Prospective study of psychiatric follow-up default and medication compliance after discharge at a psychiatric hospital in Nigeria.

We report a prospective follow-up of 81 patients recently discharged from the hospital. Their hospital attendance pattern, medication compliance, mental state and social functioning were measured. Defaulters were followed up in the community. At 3 months, 49.4% had defaulted, while 51.5% were medication noncompliant. Clinical outcome was best for the Non-Defaulter-Medication Compliant (ND-MC) group, worst for the Defaulter-Medication Non-Compliant (D-MNC) group. Reasons for default include feeling well, financial difficulty, medication side effects and stigma. Medication non-compliant patients were more likely to reside more than 20 km away from hospital. There is an urgent need to provide community psychiatric services to improve patients' access to services and medication compliance.

Psychotropic drugs prescription at two regional psychiatric hospitals in northern Nigeria.

BACKGROUND: Studies on psychotropic drug prescription in Nigeria are few, limited to the south and over a decade old. With the recent advances in psychopharmacology an audit is desirable. OBJECTIVE: To describe the practice and pattern of psychotropic drugs prescription for new patients attending out-patient clinic in two Federal Neuro-Psychiatric Hospitals in Northern Nigeria and to identify extent of potential drug-drug interaction in the prescriptions. METHODS: A cross-sectional study, using charts review, on new patients seen over a month at the out-patient clinics of two regional psychiatric hospitals in Northern Nigeria. RESULTS: Two hundred and seventy-eight patients were seen. Conventional antipsychotics were the most prescribed (68%), anticholinergic (62%), tricyclic antidepressants (35%), anticonvulsants (25%), benzodiazepines (8%). SSRIs were given to 2% of patients, while no patient was given an atypical antipsychotic. Physicians did not inquire about patients medical and medication histories, nor perform physical examinations in most cases. Polypharmacy was high, giving rise to significant potential drug-drug interactions in 28% of patients. CONCLUSION: Prescription practices are far from ideal, and continuing education, as well as development of prescription practice guidelines is suggested. Government intervention and change in clinician attitudes may be needed to improve use of newer medications.

Polypharmacy in psychiatric out-patient practice in northern Nigeria.

OBJECTIVE: To describe and analyze patterns of polypharmacy among psychiatric outpatients in northern Nigeria and identify predictors of psychotropic polypharmacy. METHOD: A cross-sectional study, using chart review of new patients at out-patient clinics of two regional psychiatric hospitals in northern Nigeria,measuring rates, patterns and predictors of psychotropic polypharmacy. RESULTS: A total of 278 patients were seen, of whom 92%were given two or more psychotropic agents.The pattern of psychotropic polypharmacy revealed that total, multi-class and adjunctive polypharmacy rates were high, while augmentation and same class polypharmacy rates were low. Age of respondent and diagnosis were the factors associated with total polypharmacy. CONCLUSION: The complex interplay of factors influencing physician prescription practices requires that a more pragmatic approach be adopted in efforts to curtail polypharmacy practice, rather than a wholesale, absolute condemnation of the practice.