In this review, the neuropathogenesis of HIV dementia (HIV-D) is discussed in the context of the local epidemic. HIV-D continues to be prevalent in the era of highly active anti-retroviral therapy. HIV neuro-invasion into the central nervous system may result in the development of separate HIV genotypes in an individual through compartmentalisation. The blood brain barrier continues to limit penetration of anti-retroviral drugs into the cerebrospinal fluid. Individuals with active neuro-inflammation appear to respond well to HAART. In some cases low grade neuro-degeneration persists with consequent clinical deterioration. In South Africa, the emergence of a sub-epidemic of HIV-D is being driven by various factors, including the incomplete coverage of HAART to all who need it, the late stage presentation of people living with HIV/AIDS (PLWHA) and a co-occurring methamphetamine epidemic. Differences in viral subtype do not appear to confer protection against HIV-D. Implications for PLWHA who are at risk for HIV-D in South Africa are explored, with a view to providing suggestions for improving practice and research into this area.

Despite evidence from high income countries, it is not known whether screening and brief interventions (SBI) for alcohol and other drug (AOD) use are feasible to implement in low and middle income countries. This paper describes the feasibility and acceptability of a peer-led SBI for AOD-using patients presenting with injuries at emergency services in Cape Town, South Africa. Data were extracted from program records on the number of eligible patients screened and the number of program refusals. A questionnaire examined preliminary responses to the intervention for 30 patients who had completed the program and 10 emergency personnel. Peer counselors were also interviewed to identify barriers to implementation. Of the 1458 patients screened, 21% (305) met inclusion criteria, of which 74% (225) were enrolled in the intervention. Of the 30 patients interviewed, most (83%) found the program useful. Emergency personnel were supportive of the program but felt that visibility and reach could improve. Peer counselors identified the need for better integration of the program into emergency services and for additional training and support. In conclusion, with limited additional resources, peer-led SBIs for AOD use are feasible to conduct in South African emergency services and are acceptable to patients and emergency personnel.

Social anxiety disorder (SAD) is one of the most common and disabling anxiety disorders, yet much remains to be learned about its psychobiology. Although functional imaging has emphasized the role of the amygdala and other limbic structures in the neurobiology of SAD, structural and connectivity imaging techniques have emphasized the possibility of abnormalities in other regions and in whole-brain networks. The involvement of a broad range of networks in SAD is consistent with current understandings of the neuroanatomy of emotion and of social processing.

With DSM-V and ICD-11 on the horizon, now is an excellent time to consider the process leading on to the revision of classificatory systems in psychiatry. The challenges of classification in psychiatry are not inconsiderable. Among these are the controversies about what constitutes a 'disorder' and the appropriate place to draw the line between 'normality' and abnormal psychological status. In the absence of validating biomarkers for most mental disorders, judgements are required about the emphasis to put on available empirical data in the revision of existing classifications. In this review we propose that, given the salience of factors such as culture and contextual social experience to the experience and nature of mental disorders, there is an important need for inclusiveness in the process of leading to the revisions of classifications of mental disorders.

Folate is a nutrient of major health significance, but its dietary intake assessment is particularly complex to quantify through traditional approaches. Attempts have been made to validate dietary instruments for assessing folate intake against circulating concentration biomarkers. However, this requires careful attention on various methodological issues. We conducted a qualitative review of 17 recently published validation studies to identify these issues. The majority of the tested instruments were self-administered food frequency questionnaires while the biomarker most frequently used was serum/plasma folate. Seasonality was not considered in most studies. Little attention was given to using updated food composition databases based on reliable chemical methods and including fortified foods and dietary supplements. Time sequence of the test instrument and the reference biomarker used was often ambiguous, and reference periods did not always match. Correlation coefficient was the metric most commonly used, and correlations between dietary folate intake and blood folate concentration varied from weak to moderate (r = 0.05-0.54). The correlations were stronger when dietary supplement use was considered, and when serum/plasma rather than red blood cell folate was used. This review summarises issues that need to be considered in future studies intending to validate instruments for dietary folate assessment against concentration biomarkers.

Abstract Crick Lund, Tom Sutcliffe, Alan Flisher, and Dan J. Stein overview key international human rights instruments and note their relevance for people suffering from mental disorders in poor settings. This includes for example providing support to stopping rights violations, making legislation and policy compatible with the latest conventions (e.g. the CRPD), monitoring progress towards achieving a rights-based approach to mental health service provision, and lending weight to providing and scaling up appropriate, accessible, and affordable mental health care. After briefly analysing human rights aspects of legislation, oversight, and mental health systems in four African countries, the authors examine recent South African legislative reforms in detail, and the role of review boards, which has significantly helped protect rights in an affordable way. The final section makes recommendations for strengthening key areas of human rights protection.

The registry description gives a detailed account of the organizational and operational aspects of each registry and is an invaluable resource that aids interpretation and evaluation of registry prevalence data.

This guideline focuses on the pharmacotherapy of obsessive-compulsive disorder (OCD). OCD is characterised by obsessions and compulsions. A number of other disorders are also characterised by repetitive thoughts and rituals and may also respond to modifications of standard OCD treatment. These so-called OCD spectrum disorders include body dysmorphic disorder (characterised by recurrent concerns with imagined ugliness), hypochondriasis (characterised by recurrent concerns with imagined illness), trichotillomania (characterised by recurrent hair-pulling), and obsessive-compulsive personality disorder. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition has a new chapter on obsessive-compulsive and related disorders, which includes several of these conditions.

The large percentage of adolescents meeting diagnostic criteria coupled with the low proportion with serious impairment suggests that current diagnostic thresholds may be too low or not developmentally sensitive. Future research should address the nature of impairment for adolescents with specific phobia. Early detection and timely treatment are important given that specific phobia is persistent and highly comorbid and that few individuals seek treatment.