Profiles of referrals to a psychiatric service: a descriptive study of survivors of the Nairobi US Embassy terrorist bomb blast.

OBJECTIVE: To document the socio-demographic characteristics and psychiatric profiles of the survivors of the Nairobi United States Embassy terrorist bomb blast referred to a psychiatric and psychotherapy (counselling) service. METHOD: This was a descriptive cross-sectional study. Clinical interviews and structured questionnaires for post-traumatic stress disorder (PTSD) and stress were administered. Survivors of the bomb blast referred to a psychiatric and psychotherapy service one year or more after the bombing were included in the study. These survivors had been treated using psychopharmacotherapy and individualised (not group) therapy/counselling. RESULTS: Eighty-three consecutive referrals to a psychiatric service participated in this study. There were more males and the sample was generally well educated. The referrals made contact with the referring agency for a number of reasons including seeking psychological, financial and medical assistance. All the patients reported varying degrees of psychiatric symptoms and functional impairment on various aspects of social occupational functioning. High scores for PTSD and other related stress were recorded one or more years after the bombing. CONCLUSION: Although the survivors indicated that initial counselling following the blast had helped them, they still scored high on PTSD suggesting that clinically, the initial counselling had little, if any impact on the development of PTSD. There is need for a holistic approach to the management of psychotrauma in individuals.

Obsessive-compulsive (oc) symptoms in psychiatric in-patients at Mathari hospital, Kenya.

OBJECTIVE: To document the prevalence of obsessive-compulsive disorders (OCD) among patients admitted at Mathari Psychiatric Hospital, Nairobi, Kenya. METHOD: This was a descriptive cross-sectional study conducted at the Mathari Hospital. RESULTS: Out of 691 patients interviewed, 84 (12.2%) had symptoms which met the Diagnostic and Statistical Manual of Mental Disorders (DSMIV) criteria for OCD, which started early in life. The clinicians had not recognized the OC symptoms/disorder. There were high co-morbidities between OCD and other Structured Clinical Interview for DSM-IV (SCID) core syndromes as well as psychotic symptoms often associated with schizophrenia. CONCLUSION: OC symptoms are common in psychiatric patients admitted at Mathari Hospital although such symptoms were clinically undetected and therefore not managed. The high co-morbidities between OCD, other psychiatric disorders and other psychiatric symptoms pose clinical challenges in differentiating between psychotic symptoms perceived by the patients to have an external locus and OC symptoms perceived to have an internal locus. A more systematic clinical procedure for assessing all DSM-IV symptoms should be adapted as standard quality control practice in all patients, particularly those with psychotic symptoms.

Burnout in staff working at the Mathari psychiatric hospital.

OBJECTIVE: As there are no data on burnout in staff in Kenyan psychiatric hospitals, this study sought to document the level of burnout among the staff at the Mathari Psychiatric Hospital. METHOD: This was a cross sectional descriptive study of staff working at Mathari Psychiatric Hospital. The hospital staff completed self-administered questionnaires on socio-demographic characteristics and work environment and the Maslach Burnout Inventory - Human Services and General Survey. Analysis of the data was undertaken using the Statistical Package for the Social Sciences (SPSS) version 11.5. RESULTS: Ninety-five percent of the respondents reported low to high emotional exhaustion while 87.8% reported depersonalization. Low accomplishment was reported by only 38.6% while 61.4% reported average to high personal accomplishment. Several work- and non-work-related factors including young age, number of own children, number of years worked, heavy workload and low morale were positively associated with various syndromes of burnout. Relationships at work, with family and society were generally rated as average. The staff made recommendations on how to improve the social support system and work performance. CONCLUSION: High levels of burnout were reported. These should be addressed at individual, collective and institutional levels.

Bullying in Public Secondary Schools in Nairobi; Kenya

Background: The prevalence and frequency of bullying in Nairobi public secondary schools in particular and in Kenyan schools in general is not known. Knowledge of the extent of the problem is essential in developing effective interventions. Aim: To study the prevalence and frequency of bullying in Nairobi public secondary schools; Kenya. Methods: A self-report sociodemographic questionnaire and the Olweus Bullying Questionnaire of 1991 were administered to 1 012 students from a stratified sample of public secondary schools in Nairobi. Results: Between 63.2(640) and 81.8(828) of students reported various types of bullying; both direct and indirect; with significant variations found for sex; age; class and year of study; whether in day or boarding school; and the place where bullied. Being bullied was significantly associated with becoming a bully; in turn. Discussion: Bullying is highly prevalent in Kenyan schools. Further studies are needed to characterise bullies and victims in terms of personality and environmental factors that may be associated with or conducive to bullying; as well as to determine the long-term prognosis for both bullies and victims. Further research is also required to determine the most appropriate intervention

Bullying in Public Secondary Schools in Nairobi; Kenya

Background: The prevalence and frequency of bullying in Nairobi public secondary schools in particular and in Kenyan schools in general is not known. Knowledge of the extent of the problem is essential in developing effective interventions. Aim: To study the prevalence and frequency of bullying in Nairobi public secondary schools; Kenya. Methods: A self-report sociodemographic questionnaire and the Olweus Bullying Questionnaire of 1991 were administered to 1 012 students from a stratified sample of public secondary schools in Nairobi. Results: Between 63.2(640) and 81.8(828) of students reported various types of bullying; both direct and indirect; with significant variations found for sex; age; class and year of study; whether in day or boarding school; and the place where bullied. Being bullied was significantly associated with becoming a bully; in turn. Discussion: Bullying is highly prevalent in Kenyan schools. Further studies are needed to characterise bullies and victims in terms of personality and environmental factors that may be associated with or conducive to bullying; as well as to determine the long-term prognosis for both bullies and victims. Further research is also required to determine the most appropriate intervention

"Outcome of a Working Diagnosis of ""Psychosis"" in Relation to DSM-IV Diagnostic Criteria in a Kenyan In-Patient Cohort at Mathari Hospital; Nairobi"

"Background: When a patient presents with mental illness and displays psychotic symptoms which are not clearly delineated; a clinical diagnosis of psychosis is usually enter-tained. Aim: To determine the underlying Diagnostic and Statistical Manual of Mental Disorders-Fourth edition (DSM-IV) disorders in clinical entities admitted with a working diagnosis of ""psychosis"" at Mathari Psychiatric Hospital; Nairobi; Kenya. Study Design: Descriptive cross-sectional quantitative study Method: A total of 138 patients with a working diagnosis of ""psychosis"" on admission at Mathari Hospital during the period of this study were recruited over a one-month period. Their DSM-IV diagnoses were made using the Structured Clinical Interview for DSM-IV (SCID). Analysis of the results was done using SPSS version 11.5. Results: Nearly three quarters (72.5) of the patients were male; 68.5were aged between 20 and 34 years and 63.7reported that they were single. Nearly half (49.2) had attained up to 12 years of formal education and 90were dependants of a member of the family. The most common DSM-IV diagnoses were schizophrenia; bipolar disorder; substance abuse; depression and anxiety disorders. Co-morbidity was recorded with an average of three DSM-IV disorders. Conclusion: ""Psychosis"" as a working diagnosis was reported in relatively young adults. The patients whose working clinical diagnosis was ""psychosis"" met the criteria for an average of three DSM-IV diagnoses. There is need for a proactive policy in clinical practice so that definitive diagnoses rather than just ""psychosis"" are made and appropriate management initiated as early as possible."

Psychometric properties of an African symptoms check list scale: the Ndetei-Othieno-Kathuku scale.

OBJECTIVES: To profile and quantify the psychometric properties of the NOK (Ndetei-Othieno-Kathuku) scale against internationally used Gold-standards and benchmarks for mild psychiatric disorders and post-traumatic stress disorders and to provide a potential easy to administer culture sensitive instrument for screening and assessing those with possible psychiatric disorders for the Kenyan and similar social-cultural situations. DESIGN: Cross-Sectional quantitative study. SETTING: A psychiatric clinical consultation setting and Kyanguli Secondary School psychotrauma counselling clinical set-up. SUBJECTS: Survivors of the Nairobi USA Embassy bombing who were referred for psychiatric treatment and survivors of a fire disaster from a rural Kenyan school (Kyanguli School fire disaster) including students, parents of the diseased children and staff members. RESULTS: Positive correlation was found between the NOK and all the instruments. The highest correlations were between the NOK and the BDI and SCL-90 (r = 0.557 to 0.786). The differences between the NOK scores among the different groups were statistically significant (F ratio = 13.54 to 160.34, p < 0.01). The reliability coefficient (internal consistency) of the scale, alpha = 0.9733. Other item statistics and correlations of the scale are discussed. CONCLUSION: It is concluded that the NOK has high concurrent and discriminant validity as well as a high internal consistency and that it can be used for the rapid assessment of psychotrauma victims of all age groups; and stress in general in similar age groups in the local setting. It is culture appropriate and sensitive.