Morbid risk of schizophrenia amongst relatives of schizophrenia probands: a family-controlled study

Introduction: There is a dearth of data on heritability of schizophrenia in Africa. The few African studies that addressed familial psychiatric morbidity in schizophrenia involved relatively small sample sizes and addressed psychiatric morbidity only in first-degree relatives. The present study sought to improve upon the methodology of previous African studies, and widen the scope to second- and third-degree relatives with a view to enriching the field of genetic epidemiology in Africa. Methods: This study elicited information on the morbid risk of schizophrenia amongst 5259 relatives of schizophrenia probands (n = 138) and 6734 relatives of healthy controls (n = 138) through direct interview of patients, available relatives of patients and controls. Diagnosis of probands was confirmed using Mini International Neuropsychiatric Interview. Through a direct interview of 138 patients and their available relatives, a family history approach using the Family Interview for Genetic Studies was utilised to obtain information on the morbid risk for all relatives that could be recalled. The same approach was utilised for the interview of the controls (aged 45 years and above) and their relatives. Morbid risk estimates were calculated using the Weinberg shorter method. Results: Morbid risk for schizophrenia in the first-, second- and third-degree relatives of schizophrenia probands was 10.9% (95% confidence interval [CI] = 10.6­11.2), 4.2% (95%CI = 4.1­4.3) and 3.9% (95%CI = 3.6­4.2), respectively, compared with 2.6% (95%CI = 2.5­2.7), 1.6% (95%CI = 1.5­1.7) and 1.5% (95%CI = 1.4­1.6), respectively, of the healthy control group. Conclusion: The findings support the widely noted impression that schizophrenia significantly aggregates in families of schizophrenia probands more than healthy controls

The Utilization Pattern and Costs Analysis of Psychotropic Drugs at a Neuropsychiatric Hospital in Nigeria.

Background/Aim: Drug utilisation study is essential for evaluating patient care to improve service delivery through awareness creation for appropriate choice of drugs. The study analysed the prescription pattern and associated costs of psychotropic drugs at the outpatient unit of a mental health facility in Nigeria, to assess and document information for enhancing rational and cost-effective use of psychotropic medicines. Methods: A retrospective analysis of prescription records covering 8 September and 28 October 2008, was carried out using the WHO recommended use indicators, adapted for mental health care. Data was analysed for number of drugs, number of prescriptions, cost of prescription and cost per defined daily dose (DDD). Results: 1,756 prescriptions were analysed. Each prescription contained an average of 2.1 (±0.75) drugs, at a mean cost of N1, 089 (±N2, 127). Antipsychotics accounted for the highest number of prescribed drugs in 82% (1441/1756) of prescriptions, followed by antidepressants, 13%. Atypical antipsychotics were the most expensive psychotropics at an average cost per DDD of N241.67 (±N97.77), about 35 times the average cost per DDD of traditional psychotropics at N7.00 (±N2.65), which were the cheapest, accounting for over 90% of total prescriptions. Conclusion: The high use frequency of antipsychotics suggests psychosis as the prevalent mental health disorders in the environment. Significant antipsychoticantipsychotic combinations indicate scope for improving the use of antipsychotics. Average cost of prescription reflects the economic status of patients’ population where cost appears to be the major consideration of the choice of prescribers, limiting the use of newer and better tolerated psychotropics. Policy measures are required to improve access to the utilisation of newer psychotropics for enhanced quality of life of patients. The study provides a baseline data for carrying out further utilisation studies, to provide regular information for improving psychotropic drugs utilisation in mental health facilities in Nigeria.