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The introduction of computed tomography (CT) is recognised as one of the most important innovations in the recent history of clinical medicine. The value of this non-invasive technique in examining intracranial contents was quickly realised in the diagnosis and detection of vascular accidents and tumours.In psychiatric research studies, CT provides important insights into the aetiology and long-term structural abnormalities in the brains of patients with schizophrenia, mood disorders, metabolic and neurological disorders of the brain. However, the place of

Treatment of depression is often accompanied by weight changes. Previous studies indicate that leptin plays no role in this change despite showing a strong correlation with body mass index (BMI) in healthy people. The aim of this study was to evaluate the effect of imipramine and fluoxetine on BMI and its correlation with leptin. Eighteen depressed female patients randomly received either drug for 3 months. BMI was calculated and fasting blood samples were assayed for glucose, leptin, insulin, free fatty acids (FFA), and lipids. The difference between the changes in BMI (imipramine + 1.0 kg/m2, fluoxetine -0.5 kg/m2) was statistically significant (P < 0.05, t = 2.106). There was a significant positive correlation between overall BMI and leptin (r = 0.784, P < 0.001) but not between BMI and insulin or FFA. However, fasting insulin levels and calculated insulin resistance levels dropped substantially in the imipramine group. We conclude that the use of tricyclic antidepressants (TCAs) in depressed patients at risk for developing type 2 diabetes remains unresolved at this stage.

The Joint United Nations Programme on HIV and AIDS recently reported that the number of people newly infected with HIV and the number of AIDS-related deaths are decreasing globally.

Aim. The aim of the study was to determine knowledge, attitudes and personal beliefs regarding HIV and AIDS in a group of mentally ill patients attending outpatient clinics in Soweto, Johannesburg. Method. All patients attending four randomly chosen clinics in Soweto were invited to complete a self-administered questionnaire after obtaining informed written consent. The 63-item questionnaire, developed from others specifically for this study, included questions on socio-demographic and clinical characteristics; knowledge on how HIV is acquired and spread; attitudes and beliefs regarding HIV and AIDS; and condom usage. The statements in the knowledge sections were used to calculate a composite score, which if greater than or equal to 75% was defined as ‘adequate knowledge’. Results. A total of 1 151 patients with mental illness participated in the study. The mean age was 41.9 years (standard deviation 11.6) and the majority were males (50%); single (55%), and had achieved only a secondary level of education (53.3%). Overall, most of the study population did not believe in the myths surrounding the spread and acquisition of HIV and AIDS. There were however, significant associations between a low level of education and the belief that HIV is acquired from mosquito bites (odds ratio (OR) 1.61; 95% CI 1.19 - 2.18; p=0.002) and through masturbation or body rubbing (OR 1.76; 95% CI 1.34 - 2.33; p=0.000). Although more than 90% of the patients were aware of the facts regarding the spread of HIV, approximately 40% did not believe that one could acquire HIV through a single sexual encounter. The composite scoring for knowledge showed that less than half the patients had adequate knowledge of HIV/AIDS. This was significantly associated with gender and level of education: females were 1.6 times (p

The term 'adherence' is often used incorrectly and synonymously with the term 'compliance'.1 Compliance is the extent to which a patient's behaviour coincides with the medical prescription and recommendations. 2 Adherence, on the other hand, refers to the willingness and ability of patients to follow health-related advice, to take medication as prescribed, to attend scheduled appointments, and to complete recommended investigations.Compliance implies an obligation on the part of the patient to blindly follow the practitioner's instructions, while adherence implies a therapeutic alliance with the practitioner. Previously patients were classified as either adherent or non-adherent but now it is more evident that there is a continuum, with many patients showing some degree of adherence.Patients with psychiatric disorders show a greater degree of non-adherence to treatment than those with physical disorders. 3The adherence rates range from 40 -70% to 60 -92% in the respective disorders. About 30% of all patients with psychiatric disorders discontinue their medication in the first month and 44% discontinue it within the first 3 months of initiation of treatment. Aside from relapse and re-hospitalisation, non-adherence to treatment greatly compromises the efficiency, quality and promptness of care of the community staff. It carries a major direct cost of increased in-hospital treatment and an indirect cost of patient or carer absenteeism from work. 16 Further, these effects are borne not only by the mental health service, but also by the family and wider community. 17 Almost half of these costs could be saved through strategies directed at improving adherence. 18 Therefore, the purpose of this article was to look at the various forms of assessing adherence, the factors associated with adherence, and ways in which to improve adherence.

<p><strong>Objectives.</strong> To determine the ECG changes in a group of outpatients on chronic psychotropic medication, and the association, if any, with factors such as gender, age, co- morbid illness and the use of concomitant medication.</p><p><strong>Methods.</strong> Study subjects included patients 18 years and older attending the outpatient departments of Chris Hani Baragwanath and Johannesburg hospitals. The subjects’ demographic and clinical characteristics were obtained and a resting ECG was recorded.</p><p><strong>Results.</strong> Eighty patients were included in the study. The mean age of the subjects was 45.4 (standard deviation (SD) =18.2) years, with a minimum age of 18 and a maximum of 86 years. Fifty-four subjects (67.5%) had evidence of some ECG abnormalities. There was no significant difference between the occurrence of ECG abnormalities and the different age groups (p &gt; 0.05), gender (p &gt; 0.05), and different race groups (p &gt; 0.05). Sixty-one subjects (76.3%) had no co-morbid medical illness and were on psychotropic medication only; of these patients 43 (70.5%) had abnormal ECG tracings (p &gt; 0.05). The ECG abnormalities recorded included abnormal rate (28.8%), abnormal ST segment (20.5%), abnormal QRS complex (17.8%), abnormal T wave (15.4%), prolonged or borderline corrected QT interval (8.2%), irregular rhythm (5.5%) and prolonged PR interval (2.7%). There was a significant positive correlation between the corrected QT interval and age (r = 0.43, p &lt; 0.05) and between corrected QT interval and female gender (r = 0.31, p &lt; 0.05). There was no correlation between corrected QT interval and treatment of a co-morbid illness (r = 0.13, p &gt; 0.05).</p><p><strong>Conclusion.</strong> The use of psychotropic drugs is associated with ECG changes in ordinary doses. However, this study serves to strengthen previous evidence that, although common, most of these changes are of a benign nature.</p>

A Af fr ri ic ca an n J Jo ou ur rn na al l o of f P Ps sy yc ch hi ia at tr ry y • May 2008