During South Africa's first two decades as a democracy, the Western Cape Province has undergone radical changes to its healthcare system in an effort to address the extensive socioeconomic inequities that remain in the aftermath of the apartheid era. Although progress has been made, there is a clear need for interventions that support parents and children receiving health services in the public sector who are vulnerable to multiple psychosocial risks associated with extreme poverty. In this mixed-method study, we examined the feasibility and acceptability of adapting an evidence-based parenting intervention called Mothering from the Inside Out that was developed for mothers who are vulnerable to similar risks in the United States. Using qualitative methods, we documented the collaborative process that was guided by principles of community-based participatory research and examined themes in the Western Cape collaborators’ perspectives about the feasibility and acceptability of the intervention. Using quantitative methods, we tested the preliminary efficacy of the adapted version of Mothering from the Inside Out for improving maternal reflective functioning and mother–child interactions. Although findings from both study components indicated preliminary promise, a number of obstacles and challenges at multiple levels underscore the need for (a) flexibility and contextual support for intervention research conducted in under-resourced communities, (b) clinical sensitivity to the unique experiences of parents rearing children in highly stressful, under-resourced environments, and (c) equal partnerships that allow the expertise of local providers to inform the design proposals of consulting investigators.

Culture plays a significant role in the variations observed in the manifestation, expression, and meaning of attachment behaviors. Africa is home to multiple cultures, with distinct organizations of caregiving relationships underlying the development of attachment. This review aims to consolidate knowledge about African attachment by describing studies of infant attachment conducted in Africa since Mary Ainsworth's Ugandan findings in 1967. Electronic databases were searched with the terms "Africa" ("attachment" or "bond") and "infant." Nine studies that assessed infant attachment style with self-report or observation methods were included, but spanned only five countries. The Strange Situation Procedure was most frequently used. Most studies described dyads living in peri-urban or township areas. Multiple socioeconomic factors affecting living conditions were identified, including, unemployment, financial difficulties, limited education, poor housing, single parenthood, lack of partner support, substance abuse, and depression. Overall distributions of attachment classification proportions appear consistent with global attachment-classification patterns. Despite adverse conditions, secure attachment was relatively widespread, and some populations had low rates of avoidant attachment. Relatively high rates of disorganized attachment were found when the category was included. Africa remains an understudied continent regarding infant attachment. The continent's cultural diversity may hold important truths necessary for understanding the complex relationship between infant and attachment figure. K E Y W O R D SAfrica, attachment, culture, infant attachment, parenting RESUMENLa cultura juega un papel significativo en las variaciones observadas en la manifestación, expresión y significado de los comportamientos de afectividad. África es hogar de múltiples culturas, con distintas organizaciones de relaciones de prestación de cuidados que resaltan el desarrollo de la afectividad. Esta revisión se propone consolidar el conocimiento acerca de la afectividad africana por medio de describir estudios de la afectividad infantil llevados a cabo en África desde los resultados que obtuvo Ainsworth en Uganda. Se buscó en los bancos de información electrónica los términos "África" ("afectividad" o "unión") e "infante." Se incluyeron nueve estudios que evaluaron el estilo de afectividad del infante con métodos de auto-reporte o de observación, pero se cubrió sólo cinco países. El Procedimiento de la Situación Extraña fue usado más Infant Ment Health J. 2019;40:799-816. © 2019 Michigan Association for Infant Mental Health 799 wileyonlinelibrary.com/journal/imhj M O T S C L É S Attachement, Afrique, culture, parentage, attachement du nourrisson ZUSAMMENFASSUNG Die Kultur spielt eine entscheidende Rolle bei der Varianz, die bezüglich der Manifestation, der Expression und der Bedeutung von Bindungsverhalten beobachtbar ist. In Afrika sind zahlreiche Kulturen beheimatet, in denen Kindesbetreuung, die Grundlage der Bindungsentwicklung, un...

Background: The peripartum period is associated with increased incidence of severe mental illness (SMI), with a greater occurrence of psychotic symptoms and psychiatric admissions. There has been little research on South African mothers with peripartum psychosis to examine what factors contribute to their experiences of pregnancy and the postpartum period. This study aimed to explore the relevant socio-demographic factors and pregnancy outcomes in order to determine focus areas for intervention. Methods: Using a prospective, descriptive design, we conducted a detailed interview and supplementary information was collected by review of clinical records. The study examined the accounts of thirty-two mothers who experienced peripartum psychosis between 6 and 18 months postpartum. Areas of focus included participants’ current circumstances, their pregnancy, birth and postpartum experiences. Results: The majority of mothers were diagnosed with bipolar disorder and all but one have had one psychiatric admission. Pregnancies were predominantly unplanned (87.5%) and half of participants reported substance use during pregnancy. Medical or psychiatric problems during pregnancy occurred in 68.8% of pregnancy and 71.9% of mothers reported complications with delivery. Common psychosocial stressors included trauma, lack of partner support and financial hardship. Early separation occurred in 56.3% of dyads, mostly due to psychiatric admission. Conclusion: Our study describes psychiatric, medical and psycho-social risk factors affecting mothers who experienced peripartum psychosis. We discuss the implications of the findings for a developing country where there exists a lack of integrated maternal and infant mental health services. The results highlight the need for close obstetric and psychiatric follow-up for women with serious mental illness, with particular attention to screening for substance use and psychosocial stressors.

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.

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