Neuropsychiatric observations in the western region of Nigeria

Child development, film evidence, and epidemiological sciences: Elwyn James Anthony and the 1957 Zurich International Congress of Psychiatry

In 1957, the British-Indian child psychiatrist Dr Elwyn James Anthony travelled to the Zurich International Congress of Psychiatry to show a film featuring 70 children with such complex symptomatology and behaviour that they betrayed the certainty of contemporary theories of developmental psychology and psychoanalysis. This article examines the significance of Anthony's film to the creation of new scientific models in international developmental psychology and psychiatric epidemiology. It marked a significant change in the use of filmed evidence that sought to create a truly global and universalist approach to atypical child development based purely on scientific observations. This new observational work was important in shaping new internationally ratified models to study the epidemiology of children's psychiatric conditions.

Characteristics of patients with motor functional neurological disorder in a large UK mental health service: a case-control study

BACKGROUND

Functional neurological disorder (FND), previously known as conversion disorder, is common and often results in substantial distress and disability. Previous research lacks large sample sizes and clinical surveys are most commonly derived from neurological settings, limiting our understanding of the disorder and its associations in other contexts. We sought to address this by analysing a large anonymised electronic psychiatric health record dataset.

METHODS

Data were obtained from 322 patients in the South London and Maudsley NHS Foundation Trust (SLaM) who had an ICD-10 diagnosis of motor FND (mFND) (limb weakness or disorders of movement or gait) between 1 January 2006 and 31 December 2016. Data were collected on a range of socio-demographic and clinical factors and compared to 644 psychiatric control patients from the same register.

RESULTS

Weakness was the most commonly occurring functional symptom. mFND patients were more likely to be female, British, married, employed pre-morbidly, to have a carer and a physical health condition, but less likely to have had an inpatient psychiatric admission or to receive benefits. No differences in self-reported sexual or physical abuse rates were observed between groups, although mFND patients were more likely to experience life events linked to inter-personal difficulties.

CONCLUSIONS

mFND patients have distinct demographic characteristics compared with psychiatric controls. Experiences of abuse appear to be equally prevalent across psychiatric patient groups. This study establishes the socio-demographic and life experience profile of this understudied patient group and may be used to guide future therapeutic interventions designed specifically for mFND.

The politics and practice of Thomas Adeoye Lambo: towards a post-colonial history of transcultural psychiatry

This article traces the career of Thomas Adeoye Lambo, the first European-trained psychiatrist of indigenous Nigerian (Yoruba) background and one of the key contributors to the international development of transcultural psychiatry from the 1950s to the 1980s. The focus on Lambo provides some political, cultural and geographical balance to the broader history of transcultural psychiatry by emphasizing the contributions to transcultural psychiatric knowledge that have emerged from a particular non-western context. At the same time, an examination of Lambo's legacy allows historians to see the limitations of transcultural psychiatry's influence over time. Ultimately, this article concludes that the history of transcultural psychiatry might have more to tell us about the politics of the 'transcultural' than the practice of 'psychiatry' in post-colonial contexts.

Neuroscience in Nigeria: the past, the present and the future

The science of the brain and nervous system cuts across almost all aspects of human life and is one of the fastest growing scientific fields worldwide. This necessitates the demand for pragmatic investment by all nations to ensure improved education and quality of research in Neurosciences. Although obvious efforts are being made in advancing the field in developed societies, there is limited data addressing the state of neuroscience in sub-Saharan Africa. Here, we review the state of neuroscience development in Nigeria, Africa's most populous country and its largest economy, critically evaluating the history, the current situation and future projections. This review specifically addresses trends in clinical and basic neuroscience research and education. We conclude by highlighting potentially helpful strategies that will catalyse development in neuroscience education and research in Nigeria, among which are an increase in research funding, provision of tools and equipment for training and research, and upgrading of the infrastructure at hand.

Suicide in Hong Kong

Enquiry into the occurrence and the pattern of S.† in different cultures promises to reveal information of importance, but there is as yet inadequate material from which definite conclusions can be drawn. Cavan (1928) and Dublin and Bunzel (1933) devoted chapters of their works on S. to this aspect of the subject. These, however, were but poorly assorted collections of descriptive items from various ethnologists, orientalists, and historians, and from them few significant relationships between S. and culture could have been deduced. Zilboorg (1936, 1937) tried to build a concept of S. as a preformed, archaic behavioural reaction on ethnological data, but it must be admitted that valuable though this formulation is he has made somewhat tendentious use of his material in weaving them into the fabric of psycho-analytic theory. His arguments have been subjected to criticism by Wile (1937). Ellenberger (1953) cited examples of S. from various cultures that could be classified under the three components of the S. impulse described by Menninger (1938), viz., the wish to die, the wish to be killed, and the wish to kill. Such a classification, however, cannot cover all the facts. The social sanctioning of S. for different motives in different cultures would seem to argue against the notion that S. everywhere involves the same “components”. The view that S. is rare in elementary and compactly organized societies has long been held, and has recently been confirmed as far as the Yorubas of West Africa are concerned by Lambo (1956).

The Yoruba Image of the Witch

Witchcraft, the extra-natural interference in the welfare of the community by women, has long since ceased to be a source of major concern in Western society. In many other areas of the world, however, the witch remains a very active and vital image in the consciousness of the people, This is certainly true for the Yoruba*—a negro group occupying large areas of Nigeria, Dahomey and Togoland along the north-west coast of Africa. With the Yoruba (irrespective of his social level, religion or education), belief in the witch and in her powers is all but universal.

Traditional healers and mental illness in Uganda

Aims and method

A cross-sectional, interview survey of the beliefs, knowledge, attitudes and practice towards mental illness of 29 traditional healers in the Pallisa district of Uganda was carried out.

Results

Many of the healers had experienced emotional problems that had been treated by other healers. Almost all had a family member who was also a traditional healer. They treated a wide range of conditions and all dealt with mental illness. Most believed that mental disorders were caused by supernatural processes. Many recognised the role of environmental agents. Their diagnosis and management of mental illness was eclectic. The healers were either traditional herbalists or spirit diviners or a mixture of both. Almost all referred patients to the district hospitals and were willing to work with government health services.

Clinical implications

The results of the survey suggest the presence of fertile ground on which to build cooperation between traditional healers and medical services. Such cooperation may harness primary care resources more effectively. Sequential or simultaneous models of collaboration (or combinations of both) may be considered. Further work on specific treatments, their outcomes and the evaluation of collaborative models is needed.

Notes on the Recent History of Neuroscience in Africa

Neuroscience began with neuroanatomy and neurosurgery in Egypt more than 5000 years ago. Knowledge grew over time and specialized neurosurgery centers were established in north Africa in the eleventh century. However, it was not until the twentieth century that neuroscience research became established in sub-Saharan Africa. In most African countries, clinical research focused on understanding the rationale and improving treatment of epilepsy, infections, nutritional neuropathies, stroke and tumors. Significant advances were made. In the twenty-first century, African knowledge expanded to include all branches of neuroscience, contributing to genetic, biochemical and inflammatory determinants of brain disorders. A major focus of basic neuroscience research has been, and is, investigation of plant extracts, drugs and stress in animal models, providing insight and identifying potential novel therapies. A significant event in the history of African neuroscience was the founding of the Society of Neuroscientists of Africa (SONA) in 1993. The International Brain Research Organization (IBRO) supported SONA conferences, as well as workshops and neuroscience training schools in Africa. Thanks to their investment, as well as that of funding agencies, such as the National Institutes of Health (NIH), International Society for Neurochemistry (ISN), World Federation of Neurosurgical Societies (WFNS), World Federation of Neurology (WFN) and the International League Against Epilepsy (ILAE), neuroscience research is well-established in Africa today. However, in order to continue to develop, African neuroscience needs continued international support and African neuroscientists need to engage in policy and decision-making to persuade governments to fund studies that address the unique regional needs in Africa.

Traumatic pasts and the historical imagination: Symptoms of loss, postcolonial suffering, and counter-memories among African migrants

This work aims to rethink the relationship between anthropology and cultural psychiatry from a historical perspective, through reflections on the dynamics of forgetting and remembering in the context of migration. While migrants' symptoms often bear cultural hallmarks of suffering, they also reveal images of a traumatic history, which resurface in moments of danger, uncertainty, and crisis. I claim these symptoms are allegories of a dispossessed past, and can be interpreted as counter-memories, as "palimpsests" of an eclipsed script. Trauma symptoms keep returning to a collective past, and thus can be considered a particular form of historical consciousness. Psychiatric diagnoses may obscure these counter-memories. In particular, the diagnostic category of posttraumatic stress disorder that is commonly attached to traumatic experiences in current clinical practice recognizes the truth of individual traumatic events, but at the same time contributes to concealing the political, racial, and historical roots of suffering.

Cross-National Analysis of Beliefs and Attitude Toward Mental Illness Among Medical Professionals From Five Countries

This quantitative study sought to compare beliefs about the manifestation, causes and treatment of mental illness and attitudes toward people with mental illness among health professionals from five countries: the United States, Brazil, Ghana, Nigeria, and China. A total of 902 health professionals from the five countries were surveyed using a questionnaire addressing attitudes towards people with mental illness and beliefs about the causes of mental illness. Chi-square and analysis of covariance (ANCOVA) were used to compare age and gender of the samples. Confirmatory factor analysis was employed to confirm the structure and fit of the hypothesized model based on data from a previous study that identified four factors: socializing with people with mental illness (socializing), belief that people with mental illness should have normal roles in society (normalizing), non-belief in supernatural causes (witchcraft or curses), and belief in bio-psycho-social causes of mental illness (bio-psycho-social). Analysis of Covariance was used to compare four factor scores across countries adjusting for differences in age and gender. Scores on all four factors were highest among U.S. professionals. The Chinese sample showed lowest score on socializing and normalizing while the Nigerian and Ghanaian samples were lowest on non-belief in supernatural causes of mental illness. Responses from Brazil fell between those of the U.S. and the other countries. Although based on convenience samples of health professional robust differences in attitudes among health professionals between these five countries appear to reflect underlying socio-cultural differences affecting attitudes of professionals with the greater evidence of stigmatized attitudes in developing countries.

Profiles and outcome of traditional healing practices for severe mental illnesses in two districts of Eastern Uganda

BACKGROUND

The WHO estimates that more than 80% of African populations attend traditional healers for health reasons and that 40%-60% of these have some kind of mental illness. However, little is known about the profiles and outcome of this traditional approach to treatment.

OBJECTIVE

The purpose of this study was to describe the profiles and outcome of traditional healing practices for severe mental illnesses in Jinja and Iganga districts in the Busoga region of Eastern Uganda.

METHODS

Four studies were conducted. Study I used focus group discussions (FGDs) with case vignettes with local community members and traditional healers to explore the lay concepts of psychosis. Studies II and III concerned a cross-sectional survey of patients above 18 years at the traditional healer's shrines and study IV was made on a prospective cohort of patients diagnosed with psychosis in study III. Manual content analysis was used in study I; quantitative data in studies II, III, and IV were analyzed at univariate, bivariate, and multivariate levels to determine the association between psychological distress and socio-demographic factors; for study IV, factors associated with outcome were analyzed. One-way ANOVA for independent samples was the analysis used in Study IV.

RESULTS

The community gave indigenous names to psychoses (mania, schizophrenia, and psychotic depression) and had multiple explanatory models for them. Thus multiple solutions for these problems were sought. Of the 387 respondents, the prevalence of psychological distress was 65.1%, where 60.2% had diagnosable current mental illness, and 16.3% had had one disorder in their lifetime. Over 80% of patients with psychosis used both biomedical and traditional healing systems. Those who combined these two systems seemed to have a better outcome. All the symptom scales showed a percentage reduction of more than 20% at the 3- and 6-month follow-ups.

CONCLUSION

Traditional healers shoulder a large burden of care of patients with mental health problems. This calls for all those who share the goal of improving the mental health of individuals to engage with traditional healers.

Ogun Oru: a traditional explanation for nocturnal neuropsychiatric disturbances among the Yoruba of Southwest Nigeria

This article describes three cases of ;ogun oru' (nocturnal warefare), a condition reported in southwest Nigeria involving an acute night-time disturbance that is culturally attributed to demonic infiltration of the body and psyche during dreaming. Ogun oru is characterized by its occurrence, a female preponderance, the perception of an underlying feud between the sufferer's earthly spouse and a ;spiritual' spouse, and the event of bewitchment through eating while dreaming. The condition is believed to be treatable through Christian prayers or elaborate traditional rituals designed to exorcise the imbibed demonic elements. Ogun oru may be a label applied to medical problems. The differential diagnosis includes mainly parasomnias, for example, sleep terror, sleepwalking and sleep paralysis and, to a lesser extent, nocturnal or sleep epilepsy.

Lay concepts of depression among the Baganda of Uganda: a pilot study

The literature indicates that although depression is highly prevalent, it is rarely recognized as such. The aim was to test the use of case vignettes in exploring the explanatory models of various subtypes of depression, in six individual interviews, and four focus-group discussions. Depressive symptoms presented in these vignettes seem to be conceptualized as a problem related to cognition (thinking too much) rather than emotion (sadness) and the resulting condition is referred to as 'illness of thoughts.' Worrisome thoughts resulting from various socioeconomic problems are seen as important aetiological factors for the illness of thoughts and require no medication as it is believed that there is no medication for thoughts. There are culturally accepted ways of dealing with and healing the condition. Once illness becomes recurrent or chronic, other explanations about causes and a different course of action have to be considered. Further exploration of the relationship between thoughts and emotions among the Baganda may be an important avenue for further research.

Focus on psychiatry in East Africa

East Africa is made up of Kenya, Uganda and Tanzania, all previous colonies of the British Empire which attained their independence in the early 1960s. At the time of independence, the East African community held the three countries together. Political expedience broke up the community in 1977 but greater wisdom and economic reality have brought the three countries back together in December 2001, in the form of a common Legislative Assembly and Court of Appeal. A Customs Union is expected soon, ahead of full political integration.

Psychiatric morbidity in elderly patients admitted to non-psychiatric wards in a general/teaching hospital in Nigeria

OBJECTIVE

To determine the mental morbidity rate and types of disorders in elderly patients admitted to non-psychiatric wards of a teaching hospital in Nigeria; the ability of the non-psychiatrists to recognise the mental disorders was also assessed.

METHOD

All subjects aged 60 years and above who were admitted into the medical, surgical and gynaecological wards were assessed with the Self-Reporting Questionnaire, Mini Mental State Examination and the Geriatric Mental State Schedule. Diagnoses of mental disorders were made with the ICD-10 Diagnostic Criteria for Research. The patients' case records were then examined to determine the medical and any mental disorder diagnoses made by the attending physicians. The data were analysed by the SPSS/PC(+) computer package.

RESULTS

The mental morbidity rate was 45.3% with depression being the commonest disorder, followed by organic disorders (delirium and dementia), adjustment disorder and generalised anxiety disorder. There were also cases of alcohol and drug abuse. The physicians recognised only 2.8% of the mental disorders and referred one dementia patient to the mental health team. The negative predictive value for the physicians was poor.

CONCLUSION

Non-psychiatrist medical practitioners in Nigeria need adequate training in mental health to enhance their ability to recognise psychiatric disorders.

The pattern of psychiatric disorders among the aged in a selected community in Nigeria

OBJECTIVE

To describe the common mental disorders in elderly Nigerians living at home.

METHOD

A house-to-house survey of a rural community was conducted to identify subjects who were aged 60 years and above. The subjects were interviewed with the Self-Reporting Questionnaire (SRQ-24) and the Geriatric Mental State Schedule (GMS). Psychiatric syndromal diagnoses were made with the Clinical and Research ICD-10 manuals (ICD-10/ICD-10, DCR).

RESULTS

The overall rate of major mental disorders was 23.1%, with depression constituting 79% of all the diagnoses. Specific dementia disorders were not found in any of the subjects (N=164), but 20.7% complained of forgetfulness. Use of tobacco (snuff), (local) alcohol, and other substances were common. No subject with any identified disorder was receiving any medical attention.

CONCLUSION

The study reveals the same range of mental disorders as in studies carried out elsewhere. This suggests that if similar methodologies are used, the mental morbidity rates among the elderly in different parts of the world may be about the same. There is a need for adequate planning to accommodate the social security and mental health needs of old Nigerians.

Depression and guilt in Indian and north american patients: a comparative study

One hundred and nineteen Indian and one hundred and fourteen North American depressed patients were compared to assess the differences in psychopathology. The study revealed two important findings: 1) Indian patients scored significantly higher than American patients on the HAMD items of poor appetite, hypochondriasis, diurnal variation, and psychomotor retardation; and lower on the items of anxiety and middle insomnia. 2) Guilt was expressed less often by Indian patients. Guilt was more common among those who felt that God was responsible for their depression and in those who believed in reincarnation. These differences may be related to cultural factors and not to religious beliefs.

On the picture of depression and suicide in traditional societies

The paper deals with three problem areas regarding depression and suicide in traditional society; 1) What is the relation between the depression and suicide? 2) Is there any illness like depression all over the world? 3) What do we know about suicide in traditional societies? The author agrees with Dürkheim's classical conclusion that the incidence of suicide in a society has no clear correlation with the prevalence of mental disorders and no clear correlation with different forms of mental disorders. There are a number of studies showing that depressive syndromes exist in traditional societies. However, there is a clear difference in symtomatology between different cultures which might be the result of differences in the conception of illness. The suicide rate is generally very low in traditional societies. The ultimate solution to an unbearable life situation is apparently known to all human cultures and the suicide rate is an important indication in every society of the existential conditions of life.

Depressive disorders in Ethiopia. A standardized assessment using the SADD schedule

Fifty-two depressed patients were selected from out-patients at the psychiatric department of St. Paul's Hospital in Addis Ababa. A clinical assessment on each patient was carried out using a slightly revised SADD schedule. The findings were very similar to those from previous SADD studies in different cultures. The same "core" of depressive symptomatology could be detected in Ethiopian depressed patients. Most patients presented with somatic complaints. An interesting finding was that more women than men admitted aggressive feelings or acts. Remarkably few "culture-specific" data were found, which probably is not surprising when using a diagnostic tool with a cultural bias. Suggestions are put forward to explain the difference in frequency of some symptoms in Ethiopian patients compared with patients from other countries.

Socio-demographic factors of depressive illness among Nigerians

The socio-demographic characteristics of 142 depressive patients seen for the first time at the Psychiatric Hospital, Enugu, were studied. Females (55%) outnumbered males (45%). While depressive neurosis occurred more commonly in those under 30 years of age, manic-depressive psychosis (MDP) depression was commoner among those over 30. Married status was commoner among female MDP depressives, but there was no significant difference regarding marital status among those with depressive neurosis. MDP depression occurred more often among rural dwellers while depressive neurosis was diagnosed more often among urban dwellers. Although the majority of patients had a low level of education, there were a significant number of students and housewives among those with depressive neurosis. The probable socio-cultural factors responsible for the observed differences are discussed. A suggestion is made for a central control and monitoring of all available alternative forms of treatment (orthodox, novel, traditional and spiritual) for a better mental health delivery.

Clinical and socio-cultural parameters in Nigerian psychiatric patients. A prospective study

Three hundred and eighteen consecutive new patients presenting at a psychiatric unit in Yorubaland were prospectively studied. The majority were young, and the sexes were equally represented. Most patients came from within 50 km of the unit. Most were brought by their blood-relatives. Significant delay before presentation was observed in most cases. Previous treatment by religious and/or traditional healers was common. According to the DSM-III classification, the majority suffered from functional psychoses, most commonly schizophrenia. Three quarters received neuroleptic medication. The immediate clinical outcome was good in the majority of cases; however, within 6 months of presentation almost half defaulted from treatment. Variables which appeared to be related to delay in presentation, prior treatment by religious or traditional healers and defaulting are presented.

Observations and comments on the psychosocial determinants of depressive illness among Nigerian adults

The psychosocial characteristics of 142 depressive patients seen for the first time at the psychiatric hospital at Enugu were studied. Women (54.9 percent) outnumbered men (45.1 percent). Whereas neurotic depression occurred more commonly in those under 30 years of age, psychotic depression was more often seen in those aged over 30 years. Married status was more common among female psychotic depressives, but was not significant among neurotic depressives. Psychotic depression occurred more often among rural dwellers, whereas neurotic depression was diagnosed more often among urban residents. The majority of the patients had a low level of education. A significant incidence of neurotic depression was observed among students and housewives. The probable sociocultural factors responsible for the observed differences are discussed. A suggestion is made for a central control of all available alternative forms of treatment (orthodox, novel, and traditional) for improved delivery of mental health care.

Standardized assessment of depressive disorders (SADD) in Ghana

A study on the Standardized Assessment of Depressive Disorders (SADD) in collaboration with WHO Headquarters, Geneva, is reported in this paper. The instruments used for the study were screening forms and the SADD schedule, both of which were supplied by WHO. Fifty depressed patients were selected from the outpatients and inpatients of the Accra psychiatric hospital by experienced specialist psychiatrists using the screening forms. The two investigators then carried out a clinical assessment on each selected patient using the SADD schedule. The data collected were subjected to computer analysis. Findings were similar to those from previous WHO/SADD studies in different cultures. Specifically, the investigators found a "core" of depressive symptomatology among African patients in Ghana. An interesting finding was the change in the presentation of depression in African patients over the past 30 years. Broad diagnostic groupings like endogenous depression and psychogenic depression could easily be applied to the study patients. There is a great need for more SADD studies in Africa.

Demographic characteristics of depressives in northern Nigeria

That depressive illness is universal can not be argued, but the severity, age of onset, manifestation, and the characteristics of those affected by the illness in different parts of the world, are issues yet to be properly resolved. This retrospective study from the northern part of Nigeria shows that 42% of all first contact patients received the diagnosis of depression. Depression was diagnosed more frequently in married women than single women.

A cross cultural study of symptomatology of depression--eastern versus western patients

The symptoms exhibited by 100 depressed patients from Western India were studied. A statistical comparison was made of these symptoms with the symptoms of British depressed patients, reported in two studies from Newcastle-upon-Tyne. The symptoms in this group are similar to what has been reported for the Indian population in general except for paranoid features, which were less common. Compared with depressed patients from North India, somatic symptoms were significantly more common, while late insomnia, reduction in work and activities, and retardation were significant less frequent. Compared to South Indian depressed patients, depressed mood and hypochondriasis were significantly greater, and suicidal tendency and diurnal variation significantly less. Amongst Indian depressed patients generally, somatic symptoms, hypochondriasis, anxiety and agitation are present in a significantly larger percentage of patients, but guilt feelings, obsessional and paranoid symptoms are significantly less frequent, compared with British depressed patients.

Psychiatric disorders in a rural practice in the Bendel State of Nigeria

Patients attending a clinic were ascertained for psychiatric morbidity by a general practitioner and reascertained by a psychiatrist. The agreement ranged from 84% for neurosis and 60% for psychosis. The differences were mainly due to a lack of the depression category in the general practitioner's classification. One year incidence of psychiatric morbidity was 35.7 per 1,000 with anxiety state and depression as the two most common disorders. Depression mainly manifested as masked depression with somatic complaints.

Nigerian psychiatry in perspective

The history of Nigerian psychiatry is reviewed, and the main features and leading figures identified. The author then proceeds to discuss future directions to be taken by Nigerian psychiatry, if it is to effectively meet the challenges involved, the most prominent being to provide service for a large but growing population living in rapidly changing times.

A factor-analytical study of depression across cultures (African and European)

In a factor-analytical study of depression across two cultures, African and European, certain similarities and important differences were found. Depression in African cultures presented principally as depressed mood, somatic symptoms and motor retardation. In European cultures depression presented with depressed mood, guilt, suicidal ideas, motor retardation or anxiety. Both groups lost interest in work and the environment. Guilt and suicidal ideas and acts are uncommon in African sample, and appear to be culturally determined.

Preliminary psychiatric observations in Egypt

In the following paper a short clinical, descriptive account is given of the first 1,000 patients attending Ain Shams University Psychiatric Clinic from the beginning of 1966. Although the clinic is in the centre of Cairo, its catchment area extends all over Egypt. Patients are referred through three channels; either general practitioners send them for a psychiatric opinion or they come from other medical out-patient clinics at the University. The third group represents those who come independently and ask for psychiatric examination. Usually these are patients from the countryside who have tried lay therapy in their villages but without improvement. This group represents a deficit in the organization of referral, as many of them, having been examined at the psychiatric clinic may have to be referred to another medical out-patient clinic because of a non-psychiatric organic pathology.