OBJECTIVE: Depression in adolescents is a matter of concern because of its high prevalence, potential recurrence and impairment of functioning in the affected individual. The study sought to determine the prevalence of d...OBJECTIVE: Depression in adolescents is a matter of concern because of its high prevalence, potential recurrence and impairment of functioning in the affected individual. The study sought to determine the prevalence of depressive symptoms among adolescents in Nairobi (Kenya) public secondary schools; make a comparison between day and boarding students; and identify associated factors in this population. METHOD: A random sample of school going adolescents was taken from a stratified sample of 17 secondary schools out of the 49 public secondary schools in Nairobi province. The sample was stratified to take into account geographical distribution, day and boarding schools, boys only, girls only and mixed (co-education) schools in the capital city of Kenya. Self administered instruments (EMBU and CDI) were used to measure perceived parental behaviour and levels of depression in a total of 1,276 students excluding those who had no living parent. RESULTS: The prevalence of clinically significant depressive symptoms was 26.4%. The occurrence was higher in girls than it was in boys p<0.001. Students in boarding schools had more clinically significant depressive symptoms compared to day students (p=0.01). More girls exhibited suicidal behaviour than boys (p<0.001). There was a significant correlation between depressive symptoms and suicidal behaviour (p<0.001). CDI scores correlated positively with age (p<0.001) with an increase in CDI score with unit increase in age among students 14-17 years old, perceived rejecting maternal parenting behaviour (p<0.001), perceived no emotional attachment paternal behaviour (p<0.001), perceived no emotional attachment maternal behaviour (p<0.001), and perceived under protective paternal behaviour (p=0.005). CONCLUSION: Perceived maladaptive parental behaviours are substantially associated with the development of depressive symptoms and suicidal behaviour in children.
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 as...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.
OBJECTIVE: Suicidal behaviour and HIV/AIDS are significant public health concerns. The aim of this study was to investigate suicidal ideation in patients who were referred to a voluntary HIV counselling and testing (VCT)...OBJECTIVE: Suicidal behaviour and HIV/AIDS are significant public health concerns. The aim of this study was to investigate suicidal ideation in patients who were referred to a voluntary HIV counselling and testing (VCT) clinic and who were found to be seropositive. This in order to improve suicide prevention and intervention strategies amongst such patients. METHOD: The sample studied consisted of volunteer adult patients referred over a three-month period to a HIVVCT clinic based at a university-affiliated general state hospital. Patients completed a questionnaire on sociodemographic data. Suicidal ideation was measured using the Beck Hopelessness Scale and the Beck Depression Inventory (BDI), at two time points (within 72 hours after notification and again at a 6 week follow-up). All patients received extensive pre-and post-test counselling. RESULTS: HIV-test results were available for 189 (99.5%) of the original sample of 190 patients studied, with 157 (83.1%) testing positive. More females tested positive as did unemployed and single/divorced patients. The mean age for HIV-positive patients was 33.49 (SD = 9.449), and for HIV-negative patients it was 37.94 (SD = 15.238). Age was a significant factor in that for each year increase in age, the risk of testing HIV-positive decreased by 4.1%. Lower education and traditional beliefs were also significantly associated with testing HIV-positive. At 72 hours suicidal ideation was present in 17.1% (95% confidence interval 12.16% to 23.45%), and at 6 weeks in 24.1% (95% confidence interval 17.26% to 32.39%) of the seropositive patients. Their average BDI scores were 15.20 and 14.23 respectively at the two time points. CONCLUSION: Suicidal ideation was present in a significant number of the seropositive cohort studied and increased over a six week period among these patients. The average BDI scores at both time points imply a clinical depression. The findings also suggest an association between positive HIV-test results and certain socio-demographic variables that can act as indicators for suicidal ideation in HIV-infected persons, although this requires further research. Although the relationship between suicidal ideation and HIV-infection is complex, it is an important consideration when assessing patient suicide vulnerability at HIV VCT clinics and when implementing suicide prevention and management strategies.
Studies have shown an association between homicidal behaviour and psychiatric disorders although it remains difficult to conclude that definite causal relationships exist between specific mental illnesses and particular...Studies have shown an association between homicidal behaviour and psychiatric disorders although it remains difficult to conclude that definite causal relationships exist between specific mental illnesses and particular forms of homicide. However, matricide has been linked to schizophrenia for several decades with an assortment of explanations to explain the connection. To review the psychosocial, contextual and clinical issues involved in the perpetration of matricide by patients with schizophrenia. Two detailed case reports are presented alongside review of relevant literature. There are complex psychodynamic, phenomenological and contextual factors in the act of matricide by persons with schizophrenia. The observation that ambivalent relationships exist between schizophrenics and their mothers (or other carers) probably suggests the need for adequate clinical intervention with families of affected patients in resolving psychological tension which might be the provoking stimulus to murder.
OBJECTIVE: Research on HIV in South Africa has not reflected the impact of the disease on psychiatric patients. The aims of the study were: to compare the HIV prevalence among patient groups in Weskoppies Hospital; to co...OBJECTIVE: Research on HIV in South Africa has not reflected the impact of the disease on psychiatric patients. The aims of the study were: to compare the HIV prevalence among patient groups in Weskoppies Hospital; to compare psychiatric diagnoses of infected and non-infected patients; to assess intravenous drug use and high-risk sexual behaviour; to establish HIV-syphilis Association; and to investigate the rapid test performance for screening, compared to the confirmatory ELISA test. METHOD: Onehundred-and-ninety-five patients were grouped into four categories according to their duration of admission and gender. HIV rapid testing, HIV ELISA, syphilis-RPR and TPHA testing were performed. RESULTS: The HIV prevalence of 11% in the sample was significantly associated with 'gender-and-duration-of-admission' categories (p = 0.003). No significant association between HIV infection and psychiatric diagnoses or intravenous drug use was found, but a significant association existed between HIV infection and high-risk sexual behaviour (p = 0.002), and between HIV and syphilis (p = 0.012). The HIV rapid screening test had a sensitivity of 91.7% and a specificity of 98.2%. CONCLUSION: The overall HIV prevalence at Weskoppies Hospital remains lower than the national average, but has increased since a previous local study. The rapid test for HIV had a lower sensitivity than was expected, and it is recommended that HIV ELISA testing be performed as a first line test in the setting of hospitalised patients. Due to the high prevalence of HIV and syphilis in the psychiatric population it is recommended that all patients be tested for both of these diseases.
OBJECTIVE: Common mental disorders constitute a considerable disease burden in low-income countries, and there is a need for acceptable and effective brief interventions for such disorders in low-income countries. This a...OBJECTIVE: Common mental disorders constitute a considerable disease burden in low-income countries, and there is a need for acceptable and effective brief interventions for such disorders in low-income countries. This article examines cultural based interpretations of the diagnosis of panic disorder (PD) in a rural Tanzanian hospital setting through clinical work. It also examines how to adapt and apply brief cognitive behaviour therapy (CBT) interventions to this setting. METHOD: A qualitative analysis of clinical data from ten participants in a hospital-setting in rural Tanzania. RESULTS: The analysis suggests that the diagnosis of PD is relevant to this rural Tanzanian setting. Patients, relatives, and health personnel at the hospital accepted brief CBT interventions for PD and regarded psychoeducational information to patients as especially useful. CONCLUSION: A manual for brief interventions for PD may be adapted to a rural Tanzanian setting, also taking into consideration the limited financial and human resources in a rural low-income country setting.
OBJECTIVE: The use of thyroid tests to assess psychiatric patients remains debatable. Therefore, this study was conducted to examine the utility and cost effectiveness of the current protocol used in thyroid testing in a...OBJECTIVE: The use of thyroid tests to assess psychiatric patients remains debatable. Therefore, this study was conducted to examine the utility and cost effectiveness of the current protocol used in thyroid testing in adult psychiatric patients presenting at Stikland Hospital, Cape Town, South Africa. METHOD: This was a retrospective chart review conducted at Stikland Hospital between 1 January 2000 and 31 December 2005. The following data was recorded: demographic variables, clinical diagnoses at admission and discharge, number of days from admission to a thyroid test request, the reason for thyroid screening, number of thyroid tests, their yield and costs involved, as well as the action taken following an abnormal thyroid test result. RESULTS: The mean age of patients (n = 1080: n = 364 male, n = 716 female) was 42.8 years (SD ± 16.6). Pre-existing thyroid disease was documented in 70 (6%) of patients. Normal Thyroid Stimulating Hormone (TSH) test results significantly (p = 0.0001) increased, whilst abnormal TSH test results significantly (p = 0.0001) decreased from baseline to follow-up. Except for gender, the outcome of TSH screening was independent of demographic and clinical diagnoses. Only 16% of TSH tests yielded clinically significant results. CONCLUSION: The findings of this study do not support the early, routine screening for thyroid dysfunction in psychiatric patients at this facility. It is possible that thyroid screening may present with transient abnormalities of no particular clinical significance, and would therefore not be a cost effective practice.
OBJECTIVE: The aim of this study was to determine the prevalence of serious mental disorders in a prison population in Durban, South Africa, one of the largest prisons in the Southern hemisphere. METHOD: 193 prisoners we...OBJECTIVE: The aim of this study was to determine the prevalence of serious mental disorders in a prison population in Durban, South Africa, one of the largest prisons in the Southern hemisphere. METHOD: 193 prisoners were interviewed using the Mini Neuro-psychiatric Interview, a screening questionnaire and a demographic questionnaire. RESULTS: The study demonstrated that 55.4% of prisoners had an Axis 1 disorder. The commonest disorder being substance and alcohol use disorders (42.0%). 23.3% of prisoners were diagnosed with current psychotic, bipolar, depressive and anxiety disorders. 46.1% were diagnosed with antisocial personality disorder. The majority of prisoners diagnosed as having an Axis 1 disorder in this study, were neither diagnosed nor treated in prison. CONCLUSION: There is a high prevalence of mental disorders among prisoners in a prison population in Durban, South Africa. The majority of these prisoners are untreated in prison, related to non detection of the mental disorder. Greater mental health awareness and provision of mental health services focusing on staff training programmes to detect mental illnesses are needed and further research is recommended throughout South Africa.
OBJECTIVE: Increased plasma homocysteine, decreased vitamin B(12) and folic acid levels have been implicated in depressive mood. Plasma homocystine, vitamin B(12), folic acid tryptophan, lipids and lipoproteins were dete...OBJECTIVE: Increased plasma homocysteine, decreased vitamin B(12) and folic acid levels have been implicated in depressive mood. Plasma homocystine, vitamin B(12), folic acid tryptophan, lipids and lipoproteins were determined in depressed patients and controls. METHOD: Sixty subjects consisting of 30 depressed patients and 30 apparently healthy volunteers, who served as controls, were selected for this study. Anthropometric indices and biochemical parameters were determined using standard procedures. RESULTS: The results showed a significantly higher plasma homocysteine level amongst depressed patients when compared with the corresponding controls (p < 0.001), the percentage increase was 116%, while the plasma vitamin B(12) (p < 0.01), total cholesterol, high density lipoprotein cholesterol and low density lipoprotein cholesterol levels (p < 0.001) were markedly lower when amongst depressed patients when compared with the corresponding controls; the percentage differences were 21%, 42% and 42% respectively. Plasma triglyceride, folic acid and tryptophan levels amongst depressed patients were not significantly different from the controls. The male subjects had significantly higher plasma tHcy levels than the female counterparts ( p < 0.001). CONCLUSION: This study showed a significant increase in plasma tHcy coexisting with a decrease in plasma vitamin B(12) TC, LDLC and HDLC, in depressed patients. Increased plasma homocysteine could be a sensitive indicator of plasma B vitamin deficiency.
OBJECTIVE: The objective of the study was to identify children with Sickle cell disease (SCD) who are experiencing psychosocial problems concurrently with their mothers; and comparing the dyads to determine correlation,...OBJECTIVE: The objective of the study was to identify children with Sickle cell disease (SCD) who are experiencing psychosocial problems concurrently with their mothers; and comparing the dyads to determine correlation, pattern of correlation and to identify correlating or modifying factors. METHOD: The psychosocial impact of Sickle cell disease in affected children and their mothers was assessed using semi-structured questionnaire and standardized instruments (The Child Behaviour Questionnaire (CBQ) - Parents' version or Scale A2) for the children and Self Reporting Questionnaire (SRQ) for their mothers) Children with bronchial asthma and some with acute medical illnesses (AMI) and their mothers who were also assessed with the same instruments served as the control population. RESULTS: There was significant correlation between children who were probable cases with psychological problems based on Child Behaviour Questionnaire (CBQ score of ≥7) and corresponding mothers who were probable cases with psychosocial problems based on Self-Reporting Questionnaire (SRQ score of ≥5).Although there were some group-specific factors that influenced this pattern (child and mother having psychosocial problems concurrently) in one or 2 groups of these diseases, none cut across the 3 groups. CONCLUSION: In psychosocial management of physical illnesses, assessment and care should include a focus on families rather than on the affected individual only. In addition, identifying emotional and social dysfunction in a family member should lead to a search in other members; in this way primary prevention or control can effectively be carried out. Finally, identifying more modifiable factors that positively influence this pattern in which child and mother experience psychosocial dysfunction concurrently should be the urgent task of future and larger studies in this environment.
OBJECTIVE: This study assessed general functioning in Nigerian adolescents with bipolar disorder. It also determined the factors associated with functioning in these adolescents. METHOD: Adolescents with bipolar disorder...OBJECTIVE: This study assessed general functioning in Nigerian adolescents with bipolar disorder. It also determined the factors associated with functioning in these adolescents. METHOD: Adolescents with bipolar disorder diagnosed over one year or more attending the outpatient unit of Federal Neuro-Psychiatric Hospital, Enugu (FNHE), Nigeria for follow-up visits were interviewed with a socio-demographic questionnaire and their functioning was rated with the Children Global Assessment Scale (C-GAS) based on the clinical information obtained from the children and their care givers during a one year follow-up period. Further information such as history of sexual risk behavior, pre-morbid peer relationship, relationship with siblings, level of religion activities among others were also obtained through clinical interview. RESULTS: A total of 46 adolescents with bipolar disorder were followed up. Minimal to moderate impairment in functioning in the past year was found in these adolescents. The mean score on C-GAS was 68.41 ± 16.63. Factors including co-morbidity, pre-morbid peer relationship, relationship with siblings, level of religion activities and history of sexual risk behavior were significantly associated with functioning (p = 0.000), while marital status of the parents showed a weak association with functioning in these adolescents (p = 0.068). Negative correlation was also found between mean number of hospital admissions in the past year during follow up and mean score on C-GAS (r = - 0.908, p = 0.000). CONCLUSION: Functional impairments complicate bipolar disorder in Nigerian adolescents. To ensure good overall outcome in these adolescents, attention needs to be focused on promoting those factors that help good functioning. Future longitudinal follow up studies that would assess long-term outcome and its correlates in children and adolescents with bipolar disorder in this environment are desirable.
OBJECTIVE: Reasons for the increase in incidence of tuberculosis (TB) in late adolescence are poorly understood. One hypothesis is that psychological and behavioural variables associated with adolescence may increase ris...OBJECTIVE: Reasons for the increase in incidence of tuberculosis (TB) in late adolescence are poorly understood. One hypothesis is that psychological and behavioural variables associated with adolescence may increase risk of developing TB. The study aimed to determine whether psychosocial and behavioural variables affect incidence of TB disease in adolescents. METHODS: A case-control study design was used in adolescents who were participants in a TB epidemiological study. Cases were adolescents diagnosed with TB disease. Approximately half of the controls had no TB disease but a positive TST indicative of latent TB. Half had neither TB disease nor latent TB. A self-administered questionnaire was completed by participants. The questionnaire consisted of a combination of standardised psychosocial instruments. RESULTS: Of 292 participants, 62 were cases, 112 had latent TB and 118 neither TB disease nor latent TB. There were no significant differences in instrument scores between cases and controls. There was a trend for certain adverse life events to be more common in the TB-disease group. CONCLUSION: In adolescents, a trend for association between TB incidence and psychosocial and behavioural variables was not statistically significant. Given the trend, research with larger samples, and more comprehensive assessment of the relationship between stressors and TB, is warranted.