Psychoactive substance use and level of risk among a geriatric population accessing three primary care facilities in Nigeria

We aimed to assess the prevalence, correlates of psychoactive substance use including misuse of prescription medications and its associated harm among a group of elderly patients attending three primary care facilities in Benin-city, Edo state, Nigeria. The WHO ASSIST was administered to assess for psychoactive substance use and level of risk of some elderly participants. Lifetime prevalence and current prevalence of substance use was obtained. Among participants, 12.7% demonstrated moderate risk to alcohol use while 2.9% demonstrated high risk to its use. Fifteen percent (15%) demonstrated moderate risk to stimulant use while 1.2% demonstrated high risk to its use. Twentyeight percent (28.3%) demonstrated  moderate risk to opioid analgesic use while 0.6% demonstrated high risk to its use. Male gender was associated with a higher risk of tobacco use, alcohol use and stimulant use. Female gender was associated with a higher risk of sedative use. Only 3(1.7%) of these participants had received   previous treatment for a substance use disorder. Keywords: Elderly, primary care, substance use, prescription medication, level of ris

Risk of manic switch with antidepressants use in patients with bipolar disorder in a Nigerian neuropsychiatric hospital

Background: Depressive disorders are common among those with bipolar affective disorder (BAD) and may necessitate the use of antidepressants. This has been suggested to precipitate manic episodes in some patients. Objectives: This study aims to determine the prevalence of and factors associated with manic switch in patients with BAD being treated with antidepressants. Methods: Case notes of patients who were treated at a Nigerian neuropsychiatric hospital for a BAD from 2004 to 2015 were reviewed. BAD diagnosis was made using ICD-10 criteria. Treatment for bipolar depression included monotherapy (i.e. antidepressants, antipsychotics or mood stabilisers) or combination therapy (mood stabiliser with an antidepressant or a combination of mood stabilisers, antipsychotics and antidepressants). The primary outcome measure was a switch to mania or hypomania within 12 weeks of commencing an antidepressant. Results: Manic or hypomanic switch (MS) was observed in 109 (44.3%) of the participants. Female gender, younger age, number of previous episodes and a past history of psychiatric hospitalisation were all significantly associated with a risk of MS. There was no significant difference in the rate of MS in either those treated with adjunct antidepressants therapy with a mood stabiliser or an antipsychotic or those placed on a combination of antidepressants, antipsychotics and mood-stabilising agents. Conclusion: A large proportion of patients with BAD on antidepressants experience medication-induced manic or hypomanic switch