LONG STANDING SCHIZOPHRENIA PRESENTING AS PARAPLEGIA IN NIGERIAN YOUTH.

Background: Schizophrenia is a severe mental health disorder characterized by abnormality in patient perception, belief and cognition resulting in gross abnormal behaviour and deterioration in interpersonal relationship and occupational functioning with onset usually in adolescence and youth period. While it is common to observe distortion in the belief system and perceptual experiences and other oddities of behaviour, including amotivational syndrome, ambivalence, social withdrawal, catatonia among youth suffering from this severe mental disorder, presenting with neurological symptom of complete inability to walk despite the desire to do so is very uncommon. We aimed to present a case report of a Nigerian youth who presented with inability to walk without any neurological deficit and had normal brain MRI scan. This is to highlight the need to have high index of suspicion among practitioner especially in young person with sudden onset of "paraplegia". Case Presentation: Mr X is a 30 years old single Lecturer who was brought into the hospital by relatives with two weeks history of sudden onset of inability to walk around and became bed bound. He graduated with first class in Mass Communication and commenced National Service as Lecturer when he started hearing voices discussing him and also believes that people want to kill. He became reclusive to self for about two years. No history of trauma to the head or hypertensive heart disease. He was earlier seen by a doctor who commenced him on carbamazepine and olanzapine but drugs adherent was poor and later completely abandon for unorthodox treatment. MRI Scan of the brain, FBC + diff, U & E and neurological examination were normal. He was commence on Risperdal and six weeks later into the treatment, he started ambulating about. Conclusion: While it may be rare, severe psychotic illness such as schizophrenia can result in complete inability to walk, mimicking neurological disorder. High index of suspicion with perseverance of treatment can resolve the patient illness and restore his social life.

Current Status of Mental Health Services at the Primary Healthcare Level in Northern Nigeria.

Mental health services at the primary healthcare level remain critical in most developing countries, especially in resource-poor and crisis-stricken communities. This study explored the erstwhile mental health services, with particular reference to their availability, at the 47 primary healthcare centres in three selected states in northern Nigeria, with a view to drawing for action. Qualitative data were collected from a purposive sample of 13 participants through in-depth interviews. Additional data were also collected from observations during the visits (a checklist based on minimum standards for primary healthcare services) and clinic records at the centres. The data were analysed using content analysis and thematic clustering to indicate the status of the mental health services at the primary healthcare centres. Despite having the mental health units on the service delivery charts of the primary healthcare centres studied, none was providing any formal mental health services. There were only few but uncoordinated services in some centres essentially provided by individual primary healthcare service providers and a non-governmental organization found in one of the 47 primary healthcare centres in one of the three states investigated. In conclusion, mental health services at all primary healthcare centres in all the Local Government Areas in all the states visited are at best scarce, poorly and haphazardly rendered in a few places or completely absent in most centres. There is an urgent need to stimulate the primary healthcare system and other levels of government and their partners, to initiate or activate policies in favour of community-based mental health services to make these important services available at the community (primary healthcare) level for the promotion of mental health and treatment of mental illnesses.

Sociodemographic and clinical correlates of sexual dysfunction among psychiatric outpatients receiving common psychotropic medications in a Neuropsychiatric Hospital in Northern Nigeria.

BACKGROUND: Sexual dysfunction is common in patients receiving psychotropic medications and may reduce their quality of life and medication adherence with resultant negative impact on treatment outcomes. OBJECTIVES: In this study, we described the various types of sexual dysfunction among psychiatric outpatients receiving psychotropic medications and the sociodemographic and clinical correlates associated with it. SETTINGS AND DESIGN: A descriptive, cross-sectional study conducted in a Neuropsychiatric Hospital in Northern Nigeria. METHODOLOGY: The participants were made up of a consecutive sample of 255 outpatients attending psychiatric clinic from January to March 2014. Data were collected on sociodemographic items, patient's clinical diagnosis, psychotropic medications received, and duration of treatment. Information about sexual functioning was obtained using the International Index of Erectile Function Questionnaire for the male participants and the Female Sexual Function Index for the female participants. RESULTS: The mean age of the patients studied was 34.7 years (standard deviation [SD] =5.9), with a mean duration of treatment of 3.8 (SD = 6.5) years. Males constituted 47.8% and patients with schizophrenia constituted 43.1%; other diagnoses include bipolar affective disorder, recurrent depressive disorder, and substance use disorder. The prevalence of sexual dysfunction was 64.3%. Age, employment status, and psychotropic medication use were significantly associated with sexual dysfunction; however, only employment status and psychotropic medication use significantly predicted sexual dysfunction. CONCLUSIONS: We concluded that sexual dysfunction is highly prevalent among patients receiving psychotropic medication; as such inquiries about sexual function should be routinely carried out by clinicians as this may negatively impact on adherence and quality of life.

Medication compliance behavior in psychiatric out-patients with psychoactive substance use comorbidity in a Nigerian tertiary hospital.

BACKGROUND: Psychotropic medication adherence is a major challenge in psychiatric patients with comorbidity. OBJECTIVE: The objective was to determine medication adherence behavior among psychiatric out-patients with psychoactive substance use comorbidity in a Nigerian Tertiary Hospital. SETTINGS AND DESIGN: A cross-sectional study of a tertiary hospital in Northern Nigeria. METHODS: Adult patients who have been attending the out-patient clinic for at least 1 year were included. From the routine clinic, each consecutive fourth patient completed a socio-demographic and drug use questionnaire, a self-administered medication adherence scale, and a semi-structured proforma which sought reasons for poor adherence, information on supervision and who keeps patient medications at home; until a calculated sample of 208 was attained. STATISTICAL ANALYSIS: Done by means of descriptive statistics using the Statistical Package for Social Sciences version 16. The level of significance was set at P < 0.05. RESULTS: Totally, 208 patients participated in the study. 61 (29.3%) of them were substance users, out of which 59% never reported missing their medications. No statistically significant relationship was found between substance use and medication adherence. A significant proportion of substance users were compliant with medication use when the drugs were in their possession. For substance users and nonusers, the major reason for poor drug adherence was the unavailability of the medications, while nonsubstance users were more likely to complain about being tired of the medications. No report of side effects in supervised patients. CONCLUSION: The use of psychoactive substances in patients with other mental disorders influences their medication adherence behavior.

Knowledge of Childhood Autism and Challenges of Management among Medical Doctors in Kaduna State, Northwest Nigeria.

Autism is a neurodevelopmental disorder with serious implications in childhood. There is a significant gap in the identification and provision of health and social services for autism in Africa. The knowledge of autism among health care providers and identifying challenges associated with its management could facilitate bridging the gap and ensuring better outcomes. A self-administered tool, the Knowledge about Childhood Autism among Health Workers (KCAHW) questionnaire, was used in assessing knowledge of autism among 175 medical doctors (participants) attending an annual scientific meeting in northwest Nigeria. Other parameters assessed were sociodemographic and professional characteristics of the participants and challenges encountered in the management of autism. Out of 175 questionnaires distributed, 167 (95.4%) were returned. Good knowledge (KCAHW score ≥15) was significantly associated with being a paediatrician or psychiatrist and practicing in a tertiary health facility (P < 0.05), while poor knowledge (KCAHW score <15) was significant among general practitioners (P < 0.05). The highest knowledge gap was associated with onset of autism and its comorbidities (KCAHW Domain 4) while the least was concerning communication impairments (KCAHW Domain 2). Major challenges encountered in autism management were dearth of specialist services, cost of evaluation, and poor caregiver perspectives of autism.

Emotional distress among caregivers of patients with epilepsy in Katsina State, Northern Nigeria.

OBJECTIVE: Caregivers of patients with epilepsy experience onsiderable emotional distress. The study aimed to assess the magnitude of the problem in a developing country. METHOD: A total 166 patients-caregivers were enrolled for the study. They were interviewed using a socio-demographic data collecting sheet and the Hospital Anxiety-Depression Scale (HADS). Data obtained were analysed using Statistical Package for Social Sciences Windows version 13. All statistical tests were carried out at a 5% level of probability. RESULTS: The mean age of the caregivers was 45.44 ± 6.67 years. Emotional distress was found among 109(65.7%) of the caregivers. This is was significantly associated with male gender of both care giver and patient as well as residing in a rural area. CONCLUSION: The study demonstrated a high level of emotional distress associated with caring for patients with epilepsy, which is comparable to other studies carried out in other parts of the world.

Adherence to highly active antiretroviral therapy in depressed patients with HIV/AIDS attending a Nigerian university teaching hospital clinic.

OBJECTIVE: To determine the prevalence of depressive disorder in patients with HIV/AIDS receiving HAART; to determine the effect of depressive disorder on adherence to antiretroviral therapy; and to determine the significance of the association. METHOD: The study was conducted amongst outpatients of Ahmadu Bello University Teaching Hospital, Zaria. A sociodemographic and drug adherence questionnaire was administered. The Centre for Epidemiological Studies Depression Scale (CES-D) was used to screen for depressive symptoms while the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) was used to confirm the diagnosis of depressive disorder. RESULTS: A total of 310 patients with HIV/AIDS receiving HAART participated in the study. 68.4% were female and the mean age was 35.5 (± 8.97 years). 37.4% had secondary education, while 27.1% had tertiary education. Sixty-six participants (21.3%) had significant depressive symptoms while 14.2% met ICD-10 diagnostic criteria for depressive disorder. Overall, 73% of participants had good adherence to HAART. 63.6% of participants with depressive disorder had poor adherence to HAART compared to 21.1% of participants without depressive disorder (p<0.05). CONCLUSION: Depressive disorder in patients with HIV/AIDS is associated with poor adherence to antiretroviral medication. Early identification and treatment of depression in such patients may improve antiretroviral medication adherence and treatment outcomes.