What is a Psychiatrist?

What is a Psychiatrist?

Psychiatry is the branch of medicine focused on the diagnosis, treatment and prevention of mental, emotional and behavioural disorders.


A psychiatrist is a medical doctor who specializes in mental health, including substance use disorders. Psychiatrists are qualified to assess both the mental and physical aspects of psychological problems.


People seek psychiatric help for many reasons. The problems can be sudden, such as a panic attack, frightening hallucinations, thoughts of suicide, or hearing “voices.” Or they may be more long-term, such as feelings of sadness, hopelessness, or anxiousness that never seem to lift or problems functioning, causing everyday life to feel distorted or out of control.

Because they are qualified doctors, psychiatrists can order or perform a full range of medical laboratory and psychological tests which, combined with discussions with patients, help provide a picture of a patient’s physical and mental state. Their education and clinical training equip them to understand the complex relationship between emotional and other medical illnesses and the relationships with genetics and family history.


Psychiatrists use a variety of treatments – including various forms of psychotherapy, medications, psychosocial interventions and other treatments (such as electroconvulsive therapy or ECT), depending on the needs of each patient.


Most medications prescribed by a psychiatrist are used in much the same way that medications are used to treat high blood pressure or diabetes. After completing thorough evaluations, psychiatrists can prescribe medications to help treat mental disorders. Psychiatric medications can help correct imbalances in brain chemistry that are thought to be involved in some mental disorders.


Patients on long-term medication treatment typically meet with their psychiatrist periodically to monitor the effectiveness of their medication and any potential side effects.


To practice as a Psychiatrist, you need to have a Bachelor of Medicine and Bachelor of Surgery degree (MBChB), followed by a Masters in Medicine, specialising in Psychiatry. Prospective students also need to be registered with the HPCSA


Some psychiatrists also complete additional specialised training after their four years of general psychiatry training. They may become certified in:

  • Child and adolescent psychiatry
  • Geriatric psychiatry
  • Forensic (legal) psychiatry
  • Addiction psychiatry
  • Pain medicine
  • Psychosomatic (mind and body) medicine
What is Antisocial Personality disorder?

What is Antisocial Personality disorder?

Antisocial personality disorder (ASPD) is a condition characterized by a lack of empathy and regard for other people. People who have antisocial personality disorder have little or no regard for right or wrong. They antagonize others and often act insensitively or in an unfeeling manner.


It is not unusual for symptoms to be present during childhood; such behaviours may include fire setting, cruelty to animals, and difficulty with authority. Individuals with this disorder may lie, engage in aggressive or violent behaviour and participate in criminal activity.


These characteristics often lead to major difficulties in many life areas. At its core, the inability to consider the thoughts, feelings, and motivations of other people can lead to harmful disregard for others. As adults, the disorder can be destructive to both the person living with it and those who come into contact with them.


People with antisocial personality disorder are more likely to engage in risk-taking behaviours and dangerous activities. Those with the disorder are often described as having no conscience and feel no regret or remorse for their harmful actions.


While the condition may begin in childhood, it cannot be officially diagnosed before the age of 18. Children who display these symptoms are diagnosed with conduct disorder. In order to be diagnosed with ASPD, a person must display a disregard and violation of the rights of others before the age of 15.


The exact causes of antisocial personality disorder are not known. Personality is shaped by a variety of forces including nature and nurture. Upbringing can also have an important influence. Childhood abuse, neglect, and trauma have also been linked to the onset of ASPD. A number of factors have been found to increase the risk of the disorder including smoking during pregnancy and abnormal brain function. Research suggests that people with ASPD have differences in the frontal lobe, the area of the brain that plays a role in planning and judgment. People with the disorder also tend to require greater stimulation and may seek out dangerous or even illegal activities to raise their arousal to an optimal level.


As this is a complex personality disorder, it is recommended that you work with your psychiatrist or mental health team in the event that you or a loved one are experiencing a range of these symptoms.



    What is a Borderline Personality Disorder?

    What is a Borderline Personality Disorder?

    A complex personality disorder where a person experiences instability in their relationships, moods, thinking, behaviour — even in their identity.


    A person with a borderline personality disorder (BPD), most probably feels like they are on a rollercoaster — and not just because of their unstable emotions or relationships, but also because of their wavering sense of who they are.


    Their self-image, goals, and even their likes and dislikes may change frequently in ways that feel confusing and unclear.


    People with BPD tend to be extremely sensitive. Some describe it as like they are having an exposed nerve ending. Small things can trigger intense reactions. And once upset, have trouble calming down. It’s easy to understand how this emotional volatility and inability to self-soothe leads to relationship turmoil and impulsive — even reckless — behaviour.


    When a person with BPD is in the throws of overwhelming emotions, they are unable to think straight or stay grounded. They may say hurtful things or act out in dangerous or inappropriate ways that then make them feel guilty or ashamed afterwards.


    It’s a painful cycle that can feel impossible to escape. But it’s not. There are effective BPD treatments and coping skills that can help people with BPD feel better and back in control of their thoughts, feelings, and actions.


    There are many complex things happening in the BPD brain, and researchers are still untangling what it all means. But in essence, if you have BPD, your brain is on high alert. Things feel scarier and more stressful to you than they do to other people. Your fight-or-flight switch is easily tripped, and once it’s on, it hijacks your rational brain, triggering primitive survival instincts that aren’t always appropriate to the situation at hand.


    This may make it sound as if there’s nothing that can be done. After all, what can you do if your brain is different? But the truth is that you can change your brain. Every time you practice a new coping response or self-soothing technique you are creating new neural pathways. Some treatments, such as mindfulness meditation, can even grow your brain matter. And the more you practice, the stronger and more automatic these pathways will become. So, don’t give up! With time and dedication, it is possible to change the way we think, feel, and act.


    Is a False Memory a Real Thing?

    Is a False Memory a Real Thing?

    A false memory is a fabricated or distorted recollection of an event and yes, it is a real thing. Such memories may be entirely false and imaginary. In other cases, they may contain elements of fact that have been distorted by interfering information or other memory distortions.


    People often think of memory as something like a video recorder, accurately documenting and storing everything that happens with perfect accuracy and clarity. In reality, memory is very prone to fallacy. People can feel completely confident that their memory is accurate, but this confidence is no guarantee that a particular memory is correct. Examples of this phenomenon can range from the fairly mundane, such as incorrectly recalling that you locked the front door, to the much more serious, such as falsely remembering details of an accident you witnessed.


    False memory differs from simple memory errors. While we are all prone to memory fallibility false memory is more than a simple mistake; it involves a level of certitude in the validity of the memory.


    Everyone experiences memory failures from time to time, false memories are unique in that they represent a distinct recollection of something that did not actually happen. It is not about forgetting or mixing up details of things that we experienced; it is about remembering things that we never experienced in the first place.


    Factors that can influence false memory include misinformation and misattribution of the original source of the information. Existing knowledge and other memories can also interfere with the formation of a new memory, causing the recollection of an event to be mistaken or entirely false.


    Over time, memories become distorted and begin to change. In some cases, the original memory may be changed in order to incorporate new information or experiences.


    While it might be difficult for many people to believe, everyone has false memories. Our memories are generally not as reliable as we think and false memories can form quite easily, even among people who typically have very good memories.


    What is Schizophrenia?

    What is Schizophrenia?

    Schizophrenia is a long term mental disorder that involves a breakdown in the relation between thought, emotion and behaviour leading to faulty perception, inappropriate actions, and feelings. There is a withdrawal from reality into a world of fantasy, delusion or false belief. 


    Schizophrenia affects the way a person thinks, acts, expresses emotions, perceives reality, and relates to others. It is often hard to spot because there’s usually no specific trigger and the exact cause of schizophrenia is unknown. Paranoid schizophrenia or schizophrenia with paranoia is often the complex disorder that is more easily recognised. People with schizophrenia or paranoid schizophrenia have an altered perception of reality. They believe in conspiracies, that they are being watched or relentlessly tracked, they may see or hear things that don’t exist and speak in strange or confusing ways.


    There is a myth that Schizophrenia refers to a “split personality” or multiple personalities. Multiple personality disorder is a different and much less common disorder than schizophrenia. People with schizophrenia do not have split personalities; rather, they are “split off” from reality. This “split off” from reality may cause relationship problems, disruption in daily activity such as bathing, eating, working and the completion of simple tasks. In many instances people with Schizophrenia withdraw from the outside world, acting in an eccentric, confused or fearful manner.


    Researchers have uncovered that genetics play a role in that when Schizophrenia runs in families that there is a greater likelihood to have Schizophrenia passed on from parent to child. The environment is a contributing factor such as exposure to viral infections, toxins, drug and substance use such as marijuana or highly stressful situations.


    Schizophrenia symptoms are referred to as positive, negative and cognitive. The reference to negative symptom doesn’t mean “bad.” It notes the absence of normal behaviours like, lack of emotion or a limited range of emotions, less energy, less speech, lack of motivation, loss of pleasure or interest in life and poor hygiene and grooming habits.


    The reference to positive symptoms doesn’t mean good. It refers to added thoughts or actions that aren’t based in reality. They’re sometimes called psychotic symptoms and can include delusions which are false, mixed, and sometimes strange beliefs that aren’t based in reality. Hallucinations, these involve sensations that aren’t real with hearing voices and or sounds being common. Or even a condition called catatonia, where the person may stop speaking, and their body may be fixed in a single position for a very long time.


    Cognitive symptoms refer to when a person has trouble understanding information and using it to make decisions or experiences a sudden decline in working memory.


    While schizophrenia is a chronic disorder, many fears about the disorder are not based on reality.  Most people with schizophrenia get better over time, not worse.  Treatment options in South Africa are improving all the time.  Schizoprenia is often episodic, so periods of remission are ideal times to employ self-help strategies to limit the length and frequency of any future episodes.  


    Along with the right support, medication, and therapy, many people with schizophrenia are able to manage their symptoms, function independently, and live a joy filled, purpose driven life. 

    Grief – how long is too long?

    Grief – how long is too long?

    There are major individual differences in reaction and adaptations to the loss of a loved one. This depends on a many factors such as the complexity of the relationship, the closeness in the relationship, the way in which the death occurred, the perceived support provided by others and personality factors.


    Religions and cultures give guidelines on what to do and when to do when a loved one passes away but rarely do they give you a how to guide to process your grief.


    There is no correct time frame for someone to grieve the loss of a loved one.


    Prolonged grief is the most common form of complicated grief in adults. It is different from normal grief in that the immediate grief reactions persist with undiminished strength, beyond what is expected in light of cultural and religious norms. This causes a considerable loss of everyday functioning and may include not being able to care for themselves or possibly their children.


    Someone experiencing prolonged grief may have difficulty accepting the death of a loved one; they may feel as if they have lost a part of themselves, they may identify and dramatise themselves as a widow or widower and they are either emotional numb or emotional volatile making it difficult for them to continue with their lives as previously.


    Prolonged grief disorder is not the same as depression; the difference is in thoughts and emotions that continue to circle around the loved ones passing. In a depressed state, feelings are more generalised and less associated with the loss of the loved one with intense feelings of sadness, hopelessness, helplessness and worthlessness.


    Sleep disturbances are common in both prolonged grief and depression. However, pronounced weight loss, slowness in thinking, speaking and moving and difficulty in making decisions are prominent in depression and less likely to be evident in prolonged grief.


    Suicidal thoughts occur in both prolonged grief and depression. In prolonged grief, this will often be associated with a wish to be reunited with their loved one, and in depression, thoughts of ending life will commonly be more associated with the irrational belief that people would be better off without them.


    As prolonged grief and depression often occur in parallel, it is advisable that you connect with a medical practioner in order to get the correct support, guidance and possible medical intervention.


    THERE IS HELP AVAIALBLE, connect with a friend today!

    Depression – the silent killer

    Depression – the silent killer

    Depression is described as a long-lasting and often all-encompassing mental health condition that may be caused by genetics and unbalanced brain chemistry.


    Many people wrongly assume that difficult, stressful and traumatic events alone may trigger depression. In many individuals irregular brain chemistry relates into depression without identifiable situational causes. This brain chemistry or the biochemical processes that control the neurotransmitters that regulate mood, sometimes malfunction without an apparent reason, leading to depression.


    A combination of symptoms lasting more than two weeks might indicate a mental health condition. But above everything else the feeling of I’m just tired of being so tired is an indicator that you will benefit from support.


    Research has found that more than one third of people who struggle with depression don’t seek help at all. That is why depression is often referred to as the silent killer; people don’t seek help and in some instances die by depression – meaning they commit suicide.


    IT’S A BIG DEAL – the struggle is real. Depression has more than just an effect on your emotions like angry outbursts, irritability, or restlessness. It also leads to isolation, you avoid family, friends and activities they you previously enjoyed. The feelings of being sad, empty, numb, hopeless, helpless or worthless overwhelm you all the time, regardless of any positive inputs around you.


    The following signs are an indication that you should seek medical support:

    Unrelenting tiredness, reduction in energy levels, change in eating habits or sleeping patterns

    Unusually poor concentration, memory, ability to think clearly, inability to complete tasks or slow or sudden poor work performance

    Body pain with no temperature, inflammation or injury

    Thoughts or plans to kill or hurt yourself or others

    Thoughts or plans to just run away


    Many people today deal with unusual physical, emotional, social and psychological changes all at once. These stresses, genetics, unbalanced brain chemistry, social structures, crime and unrealistic expectations all seem to contribute to depression.


    Overall, one in seventeen people suffer from “Major Depressive Disorder” at some point in their lives, according to a recent study and book (A guide to helping yourself or a friend – Written by: Asher Low, B.SW, R.SW), and the number of people diagnosed with depression right now is over 350 MILLION, making depression the leading cause of disability in the world.  


    THERE IS HELP AVAILABLE! Feeling or being depressed is no longer the end of the road. The world we live in is getting more and supportive every day. NEXT STEP – speak to someone about your feelings or call the free, confidential SADAG Suicide Crisis line on 0800 567 567 or call the SADAG Mental Health line on 011 234 4837.


    What is a Psychosis or Psychotic disorder?

    What is a Psychosis or Psychotic disorder?

    Psychosis or a Psychotic disorder is a group of serious illnesses that affect the mind. They make it hard for someone to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality, and behave appropriately.

    In a Psychosis or Pschychotic disorder a person may expierence hallucinations where they see, hear, taste, feel things that are not real, while a person could have a delusion which is a belief that is not real or correct. Both hallucinations and delusions are disturbances in reality. When caused by a mental illness, hallucinations and delusions often occur together.

    Brief psychotic disorder: People with this illness have a sudden, short period of psychotic behaviour, often in response to a very stressful event, such as a death in the family. Recovery is often quick — usually less than a month.

    Delusional disorder : The key symptom is having a delusion (a false, fixed belief) involving a real-life situation that could be true but isn’t, such as being followed, being plotted against, or having a disease.

    Examples of Delusional Disorders:

    Erotomanic: The person believes someone is in love with them and might try to contact that person. Often it’s someone important or famous. This can lead to stalking behavior.

    Grandiose: This person has an over-inflated sense of worth, power, knowledge, or identity. They could believe they have a great talent, are superior or made an important discovery.

    Jealous: A person with this type believes their spouse or sexual partner is unfaithful.

    Persecutory: Someone who has this believes they (or someone close to them) are being mistreated, or that someone is spying on them or planning to harm them. They might make repeated complaints to legal authorities.

    Somatic: They believe they have a physical defect or medical problem.

    Mixed: These people have two or more of the types of delusions listed above.

    Shared psychotic disorder (also called folie à deux): This illness happens when one person in a relationship has a delusion and the other person in the relationship adopts it, too.

    Substance-induced psychotic disorder: This condition is caused by the use of or withdrawal from drugs, such as hallucinogens and crack cocaine, which cause hallucinations, delusions, or confused speech.

    There are different types of psychotic disorders, including:

    Schizophrenia: People with this illness have changes in behaviour and other symptoms — such as delusions and hallucinations — that last longer than 6 months. It usually affects them at work as well as their relationships.

    Schizoaffective disorder: People have symptoms of both schizophrenia and a mood disorder, such as depression or bipolar disorder.

    Schizophreniform disorder: This includes symptoms of schizophrenia, but the symptoms last for a shorter time: between 1 and 6 months.

    Doctors don’t know the exact cause of psychotic disorders. Researchers believe that many things play a role. Some psychotic disorders tend to run in families, which mean that the disorder may be partly inherited. Other things may also influence their development, including stress, drug abuse, and major life changes. These conditions usually first appear when a person is in his or her late teens, 20s, or 30s. They tend to affect men and women about equally.

    If you or a loved one are experiencing severe symptoms and you have trouble staying in touch with reality – please make an appointment to see a Psychiatrist who will support your mental health care.

    Thoughts of Suicide – how to get help!

    Thoughts of Suicide – how to get help!

    Teen suicide is becoming more common every year in South Africa. In fact only car accidents and homicide kill more youth between the ages of 15 and 24. In South Africa 9% of all teen deaths are caused by suicide. The fastest growing age is young people under 35, specifically female suicides which peak between 15 to 19 years.

    Research indicates that although more females attempt suicide, more males succeed. This is due to the more violent nature males select. Girls are more likely to overdose on medication, or take chemicals, whereas boys often find access to firearms or hang themselves.

    There is a major link between Depression and Suicide. Most of the time teen depression is a passing mood. Sadness, loneliness, grief and disappointments we all feel at times, and are normal reactions to life’s struggles. However undiagnosed depression can lead to tragedy. Up to one third of all suicide victims had attempted suicide previously.

    The South African Depression and Anxiety Group (SADAG) answer the National Toll Free Suicide Crisis Line which takes a huge number of calls from teens who are calling for themselves or on behalf of a friend. This line has already saved thousand of lives, and with funding from Foundations, the Department of Mental Health and World Bank. This program not only encourages teens to come forward but also tells them where to go for help in their own community and how to contact the Suicide Line. There is help and we show them all their options. With treatment, over 70% can make a recovery.

    Skilled counsellors support the lines (0800 567 567) and encourage teens to get professional help, to talk to an adult they trust, to go to a doctor, or talk to a church leader.

    The fact that huge numbers of young people still take their own lives spurs on our teachers, educators, police, clinics, churches, NGO’s, community based organisations, youth and support groups to even greater efforts to improve education, reduce stigma and halt this increase and realise that Mental Health Matters.


    • Loss of interest in things you like to do
    • Sadness that won’t go away
    • Irritability or feeling angry a lot


    • Feeling guilty or hopeless
    • Not enjoying things you once liked
    • Feeling tense or worrying a lot
    • Crying a lot
    • Spending a lot of time alone
    • Eating too much or too little
    • Sleeping too much or too little
    • Having low energy or restless feelings
    • Feeling tired a lot
    • Missing school a lot
    • Hard time making decisions
    • Having trouble thinking or paying attention
    • Thinking of dying or killing yourself

    Take a look at the list above and check the things that describe your thoughts, feelings or actions in the last two weeks, if you have more than 2 of these signs and have thoughts of hurting yourself or others, please contact the free SADAG 24 hour suicide crisis helpline 0800 567 567 for immediate support.

    Mental Health in South Africa

    Mental Health in South Africa

    A SPECIAL Sunday Times investigation has uncovered the shocking state of mental health in South Africa. One third of all South Africans have mental illnesses — and 75% of them will not get any kind of help. More than 17 million people in South Africa are dealing with depression, substance abuse, anxiety, bipolar disorder and schizophrenia — illnesses that round out the top five mental health diagnoses, according to the Mental Health Federation of South Africa.

    Despite the high number, the Department of Health annually spends only 4% — or R9.3-billion — of its budget to address the crisis. An overwhelming 48% of new mothers suffer from Post Natal Depression. Nearly 2,000 Adolescent Girls in South Africa are infected with HIV each week, South Africa has the biggest HIV epidemic in the world, with 7.1 million people living with HIV — 43% of whom also have a mental disorder.

    Only 1% of beds in psychiatric wards are reserved for children or adolescents, which results in a one-month wait for a place. There is a severe lack of facilities for children suffering from mental health problems. Kids end up in the system because families can’t cope any longer. They’re often advised to report the child for a crime; otherwise they can’t get them into a mental facility.

    For adolescents and young men, 16 to 25 years of age is the “peak time” during which schizophrenia, attention-deficit hyperactivity disorder and bipolar conditions become apparent.

    There are 22 psychiatric hospitals in South Africa and 36 psychiatric wards in general hospitals. Currently, 85% of psychologists are in private practice, leaving 14% for the servicing of the population. Between 1% and 2% of people with a mental illness were classified as having a serious pathology, such as schizophrenia or bipolar disorder. The remainder had disorders such as depression, anxiety and substance dependency.

    The prevalence of mental disorder could be attributed to factors such as:
    • The large number of children orphaned by diseases such as HIV/Aids;
    • Soldiers who returned to civilian life without psychological and social assistance;
    • The number of people severely tortured by the apartheid regime;
    • People who worked long hours and were away from their homes and families for extended periods; and
    • Children who had received minimal bonding and love from their parents

    The introduction of national health insurance, which would give people access to private healthcare services, would go a long way towards correcting this, but looks only likely in 2025. Indirect cost of untreated mental disorders outweighed the direct treatment cost by a factor of almost six.

    In the first nationally representative survey of mental disorders in South Africa, lost earnings among adults with severe mental illness amounted to R28.8-billion [in 2002]. But direct spending on adult mental healthcare was only about R470-million.

    “In short, it costs more not to treat mental illness than to treat it.”