The South African Journal of Psychiatry publishes topical content in psychiatry for clinical practice and academic pursuits, including work in the subspecialty areas of psychiatry.

This narrative review examines the dynamic interplay between carbohydrate intake and diabetes medications, highlighting their combined molecular and clinical effects on glycemic control. Carbohydrates, a primary energy source, significantly influence postprandial glucose regulation and necessitate careful coordination with pharmacological therapies, including insulin, metformin, glucagon-like peptide (GLP-1) receptor agonists, and sodium-glucose cotransporter-2 (SGLT2) inhibitors. Low-glycemic-index (GI) foods enhance insulin sensitivity, stabilize glycemic variability, and optimize medication efficacy, while high-GI foods exacerbate glycemic excursions and insulin resistance. Continuous glucose monitoring (CGM) offers real-time insights to tailor dietary and pharmacological interventions, improving glycemic outcomes and reducing complications. Despite advancements, gaps persist in understanding nutrient–drug interactions, particularly with emerging antidiabetic agents. This review underscores the need for integrating carbohydrate-focused dietary strategies with pharmacotherapy to enhance diabetes management. Future research should prioritize clinical trials leveraging CGM technology to explore how glycemic index, glycemic load, and carbohydrate quality interact with newer diabetes medications. Such studies can refine evidence-based recommendations, support individualized care plans, and improve long-term outcomes. Addressing systemic barriers, such as limited access to dietitians and CGM technology in underserved regions, is critical for equitable care. Expanding the roles of community health workers and training healthcare providers in basic nutrition counseling can bridge gaps, promoting sustainable and inclusive diabetes management strategies. These efforts are essential for advancing personalized, effective, and equitable care for individuals with diabetes.

Background/Objectives: Globally, there has been an increase in the prevalence of anxiety and depression among university students, and medical students are no exception. Medical students are especially susceptible to these mental health challenges, primarily due to multifaceted stressors, which can significantly impact their academic achievements and future career. There is a pressing need for comprehensive research that not only investigates the prevalence of anxiety and depression among medical students but also explores strategies for developing effective mental health interventions and support systems that can enhance the well-being of medical students. Therefore, this study aimed to identify the prevalence and severity of anxiety and depression among medical students at a university in South Africa, evaluating the association of socio-demographic, student, and clinical variables with total general anxiety disorder (GAD-7) and patient health questionnaire (PHQ-9) scores. Methods: A survey-based quantitative cross-sectional study was conducted with 208 medical undergraduate students at a South African university. Participants who provided written consent completed GAD-7 and PHQ-9 questionnaires together with socio-demographic, student, and clinical variable information. The relationship between socio-demographic, student, and clinical variables and total GAD-7 and PHQ-9 scores was determined using the Mann–Whitney U test and Kruskal–Wallis H test. Correlation analysis was used to establish the relationship between total anxiety and depression scores. The threshold for statistical significance was set at p ≤ 0.05. Results: More than half of the participants were female (n = 130; 62.5%), single (n = 123; 59.1%), and belonged to the Pedi ethnic group. A majority of the students were Christian (n = 183; 88.0%), received a bursary (n = 183; 88.0%), and had a rural background (n = 155; 74.5%). However, a small percentage of students reported a history of psychiatric and chronic illnesses (n = 26; 12.5%) and previously received professional psychological support (n = 38; 18.3%). In this study, 38% (n = 79) of the participants reported GAD and 67.8% (n = 141) reported symptoms of depression. Significant associations (p <0.05) were observed between variables such as year of study, repeating a module, and history of psychiatric illness with total GAD-7 and PHQ-9 scores. Correlation analysis revealed a moderate positive correlation (r_s = 0.400, df = 206, p < 0.001) between total GAD-7 and PHQ-9 scores. Conclusions: This study identified a high level of depression and anxiety among medical students and found a positive correlation between anxiety and depression scores. Addressing these mental health challenges is crucial not only for the well-being of the students but also for the future of healthcare, as the mental health of medical professionals directly impacts patient care.

Antiretroviral therapy (ART) has significantly transformed the management of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), positively impacting the health-related quality of life (HRQoL) and life expectancy of people living with HIV and AIDS (PLWHA). HRQoL is a critical consideration for HIV and AIDS patients as it reflects their overall well-being and treatment outcomes. This study aimed to investigate the HRQoL of PLWHA receiving an ART regimen containing tenofovir, lamivudine, and dolutegravir at a tertiary hospital in Johannesburg, South Africa. This descriptive, quantitative, cross-sectional study included 103 patients who consented in writing to participate. Data was collected using WHOQOL HIV-BREF, socio-demographic, health characteristics, and adherence questionnaires. Participants who reported ‘excellent’ and ‘very good’ on the descriptive rating scale were considered to have optimal adherence (≥95 %). This study's statistical significance was set at p ≤ 0.05. More than half of the participants were male (n = 53; 51.5 %), employed (n = 54; 52.4 %) had an income less than 2000 South African Rands (n = 59; 57.3 %), and reported high levels of adherence over a 7-day (n = 71; 68.9 %) and 4-week (n = 70; 67.9 %) reporting period. Majority of the sample considered their health as ‘good’ (n = 82; 79.6 %) and did not consider themselves ill (n = 85; 82.5 %). This study found that education level, income, health status, and perception of illness significantly (p ≤ 0.05) affected most domains of HRQoL and Overall HRQoL. While adherent (≥95 %) patients indicated superior HRQoL across most dimensions relative to non-adherent (≥95 %) patients, significant disparities in mean scores were exclusively noted only in the psychological domain (p = 0.01). Multivariate linear regression analysis revealed that level of education (Ꞵ = 1.18; p = 0.01), income (Ꞵ = 0.72; p = 0.00), perception of illness (Ꞵ = 1.75; p < 0.001), and health status (Ꞵ = 1.68; p < 0.001) are the predictors of overall HRQoL. Monitoring HRQoL in HIV patients is essential for providing holistic care and improving outcomes. By addressing comorbidities, psychosocial challenges, and unmet needs, healthcare providers can enhance the overall well-being and HRQoL of PLWHA.

Medical education presents significant challenges for medical students' mental health. Medical students are a vulnerable group, experiencing higher rates of mental health disorders, which can have implications for their well-being and academic performance. Consequently, evaluating Positive mental health (PMH) has become significant in a contemporary and demanding society, particularly among university students. This study aimed to assess the levels of PMH and identify the association between PMH domains and socio-demographic and health related variables among medical students enrolled at a university in South Africa. This quantitative, descriptive, and cross-sectional survey was conducted with 144 undergraduate medical students. Data were collected using a multi-dimensional PMH instrument and a sociodemographic and health related questionnaire, from 144 undergraduate medical students. The university's Research and Ethics Committee granted ethical clearance for the study. Results: The data were analysed using IBM SPSS version 29. The majority of the students were older than 20 years (79.2 %, n = 114), had no prior history of psychiatric illness, and had not previously taken any psychiatric medication (94.4 %, n = 136). More than half of the participants were single (66 %, n = 95), identified as Christians (76.4 %, n = 110), received a bursary (78.5 %, n = 113), had families living in rural areas (71.5 %, n = 103) and resided in the university housing (73.6 %, n = 106). Gender (p = 0.01), age (p = 0.02), religious affiliation (p = 0.03), history of psychiatric illness (p = 0.05) and treatment for psychiatric illness (p = 0.05) had a significant influence on the Total PMH score. Male participants reported higher mean scores in most PMH domains, excluding emotional support and spirituality domains. Participants aged between 22 and 23 years reported lower mean scores in Total PMH and most PMH domains. There is a significant difference in mean scores with gender (p = 0.02) and religious affiliation (p = 0.00) in the spirituality domain. The study results emphasised the complex nature of mental health and provided a rationale for assessing the various aspects of PMH in university students. By implementing evidence-based strategies and providing adequate support, medical schools can better support the mental health and well-being of their students, ultimately cultivating a healthier and more resilient future healthcare workforce.

Tobacco use is the world's leading preventable cause of death, with the highest burden in low and middle-income countries (LMICs). Those who have mental illness are particularly vulnerable, with a smoking rate two to five times higher than that of the general population. Quitting smoking has demonstrated benefits for mental health, including reducing stress and improving the quality of life. However, the economic feasibility of introducing Nicotine Replacement Therapy (NRT) in the psychiatric medical environment in South Africa has not yet been explored. This study aims to address this gap by assessing the impact on the budget of implementing an NRT-based smoking cessation program in a psychiatric hospital. This retrospective and cross-sectional study followed a budget impact analysis framework. Data were retrieved between May 19 and Aug 18, 2023, from 214 patients' medical records. Using primary and secondary data, an ingredients costing approach was used to estimate direct treatment costs of NRT smoking cessation. All costs were expressed in ZAR (South African currency). The economic evaluation was conducted from the payer's perspective, and the results were reported at a 5% discount rate. A two-way 10% sensitivity analysis was conducted. The study showed that study participants were primarily black, male, unemployed, diagnosed with schizophrenia and smoked lightly (69.16% ±3.46). Implementing the 3-month treatment period of NRT smoking cessation program would result in an expenditure of R1 478 915.42 for 214 patients. The hospital will require an additional 0.15% (±0.0095) of the total hospital budget and 6.09% (±0.31) of the hospital pharmacy budget. Our findings indicate that while implementing a NRT is crucial for improving the overall health outcomes among patients with mental illnesses, substantial investment would be required. The budgetary allocation for NRT smoking cessation interventions would vary by treatment settings and program duration. Consequently, careful consideration of budget allocation and resource distribution is necessary to ensure the program's sustainability within the broader healthcare framework in South Africa.