Psychological and physical effects of pain on cancer patients in Ibadan, Nigeria.

OBJECTIVE: To determine the prevalence of pain and its psychological and physical effects on cancer patients. METHOD: We interviewed 210 consecutively admitted cancer patients in the University College Hospital, Ibadan between May 2006 and November, 2006 using the socio-demographic / clinical questionnaire with a section designed to measure psychological and physical symptoms. The screening modules of the depression and anxiety sections of the Structured Clinical Interview for DSM-IV diagnosis was used to screen for depression and anxiety. RESULTS: There were 63 (30%) males and 147 (70%) females. Sixty-eight (32.4%) subjects had breast cancer, 59 (28.1%) had cervical cancer, 40 (19.0%) had colon / rectal cancer while the remaining 43 (20.5%) had prostate cancer. The prevalence of pain was found to be 73.8%. Presence of pain was significantly associated with depressive and anxiety symptoms, suicidal ideation, poor sleep, impaired concentration, lack of opportunity for leisure, dissatisfaction with health, poor overall quality of life, poor ability to get around and the need for extreme amount of medical treatment to function in the daily life. CONCLUSION: Pain is common among cancer patients and is associated with significant psychological and physical impairment. Therefore pain should be adequately assessed and managed.

Psychoactive substance abuse among inmates of a Nigerian prison population.

The objectives of the study were: (1) to assess the prevalence rate of psychoactive substance use and dependence among inmates of a Nigerian prison population within the past month; (2) to highlight how aware these prisoners were, of the various drugs of abuse; (3) to compare the findings with those of reports from abroad, and general Nigerian population samples. In mid-1995, 395 subjects (97.5% males, mean age 30.5 years) were interviewed, with a questionnaire that contained DSM-III-R criteria for dependence. About two-thirds were those on remand or awaiting trial, and the majority (70%) were accused of theft and armed robbery. Compared with Nigerian general population samples, the cohort had much higher prevalence rates of awareness and life-time use of psychoactive substances. Cannabis was the only drug regularly abused in the past month, by 26 (6.6%) subjects (all males); out of whom 11 (42.3%) satisfied DSM-III-R criteria for dependence. Use of intravenous drugs was not evident. This pattern differed markedly from the situation in industrialised countries. Cannabis abuse was significantly associated with those in prison for less than six months and on a charge of theft/armed robbery.

The social condition of a cohort of peasant farmers in rural community in southwest Nigeria.

This study focused on the psychosocial condition of a cohort of rural farmers, highlighting the social condition of their children, their life style, life events in the past year, the extent of their involvement in farming, the sufficiency of material sustenance from their products, their unmet needs and social aspirations, difficulties encountered in farm work, satisfaction with farming, and psychological distress. In 1992, 186 farmers were interviewed during health education visits at farm villages in Idere town, Oyo State. There were 161 (87%) males and 25 (13%) females mean age 49.9 (sd 11.7) years: who were illiterate, mainly polygamous, with 4-6 children per household. Only two families had a child each in institutions of higher learning. The general picture that emerged was that of a peasant, hardworking (six-day per week) farmer who relaxes with a game of cards in the evenings. His greatest problem is that of transportation and hiring extra hands for work. He is impressed by the yield from his farm. Compared with urban junior civil servants, the farmers had significantly lesser life events and GHQ-12 (psychological symptoms) scores. They had unmet social needs and were not satisfied with their condition of living. Meeting some of the basic needs of these farmers will boost their morale, enhance yield, and lower prices of food for the general population.

Pathways to psychiatric care in Ibadan, Nigeria.

Pathways patients take to psychiatric care will reflect the nature of the services available and the popular beliefs about mental illness. Studying the pathways may help in the identification of sources of delay in the receipt of care and suggest possible improvements. By studying the pathways of 159 patients to a tertiary psychiatric service in Nigeria, we show that traditional and religious healers are consulted at some stage by many patients with mental illness. Such healers are the first carers to a large proportion of the patients. These patients are not different from those who consult orthodox medical practitioners either in demographic features, presenting complaints, or nearness to service. Patients who consult traditional healers first tended to arrive at a tertiary psychiatric service much later than those who consult other carers. Our observations suggest that attempts to incorporate traditional medical care into the health care system must seek to improve their referral skill.

Somatization symptoms among patients using primary health care facilities in a rural community in Nigeria.

OBJECTIVE: The somatic presentation of psychic distress among Africans is different from that in the West, and the prevalence of somatization symptoms suggests that they could be usefully incorporated in screening instruments. This report examines the prevalence of somatization symptoms among users of health care facilities in a rural community in southwestern Nigeria. It also examines the correlation between the presence of these symptoms and scores on instruments that assess psychiatric morbidity. METHOD: Over a 5-month period in 1991, 865 adults using five primary health care facilities or seeking help from voluntary village health assistants were assessed with the 28-item General Health Questionnaire and two World Health Organization instruments, the Self-Reporting Questionnaire and the Brief Disability Questionnaire. The somatization symptoms investigated included feelings of heat, peppery and crawling sensations, and numbness. RESULTS: About 20% of the subjects admitted experiencing at least one somatization symptom, while 8.2% fulfilled operational criteria for probable psychiatric "caseness" on the basis of somatization alone. The rate of caseness according to the General Health Questionnaire was 6.4%. The presence of any of the somatization symptoms was significantly correlated with scores on the other test instruments. There were no sex differences in the pattern of somatization. CONCLUSIONS: These symptoms are reliable indexes of psychic distress. In this culture, the sensitivity of standard screening instruments fashioned in the West can be improved by using these symptoms to replace the somatization symptoms contained in those instruments.

Admissions for drug and alcohol-related problems in Nigerian psychiatric care facilities in one year.

In an attempt to highlight the characteristics of patients admitted for drug-related problems in Nigerian psychiatric care facilities in 1 year a detailed retrospective analysis of the case records of all patients admitted to the 13 centres in northern Nigeria and 15 in the South in 1989 was carried out. In 1989, 10,396 admissions were made in these centres (4436 in the North and 5960 in the South). Drug-related admissions accounted for 8.3%, consisting of 10.3% (of 4436) in the North and 6.8% (5960) in the South. Commonly, the patients were multiple drug abusers (especially cannabis/alcohol or heroin/cocaine). In the North the relative frequency at which abuse of drugs was recorded was 77% for cannabis; 19.9% for alcohol; 2.4% for heroin; 1.1% for cocaine; 0.26% for pethidine; 3.5% for amphetamine; and 8.7% for a motley of ill-defined psychostimulants. In the southern centres, the figures were 60.6% for cannabis; 15.6% for alcohol; 40.3% for heroin; and 23.7% for cocaine. Most patients were young males from a low socio-economic background. Whereas patients using cannabis/alcohol were likely to exhibit schizophreniform symptoms, those with heroin/cocaine were most likely brought to hospital by relations because of the social effects of their maladjusted behaviour.

Psychiatric emergency services in a Canadian city: I. Prevalence and patterns of use.

The patterns of use of psychiatric emergency services in Saskatoon, Saskatchewan were studied. A total of 576 patients who had received psychiatric emergency care from any of the four major health care facilities in Saskatoon during a three month period were included in the study. Visits for psychiatric emergency services during the study period represented 2.32% of the total number of visits to emergency facilities. Most patients with psychiatric emergencies went to hospitals with psychiatric units. The characteristics of patients served by the four facilities and those who visited the psychiatric emergency services on more than one occasion during the study period are reported. The implications of these findings for health care planning are discussed.

Psychiatric emergency services in a Canadian city: II. Clinical characteristics and patients' disposition.

The clinical characteristics of patients seen at the psychiatric emergency facilities in a Canadian city and the determinants of decisions regarding their treatment were investigated. A total of 544 patients who sought psychiatric emergency services from the three hospitals in Saskatoon during a three month period were studied. Cognitive disturbance, past psychiatric history, previous psychiatric hospitalization and diagnoses of substance use disorders, affective disorders, anxiety disorders and schizophrenic disorders were associated with psychiatric emergencies. Psychiatric diagnoses and availability of social support were significantly associated with disposition. The implications of these findings for psychiatric emergency services are discussed.

The use of psychotropic drugs in general medical practice

The term psychotropic drugs refers to those drugs which have their primary effect on mental functioning. In other words; drugs made for other purposes; but which can have some adverse effects on mental functioning are not psychotropic drugs. The use of these drugs is of interest because they are commonly available; cheap and (especially the benzodiazepines) doctors tend to use them inappropriately when patients have personal problems

The reliability and validity of the WHO student drug-use questionnaire among Nigerian students.

The reliability and validity of the World Health Organization student drug-use survey model questionnaire was tested among 96 senior secondary school students in the Abeokuta Local Government Area of Ogun State, Nigeria. The exercise was the major theme of a pilot study of a student drug-use survey carried out in this area. The test-retest interval was 4 weeks. The questionnaire was found to be reliable when group and individual (item by item) comparisons were made. The validity scores were also comparable to those of widely accepted previous studies. It was concluded that the questionnaire is reliable and valid enough for use in this environment to allow for comparisons. It can also yield better results if slightly modified and when respondents become more familiar with questionnaire surveys.

Alcohol treatment systems in Nigeria.

In a review of the studies on alcohol use in Nigeria, evidence shows that within the last decade there has been a rapid increase in alcohol availability (production/importation) and alcohol consumption. Similarly, the literature on the subject reveals an increasing trend in alcohol-related psychosocial and physical health hazards. This observation prompted a review of the existing alcohol treatment methods in Nigeria. These treatment methods include: traditional healers' approach, syncretic churches, government hospitals including a specialised drug addiction centre and voluntary agencies. Suggestions are made on how to improve alcohol treatment systems and data collection in Nigeria.

Drinking behaviour and social change among youths in Nigeria--a study of two cities.

Earlier studies on alcohol use in Nigeria identified young and middle-aged male adults as mainly concerned. In the last decade however, there has been a noticeable trend of youths getting more and more involved in alcohol use. Some of these latter studies, apart from indicating the increasing involvement of the female sex, have also shown various pathologies associated with alcohol use in Nigeria youths. Most of these reports only looked at alcohol use in the broader context of drug and alcohol abuse in the Nigerian society. However, in the present cross-sectional study of drug use involving 2079 senior secondary school students in two major cities of Nigeria (Ibadan and Abeokuta), prevalence rates of alcohol use was 56% for Ibadan and 51.5% for Abeokuta. The male/female ratio of the users was 1.1:1 in Ibadan and 1.2:1 in Abeokuta. Males used alcohol significantly more than females in each of the two cities (P less than 0.025). Alcohol use was found more common among younger students in the lower school classes and also among those from higher and medium socioeconomic background. Among contributing factors were parental deprivation and delinquency. Alcohol users were also found to be more involved in accidents and the use of other psycho-active drugs than non-users.

Double-blind placebo substitution: withdrawal of fluphenazine decanoate in schizophrenic patients.

In a double-blind placebo substitution study, 27 chronic schizophrenic patients successfully treated for more than 2 years with fluphenazine decanoate were withdrawn from the drug. These patients showed a significantly higher relapse rate than the matched control group of 26 patients who continued to receive fluphenazine (56% versus 19%, p less than .001). This high rate of relapse is viewed as indicating the need for continued medication in most chronic schizophrenic patients.