Browsing by Author "Ojagbemi, A."

Now showing 1 - 9 of 9

Combining depot antipsychotic with an assertive monitoring programme for treating first-episode schizophrenia in a resource- constrained setting
(John Wiley & Sons Australia, Ltd, 2016) Chiliza, B.; Ojagbemi, A.; Esan, O.B.; Asmal, L.; Oosthuizen, P.; Kidd, M.; Gureje, O.; Emsley, R.
Aim: To assess the feasibility and effectiveness of depot antipsychotic (flupentixol decanoate) combined with an assertive monitoring programme (AMP) in first-episode schizophrenia. Methods: This was a prospective, non-comparative, longitudinal study conducted over 12 months assessing patient acceptance, adherence, outcome in domains of psychopathology, functionality and quality of life, and tolerability. Results: Of 207 participants, 149 (72%) completed 12 months of treatment. Acceptance of and adherence to depot was good. Treatment response was achieved by 170 (82%) participants and remission by 124 (60%). Thirty-three (19%) responders relapsed and10(5%) participants met a priori criteria for treatment resistance. Treatment was generally well tolerated. Conclusions: Combination of depot antipsychotic with an AMP maybe an effective and safe intervention linearly phase of schizophrenia, and may be particularly suitable for resource constrained settings.
Epidemiology of schizophrenia-- an update with a focus on developing countries
(Taylor & Francis, 2012) Esan, O.B.; Ojagbemi, A.; Gureje, O.
Developments over the past few decades in analytical epidemiological research in schizophrenia have challenged some long-held views about the disorder. For example, the conventional view that schizophrenia may have a favourable outcome in developing countries is currently being challenged by emerging empirical data. However, quality research from develop ing countries is still relatively scarce. In this article we review some major epidemiological fi ndings of schizophrenia with a focus on data from the developing world and within the context of the methodological issues and challenges associ ated with such studies.
Motor sequencing abnormalities are the trait marking neurological soft signs of schizophrenia
(Elsevier B.V., 2015) Ojagbemi, A.; Esan, O.B.; Emsley, R.; Gureje, O.
We describe the profile of NSS across the one-year course of schizophrenia in 84 Nigerian first-episode patients. They were assessed at baseline and 3 monthly for 12 months using the Neurological Evaluation Scale and the Positive and Negative Syndrome Scale (PANSS), and treated with flupenthixoldecanoate. The patternofNSStotalandsub-categoryscoresobtainedfromrepeatedmeasurementswereinvestigatedfor responders (≥50% reduction of baseline PANSS scores) and non-responders using the method of repeated measures analysis of variance. Trait-like features of NSS categories were quantified using intra class correlation coefficients (ICCs). NSS were present in 96.4% of the patients at baseline (mean 21.5±11.1). The motor-sequencing sub-category was found unrelated to changes in schizophrenia psycho pathology with treatment (positive, r=0.19, p=0.136., negative, r=0.12, p=0.350; disorganization, r=0.16, p=0.245; overall, r=0.20, p=0.112). Regardless of decrements in psychopathology, motor-sequencing scores remained relatively unchanged across the course of the disease (main effects: responders’ F=2.44, p=0.930, ‘poor responders’ F=0.27, p=0.764, entire sample F=1.87, p=0.160). ICC was “substantial” at 0.8 (95% C. I=0.6–0.9). Only the motor-sequencing NSS appear to be trait marker of schizophrenia in this sample. Other NSS seem to reflect symptomatic states of the disorder.
Neurological Soft Signs, Spontaneous and Treatment Emergent Extrapyramidal Syndromes in Black Africans With First Episode Schizophrenia
(Frontiers Media S.A., 2018) Ojagbemi, A.; Chiliza, B.; Bello, T.; Asmal, L.; Esan, O.B.; Emsley, R.; Gureje, O.
Background: Very little is known about the relationship between spontaneous and treatment-induced motor syndromes in Africans with first episode schizophrenia. Objective: We investigated the association between spontaneous NSS and EPS, with treatment-induced EPS in a homogenous sample of Black Africans with first episode schizophrenia. Methods: We examined Xhosa (South Africa) and Yoruba (Nigeria) patients, using the Neurological Evaluation Scale and extrapyramidal symptoms scale before and at 3 months after exposure to low dose flupenthixol decanoate. Pearson’s correlations and Linear regression models, controlling for duration of untreated psychosis (D.U.P) and premorbid adjustments, were used in examining associations. Results: Among 99 participants in the baseline sample, 91 (91.8%) and 20 (20.2%) had at least one definite NSS and EPS, respectively, before exposure to antipsychotics. Treatment-induced EPS were recorded in 34 (38.6%). Spontaneous EPS was associated with treatment-emergent Akathisia in participants with a longer D.U.P (r = 0.75, β = 0.70, p=0.008). This association was specific for Parkinsonism (r =0.75, β=0.85, p=0.008) and dyskinesia (r = 0.75, β = 1.70, p = 0.008). Conclusion: Similar to previous findings for tardive dyskinesia in studies implementing longer-term follow-up, spontaneous EPS may also predict short-term antipsychotic induced EPS such as akathisia. These results may be important for early identification of patients at risk of treatment-induced Akathisia-linked psychomotor agitation in first episode schizophrenia.
Predictors and prognoses of new onset post-stroke anxiety at one year in black Africans
(Elsevier Inc., 2020) Ojagbemi, A.; Akinyemi, J.; Owolabi, M.; Akinyemi, R.; Arulogun, O.; Gebregziabher, M.; Akpa, O.; Olaniyan, O.; Salako, B.; Ovbiagele, B.
Background: There is relatively limited information on the risk factors and outcome of new onset Post stroke Anxiety (PSA) in Low- and Middle-Income Countries. We estimated incidence, cumulative incidence, risk factors and outcome of new onset anxiety in the first year of stroke among African stroke survivors. Methods: We analyzed the dataset of a completed clinical trial comprising patients enrolled to test an intervention designed to improve one-year blood pressure control among recent ( one month) stroke survivors in Nigeria. Anxiety was measured using the Hospital Anxiety and Depression Scale. Outcomes were assessed using the modified Rankin Scale (mRS), Community screening instrument for dementia (CSID) and Health Related Quality of Life in Stroke Patients (HRQOLISP-26). Results: Among 322 stroke survivors who were free of anxiety at baseline, we found a one-year cumulative incidence of 34% (95% CI = 28.6 39.3). Rates were 36.2% (95% CI =29.6 42.7) for men and 29.2% (95% CI =19.9 38.3) for women. In multivariate Cox regression analyses, haemorrhagic stroke type was associated with higher risk of new onset PSA (Hazard Ratio=1.52, 95% CI =1.01 2.29). New onset PSA was independently associated with cognitive [(mean difference (MD) in CSID scores=1.1, 95% C.I=0.2, 1.9)] and motor decline (MD in mRS scores= 0.2, 95% C.I= 0.4, 0.02), as well as poorer quality of life overtime (MD in total HRQOLISP-26 scores=3.6, 95% C.I=1.0, 6.2). Conclusion: One in 3 stroke survivors in Nigeria had PSA at one year. Clinicians in SSA should pay special attention to survivors of haemorrhagic stroke as they are at higher risk of incident anxiety and therefore its consequences.
Spontaneous and emergent extrapyramidal syndromes in Black Africans with first-episode schizophrenia and first exposure to antipsychotics
(Taylor & Francis, 2021) Ojagbemi, A.; Chiliza, B.; Bello, T.; Esan, O. B.; Asmal, L.; Emsley, R.; Gureje, O.
Background: Persons of African ancestry are thought to carry a higher risk for extrapyramidal syndromes (EPS) in schizophrenia. Aim: We investigated the phenomenon of spontaneous and treatment-emergent EPS in a sample comprising Xhosa (South Africa) and Yoruba (Nigeria) Africans with first-episode schizophrenia and first exposure to antipsychotics. Methods: The Extrapyramidal Symptom Rating Scale (ESRS) and a variety of validated tools were used for the assessment of participants before, and two-weekly after treatment with low dose flupenthixol decanoate. Participants were followed up for 12 months. Association of EPS with clinical characteristics was investigated using Pearson’s correlation and linear regression analyses. Results: Of 88 participants at baseline, 16 (18.1%) had at least one definite EPS prior to antipsychotic exposure and 34 (38.6%) had treatment-emergent EPS. While spontaneous Parkinsonism was associated with negative symptoms (r¼0.2, p¼0.043; b¼0.6, p¼0.043), treatment-emergent EPS demonstrated non-significant correlations with clinical characteristics. Apart from dyskinesia, the frequency of treatment-emergent EPS decreased over 12 months observation. Conclusion: These findings support the hypothesis suggesting that spontaneously occurring Parkinsonism in schizophrenia may be the motor spectrum of negative symptomatology. Future studies of this relationship may lead to early identification of patients who may be more sensitive to EPS.
The confirmatory factor structure of neurological soft signs in Nigerians with first episode
(Elsevier B.V., 2015) Ojagbemi, A.; Akpa, O.; Esan, O.B.; Emsley, R.; Gureje, O.
We describe empirically derived categories of NSS in first episode schizophrenia among indigenous Africans. A total of 84 Nigerian patients with the disease were assessed using the neurological evaluation scale. An exploratory factor analysis with orthogonal varimax rotation was first conducted and the factors derived based on a priori criteria were subjected to confirmatory analyses using SPSS 18.0 and AMOS 18.0. We tested four different competing models to identify the structure with the best fit to the data. The relationship of the derived NSS structure with the clinical characteristics of schizophrenia was then explored using the Pearson correlation method. The overall clinical status was assessed using the positive and negative syndrome scale and clinical global impression. Additional assessments included the pre-morbid adjustment scale and Calgary depression scale for schizophrenia. A three-factor structure in which stereognosis is prescribed to load into a ‘perceptual and motor sequencing’ category (audio–visual integration, fist-edge palm, rhythm tapping, extinction, right–left confusion) provided the best fit to the data (chi-square goodness of fittest=1.25; comparative fit index=0.95; root square means error of approximation
The confirmatory factor structure of neurological soft signs in Nigerians with first episode schizophrenia
(Elsevier BV, 2015) Ojagbemi, A.; Akpa, O.; Esan, O.; Emsley, R.; Gureje, O.
We describe empirically derived categories of NSS in first episode schizophrenia among indigenous Africans. A total of 84 Nigerian patients with the disease were assessed using the neurological evaluation scale. An exploratory factor analysis with orthogonal varimax rotation was first conducted and the factors derived based on a priori criteria were subjected to confirmatory analyses using SPSS 18.0 and AMOS 18.0. We tested four different competing models to identify the structure with the best fit to the data. The relationship of the derived NSS structure with the clinical characteristics of schizophrenia was then explored using the Pearson correlation method. The overall clinical status was assessed using the positive and negative syndrome scale and clinical global impression. Additional assessments included the pre-morbid adjustment scale and calgary depression scale for schizophrenia. A three factor structure in which stereognosis is prescribed to load into a ‘perceptual and motor sequencing’ category (audio–visual integration, fist-edge palm, rhythm tapping, extinction, right–left confusion) provided the best fit to the data (chi-square goodness of fit test = 1.25; comparative fit index = 0.95; root square means error of approximation < 0.001), and disorganization (r = 0.559, p < 0.001) psychopathologies. NSS in this sample are heterogeneous, but aggregates into three correlated categories with significant overlap with previously described classifications.
The expression of neurological soft signs in two African populations with first-episode schizophrenia
(SAGE Publications, 2018) Ojagbemi, A.; Chiliza, B.; Bello, T.; Asmal, L.; Esan, O.B.; Emsley, R.; Gureje, O.
Information about patterns of expression of neurological soft signs (NSS) in schizophrenia among individuals belonging to the same genetic ancestry may provide new insight for the understanding of the disease’s genetic functions. This study aimed to investigate whether patterns of NSS expression in first episode schizophrenia are com parable in populations with dissimilar genetic ancestry. A sample of 207 patients with first episode schizophrenia were examined using the Neurological Evaluation Scale before they were exposed to anti-psychotics. They were allocated to two African ancestry groups: Black (81 Yoruba Nigerians, and 18 Xhosa South Africans), and non-Black (98 Colored, and 10 White South Africans). Assessments were carried out using validated measures of clinical characteristics of schizophrenia. We determined the frequency, severity, factor structure, and association of NSS with clinical characteristics. Factor derived categories were compared using the Pearson’s (r) and Tucker’s congruence methods. The associations between factor derived categories and clinical characteristics of schizophrenia were determined using Pearson’s correlations and multiple regression analyses. Neurological soft signs were more frequent and more severe in the Black African ancestry group. Also, the factor structure and presentation of NSS in the two ancestry groups were significantly different. Neurological soft signs, especially motor sequencing and cognitive-perceptual abnormalities, were independently associated with disorganization psychopathologies in all the participant groups. Differences in the profile of NSS in Black compared with non-Black African ancestry patients with first episode schizophrenia may suggest differing patterns of expression of NSS in schizophrenia according to genetic ancestry.