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

Family members' experiences of caring for a relative with substance-induced psychosis disorder

Background: When there is a lack of resources in the community to support deinstitutionalisation,family members of a relative diagnosed with substance-induced psychosis disorder (SIPD) are the most affected and vulnerable. Nevertheless, family members' care is still largely unacknowledged in the mental health sector in low- and middle-income countries. Furthermore, no prior research could be found on family members' experiences caring for a relative with SIPD in Giyani, Limpopo province, South Africa. Objectives: To explore and describe family members' experiences caring for a relative with SIPD. Method: The study employed a qualitative research design using interpretative phenomenological analysis as the research method. Telephonic interviews were conducted and analysed. Eight family members were selected to participate in the study using a purposive sampling technique. Results: The analysis of data led to the emergence of the following themes: family members experienced caring for a relative with SIPD as a destabilising responsibility; they experienced acceptance and support from significant others and the community and solace in prayer. Participants also expressed they experienced a need for support from government structures in order to care for a relative with SIPD. Conclusion: The study's findings highlighted the family members' experiences of caring for a relative with SIPD and the role of the family, community and government structures in caring for an individual with SIPD. It is evident from the challenges experienced that the family members need external interventions to develop healthy coping strategies. Contribution: This study adds knowledge to nursing practice, nursing education and nursing research by promoting effective coping amongst family members caring for a relative with SIPD.

Psychotic symptoms and its association with substance use disorders among adult prisoners in correctional institution: a facility based cross-sectional study in Southwest Ethiopia

Introduction: The prevalence of psychotic symptoms among prisoners is increasing rapidly throughout the world. It imposes considerable personal and public health burden. In recent years psychotic symptoms among prisoners has been widely emphasized and the current study aimed to assess psychotic symptoms and its association with substance use disorders among adult prisoners in correctional institution in Southwest Ethiopia. Method: Facility based cross-sectional study design was conducted in Jimma Correctional Institution among 336 prisoners selected by systematic random sampling method in June 2017. Data was collected by face-to-face interview using structured questionnaire. Data was analyzed using SPSS version 21.0. Multivariable logistic regression was computed to identify independent associated factors. Results: The prevalence of psychotic symptoms among prisoners was found to be 43%. Poor social support (AOR: 4.12, 95%CI: 1.39-12.66), alcohol use disorder (AOR: 4.03, 95%CI: 1.58-10.27), stressful life events (AOR: 2.19, 95%CI: 1.14-4.21), and common mental disorders (AOR: 5.53, 95%CI: 2.56-11.91) were independently associated with single psychotic symptom. Conclusion: This study showed high prevalence of psychotic symptoms. Psychotic symptoms were significantly associated with poor social support, alcohol use disorder, stressful life events and common mental disorders. It is essential to have screening mechanism and management practice for psychotic symptoms.

A four-year review of geriatric mental health services in a Lagos based hospital, Nigeria

Background: There is a growing global concern about the public health implications of the increasing population of the elderly. One main issue of concern is centered on how to address their mental health needs using home-grown interventions and services. We expect that important lessons on geriatric mental health issues would be brought to fore in this report.Methods: This is a four-year (2007-2011) retrospective report on the mental health services rendered to 938 clients aged 60 years and above at a Lagos based mental health treatment facility in Nigeria. Designed questionnaires were filled with socio-demographic and clinical data obtained from patients' case notes based on the objectives of the study.Results: The mean (standard deviation) age of elders was 69.6 (±7.93) years, and 65.5% were females. Majority were married, self-employed and belonged to low socio-economic status (73.1%, 63.1% and 63.2%, respectively). Close to two-thirds (62.4%) commute for at least one hour to get treatment. The commonest diagnosis was psychotic disorders (34.8%), while 5.5% had Alzheimer's dementia. Some 96.5% of the elders were solely on medications. About a quarter had past history of mental illness and 48.5% reported co-morbid medical conditions, with cardiovascular problems (53.0%) being the commonest physical comorbidity. The middle old along with very old elders (aged ≥70years), and those with at least tertiary education, were more likely to present with dementia. Elders with dementia were more likely to present with index episode of mental illness and receive outpatient care.Conclusion: The elders were managed for a wide range of treatable mental illnesses and other comorbidities and commute for hours to access care. Pharmacotherapy was the preponderant sole treatment modality. There is need for sustained development of expertise to enhance multimodal care and scaling up of comprehensive geriatric mental health services. Further research is needed on how to appropriately link and/or integrate geriatric care with services at all-tiers of health care delivery

Recollected experiences of first hospitalisation for acute psychosis among persons diagnosed with schizophrenia in South Africa

First-time admission to a psychiatric hospital for acute psychosis has been reported to be extremely traumatic; and this has not been adequately researched in the South African context. This study approached persons diagnosed with schizophrenia and explores their recollected; subjective experiences of their first admission to a South African psychiatric hospital ward for acute psychosis. Semi-structured individual interviews were conducted with seven participants diagnosed with schizophrenia. These were analysed using thematic content analysis. While some participants had positive experiences; the majority reported frightening; distressing; emotionally painful or traumatic experiences during their first hospitalisation. The first hospital admission was also described as having serious long-term implications for the person's wellbeing; particularly as the diagnosis of schizophrenia made them feel isolated and stigmatised; which further hinders them from recovering from their symptoms and reintegrating into society. This study therefore draws attention to aspects of the process of first admission to psychiatric wards in South Africa; which may benefit from proactive intervention and closer research attention

Excessive daytime sleepiness, nocturnal sleep duration and psychopathology among Nigerian university students

Background and objectives. Short nocturnal sleep duration resulting in sleep debt may be a cause of excessive daytime sleepiness (EDS). Severity of depression (psychopathology) has been found to be directly related to EDS. There is an association between sleep duration and mental health; so there may therefore be an interrelationship between sleep duration; EDS and psychopathology. The objectives of this study were to determine the prevalence rates of EDS and general psychopathology among university students in Nigeria; determine the range of and mean sleep duration in the students; and determine the extent to which sleep duration and EDS predict general psychopathology in the same group of subjects. Materials and methods. Eight hundred and forty-five students at Obafemi Awolowo University; Ile-Ife; Nigeria; were recruited for the study. The subjects were required to provide information on their age; gender and the total amount of sleep per night they usually had. General psychopathology was assessed using the eng language version of the 30-item General Health Questionnaire (GHQ-30). They were also evaluated for EDS using the eng language version of the Epworth Sleepiness Scale (ESS). Results. Six hundred and thirty-four subjects (75.03 of the participants) provided complete data. The prevalence of EDS was 11.2 and the rate of general psychopathology in the subjects 13.1. The range of sleep duration was 2 - 9 hours with a mean of 5.1 hours (standard deviation 1.3). On a regression model with the GHQ score as the dependent variable and sleep duration and ESS as the independent variables; the correlation coefficient between EDS; sleep duration and psychopathology (R) was 0.47. Conclusion. EDS and psychopathology are common in the student population studied. Nocturnal sleep duration for an average student is far less than that for an average adult. Nocturnal sleep duration and EDS acted as moderate predictors of general psychopathology among Nigerian university students

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

Cannabis use predicts shorter duration of untreated psychosis and lower levels of negative symptoms in first-episode psychosis: a South African study

Objective: Cannabis use/abuse is a common co-morbid problem in patients experiencing a first episode of psychotic illness (FEP). The relationship between the clinical presentation of FEP and cannabis abuse is complex and warrants further investigation; especially within the South African context. Method: We tested associations between recent/current cannabis use and duration of untreated psychosis (DUP); age of onset (AO); PANSS-rated (Positive and Negative Syndrome Scale) positive; negative and general psychopathology symptoms and depressive symptoms (Calgary Depression Scale for Schizophrenia) in a sample of 54 patients with FEP. Results: Mean DUP was 34.4 weeks; while mean AO was 24.7 years. Co-morbid cannabis use occurred in 35of the sample and was significantly associated with shorter DUP (Mann-Whitney U; p=0.026). While not significant; there was also a trend association between cannabis use and lower negative symptoms (Mann-Whitney U; p=0.051). Conclusion: Current/recent cannabis use was associated with clinical features of psychosis onset that previously have been associated with better outcome. Medium and long-term outcome for cannabis users however; is likely to depend on whether or not cannabis use is ongoing

Cannabis publication analysis using density-equalising mapping and research output benchmarking

Background. Cannabis has been a topic of political and medical controversy in many countries over the past century. Although many publications on this topic are available, there is currently no comprehensive evaluation of global research activities in the field. Objective. This study was conducted in order to provide a quantitative and qualitative analysis of the worldwide research output on cannabis. Methods. In a quantitative approach, items concerning cannabis published between 1900 and 2008 were retrieved from the ISI Web of Science databases developed by the Thompson Institute of Scientific Information and analysed using scientometric methods. In a second step, research fields of growing interest were identified. Results. We found that publications on this topic increased during the late 1960s, as well as during the period 1990 - 2008. We noted that South Africa was one of the countries with a high research output; having published numerous articles on cannabis. A comparison of cannabis with other drugs (e.g. alcohol, tobacco, cocaine and heroin) showed that in relation to the proportion of respective drug users, cocaine and heroin are overly represented in terms of research output. When analysing the main subjects of the publications; psychiatry was prominent, especially with regard to research on psychosis. Conclusion. There is increasing interest in research on cannabis. The research only partially reflects the drug's importance with regard to number of users

First-episode psychosis: an update

Interest in the subject of first-episode psychosis has increased considerably in the last two decades. At present; a number of centres around the world focus on early identification and intervention in people with psychotic disorders. Researchers have focused particularly on people who are possibly experiencing the prodromal phase of the illness in the hope that; by instituting appropriate early intervention; the outcome of schizophrenia will be improved. Patients with first-episode psychosis present with different symptom domains that should be taken into account when planning treatment. Most patients initially respond to treatment; however; there is a high rate of relapse within a few years. It is therefore important that we continue to seek improved relapse prevention strategies. There has also been a resurgence of interest in psychosocial risk factors for the development of schizophrenia in the recent literature. We review the literature on first-episode psychosis and highlight the significant findings

Une batterie de tests pour l'evaluation neuropsychologique des psychoses fonctionnelles non affectives chez le congolais

Contexte. Il n'existe pas, à ce jour, un modèle de batterie de tests destiné à l'exploration des troubles neuropsychologiques (cognitifs) des psychoses fonctionnelles non affectives en Afrique ; il n'y a que des batteries neuropsychologiques pour les schizophrènes occidentaux Objectif. L'objectif de cette étude est de déterminer, au sein d'une batterie neuropsychologique pour schizophrènes occidentaux, les tests recommandables à l'étude des troubles cognitifs des psychoses fonctionnelles non affectives dans le contexte culturel congolais. Sujets et méthodes. Les performances cogrutrves de 188 patients congolais présentant les psychoses fonctionnelles non affectives des types schizophrénie, trouble schizophréniforme et trouble psychotique bref, recrutés au centre de santé mentale 'TELEMA' et au Centre Neuro-Psychopathologique (CNPP) de l'Université de Kinshasa ont été comparées à celles de 152 sujets congolais de contrôle. L'analyse des variances 'one way' (ANOVA) et l'analyse des covariances (ANCOVA) ont été appliquées Résultats. Tous les tests utilisés et 90% des variables neuropsychologiques étudiées ont pu faire ressortir l'infériorité cognitive des patients. En plus, ces derniers ont affiché un déficit cognitif diffus, à l'image de celui des schizophrènes. Conclusions. Les différents tests neuropsycho-logiques utilisés sont suffisamment sensibles aux psychoses fonctionnelles non affectives chez les congolais ; ils sont recommandables dans l'exploration neuropsychologique desdites psychoses au sein du contexte culturel congolais. La question de la parenté neuropsychologique des psychoses abordées requiert une étude approfondie

"Outcome of a Working Diagnosis of ""Psychosis"" in Relation to DSM-IV Diagnostic Criteria in a Kenyan In-Patient Cohort at Mathari Hospital; Nairobi"

"Background: When a patient presents with mental illness and displays psychotic symptoms which are not clearly delineated; a clinical diagnosis of psychosis is usually enter-tained. Aim: To determine the underlying Diagnostic and Statistical Manual of Mental Disorders-Fourth edition (DSM-IV) disorders in clinical entities admitted with a working diagnosis of ""psychosis"" at Mathari Psychiatric Hospital; Nairobi; Kenya. Study Design: Descriptive cross-sectional quantitative study Method: A total of 138 patients with a working diagnosis of ""psychosis"" on admission at Mathari Hospital during the period of this study were recruited over a one-month period. Their DSM-IV diagnoses were made using the Structured Clinical Interview for DSM-IV (SCID). Analysis of the results was done using SPSS version 11.5. Results: Nearly three quarters (72.5) of the patients were male; 68.5were aged between 20 and 34 years and 63.7reported that they were single. Nearly half (49.2) had attained up to 12 years of formal education and 90were dependants of a member of the family. The most common DSM-IV diagnoses were schizophrenia; bipolar disorder; substance abuse; depression and anxiety disorders. Co-morbidity was recorded with an average of three DSM-IV disorders. Conclusion: ""Psychosis"" as a working diagnosis was reported in relatively young adults. The patients whose working clinical diagnosis was ""psychosis"" met the criteria for an average of three DSM-IV diagnoses. There is need for a proactive policy in clinical practice so that definitive diagnoses rather than just ""psychosis"" are made and appropriate management initiated as early as possible."

Les psychoses puerperales a Ouagadougou : aspects epidemiologiques; cliniques et considerations etiophatogeniques

Les auteurs ont etudie les facteurs socio-culturels et epidemiologiques des psychoses puerperales ayant deborde les limites interpretatives et therapeutiques d'une societe ou le mariage et la grossesse s'inscrivent dans des attitudes et pratiques traditionnelles de plus de 80 pour cent de la population. Dans une serie ou 59 pour cent des patientes sont d'origine rurale et ou 66;7 pour cent d'entre elles sont analphabetes avec un age moyen de 23;3 ans; ils ont trouve une majorite de psychoses puerperales typiques du post-partum. Bien que la taille de l'echantillon soit faible; ils pensent que la grossesse; objet d'une responsabilisation rare de la femme en societe traditionnelle burkinabe est un facteur morbide important parce qu'etant la source d'une tension anxieuse permanente chez les femmes en age de procreer. La demande de prise en charge de cette pathologie culturelle en milieu hospitalier serait-elle revelatrice d'echecs therapeutiques traditionnels dus a la reduction progressive de la taille de la famille et a l'emergence d'une femme africaine nouvelle? Ce travail a ete mene a partir d'une etude retrospective sur 32 dossiers colliges au service de psychiatrie sur une periode de cinq ans. Il a pour but de montrer l'importance relative des psychoses puerperales dont la pathogenie pourrait etre liee aux conceptions traditionnelles de la grossesse d'une partie de la population du Burkina Faso

Typhoid - the psychiatrist's viewpoint

The neuro-psychiatric manifestations of typhoid fever are well known in medical practice in Nigeria; especially following a review of 959 cases by Osuntokun and his team. They reviewed the case records of 959 proven cases of typhoid presenting at Ibadan from 1959 to 1971 and found that the patients suffered the following complications

HIV related risk behaviour and Psychological disorder among U.T.O.D.A. Taxi drivers in the new Taki Park; Kampala

Three hundred and thirty (330) tax drivers registered with The Uganda Taxi Owners and Drivers Association (U.T.O.D.A.) were interviewed using a semi-structured questionnaire. The questionnaire contains the following variables; socio-demographics; variables about the occupation; questions about knowledge; attitudes and practice with reference to HIV/AIDS and psychological assessment instruments; General Health Questionnaires (GHQ-12); ICD-10 checklists for depression; anxiety; somatoform disorder and alcohol abuse disorders. The results are presented; discussed and recomdendations made