Federal Neuropsychiatric Hospital Research Articles

Prevalence of School Non-attendance Among Children and Adolescents Being Managed for Neuropsychiatric Conditions at a Mental Health Facility in Lagos, Nigeria

Education is vital to the development of the skills and talent in every child. Children with neuropsychiatric conditions (NPCs) additionally require schooling to help them overcome some of those impairments that result from their neuropsychiatric condition. The aim of this study was to determine the psychiatric and neurological conditions that were most frequently associated with school non-attendance (SNA) among children and adolescents attending a child mental health facility of the Federal Neuropsychiatric Hospital, Yaba in Lagos, Nigeria. The cross-sectional descriptive study involved 443 participants who were selected using systematic random sampling from among the children and adolescents attending the outpatient clinic of the above stated facility. The questionnaire consisted of a sociodemographic section and the child’s schooling history. A proforma was used to collect clinical data about the participants and each child’s condition was diagnosed using the ICD-10 research diagnostic criteria. Prevalence of SNA among the sample was 28.0%. Of the sixteen childhood neuropsychiatric conditions diagnosed among participants, SNA was found to be commonest among children with autistic spectrum disorders (58.5%) and severe depressive disorders in that order. Significantly more of the children suffering from epilepsy comorbid with mild psychiatric symptoms attended school when compared with children with primarily psychiatric disorders. The presence of NPCs comorbid with other mental or neurological conditions tended to significantly increase SNA. In conclusion, SNA is most common among children with autistic spectrum disorders. An awareness of this situation will help to recommend and plan appropriate schooling curriculum and placement for these children and influence policies regarding formulations of special needs schools. Also, collaboration of healthcare professionals with education administrators may help to ensure the provision of individualized education curriculum that will aid more children with NPCs to participate in schooling during their schooling years.

Validity of the Crisis Triage Rating Scale among Attendees of a Psychiatric Emergency Department in Nigeria

Background: In psychiatric emergencies, there is a high premium on rapid assessment and acuity categorization. The Crisis Triage Rating Scale (CTRS), a 3-item clinician-rated instrument, has been validated for assessing the severity or urgency of emotional crises in psychiatric emergency units. The CTRS also expedites the screening of patients who require hospital admission from those who are suitable for out-patient treatment. However, its utility has not been evaluated in Nigeria. Aim: This study aimed to assess the validity of the CTRS as a triage tool among patients attending a psychiatric emergency service in Nigeria. Method: The CTRS was administered to consecutively presenting patients (N=247) at the Emergency Unit of the Federal Neuro-Psychiatric Hospital, Yaba, Lagos, Nigeria. The ability of the CTRS to discriminate between various levels of urgency of crises and to predict the need for admission at different threshold scores, compared with clinical judgement as criterion, was determined statistically. Results: CTRS scores ranged from 3 to 15 with a mean score of 12.18 (±2.8). The optimal threshold on the CTRS for detecting emergency or urgent crises is a cut-off score of 10 as it has the best trade-off with a sensitivity of 0.93 and specificity of 0.87. At this threshold, the area under the Receiver operating characteristics curve is 0.959 (95% CI= 0.934-0.983, p<0.001). The concurrent validity of the CTRS with the Clinical Global Impairment (CGI) was also satisfactory (r=-0.62, p<0.001). Conclusion: The CTRS is a useful tool in the triaging and disposal of patients presenting to psychiatric emergency service in Nigeria.

Dyslipidaemia and Medical Outcome (Health Related Quality of Life) in Patients with Schizophrenia Taking Antipsychotics in Enugu, Nigeria

Aim. Determine association between use (and type) of antipsychotics and dyslipidaemia in newly diagnosed schizophrenia patients attending Federal Neuropsychiatric Hospital, Enugu. Methods. From sixty antipsychotic naive patients with schizophrenia and sixty first-degree relatives matched for gender and age, fasting blood lipid profiles were measured at baseline and after twelve weeks. Medical Outcome Study Short Form General Health Survey was administered to patients on both occasions. Fasting lipid profile changes of both groups were compared. Results. Mean endpoint of total cholesterol (TC), low density lipoprotein (LD), and triglycerides (TG) in mmol/l for cases was significantly higher than initial values (TC 4.5 versus 4.3, t = 4.3, p < 0.0001), (LDL 2.8 versus 2.6, t = 14.3, p < 0.0001), and (TG 1.3 versus 1.0, t = 12.1, p < 0.0001). Mean endpoint of high density lipoprotein (HDL) in mmol/l for cases was significantly lower than initial values (1.1 versus 1.2, t = 12.1, p < 0.0001). Prevalence of dyslipidaemia for cases was 13%. Mean endpoint of TC, LDL, TG, and HDL in mmol/l for controls was not significantly different from initial values (TC 4.30 versus 4.27, t = 1.09, p = 0.279), (LDL 2.49 versus 2.46, t = 1.28, p = 0.205), (TG 0.96 versus 0.94, t = 1.27, p = 0.207), and (HDL 1.37 versus 1.38, t = 1.61, p = 0.113). Subjects on atypical antipsychotics had higher risk for dyslipidaemia. Conclusion. Use of antipsychotics was significantly associated with dyslipidaemia.

Psychoactive Substances Use among In-patients in a Nigerian Neuropsychiatric Hospital: Prevalence, Pattern and Presentation

1. Abstract 1.1.Objectives:To determine the extent of drug abuse, to identify common drugs of abuse among psychiatric patients in a Nigerian hospital, to determine the duration of exposure to substances prior to presentation for treatment, to identify the common mental and behavioral problems leading to admission. 1.2.Design:A cross-sectional descriptive study. 1.3.Setting:The study was carried out at the Federal Neuropsychiatric Hospital Kware, Sokoto State and north-western Nigeria. 1.4.Participants:One hundred and four inpatients (104) were interviewed. Ethical approval was obtained before the commencement of the study. 1.5.Main outcomes measure:Self-report questionnaire on substance use. Analysis was done using the statistical package for social sciences (SPSS), version 20. 1.6.Results: The lifetime prevalence of substance abuse among the patients on admission was 69.2%. Active abuse of drugs (during the last month prior to admission) was reported in 43 (41%). Common drugs of abuse were cannabis 39 (90.7%), the cough syrup, Tutolin/Codeine 35 (81.4%) and Solvents/Inhalants, a tire repair solvent 30 (69.8%). The mean duration of substance abuse prior to presentation was 7.1±4.3 years. The common mental and behavioral symptoms at presentation were poor sleep (93%), physical/verbal aggression (74.4%) and aimless wandering (51.2%). Conclusion:The lifetime prevalence of drug use was quite high among psychiatric patients in this hospital. The abuse of cannabis, codeine syrup and solvents/inhalants still remain a great challenge among patients of the hospital. Most of the patients present for treatment after long duration of abuse when dependence on the drug has developed leading to difficulty in management. We recommend that routine screening and brief interventions for substance use should be critical components of mental health service delivery in psychiatric facilities.

Effect of Short Message Service Reminders on Clinic Attendance Among Outpatients With Psychosis at a Psychiatric Hospital in Nigeria.

The objective of this study was to determine whether patients with first-episode psychosis who were seeking treatment at a regional tertiary psychiatric facility for the first time would be more likely to attend their next scheduled clinic visit after receiving short message service (SMS) reminders about the upcoming appointment. Two hundred patients seeking treatment for a psychotic episode for the first time were randomly assigned to a control group or an intervention group by using simple randomization. Both groups received appointment dates on appointment cards, and the intervention group also received SMS text reminders of their appointments. Proportion of missed next appointments was the primary outcome measured. A total of 192 patients were included in a per-protocol analysis. A majority of them were single and cared for by a first-degree relative. The mean±SD age of the patients was 33.7±11.9 years. The median duration of untreated psychosis was 12 weeks, and the mean score on the Brief Psychiatric Rating Scale was 47.3±12.9 (possible scores range from 13 to 168). Participants who received the SMS reminders were almost twice as likely to attend their appointment compared with the control group. After adjusting for sociodemographic and clinical variables, the analysis showed that receiving an SMS reminder independently reduced the risk of a missed next appointment by 50%. SMS reminders of appointments were an effective intervention to improve clinic attendance among persons treated for first-episode psychosis at the Federal Neuro-Psychiatric Hospital in Benin City, Nigeria.

Intimate partner violence, psychopathology and the women with schizophrenia in an outpatient clinic South-South, Nigeria.

BackgroundWomen with schizophrenia are a vulnerable risk group for intimate partner violence (1PV). There are few surveys that highlight the pattern, prevalence and association of IPV with psychopathology in these vulnerable group of women in South-South Nigeria. The aim of the study was to survey the forms, prevalence and association of Intimate partner violence with psychopathology.MethodThe study was a cross-sectional survey of 77 female patients diagnosed with schizophrenia who were outpatients at the Federal Neuro-psychiatric Hospital, Calabar, Cross-River State in South-South region of Nigeria.ResultsA total of 58 out of 77 (75 %) reported at least a form of IPV, Verbal abuse was the most prevalent form of IPV reported by participants (73 %, n = 56). Women who were younger were more likely to report verbal and sexual assault at p < 0.05. A shorter length of intimate relationship was significantly associated with sexual assault at p < 0.05. Sexual assault, verbal and physical abuse were significantly associated with higher mean score on the Brief Psychiatric Rating Scale at p = 0.01.ConclusionThe study highlighted the high rate of various forms of IPV among women with schizophrenia. Sexual assault, verbal and physical abuse were strongly associated with psychopathology. There is a need to identify risk of IPV among this vulnerable group by routine enquiry by clinicians’ and plan therapy accordingly. Holistic management is needed in management of victims in their care.

Perception of service satisfaction and quality of life of patients living with schizophrenia in Lagos, Nigeria.

Objective:To assess service-satisfaction and quality of life among patients with schizophrenia in a tertiary psychiatric healthcare facility in Lagos, Nigeria.Methods:Cross-sectional survey of 101 (out of 120) patients diagnosed with schizophrenia attending the outpatient clinic of the Federal Neuro-Psychiatric Hospital Yaba, Lagos, Nigeria. The Structured Clinical Interview for DSM-IV diagnosis (SCID), Charleston Psychiatric Out-patient Scale (CPOSS), and the World-Health Organisation Quality of Life –Bref scale (WHOQOL-BREF) was used in assessing diagnosis, patient satisfaction and subjective quality of life respectively.Results:The ages of the patient ranged from 19-81. Males (49.5%) and females (50.5%) had almost equal distribution. Mean duration of attendance was 8.7years ± 8.50. Service satisfaction ranged between 25-60 on the CPOSS. Areas that had higher mean scores on CPOSS were with items (1) Helpfulness of the records clerk (3.70±1.1), (7) Helpfulness of services received (3.69±1.0). Subjective quality of life was high (3.65±1.8), satisfaction with health was also high (3.40±1.1). Service satisfaction correlated with Quality of life at P < 0.00.

From asylum to psychiatric hospital in West Africa - extra.

The Federal Neuropsychiatric Hospital Yaba, located in what has become the centre of Lagos mainland metropolis today, has changed names many times but its description as a facility remains the same, a place for respite for patients with mental illness. Established 108 years ago, it was first called

Demographic Mapping of Multiple Psychoactive Substance Abusers in a Federal Neuropsychiatric Hospital in Nigeria

Demographic Mapping of Multiple Psychoactive Substance Abusers in a Federal Neuropsychiatric Hospital in Nigeria

Occurrence of Asymptomatic Bacteriuria amongst Inmates of Federal Neuropsychiatric Hospital Calabar, Nigeria

Occurrence of Asymptomatic Bacteriuria amongst Inmates of Federal Neuropsychiatric Hospital Calabar, Nigeria

Assessment of Knowledge and Attitude of Nurses towards Ionizing Radiation during Theatre/Ward Radiography

Title: Assessment of Knowledge and Attitude of Nurses towards Ionizing Radiation during Theatre/Ward Radiography Objective: To assess the knowledge and attitude of nurses towards radiation protection In Maiduguri metropolis. Methods: A descriptive cross-sectional survey design was used. A quota sampling technique was used to draw a total of 188 registered nurses from three tertiary hospitals in Maiduguri metropolis; University of Maiduguri Teaching Hospital (UMTH), Federal Neuro-Psychiatric Hospital Maiduguri (FNPH), and State Specialist Hospital Maiduguri (SSH) participated in the study. Data was obtained using a 14- item self completion questionnaire that was administered to nursing staff of these hospitals. The questionnaire was divided into 2 sections. Section A; on demographic data and Section B; on knowledge and attitude. Data obtained were analyzed using SPSS version 18.0 and descriptive statistics was used for the analysis. Results: There were more female than male participants with a ratio of 1.09:1. Majority of the nurses (74%) were below the age of forty (40). Most of the nurses 68 (36.2%) had diploma as their highest qualification followed by 61 (32.4%) certificate holders. The level of knowledge on radiation was found to be good and positive attitude towards radiation during ward/theater radiography. Conclusion: Findings of this study revealed that nurses within Maiduguri metropolis had good knowledge of ionizing radiation, although their attitude towards radiation protection during ward/theater radiography is still less than required.

Psychosocial Correlates Of Substance Abuse Among Women In A Psychiatric Facility In Nigeria

Psychoactive drug use among the female folk is fast becoming a matter of concern in many countries with gradual increase in the number of female drug abusers. In Sub-Saharan Africa, drug abuse was a male issue hence very little research has carried out among women drug abusers. The objective of this study is to identify the psychosocial variables that are linked to drug abuse among women. The study was conducted among female patients with DSM V diagnosis of substance use disorders in the Federal Neuropsychiatric Hospital, Lagos, Nigeria. There age range between 18 and 56. Socio-demographic questionnaire was administered to assess age, marital status, educational and employment status of the participants. In addition, information on their history of drug use were collected. Also, Hospital Anxiety and Depression Scale were administered on all the participants. Data obtained were analysed with SPSS version 16. The results shows that most of the participants were single, unemployed and either students or graduates of tertiary institutions. The drugs they abuse were mainly alcohol, nicotine and cannabis. They were introduced to drugs by friends, started using drugs before the age of 25 and were motivated by the need to derive pleasure. Psychological assessment did not show high level of anxiety or depression among the participants. However, they reported that drug abuse had diminished their health, social and occupational status. The findings reveal the need to address the issue of substance abuse among female adolescents to prevent increase in the number of female drug abusers.

English

Pharmacotherapy is the cornerstone in the symptomatic treatment of schizophrenia and bipolar disorder, but non-adherence to the medications constitutes major obstacles to optimal outcome in their management. This study assessed the prevalence of and exclusively x-rayed medication-related factors of non-adherence among patients with these disorders in a resource-poor setting. Three hundred and fifty eight (358) patients with schizophrenia and bipolar disorder were randomly enrolled and interviewed at the out-patient department of the Federal Neuropsychiatric Hospital, Maiduguri in North-eastern Nigeria. Data were collected using an anonymous sociodemographic questionnaire, clinical proforma and the Hausa version of the 8-item Morisky Medication Adherence Scale (MMAS-8). The overall prevalence of non-adherence was 54.2%, while the rates were 62.5% and 45.8% for subjects with schizophrenia and bipolar disorder respectively. The independent medication-related predictors of non-adherence were: multiple dosing frequency (Odds Ratio (O.R) = 7.843, 95% C.I = 4.537 to 13.557, P &le; 0.001), presence of side effects (O.R = 6.823, 95% C.I = 3.900 - 11.937, p &le; 0.001), cost of medications (O.R. = 4.009, 95% C.I = 2.555 to 6.921, p &le; 0.001), and polytherapy (O.R. = 2.317, 95% C.I = 1.363 to 3.940, p = 0.002). This study therefore, recommends the use of guidelines that encourage rational pharmacotherapy based on monotherapy, consider routine lower dosing prescriptions, and integrating side effects surveillance and early intervention in clinical practice. Key words: Non-adherence, schizophrenia, bipolar disorder, North-eastern Nigeria.

Co-morbid anxiety disorders in patients with schizophrenia in a tertiary institution in South East Nigeria: prevalence and correlates.

Anxiety disorders occur commonly in schizophrenia but are often overlooked by psychiatrists. Their presence may compound the challenges faced by these patients and may contribute to poor outcome. The purpose of this study was to determine the prevalence of anxiety disorders among the participants with schizophrenia, and the association between this co-morbidity and disability. A total of 367 participants were recruited from the out-patient department of Federal neuropsychiatric hospital Enugu, Nigeria. Socio-demographic questionnaire, schedules for clinical assessment in neuropsychiatry, positive and negative syndrome scale and the 12-item version of the World Health Organization disability assessment schedule were administered. A total of 189 females (51.5%) and 178 (48.5%) males were studied. A lifetime prevalence of 12.3% was reported for anxiety disorder. Anxiety disorder was more likely in females (ϰ(2)=4.93, p<0.03). Specific prevalence for anxiety disorder in schizophrenia was generalized anxiety disorder 6.3%, obsessive compulsive disorder 3.3%, and phobic anxiety disorder 2.7%. Anxiety disorder was associated with increased disability (t=3.50, p<0.001) and psychopathology (t=3.40, p<0.001) among the participants studied. Phobias were associated with prescription of low doses of antipsychotics (ϰ(2)=4.08, p<0.04). There was a low rate of identification of anxiety disorder in routine clinical practice (k=0.08, p<0.001). Co-morbid anxiety disorders are common in schizophrenia and they are associated with increased disability and psychopathology. The results emphasize the need to screen for anxiety disorders in patients with schizophrenia.

Prevalence of Diabetes Mellitus among Psychotropic Drug Naive Patients with Psychiatric Disorders at Federal Neuro-Psychiatric Hospital Barnawa, Kaduna

Prevalence of Diabetes Mellitus among Psychotropic Drug Naive Patients with Psychiatric Disorders at Federal Neuro-Psychiatric Hospital Barnawa, Kaduna

The Sero-prevalence of HIV/AIDS among Patients Screened from 2008 - 2013 Attending Federal Neuropsychiatric Hospital Barnawa Kaduna State North West Nigeria

Out of a total of 472 patients tested, from 2008 - 2013 at Federal Neuropsychiatric Hospital Barnawa Kaduna State Nigeria, 67 (14.2%) were found to be sero - positive to HIV I/II antibody testing. The test involves 232 males and 240 females, 17 (7.3%) of the males were tested positive, while 50 (20.8%) of the females were found to be sero - positive. The age group (21 - 30) years has the

Clinical and Socio-Demographic Profile of Women with Post-Partum Psychiatric Conditions at a Federal Neuropsychiatric Hospital in Southeast Nigeria between 2009 and 2011.

Background:Pregnancy and labor in areas with high maternal morbidities as in Nigeria could be sufficiently stressful to precipitate mental disorders in women after delivery, which may be a new or a relapse of previously existing one, or an exacerbation of an attenuated mental illness in the nursing mother. Mental illness in a nursing mother, if not treated may result in impaired mother-infant relationship.Aim:To determine the clinical and socio-demographic characteristics of women diagnosed with postpartum psychiatric conditions in a tertiary mental health facility of a developing country.Subjects and Methods:A retrospective case note reviews of 76 women diagnosed with postpartum psychiatric conditions for the first time in the Federal Neuropsychiatric Hospital Enugu between January 2009 and December 2011.Results:The mean age of the women was 27.76 years, with 63% (48/76) of them coming from the rural areas. 93% (71/76) of them had at least a secondary education and 78% (59/76) of the women had a family history of psychiatric disorders. Schizophrenia was commonest, 48.7% (37/76) followed by depression, 22% (17/76) and mania, 15% (11/76). Those presenting with schizophrenia were younger when compared with other diagnostic groups, had a lower level of education and presented earlier for treatment. The husbands were the primary caregivers in 48% of them.Conclusion:With 63% (48/76) of them being rural dwellers, policy changes become imperative that would encourage establishment of psychiatric services in rural areas to ensure early detection and prompt treatment of postpartum women with a need for psychiatric services.

Prevalence and predictors of sub-optimal medication adherence among patients with severe mental illnesses in a tertiary psychiatric facility in Maiduguri, North-eastern Nigeria.

IntroductionSub-optimal adherence constitutes a significant impediment to the management of severe mental illnesses (SMIs) as it negatively impacts on the course of the illness and the treatment outcome. In this study, the levels of adherence, prevalence and the predictors of sub-optimal adherence were assessed in a sub-Saharan African setting.MethodsThree hundred and seventy (370) respondents with diagnoses of schizophrenia, bipolar disorder or severe depression were randomly enrolled and interviewed at the out-patient department of the Federal Neuropsychiatric Hospital, Maiduguri in northeastern Nigeria. An anonymous sociodemographic questionnaire and a clinical proforma designed by the authors, Oslo social support scale and the 8-item Morisky Medication Adherence Scale (MMAS-8) were used for data collection.ResultsThe prevalence of sub-optimal adherence was 55.7%. The independent predictors of sub-optimal adherence were; seeking for traditional/ spiritual treatment (Odds Ratio (O.R.) = 6.523, 95% C.I. = 3.773 - 11.279, P = < 0.001), male gender (O.R. = 3.307, 95% C.I. = 1.907 - 5.737, P = < 0.001), low levels of insight (O.R. = 1.753, 95 C.I. = 1.220 - 2.519, P = 0.002), and low social support levels (O.R. = 1.528, 95% C.I. = 1.097 - 2.129, P = 0.012).ConclusionBased on the outcome of the study, we recommend the development of psycho-educational programmes on adherence and the active involvement of the relations and significant others in the management of patients with SMIs in sub-Saharan Africa.

Experiences of discrimination by people with schizophrenia in Lagos, Nigeria

Purpose – The label of schizophrenia attracts a high level of stigma; consequently, people with schizophrenia are victims of unfair treatment and have limited access to decent livelihood and basic opportunities. However, most studies on stigma have overlooked the experiences of patients with schizophrenia. The purpose of this paper is to assess the experience of discrimination by patients with schizophrenia in Lagos, Nigeria. Design/methodology/approach – A descriptive cross-sectional study. Out-patients with schizophrenia (n=150) were interviewed with the Discrimination and Stigma Scale (DISC 12) at the Federal Neuro-Psychiatric Hospital, Yaba, Lagos, Nigeria. Findings – The majority of the respondents (86.7 per cent) had been avoided by people who knew they had schizophrenia. Unfair treatment was experienced by 71.3 per cent from family members, 62.7 per cent from friends, 32 per cent in social life and 28.7 per cent in intimate relationships, and 38.7 per cent in personal safety. The most commonly reported unfair treatment was inappropriate physical restraint (e.g. chains and ropes) applied by family members and beating. About eight out of ten (79.3 per cent) respondents concealed their illness. Originality/value – The findings indicate that people with schizophrenia in Nigeria experience high levels of discrimination, some of which contravenes their basic human rights. The unfair treatment experienced within the family context excludes people with schizophrenia from engaging in basic social relationships, education and the pursuit of life opportunities. Legislations should be reviewed to protect patients from unfair treatment and violation of their human rights. There is also need to equip them with strategies to cope with stigma.

An investigation into the relationship between first-degree relatives of bipolar affective disorder and (idiopathic) epilepsy in a sub-Saharan African population

ObjectivePhenomenological, neuro-biological and pharmacological investigations linked bipolar affective disorders with epilepsy. Similarly, a large community-based epidemiological study of epileptic patients reported that 12% of the participants had bipolar symptoms, a rate 7× higher than in control. Bipolar and epileptic disorders are epiphenomena of an underlying genetic susceptibility. This study aimed to determine the relationship between first-degree relatives of bipolar and epileptic patients in a sub-Saharan African population. MethodIn this case-control study, we used a socio-demographic and clinical variables questionnaire to assess random convenient samples of 50 control, 40 and 60 first-degree relatives of bipolar and epileptic patients, respectively at Federal Neuro-psychiatric Hospital (FNPH), Maiduguri. Relatives of epileptic patients and the control completed the mood disorder questionnaire (MDQ). Two consultant psychiatrists made the diagnosis of epilepsy using the ILAE criteria, in relatives of bipolar patients and the control. Participants in both groups had no EEG.We analysed the data obtained, using EPI-info 7 to report averages and associations between categorical variables with Chi-square test, and analysis of variance (ANOVA) for parametric data(statistical significance set at p=0.5, two-tailed). ResultsThe rate of epilepsy among relatives of bipolar disorder compared with control was 15.2% vs. 2.0% (χ2=46.08, p<0.001), and that of bipolar among relatives of epileptics compared with control was 14.5% vs. 2.1% (χ2=31.2, p<0.001). Educational status showed significant relationship across two groups (χ2=24.19, p=0.0001). Using ANOVA, age showed significant relationship among relatives of bipolar and epileptic patients (F=5.769, p=0.0039). ConclusionDespite its limitations, this preliminary study contributes to literature on the relationship between epilepsy and bipolar affective disorder in sub-Saharan Africa.