Objective: Iron deficiency may play a role in the pathophysiology of attention deficit hyperactivity disorder (ADHD) by causing dopamine dysfunction, but there is conflicting evidence in the litera...

Background: First-episode psychosis is common in adolescents and can be distressful to the person experiencing it for the first time. However, there is limited research globally and specifically in Africa about the lived experiences of adolescents admitted into a psychiatric facility for first-episode psychosis.Aim: To understand the adolescents’ experiences of psychosis and receiving treatment in a psychiatric facility.Setting: Adolescent Inpatient Psychiatric Unit, Tygerberg Hospital, Cape Town, South Africa.Methods: This was a qualitative study that used purposive sampling to recruit 15 adolescents with first-episode psychosis and admitted to the Adolescent Inpatient Psychiatric Unit, Tygerberg Hospital in Cape Town, South Africa. Individual interviews were audio recorded, transcribed and analysed using thematic analysis consisting of both inductive and deductive coding.Results: The participants described negative experiences of their first episode psychosis, provided varying explanations for their first episode psychosis and had the insight that cannabis precipitated their episodes. They described both positive and negative interactions with both the other patients and staff. They did not wish to return to the hospital again following their discharge. Participants stated that they wanted to change their lives, return to school and try to prevent a second episode of psychosis.Conclusion: This study provides insights into the lived experiences of adolescents presenting with first-episode psychosis and calls for future research to delve deeper into factors that support or enable recovery among adolescents with psychosis.Contribution: The findings of this study call for improving the quality of care in the management of first-episode psychosis in adolescents.

Introduction: Dissociative identity disorder (DID) is a complex and controversial psychiatric condition characterised by the presence of two or more distinct identities, personality states, or identities that recurrently take control of an individual’s behaviour. The identities or personality states may have distinct characteristics, memories, and behaviours, making identifying and differentiating them challenging. We describe a complex case that presented diagnostic challenges because of the fluctuations in psychiatric presentations associated with DID, and we outline a multidisciplinary and biopsychosocial intervention. Patient presentation: A 15-year-old transgender female presented with psychosis, suicidal ideation, a history of self-harm and aggressive behaviour, and panic attacks. She had a diary with excerpts that she could not remember writing and a history of forgetting certain parts of her day. She displayed extreme variations of psychiatric presentations, including depression, mania, panic, and aggression. Management and outcome: The patient’s alters were individually treated based on their psychiatric presentation and theme. Management followed the phased approach of the International Society for the Study of Trauma and Dissociation (ISSTD guidelines), which included establishing safety and symptom reduction, integration of traumatic memories and identity as well as rehabilitation. Conclusion: In this case report, we present an adolescent with a myriad of psychiatric presentations and describe her management. We summarise key difficulties that a clinician can encounter in diagnosing DID. Contribution: We bring awareness to the complexity of this diagnosis. Lastly, we propose an Multidisciplinary team (MDT) biopsychosocial approach that helps to manage the condition.

This article presents a challenging case of a 64-year-old female with treatment-resistant major depressive disorder with psychotic features and complex medical conditions, including the presence of a cardiac rhythm management device (CRMD). Despite all the complexities, she has received maintenance electroconvulsive therapy (M-ECT) over the past 4 years (56 episodes to date). Her anesthetic plan had to be tailored to her individual needs and revisited to reflect her medical conditions and perioperative complications during this period. Despite the anesthetic challenges, her psychiatric condition improved significantly, and the benefits of her M-ECT continue to outweigh the potential perioperative risks. The successful management of this patient can be attributed to the collaborative involvement and ongoing efforts of a multidisciplinary team that includes psychiatry, anesthesiology, cardiology, and theater and ward nursing personnel. We outline the ongoing challenges with the M-ECT, namely, treatment intervals, medical comorbidities, and the anesthesia management in the presence of a CRMD at a tertiary state hospital in South Africa.

Background: Iron is a cofactor in the production and breakdown of neurotransmitters like dopamine and is vital for normal brain function. Iron deficiency potentially contributes to the development of attention deficit hyperactivity disorder (ADHD) because dopamine imbalances can cause hyperactivity, restlessness and problems with concentration and attention. However, a direct association between iron deficiency and ADHD remains to be determined. Objectives: The aim of this study was to investigate the possible correlation between iron deficiency and ADHD in children and adolescents seen at the child psychiatry outpatient service at Tygerberg Hospital, South Africa. Methods: A retrospective chart review was conducted to gather data of all outpatient children and adolescents who had their serum ferritin and/or iron levels tested between February 2011 and January 2016. Relevant demographic and clinical information was extracted from 255 records, and statistical methods were used to test for correlations between ADHD and certain variables, including iron deficiency. Results: Out of 255 patients, 88 (34.5%) had iron deficiency, 157 (61.6%) had ADHD and 54 (21.0%) had both iron deficiency and ADHD. Of those patients with ADHD, 11 (7.0%) had other psychiatric comorbidities, and more males (89.0%) had this dual diagnosis compared to females (11.0%). Variables found to be significantly associated with ADHD included gender, age, Ritalin treatment and psychiatric comorbidities, but there was no significant association between ADHD and iron deficiency (p = 0.150). Conclusion: There was no relationship between ADHD and iron deficiency in this cohort of children and adolescents. Further studies using a treatment-naïve sample are required.