Psychiatric morbidity in stroke patients attending a neurology clinic in Nigeria.

BACK GROUND: Stroke produces a wide range of mental and emotional disorders. Neuropsychiatric complications associated with stroke may have negative effects on the social functioning, overall quality of life and the recovery of motor functioning of stroke survivors. OBJECTIVE: To determine the prevalence and nature of psychiatric morbidity among stroke patients attending neurology outpatient clinic of the University of Ilorin Teaching Hospital (UITH), Ilorin-Nigeria. METHODS: All patients with stroke aged 18 years and above at an outpatient neurology clinic in Ilorin, Nigeria were assessed for mental and emotional disorders using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) over one year (March 2009 to February 2010). RESULTS: Overall prevalence of psychiatric morbidity was 36.0% (30/83) among 83 patients who constituted the study population. Specific diagnoses recorded were depression (19.2%), generalised anxiety disorder (9.6%), harmful alcohol use (2.4%); dementia, somatoform disorder, phobia and delusional disorder each had a prevalence of 1.2%. Clinical and sociodemographic variables were not significantly associated with psychiatric morbidity. CONCLUSION: Psychiatric disorders are often associated with stroke. Identifying and treating stroke patients with these psychiatric co-morbidities could thus help to improve the overall quality of life of these patients.

The correlates of stress, coping styles and psychiatric morbidity in the first year of medical education at a Nigerian University.

OBJECTIVES: This study was prompted by the heightened concerns about the stress inherent in medical education evident from the incessant requests for suspension of studies due to psychological problems. The objectives of the study were to: (i) survey the students for possible psychological problems at admission, and follow them up till exit for possible changes in morbidity, and (ii) ascertain possible risk factors, and coping strategies. METHOD: This is a preliminary 2-stage cross-sectional report, which is part of a longitudinal survey. It involves first year medical students of the College of Health Sciences of University of Ilorin between March and April, 2011. Questionnaires used included socio demographic, sources of stress, the general health questionnaire-12 (GHQ-12), Maslach's burnout inventory (MBI), and Brief COPE. Data were analysed using SPSS version 15 at 5% significance level. Chi-square, frequency distributions, Pearson's correlation, Odd ratios, and Confidence Intervals were calculated to determine the levels of risk. RESULTS: 79 students returned completed questionnaires. 12 (15.2%) were ghq-12 cases (i.e., scored ≥ 3). Students who had morbidity were 9 times at risk of being stressed consequent upon 'competing with their peers' and 4 times at risk due to 'inadequate learning materials'. Morbidity was significantly more likely to engender use of 'religion', 4 times less likely to engender use of 'positive reframing' with a trend in the use of 'self blame' as coping strategies. CONCLUSION: Aside from psychosocial/personal issues in this cohort, academic demand was an additional source of psychological problems thereby causing those who had morbidity to utilize 'religion' and 'positive reframing' to cope. There is therefore an apparent need to incorporate the principle of mental health promotion in medical education.

PSYCHIATRIC MORBIDITY IN A NIGERIAN NEUROLOGY CLINIC.

OBJECTIVE: The objective of the study was to determine the prevalence and nature of psychiatric morbidity among patients attending a neurology outpatient clinic. DESIGN: A two-stage screening procedure with General Health Questionnaire (GHQ-12) and Schedules for Clinical Assessment in Neuropsychiatry (SCAN) was used to assess psychological disorders over a one year period. Psychiatric diagnosis was based on ICD-10 criteria. SETTING: University of Ilorin Teaching Hospital (UITH), Ilorin-Nigeria SUBJECTS: Two hundred and thirty-five (235) patients aged 18 years and above attending the neurology outpatient clinic. RESULTS: Overall prevalence of psychiatric morbidity was 26.0% (61/235). The most frequent diagnoses were depression (14.9%), generalised anxiety disorder (5.5%), dementia (2.6%) and substance use disorder (1.3%). Significantly more patients with stroke had psychiatric morbidity. CONCLUSION: The study supports previous reports that psychiatric disorders are quite common among patients with neurological disorders. Efforts should, therefore, be directed at identifying and treating neurological patients with psychiatric morbidity since this will ensure improved outcome. In this regard, mental health professionals would need to provide liaison services for the neurologists and train them in the use of simple screening instruments for detecting associated psychiatric disorders with appropriate referral where necessary.

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 Buck's 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.

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.

Perception and attitude to epilepsy among teachers in primary, secondary and tertiary educational institutions in middle belt Nigeria.

Compared with the disability associated with repeated seizures or side-effects of antiepileptic medications, the social stigma associated with epilepsy is often a major handicap to people living with this condition. This study therefore looked at the knowledge, attitude and perception of teachers who see a lot of epileptics, relates on daily bases and have a high influence on students with epilepsy.Self-administered questionnaires were used to obtain information from 460 randomly selected teachers in primary, secondary and tertiary educational institutions in Kwara State-middle belt of Nigeria. The response rate was 75%. Almost all of the teachers had heard about epilepsy, but their awareness does not equate with the acceptance and understanding of epilepsy. About 30.5% believed that it could be contracted through the saliva of an epileptic, 27.7% thought it was synonymous with possession with evil spirit, while 10% misunderstood epilepsy for insanity. Close to one-fifth of the teachers were of the opinion that epileptic students have a below average mental capacity compared with other students and so cannot attainment the highest possible education. Negative attitude and bias towards epilepsy is still deeply ingrained among teachers in Nigeria. Apart from formal education, teachers need to have health education courses on common disease conditions such as epilepsy that are prevalent in school age. This might help to reduce prejudice and increase the acceptance of epileptic individuals into the classroom.