PREVALENCE AND PREDICTORS OF MEDICATION ADHERENCE AMONG PATIENTS WITH SCHIZOPHRENIA IN MAIDUGURI, NORTHEASTERN NIGERIA.

Introduction: Non-adherence to antipsychotic medication is a key factor to poor treatment outcome, frequent relapse, poor quality of life and increased economic burden of mental illness. Objective: To determine the prevalence and associated factors of medication adherence among patients with schizophrenia on antipsychotic medications. Methodology: Through a cross-sectional survey, two hundred and nine patients with schizophrenia on antipsychotic medications were recruited through a systematic random sampling to participate in the study. Data were collected using the Socio-demographic Questionnaire, Medication Adherence Rating Scale and Positive and Negative Symptoms Scale. Frequencies and percentages were used to compute categorical variables. Associations of socio-clinical variables with medication adherence were analyzed using chi-square and variables with significant association were subjected to logistic regression analysis to determine the independent predictor of medication adherence. Result: The prevalence of high, medium, and low medication adherence was 43.1%, 44%, and 12.9% respectively. Factors significantly associated with medication adherence at bivariate analysis were age (χ2=22.97; p=0.003), number of drugs (χ2=16.23; p=0.003), female gender (χ2=6.55; p=0.038), prolactin level ((χ2=14.93; p=0.021) and severity of illness (χ2=17.77; p=0.007). The independent predictors of high medication adherence were age (p=0.014), fewer number of drugs (p=0.006), and normal to mildly ill on PANSS scale (p=0.015). Conclusion: Non-adherence to antipsychotic medication was found among 56.9% of patients with schizophrenia. The findings of this study call for a proactive psychosocial counselling approach for mental health consumers and their caregivers.

Prevalence and Correlates Of Sexual Dysfunction Among Patients With Schizophrenia Spectrum Disorder on Antipsyhotic Medications in Maiduguri, Northeastern Nigeria.

OBJECTIVES: Despite the importance of a satisfying sexual life, most patients with schizophrenia spectrum disorders do not discuss sexual issue with their clinicians. The current study seeks to determine the prevalence and socio-clinical correlates of sexual dysfunction among patients with schizophrenia spectrum disorders receiving typical and atypical antipsychotic medications. The second objective is to determine the frequency and correlates of specific sexual dysfunction (desire, arousal, erection/lubrication and orgasm) by gender and drug type using the Arizona Sexual Experience Scale. METHODOLOGY: This cross-sectional study used standardized structured interviewer based survey to assess sexual dysfunction among patients with schizophrenia that are both sexually active and inactive at a tertiary hospital in Maiduguri from December 2020 to April 2021. Participants were also assayed for prolactin using ELISA Kit for a possible association with sexual dysfunction. RESULTS: The overall prevalence of sexual dysfunction among patients with schizophrenia spectrum disorder receiving antipsychotics was 34% with patients on typical and atypical antipsychotics reporting rates of 36.8% and 24.6%, respectively. Among the typical and atypical antipsychotics, patients receiving haloperidol (40.3%) and risperidone (37.5%) reported a relatively higher frequency of sexual dysfunction compared to those receiving clozapine (18.2%). Independent correlates of sexual dysfunction were: female gender (OR = 1.89, 95% CI = 1.17-3.06; P = .010), being unmarried (OR = 1.51, 95% CI = 1.17-1.96; P = .001), pseudoparkinsonism (OR = 1.66, 95% CI = 1.02-2.69; P = .008), prolactin (OR = 2.15, 95% CI = 1.34-3.43; P = .001) and severity of illness (OR = 1.34, 95% CI = 1.03-1.75; P = .030). CONCLUSION: Sexual dysfunction is prevalent among patients with schizophrenia spectrum disorder receiving either typical or atypical antipsychotics.

Comparative Study of Extrapyramidal Side Effects, Sexual Dysfunctions and Hyperprolactinaemia Using Typical and Atypical Antipsychotic Medications Among Patients with Schizophrenia in Maiduguri.

Background: Extra-pyramidal side effects, sexual dysfunctions and hyperprolactinaemia are major side effects with the use of antipsychotic medications that impede treatment adherence leading to relapse, increased cost of care and rehospitalization among patients with schizophrenia on antipsychotic medications. The study aims to compare the prevalence of extra-pyramidal side effects (EPSE), sexual dysfunctions (SD) and hyperprolactinaemia (HPRL) among patients with schizophrenia spectrum disorders on typical and atypical antipsychotic medications. The secondary aim is to determine if any associations exist between extra-pyramidal side effects, sexual dysfunctions and hyperprolactinaemia. Methodology: A cross-sectional hospital-based survey involving 209 patients with schizophrenia were interviewed with structured instruments for the assessment of sexual dysfunction, EPSE and the estimation of serum prolactin was done using Enzyme-linked Immunosorbent Assay. Frequencies and Chi-square analysis were used to compare differences in EPSE, SD & HPRL. Results: The study revealed non-statistically significant differences as a group between typical and atypical antipsychotic medication in terms of extra-pyramidal side effects, sexual dysfunction and hyperprolactinaemia. However, a significant association was observed when individual drugs were compared with haloperidol causing the highest frequency of hyperprolactinaemia (χ 2 = 14.9, P = 0.011). A significant relationship between sexual dysfunction and hyperprolactinaemia, sexual dysfunction and extra-pyramidal side effects as well as extra-pyramidal and hyperprolactinaemia was found when individual items for sexual functionin were used. Conclusion: The significant relationships between sexual dysfunction only in the domains of sexual desire and arousal with hyperprolactinaemia and extrapyramidal side effects as well as hyperprolactinaemia with extrapyramidal side effects point to a common anti-dopaminergic activity of antipsychotics via different pathways. Prospective studies among a larger sample of patients with schizophrenia are needed to unfold these relationships.

Awareness, attitude, and understanding toward epilepsy among workers in a State Specialist Hospital in Maiduguri, Northeastern Nigeria.

Background: Epilepsy is a common presentation at clinics in Psychiatric Hospitals, Teaching Hospitals, and general practice. In developing countries and Africa especially, awareness, attitude, and understanding are generally poor. People still believe in spirits as the cause of epilepsy. Objectives: The objectives were to assess the awareness; attitude and knowledge of Hospital workers in general practice concerning epilepsy. Methodology: The respondents were workers of all cadres who were working at a State Specialist Hospital and the study used a survey method proposed by Caveness and Gallup, with modifications and adaptations on the self-administered questionnaire. Results: One hundred and forty-four staffs of State Specialist Hospital completed the questionnaire containing items addressing demographics, awareness, attitude, and knowledge. Of these respondents, 89 were males and 55 were females. The mean age was 34.34 years. 96.5% heard of the disease, 77.8% knew someone with the disease, 64.6% will not object to their children playing with someone with epilepsy and 37.5% will not allow a relative to marry someone with epilepsy. Fifty-five percent (55%) of the respondents said; they will not employ such patients, and that patients with epilepsy should not be employed with others. Knowledge towards epilepsy was good, where 71.5% felt it was caused by a brain disorder. Conclusion: We found out that awareness and knowledge of epilepsy among Hospital staff were generally good. However, the attitude of healthcare workers had reservations towards patients with epilepsy (PWE) either working for them or working with other people. This attitude arose from deeply ingrained cultural misconceptions acquired over time. Thus, there is a need for consistent hospital staff education, aimed at allaying fears, mistrust as well as to lessen the stigma towards epileptics.

RésuméContexte: L'épilepsieestuneprésentation courante dans les cliniques des hôpitauxpsychiatriques, des hôpitauxd'enseignement et de la médecinegénérale. Dans les pays en développement et en Afrique en particulier, la sensibilisation, l'attitude et la compréhensionsontgénéralementmédiocres. Les gens croienttoujoursque les espritssont la cause de l'épilepsie. Objectifs: Les objectifsétaientd'évaluer la sensibilisation; l'attitudeet les connaissances des employés de l'hôpitaldans la pratiquegénéraleconcernantl'épilepsie. Méthodologie: Les répondantsétaient des travailleurs de tous les cadres qui travaillaientdansunhôpitalspécialiséd'État et l'étude a utiliséuneméthoded'enquêteproposée par Caveness et Gallup, avec des modifications et des adaptations sur le questionnaire auto-administré. Résultats: Cent quarante-quatremembres du personnel du State Specialist Hospital ontrempli le questionnaire contenant des élémentsconcernant la démographie, la sensibilisation, l'attitudeet les connaissances. Parmicesrépondants, 89 étaient des hommeset 55 étaient des femmes. L'âgemoyenétait de 34,34 ans. 96,5% ontentenduparler de la maladie, 77,8% connaissaientunepersonneatteinte de la maladie, 64,6% ne s'opposeront pas à cequeleursenfantsjouent avec unepersonneépileptique et 37,5% ne permettront pas à un parent d'épouserunepersonneatteinted'épilepsie. Cinquante-cinq pour cent (55%) des répondantsontdit; ilsn'emploieront pas de tels patients et les patients épileptiques ne devraient pas êtreemployés avec d'autres. Les connaissancessurl'épilepsieétaientbonnes, où 71,5% estimaientqu'ellesétaientcausées par un trouble cérébral. Conclusion: Nous avonsdécouvertque la sensibilisationet la connaissance de l'épilepsieparmi le personnel de l'hôpitalétaientgénéralementbonnes. Cependant, l'attitude des travailleurs de la santé avait des réservesenvers les patientsépileptiques (PWE) travaillant pour euxoutravaillant avec d'autrespersonnes. Cette attitude découle des idéesfaussesculturellesprofondémentenracinéesacquises au fil du temps. Ainsi, ilestnécessaire de dispenser une formation cohérente au personnel hospitalier, visant à apaiser les craintes et la méfianceainsiqu'àréduire la stigmatisation envers les épileptiques.

The impact of comorbid clinical depression on the health-related quality of life of adults on highly active antiretroviral therapy in maiduguri, northeastern Nigeria.

BACKGROUND: Globally, depression compromises the quality of life (QOL) of people suffering from it. We assessed the impact of comorbid depression on the health-related quality of life (HRQOL) of adults on highly active antiretroviral therapy (HAART) in northeastern Nigeria in this study. MATERIALS AND METHODS: Three hundred and three adults on HAART were recruited for this study from the ART clinic of the University of Maiduguri Teaching Hospital in northeastern Nigeria. The depressive disorder module of the Composite international diagnostic interview (CIDI version 3.0) and the WHO quality of life instrument (WHOQOL-BREF) were used for the evaluation of depression and quality of life respectively. RESULTS: The prevalence of depression in this study was 19.8%. The depressed respondents rated their HRQOL poorer than their nondepressed counterparts on the physical, psychological, social relationships and environmental domains as well as the global outcome, as shown by these statistically significant findings (T = 9.739, P = <0.001), (T = 8.972, P = <0.001), (T = 6.533, P = <0.001), (T = 8.913, P = <0.001), and (T = 10.018, P = <0.001), respectively. Female gender, CD4 counts <200/mm(3) and diagnosis of depression were significant predictors poor QOL. CONCLUSION: Depression has a negative impact on the QOL of the respondents. We therefore recommend incorporation of the routine screening of this important psychiatric comorbidity into the care of this vulnerable group in order to optimize patient care.

Unrecognized psychiatric disorders among adult patients admitted into a general hospital in Maiduguri, Northeastern Nigeria.

INTRODUCTION: Patients with unrecognized psychiatric disorders in general hospitals, suffer economic and psycho-social difficulties. This study aimed to determine (i) prevalence and pattern of psychiatric disorders, and (ii) prevalence of unrecognized psychiatric disorders among adult in-patients of a general hospital. METHODS: In this two-stage, cross-sectional study, we used (i) General Health Questionnaire (GHQ) and Composite International Diagnostic Interview (CIDI) to assess the prevalence of psychiatric disorders, and (ii) Patient Encounter Form to determine unrecognized psychiatric disorders, among patients admitted into a general hospital. RESULTS: Of the 283 respondents, 174 (61.5%) had GHQ scores of ≤ 4. Eighty seven respondents (31%) had psychiatric disorders of which 85 (98%) were not recognized. The frequency of Depression and Anxiety disorders were 61.5% and 26.2% respectively. Unmarried (2.3, 1.2-4.3; p < 0.00), females (2.1, 1.1-4.05; p = 0.01) and patients with "unexplained symptoms" (≤ = 8.4, p< 0.00, df = 1) were more likely to have diagnosis of depression and anxiety disorder. CONCLUSION: We conclude that one-third of the patients in the general hospital, had co-morbid psychiatric diagnoses, mostly unrecognized by their physicians. Unmarried, females and respondents with unexplained symptoms were associated with depression and anxiety disorders. We recommend the posting of psychiatric trainees to general hospitals, and training of general practitioners on the use of simple depression and anxiety screening instruments.

Prevalence, Correlates and Under-Diagnosis of Clinical Depression among Adults on Highly Active Antiretroviral Therapy in a Tertiary Health Institution in Northeastern Nigeria.

Clinical depression is a highly debilitating illness, which is often under-diagnosed and negatively impacts on the quality of life of its sufferers. When it co-exists with other medical conditions, its effect is even more incapacitating. Undiagnosed depression in the context of HIV infection leads to accelerated decline in CD4+ cell counts with concomitant increase in the viral load and poor adherence to the antiretroviral medications which lead to viral mutation and the evolution of resistant strains. This study examined the prevalence of depression, its correlates and the frequency of the diagnosis of the condition among HIV+ subjects on highly active antiretroviral therapy (HAART) by the internists and general physicians at the University of Maiduguri Teaching Hospital in Northeastern Nigeria. Three hundred and fifty representative samples of HIV+ adults on HAART were drawn from the Antiretroviral Therapy Clinic of the Institution. Diagnosis of depression was made using the International Classification of Diseases-10 criteria based on Composite International Diagnostic Interview generated data. Socio-demographic and clinical variables were also analyzed for their correlation with depression in the subjects. About 20% of the respondents were diagnosed with clinical depression and no diagnosis of the condition was hitherto entertained in all the respondents. The independent determinants of depression in the participants were: female gender [odds ratio (OR)=3.87 (95% confidence interval, CI: 2.089-7.183)], past history of psychiatric illness [OR=43.81 (95% CI: 9.731-197.30)] and family history of psychiatric illness in first-degree relatives of the subjects [OR=14.364 (95% CI=5.327-38.729)]. Depression is a relatively common psychiatric condition among adults on HAART, there is therefore the need for routine screening of this condition among HIV+ subjects in order to optimize patient care and improve clinical outcomes.