Scholarly works in Psychiatry
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Item Sleep quality and cognitive impairments in remitted patients with schizophrenia in Nigeria.(Elsevier, 2021) Esan, O.B.; Ephraim-Oluwanuga, O. T.Background. – Despite the ubiquity of sleep disturbance in schizophrenia, it has generally been overlooked as a potential contributor to cognitive impairments. The main aim of this study was to find out if impaired sleep quality contributes to cognitive impairments in patients with a diagnosis of schizophrenia who are in remission. Methods. – The study was conducted at the University College Hospital, Ibadan and State Hospital, Ibadan, Nigeria. The Pittsburgh Sleep Quality Index (PSQI) and Screen for Cognitive Impairment in Psychiatry (SCIP) were applied in this cross-sectional study, to all consecutive and consenting remitted outpatients with schizophrenia (N = 130). Other instruments such as Hamilton Depression Rating Scale (HDRS), the Positive and Negative Syndrome Scale (PANSS), sociodemographic and clinical measures were also applied. Results. – There were 130 participants made up of 69 females (53.1%) and 61 males(46.9%). The mean age of the participants was 38.5 ± 9.1 years. The prevalence of poor sleep quality in remitted patients with schizophrenia was 56.9%. Sleep quality was significantly negatively correlated with Verbal Learning Test-Immediate (VLT-I) (r(128) = -.18, P = .044) and Verbal Learning Test-Delayed (VLT-D) (r(128) = -.18, P = .037). The variables that independently predicted cognitive functioning were the VLT-I, odds ratio (OR) 0.66; 95% confidence interval ((CI) 0.49-0.88) and education (OR) 0.61;(CI) 0.40- 0.92). Conclusion. – Poor subjective sleep quality measured by the PSQI is linked to cognitive impairment in remitted patients with schizophrenia. We suggest that sleep quality in remitted patients with a diagnosis of schizophrenia should receive better attention by physicians.Item The self-perceived health-care needs of patients with bipolar disorder in Nigeria.(Springer Nature, 2018) Esan, O.B.; Medubi, A.Few studies have examined the health care needs of patients with bipolar disorder. The aim of this study was to comprehensively assess the clinical and social needs of patients with bipolar disorder in Nigeria and to study the demographic and clinical correlates of such needs. This was a cross-sectional study. Consecutive and consenting out patients with bipolar disorder (n = 100), were assessed with the Camberwell Assessment of Needs Short Appraisal Schedule, the Interpersonal Support Evaluation List-Shortened Version (ISEL-12), the World Health Organization Quality of life-BREF and the Young Mania Rating Scale (YMRS). The most frequently rated areas of total needs as well as unmet needs were in the domain of sexual expression, intimate relationships and the need for company. The mean number of total needs per participant was 10.70 while the median number of unmet needs was 1.50. The total number of unmet needs was significantly higher for unremitted participants compared to remit ted participants. The total number of unmet needs was positively correlated with the severity of manic symptoms (YMRS score) and negatively correlated with the level of social relationships (social domain of WHOQOL), functioning (Global Assessment of Functioning (GAF) score) and social support (Tangible Support subscale of the ISEL). The GAF score and YMRS score significantly predicted unmet needs. The study underscores the importance of assessing the needs of patients with bipolar disorder in Nigeria.Item Referral letters to the psychiatrist in Nigeria: is communication adequate?(Faculty of Medicine at Makerere University, Kampala, Uganda., 2016) Esan, O.B.; Oladele, O.Objective: Over half of patients with psychiatric disorders are first seen by primary care physicians before referral to the psychiatrist. An efficient referral system is, therefore, important to offering quality care to such patients. Communication between physicians is often sub-optimal and referral letters to specialists sometimes provide inadequate information. The current study’s aim was to observe the prevalence of deficiencies in the referral letters to a department of psychiatry in a Nigerian teaching hospital. Methods: All referral letters to the Department of Psychiatry, University College Hospital Ibadan, Nigeria over a three- year period from January 1, 2010, to December 31, 2012, were retrieved and assessed for quality using the Consultation and Referral Request Letter Assessment Tool. Result: A majority (>80%) of the referral letters had no information on the current medication list, relevant psychosocial history, outline of management to date, results of investigations to date, and known allergies. Conclusion: Deficits in communication or information transfer through referral letters to the psychiatrist are common. Interventions such as the use of standardized formats for such letters may facilitate more efficient communication.Item Concepts of madness in diverse settings: a qualitative study from the INTREPID project.(BioMed Central, 2016) Cohen, A.; Padmavati, R.; Hibben, M.; Oyewusi, S.; John, S.; Esan, O.B.; Patel, V.; Weiss, H.; Murray, R.; Hutchinson, G.; Gureje, O.; Thara, R.; Morgan, C.Background: In order to facilitate case identification of incident (untreated and recent onset) cases of psychosis and controls in three sites in India, Nigeria and Trinidad, we sought to understand how psychoses (or madness) were conceptualized locally. The evidence we gathered also contributes to a long history of research on concepts of madness in diverse settings. Methods: We conducted focus group discussions and individual interviews to collect information about how informants in each site make sense of and respond to madness. A coding framework was developed and analyses of transcripts from the FGDs and interviews were conducted. Results: Analyses suggest the following: a) disturbed behaviors are the primary sign of madness; b) madness is attributed to a wide range of causes; and, c) responses to madness are dictated by cultural and pragmatic factors. These findings are congruent with similar research that has been conducted over the past 50 years. Conclusions: The INTREPID research suggests that concepts about madness share similar features across diverse settings: a) terms for madness are often derived from a common understanding that involves disruptions in mental processes and capacities; b) madness is recognized mostly by disruptive behaviours or marked declines in functioning; c) causal attributions are varied; and, d) help-seeking is a complex process.Item The incidence of psychoses in diverse settings, INTREPID (2): a feasibility study in India, Nigeria, and Trinidad(Cambridge University Press, 2016) Morgan, C.; John, S.; Esan, O.B.; Hibben, M.; Patel, V.; Weiss, H.; Murray, R.M.; Hutchinson, G.; Gureje, O.; Thara, R.; Cohen, A.Background. There are striking global inequities in our knowledge of the incidence, aetiology, and outcome of psychotic disorders. For example, only around 10% of research on incidence of psychotic disorders originates in low- and middle-income countries. We established INTREPID I to develop, implement, and evaluate, in sites in India (Chengalpet), Nigeria (Ibadan), and Trinidad (Tunapuna-Piarco), methods for identifying and recruiting untreated cases of psychosis, as a basis for investigating incidence and, subsequently, risk factors, phenomenology, and outcome. In this paper, we compare case characteristics and incidence rates across the sites. Method. In each site, to identify untreated cases of psychoses in defined catchment areas, we established case detection systems comprising mental health services, traditional and spiritual healers, and key informants. Results. Rates of all untreated psychoses were 45.9 (per 100000 person-years) in Chengalpet, 31.2 in Ibadan, and 36.9 in Tunapuna-Piarco. Duration of psychosis prior to detection was substantially longer in Chengalpet (median 232 weeks) than in Ibadan (median 13 weeks) and Tunapuna-Piarco (median 38 weeks). When analyses were restricted to cases with a short duration (i.e. onset within preceding 2 years) only, rates were 15.5 in Chengalpet, 29.1 in Ibadan, and 26.5 in Tunapuna-Piarco. Further, there was evidence of age and sex differences across sites, with an older average age of onset in Chengalpet and higher rates among women in Ibadan. Conclusion. Our findings suggest there may be differences in rates of psychoses and in the clinical and demographic profiles of cases across economically and socially distinct settings.Item Persistence in treatment for one year among patients in Nigeria with first-episode of Schizophrenia(American Psychiatric Association Publishing, 2014) Esan, O.B.Objective: The aim of this study was to examine the magnitude of poor persistence in treatment among patients with schizophrenia and to identify associated factors. Methods: All eligible patients (N5216) seen at the University College Hospital in Ibadan, Nigeria, over a five-year period were retrospectively followed up until the time of their last visit. Time to first default was examined by Kaplan-Meier survival analyses. Alog-rank test was used to compare survival times for different variables. The contribution of the variables that affected time to default was examined by Cox regression analysis. Results: Only 24% of the sample remained in treatment at the one-year follow-up. Persistence as measured by mean6SE time to all-cause treatment default was 17.8061 .44 weeks. Of several variables examined, including whether patients were taking first- or second-generation antipsychotics, none were found to predict persistence. Conclusions: Persistence in treatment of patients with a first episode of schizophrenia was low.Item Determinants of transition across the spectrum of alcohol use and misuse in Nigeria(Elsevier Inc, 2013) Esan, O.B.; Makanjuola, V.; Oladeji, B.; Gureje, O.Many studies have examined the risk factors associated with alcohol use disorders. No information is available from developing countries about the factors that may determine the transitions across different levels of use and misuse. Alcohol use and its misuse were assessed in a cohort of 2143 Nigerians using Version 3.0 of the World Health Organization Composite International Diagnostic Interview (WHO-CIDI). This generated six levels of alcohol use and related disorders. Using age of onset variables created for the purpose, analysis was done to determine rates of and risk factor for transition between the levels. Lifetime prevalence estimates were 57.8% for alcohol use, 27.6% for regular use, 2.9% for abuse, and 0.3% for dependence. Whereas 47.8% transited to regular use from lifetime ever use, only 10.5% transited to abuse from regular use and 9.5% from abuse to dependence. Male sex, age 18e49 years and being never married predicted onset of alcohol use. Transition to regular use was predicted only by male sex while transition to abuse was predicted by male sex and age 35e49 years. Factors associated with recovery from abuse were female sex and a student status. Higher rates of transition occurred in the stages preceding the onset of alcohol use disorders. Sex and age were the main determinants of transition, with male gender and middle age being risk factors for transition to problematic use of alcohol.Item Prevalence and correlates of suicidal behaviour among adolescents in southwest Nigeria(Nigerian Medical Association, 2008) Omigbodun, O.; Dogra, N.; Esan, O.B.; Adedokun, B.Background: Despite being recognized by the World Health Organization as a significant social and health concern, information on suicidal behaviours in Nigerian adolescents is unknown. Aims: To establish the prevalence and associated psychosocial correlates of suicidal ideation and attempts in Nigerian youth. Methods: Stratified sampling was used to identify youth aged 10–17 years who completed the Nigeria version of the Global School Health Questionnaire (GSHQ) and the Diagnostic Predictive Scale (DPS) for youths (suicidal behaviour questions) in a classroom setting. Results: A total of 1429 youth completed the instruments. Over 20% reported suicidal ideation and approximately 12% reported that they had attempted suicide in the last year. Adolescents living in urban areas, from polygamous or disrupted families, had higher rates of suicidal behaviour. Multiple psychosocial factors such as sexual abuse, physical attack and involvement in physical fights were significant predictors of suicidal behaviour. Conclusion: Factors associated with suicidal ideation and behaviours are similar to those found in other studies but the rates of both suicidal ideation and attempts are towards the upper limit of rates for youth. This study suggests that there is an urgent need for Nigerian policymakers and health providers to review and address this issue.