Forensic mental health service implications of COVID-19 infection in Nigeria.

Forensic mental health services are fledgling in most African countries including Nigeria. The current formulation of such services in Nigeria is correctional psychiatry in addition to some hospital-based services. The COVID-19 pandemic presents significant challenges to the already fragile state of forensic mental health services within the country. Its impact includes limitation of access to and continuity of mental healthcare in prison as well as reduction in referrals from other services within the criminal justice system such as the police and the courts. Further tapering of previously less prominent aspects of forensic mental health service in the country such as the preparation of psychiatric court reports has also been observed. Forensic psychiatry training and research have equally been hampered by the pandemic. The lessons learnt from these challenges should offer practitioners and policy makers insight into strategic developmental objectives for the post-COVID era within services and training programmes.

Correctional psychiatry in Nigeria: dynamics of mental healthcare in the most restrictive alternative.

Nigeria has poorly structured services for correctional mental health driven by a mix of socioeconomic and legal factors. The archaic asylum systems established in the early part of the 20th century under the Lunacy ordinance of 1916 are no longer fit for purpose. The present strategy is to provide mental healthcare for mentally abnormal offenders within some prisons in the country. The current models for this are poorly staffed and underfunded. Adoption of task-shifting approaches based on evidence-based strategies within the context of professional innovation, government commitment and international collaboration should help to develop and sustain the needed correctional psychiatry services.

Patterns of serologic markers of hepatitis B virus infection and the risk of transmission among pregnant women in southwestern Nigeria.

Hepatitis B virus (HBV) infection is a major health concern in developing countries that has a high morbidity and mortality rate. Vertical transmission of HBV from mother to child has been identified as a major factor leading to chronicity with attendant liver conditions, especially in poor socioeconomic settings. This study aims to evaluate the prevalence of serological HBV markers among pregnant women in Ibadan southwestern Nigeria and to determine the implications for perinatal HBV transmission. This study revealed the presence of varied HBV serological patterns of infection or immunity among pregnant women in Ibadan, Nigeria, and thus the risk of mother to child transmission.

Acute Hepatitis E Virus Infection in Two Geographical Regions of Nigeria.

Hepatitis E virus (HEV) remains a major public health concern in resource limited regions of the world. Yet data reporting is suboptimal and surveillance system is inadequate. In Nigeria, there is dearth of information on prevalence of acute HEV infection. This study was therefore designed to describe acute HEV infection among antenatal clinic attendees and community dwellers from two geographical regions in Nigeria. Seven hundred and fifty plasma samples were tested for HEV IgM by Enzyme Linked Immunosorbent Assay (ELISA) technique. The tested samples were randomly selected from a pool of 1,115 blood specimens previously collected for viral hepatitis studies among selected populations (pregnant women, 272; Oyo community dwellers, 438; Anambra community dwellers, 405) between September 2012 and August 2013. One (0.4%) pregnant woman in her 3rd trimester had detectable HEV IgM, while community dwellers from the two study locations had zero prevalence rates of HEV IgM. Detection of HEV IgM in a pregnant woman, especially in her 3rd trimester, is of clinical and epidemiological significance. The need therefore exists for establishment of a robust HEV surveillance system in Nigeria and especially amidst the pregnant population in a bid to improve maternal and child health.

Who guards the guards: drug use pattern among medical students in a nigerian university.

BACKGROUND: Several studies have examined the prevalence and pattern of substance use among medical students in Nigeria. Few of these studies have specifically examined the relationship between the psychological distress and psychoactive substance use among these students. Yet, evidence world-wide suggests that substance use among medical students might be on the rise and may be related to the level of stress among them. AIM: The present study is the first study aimed to determine the prevalence, pattern and factors associated with psychoactive substance use among medical students of Olabisi Onabanjo University, Ogun State, Nigeria. SUBJECTS AND METHODS: The World Health Organization student drug use questionnaire was used to evaluate for substance use among 246 clinical medical students between September and October 2011. General health questionnaire (GHQ) 12 was used to assess for psychological distress among these students. Statistical analysis was performed using the SPSS version 16. (Chicago, USA). Proportions were compared using the Chi-square test while a value of P < 0.05 was considered statistically significant. Fisher exact test was used instead of Chi-square when the number in the cell is less than 5. RESULTS: Lifetime prevalence of substance use among medical students was 65% (165/246). It was found that the most commonly used substances were alcohol 63.4% (156/246), mild stimulants 15.6% (38/246), tobacco 15% (37/246) and sedatives 6.1% (15/246). Substance use was associated with gender, frequency of participation in religious activities and GHQ scores. CONCLUSION: Psychoactive substance use is a major problem among medical students. Psychological well-being plays a significant role in substance use among these students. There is a need for adequate screening and assessment for substance use disorders among these students and incorporating stress management strategies in their curriculum.

HIV Risk Behavior in Persons with Severe Mental Disorders in a Psychiatric Hospital in Ogun, Nigeria.

BACKGROUND: Few studies in Nigeria have investigated HIV risk behavior among persons with severe mental disorders. This study examined HIV risk behavior and associated factors among patients receiving treatment at a Nigerian psychiatric hospital. AIM: To determine the HIV risk behavior in persons with severe mental disorders in a psychiatric hospital. SUBJECTS AND METHODS: This was a cross-sectional survey involving 102 persons with serious mental disorders receiving treatment at a major psychiatric facility in Southwestern Nigeria. HIV risk screening instrument was self-administered to assess HIV risk behavior. A questionnaire was used to elicit socio-demographic variables while alcohol use was assessed with the alcohol use disorder identification test. Differences in HIV risk levels were examined for statistical significance using Chi square test. RESULTS: Forty eight percent of the respondents engaged in HIV risk behavior. This study revealed that 10.8% (11/102) gave a history of sexually transmitted disease, 5.9% (6/102) reported sex trading and no reports of intravenous drug use was obtained. A single risk factor was reported by 19.6% (20/102), 12.7% (13/102) reported two risk factors and 15.7% (16/102) reported three or more risk factors. HIV risk behavior was significantly related to alcohol use (P = 0.03). CONCLUSION: Mental health services provide an important context for HIV/AIDS interventions in resource-constrained countries like Nigeria.

Pattern of attendance and predictors of default among Nigerian outpatients with schizophrenia.

OBJECTIVE: To assess the pattern of and factors associated with outpatient clinic attendance among patients diagnosed with schizophrenia at a Nigerian psychiatric hospital. METHODS: This was a cross-sectional descriptive study of 313 consecutive outpatients with diagnosis of schizophrenia confirmed with the Structured Clinical Interview for Diagnosis (SCID). Data was collected on sociodemographics, clinic attendance, perceived social support, perceived satisfaction with hospital care and illness severity (assessed using the Brief Psychiatric Rating Scale, BPRS). Logistic regression analysis was used to identify factors associated with outpatient clinic default. RESULTS: Overall, 20.4% respondents were defaulters, with a median duration of clinic non-attendance of 8 weeks. Outpatient clinic defaulters had significantly higher BPRS scores and had missed more outpatient clinic appointments compared with non-defaulters. A significantly higher proportion of defaulters resided more than 20 km away from the hospital and reported "not satisfied" with their outpatient care. Being financially constrained was the commonest reason given by defaulters for missing their clinic appointments. The significant predictors of outpatient clinic default included residing more than 20 km from the hospital, missing previous appointments and dissatisfaction with outpatient care. CONCLUSION: Outpatient clinic non-attendance is common among patients with schizophrenia, and is significantly associated with demographic, clinical and service related factors. Interventions targeted at addressing the risk factors for defaulting peculiar to developing country settings similar to the location of this study, could significantly improve treatment outcome.

Socio-demographic and clinical correlates of subjective quality of life among Nigerian outpatients with schizophrenia.

This study aimed to measure the subjective quality of life (QOL) of Nigerian outpatients with schizophrenia and to examine its socio-demographic as well as clinical determinants. A total of 313 outpatients with schizophrenia participated in the study. Data were collected on socio-demographics, outpatient clinic attendance, perceived social support, perceived satisfaction with hospital care, medication adherence, illness severity and QOL. Multiple linear regression analysis was used to determine the amount of variance in the QOL domain scores explained by socio-demographic and clinical variables. Employment status, perceived social support, satisfaction with outpatient care, antipsychotic medication dose, Brief Psychiatric Rating Scale (BPRS) scores and medication adherence had significant relationships with all the QOL domains. Average monthly allowance and outpatient clinic default were significantly associated with all QOL domains except social relationship. Socio-demographic and clinical factors explained only a modest part (29.4%) of the variance in the QOL scores. It is likely that unmeasured 'internalised' determinants contribute in a much larger sense to the variation in subjective QOL.

The impact of a psychiatry clinical rotation on the attitude of Nigerian medical students to psychiatry.

OBJECTIVE: Undergraduate medical students have ingrained and often negative attitudes towards psychiatry as a field and as a career. This in turn has affected recruitment of graduate medical students into the specialty. Little is known about the impact of psychiatry rotations during undergraduate medical training on students' attitudes about psychiatry and eventual specialty choice in developing countries. This study examined the impact of a psychiatry clinical rotation on medical students' attitudes to psychiatry and possible career choice. METHOD: Eighty-one and one hundred and six fifth year medical students completed the ATP-30, socio-demographic and career choice questionnaires at the beginning and the end of a four week clinical rotation respectively. RESULTS: The overall attitude of the students to psychiatry was favourable at the beginning of the rotation with significant improvement following the rotation (p = 0.003). Significant improvement in attitude was observed among female and younger students. Students who indicated preference for specialties other than psychiatry showed a greater improvement in their attitude to psychiatry following the rotation (p = 0.011). The rotation however did not enhance students' preference for psychiatry as a future career. CONCLUSION: The four-week clinical rotation in psychiatry resulted in increased mean attitudinal score, but not in enhanced preference for psychiatry as a career.

Matricide and schizophrenia in the 21(st) century: a review and illustrative cases.

Studies have shown an association between homicidal behaviour and psychiatric disorders although it remains difficult to conclude that definite causal relationships exist between specific mental illnesses and particular forms of homicide. However, matricide has been linked to schizophrenia for several decades with an assortment of explanations to explain the connection. To review the psychosocial, contextual and clinical issues involved in the perpetration of matricide by patients with schizophrenia. Two detailed case reports are presented alongside review of relevant literature. There are complex psychodynamic, phenomenological and contextual factors in the act of matricide by persons with schizophrenia. The observation that ambivalent relationships exist between schizophrenics and their mothers (or other carers) probably suggests the need for adequate clinical intervention with families of affected patients in resolving psychological tension which might be the provoking stimulus to murder.

Trends in sociodemographic and drug abuse variables in patients with alcohol and drug use disorders in a Nigerian treatment facility.

BACKGROUND: Globally, patterns of the use of psychoactive substances have been changing. OBJECTIVE: To evaluate the trend in two five year periods, 1992 to 1997 versus 2002 to 2007, of alcohol and substance use disorders and associated variables in patients admitted to a drug abuse treatment facility. METHODS: This was a comparative cross-sectional study involving all patients admitted into Drug Abuse Treatment, Education, and Research (DATER), Unit of the Neuropsychiatric Hospital, Aro, Nigeria within the study period. All subjects had a structured psychiatric interview, a physical examination, laboratory investigations and DATER Questionnaire protocols that elicited socio-demographic, drug and family variables. RESULTS: The patients in 2002 to 2007 versus those of 1992 to 1997 were younger (chi squared 13.29; p,0.01). More last borns were using drugs by 2002 to 2007 (chi squared, 11.37; p,0.01). Cannabis was the most abused drug in 2002 to 2007 (53.5%) as compared to cocaine (44%) in 1992 to 1997 (chi squared 35.5; p,0.001). Polydrug abuse was high in the two periods but significantly the drug combination changed to cannabis in combination with alcohol in 2002 to 2007 as against cocaine in combination with opiates in 1992 to 1997 chi squared 45.3, p 0.001). More patients had co-morbid psychiatric disorders in 2000 to 2007 (67.6% as against 38.5% in 1992 to 1999 chi squared 28.32, p,0.001). In both periods, co-morbidity associated with cannabis use rather than any other drug of abuse as the odds ratio was greater than one. CONCLUSION: The findings in the trend in the two five year periods underscore the imperatives of continuous evaluation of the drug abuse patient population in treatment which may help drive changes in treatment inputs.

Trends in sociodemographic and drug abuse variables in patients with alcohol and drug use disorders in a Nigerian treatment facility

"BACKGROUND: Globally; patterns of the use of psychoactive substances have been changing. OBJECTIVE: To evaluate the trend in two five-year periods; 1992-1997 versus 2002 - 2007; of alcohol and substance use disorders and associated variables in patients admitted to a drug abuse treatment facility. METHODS: This was a comparative cross-sectional study involving all patients admitted into Drug Abuse Treatment; Education; and Research (DATER); Unit of the Neuropsychiatric Hospital; Aro; Nigeria within the study period. All subjects had a structured psychiatric interview; a physical examination; laboratory investigations and ""DATER"" Questionnaire protocols that elicited socio-demographic; drug and family variables. RESULTS: The patients in 2002-2007 versus those of 1992-1997 were younger (c2 13.29; p=0.01). More last borns were using drugs by 2002-2007 (c2 11.37; p=0.01). Cannabis was the most abused drug in 2002-2007 (53.5) as compared to cocaine (44) in 1992-1997 (c2 35.5; p"