Trauma and mental disorder: multi-perspective depictions in Top Boy

Psychiatry has often had an uneasy relationship with popular culture as depictions of mental health may be stigmatising and inaccurate. A recent critically acclaimed series, Top Boy, set in a crime-filled fictional housing estate in the London Borough of Hackney offers an informed and fairly balanced insight into broad mental health-related themes including racial trauma embodied in social inequities, the syndemic of mental disorder, substance misuse and gang-based crime as well as the psychosocial ramifications of illustrated mental health conditions. From both idiographic and nomothetic perspectives, Top Boy touches on a rich variety of structural determinants of mental health, as well as individual and environmental predisposition to mental disorder and substance misuse. The show offers an opportunity for education for both the broader society and the groups which suffer these syndemics. An understanding of how structural factors epidemiologically affect what psychiatric conditions individuals are likely to suffer, how they can be better reached by psychiatric services, and what interventions can help improve the socioeconomic factors that lead to the behaviours/paths that individuals end up is vital for public mental health policy.

Indigenous mental healthcare and human rights abuses in Nigeria: The role of cultural syntonicity and stigmatization

Background

Indigenous mental healthcare using traditional non-western methods termed "unorthodox approaches" has been observed in Nigeria historically. This has been largely due to a cultural preference for spiritual or mystical rather than biomedical formulations of mental disorder. Yet, there have been recent concerns about human rights abuses within such treatment settings as well as their tendency to perpetuate stigmatization.

Aim

The aim of this review was to examine the cultural framework for indigenous mental healthcare in Nigeria, the role of stigmatization in its utilization and interrogate the issues of human rights abuses within a public mental health context.

Methods

This is a non-systematic narrative review of published literature on mental disorders, mental health service utilization, cultural issues, stigma, and indigenous mental healthcare. Media and advocacy reports related to human rights abuses in indigenous mental health treatment settings were also examined. International conventions on human rights and torture, national criminal legislation, constitutional provisions on fundamental rights and medical ethics guidelines relevant to patient care within the country were examined in order to highlight provisions regarding human rights abuses within the context of care.

Results

Indigenous mental healthcare in Nigeria is culturally syntonic, has a complex interaction with stigmatization and is associated with incidents of human rights abuses especially torture of different variants. Three systemic responses to indigenous mental healthcare in Nigeria include: orthodox dichotomization, interactive dimensionalization, and collaborative shared care. Conclusions: Indigenous mental healthcare is endemic in Nigeria. Orthodox dichotomization is unlikely to produce a meaningful care response. Interactive dimensionalization provides a realistic psychosocial explanation for the utilization of indigenous mental healthcare. Collaborative shared care involving measured collaboration between orthodox mental health practitioners and indigenous mental health systems offers an effective as well as cost-effective intervention strategy. It reduces harmful effects of indigenous mental healthcare including human rights abuses and offers patients a culturally appropriate response to their problems.

The effectiveness of psychoeducation and problem-solving on depression and treatment adherence in adolescents living with HIV in Botswana: an exploratory clinical trial

BACKGROUND

This study aimed to explore the effectiveness of psychological interventions (PI): psychoeducation, problem-solving, and rehearsal strategies on depression and adherence in HIV-infected adolescents in Botswana.

METHODS

Fifty adolescents living with HIV were randomized into control (n = 25) and intervention groups (n = 25), the latter being exposed to five weeks of PI sessions. The PHQ-9 and visual analog scale (VAS) were used to measure the outcomes: depression and adherence at pre-intervention, 5- and 24 weeks post-intervention.

RESULTS

The participants' mean age (SD) was 17.38 years (1.1), the two groups being similar in socio-demographic variables: gender (χ² = 2.22; p = 0.135) and age (U = 285, z =  - 0.55, p = 0.579). The intervention group scored significantly lower on depressive symptoms (PHQ-9 [F (1,50) = 12.0, p = 0.001, ƞ_p² = 0.20]) and higher on adherence score (VAS [F (1,50) = 13.5, p = 0.001, ƞ_p² = 0.22]) than the control group after 5 weeks. The post-hoc analysis showed that the significant improvements in depressive symptoms (z =  - 4.03, p < 0.01, r [effect size] = 0.88) and adherence (z =  - 4.05, p < 0.01, r = 0.88) at post-test in the intervention group were maintained at 24 weeks. This project was registered with ClinicalTrials.gov (NCT05482217).

CONCLUSION

The 5-week PI showed promising effectiveness in addressing depression and adherence in adolescents living with HIV in Botswana.

Plausible subjective experience versus fallible corroborative evidence: The formulation of insanity in Nigerian criminal courts

Insanity as a defence against criminal conduct has been known since antiquity. Going through significant reformulations across centuries, different jurisdictions across the globe, including Nigeria, have come to adopt various strains of the insanity defence, with the presence of mental disorder being the causative mechanism of the crime as their central theme. A critical ingredient in the Nigerian insanity plea is the presence of 'mental disease' or 'natural mental infirmity' as the basis for the lack of capacity in certain cognitive and behavioural domains resulting in the offence. Mental disorders, which are the biomedical formulations of this critical legal constituent are primarily subjective experiences with variable objective features. Using illustrative cases based on psycho-legal formulation as well as reform-oriented and fundamental legal research, it is shown that Nigerian courts have held that claims of insanity based on the accused person's evidence alone should be regarded as "suspect" and not to be "taken seriously." Thus, Nigerian judicial opinions rely on non-expert accounts of defendants' apparent behavioural abnormalities and reported familial vulnerability to mental illness, amongst other facts while conventionally discountenancing the defendants' plausible phenomenological experiences validated by expert psychiatric opinion in reaching a conclusion of legal insanity. While legal positivism would be supportive of the prevailing judicial attitude in entrenching the validity of the disposition in its tenuous precedential utility, legal realism invites the proponents of justice and fairness to interrogate the merit of such preferential views which are not supported by scientific evidence or philosophical reasoning. This paper argues that disregarding the subjective experience of the defendant, particularly in the presence of sustainable expert opinion when it stands unrebutted is not in the interest of justice. This judicial posturing towards mentally abnormal offenders should be reformed on the basis of current multidisciplinary knowledge. Learning from the South African legislation, formalising the involvement of mental health professionals in insanity plea cases, ensures that courts are guided by professional opinion and offers a model for reform.

Disability and premorbid adjustment in schizophrenia: A retrospective analysis

Background

Schizophrenia is highly disabling. Though efforts at genetic mapping to identify those at risk of the illness have been promising but same cannot be said about predicting its associated disability before illness-onset (i.e., during premorbid phase). It is envisaged that Schizophrenia-related disability may be ameliorated if premorbid clinical markers are adequately predictive enough to identify those at risk and worked upon them.

Aim

This study aimed to determine whether there is a relationship between schizophrenia-related disability and premorbid adjustment.

Setting

This cross-sectional study was conducted at the out-patient clinic of the Neuropsychiatric Hospital, Aro, Abeokuta, Ogun State, Nigeria.

Methods

Three hundred patients with the diagnosis of schizophrenia and within the age range of 18-64 years were eligible for the study.

Results

Mean age of the participants was 41.9 ± 10.05 years with a slight female dominance (50.7%). Spearman's correlation revealed a direct correlation between disability and premorbid adjustment, albeit rather weak (r _s = 0.130, p = 0.025).

Conclusion

Pre-diagnostic factors such as premorbid functioning may play a role in the subsequent functioning of an individual post-diagnosis. Other research efforts may focus on yet-to-be identified premorbid factors that may be targets of prevention to reduce disability in schizophrenia.

Contribution

This research serves as a pioneer work on disability and premorbid adjustment and has provided a template for the early identification of those at risk of schizophrenia by providing an intervention opportunity at the premorbid stage.

Insomnia and quality of life of prisoners at a Nigerian maximum-security prison

Purpose

This study aims to determine the prevalence of insomnia as well as its association with the quality of life of the inmates in a Nigerian prison. Prisoners are a disadvantaged group of people whose needs are often unmet. Many authors have focussed on investigating the prevalence and pattern of psychiatric morbidity, as well as substance use among prisoners. However, sleep disorders, which can predispose or precipitate psychiatric disorders, have been largely neglected in research. The relationship between insomnia and quality of life (QoL) among the general population has been documented but similar investigations have yet to be conducted among the prisoner population.

Design/methodology/approach

This was a cross-sectional study with 300 male prisoners at the Ibara prison, Abeokuta, Nigeria who were not diagnosed with depressive, generalized anxiety or post-traumatic stress disorders. Each respondent was interviewed with a sociodemographic proforma, Insomnia module of the Schedule for Clinical Assessment in Neuropsychiatry and the brief World Health Organisation Quality of Life questionnaire.

Findings

About half of the respondents (45.7%) met diagnostic criteria for insomnia. A diagnosis of insomnia and some sleep-related variables were significantly associated with QoL.

Research limitations/implications

All the possible correlates of insomnia could not be investigated. Further research should be conducted to identify more correlates and investigate the impact of insomnia on prisoners’ lives.

Practical implications

Improvement of prison climate (relationships in prison, safety and order, contact with the outside world, facilities, meaningful activities and autonomy) may mitigate insomnia among prisoners. Prison psychiatry in Nigerian correctional centres should be made a priority.

Social implications

The findings have brought to light the need to address the current social welfare system in place for Nigerian correctional centres.

Originality/value

The study provided information on the prevalence of insomnia and poor QoL among prisoners in a Nigerian correctional facility.

Premorbid adjustment amongst outpatients with schizophrenia in a Nigerian psychiatric facility

BACKGROUND

Studies from developed countries have shown that poor premorbid adjustment in patients with schizophrenia is associated with poor outcome. However, similar studies in developing countries like Nigeria are few despite the stability of schizophrenia prevalence across cultures.

AIM

The aim of this study was to assess the prevalence and correlates of poor premorbid adjustment amongst outpatients with schizophrenia.

SETTING

The Neuropsychiatric Hospital, Abeokuta in Ogun State, Nigeria.

METHODS

The premorbid adjustment of 300 outpatients with schizophrenia was assessed using the premorbid adjustment scale. Pattern and severity of psychosis, overall illness severity, global assessment of functioning and socio-demographic factors were investigated as correlates of premorbid functioning.

RESULTS

About half (53.3%) of the respondents had poor premorbid adjustment and most of them were males (56.9%). Poor premorbid adjustment was associated with male gender (χ 2 = 7.81, p = 0.005) whilst good premorbid adjustment was associated with no or borderline illness severity (χ 2 = 8.26, p = 0.016) as well as no or mild impairment in functioning (χ 2 = 7.01, p = 0.029) amongst the respondents. Positive, negative and general symptomatology were predicted by premorbid adjustment at different developmental stages.

CONCLUSION

Consistent with existing literature, poor premorbid adjustment was prevalent amongst patients with schizophrenia in this study and was associated with male gender, poorer clinical outcomes and greater illness severity. Mental health promotion and other preventative approaches are recommended as possible early intervention strategies in dealing with schizophrenia.

Comparison of impulsivity, aggression and suicidality between prisoners in Nigeria who have committed homicide and those who have not

Most studies of prisoners, the nature of their offending and any related characteristics have been conducted in rich Western countries. In Nigeria, prison conditions differ in many important respects, key among them that prisoners share large communal spaces much of the time-up to 50 men sleeping in the same space as well as spending the day together. Our aim was to compare levels of impulsivity, aggression and suicide-related behaviours between prisoners in one prison in Nigeria who had committed a homicide and those who had not, allowing for socio-demographic factors. A case-control study design was employed with 102 homicide and an equal number of non-homicide offenders. Each participant was interviewed using the Abbreviated Barratt Impulsiveness Scale for impulsivity, the Modified Overt Aggression Scale for aggression, the MINI International Neuropsychiatric Interview (Module C) for suicide-related behaviours, and a questionnaire for ascertaining socio-demographic characteristics. On bivariate analysis, motor impulsivity was higher among homicide offenders (p = .014) while non-planning was higher among non-homicide offenders (p = .006), but this relationship was affected by demographic variables. Physical aggression levels did not distinguish the two groups, but homicide offenders were less likely to record property-directed and auto-aggressive behaviours (p < .05). By contrast, on average, scores for suicide-related behaviours were lower among the homicide offenders (p = .001), with non-homicide offenders showing a mean score in the high-risk category (13.25; SD, 1.25). As motor impulsivity significantly differentiated the groups, this may be an important measure to add to any risk assessment battery when there are concerns about homicidal behaviours. In this sample, history of interpersonal aggression did not distinguish the groups. People with indications of self-harm or suicide-related behaviours may be at less risk of violence to others, but care should be taken in interpreting this finding as it is not entirely consistent with other findings.

Self-stigma and decision about medication use among a sample of Nigerian outpatients with schizophrenia

OBJECTIVE

Self-stigma is a common barrier to maintenance therapy and recovery in schizophrenia. We investigated the prevalence of the decision not to use medication as prescribed and describe the multidimensional relationship of self-stigma with such a decision in 370 adults with schizophrenia.

METHOD

A multivariate binary logistic regression model was used to examine the relationship between specific aspects of self-stigma (alienation, perceived discrimination, stigma resistance, stereotype endorsement and social withdrawal) and the decision not to take medication, while controlling for other clinical variables.

RESULTS

Of the total study participants, 16.5% reported high self-stigma while 39.2% decided not to use their medications. The decision not to use medication was associated with a high self-stigma global score, alienation, perceived discrimination and stigma resistance. Stereotype endorsement and social withdrawal did not demonstrate a relationship with nonuse of medication. Following regression analysis, the decision not to use medication was associated with self-stigma, especially high alienation and perceived discrimination, and other factors including medication side effects, worse psychopathology, not living alone, poor 24-hr medication use recall, and absence of medical comorbidity.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Medication nonuse and self-stigma are prevalent and interrelated in patients on maintenance therapy for schizophrenia. Obtaining routine information during follow-up appointments about medication use including side effects, the symptom profile, and conducting a focused stigma screening can inform clinical discussions regarding medication use in a shared decision-making process. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Disability among patients with schizophrenia: A hospital-based study

BACKGROUND

Schizophrenia has been described as the most disabling mental disorder, and patients with schizophrenia have been said to be disabled mostly in self-care, occupation, sexual relation and social relationship domains. Previous authors have studied disability among this study population. However, the limitations of these previous works include non-report of the prevalence rates of disability, report on disability limited to only a particular domain of life and the utilization of disability instruments fraught with significant weaknesses.

AIM

To determine the prevalence, severity, domains and correlates of disability among outpatients with schizophrenia at the Neuropsychiatric Hospital, Aro, Abeokuta in Ogun State, Nigeria.

METHODS

It was a cross-sectional study conducted among three hundred consenting adult outpatients with schizophrenia attending the Neuropsychiatric Hospital, Aro, Abeokuta, Ogun State. Each participant was interviewed with the sociodemographic questionnaire, Mini International Neuropsychiatric Interview, Positive and Negative Syndrome Scale (PANSS) and the 36-item World Health Organization Disability Assessment Schedule.

RESULTS

The prevalence of disability was 78% (with 22% having no disability in any of the domains). Most were disabled in the mild to moderate range. Seventy-seven percent (77%) had mild to moderate disability while only 1% had severe disability. Excluding those free of disability, 98.7% of those with disability had mild to moderate form while only 1.3% had severe form. Highest prevalence rates for disability were reported in the 'participation in society' and 'getting along' domains while the lowest rates were reported in the 'activities' (household, work, school) and 'self-care' domains. Of all the sociodemographic and clinical variables explored, only the PANSS positive, negative and total scores demonstrated significant relationships with disability.

CONCLUSION

Consistent with existing literature, disability is very prevalent among patients with schizophrenia and it is associated with higher levels of illness severity. Clinicians have a role in limiting disability by focusing on early and comprehensive treatment approaches.

Psychoactive substance use among outpatients with severe mental illness: A comparative study

Background

Despite several studies on the prevalence and pattern of substance use in Nigeria, there is little information on substance use in patients diagnosed with serious mental illness (SMI) such as schizophrenia and bipolar affective disorder (BD).

Aim

The aim of the study was to compare the pattern of psychoactive substance use among outpatients with BD and schizophrenia.

Setting

The study was conducted in a neuropsychiatric hospital in Nigeria.

Methods

Seventy five consecutive patients with a MINI-PLUS diagnosis of BD were compared with an equal number of patients obtained by systematic random sampling with a MINI-PLUS diagnosis of schizophrenia.

Results

The respondents with schizophrenia were aged 18–59 years (37.2 ± 9.99) and were predominantly young adult (49, 65.3%), men (46, 61.3%), who were never married (38, 50.7%). Overall, lifetime drug use prevalence was 52%, while for current use, overall prevalence was 21.3%. Participants with BD were aged 18–63 years (36.7 ± 10.29) and were predominantly young adult (53, 70.7%), women (44, 58.7%), who were married (32, 42.7%), with tertiary education (31, 41.3%). Overall, lifetime drug use prevalence was 46.7%, while current overall prevalence was 17.3%. These rates (lifetime and current) for both diagnostic groups are higher than what was reported by the World Health Organization in the global status report of 2014 (0% – 16%). The statistically significant difference between the two diagnostic groups was related to their sociodemographic and clinical variables and psychoactive substance use.

Conclusion

Psychoactive substance use remains a burden in the care of patients diagnosed with schizophrenia and BD. Future policies should incorporate routine screening for substance use at the outpatient department with a view to stemming the tide of this menace.

Correctional psychiatry in Nigeria: dynamics of mental healthcare in the most restrictive alternative

Nigeria has poorly structured services for correctional mental health driven by a mix of socioeconomic and legal factors. The archaic asylum systems established in the early part of the 20th century under the Lunacy ordinance of 1916 are no longer fit for purpose. The present strategy is to provide mental healthcare for mentally abnormal offenders within some prisons in the country. The current models for this are poorly staffed and underfunded. Adoption of task-shifting approaches based on evidence-based strategies within the context of professional innovation, government commitment and international collaboration should help to develop and sustain the needed correctional psychiatry services.

Mental health legislation in Nigeria: current leanings and future yearnings

Nigeria's current mental health legislation stems from a lunacy ordinance enacted in 1916 that assumed the status of a law in 1958. The most recent attempt to reform the law was with an unsuccessful Mental Health Bill in 2003. Currently, though, efforts are being made to represent it as an executive Bill sponsored by the Federal Ministry of Health. The present paper reviews this Bill, in particular in light of the World Health Organization's recommendations on mental health legislation.

Perceived expressed emotions in relatives of patients with severe mental illness: A comparative study

There is paucity of studies on expressed emotion (EE) in families of patients with severe mental illness in sub-Saharan Africa. This study aimed to assess and compare the levels of expressed emotion (LEE) in relatives of patients with schizophrenia and bipolar affective disorder attending an out-patient clinic in Southwestern Nigeria. One hundred and forty consecutive clinic attendees with Mini-Plus diagnosis of schizophrenia and bipolar affective disorder and 140 accompanying relatives were recruited. The patients and relatives were interviewed using a socio-demographic questionnaire. The perceived level of expressed emotion was assessed using the client version of the Level of Expressed Emotion Questionnaire (LEEQ). Although, the prevalence of high expressed emotion was higher among relatives of patients with schizophrenia when compared with relatives of patients with bipolar affective disorder (41% vs 37%), the difference was not statistically significant. The socio-demographic characteristics of the relatives of patients with these disorders were not significantly related to high EE. High expressed emotion is just as prevalent among relatives of patients with bipolar affective disorder as among relatives of patients with schizophrenia and clinicians should give similar attention to early detection of high EE and intervention in this population of patients and their relatives.

A 12 year chart review of childhood and adolescent onset psychosis at a Nigerian tertiary mental health facility

OBJECTIVES

To review the profile of children and adolescents presenting with psychosis at a specialist mental health facility, and to compare childhood with adolescent onset psychosis.

METHOD

Hospital records of all children and adolescents over a 12-year period (1999-2010) were perused to identify those falling under the categories of psychotic disorders. Clinical, socio-demographic, obstetric, and developmental information was extracted.

RESULTS

Mean age of the children ((n = 409)) was 15.9 years, with 8.1% aged 12 years or less. The most frequent diagnoses were schizophrenia (40.8%), brief psychotic disorder (25.9%), mood disorder with psychosis (15.2%), and organic psychosis (7.8%). Family history of mental illness was reported among 22.5%. Subjects with childhood onset were significantly less likely than those with adolescent onset to have a family history of mental illness (p = 0.016), more likely to report maternal illness during pregnancy (p = 0.005) and illness during infancy (p = 0.010), and more likely to have a diagnosis of psychotic disorder due to another general medical condition (p < 0.001).

CONCLUSION

The study suggests that antenatal/obstetric factors and illness during infancy may be particularly relevant in psychosis of childhood onset. Family history of mental illness may however be of greater relevance in adolescent onset psychosis.

Correlates of conduct disorder among inmates of a Nigerian Borstal Institution

BACKGROUND

Juvenile delinquency has become a significant global problem. Conduct disorder (CD), among other psychiatric disorders, has assumed prominence in its association with juvenile offending as well as criminality in adulthood. Despite this knowledge, little attention is given to this problem especially as it affects adjudicated adolescent offenders in developing countries.

AIM

To examine the prevalence and correlates of CD among incarcerated adolescents in a Nigerian Borstal Institution and to investigate its independent predictors.

METHODS

A cross-sectional descriptive study was conducted among 147 inmates of a Borstal Institution in Abeokuta, South Western Nigeria. A self-administered questionnaire and interviewer administered MINI-KID were used. The associations between conduct disorder and socio demographic as well as forensic variables were investigated using Chi square statistics while logistic regression was used to predict CD.

RESULTS

Out of 147 respondents, 83 (56.5 %) met the criteria for CD with a mean age 17.1 ± 1.1. Of the socio-demographic and forensic variables investigated, number of siblings (OR 4. 630; p = 0.010; 95 % CI 1.433-14.964) and previous history of incarceration (OR 4. 99; p = 0.043; 95 % CI 1.048-23.846) emerged as independent predictors of CD.

CONCLUSIONS

This study recorded a high prevalence of conduct disorder among a sample of incarcerated juvenile offenders. The association of conduct disorder with large family size and recidivism highlights the need for comprehensive early interventions focused on improving parental supervision in large families as well as other re-training programs aimed at reducing juvenile re-offending.

Who guards the guards: drug use pattern among medical students in a nigerian university

Background:

Several studies have examined the prevalence and pattern of substance use among medical students in Nigeria. Few of these studies have specifically examined the relationship between the psychological distress and psychoactive substance use among these students. Yet, evidence world-wide suggests that substance use among medical students might be on the rise and may be related to the level of stress among them.

Aim:

The present study is the first study aimed to determine the prevalence, pattern and factors associated with psychoactive substance use among medical students of Olabisi Onabanjo University, Ogun State, Nigeria.

Subjects and Methods:

The World Health Organization student drug use questionnaire was used to evaluate for substance use among 246 clinical medical students between September and October 2011. General health questionnaire (GHQ) 12 was used to assess for psychological distress among these students. Statistical analysis was performed using the SPSS version 16. (Chicago, USA). Proportions were compared using the Chi-square test while a value of P < 0.05 was considered statistically significant. Fisher exact test was used instead of Chi-square when the number in the cell is less than 5.

Results:

Lifetime prevalence of substance use among medical students was 65% (165/246). It was found that the most commonly used substances were alcohol 63.4% (156/246), mild stimulants 15.6% (38/246), tobacco 15% (37/246) and sedatives 6.1% (15/246). Substance use was associated with gender, frequency of participation in religious activities and GHQ scores.

Conclusion:

Psychoactive substance use is a major problem among medical students. Psychological well-being plays a significant role in substance use among these students. There is a need for adequate screening and assessment for substance use disorders among these students and incorporating stress management strategies in their curriculum.

Self-stigma, quality of life and schizophrenia: An outpatient clinic survey in Nigeria

BACKGROUND

Stigma is a major obstacle to the treatment and recovery of people with mental illness. In Nigeria, there is a dearth of information on internalization of stigma and its effect on treatment outcome measures such as quality of life.

AIM AND OBJECTIVES

The aim of the study was to assess self-stigma among patients with schizophrenia attending a psychiatric hospital outpatient clinic, and the relationship of self-stigma to the socio-demographic, clinical characteristics and quality of life of the patients.

METHOD

Two hundred and fifty-six consecutive outpatient attendees of the Neuropsychiatric Hospital, Aro, Abeokuta in Nigeria with a Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) diagnosis of schizophrenia were recruited for the study. The diagnosis of schizophrenia was established with the Structured Clinical Interview Schedule for DSM-IV Axis I disorder (SCID), while item 17 of the Present State Examination was used to ascertain the presence of insight into the illness. The subjects were interviewed with a socio-demographic questionnaire, the Internalized Stigma of Mental Illness (ISMI) scale, the Brief Psychiatric Rating Scale (BPRS) and the World Health Organization's Quality of Life (WHOQOL-Bref) questionnaire.

RESULTS

The mean age of the subjects was 39.5 (SD = 10.6) years with males constituting 52.0% of the sample. High self-stigma was found in 18.8% of the subjects. The socio-demographic and clinical correlates of high self-stigma found using univariate analysis were low educational level (χ(2) = 22.69, p < .001), unemployment (χ(2) = 15.9, p < .001), low income (χ(2) = 25.03, p < .001), source of income (χ(2) = 12.52, p = .007) and severity of psychopathology (t = 8.245, p < .001). High self-stigma was associated with poor quality of life in all the domains of WHOQOL-Bref.

CONCLUSION

This study revealed that self-stigma was common among subjects with schizophrenia. It is associated with poor treatment outcome, highlighting the need to incorporate stigma intervention strategies into mental health care delivery.

Pattern of attendance and predictors of default among Nigerian outpatients with schizophrenia

OBJECTIVE

To assess the pattern of and factors associated with outpatient clinic attendance among patients diagnosed with schizophrenia at a Nigerian psychiatric hospital.

METHODS

This was a cross-sectional descriptive study of 313 consecutive outpatients with diagnosis of schizophrenia confirmed with the Structured Clinical Interview for Diagnosis (SCID). Data was collected on sociodemographics, clinic attendance, perceived social support, perceived satisfaction with hospital care and illness severity (assessed using the Brief Psychiatric Rating Scale, BPRS). Logistic regression analysis was used to identify factors associated with outpatient clinic default.

RESULTS

Overall, 20.4% respondents were defaulters, with a median duration of clinic non-attendance of 8 weeks. Outpatient clinic defaulters had significantly higher BPRS scores and had missed more outpatient clinic appointments compared with non-defaulters. A significantly higher proportion of defaulters resided more than 20 km away from the hospital and reported "not satisfied" with their outpatient care. Being financially constrained was the commonest reason given by defaulters for missing their clinic appointments. The significant predictors of outpatient clinic default included residing more than 20 km from the hospital, missing previous appointments and dissatisfaction with outpatient care.

CONCLUSION

Outpatient clinic non-attendance is common among patients with schizophrenia, and is significantly associated with demographic, clinical and service related factors. Interventions targeted at addressing the risk factors for defaulting peculiar to developing country settings similar to the location of this study, could significantly improve treatment outcome.

Socio-demographic and clinical correlates of subjective quality of life among Nigerian outpatients with schizophrenia

This study aimed to measure the subjective quality of life (QOL) of Nigerian outpatients with schizophrenia and to examine its socio-demographic as well as clinical determinants. A total of 313 outpatients with schizophrenia participated in the study. Data were collected on socio-demographics, outpatient clinic attendance, perceived social support, perceived satisfaction with hospital care, medication adherence, illness severity and QOL. Multiple linear regression analysis was used to determine the amount of variance in the QOL domain scores explained by socio-demographic and clinical variables. Employment status, perceived social support, satisfaction with outpatient care, antipsychotic medication dose, Brief Psychiatric Rating Scale (BPRS) scores and medication adherence had significant relationships with all the QOL domains. Average monthly allowance and outpatient clinic default were significantly associated with all QOL domains except social relationship. Socio-demographic and clinical factors explained only a modest part (29.4%) of the variance in the QOL scores. It is likely that unmeasured 'internalised' determinants contribute in a much larger sense to the variation in subjective QOL.

HIV Risk Behavior in Persons with Severe Mental Disorders in a Psychiatric Hospital in Ogun, Nigeria

Background:

Few studies in Nigeria have investigated HIV risk behavior among persons with severe mental disorders. This study examined HIV risk behavior and associated factors among patients receiving treatment at a Nigerian psychiatric hospital.

Aim:

To determine the HIV risk behavior in persons with severe mental disorders in a psychiatric hospital.

Subjects and Methods:

This was a cross-sectional survey involving 102 persons with serious mental disorders receiving treatment at a major psychiatric facility in Southwestern Nigeria. HIV risk screening instrument was self-administered to assess HIV risk behavior. A questionnaire was used to elicit socio-demographic variables while alcohol use was assessed with the alcohol use disorder identification test. Differences in HIV risk levels were examined for statistical significance using Chi square test.

Results:

Forty eight percent of the respondents engaged in HIV risk behavior. This study revealed that 10.8% (11/102) gave a history of sexually transmitted disease, 5.9% (6/102) reported sex trading and no reports of intravenous drug use was obtained. A single risk factor was reported by 19.6% (20/102), 12.7% (13/102) reported two risk factors and 15.7% (16/102) reported three or more risk factors. HIV risk behavior was significantly related to alcohol use (P = 0.03).

Conclusion:

Mental health services provide an important context for HIV/AIDS interventions in resource-constrained countries like Nigeria.

Risk factors of obstructive sleep apnea among Nigerian outpatients

Obstructive sleep apnea (OSA) is a medical condition with adverse consequences. OSA is credited to be a sleep disorder that disproportionately affects blacks. The Berlin Questionnaire (BQ) is a screening questionnaire for OSA.

OBJECTIVE

To describe the risk factors associated with OSA among adults attending an out-patient specialist clinic.

STUDY DESIGN

Prospective, clinical study including adult outpatients attending a specialist clinic.

METHOD

Data was collected using a questionnaire incorporating the BQ and patients were divided into low and high risks of OSA. The risk factors associated with OSA in the univariate analyses were subjected to a multivariate binary logistic regression model. Adjusted odds ratios with 95% confidence intervals were calculated for these independent variables.

RESULTS

One hundred and ninety five patients participated in the study (Males 56.4%; Age 43.5 ± 15.6 years; Non-habitual snorers 81.5%; High risk OSA 17.4%; BMI 24.1 ± 4.6 kg/m²; Obese 12.9%). Six factors including marital status and blood pressure were significantly associated with OSA using bivariate analysis nevertheless age, hours at work, smoking status and BMI remained predictive of OSA on logistic regression analysis.

CONCLUSIONS

OSA is common among Nigerian outpatients, may be under-recognized and is associated with risk factors that are amenable to preventive strategies.

Mental health legislation in Nigeria: current leanings and future yearnings

Nigeria's current mental health legislation stems from a lunacy ordinance enacted in 1916 that assumed the status of a law in 1958. The most recent attempt to reform the law was with an unsuccessful Mental Health Bill in 2003. Currently, though, efforts are being made to represent it as an executive Bill sponsored by the Federal Ministry of Health. The present paper reviews this Bill, in particular in light of the World Health Organization's recommendations on mental health legislation.

A descriptive survey of types, spread and characteristics of substance abuse treatment centers in Nigeria

BACKGROUND

Nigeria, the most populous country in Africa and the 8th most populous in the world with a population of over 154 million, does not have current data on substance abuse treatment demand and treatment facilities; however, the country has the highest one-year prevalence rate of Cannabis use (14.3%) in Africa and ranks third in Africa with respect to the one-year prevalence rate of cocaine (0.7%) and Opioids (0.7%) use. This study aimed to determine the types, spread and characteristics of the substance abuse treatment centers in Nigeria.

METHODS

The study was a cross sectional survey of substance abuse treatment centers in Nigeria. Thirty-one units were invited and participated in filling an online questionnaire, adapted from the European Treatment Unit/Program Form (June 1997 version).

RESULTS

All the units completed the online questionnaire. A large proportion (48%) was located in the South-West geopolitical zone of the country. Most (58%) were run by Non-Governmental Organizations. Half of them performed internal or external evaluation of treatment process or outcome. There were a total of 1043 for all categories of paid and volunteer staff, with an average of 33 staff per unit. Most of the funding came from charitable donations (30%). No unit provided drug substitution/maintenance therapy. The units had a total residential capacity of 566 beds. New client admissions in the past one year totalled 765 (mean = 48, median = 26.5, min = 0, max = 147) and 2478 clients received services in the non-residential units in the past year. No unit provided syringe exchange services.

CONCLUSIONS

The study revealed a dearth of substance abuse treatment units (and of funds for the available ones) in a country with a large population size and one of the highest prevalence rates of substance abuse in Africa. The available units were not networked and lacked a directory or an evaluation framework. To provide an environment for effective monitoring, funding and continuous quality improvement, the units need to be organized into a sustainable network.

Trends in sociodemographic and drug abuse variables in patients with alcohol and drug use disorders in a Nigerian treatment facility

BACKGROUND

Globally, patterns of the use of psychoactive substances have been changing.

OBJECTIVE

To evaluate the trend in two five year periods, 1992 to 1997 versus 2002 to 2007, of alcohol and substance use disorders and associated variables in patients admitted to a drug abuse treatment facility.

METHODS

This was a comparative cross-sectional study involving all patients admitted into Drug Abuse Treatment, Education, and Research (DATER), Unit of the Neuropsychiatric Hospital, Aro, Nigeria within the study period. All subjects had a structured psychiatric interview, a physical examination, laboratory investigations and DATER Questionnaire protocols that elicited socio-demographic, drug and family variables.

RESULTS

The patients in 2002 to 2007 versus those of 1992 to 1997 were younger (chi squared 13.29; p,0.01). More last borns were using drugs by 2002 to 2007 (chi squared, 11.37; p,0.01). Cannabis was the most abused drug in 2002 to 2007 (53.5%) as compared to cocaine (44%) in 1992 to 1997 (chi squared 35.5; p,0.001). Polydrug abuse was high in the two periods but significantly the drug combination changed to cannabis in combination with alcohol in 2002 to 2007 as against cocaine in combination with opiates in 1992 to 1997 chi squared 45.3, p 0.001). More patients had co-morbid psychiatric disorders in 2000 to 2007 (67.6% as against 38.5% in 1992 to 1999 chi squared 28.32, p,0.001). In both periods, co-morbidity associated with cannabis use rather than any other drug of abuse as the odds ratio was greater than one.

CONCLUSION

The findings in the trend in the two five year periods underscore the imperatives of continuous evaluation of the drug abuse patient population in treatment which may help drive changes in treatment inputs.