G-OCD compared with younger patients represented a small minority of the sample and showed later age at onset, more frequent adult onset and lower CBT use. Age at onset may influence course and overall management of OCD, with additional investigation needed.

Obtaining informed consent is a great challenge in global health research. There is a need for tools that can screen for and improve potential research participants' understanding of the research study at the time of recruitment. Limited empirical research has been conducted in low and middle income countries, evaluating informed consent processes in genomics research. We sought to investigate the quality of informed consent obtained in a South African psychiatric genomics study. A Xhosa language version of the University of California, San Diego Brief Assessment of Capacity to Consent Questionnaire (UBACC) was used to screen for capacity to consent and improve understanding through iterative learning in a sample of 528 Xhosa people with schizophrenia and 528 controls. We address two questions: firstly, whether research participants' understanding of the research study improved through iterative learning; and secondly, what were predictors for better understanding of the research study at the initial screening? During screening 290 (55%) cases and 172 (33%) controls scored below the 14.5 cut-off for acceptable understanding of the research study elements, however after iterative learning only 38 (7%) cases and 13 (2.5%) controls continued to score below this cut-off. Significant variables associated with increased understanding of the consent included the psychiatric nurse recruiter conducting the consent screening, higher participant level of education, and being a control. The UBACC proved an effective tool to improve understanding of research study elements during consent, for both cases and controls. The tool holds utility for complex studies such as those involving genomics, where iterative learning can be used to make significant improvements in understanding of research study elements. The UBACC may be particularly important in groups with severe mental illness and lower education levels. Study recruiters play a significant role in managing the quality of the informed consent process.

Death by maladministration: An important category of patient mortalityTo the Editor: South Africa (SA) has witnessed regular protest actions in recent years.These involve major political issues including quality education, service delivery, state capture, and other crucial matters.Despite their large contribution to the national burden of disease, including morbidity and mortality, mental health issues have received much less attention from the public and from the press.And the fate of the most severely impacted, such as those with intellectual disability, appears to be of particularly little interest.Yet the quality of life of those who are the most vulnerable and voiceless in society often serves as the proverbial canary in the coal mine.Disregard for such individuals is a marker of deep dysfunction in health systems.This has been tragically illustrated through the recent debacle at the Gauteng Department of Health, where administrators demanded the discharge of around 2 000 patients with mental illness from the Life Esidimeni facility, leading to the death of at least 94. [1]f we are to learn one lesson from the international experience of deinstitutionalisation over the last 50 years, it is that it should never be pursued as a cost-saving strategy.The funds should always follow the patients into the community.Well-resourced community-based mental health services can provide high-quality care for people living with mental illness, within a human rights framework.Indeed, this approach is strongly endorsed by the World Health Organization. [2]In effect, administrative decisions which override such considerations constitute an important category of patient morbidity and even mortality.Sustainable development, so sorely needed by our country, is crucially dependent on functional health systems. [3]In the case of HIV, death by maladministration was exemplified in the failure to roll out antiretrovirals, which severely impacted our economic growth.Analogously, deinstitutionalisation of psychiatric services without adequate community care has previously been proposed locally, but fails to provide health or save funds over the long term. [4]Not only is there no health without mental health, [5][6][7][8] but arguably there is no sustainable development without mental health; the data continuously indicate that it is less expensive for countries to treat mental illness than to ignore it. [7]e are heartened that health professionals (including the Society of Psychiatrists of SA) and civil society (including the SA Depression and Anxiety Support Group, and the SA Federation of Mental Health) joined to vigorously oppose the Gauteng Department of Health, and by the independence demonstrated by both the courts and the Health Ombud on this matter.We call for immediate action to implement the National Mental Health Policy Framework and Strategic Plan (2013 -2020) in provinces, and for adequate community-based care for people living with mental illness.

The unexpected finding that maternal HIV status did not predict any of the gestational outcomes may be due to high rates of ART usage among HIV-infected mothers. The potentially negative effects of HIV on gestational outcomes may have been attenuated by improved maternal health due to high coverage of antiretroviral treatment in South Africa. Interventions are needed to reduce alcohol consumption among pregnant mothers and to support healthy growth and psychosocial development of infants.

Findings suggest that more work is needed to understand the mechanisms underlying treatment acceptance. Brief interventions delivered in ED services in countries such as South Africa should target alcohol users with higher ASSIST scores in order to ensure the efficient use of scarce health resources.

Large-scale collaborative analysis of brain imaging data, in psychiatry and neu-rology, offers a new source of statistical power to discover features that boost ac-curacy in disease classification, differential diagnosis, and outcome prediction. However, due to data privacy regulations or limited accessibility to large datasets across the world, it is challenging to efficiently integrate distributed information. Here we propose a novel classification framework through multi-site weighted LASSO: each site performs an iterative weighted LASSO for feature selection separately. Within each iteration, the classification result and the selected features are collected to update the weighting parameters for each feature. This new weight is used to guide the LASSO process at the next iteration. Only the fea-tures that help to improve the classification accuracy are preserved. In tests on da-ta from five sites (299 patients with major depressive disorder (MDD) and 258 normal controls), our method boosted classification accuracy for MDD by 4.9% on average. This result shows the potential of the proposed new strategy as an ef-fective and practical collaborative platform for machine learning on large scale distributed imaging and biobank data.

Kong and colleagues (Kong, Dunn, and Parker 2017) explore how a genomic medicine approach may impact on the perceptions and treatment of psychiatric conditions, and set out an interdisciplinary, cl...

Olfactory reference syndrome is characterised by the erroneous belief that one emits an unpleasant body odour. This results in significant distress and is often accompanied by repetitive behaviour such as frequent showering in an attempt to camouflage the perceived odour. The body odour concerns may have a delusional quality and do not respond to simple reassurance or counterexample. Herein, we report the case of an olfactory reference disorder (ORD) patient who had received multiple medical interventions and undergone polysurgery prior to an accurate diagnosis being established. ORD may lead to significant disability, yet often goes unrecognised for many years. For many patients, poor insight will contribute to their reluctance to consider psychiatric treatment. This case demonstrated that a multimodal treatment approach comprising judicious medication use, combined with cognitive behavioural therapy, in the context of a therapeutic alliance yielded therapeutic success.

Lower respiratory tract illness is a major cause of childhood morbidity and mortality. It is unknown whether infants are predisposed to illness because of impaired lung function or whether respiratory illness reduces lung function.To investigate the impact of early life exposures, including lower respiratory tract illness, on lung function during infancy.Infants enrolled in the Drakenstein child health study had lung function at 6 weeks and 1 year. Testing during quiet natural sleep included tidal breathing, exhaled nitric oxide, and multiple breath washout measures. Risk factors for impaired lung health were collected longitudinally. Lower respiratory tract illness surveillance was performed and any episode investigated.Lung function was tested in 648 children at 1 year. One hundred and fifty (29%) infants had a lower respiratory tract illness during the first year of life. Lower respiratory tract illness was independently associated with increased respiratory rate (4%; 95% confidence interval [CI], 1.01-1.08; P = 0.02). Repeat episodes further increased respiratory rate (3%; 95% CI, 1.01-1.05; P = 0.004), decreased tidal volume (-1.7 ml; 95% CI, -3.3 to -0.2; P = 0.03), and increased the lung clearance index (0.13 turnovers; 95% CI, 0.04-0.22; P = 0.006) compared with infants without illness. Tobacco smoke exposure, lung function at 6 weeks, infant growth, and prematurity were other independent predictors of lung function at 1 year.Early life lower respiratory tract illness impairs lung function at 1 year, independent of baseline lung function. Preventing early life lower respiratory tract illness is important to optimize lung function and promote respiratory health in childhood.

Our results indicate that SNs prevalence is significantly greater in the DLSS group compared to the control. Furthermore, SNs are strongly associated with DLSS.