Risk of manic switch with antidepressants use in patients with bipolar disorder in a Nigerian neuropsychiatric hospital.

BACKGROUND: Depressive disorders are common among those with bipolar affective disorder (BAD) and may necessitate the use of antidepressants. This has been suggested to precipitate manic episodes in some patients. OBJECTIVES: This study aims to determine the prevalence of and factors associated with manic switch in patients with BAD being treated with antidepressants. METHODS: Case notes of patients who were treated at a Nigerian neuropsychiatric hospital for a BAD from 2004 to 2015 were reviewed. BAD diagnosis was made using ICD-10 criteria. Treatment for bipolar depression included monotherapy (i.e. antidepressants, antipsychotics or mood stabilisers) or combination therapy (mood stabiliser with an antidepressant or a combination of mood stabilisers, antipsychotics and antidepressants). The primary outcome measure was a switch to mania or hypomania within 12 weeks of commencing an antidepressant. RESULTS: Manic or hypomanic switch (MS) was observed in 109 (44.3%) of the participants. Female gender, younger age, number of previous episodes and a past history of psychiatric hospitalisation were all significantly associated with a risk of MS. There was no significant difference in the rate of MS in either those treated with adjunct antidepressants therapy with a mood stabiliser or an antipsychotic or those placed on a combination of antidepressants, antipsychotics and mood-stabilising agents. CONCLUSION: A large proportion of patients with BAD on antidepressants experience medication-induced manic or hypomanic switch.

Psychosocial characteristics of female infertility in a tertiary health institution in Nigeria.

OBJECTIVES: Women with infertility experience higher rates of psychological distress compared with their fertile counterparts. In developing countries, socio-cultural factors may aggravate this distress. We aimed to determine the prevalence of psychological distress as well as its associated socio-cultural characteristics among women attending the infertility clinic of a tertiary hospital in Nigeria. MATERIALS AND METHODS: Women (n=100) attending an infertility clinic were consecutively recruited over a two-month period and compared with a similar number of pregnant women attending the antenatal clinic at the same hospital. A semi-structured questionnaire was designed to record socio-demographic and clinical variables. The 30-item General Health Questionnaire was used to screen for psychological distress. RESULTS: The prevalence of probable psychological distress was significantly higher among the infertile group compared with their fertile counterparts (P<0.001). There were significant differences between the groups in terms of their mean age (P<0.01), employment status (P<0.02), educational status (P<0.01), and duration of marriage (P<0.001). Infertile women who had previously sought help from a traditional or faith-based healer for infertility were more likely to experience probable psychological distress (P<0.017). CONCLUSION: Infertile women are more vulnerable to psychological distress and require psychological support. There is a need to incorporate mental health screening and treatment in the routine care of infertile women in Nigeria.

Unmodified electroconvulsive therapy: the perspective of patients from a developing country.

BACKGROUND: The controversy that exists over the relevance of electroconvulsive therapy (ECT) in contemporary psychiatric care often excludes the opinion of patients. Optimizing ECT service delivery must include the perspectives and input of service users. In Nigeria, the opinions of patients have not been explored. AIM: To evaluate the perspective of patients who have previously received ECT toward the process of delivery and the benefits and adverse effects of unmodified ECT. METHOD: Ninety consecutive consenting stable outpatients who had received unmodified ECT between 6 and 12 months from the time of study were surveyed in a cross-sectional study design over a 3-month period using a semistructured Likert-type questionnaire at a referral psychiatric hospital in Nigeria. RESULTS: Most (75.5%) of the patients did not find the procedure stressful and reported ECT being beneficial (82.2%). Most complained of deficiency in the process of ECT service delivery and reported not been adequately informed before receiving ECT (88.9%). A third reported experiencing memory impairment after ECT. Headaches and muscle pains were reported in 8.9% and 17.8% of patients, respectively. Patients who experienced headaches after ECT were more likely to perceive ECT as stressful (P < 0.005), whereas those who experienced memory impairment were less likely to receive ECT again if indicated (P < 0.001). CONCLUSIONS: Unmodified ECT is fairly well accepted among patients, although a majority complained of deficiencies in information provided about and consent toward the procedure. Improving ECT service delivery and addressing adverse effects may improve treatment acceptability.

Nigerian medical students attitudes to unmodified electroconvulsive therapy.

UNLABELLED: Electroconvulsive therapy (ECT) is an effective and affordable form of treatment for a range of psychiatric disorders. Historical antecedents, the media, and movies have generated myths about its continued use and relevance. OBJECTIVES: We explored medical students' knowledge of and attitude to ECT on completion of an 8-week clinical rotation (clerkship) in psychiatry. METHODS: A cross-sectional survey was carried out among final-year medical students at the end of a clerkship in psychiatry using a self-administered questionnaire adapted from previously published work, to assess their attitudes to and knowledge of unmodified ECT. RESULTS: Knowledge of medicine, psychiatry, and ECT were self-rated as average by most students. Most had an interest in pursuing psychiatry as a profession and would receive ECT if judged clinically appropriate. Most students had positive attitudes toward ECT; the vast majority thought it was a relevant form of treatment and did not think that ECT was used to control violent or used by government to torture opponents. Although an overwhelming majority did not think ECT was outmoded or causes permanent brain damage, answers about pain associated with ECT and about the dangers associated with the procedure seem to be more evenly split. A minority thought that ECT was used only in the poor and should not be given to the elderly or children. A substantial majority thought that ECT was the treatment of last resort. Respondents who were likely to choose psychiatry as a profession agreed that ECT causes pain, but disagreed that it was used by governments to torture political opponents or that it causes permanent brain damage. Students with minimal knowledge of ECT showed more negative attitudes toward the myth that ECT is misused and should be a treatment of last resort. CONCLUSION: The similarity of the attitudes of students exposed to unmodified ECT with attitudes of students exposed to modified ECT suggests that modification has made little impact on the attitudes of health professionals. The importance of lectures, patient follow-up while on clinical rotations has significant contributions in shaping attitudes and should be harnessed during training.