Guest editorial

Psychiatry

Henk Temmingh, MB ChB, FCPsych (SA), MMed (Psych)

Consultant Psychiatrist, Acute Services, Valkenberg Hospital, Cape Town

Henk Temmingh is a consultant psychiatrist in the acute male admission service at Valkenberg Hospital. His interests include schizophrenia and severe mental illness co-occurring with substance use disorders. He also has an interest in evidence-based medicine and research methodology in psychiatry.

Pete Milligan, MB ChB, DCH (SA), DTM&H, DPH, DHSM, FCPsych (SA)

Clinical Head, Acute Services, Valkenberg Hospital, Cape Town

Pete Milligan spent the first 15 years of his medical career working in primary healthcare and health service management in the Eastern Cape. Since specialising in psychiatry, he has worked in various clinical units in Cape Town and is currently the Clinical Head of Acute Services at Valkenberg Hospital. His interests include postgraduate psychiatry training and public mental health.

Correspondence to: H Temmingh (henk.temmingh@uct.ac.za)

The role of the primary care medical practitioner in the management of mental illness has recently received increased emphasis and is likely to become even more important in the future. National policy on mental health focuses on increasing the integration of mental health services into primary care, with the latter becoming the main point of service delivery for the vast majority of persons with mental illness. The lifetime prevalence of any psychiatric disorder in the South African adult population has been estimated to be as high as 30.3%. As many as 9.8% of adults will experience a depressive disorder and as many as 13.3% a substance use disorder in their lifetime.1 Among children and adolescents in the Western Cape the prevalence of any psychiatric disorder has been estimated to be as high as 17%, with as many as 8% of adolescents experiencing a depressive or dysthymic disorder.2 In a society characterised by high levels of violence and crime the 12-month prevalence of post-traumatic stress disorder has been found to be 8% among children and adolescents and the lifetime prevalence is estimated to be 2.3% in adults.1 , 2 While the focus is often on the health-related problems of younger generations in developing countries, the South African population is also ageing. The burden of dementia is likely to increase in future, as will its related psychological and behavioural consequences. The primary care practitioner can play a vital role in supporting families in managing patients with neurodegenerative illnesses such as Alzheimer’s disease.

In this edition of CME we address the management of some of the most common mental health problems general practitioners will need to be equipped to deal with. As many practitioners are already involved in the primary care management of depressive disorders, we discuss some of the aspects of treatment ranging from mild to treatment-resistant depression. We include a second article on the management of depression in children and adolescents. Whereas experiences of trauma are common, post-traumatic stress disorder is a less common complication and may require treatment with psychotropic medication but also with psychological treatment modalities. In an article on the management of trauma the evidence-based care of persons who have experienced severe trauma is discussed, including simple ways in which to manage the aftermath of trauma. Insomnia is a common problem; however, the management of this condition is often neglected and fraught with potential pitfalls if management goes wrong. In an article on insomnia we look at how insomnia can be effectively managed using a variety of different treatment modalities. Although the use of illicit drugs such as methamphetamine and heroin is on the increase in South Africa, the most frequently abused drug remains alcohol. Alcohol abuse occurs at a lifetime prevalence rate of 11.4%, with alcohol dependence reaching a rate of 2.6%.3 Although primary care practitioners sometimes feel overwhelmed when faced with patients suffering from an addictive disorder, there is reason for optimism as simple interventions can make a difference in this difficult-to-treat population. In this regard, we include an article on the current evidence-based management of addictive disorders. Finally, we address the issue of behavioural and psychological difficulties in the elderly demented patient and include an article on the legal and ethical aspects of curatorship, wills and administratorship.

We trust that the choice of articles will cater to the needs of practitioners faced with the daily challenge of treating persons with psychiatric problems.

1. Herman AA, Stein DJ, Seedat S, Heeringa SG, Moomal H, Williams DR. The South African Stress and Health (SASH) study: 12-month and lifetime prevalence of common mental disorders. S Afr Med J 2009;99(5):339-344.

2. Kleintjes S, Flisher A, Fick M, et al. The prevalence of mental disorders among children, adolescents and adults in the Western Cape, South Africa. South African Psychiatric Review 2006;9:157-160.

3. Stein DJ, Seedat S, Herman A, et al. Lifetime prevalence of pychiatric disorders in South Africa. Br J Psychiatry 2008;192:112-117.