Risk factors towards self-destructive behaviour among fresh students at Makerere University

It has been suggested that some individuals are suicide prone; and that such individuals can be detected long before they commit suicide. This paper reports the risk factors associated with potential self-destructive behaviour among a group of freshwomen at Makerere University. A suicide proneness questionnaire; the Umzimkulu suicide Proneness Inventory (USPI); was completed by 619 students admitted to the University in the academic year 1992/93. The results indicate that students' propensity to self-destructive behaviour was significantly related to the history of suicide behaviour among the students; or their relatives; and the presence of a probable depressive disorder as indicated by scores above at least 60 on each of SR; AL; AS; and PDW; scales on the questionnaire. The paper describes in detail the development of the USPI; and the theory underlying the study. Implications for improving counselling services for students at Makerere University are highlighted

Gender and the stigma of onchocercal skin disease in Africa.

This paper reports results from a multicenter study of gender differences in the stigma associated with onchocercal skin disease (OSD) in five African sites: Cameroon, Ghana, Nigeria (Awka and Ibadan) and Uganda. The studies used a common protocol to compare affected and unaffected respondents, that is, men and women with onchodermatitis in highly endemic areas and respondents from communities with low endemicity or no onchocerciasis. The methods were both quantitative and qualitative, allowing for the comparison of stigma scores and people's verbal descriptions of their experiences and attitudes. Questions to the unaffected were asked after providing them with photographs and short descriptions (vignettes) depicting typical cases. We found that stigma was expressed more openly by the unaffected, who perceived OSD as something foreign or removed from themselves, whereas the affected tended to deny that they experienced stigma as a result of the condition. Gender differences in stigma scores were not significantly different for men and women, but qualitative data revealed that stigma was experienced differently by men and women, and that men and women were affected by it in distinctive ways. Men were more concerned about the impact of the disease on sexual performance and economic prospects, whereas women expressed more concern about physical appearance and life chances, especially marriage. Similar trends were found in the different sites in the responses of affected and unaffected respondents, and differences between them, despite geographical and cultural variations.

The effects of ivermectin on onchocercal skin disease and severe itching: results of a multicentre trial.

OBJECTIVE: To determine the effects of ivermectin in annual, 3-monthly and 6-monthly doses on onchocercal skin p6isease (OSD) and severe itching. METHOD: A multicentre, double-blind placebo controlled trial was conducted among 4072 residents of rural communities in Ghana, Nigeria and Uganda. Baseline clinical examination categorized reactive skin lesions as acute papular onchodermatitis, chronic papular onchodermatitis and lichenified onchodermatitis. Presence and severity of itching was determined by open-ended and probing questions. Clinical examination and interview took place at baseline and each of 5 subsequent 3-monthly follow-up visits. RESULTS: While prevalence and severity of reactive lesions decreased for all 4 arms, those receiving ivermectin maintained a greater decrease in prevalence and severity over time. The difference between ivermectin and placebo groups was significant for prevalence at 9 months and for severity at 3 months. Differences between placebo and ivermectin groups were much more pronounced for itching. From 6 months onward, the prevalence of severe itching was reduced by 40-50% among those receiving ivermectin compared to the trend in the placebo group. CONCLUSION: This is an important effect on disease burden as severe itching is for the affected people the most troubling complication of onchocerciasis. The difference among regimens was not significant, and the recommended regimen of annual treatment for the control of ocular onchocerciasis appears also the most appropriate for onchocerciasis control in areas where the skin manifestations predominate. The final determination of the effect on skin lesions requires a longer period of study.

Prediction of self-destructive behaviour among Makerere University students.

Student suicides at Makerere University have occurred sporadically and no systematic programme of suicide prevention has been developed. In addition, no clear guidelines have been worked out to guide the operations of the university counselling centre. A study on the possible predictability of suicide behaviour among students was conducted from October 1992 to June 1995. Study objectives included the identification of possible characteristics of suicidal students; the determination of the proportion of students who will seek counselling services at the university hospital in the course of their studies; and the identification of characteristics of counsellees. Study participants were the entire group of the 1992/93 academic year intake. Six hundred and nineteen students consented to complete a self-administered questionnaire, especially designed to identify suicidal and or depressed persons. The students were then followed up for three years during which data on student attendance at the counselling centre were collected. The results were analysed using the EPI INFO computer software. The results indicated that some students (at least 5.5%) who enrolled at Makerere university annually will probably require counselling services in the course of their studies; and it is possible to recognise students who might require counselling services early at the time of their enrollment at the university. The following recommendations are made to improve counselling services for students: all students should be inducted at the time of their entry into the university; counselling services should be made attractive to students; students should be involved in providing counselling services, particularly at emergency level; a prompt and attractive referral system for students requiring psychiatric care should be established; a telephone hot-line to be managed by the students should be established and; further research is needed to improve counselling services for students at Makerere university.

Prediction of self-destructive behavior among Makerere University students

Student suicides at Makerere University have occured sporadically and no systematic programme of suicide prevention has been developed. In addition; no clear guidelines have been worked out to guide the operations of the University counselling centre. A study on the predictability of suicide behaviour among students was conducted from October 1992 to June 1995. Study objectives included the identification of possible characteristics of suicidal students; the determination of the proportion of students who will seek counselling services at the University hospital in the course of their studies; and the identification of characteristics of counsellees. Study participants were the entire group of the 1992/93 academic year intake. Six hundred and nineteen students consented to complete a self-adminsitered questionnaire; especially designed to identify suicidal and or depressed persons. The students were then followed up for three years during which data on student attendance at the counselling centre were collected. The results were analysed using the EPIINFO computer software. The results indicated that some students (at least 5.5) who enrolled at Makerere University annually will probably require counselling services early at the time of their enrollment at the University. The following recommendations are made to improve counselling services for students: all students should be inducted at the time of their entry the University; counselling services should be made attractive to students; students should be involved in providing counselling services; particularly at emergency level; a prompt and attractive referral system for students requiring psychiatric care should be established; a telephone hot-line to be managed by the students should be established and; further research is needed to improve counselling services for students at Makerere University

Risk factors towards self-destructive behaviour among fresh students at Makerere University.

It has been suggested that some individuals are suicide prone, and that such individuals can be detected long before they commit suicide. This paper reports the risk factors associated with potential self-destructive behaviour among a group of freshmen and freshwomen at Makerere University. A suicide proneness questionnaire, the Umzimkulu Suicide Proneness Inventory (USPI), was completed by 619 students admitted to the university in the academic year 1992/93. The results indicate that students' propensity to self-destructive behaviour was significantly related to the history of suicide behaviour among the students, or their relatives, and the presence of a probable depressive disorder as indicated by scores above at least 60 on each of SR, AL, AS, and PDW, scales on the questionnaire. The paper describes in detail the development of the USPI, and the theory underlying the study. Implications for improving counselling services for students at Makerere University are highlighted.

Social anthropological aspects of onchocercal skin disease in Nebbi District, Uganda.

In providing health care, the busy medical practitioner often lacks the "I-You" quality of the personal experience of illness. This paper reports the perceptions, beliefs and practices of persons living in a hyperendemic focus of onchocerciasis in Nebbi District, north-western Uganda. The study involved the use of focus group discussion and semi-structured interviews designed to explore the experiences, meanings, and illness-related coping strategies employed by the community. The results indicated that oncherciasis is considered to be a mysterious elusive disease which cannot be treated by local herbs. The disease is often mistaken for measles (odyer), and leprosy (dhobu). Persons who suffer from onchocerciasis believed that the cause of the disease is the small black fly (Kamacur), dirty water or rivers. However, non-affected individuals believed that the condition is caused by poor personal and environmental hygiene, and personal contact with persons affected by onchocerciasis. Affected people recommended public health education to control the disease while non-affected people, recommended the avoidance of personal contact with affected people, ensuring personal hygiene, and the improvement of environmental sanitation and the nutritional status of community. The belief systems of the community are probably responsible for the discriminatory practices of the people against those affected by the condition. The results indicate that onchocerciasis is a serious public health problem which needs to be controlled.

Social and psychological aspects of onchocercal skin disease in Nebbi district, Uganda.

Onchocerciasis affects 7% of Uganda's population and 1.5 million more people are at risk of infection with Onchocerca volvulus, the nematode that causes the disease. This paper reports the results of part of a multi-centre study whose objective was to determine the prevalence of onchocercal skin disease and its associated psychosocial importance in Uganda. The study employed a standardised clinical dermatological survey method along with the use of structured questionnaires, focus group discussions and key informant interviews. Out of a total of 993 persons examined to determine the prevalence of onchocercal skin lesions 253 persons were interviewed to determine the psychosocial importance of the disease. The results indicate that onchocercal skin disease is associated with a variety of psychosocial, physical and economic effects. The disease also leads to stigmatisation of affected persons and their families. It is suggested that dermatological effects of onchocerciasis should be recognised as an important cause of morbidity in Uganda.

Dermatological problems of onchocerciasis in Nebbi District, Uganda.

A cross-sectional survey of 770 subjects in onchocerciasis hyperendemic villages and 223 subjects from a control community in Nebbi District in the West Nile region of Uganda revealed a high prevalence of onchocercal skin disease of 48% in endemic villages. The most common skin problem was troublesome itching (40%); and the prevalent skin lesions were chronic papular onchodermatitis (16%), depigmentation (4%), lichenified onchodermatitis (2%) and acute papular onchodermatitis (1%). Other typical varieties of onchocercal skin diseases such as, hanging groin, lymphoedema and marked lymphadenopathy were infrequent, and considered rare. Pityriasis vergicolor was the most common non-onchocercal skin lesion in both control and endemic communities, accounting for 37% of all non-onchocercal skin lesions. These skin lesions were associated with a variety of psycho-social and economic impact; and there was a positive correlation between the prevalence of troublesome itching and the prevalence of modules (correlation coefficient r = 0.62, p = 0.00). Given the prospects of onchocerciasis control based on mass ivermectin distribution in communities where blindness is common, we recommend that treatment be extended to communities where blindness is less common, but skin disease known to be predominant.

Social anthropological aspects of onchocercal skin disease in Nebbi District; Uganda

"In providing health care; the busy medical practitioner often lacks the ""I-You"" quality of the personal experience of illness. This paper reports the perceptions; beliefs and practices of persons living in a hyperendemic focus of onchocerciasis in nebbi District; north-western Uganda. The study involved the use of focus group discussion and semi-structured interviewes designed to explore the experiences; meanings; and illness-related coping strategies employed by the community. The results indicated that oncherciasis believed that the cause of the disease is the small black fly (Kamacur); dirty water or rivers. However; non-affected individuals believed that the condition is caused by poor personal and environmental hydiene; and personal contact with persons affected by onchocerciasis. Affected people recommended public health education to control the diases while non-affected people; recommended the avoidance of personal contact with affected people; ensuring personal hygiene; and the improvement of environmental sanitation and the nutritional status of community. The belief systems of the community are probably responsible for the discriminatory practices of the people against those affected by the condition. The results indicate that onchocerciasis is a serious public health problem which needs to be controlled."

Dermatological problems of onchocerciasis in Nebbi District; Uganda

A cross-sectional survey of 770 subjects in onchocerciasis hyperendemic villages and 223 subjects from a control community in Nebbi District in the West Nile Region of Uganda revealed a high prevalence of onchocercial skin disease of 48in endemic villages. The most chronic skin problem was troublesome itching (40); and the prevalent skin lesions were chronic popular onchodermatitis (16); depigmentation (4); lichenifield onchodermatitis (2) and acute popular onchodermatitis (1). Other typical varieties of onchocercal skin diseases such as; hanging groin; lymphoedema and marked lymphadenopathy were infrequent; and considered rare. Pityriasis vergicolor was the most common non-onchocercal skin lesion in both control and endemic communities; accounting for 37of all non-onchocercal skin lesions. These skin lesions were associated with a variety of psycho-social and economic impact; and there was a positive correlation between the prevalence of troublesome itching and the prevalence of modules (correlation coefficient r=0.62; p=0.00). Given the prospects of onchorcerciasis control based on mass ivermectin distribution in communities where blindness is less common; but skin disease known to be predominant

Epilepsy: case report and analysis of clinical management problems.

Epilepsy is a major cause of morbidity and accounted for up to 40% of psychiatric outpatient attendances in the experience of the author in Transkei, South Africa. In many cases clinical diagnosis and management were easy. In this paper, the author analyses the clinical management problems presented by seven patients between January 1986 and May 1989. A detailed case report is presented to illustrate difficulties in management. It is suggested that ethosuximide might be effective in the control of probable partial seizure disorders. Underlying electrophysiological considerations are discussed. It is noted, however, that it may not be easy to differentiate between partial or generalised seizure disorders on clinical grounds.

Erotic delusions: a case report.

Few cases of erotomania, a delusional love affair, usually affecting females, have been reported from Africa. Expert opinion on the nature of this form of psychopathology is divided. In this paper, one case of erotomania from Uganda is reported after two years follow up. An account of personal experiences is provided to offer a glimpse of insight into the psychodynamics of this unusual presentation of mental illness.

Murder during sleep-walking.

The issue of criminal responsibility is no easy matter to resolve at times. One such instance is offered by the case of the sleep walker who commits a violent act in the course of his sleep. However, sleep-walking disorder has not received much professional attention. In this article the author reports one case of sleep-waking disorder (Somnambulism) in which murder was committed in cold blood.

What! Criteria for criminal responsibility?

Criminal responsibility is established on the basis of intent and the usual absence of psychiatric symptomatology. Crime constitutes a choice of actions in response to stress and may be directed by clear-cut motives. For the empirical assessment of criminal responsibility the offender should initially be considered responsible for his or her criminal deeds until all relevant psychiatric facts prove otherwise. A clinical instrument that has been used by the author for this purpose is described in this paper.

The use of electroconvulsive therapy in the treatment of psychiatric illness at Umzimkulu Hospital in Transkei. A retrospective study.

Out of 1,816 patients admitted to Umzimkulu Hospital between 1976 and 1982, 378 (20.8%) received electroconvulsive therapy (ECT) in combination with drugs. The use of ECT at this hospital is described and comparisons are made between ECT and non-ECT patients using length of stay in hospital as the criterion variable. The percentage of patients receiving ECT dropped from 32% in 1976 to 6% in 1982, when it was discontinued. ECT patients tended to be slightly younger and stayed in hospital a few days more. There was a tendency for all groups patients, male v. female, first admissions v. previously admitted, to stay in hospital slightly longer if they received ECT. It is suggested that the use of ECT in addition to neuroleptics was probably a reflection of the severity of symptomatology.

Attitudes and psychological characteristics of suicidal individuals.

The study of suicidal behavior is so complex that the search continues for clues that might explain why some people make successful suicide attempts on their lives. In this article, the authors describe attitudes and psychological characteristics of suicidal psychiatric patients and university students in Transkei. Using a specially designed suicide proneness inventory, the authors describe three factors associated with suicide proneness in Transkei, namely, Suicidal Ideation, Feeling Abandoned, and Lack of Self-Esteem. The findings suggest that suicide wishes are probably more prevalent in the general population than clinical evidence might suggest. Also, it appears that the two most important factors associated with high risk for suicide are a person's inability to cope with stressful situations and a negative personal attitude toward life.