Secondary trauma amongst administrative support staff working with traumatic incident dockets within the South African Police Service in Johannesburg, South Africa

Background: Secondary trauma is trauma experienced by those in close contact with the victims of trauma. Research shows that some individuals exposed to photographs or video presentations of traumatic events may experience secondary trauma. This includes administrative staff within the South African Police Service (SAPS), who work with trauma dockets. Objectives: We explored the effects of secondary trauma on administrative support staff within the SAPS, their access to psychological support in the SAPS, and their use of the employee health and wellness (EHW) services in the SAPS. Methods: An exploratory qualitative study was conducted among administrative support staff from one of the four Johannesburg clusters of the SAPS. In-depth interviews took place with seven staff members. The data were analysed using Atlas.ti. Results: Administrative support staff are exposed to trauma through incident dockets, victim statements, and gruesome images. The study participants indicated that they experienced trauma daily, and symptoms of trauma such as flashbacks, anxiety, sadness, nightmares, paranoia, avoidance, recurrent thoughts, and fear of death. They were overprotective of their loved ones and paranoid. They were not utilising the EHW services due to lack of access to appropriate services, or the stigma attached to seeking help from mental health professionals. Conclusion: The SAPS needs to develop and implement a strategy to mitigate the impact of secondary trauma on its personnel, which include administrative support staff. Evidence-based interventions, such as resilience training, should be considered as part of the strategy

Secondary School Learners' Essays on Suicide Prevention

Objectives: Considering the extent of the problem of suicidal behaviour among young people; the need for prevention programmes is paramount. The KwaZulu-Natal based 'Love to Live' campaign is a programme aimed at the prevention of suicidal behaviour among children and adolescents. Methods: The present study is an analysis of 63 essays written by secondary school learners on the subject of suicide prevention. Results: Just over two-thirds of the essays revealed reasonable knowledge without serious inaccuracies; with over half the sample citing conflict with parents as precipitants to suicidal behaviour. Over one-third of the essays blamed suicidal persons for being ineffective in dealing with their life problems; and over one-third identified mental health workers and parents as sources of help. Conclusions: The results are discussed in terms of adolescents' views of suicidal behaviour; as well as within the context of the limitations of the study methodology

Secondary School Learners' Essays on Suicide Prevention

Objectives: Considering the extent of the problem of suicidal behaviour among young people; the need for prevention programmes is paramount. The KwaZulu-Natal based 'Love to Live' campaign is a programme aimed at the prevention of suicidal behaviour among children and adolescents.Methods: The present study is an analysis of 63 essays written by secondary school learners on the subject of suicide prevention.Results: Just over two-thirds of the essays revealed reasonable knowledge without serious inaccuracies; with over half the sample citing conflict with parents as precipitants to suicidal behaviour. Over one-third of the essays blamed suicidal persons for being ineffective in dealing with their life problems; and over one-third identified mental health workers and parents as sources of help.Conclusions: The results are discussed in terms of adolescents' views of suicidal behaviour; as well as within the context of the limitations of the study methodology

Secondary School Learners' Essays on Suicide Prevention

Objectives: Considering the extent of the problem of suicidal behaviour among young people; the need for prevention programmes is paramount. The KwaZulu-Natal based 'Love to Live' campaign is a programme aimed at the prevention of suicidal behaviour among children and adolescents.Methods: The present study is an analysis of 63 essays written by secondary school learners on the subject of suicide prevention.Results: Just over two-thirds of the essays revealed reasonable knowledge without serious inaccuracies; with over half the sample citing conflict with parents as precipitants to suicidal behaviour. Over one-third of the essays blamed suicidal persons for being ineffective in dealing with their life problems; and over one-third identified mental health workers and parents as sources of help.Conclusions: The results are discussed in terms of adolescents' views of suicidal behaviour; as well as within the context of the limitations of the study methodology

The use of a side effect as a qualitative indicator of plasma chlorpromazine levels.

Chlorpromazine (CPZ) is widely used in South African hospitals. The purpose of this study was to determine whether any physiological parameter (side-effect) could be correlated with plasma concentrations of CPZ or its metabolites. In the absence of a blood level, such a correlation could serve as a qualitative indicator of the amount of chlorpromazine in the body. Such a marker can assist the psychiatrist with therapeutic decisions regarding poor compliance and the lack of response with the drug. Fifteen schizophrenic patients were included in this study and regression analysis was used to determine any correlation between CPZ, 7-hydroxychlorpromazine, Chlorpromazine-N-oxide, Nor1 chlorpromazine, Nor2 chlorpromazine, chlorpromazine sulfoxide, Nor2 chlorpromazine sulfoxide and blood pressure, pulse rate, sedation and finger tremor. No correlation was seen between blood pressure or pulse rate and plasma concentrations of CPZ or the metabolites. A good correlation was seen between sedation, 7- hydroxychlorpromazine (P=0.035) and chlorpromazine sulfoxide (P=0.016). The results suggest that as the levels of chlorpromazine sulfoxide increase, the probability of sedation increases, while increasing levels of 7-hydroxychlorpromazine have the opposite effect. A good correlation was also seen between finger tremor and chlorpromazine levels (P=0.035). These results suggest that there is a 50% probability that the patient would experience finger tremor when the plasma concentration of chlorpromazine is 46 ng/ml. This study demonstrated the potential for the use of sedation and finger tremor as qualitative indicators of the plasma concentration of CPZ and two metabolites. Further studies with larger patient numbers are warranted.

Response in chronic schizophrenia correlated with chlorpromazine, 7-OH-chlorpromazine and chlorpromazine sulfoxide levels.

The relationship between chlorpromazine, six of its metabolites and therapeutic response in chronic schizophrenic patients was investigated in this study. Logistic regression revealed no correlation between therapeutic response and four metabolites viz. Nor1 chlorpromazine, Nor2 chlorpromazine, chlorpromazine-N-oxide and Nor2 chlorpromazine sulfoxide. A good correlation was seen between CPZ (P = 0.036), 7-hydroxychlorpromazine (P = 0.004), chlorpromazine sulfoxide (P = 0.002) and therapeutic response. Good therapeutic response was correlated to high levels of chlorpromazine and its 7-hydroxy metabolite while high levels of the sulfoxide metabolite appeared to have a negative effect on therapeutic response. Poor responders who had high levels of chlorpromazine also had high levels of the sulfoxide metabolite. This suggests that the difference in response may lie in the difference in the metabolism of the drug.

Important metabolites to measure in pharmacodynamic studies of chlorpromazine.

Plasma concentrations of chlorpromazine (CPZ) and six metabolites were measured in 12 chronic schizophrenic patients on a fixed dose of CPZ. All six metabolites were measured in significant concentrations, ranging from 12 to 57% of the parent drug concentration. They are listed in order of decreasing mean concentration as follows: chlorpromazine-N-oxide > chlorpromazine sulfoxide > 7-OH chlorpromazine > Nor2 chlorpromazine sulfoxide > Nor2 chlorpromazine > Nor1 chlorpromazine. CPZ concentrations showed significant correlation with the 7-OH chlorpromazine metabolite concentration. Since these metabolites have been associated with in vitro activity and occur in significant concentrations, it is recommended that all six metabolites be measured in studies correlating drug levels with pharmacodynamic effects.

Smoking and body weight influence the clearance of chlorpromazine.

The population pharmacokinetic parameters of chlorpromazine (CPZ) in chronic schizophrenic patients were evaluated using 189 plasma concentration measurements from 31 patients. A NONMEM analysis demonstrated that the clearance of CPZ depended on the patient's body weight. Cigarette smoking and cannabis smoking increased the clearance of CPZ. Chronic alcohol consumption and the concurrent use of anticholinergics did not appear to influence the clearance of CPZ significantly.

Two years of admissions to Natal's first inpatient child mental health centre.

The need for increased provision of mental health services for children has long been expressed. Equally, there is a shortage of training opportunities for mental health workers in this specialised field. The establishment of the first inpatient child mental health centre in Natal, together with clinical and demographic characteristics of the first 100 patients admitted to the unit, is discussed. Almost one-third of the children were diagnosed as having disruptive behaviour disorders, including conduct disorder, attention-deficit hyperactivity disorder and oppositional defiant disorder. Parent-child problems were also very prevalent. While a variety of therapeutic modalities were employed, behavioural management formed the mainstay of the treatment programme. Recommendations for additional child mental health centres are made.