Mental Health Burden and Facilitators Among Frontline Healthcare Professionals in Nigeria Amid COVID-19 Pandemic: A Cross-sectional Study.

BACKGROUND: During the COVID-19 pandemic, the frontline healthcare providers faced significant mental health stressors. Previous pandemics have revealed the need for psychosocial support and healthy coping mechanisms to mitigate mental health risks. AIM: The study aimed to assess psychological impact and supportive mechanisms experienced by frontline healthcare workers treating COVID-19 patients in Kaduna State. METHODS: This study involved 38 frontline healthcare providers mainly from Kaduna State Infectious Disease Treatment Center. Participants' mental health burden was captured through Hospital Anxiety and Depression Scale. Mental health facilitators were assessed through six tools: Ten-Item Values Inventory, healthy defense section of the Defense Style Questionnaire, Existential Anxiety Questionnaire, Brief Resilience Scale, Oslo Social Support Scale, and the Insomnia Severity Index. RESULTS: The mean age of the study participants was 35.5 ± 6.6 years, with the majority being males (68.4%) and doctors (39.5%). More than a quarter of the participants showed appreciable symptoms of depression and anxiety. Psychosocial facilitators such as moral values, openness to change, self-transcendence, sublimation, anticipation, and humor scored above average for more than half of the participants. Most participants demonstrated moderate resilience and social support, with few experiencing sleep challenges. Comparisons of variables indicated "openness to change" was significantly higher among males, whereas symptoms of depression and anxiety were associated with higher levels of existential concerns and sleep challenges. CONCLUSION: Our study finds that Nigerian frontline health workers experienced significant mental health challenges during the COVID-19 pandemic. It identified specific facilitators linked to gender and psychological burdens, informing the need for tailored support interventions.

Longitudinal Factor Structure of the Brief Psychiatric Rating Scale Among Incident Cases of Schizophrenia Attending a Nigerian Hospital.

Background: Schizophrenia, from its early conceptualization, has been described in distinct clinical subtypes. However, these categories were found not to be stable phenotypes over time, hence the dimensional option, whereas at cross-sectional level, the dimensions of psychopathology have been replicated across studies; there is dearth of data on the longitudinal stability of the factor structure of the symptoms of schizophrenia in African populations. Aim: This study examined the longitudinal stability of the factor structure of the 18-item Brief Psychiatric Rating Scale (BPRS) across intervals of 16-week naturalistic treatment follow-up. Patients and Methods: Consecutive incident cases that fulfilled the criteria for schizophrenia were recruited into the study. After a baseline assessment, 160 incident cases of schizophrenia were followed up 4 weekly for indicators of symptomatic outcome for 16 weeks. The Brief Psychiatric Rating Scale (BPRS) assessments were conducted in clinical interviews and with the Scale for Assessment of Negative Symptoms (SANS). Five BPRS assessments were made across the monthly intervals of follow-up. Exploratory factor analyses (EFA) using maximum likelihood extraction and varimax rotation with Kaiser normalization was used to extract the factors. Results: A four-factor structure was found at baseline, namely negative, positive, depressive/anxiety, and manic symptom dimensions. From week 4, the manic and anxiety/depression dimensions remained invariant over time, while negative and positive symptoms merged into a psychosis dimension that was invariant. Conclusion: The persistence of the mood dimensions supports the DSM-5 recommendation to include these dimensions in the assessment of schizophrenia psychopathology. The longitudinal emergence and invariance of the psychosis factor echo the idea of unitary psychosis and, along with the prominence of mood dimensions over time, reflect recent molecular genetic findings about the sharing of genes by schizophrenia and mood disorders.

Religion, coping and outcome in out-patients with depression or diabetes mellitus.

OBJECTIVE: The study assesses the association between religiosity and coping style with the outcome of depression and diabetes. METHOD: Using a simple random sampling, we recruited 112 participants with diabetes and an equal number with depression consecutively, matching for gender. Religiosity was determined using Religious Orientation Scale (revised) (ROS-R), coping styles with Brief Religious Coping (Brief RCOPE) scale and Mental Adjustment to Cancer (MAC) scale (adapted). Primary and secondary outcomes were evaluated using Sheehan's Disability Scale (SDS) and Becks Depression Inventory-II (BDI-II) respectively. RESULTS: Among participants with diabetes, BDI-II total scores correlated negatively with ROS-R Extrinsic Social (r = -0.2, P < 0.05) and Fighting Spirit (r = -0.3, P < 0.05) but correlated positively with Helplessness/Hopelessness (r = 0.3, P < 0.05) and Brief RCOPE Negative (r = 0.4, P < 0.05). SDS global scores correlated positively with Helplessness/Hopelessness (r = 0.3, P < 0.05) and Brief RCOPE Negative (r = 0.4, P < 0.05). Among participants with depression, BDI-II total scores correlated negatively with Intrinsic religiosity (r = -0.2, P < 0.05) and Fighting Spirit (r = -0.4, P < 0.05) but correlated positively with Helplessness/Hopelessness (r = 0.6, P < 0.05) and Brief RCOPE Negative (r = 0.7, P < 0.05). SDS global scores correlated negatively with Intrinsic religiosity (r = -0.2, P < 0.05) and Fighting Spirit (r = -0.3, P < 0.05) but correlated positively with Helplessness/Hopelessness (r = 0.5, P < 0.05) and Brief RCOPE Negative (r = 0.4, P < 0.05). CONCLUSION: High intrinsic and extrinsic religiosities are likely to be associated with positive coping skills and better treatment outcome in patients with depression or diabetes.

Clinical and psychosocial factors associated with needs for care: an Arab experience with a sample of treated community-dwelling persons with schizophrenia.

OBJECTIVES: To (1) highlight the profile of the needs for care among a sample of persons with schizophrenia, using the Camberwell Assessment of Needs (CAN-EU), in comparison with the international data; (2) assess the association of patients' needs with socio-demographics, clinical characteristics and objective quality of life (QOL); and (3) compare the perceptions of patients with those of the staff. METHOD: Consecutive outpatients in stable condition were interviewed with the CAN-EU and measures of QOL and psychopathology. RESULTS: There were 130 patients (68.5% men, mean age 36.8). The highest frequency of unmet needs was for money (29.2%). About a fifth of the subjects expressed unmet needs for six other items, including accommodation. The mean total needs was 8.67(7.1), the total met needs was 5.29 and total unmet needs was 3.38. The dimension with the highest frequency (40%) of unmet needs (functioning) is constituted by items that are related to family care at home. Staff identified significantly more needs than patients. Higher levels of needs were significantly associated with severity of psychopathology and negative affect, and not participating in outdoor activities. The mean number of needs was similar to reports from developing countries and higher than those from European countries. The met/unmet need ratio was similar to European data. CONCLUSION: Despite free health services and family support, a number of our treated community-dwelling persons with schizophrenia had problems meeting basic and health-care needs. The findings call for a consideration of techniques for enhancing the capability of families to cope with the care of patients.

Burden of health-care of carers of children with sickle cell disease in Nigeria.

Sickle cell anaemia in children is characterised by recurrent crises that frequently involve intensive medical care which may impact on the health and well-being of their carers. The psychosocial impact of sickle cell disease on 67 carers of children with sickle cell disease attending the Paediatric Haematology/Oncology clinic of the University College Hospital, Ibadan, Nigeria, was determined between February and May 2007 using a structured questionnaire adapted from an instrument earlier validated for the study of carer burden in sickle cell disease and relevant to the Nigerian culture. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 15.0. Demographic factors as well as frequency of hospitalisations and blood transfusions were each categorised into groups and the Mann-Whitney U-test was used to test for differences in stress scores between any two groups while the Kruskal-Wallis test was used to test for differences in more than two groups. Level of statistical significance was set at P < 0.05. Family finances were adversely affected in 39 (58.2%) families. Financial stress was frequently associated with a history of two or more hospitalisations in the previous year and more so in families with more than three children. Majority (80.6%) of the carers said they had minimal or no difficulty coping with their children. There was also a significant correlation between financial stress and difficulty in parental coping. Caring for the illnesses in the children often caused disruptions in family interactions; worst in the first year after diagnosis and improved over the years. Regular assessment of psychosocial areas of need is necessary to guide provision of necessary support.

Correlates of quality of life in an Arab schizophrenia sample.

OBJECTIVES: We focused on the subjective quality of life (QOL) indicators of the Lancashire quality of life profile, European version (LQoLP-EU) in a Kuwaiti schizophrenia sample. The objectives were: First, to assess the reliability and validity of the questionnaire. Second, to highlight the patients' QOL profile, in comparison with the results of the European five-nation study. Third, to examine the association of perceived needs for care, caregiver burden, service satisfaction, self-esteem and psychopathology, with three indices of global QOL: total life satisfaction or perceived QOL (PQOL) score; general wellbeing (GW) and Cantril's ladder (CL). METHOD: Consecutive outpatients in stable condition and their family caregivers were interviewed with the LQoLP, and measures of needs for care, service satisfaction, caregiver burden and psychopathology. RESULTS: There were 130 patients (66.1%m, mean age 36.8). Majority of the patients (56%) felt satisfied with the nine domains of life investigated, and 44.6% felt "averagely" happy. Their clinical severity was moderate (BPRS-18 = 44.4). In exploratory factor analysis (FA), the original domains were mostly replicated. Reliability indices were significant (>0.7). In stepwise regression analyses, the associations of PQOL were more in number and mostly different from those of GW and CL. The correlates of PQOL included, social unmet need (8.1% of variance), staff perception of unmet need (10.3%), general satisfaction with services (11.3%), burden of caregiver supervision (3.7%), self-esteem (2.9%) and positive symptoms (2.6%). Of the nine life domains, health was the most important correlate of GW and CL, indicating the centrality of health status in judgments of subjective QOL. In secondary FA, GW and CL loaded together, but separately from life domains, implying that these are separable parts of the subjective wellbeing construct. CONCLUSION: The profile of QOL scores was mostly similar to European data. The significant multivariate association with patients/staff perceptions of unmet need for care and service satisfaction indicate the usefulness of staff professional development and service improvement in outcome; and imply that promotion of QOL should be an institutional objective. Our finding about the relationship between the three global measures of QOL has added support to the emerging QOL theory.

Apolipoprotein E polymorphism and clinical disease phenotypes in Arab patients with schizophrenia.

BACKGROUND: Apolipoprotein E (APOE) is polymorphic, and may be involved in the pathogenesis and clinical expression of schizophrenia. This study aimed to investigate the frequency of specific APOE genotypes and alleles in a schizophrenic Arab population and evaluate the association of specific APOE types with clinical phenotypes of the disease. SUBJECTS AND METHODS: Two age-matched groups of subjects were studied: (1) healthy controls, n = 165; (2) patients with schizophrenia (SZ), n = 207. Each subject was evaluated for age and mode of onset of disease, family history of psychosis, disease severity and outcome over the years of illness. APOE genotyping was performed by a validated PCR-RFLP technique. RESULTS AND DISCUSSION: Genotype E3E2 and allele E2 were less frequent in the patients with schizophrenia (p = 0.04), and both APOE types tended to be more common in male than female schizophrenic patients (p = 0.08). Schizophrenic patients with a positive family history of psychosis had lower frequencies of genotype E3E2 and allele E2 (both p = 0.04). Genotype E3E4 and allele E4 were least common in patients with an age at onset of disease >31 years (OR: 5.5, 95% CI: 1.1-27.4), particularly in males. CONCLUSION: APOE genetic polymorphism potentially influences susceptibility to schizophrenia and may be associated with aspects of its phenotypic expression, particularly gender, age of onset and family history of psychotic illness. This relationship of APOE with schizophrenia is likely to be race- and gender-specific.

Quality of life in multiple sclerosis: a Kuwaiti MSQOL-54 experience.

OBJECTIVES: We compared the quality of life (QOL) self-ratings of relapsing-remitting multiple sclerosis (RRMS) and progressive multiple sclerosis (PMS) patients with those of the general population; and assessed the association of demographic, clinical, and caregiver variables with patients' QOL. METHODS: Consecutive clinic attendees were assessed with MSQOL-54, Beck's Depression Inventory, and Expanded Disability Status Scale. Caregivers rated their impression of patients' QOL and attitudes to patients' illness. RESULTS: Of 170 patients (35.5% M, 64.5% F), 85.3% had RRMS and 14.7% PMS. RRMS had higher QOL domain scores (P < 0.001). Patients had lower QOL than controls (P < 0.001). Depression was the commonest significant covariate of QOL domains. After controlling for depression and disability, differences between the MS groups were less significant. Predictors of overall QOL were caregiver impression of patient's QOL, depression, and treatment side effects. CONCLUSION: Programs that address depression, disability, the impact of treatment side effects, caregiver attitudes and education should enhance QOL outcomes.

Associations of blood homocysteine concentrations in Arab schizophrenic patients.

BACKGROUND: This study aimed to evaluate the blood homocysteine concentration in Arab patients with schizophrenia and assess its associations with clinical phenotypes of the disease. SUBJECTS AND METHODS: Two age-matched groups of subjects were studied: (1) Healthy Controls, HC, n=165; (2) patients with schizophrenia, SZ: n=207. Each subject was evaluated with a standard questionnaire for age at disease onset, family history, disease severity and outcome. Plasma homocysteine levels (Hcys) were measured by immunoassay and serum levels of other biochemical parameters were measured by routine Autoanalyzer techniques. RESULTS AND DISCUSSION: Group HC was heavier (body mass index, BMI) while SZ had greater waist-hip ratio (WHR) and plasma Hcys levels. In SZ, there were significant correlations between Hcys and BMI, triglycerides and HDL. Hcys levels in SZ were highest in the younger male patients. CONCLUSION: Schizophrenic patients have increased blood Hcys levels which correlate with components of the metabolic syndrome. Hcys levels were highest in the younger male patients and were not influenced by prognostic features of the disease.

Subjective quality of life of community living Sudanese psychiatric patients: comparison with family caregivers' impressions and control group.

BACKGROUND: Researchers have paid scant attention to comparative studies of quality of life (QOL) issues among psychiatric diagnostic groups; the studies of patient-caregiver concordance ratings had small sample sizes; and the reports are rare from the African and Arab worlds. OBJECTIVES: to assess the subjective QOL of stable Sudanese outpatients, using the WHOQOL-Bref, compared with a general population sample; examine the caregiver-patient concordance; and assess the variables that impact on domains of QOL. METHOD: The responses of outpatients with schizophrenia (99), major affective disorders (120) and neuroses (81) (mean age 33.8) were compared with 211 controls and the impression of their family caregivers. RESULTS: Patients were dissatisfied with life circumstances; the schizophrenia group and those with co-morbidity had significantly lower QOL scores; while the control group had higher QOL scores. There was no significant impact on QOL domains, of socio-demographic factors, duration of illness and treatment side effects. The schizophrenia group had least concordance with caregivers, but eight items were judged to be satisfactorily concordant for all groups. CONCLUSIONS: Psychiatric patients in stable condition can make reliable judgments of QOL, with relatives providing additional information. Differences in QOL and concordance of ratings reflect disease severity.

Features of isolated sleep paralysis among Nigerians.

BACKGROUND: There is paucity of studies on isolated sleep paralysis (ISP). OBJECTIVES: To explore the relationship of variables for ISP sufferers, and clarify factors predictive of ISP health behaviour (IHB--doing something to prevent further attacks). DESIGN: Cross-sectional study. SETTING: General population. MEASUREMENT: 24-item ISP questionnaire completed by respondents. SUBJECTS: One hundred and ten (38.2%m, aged 30.9 years). RESULTS: Mean ISP frequency in the lifetime, past year and past month, were respectively, 6.7, 2.02, and 0.5; average duration of episodes was four minutes, and 63.6% experienced it while awakening from sleep. Using ICSD criteria, 2.7% had severe experience (i.e. at least once per week), 18.2% moderately severe (once per month) and 75.5% mildly severe (less than once per month), with no significant demographic associations. 56.4% were afraid of the experience, 76.4% had little/no worries that something was seriously wrong with their bodies; 39.1% cited supernatural causes, 35.5% cited physiological/psychosocial causes; and 44.5% described a hallucinatory experience. 1.8% took medical measures, and 7.3% consulted a faith healer; 44.5% resorted to prayers and 41.8% did nothing to prevent further attacks. The primary determinant of IHB was being afraid of ISP. CONCLUSION: These findings have public mental health education, treatment and research implications.

Caregiver burden and psychotic patients' perception of social support in a Nigerian setting.

BACKGROUND: In Nigeria, there are no national social welfare and community rehabilitation programmes for the mentally ill. Families have to bear the major burden of care. The present study aimed to assess the severity of indices of burden among relatives of 75 schizophrenics and 20 major affective disorder cases, to identify the factors associated with burden, to assess the relationship between caregiver burden and patients' perception of social support, and to compare these with equivalent data for cancer patients' relatives. METHOD: Caregivers were assessed, using a burden questionnaire and Goldberg's General Health Questionnaire (GHQ-12). Patients were assessed for perception of social support from the extended family. RESULTS: Clinical severity and burden indices were similar for the psychiatric illness groups. However, relatives of patients with psychotic symptoms, unco-operative behaviour, marital instability and unemployment had significantly higher GHQ scores; while patients from such families perceived a wider social support network. Financial burden was greater than effect on family routines. Disruption of family routines, GHQ scores and (inversely) size of family network patient expected support from, predicted global rating of burden. Although clinical severity and disruption of family routines for cancer patients were higher; relatives of psychiatric patients had higher GHQ scores, more family disharmony and greater social stigma. CONCLUSIONS: Disturbed behaviour is a greater determinant of severity of burden than psychiatric diagnosis; hence adequacy of treatment is a first step in reducing caregiver burden. The tolerance shown by this group of relatives implies that they have strong potentials for playing useful roles in community care. Research and policy should consider measures to strengthen extended family network ties in developing countries.

Social support needs and adjustment of cancer patients.

BACKGROUND: Given the limited health care funds and increasing survival from cancer, services should be targeted to meet patients' post-treatment need. OBJECTIVES: To identify which of the needs that patients consider important; examine how they compare the role of the family, nurses and friends in meeting these needs; and assess the relationship between social support and adjustment to cancer. SETTING: Radiotherapy clinic, University College Hospital, Ibadan, Nigeria. DESIGN: Cross-sectional study. MEASUREMENTS: A 29-item needs questionnaire for assessing patients' expressed and perceived informational, physical (relief of pain), emotional and instrumental (economic) needs/support from family, friends and nurses; and indices of social adjustment (self-esteem, coping, acceptance). SUBJECTS: Seventy two (20 males and 52 females) consecutive attendees mean age, 41.1, SD 12.7. RESULTS: The highest needs expressed were physical (95.8%) and informational (81.7%), while emotional support was the most perceived as provided. Nurses and families were similarly perceived as significant providers of total social support, with nurses being identified as best providers of physical and instrumental support. Over 75% felt socially adjusted. Informational support was the most important predictor of social adjustment, while total social support predicted self-esteem. CONCLUSION: The findings support previous work indicating that clinicians should drop their reticence and provide adequate information to cancer patients and their relatives. Staff social support is appreciated by patients and is predictive of social adjustment. Policy makers should consider social welfare measures to relieve the burden of cancer on families.

Attitudes and beliefs of relatives of patients with sickle cell disease.

OBJECTIVES: To assess the attitudes and beliefs of relatives of eighty one SCD sufferers on aspects of the disease, the relationship of their responses with global rating of burden, and compare with the responses of relatives of cancer patients from a similar previous study. DESIGN: Cross-sectional survey. SETTING: Haematology outpatient clinic. MEASUREMENTS: Burden questionnaire and Goldberg's GHQ-12. RESULTS: Natural/genetic aetiologies were the most commonly proffered (>70%), compared to 19.2% for cancer. Only 8.6% believed in re-incarnation theory forSCD. More thaneighty three per cent believed that caring had made family ties closer. Though 43.2% felt depressed about patient's condition, 83.9% felt glad with caregiving roles, and there was no evidence of stigma from the neighbourhood. Only 4.9% had known about possibility of SCD before marriage. Over twelve per cent believed that SCD induced inferiority feelings in patient, and 33.3% that SCD caused lower intelligence. Beliefs and attitudes were not significantly correlated with global rating of burden. CONCLUSION: Beliefs about aetiology reflect availability of proven knowledge. The caregivers evidenced emotional disposition for community psychosocial support roles if they can be supported by social welfare and health education.

The opinion of caregivers on aspects of schizophrenia and major affective disorders in a Nigerian setting.

BACKGROUND: In Nigeria the burden of caring for persons with severe mental disorders rests largely on families whose attitudes to these conditions have not been explored. OBJECTIVES: To assess the opinion of relatives of 75 schizophrenics and 20 major affective disorder cases on aspects of the disease and compare with the responses of relatives of cancer, infertility and sickle cell disease (SCD) cases. METHOD: Caregivers were assessed using a burden questionnaire that contained items on etiological beliefs and attitudes to illness. RESULTS: The responses of relatives of the two psychiatric illness groups were similar. The single most important etiological factors were that "it is Satan's work" (35.8%) and "it is a natural illness" (23.2%). Other factors were "genetic" (9.5%), "witchcraft" (10.5%) and "curse by enemies" (10.5%). This was similar to the opinion of cancer and infertility caregivers; but different from SCD where the most important causative factors were "genetic" (41.5%) and "natural" (21.5%). Psychiatric caregivers had higher frequency of anger and stigma. Over two-thirds of psychiatric caregivers felt glad caring for the patient and would not like the patient institutionalized. Most families were thought to be supportive and there was an impression that caring had made family emotional ties closer. CONCLUSIONS: These families were tolerant and would cooperate with health authorities. Causative models are influenced by available knowledge and practices in the culture. To actualize the potential of families to play useful community psychosocial roles, there is a need for public mental health literacy and welfare support.

Depressive symptomatology and short-term stability at a Nigerian psychiatric care facility.

The aims of the study were to examine: the frequency of the subtypes and symptoms of depression, the stability of symptoms in 3 months and to compare the data with previous studies. Ninety-six consecutive patients (31 males, 65 females) fulfilling ICD-10 criteria were assessed. Compared with the WHO study, the core symptoms of depression were similar; pathological guilt and suicidal behaviour were less prevalent, and psychoticism was more prevalent. Overall, 61.5% had severe depression, 64.6% had somatic syndrome, and subjects were in remission at follow-up. The results were similar to those of a report from the hospital 26 years earlier. The purported rarity of guilt, self-depreciation, suicide and psychotic symptoms should not imply rarity of severe depression among Africans; for these are not its commonest symptoms.

Specific psychiatric morbidity among diabetics at a Nigerian General Hospital.

BACKGROUND: In Nigeria, with a rising incidence of diabetes mellitus (DM), there are no controlled studies of specific psychiatric morbidity among sufferers. OBJECTIVE: To assess the prevalence of specific psychiatric disorders and general cognitive impairment in patients with diabetes mellitus. METHOD: Using Wing's Present State Examination and the Mini-Mental State Examination, we assessed the prevalence of specific psychiatric disorders and cognitive impairment among 100 DM patients attending an out-patient clinic, in comparison with a matched non-clinic sample; and examined the relationship between psychiatric morbidity and clinical variables. RESULTS: They were predominantly males (66%), mean age 43.0 years, mean duration of illness, 7.7 years and in low level occupations. Only 11 of the patients had sexual dysfunction (11%) and psychiatric symptoms (31%). Psychiatric diagnosis (ICD-10) were, generalised anxiety (6%) and mild depressive disorder (4%). Two had subjective memory disturbance. Insulin-dependent patients had significantly more widespread psychiatric symptoms than the non-insulin dependent. Psychiatric symptomatology was significantly associated with low occupational status, duration of illness and sexual dysfunction. CONCLUSION: Health education, subsidizing the cost of treatment, and physicians' sensitivity to the emotional condition of patients, will help to relieve psychic distress and make for more adequate management.

Naturalistic study of olanzapine in treatment-resistant schizophrenia and acute mania, depression and obsessional disorder.

BACKGROUND: Whereas the Fiji government provides all aspects of mental health care services free of charge to its citizens, many schizophrenics have failed to respond to classical antipsychotic drugs. OBJECTIVE: To assess the efficacy and safety of olanzapine among various patients with severe psychiatric disorders. SETTING: Naturalistic setting. DESIGN: Descriptive study. MEASUREMENTS: Outcome was based on reduction of symptoms on the PANSS (> or = 40%) and CGI shift to 1-3. SUBJECTS: The were 64 patients (30 males) aged 17-77 years. Thirty six (56.3%) had schizophrenia, eight mania, ten severe depression, four obsessive compulsive disorder (OCD), one each had schizo-affective and delusional disorders, while the remaining had chronic brain diseases. RESULTS: At weeks 3, 8, 12, the proportion of subjects with 40% improvement was 60.6%, 79.9%, and 76.8%, respectively. Positive and negative symptoms improved. Thirteen (48.1%) of the 27 long-stay treatment--resistant schizophrenics achieved clinical recovery at eight weeks. All with primary diagnosis of severe depression and mania achieved full clinical recovery (mostly within two weeks). Two OCD cases achieved clinical recovery at week eight. CONCLUSION: Olanzapine was safe for all categories of patients. There was not a single case of extrapyramidal reaction among subjects who did not have it pre-treatment; and the drug was safe in a suicidal overdose of 205 mg. Most patients experienced weight gain; two adolescent girls had temporary amenorrhoea and one subject had transient rise in liver transaminases which normalised without discontinuing the drug.

The psychosocial burden of caring for some Nigerian women with breast cancer and cervical cancer.

In Nigeria, the rising incidence of cancer and the paucity of institutional facilities and specialist man-power implies that the burden of care rests largely on relatives. We assessed the severity of indices of psycho-social and economic burden among relatives of women with breast and cervical cancer; and its relationship with patients' psychosocial distress. Using a burden questionnaire, relatives of 73 women with cancer (41 cervical and 32 breast, mean age of caregivers 35.6 years) were interviewed, in out-patient clinics. While the caregivers admitted high frequency of all indices of 'objective' burden, emotional ties at home and social relationships in the neighbourhood seemed intact, indicating tolerance and lack of social stigma. The financial burden was more problematic than the effect of caring on family routines; and these two factors significantly predicted global rating of burden. The severity of patient's worries and psychopathological symptoms were not significantly correlated with care-giver global rating of burden. The tolerance shown by this group of relatives implies that they have strong potentials for playing useful roles in community care of patients.

The opinion of caregivers of some women with breast and cervical cancer on aspects of the disease.

RATIONALE: The paucity of institutional facilities and specialist manpower for treating cancer, implies great reliance on relatives, whose attitudes to the disease have not been explored. OBJECTIVES: To assess the attitudes and beliefs of relatives of women with breast and cervical cancer on aspects of the disease, the relationship of these variables to global rating of burden; and compare with responses of relatives of infertility cases. METHOD: In 1995, relatives of 73 women with cancer (41 patients with cervical and 32 with breast cancer, mean age of caregivers 35.6) and 33 women with infertility (mean age of caregivers 33.2 years) were interviewed in out-patient clinics at UCH, Ibadan. RESULTS: Supernatural aetiologies were the most commonly preferred by both groups (P > 0.05). Cancer commonly provoked feelings of depression among caregivers, though most of them felt glad with their caregiving roles (98.6%) and had positive attitudes towards hospital staff. Cancer seemed not to provoke feelings of social stigma. Most caregivers did not like patients institutionalised. Global rating of psychosocial burden was not significantly associated with variables explored. CONCLUSION: These relatives have the emotional disposition and social potentials for playing informal caregiving roles; hence there is a need to strengthen institutional capabilities for community-based treatment of cancer.