Pm Joubert

A comparison between the Mini-Mental State Examination and the Montreal Cognitive Assessment Test in schizophrenia

Background Cognitive impairment is a core feature of schizophrenia that also has strong prognostic significance. In most clinical settings comprehensive neuropsychological testing to detect cognitive impairment in schizophrenia patients is not readily available, but because cognitive deficits in schizophrenia are clinically important it would be useful to detect or at least screen for them in a clinical setting. Unfortunately there are no validated, brief screening instruments for the detection of cognitive impairment in schizophrenia. Nevertheless, the Montreal Cognitive Assessment Test (MoCA) and the Mini-Mental State Examination (MMSE) show promise in this regard. The objective of this study was to compare the results of the MMSE and MoCA in a group of outpatient schizophrenia sufferers to contribute to research into the instruments’ potential usefulness as screening tools for cognitive impairment in schizophrenia. Method The Afrikaans versions of the MMSE and MoCA were administered to Afrikaans-speaking adult outpatients. Participants had at least seven years of formal education and had been in partial or full remission for at least 3 months. The MMSE and MoCA scores for each participant were matched and compared using the non-parametric Wilcoxon matched pairs test. Results The sample consisted of 30 Afrikaans-speaking outpatients with schizophrenia. The mean MMSE score was 27.17 ± 2.64, and the mean MoCA score was 22.53 ± 3.91. There was a statistically significant difference between participants’ performance on the MMSE and MoCA tests (p = 0.000008). Conclusion Compared to the MMSE, the MoCA may be a more useful instrument to detect cognitive impairment in patients with schizophrenia. Further studies are required.

What patients with bipolar disorder and major depressive disorder perceive as adverse life events precipitating a current major depressive episode

Background. Adverse life events (ALEs) as precipitants of a major depressive episode (MDE) have been the subject of many studies. These studies indicate an increase in ALEs in the 6 months preceding an MDE. Objectives. The study examined what participants, suffering from major depressive disorder (MDD) or bipolar disorder (BD), perceived as the precipitating ALE of a current MDE. The severity and categories of ALEs were compared between these two patient groups. Methods. Consenting, adult inpatients were sourced from Weskoppies Hospital, Steve Biko Academic Hospital, Tshwane District Hospital, Denmar Psychiatric Hospital and Vista Clinic in the Pretoria area. A semi-structured questionnaire was used to obtain demographic data and the diagnosis. Information regarding the course of the disorder, including the number of previous MDEs and the age at which the first MDE occurred, was also obtained. The perceived precipitating ALE was detailed for each participant. A severity value referred to as a Life Change Unit Score (LCU score), based on the Recent Life Changes Questionnaire (RLCQ) by Miller and Rahe, was then assigned to each participant’s perceived precipitant. Results. Of the 64 participants, 12.7 % were experiencing a first MDE. In those participants who had experienced prior episodes the average number (standard deviation (SD)) of previous episodes was 3.86 (2.46). The mean approximate age (SD) at first onset of an MDE was 24.81 (10.9) years. The BD group had significantly more previous MDEs than the MDD group. Although the average LCU scores were higher in the BD group than the MDD group this did not reach statistical significance. Therefore, this study could not find a difference in the severity of the perceived precipitants between the BD group and MDD group. However, when the LCU scores were analysed within subcategories of the RLCQ, it was found that participants with BD perceived significantly more problems associated with the workplace as precipitants of a current MDE than individuals with MDD. Conclusion. Most participants could link an ALE to the onset of a current MDE. The study did not find a differential response to ALEs between patients with BD and MDD. The severity of the social precipitants did not differ significantly between the two groups. The notion of a ‘kindling effect’ could not be supported by the outcome of this study. Because some study participants experienced ALEs not accounted for by the RLCQ, a more comprehensive assessment instrument may be more appropriate for similar studies.

Behaviour that underpins non-pathological criminal incapacity and automatism : toward clarity for psychiatric testimony

Psychiatric expert testimony is challenging in cases of violence when the accused person submits a defence that he or she was so overwhelmed by emotions triggered by an upsetting event that his or her violent behaviour was an uncontrollable consequence of the emotions. This defence is usually presented in terms of an automatism particularly not attributed to a mental disorder. Clouding testimony in these cases is the various definitions of both automatism and mental disorder-definitions by which the jurisprudential distinction is made between a sane and an insane automatism, or pathological and non-pathological incapacity (NPCI). To avert testimony that is tainted from the very beginning by the lack of agreed definitions, this article proposes that psychiatrists focus in their assessment and testimony on particularly the behaviour as being distinct from the jurisprudential concerns whether that behaviour constitutes an automatism and whether it is (not) attributed to a mental disorder. This focus on the behaviour affords clarity by which the properties of the behaviour may be examined theoretically and clinically in terms of behaviour therapy, specifying accordingly its antecedents, consequences, topography, intensity, latency, duration, frequency, and quality. So informed, the behaviour that underpins NPCI and automatism is described here as emotionally triggered involuntary violent behaviour about which testimony may be given distinct from whether the behaviour is (not) causally attributed to a mental disorder, and from jurisprudential concerns with accountability.

Anxiety in family practice

Abstract Anxiety disorders represent some of the most common mental disorders. The lifetime prevalence rates for the different disorders are between 1% and 13%. Most anxiety disorders have a chronic, waxing and waning course. The impairment patients suffer due to the anxiety disorders ranges from mild to incapacitating. It is important that general practitioners understand the diagnostic and treatment concepts of the anxiety disorders to ensure early diagnosis and intervention in order to prevent undue suffering and impairment.