Founder populations hold tremendous promise for mapping genes for complex traits, as they offer less genetic and environmental heterogeneity and greater potential for genealogical research. Not all founder populations are equally valuable, however. The Afrikaner population meets several criteria that make it an ideal population for mapping complex traits, including founding by a small number of initial founders that likely allowed for a relatively restricted set of mutations and a large current population size that allows identification of a sufficient number of cases. Here, we examine the potential to conduct genealogical research in this population and present initial results indicating that accurate genealogical tracing for up to 17 generations is feasible. We also examine the clinical similarities of schizophrenia cases diagnosed in South Africa and those diagnosed in other, heterogeneous populations, specifically the US. We find that, with regard to basic sample descriptors and cardinal symptoms of disease, the two populations are equivalent. It is, therefore, likely that results from our genetic study of schizophrenia will be applicable to other populations. Based on the results presented here, the history and current size of the population, as well as our previous analysis addressing the extent of background linkage disequilibrium (LD) in the Afrikaners, we conclude that the Afrikaner population is likely an appropriate founder population to map genes for schizophrenia using both linkage and LD approaches.

Objective: South Africa has a shortage of facilities and psychiatrists to assess adjudicative competence of prisoners awaiting assessment under sections 77 to 79 of the Criminal Procedures Act of 1977. Various solutions have been proposed by the Department of Health. The recent linking of a Magistrate's court and a prison by videoconferencing offers the opportunity to implement a forensic telepsychiatry service. The literature on forensic telepsychiatry for assessment of adjudicative competence was reviewed. Method: The electronic databases, PubMed, Scopus, Cinahl and Google Scholar were searched for papers on forensic telepsychiatry. The inclusion criterion was papers reporting the use of videoconferencing for assessment of adjudicative competence or for assessment for referral out of the judicial system, by psychiatrists or psychologists. Results: 411 papers were found of which 13, published between 1997 and 2008 were relevant. The use of videoconferencing for forensic psychiatric assessment was reported from four countries. The courts in those jurisdictions have accepted the use of videoconferencing for assessment and no successful appeals have been mounted on the basis of the use of videoconferencing for assessment. User satisfaction has not been reported for assessing adjudicative competence. Forensic telepsychiatry has been found to be cost effective, improve access to scarce specialist skills and reduce transport of prisoners under guard to hospitals or psychiatrists to prisons. Conclusion: There is nothing in the literature to suggest that a forensic telepsychiatry service is not feasible in South Africa and a pilot project is being planned.

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Mental health law in South Africa has been dominated in recent times by the Mental Health Care Act 2002. This paper provides selective insights into specific aspects of that Act and highlights its impact on clinical practice within a broad clinical setting and in so doing suggests areas for review and revision.

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Objective: Pre‐trial referrals to the Valkenberg Hospital forensic unit over a 6‐month period were studied. Habitually violent offenders were compared with those with no history of violence. Methods:  Risk factors known to be associated with violent behaviour were elicited, i.e. demographics, behaviour during index offence (such as impulsivity, identity of victim, use of weapon, accomplices, intoxication, psychotic symptoms), psychiatric and family histories, history of suicide attempts, past child abuse, head injury, criminal record, psychiatric diagnosis and presence of medical disorders. EEG's, Barratt's Impulsivity, Zuckerman's Sensation Seeking and Mini‐Mental Scales were administered. Behaviour in the ward during the 30 days was also appraised. Logistic regression models were used to determine relative risks. Results:  There were 155 subjects; 89.7% were male, 71.6% were single and 58.7% were unemployed. For 44.5% the index offence was violent, and 9.7% had committed sexual offences; 61.9% had histories of habitual violence. A psychotic disorder was diagnosed in 32.3% and a personality disorder in 48.4%. Habitually violent subjects were distin‐ guished by a history of issuing threats (OR=3.68; CI=3.19–4.16; P= 0.000), delusions of persecution (OR=3.43; CI=2.67–4.17; P=0.001), history of conduct disorder (OR=1.95; CI=1.70–2.19; P=0.006), alcohol/substance abuse (OR=2.08; CI=1.53–2.61; P=0.008) and violent index offence (OR=1.66; CI=1.54–2.61; P=0.035). Conclusion: This seems to confirm the relationship between threats, feeling threatened, psychosis, a history of antisocial behaviour and alcohol abuse.

Clostridium perfringens food poisoning can be fatal in patients with chronic constipation. We report the investigation and management of a probable outbreak of C. perfringens food poisoning among psychiatric patients in Cape Town, South Africa, in 2013.

There is a dearth of research on risk management of violent patients during the phase of transition from hospital to community care. D ischarge can only be contemplated when identi® ed risk factors are managed and tested in non-secure environments. Therefore this process should proceed cautiously and over as protracted a period as circumstances allow. A gradated programme which caters for various levels of risk allows for the testing of measures within a relatively well controlled milieu. Initial measures would include anticipating and preparing for future living arrangements (especially accommodation, supervision, ® nances) and psychoeducation for the patient and care givers. Speci® c risk factors, such as co-morbidity (especially alcohol and substance abuse), and relationship dif® culties may need specialized or particular individual interventions. Increasingly cultural issues will have to be considered and incorporated into management plans.M ost clinicians contem plate the discharge of dif® cult and previously violent patients with trepidation. The clinical team is confronted with competing interests: the need to treat and return the individual to the com munity, and the necessity of protecting others from possible harm. Various other factors have to be considered, such as the requirem ents of relevant legislation, problems encountered during previous attem pts at rehabilitation, and the resources available in the region. Unfortunately, the m ilieu of secure units is generally far removed from the demands and realities patients will confront outside' (Prins, 1990; Tong & M acKay, 1959). There will always be a sm all nucleus of treatm entresistant psychotic individuals with im pressive histories of sym ptom-driven violence for whom inde® nite institutionalization is appropriate, even though their behaviour in hospital m ay be exemplary. Som e will only be allowed brief (albeit frequent) supervised forays into the local surrounds. But for most, risk m anagement will have progressed as a counterpoint to risk assessm ent such that their eventual re-integration into society becomes possible. This process begins on admission and continues throughout rehabilitation. The pre-discharge period, during which the recent m em ories of containm ent in a secure unit com bine with the patient' s impatience to leave, is an exquisitely sensitive (and often precarious) opportunity to achieve long-lasting therapeutic gains.A com plicating factor is that m ost patients possess little insight into their disorder (or behaviour that precipitated the adm ission), and have had to submit to treatment under varying degrees of coercion. Whether continued m onitoring and m anagem ent in the com munity should be enforced by resorting to legislative measures rem ains contro-