GLOBAL PSYCHIATRY

Objectives
Globally, Moslems are the second largest religious group. During the month of Ramadan from dawn to sundown, healthy Moslems are required to refrain from eating, drinking, smoking, sexual activity and harmful behaviour towards others and themselves. Thus Ramadan may change individual physical states and social interactions. Both might affect mental health within society. Consequently, this systematic review looks at the various effects of Ramadan on mental health.


Methods
A literature search on Ramadan and mental health initially identified 294 papers. We finally selected all 22 relevant papers covering Ramadan and mental health from which study data were extracted.


Results
Relevant papers focussed on the general population and healthy volunteers, on subjects practising sports, on subjects with severe physical disorders, on subjects at risk of eating disorders and on subjects with mental health disorders. The effects of Ramadan on mental well-being were mixed. Positive and negative effects were usually minor, except in subjects with schizophrenia and metabolic syndrome, and in subjects with bipolar disorder who suffered a substantial increase of relapses.


Conclusion
Ramadan fasting is safe in most conditions and disorders, but caution is required in subjects with schizophrenia and bipolar disorder. The research on mental health and Ramadan would profit from larger studies with more representative samples to help understand the intra-individual and social factors that affect the mental health and well-being in patients and in society. The scientific potential of such studies may have been overlooked in the psychiatric community.

Objectives
To describe the range and frequency of psychotropics used in the management of bipolar disorder in a specific setting as well as describe the nature and frequency of monotherapy versus polypharmacy use. Specifically to determine congruence with recommended standard of care that might inform a review and refinement of prescribing within this context.
 
Methods
The study was a retrospective file review for patients with bipolar disorder (ICD 10 and or DSM IV TR diagnostic criteria) attending the outpatient clinic of a specialised psychiatric hospital (Tara Hospital) affiliated to the Department of Psychiatry (University of the Witwatersrand) in Johannesburg, South Africa. Data were presented both descriptively (continuous, discrete and categorical data) and with a range of appropriate statistical tests used for associations between categorical data (Chi Square; Fisher’s exact test; Cramer’s V and the phi coefficient).
 
Results
The majority of patients (93.8%) were prescribed polypharmacy, with 3.2 as the mean number of psychotropic medications prescribed per patient (as determined from the last prescription written during the period of review, i.e. one year). There was a notable variety in the combinations used with no particular combination being prescribed in the majority of patients, noting, however, that 47% of the combinations used included a standard mood stabiliser prescribed together with an antipsychotic.
 
Conclusions
The current study provides data on the prescribing patterns for bipolar disorder in a specialist psychiatric clinic within an academic complex in South Africa. The findings reflect international studies and highlight polypharmacy and combination treatment as common in such settings. Where polypharmacy is prescribed, the variation in combinations prescribed indicate that whilst treatment guidelines may provide a best practice approach, studies determining the most useful combinations are few and ultimately clinical requirements for individual patients will dictate treatment.