Case-controlled field study of the ICD-11 clinical descriptions and diagnostic requirements for Bodily Distress Disorders.

AIMS: Mental disorders characterized by preoccupation with distressing bodily symptoms and associated functional impairment have been a target of major reconceptualization in the ICD-11, in which a single category of Bodily Distress Disorder (BDD) with different levels of severity replaces most of the Somatoform Disorders in ICD-10. This study compared the accuracy of clinicians' diagnosis of disorders of somatic symptoms using either the ICD-11 or ICD-10 diagnostic guidelines in an online study. METHODS: Clinically active members of the World Health Organization's Global Clinical Practice Network (N = 1065) participating in English, Spanish, or Japanese were randomly assigned to apply ICD-11 or ICD-10 diagnostic guidelines to one of nine pairs of standardized case vignettes. The accuracy of the clinicians' diagnoses as well as their ratings of the guidelines' clinical utility were assessed. RESULTS: Overall, clinicians were more accurate using ICD-11 compared to ICD-10 for every presentation of a vignette characterized primarily by bodily symptoms associated with distress and impairment. Clinicians who made a diagnosis of BDD using ICD-11 were generally correct in applying the severity specifiers for the condition. LIMITATIONS: This sample may represent some self-selection bias and thus may not generalize to all clinicians. Additionally, diagnostic decisions with live patients may lead to different results. CONCLUSIONS: The ICD-11 diagnostic guidelines for BDD represent an improvement over those for Somatoform Disorders in ICD-10 in regard to clinicians' diagnostic accuracy and perceived clinical utility.

Integrating mental health into primary care in Nigeria: report of a demonstration project using the mental health gap action programme intervention guide.

BACKGROUND: The World Mental Health Surveys conducted by the World Health Organization (WHO) have shown that huge treatment gaps for severe mental disorders exist in both developed and developing countries. This gap is greatest in low and middle income countries (LMICs). Efforts to scale up mental health services in LMICs have to contend with the paucity of mental health professionals and health facilities providing specialist services for mental, neurological and substance use (MNS) disorders. A pragmatic solution is to improve access to care through the facilities that exist closest to the community, via a task-shifting strategy. This study describes a pilot implementation program to integrate mental health services into primary health care in Nigeria. METHODS: The program was implemented over 18 months in 8 selected local government areas (LGAs) in Osun state of Nigeria, using the WHO Mental Health Gap Action Programme Intervention Guide (mhGAP-IG), which had been contextualized for the local setting. A well supervised cascade training model was utilized, with Master Trainers providing training for the Facilitators, who in turn conducted several rounds of training for front-line primary health care workers. The first set of trainings by the Facilitators was supervised and mentored by the Master Trainers and refresher trainings were provided after 9 months. RESULTS: A total of 198 primary care workers, from 68 primary care clinics, drawn from 8 LGAs with a combined population of 966,714 were trained in the detection and management of four MNS conditions: moderate to severe major depression, psychosis, epilepsy, and alcohol use disorders, using the mhGAP-IG. Following training, there was a marked improvement in the knowledge and skills of the health workers and there was also a significant increase in the numbers of persons identified and treated for MNS disorders, and in the number of referrals. Even though substantial retention of gained knowledge was observed nine months after the initial training, some level of decay had occurred supporting the need for a refresher training. CONCLUSION: It is feasible to scale up mental health services in primary care settings in Nigeria, using the mhGAP-IG and a well-supervised cascade-training model. This format of training is pragmatic, cost-effective and holds promise, especially in settings where there are few specialists.

Life-threatening haematemesis associated with clozapine: a case report and literature review.

Clozapine is regarded as a second-line and in some cases last-line antipsychotic known for its common life-threatening side effects, such as agranulocytosis, constipation and cardiomyopathies, but rarely haematemesis. We report a case of severe haemetemesis in a chronic schizophrenic patient managed with clozapine. The patient was a 46-year-old male being managed for chronic schizophrenia with treatment resistance who developed sudden severe haematemesis following commencement of clozapine for 6 weeks. The patient had 1.1 l of blood transfusion. The relevant literature is reviewed. Clozapine can be associated with a life-threatening haematemesis. Psychiatrists and other medical specialists need to be alert to the fatality of clozapine-induced haematemesis in the treatment of psychiatric disorders.

Quality of life of people with cancers in Ibadan, Nigeria.

BACKGROUND: Cancer is associated with psychological and physical morbidities. The presence of such comorbidities has been reported to worsen the overall outcome and quality of life (QOL) of affected people. AIMS: To assess the QOL and its determinants among participants with cancer. METHODS: We administered the short version of the World Health Organization Quality of Life-BREF instrument, socio-demographic/clinical data collection sheet and structured clinical interview for Diagnostic and Statistical Manual Fourth Edition (DSM-IV) diagnosis to 210 consecutively admitted participants with cancer at the University College Hospital Ibadan to determine the diagnosis of major depression. RESULTS: The sample consisted of 63 men and 147 women; 68 participants had cancer of the breast, while 59, 40 and 43 had cancers of the cervix, colon/rectum and prostate, respectively. The QOL of most of the participants was fair. Approximately 30% of the participants were depressed, 75.7% had pains while 49.5% of them had advanced cancer. Male sex, older age, depression, pains and advanced stage cancers were significantly associated with poor QOL. CONCLUSION: The QOL of participants is negatively affected by male sex, older age, depression, advanced stage of cancer and pains.

Body dysmorphic disorder in a Nigerian boy presenting as depression: a case report and literature review.

BACKGROUND: Body dysmorphic disorder (BDD) has been described widely in the Western world as relatively common yet under-recognized, but rarely in Africans and none in Nigeria to the best of our knowledge. AIM: To report a case of BDD in a Nigerian boy presenting with depression to the psychiatric unit of a teaching hospital. METHOD: A 17-year-old secondary school boy with BDD presenting with depression is reported and relevant literature is reviewed. CONCLUSION: BDD is rare and hardly reported in this environment and high index of suspicion is necessary in patient presenting with medically unexplained physical complaints and depression.

The prevalence and profile of non-affective psychosis in the Nigerian Survey of Mental Health and Wellbeing.

This study aimed to estimate the prevalence and correlates of non-affective psychosis among adult Nigerians. It was part of the Nigerian Survey of Mental Health and Wellbeing and was conducted in 8 out of the 22 states in Nigeria, representing about 22% of the national population. Face-to-face interviews with adults aged 18 years and over were administered using the WHO Composite International Diagnostic Interview, version 3 (CIDI.3). Clinical reappraisal was conducted by clinicians on a subsample of respondents. The CIDI.3 was found to have acceptable agreement with clinician-administered assessments, with kappa values ranging between 0.52 to 0.72, respectively, for narrowly-defined and broad categories of non-affective psychosis. The lifetime prevalence of non-affective psychosis was 2.1%, with visual hallucinations being the most commonly reported symptom and delusions of reference the least. Non-affective psy-chosis was significantly more common among urban dwellers. Persons with non-affective psychosis were at elevated risk to report both lifetime and 12-month comorbid DSM-IV disorders as well as to experience impairment in basic and instrumental role functioning. Only a minority had received any treatment.