Scholarly works in Psychiatry
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Item Achieving health security in Nigeria: A strategic blueprint for addressing psychoactive substance use(College of Medicine, University of Ibadan, 2019) Abdulmalik, J.O.; Lasebikan, V.O.; Makanjuola, V.A.; Oshiname, F. O.; Oladeji, B. D.; Esan, O. B.; Bella - Awusah, T. T.; Ojagbemi, A. A.; Adeniyi, Y. P.; Gureje, O.; Omigbodun, O. O.Introduction: Psychoactive substance use is an important component of health and national security. Nigeria has evolved from a largely transit nation for psychoactive substances to a high consumption nation. Increasing rates of use result in a concurrent rise in crime rates and insecurity, as well as road traffic accidents. The use of psychoactive substances is also implicated in episodes of civil strife, conflicts and wars, such as the ongoing Boko Haram insurgency in North East Nigeria. This observation is likely to worsen over time if there is no coherent and strategic plan to halt and reverse this trend. The forecast portends higher crime rates, heightened insecurity, civil unrest and violent conflicts by 2050, if the rising trend of psychoactive substance use is not reversed. It is a scenario that will not augur well for the stability of Nigeria and the West African region. Methods: A narrative review of the published literature, as well as expert opinion deliberations was utilized to develop a comprehensive analysis of the strategic strengths, weaknesses, opportunities and threats (SWOT) of psychoactive substance use and health security implications for Nigeria. Results: An array of the unique strengths and opportunities are spelt out; along with the inherent weaknesses and threats that should be taken into consideration in mapping out strategies to address the clear and present danger from the rising use of psychoactive substances in Nigeria. Conclusion: Recommended interventions should focus on public awareness campaigns, utilizing behaviour change communication strategies – with a special focus on prevention, mental health promotion activities, training and re-training of regulatory agencies, development and revision of existing policies, as well as better policing and enforcement of access restriction.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 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.