Risk of manic switch with antidepressants use in patients with bipolar disorder in a Nigerian neuropsychiatric hospital

Background: Depressive disorders are common among those with bipolar affective disorder (BAD) and may necessitate the use of antidepressants. This has been suggested to precipitate manic episodes in some patients. Objectives: This study aims to determine the prevalence of and factors associated with manic switch in patients with BAD being treated with antidepressants. Methods: Case notes of patients who were treated at a Nigerian neuropsychiatric hospital for a BAD from 2004 to 2015 were reviewed. BAD diagnosis was made using ICD-10 criteria. Treatment for bipolar depression included monotherapy (i.e. antidepressants, antipsychotics or mood stabilisers) or combination therapy (mood stabiliser with an antidepressant or a combination of mood stabilisers, antipsychotics and antidepressants). The primary outcome measure was a switch to mania or hypomania within 12 weeks of commencing an antidepressant. Results: Manic or hypomanic switch (MS) was observed in 109 (44.3%) of the participants. Female gender, younger age, number of previous episodes and a past history of psychiatric hospitalisation were all significantly associated with a risk of MS. There was no significant difference in the rate of MS in either those treated with adjunct antidepressants therapy with a mood stabiliser or an antipsychotic or those placed on a combination of antidepressants, antipsychotics and mood-stabilising agents. Conclusion: A large proportion of patients with BAD on antidepressants experience medication-induced manic or hypomanic switch

Level of awareness and treatment of anxiety and depression during pregnancy in southeast Nigeria

Background: Anxiety and depressive disorders are somewhat masked by features of pregnancy; hence many women are ignorant of them and are untreated. Aim: To determine the level of awareness and treatment of anxiety and depression in pregnancy. Setting: The study was carried out at the antenatal clinic of Enugu State University Teaching Hospital, Enugu, Nigeria. Method: This was a cross-sectional and descriptive study of 200 pregnant women in consecutive attendance of the antenatal clinic using the Hospital Anxiety and Depression Scale (HADS) and a sociodemographic questionnaire. Results: Of the participants, 23.5% had anxiety and/or depression, 7.5% of them were aware of their condition and only 0.5% of all the participants or 6.7% of those who were aware of their problem received treatment. Conclusion: Anxiety and depression are prevalent among pregnant women. Because of overlap of symptoms of anxiety and depression with those of pregnancy, the awareness is very low; hence many of them suffer immensely without treatment

Depressive features among adult patients receiving antiretroviral therapy for HIV in Rustenburg district, SA

Background. Globally; it is estimated that depressive features occur in 15 - 36 of people suffering from chronic diseases and 60 of people with HIV/AIDS. A high prevalence of mental disorders among HIV-infected individuals has been shown in South Africa and other parts of sub-Saharan Africa. Untreated depression leads to poor adherence to treatment and poor quality of life for patients with chronic diseases.Methods. Using the Zung self-rating scale; we screened for depressive features among adult patients receiving highly active antiretroviral therapy (HAART) who attended primary healthcare facilities in the Rustenburg district of North West Province in South Africa during December 2009.Results. Among 117 participants; 81 (69.2 ) had mild depressive features; 2 (1.7) had moderate depressive features; 1 (0.9 ) had severe depressive features and 33 (28.2) did not have depressive features. Depressive features were more common in males (77.1) than in females (69.5); and were most common in patients taking the combination of efavirenz; lamivudine and stavudine.Conclusion. Depressive features seem to be common among adult patients receiving HAART and attending primary healthcare facilities in the Rustenburg district

The Association between Depression and Adherence to Antiretroviral Therapy in HIV-Positive Patients; Kwazulu-Natal; South Africa

Background: Depressive disorders are associated with poorer health outcomes in people living with human immunodeficiency virus infection and acquired immunodeficiency syndrome (PLHIV) and have been shown to contribute to non-adherence to antiretroviral therapy (ART) in Western contexts. Limited data from developing countries are available. The aim of this study was to explore whether there was an association between depressive symptoms and adherence to ART among PLHIV in KwaZulu-Natal; South Africa.Method: A cross-sectional analytical study was undertaken in a population of HIV-positive patients accessing ART at a government funded; semi-urban clinic in the eThekwini Municipal District; KwaZulu-Natal; South Africa. The tools used to measure depressive symptoms and adherence were the Centre for Epidemiology Studies Depression Scale (CES-D) and clinic-based pill counts; respectively. Socio-demographic and clinical data were collected during interviews and from patient records.Results: Sixty-two per cent of the sample (n = 146) had higher-than-threshold levels on the depression scale; and 32 were less than 95 adherent to ART. High depression scores were associated with lower levels of education [odds ratio (OR) 2.0; 95 confidence interval (CI); 1.0-4.1] and unemployment (OR 2.8; 95 CI; 1.3-6.0); while non-adherence was associated with unemployment (OR 2.4; 95 CI; 1.0-6.1) and mid-range CD4 counts (200-499 cells/?l; OR 3.0; 95 CI; 1.3-6.9). No significant association was found between depressive symptoms and non-adherence to ART (OR 0.5; 95 CI; 0.2-1.2; p-value; 0.125).Conclusion: The large percentage of participants who scored high on the CES-D suggests a high prevalence of major depression in the study population. No significant association was found between high depression scores and nonadherence to ART. Depressive symptoms were significantly linked to lower levels of education and unemployment; while non-adherence was associated with unemployment and mid-range CD4 counts (200-499 cells/?l). The study had some limitations. Further studies are needed to determine the prevalence and causes of depression and its impact on PLHIV in this population and in the developing world

Risk factors towards self-destructive behaviour among fresh students at Makerere University

It has been suggested that some individuals are suicide prone; and that such individuals can be detected long before they commit suicide. This paper reports the risk factors associated with potential self-destructive behaviour among a group of freshwomen at Makerere University. A suicide proneness questionnaire; the Umzimkulu suicide Proneness Inventory (USPI); was completed by 619 students admitted to the University in the academic year 1992/93. The results indicate that students' propensity to self-destructive behaviour was significantly related to the history of suicide behaviour among the students; or their relatives; and the presence of a probable depressive disorder as indicated by scores above at least 60 on each of SR; AL; AS; and PDW; scales on the questionnaire. The paper describes in detail the development of the USPI; and the theory underlying the study. Implications for improving counselling services for students at Makerere University are highlighted

Approche epidemiologique et clinique des troubles psychiatriques des personnes agees : a propos de 464 cas recenses au DHM de l'INSP du 1er Janvier 1999 au 31 Decembre 2003

L'etude des personnes agees ayant consultees au DHM du 1er janvier 1999 au 31 decembre 2003 montre une predominance des femmes (65;52pour cent) soit un sexe ratio de 1;9 femmes pour un homme. Ces sujets ont le plus souvent entre 55 et 65 ans; resident majoritairement a Abidjan (63;15pour cent) et sont sans profession (59;70pour cent). Ces personnes agees sont; dans la plupart des cas (73;28pour cent); adressees par leur famille; cependant; apres plus de six mois de latence (35;34pour cent). Le tableau clinique est le plus souvent domine par des troubles de la pensee (41;81pour cent) suivis par les troubles instinctuels (39;22pour cent). La pathologie organique constitue le diagnostic le plus frequent (36;22pour cent) avec les syndromes dementiels qui y sont predominants (86;90pour cent). Concernant le traitement; les neuroleptiques sont les psychotropes les plus prescrits (58;53pour cent) suivis par les antidepresseurs (28;38pour cent) et les anxiolytiques (25;43pour cent). Dans certains cas; d'autres classes therapeutiques sont associees. Il s'agit; par ordre decroissant de frequence des oxygenateurs cerebraux (19;61pour cent); des antiischemiques (11;21pour cent) et des complexes vitaminiques (2;37pour cent)

Cephalee depressive: trouble psycho-somatique par excellence

A partir d'une etude semio-nosographique de 50 malades deprimes majeurs suivis au CNPP/UNIKIN (Centre neuro Psycho Pathologique - universite de Kinshasa); les auteurs montrent l'importance de la cephalee comme symptome physique d'origine psychique. Celle-ci masque souvent une depression et cree ainsi un tableau clinique special qui constitue une source d'egarement des malades et d'erreur diagnostique avec toutes les consequences imaginables. Les auteurs insistent sur l'importance de l'intrication psycho-somatique de la symptomatologie depressive afin d'eveiller l'attention des praticiens. Ils invitent ces derniers a evoquer l'eventualite d'une depression devant toute cephalee de type ''Dysthymie holocranienne diffuse'' et non systematisee