Scholarly works in Psychiatry
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Item Spirituality and Suicidality Among Patients with Schizophrenia: A Cross-sectional Study from Nigeria(Springer Science+Business Media / Springer Nature, 2021) Esan, O. B.; Lawal, K.Studies which have explored the effect of spirituality on suicidality among patients with schizophrenia have been characterized by inconsistent results. The aim of this study was to examine the relationship between spirituality and suicidality among stable patients with schizophrenia in Nigeria. The Daily Spiritual Experience Scale was applied to measure spirituality. There was found a significant relationship between spirituality and having had suicidal thoughts in a lifetime. Spirituality was negatively correlated with the severity of negative symptoms, total positive and negative syndrome scale score (PANSS), the severity of depression, and positively correlated with functioning.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 Body mass index (BMI) and obesity in Nigerians with schizophrenia(Taylor & Francis, 2021) Esan, O. B.; Esan, A.Background: Few Nigerian studies have examined BMI in people with schizophrenia. The aims of the present study were to assess the prevalence and distribution of obesity in Nigerians with schizophrenia and to examine the clinical correlates of BMI and obesity. Methods: A total of 207 people with schizophrenia met the inclusion criteria and were evaluated for BMI. The Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HDRS), Social and Occupational Functioning Assessment Scale (SOFAS) were rated for all participants. Anthropometric measures such as weight and height were taken using a standard protocol. Results: The prevalence of obesity was 12.6%. The non-obese participants were made up of underweight 24 (11.7%), normal weight 118 (57%) and overweight 38 (18.4%). Compared to non-obese participants, obese participants were older, more educated, more likely to be employed, had higher incomes, lower PANSS score (negative subscale), had fewer female participants, and better social and occupational functioning (p<0.05) BMI was positively correlated with age and monthly income. In the adjusted model, age, gender and education were independently associated with obesity while only age was associated with BMI. Conclusion: The present study suggests that unlike in high-income countries, obese patients with schizophrenia in Nigeria have better social and psychological functioning than non-obese patients.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 Mental health and wellbeing of medical students in Nigeria. A systematic review(Taylor & Francis, 2019) Esan, O. B.; Esan, A.; Folasire, A.; Oluwajulugbe, P.In additional peculiar contemporary social problems due to income inequality, poverty, insecurity and political instability. These have a direct impact on their mental health and wellbeing. The aim of this study was to systematically review articles reporting on the epidemiology of psychiatric disorders among medical students in Nigeria. Studies were identified using MEDLINE, HINARI, African Journal Online (AJOL) and Google Scholar databases using search terms encompassing psychiatric morbidity amongst medical students. No date restrictions were applied to the search. The pooled prevalence estimate was calculated for each disorder. Psychological dis tress was present in 25.2% of the students, perceived stress in 60.5%, depression in 33.5% and anxiety in 28.8%. The current use of at least one psychoactive substance was present in up to 44.2%, while 35.5% of all the respondents had experienced one or more forms of abuse during their training as medical students. The prevalence of psychiatric disorders among medical stu dents in Nigeria is high. Positive coping mechanisms such as religiosity, positive reframing and resilience which were identified in this review should be optimized to reduce the burden.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 Sexual Dysfunction Among Patients With Schizophrenia in Southwest Nigeria(Routledge (Taylor & Francis Group), 2018) Esan, O. B.; Esan,A.Sexual functioning has received little attention as an important aspect of patient care for those suffering from schizophrenia. In Nigeria, cultural and religious factors often prevent patients from talking with their clinician about their sexual life. The aim of our study was to assess the frequency and nature of sexual dysfunction inpatients with schizophrenia and assess the determinants of sexual dysfunction in such patients. Sexual dysfunction was assessed with the Arizona Sexual Experience Scale in 90 patients with schizophrenia. Demographic and clinical characteristics including quality of life, the severity of schizophrenia, and perceived stigma were recorded using a standardized protocol and at a collection. The prevalence of sexual dysfunction was 36.7%. Higher scores on the negative subscale of the Positive and Negative Syndrome Scale (PANSS), the general subscale of the PANSS, the total scores on the PANSS, and a family history of mental illness were significantly associated with sexual dysfunction. The only significant predictor of sexual dysfunction was the severity of the negative subscale of the PANSS. This study highlights the high prevalence of sexual dysfunction among patients with schizophrenia. Efforts should be made to identify and address this problem.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.