COURSE OF ILLNESS IN A SOUTH AFRICAN POPULATION WITH BIPOLAR DISORDER

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Measuring instrument

After signing the informed consent form, a questionnaire, the Affective Disorder Evaluation (ADE) (99), was completed by the researcher for every study subject. See Appendix F for an example of the ADE. The researcher was assisted by registered nurses fluent in Northern Sotho, who translated the questions to non-English-speaking participants. The ADE is a standardised tool for initial clinical assessment of patients possibly suffering from bipolar disorder. Developed for the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), the main objective of the ADE is to provide an efficient way of making a reliable current and lifetime diagnosis of bipolar disorder. (102) The ADE uses an adaptation of the mood disorder modules from the Structured Clinical Interview for DSM-IV (SCID). (103) These modules assess current mood episode and lifetime mood disorder diagnosis and flow in an orderly sequence designed to reflect the DSM-IV mood disorder classification.

Definition of recurrent unipolar mania

One of the challenges in the research of recurrent bipolar mania is a lack of consensus on the defining criteria. Different authors have used different criteria for the diagnosis of recurrent mania with respect to the number of manic episodes, diagnosis of manic episode, and inclusion/exclusion of the depressive symptoms in the intercurrent period. (27) In the studies published in the last decade there appears to be some consensus on the presence of at least three manic episodes with no depressive episodes, but there is no consensus on the timeframe for the same. Aghanwa defined “recurrent mania” as three previous episodes of mania or hypomania (ICD-10) and the presence of affective illness for at least four years. (91) On the other hand, Yazici et al defined recurrent mania by the occurrence of at least four episodes of mania (DSM-IV) and at least four years of follow up without any depressive episode.(92) Thus, a critical issue that remains unresolved concerns the maximum number of manic/hypomanic episodes that a person must experience in a particular timeframe without any depressive episodes so as to enable a psychiatrist to make a confident diagnosis of recurrent unipolar mania. One should consider however that this issue is not unique to making a diagnosis of only recurrent unipolar mania but is equally important when making a diagnosis of recurrent unipolar depression. For the purposes of this study, a unipolar manic course was considered in all patients who had never experienced a major depressive episode. However, the rate of unipolar mania was also established for those in the sample who were diagnosed with bipolar disorder in particular and had three or more lifetime number of phases without the occurrence of any depressive episodes.

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Religious affiliation

Most of the patients interviewed (63,11%) were members of the Zion Christian Church (ZCC), (see Table 5.5). The ZCC is a religious denomination with an extremely large following in Limpopo Province, their headquarters, Zion City Moria, situated a mere 5 kilometres from Mankweng Hospital. It is one of the largest African-initiated churches in southern Africa with congregations throughout South Africa as well as in neighbouring countries.
The ZCC comprises two main congregations which are led by Barnabas Lekganyane (identified by wearing a green badge with a silver star) and Saint Engenas Lekganyane (identified by wearing a green badge with a silver dove), the grandsons of the founder of the church.
In a scientific letter to the African Journal of Psychiatry; Culture, religion and psychosis – a case study from Limpopo province, South Africa, Grobler (2011) describes a family affiliated to the ZCC church that became psychotic and were treated at the Mankweng Hospital Psychiatric Unit. (105) They became psychotic after one of the family members received a prophecy from an elder of the church suggesting that something bad was going to happen to her and her family. The role of traditional- and faith healers will be discussed in more detail under the section ‘Treatment’, as a large number of patients in this study (64%) also sought help from traditional healers, most of whom would be within the context of the ZCC church, considering that 63% were members of this church.

Chapter 1
Introduction
Chapter 2
The History of Bipolar Disorder
Chapter 3
Unipolar Mania
Chapter 4
Purpose and Methodology
Chapter 5
Results
Chapter 6
Discussion
Chapter 7
Conclusion
Chapter 8
References
Appendix A
Thesis Photographs
Appendix B
Affective Disorder Evaluation
Appendix C
Informed Consent Documents
Appendix D
Letter from Faculty of Health Sciences Research Ethics Committee, University of Pretoria
Appendix E
Letters of Approval from Chief Executive Officers at the Mankweng-, Mokopane- and George Masebe Hospitals
Appendix F
Letter from Limpopo Department of Health and Social Development

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