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.

Maternal depression and child psychopathology among Attendees at a Child Neuropsychiatric Clinic in Abeokuta, Nigeria: a cross sectional study.

BACKGROUND: Children with recognized, diagnosable mental and neurological disorders are in addition prone to emotional and behavioral problems which transcend their specific diagnostic labels. In accessing care, these children are almost invariably accompanied by caregivers (usually mothers) who may also have mental health problems, notably depression. The relationship between child and maternal psychopathology has however not been sufficiently researched especially in low and middle income countries. METHODS: Mothers (n = 100) of children receiving care at the Child and Adolescent Clinic of a Neuropsychiatric Hospital in Abeokuta, Nigeria took part in the study. To each consenting mother was administered a sociodemographic questionnaire and the Patient Health Questionnaire, while information regarding their children (n = 100) was obtained using the Strengths and Difficulties Questionnaire. Data analysis was done with the Statistical Package for Social Sciences (SPSS) version 16. RESULTS: The mean ages of the mothers and children were 40.4 years (SD 4.7) and 11.6 years (SD 4.1), respectively. Among the children, 63 % had a main diagnosis of seizure disorder. Regardless of main diagnosis, 40 % of all the children had a comorbid diagnosis. Among the mothers, 23 % had major depressive disorder. A quarter (25 %) of the children had abnormal total SDQ scores. A diagnosis of major depressive disorder in mothers was associated with poor total SDQ scores and poor scores in all SDQ domains except the emotional domain for the children. Major depressive disorder among the mothers was associated with not being married (p = 0.004; OR = 0.142, 95 % CI 0.037-0.546) and longer duration of the child's illness (p = 0.039, OR = 1.165, 95 % CI 1.007-1.346). CONCLUSION: The study showed notable rates of depressive illness among mothers of children with neuropsychiatric disorders. Marked rates of emotional and behavioral disorders were also found among the children. Associations were found between maternal and child psychopathology. Mothers of children with neuropsychiatric disorders should be screened for depressive illness.

Morbidity profile of first-degree relatives of probands with schizophrenia: a comparison with mood disorder and healthy control.

PURPOSE: There is a paucity of data on heritability of psychotic disorders in Africa. The study aimed to investigate morbid risk of schizophrenia and mood disorder among first-degree relatives of schizophrenia probands, compared with mood disorder and healthy controls. METHODS: The study examined 330 first-degree relatives of probands with schizophrenia (n = 50), 350 first-degree relatives of probands with mood disorder (n = 50) and 387 first-degree relatives of healthy control (n = 50). The Schedules for Clinical Assessment in Neuropsychiatry, SCAN was used to ascertain diagnosis in ill subjects. To each subject, a socio-demographic questionnaire was administered. Family history was obtained using the Family History Schedule. Morbid risk estimates were calculated using the Weinberg shorter method. RESULTS: There was a significant difference between the mean age of relatives of schizophrenia probands compared to mood disorder (p = 0.01, 95 % CI 1.34-9.61) and healthy control (p < 0.01, 95 % CI 1.53-9.84). There were also significant differences between the number of children of schizophrenia probands and the number of children of normal control (p < 0.01, 95 % CI -2.0 to -3.9), as well as the number of deceased first-degree relatives of schizophrenia probands compared to normal control (p = 0.04, 95 % CI 0.01-0.94). Finally, there was a significant difference between the number of first-degree relatives of schizophrenia probands compared to the number of first-degree relatives of healthy control who were below the age of risk for schizophrenia (p = 0.01, 95 % CI -0.12 to -1.27). Morbid risks of 4.38 and 0.39 were obtained for schizophrenia among first-degree relatives of probands with schizophrenia and mood disorder, while first-degree relatives of probands with schizophrenia, mood disorder and healthy control had morbid risks for mood disorder of 0.42, 3.82 and 0.35, respectively. CONCLUSION: The study revealed excess mortality among first-degree relatives of schizophrenia patients. First-degree relatives of probands with schizophrenia and mood disorder also had higher morbid risks for these psychotic conditions than healthy control with some measure of overlap between the two diagnostic categories.

Prodromal psychotic symptoms and psychological distress among secondary school students in Abeokuta, Nigeria.

OBJECTIVE: This study aimed to investigate the relationship between prodromal psychotic symptoms and psychological distress among Nigerian adolescents. METHOD: Students (n=508) were randomly selected from secondary schools in Abeokuta, Nigeria. A socio-demographic questionnaire, the Prodromal Questionnaire-Brief Version (PQ-B) and the Strengths and Difficulties Questionnaire (SDQ) were administered to each student. RESULTS: The mean age of the students was 15.4 years (SD 1.3), with most (63%) being female. More than half (55.3%) reported having had a lifetime experience of major life event (20.9% in the preceding 6 months) while 13.9% had experienced bullying or abuse (5.1% in the preceding 6 months). The prevalence of prodromal symptoms was 20.9% (95% CI 0.174-0.244). Abnormal scores in emotional and conduct problems were seen in 11.8% and 6% respectively, while 7.3% had abnormal scores in each of the hyperactivity and peer problems subscales of the SDQ. Abnormality in prosocial behaviour was found in 1.8% of students, with overall abnormality in 4.9%. Regression analysis showed that prodromal symptoms were predicted by female sex, lifetime and 6 month history of major life event, and lifetime and 6 month history of bullying or abuse. Prodromal symptoms were also predicted by higher total SDQ scores and higher scores in all domains of psychological distress except the prosocial domain. CONCLUSION: The study showed a relationship between reported prodromal symptoms and the occurrence of psychological distress. It also showed that early childhood trauma may be a predisposing factor to the early stages of development of psychosis, with female children being especially prone in the years of adolescence.

Prevalence and correlates of poor medication adherence amongst psychiatric outpatients in southwestern Nigeria.

OBJECTIVE: The aim of this study was to assess the rate of adherence to medications amongst psychiatric outpatients in Nigeria and examine factors associated with medication nonadherence amongst this group. METHOD: Psychiatric outpatients (n=342) from three centres were assessed for medication adherence using the Morisky Medication Adherence Questionnaire. Details regarding sociodemographic variables (age, sex, education, religion, marital status, employment, income, medication cost), illness related variables (diagnosis, duration, number of episodes/admissions, insight, severity of symptoms, mental state, functional status), medication related variables (type, mode of administration, side effect, attitude to medication) and perception related variables (self-stigma, perceived causation and prognosis) were also obtained. RESULTS: There were 76 participants (22.2%) with good medication adherence, 102 (29.8%) with moderate adherence and 164 (48.0%) with poor adherence. The significant independent correlates of poor medication adherence included being employed [odds ratio (OR) 3.42, 95% confidence interval (95% CI) 2.17-5.39], poor social support (OR 5.86, 95% CI 2.87-12.17), high self-stigma (OR 4.70, 95% CI 2.24-9.96) and perceived spiritual causation of mental illness (OR 3.74, 95% CI 1.87-7.74). CONCLUSIONS: The majority of psychiatric outpatients in southwestern Nigeria had poor medication adherence. Our findings stressed the importance of patients' perception and social environment in determining treatment adherence and the necessity of educating the patient. Clinicians' attention to psychological barriers early in treatment may improve medication adherence and ultimately affect the course of illness.