Research Articles (Psychiatry)

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The association between burnout and empathy in intern medical doctors rotating at Steve Biko Academic Hospital in Pretoria, South Africa
Tatchell, Quanita N.; Fernihough, Melissa; Lippi, Gian (AOSIS, 2026-07-08)
BACKGROUND : Burnout, a state of mental and physical exhaustion from chronic work stress, affects approximately one in three doctors. Burnout is associated with substance use, suicidality and impaired doctor-patient relationships. It also contributes to reduced quality of care, increased medical errors and malpractice claims. Empathy is the cognitive ability to understand and respond to a patient’s experiences. This study explored the relationship between burnout and empathy among South African intern doctors. METHODS : This cross-sectional quantitative study used consecutive sampling. Self-administered questionnaires were completed by 95 interns. Data were analysed using descriptive statistics, as well as bivariate and multivariable analyses. RESULTS : The median age of interns was 26 years. Over 70% were overextended or burnt out. About one-third (33.68%) of participants had a diagnosed mental illness, and over half reported worsening illness during their internship. Lack of awareness of counselling services (83.16%) was associated with higher burnout (p = 0.020). Age was associated with burnout profile (p < 0.001), with younger interns more likely to be burnt out. Empathy scores were significantly lower in the burnt out, overextended and ineffective interns (p = 0.002), even after adjustment for demographic, clinical and work-related factors. CONCLUSION : The high prevalence of burnout among intern doctors and its inverse association with empathy underscore the need for systemic, evidence-based interventions to reduce burnout and enhance empathy, supporting the delivery of quality patient care. Contribution: This study offers novel insights into the challenges faced by South African intern doctors, providing a foundation for future research and targeted institutional reform.
Empathy and responses to self-effacing empathy training within adolescent-parent dyads
Gyapersad, Veren; Van Staden, Werdie (Elsevier, 2026-04)
PURPOSE : This study investigated empathy as a relational and developmental phenomenon by comparing adolescents and their parents for baseline empathy and their responses to a structured conjoint 8-week self-effacing empathy training (SEET) program. No prior reports have contributed quantitatively to the understanding of empathy within this specific generational pairing. METHODS : Data from 112 research participants, comprising 56 adolescent–parent dyads, were sourced from a randomized blinded placebo-controlled parallel group study on the efficacy of SEET. As measured on the Self-Effacing Empathy Scale (SEES), the Basic Empathy Scale (BES), and the four subscales of Interpersonal Reactivity Index (IRI), adolescents and their parents were compared statistically for empathy and the extent of change in response to SEET. RESULTS : At baseline, the adolescents scored significantly higher than their parents on the BES (MWU = 1,916; p = .041) and 55.4% of adolescents scored higher on the SEES but the latter was not statistically significantly (MWU = 1,758.5; p = .266). While both adolescents and parents showed increased empathy on all the measures, increases in self-effacing empathy were significantly higher in adolescents (MWU = 548.5; p = .01). Whether being an adolescent or a parent contributed significantly to the effect of the training on their self-effacing empathy (β = .20; p = .007) (accounting for 7.3% of the variance), but not so for the other measures of empathy. DISCUSSION : Adolescents appeared to be more empathic and responsive to SEET than their parents, notwithstanding that their parents responded in tandem while participating interactively in SEET.
Psychiatry and artificial intelligence : a need for informed engagement
Szabo, Christopher P.; Kotze, Carla; Galvin, Lisa; Minty, Yumna; Mgweba-Bewana, Lihle; Talatala, Mvuyiso; Gwanya-Mdletye, Sisikelelwe; Nortje, Gareth (AOSIS, 2026-06-18)
No abstract available.
Association of socio-clinical factors with psychological distress in parents or caregivers of children with mental illness
Bensingh, Zeruiah; Tsolekile De Wet, Zukiswa; Joubert, Marinda (Sage, 2026)
The COVID-19 pandemic has had a strong psychological impact on family units. This study investigated the contribution of sociodemographic and clinical factors to psychological distress in parents or caregivers of children with a mental illness at a specialist tertiary hospital in Gauteng, South Africa. A structured sociodemographic and clinical questionnaire measuring psychological distress was self-administered to 150 participants. The Perceived Stress Scale (PSS) was used to measure the severity of stress, the Patient Health Questionnaire-9 (PHQ-9) was used to measure the severity of depression, and the Generalized Anxiety Disorder-7 (GAD-7) was used to measure the severity of anxiety. Significant predictors of mental health status include loss of home due to COVID-19 (odds ratio [OR: 46.61], 95% confidence interval [CI: 5.81, 1,089.92]), history of psychiatric treatment (OR: 11.98, [3.16, 57.22]), perceived decline in quality of life (OR: 11.88, [1.20, 185.28]), female sex (OR: 3.83, [1.00, 17.7]), and difficulty spending time with extended family (OR: 3.09, [1.10, 9.29]). The mental health status of caregivers of children with mental illness during the COVID-19 pandemic was likely influenced by the loss of a home due to COVID-19, a history of psychiatric treatment, a perceived decline in quality of life, the female gender, and difficulty spending time with extended family. Our study demonstrated the intricate interplay of socioclinical factors with depression, anxiety, and perceived stress.
Factors associated with depression and anxiety among mental healthcare practitioners
Murugas, Cheval; Kotze, Carla (AOSIS, 2025-02-21)
BACKGROUND : Anxiety and depression constitute a significant global mental health burden. The extant literature indicates elevated rates of anxiety and depression among mental healthcare practitioners; however, this phenomenon remains understudied within this particular population. METHODS : A cross-sectional study was conducted using self-administered questionnaires. Participants voluntarily completed an anonymous socio-demographic questionnaire, the General Anxiety Disorder-7 scale and the Patient Health Questionnaire-9. RESULTS : The study included 255 participants from various occupational categories within mental health. High levels of anxiety (N = 56; 22%) and depression (N = 42; 16.5%) were found among mental healthcare practitioners. Participants with a prior history of anxiety and/or depression (21.2%) demonstrated a significant association with anxiety and depression at the time of completion of the questionnaire (p = 0.000). CONCLUSION : Mental health practitioners with a previous history of anxiety and depression were at a substantially higher risk of experiencing current symptoms, highlighting the need for workplace support mechanisms tailored to this vulnerable group. CONTRIBUTION : This research identified a specific group of mental health practitioners at elevated risk for anxiety and depression that warrants targeted interventions through occupational assistance initiatives and preventative strategies.
Opinions and experiences of tertiary-level mental health providers regarding the down-referral of patients : a qualitative study
Tjiana, Nomthandazo S.; Nkondo-Ndaba, M.P.; Joubert, Pierre M. (AOSIS, 2025-12-11)
BACKGROUND : Down-referral of patients from tertiary psychiatric hospitals to primary healthcare (PHC) is central to South Africa’s National Mental Health Policy, which advocates for decentralised, accessible and sustainable mental healthcare. This process supports continuity of care, reduces pressure on specialist services and promotes community reintegration. Despite these benefits, challenges such as limited PHC resources, poor medication supply, inadequate staffing and stigma undermine effective implementation. This study explored the opinions and experiences of mental health providers at Weskoppies Psychiatric Hospital, a tertiary psychiatric facility in Pretoria, South Africa, to better understand these challenges, perceptions and potential strategies. METHODS : A qualitative, exploratory design using grounded theory was employed. Purposive sampling was used to recruit 12 healthcare professionals who worked at the outpatient department and were involved in the down-referral process, with data collection continuing until theoretical saturation was reached. Semi-structured interviews were conducted. Data were analysed thematically. RESULTS : Five key themes emerged: (1) The importance of early planning for discharge and down-referral but inconsistently applied; (2) patient resistance, often driven by fear, stigma and distrust of PHC, complicates transitions; (3) perceived challenges at PHC included staff shortages, long waits and poor medication availability; (4) perceived stigmatisation; and (5) recommendations for improving the down-referral process including better communication, dedicated referral coordinators, use of outreach teams, improved documentation and dedicated mental healthcare providers at the PHC level. CONCLUSION : Down-referral is necessary but challenged by systemic and relational gaps. Down-referral can be enhanced by improving PHC capacity, standardising discharge planning and reducing stigma. Patients and their families should be included in care decisions.
Knowledge and perceptions of mental health care users on decriminalisation of cannabis at Weskoppies, a tertiary psychiatric hospital in Gauteng, South Africa
Montoedi, Botshelo P.; Sibanyoni, A.U.D.; Moeketsi, Tshepiso D.; Tosh, Cheryl (AOSIS, 2025-12-11)
BACKGROUND : The decriminalisation of cannabis is gaining support in many countries, including South Africa. Decriminalisation does not make cannabis entirely legal but reduces the severity of punishment for possession and use. This study aimed to explore perceptions and knowledge of cannabis decriminalisation among mental health care users (MHCUs) at a tertiary psychiatric hospital (Weskoppies hospital) in Gauteng, South Africa. METHODS : This was a cross-sectional, quantitative study. Mental health care users with positive cannabis urine tests completed a structured questionnaire. Participation was voluntary and anonymous. Using the cannabis use disorder identification tool (CUDIT-R), participants were categorised into two groups: those with hazardous cannabis use and those with a cannabis use disorder. Both bivariate analyses (t-tests) and logistic regression models were performed to assess associations between knowledge or perceptions and sociodemographic variables (p ≤ 0.05). RESULTS : The study included 90 participants, mostly single male (81%, n = 73), with Grade 12 education. The findings revealed that 6% of participants had accurate knowledge of cannabis, 56% had good knowledge and 38% had poor knowledge. Participants with good knowledge of cannabis had 3.3 (95% confidence interval [CI] 1.54–15.44) greater odds of poor perceptions on decriminalisation of cannabis and a 4.9 (95% CI 1.12–8.23) decreased odds of cannabis use disorders. Additionally, older age (OR: 8.15; 95% CI 0.98–68.52) was statistically significant with increased odds of cannabis use disorders. CONCLUSION : This study highlights the varied levels of knowledge about cannabis among MHCUs and underscores the need for targeted education and rehabilitation services to address cannabis use issues.
Examining suicide risk among people with schizophrenia, focusing on the role of anosognosia and the ethical considerations for future research directions
Kotze, Carla; Roos, J.L. (Johannes Louw) (Frontiers Media, 2025-10-20)
This perspective paper discusses the primary risk factors consistently identified in systematic reviews of suicide among individuals with schizophrenia. Particular attention is given to the intricate relationship between anosognosia (lack of insight into one’s illness) and suicide risk in this population. This paper explores how anosognosia may influence other established risk factors and potentially contribute to suicidal behavior in patients with schizophrenia. By analyzing this complex interplay, this paper aims to provide a more comprehensive understanding of suicide risk in schizophrenia, potentially informing more effective prevention strategies and interventions for this vulnerable group. Future research in this area should carefully consider the ethical implications, including the potential impact of interventions on individuals with varying levels of insight into their condition. Researchers must prioritize participant safety and well-being while balancing the need to advance knowledge in this critical field.
Clinicians and artificial intelligence
Szabó, Christopher Paul; Kotze, Carla; Galvin, Lisa J.; Minty, Yumna; Mgweba-Bewana, Lihle; Talatala, Mvuyiso; Gwanya-Mdletye, S.; Nortje, Gareth (South African Medical Association, 2026-02)
No abstract available.
Defining public health transformation : a scoping review
Phooko, Violet; Maluleke, Kuhlula; Ramatsokotla, Sebueng; Serite, Thato; Kgarosi, Kabelo; Sokudela, Funeka Brenda; Mashamba‑Thompson, Tivani Phosa (Wiley, 2025-06)
Public health transformation aims to instigate enduring changes in healthcare services, staff roles and patient involvement, fostering heightened satisfaction among patients and staff while bolstering financial sustainability. Public health transformation is the process of reorganizing and creating a shared vision to ensure the right mindsets, capacity, resources and workforce to deliver equitable Foundational Public Health Services and ultimately promote health, well-being and equity. Such transformation requires a fundamental change in public health systems’ structure, functioning and interactions, supported by continuous quality improvement, innovation, partnerships, community-driven efforts and systems change. This scoping review maps evidence of public health transformation. Searches encompassed databases including EBSCO Host, Academic Search Complete, Africa-Wide Information, Dentistry & Oral Sciences Source, Health Source–Consumer and Academic Edition, PUBMED and Scopus. Abstracts and full-text articles were screened by two independent reviewers against predefined criteria. Inclusion criteria spanned peer-reviewed published between 2013 and 2023. The quality of the included studies was assessed using the 2018 version of the mixed method appraisal tool. Screening results were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Of 9509 articles retrieved, 808 duplicates were excluded, leaving 8692 for title and abstract screening. Following title and abstract screening, 105 articles were relevant and underwent full article screening, which resulted in 20 that became eligible for data extraction. Emergent themes included (1) Transformation in Public Healthcare; (2) Evaluation of Health Transformation Programs; (3) Financial Implications; (4) Public Health Access; and (5) Job Satisfaction. Theme 4 featured a subtheme addressing healthcare access for minority groups. Overall, the review highlights a dearth of evidence guiding policymakers in decision-making on public health transformation, oversight of vulnerable populations, financial implications, and healthcare accessibility. Solutions should prioritize a people-centred approach in both practice and research to effectively address these gaps.
Genetiese argitektuur van skisofrenie : wat weet en sê ons nou?
Roos, J.L. (Johannes Louw); Kotze, Carla (Suid-Afrikaanse Akademie vir Wetenskap en Kuns, 2025)
AFRIKAANS : Tien jaar gelede is bevindinge oor die genetiese argitektuur van skisofrenie en die bydrae van studies onder Afrikaners gerapporteer. In hierdie oorsigsartikel word gekyk na wat ons nou weet en watter inligting ons aan pasiënte en familie kan oordra. Genetiese oorvleueling by psigiatriese steurnisse word uitgelig. Daar word beklemtoon dat die kliniese gebruik van poligeniese risikotellings (PRT) vir skisofrenie tentatief is. Daar word ook verwys na die nut van die uitsonderlike gebruik van PRT in kombinasie met kopiegetalvariante-toetsing (KGV-toetsing) word genoem. Tydens genetiese raadgewing vir skisofrenie word pasiëntgesentreerde psigoterapeutiese benadering gevolg. In hierdie proses word die pasiënt bemagtig om leefstylveranderinge aan te bring wat onder andere omgewingsrisikofaktore die hoof sal bied. Skisofrenie is poligeniese steurnis, waar die kumulatiewe eff ek van verskeie gene wat onafhanklik reageer tot die uiteindelike eff ek lei. Daar is tans geen genetiese toets beskikbaar om diagnose van skisofrenie te bevestig nie. Die individuele voorspelling van risiko om skisofrenie te ontwikkel bly uitdaging. Algemene en seldsame DNAvariante betrokke by skisofrenie word gebruik om die komplekse aard van die siektepatogenese te verduidelik. Epigenetika in genetiese raadgewing word beklemtoon. Hopelik sal hierdie inligting die onrealistiese verwagtinge, stigma en diskriminasie teenwerk wat met onvoldoende begrip van genetiese bevindinge in skisofrenie verband hou.
The self-effacing empathy scale : its validity and reliability among adolescents and their parents
Gyapersad, Veren; Van Staden, Werdie (Elsevier, 2026-01)
BACKGROUND : Empathy is a cornerstone of interpersonal and emotional health, yet its measurement often conflates self-oriented sympathetic responses with other-oriented empathy. To measure other-oriented empathy in its interpersonal manifestation, the Self-Effacing Empathy Scale (SEES) was examined for its validity and reliability among adolescents and their parents. METHOD : Adolescents and their parents, resident in South Africa were recruited through social media. Hundred and twelve participants completed a composite questionnaire that comprised the SEES, Basic Empathy Scale (BES), Interpersonal Reactivity Index (IRI), and the Vigour Assessment Scale (VAS). A replicative data set comprising the same measures was collected eight weeks later from the same participants. RESULTS : Convergent validity of the SEES was found in it correlating strongly in the initial data set with the BES (r = 0.639) and moderately with the other-oriented items of the IRI (r = 0.528), and strongly in the replicative data set (r = 0.884; r = 0.771). Discriminant validity was found in its weak correlation with the VAS (r = 0.326) in the initial data set. Cronbach's alpha coefficients indicated good (0.697) and excellent (0.940) internal consistency. The SEES incurred a small standard error of measurement, whereby the total scores were differing at most between 2.34 and 2.49 from the true values over 72 theoretically possible scores. A three-factor model indicated structural reliability, accounting for 46.3 % and 64.8 % of the cumulative variance in the respective data sets. CONCLUSIONS : The SEES provides a valid and reliable measure for investigating associations between health and self-effacing empathy, and effects of interventions on it. HIGHLIGHTS • The SEES is reciprocally other-oriented rather than self-oriented like sympathy. • The SEES showed convergent validity with other empathy scales. • The SEES showed good internal consistency and only a small error of measurement. • Structurally, it yielded a 3-factor model accounting for 64.8 % of the variance. • The SEES provides for research on health associations and effects of interventions.
Examining the Mr Tsafendas enquiry trial : current insights on forensic psychiatric assessment and ethics
Roos, J.L. (Johannes Louw); Kotze, Carla (South African Medical Association, 2024-04)
On 6 September 1966, the prime minister of South Africa, Dr HF Verwoerd was killed by Mr Tsafendas, a Portuguese national of Greek descent, in parliament by stabbing him in the chest. Mr Tsafendas was a messenger in parliament. At the enquiry trial of Mr Tsafendas, he was found unfit to stand trial on the ground that he suffered from schizophrenia. The psychiatric evidence during the enquiry trial was reviewed and discussed under the following headings: Diagnosis of schizophrenia; Consideration of cultural factors in forensic psychiatric settings; Delusional infestation v. extreme overvalued beliefs; Simulation of psychosis; Ethical considerations in criminal capacity and trial competency assessments. Lessons from the Mr Tsafendas enquiry trial for forensic psychiatrists where a defendant previously diagnosed with schizophrenia commits a prominent political murder, are summarised. It is emphasised that the personhood of an accused referred for forensic observation should be respected and protected, instead of focusing exclusively on a specific diagnosis.
Psychiatric nurses' knowledge of COVID-19 within a patient care context : a qualitative study
Dyonase, Sandisiwe; Swanepoel, Isabelle; Lippi, Gian (AOSIS, 2025-01)
BACKGROUND : Coronavirus disease 2019 (COVID-19) infection caused unparalleled hastening of the transmission of infection worldwide, commonly affecting healthcare workers’ well-being. Nursing staff spend most hours caring for patients and are the first contact that patients utilise when reporting symptoms or receiving treatment. AIM : This study aims to evaluate the knowledge of COVID-19 among psychiatric nurses at a tertiary psychiatric hospital. SETTING : Weskoppies Hospital, Gauteng, South Africa. METHODS : We conducted a qualitative study comprising 14 semi-structured interviews with nurses working at Weskoppies Hospital in South Africa. We used open-ended questions to facilitate the discussion and provide some structure for the interview while still allowing the participants to elaborate freely. The recordings were later transcribed into text. RESULTS : Twenty nurses working full time at the hospital, were recruited for the study. The nurses’ knowledge about COVID-19 was summarised into five major themes, each with subthemes: signs and symptoms of COVID-19, risk of contracting the virus, the spread of COVID-19, prevention, and complications. In this study, the majority of participants had relatively good knowledge regarding COVID-19. CONCLUSION : The majority of nurses at the hospital had adequate knowledge about COVID-19 but limited knowledge about the mode of transmission of the infection. Consistently improving healthcare workers’ knowledge about infection control measures through training, supplying information and identifying areas for improvement can ultimately enhance patient care and outcomes. CONTRIBUTION : This study sheds light on the value of nurses’ understanding of COVID-19, particularly in a psychiatric setting.
Mental health literacy among secondary school learners in Tshwane region 1 : a quantitative study
Madlala, Dumisile P; Joubert, Pierre M.; Mokoena, Oratilwe P. (AOSIS, 2025-04)
BACKGROUND : Mental health literacy (MHL) is one of the crucial factors in the prevention and maintenance of youth mental health. Despite this fact, there is limited research on MHL in this age group. AIM : To determine the MHL in a sample of secondary schoolgoing learners. SETTING : Five schools in Tshwane, South Africa. METHODS : A quantitative cross-sectional study was done. Three fictive vignettes depicting individuals having symptoms of major depressive disorder (MDD), substance-induced psychotic disorder (SIPD) and social anxiety disorder (SAD) were presented to participants. The ability to recognise the disorder, knowledge of the best form of help to address the symptoms, and the ability to provide psychological first aid support were assessed. A comparison of MHL between township school learners and urban school learners was conducted. The association between MHL and demographic factors was also assessed. RESULTS : The ability to recognise symptoms and connect them to a particular disorder was high (80.71% for MDD, 61.96% for SIPD and 67.91% for SAD). Correct knowledge on who would best address the symptoms was 52.55% for MDD, 63.83% for SIPD and 23.86% for SAD with a sizable number choosing informal help for the cases of MDD and SAD. There was good psychological first aid knowledge for both MDD and SIPD cases but poor for SAD case. CONCLUSION : Even though the results are promising regarding the recognition of all three disorders, there is still room for improving MHL in this group, especially in the areas of help-seeking and knowledge about anxiety disorders in general. CONTRIBUTION : The findings highlight key areas of focus during mental health awareness campaigns to learners.
Medication non-adherence in re-admitted patients at a psychiatry hospital : a qualitative study
Zwide, Gopolang E.; Dewet, Zukiswa Tsolekile; Sokudela, Funeka Brenda (AOSIS, 2025-02)
BACKGROUND : Medication non-adherence is a significant public health concern and is prevalent among mental healthcare users. Approximately 65% of patients with severe mental illness do not adhere to their prescribed medication. Medication nonadherence may worsen mental illness and result in poorer clinical outcomes, including frequent relapses and rehospitalisation rates, as well as long time to remission, which may contribute to increased cost of care. AIM : We explored perspectives regarding reasons for medication non-adherence among readmitted psychiatric patients. SETTING : Weskoppies Psychiatric Hospital, Pretoria, South Africa. METHODS : We adopted the social constructivism paradigm for this exploratory qualitative study. Purposive sampling was used to select 15 re-admitted patients, who were nonadherent to their medication. Data were collected through individual semi-structured interviews. The interviews were audio recorded and transcribed. The data were thematically analysed, using the principles of grounded theory. RESULTS : Substance abuse, a lack of family support and poor health literacy were the most common reasons for non-adherence to medication. Other reasons included medication side effects, healthcare system drawbacks and a lack of finances to access healthcare. Some patients did not adhere to their medication because they believed that their mental illnesses were spiritual in origin. CONCLUSION : Multiple factors contributed to patients not adhering to their medication, ultimately resulting in their relapse and readmission. Clinicians should be cognisant of these factors when trying to prevent relapse and readmission. CONTRIBUTION : Clinicians also ought to identify patients who are at risk of not adhering to medication. Targeted interventions should be established for tackling medication non-adherence.
Exploration of psychiatric inpatients' experience of adapting to the COVID-19 pandemic
Magwabeni, Muimeleli Prudence; Swanepoel, Isabelle; Joubert, Marinda (AOSIS, 2025-06)
BACKGROUND : The coronavirus disease 2019 (COVID-19) pandemic has changed life globally and significantly disrupted psychiatric inpatient care, with infection control measures altering therapeutic environments and exacerbating patient distress. Both staff and inpatients had to quickly adapt to new norms while maintaining care in an already vulnerable setting. AIM : This study aimed to explore psychiatric inpatients' experience of adapting to the COVID-19 pandemic. SETTING : The study was conducted in Weskoppies Psychiatric Hospital, Tshwane, Gauteng. METHODS : We conducted a qualitative study comprising 15 semi-structured interviews with psychiatric inpatients admitted to Weskoppies Hospital in South Africa during the COVID-19 pandemic, using purposive sampling. Open-ended questions encouraged detailed responses and guided the conversation. Recordings were later transcribed for analysis. RESULTS : Our study showed that psychiatric inpatients displayed an engagement strategy, rather than a disengagement approach, in adapting to a crisis. They actively tried to control, manage, and change stressful situations by accepting the hospital infrastructure and new COVID-19 rules, seeking social support, and holding on to their faith. CONCLUSION : Psychiatric inpatients at Weskoppies Hospital adapted to the COVID-19 pandemic through support from staff, family, hospital systems, and personal coping strategies. These findings highlight the need for holistic, patient-centred care that includes psychosocial and spiritual support during times of crises. CONTRIBUTION : This study provided insights into psychiatric inpatients' experiences and can help mental healthcare practitioners to ensure a more positive experience during rehabilitation and reintegration of psychiatric patients into society.
A psychiatrist in training encounters a traditional healer
Singh, Raksha; Joubert, Pierre M. (AOSIS, 2025-06)
BACKGROUND : Traditional healers play a significant role in healthcare seeking in South Africa. Many South Africans often seek healthcare services from both medical practitioners and traditional healers simultaneously for the same condition. Despite this, many medical practitioners seem ignorant about the practices of traditional healers. AIM : This study aimed to explore the similarities and differences between the practices of a traditional healer (TH) and a psychiatrist in training (PIT) regarding an inpatient mental healthcare user (MHCU). SETTING : This study was conducted at an inpatient ward at Weskoppies Hospital, Pretoria. METHODS : An autoethnographic method was utilised in this study. RESULTS : The TH and PIT evaluated the same MHCU. While doing so, the PIT used participant observation, field notes, and finally a qualitative content analysis. The findings of the content analysis were validated with the TH. Two previously unpublished findings in South African traditional healing emerged: the use of a doll (effigy) and calling on angels. CONCLUSION : The TH and PIT followed the same basic steps in evaluating and treating the MHCU, but there were notable differences in the details (subcategories) of those steps. These differences reflect very different epistemologies about mental illness: the PIT used an evidence-based, naturalistic (or positivistic) model, while the TH used a model that can best be designated as transcendent. CONTRIBUTION : This study contributes towards an understanding of a TH’s approach to a mentally disordered patient.
Maladaptive daydreaming should be included as a dissociative disorder in psychiatric manuals : position paper
Soffer-Dudek, Nirit; Somer, Eli; Spiegel, David; Chefetz, Richard; O'Neil, John; Dorahy, Martin J.; Cardena, Etzel; Mamah, Daniel; Schimmenti, Adriano; Musetti, Alessandro; Boon, Suzette; Van Dijke, Annemiek; Ross, Colin; Nijenhuis, Ellert; Krause-Utz, Annegret; Dell, Paul; Gold, Steven N.; Pietkiewicz, Igor; Silberg, Joyanna; Steele, Kathy; Moskowitz, Andrew; Draijer, Nel; Thomson, Paula; Barach, Peter; Kinsler, Philip; Maves, Peter; Sar, Vedat; Kruger, Christa; Middleton, Warwick (Cambridge University Press, 2025)
Maladaptive daydreaming is a distinct syndrome in which the main symptom is excessive vivid fantasising that causes clinically significant distress and functional impairment in academic, vocational and social domains. Unlike normal daydreaming, maladaptive daydreaming is persistent, compulsive and detrimental to one’s life. It involves detachment from reality in favour of intense emotional engagement with alternative realities and often includes specific features such as psychomotor stereotypies (e.g. pacing in circles, jumping or shaking one’s hands), mouthing dialogues, facial gestures or enacting fantasy events. Comorbidity is common, but existing disorders do not account for the phenomenology of the symptoms. Whereas non-specific therapy is ineffective, targeted treatment seems promising. Thus, we propose that maladaptive daydreaming be considered a formal syndrome in psychiatric taxonomies, positioned within the dissociative disorders category. Maladaptive daydreaming satisfactorily meets criteria for conceptualisation as a psychiatric syndrome, including reliable discrimination from other disorders and solid interrater agreement. It involves significant dissociative aspects, such as disconnection from perception, behaviour and sense of self, and has some commonalities with but is not subsumed under existing dissociative disorders. Formal recognition of maladaptive daydreaming as a dissociative disorder will encourage awareness of a growing problem and spur theoretical, research and clinical developments.
Schneiderian first rank symptoms significantly predict a dissociative disorder diagnosis in psychiatric in-patients
Kruger, Christa; Fletcher, Lizelle (Taylor and Francis, 2025)
Previous empirical studies on the relationship between psychotic symptoms and dissociative disorders focused on auditory hallucinations only or employed limited statistical analyses. We investigated whether the frequency of Schneiderian first rank symptoms (FRS) predicts the presence or absence of a dissociative disorder (DD). Psychiatric in-patients (n = 116) completed measures of dissociation, FRS and general psychological distress (GPD). DD diagnoses were confirmed by multidisciplinary teams or administering the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised (SCID-D-R). The FRS were recorded in the Multidimensional Inventory of Dissociation (MID) and a mean score obtained for 35 relevant items: Voices arguing, voices commenting, made feelings, made impulses, made actions, influences on body, thought withdrawal, and thought insertion. A global severity index (GSI) of GPD was obtained from the Symptom Checklist–90–Revised (SCL-90- R). Logistic regression models examined whether FRS predict diagnostic classification of patients under a DD (n = 16) or not (n = 100), controlling for GSI. The overall fit of the model was significant (p = .0002). DD was correctly classified using frequency of FRS, controlling for GSI. The latter was moderately associated with FRS (r = 0.56). FRS more than doubled the odds of a DD diagnosis (odds = 2.089; 95% CI = 1.409–3.098; correct classification rate 87.1%). The study provides convincing evidence that FRS are closely related to DDs. FRS should alert clinicians to consider DDs in differential diagnosis of psychiatric in-patients. Future research should analyze whether FRS also predict a diagnosis of schizophrenia or other psychiatric disorders.

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