Early deviant behaviour as a dimension trait and endophenotype in schizophrenia.

Background: In psychiatry, there is still a lack of objective biological diagnostic measurements. It is important to investigate measurements or symptom dimensions that can inform diagnostic assessments and allow for a more personalised approach to patients. Aim: To discuss how early deviant behaviour (EDB) may be seen as a possible continuous symptom dimension trait and endophenotype in schizophrenia. Methods: Conducting a commentary review by highlighting some important findings from available literature. Results: Findings regarding EDB in schizophrenia in a South African genetic sample point towards EDB as a progressive subtype of schizophrenia, with very early onset of illness (even prior to the psychotic symptomatology) and a genetic form of illness. Conclusion: Valuable information can be gained by enquiring into EDB and viewing it as a continuous symptom dimension trait and endophenotype during the psychiatric diagnostic interview.

The perceptions of adult psychiatric inpatients with major depressive disorder towards occupational therapy activity-based groups.

BACKGROUND: Occupational therapists have been using group therapy as their preferred treatment modality in mental healthcare since the origin of the profession. In private mental healthcare units, major depressive disorder (MDD) is the most common psychiatric disease. Occupational therapists use individual and group therapy to treat adult inpatients with MDD. Little is known about the perceptions and experiences of adult inpatients with MDD regarding occupational therapy activity-based groups. AIM: To describe the perceptions and experiences of adult psychiatric inpatients with MDD towards occupational therapy activity-based groups. This article reports on the perceptions of adult psychiatric inpatients with MDD, which formed part of a larger study. SETTING: The study took place at two private general hospitals in Gauteng province, South Africa, each with a psychiatric ward. METHODS: The researcher used a qualitative explorative descriptive design. Accessible participants were selected using convenience sampling. Only consenting participants took part in the study. Data were collected during focus group discussions. Data were thematically analysed. RESULTS: Participants' perceptions could be placed into one of four themes: (1) experience improved mood, (2) learned coping skills, (3) regained self-esteem and (4) becoming part of the solution to face life challenges. CONCLUSION: Activities that are unique to occupational therapy profession can benefit inpatients with MDD. This supports the profession's historical beliefs, assumptions and foundations regarding therapeutic use of activities. According to these inpatients, group activities improved their overall mental health.

Family history identifies sporadic schizoaffective disorder as a subtype for genetic studies.

BACKGROUND: Schizophrenia is a heterogeneous disorder with strong genetic vulnerability. Family history of schizophrenia has been considered in genetic studies under several models. De novo genetic events seem to play a larger role in sporadic cases. AIM: This study used the familial-sporadic distinction with the aim of identifying a more homogeneous phenotype to delineate the genetic and clinical complexity of schizophrenia. SETTING: The study was conducted at Weskoppies Hospital, Pretoria, South Africa. METHODS: The study included 384 participants with schizophrenia or schizoaffective disorder from the Afrikaner founder population in South Africa who are considered comparable to Caucasian patients from the United States. A comprehensive data capturing sheet was completed. RESULTS: When schizophrenia and schizoaffective disorder diagnoses were considered jointly, we found no significant differences between the sporadic and the familial groups for age at disease onset, season of birth, comorbid diagnoses, clinical symptomatology, history of suicide or marital status. When the diagnoses were examined separately, however, the sporadic schizoaffective disorder, bipolar type, was found to have a significantly lower age at onset (mean 20.6 vs. 25.3 years). CONCLUSION: The sporadic schizoaffective disorder, bipolar type, forms a more homogeneous subgroup for genetic studies.

End-of-life decision-making capacity in an elderly patient with schizophrenia and terminal cancer.

Medical practitioners are confronted daily with decisions about patients' capacity to consent to interventions. To address some of the pertinent issues with these assessments, the end-of-life decision-making capacity of a 72-year-old female with treatment-resistant schizophrenia and terminal cancer is discussed, as are the role of the treating clinician and the importance of health-related values. There is a recommendation that the focus of these assessments can rather be on practical outcomes, especially when capacity issues arise. This implies that the decision-making capacity of the patient is only practically important when the treatment team is willing to proceed against the patient's wishes. This shifts the focus from a potentially difficult assessment to the simpler question of whether the patient's capacity will change the treatment approach. Clinicians should attend to any possible underlying issues, instead of focusing strictly on capacity. Compared to the general populations people with serious mental illness (SMI) have higher rates of physical illness and die at a younger age, but they do not commonly access palliative care services. Conversations about end-of-life care can occur without fear that a person's psychiatric symptoms or related vulnerabilities will undermine the process. More research about palliative care and advance care planning for people with SMI is needed. This is even more urgent in light of the coronavirus disease-2019 (COVID-19) pandemic, and South African health services should consider recommendations that advanced care planning should be routinely implemented. These recommendations should not only focus on the general population and should include patients with SMI.

Physical exercise and the patient with schizophrenia.

BACKGROUND: Schizophrenia is a severe mental disorder with profound effects on a person's life. In addition to the psychiatric symptoms, patients with schizophrenia generally have multiple somatic comorbidities, such as cardiovascular and metabolic disorders. The general practitioner (GP) is of key importance for the patient's continuous care and holistic wellbeing. OBJECTIVE: The aim of this article is to emphasise the role of GPs in embracing physical exercise as add-on treatment to antipsychotic medications, and to illustrate the value of exercise for people with schizophrenia by summarising the effects on the psychiatric symptoms, neuroanatomical and neurochemical characteristics, and general physiological and psychological health. DISCUSSION: Physical exercise can lead to improvements in positive, negative and cognitive symptoms, as well as in somatic comorbidities, global functioning and quality of life. Physical exercise can be a valuable add-on intervention for people with schizophrenia. The GP is essential for prescribing and following up on exercise tailored for the individual.