Knowledge and perception of mental disorders among relatives of mentally ill persons in a rural community in South-South Nigeria

Background: In Nigeria, mental disorders (MDs) are prevalent in the population and compounding the problem is the misconceptions and poor perceptions associated with these conditions. Consequently, the study was designed to assess the knowledge and perception of mental disorders among relatives of mentally ill persons in Amai community, Ukwuani Local Government Area, Delta State Nigeria. Methods: This was a descriptive study utilising qualitative method of data collection. An in-depth interview was conducted among 20 relatives of mentally ill people selected purposively from four quarters in Amai community. An in-depth interview guide was used to collect the data and was analysed manually for themes and content. Results: The age range of the participants was 25-75 years, comprising 11 females and nine males. The participants demonstrated some form of knowledge of the critical element of MDs, but showed misconceptions on the causes of MDs. Most of the participants preferred traditional (unorthodox) medicine for the treatment of MDs. Furthermore, despite their affirmative perception of MDs as a serious illness, the majority exhibited negative perception towards people with MDs. Conclusion: Misconceptions and myths about the causes of mental disorder are very prevalent among rural dwellers. Poor perception towards mentally challenged persons among relatives of mentally challenged persons was also common. Therefore, these misconceptions and myths should be corrected through organized strategic awareness campaigns among rural dwellers aimed at eliminating these misconceptions and myths, thereby improving the quality of life of persons suffering from MDs

Facteurs socioéconomiques des maladies mentales des patients hospitalisés à l'hôpital Errazi, Tétouan, Maroc

Le présent travail s'inscrit dans le cadre des travaux de recherche de fin d'étude au niveau de l'ISPITS de Tétouan (étudiants, option infirmier en santé mentale, promotion 2011-2014), a intéressé tous les patients hospitalisés (soit 405 dossiers) à l'Hôpital psychiatrique Errazi de Tétouan durant l'année 2013. Ce travail correspond à une étude des facteurs de risques socioéconomiques et environnementaux en relation avec le diagnostic des maladies mentales révélé. L'exploitation des dossiers a montré que la majorité des patients psychiatriques hospitalisés sont de sexe masculin (85%) appartenant à la tranche d'âge 20-35ans (52%) qui sont célibataires (78%) avec un niveau intellectuel très faible (56%) et sans scolarisation (24%) et dont la plus part sans emploi (62%). Pour les femmes (15%) dont la plus part appartiennent à la tranche d'âge de 20-35 ans (32%) et 35-50 ans (39%) et qui sont célibataires (45%) et divorcées (24%). Elles sont non scolarisées (44%) ou avec un niveau de scolarisation primaire (29%) et dont la majorité reste sans emploi (89%). Cette situation socioéconomique tellement défavorable a une grande influence sur l'état de santé mentale des patients et sur leur personnalité. En effet, le diagnostic pathologiques enregistrés a montré une diversité de maladies mentales dont la schizophrénie (F20-F29), les troubles schizophréniques et les troubles délirantes avec plus de 93% (dont 75% de F20), les troubles d'humeur (F16-F18) de 2%, les troubles liés à l'utilisation des substances psycho-actives (F30-F32) de 1,5%, les troubles de la personnalité (F43-F48) de 1%, les troubles névrotiques (F60-F68) 2% et les affections paraxystiques (G40) de 0,5%. Durant cette étude, nous pourrons conclure que le diagnostic pathologique révélé des patients hospitalisés dans cet hôpital, pourrait être favorisé par leurs faibles niveaux socio-économiques et environnementaux

Stigmatising attitudes towards the mentally ill: a survey in a Nigerian university teaching hospital

Background. The burden of mental illness is particularly severe for people living in low-income countries. Negative attitudes towards the mentally ill; stigma experiences and discrimination constitute part of this disease burden.Objective. The aim of this study was to investigate knowledge of possible causes of mental illness and attitudes towards the mentally ill in a Nigerian university teaching hospital population.Method. A cross-sectional descriptive study of a convenience sample of 208 participants from the University of Uyo Teaching Hospital; Uyo; Nigeria; using the Community Attitudes towards the Mentally Ill (CAMI) scale. Information was also obtained on beliefs about possible causes of mental illness.Results. The respondents held strongly negative views about the mentally ill; mostly being authoritarian and restrictive in their attitudes and placing emphasis on custodial care. Even though the respondents appeared to be knowledgeable about the possible role of psychosocial and genetic factors in the causation of mental illness; 52.0 of them believed that witches could be responsible; 44.2 thought mental illness could be due to possession by demons; and close to one-third (30) felt that it could be a consequence of divine punishment.Conclusions. Stigma and discrimination against the mentally ill are widespread even in a population that is expected to be enlightened. The widespread belief in supernatural causation is likely to add to the difficulties of designing an effective antistigma psycho-educational programme. There is a need in Nigeria to develop strategies to change stigma attached to mental illness at both institutional and community levels

Continuity of care of outpatients with schizophrenia in Pretoria

Objective. To study the needs of outpatients suffering from schizophrenia and their primary caregivers. Methods. A qualitative descriptive design was selected to study the needs of a non-probability purposive sample of 50 outpatients with schizophrenia and their primary caregivers. Data were collected on their compliance-related needs as well as psychosocial and aftercare treatment needs. Results. Compliance needs: Eighty-three per cent of the participants supported their medication treatment and aftercare, but needed more information on the illness than they had received or had managed to gather. Psychosocial needs: Participants had difficulty in accepting the illness and in understanding its consequences for their everyday functioning. Ninety-seven per cent of patients were aware that their illness had affected the health of their primary caregiver. The majority of participants had lost friendships since the diagnosis of schizophrenia. Eighty-eight of the primary caregivers supported the patient financially, despite the fact that many were over 60 years of age. Aftercare treatment needs: A strong need was expressed for services such as day-care centres, workshops, and psychoeducational and social work services. Conclusions. As South African health policy is moving towards de-institutionalisation and treating mental health as part of primary care; support must be improved for sufferers of schizophrenia and their primary caregivers. Many people are prepared to face up to the challenge of caring for a mentally ill family member, yet are faced with significant needs that should be addressed

The regulation of informed consent to participation in clinical research by mentally ill persons in South Africa: an overview

The article examines the legal requirements relating to the informed consent of mentally ill persons to participation in clinical research in South Africa. First; the juridical basis of informed consent in South African law is outlined; and second; the requirements for lawful consent developed in South African common law and case law are presented. Finally; the article deliberates upon the requirements for the participation of mentally ill persons in research as laid down by the Mental Health Care Act and its regulations; the National Health Act and its (draft) regulations; and the South African Constitution

A review of the applications for involuntary admissions made to the Mental Health Review Boards by institutions in Gauteng in 2008

Aim. To review applications for involuntary admissions made to the Mental Health Review Boards (MHRBs) by institutions in Gauteng. Method. A retrospective review of the register/database of the two review boards in Gauteng for the period January - December 2008. All applications for admissions (involuntary and assisted inpatient) and outpatient care (involuntary and assisted), and periodic reports for continued care (inpatient or outpatient care) were included. Results. During the study period the two MHRBs received a total of 3 803 applications for inpatient care, of which 2 526 were for assisted inpatient care (48.1 regional hospitals, 29.6 specialised psychiatric hospitals, 22.2 tertiary academic hospitals). Of the applications for involuntary inpatient care, 73.1 were from the specialised psychiatric hospitals (65.2 from Sterkfontein Hospital). Applications for outpatient care; treatment and rehabilitation (CTR) numbered 1 226 (92 assisted outpatient CTR). Although the health establishments in northern Gauteng applied for more outpatient CTR compared with those in southern Gauteng (879 v. 347; respectively), the ratios of assisted to involuntary outpatient applications for CTR for each region were similar (approximately 12:1 and 9:1, respectively). The boards received 3 805 periodic reports for prolonged CTR (93.5 inpatient, 6.5 outpatient) in the majority of cases for assisted CTR. Conclusion. The study suggests that in the 4 years since the promulgation of the Mental Health Care Act (MHCA) in 2004, there have been significant strides towards implementation of the procedures relating to involuntary admission and CTR by all stakeholders. Differences in levels of implementation by the various stakeholders may result from differences in knowledge, perceptions, attitudes and understanding of their roles and therefore indicate the need for education of mental health care professionals and the public on a massive scale. The Department of Health also needs to invest more funds to improve mental health human resources and infrastructure at all health establishments

Attitudes towards psychiatry of undergraduate medical students at Bayero University, Nigeria

Background. This study determined and compared responses of 5th- and 6th (final)-year medical students on their attitudes to psychiatry as a profession. Also elicited were their choices of area of future medical specialisation. Method. A prospective and cross-sectional study using an adapted 27-item self-administered questionnaire to obtain responses from 91 5th- and 6th-year medical students at Bayero University, Kano, Nigeria. Results. More than 60% of the students' first choices for future specialisation were surgery, obstetrics/gynaecology or internal medicine. Psychiatry was the first preference for less than 2%. More than 75% of the students' views on the overall merits and efficacy of psychiatry were positive, although they felt that psychiatry had low prestige and status as a profession. In addition, the same proportion considered that psychiatry was scientific, making advances in the treatment of major mental disorders, and helpful in liaison practice. More than 50% stated that psychiatry would not be their choice of last resort for residency education and the same proportion felt that friends and fellow students rather than family members would discourage them from specialising in psychiatry. More than 50% would feel uncomfortable with mentally ill patients, felt that psychiatry would not be financially rewarding, and did not think that psychiatrists abuse their legal power to hospitalise patients. Attitudes of the two groups of students to psychiatry as a profession were not significantly different (p>0.05). Conclusion. A clinical clerkship in psychiatry did not influence the students' choice of future specialisation

Post traumatic stress disorder symptoms in a psychiatric population not presenting with trauma: a preliminary study

Post Traumatic Stress Disorder (PTSD) is a diagnostic category used to describe symptoms arising from emotionally traumatic experience(s). Research suggests that PTSD may be under- diagnosed when trauma is not the presenting problem or when not the focus of clinical intervention. There is a dearth of South African information on the prevalence of PTSD in a psychiatric population. The aim of this study was to determine the prevalence and comorbidity of PTSD in a psychiatric population; not presenting on the basis of trauma. Method: The study was cross sectional and conducted at a psychiatric outpatient clinic in the Durban Metropolitan area. The sample was obtained from patients seen at follow up over a period of twelve weeks. The researcher randomly selected prospective participants and at the end of their consultation the purpose of the study was explained and they were invited to participate. Demographic characteristics and diagnosis were recorded. Thereafter; the Zulu version of the Modified Posttraumatic Diagnostic Scale (MPDS) was administered and data collected. Results: The study demonstrated that 22of subjects reported symptoms of PTSD where the primary presentation was not trauma related. Conclusion: A significant number of psychiatric patients presenting for non-trauma related psychopathology report symptoms of PTSD when specifically questioned. The findings suggest that such questioning may be overlooked when dealing with psychiatric patients who do not specifically present on the basis of trauma

Patients with Severe Mental Illness : a New Approach for Testing for HIV

Background :The prevalence of infection with the Human Immuno-deficiency Virus (HIV) in South Africa is approaching 20of young adults. In severely mentally ill people; it is probably higher. Testing for infection is subject to stringent ethical principles. Undiagnosed HIV infection in people with severe mental illness increases costs and morbidity. Since effective treatments are available; it is imperative to diagnose HIV infection early in this high risk population. Methods : a literature review established the prevalence of HIV infection in in-patient populations with HIV infection. The pattern of testing for HIV over three years at a major psychiatric hospital was investigated. We surveyed public sector psychiatrists in the Western Cape to establish their attitudes to HIV in their patients. Results The HIV reported seroprevalence in psychiatric in-patients ranges from 0-59.3; with a mean of 10. Data show a clear trend towards an increase in prevalence: Pre 1996 the mean HIV seroprevalence was 7.4; while post 1996 the mean was 15. State psychiatrists in the Western Cape do not test routinely for HIV infection; mainly due to ethical constraints: 14.6of patients at Lentegeur Hospital were tested in 2006. Conclusions The high prevalence of HIV infection in South Africa; that is probably higher in patients with severe mental illness (most of whom are not competent to provide informed consent) and the availability of effective treatment; requires debate and a clear policy regarding testing for HIV infection to be implemented. We recommend a new approach to HIV testing in these patients

Involuntary Admission of Psychiatric Patients in the Northern Cape Province and the Accuracy of the Initial Psychiatric Assessment done by Referring General Practitioners

"Background : Admission to a mental healthcare facility is not always based on the voluntary consent of the patient. Sometimes a patient is unable or unwilling to consent to admission because of his mental status and lack of insight into his mental illness. If a mentally ill person needs admission because of a threat to himself and other people; the law prescribes procedures to admit such a person into an appropriate facility for care; treatment and rehabilitation. Such admissions are called involuntary admissions. Involuntary admissions in a psychiatric hospital have financial; legal and ethical implications. In order to avoid unnecessary involuntary admissions; there is a need to determine and understand the factors causing involuntary admissions. Many previous studies have focused on the differences between patients admitted voluntarily and involuntarily. The goal of this study was to analyse the conditions responsible for the involuntary admission of psychiatric patients in the Northern Cape Province and the accuracy of the initial psychiatric assessment done by the referring general practitionersMethods : This descriptive study included 199 patients admitted to West End Hospital in Kimberley for involuntary treatment during 2003. The data were extracted from clinical records and legal documentation relating to these patients. The patients' final diagnoses were extracted from the discharge summary and were based on the text revision of the fourth edition of DSM (DSM-IV-TR). Only diagnoses on axis I (clinical disorders and other conditions that may be a focus 1 clinical attention); axis II (personality disorders and mental retardation) and axis III (physical disorder or general medical condition that is present in addition to the mental disorder) were included in this study.Results : Most patients were male (65.8) and the patients' ages ranged from 16 to 67 years (mean 32 years). Patients were mostly diagnosed with schizophrenia (57.8); while 26.6had substance-related disorders. Few patients (5.0) were diagnosed with mental retardation and personality disorders. A quarter (24.1) of the patients had a general medical condition. The majority (81.4of patients were found ""certifiable"" and 77.4 were known psychiatric patients. Two-thirds of the patients were referred by general practitioners doing session for the state hospitals. The overall accuracy of psychiatric diagnosis by the referring doctors was considered correct if any of the provisional diagnoses listed by the referring (certifying) doctor matched with the final diagnosis at discharge from the hospital. Approximately half (49.5) of the patients were diagnosed correctly by the referring doctors. Conclusion : Schizophrenia and psychoactive substance-related disorders were the most important conditions leading to involuntary care in the Northern Cape. General practitioners play a major role in involuntary admission; but only made correct psychiatric diagnoses in approximately half of the patients."