Adjustment disorder with anxiety (ADWA) is a highly prevalent condition, particularly in primary care practice. Adjustment disorders significantly impair patients’ quality of life, but there are relatively few systematic treatment trials in the area of ADWA, and there are few data on predictors of treatment response. Here we review the limited pharmacotherapy data available on the treatment of ADWA. In primary care settings benzodiazepines are frequently prescribed for psychiatric symptoms, despite their adverse event profile and their potential risk for dependence. The non-benzodiazepine drug etifoxine is a promising agent insofar as it is not associated with dependence. Its efficacy and safety have been evaluated in three double-blind randomized clinical trials in comparison with non-benzodiazepine (buspirone) and benzodiazepines (lorazepam and alprazolam) . The three trials point to the anxiolytic properties of etifoxine, demonstrating an overall clinical improvement of patients, and no risk for dependence or rebound effect. In conclusion, even if benzodiazepines are often used for the treatment of ADWA, other therapeutic options are possible, with a better safety profile.

Given the near ubiquity of exposure, limited resources may best be dedicated to those that are more likely to be further exposed such as victims of interpersonal violence. Identifying mechanisms that account for the associations of prior interpersonal violence with subsequent trauma is critical to develop interventions to prevent revictimization.

Results from previous studies on maternal folic acid intake and infant oral clefts are inconclusive. The aim of the present study was to investigate the association between women's use of folic acid and/or multivitamin supplements and the risk for oral cleft in the newborn. We used data from the Medical Birth Registry of Norway based on all births in Norway from 1999 to 2013. A total of 528 220 women had 880 568 pregnancies, resulting in 896 674 live births and stillbirths, of which 1623 had oral clefts (isolated oral clefts, n 1311; non-isolated oral clefts, n 312). Altogether, 21·5% of women were vitamin supplement users before pregnancy. The birth prevalence of oral clefts was 1·81/1000 live births and stillbirths. Relative risks (RR) were estimated with log-binomial regression. For pregnancies with maternal use of vitamins, the adjusted RR for clefts overall was 0·90 (95% CI 0·79, 1·04). The adjusted RR for cleft palate only (n 586) was 0·84 (95% CI 0·66, 1·06) and that for cleft lip with or without cleft palate (n 1037) was 0·94 (95% CI 0·79, 1·13). Associations were stronger for cleft cases that occurred in combination with other malformations (adjusted RR 0·63; 95% CI 0·45, 0·88), although vitamin supplements provided no protection against isolated clefts (adjusted RR 0·98; 95% CI 0·84, 1·15). In conclusion, our study demonstrates no statistically significant association between vitamin use and isolated oral clefts. However, we found lower risk for oral clefts that occurred in combination with other malformations.

A total of 64 relevant articles were identified across all modalities. Overall, studies reported smaller total brain volume as well as smaller volume of both the white and grey matter in specific cortical regions. The most consistently reported structural MRI findings were alterations in the shape and volume of the corpus callosum, as well as smaller volume in the basal ganglia and hippocampi. The most consistent finding from diffusion tensor imaging studies was lower fractional anisotropy in the corpus callosum. Proton magnetic resonance spectroscopy studies are few to date, but showed altered neurometabolic profiles in the frontal and parietal cortex, thalamus and dentate nuclei. Resting-state functional MRI studies reported reduced functional connectivity between cortical and deep grey matter structures. Discussion There is a critical gap in the literature of MRI studies in alcohol-exposed children under 5 years of age across all MRI modalities. The dynamic nature of brain maturation and appreciation of the effects of alcohol exposure on the developing trajectory of the structural and functional network argue for the prioritisation of studies that include a longitudinal approach to understanding this spectrum of effects and potential therapeutic time points.

CITATION: Long, W., Chiliza, B. & Stein, D.J. 2015. Anger and Afrophobia in South Africa: What is a health practitioner to do?. South African Medical Journal, 105(7):510, doi:10.7196/SAMJnew.7968.

The Social Problem Solving Inventory-Revised Short-Form (SPSI-R:SF) has been used in several countries to identify problem-solving deficits among clinical and general populations in order to guide cognitive-behavioural interventions. Yet, very few studies have evaluated its psychometric properties. Three language versions of the questionnaire were administered to a general population sample comprising 1000 participants (771 English-, 178 Afrikaans- and 101 Xhosa-speakers). Of these participants, 210 were randomly selected to establish test-retest reliability (70 in each language). Principal component analysis was performed to examine the applicability of the factor structure of the original questionnaire to the South African data. Supplementary psychometric analyses were performed, including internal consistency and test-retest reliability. Collectively, results provide initial evidence of the reliability and validity of the SPSI-R:SF for the assessment of problem solving deficits in South Africa. Further studies that explore how the Afrikaans language version of the SPSI-R:SF can be improved and that establish the predictive validity of scores on the SPSI-R:SF are needed.

The HAND criterion designed for adults was able to identify youth with important functional cognitive impairments who do not fit criteria for HIVE and would therefore not have been identified otherwise. This has major clinical implications regarding the importance of managing HIV-infected youth.

Background Trichotillomania (TTM), obsessive-compulsive disorder (OCD), and skin-picking disorder (SPD) frequently occur together and share overlapping phenomenology, pathophysiology, and possible genetic underpinnings. This study sought to identify factors that predict OCD and SPD in hair pullers. Methods Five hundred fifty-five adult female hair pullers were recruited from specialty clinics and assessed using standardized, semi-structured interviews and self-reports. Clinical predictors and multivariate models were evaluated using logistic regression modeling. Results Hair pullers met criteria for OCD (18.9%), SPD (19.5%), or chronic skin picking (CSP) (5%), or both comorbid diagnoses, respectively. In the final multivariate model for OCD, family history of OCD and an eating disorder diagnosis were associated with an increased risk of OCD in TTM. A nail-biting diagnosis was associated with a decreased risk of OCD in TTM. In the final multivariate model for SPD/CSP, only family history of OCD was associated with an increased risk of SPD/CSP in TTM. Conclusions Identification of factors predicting OCD and SPD in TTM provides evidence for the relatedness of these disorders and supports their collective classification as obsessive-compulsive and related disorders (OCRDs) in DSM-5. The findings of this study further underscore the importance of assessing for comorbid OCRDs and family histories of OCRDs in clinical practice.

Introduction\nDisease burden estimates describe how diseases, injuries and risk factors affect the mortality and disability in a population. The comparison of the disease burden in different groups of the population is central in the estimations. The Global Burden of Disease project (GBD) is a large epidemiological project aimed at identifying and describing the main drivers of fatal and non-fatal health loss at global, regional, national, and, in some cases, subnational levels. The project is coordinated from the Institute for Health Metrics and Evaluations (IHME) in Seattle, United States. GBD describes the development in disease burden for more than 300 health conditions and almost 80 risk factors for 195 countries. In the autumn 2016 GBD published new global, regional and national estimates of disease burden (GBD 2015), including detailed measures of disease burden in Norway. The present report gives a summary of the Norwegian results. \nMethods\nThe GBD project employs four main measures of disease burden: number of deaths, years of life lost (YLL), years lived with disability (YLD) and disability-adjusted life-years (DALY). Life expectancy and healthy life expectancy are also estimated. YLLs are estimated based on life expectancy at the age of death. Non-fatal health loss (YLD) is estimated by multiplying the prevalence of disease and injuries with their associated health loss, quantified through disability weights. DALY is a summary measure of fatal and non-fatal health loss, and is estimated by summarising the YLLs and YLDs for different health conditions. The data sources used in GBD are collected through systematic searches and literature reviews of health data from sources such as health registries, health surveys and published articles around the world. When data are sparse or missing in a geographical area, the global model in GBD provides estimates from that area based on data from other similar areas. Norwegian estimates are most heavily influenced by data from other Western-European countries.\nResults\nThe GBD 2015 results for Norway show that both life expectancy and healthy life expectancy have increased since 2005. The disease burden in Norway is dominated by non-communicable diseases, both in terms of fatal and non-fatal health loss. The most important causes of death are diseases common in the population 70 years and older, in particular cardiovascular diseases and dementias. Neoplasms (cancer) is the second largest cause of death in the population, and the most important cause of death before age 70. Despite decreasing since 2005, ischemic heart disease (myocardial infarction) is still the largest cause of both number of deaths and YLLs in Norway. Other important contributors to number of deaths and YLLs are cerebrovascular disease (stroke), dementia, lung cancer, colorectal cancer, lower respiratory infection (pneumonia) and chronic obstructive pulmonary disease (copd). Suicide and overdoses are the most common causes of death in the age group 15 to 49 years, and are therefore among the ten largest causes of premature mortality (YLLs). Musculoskeletal and mental disorders are the largest causes of non-fatal health loss (YLDs). Mental disorders cause substantial non-fatal health loss in almost all age-groups, and depressive and anxiety disorders are the most important causes within this group. Low back and neck pain is the largest single cause of disease burden measured as DALYs in the Norwegian population. High blood pressure, unhealthy diet and smoking are the modifiable risk factors that cause the most deaths. Smoking is the most important risk factor for death before the age of 70. The risk factors in GBD explain around half of the deaths, but only 20 % of the non-fatal health loss in Norway.\nDiscussion\nThe extensive collection of data sources from all over the world, the quantification of uncertainty and the effort to maximize comparability over time, geographical area and across different health conditions are the main strengths of the GBD project. GBD also contributes to identifying areas with sparse or missing information. For instance, there are large differences in the amount of disease burden that is explained by the included risk factors in GBD. While 85 % of the disease burden due to cardiovascular diseases is attributed to the GBD risk factors, they only explain about 20 % of the disease burden due to musculoskeletal and mental disorders.\nMissing and sparse data, and varying quality of the data are the major challenges for the validity of the GBD results. This also applies to data from high income countries such as Norway. There is little tradition for systematic data-collection on many non-fatal health conditions, such as mental and drug use disorders, and the prevalence and distribution of these in the Norwegian population are not known. Norway also lacks a system for regular collection of national representative data on prevalence of important risk factors, such as alcohol use, diet, high cholesterol, high blood pressure and low physical activity. To improve the quality of the Norwegian estimates, it is essential that health conditions and risk factors that are important for the Norwegian disease burden are regularly assessed in the Norwegian population.\nConclusion\nThe results from the GBD-project provide a comprehensive and comparative overview of fatal and non-fatal disease burden over time and across sex and age groups in the Norwegian population. The project also estimates the contribution from important risk factors on public health. The results may inform the knowledgebase and discussions on public health issues in Norway.