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.

Personality profiles of patients with alcohol and drug misuse in a Nigerian treatment facility.

Drug dependence treatment in Nigeria is at an early stage of development. The first 'stand alone' drug dependence treatment in-patient unit in Nigeria, the Drug Addiction Treatment Education and Research (DATER) unit, Aro, Abeokuta, Nigeria, was established in 1983. Prior to this, patients with drug dependence received care along with other patients in psychiatric wards and traditional healing homes (United Nations International Drug Control Programme, 1998). Currently, there is no national body in Nigeria actively involved in regulating or facilitating good practice in drug dependence treatment.

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"

The productivity and impact of psychiatric research on development of mental health services in Nigeria.

A study was conducted on three decades of medical research at the College of Medicine of the University of Ibadan (UCH) Nigeria, (1948-1980) and the perceived impact of this research on the development of psychiatry and mental health services in Nigeria. The Department of Psychiatry, UCH was for many years a unit in the Department of medicine but its scientific publications which commenced in the late fifties ranked seventh out of the twelve departments in the Faculty of Clinical Services of the College. Psychiatric researches during this period were mainly directed to the problems related to the scientific practice and acceptability of psychiatry as a distinct discipline of medicine. The research studies created a positive awareness which led to the establishment of more Departments of Psychiatry, several specialist psychiatric institutions and psychiatric residency programs in the country. Western type treatment of psychiatric disorders was accepted wholly or as additional treatment to the traditional methods.

Psychoactive substance abuse among inmates of a Nigerian prison population.

The objectives of the study were: (1) to assess the prevalence rate of psychoactive substance use and dependence among inmates of a Nigerian prison population within the past month; (2) to highlight how aware these prisoners were, of the various drugs of abuse; (3) to compare the findings with those of reports from abroad, and general Nigerian population samples. In mid-1995, 395 subjects (97.5% males, mean age 30.5 years) were interviewed, with a questionnaire that contained DSM-III-R criteria for dependence. About two-thirds were those on remand or awaiting trial, and the majority (70%) were accused of theft and armed robbery. Compared with Nigerian general population samples, the cohort had much higher prevalence rates of awareness and life-time use of psychoactive substances. Cannabis was the only drug regularly abused in the past month, by 26 (6.6%) subjects (all males); out of whom 11 (42.3%) satisfied DSM-III-R criteria for dependence. Use of intravenous drugs was not evident. This pattern differed markedly from the situation in industrialised countries. Cannabis abuse was significantly associated with those in prison for less than six months and on a charge of theft/armed robbery.

Changes in blink rates of Nigerian schizophrenics treated with chlorpromazine.

Chlorpromazine was administered over a 4-8 week period to 40 schizophrenic patients who had not received previous neuroleptic drug treatment out of a total of 222 schizophrenic patients seen during the study period. Pre-treatment spontaneous eye blink rate was high in the 40 schizophrenics when compared to 34 normal controls, (22 vs 14 blinks/min respectively, t = 17.04, df = 72, p < 0.001). Clinical improvement in the schizophrenic patients correlated with a significant reduction in their pre-treatment versus post-treatment spontaneous eye blink rate (22 vs 9 blinks/min, t = 18.83, df = 78, p < 0.001). The blink rate in the clinically-well schizophrenic patients did not however, reach the level obtained in the normal controls but rather was lowered significantly (9 vs 14 blinks/min, t = 8.11, df = 72, p < 0.001). Blink rate changes in schizophrenic patients on neuroleptic treatment may serve as a quick bedside assessment of clinical improvement and can also be a pointer to those patients who may have sub-clinical drug induced parkinsonism.

Prescribing habits for psychiatric in-patient admissions in a Nigerian psychiatric hospital.

The study evaluated the prescribing habits of psychotropic drugs in a psychiatric set-up. It revealed that neuroleptics were the most frequently prescribed psychotropic drugs, as they were given to 88% of the 170 patients placed on admission during the study period. They also formed a major part of the treatment of patients with depressive illness, where their combination with antidepressant drugs were more frequently prescribed than antidepressants alone. Depot neuroleptics were not used only as maintenance drugs or for patients with poor oral compliance, but prescribed as stat doses given once daily, in 16% of the patients. Antiparkinsonian drugs were frequently prescribed and were not necessarily commenced after the development of extrapyramidal side effects, as one-third of the patients on them had the drugs prescribed on the first day of treatment. A combination of two or more drugs, administered frequently per day was common. Prescribing instructions for pro re nate (p.r.n.) drugs were inadequate. The study highlights areas of improvement in prescribing habit over earlier studies and further reveals the ones that need to be improved especially in an economy that can least afford wastage.

Experience with an in-patient treatment model for alcohol and drug dependence in Nigeria.

A new programme for the treatment of alcohol and drug dependence at the Neuropsychiatric Hospital, Aro, Abeokuta, Nigeria is based on the modified Minnesota/Therapeutic Community model. It therefore incorporates the disease concept of drug dependence and the 12-steps of Alcoholic Anonymous (AA). Chores and responsibilities are shared by all while learning experiences/sanctions are meted out for rule contravention. Most of the patients seen were forcibly brought by relatives, they were all males and polydrug abusers with no appreciable withdrawal symptoms during detoxification phase of the programme. About a third completed the treatment schedule. A sharp drop in abscondence rate was observed with the introduction of spiritual therapy. Experience showed that the patients had difficulty in conforming to rigid rules and staff had problems in coping with some of the complex issues of drug management.

Psychiatric illness in first degree relatives of Nigerian schizophrenic and surgical control patients.

Psychiatric morbidity risk was assessed in 293 first degree relatives of patients with schizophrenia and 277 first degree relatives of surgical control patients using the family history method (FH-RDC). The morbidity risk for schizophrenia, alcoholism and schizoid personality disorder was significantly greater in relatives of schizophrenic patients. Affective disorder was difficult to diagnose using the family history method. Of the relatives of the schizophrenic probands who had psychotic illness 73.3% received treatment from traditional healers. The problem of social stigmatization of psychiatric illness was a deterrent to obtaining adequate family history, invariably the most reliable informant was the index proband. The problem was compounded by the paucity of and inaccessibility to treatment records from the traditional healers.

Absconders from the Nigerian National Neuropsychiatric Hospital: a case control study.

A case-control survey of 136 absconders who left hospital without permission on a total of 170 occasions over a 15-month period was carried out. Absconding tended to be more frequent during the day time shifts (in contrast to the night shifts) and during the weekdays (in contrast to the weekends). The destination in the majority (62.4%) was the home. Absconders differed significantly from non-absconders in terms of a tendency towards being single (p < 0.01), having a current or previous history of drug abuse (p < 0.01), being employed (p < 0.05) and staying longer on admission (p < 0.01). The results were discussed and explanations proffered for the significant differences. Finally, suggestions were made on ways of minimising the frequency of absconding from mental hospitals in the light of the results.

Blood tryptophan and ATPase in psychosis of epilepsy.

Serum tryptophan and erythrocyte Na+/K+ ATPase were determined in 14 epileptics with and without psychosis. The nature of the psychosis in four patients was non-specific. The amino acid and the enzyme levels were also estimated in 11 patients with a diagnosis of functional affective psychosis, 14 patients with schizophrenia, and 9 normal subjects. Comparison of data among the patients and the normal subjects were done using analysis of variance. There were no significant differences in tryptophan profiles and Na+/K+ ATPase levels in epileptics with or without psychosis. In addition, the data obtained for these parameters for the schizophrenics were homogenous to those of epileptics. Significant differences were, however, obtained between the epileptics and patients with affective illness. The data thus suggested that the non-specific psychosis presented by the epileptics may be schizophrenia-like and lend support to a specific psychosis associated with epilepsy.