Occupational Burnout Among Nigerians: The Need for Urgent Intervention.

EDITORIAL.

Pattern of impairments and late diagnosis of autism spectrum disorder among a sub-Saharan African clinical population of children in Nigeria.

BACKGROUND: Autism spectrum disorder (ASD) is a complex group of neurodevelopmental disorders. Studies conducted among Africans living outside the continent indicate that African children are more likely than Caucasian children to have a late diagnosis of ASD. There is a dearth of information on this topic among children with ASD living in Africa. METHODS: To determine the pattern of impairments and age at diagnosis in ASD, sixty Nigerian children with a diagnosis of ASD were recruited from a neurodevelopmental clinic. DSM-V criteria were used to make a diagnosis of ASD, while a symptom checklist for ASD was used to determine the pattern of impairments in ASD. RESULTS: Ages of the children ranged from 2 to 17 years with a mean age of 9.45 ± 4.33 years with the majority of them (75%) being 12 years or younger. All the children (100%) with ASD exhibited poor eye contact, difficulty in mixing with other children and inability to consistently respond to his/her name. More than a half of them (55%) lack verbal communication. Impairments that were uncommon are in the areas of object attachment (20.0%), odd postures (26.7%) and inappropriate facial expression (30.0%). Mean age at the observation of ASD features was 17.0 ± 6.7 months. Mean age at diagnosis of ASD was 9.00 ± 4.30 years. The mean time lag from a parental concern of ASD features to seeking specialist care was 85 months and to diagnosis was 91 months. CONCLUSIONS: Core symptoms/impairments of ASD are present in Nigerian children but a late diagnosis is common.

Recognition of Autism Spectrum Disorder (ASD) symptoms and knowledge about some other aspects of ASD among final year medical students in Nigeria, Sub-Saharan Africa.

BACKGROUND: Earlier studies suggest that knowledge about Autism Spectrum Disorder (ASD) among healthcare workers in Nigeria is low. This present study assessed the knowledge of Nigerian final year medical students about symptoms of ASD and some other aspects of ASD. This is a cross sectional descriptive study that drew a total of seven hundred and fifty-seven (757) final year medical students from ten (10) randomly selected fully accredited medical schools out of a total of twenty-seven (27) fully accredited medical schools in Nigeria. Sociodemographic and Knowledge about Childhood Autism among Health Workers (KCAHW) questionnaires were used to assess knowledge of final year medical students about ASD and obtain demographic information. RESULTS: Only few, 218 (28.8 %) of the 757 final year medical students had seen and participated in evaluation and management of at least a child with ASD during their clinical postings in pediatrics and psychiatry. Knowledge and recognition of symptoms of ASD is observed to be better among this group of final year medical students as shown by higher mean scores in the four domains of KCAHW questionnaire. Knowledge about ASD varies across gender and regions. Misconceptions about ASD were also observed among the final year medical students. CONCLUSIONS: More focus needs to be given to ASD in the curriculum of Nigerian undergraduate medical students, especially during their psychiatry and pediatric clinical postings.

Quantification and comparison of psychiatric distress in African patients with albinism and vitiligo: a 5-year prospective study.

BACKGROUND: Vitiligo and albinism are two disorders of pigmentation that make the affected African highly visible and strikingly different from their peers. Both pose considerable management challenges, attract significant stigma and profound impairment of quality of life. OBJECTIVE AND METHODS: To determine and compare psychiatric distress in vitiligo and albinism using the Hospital Anxiety and Depression Scale (HADS). Participants were 87 albinos and 102 vitiligo adult patients seen at an urban tertiary hospital in Nigeria between 2004 and 2009. RESULTS: Prevalence of psycho morbidity was 59% (60/102) in vitiligo compared with 26% (23/87) in the albinos. The mean anxiety score was estimated to be 2.55 points lower for albino patients (95% CI: 1.47 to 3.64), and the mean depression score 2.76 points lower (95% CI: 1.84 to 3.68), after adjustment for age, sex and marital status. However, significant differences were not observed when comparing the vitiligo patients with the subset of albino patients with skin cancer. Older patients had significantly higher anxiety and depression scores. Females had significantly higher anxiety scores (but not depression scores) compared to males. Genital involvement in vitiligo was significantly associated with anxiety but not depression. CONCLUSIONS: We found that the African with vitiligo suffers significantly higher psychiatric distress than the African albino on average. Clinical evaluation of these patients would be incomplete without assessment of their psycho morbidity. There is need for increased focus on cancer prevention strategies in the African albino.

Psychosocial aspects of epilepsy in Nigeria: a review.

BACKGROUND: Epilepsy is a chronic disorder marked by intermittent, often unpredictable seizures which may be embarrassing and disruptive to the normal activity of daily living. This review was undertaken to provide information / data on the prevalence, seizure types, treatment issues and psychosocial impact of epilepsy in Nigeria. METHOD: We searched the PUBMED database with emphasis on studies conducted in Nigeria using a combination of the following words: epilepsy, seizure, convulsion, prevalence, epidemiology, psychiatric morbidity, social issues, quality of life, cognition, school performance, treatment issues and Nigeria. RESULT: 48 relevant studies that met the criteria were reviewed. The point prevalence of epilepsy varies from 5.3 to 37 per 1000 in Nigeria. Most studies showed a predominance of generalized tonic-clonic seizures. Nigerian patients with epilepsy suffer social deprivation and discrimination in education, employment, housing, marital life as well as associated psychiatric morbidity. CONCLUSION: Epilepsy, a stigmatizing disorder in Nigeria, has a significant impact on the day to day functioning of those with the condition.

Psychosocial aspects of epilepsy in Nigeria: a review

Background: Epilepsy is a chronic disorder marked by intermittent; often unpredictable seizures which may be embarrassing and disruptive to the normal activity of daily living. This review was undertaken to provide information / data on the prevalence; seizure types; treatment issues and psychosocial impact of epilepsy in Nigeria. Method: We searched the PUBMED database with emphasis on studies conducted in Nigeria using a combination of the following words: epilepsy; seizure; convulsion; prevalence; epidemiology; psychiatric morbidity; social issues; quality of life; cognition; school performance; treatment issues and Nigeria. Result: 48 relevant studies that met the criteria were reviewed. The point prevalence of epilepsy varies from 5.3 to 37 per 1000 in Nigeria. Most studies showed a predominance of generalized tonic-clonic seizures. Nigerian patients with epilepsy suffer social deprivation and discrimination in education; employment; housing; marital life as well as associated psychiatric morbidity. Conclusion: Epilepsy; a stigmatizing disorder in Nigeria; has a significant impact on the day to day functioning of those with the condition

Brain Fag Syndrome - a myth or a reality.

The Brain Fag Syndrome (BFS) is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as a culture bound syndrome. BFS is a tetrad of somatic complaints; cognitive impairments; sleep related complaints; and other somatic impairments. Prince first described this psychiatric illness associated with study among African students in 1960. There have been questions relating to the nosological status of the syndrome as to whether: BFS is an objective or subjective phenomenon; it is one phenomenon or a variant of other known disorders; it is a mental illness? These three questions pose challenges to the culture bound/depressive or anxiety equivalent approach to the condition. The scope of this paper is the scope of BFS history from its first reference in the psychological medicine to the most contemporary descriptions in transcultural psychiatry. The conceptual history of BFS is divided into four major perspectives: Traditional medicine, Psychoanalysis, Biopsychological and Transcultural psychiatry. This helps to outline some of the key issues, helps to clarify its nosological status, its present status and helps to set the stage for the future progress. From its conceptual history, BFS as a phenomenon, with its distinct presentations, is subjectively real and is best classified with the framework of psychiatry, psychology and or sociology. The existence of BFS is evidenced by case as well as epidemiological reports of the condition in different locations. However, its course, response to treatment and outcome deserve more attention than has been given.

Subjective quality of life of Nigerian schizophrenia patients: sociodemographic and clinical correlates.

OBJECTIVE: Subjective quality of life (QOL) is dependent upon culture and its evaluation based on one's particular belief system. This study aimed to examine the subjective QOL of Nigerian out-patients with schizophrenia and its correlates. METHOD: Out-patients with Schizophrenia (n = 99) completed the WHOQOL-BREF as a measure of their subjective QOL. Sociodemographic, illness related and medication related details were also obtained. RESULTS: Overall, 21 patients (21.2%) were categorised as having 'good' and 36 (36.4%) as having 'poor' subjective QOL. 'Poor' subjective QOL correlated with anxiety/depression symptoms (OR 4.88, 95% CI 2.93-11.48), comorbid medical problems (OR 4.75, 95% CI 1.43-16.33), unemployment (OR 3.75, 95% CI 1.25-11.72) and poor social support (OR 4.60, 95% CI 1.49-14.28). CONCLUSION: Efforts to improve the QOL of patients with schizophrenia in this environment should encompass the identified variables. Larger, longitudinal and multi-centred studies are needed to adequately identify factors predicting QOL in this environment.

Premenstrual dysphoric disorder amongst Nigerian university students: prevalence, comorbid conditions, and correlates.

AIMS: The rate of premenstrual dysphoric disorder (PMDD) amongst sub-Saharan Africans is unknown. This study aimed to estimate the rate of PMDD amongst Nigerian undergraduates and to evaluate psychosocial correlates and comorbid psychiatric conditions. METHOD: Female university students (n=410) completed questionnaires detailing sociodemographic, menstruation, and gynaecological history. They also completed the Big Five Personality Inventory (BFI), and the presence of PMDD and any other DSM-IV axis 1 psychiatric diagnosis was assessed with the Mini International Neuropsychiatric Interview (MINI). RESULTS: The prevalence of PMDD was 6.1% and the correlates included older age (p=0.001), painful menstruation (p=0.006), and high score on neuroticism scale (p=0.019). Compared with participants without PMDD, participants with PMDD have significantly higher rates for the following psychiatric diagnoses: dysthymia (odds ratio [OR], 3.82; 95% confidence interval [CI], 1.68-8.69), major depressive disorder (OR, 17.00; 95% CI, 6.72-43.00), panic disorder (OR, 4.39; 95% CI, 1.35-14.30), and generalised anxiety disorder (OR, 1.21; 95% CI, 1.21-17.83). CONCLUSION: The rate of PMDD in sub-Saharan African women was comparable to that in the western cultures. Planning and implementing an effective strategy to manage perimenstrual problems in this region should be an issue of priority.

Clinically diagnosed Guillain-Barre syndrome in Ile-Ife, Nigeria.

BACKGROUND: Guillain Barre Syndrome (GBS) is a neurological disorder that poses a great challenge to medical care. It affects all age groups, gender and socio-economic groups. OBJECTIVE: To determine the pattern of clinical presentation as well as the factors that determine morbidity and mortality in Guillain Barre Syndrome (GBS) patients. METHODS: The case records of all the patients with diagnosis of GBS from 1988-2005 were retrieved. Socio-demographic, clinical data and laboratory investigations were collated. RESULTS: There were a total of 14 patients managed during this period, which comprised seven males and seven females. The mean(SD) age was 23.6 (13.3) years. Nine (64.3%) patients were students, only one (8%) patient was a professional and the rest 4 (36%) were artisans. Five (36%) patients presented with weakness of both upper and lower limbs while another five (36%) patients presented with weakness of the lower limbs only and four (28%) patients had bulbar symptoms in addition to weakness of the upper and lower limbs. The most common prodromal symptoms were headache, fever and joint pains. The common symptoms at presentation were excessive sweating paraesthesia (43%), urinary hesitancy and retention (35%). Physical findings include Flaccid quadriparesis 13 (93%), autonomic dysfunction 9 (64.3%), sensory impairment (71.4%) and cranial neuropathies 6 (43.5%). Albuminocytological dissociation was present in the cerebrospinal fluid of five (56%) of nine patients who had lumbar puncture done and erythrocyte sedimentation rate (ESR) was elevated in five patients (38%). The sex, age presenting complaints and treatment given were found not to have correlation with clinical outcome. The pattern of motor paresis and the nature of discharge patient had were significantly correlated with clinical outcome. CONCLUSION: Guillain Barre syndrome present impotant challenge to medical care in Nigeria and it is hoped that this study would sensitize clinicians to the clinical burden of Guillain Barre syndrome among Nigerians.

Anxiety disorders among Nigerian women in late pregnancy: a controlled study.

This study aimed to investigate the rate and type of anxiety disorders among Nigerian women in late pregnancy. Women in late pregnancy (n = 172) and a non-pregnant control group were assessed for DSM-IV anxiety disorders. The rate of any anxiety disorder in the pregnant women was 39.0% compared with 16.3% in the non-pregnant population (p < 0.001). Although all the anxiety disorders were more common, only the rate of social anxiety disorder was significantly higher among the pregnant than non-pregnant population. Correlates of anxiety disorder in the pregnant population include age less than 25 years (OR 4.62, 95% CI 2.39-8.92), primiparity (OR 3.90, 95% CI 2.00-7.59) and presence of medical conditions (OR 3.60, 95% CI 1.28-10.12). More research is needed in this field to ascertain the specific association between pregnancy and anxiety disorders.

Emotional distress and self-reported quality of life among primary caregivers of stroke survivors in Nigeria.

OBJECTIVES: To investigate emotional symptoms and domain quality of life (QOL) among primary caregivers of stroke survivors and to determine survivor-related and caregiver-related predictors of these variables. DESIGN: A cross-sectional study. SETTING: Medical units of the two major hospitals of the Obafemi Awolowo University Teaching Hospitals Complex, ile-Ife, Nigeria. SUBJECTS: One hundred and three matched-pairs of caregivers of stroke survivors and caregivers of mild hypertensive patients, and 103 stroke survivors. RESULTS: Twenty three (22.3%) and 25(24.3%) stroke caregivers were observed with clinically significant anxiety and depressive symptoms respectively compared with 12(11.7%) and 14(13.6%) subjects in the control group. Stroke caregivers were observed with significantly higher mean anxiety and depressions scores, and also, with significantly lower mean scores on the four QOL domains (physical health, psychological health, social relationships and environment). By multiple linear regression analysis, anxiety symptoms in stroke caregivers were predicted by high socioeconomic status of survivors and paresis in them. Depressive symptoms were predicted by high caregivers' age and depression in the patients. Higher QOL on one or more WHOQOL-Bref domains was predicted by intimate relationship with survivor, female gender of caregiver, longer duration of caring, higher education of survivor and higher age of survivor. Low QOL on one or more domain(s) was predicted by higher caregivers' age, carers' perception of survivor as cooperative, female gender of survivor, depression in survivor, paresis and cognitive impairment in survivor. CONCLUSION: Caregiving imposes high burden on stroke carers. Attention should be paid to their psychological needs and services should be designed for them to ameliorate the burden.

Attitude towards antipsychotics among out-patients with schizophrenia in Nigeria.

OBJECTIVE: The study aim to assess the attitude of patients with schizophrenia attending out-patient clinics in Nigeria towards antipsychotic medication and examine the factors associated with such attitude. METHOD: Out-patients with schizophrenia (n = 312) completed the 10-item Drug Attitude Inventory. They were also evaluated for sociodemographic details, illness-related and drug-related variables. RESULTS: Overall, the patients had a good attitude towards antipsychotic medication. The factors significantly associated with poor attitude towards medication include presence of symptoms, presence of side-effects like dyskinesia and sedation, lack of insight into the illness, and being employed. CONCLUSION: Special attention should be paid to patients with these factors while designing programmes to improve overall compliance in patients with schizophrenia.

Post-traumatic stress disorder after childbirth in Nigerian women: prevalence and risk factors.

OBJECTIVE: To estimate the prevalence of post-traumatic stress disorder (PTSD) after childbirth in a group of postpartum Nigerian women and to examine any associated factors. DESIGN: A cross-sectional survey. SETTING: Postnatal clinics and infant immunisation clinics of the five health centres in Ilesa Township, Nigeria. POPULATION: A total of 876 women at 6 weeks postpartum. METHODS: The postpartum women were assessed for PTSD at 6 weeks. Other data collected were demographic characteristics, details of pregnancy and delivery and neonatal outcome. Additionally, the following measures were used: the MINI International Neuropsychiatric Interview to assess PTSD, the Index of Marital Satisfaction to measure the degree of problem a spouse encounters in the marital relationship, the Medical Outcome Study Social Support Survey to measure social support, the Life Events Scale to measure the life stress covering the preceding 12 months and the Labour Agentry Scale that measures the maternal experiences of control during childbirth. MAIN OUTCOME MEASURES: Prevalence of PTSD in this population of postpartum Nigerian women, and how this prevalence related to other maternal and neonatal characteristics. RESULTS: The prevalence of PTSD was 5.9%. The factors independently associated with PTSD after childbirth include hospital admission due to pregnancy complications (OR 11.86, 95% CI 6.36-22.10), instrumental delivery (OR 7.94, 95% CI 3.91-16.15), emergency caesarean section (OR 7.31, 95% CI 3.53-15.10), manual removal of placenta (OR 4.96, 95% CI 2.43-10.14) and poor maternal experience of control during childbirth (OR 5.05, 95% CI 2.69-9.48). CONCLUSIONS: The prevalence of PTSD after childbirth in Nigerian women is slightly higher than those found in western culture. An effective model for the prediction of the development of PTSD after childbirth needs to be developed and evaluated, and interventions aimed at reducing the incidence of PTSD after childbirth need further research.

The course of anxiety and depressive symptoms in Nigerian postpartum women.

Postnatal depression is mostly studied within the first 12 weeks postpartum and postnatal anxiety neglected. Using the Zung's self rating anxiety and depression scales in a repeated cross sectional study of postpartum women we found both anxiety and depressive symptoms more in first 8-weeks postpartum with a gradual decline in later postpartum period. Anxiety is more common than depression in the first 4-weeks with reversal of the trend subsequently. Both symptoms may persist till late postpartum period.

Post partum emotional distress in mothers of preterm infants: a controlled study.

OBJECTIVE: To investigate whether mothers of preterm infants experience more psychological distress than mothers of normal full term infants in the immediate postpartum period. DESIGN: Cross sectional prospective study of postpartal women using the Beck Depression Inventory (BDI) and the GHQ-30. SETTING: Neonatal intensive care units and the obstetric units of Wesley Guild Hospital, Ilesa and Multipurpose Health Centre, Ilesa (These are component Units of Obafemi Awolowo University Teaching Hospitals Complex, Osun State Nigeria). RESULTS: Of the 60 postnatal women recruited into the study, 33 mothers of preterm neonates formed the index group and 27 mothers of full term normal infants constituted the control group. More mothers of preterm neonates (27.3%) had GHQ-30 scores which categorised them as having significant emotional distress than mothers of full term normal infants (3.7%). Similarly more mothers of preterm neonates (15.1%) were more depressed than mothers of full term normal infants (3.7%). These differences were found to be statistically significant when the mean scores of the two groups on the instruments swere compared. CONCLUSION: These problems are not usually detected nor appropriately referred by the paediatrician/obstetrician to the psychiatrist. This has a number of implications for preventive psychiatry. A multidisciplinary approach is therefore essential in the detection and management of these problems.