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.

Impact of Epilepsy on Adolescents in a Rural Nigerian Community: A Case-Control Study.

BACKGROUND: Epilepsy is associated with impaired physical, psychological and social functioning. Assessing its impact on these parameters is important to improving the wellbeing of those with the disorder. OBJECTIVE: To assess the impact of epilepsy on the physical, psychological and social status of adolescents in a rural community. METHODS: Adolescents with epilepsy (Subjects) were identified in a community house to house survey. Controls (adolescents without epilepsy) matched for age and sex were randomly selected from the community. Information obtained from the subjects, controls and their care givers using a structured questionnaire included: Age, Sex, Social Class, Knowledge of epilepsy, Characteristics of epilepsy, Treatment options utilized, Health-Related Quality of Life (HRQOL), Body Mass Index (BMI), Academic performance and Epilepsy related problems. RESULTS: Eighteen subjects, 10.5/1000 of the adolescent (10-19 years) population, had epilepsy. The mean age was 16.7± 2.6 years and 16.3± 2.6 years for the subjects and controls respectively. Most of the subjects were males (83.3%). All the subjects had generalized epilepsy, were on traditional medication and none was on orthodox medical therapy. Occurrence of seizures, cost of accessing orthodox medical treatment and stigma were the major problems identified. Ingestion of traditional medication was the commonest modality for overcoming the major problems identified. Seven (38.8%) were underweight but it was not significant (p>0.05). Epilepsy was significantly associated with impaired HRQOL, academic performance and social relationships (p>0.05). CONCLUSION: Epilepsy had a negative impact on the psychosocial and academic status of adolescents. It highlights the need to provide comprehensive adolescent health and social services in epilepsy management.

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.

Aetiology and Precipitants of Epileptic Seizures among Nigerians Treated at Two Tertiary Hospitals in Kaduna State, Northern Nigeria.

BACKGROUND: Epilepsy is a common neurological illness in Nigeria with a prevalence of 5-37 per 1000 in a rural population. Several studies suggest that the prevalence of epilepsy is higher in developing than developed countries due to the preponderance of more risk factors in the former. This study investigated the aetiological factors and precipitants of epileptic seizures among patients attending outpatient clinics of two tertiary hospitals in Kaduna State, Northern Nigeria from October 2008 to April 2013. PATIENTS AND METHODS: Two hundred and forty two consecutive adult patients with history of at least 2 unprovoked afebrile seizures were investigated for seizure patterns, aetiological and precipitating factors through history, physical examinations, laboratory tests and electroencephalography. RESULTS: The male to female ratio of study population was 3 (69%): 1(31%), with respective mean ages of 29.5±12.4and 30.7 ± 16.0years. Their respective mean ages of onset of first seizures were 18.6 ±14.0and 20.9 ±17.4 years. 88% of seizures were of focal origin (complex partial, 80%; simple partial, 8%). Although the causes and precipitants were unknown in 41% and 68% of cases respectively; head injury, neonatal asphyxia and psychoactive substance abuse were prominent aetiological factors. CONCLUSION: Although majority of epileptic seizures in Kaduna State, Northern Nigeria were of focal origin, majority of causes and precipitants remained largely unknown.

Factors affecting epilepsy treatment outcomes in Nigeria.

OBJECTIVES: Epilepsy is a complex chronic illness with variable treatment outcomes determined by factors specific to each affected person. We investigated prognostic factors for epileptic seizure outcome after 2 years of anti-epileptic drug (AED) monotherapy. MATERIALS AND METHODS: Two hundred and thirty-four AED naïve epilepsy patients were started on AED monotherapy and monitored for 2 years for seizure control. Patients on AED polytherapy were excluded. Prognostic factors investigated were socio-demographics characteristics, age of onset of epilepsy, etiology and precipitants of seizures, presenting seizure types, duration of epilepsy before initiation of AED, family support for treatment, compliance to AED, and clinic attendance. RESULTS: Patients were 160 (68.4%) males and 74 (31.6%) females, with mean ages of 26.2 ± 10.4 and 30.7 ± 16.0 years, respectively. Mean age of onset of epilepsy was 19.0 ± 15.0 years. None of the patients was treated with AED for first seizures, although 75% received traditional and spiritual therapy. Majority were single and of low socioeconomic background, and treatment was funded mainly by parents/guardians. About 88% presented with partial seizures, and carbamazepine was the commonest AED used followed by phenytoin sodium. At the end of 2 years of AED, 147 (63%) achieved complete seizure control, and significant prognostic factors were female sex, age older than 20 years at presentation, secondary and tertiary education attainment, being employed, family support, regular clinic attendance, AED compliance, and generalized epilepsy. CONCLUSIONS: Patients with epilepsy are more likely to achieve complete seizure control when they are older, educated, and employed or supported by family members to buy their AEDs and attend clinics regularly.

The frequency and outcome of neuropathies among HIV/AIDS adults treated at a tertiary hospital in Kaduna State, Nigeria.

AIMS AND OBJECTIVES: Highly active antiretroviral therapy (HAART) has been shown to reduce AIDS- defining illnesses, including neuropathies. However, it has been postulated that an increase in age -, HIV- and HAART- related neurological complications will occur as HIV-infected persons live longer. This study investigated the frequency and outcome of neuropathies in relation to CD4+ cell count and HAART status of hospitalised HIV/AIDS patients in Shika. PATIENTS AND METHODS: Consecutive adult (e"15 years) non pregnant HIV- infected patients treated at Ahmadu Bello University Teaching Hospital Shika-Zaria from January 2006 to May 2013 with neuropathies were studied. Non HIV-infected patients with neurological disorders and HIV-infected patients without neuropathies were excluded. RESULTS: Of 5240 HIV/AIDS patients seen , 11% (566) presented with neuropathy at median CD4+ cell counts of 200 cells / ul, with yearly reduction of the frequency of patients with neuropathy from 3.9% in 2006 to 0.06% in 2013. Male: female ratio was 2:1 and respective mean years were 41.9±10.1: 45.3±17.4 (p<0.00). 253 (45%) were on HAART at presentation. 40 patients died and the mortality was associated with recurrent seizures, CD4+ cell counts d" 100 / ul, male sex, HAART-naivety and presence of co-morbidity and complications. CONCLUSIONS: The progressive reduction in the yearly frequency of neuropathy among HIV/AIDS patients suggests a beneficial effect of HAART on neuropathies. However, late presentation, low CD4+ cell counts and failure of patients to start HAART early were responsible for AIDS-related mortality thus highlighting the importance of early HIV screening and treatment.

Male urinary incontinence and dementia in Zaria, Nigeria.

BACKGROUND: Ageing population in all parts of the world has make dementia in the elderly an important public health issue. Behavioural and Psychological symptom of dementia like urinary incontinence seldom attract the attention of clinicians providing care for the elderly. OBJECTIVE: To determine the prevalence of dementia among elderly male patients presenting with urinary incontinence to a urology clinic. SUBJECTS AND METHOD: We recruited consecutive elderly patients and their caregivers presenting to the urology clinic of Ahmadu Bello University Teaching Hospital for the treatment of urinary incontinence. The patients were assessed using Socio-demographic data collecting sheet, Consortium to Establish Registry for Alzheimer's Disease (CERAD), Stick Design Test and physical examination. While the caregivers were interviewed using the Blessed Dementia Scale. A consensus diagnosis was made for each of the patients based on criteria for dementia in both Diagnostic and Statistical Manual 4th edition (DSM-IV) and International Classification for Diseases 10 edition( ICD-10). All test of statistics were carried out at 5%level of probability. RESULTS: A total of 121 patients participated in the study. The mean age of the patients was 70.58 ± 5.47 years (95% CI=69.10-71.55). A total of 11 patients (9.10%, 95% CI=3.98-14.22) have dementia based on the consensus diagnosis. Dementia among this cohort is significantly associated with advancing age and enuresis. CONCLUSION: Dementia is common among elderly patients with urinary incontinence in Africa but remains large undetected and unrecognised.

Fear of future terrorism: Associated psychiatric burden.

BACKGROUND: The mental health burden from fear of future terrorism has not been given much research attention compared to the immediate mental distress such as post-traumatic stress disorder (PTSD). Such neglected ongoing mental health morbidity associated with threats of terrorism had been described as pre-traumatic stress syndrome (PTSS). OBJECTIVE: The study highlighted this phenomenon (PTSS) in Nigeria by examining the catastrophic burden of the fear of future terrorism and associated psychiatric burden among adult population in Kaduna city. METHOD: Participants were students and staff of Kaduna State University (KASU), Kaduna Polytechnic, and students awaiting admission into Kaduna State University. They responded to the following instruments after obtaining their informed consents: a sociodemographic questionnaire, the Terrorism Catastrophising Scale (TCS), and the depression and Generalised Anxiety Disorder (GAD) portion of Mini International Neuropsychiatric Interview (MINI). RESULTS: The TCS showed that 78.8% of the participants had from moderate to severe clinical distress on fear of terrorism. The TCS has a Cronbach's alpha of 0.721 and also had significant moderate correlation with depression (r=0.278; p<0.01) and GAD (r=0.201; p<0.01) scales of MINI. CONCLUSION: The study illustrated that the mental health burden from the fear of terrorism was high and this was relatively related to depression and GAD. This highlighted the need for ongoing monitoring and called for their effective prevention from the identified underlying cognitive mechanisms.

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.

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.

Severe depression following á-interferon usage in a patient with chronic myeloid leukemia.

BACKGROUND: Chronic myeloid leukaemia (CML), with a median age of 40 years, is one of the commonest haematological malignancies in Nigeria. Cytoreductive agents, which were hitherto the mainstay of treatment, neither induce cytogenetic nor haematologic remission. Alphainterferon (á-IFN), an endogenous glycoprotein with cytotoxic and natural killer cell enhancer effects has been found to induce haematologic and cytogenetic remission in patients with CML, but neuro-psychiatric complications of á -interferon (á-IFN) usage were not reported in Nigeria. OBJECTIVE: To report a case of deliberate self-harm in University Lecturer as a side effect of á-IFN in the treatment of CML METHOD: Clinical and laboratory follow up of a patient receiving á-IFN in the management of CML from the time of diagnosis of CML to the point of loss of contact. RESULT: Severe depression is a complication that may adversely influence the clinical outcome of á-IFN usage CONCLUSIONS/RECOMMENDATIONS: Although interferon related depression is uncommon, it is suggested that pre-therapy interferon assays and neuro-psychiatric assessment are carried out in prospective users of á-IFN.