Quantification and comparison of psychiatric distress in African patients with albinism and vitiligo: a 5-year prospective study.

BACKGROUND: Vitiligo and albinism are two disorders of pigmentation that make the affected African highly visible and strikingly different from their peers. Both pose considerable management challenges, attract significant stigma and profound impairment of quality of life. OBJECTIVE AND METHODS: To determine and compare psychiatric distress in vitiligo and albinism using the Hospital Anxiety and Depression Scale (HADS). Participants were 87 albinos and 102 vitiligo adult patients seen at an urban tertiary hospital in Nigeria between 2004 and 2009. RESULTS: Prevalence of psycho morbidity was 59% (60/102) in vitiligo compared with 26% (23/87) in the albinos. The mean anxiety score was estimated to be 2.55 points lower for albino patients (95% CI: 1.47 to 3.64), and the mean depression score 2.76 points lower (95% CI: 1.84 to 3.68), after adjustment for age, sex and marital status. However, significant differences were not observed when comparing the vitiligo patients with the subset of albino patients with skin cancer. Older patients had significantly higher anxiety and depression scores. Females had significantly higher anxiety scores (but not depression scores) compared to males. Genital involvement in vitiligo was significantly associated with anxiety but not depression. CONCLUSIONS: We found that the African with vitiligo suffers significantly higher psychiatric distress than the African albino on average. Clinical evaluation of these patients would be incomplete without assessment of their psycho morbidity. There is need for increased focus on cancer prevention strategies in the African albino.

Delayed diagnosis of intersex state: surgical outcome of cases seen and review of current concepts.

BACKGROUND: Sexual ambiguity is said to occur when the gender of the baby cannot be determined at birth. The gender of an individual is in question because the genitals do not appear clearly as that of male or female. It is traumatizing to the family. It also causes confusion and problems in determining the sex, in which a child would be reared. The abnormality is relatively uncommon. Disorders of sexual differentiation can arise from abnormalities in chromosomes, gonadal development or hormonal production or activity. The orderly development process may also be affected by various environmental factors. Some of these factors may ultimately lead to the development of ambiguous external genitalia. CASE PRESENTATIONS AND MANAGEMENT: Three of such patients with ambiguous genitalia are presented, in which the initial diagnosis proved to be incorrect. The various investigations that were carried out and surgical management are discussed. CONCLUSION: Arguments which led to the ultimate choice of the sex of a child ranged from strict medical, to psychosocial and even cultural considerations. Expert examination shortly after birth would allow an early and definite decision, avoiding more serious problems with sexual ambiguity in later life.

The Relationship between Creativity and Mental Disorder in an African Setting.

BACKGROUND: There has for some time now been recognition that there was a relationship between exceptional creative talent and mental disorder. The works of Andreasen (2008) and others in this area have been very significant. However, most of the research has been carried out in USA and Europe. Very little has come out of Africa on the subject. AIM: To survey the beliefs of different groups within an African society, concerning the possibility of a relationship between creative talent and mental disorder. To assess creativity within a community of people with a formal diagnosis of mental disorder. MATERIALS AND METHODS: Some of the mythology of the Yoruba was examined for content, concerning the behaviour of certain notable individuals and the existence of psychopathology based on modern-day criteria. The beliefs of members of the general public and mental health professionals concerning the existence of a relationship between creative talent and psychopathology were surveyed using a questionnaire designed for the project. A sample of patients with formal diagnoses of affective disorder or schizophrenia drawn from two units, the Lagos State University Teaching Hospital and the Federal Neuropsychiatric Hospital Yaba, were assessed for 'Creativity.' RESULTS: Although there are notable 'eccentric' figures in local mythology, the overwhelming majority of the people surveyed do not believe there is any relationship between creativity and mental illness. They however believe that engaging in creative activities helps the mentally ill to recover from illness. The mental health professionals, who were clinical psychologists and psychiatrists, had a significant minority who believed that a relationship does exist, and they also strongly assert that creative activity has a therapeutic effect for the mentally ill. A survey of in-patients diagnosed with schizophrenia and affective disorder failed to show a significant difference in the creativity of the two populations, as measured by the originality score of the Rorschach scale. The survey of patients is inconclusive, based on small sample size (ten patients with a diagnosis of schizophrenia, ten with bipolar affective disorder.). The linkage between formal mental disorder is only recognised by a significant minority of mental health professionals. A significant proportion of the population believe that creative activity aids recovery from mental illness. More research is required into this important subject in Africa.

Yoruba world view and the nature of psychotic illness.

OBJECTIVE: The Yoruba are an ethnic group in southern Nigeria. It is said that their world view centers around a continuous battle between forces of good and evil. Adverse events such as illness are due to the malevolence of enemies, using metaphysical means. Remedy often involves corrective metaphysical intervention, either exclusively or in addition to other methods, such as 'western Medicine'. This 'rule' is said to fit mental illness more than any other type of illness, although there is a lack of empirical data on the subject. This study is aimed at identifying elements of a Yoruba world view, and factors relevant to the perception and treatment of psychotic illness. METHOD: 500 Yorubas in Lagos were randomly sampled (with a questionnaire), and 100 'home video' films were analyzed. Data were analyzed for: elements of world view; elements that pertain to illness in general; elements that pertain to psychotic illness; how such illness is to be treated. RESULTS: The world view has a significant influence on perception of psychotic illness. CONCLUSION: It is necessary to understand a people's world view in order to understand (and influence) attitudes towards psychotic illness in themselves and other people.

Provision of mental health services in Nigeria.

Nigeria, like other African countries, is short of personnel trained in mental healthcare. Efforts to tackle the problem have often focused on increasing the numbers of psychiatrists and nurses in the field. These efforts, over the past 20 years, have not appeared to have greatly improved service delivery at the grass roots. Most of the specialist centres where such highly trained personnel work are in urban areas and for a large part of the population access to them is limited by distance and cost.

The Differential Impact of Various Assessment Parameters on the Medical Students Performance in the Professional Anatomy Examination in a New Medical School / El Impacto Diferencial de Varios Parámetros de Evaluación del Desempeño de Estudiantes de Medicina en el Examen Profesional de Anatomía en una Nueva Escuela de Medicina

There is a dearth of knowledge on the level of agreement between all the various assessment tasks on the same content area, in order to test this hypothesis we adopted the concept of convergent validity and also to isolate area of academic weakness among the students and to readjust the curriculum content to balance the weakness. A blinded cohort retrospective study was carried out on a total of sixty-six third year medical students who had sat for their first professional examination in anatomy in the new medical college of Lagos State University. Using records of their grades in the various assessments parameters- the average end-in course assessment, short essays question (SEQ), multiple-choice questions (MCQ), and practical (Steeple-chase). The mean + S.D. Pearson's correlation with students t-test (p< 0.05 being significant) were analyzed using the computerized SPSS 11 (SPSS inc. Chicago, Illinois) software package. The practical was significantly correlated with overall performance (r = 0.89, p< 0.01); with the student t-value of 6.15 (p< 0.01). Although, the SEQ showed significant correlation to overall performance (r =0.72; p<0.01), the t-value of 0.4 was non-significant, but, within an acceptable range. The practical, MCQ, SEQ and end-incourse showed an overall rank order of relative performance in assessment tasks, therefore indicates that, in general, students performance in the Professional examination was better than in the end-incourse examination and hence, the need to reappraise this pattern and emphasize the role of incourse assessment in the curriculum.

Existe escasez de conocimiento sobre el nivel de concordancia entre todas las varias tareas de evalución sobre los contenidos de una misma área. En orden a evaluar esta hipótesis, adoptamos el concepto de validez convergente y también de área aislada, de falta de solidez académica entre los estudiantes y readecuar el contenido curricular para balancear esa falta de solidez. Se llevó a cabo un estudio retrospectivo al azar sobre un total de 66 alumnos de Medicina de Tercer Año, quienes tuvieron su primer examen profesional de Anatomía en la nueva Escuela de Medicina de la Universidad del Estado de Lagos, Nigeria. Usando registros de sus grados en varios parámetros de evaluación: promedio final de la evaluación del Curso, preguntas cortas de redacción, ítemes de selección múltiple y prácticas. La media + desviación estándar, correlación de Person con el t-test de Sudents (p< 0.05) fueron analizados con el programa SPSS 11 (SPSS inc. Chicago, Illinois). La parte práctica fue significativamente correlacionada con todo el rendimiento (r = 0.89, p< 0.01); con un valor del t-Students de 6.15 (p< 0.01). Aunque las preguntas cortas mostraron correlación significativa para la totalidad de lo hecho (r =0.72; p<0.01), el valor de t de 0,4 no fue significativo, pero estuvo dentro de un rango aceptable. La parte práctica, selección múltiple y preguntas cortas de redacción y final del curso, mostraron un orden de clasificación de relativo desempeño en las tareas de evaluación, lo que indica que, en general, la actividad de los estudiantes en el examen profesional fue mejor que en el examen del curso y de ahí, la necesidad de readecuar este patrón y enfatizar el rol de evaluación dentro del curso en el curriculum.

The objective structured clinical examination in undergraduate psychiatry.

Inadequate attention has been given to verifying the psychometric attributes of the objective structured clinical examination (OSCE), yet its popularity has been increasing in recent years. Our 6 years' experience in Nigeria showed that OSCE is practicable in undergraduate psychiatry assessment and there is evidence over consecutive years that it has satisfactory reliability and criterion-based validity. The importance of students' feedback in assessing the quality of examination is reinforced, and subtle, less tangible elements which determine students' performance, such as social interactional mystique and some personality traits, are worthy of evaluative research.