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Catatonia a manifestation of serious mental Illness: prevalence, presentation, management, and outcomes in a mental health unit

  • Authors: Zingela, Zukiswa
  • Date: 2022-07
  • Subjects: Mental Health , Catatonia , Psychomotor disorders
  • Language: English
  • Type: Doctoral's theses , text
  • Identifier: http://hdl.handle.net/10948/60400 , vital:64706
  • Description: Catatonia is a psychomotor abnormality that may be caused by severe physical or mental illness or by substances. It has a wide-ranging prevalence from less than 10% to just over 60%, worldwide. This thesis investigated multiple aspects of catatonia in an acute mental health unit setting. Critical aspects examined include the psychological experience of catatonia and assessment, prevalence, presentation, management, and treatment outcomes of catatonia. The research design was a prospective descriptive triangulation study that used a mixed quantitative and qualitative approach. The theoretical framework applied in this thesis was a positivist paradigm approach to explore the quantitative data collected, with application of deductive reasoning, supported by statistical analysis to detect correlations between catatonia and demographic and clinical data. The research explored the experience of a person with catatonia from the beginning to the end of the catatonic episode, inclusive of neglected areas such as the patient’s psychological and experiences. Sources of information included participant reports, clinical notes, and assessments conducted using screening tools for catatonia. Key knowledge gaps on catatonia were identified as target areas for this thesis. These are the prevalence of catatonia in a South African setting; the use of assessment tools like the Bush Francis Catatonia Screening Instrument (BFCSI), the Bush Francis Catatonia Rating Scale (BFCRS), and the Diagnostic and Statistical Manual (5th Edition; DSM-5) in this setting; interventions for catatonia; treatment outcomes; and the subjective experiences of catatonia, as described by patients. To date, there have been five publications produced from this thesis. The first paper was on the protocol for the research and was published in the British Medical Journal (BMJ) Open and presented the literature review, research design, and methodology for the planned Abstract ii research on catatonia (which has ultimately been presented in this current thesis). This paper also identified the aforementioned critical knowledge gaps. The second paper was published in the Biomedicine Central (BMC) International Journal of Mental Health Systems. This paper described a 6-month prevalence rate of catatonia of 11.9%, and concluded that the BFCSI and BFCRS had the highest inter-rater reliability (IRR) and pick-up rate when screening for catatonia, while the DMS-5 had low IRR, and the lowest correlation with the BFCSI and BFCRS. The 12-month prevalence rate was found to be 18.3% and was described in the third paper which was published in the PLOS One Psychiatry. Both lorazepam and electroconvulsive therapy (ECT) were found to be the most widely used treatment at the study site, with good response rates and outcomes. The results were published in the 4th paper in SAGE Open. The fifth paper was on the subjective and psychological experience and published in the BMC Psychology journal. It described the psychological and subjective experience of catatonia as narrated by participants which is characterised by intense experiences of fear, anxiety, and sadness that manifested as extreme withdrawal, combined with obedience or submission. This research has yielded new knowledge with potential applications at a regional, national, and global level. New knowledge yielded includes the need for screening of patients for catatonia across all acute settings, the need for training of both medical and nursing personnel in the assessment of catatonia, the effectiveness of screening and assessment tools, effective interventions for catatonia and outcomes. The descriptions of catatonia at an emotional, cognitive, and behavioural level also highlight the need to develop psychological strategies and targeted psychological interventions to complement the current management strategies. , Thesis (PhD) -- Faculty of Health Sciences, 2022
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  • Date Issued: 2022-07

Adaptation and validation of a computerized neurocognitive battery in the Xhosa of South Africa

  • Authors: Cobb, Scott J , Moore, Tyler M , Stein, Dan J , Pretorius, Adele , Zingela, Zukiswa , Nagdee, Mohammed , Ngqengelele, Linda , Campbell, Megan M , Sibeko, Goodman , King, Mary C , McClellan, Jon M , Port, Allison M , Jackson, Chad , Ruparel, Kosha , Susser, Ezra , Gur, Ruben C
  • Date: 2021
  • Subjects: To be catalogued
  • Language: English
  • Type: text , article
  • Identifier: http://hdl.handle.net/10962/302439 , vital:58196 , xlink:href="https://doi.org/10.1037/neu0000742"
  • Description: Objective: Large-scale studies have revolutionized biomedical research, and neurocognitive tests can help elucidate the biological basis of neuropsychiatric diseases. However, studies have predominantly been conducted in Western settings. We describe the development and validation of a computerized battery (PennCNB) with the Xhosa population of South Africa. Method: Individuals with schizophrenia (n = 525) and a normative comparison group (n = 744) were balanced on age, sex, education, and region. Participants provided blood samples, were assessed psychiatrically, and were administered a PennCNB translation to isiXhosa, including measures of executive functions, episodic memory, complex cognition, social cognition, and sensorimotor speed. Feasibility was examined with test completion rates and input from administrators, and psychometric structural validity and associations with clinical and demographic characteristics were examined. Results: Tests were well tolerated by participants, as >87% had one (or fewer) test missing. Results suggested a similar factor structure to prior PennCNB studies in Western contexts, and expected age and sex effects were apparent. Furthermore, a similar profile of schizophrenia was observed, with neurocognitive deficits most pronounced for executive functions, especially attention, as well as memory, social cognition, and motor speed relative to complex cognition and sensorimotor speed. Conclusions: Results support the feasibility of implementing a culturally adapted computerized neurocognitive battery in sub-Saharan African settings and provide evidence supporting the concurrent validity of the translated instrument. Thus, the PennCNB is implementable on a large scale in non-Western contexts, shows expected factor structure, and can detect cognitive deficits associated with neuropsychiatric disorders. Obtaining valid measures of cognition by nonspecialized proctors is especially suitable in resource-limited settings, where traditional testing is prohibitive. Future work should establish normative standards, test–retest reliability, and sensitivity to treatment.
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  • Date Issued: 2021

Factors affecting specialist psychiatry training in South Africa: Bullying during specialist psychiatric training?

Neuropsychiatric Genetics of African Populations-Psychosis (NeuroGAPPsychosis): a case-control study protocol and GWAS in Ethiopia, Kenya, South Africa and Uganda

Protocol for a prospective descriptive prevalence study of catatonia in an acute mental health unit in urban South Africa

Genetics of schizophrenia in the South African Xhosa

First-episode psychosis and substance use in an acute mental health unit

Predictors of consent to cell line creation and immortalisation in a South African schizophrenia genomics study

Using iterative learning to improve understanding during the informed consent process in a South African psychiatric genomics study

  • Authors: Campbell, Megan M , Susser, Ezra , Mall, Sumaya , Mqulwana, Sibonile G , Mndini, Michael M , Ntola, Odwa A , Nagdee, Mohamed , Zingela, Zukiswa , Van Wyk, Stephanus , Stein, Dan J
  • Date: 2017
  • Subjects: Informed consent (Medical law) , Patient education
  • Language: English
  • Type: text , article
  • Identifier: http://hdl.handle.net/11260/6114 , vital:45124 , https://doi.org/10.1371/journal.pone.0188466
  • Description: Obtaining informed consent is a great challenge in global health research. There is a need for tools that can screen for and improve potential research participants’ understanding of the research study at the time of recruitment. Limited empirical research has been conducted in low and middle income countries, evaluating informed consent processes in genomics research. We sought to investigate the quality of informed consent obtained in a South African psychiatric genomics study. A Xhosa language version of the University of California, San Diego Brief Assessment of Capacity to Consent Questionnaire (UBACC) was used to screen for capacity to consent and improve understanding through iterative learning in a sample of 528 Xhosa people with schizophrenia and 528 controls. We address two questions: firstly, whether research participants’ understanding of the research study improved through iterative learning; and secondly, what were predictors for better understanding of the research study at the initial screening? During screening 290 (55%) cases and 172 (33%) controls scored below the 14.5 cut-off for acceptable understanding of the research study elements, however after iterative learning only 38 (7%) cases and 13 (2.5%) controls continued to score below this cut-off. Significant variables associated with increased understanding of the consent included the psychiatric nurse recruiter conducting the consent screening, higher participant level of education, and being a control. The UBACC proved an effective tool to improve understanding of research study elements during consent, for both cases and controls. The tool holds utility for complex studies such as those involving genomics, where iterative learning can be used to make significant improvements in understanding of research study elements. The UBACC may be particularly important in groups with severe mental illness and lower education levels. Study recruiters play a significant role in managing the quality of the informed consent process.
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  • Date Issued: 2017
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