Psychosocial Factors Associated with Substance Use among Secondary School Students in Ilorin, Nigeria

BACKGROUND

Adolescent substance use is a global concern. Identifying factors associated with it can help in preparing prevention programmes.

OBJECTIVES

The objectives were to determine the sociodemographic factors associated with substance use and the prevalence of associated psychiatric morbidity among secondary school students in Ilorin.

MATERIALS AND METHODS

Instruments used were a sociodemographic questionnaire, a modified WHO Students' Drug Use Survey Questionnaire, and the General Health Questionnaire-12 (GHQ-12) which was used to determine psychiatric morbidity, using a cut-off score of 3.

RESULTS

Substance use was associated with older age groups, male gender, parental substance use and poor relationship with parents, and urban location of school. Reported religiosity did not confer protection against substance use. The overall prevalence of psychiatric morbidity was 22.1% (n= 442). Psychiatric morbidity was more common among users of opioids, organic solvents, cocaine and hallucinogens, with current opioid users having ten times the odds of psychiatric morbidity.

CONCLUSION

Factors influencing adolescent substance use serve as a substrate for interventions. A good relationship with parents and teachers are protective factors, while parental substance use calls for holistic psychosocial support. The association of substance use with psychiatric morbidity highlights the need to incorporate behavioural treatment in substance use interventions.

Polypharmacology of some medicinal plant metabolites against SARS-CoV-2 and host targets: Molecular dynamics evaluation of NSP9 RNA binding protein

Medicinal plants as rich sources of bioactive compounds are now being explored for drug development against COVID-19. 19 medicinal plants known to exhibit antiviral and anti-inflammatory effects were manually curated, procuring a library of 521 metabolites; this was virtually screened against NSP9, including some other viral and host targets and were evaluated for polypharmacological indications. Leads were identified via rigorous scoring thresholds and ADMET filtering. MM-GBSA calculation was deployed to select NSP9-Lead complexes and the complexes were evaluated for their stability and protein-ligand communication via MD simulation. We identified 5 phytochemical leads for NSP9, 23 for Furin, 18 for ORF3a, and 19 for IL-6. Ochnaflavone and Licoflavone B, obtained from Lonicera japonica (Japanese Honeysuckle) and Glycyrrhiza glabra (Licorice), respectively, were identified to have the highest potential polypharmacological properties for the aforementioned targets and may act on multiple pathways simultaneously to inhibit viral entry, replication, and disease progression. Additionally, MD simulation supports the robust stability of Ochnaflavone and Licoflavone B against NSP9 at the active sites via hydrophobic interactions, H-bonding, and H-bonding facilitated by water. This study promotes the initiation of further experimental analysis of natural product-based anti-COVID-19 therapeutics.

Knowledge and Attitude of Fathers towards Childhood Vaccination in Ogun State, Nigeria: A Comparative Study

ACKGROUND/OBJECTIVES

Vaccine-preventable diseases (VPDs) have been shown to account for one-fifth of deaths among under-fives. Father's knowledge and attitude greatly influence the approval and uptake of childhood vaccination in patriarchal communities. This study aimed to assess and compare fathers' knowledge and attitude to childhood vaccination in urban and rural communities of Ogun State, Nigeria.

METHODS

Four hundred and forty men each were interviewed in rural and urban areas. An interviewer-administered questionnaire was used to elicit data which were analyzed with IBM SPSS version 20. Mean ages of respondents were compared using T-test while chisquare was used in testing association between categorical variables. Results were presented in tables and P < 0.05 was considered statistically significant.

RESULTS

There was no statistically significant difference in the mean ages of residents in the urban and rural areas (t = -1.82, p= 0.07). A greater proportion of rural participants (51.4%) had an overall good knowledge of childhood vaccination as against 45.2% of urban men but this difference was not statistically significant with p = 0.069. A greater percentage of participants in the urban area (58.0%) had an overall positive attitude to male participation in childhood vaccination compared to 54.1% of rural men. However, this difference was not statistically significant (p= 0.204).

CONCLUSION/RECOMMENDATION

There was better knowledge of childhood vaccination among rural participants. In contrast, attitude towards childhood vaccination was better among urban residents. There is a need for educational interventions that may positively influence the attitude of men towards childhood vaccinations, particularly in rural areas to be conducted by the government, health workers, and other stakeholders through various communication media and adopting diverse health education methods.

A COMMUNITY-BASED PREVALENCE OF PRESBYOPIA AND SPECTACLE COVERAGE IN SOUTHWEST NIGERIA

BACKGROUND

The use of population-based method to assess the prevalence of presbyopia and spectacle use is few even though it is more reliable compared to the commoner hospital based studies. This study was carried out to determine the need for spectacle services in our coverage area.

AIM

To determine the prevalence of presbyopia among adults of 30 years old and above in Sagamu local government area of Ogun state, South-West, Nigeria.

DESIGN

The study was a population based descriptive and cross-sectional design.

SETTING

The study was carried out using a multistage cluster random sampling with probability proportional to size of regular adult residents of Sagamu Local Government area, Sagamu, Ogun state, Nigeria.

MATERIALS AND METHODS

Examination of respondents included administration of semi-structured interviewer assisted questionnaire and distance visual acuity measurement with or without pinhole at 6 meters using the Snellen's charts. Automated refraction with subjective refraction was carried out in all participants with presenting visual acuity (PVA) worse than 6/9 but with an improvement with pinhole. Near assessment was done at 40cm with the distance correction in place if required. Ocular examination was also carried out in all participants that had refraction including pupillary dilatation when indicated.

RESULTS

The prevalence of presbyopia was 80.9%. There was an increasing prevalence with age (p<0.001) with a 100% prevalence in the ≥80 years age group. The mean add requirement was +2.24DS. The met presbyopic need was 22.9% and the unmet need 58%. The presbyopic spectacle coverage was 28.4% which was positively associated with younger age (p=0.034), attaining at least secondary school education (p<0.001), and living in an urban area (p<0.001).

CONCLUSION

The prevalence of presbyopia is high in this community and found in persons younger than 40 years and the spectacle coverage for the population is low with a high unmet spectacle need. There is a need to provide near vision spectacles to a large proportion of residents in the community.

Nutritional quality and essential oil compositions of Thaumatococcus danielli (Benn.) tissue and seed

Nutritional quality and essential oil compositions of Thaumatococcus danielli (Benn.) tissue and seed were determined. Oil was extracted from the seed using standard methods while the fatty acids of the oil, chemical and anti-nutritional properties of defatted seed flour were determined. Total fat yield of the seed flour was 12.20%. Defatted seed flour had higher crude fibre (36.92%), carbohydrate (40.07%) and ash (8.17%) contents. Major mineral contents were potassium, calcium, sodium and magnesium. The tissue contain appreciable amount of vitamin C (8.10 mg/100 g). Oleic acid (42.59%) was the major fatty acid in the seed oil and the total unsaturated fatty acid was 62.38%. The seed oil had higher acid and saponification values and low iodine value. Oxalate (11.09 mg/100 g) content was the major anti-nutrient in the defatted seed flour. Defatted T. danielli seed flour serves as good source of dietary fibre and energy.

Psychiatric morbidity in stroke patients attending a neurology clinic in Nigeria

BACK GROUND

Stroke produces a wide range of mental and emotional disorders. Neuropsychiatric complications associated with stroke may have negative effects on the social functioning, overall quality of life and the recovery of motor functioning of stroke survivors.

OBJECTIVE

To determine the prevalence and nature of psychiatric morbidity among stroke patients attending neurology outpatient clinic of the University of Ilorin Teaching Hospital (UITH), Ilorin-Nigeria.

METHODS

All patients with stroke aged 18 years and above at an outpatient neurology clinic in Ilorin, Nigeria were assessed for mental and emotional disorders using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) over one year (March 2009 to February 2010).

RESULTS

Overall prevalence of psychiatric morbidity was 36.0% (30/83) among 83 patients who constituted the study population. Specific diagnoses recorded were depression (19.2%), generalised anxiety disorder (9.6%), harmful alcohol use (2.4%); dementia, somatoform disorder, phobia and delusional disorder each had a prevalence of 1.2%. Clinical and sociodemographic variables were not significantly associated with psychiatric morbidity.

CONCLUSION

Psychiatric disorders are often associated with stroke. Identifying and treating stroke patients with these psychiatric co-morbidities could thus help to improve the overall quality of life of these patients.

Predictive factors for psychiatric morbidity among women with infertility attending a gynaecology clinic in Nigeria

OBJECTIVE

To determine the psychosocial and clinical factors that are associated with psychiatric morbidity among women with infertility attending a Nigerian gynaecology clinic.

METHOD

Over a four month period, 320 respondents (160 in the study group and 160 in the control group) were interviewed using a proforma (designed by the authors) and a screening instrument, General Health Questionnaire version 30 (GHQ-30). All probable cases with a score of 5 or more on GHQ-30 were interviewed using the Present State Examination (PSE). Psychiatric diagnosis was made in accordance with the diagnostic criteria of the 10th edition of the International Classification of Diseases (ICD-10).

RESULTS

The infertility rate among the study group was found to be 25.8% with primary and secondary infertility rates constituting 21.9% and 78.1% respectively. The prevalence of psychiatric morbidity among women with infertility (48.8%) was significantly more than that in the control group (11.2%) (chi(2) = 51.80, p < 0.0001). Lack of support from husband (chi(2) = 15.31, p < 0.001), lack of support from husband's relatives (chi(2) = 39.60, p < 0.0001), discrimination (chi(2) = 69.91, p < 0.0001) and history of induced abortion (chi(2) = 30.40, p < 0.0001) were found to be significantly associated with psychiatric morbidity among patients with infertility when compared with the fertile control population. There was no significant difference in the rate of psychiatric morbidity between women with primary infertility and those with secondary infertility (chi(2) = 0.03; p = 0.87).

CONCLUSION

Psychiatric morbidity is significantly more common among patients with infertility as compared with those without. There was a significant association between psychiatric morbidity and absence of support from husband and his relations, presence of discrimination, and a history of induced abortion. We suggest more public enlightenment on the need for moral/psychosocial support to women with infertility. In addition, more efforts should be made towards early screening and identification of cases of psychiatric morbidity among patients with infertility.

Detecting child psychiatric disorders during routine clinic work: A pre-interventional study of primary care physicians in Ilorin, Nigeria

<p>Back-ground Primary care physicians (PCP) are accessible health care provider for most patients and are gatekeepers to specialist care. The extent to which they can identify children with mental health problems need to be explored.</p><p><strong>Objective:</strong> To explore the extent to which primary care physicians can identify children with mental health problems. Study setting The study was carried out at the Paediatric Clinic of the department of Family Medicine, University of Ilorin teaching Hospital, Ilorin, Nigeria.</p><p><strong>Method:</strong> A 2 staged study in which 350 children aged 7-14 years were screened with child behaviour questionnaire (Rutter Scale A2). A stratified sub-sample of 157 (all high scorers and about 30% of low scorers) were further interviewed with children version of Schedule for Affective Disorders and Schizophrenia (K-SADS) by the psychiatrists. They were also evaluated by primary care physicians for the presence of mental health problems.</p><p><strong>Results:</strong> Out of the 157 children interviewed in the second stage, primary care doctors identified 12 children as having mental health problems. K-SADS identified 40 as cases, this includes 8 of the 12 identified by primary care doctors; that is, they identified 8 cases. They were poor in discriminating between cases and non- cases (P=0.012). Poor school attendance (P=0.001), frequent hospital visit (P=0.009) and long standing illness (P=0.039) were associated with case-ness. <strong></strong></p><p><strong>Conclusion:</strong> This study suggests that primary care physicians had difficulties in identifying mental health problems in the children. Interventions such as guideline protocols, primary care physician education and educational programmes to increase mental health literacy, may be effective in improving detection by primary care physicians.</p>

Postnatal depression in primary care populations in Nigeria

OBJECTIVE

The purpose of this study is to determine the prevalence and associated factors for postnatal depression in primary health care (PHC) centers of a developing society.

METHOD

A two-stage screening procedure involving the 10-item self-report Edinburgh Postnatal Depression Scale (EPDS) and the Present State Examination Schedule was employed.

RESULTS

The prevalence of postnatal depression in the primary care populations studied was 18.6%. Postnatal depression was found on logistic regression to be independently predicted by younger age (OR, 5.42; 95% CI, 2.61-10.32; P<.05), by being primigravida (OR, 2.73; 95% CI, 1.44-4.24; P<.05), by not having the desired gender for their babies (OR, 2.86; 95% CI, 1.62-5.93; P<.05) and by in-law relationship problems (OR, 3.64; 95% CI, 1.84-7.22; P<.05). The EPDS was shown to be a feasible screening instrument for postnatal depression in the PHC centers (sensitivity, 88.1%; specificity, 84.3%; minimum misclassification rate, 15.0%).

CONCLUSION

The EPDS should be incorporated into the maternal and child health care programs of PHC centers in developing countries in order to ensure early detection and appropriate therapeutic intervention in cases of postnatal depression.

Role of radiology in psychiatry: a review

OBJECTIVE

To assess the contributions of radiological studies to current level of understanding of the pathophysiological mechanisms that underlie psychiatric symptoms/ disorders and their treatment.

DATA SOURCES

Published articles in indexed journals.

STUDY SELECTION

Radiological studies of psychiatric populations with emphasis on neuroimaging techniques.

DATA EXTRACTION

Information concerning aetiological factors, pathophysiological mechanisms and treatment of psychiatric disorders were scrutinized.

DATA SYNTHESIS

Structural changes on CT, in schizophrenia include enlargement of the ventricles, cerebral sulci and fissure. MRI studies in these patients confirm significant differences in ventricular volume and medial temporal structures. Functional changes on PET, SPECT and fMRI in depressed patients include altered cerebral blood flow and metabolism in the pre-frontal cortex, anterior cingulate, caudate nucleus, amygdala and thalamus, suggesting abnormal interactions in several brain regions. Drug distribution can be imaged by MRS and this has shown brain lithium level to be about half the plasma level. PET and SPET studies have demonstrated that unlike the classical antipsychotics (e.g. chlorpromazine), atypical antipsychotic drugs such as risperidone and clozapine have high cortical serotonin (5HT2) receptor occupancy (80-90%), thus challenging the theory of a simple relationship between dopamine (D2) receptor occupancy (blocked by classical antipsychotics) and clinical efficacy.

CONCLUSION

Radiological studies of psychiatric populations add to available knowledge on the biological aspects of psychiatry. It is therefore essential to provide and update radiological facilities in mental health institutions in developing countries.

Physical morbidity in a psychiatric population in Nigeria

The rate of physical morbidity amongst 191 psychiatric in-patients in a Nigerian general hospital was found to be 27.2%. Older psychiatric patients were observed to be significantly more likely to suffer from physical morbidity. Infective processes constituted 57.7% of the physical health problems identified in the study population. Organ systems most frequently involved were the central nervous system (mainly as acute organic brain syndrome from septicaemia) (28.9%), cardiovascular/haematological (19.2%), and gastrointestinal (17.3%). Over 70% of physical disorders remained undiagnosed by the referring sources. It is emphasized that adequate attention should be paid to the physical status of psychiatric patients (both new and old cases) at all levels of health care. Collaborative work between medicine and psychiatry should also be encouraged in developing countries, and this should extend beyond clinical services and training (undergraduate and postgraduate) into the areas of evaluative research.

Psychotropic drug use in primary health care units in Nigeria

The rate of psychotropic drug use in primary care units in Nigeria was found to be 23.6%. The older age group, female sex, those with less education, those who were either separated, divorced or widowed and patients with mental morbidity on GHQ-12 were observed to be significantly more likely to have psychotropic drug prescription. It is suggested that part of efforts aimed at ensuring a more rational use of psychotropic drugs at primary health care (PHC) level of developing countries would need to include improving the ability of PHC workers to detect and manage common mental health problems in primary care.

Alcohol-related problems in primary care patients in Nigeria

A total of 440 (50.1%) drinking patients were found in a study of 878 primary care patients in Nigeria, of whom 126 (28.6%) of drinking patients were observed to have alcohol-related problems. Those with alcohol-related problems were significantly more likely to be males, middle-aged and to belong to higher occupational groups. In addition, they were also more likely to be separated, divorced or widowed, made more frequent visits to health care facilities and were more likely to have associated mental morbidity. The primary health care (PHC) workers did not recognize these problem drinkers in their care. The need to improve the ability of PHC workers to detect and manage primary care patients with alcohol-related problems in developing countries through the use of reliable and valid short alcohol screening instruments (e.g. CAGE, AUDIT) and brief intervention techniques is emphasized. It is also suggested that, on a long-term basis, the training curricula for medical and paramedical primary care personnel in third world countries should include more hours on alcohol education.

Pathways to mental health care in Nigeria

A total of 238 patients who attended a mental health service in Ilorin, Nigeria, over a one-month period were interviewed to assess the routes they took to psychiatric care. Ninety-five patients reported that they had first contacted traditional or religious healers when they became mentally ill. Patients who contacted such healers included significantly more males and Muslims and fewer patients with professional occupations. Family members played important roles in patients' decisions about the type of practitioner to consult. The author suggests that use of psychiatric care in developing countries could be improved by training primary health care workers to give mental health education to the communities they serve.

A validity study of the Hospital Anxiety and Depression Scale in general hospital units and a community sample in Nigeria

BACKGROUND

The utility of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for anxiety and depressive disorders in non-psychiatric units (medical & surgical wards; gynaecology & antenatal clinics of a teaching hospital) and a community sample in Nigeria was investigated.

METHOD

A two-stage screening procedure was employed. This involved the use of GHQ-12/GHQ-30 and HADS against the criteria of a standardised (PSE schedule) psychiatric interview, with psychiatric diagnosis assigned in accordance with ICD-9 criteria.

RESULTS

Sensitivity for the anxiety sub-scale ranged from 85.0% in the medical and surgical wards to 92.9% in the ante-natal clinic, while sensitivity for the depression sub-scale ranged from 89.5% in the community sample to 92.1% in the gynaecology clinic. Specificity for the anxiety sub-scale ranged from 86.5% in the gynaecology clinic to 90.6% in the community sample, while specificity for the depression sub-scale ranged from 86.6% in the medical and surgical wards to 91.1% in the ante-natal clinic and community sample. Misclassification rates ranged from 9.9% in the community sample to 13.2% in the medical and surgical wards. Relative Operating Characteristic (ROC) analyses showed the HADS and the GHQ-12 to be quite similar in ability to discriminate between cases (anxiety and depression) and non-cases.

CONCLUSIONS

The HADS is valid for use as a screening instrument in non-psychiatric units and although initially developed for use in hospital settings, it could be usefully employed in community settings of developing countries to screen for mental morbidity.

Psychosocial correlates of alcohol, tobacco and cannabis use amongst secondary school students in Ilorin, Nigeria

The psychosocial correlates of alcohol, cigarette and cannabis use were examined in a population of secondary school students in Ilorin, Nigeria, using a 117-items substance use questionnaire. Current alcohol use was found to be significantly associated with urban location of schools, self-reported study difficulty, self-reported poor mental health and having fathers who are highly skilled professionals. Current cigarette use was found to be positively correlated with rural location of school, male sex, older age group and self-reported poor mental health. Lifetime cannabis use was found to be significantly associated with male sex, self-rated poor academic performance and self-reported poor mental health. Perceived availability of alcohol, cigarette and cannabis by the respondents was found to be related to the rate of use of these drugs while perceived harmfulness did not appear to serve as a sufficient deterrent against substance use in the student population. These findings indicate the need for preventive strategies that emphasize school based drug education programmes, parent and teacher education, and national health policies that control availability and accessibility to these substances by Nigerian youths.

Pattern of substance use amongst secondary school students in Ilorin, northern Nigeria

One thousand and forty one Senior secondary School Students in Ilorin, Kwara State, Nigeria were surveyed using a 117-items self-administered substance use questionnaire in May 1988. Males constituted 56.6% and Females 43.5% of the study population. The mean age was 16.8 years (S.D. 1.84). The most currently used substances were found to include salicylate analgesics (56.2%), antibiotics (23.6%), stimulants (21.6%), alcohol (12.0%) and cigarette (4.4%). Current use of alcohol, antibiotics and salicylate analgesic was significantly more common in the rural school. Current use of cigarette and cannabis occurred significantly more in the male population while no significant sex differences were noted for the other drugs surveyed. For many students, initiation into substance use started at primary school level. The need to monitor the pattern of substance use at all levels of our educational system (primary, secondary and post-secondary) and to develop adequate preventive programmes for the student population was emphasized.

The role of psychosocial factors in the causation, course and outcome of physical disorders: a review

Complex interactions occur between psychological and biological factors in health and disease. Stressful life events have been shown to be important in the initiation and exacerbation of both infectious and non-infectious diseases while personality factors may act to increase or reduce vulnerability to physical disorders. Some of the psychosocial complications of physical disorders include marital and financial difficulties, personality changes, affective disturbances, memory impairment and intellectual deterioration. Psychotic reactions may occur in some cases. These complications could worsen the overall outcome and increase family stress and burden. Psychosocial intervention techniques may be required in the management of psychosocial consequences of physical disorders and for some physical illnesses uncomplicated by psychological disorders (e.g. application of biofeedback and relaxation training in the management of hypertension). It is thus important to pay more attention to the behavioural, psychological and social aspects of medical care, particularly in developing countries where available resources are limited.

Psychosocial correlates of alcohol, tobacco and cannabis use: findings from a Nigerian university

The possible correlates of alcohol, tobacco and cannabis use were investigated in a survey conducted among undergraduate students of the University of Ilorin, Nigeria. Factors that emerged as common correlates to the three substances investigated were peer influence, self-reported poor mental health, religiousity, parental/guardian supervision, perceived availability and perceived harmfulness. In addition, drinking and smoking were found to be commoner among the male sex and among respondents who reported study difficulty. There was also a significant positive relationship between cannabis use and a polygamous family background and belonging to an older age group. Although the data used in the analysis is limited due to its cross-sectional nature, the observations made are useful enough for the formulation of primary prevention strategies. A further and more elaborate longitudinal study is, however, suggested.

Psychiatric morbidity in a pregnant population in Nigeria

Psychiatric morbidity among 240 pregnant women attending an antenatal unit was assessed by a two-stage screening procedure, using the General Health Questionnaire (GHQ-30) and Present State Examination Schedule (PSE). The prevalence of psychiatric morbidity was found to be significantly associated with younger age (< 24 years), being primigravid, married for less than 1 year, having an unsupportive husband, and a previous history of induced abortion. It is suggested that more attention needs to be paid to the mental health of pregnant women in developing countries (where pregnancy rates and the risks associated with pregnancy/delivery are much higher than in the developed countries) at the primary, secondary, and tertiary levels of health care.

Emotional illness in a pediatric population in Nigeria

In a survey of 500 children aged between 5 and 15 years in a small rural community in Nigeria, 15 per cent were found to suffer from mental morbidity. Disturbances of emotion and conduct disorder constituted 67 per cent of total morbidity detected. Children from disrupted families (due to divorce, separation, and widowhood) were found to be significantly more likely to suffer from psychiatric morbidity. The need to train primary health care workers, and for them to work closely with families and school teachers in the provision of community mental health care services for children in the rural communities of developing countries is emphasized.

A study of mental morbidity among primary care patients in Nigeria

Psychological disorders among 272 primary care patients were assessed by a two-stage screening procedure, using the 12-item version of the General Health Questionnaire (GHQ-12) and the Present State Examination schedule (PSE). The prevalence of psychiatric disorder was 21.3%. Depressive neurosis (51.7%) and anxiety neurosis (36.3%) were the most common disorders. The older age group, females, and those who were either widowed, separated, or divorced were found to be more likely to suffer from psychiatric morbidity. Primary health care (PHC) workers were only able to detect 13.8% of the psychiatric cases identified in the study population. The GHQ-12 was shown to be a feasible screening instrument for psychoemotional disturbance in the primary care setting (sensitivity, 83.7%; specificity, 79.8%; minimum misclassification rate, 19.4%). Based on these findings, short- and long-term training strategies are suggested for PHC workers in developing countries to help improve their abilities to detect and manage common mental disorders in primary care settings.

Psychosocial complications and management of sickle cell disease

Psychosocial disorders frequently complicate sickle cell disease. Psychological problems include neurotic illness, personality changes and psychotic reactions. Social problems may relate to work, marital and financial difficulties. Patients' siblings, parents and significant others may also suffer from emotional disorders. The role of nonpsychiatric medical and para-medical personnel in the identification and management of the psychosocial complications of sickle cell disease was mentioned. The need to pay more attention to preventive measures such as genetic counselling was also emphasized.

Emotional illness in a paediatric population in Nigeria

In a survey of 500 children aged between 5-15 years in a small rural community in Nigeria, 15.0% were found to suffer from mental morbidity. Disturbances of emotion and conduct disorder constituted 66.7% of total morbidity detected. Children from disrupted families (due to divorce, separation and widowhood) were found to be significantly more likely to suffer from psychiatric morbidity. The need to train primary health care worker and for them to work closely with families and school teachers in the provision of community mental health care services for children in the rural communities of developing countries was emphasized.

Psychiatric morbidity in a gynaecology clinic in Nigeria

Psychological disorders among 233 women attending a gynaecology out-patient clinic was assessed by a two-stage screening procedure, using the GHQ-30 and the PSE. The prevalence of psychiatric disorders was found to be 35.2%. Psychiatric morbidity was significantly associated with a history of induced abortion, previous marriages, having no children, complaints of menstrual abnormalities, chronic pelvic pain and having unsupportive husbands. It is suggested that more attention needs to be paid to the psychological health of patients with gynaecological disorders (in line with the biopsychosocial model of health care). This will ensure an overall improvement in the quality of care.

Prevalence and pattern of substance use among undergraduates in a Nigerian University

The prevalence and pattern of substance use was investigated among undergraduate students of the University of Ilorin, Kwara State, Nigeria in June 1988. Six hundred and forty-nine students completed a 117-item self-report questionnaire 636 of which were analysed. Mean age and S.D. of respondents was 23 +/- 3.7 years; 69% were males. The most commonly used substances with their 'lifetime' prevalence rates were as follows: salicylate analgesics, 95.2%; alcohol, 77%; stimulants, 69.2%; antibiotics, 63.3%; hypno-sedatives, 49.4% and cigarettes, 37.4%. The corresponding 'current use' rates were relatively lower. Low use was recorded for cannabis, organic solvents, hallucinogens, cocaine and narcotic analgesics. Majority of the 'current users' use the substances on an occasional basis except for cigarettes where more than half reported weekly or daily use. Males were significantly more of 'current' users of cigarettes and alcohol while females tend to use stimulants more. The use of most of the substances started in primary school. The need for a comprehensive demand-reduction programme in Nigeria based on this and other local findings was advocated. Continuous monitoring, particularly of hard drug use, appears imperative.

Psychotropic drug use in medical and surgical wards of a teaching hospital in northern Nigeria

The overall prescription rate of psychotropic drugs in a Nigerian teaching hospital was 33.1%. This was slightly higher among surgical than medical patients. It is suggested that more attention needs to be paid to psychotropic drug education in developing countries in order to ensure a more rational use of these drugs.

Knowledge and views on drug abuse of primary health care workers in Nigeria

Primary health care (PHC) in Nigeria (as in many developing countries) relies heavily on paramedical personnel. Using a self-report structured questionnaire design, 207 PHC workers were assessed on their knowledge and views about drug and alcohol abuse. PHC workers with previous exposure to some form of drug abuse training were significantly more likely to be aware of the correct usage for the term 'drug abuse', although the whole range of drugs of abuse/dependence was much less well appreciated. Drugs reported by the PHC workers to be commonly abused in the study area were in keeping with previous findings on drug abuse in the country. However, 75.4% of the PHC workers perceived drug abuse as a low grade problem, in contrast to recent reports, of the increasing magnitude of drug abuse problems in the country. About one fifth of PHC workers were of the opinion that drug abusers should be punished. Only 35 (16.9%) of those who indicated the need for treatment mentioned that this could be carried out by PHC personnel. Many of the PHC workers showed limited knowledge of factors associated with drug abuse and on the scope of preventive strategies against drug abuse. Suggestions are made on the short and long term training needs of the PHC workers in order to ensure the successful incorporation of drug abuse treatment and prevention programmes into the PHC programme in Nigeria.

The role of laboratory medicine in psychiatry

The application of contemporary biological methods in psychiatric practice has encouraged the reintegration of psychiatry into medicine. These investigative techniques assist in the elucidation of factors of aetiological importance, confirmation of diagnosis, regulation of dosage of medication, prediction of response to treatment and assessment of prognostic factors. It is emphasized that there is an urgent need to improve upon available laboratory facilities in mental health institutions in Africa and other third world countries, and also to encourage research in biological psychiatry. This will allow for cross-cultural comparison (between developed and developing countries) on the issue of aetiology, clinical manifestation/nosology, management and prognosis of mental disorders.

The need for a holistic approach to patient care

A review of the literature shows that psychological disorders frequently complicate physical illness. Similarly, biological factors have been shown to be important in psychiatric patients. The social environment of patients similarly contributes to their susceptibility to physical and mental disorders. The need to encourage a biopsychosocial model of health care is emphasized. It is suggested that there is an urgent need to evolve better collaboration between psychiatric and non-psychiatric physicians in clinical services, research and training at the primary, secondary and tertiary levels of health care.

Drug abuse and its clinical implications with special reference to Nigeria

A review of the literature shows that drug abuse has become a major public health problem in Nigeria. Alcohol, cannabis, psychostimulants and hypnosedatives are the most commonly abused drugs, although the abuse of hard drugs such as cocaine and heroin appears to be on the increase in the big cities. Drug abuse in the country now starts at an early age and cuts across all social groups. The need to incorporate drug and alcohol treatment and prevention programmes into the primary health care programmes (as part of the mental health component), was emphasised as a necessary strategy to ensure early detection and management, and a better coverage of the population of patients in need of care. It was also suggested that there is an urgent need to encourage extensive epidemiological and longitudinal studies of drug and alcohol abuse in Nigeria in order to accurately determine the populations at risk, the changing patterns of abuse over time (including cross-cultural comparison), and to allow for adequate social monitoring, planning and evaluation of services.

Knowledge and attitude concerning mental health of primary health care workers in Nigeria

Primary health care (PHC) in developing countries continues to rely heavily on paramedical personnel. Using a structured questionnaire, 207 PHC workers in Nigeria were assessed on the concept, attitude to, detection and treatment of mental disorders. PHC workers without previous exposure to mental health training were significantly more likely to hold on to traditional views on the aetiology of mental disorders. Most of the health workers (82%) indicated that mental disorders accounted for 5% or less of their patient load. Detection rate for the vignette on neurosis as a case of mental disorder was poorer than that for psychosis (36% vs. 71% of respondents respectively). Psychopharmacological knowledge of the PHC workers was found to be poorest for antidepressant medication. Only 30% of the health workers could suggest specific types of mental health programme that could be introduced at PHC level. Many of them (72%) expressed a generally negative attitude towards mentally ill patients. Suggestions are made on the short and long term training requirements of the PHC workers in order to ensure the successful integration of mental health care into the primary health care programme in Nigeria.

Neuro-psychiatric manifestations of acquired immune deficiency syndrome (AIDS)

Acquired Immune Deficiency Syndrome (AIDS) has been spreading in Africa and other continents of the world. While there is a dearth of information on AIDS-related neuro-psychiatric disorders in the African population, data from Europe and America indicate that patients with AIDS experience a lot of psycho-social difficulties and suffer from a variety of psychiatric syndromes such as anxiety state, depression, manic illness and schizophreniform disorder. Neurological sequelae of AIDS include acute and sub-acute encephalitis, meningitis, myelopathy, chorioretinitis and peripheral neuropathy. These changes may occur from direct neuropathic effects of human immuno-deficiency virus (HIV) or secondary to opportunistic infections and neoplasms involving the central nervous system. It is suggested that psychiatrists need to be fully involved at all levels of clinical care, education and research on AIDS. Attention should be focussed on the neuro-psychiatric consequences of AIDS in the African population to allow for cross-cultural comparison. In addition, the need to incorporate information and education programmes on AIDS into the primary health care programmes of developing countries is emphasised.

Mental health and primary care in Africa

Epidemiological studies from Africa indicate that the prevalence of psychiatric morbidity is similar to that found in the western world. The dearth of mental health personnel and facilities had resulted in an urgent need to decentralize and integrate mental health care with the general health services in African countries. This is seen as a viable means of extending mental health care to all in the African continent. The strategies for achieving this integration are discussed.

Psychiatric morbidity in medical and surgical wards of a Nigerian general hospital

Psychological disorders among 275 medical and surgical in-patients was assessed by a two-stage screening procedure, using the GHQ-30 and the PSE. The prevalence of psychiatric disorders was 30.2% with an additional 9.8% reporting distressing psychiatric symptoms. The morbidity rates among medical (30.6%) and surgical (29.6%) patients were comparable. Older patients and females were found to be more likely to suffer from psychiatric disorders. It is suggested that the paramedical personnel in general hospital wards of developing countries could be taught psychosocial intervention techniques necessary in the management of emotional complications of physical disorders.

Neuroleptic malignant syndrome: a report of two cases in Nigeria

Neuroleptic malignant syndrome occurring in two Nigerians are reported. The features of this life threatening complication of treatment with neuroleptic drugs are highlighted with a view to emphasizing the need for the clinician to consider it a possibility in any febrile patient with a history of neuroleptic ingestion. The increased awareness will aid early diagnosis and prompt management which are necessary to prevent fatal outcome.

Psychiatric morbidity in a primary health care centre in a rural community in Nigeria

Two hundred and fourteen adult patients (148 females and 68 males) attended a Primary Health Care Facility in a rural community in Nigeria over a period of 4 weeks. 48 (22.4 percent) psychiatric cases were detected from the general out-patient and school clinics. All the cases suffered from neurotic illnesses. Depressive neurosis constituted 62.5 percent of the cases while anxiety neurosis made up the remaining 37.5 percent. The health workers involved were only able to detect 7 (14.6 percent) of the 48 neurotic cases. The presenting complaints in many of hte cases was in the form of physical symptoms like poor sleep, weakness and generalised body ache. The need to adequately train and actively involve primary health care workers in the detection and management of mental disorders presenting at primary health care level was emphasized.

Mortality in a psychiatric population: a Nigerian psychiatric hospital experience

Out of a total of 10,661 patients admitted over a 10-year period in a Nigerian psychiatric hospital, 138 deaths were recorded. A decreasing trend in the mortality figures was demonstrated despite a marked increase in the number of admissions. There were more male deaths (60%) than female deaths (40%). The majority of the patients who died (64%) were under the age of 40 years. Infection was the single most important cause of death. There was one case of suicide and one other death resulted from ECT. Sudden unexplained deaths occurred in 19% of the cases. Possible ways of further reducing the mortality figures are suggested.