Psychiatric morbidity in two urban communities in Nigeria.

BACKGROUND: There is a welter of evidence for an inverse relationship between socio-economic status (SES) and mental health. The relationship is grossly under researched in the developing countries. OBJECTIVE: To ascertain rates of gross psychiatric morbidity and some demographic correlations in two communities with different socio-economic standards. DESIGN: A cross-sectional community based study. SUBJECTS: Random samples of two socio-economically dissimilar communities (N1 = 189, N2 = 148) were assessed for psychiatric morbidity. RESULTS: Rates of psychiatric morbidity obtained for the lower status community (Ajegunle) and the higher status community (Victoria Island/Ikoyi) on the GHQ-12 were 26.5 and 14.2 respectively and the corresponding figures on the SRQ (non-psychosis) were 41.8 and 18.2 and on the SRQ (psychosis) 61.5 and 31.7. A large number of positive socio-demographic correlations between cases and non-cases were obtained on SRQ and GHQ-12 in both communities. Family history of psychiatric illness significantly differentiates cases from non-cases on all measures of morbidity. CONCLUSION: The socio-economic inequality demonstrated should be minimised by evolving a social welfare policy in Nigeria and other developing countries that is responsive to the survival needs of the populace and ensures equitable distribution of resources across socio-economic strata. There is dire need for further research into the complex bearings of the link between social status and psychological wellness in the developing world.

A case report of body dysmorphic disorder and literature review.

BACKGROUND: Body dysmorphic disorder (BDD) is an obsessive preoccupation with a perceived defect in one's physical appearance which the individual persistently seeks medical attention to correct surgically. BDD often goes unrecognized and undiagnosed, due to patients' reluctance to divulge their symptoms because of secrecy and shame. OBJECTIVE: To present the case of a patient who presented with an extreme form of dysmorphophobia. METHODS: A 22-year-old university graduate presented with complaints of not "looking like herself any more" and of looking ugly. Patient was fully clinically and psychologically assessed. Psychological and dental surgical treatment were offered to the patient. RESULTS: She was a young woman who was complaining seriously of how her teeth made her ugly and of hating herself. She chiseled and filed her tooth to make them appear better but to no avail. She had thought of committing suicide. She appeared distressed, tearful and remorseful of her actions. The teeth were chipped and stained. She refused treatment modalities offered, and would not accept a psychological support. CONCLUSION: The case highlights the need for the dentist to be educated on these disorders so that they can recognize and refer accordingly. There is also need for interdisciplinary interactions between the dentists and the psychologist.

Ogun Oru: a traditional explanation for nocturnal neuropsychiatric disturbances among the Yoruba of Southwest Nigeria.

This article describes three cases of ;ogun oru' (nocturnal warefare), a condition reported in southwest Nigeria involving an acute night-time disturbance that is culturally attributed to demonic infiltration of the body and psyche during dreaming. Ogun oru is characterized by its occurrence, a female preponderance, the perception of an underlying feud between the sufferer's earthly spouse and a ;spiritual' spouse, and the event of bewitchment through eating while dreaming. The condition is believed to be treatable through Christian prayers or elaborate traditional rituals designed to exorcise the imbibed demonic elements. Ogun oru may be a label applied to medical problems. The differential diagnosis includes mainly parasomnias, for example, sleep terror, sleepwalking and sleep paralysis and, to a lesser extent, nocturnal or sleep epilepsy.

Pattern of histocompatibility (HLA) antigen distribution among Nigerian (West African black) diabetics.

The pattern of HLA distribution was studied in 70 Nigerian diabetics. There was no association at all between HLA-B8 and insulin-dependent diabetes mellitus (IDDM). There was an increased frequency of HLA-B15 in all categories of patients: those with onset before 40 yr, those with onset after 40 yr (P less than 0.05), those with IDDM (P less than 0.05), and those with non-insulin-dependent diabetes mellitus (NIDDM). HLA-B7 was slightly increased in frequency contrary to the findings in Caucasian IDDM. HLA-A10 and HLA-Aw32 were increased in all the groups of patients, while HLA-B17 was higher in those with onset after 40 yr (P less than 0.02) and NIDDM (P less than 0.02). HLA-Bw35 was decreased in all categories of patients. However, all the observed deviations fell short of statistical significance when correction was made for the number of antigens tested for. Comparison of the data with those in other black populations revealed that the over-all pattern of HLA distribution in black diabetics is rather disparate and still relatively ill defined. It is concluded that the pattern of HLA and diabetes association in Nigerian diabetics would appear to be different from that in most other racial groups including North American and South African blacks. There is, however, a need to further study larger numbers of Nigerian diabetics and other black population groups so that a clearer picture may emerge.

HLA-DR associations in black type I diabetics in Nigeria. Further support for models of inheritance.

The distributions of HLA-A, -B, -(Bw4/Bw6), -C, -DR, -(DRw52/DRw53), and -DQ genes in 19 type I diabetics, 37 type II diabetics, and 13 nondiabetics of the Yoruba tribe in southwestern Nigeria were studied. Because no associations between type II diabetes and HLA were detected in the current study and such associations are not known to exist in most ethnoracial groups, type II diabetics plus nondiabetics were used as a group of controls for the group of type I diabetics. Trends toward associations between increased DR3 (53 versus 30% of controls) and decreased DR2 (21 versus 46% of controls) and type I diabetes were found (0.1 greater than P greater than 0.05). The strongest HLA association with type I diabetes in Caucasians is usually with DR4. The percent of DR4-positive type I diabetes (11%) was not significantly greater that that in the controls (4%). Because the strong HLA associations with type I diabetes in American Blacks are the same as in Caucasians (i.e., increased DR3 and DR4 and decreased DR2), the genetic contribution (i.e., the lack of an association with DR4) to susceptibility to type I diabetes in most Nigerian Blacks may be different from that in most Caucasians and American Blacks. Onset of diabetes in most of the type I subjects was after age 20, and type I diabetics were difficult to recruit for the study, in keeping with reports on the rarity of type I diabetes among Blacks in western Africa and reports of DR4, but not DR3, being correlated with an early age of onset in Caucasians.(ABSTRACT TRUNCATED AT 250 WORDS)

Oral glucose tolerance test in healthy pregnant Nigerian women.

Oral glucose tolerance tests (OGTTs) with 75 g glucose were performed in 20 healthy pregnant Nigerian women in each trimester of pregnancy and the puerperium; 34 nonpregnant control subjects matched for age and parity were also studied. The blood glucose levels from fasting to 60 min were lower in pregnant subjects, but the 90- and 120-min values were higher. The highest blood glucose values were observed in the first trimester with an apparent improvement in glucose tolerance in the second and third trimesters. This observation is strikingly different from the established pattern of OGTT in pregnant Caucasian women. With pooled data from OGTT results in the three trimesters for the 20 pregnant women (60 OGTTs), a statistically derived criterion (based on mean + 2SD approximated to the nearest 5) for the interpretation of OGTT in pregnant Nigerian women was devised. This criterion defines the upper limits of normal for venous whole-blood glucose in pregnant Nigerian women during an OGTT with a 75-g glucose load as follows: fasting, 90; 30 min, 135; 60 min, 150; 90 min, 145; and 120 min, 125 mg/dl. These values are lower than those recommended for pregnant women by the National Diabetes Data Group (O'Sullivan and Mahan criteria) and the World Health Organization. The results from this study underscore the need for caution regarding uncritical application of data from one racial or ethnic group to others.

Localization and sex steroid regulation of androgen receptor gene expression in rhesus monkey uterus.

OBJECTIVE: To characterize the cellular sites and hormonal regulation of uterine androgen receptor gene expression in the monkey. METHODS: Ovariectomized rhesus monkeys (five in each group) were treated with placebo (the control group), estradiol (E2), E2 plus progesterone, or E2 plus testosterone by sustained-release pellets administered subcutaneously. After 3 days of treatment, uteri were removed and uterine sections were analyzed by in situ hybridization for androgen receptor messenger RNA (mRNA). RESULTS: Androgen receptor mRNA was detected in endometrial stromal cells and myometrial smooth muscle cells, with lesser expression in endometrial epithelial cells. Both E2 and E2 plus progesterone treatment doubled androgen receptor mRNA levels in stromal cells (P < .01), whereas E2 plus testosterone treatment increased stromal androgen receptor mRNA levels by about five-fold (P < .001) compared with placebo treatment. In the endometrial epithelium, E2 alone did not increase androgen receptor mRNA levels significantly. However, the E2 plus progesterone and E2 plus testosterone treatments increased epithelial androgen receptor mRNA levels by 4.3 and 5 times, respectively (P = .008 and P < .002, respectively). Androgen receptor mRNA was distributed homogeneously in smooth muscle cells across the myometrium. Estradiol treatment alone did not increase myometrial androgen receptor mRNA levels significantly, but the E2 plus progesterone and E2 plus testosterone treatments increased myometrial androgen receptor mRNA levels by 1.8 and 2 times, respectively (P = .001 and P < .001, respectively). CONCLUSION: Androgen receptor gene expression was detected in all uterine cell compartments where it was subject to significant sex steroid regulation. The fact that androgen receptor mRNA levels were consistently up-regulated by a combined E2 plus testosterone treatment while E2 treatment alone had little or no effect shows that a collaborative action of E2 and testosterone enhances androgen receptor expression in the monkey uterus.

Stress among factory workers in a developing country.

This cross-sectional study reveals that a significant proportion (35%) of the sampled population of factory workers experienced measurable health problems in the form of anxiety, sleep disturbance, depression, somatic complaints and other clinical indicators of stress. Job stress and social support levels experienced by the group of workers judged 'sick' were significantly different from the control group, particularly so for employees in the lower levels of work hierarchy. In consonance with findings from the literature, job stress has a significant impact on mental health, with all the job stress parameters accounting for 41% of the variation in the general health. Those job stress variables that were significant predictors of health were job pressure, namely security and job tension, and interpersonal rewards. Extrinsic rewards i.e. those factors relating to income and status were not significant predictors of health. Perceived social support tended to increase at the higher levels of occupational status and at the work place it appeared to exert a positive influence on health presumably by counteracting the adverse effects of job stress. This study stresses the need for industrial organizations of the emergent nations to initiate measures which would enhance health status of workers as a cardinal factor in organizational growth [corrected].

The Othello syndrome.

A case of the Othello syndrome is presented. In its classical form the syndrome is rare, but as with other allied paranoid states, its medicosocial implications are great. Rational management should include pharmacotherapy, conjoint family therapy after symptom remission, and long-term individual psychotherapy.

Sheehan's syndrome in a developing country, Nigeria: a rare disease or problem of diagnosis?

Over a five year period, 11 cases of Sheehan's syndrome were seen in the Endocrinology Unit of a teaching hospital in Ibadan, Nigeria. The mean age at diagnosis was 35.1 years; the mean parity was four and the average interval between the obstetric injury and diagnosis was 6.9 years. Four patients were in middle socio-economic class and seven were in low socio-economic class. The most frequent presenting symptoms were failure of lactation (11 out of 11 patients) and amenorrhoea (9 out of 11 patients). Seven patients had multiple endocrine insufficiency involving essentially all pituitary cell types. Six out of 8 patients were lost to follow-up. In a review of autopsy records over a 5-year period at the same institution, out of 1,951 post-mortem examinations, no additional cases of Sheehan's were found. With an average of about two clinical cases per year, it would seem that Sheehan's syndrome is still a relatively rare entity in this part of the world in spite of the poor level of obstetric care generally available. There is a need for increased awareness about this disease on the part of practitioners in developing countries in order to establish whether this rarity is real or it is due to missed diagnosis.

Diagnosing childhood depression who should be interviewed--parent or child? The Newcastle Child Depression Project.

The extent of the similarities and discrepancies in the reporting of depressive symptomatology by children and their mothers was examined. Child-parent agreement was not always impressive, particularly for more subjective symptoms. It is suggested that direct psychiatric assessment of children provides a more accurate picture of their mental state regardless of presenting disorder, but particularly where depression is suspected.

Reliability and validity of two self-rating scales in the assessment of childhood depression.

A comparison was made of the reliability and validity of two self-rating scales, the Children's Depression Inventory (CDI) and Depression Self-Rating Scale (DSRS), in the diagnosis of depression in 93 children (aged 8-16 years) attending a university child psychiatry department. The two scales were of comparable merit but had only moderate discrimination between depressed and non-depressed children, with each scale having a misclassification rate of 25%. Better agreement was obtained in more verbally intelligent children, irrespective of age. Girls scored higher on the instruments than boys. No significant relationship was found between teacher assessment of classroom behaviour and the two self-rating depression instruments.

The context of childhood depression. The Newcastle Childhood Depression Project.

This paper examines the family background, premorbid personality traits and adverse life events preceding childhood depression. The non-depressed group proved more likely to have experienced pre-school bereavement and familial disturbance, and to come from the more deprived background; there was also an excess of premorbid anxiety and hysterical personality traits in this group. School phobia and premorbid obsessional traits were associated with the depressed group. Although there was an association between depression and the total number of adverse life events, this was more substantial when the perceived impact of the events was taken into account. Of the individual classes of life event, only illness and a change in social relationships were associated specifically with depression.

The Newcastle Child Depression Project. Diagnosis and classification of depression.

A total of 275 successive referrals to a university child psychiatry unit out-patient department were examined using the Child Depression Inventory. Of these, 95 children were examined further by a structured clinical interview, and the relationship between different instruments for the assessment of depression in childhood was investigated. Just over one-third of the children (35%) had significant depression, and it was found that depression may be missed unless children with other psychiatric diagnoses are examined closely. Multivariate analyses of the clinical data provided factorial validation of diagnoses when employing different clinical diagnostic schemas.

Carbohydrate tolerance in pregnant Nigerian women--comparison of 75 gms and 100 gms glucose loads.

Oral glucose tolerance tests (OGTT) with 75 gms. and 100 gms. glucose loads were performed two weeks apart in each of 20 healthy Nigerian women in the third trimester of pregnancy. The mean (+/- SD) blood glucose values (venous whole blood in mgs/100 ml) during the tests with the two loads were as follows: 75 gms. -fasting -71.1 (12.6), 30 min. -96.9 (19.1), 60 mins. -99.5 (19.8), 120 mins. -92.3 (19.3), 180 mins. -79.6 (17.2); 100 gms. -fasting -60.5 (7.4), 30 mins. -93.4 (13.8), 60 mins. -94.9 (21.7), 120 mins. -82.3 (10.3), 180 mins. -72.7 (12.2). The differences were statistically significant for the fasting and 120 mins. values, p less than 0.05. These results suggest that increasing the glucose load above 75 gms. does not necessarily increase the maximum glycemic response. Therefore, criteria for the interpretation of the OGTT in pregnancy based on a 75 gms. dose. It would be desirable to establish reliable criteria for the diagnosis of diabetes in pregnancy based on a 75 gms. dose OGTT. This would foster a uniform standard for the performance of this test in all adult population groups and it may also mean a little saving in cost for those working in the less developed countries of the world.

Social networks of Nigerian psychiatric patients.

Despite the indubitable cohesiveness of their community life, Nigerian psychiatric patients had social networks with deficiencies not dissimilar to those reported for patients in the industrialised societies. Interactions between these Nigerian patients as focal persons and other members of their network, were found to be intense, but seemed to lack a strong affectional core. As expected, the separated, and the divorced patients scored less than the married patients on intensity of social relationships, but the two groups were not significantly different on all other network parameters examined. These findings should constitute a substratum of a kinship community-based counselling service with the goal of providing individual-oriented support for the psychiatrically disabled persons. It is believed that this may be realised by the relevant training and utilisation of para-professionals; effective liaison with families and special attention to prevailing concepts and socio-cultural norms.

Pattern of pharmaceutical retailing of anti-diabetic products in Ibadan, Nigeria.

Twenty-four pharmacists in the city of Ibadan were surveyed through a self-administered structured questionnaire as to the extent of their involvement in the pharmaceutical retailing of antidiabetic products and their cost. Oral hypoglycemic agents especially, chlorpropamide (Diabenese) and glibenclamide (Daonil) were the most readily available drugs being obtainable from 21 (87.5%) pharmacies. Insulin was stocked regularly by only 14 (58.3%) of the pharmacists and insulin syringes and needles could be obtained from only 10 (41.6%) of the pharmacies. Among materials for urine testing, clinistix strip was the most readily available and fully one-third of the pharmacies did not stock any such material. The prices of all the products were disturbingly high and between 1983 and 1986 when retail prices were re-assessed, the cost of some materials had escalated by as much as 400%. Scarcity of antidiabetic products and their high cost pose serious challenges for those involved in the care of diabetic patients in Nigeria. Some suggestions have been made as to what steps both the government and the pharmaceutical industry can take in ensuring the availability of these life sustaining products for the increasingly large Nigerian diabetic population.

Short stature at the University College Hospital, Ibadan, Nigeria.

Twenty four patients were evaluated for short stature at the University College Hospital, Ibadan, Nigeria, over a seven year period. Fourteen were males, 10 were females and their ages ranged from 6 to 23 years at first presentation. Nine out of the 10 females came to the hospital primarily because of failure of sexual development whereas only 1 of the 14 males presented with this complaint. The causes of short stature were as follows: idiopathic hypopituitarism in 5 (20.8%) patients (4 males, 1 female), gonadal dysgenesis in 5 patients (all females), syndrome of hepatosplenomegaly, dwarfism and poor sexual development in 5 patients (all males); 2 (8.3%) patients had hypothalamic-pituitary lesions, 2 had juvenile hypothyroidism and 1 (4.2%) had sickle cell hemoglobinopathy; the cause of the short stature was not certain in 4 (16.7%) patients. This is perhaps the first time that the syndrome of hepatosplenomegaly of uncertain etiology with delayed growth and sexual maturation previously reported in Iranian and Egyptian adolescents, is being described in black Africans. Although comprehensive hormonal data were not available in most of these patients, this clinical descriptive study is the first attempt at reporting some of the causes of short stature in Nigerians.

Computerised axial tomographic scanning in neuropsychiatric disorders.

The invention of the computerised tomography scanner - a product of modern bio-medical technology has significantly enhanced the diagnostic capability of physicians in the management of brain disorders such as cerebral atrophy, subdural haematoma, tuberous sclerosis, small calcifications and small intravascular clots. It is also useful in radiotherapy planning. The advantages of the CT scanner over the older conventional techniques, namely pneumoencephalography and arteriography are accuracy, reliability, and simplicity of operation. The major limitation is its diminished ability relative to angiography to precisely detect vascular disease, e.g. aneurysm. Furthermore, it is expensive and not precise in the differentiation of benign from malignant lesions. Despite the development of newer neuro-radiological equipment such as position emission tomography (PET) and nuclear magnetic resonance, the CT scanner remains a most invaluable diagnostic tool and should be given priority consideration in health vote allocation.

Acromegaly in Ibadan--a report of six cases.

Six patients with acromegaly were seen over a six year period at the University College Hospital, Ibadan, Nigeria. There were 5 males and 1 female giving a sex ratio which differed from the equal sex prevalence observed in larger caucasian series. The diagnosis was made strictly on clinical grounds with corroborative evidence from x-ray of the skull and limbs. An unusual and unexpected finding was the observation of a hernia or a history of herniorrhaphy in 4 out of the 5 male acromegalics. It was not certain whether the association was real or what the explanation might be. Transfrontal surgery was the only definitive form of treatment that could be offered to the patients because of lack of facilities for transphenoidal adenomectomy or pituitary irradiation. The operation was refused by 4 of the 5 patients to whom surgery was recommended because of cultural fears regarding operations on the brain. Bromocryptine was prescribed as an alternative therapy but its scarcity and prohibitive cost precluded any serious compliance. There is a need to highlight the problems of the silent sufferer of endocrine disorders in developing countries.