Relapse precipitants in Nigerian drug abusers.

OBJECTIVE: To determine the precipitants of relapse among patients admitted to a Psychiatric Hospital in Nigeria for substance abuse. PATIENTS AND METHODS: A cross-sectional survey of consecutive admitted drug abuse patients was carried out at the Psychiatric Hospital, Yaba, Lagos, using Marlatt's categories to measure high risk situations for relapse. RESULTS: Eighty-two subjects who were mostly male (87.9%), never married (53.7%), privately employed (58.5%), professionals (32%) with mean age 31.2 (+/- 6.56) years were evaluated. Most had used two or three different drugs. Coping with negative emotional states or enhancement of positive emotions were the main reasons for relapse determinants given by the subjects. Substance abuse management in Nigeria should embrace inquiries into these emotional states during both the admission and the post-discharge periods. CONCLUSION: Routine use of Marlatt' relapse precipitant categories may be helpful in designing intervention strategies to sustain abstinence in Nigerian drug abuser.

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.

Rehabilitation of heroin and cocaine abusers managed in a Nigerian psychiatric hospital.

Eighty patients, managed primarily for heroin and cocaine dependence at the Drug Rehabilitation Unit of Psychiatric Hospital, Yaba, Lagos, were followed up monthly for a period of 12 months post-discharge and assessed with regard to continued substance use, employment status and illegal activities. The management package included full assessment, detoxification, treatment of associated physical conditions, group therapy sessions, occupational and vocational rehabilitation. The sample was predominantly male (91%), young adults (mean age 29.1 years; SD 5.99) and single (58%). Although 95% had some formal education, many were school drop-outs, and only 31.3% were gainfully employed. The majority (84%), used a combination of heroin and cocaine, almost all on a daily basis, mainly by smoking and "chasing the dragon" (95%). Other substances reportedly used preadmission were alcohol (22.5%), cannabis (76.3%) and tobacco (97.5%). Less than one half (43.8%) completed the minimum one month required for inpatient treatment. Only seven (8.7%) attended the follow-up clinic regularly, but all defaulters were assessed in their homes. The level of heroin, cocaine and cannabis use, as well as report of illegal activities, dropped sharply from the first month post-discharge, but started to rise again (albeit slowly) by the second half of the follow-up period. There was only a slight insignificant gain in employment status of patients during the follow-up period. The community-based management approach is strongly advocated as a way of addressing the several factors identified in this study as militating against the successful management of substance abusers.

Comparative study of psychiatric morbidity among workers at a paint factory in Nigeria.

Inspite of numerous reports on the neurobehavioural effects of paints, there have been no such studies from Nigeria, where there are now many paint factories. The general aim of this study was, to assess the prevalence of specific psychiatric morbidity among workers in a large paint manufacturing factory. Using the Psychiatric Assessment Schedule (PAS), 60 workers (mean age, 38.1) directly involved in paint manufacture, 60 administrative staff (mean age 41.1) in the factory, and 60 postal workers (mean age 37.7) were assessed. Although higher proportions of factory workers (80%), and postal workers (73.3%) had positive PAS scores compared with administrators (36.7%), there were no significant differences in mean PAS scores across the groups. Two subjects each of factory workers (agoraphobia and dysthymia) and postal workers (dysthymia and generalised anxiety) fulfilled DSM-IIIR criteria for specific diagnosis. However, the paint workers had a wider spread of PAS symptoms, were significantly more likely to experience the symptoms constituting neurasthenia, had many more psychological complaints, experienced a wider variety of spontaneously reported symptoms, and constituted the most frequent users of health services. They had no knowledge of the possible mental health effects of exposure to paint. This level of distress is comparable to many reported findings.

Kleine-Levin syndrome: case report.

A case of Kleine-Levin syndrome in a fourteen year old junior high school female student is described. The episodic disorder was characterised by excessive sleep, voracious appetite, irritability, confusion and electro-encephalographic changes. Remission was spontaneous. Prospects for organic aetiology, differential diagnosis, and the importance of early detection are discussed.

Financial cost of treating out-patients with schizophrenia in Nigeria.

BACKGROUND: An assessment of the monetary costs of treating a group of Nigerian out-patients with schizophrenia, in comparison with insulin-dependent diabetics, was made. METHOD: Fifty out-patients with schizophrenia (mean age 42.9) and 40 with diabetes (mean age 41.9), attending government hospitals in Lagos, were assessed at six-monthly intervals, for direct and indirect costs (US$ = 82 naira; minimum monthly wage = 500 naira). RESULTS: Twenty (40%) of those with schizophrenia and eight (20%) of the diabetics had no income at all. The mean total cost of schizophrenia in six months (2941.4 naira) or US$ 35.9) was significantly less than that of diabetes (11,791 naira or US $143). The cost of antipsychotic drugs accounts for 52.8% of the cost of schizophrenia; insulin injections accounted for 92.8% of the total cost of diabetes. Patients with schizophrenia and their relatives suffered significantly more loss of working days. Cost of illness was not significantly correlated with age and duration of illness. CONCLUSIONS: Because of drastic currency devaluation, and lack of disability benefits and nursing homes, the findings contrast with Western reports where cost of drugs constitutes 2-5%, and indirect costs constitute over 50% of the total cost of schizophrenia.

Folie-a-deux: report of two incidents.

Two incidents of shared delusions are presented, one between two brothers and the other between an elderly couple. Their presentation and management are discussed. The possible role of projection and overvalued ideas as aetiological factors in Nigerians with shared delusions are highlighted.