Clinical and Socio-demographic Profile of Women with Post-partum Psychiatric Conditions at a Federal Neuropsychiatric Hospital in Southeast Nigeria between 2009 and 2011

Background: Pregnancy and labor in areas with high maternal morbidities as in Nigeria could be sufficiently stressful to precipitate mental disorders in women after delivery, which may be a new or a relapse of previously existing one, or an exacerbation of an attenuated mental illness in the nursing mother. Mental illness in a nursing mother, if not treated may result in impaired mother.infant relationship. Aim: To determine the clinical and socio.demographic characteristics of women diagnosed with postpartum psychiatric conditions in a tertiary mental health facility of a developing country.Subjects and Methods: A retrospective case note reviews of 76 women diagnosed with postpartum psychiatric conditions for the first time in the Federal Neuropsychiatric Hospital Enugu between January 2009 and December 2011.Results: The mean age of the women was 27.76 years, with 63% (48/76) of them coming from the rural areas. 93% (71/76) of them had at least a secondary education and 78% (59/76) of the women had a family history of psychiatric disorders. Schizophrenia was commonest, 48.7% (37/76) followed by depression, 22% (17/76) and mania, 15% (11/76). Those presenting with schizophrenia were younger when compared with other diagnostic groups, had a lower level of education and presented earlier for treatment. The husbands were the primary caregivers in 48% of them. Conclusion: With 63% (48/76) of them being rural dwellers, policy changes become imperative that would encourage establishment of psychiatric services in rural areas to ensure early detection and prompt treatment of postpartum women with a need for psychiatric services.Keywords: Clinical, Postpartum Mental disorders, Socio.demographic, Southeast Nigeri

Knowledge of conversion disorder in children by pediatricians in a developing country

Introduction: Conversion disorder (CD) in children presents the clinician with a diagnostic and treatment dilemma. Mistaking a physical condition for CD carries serious consequences for the child while continued investigation in line with physical disease in a child with CD also may expose the child to serious harm.Materials and Methods: One hundred and seventy‑four consenting doctors who attended a national conference of pediatricians were administered a 10 item questionnaire developed by the researchers.Results: Only 5 (2.9%) of participants had good knowledge (scored above the mean plus one standard deviation of the score obtained by the psychiatry residents. Gender, rank, years of experience, availability of psychiatric service in center and duration of the psychiatry posting as the medical student could not differentiate those with good/fair knowledge from those without. However, those who have referred children for psychiatric assessment (P = 0.015), those who believe that children can have CD (P = 0.000) and those who are fairly confident that they could diagnose CD in children (P = 0.000) had better knowledge of CD.Conclusion: Pediatricians have poor knowledge of CDs in children. Those that know that children could have the condition have confidence that they can identify children with the condition and have referred with mental health problems to psychiatrists have better knowledge than those who did not.Keywords: Conversion disorder, knowledge, pediatrician

Socio-demographic correlates of postpartum psychological distress among apparently healthy mothers in two tertiary hospitals in Enugu, South-East Nigeria

Background: Postpartum depression and anxiety could cause poor mother-infant relationship that could impair infant growth and cognitive development. Psychiatric assessment has not been part of periodic evaluations in postnatal clinics. Some apparently well, but high-risk mothers continue to live with psychological distress, without treatment to relieve their burden. Objectives: The study assessed the prevalence of postpartum anxiety and depression, their co-morbidity, and socio-demographic predictors, within 6 - 14 weeks postpartum among nursing mothers in two tertiary hospitals in Enugu, South-East Nigeria. Methods: A cross-sectional study that was carried out at the postnatal and children\u2019s welfare clinics of two tertiary hospitals in Enugu, South-East Nigeria. Hospital Anxiety and Depression Scale, Social Support Scale and Socio-demographic Questionnaire were used for the study. Correlations and multiple regressions were used to test for associations and risk factors. Results: Occurrence rate for anxiety and depression were 30.1% and 33.3% respectively with a co-morbidity rate of 22%. Low social support and multigravida predicted risk factors for postpartum psychological distress, while a higher number of children alive predicted a decrease in the risk for postpartum psychological distress. Conclusion: The study supports service planning and the development of strategies to reliably identify women at high-risk, for effective treatment

Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) Among Rural Primary School Children in Southeastern Nigeria: Comparison of School and Home Settings

Background: Diagnosis of ADHD depends on manifestation of symptoms in at least two different settings. This therefore emphasizes the importance of multiple informants, parents and teachers. However perception could differ because of differences and inconsistencies across different settings. This is particularly important in rural settings in Africa where the educational  attainment and outlook of teachers are very different from those of the parents. The study is aimed at comparing the presentations of children with ADHD in the rural area, across two different settings: home and school.Methods: The teachers of 181 rural primary school children in Ogberuru in Imo state, south eastern, Nigeria completed the school version of ADHD rating scale-IV, and their parents completed a Socio demographic questionnaire and the home versions of the ADHD rating scale-IV.Results: Of the 18 symptoms of the condition, there were significant differences in the rate of identification in eight symptoms. These symptoms include ‘being easily distracted’ (p=0.0427), ‘difficulty following through on instruction’ (p=0.0026), ‘fails to give close attention to details (p=0.0001), ‘avoids tasks necessary for tasks’ (p=0.0013), ‘difficulty playing quietly (p=0.0059 ) , ‘talks excessively’ (p=0.0023), ‘intrudes on others’ (p=0.0004), and ‘seems not to listen when spoken to directly’ (p=0.0002). They were all consistently more manifest in school settings than in their homes.Conclusion: Teachers identified ADHD symptoms more commonly than parents. They could therefore play critical roles in programs aimed at improving early identification and management of children with ADHD especially in rural Africa where healthcare facilities are scarce

Work-Family Conflict and Stress: A Triangulated Analysis of the Plight of Working Mothers in Nigerian Universities

This study investigated the plight of working mothers of children under the age of 18 at the University of Nigeria within the context of work-family conflict, using data from a cross-sectional sample of 485 academic and non-academic staff selected through a multi-staged sampling technique. Data were obtained using questionnaires and seven IDI (in-depth interview) respondents. Data were analyzed using descriptive statistics such as percentages and frequency tables, while the Chi-square was used to examine the study variables. The results indicated that there is a statistically significant relationship between couples living together and the stress experience of working mothers with under-age children. The findings further show that there is a statistically significant relationship between the staff category of working mothers and the experience of stress. This underscored the recommendation that the government needs to review the working conditions of women and support workplace policies that allow flexibility and support for working mothers. Social workers are also recommended to be involved in some government and organization policies that will help to reduce work overload for working mothers

Socio-demographic correlates of treatment response among patients with schizophrenia in a tertiary hospital in South-East Nigeria.

Background: Many patients with schizophrenia respond poorly to antipsychotic medication. Few studies have systematically examined the relationship of social and demographic characteristics of these patients to treatment response in our environment. Objective: To identify the social and demographic variables associated with treatment response in patients with schizophrenia. Method: A total of 172 participants with a diagnosis of schizophrenia receiving antipsychotics took part in the study. Participants were consecutively recruited involving patients presenting for the first time, or relapsed patients who had stopped antipsychotics in the previous six months. Both in-patients and out-patients who met the inclusion criteria were studied. Socio-demographic interview schedule and the Positive and Negative Syndrome Scale (PANSS) were administered at the initial encounter and between 4 and 6 weeks, subsequently. Results: Defining good treatment response as 65 20% reduction in PANSS score, 68% had a good response while 32% had poor response. Good response to treatment was associated with late age of onset of illness, satisfactory family relationship, acquisition of skilled occupation and being married. However, there was no association between treatment response and gender. Conclusion: Knowledge about these variables in relation to treatment response would improve mental health services as regards articulation of prognosis and psycho education

Relationship between religiosity, religious coping and socio-demographic variables among out-patients with depression or diabetes mellitus in Enugu, Nigeria.

Background: Religion is a powerful coping strategy. Diabetes and depression are common conditions in our environment that induce psychological distress, thus requiring coping for better outcome. Studies indicate that increased religiosity is associated with better outcome in clinical and general populations. Therefore, studies of the distribution of religiosity and religious coping among these populations are essential to improve outcome. Objectives: To assess the association between religiosity, religious coping in depression and diabetes mellitus, and selected sociodemographic variables (age, gender and occupational status). Methods:Using simple random sampling we recruited 112 participants with diabetes and an equal number with depression consecutively, matching for gender. Religiosity was determined using religious orientation scale (revised), religious coping with brief religious coping scale and socio-demographic variables with a socio-demographic questionnaire. Results: Intrinsic religiosity was greater among older people with depression than among older people with diabetes(t=5.02,p<0.001); no significant difference among young people with depression and diabetes(t=1.47,p=0.15).Positive religious coping was greater among older people with depression than among older people with diabetes(t=2.31,p=0.02); no difference among young people with depression and diabetes(t=0.80,p=0.43). Females with depression had higher intrinsic religiosity scores than males with depression(t=3.85,p<0.001); no difference in intrinsic religiosity between females and males with diabetes(t=0.99,p=0.32).Positive religious coping was greater among participants with diabetes in the low occupational status(t=2.96,p<0.001) than those in the high occupational status. Conclusion: Religion is indeed a reliable coping method, most commonly used by the elderly and females with depression. Positive religious coping is more common among diabetic patients who are in the low occupational status

Post-partum depression, anxiety and marital satisfaction: A perspective from Southeastern Nigeria

Background: Many studies have noted the high prevalence of post-partum depression (PPD) and anxiety associated with poor marital satisfaction, albeit amidst a dearth of literature on comorbid PPD and anxiety among women in Nigeria. Objective: The study was aimed to assess the prevalence of PPD and anxiety, and to investigate their relationship with marital satisfaction in low-risk women in Enugu, Southeastern Nigeria. Method: A cross-sectional study of 309 randomly selected nursing mothers at two tertiary health institutions. Socio-demographic Questionnaire, Hospital Anxiety and Depression Scale, and Index of Marital Satisfaction (IMS) were used to collect data on demography, anxiety and depression and marital relationship respectively. All statistical tests were performed at a significant level of 0.05. Results: The age range of the respondents was 20–46 years; mean and s.d. was 29.65 and ± 4.87, respectively, and most of them were graduates of tertiary educational institutions (74.1%). The prevalence of post-partum anxiety was 31.1% and of PPD was 33.3%. Marital dissatisfaction was observed in 39.5% (122) of the respondents who were mothers. Those with co-morbid depression and anxiety (22.0%) had worse marital dissatisfaction. The strongest correlation with depression and anxiety was item 12 of IMS (‘feel that my partner doesn’t confide in me’). Conclusion: There was a high prevalence of marital dissatisfaction, PPD and anxiety among nursing mothers in Enugu, but with low detection rate. The effects of PPD and anxiety on the mother, her marital relationship and her infant make them essential conditions for early diagnosis, prevention and treatments

Resources available for school based mental health services in Enugu urban and head teachers’ knowledge of childhood mental health problems

Background: Childhood mental illnesses most times are detected earlier in schools than at homes as the schools provide enabling environment for early identification of children with problems.Objectives: To evaluate the resources available for school-based mental health services in Enugu urban and to determine the head teachers’ knowledge of childhood mental health problems.Methodology: A cross-sectional survey of 176 head teachers, who consented and were randomly selected. They were asked questions on how often they encountered children with mental health problems, facilities for the care of mentally ill children in their schools, the symptoms that could signify mental health problems in a school child and their first line of action in a situation where a child is found to have such problems.Results: Seventy-four (77.1%) primary schools did not have any personnel for the care of mentally ill children compared with 24 (30%) of secondary schools. School guidance and counsellors were the most likely personnel to handle mental health needs of children in both the primary and secondary schools. Overall, only 24 (13.6%) of the head teachers would send the mentally ill child to a guidance and counsellor. About 40% of them suggested prayer house/herbal homes as a place where children with mental health challenges could get help.Conclusions and Recommendations: This study exposed the paucity of facilities and personnel required to meet the mental health needs of children in schools and a need to increase the level of mental health awareness among the stakeholders that could facilitate the process of addressing these needs.Keywords: Early intervention, guidance and counselling, private and public school

The Use of Physical Restraint in the Care of the Mentally Ill by Nurses in a Psychiatric Hospital in Southeast Nigeria

Background: The use of physical restraint as an intervention in the care of psychiatric patients is as old as psychiatry and remains one of the common procedures in psychiatry. Nurses play crucial roles in the application.Aim: To evaluate the practice of physical restraint by nurses in a tertiary psychiatric hospital.Methods: Sixty-seven nurses who work at the emergency clinic, the male and female acute wards of the hospital, were administered a questionnaire that asked about their practice of physical restraint.Results: Sites of the restraints were mostly bilateral at the wrist and ankle restraint (56.5%), and  wrapper was the most commonly used material for physical restraints. About 97% of physical restraints were to protect staff and other patients from injury.Conclusion: There is the need to ensure that protocols are developed by different psychiatric service centres, in addition to the training and retraining of nurses to ensure safe and effective  use of physical restraint