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Aim: To determine the prevalence and pattern of psychopathology and NSS among patients with FEP, and compare the prevalence of NSS with First-Degree Relatives (FDRs) and a healthy control group (HCG).Methodology: A cross-sectional study of 606 participants, of 3groups, namely, participants with FEP, their FDRs and a HCG were consecutively enrolled. Psychopathology was assessed with Psychosis module of Mini International Neuropsychiatric Interview and Brief Psychiatric Rating Scale. NSS was assessed with 26-item Neurological Evaluation Scale (NES).Results: Schizophrenia was the most frequent FEP diagnosis (39.1%). The prevalence of NSS in FEP, FDRs and HCG were: 100%, 95.0% and 47.0%, respectively. Participants with antipsychotic-naïve FEP showed 100% prevalence in all components of motor sequencing, more than 70% in all components of sensory integration, and more than 50% in major components of motor coordination and primary NSS. Negative symptoms dimension correlated with number of NSS (r=0.4) and NSS total score (r=0.3), while anxiety/depression dimension correlated negatively with number of NSS (r=-0.3) and NES total score (r=-0.2).Conclusion: The findings of this study underscore the consideration of NSS as a viable marker for FEP.Aim: To determine the prevalence and pattern of psychopathology and NSS among patients with FEP, and compare the prevalence of NSS with First-Degree Relatives (FDRs) and a healthy control group (HCG).Methodology: A cross-sectional study of 606 participants, of 3groups, namely, participants with FEP, their FDRs and a HCG were consecutively enrolled. Psychopathology was assessed with Psychosis module of Mini International Neuropsychiatric Interview and Brief Psychiatric Rating Scale. NSS was assessed with 26-item Neurological Evaluation Scale (NES).Results: Schizophrenia was the most frequent FEP diagnosis (39.1%). The prevalence of NSS in FEP, FDRs and HCG were: 100%, 95.0% and 47.0%, respectively. Participants with antipsychotic-naïve FEP showed 100% prevalence in all components of motor sequencing, more than 70% in all components of sensory integration, and more than 50% in major components of motor coordination and primary NSS. Negative symptoms dimension correlated with number of NSS (r=0.4) and NSS total score (r=0.3), while anxiety/depression dimension correlated negatively with number of NSS (r=-0.3) and NES total score (r=-0.2).Conclusion: The findings of this study underscore the consideration of NSS as a viable marker for FEP.

Background: Despite the enormous burden of stigma toward people with mental illness in Africa and the presence of evidence-based interventions to reduce it; there is a dearth of data in Africa on how to improve the attitudes of students in training about mental illness. Objectives: This study aimed to determine the impact of a 4-week contact-based education on the knowledge and attitudes of medical students in a Nigerian tertiary institution. Methods: A total population sample of 5th-year medical students on 4-week psychiatry rotation was utilized using a prospective pre-/post-test design. The researcher designed a questionnaire based on the literature on stigma in Africa and this was administered at the beginning and within one week after the posting ended. The rotation involved didactic lectures, case-based learning, individual case presentation, clinics, and ward rounds. The pre-and post-test responses were compared using McNemar Chi-square. Results: After 4 weeks of contact-based learning, the following thoughts and attitudes of the students' about persons with mental illness significantly improved: being dangerous (p=0.001), giving them a job (p=0.001), comfortable examining them (p=0.02) and the genetic basis of the disease (p=0.001). However, the intervention did not significantly change such attitudes related to more personal relationships like maintaining a friendship (p=0.73) and marrying them (p=0.25). Conclusion: The findings of this study suggest that contact-based education is useful in improving knowledge about the causation of mental illness and some general stereotypes about them (e.g., being dangerous), but was not useful in improving personal and more intimate relationships with them.

Background: The preference for male child abounds in many cultures across the globe and not having a male child serves as a source of worry for a woman in the postpartum period which might contribute to depression. There is dearth of information on the role of infant's gender and other psycho-social factors associated with pregnancy and postpartum depression in Jos Nigeria.Aim: This study aimed to determine the association between the role of infant's gender and other psychosocial factors, and postpartum depression.Methods: Five hundred and fifty women were recruited in a cross sectional study that involved a two stage procedure in a Tertiary Hospital in Jos, Nigeria. The Edinburgh Postnatal Depression Scale (EPDS) questionnaire and the Depression Module of the Structured Clinical Interview for DSM-IV axis I Diagnosis (SCID) were used.Results: One hundred and sixteen (21.8%) participants were found to have postpartum depression among the study population. Though the gender of the infant was not statistically associated with postpartum depression, however, the expected gender of baby by both parents [new mothers (p=0.002) and spouses (p

Background: Individuals with Bipolar Affective Disordere unpredictable. This study is aimedat investigating the profile of disability among individuals with BAD and the associated factors.Methods: A total of one hundred consecutively enrolled study participants, made up of adult outpatients with BAD attending a Lagos based mental health facility were interviewed. The participants were subjected to designed questionnaire to inquire about demographic and illness related variables. Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) was used to confirm diagnoses of BAD in them. Both Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS) were used to rate the severity of symptoms, and lastly the World Health Organization Disability Assessment Schedule II (WHODAS II) was used to assess disability in participants.Results: The mean and range scores for the participants on WHODAS were 24.93(±2.2) and 21.11-32.20 respectively. The WHODAS mean score in domain 3[self-care, 2.39 ±0.30] was least, while domain 6 [participation in the society, 7.55 ±1.18] had the highest mean score. Participants that were single (p= 0.047) and unemployed (p=0.023) had greater levels of disability, while those that earned money had lesser levels of disability (p=0.005). Conclusion: This study finds varied levels of disability among people with BAD, and participation in the society was the worst affected area. The single and unemployed were more likely to have greater levels of disability, while those with source of income seem less affected with disability. Thus, proactive interventions with incorporation of relevant social policy(s) to address disability in people with BAD to ensure better overall outcome are implied.Keywords: Associated factors; Bipolar Affective Disorder; Disability; Socio-economic; Rehabilitation

Background: Nigerian Medical Schools need to attain international bes t prac t i ces in teaching psychiatry. The supply or availability of mental health professionals demands strong medical school psychiatry curriculum. The study therefore aims to investigate the level of adherence of Nigerian Medical Schools to the requirements of the regulatory bodies with regard to the teaching of Psychiatry at the undergraduate level.Methods: A short seven item questionnaire was distributed to examiners in the Faculty of Psychiatry in April 2011, during the Fellowship Examination of the West African College of Physicians.Results: Thirteen medical schools, spread across the six geopolitical zones of Nigeria were represented. Ten of the schools (79.6%) reported having a separate department of psychiatry. Only five of the medical schools provide some teaching in behavioural sciences during the preclinical years. Seven schools have no ward round teaching, most have neither tutorials nor seminars and majority (84.6%) do not conduct an independent examination in psychiatry. Conclusions: Ppsychiatry curriculum is being selectively implemented in Nigerian Medical Schools.Keywords : Psychiatry , Curriculum, Medical schools, Nigeria, Teaching

Postgraduate medical training is essential in the development of specialist manpower in health care delivery services. In this paper, postgraduate residency training in Nigeria was examined with highlights on the problems involved and the prospectsKeywords : Postgraduate, Residency, Medical, Nigeria, Training.

Background: Workplace violence is a well-recognized concern for healthcare workers and can broadly be divided into physical and psychological types.Objective: The purpose of this study was to investigate the frequency and pattern of violence towards healthcare workers in a mental health facility in Maiduguri, North-East Nigeria.Methodology: It was a descriptive study that involved members of staff who belonged to the Departments of Nursing Services and Mental Health, Federal Neuro-Psychiatric Hospital Maiduguri, Borno State, Nigeria. Recruitment was via convenience method over four weeks in the month of December 2013, using a self-administered questionnaire containing 26 questions, with a section for socio-demographic data, adapted from aggression questionnaire designed by Hasan Hüseyin Eker, et al.Results: Overall, 71 out of 114 members of staff (62.3%) belonging to both Departments of Nursing Services and Mental Health of the hospital were involved in the study. More than two-thirds (69.0%) of the participants were males, and more than half (53.5%) reported being exposed to violence in the preceding 12months. Among those exposed to violence, 92.1% of them reported verbal, and 7.9% physical violence. Nearly a quarter (23.7%) of those exposed to violence reported being negatively affected.Conclusion: Violence by patients and their relations in this study setting was common but mainly verbal. Exposure to violence may result in negative post-exposure consequences.Keywords: Maiduguri, Mental Health Department, Nigeria, Nursing Services

Background. Duration of untreated psychosis (DUP) has been widely recognised in recent years as a potentially important predictor of illness outcome, and the manifestations of schizophrenia have been known to influence its early recognition as a mental illness. Objective. To assess the association between the positive and negative symptoms of schizophrenia, help-seeking and DUP. Methods. We performed a cross-sectional study of 360 patients with schizophrenia, who had had no previous contact with Western mental health services. The Sociodemographic Questionnaire, World Health Organization Pathway Encounter Form and a questionnaire to establish DUP were used. The positive and negative syndrome scale and Composite International Diagnostic Interview were used for the assessment of mental disorders and to diagnose.Results. Respondents who had predominant positive symptoms and who had a median DUP of 8 weeks or 24 weeks, tended to use psychiatric hospitals and other Western medical facilities, respectively, as their first treatment options. However, those who had predominant negative symptoms and who had a median DUP of 144 weeks or 310 weeks, tended to use faith healers and traditional healers, respectively, as first treatment options.Conclusion. The predominance of negative symptoms could militate against early presentation among people with schizophrenia, probably because negative symptoms are poorly recognised as indicating mental illness in Nigeria, as they could be interpreted as deviant behaviour or spiritual problems that would require spiritual solutions.

Aims: To investigate the effect of the use of antipsychotic medication on patients with schizophrenia with regard to their blood glucose profile andweight. Methods: From a sample of 209 antipsychotic naive patients with schizophrenia and an equal number of their first degree relatives matched for weight and gender, fasting blood glucose and weight were measured at baseline and repeated after four months. Results: The mean initial and second wave fasting blood sugar for the cases were 4.24mmol/l (SD=0.36), and 5 . 2 6mmol/l (SD = 0.67) respectively, (t=22.13, df=208, p

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Background: In many cultures and countries, mental and physical disorders have been found to occur concurrently with more than mere chance phenomena. Such co-morbidity increases poor outcome for both disorders and results in high mortality and health care costs. Studies in Nigeria along this line seem scanty.Objective: To describe the rates of physical illness in patients with mental disorders in a tertiary health care institution in Eastern Nigeria.Methodology: All first ever referrals to the Mental Health Unit of Nnamdi Azikiwe University Teaching Hospital, Nnewi within one year were recruited. A full and standard structured mental state and physical examination was objectively done for each participant. Necessary ancillary laboratory investigations were done. After three months (for outpatients) or following discharge (for in patients), the physical examinations were repeated. The medical records were checked a year later for service drop out and mortality.Results: Of the 413 participants, aged 15 to 74 years, mean age, 37.2+8.2 SD years, 205 males (49.6%), 43% had at least one physical disease at objective examination, of which only 14% was known prior to the referral. The major physical diseases were: cardiovascular (15.1%), Diabetes mellitus (5.4%), gastrointestinal diseases (1.5%). Only 2 (0.5%) of the patients had obesity at presentation but this sharply increased after 3 months to almost 13%.Conclusion: Cardiovascular, endocrine (metabolic) and other physical diseases commonly occur in patients with mental disorders, especially mood and psychotic disorders, with a low rate of detection before full assessment.Keywords: Bipolar, co-morbidity, depression, disorders, Nigeria, schizophrenia-spectrum

Background: Major psychotic disorders such as the schizophrenias consume a high proportion of health budgets in developed countries. The economic implications of acute psychotic disorders in Nigeria have not been well documented.Aim: To estimate the direct cost of treating patients with acute psychotic episodes in a mental health unit in Anambra State, Nigeria.Methods: Forty one patients, 29 males (70.7%) with acute psychotic episode admitted between January and September 2006 in a small Private Psychiatric Clinic were assessed with the Brief Psychiatric Rating Scale (BPRS) at intake and on discharge. The cost of drugs, laboratory investigations and hospital services were estimated using the charges obtainable in nearby facilities.Results: The 41 patients consumed over $11,000 during the admission period. Hospital bill constituted the highest cost (70.1%), especially professional charges (Nursing fees and Doctor’s fees which accounted for about a third of the entire costs). Patients on new generation antipsychotics tended to be discharged earlier than those on first generation drugs, but were more vulnerable to relapse.Conclusion: The direct cost of treating acute psychotic episode in the present health service system is very high. Why avoiding “false economy,” there is need to develop cost effective treatment strategies for persons with acute mental disorders.

Objectives: In a multi-site population-based study in several middle-income countries, we aimed to investigate relative contributions of care arrangements and characteristics of carers and care recipients to strain among carers of people with dementia. Based on previous research, hypotheses focused on carer sex, care inputs, behavioural and psychological symptoms (BPSD) and socioeconomic status, together with potential buffering effects of informal support and employing paid carers. Methods: In population-based catchment area surveys in 11 sites in Latin America, India and China, we analysed data collected from people with dementia and care needs, and their carers. Carer strain was assessed with the Zarit Burden Interview. Results: With 673 care recipient/carer dyads interviewed (99% of those eligible), mean Zarit Burden Interview scores ranged between 17.1 and 27.9 by site. Women carers reported more strain than men. The most substantial correlates of carer strain were primary stressors BPSD, dementia severity, needs for care and time spent caring. Socioeconomic status was not associated with carer strain. Those cutting back on work experienced higher strain. There was tentative evidence for a protective effect of having additional informal or paid support. Conclusions: Our findings underline the global impact of caring for a person with dementia and support the need for scaling up carer support, education and training. That giving up work to care was prevalent and associated with substantial increased strain emphasizes the economic impact of caring on the household. Carer benefits, disability benefits for people with dementia and respite care should all be considered.

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No Abstract.Nigerian Medical Journal Vol. 46 (4) 2005: pp. 91-95

Background: Expression of mental disorder through physical symptoms is a common clincial presentation in Nigeria. Objective: To compare life events and life satisfaction in Nigerians with undifferentiated somataform disorder and normal subjects. Method: Ninety one patients with undifferentiated somatoform disorder and 67 normal community dwelling subjects were assessed with the Social Readjustment Rating Scale (SRRS), Stress Quiz (SQ), and Life Satisfaction Scale (LS). Results: There was no statistically significant difference between the SRRS scores of the patients and normal subjects; however, patients scored significantly higher than the normal subjects on the Stress Quiz. Conclusion: In a Receiver Operating Characteristic analysis, the most distinguishing factor between patients and subjects was life satisfaction, with the latter having much higher life satisfaction . Keywords: Undifferentiated somatoform disorder, life events, life satisfaction, Nigeria.Nigerian Medical Journal Vol. 48 (1) 2007: pp. 9-13

Background: Studies of the epidemiology of personality disorders in Nigeria are scanty. From clinical experience, diagnoses of personality disorders are hardly ever made in both out patients and inpatients in our mental health department. It is unclear whether the non-diagnosis of personality disorders in our psychiatric practice is an artifact of clinical omission or the genuine rarity of the disorder in our setting. Aim: The major purpose of the present study was to estimate the rate of personality disorders in a non-patient population. A second objective was to explore the diagnostic value of using a two-stage technique in diagnosing personality disorders. Method: Community dwelling residents 18 years and above were selected by convenience sampling from four communities at Nnewi (Eastern Nigeria). After proper explanation of the study and verbal consent by (potential) subjects, those who agreed to participate were administered the Personality Disorders Screening interview (PDS). The General Health Questionnaire (GHQ-12) was subsequently administered and thereafter a structured clinical interview using the Personality Assessment Schedule (PAS) was conducted. Analysis: the SPSS 11.5 was used for analysis. Simple descriptive statistics were presented. Result: Of the 108 subjects, 63.8% were females. The subjects were aged 18-55 years, mean, 31.7 ± 8.6 SD. At a cut score of 3 for the GHQ-12, 25% of the subjects had probable mental disorder. Sixty-two subjects (57.4%) scored >2 on the Personality-Screening interview. On the PAS, 15.7% had personality disorders. The commonest personality disorders were schizoid, anankastic, passive – dependent and dissocial personality disorders. Conclusion: All subjects who had personality disorder on the PAS scored e”2 on the screening interview. About 16% of the subjects had at least one type of personality disorder Keywords: Personality disorder, Community, Nigeria.Nigerian Medical Journal Vol. 48 (2) 2007: pp. 31-34

Aim: To describe the pattern of disability and care for older community residents in a selected Nigerian location. Method: Older persons living at home in Okporo Community were first identified through the traditional ruler and his assistant. The socio demographic profiles and any present diseases of these older subjects were obtained through a face- to face interview and they were subsequently assessed with the modified World Health Organization Disability Assessment Schedule –Short version (WHO DAS-S). The primary care givers of the older subjects were interviewed to obtain their actual care giving role. A summarized Zarit Burden Interview and the twelve item General Health Questionnaire ( GHQ-12 ) were used to measure the emotional impact on the caregivers. Results: A total of 102 older subjects were recruited, with about 47% having some form of disability. Many co-morbid physical diseases were reported. Most of the older subjects' children had left the community and females were the main care providers. Help with self-care was the greatest problem reported by the carers and care giving was regarded as very heavy burden associated with high emotional distress. Conclusion: Disability is high in community elderly subjects. Care giving is proving a great challenge in the face of children disserting their parents, and increasing harsh economy. There is need for a systematic, realistic plan to implement qualitative care policy for older Nigerians. Keywords: Older subjects; disability; care-giving Nigerian Journal of Clinical Practice Vol.10 (1) 2007: pp.58-65

Modern neuroimaging and other investigative techniques have provided a lot of new information on the neurobiology of the dementias. Unfortunately no permanent cure has been found for this debilitating disease, giving rise to continuing trial of various products. Alternative and herbal medicines have become popular in neuropsychiatric disorders including dementia. In this report, we present our experience with Kippo – a Japanese herbal product – in 4 Nigerians with dementia. Two of the patients fully completed the study. The ten word list learning test, community screening interview for dementia (CSI –D), structured dementia interview (SIDAM) and the Geriatric Mental State schedule (GMS) were used to identify dementia according to ICD – 10 diagnostic criteria. Dementia behaviour disturbance scale (DBD) and modified 22 – item mini – mental state examination (MMSE) were used to evaluate the product efficacy over 8 weeks. One patient showed some initial improvement on the DBD without effect on the MMSE and the other patient showed some initial improvement on the MMSE without effect on the DBD. Both patients had worsening on the clinical Global Impression Scale (CGI) within the study period. There were no demonstrable adverse effects as shown by physical examinations and laboratory tests. No definite conclusion could be drawn on the efficacy and safety of Kippo in dementia in this short study. We recommend a well-controlled larger scale investigation of the effect of Kippo on well-defined different subtypes of dementia.Key Words: Dementia, herbal products, KippoNigerian Journal of Clinical Practice Vol 8(1) 2005: 51-55

Objective: To measure the ability of family members to detect dementia/depression in their elderly relatives. Method: Subjects diagnosed with dementia/depression were assessed with 10/66 dementia package. The Geriatric Depression Scale (GDS), Family Questionnaire (FQ) and the Functional Activities Questionnaire (FAQ) were used to interview the family members of the patients. These were then compared with cognitively normal individuals with high and low education. Results: Seventy-six patients aged 60 – 69 participated in the study. Nearly 24% of all the subjects scored above the cut off score of the GDS. The FAQ, FQ and CSI – D (informant section) correlated significantly with the GMS organicity. Conclusion: the FQ and FAQ may be used to indirectly screen elderly subjects who have cognitive deficits and dementia through their family co-residents. This will likely yield an increase in the detection of dementia/depression in elderly subjects who have limited access to direct contact with health care services. Key Words: Dementia, Depression, elderly, family members. Nigerian Journal of Clinical Practice Vol.7(2) 2004: 82-87

Objective: To study the prevalence of substance abuse among female secondary school students in Anambra State. Design: This is a cross sectional study. Materials and Methods: A pre-tested structured questionnaire was used to obtain information on smoking, use of sedatives and alcohol drinking habits from 725 students of nine randomly selected female senior secondary schools, 3 each from the three senatorial zones of the state. Results: Out of a study population of 725, 34 or 4.7% of the girls smoked tobacco (cigarette) while 69 or 9.5% indulged in alcohol and 109 or 15% took sedatives as a means of inducing sleep. There was no statistical difference between the smokers in the three classes while significant statistical difference existed between the classes in terms of use of alcohol and sedatives (p

Objective: To evaluate the problems of alcohol, other substance and non- prescription drugs use during pregnancy. Methods: The study was carried out at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. Participants who were recruited during the study period, consisted of 1160 alternate pregnant patients who registered at the antenatal clinic from January 1999 to December 2001. They were administered the psychoactive substance screener section of the ICD – 10 symptom checklist (WHO, 1994); the self-reporting questionnaire (SRQ – 24 Harding et al, 1980) and the health questionnaire (Sheila Blume, 1996). Results: Thirty percent of the women admitted to use of non- prescription drugs. Vitamins were the most commonly abused (41.4%) followed by analgesics (33.4%), kola nuts (25.7%), laxatives (10.6%), and antacids (8.9%) Alcohol was consumed by 43.7%. Whereas 16.7% found alcohol not helpful in feeling better or relaxed when they are depressed or nervous, 27.1% found it helpful. The incidence of drinking alcohol was higher (50%) among the 35 and above year age group, followed by the 30-34 year age group with 37.5%. Only 2.9% admitted to using tobacco. Conclusion: Alcohol consumption in pregnancy appears to be higher in the older pregnant Nigerians. The implications of use in early pregnancy and during labour are highlighted. Key Words: Non-prescription drugs, Substance use, Pregnant Women, Nigeria (J College Med: 2003 8(1): 23-26)