Aggressive behaviour towards a care-giver: a case report of a patient with paranoid schizophrenia

Background: Aggressive behaviours are often found in paranoid schizophrenia, which could occur either at the acute or chronic phases of the disorder. Paranoid schizophrenic patients may show dysfunctional impulsive aggression which may be caused by several factors such as environmental frustration. These patients have poor insight, experience disorders of thought and have poor control of their aggressive impulses.Methods: This is a case report of a 27 year old school dropout, who has been on treatment for paranoid schizophrenia for five years. He presented with acute symptoms of the disorder which includes delusion of reference, delusion of persecution, command hallucination and restlessness. Prior to the current presentation, patient had stopped taking his medication and refused to come for follow-up. Last follow-up from records was thirteen months prior to this current admission.Results: Clinical features met the criteria for diagnosis of paranoid schizophrenia following a relapse due to poor compliance with medication and follow-up visits.Conclusions: Elevated risk forviolent-offending in paranoid schizophrenia is not just as a result of active symptoms, but also associated social problems. Therefore managing these groups of patients should target such issues.Keywords: Aggressive behaviour, Care-Giver, Paranoid, Schizophreni

Prevalence of depression and associated clinical and socio-demographic factors in people living with lymphatic filariasis in Plateau State, Nigeria.

BACKGROUND: Lymphatic filariasis is a chronic, disabling and often disfiguring condition that principally impacts the world's poorest people. In addition to the well-recognised physical disability associated with lymphedema and hydrocele, affected people often experience rejection, stigma and discrimination. The resulting emotional consequences are known to impact on the quality of life and the functioning of the affected individuals. However, the management of this condition has focused on prevention and treatment through mass drug administration, with scant attention paid to the emotional impact of the condition on affected individuals. This study aimed to determine the prevalence and severity of depression among individuals with physical disfigurement from lymphatic filariasis in Plateau State, Nigeria. METHODOLOGY: A cross-sectional 2-stage convenience study was conducted at 5 designated treatment centers across Plateau State, Nigeria. All available and consenting clients with clearly visible physical disfigurement were recruited. A semi-structured socio-demographic questionnaire, Rosenberg Self-esteem and a 9-item Patient Health Questionnaire (PHQ-9) were administered at the first stage. Those who screened positive (with a PHQ-9 score of five and above) were further interviewed using the Depression module of the Composite International Diagnostic Interview (CIDI). RESULTS: Ninety-eight individuals met the criteria and provided consent. Twenty percent of the respondents met criteria for depression, with the following proportions based on severity: Mild (42.1%), Moderate (31.6%) and Severe (26.3%). History of mental illness (OR 40.83, p = 0.008); Median duration of the illness was 17 years (IQR 7.0-30 years) and being unemployed (OR 12.71, p = 0.003) were predictive of depression. High self-esteem was negatively correlated (OR 0.09, p<0.004). CONCLUSION: Prevalence of depression is high among individuals with lymphatic filariasis and depression in sufferers is associated with low self-esteem and low levels of life satisfaction

Normal pressure hydrocephalus with onset following a traumatic experience

Background: Normal Pressure Hydrocephalus (NPH) is a neurological disorder caused by excessive accumulation of cerebrospinal fluid (CSF) with resultant pressure to the brain. It is a rare syndrome usually found in the sixth and seventh decades of life. The condition is often misdiagnosed because of its non specific symptoms and chronic nature, but recently NPH is receiving a great deal of media and medical attention, leading to a more efficient and timely diagnosis and treatment.Methods: This is a case report of a 40 year old widow, who presented with eight weeks history of recurrent vomiting, fearfulness and withdrawal to self following a traumatic experience. Prior to above presentation patient was normal and stable with no past history of physical or mental illness.Results: Clinical features met the criteria for diagnosis of Post Traumatic Stress Disorder following a traumatic experience. Clinical examination and investigations including (skull xray) conducted were all within normal limits. Two weeks into admission patient developed seizure, facial nerve palsy, and progressive weakness of lower limbs which warranted further investigation. The patient had Computer Tomography scan which revealed NPH, she had a ventro-peritoneal shunt at the neurosurgical unit of the hospital.Conclusion: Despite the advances in the diagnosis and treatment of hydrocephalus, there is still much to be learned about hydrocephalus and the subtle forms it can take. Even though it is more common in infants and elderly, it can occur at any time in life and as a result of a variety of causes.Keywords: Hydrocephalus, Post Traumatic Stress Disorder, Female, Adul

Substance Use Disorder and Reoffending Among Inmates Awaiting Trial in a Maximum Security Prison in Nigeria

Aim and Objectives: The present study aimed to determine the prevalence of substance use disorder (SUD) and the relationship between inmates with SUD and those without SUD with reoffending. Materials and Methods: A cross-sectional, descriptive study was carried out among 366 male inmates awaiting trial in Jos maximum security prison, Plateau state (Nigeria). Two sets of questionnaires were used, namely General Health Questionnaire (GHQ-28) and the Composite International Diagnostic Interview (CIDI). Results: Prevalence of SUD was 32.8% (120) among inmates. Reoffending was statistically significant with SUD (p < 0.001). Conclusion: These results suggest a significant rate of SUD among awaiting trial inmates. It also shows a significant difference between SUD and reoffending

Complex partial seizure, disruptive behaviours and the Nigerian Legal System

Background: Complex partial seizure is an epileptic seizure which results in impairment of responsiveness or awareness such as altered level of consciousness. Complex partial seizures are often preceded by an aura such as depersonalization, feelings of de javu, jamais vu and fear. The ictal phase of complex partial seizure is often associated with complex activities where an individual may still be able to perform routine task such as walking, though such movements are not planned and are often purposeless. Witnesses' around may not recognize anything wrong.Method: This is a case of a 43 year old commercial motor cycle driver, who was accused of first degree murder in the year 2000. He was convicted and sentenced to death. Prior to commission of crime, he was diagnosed with complex partial seizure with secondary generalization in 1990 at a tertiary hospital in Nigeria.Results: During his 15 years stay on death row at a maximum security prison in Nigeria, he had several episodes of seizure and subsequently developed a depressive disorder. He was placed on medication which includes anticonvulsants and antidepressants by the Forensic Psychiatry team. With regular follow-ups and available medication, he became stable. He was pardoned by the state Governor in 2015 following a recommendation by the Forensic Psychiatry team.Conclusion: Complex partial seizure comes with altered consciousness and  disruptive behaviour, which could result in  commission of a crime. Therefore, the strict adherence to the M'Naghten rule by the Nigerian legal system results in strict reliance by judges and not considering these rules in most cases bothering on  insanity. This is without taking into cognizance the peculiarity of each case.Keywords: complex partial seizure, death row, murder, pardon

Association between the types of offence, demographic profile, and level of intoxication among substance abusing violent offenders in a Nigerian prison

The association between substance use and criminality can be deduced from the acknowledgment of the increase of what are commonly called drug-defined offences, and those offences committed while under the influence of drug and/or alcohol. The aim of this study was to determine the prevalence of substance use disorder, the relationship between type of crime and demographic profile, and the relationship between offence committed and degree of intoxication with alcohol and illegal drugs at the time of crime among convicted and awaiting trial violent offenders. A cross-sectional descriptive study was carried out among 432 male inmates either convicted or awaiting trial in Jos maximum security prison, Plateau state. They completed a pro forma questionnaire containing their demographic and forensic profiles. They were screened with self-administered General Health Questionnaire item 28 and interviewed with the Composite International Diagnostic Interview questionnaire. The prevalence of substance use disorder was 54% (233). A significant correlation was found between type of offence committed and intoxication with substance at the time of crime (odds ratio = 0.3003; P= 0.001). High prevalence of substance use disorder was found among violent offenders in the prison

Relationship between quality of life and postpartum depression among women in North-Central, Nigeria

Background: Postpartum depression is a problem of public health interest and impacts negatively on the perception of quality of lifer of sufferers. Quality of life' (QoL) as an outcome measure, is scantly used on women with postpartum depression in Nigeria. The current study was designed to assess the QoL of women with postpartum depression (PPD) in a tertiary hospital in North-Central, Nigeria.Method: A two-stage cross sectional procedure was used to recruit 550 participants 6 to 8 weeks postpartum in Jos, Northcentral, Nigeria. The Edinburgh Postnatal Depression Scale (EPDS), the World Health Organization Quality of Life-BREF-26 (WHOQoL-BREF-26) questionnaire and the Depression Module of the Structured Clinical Interview for DSM-IV axis I Diagnosis (SCID) were used.Results: The studied participants were 531 out which 21.8% with postpartum depression had significantly poor perception in all the four domains of the WHOQoL-BREF-26 i.e., in the physical health (p&lt;0.001), psychological (p&lt;0.001), social relationships (p&lt;0.001) and environmental (p&lt;0.001) domains. On the whole, the overall rating of quality of life (p=0.002) and satisfaction with general health (p&lt;0.001) were also perceived to be poor when compared to those without depression. However, regression model analysis showed that the presence of postpartum depression in a participant predicts a significant negative perception on physical and environmental domains of quality of life, but a positive prediction on the general satisfaction with health.Conclusion: Postpartum depression as a disorder of public health importance impacts on the perception of quality of life of women who suffer from it. Early detection and treatment will improve the quality of life of women with postpartum depression.Keywords: Quality of life, WHOQoL-BREF-26, Postpartum Depression, prevalence, North-Central, Nigeri

Prevalence and sociodemographic correlates of postpartum depression among women attending Postnatal and/or Children's Welfare Clinics in a Tertiary Hospital, Jos, Nigeria

Background: Postpartum depression (PPD) is of public health importance. Estimation of it occurrence in other parts of the developed world showed prevalence rates of approximately 10%–25%. Previous prevalence studies in crisis-ridden areas showed prevalence rates ranging from 28% to 58%. However, since the entrenchment of relative peace in Jos, Nigeria there has not been any other study to the best of the authors' knowledge. Aim: The aim of the present study was to determine the prevalence of PPD in a postethno-religious crisis period among women attending the Postnatal and Children's welfare clinic in a tertiary hospital, Jos, Nigeria. Materials and Methods: In total, 550 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 questionnaire and the Depression Module of the Structured Clinical Interview for DSM-IV axis I Diagnosis were used. Results: A weighted prevalence of 21.8% of PPD was found among the participants. Age (P< 0.001), marital status (P< 0.001), types of marriage (P< 0.001), and educational level (P< 0.001) were significantly associated with PPD. Conclusions: PPD was found in about a quarter of the studied sample in the postcrisis period. Therefore, screening of women in the postpartum period for depression will help in early detection and treatment of women of childbearing age