Incidence and correlates of delirium in a West African mental health clinic

Objective: <br/> <br/> To determine the incidence of delirium in those patients presenting to a psychiatric clinic in Nigeria and to examine if any demographic or clinical variables were correlated with this diagnosis. <br/> <br/> Method <br/> <br/> A prospective survey design; 264 consecutive new referrals to a psychiatric clinic in Nigeria were assessed for the presence of delirium using a standardised diagnostic scale. Data was analysed for normality and appropriate statistical test employed to examine the relationships between the presence of delirium and demographic and clinical variables. <br/> <br/> Results <br/> <br/> Of individuals presenting to the mental health clinics, 18.2% had delirium. No demographic variable was significant regarding the presence or absence of delirium. With regard to clinical variables duration of current symptoms, referral source and the presence of comorbid physical illness were significantly associated with the presence of delirium. Most delirium was due to infections. Nearly all patients with delirium were prescribed psychotropic medication (95.2%), and most attributed their symptoms to a spiritual cause.Conclusion(s) Delirium presents more commonly to psychiatry services in the less developed world compared to the West. Development efforts should focus on recognition and management of delirium to improve outcomes and maximise resource

Factors influencing compliance in patients with tuberculosis on directly observed therapy at Ile-Ife, Nigeria

Background: Increased morbidity and mortality of tuberculosis have been blamed on neglect of the human dimension of tuberculosis control. One of such factors included in human dimension is non-compliance, a behavioural parameter, which has led to the emergence of multi-drug resistant tuberculosis, and poor treatment outcome.Objective: To explore the impact of directly observed therapy (DOT) on compliance and the factors influencing it.Design: A retrospective study.Setting: Chest clinic of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.Methods: Directly observed therapy (DOT) was employed. Records of the socio-demographic characteristics, treatment categories, complications developed, results of investigations, level of compliance and treatment outcome for the patients were kept. The data for thepatients seen between May 1996 and April 1997 were retrieved and analysed. Those that complied were compared with those that did not comply.Results: One hundred and ninety nine patients comprising ninety one males and 108 females, were seen during the period .They were mostly between the ages of 16 years and 45 years(mean ± SD = 31.7±14.98). One hundred and fifty eight (73%) complied and all of themwere cured. The only factor that significantly influenced rate of compliance was proximity to the chest clinic.Conclusion: DOT improves the rate of compliance. No socio-demographic factors considered significantly influenced the rate of compliance under DOT, and as such they are not reliablepredictive factors. Locating chest units in the existing primary health care facilities will improve the rate of compliance with antituberculosis therapy. More attention should be paid to behavioural aspect of tuberculosis control

Common mental disorders in TB/HIV co-infected patients in Ethiopia

<p>Abstract</p> <p>Background-</p> <p>The relationship between TB/HIV co-infection and common mental disorders (CMD) has been scarcely investigated. In this study, we compared the occurrence of CMD in TB/HIV co-infected and non-co-infected HIV patients in Ethiopia.</p> <p>Methods-</p> <p>We conducted a cross sectional study in three hospitals in Ethiopia from February to April, 2009. The study population consisted of 155 TB/HIV co-infected and 465 non-co-infected HIV patients. CMD was assessed through face to face interviews by trained clinical nurses using the Kessler 10 scale. Several risk factors for CMD were assessed using a structured questionnaire.</p> <p>Results-</p> <p>TB/HIV co-infected patients had significantly (p = 0.001) greater risk of CMD (63.7%) than the non-co-infected patients (46.7%). When adjusted for the effect of potential confounding variables, the odds of having CMD for TB/HIV co-infected individuals was 1.7 times the odds for non-co-infected patients [OR = 1.7, (95%CI: 1.0, 2.9)]. Individuals who had no source of income [OR = 1.7, (95%CI: 1.1, 2.8)], and day labourers [OR = 2.4, 95%CI: 1.2, 5.1)] were more likely to have CMD as compared to individuals who had a source of income and government employees respectively. Patients who perceived stigma [OR = 2.2, 95%CI: 1.5, 3.2)] and who rate their general health as "poor" [OR = 10.0, 95%CI: 2.8, 35.1)] had significantly greater risk of CMD than individual who did not perceive stigma or who perceived their general health to be "good".</p> <p>Conclusion-</p> <p>TB/HIV control programs should develop guidelines to screen and treat CMD among TB/HIV co-infected patients. Screening programs should focus on individuals with no source of income, jobless people and day labourers.</p

Recurrent unipolar mania in a psychiatric hospital setting in the Fiji Islands

This study aimed to determine the rate of unipolar mania and compare its characteristics with those of other bipolar affective disorders in a psychiatric hospital in the Fiji Islands. Fifty-one patients with unipolar mania seen between January 1999 and October 2000, had their diagnosis confirmed using the Schedules for Clinical Assessment in Neuropsychiatry and the International Classification of Diseases, 10th edition. Their demographic and clinical characteristics were compared with those of 31 manic-depressive patients seen during the period under review. Unipolar mania constituted 47.2% of the bipolar affective disorders in this sample. The frequency of episodes, duration of affective illness, mean age at onset, gender distribution, marital status, employment status and race were not significantly different for the unipolar manic and manic-depressive groups (p > 0.05). Family history of major psychiatric morbidity was 9.8% for the unipolar manic patients and 22.6% for the manic-depressive group (p > 0.05). Recurrent unipolar mania may be considered a useful category based on its high rate, although its demographic and clinical characteristics do not clearly distinguish it from manic-depression

The characteristics of suicide attempters admitted to the main general hospital in Fiji Islands

Objective: To study the characteristics of suicide attempters attending the main general hospital in Fiji Islands. Method: Consecutive suicide attempters were clinically evaluated, and their sociodemographic and clinical characteristics were compared with those of other patients seen in the psychiatric service between January 15, 1999 and January 14, 2000. Results: Thirty-nine suicide attempters were seen, representing 36.8% of all the cases referred to the psychiatric service. The prevalence of attempted suicide in the Greater Suva Area was 34.8 per 100,000. Majority (56.4%) were young (16-25 years), Indians (59%), female (61.5%), students (41%), never married (74.4%) and of Hindi faith (48.7%). The commonly used methods were ingestion of drugs and pesticides. The intention to die was present in 20 (51.3%) of the population. Social problems and/or psychiatric comorbidity were present in over 60% of cases. Suicide attempters were significantly younger, more of single persons (

The determinants of attempted suicide in a general hospital setting in Fiji Islands: a gender-specific study

The objective of the study was to examine the sociodemographic and clinical factors influencing gender-specific attempted suicide. Suicide attempters, 40 males and 88 females, seen on a consultation-liaison psychiatric service over a period of 42 months (from January 1, 1999 to June 30, 2002) were compared on sociodemographic and clinical variables. The female attempters [22.99 years (SD 8.1)] were younger than their male counterparts [25.15 years (SD 9.5)] [P = 0.0002]. A higher proportion of the male attempters were engaged in outside occupations, compared with their female counterparts who were mainly full-time housewives or engaged in domestic duties [P = 0.003]. Alcohol misuse was more associated with male suicide attempts [P = 0.001]. Ninety percent of male attempters and 54.6% of the female attempters had the intention to die [P = 0.001]. Although depressive episode was the most common psychiatric disorder in male attempters, followed by neurotic and stress-related disorders, while neurotic and stress-related disorders ranked first in female attempters followed closely by depressive episode, the difference was not significant. However, significantly more male attempters required pharmacotherapy and psychological intervention than their female counterparts [P = 0.002]. More females had marital difficulties, although comparing the two groups on social difficulties did not yield a significant difference. Method used, personality disorders, previous attempt, repeat attempt, race, religion, and marital status were not significant distinguishing factors. Younger age, lack of employment outside home, marital problems, and nondeath motives were more influential in female attempted suicide, while alcohol misuse and severe psychiatric morbidity were more frequently associated with male attempted suicide. The findings support gender-specific preventive and interventional strategies. (C) 2004 Elsevier Inc. All rights reserved

Attitude toward and knowledge about mental illness in Fiji islands

Backgrounds: There is a dearth of information on the extent of knowledge about mental illness and attitudes toward the mentally ill in Fiji. Aims: This study aimed to explore these aspects, and also to determine the factors influencing them. Method: Market vendors, peri-urban dwellers, white-collar and health workers from Greater Suva were interviewed. The interview schedule used elicited socio-demographic characteristics, knowledge of, and attitudes toward, mental illness. Results: A majority of the subjects attributed the cause of mental illness to substance abuse, believed in the diversity of mental illness, considered hospital as an important source of help and acknowledged the effectiveness of medication. Less than one-fifth of the subjects were willing to marry or employ mentally ill persons. About 42% of the sample would be deterred by embarrassment from seeking help. Educational attainment was correlated with knowledge about mental illness, except with knowledge about early mental symptoms (p < 0.01). Prestigious occupation, single marital status, female gender, younger age and urban dwelling were associated with positive disposition toward the mentally ill (p < 0.01). Race was not significantly influential on almost all attitudinal variables. Conclusion: Health education is capable of positively influencing knowledge about, and attitudes toward, mental illness in Fiji. Copyrigh

Attempted suicide by drug overdose and by poison-ingestion methods seen at the main general hospital in the Fiji islands: a comparative study

Objective: This study examined the prevalence and the characteristics of deliberate self-poisoning patients seen at the main general hospital in the Fiji Islands

Psychiatric complications of hemodialysis at a kidney center in Nigeria

The mental state of 20 consecutive hemodialysis patients investigated at a Nigerian renal unit was assessed using the 30-item General Health Questionnaire, Present State Examination, and clinical evaluation using the Diagnostic and Statistical Manual, revised third edition (DSM-III-R). Findings were compared with those of orthopedic patients and apparently healthy controls. A standard interview was used in eliciting sociodemographic data from the subjects. A significantly higher prevalence of psychiatric disorders was identified in hemodialysis patients (55%) than in orthopedic patients (20%) and apparently healthy controls (0%). The psychiatric disorders encountered in this hemodialysis population included major depressive episode (35%) and generalized anxiety disorder (20%). The probable reasons for the higher prevalence of psychiatric morbidity in this hemodialysis population, compared with those in Western societies, are discussed. Psychiatric morbidity was higher in patients with low levels of education, and did not show statistically significant relationship with other sociodemographic variables. (C) 1997 Elsevier Science Inc