Using Linkage-enhancement Strategies to Bridge Treatment Gap among Inmates and Former Inmates in Correctional Settings with Inadequate Mental Health Care.

Service linkage and skill enhancement strategies were devised in Nigerian prisons with inadequate mental health resources to support the provision of psycho-legal services, including the assessments, identification, and care of inmates and former inmates with mental illness. Over the study period, 74 individuals, consisting of 64 (86.5%) males with a mean age of 33.25 (SD=11.2) years received care or psycho-legal services through these strategies. Clinically, 49% of the participants were diagnosed with schizophrenia (International Classification of Diseases, Tenth Revision (ICD-10) diagnosis code: F20.0-9), 66.7% had first formal clinical diagnosis of mental illness, and as many as 56.1% of the participants endorsed using psychoactive substances. Most participants (73.0%) were assessed and treated within the prison's general medical services with support from a multidisciplinary team from a regional psychiatric hospital. Of the 50 psycho-legal assessments conducted, eight (10.8%) and 12 (16.2%) participants were not criminally responsible and unfit to stand trial, respectively. We included an action-plan to support the implementation of collaborative care, skill-enhancement, and linkage of services as viable strategies in correctional settings with inadequate mental health care.

Prevalence and correlates of major depression among Nigerian adults with sickle cell disease.

Objective To ascertain the current and lifetime prevalence of depression among adults with sickle cell disease and identify relevant socio-demographic and clinical correlates. Method A cross-sectional study of 205 stable adult out-patient attendees at a treatment center in southern Nigeria between April and September, 2014. A socio-demographic questionnaire, the depression module of Mini International Neuropsychiatric Interview, and the eight-item Morisky Medication Adherence Scale were administered. Categorical and continuous variables associated with a diagnosis of depression were tested using chi-squared and t-tests respectively. Level of significance was set a priori at P < 0.05. Results Prevalence of current depression was 16.6%, while lifetime prevalence was 29.8%. Current depression was significantly associated with frequent analgesic use ( P < 0.03), unemployment ( P = 0.04), low income ( P < .04), low educational status ( P < 0.01), and subjective pain ( P < 0.001). Subjective pain was nearly twice as likely to predict a current depressive episode (AOR: 1.81, 95%CI: 1.42-2.02, P < 0.03). Conclusions Depression is common among adults with sickle cell disease and is significantly associated with severity of subjective pain.

Prevalence of Toxoplasma gondii infection among individuals with severe mental illness in Nigeria: a case control study.

BACKGROUND: While the aetiology for most psychotic disorders is unknown, a strong association has been observed between Toxoplasma gondii infection and psychosis. The proportion of individuals with psychotic disorders who have current or past infection with toxoplasma has been varied. Reports from the African continent have however been scanty. METHODS: A case control study of patients with a psychotic disorder presenting for the first time to a regional psychiatric facility was undertaken and compared to age and sex-matched healthy controls. In addition to socio-demographic and clinical characteristics, seroprevalence (IgG and IgM) of T. gondii was undertaken using an immunoassay test kit. RESULTS: IgG seropositivity was significantly higher among cases (30·7% vs 17·85%, OR = 2·04, 95% CI = 1·12-3·74, P<0·02). In contrast, IgM seropositivity was significantly lower among the cases (7·14% vs 8·57%, OR = 0·82, 95% CI = 0·31-2·16, P = 0·82). Cases who were IgG seropositive to T. gondii were more likely to be older (P<0·001) and female (P<0·001). There was no statistically significant difference in terms of T. gondii infection and, eaten poorly cooked meat (0·88), and diagnostic group (P = 0·53). Though there was a trend towards exposure to cats, this failed to reach significance (P = 0·08). CONCLUSION: T. gondii (IgG) infection is common among individuals with severe mental illness sampled and significantly higher compared to controls.

Burden of care among relatives of patients with schizophrenia in midwestern Nigeria.

BACKGROUND: Schizophrenia is a devastating mental disorder which places immense burden on family members. There are few studies that have explored the enormity of burden experienced by caregivers in sub-Saharan Africa. METHOD: Two hundred caregivers who were relatives of 200 consecutive outpatients with a diagnosis of schizophrenia and undergoing treatment at the Federal Psychiatric Hospital, Uselu, Benin, between August and November 2008, were studied. The degree of burden experienced by the caregivers was assessed using the Burden Questionnaire (BQ). The patients' symptomatology was assessed using the Positive and Negative Syndrome Scale (PANSS). RESULTS: Mean financial burden score was significantly greater than the mean scores for burden of disruption of family routine and interaction, social stigma and subjective distress. Caregivers of unemployed patients had significantly higher mean burden scores compared to those of employed patients. Level of burden showed significant associations with caregivers' educational level, age of patient, employment status of patients and global rating of difficulty in coping with caregiving. CONCLUSION: Caregivers of patients with schizophrenia experience immense burden. Public health education as well as targeted interventions in the area of employment, financial and other support for persons with mental disorders would help to ameliorate this burden.

Psychosocial characteristics of female infertility in a tertiary health institution in Nigeria.

OBJECTIVES: Women with infertility experience higher rates of psychological distress compared with their fertile counterparts. In developing countries, socio-cultural factors may aggravate this distress. We aimed to determine the prevalence of psychological distress as well as its associated socio-cultural characteristics among women attending the infertility clinic of a tertiary hospital in Nigeria. MATERIALS AND METHODS: Women (n=100) attending an infertility clinic were consecutively recruited over a two-month period and compared with a similar number of pregnant women attending the antenatal clinic at the same hospital. A semi-structured questionnaire was designed to record socio-demographic and clinical variables. The 30-item General Health Questionnaire was used to screen for psychological distress. RESULTS: The prevalence of probable psychological distress was significantly higher among the infertile group compared with their fertile counterparts (P<0.001). There were significant differences between the groups in terms of their mean age (P<0.01), employment status (P<0.02), educational status (P<0.01), and duration of marriage (P<0.001). Infertile women who had previously sought help from a traditional or faith-based healer for infertility were more likely to experience probable psychological distress (P<0.017). CONCLUSION: Infertile women are more vulnerable to psychological distress and require psychological support. There is a need to incorporate mental health screening and treatment in the routine care of infertile women in Nigeria.

Depression and subjective quality of life among outpatients with diabetes mellitus at a teaching hospital in Nigeria.

Objective To determine the relationship between depression and the subjective assessment of quality of life (QoL) in a sample of patients with diabetes mellitus (DM) attending outpatient clinics at a regional university teaching hospital in Nigeria.Methods A cross-section of 200 patients were administered the depression module of the Schedule for the Clinical Assessment in Neuropsychiatry (SCAN) and the World Health Organization Quality of Life assessment - brief version (WHOQoL-Bref) over a two-month study period.Results A major depressive disorder (MDD) was diagnosed in 30% of patients. MDD was significantly associated with lower mean scores on the facets of overall QoL (p<0.01) and health satisfaction (p<0.01), but not in the domains of physical health (p=0.67), psychological health (p=0.59), environment (p=0.70), or social relations (p=0.58) of the WHOQoL-Bref.Conclusion Depression is associated with a poorer subjective assessment of QoL among DM patients in Nigeria.

Unmodified electroconvulsive therapy: the perspective of patients from a developing country.

BACKGROUND: The controversy that exists over the relevance of electroconvulsive therapy (ECT) in contemporary psychiatric care often excludes the opinion of patients. Optimizing ECT service delivery must include the perspectives and input of service users. In Nigeria, the opinions of patients have not been explored. AIM: To evaluate the perspective of patients who have previously received ECT toward the process of delivery and the benefits and adverse effects of unmodified ECT. METHOD: Ninety consecutive consenting stable outpatients who had received unmodified ECT between 6 and 12 months from the time of study were surveyed in a cross-sectional study design over a 3-month period using a semistructured Likert-type questionnaire at a referral psychiatric hospital in Nigeria. RESULTS: Most (75.5%) of the patients did not find the procedure stressful and reported ECT being beneficial (82.2%). Most complained of deficiency in the process of ECT service delivery and reported not been adequately informed before receiving ECT (88.9%). A third reported experiencing memory impairment after ECT. Headaches and muscle pains were reported in 8.9% and 17.8% of patients, respectively. Patients who experienced headaches after ECT were more likely to perceive ECT as stressful (P < 0.005), whereas those who experienced memory impairment were less likely to receive ECT again if indicated (P < 0.001). CONCLUSIONS: Unmodified ECT is fairly well accepted among patients, although a majority complained of deficiencies in information provided about and consent toward the procedure. Improving ECT service delivery and addressing adverse effects may improve treatment acceptability.