Free State Psychiatric Complex Research Articles

Psychiatric morbidity in children involved in bullying treated at the Free State Psychiatric Complex.

Bullying is a multifaceted problem with many consequences. This study aimed to determine the psychiatric morbidity of children involved in bullying, either as bullies or victims, treated at the Child and Adolescent Mental Health Care Centre of the Free State Psychiatric Complex (FSPC). Free State Psychiatric Complex, Bloemfontein, South Africa. This retrospective cross-sectional study included children under 18 years treated at the FSPC Care Centre between January and September 2017. Information was extracted from patient files. Of 288 patients, 98 (34.0%) were involved in bullying: 66 were bullies, 28 victims, 3 bully-victims, and 1 unspecified. For gender and family structure, there were no statistically significant differences between children involved and those not involved in bullying and between bullies and victims. Almost all bullies (95.4%) had aggression as presenting complaint compared with 39.3% of the victims (p < 0.01). Statistically significantly more victims, than bullies, reported sadness (21.4%, 4.6%, p = 0.02). Attention deficit/hyperactivity disorder (ADHD) was diagnosed in most children, both involved (73.5%) and not involved (63.2%). Statistically significant differences for the presence of conduct disorder were found between children involved and those not involved in bullying (31.6%, 10.0%, p < 0.01) and between bullies and victims (39.4%, 14.3%, p = 0.02). The prevalence of conduct disorder diagnosis was more common in bullies than in victims and those involved in bullying as opposed to those not involved. Psychiatric information of bullying victims and perpetrators in the Free State, which had a high prevalence of bullying in a national survey.

The profile of offenders accused of rape referred to the Observation Ward of the Free State Psychiatric Complex, Bloemfontein, South Africa, 2011-2015.

BackgroundSexual assault in South Africa has reached alarming proportions. Mental illness amongst offenders accused of rape is one of the complicating factors.AimTo describe the sociodemographic, clinical and forensic profile of alleged offenders accused of rape referred to a South African tertiary public psychiatric hospital for forensic evaluation, as well as describe the profile of the reported victims.SettingFree State Psychiatric Complex (FSPC) Observation Ward, Bloemfontein, South Africa.MethodsThis cross-sectional retrospective study compiled a sociodemographic, clinical and forensic profile of offenders accused of rape referred to the FSPC for forensic assessment between 2011 and 2015. The study population comprised 159 alleged offenders. Sociodemographic data, mental status, clinical diagnoses, comorbid substance use and forensic outcomes were collected from clinical files.ResultsAll accused offenders were male with a median age of 30 years. About half obtained primary school level education. Unemployment was common (37.3%) with 40% receiving government grants. Most accused offenders were single (78.0%). Clinically, schizophrenia spectrum and other psychotic disorders were the most common diagnoses (30.8%), followed by intellectual disability (16.3%). Almost a third of the accused offenders did not suffer from any mental illness. Alcohol (20.1%) and cannabis use disorders (12.6%) were dominant comorbidities. After a 30-day evaluation period, 53.2% of alleged offenders were found competent to stand trial. The verdict of criminal responsibility was made for 43.7% of this sample.ConclusionThis study contributes data on sociodemographics, psychiatric morbidities and comorbidities and forensic findings amongst alleged offenders of rape referred for forensic assessment.

Demographic, clinical and social characteristics of forensic patients diagnosed with schizophrenia at the Free State Psychiatric Complex, Bloemfontein, South Africa

Schizophrenia, prevalent in forensic mental health settings, is chronic and devastating, with a generally unfavourable course and prognosis. The aim of this study was to determine the demographic, clinical and social characteristics of forensic patients diagnosed with schizophrenia at the Free State Psychiatric Complex. A data collection form was used to gather information from the clinical records of patients diagnosed with schizophrenia between 1 January 2011 and 31 December 2015. The majority of the 110 participants were young male adults aged between 18 and 35 years with a low educational level. Cognitive impairment and positive symptoms were the most prominent clinical features. Aggressive and violent behaviour was notably prevalent. The majority of our sample had committed crimes against humans, while fewer had committed other types of crimes. It was concluded that causal factors included young adulthood, male gender, substance abuse, a poor social support system and lower educational level.

Reported exposure to trauma among adult patients referred for psychological services at the Free State Psychiatric Complex, Bloemfontein

Background: Information regarding lifetime exposure to potentially traumatic events is critical in the management of various psychiatric disorders. Recent South African research suggests high levels of trauma exposure in the general population, however, the prevalence and type of potentially traumatic events among tertiary psychiatric patients are unknown.Objective: The study aimed to explore and describe the extent and nature of reported potentially traumatic events and associated variables in adult patients referred for psychological services at the Free State Psychiatric Complex (FSPC), Bloemfontein.Methods: In this cross-sectional study, demographic information, diagnostic morbidity and co-morbidity, and presence and type of reported trauma exposure reported by patients during the initial assessment were obtained from files of adult patients seen during a one-year period (2010) at the out-patient unit and the in-patient affective ward at the FSPC. Data were captured on data record forms by the researchers and analysed by means of descriptive statistics, univariate analysis and logistic regression (SAS version 9.1).Results: Of the 192 adults (71.9% White and 67.2% female) referred for psychological services,75.5% were diagnosed with mood disorders, 17.2% with anxiety disorders, 22.4% with substance-related disorders and 20.9% with cluster B personality disorders or traits. A total of 145 (75.5%) reported past trauma exposure. The most frequently reported types of trauma exposure were traumatic death/injury of a loved one (37.0%), physical assault (24.5%), witnessed/threatened violence (19.3%), and sexual assault (17.7%). Women were more likely to have been exposed to trauma than men (OR 4.02, 95% CI 1.87–8.62), in particular to traumatic death of a loved one (OR 3.13), physical assault (OR 4.08), or sexual assault (OR 5.43).Conclusions: The findings of this study contribute to current data regarding the prevalence of exposure to trauma and its possible association with mental illness. The importance of comprehensive trauma exposure screening in routine psychiatric interviewing practices is highlighted.

Reported exposure to trauma among adult patients referred for psychological services at the Free State Psychiatric Complex, Bloemfontein

BackgroundInformation regarding lifetime exposure to potentially traumatic events is critical in the management of various psychiatric disorders. Recent South African research suggests high levels of trauma exposure in the general population, however, the prevalence and type of potentially traumatic events among tertiary psychiatric patients are unknown. ObjectiveThe study aimed to explore and describe the extent and nature of reported potentially traumatic events and associated variables in adult patients referred for psychological services at the Free State Psychiatric Complex (FSPC), Bloemfontein. MethodsIn this cross-sectional study, demographic information, diagnostic morbidity and co-morbidity, and presence and type of reported trauma exposure reported by patients during the initial assessment were obtained from files of adult patients seen during a one-year period (2010) at the out-patient unit and the in-patient affective ward at the FSPC. Data were captured on data record forms by the researchers and analysed by means of descriptive statistics, univariate analysis and logistic regression (SAS version 9.1). ResultsOf the 192 adults (71.9% White and 67.2% female) referred for psychological services, 75.5% were diagnosed with mood disorders, 17.2% with anxiety disorders, 22.4% with substance-related disorders and 20.9% with cluster B personality disorders or traits. A total of 145 (75.5%) reported past trauma exposure. The most frequently reported types of trauma exposure were traumatic death/injury of a loved one (37.0%), physical assault (24.5%), witnessed/threatened violence (19.3%), and sexual assault (17.7%). Women were more likely to have been exposed to trauma than men (OR 4.02, 95% CI 1.87–8.62), in particular to traumatic death of a loved one (OR 3.13), physical assault (OR 4.08), or sexual assault (OR 5.43). ConclusionsThe findings of this study contribute to current data regarding the prevalence of exposure to trauma and its possible association with mental illness. The importance of comprehensive trauma exposure screening in routine psychiatric interviewing practices is highlighted.

Accountable or not accountable: A profile comparison of alleged offenders referred to the Free State Psychiatric Complex Forensic Observation Ward in Bloemfontein from 2009 to 2012.

BackgroundThe crime rate in South Africa is extraordinarily high. The problem of crime is further complicated when a person, who suffers from a mental illness, becomes involved in a crime. Furthermore, the forensic evaluation of a person suspected of having a mental illness involved in alleged criminal behaviour can be challenging. However, a dearth of information exists in South African literature regarding the link between crime and mental illness.AimTo determine the percentage of alleged offenders, referred to the Free State Psychiatric Complex (FSPC) for observation, found accountable and not accountable, and to compare the biographical, diagnosis and offence profiles of these two groups. The analysis of differences can contribute to a better understanding of the complex process of forensic assessments.SettingForensic Observation Ward, FSPC, Bloemfontein.MethodsIn this comparative, retrospective study, all 505 trial-awaiting alleged offenders (observati) referred from 2009 to 2012 for a 30-day observation period, according to Sections 77 and/or 78 of the Criminal Procedures Act, were included. Results were summarised as frequencies and percentages, and means or percentiles. Significant differences between the groups were determined by sample t-tests or chi-squared tests.ResultsObservati found not accountable were in the majority (64.5%). Significant differences were found regarding marital and employment status, substance abuse, type of offence and diagnoses between the two groups. Almost all of the observati found to be not accountable were diagnosed with mental illness at the time of the assessment, whereas most observati found to be accountable for their actions at the time of the alleged offence were not found to be mentally ill. Observati found not accountable were significantly more likely to be diagnosed with schizophrenia, intellectual disability and substance-induced psychotic disorder, and committed mostly assault, murder and vandalism. Observati found accountable committed mostly rape, murder and theft.ConclusionThe majority of observati were found not accountable, with significant differences found between the two groups regarding demographic characteristics, type of diagnosis and offences committed. The identified differences can be used to assist in establishing criteria for the appropriate referral of alleged offenders by courts. Unnecessary referrals have a serious financial impact on the Department of Health. Furthermore, the high incidence of substance abuse among persons referred to the FSPC highlights the need for more substance rehabilitation centres in the Free State Province.

A profile of perceived stress factors among nursing staff working with intellectually disabled in-patients at the Free State Psychiatric Complex, South Africa.

IntroductionNursing staff working with intellectually disabled in-patients experience unique stress factors that can influence their personal well-being and work performance.ObjectivesTo compile a profile of stress factors experienced by nursing staff working with intellectually disabled in-patients at the Free State Psychiatric Complex (FSPC).MethodsThis descriptive study included 89 nursing staff members from this environment. A questionnaire was used to collect socio-demographic information and determine personal and occupational stressors. The data were summarised by frequencies and percentages (categorical variables) and means or percentiles (numerical variables).ResultsMost participants were aged between 46 and 55 (41.2%), female (93.2%) and black (93.2%), and 76.7% had children or dependant minors. The main stressors among participants were pressure providing financially for their children and dependant minors (71.2%), caring for them (39.4%) and fearing them moving away (25.8%). Occupational stressors included high workload (66.3%), lack of decision-making by superiors (58.1%), underpayment (53.5%), endangerment of physical health (52.3%) and safety (50.0%), working hours (51.2%), pressure of expectations from superiors (48.8%), uncertainty of employment (48.8%), work responsibilities (47.7%) and perceiving that skills and training were not appreciated. They experienced stress regarding health issues such as hyper- and hypotension (35.3%). Because of stress 34.5% of participants took leave, 34.5% developed depression and 14.3% had panic attacks.ConclusionMost of the respondents experienced personal and occupational stress that influenced their health, which poses serious challenges for the management of the FSPC. Security should be upgraded, medical and psychological support for the staff and care facilities for their dependants should be provided, and financial problems experienced by these staff members should be addressed. The workload of the nursing staff at FSPC needs urgent attention. This can be done by means of a workforce analysis to determine minimum staffing levels for nursing.

The use of computed tomography scans and the Bender Gestalt Test in the assessment of competency to stand trial and criminal responsibility in the field of mental health and law

computed tomography and the Bender Gestalt Test are some of the tests used routinely for the assessment of alleged offenders referred under Sections 77 and 78 of the Criminal Procedure Act 51 of 1977. An exploratory retrospective study was conducted at the Free State Psychiatric Complex. The aim of this study was to identify the extent to which the Bender Gestalt Test results and the computed tomography scans are associated with outcomes in the assessment of competency to stand trial and criminal responsibility in individuals referred to the Free State Psychiatric Complex (FSPC) observation unit. This was a cross-sectional study and the entire population of patients admitted in 2013 was included in the study. The clinical and demographic data were obtained from patient files. The majority of participants were black, males, single and unemployed. The most common diagnosis was schizophrenia. The current study showed no statistically significant association between the Bender Gestalt Test Hain's scores and the outcome of criminal responsibility and competency to stand trial. Similarly, the study also showed no statistically significant association between the presence of a brain lesion and the outcome of criminal responsibility and competency to stand trial. It was also concluded that as CT scans are expensive, patients should be referred for that service only when there is a clear clinical indication to do so.

Profile of rape victims referred by the court to the Free State Psychiatric Complex, 2003 - 2009

&lt;p&gt;&lt;strong&gt;Background.&lt;/strong&gt; The psychological evaluation of rape victims to determine their competency to testify in court and whether they are capable of consenting to sexual intercourse is challenging, especially when the rape victim is mentally retarded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective.&lt;/strong&gt; To describe the profile of mentally retarded rape victims referred to the Free State Psychiatric Complex (FSPC) in Bloemfontein from 2003 to 2009.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods.&lt;/strong&gt; A descriptive retrospective study was conducted. The study consisted of 137 rape victims referred by the court to the FSPC for psychological evaluation from 2003 to 2009. Patient files were used to obtain information.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results.&lt;/strong&gt; The majority of individuals (&lt;em&gt;n&lt;/em&gt;=129; 94.2%) in the cohort were female. The mean age of the participants was 19 years (range 3 - 52). The number of victims evaluated increased from four in 2003 to 36 in 2009. Most participants were diagnosed with moderate (67.2%), followed by severe (18.3%) and mild (14.6%) mental retardation. Only two of the victims were able to give legal consent to sexual intercourse. Only one participant was able to testify in a court of law. A noteworthy finding was that in only 25 (18.2%) cases, a clinical psychologist was subpoenaed to testify in court.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion.&lt;/strong&gt; The vast majority of mentally retarded rape victims in our cohort, regardless of their level of intellectual functioning, were not able to testify in court and were not able to give informed consent to sexual intercourse.&lt;/p&gt;

Children and adolescents treated for post-traumatic stress disorder at the Free State Psychiatric Complex

&lt;p&gt;&lt;strong&gt;Background.&lt;/strong&gt; Children and adolescents can develop post-traumatic stress disorder (PTSD) after exposure to a range of traumatic events, including domestic, political or community violence, violent crime, physical and sexual abuse, hijacking, witnessing a violent crime and motor vehicle accidents. This is particularly critical given the substantial challenge that PTSD poses to the healthy physical, cognitive and emotional development of children and adolescents.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods.&lt;/strong&gt; The clinical records of 1 229 children (age 2 - 11 years) and adolescents (age 12 - 18 years) treated at the Child Mental Health Unit of the Free State Psychiatric Complex (FSPC) were screened for the diagnosis of PTSD and analysed for the purpose of this study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results.&lt;/strong&gt; Forty-nine (4.0%) of the children and adolescents treated at the unit were diagnosed with PTSD, of whom most were female (63.3%). Approximately 22% of the participants had comorbid major depressive disorder. The main traumatic event in both groups was witnessing the death of a close relative (32.7%), followed by sexual assault (25%), rape (25%) and physical attack (10.2%). Associated stressors identified included problems at school (55.1%), isolation (39%), fear or anxiety (37%), problematic family relationships (29%), emotional (27%) and physical (23%) abuse, and lack of social support (23%). Most of the participants (59.2%) received psychotherapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions.&lt;/strong&gt; Children and adolescents referred to the FSPC are also exposed to traumatic events which lead to the development of PTSD. The Free State is a sprawling province with remote areas where specialist services and facilities are limited. It is therefore recommended that preventive programmes, training opportunities and consultation services are implemented to identify and treat children and adolescents with PTSD. Schools with limited access to psychological services and large classrooms, impeding the diagnosis and treatment of PTSD specifically, face similar challenges. Reinforcement of professional services and the upgrading of facilities will decrease the burden on the Child Mental Health Unit, but will require collaborative efforts from role players such as the National Departments of Health and Education.&lt;/p&gt;

Profile of rape victims referred by the court to the Free State Psychiatric Complex, 2003 to 2009

Background. The psychological evaluation of rape victims to determine their competency to testify in court and whether they are capable of consenting to sexual intercourse is challenging, especially when the rape victim is mentally retarded. Objective. To describe the profile of mentally retarded rape victims referred to the Free State Psychiatric Complex (FSPC) in Bloemfontein from 2003 to 2009. Methods. A descriptive retrospective study was conducted. The study consisted of 137 rape victims referred by the court to the FSPC for psychological evaluation from 2003 to 2009. Patient files were used to obtain information. Results. The majority of individuals ( n =129; 94.2%) in the cohort were female. The mean age of the participants was 19 years (range 3 - 52). The number of victims evaluated increased from four in 2003 to 36 in 2009. Most participants were diagnosed with moderate (67.2%), followed by severe (18.3%) and mild (14.6%) mental retardation. Only two of the victims were able to give legal consent to sexual intercourse. Only one participant was able to testify in a court of law. A noteworthy finding was that in only 25 (18.2%) cases, a clinical psychologist was subpoenaed to testify in court. Conclusion. The vast majority of mentally retarded rape victims in our cohort, regardless of their level of intellectual functioning, were not able to testify in court and were not able to give informed consent to sexual intercourse.

Children and adolescents treated for post-traumatic stress disorder at the Free State Psychiatric Complex

Background. Children and adolescents can develop post-traumatic stress disorder (PTSD) after exposure to a range of traumatic events, including domestic, political or community violence, violent crime, physical and sexual abuse, hijacking, witnessing a violent crime and motor vehicle accidents. This is particularly critical given the substantial challenge that PTSD poses to the healthy physical, cognitive and emotional development of children and adolescents. Methods. The clinical records of 1 229 children (age 2 - 11 years) and adolescents (age 12 - 18 years) treated at the Child Mental Health Unit of the Free State Psychiatric Complex (FSPC) were screened for the diagnosis of PTSD and analysed for the purpose of this study. Results. Forty-nine (4.0%) of the children and adolescents treated at the unit were diagnosed with PTSD, of whom most were female (63.3%). Approximately 22% of the participants had comorbid major depressive disorder. The main traumatic event in both groups was witnessing the death of a close relative (32.7%), followed by sexual assault (25%), rape (25%) and physical attack (10.2%). Associated stressors identified included problems at school (55.1%), isolation (39%), fear or anxiety (37%), problematic family relationships (29%), emotional (27%) and physical (23%) abuse, and lack of social support (23%). Most of the participants (59.2%) received psychotherapy. Conclusions. Children and adolescents referred to the FSPC are also exposed to traumatic events which lead to the development of PTSD. The Free State is a sprawling province with remote areas where specialist services and facilities are limited. It is therefore recommended that preventive programmes, training opportunities and consultation services are implemented to identify and treat children and adolescents with PTSD. Schools with limited access to psychological services and large classrooms, impeding the diagnosis and treatment of PTSD specifically, face similar challenges. Reinforcement of professional services and the upgrading of facilities will decrease the burden on the Child Mental Health Unit, but will require collaborative efforts from role players such as the National Departments of Health and Education.

Profile of stress factors associated with mental disorders in children and adolescents referred for evaluation and treatment to the Free State Psychiatric Complex, 2007

&lt;p&gt;&lt;strong&gt;Introduction.&lt;/strong&gt; South African children and adolescents face serious challenges. Over the past decades children have been exposed to rapid and stressful changes in their environment, including increased crime and violence. &lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim of study.&lt;/strong&gt; The aim of the study was to determine the profile of stress factors leading to mental disorders in children and adolescents referred to the Child and Adolescent Unit at the Free State Psychiatric Complex, Bloemfontein, from January 2006 to December 2007. &lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods.&lt;/strong&gt; A total of 669 children (0 - 12 years) and adolescents (13 - 18 years) referred to the unit for evaluation and treatment were included in the study.&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results.&lt;/strong&gt; Thirty per cent were diagnosed with attention deficit and disruptive behaviour disorders, followed by major depressive disorders (22.7%), anxiety disorders (18.5%), conduct disorders (16.1%), mild mental retardation (15.7%), adjustment disorders (9.6%), elimination disorders (8.8%), developmental disorders (7.6%) and bereavement (7.0%). Social stressors were identified in 64.1% of participants, and psychological stressors in 19%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions.&lt;/strong&gt; Stress plays an important role in the lives of children and adolescents, which could lead to emotional problems if not well managed. The functioning of children and adolescents should be monitored continuously. Schools are in a favourable position to identify stressors affecting children and adolescents. Educators therefore need training and opportunities to consult on mental health matters. Furthermore, religious organisations should be enlisted to identify stressors manifesting as spiritual dysfunction. School health services can play a role in the recognition of biological stressors such as epilepsy, pregnancy, enuresis, illness, speech problems and sensory dysfunction.&lt;/p&gt;

Profile of forensic psychiatric inpatients referred to the Free State Psychiatric Complex, 2004–2008

&lt;p&gt;&lt;strong&gt;Introduction:&lt;/strong&gt; An accused found unfit to stand trial and/or not responsible for his/her actions because of mental illness, is declared a state patient by the court. &lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim:&lt;/strong&gt; The aim of the study was to analyse the biographical data and relevant particulars of forensic psychiatric inpatients who were admitted to the Free State Psychiatric Complex (FSPC) according to section 42 of the Mental Health Care Act (no. 17 of 2002), from 2004 to 2008. Study design A descriptive, retrospective study was conducted. Method One hundred and twenty forensic psychiatric inpatients admitted to the FSCP in the terms of section 42 of the Mental Health Care Act in the period 2004–2008, were included in the study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; The majority (95.8%) of the offenders were male, unmarried (83.8%) and unemployed (81.5%). The median age was 32.5 years. Most of the offenses against persons were of a sexual nature (45.8%). More than half (55.5%) of the forensic inpatients were diagnosed with schizophrenia, followed by mental retardation (10%) and bipolar mood disorder. Eighty percent (80%) of these patients were found not competent to stand trial and unaccountable. Fifty percent (50%) of the participants received treatment for a mental illness prior to the crime, and were also known to have poor compliance and defaulted from treatment in the past.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; The findings of this study can contribute to implement effective management and training programmes for the benefit of state patients.&lt;/p&gt;

The demographic, clinical and forensic profile of offenders diagnosed with epilepsy referred to the Free State Psychiatric Complex Observation Unit in terms of section 77 and/or 78 of the Criminal Procedure Act 51 of 1977

&lt;p&gt;&lt;strong&gt;Introduction.&lt;/strong&gt; Limited information regarding the relation between psychopathology associated with epilepsy, crime and the legal aspects thereof is available in South Africa.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives:&lt;/strong&gt; The demographic, clinical and forensic profile of alleged offenders diagnosed with epilepsy and referred to the Free State Psychiatric Complex (FSPC) Observation Unit from 2001 to 2006, was investigated. Design A retrospective cross-sectional study was conducted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt; Results:&lt;/strong&gt; Of the 69 alleged offenders, aged 17–79 years (median 30 years), 94.2% were male, 81.2% Black, 72.5% single, and 69.9% unemployed. The median qualification was grade six. Offences were violent in nature and committed against a person in 75% of cases. A direct link between epilepsy and the alleged offences occurred in 7% of cases. Generalised epilepsy (34.8%) and interictal psychosis (20.3%) were the most commonly diagnosed conditions. Twenty-nine (42%) alleged offenders lacked criminal responsibility and were not fit to stand trial. Most observati (79.2%) diagnosed with generalised epilepsy were criminally liable and fit to stand trial. The highest rate of criminal incapacity was found among observati with interictal psychoses (85.7%) and comorbid mental retardation (90%). Almost 60% of referred cases were declared as state patients by the court.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; In only 16% of cases, observati were found unaccountable because of epilepsy (automatisms) or postictal confusional states. Our findings confirmed an increased prevalence of violent behaviour during seizure-free periods. This contributes to evidence that factors associated with epilepsy, rather than the epilepsy itself, play an important role in the possible increased risk of violent behaviour in people with epilepsy.&lt;/p&gt;

Psychiatric evaluation of intellectually disabled offenders referred to the Free State Psychiatric Complex, 1993-2003

Background . Increased crime is a problem in South Africa and complications arise when the accused is intellectually disabled. The accountability and fitness to stand trial of such individuals is an important facet that needs to be managed by the judicial and health systems. Objective . To analyse the accountability and triability of intellectually disabled people awaiting trial referred to the Free State Psychiatric Complex (FSPC) from 1993 to 2003 according to Sections 77 and 78 of the Criminal Procedures Act (Act 51 of 1977). Method . A retrospective study was conducted. The study population consisted of 80 intellectually disabled people awaiting trial in the Free State, referred to the FSPC. The reason for referral was the possibility that they were not triable or accountable. A data form was compiled to transfer the relevant information from the patients’ clinical files. Results . The study found that the majority of subjects were male (96.3%), unmarried (76.3%) and unemployed (63.8%). The median age was 27 years. A relatively high percentage (49%) had received some schooling and 16% had attended a special school. Most (32%) were referred from the Bloemfontein area and 68% were referred from the remainder of the Free State and other areas. The majority were referred according to Sections 77 and 78. The highest number of the offences were of a sexual nature (78%). Of the subjects, 62 (62.5%) were diagnosed as having mild mental retardation, while 16% were diagnosed as having moderate mental retardation. A total of 71 (71.25%) were found to be untriable and unaccountable. Conclusion . Triability and accountability are not only reflected by IQ score, but also involve the accused’s understanding of his/her environment, his/her speech and language proficiency, level of education, reasoning ability and the manner in which the crime was committed. It is important to note that having an IQ of 70 or less does not automatically mean that the accused is unfit to stand trial or is not accountable. It is possible for an intellectually disabled person to be triable, accountable or diminished accountable.

The general profile of children and adolescents with major depression referred to the Free State Psychiatric complex

&lt;div style="left: 155.087px; top: 577.926px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.856878);" data-canvas-width="318.63"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Depression can have far-reaching effects on the&lt;/div&gt;&lt;div style="left: 80.9418px; top: 601.256px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.92316);" data-canvas-width="392.82000000000005"&gt;functioning and adjustment of young people. Among both&lt;/div&gt;&lt;div style="left: 80.9418px; top: 624.585px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.910571);" data-canvas-width="392.775"&gt;children and adolescents depression confers an increased risk&lt;/div&gt;&lt;div style="left: 80.9418px; top: 647.915px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.898096);" data-canvas-width="325.38"&gt;for illness, interpersonal and psychosocial difficulties.&lt;/div&gt;&lt;div style="left: 80.9418px; top: 647.915px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.898096);" data-canvas-width="325.38"&gt; &lt;/div&gt;&lt;div style="left: 141.257px; top: 685.427px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.906132);" data-canvas-width="332.50499999999994"&gt;&lt;strong&gt;Objective:&lt;/strong&gt;The aim of this study was to determine the profile of&lt;/div&gt;&lt;div style="left: 80.9418px; top: 708.757px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.914105);" data-canvas-width="392.7450000000001"&gt;children (birth - 12 years) and adolescents (13 - 18 years) with&lt;/div&gt;&lt;div style="left: 80.9418px; top: 732.086px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.896099);" data-canvas-width="392.76000000000005"&gt;major depression referred to the Child Mental Health Unit at the&lt;/div&gt;&lt;div style="left: 80.9418px; top: 755.416px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.893043);" data-canvas-width="392.77500000000015"&gt;Free State Psychiatric Complex (FSPC) from 1 January 2004 to&lt;/div&gt;&lt;div style="left: 80.9418px; top: 778.745px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.976556);" data-canvas-width="132.6"&gt;31 December 2004.&lt;/div&gt;&lt;div style="left: 80.9418px; top: 778.745px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.976556);" data-canvas-width="132.6"&gt; &lt;/div&gt;&lt;div style="left: 129.137px; top: 816.258px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.917412);" data-canvas-width="344.5799999999999"&gt;&lt;strong&gt;Method:&lt;/strong&gt; A total of 904 children and adolescents were referred&lt;/div&gt;&lt;div style="left: 80.9418px; top: 839.587px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.919419);" data-canvas-width="392.745"&gt;to the Unit during 2004. From these referrals 100 children and&lt;/div&gt;&lt;div style="left: 80.9418px; top: 862.917px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.933475);" data-canvas-width="392.775"&gt;adolescents (11.06%) were diagnosed with major depression&lt;/div&gt;&lt;div style="left: 80.9418px; top: 886.246px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.910612);" data-canvas-width="193.06499999999997"&gt;and were included in the study.&lt;/div&gt;&lt;div style="left: 80.9418px; top: 886.246px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.910612);" data-canvas-width="193.06499999999997"&gt; &lt;/div&gt;&lt;div style="left: 180.887px; top: 923.759px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.870766);" data-canvas-width="312.75000000000006"&gt;&lt;strong&gt;Data analysis:&lt;/strong&gt; The data were summarised using frequencies&lt;/div&gt;&lt;div style="left: 80.9418px; top: 947.088px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.925438);" data-canvas-width="392.91000000000014"&gt;and percentages (categorical variables) and means of&lt;/div&gt;&lt;div style="left: 80.9418px; top: 970.418px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.885185);" data-canvas-width="200.76000000000002"&gt;percentiles (numerical variables).&lt;/div&gt;&lt;div style="left: 80.9418px; top: 970.418px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.885185);" data-canvas-width="200.76000000000002"&gt; &lt;/div&gt;&lt;div style="left: 120.362px; top: 1007.93px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.905652);" data-canvas-width="353.31000000000006"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The majority (74%) of the cases were in the adolescent&lt;/div&gt;&lt;div style="left: 80.9418px; top: 1031.26px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.904977);" data-canvas-width="392.74499999999995"&gt;age group and 61% were girls. The main complaints presented&lt;/div&gt;&lt;div style="left: 80.9418px; top: 1054.59px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.882313);" data-canvas-width="392.8350000000001"&gt;by the parents or in the referral letter by the general practitioners&lt;/div&gt;&lt;div style="left: 80.9418px; top: 1077.92px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.903519);" data-canvas-width="392.83500000000004"&gt;were behavioural problems (37%) such as stealing, aggression&lt;/div&gt;&lt;div style="left: 80.9418px; top: 1101.25px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.936476);" data-canvas-width="392.80500000000006"&gt;and attention-seeking behaviour, followed by decrease in&lt;/div&gt;&lt;div style="left: 80.9418px; top: 1124.58px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.898045);" data-canvas-width="392.7899999999999"&gt;school performance (25%), suspected depression (21%),&lt;/div&gt;&lt;div style="left: 80.9418px; top: 1147.91px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.8945);" data-canvas-width="392.74499999999983"&gt;suicidal tendencies (17%), and school refusal (8%). Twelve per&lt;/div&gt;&lt;div style="left: 80.9418px; top: 1171.24px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.880596);" data-canvas-width="392.775"&gt;cent of the group had lost a family member. The main presenting&lt;/div&gt;&lt;div style="left: 80.9418px; top: 1194.57px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.912615);" data-canvas-width="392.81999999999994"&gt;clinical symptoms of major depression in the study group were&lt;/div&gt;&lt;div style="left: 80.9418px; top: 1217.9px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.870739);" data-canvas-width="392.805"&gt;sleep disturbance (59%), dysphoric (depressed) mood (57%),&lt;/div&gt;&lt;div style="left: 80.9418px; top: 1241.23px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.92694);" data-canvas-width="392.7599999999999"&gt;disturbance in appetite (49%), constant fatigue/loss of energy&lt;/div&gt;&lt;div style="left: 80.9418px; top: 1264.56px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.908711);" data-canvas-width="392.76"&gt;(43%), inability to enjoy activities that would normally give&lt;/div&gt;&lt;div style="left: 80.9418px; top: 1287.88px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.892772);" data-canvas-width="392.80500000000006"&gt;pleasure (37%), and impaired concentration (36%). Somatic&lt;/div&gt;&lt;div style="left: 80.9418px; top: 1311.21px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.909585);" data-canvas-width="325.965"&gt;complaints occurred in 42% of the study population.&lt;/div&gt;

Profile of mentally ill offenders referred to the Free State Psychiatric Complex

NO ABSTRACT AVALIBLE

Psychiatric evaluation of offenders referred to the Free State Psychiatric Complex according to sections 77 and/ or 78 of the Criminal Procedures Act

&lt;p&gt;&lt;strong&gt;Background.&lt;/strong&gt; The increase in crime is a problem of great concern in South Africa and complications arise when the accused is mentally ill.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective.&lt;/strong&gt; Analysis of the offenders referred to the Free State Psychiatric Complex from 1995 to 2001 according to section 77 (triability) and/or section 78 (accountability) of the Criminal Procedures Act (Act 51 of 1977).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method.&lt;/strong&gt; The study population consisted of 514 persons awaiting trial in the Free State. They were referred to the Free State Psychiatric Complex for 30 days’ observation from 1995 to 2001. A data form was created and used to transfer the relevant information from the accused’s clinical files.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data analysis.&lt;/strong&gt; The data collected were analysed by the Department of Biostatistics at the University of the Free State.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results.&lt;/strong&gt; The majority of the offenders were male (94.6%) and unmarried (66.3%). The median age of the group was 30 years. The unemployment rate was 60%. Most of the referrals (84.2%) were in terms of sections 77 and 78. The accused were found to have mainly average intelligence (75.3%). The main offences were theft (27.8%), murder (18.9%), assault (18.1%) and rape (16.2%). The most common mental disorder diagnosed was schizophrenia (23.0%), with 54.3% having no mental disorder. Nearly half the offenders (48.6%) were found to be triable and accountable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion.&lt;/strong&gt; The majority of the offenders referred for psychiatric observation were found to have no mental illness and were referred back to the courts. This results in high costs for the Department of Health. To reduce the high rate of unnecessary referrals it is recommended that courts give clear reasons for the referrals according to each section (77 and 78).&lt;/p&gt;

Use of the Judicial Section 9 Certification in the Free State

A direct referral system for referring persons who perpetrate a crime while suffering from a mental illness has evolved between the office of the Director of Public Prosecution (DPP) in the Free State, and the Free State Psychiatric Complex (FSPC) over the years. The efficiency and impact of this direct referral system have never been quantified. This study found that this alternative system is uncomplicated, functions quite effectively with a minimum of inappropriate referrals, and contributes greatly towards decreasing the workload of the judicial as well as the psychiatric system.