BackgroundSmoking is the leading cause of preventable death worldwide and the prevalence is particularly high among psychiatric patients but recent international studies demonstrated that psychiatric patients are able and motivated to quit. The aim of this study was to evaluate cigarette smoking, nicotine dependence, and motivation for smoking cessation in male psychiatric inpatients in a sample of South African acute-care male psychiatric inpatients.MethodsAll inpatients admitted during a 2-month period (April to May 2016) to the Stikland Hospital Acute Male Admissions Unit in Cape Town, Western Cape, were included. Subjects completed a survey including a set of tests: Global Adult Tobacco Survey (GATS), the Fagerström Test for Nicotine Dependence (FTND), and the Decisional Balance for Cigarette Smoking (DBCS) (6-item version). Demographic data were obtained from patients’ clinical charts.ResultsAmong the 160 new inpatients, 72.5% (n = 116) completed the survey. Of the 116 participants, 91.4% (n = 106) were current smokers of whom 82% (n = 87) smoked daily and 55.6% (n = 59) were identified as having high nicotine dependence (FTND ≥ 6). Although a large majority (71.7%; n = 76) of current smokers expressed positive perceptions regarding smoking, a notable proportion (59.4%; n = 63) still attempted to quit the habit in the preceding 12 months and daily smokers were less likely to quit. However, only a minor proportion of all current (43.4%; n = 46) and specifically daily (40.2%; n = 35) smokers were advised on smoking cessation by a health worker.ConclusionThis study confirms that, similar to populations elsewhere, rates of cigarette smoking among psychiatric inpatients in South Africa is exceedingly high. While patients are motivated to quit smoking, few were provided with the necessary advice. Our findings provide further support for the integration of smoking cessation support in mental health care.

BackgroundThe non-medical use of prescription psychostimulants or cognitive-enhancing substances among healthy college students is a growing concern. This use appears to be particularly high among medical students. To our knowledge, no literature is available on the non-medical use of stimulants among South African medical students.ObjectiveTo determine the prevalence and correlates of non-medical stimulant use as well as subjective opinion on peer numbers using stimulants and university attitude towards stimulant use among a sample of South African undergraduate medical students.MethodsA descriptive observational study was conducted by means of a self-report questionnaire. Second- and fourth-year medical students (n = 252) completed the questionnaire.ResultsOf the sample, 44 (18%) reported a lifetime use of stimulants for non-medical purposes and 33 (85%) of this group reported use within the past year. A total of six (2%) students reported a diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD). In the group without a diagnosis of ADHD, non-medical stimulant use was associated with the year of study (p = 0.03) and illicit substance use (p = 0.01). Most of the students in this group (31, 32%) reported using stimulants to improve concentration.ConclusionNon-medical use of stimulants to improve concentration and academic performance is prevalent among the South African medical students sampled in this study. Further research at other institutions and under non-medical students would be helpful to assess the scope of this phenomenon.

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ObjectiveTo investigate the clinical features, prescribing patterns and outcomes of psychiatric inpatients admitted with methamphetamine-induced psychosis.MethodA cross-sectional, descriptive pilot study was conducted between March 2014 and August 2014 at three South African Mental Health Care Act designated hospitals prior to admission to a psychiatric hospital. Patients with methamphetamine-related psychotic symptoms according to the DSM-5 criteria were eligible. Structured face-to-face interviews were conducted and the Brief Psychiatric Rating Scale was employed as a measure of current psychopathology.ResultsFifty-six participants were included. Positive psychotic symptoms (e.g. hallucinations) were more prominent than negative symptoms (e.g. affective blunting). Almost half the participants (43%) had previous episodes of methamphetamine-induced psychosis. Within this group, all had defaulted on the prescribed treatment prior to admission. Only 29% of the participants had received prior formal substance-use rehabilitation as treatment for their disorder. High rates of comorbid cannabis and alcohol use (51%) were recorded. Most of the participants required transfer to specialist psychiatric hospitals. The amounts of methamphetamine used were not a predictor of the persistence of psychosis; however, the pattern of use was.ConclusionClinical features correspond with other international findings. The currently employed model of sequential, non-integrated psychiatric and substance use treatment in this setting appears ineffective.