Consequences of COVID-19 on access and delivery of mental health care in two rural Ethiopian districts. A mixed method study

Introduction: The impact of COVID-19 on people with Severe Mental Health Conditions (SMHCs) has been neglected. We aimed to describe the effect and explore the consequences of COVID-19 on people with SMHCs and mental health services in rural districts of Ethiopia. Methods: We conducted a mixed-method study nested within well-characterized population cohorts in Butajira and Sodo districts. We sampled 336 people (168 people with SMHCs, 168 comparisons) in a cross-sectional survey. We conducted qualitative key informant interviews with psychiatric nurses (n=3), primary health care workers (n=3), service users (n=4), family members (n=6) and community members (n=2). We assessed wellbeing (WHO wellbeing index), social support (Oslo social support scale; OSS) and food security quantitatively and used thematic analysis to explore impacts. Results: People with SMHCs reported significantly lower wellbeing (WHO wellbeing score 52 vs. 72; p<0.001), less social support (OSS score 8.68 vs. 9.29; p<0.001), worse living standards (47.0% vs. 29.0%; p<0.001) and increased food insecurity (26.0% vs. 12.5%; p<0.001). Household economic status worsened for over one-third of participants. Participants reported increased relapse, exacerbated stigma due to perceived susceptibility of people with SMHCs to COVID-19, and increased restraint. In mental healthcare settings, there was decreased patient flow but an increase in new cases. Innovations included flexible dispensing of medicines, longer appointment intervals and establishing new treatment centers. Conclusions: COVID-19 had negative consequences on people with SMHCs and mental health services, which must be anticipated and prevented in any future humanitarian crisis. Adaptive responses used during COVID may increase health system resilience

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

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

Prevalence and correlates of alcohol use disorders among bipolar patients at Amanuel Mental Specialized Hospital, Addis Ababa (Ethiopia): A cross-sectional institution based study

At this time, alcohol use is increasing in African countries. The prevalence of alcohol use disorders (AUDs) remains unknown in patients with psychiatric disorders. This study aimed to assess the prevalence of AUDs among individuals with bipolar disorder in the outpatient department at Amanuel Mental Specialized Hospital. An institution-based cross sectional study was conducted among 412 bipolar patients attending the outpatient department at Amanuel Mental Specialized Hospital from May ­ July 2015.Participants were selected using a systematic random sampling technique. Semi-structured questionnaires were used to collect socio-demographic and clinical data. Alcohol use disorder was measured using the Alcohol Use Disorders Identification Test (AUDIT-10). Binary logistic regression analysis was performed. The prevalence of alcohol use disorder was found to be 24.5%. Those affected were predominantly female (58.5%). Being18-29 years of age(AOR=3.86, 95% CI: 1.34, 11.29), being 30-44 years of age (AOR=4.99, 95%CI: 1.85, 13.46), being unable to read and write (AOR=5.58, 95%CI: 2.026, 13.650), having a secondary education (AOR=3.198, 95%CI: 1.149, 8.906), being a farmer (AOR=4.54, 95%CI: 1.67, 12.32), being employed by the government (AOR=3.53, 95%CI: 1.36, 4.15), being a day labourer (AOR=3.5, 95%CI: 1.14, 10.77), use of other substances during past 12 months (AOR=2.06, 95%CI: 1.06, 3.99), having a family history of alcohol use (AOR=2.18, 95%CI: 1.29, 3.68), having discontinued medication (AOR=2.78, 95%CI: 1.52, 5.07), having suicidal thoughts (AOR=4.56, 95%CI: 2.43, 8.54), and having attempted suicide (AOR=5.67, 95%CI: 3.27, 9.81) were statistically significant to alcohol use disorder using multivariate logistic analysis. The prevalence of co-morbid alcohol use disorder was high. This finding suggests that screening for risky alcohol use should be integrated into routine hospital outpatient care. Further, preventive measures against alcohol use disorder should be established

Prise en charge medicamenteuse des troubles de l'humeur des adolescents au Service d'Hygiene Mentale; Abidjan Cote d'Ivoire

Introduction. Les troubles mentaux et neurologiques sont devenus une priorite de sante publique. En effet; la morbidite liee a la depression apparait desormais au premier rang des pathologies psychiatriques dans le monde et une place de choix pour les troubles bipolaires avec ses consequences individuelles et sociales majeures. En Cote d'Ivoire; ces troubles pourraient etre aggraves chez l'adolescent du fait de la longue crise militaro- politique. Notre etude avait pour but d'evaluer les elements indicatifs de la prise en charge medicamenteuses des troubles de l'humeur chez les adolescents dans un contexte de crise sociopolitique a Abidjan. Materiels et Methodes. Ce travail retrospectif a visee descriptive a concerne des patients ages de plus seize ans en Cote d'Ivoire. Le recueil actif des donnees s'est fait a partir d'un questionnaire valide; de consultation des dossiers medicaux des patients du service de l'hygiene Mentale et d'un entretien structure avec le personnel Resultats. Adolescents ages de 18 ans a 20 ans (48;1). La repartition des adolescents selon le sexe a releve une predominance du sexe feminin (58) contre 42; soit une sex ratio de 1;24. Les eleves et etudiants (69;5) etaient les plus atteintes des troubles de l'humeur; 63;4 des adolescents ont ete adresses par la famille; vivent dans une famille monoparentale. La majorite des adolescents (63;4) ont ete adressees au SHM par leurs familles dont 25;9 des centres soins conventionnelles. Les bizarreries comportementales representaient le motif de consultation le plus frequent avec un taux (11;7). Le mode de debut des troubles de l'humeur etait brutal dans la majorite des cas (63;4). Les symptomes somatiques (37;7) representent l'essentiel des symptomes de la consultation psychiatrique; Les etats depressifs (56;4) representent essentiellement le diagnostic le plus rencontre devant les acces maniaques (40;54). Les antidepresseurs (30;9) ont ete les plus prescrits car les etats depressifs etaient les plus rencontres (56;4); suivis des thymoregulateurs (25;1).Conclusion. Notre etude a permis de montrer une bonne prise en charge medicamenteux des troubles de l'humeur chez l'adolescent. Il en ressort qu'une subvention de l'etat Ivoirien du cout des psychotropes; utilises au long court; serait un soulagement des patients et la famille car ils constituaient le facteur determinant du pronostic du malade

Psychosis and relapse in bipolar disorder are related to GRM3, DAOA, and GRIN2B genotype

Objective: Dysfunction in glutamate signalling is thought to play a role in the pathophysiology of bipolar disorder (BD). There is evidence of associations between single nucleotide polymorphisms (SNPs) in GRM3, GRIN2B, and DAOA genes and the diagnosis of BD. In this pilot study, we investigated the frequency of SNP variants in these 3 genes within South African population groups, and assessed interactions between genes and phenotypes of BD disease severity. Method: Multiplex SNaPshotTM PCR was used to genotype 191 case and 188 control samples. Cases comprised of 191 individuals in a South African cohort of mixed ancestry and Caucasians, with BD Type 1. Phenotypes of BD disease severity were: age of onset, number of illness episodes, number of hospitalisations for depression or mania and history of psychotic symptoms. Results: There were no significant difference in SNP allele frequencies between cases and controls. In the case-only analysis; the GRM3 rs6465084 heterozygote was associated with a 4-fold increased risk of lifetime history of psychotic symptoms, and the specific variants within the gene pair, DAOA and GRIN2B, had a significant interaction with the number of hospitalisations for mania, with lowest admission rates associated with both pairs of ancestral alleles. Conclusion: In BD, variations in glutamatergic genes may influence phenotypes related to the severity of illness. Speculatively; newly derived genes associated with various evolutionary advantages, may also increase the risk for more severe BD. These preliminary findings deserve validation in a larger cohort