Pattern of attendance and predictors of default among Nigerian outpatients with schizophrenia

Objective: To assess the pattern of and factors associated with outpatient clinic attendance among patients diagnosed with schizophrenia at a Nigerian psychiatric hospital. Method: This was a cross-sectional descriptive study of 313 consecutiveoutpatients with diagnosis of schizophrenia confirmed with the Structured Clinical Interview for Diagnosis (SCID). Data was collected on sociodemographics, clinic attendance, perceived social support, perceived satisfaction with hospital care and illness severity (assessed using the Brief Psychiatric Rating Scale, BPRS). Logistic regression analysis was used to identify factors associated with outpatient clinic default.Results: Overall, 20.4% respondents were defaulters, with a median duration of clinic nonattendance of 8 weeks. Outpatient clinic defaulters had significantly higher BPRS scores and had missed more outpatient clinicappointments compared with non-defaulters. A significantly higher proportion of defaulters resided more than 20km away from the hospital and reported “not satisfied” with their outpatient care. Being financially constrained was the commonest reason given by defaulters for missing their clinic appointments. The significant predictors of outpatient clinic default included residing more than 20km from the hospital, missing previous appointments and dissatisfaction with outpatient care. Conclusion: Outpatient clinic non-attendance is common among patients with schizophrenia, and is significantly associated with demographic, clinical and service related factors. Interventions targeted at addressing the risk factors for defaulting peculiar to developing country settings similar to the location of this study, could significantly improve treatment outcome.Keywords: Outpatients; Default; Schizophrenia; Non-attendance; Nigeri

Quality of life in patients with schizophrenia in Nigeria

This study was carried out to determine the degree of satisfaction with various aspects of life (or lack of it) in patients with schizophrenia, to compare QOL at onset of illness (first episode) with QOL at time of study, and to identify socio-demographic and clinical variables that may predict QOL. Using WHOQOL-Bref, all consenting schizophrenia patients who satisfied the inclusion criteria were interviewed both at the time of study and by changing the tenses of the instrument, at time of onset of illness. Scores of the overall quality of life and general health and the other five domains of QOL were then compared. It was found that over the course of illness, individual living with major mental illness such as schizophrenia have an appreciably good objective QOL and social outcome in all areas of life, except for the social relationships domain (marital status and occupational status). However, respondents experienced increased subjective dissatisfaction in all QOL domains over the cause of their illness. There was a poor correlation between objective indices and subjective QOL. Gender and occupational status were the socio-demographic and clinical variables that correlated with subjective QOL. It was concluded that clinicians and policy makers should not limit treatment interventions to reducing levels of psychopathology and/or enhancing levels of functioning alone, but also improve patients' subjective well being and overall QOL. Rehabilitation and intervention programme designs should take cognizance of the importance of cognitive constructs such as inner feelings, self-efficacy, self-esteem, task coping behaviors and perceived social support. Key words: Quality of life (QOL), schizophrenia, Nigeria Nigerian Medical Practitioner Vol. 48(2) 2005: 36–4

Assessing trauma in a transcultural context: challenges in mental health care with immigrants and refugees

The growing numbers of refugees and immigrants from conflict-prone areas settling throughout the world bring several challenges for those working in the mental health care system. Immigrants and refugees of all ages arrive with complex and nuanced mental health histories of war, torture, and strenuous migration journeys. Many of the challenges of addressing the health care needs for this growing population of immigrants and refugees are often unfamiliar, and thus practices to address these challenges are not yet routine for care providers and health care organizations. In particular, complex trauma can make mental health assessments difficult for health care organizations or care providers with limited experience and training in transcultural or trauma-informed care. Using a transcultural approach can improve assessment and screening processes, leading to more effective and high-quality care for immigrant and refugee families experiencing mental health disorders. This paper presents findings from an assessment of current mental health services focusing on current practices and experiences with immigrant and refugee patients and families. The difficulties in developing shared understandings about mental health can hinder the therapeutic process; therefore, it is imperative to ensure an effective assessment right from the beginning, yet there is limited use of existing cultural formulation tools from the DSM-IV or DSM-5. The paper outlines current practices, approaches, challenges, and recommendations shared by mental health care providers and program leaders in addressing the mental health care needs of immigrants and refugees. The results from this study demonstrate that there are many challenges and inconsistencies in providing transcultural, trauma-informed care. Respondents emphasized the need for a thorough yet flexible and adaptive approach that allows for an exploration of differences in cultural interpretations of mental health. Our study concluded that ensuring a mindful, reflexive, transcultural, and trauma-informed health care workforce, and a learning environment to support staff with education, resources, and tools will improve the health care experiences of immigrants and refugees in the mental health care system