Psychiatric morbidity in hypertensives attending a cardiology outpatient clinic in West Africa

Objectives: To determine kinds of psychiatric morbidity among a sample of stable hypertensive outpatients in a teaching hospital. Materials and Methods: A cross‑sectional study of 260 enrolled outpatients. Psychiatric morbidity was assessed using a 2‑stage evaluation method with the General Health Questionnaire Version 12 (GHQ‑12) and Structured Clinical Interview for DSM‑IV (SCID) to assess for psychiatric diagnosis. Results: 28 (10.8%) of the 260 patients endorsed some psychological distress, with a mean GHQ‑12 score of ≥2. At the second stage, 16.1% (N=13 of 81) interviewed had one or more psychiatric disorder on the SCID. The commonest psychiatric diagnosis made were mood disorders, with current major depressive disorder occurring at a rate of 6.2%. Other disorders found were past major depressive episode (2.5%), organic mood syndrome (3.7%), and somatoform disorder (3.7%). Conclusion: The relationship between hypertension and mood disorders should inform a higher index of suspicion among physicians and general practitioners in order to give patients appropriate treatments or referrals where necessary. It is recommended that collaboration with mental health service providers be encouraged.Keywords: African, cardiology, hypertensive, psychiatric morbidityNigerian Journal of Clinical Practice •Jan-Mar 2012 • Vol 15 • Issue

Burden and psychological effects : caregiver experiences in a psychiatric outpatient unit in Lagos, Nigeria

Objective: Worldwide, research into experiences of care givers are gradually increasing and their central role in community care is being acknowledged. Caregivers experience a multidimensional range of problems, often associated with their caregiving role. It becomes important to identify these areas of burden and provide necessary support. The study sought to determine the prevalence of psychological distress and experience of burden of care among the caregivers of mentally ill patients. Method: A cross sectional descriptive study. Eligible consecutive subjects were recruited to the study over a 6 month period. Fifty three caregiver relatives of patients diagnosed with a psychiatric illness were assessed using the General Health questionnaire version 12, an Adapted Burden of Care (BOC) Schedule and a Sociodemographic questionnaire. Results: The caregivers were 51% male and 49% female. Most were above 35years in age (66.1%). They were either parents (38.8%), siblings (18.4%), uncle/aunt (14.3%), first cousin (12.2%) or other extended relatives (16.3%). Almost half of the relatives had psychological distress (43.8%) and most of which (63%) had more burden. The mean score on the BOC among the caregivers was 41 (±18.68SD), with scores ranging from 0.00-89.00, and 45.3% of relatives experiencing more than average burden of care. Conclusion: There is a significant level of burden and psychological distress experienced by caregivers in this study location. It is recommended that effectively planned interventions are targeted at  alleviating this burden and at improving the ability of caregivers to cope, within the Nigerian mental health service delivery system.Key Words: Caregiver; Burden; Patients; Psychiatry; Nigeri

Recent advances in understanding hypertension development in sub-Saharan Africa

Consistent reports indicate that hypertension is a particularly common finding in black populations. Hypertension occurs at younger ages and is often more severe in terms of blood pressure levels and organ damage than in whites, resulting in a higher incidence of cardiovascular disease and mortality. This review provides an outline of recent advances in the pathophysiological understanding of blood pressure elevation and the consequences thereof in black populations in Africa. This is set against the backdrop of populations undergoing demanding and rapid demographic transition, where infection with the Human Immunodeficiency Virus predominates, and where under and over-nutrition coexist. Collectively, recent findings from Africa illustrate an increased lifetime risk to hypertension from foetal life onwards. From young ages black populations display early endothelial dysfunction, increased vascular tone and reactivity, microvascular structural adaptions, as well as increased aortic stiffness resulting in elevated central and brachial blood pressures during the day and night, when compared to whites. Together with knowledge on the contributions of sympathetic activation and abnormal renal sodium handling, these pathophysiological adaptations result in subclinical and clinical organ damage at younger ages. This overall enhanced understanding on the determinants of blood pressure elevation in blacks encourages (a) novel approaches to assess and manage hypertension in Africa better, (b) further scientific discovery to develop more effective prevention and treatment strategies, and (c) policymakers and health advocates to collectively contribute in creating health-promoting environments in Africa

Community psychiatric service in a Nigerian rural centre: Bridging mental health gap

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A comparative analysis of disability in individuals with bipolar affective disorder and schizophrenia in a sub-Saharan African mental health hospital: towards evidence-guided rehabilitation intervention

PURPOSE: Bipolar affective disorder (BAD) and schizophrenia are two severe psychotic conditions that are associated with disability. The present study was designed to compare the pattern of disability between clinically stable individuals with BAD and schizophrenia in a sub-Saharan mental health facility. METHODS: A total of 200 consecutive participants (made up of 100 each among clinically stable individuals with BAD and schizophrenia) were recruited. All participants had their diagnoses confirmed using Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID), after which the designed questionnaire and the 36-item World Health Organisation Disability Assessment Schedule interview (WHODAS II) were administered to them. RESULTS: In this study, the level of disability among participants with BAD was better compared to those with schizophrenia as determined by mean WHODAS score of 24.93 and 27.02, respectively. Similarly, there was a significant difference between participants with BAD and schizophrenia with respect to four domains of the WHODAS-II, viz, self-care (p < 0.001), getting along with others (p < 0.001), life activities (p < 0.001) and participation in the society (p < 0.001). The factors that were significantly associated with disability in the two groups (BAD and schizophrenia) were: unemployment status (p < 0.001) and remittance source of income (p < 0.001), while those that spent not more than ₦2,000 (13 dollars) per month on treatment (p = 0.004) were observed to be less disabled. CONCLUSIONS: Overall, participants with BAD fared better in the level of disability and most of the measured domains of disability in comparison with those with schizophrenia. Both socio-demographic and treatment-related factors seem to define the pattern disability among participants. Thus, evidence-guided preventive and rehabilitative treatment strategies directed against functional impairment using prioritized model among individuals with BAD and schizophrenia are advocated.Dapo Adebowale Adegbaju, Andrew Toyin Olagunju, Richard Uwakw