An investigation into puerperal psychoses in black women admitted to Baragwanath Hospital.

OBJECTIVES: Puerperal psychosis was studied in black African women at Baragwanath Hospital in Johannesburg. DESIGN: A retrospective study analysed the clinical notes of 314 cases of puerperal psychosis seen over previous years. A prospective study researched 67 cases of puerperal psychosis referred during a full calendar year. A control group of 98 patients was matched with the prospective study patients for age, marital status, parity and month of delivery. RESULTS: The incidence (2-3 cases per 1,000 births), onset and pattern of illness are all remarkably similar to that described in the international literature. Confirmed risk factors were a primiparous patient; a family history of psychiatric illness; and a personal psychiatric history, particularly a history of mania. Additional risk factors found in this study were substance dependence; a medical illness; the season of the year; a male child; and psychosocial stress including need for intensive medical care for the baby or death of the baby. CONCLUSION: The conclusion reached is that the puerperal psychoses are undifferentiated psychoses, usually mood disorders, showing some special symptomatology, and are precipitated in constitutionally predisposed patients by the physiological factors of the involutionary period.

AIDS--the Baragwanath experience. Part I. Epidemiology of HIV infection at Baragwanath Hospital, 1988-1990.

This four-part series describes the experience with HIV infection at Baragwanath Hospital to December 1990. In this first part we give an overview of the emergence of this disease and of its impact on the hospital. From July 1988 to December 1990, 426 HIV-positive individuals were identified: 58 were women identified in surveys at antenatal and gynaecology clinics, 60 were parents of infected babies or sexual contacts of hospitalised patients, and 30 were not inpatients (mainly patients at Soweto clinics). Of the 278 inpatients, 16 were identified in the latter 6 months of 1988, 54 in 1989 and 208 in 1990. Fifty-one per cent of the patients were in the adult medical wards, 11% in surgery, 20% in paediatrics and 18% in other disciplines. One per cent of sera from Wassermann reaction-positive women in mid-1990 were HIV-positive; this also applied to 1% of antenatal women in late 1990 and 2.7% of women with pelvic inflammatory disease. The HIV antigen assay is a useful adjunctive assay in the evaluation of HIV-antibody-positive children. The false/true-positive ratio of a rapid HIV antibody test was 2:1 initially, but the specificity improved with experience. The use of rapid diagnostic assays for HIV must be restricted to laboratories with experience in reading assays and where definitive follow-up testing is assured.

AIDS--the Baragwanath experience. Part IV. Counselling and ethical issues.

This fourth part of the series describes the setting up of counselling for HIV-positive patients in response to the need at Baragwanath Hospital. Nurse counsellors were trained and supervised. The work, extending over 2 1/2 years, raised a number of issues for patient care and also for wider community education. Brief reference is made to pertinent ethical and cultural issues.

Suicide attempts or threats by children and adolescents in Johannesburg.

Current literature on suicide attempts by children and adolescents is reviewed. The records of children and adolescents in the 10-15-year age group who were referred to a child psychiatric unit over the 6-year period 1 January 1977-31 December 1982 were analysed. The results are presented and discussed. Suicide attempts or threats together constituted an average of 10% of the psychiatric referrals in this age group, the figure for 1982 being substantially increased. The peak incidence was among 13-year-olds for both boys and girls. The female: male referral ratio was 2:1. Drug overdosage was the most common method, the commonly employed drugs being analgesics and benzodiazepines. In about 30% of both the boys and girls referred because of taking an overdose, a multiple-drug overdose had been used. Methods other than this were used three times more frequently by boys than by girls. Major predisposing and antecedent factors were family stress (especially divorce), psychiatric illness in the patient or a family member, and school problems. Some 30% had previously made suicide attempts or threats, and at least 7% made further serious suicide attempts after initial treatment. These results suggest a need for further investigations into factors relating to suicide attempts or threats in children and adolescents and their subsequent management.