmission. This has prompted an increased interest in transitional care interventions to bridge the gap between in- and outpatient care to reduce such readmissions. Our study aimed to assess the effect of a Transitional Care Service (TCS) on...

Whilst comprehensive post-discharge interventions have been successful in reducing readmissions in our setting, they are possibly not sustainable due to limited resources. We assessed the impact of a more cost-effective telephone-based intervention on readmissions in a developing country over 12 months. 100 patients with severe mental illness were...

Background Optimal parental care relies on the ability to respond appropriately to a child’s affective state. The current study examined pupil diameter as a potential physiological index of mothers’ affective response to infant facial expressions. Methodology A sub-study of mothers participating in an ongoing longitudinal study examining the ment...

Selective serotonin reuptake inhibitor (SSRI) antidepressants are considered the primary pharmacological treatment for moderate to severe depression during pregnancy. Data regarding the safety of their use during pregnancy remain controversial and conflicting. Decisions regarding the prescription of antidepressant treatment are often fraught with c...

p> List of Abstract Titles and authors: 1. Psychosis: A matter of mental effort? M Borg, Y Y van der Zee, J H Hsieh, H Temmingh, D J Stein, F M Howells 2.In search of an affordable, effective post-discharge intervention: A randomised control trial assessing the influence of a telephone-based intervention on readmissions for patients with severe...

p>Selective serotonin reuptake inhibitor (SSRI) antidepressants are considered the primary pharmacological treatment for moderate to severe depression during pregnancy. Data regarding the safety of their use during pregnancy remain controversial and conflicting. Decisions regarding the prescription of antidepressant treatment are often fraught with...

Selective serotonin reuptake inhibitor (SSRI) antidepressants are considered the primary pharmacological treatment for moderate to severe depression during pregnancy. Data regarding the safety of their use during pregnancy remain controversial and conflicting. Decisions regarding the prescription of antidepressant treatment are often fraught with c...

Where must a clinician turn when straightforward schizophrenia suddenly turns out to be just the opposite? Fortunately, these days, there are protocols for just about everything. But how much value do these add? This article outlines the journey of our attempt to follow one such protocol.

p>Where must a clinician turn when straightforward schizophrenia suddenly turns out to be just the opposite? Fortunately, these days, there are protocols for just about everything. But how much value do these add? This article outlines the journey of our attempt to follow one such protocol. </div

Background Facial affect recognition (FAR) abilities underpin emotional intelligence (EI). The latter is suggested to predict academic success and to be important for clinician-patient interaction. It is therefore of interest to investigate the possible association between FAR and academic performance in undergraduate medical students.Methods We as...

Suicide is ranked as the ninth overall cause of death in the United States. Whether a true suicide or parasuicide attempt, it remains a psychiatric emergency for which each clinician needs an appropriate management strategy.

p> Background. Clozapine use is known to be associated with significant side-effects, including prolongation of the QT-interval, agranulocytosis and metabolic syndrome. However, few data exist on the prevalence of clozapine side-effects in patients of Xhosa descent. Objective. To gather data from Xhosa patients with schizophrenia to establish the...

Background. Clozapine use is known to be associated with significant side-effects, including prolongation of the QT-interval, agranulocytosis and metabolic syndrome. However, few data exist on the prevalence of clozapine side-effects in patients of Xhosa descent. Objective. To gather data from Xhosa patients with schizophrenia to establish the prev...

Introduction Women with pre-existing mental illness are especially vulnerable during pregnancy. In Cape Town (South Africa) a state-private collaboration has been formed to focus on care for these mothers. Additionally the partnership provides valuable data on the outcome of pregnancy in women with major psychiatric disorders in Sub-Saharan Africa...

Here, we assessed for the first time the frequency of religious delusions and the effect of treatment on religiosity and the phenomena of religious delusions in a Xhosa schizophrenia population. Religious delusions were present in 42 (70 %) participants, and treatment significantly reduced religiosity (p = 0.02) as well as mean scores for certain p...

GPR88, coding for a G protein-coupled orphan receptor that is highly represented in the striatum, is a strong functional candidate gene for neuropsychiatric disorders and is located at 1p22-p21, a chromosomal region that we have previously linked to bipolar disorder (BD) in the Sardinian population. In order to ascertain the relevance of GPR88 as a...

Background Many countries have over the last few years incorporated mental health assertive interventions in an attempt to address the repercussions of deinstitutionalization. Recent publications have failed to duplicate the positive outcomes reported initially which has cast doubt on the future of these interventions. We previously reported on 29...

Haplotype analyses.

Linkage disequilibrium between paired SNP markers.

PCR primers and probes.

Suicide risk behavior is a significant contributor to the mortality and morbidity of schizophrenia. We previously reported affected sibship status in a Xhosa schizophrenia or schizoaffective disorder sample to be protective in nature; given the counterintuitive nature of this finding, we expanded the sample size to seek further clarification. Subje...

The CYP3A4 enzyme is the most abundant human cytochrome P450 (CYP) and is regarded as the most important enzyme involved in drug metabolism. Inter-individual and inter-population variability in gene expression and enzyme activity are thought to be influenced, in part, by genetic variation. Although Southern African individuals have been shown to ex...

This study investigated whether illness progression and treatment refractoriness emerge after relapse in schizophrenia. We compared outcomes in a cohort treated with a standardized protocol for the first and second episodes of illness. The sample comprised 31 participants who (1) had successfully completed a 2-year open-label treatment phase with r...

Accessible summary Research on trends in assaults and seclusion over time in developing countries such as South Africa is scant. Here, we assessed trends in assaults and seclusion, stratified by gender, at the acute admission wards in one psychiatric facility over a 5‐year period. The results of this study show that continuous monitoring of assault...

The catechol-O-methyltransferase (COMT) gene is an attractive schizophrenia candidate gene, encoding a catabolic dopamine enzyme. The enzyme exists as two distinct isoforms, with the membrane bound enzyme (i.e. MB-COMT) being predominantly expressed in the brain. Since African populations remain underrepresented in genetic/genomic research, we perf...

An unanswered question in the management of schizophrenia is how long antipsychotic treatment should be continued after a single psychotic episode. In this study, we assessed the rates of symptom recurrence with intermittent treatment in patients with a first episode of DSM-IV-defined schizophrenia or related illness after 2 years of successful con...

Chromosome 22q11 aberrations substantially increase the risk for developing schizophrenia. Although micro-deletions in this region have been extensively investigated in different populations across the world, little is known of their prevalence in African subjects with schizophrenia. We screened 110 African Xhosa-speaking participants with schizoph...

There are several methods of evaluating medical students' performance, such as written examination, oral examination and objective structured clinical examination (OSCE). Many studies have focused on the reliability and validity of these methods but few studies have explored comparison between these methods. Psychiatry is the only subject at the Un...

The use of endophenotypes, such as neurological soft signs (NSS), is advocated as one possible method to elucidate the heterogeneity of schizophrenia. Exploring the associations between NSS and specific illness symptoms has revealed some trends, although results have been conflicting. To date, such studies have been conducted largely on Caucasian p...

p> Objectives. The national Department of Health strongly advocates the strengthening of primary health care systems, and recommendations for appropriate level of care referrals exist. Very few published data on the scope of current ambulatory specialised psychiatric hospital services in South Africa are currently available, making it difficult to...

Psychiatric disorders place a considerable healthcare burden on South African society. Incorporating genetic technologies into future treatment plans offers a potential mechanism to reduce this burden. This review focuses on psychiatric genetic research that has been performed in South African populations with regards to obsessive-compulsive disord...

Lack of awareness of tardive dyskinesia (TD) and poor insight into mental illness are common in schizophrenia, raising the possibility that these phenomena are manifestations of a common underlying dysfunction. We investigated relationships between low awareness of TD and poor insight into mental illness in 130 patients with schizophrenia and TD. W...

A number of recently published randomized controlled trials conducted in developed countries have reported no advantage for assertive interventions over standard care models. One possible explanation could be that so-called "standard care" has become more comprehensive in recent years, incorporating some of the salient aspects of assertive models i...

Key Elements of ACT. Contains description of core elements defining Assertive Community Treatment as defined by Burns et al. This model were adapteded from the original PACT model described by Stein and Test in 1992.

Table S1. Modified Weiden's criteria for differentiating high frequency (HFU) and low frequency (LFU) schizophrenia-spectrum disorder users of psychiatric services.

This study was aimed at elucidating the common sequence variation present in the CYP2C19 gene within the South African Xhosa population and comparing it with the Cape Mixed Ancestry (CMA) population for possible future pharmacogenetic applications. Common sequence variation was identified through the resequencing of 15 Xhosa individuals. The detect...

Genetic variation of the CYP2D6 gene has been associated with altered drug metabolism; however, limited studies have investigated CYP2D6 sequence diversity in African populations. We devised a CYP2D6 genotyping strategy to analyse the South African Xhosa population and genotype a Xhosa schizophrenia cohort, as CYP2D6 metabolises many antipsychotics...

Psycho-educational programmes for families of persons with schizophrenia have been shown to reduce relapse rates, subsequently reducing the burden on the family as well as health care systems. Although various South African helplines and psycho-educational websites exist, none of these focused specifically on schizophrenia. The South African Depres...

This study examined service utilization patterns and pathways to specialist mental health services among individuals with schizophrenia spectrum disorders in the Western Cape, South Africa, an area that has undergone deinstitutionalization since the mid-1990s. Individuals who were consecutively admitted to any of the three psychiatric hospitals in...

Deinstitutionalization has led to a dramatic reduction of inpatient beds and subsequent increase in pressure on available beds. Another consequence of deinstitutionalization has been the phenomenon of the revolving door patient; high-frequency users (HFUs) admitted to hospital repeatedly, remaining well for only short periods of time. The purpose o...

p> Objective. Worldwide, cannabis is the most widely used illicit substance, and it has been identified as a correlate in schizophrenia samples for poorer symptomatic and functional outcomes in many international studies. The object of this retrospective study was to identify the prevalence of cannabis use/abuse and the demographic and clinical cor...

Omega-3 fatty acids, particularly eicosapentaenoic acid (EPA), are increasingly being used by psychiatric patients. Most studies have concentrated on efficacy aspects, while little is known about their safety and tolerability in psychiatric populations. This study aimed to assess the effects of EPA treatment on body mass, glucose metabolism, lipid...

Schizophrenia is a heterogeneous psychiatric disorder with a strong heritable component. However, to date, no single gene, cellular or molecular marker has consistently been identifi ed to be associated with this illness. Rather, it appears more likely that schizophrenia develops as a consequence of contributions from multiple susceptibility genes...

Recently proposed criteria for remission by a 'Remission in Schizophrenia Working Group' have generated considerable interest. We assessed rates, predictors, and correlates of remission in a sample of patients with first-episode schizophrenia treated with injectable, long-acting risperidone. This allowed us to examine remission among patients known...

The present study examined whether reduced attentiveness to facial features and biased weighting of attention to the eye and mouth region might explain deficits in face processing in schizophrenia. Healthy controls (n=21) and schizophrenia patients (n=28) from an African Xhosa population were asked to detect target stimuli (dots) superimposed on pi...

Few studies have compared long-acting injectable second-generation antipsychotics with oral antipsychotics. Long-acting injectable antipsychotics-developed specifically to address the problem of adherence-might have an important role to play in treating early psychosis. The effects of oral antipsychotics versus risperidone long-acting injection (RL...

The inclusion of dimensional elements in the psychiatric diagnostic systems have been advocated for many years, however it has been resisted due to concerns about clinical utility. Recent suggestions have been for a combination of categorical and dimensional data in future diagnostic classification systems. In this paper we discuss the overlap in s...

Although the integration of psychiatric services into the community has potentially been beneficial to many patients, this transition has not been without problems. A major obstacle to establishing successful community-based treatment in South Africa has been that the reduction in number of inpatients beds did not coincide with the development of a...

Objective: To examine the degree to which South African physicians use similar treatment guidelines in their prescription of antipsychotic medication. Method: Data on the prescriptions for Xhosa patients with schizophrenia and schizoaffective disorder were retrospectively examined to investigate differences between three catchment areas in the W...

p> Objective. Clozapine is the current gold standard treatment for severe treatment-refractory schizophrenia, but even so 40 - 70% of these patients will continue to experience disabling symptoms when treated with clozapine monotherapy. Current clinical practice at Stikland Hospital holds that known clozapine-refractory schizophrenia patients who r...

Conflicts of interest Professor Piet Oosthuizen has received honoraria from Pfizer, Lundbeck, Astra-Zeneca and Cipla for speaking at educational meetings. Dr Bonginkosi Chiliza has received honoraria from Sandoz and Janssen for speaking at educational meetings. Professor Robin Emsley has received honoraria from AstraZeneca, Bristol-Myers Squibb, Ja...

Using a long-acting antipsychotic to improve adherence early in the illness may reduce relapse rates and promote sustained remission, thereby improving the long-term outcome of schizophrenia. We assessed whether risperidone long-acting injection (RLAI) could be used safely and effectively in the treatment of recent-onset psychosis. Fifty patients a...

p> Background. Although clozapine is the treatment of choice for treatment-resistant schizophrenia, many patients remain symptomatic despite adequate treatment with this medication. One suggested strategy to improve efficacy has been the addition of a potent D2 blocker such as amisulpride to treatment with clozapine. Methods. In this study, 20 su...

Clozapine is an atypical antipsychotic drug indicated for the management of severely ill patients with schizophrenia who fail to respond adequately to standard antipsychotic treatment. It has demonstrated superior efficacy in treating both the positive and negative symptoms in treatment-refractory cases. It also has the added benefit of causing min...

The present study in an African Xhosa sample examined whether familial vulnerability to schizophrenia is associated with deficits in facial affect recognition. Healthy comparison subjects, unaffected siblings of schizophrenia patients, and schizophrenia patients were tested with a task requiring rapid recognition of matched positive (happy), negati...

As little is known about the risk factors for abnormal involuntary movements in African patients with schizophrenia, 170 Xhosa participants with schizophrenia were rated with the abnormal involuntary movement scale. Abnormal involuntary movements occurred in 19.4% of this group. Modeling of the data set showed that combining age at interview, age-s...

Severe pressures on beds in psychiatric services have led to the implementation of an early ("crisis") discharge policy in the Western Cape, South Africa. The study examined the effect of this policy and length of hospital stay (LOS) on readmission rates in one psychiatric hospital in South Africa. Discharge summaries of adult male patients (n = 43...

div style="left: 81.816px; top: 554.304px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.945404);" data-canvas-width="64.96499999999999"> Objective: Hoarding is commonly defined as the acquisition of and failure to discard possessions of little use or value, and is included as a symptom in the diagnostic criteria for obsessive c...

Despite the prevalence of multisomatoform disorder (MSD), there are few controlled trials of its pharmacotherapy. The aim of this study was to compare the efficacy and safety of escitalopram (10-20 mg/day) with that of placebo in treating patients with MSD over a 12-week period. Fifty-one outpatients aged from 18 to 65 years, with multiple medicall...