Emotional distress among caregivers of patients with epilepsy in Katsina State, Northern Nigeria

Objective: Caregivers of patients with epilepsy experience considerable emotional distress. The study aimed to assess the magnitude of the problem in a developing country. Method: A total 166 patients-caregivers were enrolled for the study. Theywere interviewed using a socio-demographic data collecting sheet and the Hospital Anxiety-Depression Scale (HADS). Data obtained were analysed using Statistical Package for Social Sciences Windows version 13. All statistical tests were carried out at a 5% level of probability. Results: The mean age of the caregivers was 45.44±6.67 years. Emotional distress was found among 109(65.7%) of the caregivers. This is was significantly associated with male gender of both care giver and patient as well as residing in a rural area.Conclusion: The study demonstrated a high level of emotional distress associated with caring for patients with epilepsy, which is comparable to other studies carried out in other parts of the world.Key words: Epilepsy; Caregivers; Emotions; Nigeri

Diagnostic challenges and psychosocial impacts of hypersomnia in a Nigerian adolescent: A case report

Hypersomnia, a disorder of sleep characterized by excessive quantity of sleep and excessive daytime sleepiness (EDS), could adversely affect health outcomes in childhood. To highlight diagnostic challenges and the impact of childhood hypersomnia in a resource limited setting, a 14year old Nigerian who presented with a seven year history of hypersomnia was studied. Screening for sleep disorder using BEARS sleep algorithm and assessment for EDS using the Epworth Sleepiness Scale were both positivefor EDS. The assessment of sleep hygiene using the Adolescent Sleep Hygiene Scale was normal and the use of Raven’s Progressive Matrices to assess intelligence was also normal. There was no contributory pastmedical history or demonstrable etiology. Magnetic Resonance Imaging (MRI) of the brain, Electro Encephalogram (EEG), assay of serum electrolytes were all normal while screening test for trypanosomiasis was negative. Poor level of awareness, high cost of evaluation and limited facilities for diagnosis of sleep disorder were the major diagnostic challenges. Depression, poor academic performance, suicidal ideation andstigmatization were all associated with hypersomnia in the patient.Keywords: Hypersomnia, adolescence, depression, sleep disorders, diagnostic challenges

Impact of childhood mental health disorders on the family: A Case report

Background: Care of the children with mental health disorders is fraught with challenges particularly in developing countries and, where the family isthe major source of care. Consequently assessing the impact of these disorders on the family is relevant to providing these children with optimal care.Objective: To assess the impact of childhood mental health disorderson family function and parental burden.Method: A monogamous family that had 3 children diagnosed as having childhood onset schizophrenia using the International Classification of Disease version 10(ICD 10) Classification was studied. Family function was assessed using the Family APGAR Score and the Zarit Burden Interview(ZBI) Score used in assessing parental burden.\Results: The Family APGAR Scores were low (highly dysfunctional family) and the ZBI Scores high (highly burdened) in the family. Areas of serious dysfunction in the family were in adaptation, partnership and growth.In the ZBI Scores feelings about quality and cost of care offered, stress and other negative attributes associated with providing care, inability to meet other parental obligations and uncertainty about the future, were the major contributors to the highly burdensome outcome.Conclusion: The study highlights significant family burden and dysfunctionin a family who had three children with schizophrenia. It underscored the need for provision of more comprehensive health and social support  services to children with mental health disorders and their families.Key Words: Childhood, Schizophrenia, Parent, Burden, Family functio

Psychiatric sequelae of traumatic brain injury: Retrospective analysis of 75 subjects from Kaduna, Nigeria

Objective: Traumatic brain injury (TBI) is a public health problem and is associated with many complications. However little is known about the psychiatric sequelae of TBI in Nigeria. This study described the pattern and determinants of psychiatric sequelae among subjects with TBI.Materials and Methods: The study is a retrospective review of cases of subjects referred to Federal Neuropsychiatric Hospital, Kaduna on account of TBI or its complications from 2001 to 2008. Information obtained included the sociodemographic characteristics, type of injury, durations of unconsciousness (LOC) and posttraumatic amnesia (PTA), psychiatric and psychoactive substance use history. Psychiatric diagnosis was based on the criteria of the 10th edition of the International Classification of Diseases (ICD-10)Results: Mean age of the subjects was 32.2 ± 35.8 years, mean duration of unconsciousness was 6.88 ± 9.40 days, mean duration of PTA was 5.45 ± 8.78 days, 90.7% were males, 69.3% had road traffic accident (RTA), 28.0% had psychosis, 25.3% had cognitive impairment while 17.3%, 8.0%, and 6.7% had epilepsy, personality change and depression respectively. About 15% had no complications yet. Only 30.7% did cranial CT scan. Long duration of LOC and PTA were significantly associated with psychiatric complications (P value <0.05).Conclusions: Psychiatric sequelae are common after TBI. Long periods of LOC and PTA are predictive of such sequelae. Efforts should be made to prevent RTA, communal clashes and other activities that can lead to TBI

Use of Restraint in the Psychiatric Setting: Knowledge of Medical Staff in a Nigerian Psychiatric Hospital

Background: Restraint is a widely used method of controlling patient’sbehaviour throughout the world. However, next to nothing is knownabout its use in the developing countries. Aims: To assess the knowledge of medical staff of a Nigerian psychiatric hospital concerning the use of restraint. Methods: We administered a questionnaire designed for the purpose of this study to 74 medical staff to record their socio-demographic characteristics and assess their knowledge about the use of restraint in a psychiatric setting. Results: Fifty eight staff returned duly completed questionnaires (response rate, 78.4%). The mean age was 38.6 years, 69% were nurses and the mean year of practice was 11.9±9.0. Participants agreed that restraint was used to prevent patients from disturbing people 76%, to punish patients 14%, use of restraint could not lead to patient’s death 47%. Thirtyfive percent had no training in the use of restraint. Conclusion: Respondents’ knowledge on some aspects of restraint was poor and this may be due to lack of training.Keywords: restraint, psychiatric ward, knowledge, medical staf

Psychological and physical effects of pain on cancer patients in Ibadan, Nigeria

No Abstract. African Journal of Psychiatry Vol. 12 (1) 2009: pp. 64-7

Suicide Attempt in a Recently Diagnosed HIV Positive Subject: Is Pre and Post Counseling Still Being Adequately Practiced? Case Report

Suicide and attempted suicide are recognized neuropsychiatric complications of HIV/AIDS and one of the risk factors is recent notification of seropositivity. A case of attempted suicide in a recently diagnosed HIV positive subject without adequate counseling is reported. Subject presented at a government hospital with symptoms of recurrent vaginal discharge. She was not adequately counseled on the need to undertake HIV screening which she was asked to do. The result came out positive and she received the result with disbelief, shock and sad feeling, consequently she attempted suicide on two occasions. The subject was managed and subsequently referred to AIDS relief centre of St Gerard Catholic Hospital, Kaduna for disease confirmation and comanagement. Subject revealed that the counseling was not properly handled before and after the test. Therefore the need for adequate pre and post test counseling, an integral part of HIV/AIDS management should not be ignored as its importance cannot be overemphasizedKey Words: Suicide Attempt, HIV/AIDS, Pre and Post test Counseling

Social consequences of epilepsy: A study of 231 Nigerian patients

Background: Epilepsy is the commonest neurological disorder and majority of the sufferers are found in the developing countries. It is associated with psychological and social problems. The aim of this study was to determine the social difficulties experienced by epileptic patients and the factors that are associated with these difficulties.Methods: Two hundred and thirty-one consecutive epileptic patients who were of age 10 years and above, and who had no co-morbid major psychiatric disorder, seen over a 6-month period at the outpatient clinic of Federal Neuropsychiatric Hospital, Kaduna, were interviewed. We used an instrument designed for the purpose of this study, which focused on people’s attitudes to epilepsy, relationship/marital, employment and academic problems.Results: The mean age of the subjects was 28 ± 13.2 years; 59.3% were males; 44.6% said people make negative remarks about their illness; 14.1% have been denied leadership role; 36.4% were irregular at work; 37.3% performed poorly at work; 22.5% have had their marriage proposals rejected; 19.5% have been abandoned by spouse. At least 39.4% had poor academic performance while 19.5% were withdrawn from school because of epilepsy. Short seizure-free period, long duration of seizure disorder and family history of epilepsy were significantly associatedwith social problems.Conclusion: Social difficulties are common among epileptics. Effort should be made to educate the society about epilepsy, and physicians treating patients with epilepsy should aim at achieving a good seizure contro

Cognative impairment among elderly hypertensive patients in Zaria, Northern Nigeria

No Abstrac

Anxiety and Depression Symptomatology in Migraine: Retrospective Review of 257 Cases from Kaduna, Northern Nigeria

Objectives: To determine the prevalence of depressive and anxiety symptoms/disorders among patients with migraine attending the outpatient clinic of Federal Neuropsychiatric Hospital, KadunaMethods: This is a retrospective study. Case files of all patients who presented with 'headache syndrome' from January, 2000 to December, 2009 were reviewed applying the International Headache Society (IHS) criteria to identify those who met the criteria for migraine. These were further reviewed to determine the prevalence of depressive and anxiety symptoms/disorders using the ICD-10 and DSM-IV diagnostic criteria.Results: During the 10 year period, 257 of 604 patients who presented with 'headache syndrome' met the IHS criteria for migraine. Analysis of these 257 patients revealed the following; mean age of subjects 31.3 (SD 11.1) years, mean duration of illness 53.3 (SD 50.6) months, mean duration of a migraine attack 26.5 (SD15.4) hours and mean frequency of migraine attack in 3 months 1.5 (SD 0.8) times. Sixty-three (24.5%) and 36 (14.0%) of the patients had depressive and anxiety symptoms/disordersrespectively. Presence of aura (OR 3.392, P value 0.030, 95%CI 1.129 - 10.196 ) predicted depressive symptoms /disorders while presence of aura (OR 4.008, P value <0.001, 95%CI 3.201-7.520) and psychosocial stressors (OR 5.099, P value 0.024, 95%CI 1.244-20.892) were predictors of anxiety symptoms/ disorders.Conclusion : Migraineis associated with increased risk of psychiatric morbidities. Presence of aura and psychosocial stressors are the predictive factors.Keywords: Anxiety, depression, migraine, Nigeri