B. A. Issa

Premenstrual dysphoric disorder among medical students of a Nigerian university

BACKGROUND/OBJECTIVE This study aimed at estimating the prevalence and associated factors of premenstrual dysphoric disorder (PMDD) among medical students in a University in the North-Central State of Nigeria. PMDD is the severest form of premenstrual symptoms and is associated with impairment of social and role functioning. METHODS A cross-sectional study of female medical students of the University of Ilorin College of Health Sciences (n=208), which involves completing a questionnaire to elicit socio-demographic and gynecological information as well as the GHQ-12 questionnaires. They were later interviewed with DSM-IV PMDD instrument. RESULTS Seventy-five (36.1%) of the respondents met the criteria for the diagnosis of PMDD. Sixty-five (%) of the PMDD cases reported having pain during menses among whom 14 (21.5%) reported mild, 32 (49.2%) moderate and 19 (29.2%) severe form of menstrual pain. Forty-two persons (20.2%) were categorized as having probable psychiatric morbidity using a cut-off of >or= 3 on GHQ 12. There was neither a causal relationship between psychiatric morbidity (>or= 3 score), and PMDD, nor any association between gynecological factors and PMDD. However, menstrual pain was significantly associated with PMDD (P=0.019). CONCLUSION The rate of PMDD in this study is high. Dysmenorrhoea of moderate/severe intensity correlated significantly with the possibility of having PMDD. Efforts should therefore be made to alleviate the pain associated with menses. In addition, the Colleges health-care providers should take into account the issues of dysmenorrhoea and its management more seriously by intensifying health education on dysmenorrhoea and PMDD in order to improve the quality of life of the students.

Charles bonnet syndrome, management with simple behavioral technique

Charles Bonnet syndrome occurs in visually impaired but cognitively normal individuals. This report describes a condition of vivid visual hallucination (phantom images) in an 85-year-old conscious man, who had been blind by bilateral progressively worsening glaucoma. This common, but rarely reported, condition was managed by behavioral approach of repeated blinking, intermittent eyes closure, and reassurance. While emotional, mood and cognitive disorders need to be ruled out, the condition, though frightening to the afflicted, is benign and remediable with simple, inexpensive approach. Health workers managing people with terminal blindness should always ask for the presence of hallucinations from their patients to forestall a preventable distress resulting from wrong perception without visual stimulus.

Genital self-mutilation.

We present a case report of a 22-year-old Nigerian student who presented to the accident and emergency unit of a Nigerian Teaching Hospital with a history of self-inflicted genital injury following a suicide attempt. He had background history of predisposition to depressive illness, a current diagnosis of a major depressive disorder, and had had two attempted suicidal episodes in the last 3 months prior to this event. The clinical finding shows a patient with sad affect, feeling of hopelessness, and worthlessness; however, the vital signs remained fairly stable. At examination under anesthesia, the testes were exposed and the right already self-castrated. The penis was degloved to the level of the Bucks fascia with intact corpora cavernosa and urethra. He had surgical excision of the hanging self-castrated right testis with debridement and primary closure of the genital laceration. He was promptly reviewed by the psychiatrists who co-managed appropriately.

Sero-prevalence of hepatitis B and C among mentally ill patients attending a tertiary hospital in Nigeria

BACKGROUND Mentally ill persons are vulnerable to sexually transmitted infections including hepatitis B and C because of their high level risky behaviors. This study is aimed at establishing the sero-prevalence of hepatitis B and C among the mentally ill individuals (MII) attending psychiatric clinic of the University of Ilorin Teaching Hospital (UITH), Nigeria since it has not been documented. METHODS A total of 350 MII were recruited. HBsAg testing was by immunoassay test strip (Grand Medical Diagnostic R USA) while hepatitis C was tested by commercially prepared kits from ACON, R USA. Healthy adults who presented as donors in the blood bank of the hospital were used as controls. RESULTS A total of 700 participants including 350 MII and 350 blood donors (BDs) were recruited for the study. The mean ages of MII and control participants were 36.5 ± 12.3 and 31.4 ± 8.3, respectively.The sero-prevalence of hepatitis B and C among patients with mental illness was 10.0 and 12.6%, respectively, as compared to 10.9% and 1.1% of the blood donors. There was a significant difference in the prevalence of HCV among mentally ill when compared with the blood donors (P = 0.001, χ2 = 33.97; OR (CI) =12.44 (5.33-29.03). CONCLUSION Mentally ill patients attending UITH were significantly infected with hepatitis C virus. There is need for interventional measures to reduce the prevalence of hepatitis C among the mentally ill population such as health education and early screening of mentally ill in our setting.

Prevalence of psychiatric morbidity among inmates of a borstal institution in Nigeria.

Studies have reported increased psychiatric morbidity among young detainees, with as many as three-quarters reported to have one or more psychiatric disorders. Despite this, however, there is a dearth of published work among young inmates of prisons, remand homes or borstal institutions in Nigeria. The aim of this study was to assess possible psychiatric morbidity among young inmates of a borstal institution in Nigeria and to determine the factors that may be associated with this morbidity. Fifty-three inmates of one of the two existing borstal institution in Nigeria were assessed for psychiatric morbidity using the 12-item General Health Questionnaire (GHQ-12). The GHQ-12 scores were compared with the socio-demographic factors of the respondents. Twenty-eight (52.8%) of the inmates were over 18 years old, 35.8% were in the middle position within the family, 62.3% were of Christian faith, and 64.2% had their parents still living together. Seventeen (32.1%) of the inmates were from Hausa ethnic extraction, 58.5% stayed for more than 6 months at the borstal institution, and 81.1% were brought to the institution by their parents. The mean age of the inmates was 17.3 years (range, 14-23 years) and 26 (49.1%) of them were GHQ-positive. There was no statistically significant difference between the mean age of GHQ-positive and GHQ-negative inmates (F=1.73, p=0.19), and none of the socio-demographic variables were significantly associated with psychiatric morbidity (i.e. GHQ-12 positivity). The study observed a high prevalence of undetected psychiatric morbidity among inmates at the borstal institution. Efforts should be intensified by the authority responsible for managing the Nigerian prison services (including the borstal institutions) to improve mental health services.

Strong family history and early onset of schizophrenia: about 2 families in Northern Nigeria

Schizophrenia is a highly heritable psychotic disorder and high genetic loading is associated with early onset of the disease. The outcome of schizophrenia has also been linked with the age of onset as well as the presence of family history of the disease. Therefore families with patients with early onset Schizophrenia are subpopulations for genetic studies. We present 2 families with heavy genetic loading who have adolescents with schizophrenia.