Factors associated with anxiety disorders among HIV-positive attendees of an HIV clinic in Lagos, Nigeria.

Anxiety disorders (ADs) occurring in people living with HIV/AIDS (PLWHA) are often poorly identified in spite of the untold consequences that may result if not diagnosed and treated promptly. This study aimed to describe factors associated with ADs among PLWHA. Three hundred participants were administered sociodemographic/clinical profile questionnaires, and diagnoses of ADs were made using Schedule for Clinical Assessment in Neuropsychiatry (SCAN) based on International Classification of Diseases, 10th edition (ICD-10) criteria. In this study, 65 (21.7%) participants were diagnosed with ADs. A lack of family support, unemployment, younger mean age and being unmarried (P < 0.05) were factors associated with ADs in PLWHA; however, lack of family support (odds ratio [OR] = 0.458, 95% confidence interval [CI] = 0.254-0.827, P = 0.010), being unmarried (OR = 1.930, 95% CI = 1.046-3.560, P = 0.035) and unemployment (OR = 0.495, 95% CI = 0.264-0.926, P = 0.028) were the only factors that remained significant following logistic regression analysis. Prompt identification with active management of ADs and their associated factors among PLWHA are advocated. Further research on the risk factors for ADs is also warranted.

Burden and psychological effects: caregiver experiences in a psychiatric outpatient unit in Lagos, Nigeria.

OBJECTIVE: Worldwide, research into experiences of care givers are gradually increasing and their central role in community care is being acknowledged. Caregivers experience a multidimensional range of problems, often associated with their caregiving role. It becomes important to identify these areas of burden and provide necessary support. The study sought to determine the prevalence of psychological distress and experience of burden of care among the caregivers of mentally ill patients. METHOD: A cross sectional descriptive study. Eligible consecutive subjects were recruited to the study over a 6 month period. Fifty three caregiver relatives of patients diagnosed with a psychiatric illness were assessed using the General Health questionnaire version 12, an Adapted Burden of Care (BOC) Schedule and a Sociodemographic questionnaire. RESULTS: The caregivers were 51% male and 49% female. Most were above 35years in age (66.1%). They were either parents (38.8%), siblings (18.4%), uncle/aunt (14.3%), first cousin (12.2%) or other extended relatives (16.3%). Almost half of the relatives had psychological distress (43.8%) and most of which (63%) had more burden. The mean score on the BOC among the caregivers was 41 (±18.68SD), with scores ranging from 0.00-89.00, and 45.3% of relatives experiencing more than average burden of care. CONCLUSION: There is a significant level of burden and psychological distress experienced by caregivers in this study location. It is recommended that effectively planned interventions are targeted at alleviating this burden and at improving the ability of caregivers to cope, within the Nigerian mental health service delivery system.

Psychiatric morbidity in hypertensives attending a cardiology outpatient clinic in West Africa.

OBJECTIVES: To determine kinds of psychiatric morbidity among a sample of stable hypertensive outpatients in a teaching hospital. MATERIALS AND METHODS: A cross-sectional study of 260 enrolled outpatients. Psychiatric morbidity was assessed using a 2-stage evaluation method with the General Health Questionnaire Version 12 (GHQ-12) and Structured Clinical Interview for DSM-IV (SCID) to assess for psychiatric diagnosis. RESULTS: 28 (10.8%) of the 260 patients endorsed some psychological distress, with a mean GHQ-12 score of ≥ 2. At the second stage, 16.1% (N=13 of 81) interviewed had one or more psychiatric disorder on the SCID. The commonest psychiatric diagnosis made were mood disorders, with current major depressive disorder occurring at a rate of 6.2%. Other disorders found were past major depressive episode (2.5%), organic mood syndrome (3.7%), and somatoform disorder (3.7%). CONCLUSION: The relationship between hypertension and mood disorders should inform a higher index of suspicion among physicians and general practitioners in order to give patients appropriate treatments or referrals where necessary. It is recommended that collaboration with mental health service providers be encouraged.

Sexual dysfunction among subjects with hypertension in a Nigerian teaching hospital.

BACKGROUND: In Africa, few studies highlight associations between sexual dysfunction and other medical conditions. It is important to know the experiences of these patients, how it affects their subsequent compliance with medications prescribed and also identify relevant factors that may be useful in planning for their care hence this study. OBJECTIVES: The study is to examine the patterns of sexual dysfunction among stable hypertensive out patients. METHODS: In a cross sectional descriptive study, 186 patients were enrolled. The Arizona Sexual Experiences scale (ASEX) and the General Health Questionnaire Version 12 (GHQ-12) were used. RESULTS: One hundred and eleven 56.7% had sexual dysfunctions, of these (33.3%) males and (66.6%) females. The mean sexual dysfunction score (on ASEX) for the hypertensive group was 14.51 (SD +/- 4.32), this was significantly higher than the figure obtained for the control group. Overall, female hypertensives experienced sexual dysfunction more than males. Males had mostly libido problems and most women had orgasmic problems. CONCLUSION: The study showed that sexual dysfunction is highly prevalent among stable patients with hypertension. Erectile dysfunction and orgasmic problems were the most common sexual dysfunctions experienced among male and female hypertensives respectively. It is recommended that monotherapy be encouraged and interventions planned for patients at higher risk.

A rapid situation assessment of sexual risk behaviour of alcohol users in Lagos, Nigeria.

BACKGROUND: National sentinel surveys of HIV/AIDS among pregnant women in Nigeria have shown steady rise in prevalence from 1991 (1.8%) to 2001 (5.8%), which may reflect the pattern in the adult population in the country. The roles of known potential risk factors of the HIV/AIDS scourge in Nigeria deserve elucidation. This work aims to study the relationship between alcohol use and sexual risk behaviour. PATIENTS AND METHODS: Rapid assessment technique involving qualitative and quantitative methods was employed. A multi-site design which made it possible to compare samples recruited in high and low density settings was used. RESULTS: One hundred and nine of the alcohol users were recruited in the Low Density Area (LDA), while 130 were recruited in the High Density Area (HDA). In the HDA, 49 (53%) of the beer users used alcohol before sex either most or all of the time 21 (22.6%), or occasionally 28 (29.1%). Unlike the beer users less than half, 8 (42.1%), of Palm wine drinkers drank alcohol before sex. Beer users in the HDA used beer after sex with casual partners significantly more than the Palm wine drinkers (P = 0.036). Alcohol users in the LDA were more inclined to casual sex and they (54, 56.8%) believed that it had some or major role in their desire as well as performance of sex compared with users in the HDA (P = 0.005). CONCLUSION: Irrespective of their socioeconomic class, ethnicity, religion and educational attainment alcohol users in the country indulge in high risk sexual behaviours that predispose them to infection with HIV and other sexually transmitted diseases.

Prospective case-control study of interictal depression and suicidal ideation in Nigerians with epilepsy.

BACKGROUND: Co-morbid depression and suicidal ideation in people with epilepsy (PWE) in developing countries are under-recognised, and so may be consequently undertreated. This study was designed to determine the frequency and clinical correlates of interictal depression and suicidal ideation in PWE. PATIENTS AND METHODS: Using a prospective design, we evaluated 96 PWE and two groups of controls (103 age- and sex-matched population controls and 13 persons with DSM - IV diagnosis of major depression (controls with depression - CWD) without epilepsy. Depression was assessed using Zung Self-rating depression scale (scores =40 indicating depression). RESULTS: Depression was more prevalent in PWE (25/96 i.e. 26.0%) than normal controls (10/103 i.e. 9.7%) (P = 0.004). Suicidal ideation scores were similar for depressed PWE and depressed normal controls (1.7 +/-1.0 v. 1.5 +/- 1.0; P>0.05), but significantly higher in CWD (2.61.3; P=0.04). Among PWE, mean duration of epilepsy (years) was the only variable significantly related to depression (i.e. 12.7 8.8 in depressed PWE v. 8.3 6.6 in non-depressed PWE (P=0.01). CONCLUSION: Depressive symptomatology is a frequent co-morbidity in our tertiary care population of PWE. However, suicidal ideation is less common in contrast to persons with major depression.

Relapse precipitants in Nigerian drug abusers.

OBJECTIVE: To determine the precipitants of relapse among patients admitted to a Psychiatric Hospital in Nigeria for substance abuse. PATIENTS AND METHODS: A cross-sectional survey of consecutive admitted drug abuse patients was carried out at the Psychiatric Hospital, Yaba, Lagos, using Marlatt's categories to measure high risk situations for relapse. RESULTS: Eighty-two subjects who were mostly male (87.9%), never married (53.7%), privately employed (58.5%), professionals (32%) with mean age 31.2 (+/- 6.56) years were evaluated. Most had used two or three different drugs. Coping with negative emotional states or enhancement of positive emotions were the main reasons for relapse determinants given by the subjects. Substance abuse management in Nigeria should embrace inquiries into these emotional states during both the admission and the post-discharge periods. CONCLUSION: Routine use of Marlatt' relapse precipitant categories may be helpful in designing intervention strategies to sustain abstinence in Nigerian drug abuser.

Emotional reactions of relatives to schizophrenic patients in Lagos, Nigeria.

Unlike what obtains in the developed countries, not much is known about the expressed emotions (EE) of the family to mental illness in developing nations, including Nigeria. Therefore, the objective of this study is to investigate the EE among family members to schizophrenics in Lagos, Nigeria. The Camberwell Family Interview was conducted with Nigerian family members of 19 schizophrenics whose symptoms were further ascertained using the Present State Examination. Sixty-three percent of the family sample showed high expressed emotions (HEE). The proportion of HEE families increased progressively with the number of previous hospitalization (r = 1, p = 0.000). The mean ratings of Critical Comment, Warmth and Positive Remarks were, respectively, 6.1 (+/- 3.8), 2.6 (+/- 0.9) and 2.2 (+/- 0.9) and 2.2 (+/- 1.3). The proportions of relatives showing Emotional Over-Involvement and Hostility were, respectively, 26.3% and 31.6%. The correlation between Warmth and Critical Comment was -0.39. The findings were compared with those of a key cross-cultural study of EE and the implications highlighted.

Attitude to Psychiatric Referral: A study of Primary Care Physicians.

To evaluate the attitudes of primary care physicians to psychiatric referral using a structured questionnaire. Cross-sectional survey of the attitude of 126 (105m, 2lf) consenting doctors working in randomly selected health institutions offering primary care services in Lagos using a structured questionnaire was conducted. Non-recognition of the extent of psychiatric morbidity among patients, stigma, effect of psychiatric referral on self-esteem of patients, not being sure of how rewarding such referral could be, and difficulty in securing psychiatric services seem to affect the referral decisions of most physicians. Equal proportions of physicians (44.4%) agree or disagree with the statement "doctors need to be very careful in referring patients to psychiatrists". Addressing doctors attitudinal dispositions may be a useful step in the design of intervention measures aimed at improving the outcome of psychiatric morbidity presenting in primary care.

Correlates of psychiatric morbidity and case identification in Ibadan, Nigeria.

OBJECTIVE: To determine the correlates of psychiatric morbidity and the factors that may influence the recognition of psychiatric cases in primary care. DESIGN: In the cross-sectional survey, the sample was selected by systematic sampling technique. Each subject was interviewed in sequence by a research nurse, a psychiatrist and a general practitioner (GP). SETTING: The primary care facility at the University College Hospital, Ibadan. SUBJECTS: Eight GPs and 414 (44% males, 56% females) patients were selected. INTERVENTION: A socio-demographic questionnaire, the present state examination (PSE), and clinical interview were administered to the subjects. Eysench personality questionnaire (EPQ) was completed by GPs. The research nurses scored each GP on an enthusiasm scale. MAIN OUTCOME MEASURES: The diagnosis by psychiatrist and GPs recorded on doctors' information sheet: the PSE scores of subjects, the EPQ scores of GPs and their observed enthusiasm ratings among others were the main measures. RESULTS: The psychiatric morbidity rate was 43.4% in the centre. GPs accuracy was 0.7 and Kappa score was 0.44. EPQ Neuroticism and Psychoticism scores correlated negatively with GPs ability to recognise cases, whereas enthusiasm correlated positively. GPs had difficulty in recognising minor psychiatric disorders accounting for 94.4% of morbidity in the primary care. Morbidity was significantly associated with female sex, age 45-54 years, self-employment, low level of education and being currently married. Females and the self-employed were over-represented among GPs' cases. CONCLUSION: More data from similar studies across cultures would provide useful insight into strategies that could bring about early recognition and treatment of minor psychiatric disorders in the primary health care.

Health problems and socio-demographic findings in elderly Nigerians.

Nine hundred and fifty-one persons aged 60 years and over, living at home in four locations in southwestern Nigeria were studied. The cohort representing urban and rural dwellers, constituted 7.8% of the total population. Female residents had higher widowhood rates and lower levels of educational attainment than males. Multigenerational living arrangements were popular. Ninety-five percent of the cohort had no physical impairment on assessment of activities of daily life. Only 6.4% were on a regular pension (males more than females, P < 0.001) and income for 75% was less than the estimated poverty line (females more than males P < 0.001). Estimated crude death rate was also higher than the national average. The effects of these socio-demographic factors on health are diverse. Comparisons were made with similar studies in other cultures.

Attitude to aging among different groups in Nigeria.

Attitude to aging and the aged was surveyed in three groups of Nigerians, 1) caregivers living at home with the elderly, 2) various categories of hospital workers, and 3) the general public. Based on scores of an eleven-item questionnaire the best attitude was in caregivers, and the poorest in hospital workers. Years of education had an overall negative effect on attitudinal measurement. An inference from this study is that the elderly are still valued, but caregivers could be under some stress and would appreciate assistance. It is important for developing countries like Nigeria to begin to think seriously of what types of public assistance the elderly and their families would need.

Psychiatric disorders in Nigerian nursing home residents.

BACKGROUND: The prevalence of psychiatric disorders in nursing homes, which has not been studied before in Nigeria, is the subject of this cross-sectional study. METHOD: Psychiatric disorders were assessed in 23 of the 29 residents of the two nursing homes in Lagos and diagnoses based on DSM-III-R criteria (APA, 1987) and AGECAT (Copeland et al., 1986) were made independently. RESULTS: The commonest diagnoses were dementia in 11 out of 23 residents and depression in four residents. Overall prevalence rate of psychiatric disorders was 74%. CONCLUSION: The present prevalence rate of psychiatric disorders is similar to those reported in similar institutions in the industrialized societies. This has implications for the care of the elderly in a non-industrialized society.

In-patient psychiatric referrals in a teaching hospital: a case controlled report.

The 77 (47 females, 30 males) in-patient referrals to the Psychiatric Department of the University College Hospital, Ibadan, Nigeria, over a 1-year period, were compared with a control sample of 75 (45 females, 30 males) unreferred patients. The low referral rate of 0.8%, after excluding deliberate self-harm (relatively infrequent in Nigeria), was comparable to reports in Western literature. Treatable minor psychiatric morbidity, mainly anxiety and depressive disorders, occurred in 41.3% of the controls. Sixty-eight percent of those referred had definite mental disorders, most commonly psychoses (50.7%), especially delirium (29.9%). Infectious disorders, notably Salmonella typhi infection, were the most predominant physical etiological factors. The results are discussed and the implications highlighted.

Case recognition and interview utterances: effect of GHQ feedback.

Eighty-four audiotaped clinical interviews of seven general practitioners (GPs) with high scoring patients on the General Health Questionnaire (GHQ-28) were analysed at baseline and compared with a similar number at feedback during which doctors were presented with the GHQ-28 scores of their patients. At feedback, there was a significant reduction in the use of physical utterances (deviance 35.150, df 1, P < 0.001), an increase in the use of directive questions, a reduction in closed questions, and more advice and more psychological utterances were made. The five doctors who improved had a mean rise in identification index (ID) of 0.25 +/- 0.12. Such benefit was more apparent among doctors with lower IDs at baseline. There was no significant correlation in the magnitude of rise in ID and change in psychological utterances. Most doctors were not aware of the impact of the GHQ on their interview technique and case recognition ability.

Integrating psychiatry into primary care: an experimental model.

General practitioners (GPs) working in a busy primary care setting attached to a teaching hospital were exposed to patient-centred feedback teaching in which symptoms elicited by the general practitioner (GP) and an interview schedule in the index patient were used as a focus for instruction. Each of the seven GPs who completed the study had an average of 52 validated exposures spread over 3 months. Three of them became much better at detecting psychiatric disorders, two showed no noticeable improvement and two showed some deterioration. The personality and disposition of the GPs, rather than their years of experience, determined their response to the training programme. The implications of the findings is highlighted.

The pattern of medical illness in a community of elderly Nigerians.

A community survey of Nigerians aged 60 years and above was carried out. Nine hundred and fifty one subjects were interviewed by trained nurses. Seven hundred and fifty nine (79pc) had physical examination carried out on them. It was found that musculoskeletal, dental, ocular and cardiovascular disorders were the commonest problems in this group of people. Poor dental hygiene, anaemia and goitre were problems significantly associated with living in rural areas, while hypertension was commoner in urban areas, but this did not reach significance at five pc level. The results show that about one out of five elderly Nigerians suffer from chronic disabling conditions such as osteoarthritis and 2.4pc of them were diabetic. The impact of these chronic diseases on the health of the elderly Nigerians is discussed and suggestions made for health promotion interventions and treatment programmes.

The pattern of somatization symptoms at the Ibadan Teaching Hospital Psychiatric Clinic.

A six-month cross-sectional study of consecutive new referrals at the psychiatric clinic of a large general hospital was carried out, aimed at highlighting the pattern of somatization symptoms. Two hundred and six new patients attended the clinic in the period of study. Of this number, 74 (35.9%) presented predominantly with these symptoms. Significantly more males than females had these symptoms. Vague, poorly localised aches and pains were the commonest symptoms complained of by the somatizers. Most of them had each at least three of these symptoms and the symptoms had been commonly present for at least six months before presentation in hospital. Comparatively, few of those with predominant somatic symptoms also spontaneously reported vegetative and psychological symptoms of psychic distress, especially insomnia, palpitations and free-floating anxiety. Although somatization symptoms cut across socio-demographic and clinical diagnostic categories and were experienced in all parts of the body, these symptoms were much commoner among those aged 21 to 40 years, of lower socio-economic status and with a diagnosis of neurosis. Anxiety and depressive neurosis most commonly presented with widespread somatic symptoms. These findings are compared with the results of previous studies and the implications were discussed.

Psychiatric emergencies in a Nigerian general hospital.

Subjects attending the emergency services of the Ibadan teaching hospital for psychological problems in a 14-month period were studied, with a view to highlighting the pattern of psychiatric emergencies in a large general hospital. Three hundred and twenty-six subjects made 335 emergency visits. The 181 new cases seen at the Casualty constituted 2% of the newly registered patients attending that unit of the hospital. About 7% of the subjects attended for deliberate self-harm, while 45.7% and 20.9% of the visits were for functional psychotic and non-psychotic illnesses respectively. Cases with acute undifferentiated psychosis of suspected organic aetiology constituted 13.7% of the visits. About 5% of the visits were for substance abuse problems, 6.3% for extrapyramidal reaction to anti-psychotic drugs, while 5.7% were cases of other forms of organic psychotic conditions. In only 19.5% of the visits requiring admission could the subjects be admitted because of scarcity of in-patient beds.