Clinical neuropsychiatric correlates and EEG findings among children with developmental disorders in Lagos, Nigeria

Objective: Developmental disorders with or without associated neuropsychiatric complications continue to be one of the major health problems in Africa. The grossly inadequate management/ rehabilitative facilities further worsen this. A prospective study aimed at finding the types of developmental disorders and associated neuropsychiatric complications among children aged ≤15 years that presented with developmental disorder in the study centers over 36 month study duration. Methods: The study was carried out in the paediatric and child psychiatric clinics as well as the Electroencephalographic (EEG) unit of two major health facilities in Lagos, Nigeria: Lagos University Teaching Hospital (LUTH) and Psychiatric Hospital, Yaba, Lagos. For each subject, socio-demographic data was obtained and appropriate clinical evaluation was carried out to obtain the necessary data and clinical diagnoses. Furthermore, each of the subjects had waking EEG recording using 20-channel computerized Medelec® EEG machine. The EEG interpretation was blinded to the clinical history of the subjects. Results: Overall, one hundred and eleven (111) subjects were evaluated over the 36 month study period. The cohort was made up of 63 (56.8%) males and 48 (43.2%) females. The mean age was 4.8 (±3.9) years, with most subjects falling in the age group of 0-5 years(69.4%). Mixed specific developmental disorders were most common (55%) followed by that of specific developmental disorders of speech and language (34.2%). Forty-one (36.9%) subjects suffered from one or more types of complications, with seizure, 22(19.8%) being the most common. The waking EEG recording was normal in 22 (19.8%) subjects; while abnormal epileptiform activities were found in 85 (76.6%) of recordings. No statistically significant relationship existed between EEG abnormalities and the factors of age and clinical diagnoses (i.e developmental abnormalities). Conclusion: The small number of subjects in this study is a major hindrance to drawing a general conclusion. However, it has been shown that a number of the cohort in addition to their developmental disorders suffered from such complications as seizures, hyperactivity etc. Furthermore, a significant proportion had EEG abnormalities of the epileptiform types possibly reinforcing the previously known fact of prevalent subtle brain damage among African children. The need for preventive health care is therefore emphasized. Keywords: Developmental disorders; Associated complications; EEG abnormalities.African Journal of Psychiatry Vol. 11 (2) 2008 pp. 123-12

Prevalence of Co-morbid Psychiatric Disorders in a Clinic Sample of Children with Attention-deficit Hyperactivity Disorder

Background: Co-morbid psychiatric disorders may mask or be masked by Attention-deficit hyperactivity disorder (ADHD), thereby confounding the clinical assessment of children with ADHD.Aim: To determine the prevalence of co-morbid psychiatric disorders in children and adolescents with ADHD attending an out-patient clinic.Methods: Sixty-seven children and adolescents with ADHD, attending the Child and Adolescent clinic of the Federal Neuro- Psychiatric Hospital, Yaba, were consecutively recruited into the study. The prevalence of psychiatric co-morbidity was determined with the Vanderbilt ADHD Diagnostic Parent Scale.Results: The prevalence of the combined sub-type of ADHD was 6 2 . 7%. The predoinantly Hyperactive-Impulsive and the Inattentive subtypes were prevalent in 20.9% and 16.4% of the sample respectively. About three-quarter (74.6%) of the sample had comorbid psychiatric disorders. The most common co-morbid psychiatric disorder was oppositional defiant disorder (58.2%), followed by anxiety/depression (32.8%) and conduct disorder (26.9%).Conclusion: Co-morbid psychiatric disorders are common in children with ADHD. There is need for increased clinicians' awareness of these co-morbid disorders, which could become targets for interventions that may reduce the overall morbidity profile of children with ADHD

Late Identification of Autistic Disorder in Nigeria: An Illustration with 2 Case Reports

Background: Autistic disorder is a severe neuro-developmental disorder.In recent years, there has been an increased concern about the upsurgein the prevalence of autism. Psychiatrists and other clinicians have a pivotal role in its identification.Methods: This is a report of 2 cases of autistic disorder seen at a child andadolescent psychiatric clinic in Nigeria.Results: The first case was a boy (17 years) and the second was a girl (14years). Both cases had severe impairments in social relationships, communication, and behaviour; masked by non-specific autistic symptoms. They were diagnosed late.Conclusion: The importance of early identification was illustrated. Factorsimplicated in late identification include non specific pattern of presentation,poor level of autism awareness, late referral to specialist centres andinadequate child psychiatric facilities in Nigeria. These should be reviewedand given urgent attention

Pattern of Defaulting from a Nigerian Child and Adolescent Psychiatric Clinic

Background: Despite the availability of effective treatment for childhood psychiatric disorders, the successful treatment of children who access mental health services could be undermined by defaulting from treatment.Aim: To determine the pattern of defaulting from the Child and Adolescent clinic of the Federal Neuro-Psychiatric Hospital, Yaba.Methods: The case notes of all patients registered at the Child and Adolescent Clinic of the Federal Neuro-Psychiatric Hospital Yaba, within a period of one year, were ret rospect ively reviewed to determine their pattern of default from clinic appointments.Results: A fifth of the sample missed their first clinic appointment. By the 2nd and 4th appointment, the percentage of defaulters had increased to 51.0% and 61.7% respectively. The median number of out-patient clinic attendance before defaulting was 2 (IQR 1 to 6). Patients who missed their first appointment were more likely to drop-out from treatment (p<0.001). Conclusion: There is a high rate of defaulting from child psychiatric clinic in this environment. This highlights the need for interventions that could facilitate the retention of children in treatment

Oxidative Stress Markers and Genetic Polymorphisms of Glutathione S-Transferase T1, M1, and P1 in a Subset of Children with Autism Spectrum Disorder in Lagos, Nigeria

Background: The role of oxidative stress has been identified in the development of autism spectrum disorder (ASD), and polymorphisms of glutathione S-transferase have been associated with some diseases linked to oxidative stress. Hence, we evaluated the serum levels of oxidative stress markers and investigated genetic polymorphisms of glutathione S-transferase associated with autism. Materials and Methods: Forty-two children clinically diagnosed with ASD using the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) criteria and a clinical interview were included in the study. Twenty-three age-matched controls without any known genetic/developmental disorder were also recruited. Oxidative stress markers along with the genetic polymorphisms of glutathione S-transferase were determined. Results: Reduced glutathione in ASD patients was significantly lower than the control (P = 0.008), whereas other oxidative stress markers measured were not significantly different in both the control and case populations. The frequencies of GSTT1 and GSTM1 null genotypes were lower among the controls compared with the cases, however, no association risk was observed. The observed risk of carrying Val/Val genotype among the cases was approximately six times that of the controls. Conclusion: Individuals with ASD showed a significant diminished level of reduced glutathione, however, the distribution of GSTT1, GSTM1, and GSTP1 polymorphisms was not found to be associated with autism in this study population.Keywords: Autism, genetic polymorphisms, glutathione S-transferase, Nigeria, oxidative stres

Determinants of the disposition of patients attending a psychiatric emergency department in Nigeria

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Prevalence Of Sleep Disturbances Among Primary Informal Caregivers To Persons With Mental Illness Attending The Neuropsychiatric Facility In Lagos, Nigeria: A Comparative Study

Background : Sleep is a physiological process that is important to the physical and psychological  wellbeing of humans. Sleep can become disturbed for medical , psychological and environmental reasons. Studies from different parts of the world has shown that informal caregivers of chronically ill persons have high prevalence for sleep disturbances. There is a dearth of such studies among Nigerians.Aim: To determine the prevalence of sleep disturbances among primary informal caregivers to persons with mental illness and to compare it with that obtained among non-caregivers within the same region.Methods: This study was a crosssectional, comparative study conducted among 250 caregivers to persons with mental illness and 216 non-caregivers. All the subjects were randomly selected and had to meet the inclusion criteria. The selfadmini s tered ques t ionnai re contained the General Health Questionnaire-28 and a proforma which was designed to elicit sociodemographic data and the presence of sleep disturbance in the subjects within the last 6-12 months period.Results: The prevalence of sleep disturbance was found to be significantly higher among caregivers  (27.7%) when compared with non-caregivers (12.3%). The general health questionnaire (GHQ) which is popularly used for screening for psychological distress was only able to pick out 53.3% of the caregivers with sleep disturbances. Amongst the caregivers, advancing age and belonging to a polygamous family setting were significantly associated with sleep disturbances.Conclusion: Caregivers are at almost thrice the risk of sleep disturbances than the noncaregivers (OR = 2.7, CI= 1.26-1.74). Periodic screening of caregivers should be done with specific sleep instruments especially for those of them who operate dangerous machinery and commercial vehicles.Keywords: Prevalence, Sleep disturbances, primary informal caregiver, persons with mental illnes