A B R Janse van Rensburg

Psychiatric consultations and the management of associated comorbid medical conditions in a regional referral hospital

Background . Psychiatrists are often called upon to evaluate patients with a medical condition and psychiatric symptoms, either as a complication thereof or initial presenting symptoms. There are often grey areas with regard to neuropsychiatric disorders in which psychiatrists and specialists from other clinical disciplines would need to co-manage or share ideas on the comprehensive treatment of a presenting patient. Objectives. This study was undertaken to provide a demographic and clinical profile of all patients consulted by the consultation-liaison psychiatry (CLP) service at the Helen Joseph Hospital (HJH) in Johannesburg, and to describe the clinical management of patients admitted with a diagnosis of a mental disorder associated with a comorbid medical condition, including delirium, dementia and a mood or psychotic disorder due to a general medical condition. Methods. A retrospective record review of all patients referred to the HJH CLP team over a 6-month period. Results. A total of 884 routine and emergency consultations were done for 662 patients (males n=305; females n=357) between the ages of 13 and 90 years who were referred from various other clinical departments. The most common documented reason for referral was a request for assessment (n=182; 27.5%), which consisted of mental state assessment, reconsultation and assessing capacity. A total of 63 patients (10.0% of cases consulted) were admitted to either the medical or psychiatric wards with a confirmed diagnosis of delirium, dementia and/or a mood or psychotic disorder due to a general medical condition (although admission wards were identified in 55 files only). The medical wards admitted the majority (n=37; 67.3%) mostly for delirium (n=28; 50.9%). HIV was identified as the most common systemic aetiological factor (n=23; 67.7%). Conclusion. In this study, a female patient between 31 and 45 years of age was slightly more likely to be referred to the HJH CLP service for assessment, and was more likely to be managed in the medical wards for delirium, which was most often associated with HIV/AIDS. The study highlighted the need for development of guidelines to facilitate adequate and effective use of this service for the local practice of CLP in a general specialist referral hospital like HJH, which would cover the following: clinical management; training needs; and administrative procedures.

Defining and Measuring Spirituality in South African Specialist Psychiatry

To define the meaning of “spirituality” in a South African phenomenological, theory-generating qualitative inquiry, theory construction methodology was used. This refers to the tradition of nursing theory development, where a central core concept identified from the integrated data—in this case, interviews and the literature content—had to be defined. A major focus of the study was to distinguish spirituality from religion. The denotative and connotative meanings of “spirituality” were explored to establish the components for a definition. The attributes of this definition included that spirituality constitutes a “quality”, a “journey”, a “relationship” as well as a “capacity”. While these items derived from this local definition of spirituality can be proposed for inclusion in a questionnaire for measuring spirituality in a South African context, the limits of the scope of the explorative qualitative inquiry from which it was derived must be considered.

Writing into design: An embedded writing course for architectural studies

Architects must be able to express their ideas clearly to communicate their designs; at the same time graduate professional degree programs demand advanced critical literacy and academic writing skills. Competence in this domain for high school graduates in South Africa often falls short of the expected proficiencies of first-year students at tertiary level. To address this gap, an embedded writing course was integrated into the first-year Design Studio and History of Architecture course. This intervention adopted the approaches provided by writing-intensive pedagogy, successfully improving students’ written expression, and their ability to engage with their architectural studies in deeper and more critical ways.

Integrating spirituality in the approach to psychiatric practice : editorial

Interest in spirituality and psychiatry has grown significantly over the past two decades. Since the 1990s, interest groups have been formed by several professional associations in the USA, Canada, the UK, the Netherlands, Brazil and Australia. Interest in spirituality, religion and culture has, however, always existed in Africa and has recently in a South African (SA) context also emerged more publicly in secular areas such as health and mental health, where the need to be ‘culturally competent’ has extended to competence regarding the multireligious and spiritually diverse contexts of local medical practice. Locally, in SA, a Spirituality and Psychiatry Special Interest Group (S&PSIG) of the South African Society of Psychiatrists (SASOP) was established with the objectives, among others, to promote, maintain and protect the discipline of psychiatry as a medical speciality as far as it relates to spirituality as an additional dimension to the biopsychosocial model, and to provide a forum to clarify concepts and professional boundaries. It also became important to develop local guidelines, which was initiated by the S&PSIG, undertaken in view of the extent of local and worldwide religious affiliation, rapid growth of academic