Impact of problem-solving skills and attributional retraining on conduct disorder among students at public secondary schools in Nigeria

Purpose: This paper reports a non-randomized control study undertaken (1) to investigate prevalence and correlates of conduct disorder among male secondary education students in South-West Nigeria; and (2) to assess the impact of a Problem-Solving Skills and Attributional Retraining (PSSAR) intervention with this population. Design/methodology/approach: Seven hundred and eighty-seven male students from two schools were screened for conduct disorder. All participants who met criteria for the disorder were allocated to either treatment (n = 55) or control (n = 47) groups. Outcome measures comprised the Strengths and Difficulties Questionnaire (SDQ; teacher and student versions) and the Teacher Rating of Students’ Aggressive Behaviors. Findings: Thirteen percent of the sample were found to present with difficulties which met criteria for conduct disorder. The presence of these difficulties correlated with several demographic variables, including parental conflict and alcohol use. A statistically significant reduction in mean scores was observed for the treatment group in the student rating of the SDQ emotional subscale and total difficulties scores. Teacher ratings were less consistent in that conduct problems, prosocial behavior, and total difficulties increased following the intervention, whereas peer problems and aggressive behavior were reported by teachers to reduce. No statistically significant change was found in the outcome measures for the control group. Practical implications: In resource-constrained settings, school-based interventions are an important means through which treatment gaps in child and adolescent mental health can be addressed. Originality/value: This study’s findings offer some preliminary support for the PSSAR intervention for conduct disorder in this context and suggest areas for further research

Examining the role of bullying victimisation in predicting psychopathology among in-school Nigerian adolescents

Purpose: This paper reports on a cross-sectional study undertaken to examine the role of bullying victimisation in predicting psychopathology, encompassing post-traumatic stress disorder (PTSD), risk of developing prodromal psychosis, and emotional and behavioural problems, among in-school Nigerian adolescents. Methodology: Three hundred and fifty-one junior secondary students (n = 173 males, 178 females; age range: 9-17 years) were recruited from five randomly selected public secondary schools in Nigeria. Students completed a variety of self-report measures, including a socio-demographic questionnaire, the Prodromal Questionnaire – brief version, the Strengths and Difficulties Questionnaire (SDQ), and the Multidimensional Peer Victimisation Scale. They were also interviewed using the PTSD module of the Mini International Neuropsychiatric Interview-Kid Version. Findings: Although bullying victimisation was not found to predict the presence of PTSD, it predicted the risk of developing prodromal psychosis. All SDQ subscales also held significant positive associations with bullying victimisation. This indicates that higher levels of victimisation are associated with increased behavioural and emotional difficulties among adolescents. Value: The study contributes to the evidence demonstrating a need for improved understanding regarding the role of exposure to bullying victimisation in predicting various forms of psychopathology. Furthermore, there is specifically a need for research with this focus in developing countries in sub-Saharan Africa and the Nigerian education system

Perspective on Clinical High-Risk for Psychosis in Africa

Clinical High Risk for Psychosis has evolved in recent years as a conceptual and clinical entity, representing a shift in focus from the syndromal psychosis state to a recognition of the pre-psychotic state as a period of potential preventive intervention. Much existing evidence has been generated from well-resourced countries, with a more limited body of literature available from Africa and other Majority World countries. Against a backdrop of prevailing systemic challenges, it is necessary to appraise the state of knowledge on Clinical High Risk for Psy-chosis in Africa. In this perspective article, we cover epidemiology, risk factors, predictors of psychosis conversion, as well as an overview of sociocultural factors, notably stigma, and the barriers to mental health services in African settings. We discuss existing and promising as-sessment approaches and reflect on preventive and early intervention strategies. We conclude with recommendations including the need for more clinical, longitudinal, and collaborative research anchored in an integrative transdisciplinary approach. We highlight the need for more culturally valid assessment tools and strategies to improve access to and utilization of services while also reducing stigma.Non

Perspective on clinical high-risk for psychosis in Africa

Peer reviewed: TrueClinical High Risk for Psychosis has evolved in recent years as a conceptual and clinical entity, representing a shift in focus from the syndromal psychosis state to a recognition of the pre-psychotic state as a period of potential preventive intervention. Much existing evidence has been generated from well-resourced countries, with a more limited body of literature available from Africa and other Majority World countries. Against a backdrop of prevailing systemic challenges, it is necessary to appraise the state of knowledge on Clinical High Risk for Psychosis in Africa. In this perspective article, we cover epidemiology, risk factors, predictors of psychosis conversion, as well as an overview of sociocultural factors, notably stigma, and the barriers to mental health services in African settings. We discuss existing and promising assessment approaches and reflect on preventive and early intervention strategies. We conclude with recommendations including the need for more clinical, longitudinal, and collaborative research anchored in an integrative transdisciplinary approach. We highlight the need for more culturally valid assessment tools and strategies to improve access to and utilization of services while also reducing stigma

A 12 year chart review of childhood and adolescent onset psychosis at a Nigerian tertiary mental health facility

Objectives: To review the profile of children and adolescents presenting with  psychosis at a specialist mental health facility, and to compare childhood with adolescent onset psychosis.Method: Hospital records of all children and adolescents over a 12-year period (1999–2010) were perused to identify those falling under the categories of psychotic disorders. Clinical, socio-demographic, obstetric, and developmental information was extracted.Results: Mean age of the children ((n = 409)) was 15.9 years, with 8.1% aged 12 years or less. The most frequent diagnoses were schizophrenia (40.8%), brief psychotic disorder (25.9%), mood disorder with psychosis (15.2%), and organic psychosis (7.8%). Family history of mental illness was reported among 22.5%. Subjects with childhood onset were significantly less likely than those with adolescent onset to have a family history of mental illness (p = 0.016), more likely to report maternal illness during pregnancy (p = 0.005) and illness during infancy (p = 0.010), and more likely to have a diagnosis of psychotic disorder due to another general medical condition (p < 0.001).Conclusion: The study suggests that antenatal/obstetric factors and illness during infancy may be particularly relevant in psychosis of childhood onset. Family history of mental illness may however be of greater relevance in adolescent onset  psychosis

Perspective on clinical high-risk for psychosis in Africa

Clinical High Risk for Psychosis has evolved in recent years as a conceptual and clinical entity, representing a shift in focus from the syndromal psychosis state to a recognition of the pre-psychotic state as a period of potential preventive intervention. Much existing evidence has been generated from well-resourced countries, with a more limited body of literature available from Africa and other Majority World countries. Against a backdrop of prevailing systemic challenges, it is necessary to appraise the state of knowledge on Clinical High Risk for Psychosis in Africa. In this perspective article, we cover epidemiology, risk factors, predictors of psychosis conversion, as well as an overview of sociocultural factors, notably stigma, and the barriers to mental health services in African settings. We discuss existing and promising assessment approaches and reflect on preventive and early intervention strategies. We conclude with recommendations including the need for more clinical, longitudinal, and collaborative research anchored in an integrative transdisciplinary approach. We highlight the need for more culturally valid assessment tools and strategies to improve access to and utilization of services while also reducing stigma

Comparison of catatonia presentation in patients with schizophrenia and mood disorder in Lagos, Nigeria

"nObjective: To compare the clinical profile and pattern of catatonic symptoms of patients with schizophrenia and mood disorder. "n "nMethod: Records of 13,968 patients seen between 1983-1985 and 2003- 2005 were reviewed for symptoms of catatonia by resident doctors in psychiatry. Cases in which the diagnosis were schizophrenia or mood disorder were then noted. Socio-demographic and clinical features were described for each diagnosis. "nResults: There were a total of 98 cases with catatonia out of the 13,968 case notes reviewed. Schizophrenia accounted for 82.5% and 53.4% in the two periods, while the proportion associated with mood disorders increased from 10% to 20.7%. Male to female  ratio was 1.2:1 in schizophrenia and 1:3 in mood disorder. Those with schizophrenia were younger and with an earlier age of onset of symptoms than those with mood disorders. "nConclusion:Catatonia associated with mood disorder was found to be increasing over the years when compared with schizophrenia. Differences were observed in socio-demographic characteristics and number of predominant catatonic symptoms. Having a separate category for catatonia due to the mood disorders in the current diagnostic guidelines (10th edition of the International Classification of Diseases and the 4th edition of the Diagnostic and Statistical Manual) will help in better diagnosis of catatonia

Genetic architecture of schizophrenia: a review of major advancements

Schizophrenia is a severe psychiatric disorder with high heritability. Consortia efforts and technological advancements have led to a substantial increase in knowledge of the genetic architecture of schizophrenia over the past decade. In this article, we provide an overview of the current understanding of the genetics of schizophrenia, outline remaining challenges, and summarise future directions of research. World-wide collaborations have resulted in genome-wide association studies (GWAS) in over 56 000 schizophrenia cases and 78 000 controls, which identified 176 distinct genetic loci. The latest GWAS from the Psychiatric Genetics Consortium, available as a pre-print, indicates that 270 distinct common genetic loci have now been associated with schizophrenia. Polygenic risk scores can currently explain around 7.7% of the variance in schizophrenia case-control status. Rare variant studies have implicated eight rare copy-number variants, and an increased burden of loss-of-function variants in SETD1A, as increasing the risk of schizophrenia. The latest exome sequencing study, available as a pre-print, implicates a burden of rare coding variants in a further nine genes. Gene-set analyses have demonstrated significant enrichment of both common and rare genetic variants associated with schizophrenia in synaptic pathways. To address current challenges, future genetic studies of schizophrenia need increased sample sizes from more diverse populations. Continued expansion of international collaboration will likely identify new genetic regions, improve fine-mapping to identify causal variants, and increase our understanding of the biology and mechanisms of schizophrenia

Prodromal psychotic symptoms and psychological distress among secondary school students in Abeokuta, Nigeria

Objective: This study aimed to investigate the relationship between prodromal psychotic symptoms and psychological distress among Nigerian adolescents.Method: Students (n = 508) were randomly selected from secondary schools in Abeokuta, Nigeria. A socio-demographic questionnaire, the Prodromal Questionnaire-Brief Version (PQ-B) and the Strengths and Difficulties Questionnaire (SDQ) were administered to each student.Results: The mean age of the students was 15.4 years (SD 1.3), with most (63%) being female. More than half (55.3%) reported having had a lifetime experience of major life event (20.9% in the preceding 6 months) while 13.9% had experienced bullying or abuse (5.1% in the preceding 6 months). The prevalence of prodromal symptoms was 20.9% (95% CI 0.174–0.244). Abnormal scores in emotional and conduct problems were seen in 11.8% and 6% respectively, while 7.3% had abnormal scores in each of the hyperactivity and peer problems subscales of the SDQ. Abnormality in prosocial behaviour was found in 1.8% of students, with overall abnormality in 4.9%. Regression analysis showed that prodromal symptoms were predicted by female sex, lifetime and 6 month history of major life event, and lifetime and 6 month history of bullying or abuse. Prodromal symptoms were also predicted by higher total SDQ scores and higher scores in all domains of psychological distress except the prosocial domain.Conclusion: The study showed a relationship between reported prodromal symptoms and the occurrence of psychological distress. It also showed that early childhood trauma may be a predisposing factor to the early stages of development of psychosis, with female children being especially prone in the years of adolescence