Body dysmorphic disorder in patients attending a dermatology clinic in Nigeria: sociodemographic and clinical correlates.

BACKGROUND: Body dysmorphic disorder is a relatively common psychiatric disorder in the context of dermatology and cosmetic and plastic surgery but is underdiagnosed and underreported in Africa. OBJECTIVE: To evaluate the prevalence of body dysmorphic disorder and symptoms of anxiety/depression and determine their sociodemographic and clinical correlates. METHODS: A systematic random sampling design was made to recruit 114 patients with skin diseases. Sociodemographic and clinical data were obtained. The Body Dysmorphic Disorder Modification of the Yale-Brown Obsessive-Compulsive Scale, Hospital Anxiety and Depression Scale was administered, and data were analyzed using SPSS 20. RESULTS: Mean age of participants was 37.70±17.47 years, and 67/114 (58.8%) were females. Prevalence of body dysmorphic disorder was 41/114 (36.0%), and prevalence of anxiety/depression symptoms was 35/114 (30.7%). Prevalence of body dysmorphic disorder in patients with anxiety/depression symptoms was 15/41 (36.6%), and patients with facial disorders expressed the highest burden of anxiety/depression symptoms, in 15/35 (42.9%). Factors associated with significantly higher mean body dysmorphic disorder include age<50years (p=0.039), and anxiety/depression (p<0.001), education below high school was associated with higher mean anxiety/depression score (P= 0.031). In a binary logistic regression model, presence of anxiety/depression symptoms was predictive of body dysmorphic disorder (OR=10.0, CI: 4.1-28.2, p<0.001). STUDY LIMITATIONS: the study is uncontrolled, conducted in a single source of care, thus limiting generalization to nonrelated settings. CONCLUSION: Prevalence of body dysmorphic disorder is high among dermatology patients and most prevalent in facial disorders. Facial diseases are associated with the highest burden of anxiety/depression symptoms. This is a clarion call for dermatologists to routinely assess for body dysmorphic disorder and appropriately refer affected patients to mental health care.

Body dysmorphic disorder in patients attending a dermatology clinic in Nigeria: sociodemographic and clinical correlates

Abstract: Background: Body dysmorphic disorder is a relatively common psychiatric disorder in the context of dermatology and cosmetic and plastic surgery but is underdiagnosed and underreported in Africa. Objective: To evaluate the prevalence of body dysmorphic disorder and symptoms of anxiety/depression and determine their sociodemographic and clinical correlates. Methods: A systematic random sampling design was made to recruit 114 patients with skin diseases. Sociodemographic and clinical data were obtained. The Body Dysmorphic Disorder Modification of the Yale-Brown Obsessive-Compulsive Scale, Hospital Anxiety and Depression Scale was administered, and data were analyzed using SPSS 20. Results: Mean age of participants was 37.70±17.47 years, and 67/114 (58.8%) were females. Prevalence of body dysmorphic disorder was 41/114 (36.0%), and prevalence of anxiety/depression symptoms was 35/114 (30.7%). Prevalence of body dysmorphic disorder in patients with anxiety/depression symptoms was 15/41 (36.6%), and patients with facial disorders expressed the highest burden of anxiety/depression symptoms, in 15/35 (42.9%). Factors associated with significantly higher mean body dysmorphic disorder include age<50years (p=0.039), and anxiety/depression (p<0.001), education below high school was associated with higher mean anxiety/depression score (P= 0.031). In a binary logistic regression model, presence of anxiety/depression symptoms was predictive of body dysmorphic disorder (OR=10.0, CI: 4.1-28.2, p<0.001). Study limitations: the study is uncontrolled, conducted in a single source of care, thus limiting generalization to nonrelated settings. Conclusion: Prevalence of body dysmorphic disorder is high among dermatology patients and most prevalent in facial disorders. Facial diseases are associated with the highest burden of anxiety/depression symptoms. This is a clarion call for dermatologists to routinely assess for body dysmorphic disorder and appropriately refer affected patients to mental health care.

Cognitive behavioral therapy for post-traumatic stress disorder, depression, or anxiety disorders in women and girls living with female genital mutilation: A systematic review.

BACKGROUND: Female genital mutilation (FGM) is associated with psychological consequences such as post-traumatic stress disorder (PSTD), depression, and anxiety disorders. Cognitive behavioral therapy (CBT), an empirically supported form of psychotherapy, may be an effective treatment for these psychological sequelae of FGM. OBJECTIVES: To assess the effectiveness of CBT among individuals living with any type of FGM and diagnosed to have PTSD, depression, or anxiety disorders. SEARCH STRATEGIES: CENTRAL, Medline, African Index Medicus, SCOPUS, PILOTS, POPLINE, PsycINFO, WHOLIS, LILACS, ERIC, NYAM Library, CINAHL, Web of Science were searched from inception up to August 10, 2015. SELECTION CRITERIA: Both randomized and nonrandomized studies comparing the efficacy of CBT to other forms of interventions for PTSD, depression, or anxiety disorders in individuals with FGM, were systematically reviewed. DATA COLLECTION AND ANALYSIS: We did not identify any studies with eligible design that addressed the objective of the review. MAIN RESULTS: There are no included studies. CONCLUSION: Future studies need to look beyond establishing the prevalence and correlates of FGM to conducting well-designed, randomized controlled studies or well-designed interventional observational studies for the management of the psychological consequences of women and girls living with FGM. PROSPERO REGISTRATION: CRD42015024458.

Psychiatric Morbidity and Subjective Burden Among Carers of Outpatients of a Psychogeriatric Clinic in Southwestern Nigeria.

Few studies in Nigeria have investigated the burden of caring for elderly persons with mental illness. The aim of this study was to examine psychiatric morbidity and burden of care among caregivers of outpatients of a psychogeriatric clinic. Burden of care was evaluated with Zarit Burden Interview. A questionnaire was also used to elicit caregivers' sociodemographic and caregiving variables while psychological well-being was assessed with the General Health Questionnaire (GHQ). Overall, 52.3% had high care burden. High care burden was associated with financial difficulty (χ(2) = 9.37; df = 1; p = 0.002; OR = 3.1; 95% CI = 1.50-6.4), restrictions on caregivers' social activity (χ(2) = 4.87; df = 1; p = 0.027; OR = 2.4; 95% CI = 1.09-5.27), lack of support from relatives (χ(2) = 6.85; df = 1; p = 0.009; OR = 6.3; 95% CI = 1.35-29.6), physical health problems (χ(2) = 10.52; df = 1; p = 0.001; OR = 4.7; 95% CI = 1.75-12.7), and psychiatric morbidity (χ(2) = 4.05; df = 1; p = 0.044; OR = 2.62; 95% CI = 1.00-6.85). Psychiatric morbidity was predicted by physical health problems (OR = 3.0; 95% CI = 1.1-8.1), financial difficulty (OR = 17.2; 95% CI = 3.8-77.5), and job loss (OR = 5.3; 95% CI = 2.0-13.8). Care burden is a significant problem among caregivers of elderly persons with mental illness attending the clinic. This may have important implications for the mental well-being of the patients.

Pyridoxal 5 phosphate for neuroleptic-induced tardive dyskinesia.

BACKGROUND: Tardive dyskinesia is a chronic and disabling abnormal movement disorder affecting the muscles of the face, neck, tongue and the limbs. It is a common side effect of long-term antipsychotic medication use in individuals with schizophrenia and other related psychotic disorders. While there are no known effective treatments for tardive dyskinesia to date, some reports suggest that pyridoxal 5 phosphate may be effective in reducing the severity of tardive dyskinesia symptoms. OBJECTIVES: To determine the effectiveness of pyridoxal 5 phosphate (vitamin B6 or Pyridoxine or Pyridoxal phosphate) in the treatment of neuroleptic-induced tardive dyskinesia among people with schizophrenia and other related psychotic disorders. SEARCH METHODS: The Cochrane schizophrenia group's register of clinical trials was searched (January 2013) using the phrase: [*Pyridoxal* OR *Pyridoxine* OR *P5P* OR *PLP* OR *tardoxal* OR *Vitamin B6* O *Vitamin B 6* R in title, abstract or index terms of REFERENCE, or interventions of STUDY. References of relevant identified studies were handsearched and where necessary, the first authors of relevant studies were contacted. SELECTION CRITERIA: Studies described as randomised controlled trials comparing the effectiveness pyridoxal 5 phosphate with placebo in the treatment of neuroleptic-induced tardive dyskinesia among patients with schizophrenia. DATA COLLECTION AND ANALYSIS: The review authors independently extracted data from each selected study. For dichotomous data, we calculated risk ratios (RR) and their 95% confidence intervals (CIs) on an intention-to-treat basis based on a fixed-effect model. For continuous data, we calculated mean differences (MD) with 95% CIs, again based on a fixed-effect model. We assessed risk of bias for each included study and used GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to rate quality of evidence. MAIN RESULTS: Of the 12 records retrieved by the search, three trials published in 2001, 2003 and 2007, involving 80 inpatients with schizophrenia, aged 18 to 71 years, admitted in a psychiatric facility and followed up for a period nine weeks to 26 weeks, were included. Overall, pyridoxal 5 phosphate produced a significant improvement in tardive dyskinesia symptoms when compared with placebo, assessed by a change in Extrapyramidal Symptoms Rating Scale (ESRS) scores from baseline to the end of the first phase of the included studies (2 RCTs n = 65, RR 19.97, CI 2.87 to 139.19, low quality evidence). The endpoint tardive dyskinesia score (a measure of its severity) assessed with the ESRS, was significantly lower among participants on pyridoxal 5 phosphate compared to those on placebo (2 RCTs n = 60, MD -4.07, CI -6.36 to -1.79, low quality evidence).It was unclear whether pyridoxal 5 phosphate led to more side effects (n = 65, 2 RCTs, RR 3.97, CI 0.20 to 78.59, low quality evidence) or caused deterioration in tardive dyskinesia symptoms when compared to placebo (n = 65, 2 RCTs, RR 0.16, CI 0.01 to 3.14, low quality evidence). Five participants taking pyridoxal 5 phosphate withdrew from the study because they were not willing to take more medications while none of the participants taking placebo discontinued their medications (n = 65, 2 RCTs, RR 8.72, CI 0.51 to 149.75, low quality evidence).There was no significant difference in the endpoint positive and negative psychiatric symptoms scores, measured using the Positive and Negative symptoms Scale (PANSS) between participants taking pyridoxal 5 phosphate and those taking placebo. For the positive symptoms: (n = 15, 1 RCT, MD -1.50, CI -4.80 to 1.80, low quality evidence). For negative the symptoms: (n = 15, 1 RCT, MD -1.10, CI -5.92 to 3.72, low quality evidence). AUTHORS' CONCLUSIONS: Pyridoxal 5 phosphate may have some benefits in reducing the severity of tardive dyskinesia symptoms among individuals with schizophrenia. However, the quality of evidence supporting the effectiveness of pyridoxal 5 phosphate in treating tardive dyskinesia is low, based on few studies, short follow-up periods, small sample sizes and inadequate adherence to standardised reporting guidelines for randomised controlled trials among the included studies.

Self-stigma, quality of life and schizophrenia: An outpatient clinic survey in Nigeria.

BACKGROUND: Stigma is a major obstacle to the treatment and recovery of people with mental illness. In Nigeria, there is a dearth of information on internalization of stigma and its effect on treatment outcome measures such as quality of life. AIM AND OBJECTIVES: The aim of the study was to assess self-stigma among patients with schizophrenia attending a psychiatric hospital outpatient clinic, and the relationship of self-stigma to the socio-demographic, clinical characteristics and quality of life of the patients. METHOD: Two hundred and fifty-six consecutive outpatient attendees of the Neuropsychiatric Hospital, Aro, Abeokuta in Nigeria with a Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) diagnosis of schizophrenia were recruited for the study. The diagnosis of schizophrenia was established with the Structured Clinical Interview Schedule for DSM-IV Axis I disorder (SCID), while item 17 of the Present State Examination was used to ascertain the presence of insight into the illness. The subjects were interviewed with a socio-demographic questionnaire, the Internalized Stigma of Mental Illness (ISMI) scale, the Brief Psychiatric Rating Scale (BPRS) and the World Health Organization's Quality of Life (WHOQOL-Bref) questionnaire. RESULTS: The mean age of the subjects was 39.5 (SD = 10.6) years with males constituting 52.0% of the sample. High self-stigma was found in 18.8% of the subjects. The socio-demographic and clinical correlates of high self-stigma found using univariate analysis were low educational level (χ(2) = 22.69, p < .001), unemployment (χ(2) = 15.9, p < .001), low income (χ(2) = 25.03, p < .001), source of income (χ(2) = 12.52, p = .007) and severity of psychopathology (t = 8.245, p < .001). High self-stigma was associated with poor quality of life in all the domains of WHOQOL-Bref. CONCLUSION: This study revealed that self-stigma was common among subjects with schizophrenia. It is associated with poor treatment outcome, highlighting the need to incorporate stigma intervention strategies into mental health care delivery.

Psychosocial correlates of hazardous alcohol use among undergraduates in southwestern Nigeria.

OBJECTIVE: The aim of this study was to examine the relationship between alcohol use and psychological well-being among undergraduates of a Nigerian tertiary institution. The objectives included determining the prevalence and pattern of problematic alcohol use and ascertaining the association between alcohol use and some sociodemographic variables. METHOD: The Alcohol Use Disorders Identification Test (AUDIT) was used to evaluate for alcohol-related problems in 443 students of a university in southwestern Nigeria. A questionnaire was also used to obtain data on sociodemographic variables while psychological well-being was assessed with the General Health Questionnaire-28. RESULTS: The prevalence of alcohol use was 40.6% while alcohol-related problems were found in 14.9% of the students using the AUDIT questionnaire with a cutoff score of 5. Heavy episodic alcohol use was reported by 31.1% while alcohol-related injury had occurred in 8.9% of the students. Male gender (χ2=4.54; P<.05), older age (χ2=3.92; P<.05) and higher paternal education (χ2=4.40; P<.05) were associated with problem drinking. In addition, psychological distress was significantly associated with heavy episodic drinking (χ2=9.58; P<.05) and history of alcohol-related injury (χ2=3.96; P<.05). CONCLUSION: The significant relationship between hazardous drinking and mental ill health among undergraduates in the institution suggests the need for integrating mental health services in screening, brief intervention and referral to treatment services in Nigerian university settings.

The 3rd Schizophrenia International Research Society Conference, 14-18 April 2012, Florence, Italy: summaries of oral sessions.

The 3rd Schizophrenia International Research Society Conference was held in Florence, Italy, April 14-18, 2012 and this year had as its emphasis, "The Globalization of Research". Student travel awardees served as rapporteurs for each oral session and focused their summaries on the most significant findings that emerged and the discussions that followed. The following report is a composite of these summaries. We hope that it will provide an overview for those who were present, but could not participate in all sessions, and those who did not have the opportunity to attend, but who would be interested in an update on current investigations ongoing in the field of schizophrenia research.

Demographic and clinical correlates of sexual dysfunction among Nigerian male outpatients on conventional antipsychotic medications.

BACKGROUND: In psychotic disorders, early intervention with antipsychotic medications increases the likelihood of favourable long-term course. However, the pharmacologic management especially with conventional antipsychotic medications is complicated by a high rate of adverse effects including sexual dysfunction. This study aims to determine the demographic and clinical factors associated with sexual dysfunction among male psychiatric outpatients on conventional antipsychotic medications in South-western Nigeria. METHODS: Two hundred and seventy five consecutive male outpatients with psychotic disorders on conventional antipsychotic medications were interviewed. Data was collected on demographic characteristics, illness-related and medication-related variables. Illness severity was assessed with the Brief psychiatric rating scale. The International Index of Erectile Function questionnaire was used to assess for sexual dysfunctions. RESULTS: A total of 111 (40.4%) respondents had one or more forms of sexual dysfunction. Sexual desire dysfunction was present in 47 (17.1%) of respondents, erectile dysfunction in 95 (34.5%), orgasmic dysfunctions in 51 (18.5%), intercourse dissatisfaction in 72 (26.2%) and overall dissatisfaction in 64 (23.3%). Sexual dysfunction was significantly associated with employment status, age, marital status, haloperidol use, medication dosage, and presence of psychopathology. Unemployment was the only significant independent correlate of sexual dysfunction, with unemployed respondents twice more likely to have sexual dysfunction compared with those employed (Wald = 3.865, Odds Ratio = 2.033, 95% confidence interval = 1.002 - 4.124, p = 0.049). CONCLUSIONS: The high prevalence of sexual dysfunction found in this study suggests a need among clinicians for increased awareness and recognition of the sexual side effects in patients taking conventional antipsychotic medications. This knowledge should guide conventional antipsychotic medication prescription in the at-risk population to improve treatment adherence.

Medication adherence and quality of life among Nigerian outpatients with schizophrenia.

OBJECTIVE: The aim of this study was to examine medication adherence among outpatients with schizophrenia in relation to their subjective quality of life and other sociodemographic, clinical and service related factors. METHODS: Three hundred and thirteen consecutive outpatient clinic attendees with a Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) diagnosis of schizophrenia confirmed with the Structured Clinical Interview for Diagnosis were recruited for the study. Respondents were interviewed using a questionnaire evaluating sociodemographic, medication, illness and clinic attendance related variables. Medication adherence was assessed using the Morisky medication adherence questionnaire. Participants also completed the World Health Organization Quality of Life Scale-BREF questionnaire as a measure of their subjective quality of life, while severity of illness was measured using the Brief Psychiatric Rating Scale (BPRS). RESULTS: Overall, 40.3% of the respondents were medication nonadherent. Medication adherent respondents significantly reported their perceived social support as "good" (P=.006), took significantly fewer number of medications (P≤.001), had higher medication use recall scores (P≤.001), had lower total BPRS scores (P=.001) and were "very satisfied" with their outpatient care (P=.002). Independent predictors of medication nonadherence were BPRS score [odds ratio (OR)=1.08, 95% confidence interval (95% CI)=1.03-1.13], outpatient clinic default (OR= 4.97, 95% CI=2.59-9.53) and moderate satisfaction with outpatient care (OR=2.78, 95% CI=1.47-5.24). Medication nonadherence was significantly associated with lower scores on all domains and facets of quality of life. CONCLUSIONS: Medication nonadherence is common among outpatients with schizophrenia and is associated with poor quality of life. Clinicians' awareness of the risk factors for medication nonadherence early in patients' management may significantly improve treatment outcomes, including patients' quality of life.