Lateef Olutoyin Oluwole

Dexamethasone induced psychosis presenting with catatonic features

Catatonia is a complex condition characterized by the presence of various motor signs and symptoms. It remains a poorly understood, poorly studied, and poorly recognized syndrome. Catatonic features are seen in a range of psychiatric conditions including psychotic disorders, mood disorders, conversion disorder and dementia. Studies have also identified over 35 medical and neurological illnesses associated with catatonia including corticosteroids exposure, central nervous system (CNS) structural damage, encephalitis and other CNS infections, seizures, metabolic disturbances, phencyclidine exposure, neuroleptic exposure, lupus cerebritis, disulfuram, porphyria, and other conditions. These medical causes of catatonia account for between 20% to 30% of such cases.

Assessment of Depression in a Primary Care Setting in Nigeria using the PHQ-9

Context: Mental disorders are major contributors to the burden of diseases all over the world. In general practice, which provides essentially primary care, depression is the most common mental disorder seen and often goes unrecognized. Aims: The aims of the study were to determine the prevalence of depression, the variables associated with depression, and the degree of recognition by the Physician in family medicine unit. Setting and Design: A cross-sectional descriptive survey of consecutive patients who presented at the general medical out-patient unit of the State University Teaching Hospital, Ado-Ekiti, Nigeria was done. Materials and Methods: Data were collected using a questionnaire incorporating sociodemographic variables and primary diagnosis made by attending Physician. Depression was assessed with the PHQ-9. Results: Two hundred and seventy two patients were interviewed during the period of the study. Participants were mostly of 45 years or older (51.2%), female (59.9%), married (68.4%), and educated (85.7%). One hundred and thirty (47.8%) of the respondents had significant depressive symptoms with majority (49.2%) being classified as mild. Statistical analysis revealed significant association between depression and age, gender, marital status, and clinical diagnoses (P < 0.05). Over a quarter (28.7%) were presented with infectious diseases, other diagnoses made included cardiovascular disorders (15.8%), endocrine disorders (8.8%), psychiatric disorders other than depression (2.9%) and none had depression as primary diagnosis. Conclusions: The prevalence of depression among patients attending the general medical out-patient clinics is high and highly under-recognised.

Burden of stigma among relatives of Nigerian patients living with epilepsy

Background: Epilepsy, a chronic noncommunicable disease is recognized as a major public health concern. Stigma is an important factor that has a negative influence on people with epilepsy (PWE) and their families. The burden for people with epilepsy and their families is greatest in poor countries. Aims: The aim of this study is to elicit the lived experiences of individuals who had experienced burden of stigma while they live and care for patients with epilepsy. Settings and Design: The participants in this study are relatives who are the caregivers of patients with epilepsy who visited the mental health unit of a tertiary health center in Southwest Nigeria. Materials and Methods: Sociodemographic data of participants were collected in addition to recorded significant statements following extensive interactions held with the participants. Thematic analyses of varying experiences of participants, as recorded, were done using the phenomenological method of Colazzi. Results: Nineteen participants were engaged in the study with 12 (63.2%) of them being females and half of the females being mothers. Child and spouse of patients of epilepsy were least likely as care givers. The mean age of participants was 38.3 years and mean duration of patients′ illness was 5.6 years. Four major themes including prejudice, fear, shame, and social isolation were the most recurring of the -33 significant statements recorded from the participants. Conclusions: It is pertinent to have enhanced and sustained self-efficacy with great empathy toward the patients and their family members.

Alcohol use and psychological wellbeing of health workers in a Nigerian Hospital: An exploratory study

Background The degree of alcohol use influences ones mental health and psychological wellbeing. Psychological well-being of health workers, however, is crucial to the quality of care their patients receive. Aims The aim of this study was to determine the pattern of alcohol use and factors associated with psychological well-being of health care workers at a University Teaching Hospital. Methods This was a cross sectional survey of health workers in the medical and surgical specialties at the State University Teaching Hospital in Nigeria. Socio-demographic questionnaire, the 10-items Alcohol Use Identification Test (AUDIT) and the 12-items General Health Questionnaire (GHQ-12) were used to assess socio-demographic, alcohol use and psychological well-being of the participants. Statistical analyses were done using the Statistical Package for Social Sciences (SPSS) version 16. Appropriate statistical tools were used to determine relationships between various variables. Results A total of 256 participants were interviewed. Fifteen (5.9%) of the respondents were either hazardous or harmful drinkers. Psychological distress was reported among 17.2% of the respondents and this was significantly associated with marital status, years of practice, specialty of practice, presence of ongoing chronic illness, current stressors and level of alcohol use. Conclusion A high proportion of the participants in the study were abstainers and a significant number were experiencing psychological distress. Psychological distress was however found to be significantly associated with harmful alcohol use, some socio-demographic variables, and work related factors. Efforts should be geared towards identifying these factors so as to ensure effectiveness and well-being of health workers.

Depression and associated physical co-morbidities in elderly prison inmates

ABSTRACT Elderly prisoners constitute a group of vulnerable individuals in correctional institutions with more propensities for the negative effect of incarceration with its attendant public health problems. Many studies had explored and confirmed a higher rate of psychiatric morbidity among elderly prison inmates in most part of the globe; however, data in this part of the globe is practically unavailable. This study aims at determining the prevalence and pattern of major depressive disorder and physical co-morbidity among elderly inmates aged 50 and above in the Ogun State Prisons. This is a cross-sectional descriptive study of the population of elderly male prisoners aged 50 and above across a state in Nigeria. They were assessed using a proforma incorporating a sociodemographic, medical/forensic questionnaire, designed by the authors, and depression modules of the structured clinical interview schedule for axis I DSM-IV Disorder (SCID). Diagnosis of depression was made according to the DSM–IV criteria. Depression severity was measured using Montgomery–Asberg Depression Rating Scale (MADRS). All the eighty-five elderly inmates studied were male with mean age of 58.65 years. Majority had none or primary education, were from a polygamous background, and 43.5 percent were on current medicare. The prevalence of Major Depressive Disorder was 24.7 percent. Depression was significantly associated with prison locations, perceived condition of the prisons, and current medical care. Prevalence of Major Depressive disorders and physical morbidity among elderly male inmates were high. The presence of physical co-morbidity as well as the inmate’s perception of the prison were major predictor of depression and hence the need for modalities to detect and treat both emotional and physical disorders and to upgrade the prison environment in order to improve the quality of life of the inmates.

Perceptions and attitudes of students of mass communication toward mental illness in Nigerian Tertiary Institution

Background: The power of the modern mass media is not limited to its ability to communicate information and entertain but derives primarily from its ability to define situations, thereby enabling it to construct social reality. Stigma is related to negative stereotyping and prejudicial attitudes that in turn lead to discriminatory practices. Aims: The study sought to know the perceptions of and attitudes of mass communication students towards mental illness and the mentally ill. Settings and Design: The study population comprised of final year Diploma students of Mass Communication of a foremost tertiary institution in Nigeria. Methods and Material: The World Psychiatric Association questionnaire measuring attitudes towards Schizophrenia was modified and administered to the students. Results: Study also showed only one-fifth of all respondents had contact with either an advert or a promotion about mental illness. About three-quarter (74.1%) of those who had come in contact with information on mental illness had done so through audiovisuals including television and radio. More than half of the students ranked environmental factors foremost among causes of mental illness. Majority of the students (85.9%) would definitely not marry someone with mental illness. Conclusions: The enormous potential and influence the media has on mental health issues would require that mental health professionals provide great input into the enlightenment program for these young and mental health-naive potential image makers.

Hazardous alcohol use among doctors in a Tertiary Health Center

Background: Doctors have been identified as one of the key agents in the prevention of alcohol-related harm, however, their level of use and attitudes toward alcohol will affect such role. Aim: This study is aimed at describing the pattern of alcohol use and the predictors of hazardous drinking among hospital doctors. Setting: Study was conducted at the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. Design: A cross-sectional survey involving all the doctors in the teaching hospital. Materials and Methods: All the consenting clinicians completed a sociodemographic questionnaire and alcohol use was measured using the 10-item alcohol use disorder identification test (AUDIT) and psychological well-being was measured by the 12-item General Health Questionnaire (GHQ-12). Statistical Analysis Used: Statistical analyses were done using the Statistical Package for Social Sciences version 16. Chi-square tests with Yates correction were used to describe the relationship between respondent′s characteristics and AUDIT scores as appropriate. Results: There were a total of 122 participants. Eighty-five (69.7%) of them were abstainers, 28 (23%) were moderate drinkers, and 9 (7.3%) hazardous drinkers. With the exception of age, there was no significant relationship between sociodemographic status, years of practice, specialty of practice, and hazardous alcohol use. Experiencing stress or GHQ score above average is significantly associated with hazardous drinking. Conclusion: Hazardous drinking among hospital doctors appears to be essentially a problem of the male gender, especially among those older than 40 years. Stress and other form of psychological distress seem to play a significant role in predicting hazardous drinking among doctors.

Pattern and predictors of alcohol use disorders in a family practice in Nigeria.

Background: Primary care has been identified as a key setting for the reduction of alcohol-related harm, while general practitioners are expected to play a significant role. The study aimed at identifying pattern of, and factors that are associated with alcohol use disorders (AUDs) among patients attending Family Medicine unit of State University Teaching Hospital. Materials and Methods: Sample was selected through a random sampling from a population of patients, aged 18-65 years, attending the general medical out-patients unit of the hospital from January to April 2013. A pretested, semi-structured questionnaire was administered, incorporating sociodemographics and the diagnoses made by the attending Physician. The participants also completed the alcohol use disorders identification test (AUDIT) questionnaire and the patient health questionnaire-9. Results: The prevalence of AUDs among the population of general out-patients was 9.7%. The AUDIT scores of the participants range from 0 to 29 with a mean of 1.3 (standard deviation = 4.08). AUDs were significantly associated with gender, level of education, occupational class, and the presence of significant depressive symptoms (P < 0.05). There was no statistically significant association found for age, employment status, marital status, and religion. Conclusion: The prevalence of AUDs among population studied was lower compared with a similar study in similar setting, but however, significant. AUDs were predicted by gender, lower education level, occupational group, and the presence of significant depressive symptoms mostly in the mild to moderate form. Identifying the group at risk in clinical setting may go a long way in reducing the adverse effect of AUDs in our society.