Psychoactive substance use among outpatients with severe mental illness: A comparative study

Background: Despite several studies on the prevalence and pattern of substance use in Nigeria, there is little information on substance use in patients diagnosed with serious mental illness (SMI) such as schizophrenia and bipolar affective disorder (BD).Aim: The aim of the study was to compare the pattern of psychoactive substance use among outpatients with BD and schizophrenia.Setting: The study was conducted in a neuropsychiatric hospital in Nigeria.Methods: Seventy five consecutive patients with a MINI-PLUS diagnosis of BD were compared with an equal number of patients obtained by systematic random sampling with a MINI-PLUS diagnosis of schizophrenia. Results: The respondents with schizophrenia were aged 18­59 years (37.2 ± 9.99) and were predominantly young adult (49, 65.3%), men (46, 61.3%), who were never married (38, 50.7%). Overall, lifetime drug use prevalence was 52%, while for current use, overall prevalence was 21.3%. Participants with BD were aged 18­63 years (36.7 ± 10.29) and were predominantly young adult (53, 70.7%), women (44, 58.7%), who were married (32, 42.7%), with tertiary education (31, 41.3%). Overall, lifetime drug use prevalence was 46.7%, while current overall prevalence was 17.3%. These rates (lifetime and current) for both diagnostic groups are higher than what was reported by the World Health Organization in the global status report of 2014 (0% ­ 16%). The statistically significant difference between the two diagnostic groups was related to their sociodemographic and clinical variables and psychoactive substance use.Conclusion: Psychoactive substance use remains a burden in the care of patients diagnosed with schizophrenia and BD. Future policies should incorporate routine screening for substance use at the outpatient department with a view to stemming the tide of this menace

Epidemiology of drug abuse treatment in South Africa

Background. The aim of the study was to explore the epidemiology of drug abuse treatment in South Africa. Methods. Treatment demand statistics were analysed from South African National Council on Alcoholism and Drug Dependence and the South African Community Epidemiology Network on Drug Use records; and a rapid situation assessment was conducted. Twenty-one key informant interviews were conducted in all 9 provinces among provincial substance abuse co-ordinators, and one manager per treatment centre from a sample of treatment centres. Three focus groups were conducted and 46 self-administered questionnaires were distributed among inpatients at 2 selected treatment centres in Free State and North West provinces. Qualitative data were analysed using grounded theory, and quantitative data analysed using SPSS. Results.Treatment records show that the most frequent substance of abuse was alcohol (51), followed by cannabis (21), crack/cocaine (9.6), heroin/opiates (7.9), methamphetamine (Tik) (4.5), prescription/over-thecounter drugs (2.0), and cannabis/mandrax (1.7). More substance abusers were male, of lower education, white or black, than were female, more highly educated; coloured and Indian/Asian. Key informant interviews showed that females are the 'hidden' substance abusers and tend not to be identified in research statistics and at treatment centres. Poverty, unemployment, lack of recreational facilities, being surrounded by substance abusers; and long work shifts were also mentioned as factors contributing to substance abuse. The age of initiation of substance abuse using non-drugs such as glue was 9 years old; alcohol 10 - 12 years old, dagga 11 -12 years old, poly-drug use (alcohol, tobacco and dagga) 14 years old, and harder drugs such as cocaine and heroin at 16 - 17 years old, as reported by key informants. Family care and support, improved socio-economic conditions and increased law enforcement would help to discourage substance abuse. Conclusion. Prevention interventions and policies in South Africa should focus on reducing substance abuse by targeting the 'at risk populations' identified in this study

Profils epidemiologiques et cliniques des toxicomanies : a propos de 109 cas (C.H.U. de Ouagadougou)

Les auteurs ont etudie les manifestations cliniques chez 109 patients vus en consultation externe ou hospitalises au service de Psychiatrie du Centre Hospitalier National Yalgado OUEDRAOGO. 93 des 109 patients sont des jeunes et des adultes de 16 a 40 ans dont 4 pour cent sont des femmes. 76 pour cent sont de celibataires et 36;1 pour cent de l'echantillon sont des chomeurs. Ces patients consommaient regulierement des amphetamines (43 pour cent) du cannabis (42 pour cent); de l'alcool (37 pour cent) et des barbituriques (12 pour cent). Cliniquement; 44 pour cent avaient des hallucinations auditives; visuelles ou coenesthesiques tandis que les auteurs ont note que 62 pour cent presentaient une agressivite et 60 pour cent une agitation. L'anxiete etait notee chez seulement 4 pour cent des patients. Les patients consommateurs d'alcool etaient agites (25 pour cent); delirants (21 pour cent) agressifs (21 pour cent) hallucines (17 pour cent) et insomniaques (17 pour cent); 26 pour cent des consommateurs d'amphetamines etaient agressifs tandis qu'on notait un delire (24 pour cent) une agitation (22 pour cent) et l'insomnie (17 pour cent) chez les consommateurs de chanvre indien. Les traitements les plus administres etaient surtout lemeprobamate (68 pour cent) le chlorpromazine (58 pour cent) et le diazepam (33 pour cent)