Sociodemographic and Clinical Variables of Depression among Patients with Epilepsy in a Neuropsychiatric Hospital in Nigeria.

BACKGROUND: Depression is a major contributor to the global burden of disease. Its occurrence in patients living with epilepsy is not just common but also a serious comorbidity. Patients tend to suffer if the depressive disorder is undetected and thus untreated. The aim of this study is to estimate the prevalence of depressive disorder in patients with epilepsy. Also, the sociodemographic and clinical factors that are associated with the development of depression in people living with epilepsy were examined. Materials and Method. This was a descriptive cross-sectional study of participants living with epilepsy and receiving care at the Federal Neuropsychiatric Hospital, Sokoto, Nigeria. Participants were recruited consecutively as they come for follow-up care. A sociodemographic/clinical questionnaire and General Health Questionnaire version 28 (GHQ-28) were first administered to participants followed by the Composite International Diagnostic Interview (CIDI). The descriptive statistics were generated and analyzed. Logistic regression was also done to determine the predictors of depression in the study participants. All test of probability was set at p < 0.05. RESULTS: A total of 400 participants with epilepsy were examined with GHQ-28 and CIDI. Out of the GHQ-28 examined individuals, 71 people (17.8%) met criteria for caseness while 35 participants (8.8%) were depressed when assessed with CIDI. The predictors of depressive illness in participants living with epilepsy were GHQ caseness (p < 0.05. p < 0.05. p < 0.05. CONCLUSION: Depression is common in people with epilepsy. Physicians should actively assess individuals with epilepsy for symptoms of depression. Special attention should be paid to patients with a family history of epilepsy and those from minority ethnic groups.

Bridging the childhood epilepsy treatment gap in northern Nigeria (BRIDGE): Rationale and design of pre-clinical trial studies.

Epilepsy is the most common serious childhood neurological disorder. In the low- and middle-income countries (LMICs) of Africa, children with epilepsy suffer increased morbidity and mortality compared to their counterparts in high-income countries, and the majority do not receive treatment - the childhood epilepsy treatment gap. Reports of the childhood epilepsy treatment gap in Africa are likely underestimates; most surveys do not include several common childhood seizure types, including most types of non-convulsive epilepsy. Efforts to scale up childhood epilepsy care services in the LMICs of Africa must contend with a shortage of physicians and diagnostic technology [e.g., electroencephalograms (EEGs)]. One pragmatic solution is to integrate epilepsy care into primary care by task-shifting to community health extension workers. The aims of this project (BRIDGE) are to: 1) train, develop, and pilot task-shifted epilepsy care teams; 2) develop and pilot innovative childhood epilepsy screening and diagnostic paradigms adapted to the local Hausa language/culture in Kano, northern Nigeria; and, 3) quantify and map the childhood epilepsy treatment gap, using geographic information systems (GIS), to target limited resources to areas of greatest need. Task-shifted teams will diagnose and manage childhood epilepsy using an innovative epilepsy screening tools and diagnostic and management paradigms in environments with limited EEG access. If validated and demonstrated efficacious in clinical trials, this project can be taken to scale across broader areas of west Africa's LMICs that share language and culture. BRIDGE has the potential to enhance access to basic childhood epilepsy care and establish the foundation for childhood epilepsy clinical trials in west Africa.

Psychosocial correlates of perceived stress among undergraduate medical students in Nigeria.

OBJECTIVES: To assess the prevalence and factors associated with perceived stress among medical students. METHODS: A cross-sectional study of students (n=623) selected across eight medical schools in Nigeria. A structured questionnaire obtained socio-demographic characteristics, alcohol use (Alcohol Use Disorders Identification Test), other psychoactive drug use (Drug Abuse Screening Test), anxiety/depression symptoms (Hospital Anxiety Depression Scale) and stress (Perceived Medical School Stress Scale). We performed bivariate analysis using the chi-squared test, t-test and one-way ANOVA, with multiple regression analysis for multivariate testing in analysing the data. RESULTS: Most students reported experiencing medical school stress. Female participants were more likely to perceive medical school as competitive (t(621)=1.17, p=0.003), less likely to see medical school as a threat (t(621)=-2.70, p=0.01) or worry about finances (t(621)=-4.80, p=0.001). Nearly a quarter; 21.3% (n=133) and 28.6% (n=178) reported depression and anxiety symptoms respectively. Approximately 4.2% (n=26) were dependent on alcohol, while 14.1% (n=88) had 'low-risk use' for other psychoactive substances. In the multiple regression model, lack of finance (B=2.881, p=0.001), weak adherence to religious faith (B=2.376, p=0.001), anxiety symptoms (B=-2.231, p=0.002), problematic alcohol use (B=5.196, p=0.001) and choice of study influenced by parents (B=-3.105, p=0.001) were predictors of greater perceived stress. CONCLUSIONS: Medical students in Nigeria report high levels of stress. Incorporating stress reduction strategies in the medical curriculum, and the input of students in providing feedback regarding the methods and styles of undergraduate medical education is required.

Prevalence and correlates of ADHD in individuals with substance use disorder in Nigeria.

Substance use disorder (SUD) is associated with ADHD. ADHD increases the severity of SUD and has negative influence on the prognosis of the disorder. The aim of the study was to determine the prevalence and correlates of ADHD in individuals with SUD. During 2013-2015, a cross-sectional descriptive study of 233 drug treatment-seeking individuals was assessed. Diagnosis of ADHD was done using DSM-IV criteria with the Diagnostic Interview for ADHD in Adults (DIVA 2.0), while Semi-structured Assessment for Drug Dependence and Alcoholism (SSADDA 6.1) and Adult ADHD Quality of Life (AAQoL) were used for diagnosis of substance use disorder and assessment of QoL, respectively. Multivariable logistic regression was used to determine factors that were associated with ADHD. The prevalence of ADHD in SUD patients was 21.5%, with the combined subtype being the most prevalent. SUD patient with ADHD had more history of severe dependence on cigarette, depression, suicidal ideation, aggression, dependence on benzodiazepine and heroin, number of relapses, poor QoL and number of hospitalization. After logistic regression, only the number of relapses (p = 0.004), history of aggression (<0.001) and poor QoL differentiated between SUD patients with ADHD from those with no diagnosis of ADHD. The prevalence of ADHD in SUD individuals is high and may be associated with a more severe phenotypic expression of SUD.