Adebayo R. Erinfolami

A Case Control Study of Psychiatric Morbidities among Subjects with Leprosy in Lagos, Nigeria:

Objectives: To determine the pattern of psychiatric morbidity prevalent among leprosy patients and to compare it with two control groups; those suffering from Tinea vesicolor and Normal subjects. Design: Eighty-eight leprosy patients were matched for age and sex with those suffering from Tinea vesicolor as well as normal subjects. The subjects were assessed for psychiatric morbidity through a clinical interview with PSE-9. Results: The prevalence of psychiatric morbidity among leprosy patients (580/1000) was significantly more than those with tinea vesicolor patients (182/1000) and normal subjects (148/1000) (p < 0.05). Depressive illness was the most common diagnosis in the three groups. Conclusions: Leprosy patients are more likely to manifest with psychiatric illness than those suffering from Tinea vesicolor and normal subjects.

Detection of mental disorders with the Patient Health Questionnaire in primary care settings in Nigeria

Mental disorders lead to difficulties in social, occupational and marital relations. Failure to detect mental disorder denies patients potentially effective treatment. This study aimed to assess the prevalence and nature of mental disorders at the primary care settings and the recognition of these disorders by the attending physicians. Over a period of eight weeks, consecutive and consenting patients who attended three randomly selected primary health care facilities in Sagamu Local Government Area of Ogun state were recruited and administered a questionnaire that included a socio-demographic section and Patient Health Questionnaire (PHQ). A total of 412 subjects took part in the study. Subject age ranged from 18–90 years with a mean age of 52.50±21.08 years. One hundred and seventy-six (42.7%) of the subjects were males. A total of 120 (29.1%) of the subjects had depressive disorder, 100 (24.3%) had anxiety disorder, 196 (47.6%) somatoform disorder and 104 (25.2%) met the criteria for an alcohol related problem. The PHC physicians were only able to diagnose disorders relating to mental health in 52 (12.6%) of the subjects. Health and work situations accounted for more than three-quarters of the causes of stress experienced by the subjects. We conclude that there is a high prevalence of mental disorders among patients seen in primary care settings and that a significant proportion of them are not recognized by the primary care physicians. Stress relating to health, work and financial problems is common among primary health care attendees. Physicians in primary health care should be alert to the possibility and the impact of undetected psychiatric morbidity.

Incidence and correlates of delirium in a West African mental health clinic

OBJECTIVE To determine the incidence of delirium in those patients presenting to a psychiatric clinic in Nigeria and to examine if any demographic or clinical variables were correlated with this diagnosis. METHOD A prospective survey design; 264 consecutive new referrals to a psychiatric clinic in Nigeria were assessed for the presence of delirium using a standardised diagnostic scale. Data was analysed for normality and appropriate statistical test employed to examine the relationships between the presence of delirium and demographic and clinical variables. RESULTS Of individuals presenting to the mental health clinics, 18.2% had delirium. No demographic variable was significant regarding the presence or absence of delirium. With regard to clinical variables duration of current symptoms, referral source and the presence of comorbid physical illness were significantly associated with the presence of delirium. Most delirium was due to infections. Nearly all patients with delirium were prescribed psychotropic medication (95.2%), and most attributed their symptoms to a spiritual cause. CONCLUSION(S) Delirium presents more commonly to psychiatry services in the less developed world compared to the West. Development efforts should focus on recognition and management of delirium to improve outcomes and maximise resources.

Factors associated with anxiety disorders among HIV-positive attendees of an HIV clinic in Lagos, Nigeria

Anxiety disorders (ADs) occurring in people living with HIV/AIDS (PLWHA) are often poorly identified in spite of the untold consequences that may result if not diagnosed and treated promptly. This study aimed to describe factors associated with ADs among PLWHA. Three hundred participants were administered sociodemographic/clinical profile questionnaires, and diagnoses of ADs were made using Schedule for Clinical Assessment in Neuropsychiatry (SCAN) based on International Classification of Diseases, 10th edition (ICD-10) criteria. In this study, 65 (21.7%) participants were diagnosed with ADs. A lack of family support, unemployment, younger mean age and being unmarried (P < 0.05) were factors associated with ADs in PLWHA; however, lack of family support (odds ratio [OR] = 0.458, 95% confidence interval [CI] = 0.254–0.827, P = 0.010), being unmarried (OR = 1.930, 95% CI = 1.046–3.560, P = 0.035) and unemployment (OR = 0.495, 95% CI = 0.264–0.926, P = 0.028) were the only factors that remained significant following logistic regression analysis. Prompt identification with active management of ADs and their associated factors among PLWHA are advocated. Further research on the risk factors for ADs is also warranted.

Psychological Distress and Emotional Pain Among Adult Attendees of a Dental Clinic: A Case-Control Study.

We set out to carry out a case-control evaluation of psychological distress and emotional pain among adult attendees of a Nigerian dental clinic. A total of 201 subjects, made up of 101 dental patients (test group) matched with age and sex with 100 normal subjects (controls), was recruited into the study. All participants completed a designed socio-demographic questionnaire. General Health Question naire and Psyche ache Assessment Schedule were also administered to assess psychological distress based on cut-off scores ≥3 and emotional pain based on cut-off scores ≥28 respectively. The mean ages of study and control group were 33 (±12) and 36 (±13) years respectively, and both study and control groups were not significantly different in all the assessed socio-demographic parameters. Overall, 21.8% (n=22) of the subjects had psychological distress, while only 7% of the control group had psychological distress. This difference was statistically significant (P=0.003). Similarly, there was significant difference in the experience of psyche ache (unbearable psychological pain) as over a third of the dental patients (37.6%, n=38) had emotional pain, while only 13% of the controls experienced psych ache (P<0.001). In this study, the burden of psychological distress and emotional pain was many-fold in dental patients when compared with the controls.

A Study of Insomnia among Psychiatric Out-Patients in Lagos Nigeria

Insomnia is closely related to psychiatric disorders, occurring as an accompanying symptom or as an aetiological factor. It is also a common side-effect of some of the drugs used in treating psychiatric disorders. Several studies have been carried out in different populations however there is the need for more studies aimed at taking a closer look at this relationship in the Nigerian population. The objective of this work is to study the relationship between insomnia and patient characteristics such as sleeping conditions and psychiatric diagnoses. The study was carried out at the Lagos University Teaching Hospital. The methodology involved administering a socio-demographic questionnaire and the Sleep-50 questionnaire to consenting subjects whose psychiatric diagnoses were ascertained using the Structured Clinical Interview for DSM-IV. An analysis of the one hundred and eighty four subjects studied showed that schizophrenia was the commonest psychiatric diagnosis (35.9%). The prevalence of insomnia in this population was found to be 20.1% and it was significantly most prevalent among those with major depression. The noise experienced at night, the subject’s subjective estimation of hours asleep, being elderly and being unemployed were significantly related to the presence of insomnia. In conclusion the study supports the importance of enquiring about insomnia among psychiatric out-patients and highlights the usefulness of sleep questionnaires in obtaining information in sleep disorder research.

Prevalence and associated risk factors of Kola nut chewing among secondary school students in Osogbo, Nigeria

The objectives of this study were to determine the prevalence and pattern of Kola nut use among secondary school students in Osogbo, Osun State, Nigeria. The study also aimed to determine the association of socio-demographic variables (of the students and their parents) with kola nut chewing. A questionnaire consisting of socio-demographic variables, the stimulant use section of the WHO Students Drug Use Questionnaire was administered on three hundred and eighty-five (385) randomly selected students of the two Local Government Areas of Osogbo. The prevalence rate of kola nut use was calculated and some socio demographic variables were determined. The 30-day prevalence rate of kola nut use was 11.2%. The one-year prevalence of kola nut use was 29.1 percent and the lifetime rate was 74.8 percent. Majority of users started at age 14 years or below. Kola nut use was associated with lower age group, poor school attendance, polygamous background, low education of mother, high education of father and the description of mother as being too permissive. The findings suggest the need to increase the awareness of the dangers of kolanut use among adolescents. Control program are urgently needed to prevent student wastage.

Anxiety disorders in breast cancer: Prevalence, types, and determinants

ABSTRACT The coexistence of anxiety disorders among women with breast cancer has been linked with delay in diagnosis, treatment abandonment, and poor quality of life. This study investigated anxiety disorders with their determinants among 200 participants with histological diagnosis of breast cancer. A questionnaire was designed to elicit sociodemographic and clinical factors, while the schedule for clinical assessment in neuropsychiatry (SCAN) was used to ascertain the presence of anxiety disorders. The mean age of participants was 49.6 years (SD = 11.2) and more than half (54%) presented with advanced cancers (stages 3 and 4). Anxiety disorder was observed in 38 (19%) of the participants. Low income, absence of previous history of breast cancer, and early stage of breast cancer were the significant determinants of anxiety disorders (p < 0.05). However, only absence of previous history of breast cancer (odds ratio [OR] = 3.460, 95% confidence interval [CI] = 1.200–6.960) and early stage of breast cancer (OR = 1.560, 95% CI = 1.120–2.174) were the determinants of anxiety disorders following logistic regression. We advocate for public awareness to promote early screening. Similarly, there is need to improve access to care and integrate culturally appropriate psychosocial intervention into breast cancer care using the available knowledge on vulnerability factors. Further study on anxiety disorders in breast cancer is indicated.

P03-208 - Correlates and prevalence of substance use among primary care patient in Ikorodu, Nigeria

Quality of life and sociodemographic factors of patients with unexplained symptom in general practice. Objectives We aimed to evaluate the correlates and prevalence of psychoactive substance use in primary care patients in Ikorodu, Lagos Nigeria. Method Six Primary Health Care clinics were randomly selected of the public health clinic in Ikorodu area of Lagos. A total of 1,550 were screened with World Health Organization Alcohol, Smoking and substance involvement screening test (ASSIST) between June 2007, and May 2008. Results Hazardous use of tobacco was most prevalent (30%) especially among 18 - 25 age group, follow by Alcohol and then cannabis. Hazardous use of alcohol was associated with male gender, younger age group and lack of employment. For all substances, we recorded lowest rate for women. Conclusion Psychoactive substance use are common among primary care patients, effective methods of early identification and form of anti drug use education are needed. Younger age groups, especially men are to receive more attention.

P01-270 - Quality of life and sociodemographic factors of patients with unexplained symptom in general practice

Objectives We aimed to assess the quality of life and psychosocial factor of patients presenting with medically unexplained symptom at a private general practice in Lagos Nigeria. Method A total of 150 subjects presenting with unexplained symptoms out of 1,450 G.P consulted had world health organization Quality of life (Brif) questionnaire obtained. The Quality of life score and social factors were compared with patients without unexplained symptoms. Results Majority of patients with unexplained symptom were female, with mean age of 42(±8) and unemployed. Among the patients, 80% had unexplained pain symptoms. Quality of life was poor in subject with unexplained symptoms and was significantly different in comparison with those without medically unexplained symptoms. Conclusion General practice patients with medically unexplained symptom had remarkably poorer quality of life and associated sociodemographic factors include age, sex and unemployment. Early identification and prompt treatment should be encouraged.