Refractive errors in children with autism in a developing country.

BACKGROUND: In a resource-limited country visual problems of mentally challenged individuals are often neglected. AIM: The present study aims to study refractive errors in children diagnosed with autism in a developing country. MATERIALS AND METHODS: Ophthalmic examination was carried out on children diagnosed with autism attending a school for the mentally challenged in Enugu, Nigeria between December 2009 and May 2010. Visual acuity was assessed using Lea symbols. Anterior and posterior segments were examined. Cycloplegic refraction was performed. Data was entered on the protocol prepared for the study and analyzed using Statistical Package for the Social Sciences version 17 (Chicago IL, USA). RESULTS: A total of 21 children with autism were enrolled in the school; 18 of whom were examined giving coverage of 85.7%. The age range was 5-15 years, with a mean of 10.28 years (standard deviation ± 3.20). There were 13 boys and 5 girls. One child had bilateral temporal pallor of the disc and one had bilateral maculopathy with diffuse chorioretinal atrophy. Refraction revealed 4 children (22.2%) had astigmatism and 2 children (11.1%) had hypermetropia. CONCLUSION: Significant refractive error mainly astigmatism was noted in the children with autism. Identifying refractive errors in these children early and providing appropriate corrective lenses may help optimize their visual functioning and impact their activities of daily life in a positive way.

Functional status and its associated factors in Nigerian adolescents with bipolar disorder.

OBJECTIVE: This study assessed general functioning in Nigerian adolescents with bipolar disorder. It also determined the factors associated with functioning in these adolescents. METHOD: Adolescents with bipolar disorder diagnosed over one year or more attending the outpatient unit of Federal Neuro-Psychiatric Hospital, Enugu (FNHE), Nigeria for follow-up visits were interviewed with a socio-demographic questionnaire and their functioning was rated with the Children Global Assessment Scale (C-GAS) based on the clinical information obtained from the children and their care givers during a one year follow-up period. Further information such as history of sexual risk behavior, pre-morbid peer relationship, relationship with siblings, level of religion activities among others were also obtained through clinical interview. RESULTS: A total of 46 adolescents with bipolar disorder were followed up. Minimal to moderate impairment in functioning in the past year was found in these adolescents. The mean score on C-GAS was 68.41 ± 16.63. Factors including co-morbidity, pre-morbid peer relationship, relationship with siblings, level of religion activities and history of sexual risk behavior were significantly associated with functioning (p = 0.000), while marital status of the parents showed a weak association with functioning in these adolescents (p = 0.068). Negative correlation was also found between mean number of hospital admissions in the past year during follow up and mean score on C-GAS (r = - 0.908, p = 0.000). CONCLUSION: Functional impairments complicate bipolar disorder in Nigerian adolescents. To ensure good overall outcome in these adolescents, attention needs to be focused on promoting those factors that help good functioning. Future longitudinal follow up studies that would assess long-term outcome and its correlates in children and adolescents with bipolar disorder in this environment are desirable.

[Manifestations of somatization in Nigerian patients--diagnostic attempts and therapeutic approaches]. / Somatisierungserscheinungen bei Nigerianern--diagnostische Versuche und therapeutische Ansätze.

Within the last decades transcultural psychiatry has been more and more concerned with culture-depending illness. A tendency to somatization and symbolism proofed to be of importance. In this study from Nigeria specific patterns of black Africa are presented. Special complaints such as the followings are part of different psychiatric disturbances: "heat in the body and in the head; crawling, heavy and biting sensations". In this paper the communicative aspects of these complaints are emphasized. The more difficult verbal communication is, especially among immigrants, the more important regression to body language becomes. It is not rare that these symptoms are part of the defense system. The content of the complaints must also be understood in the context of the specific educational rules of Nigeria where longstanding skin contact in mothering increases the cathexes of the body.

Child abuse and neglect in Nigeria -- a situation analysis.

PIP: The Nigeria chapter of the African Network for the Prevention and Protection Against Child Abuse and Neglect conducted a nationwide study to acquire an overview of the nature and extent of child abuse and neglect in Nigeria. The 3-part study assessed the density of children working on the streets and the attitudes of adults and children related to child abuse and neglect. Counts of working street youths under age 16 years and respondent attitudes were assessed in Kaduna/Zaria, Enugu/Onitsha, and Ibadan. The densities of street children and questionnaire responses from sampled adults suggest that child abuse and neglect are serious problems in Nigeria; cultural practices and traditional attitudes contribute to the problem; institutions tasked with addressing family and child welfare have failed to do so; hawking, begging, and abandonment place these children at risk; and some handicapped children roam the streets without care. School children were surveyed to provide information on their before- and after-school chores, their views on physical punishment by parents and teachers, and their nutritional standards. 94% received three meals/day; 52% typically spent 2-4 hours after school in domestic chores such as sweeping the house, washing dishes, and preparing evening meals; and many were either scolded, beaten, or assigned additional household duties as punishment for behaving contrary to the desires of adults.^ieng

[Better understanding and treatment of paranoid and somatization clinical pictures in Nigerians]. / Zum besseren Verständnis und zur Behandlung von Paranoia und Somatisierungserscheinungen bei Nigerianern.

This work identified an important attitude of Nigerians namely that behaviour is controlled from outside including deviant behaviour. Furthermore, there is always some external situation which has some relationship, no matter how remote to mental illness. On the other hand very often psychic distress is often communicated through the body. There is an unconscious link between somatic complaint and the underlying psychological and social problem. Most types of mental illness in Nigeria are expressed through the body and are felt to be caused from outside. A psychological model is described which makes conscious the link between the bodily discomfort and the underlying social or psychological problem. The model also tries to find the outside situation which is attributable to present mental illness. Through social work the problem can be resolved or through psychotherapy accepted as unchangeable and real.

A cross sectional study of somatic complaints of Nigerian females using the Enugu Somatization Scale.

Among Nigerian mentally ill a constant male-female ratio of 2:1, over-representation of single males and married females and the tendency for the females who seek psychiatric aid to be psychotic with schizoaffective disturbances have been observed. The question arose as to why this is so. To answer this, the Enugu Somatization Scale, developed in an effort to avoid the difficulty encountered in using Western diagnostic illness categories and scales for assessing mental illness in Nigeria was administered to 51 mentally ill females, 60 adolescent secondary school girls, 67 post secondary school females, 149 pregnant females, and 60 women who were once able to bear children but now no longer can. It was found that somatization is used by Nigerian females to contain their stress. The pregnant females scored lowest while those women who can no longer deliver scored highest. Pregnancy is seen as a state of rest from societal stress for the females, who otherwise are not allowed by the society to be so mentally ill as to seek a psychiatrist and who have to be psychotic to be able to do so. Various tentative, dynamic explanations of the items in the scale answered in the affirmative by a wide cross section of the women, based on the clinical experience of the author, are offered.

[Stress in the life of Nigerian diabetics]. / Stress im Leben nigerianischer Diabetiker.

The authors set out to answer the question (a) whether there are stress conditions in the life histories of Nigerian diabetic patients and (b) whether diabetic patients have complaints which have psychiatric significance. With regard to the first question, important biographic data of 54 diabetics were elicited. A constellation of significant stressful life situations was found among the diabetics such as early loss of father, being first borns, born of polygamous parents, being themselves polygamous, being the children of the first wives, and producing many children without having the adequate professions to yield the necessary financial resources to train them. Loneliness was not seen as part of these stressful life situation since almost all of them were married. With regard to the second question, the Enugu Somatization Scale was administered to the above mentioned diabetics (n = 54). It was found that about 37% of the diabetics have somatic symptoms which are indicative of psychiatric disturbance.

Development of a culture specific (Nigeria) screening scale of somatic complaints indicating psychiatric disturbance.

In a pre-study it was seen that somatization complaints formed the basis of the distress of the mentally ill in Nigeria and there was need for somatic complaints to be employed in evolving a psychodiagnostic system which would lead to a better understanding of mental illness in Nigeria. In pursuit of this goal, some 65 somatic complaints were drawn from protocols of patients treated at the Psychiatric Hospital, Enugu, from 1978-1981. These complaints were administered in form of questions to 179 psychiatric patients and 349 students (normals) of the Institute of Management and Technology, Enugu. Forty-six of the 65 complaints distinguished male normals from the psychiatric patients and 30 items of the 65 distinguished the female normals from the female psychiatric patients at the 0.05 level or better. In a further step each subject was rated. A positive response to each of the discriminant items was scored as one point. The mean, standard deviation and cumulative frequency percentage of both groups were calculated. These values are recommended for use in discriminating normals from the mentally ill in Nigeria. This study is seen as a first step leading towards a much wider study involving somatizations in a psychodiagnostic endeavor, as well as throwing more light into the problem of classification of psychiatric disorders in Nigeria.

Present status and practice of electroconvulsive therapy at the Psychiatric Hospital, Enugu, Nigeria.

During the 12-month period, 1 January 1978 to 31 December 1978, 690 people received 4,194 electroconvulsive treatments at the Psychiatric Hospital, Enugu. The diagnostic classifications of patients receiving this form of treatment included severe psychotic depression (and masked depression), catatonic schizophrenia (with marked withdrawal, mutism, or excitement); mania which has become unresponsive to major tranquilizers, some selected cases of acute delirium and the collective group "puerperal psychosis". Bilateral ECT was generally used and the frequency of treatment was two ECT's per week. The method of anaesthesia used is described and mention is made of the few and mild complications which were encountered. ECT was found to have reduced the total duration of stay in hospital (for in-patients). Considering the acute shortage of specialized manpower in the field of psychiatry in Nigeria, a suggestion is made for the establishment of community based psychiatric centres where, among other forms of therapy, ECT could be given in appropriate cases, on out-patient basis. The wider use of this form of treatment in deserving cases in psychiatric hospitals is also recommended.

[Belief in reincarnation (the "ogba nje" phenomenon) and its significance for psychotherapy in Nigeria]. / Der Glaube an Reinkarnation (das OGBA NJE-Phänomen) und seine Bedeutung für die Psychotherapie in Nigeria.

The Phenomenon OGBA NJE was described by 25 elderly men from Enugu (township N = 10) and Amaofuo (village N = 15) in Nigeria as follows: It means coming again. One who returns. The human being comes back to this life after death. Sometimes people coming back arrange to come to life together under certain conditions e.g. like living only 20 years and dying together therafter, not to have children, not to marry or to perform very specific tasks and returning again etc. Should a member under such a contract not wish to keep to it any longer while alive, the other members of the agreement will harrass the one living. This is manifested in various forms of mysterious and pathological behaviours. The native doctor diagnoses this disturbance mostly through handreading. He can heal OGBA NJE by freeing the patient from the agreement. The authors however believe that OGBA NJE is a native way of explaining and healing mental disturbances. 2 out of 20 cases documented within the period of 1 year and successfully treated by Psychotherapy are presented as illustration.

Child spacing and child mortality among Nigerian Igbos.

Until recently, a birth interval of at least two years was the norm in the Nigerian Igbo culture, a practice necessary for infant health and survival. A study of antenatal patients of the University of Nigeria Teaching Hospital, Enugu, Nigeria, shows that this cultural pattern has been disrupted by Westernization, urbanization and consumerism. The patients studied had an average of four pregnancies in five years. Roughly half of those conceived did not survive: 41% of the patients reported having lost at least one child. Modern family planning methods are urged as replacements for the abandoned traditional methods of child spacing.

PIP: Birth intervals and infant and child mortality among the Igbos of Nigeria were assessed using interview data collected from a random sample of married women who attended the antinatal clinic of the University of Nigeria Teaching Hospital in Enugu, Nigeria. Major findings were 1) birth intervals decreased markedly from in the past when the Igbo followed the traditional pattern of spacing children 2 years apart and 2) approximately 40% of the children born to the sample of women did not survive. The shorter birth intervals were attributed to the reduction in breast-feeding which occurred when commercial infant milk products were introduced into the culture. The closely spaced births resulted in a higher number of infant deaths. Mothers who lost their babies were in turn likely to become pregnant again in a short period of time. The interviewed women ranged in age from 14-14 and the average age was 25.19. The women were married for an average of 16.5 years. The number of pregnancies experienced by the women ranged from 1-12 and the average women experienced 3.9 pregnancies but only had 2.4 living children. Major findings were presented in 4 descriptive tables.

[Arranged marriages of underage girls and the resulting psychic consequences]. / Arrangierte Verheiratung minderjähriger Mädchen und die daraus resultierenden psychischen Folgen.

This study is based on 20 cases of disturbed female clients whose marriages were arranged at an under age ranging from 9-13 years. When the men have paid the dowry and fulfilled the marriage customs they are entitled to have sexual intercourse with their wives. Some have this sexual intercourse before or shortly after menstruation and some even have seen their husbands only once or twice before their hands are given in marriage. This early sexual experience, mostly against the will of the underage girls, can precipitate positive or negative reactions. In the positive reaction cases an imprinting fixation on the man takes place. Should the man die or reject the young woman, a disorientation takes place resulting mostly in an inability to have sexual relationship with another man. Should the reaction be negative the woman will do all she can to prevent sexual relationship with the husband through all sorts of symptoms like frequent pregnancies, crawling sensation, secret love affairs with remorse of concience, internal heat, constant head-ache etc. 2 cases are selected from the 20 cases as illustration.