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

Prevalence and correlates of substance use among persons with mental disorders in a Nigerian Psychiatric Hospital

Few studies in Nigeria have investigated the relationship between psychiatric disorders and substance use. Yet, evidence worldwide suggests that substance related problems might be a major burden among persons with psychiatric disorders. One hundred and five persons with mental illness (105) were evaluated for substance use with the Alcohol, Smoking, and Substance Involvement screening test (ASSIST). A questionnaire was used to elicit Sociodemographic variables. A high proportion had initiated tobacco (50.9%) and cannabis (34.5%) during adolescent. Factors associated with hazardous drug consumption were male sex (p<0.05), younger age (p<0.05)  unemployment (p<0.01) being unmarried (p<0.05) and lower educational level (p<0.05). Routine screening and brief interventions for substance use in psychiatric facilities should be critical components of mental health service delivery

The impact of a psychiatry clinical rotation on the attitude of Nigerian medical students to psychiatry

Objective: Undergraduate medical students have ingrained and often negative attitudes towards psychiatry as a field and as a career. This in turn has affected recruitment of graduate medical students into the specialty. Little is known about the impact of psychiatry rotations during undergraduate medical training on students’ attitudes about psychiatry and eventual specialty choice in developing countries. This study examined the impact of a psychiatry clinical rotation on medical students’ attitudes to psychiatry and possible career choice. Method: Eighty-one and one hundred and six fifth year medical students completed the ATP-30, socio-demographic and career choice questionnaires at the beginning and the end of a four week clinical rotation respectively. Results: The overall attitude of the students to psychiatry was favourable at the beginning of the rotation with significant improvement following the rotation (p=0.003). Significant improvement in attitude was observed among female and younger students. Students who indicated preference for specialties other than psychiatry showed a greater improvement in their attitude to psychiatry following the rotation (p= 0.011). The rotation however did not enhance students’ preference for psychiatry as a future career. Conclusion: The four-week clinical rotation in psychiatry resulted in increased mean attitudinal score, but not in enhanced preference for psychiatry as a career.Keywords: Psychiatry; Attitude; Medical students; Nigeri

Application of Token Economy in the Management of Chronic Schizophrenia: A Case Report

A case of chronic schizophrenia with “inability to walk” in the absence of a neurological basis is presented. Patient responded to antipsychotic medications in terms of improvement in the symptoms of schizophrenia but “inability to walk” persisted necessitating the introduction of graded tokens / incentives to the treatment regimen. The patient regained the use of his leg and sustained improvements in mental state at discharge. Voluntary ambulation was sustained for three months after discharge before patient was lost to follow-up. Token economy may be very useful in rehabilitation of chronic psychotic illness as this case illustrates. This treatment approach may be essential in a developing country like Nigeria where socio-economic deprivations may modify the presentation of chronic schizophrenia symptoms.Key Words: chronic schizophrenia, inability to walk, token economy

Better quality of life in patients offered financial incentives for taking anti-psychotic medication: Linked to improved adherence or more money?

This trial was funded by the National Institute of Health Research Health Technology Assessment (Project No. 07/60/43