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 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 Neurocognitive Impairments (NCI) in bipolar disorder: Comparison with schizophrenia and healthy controls(Elsevier B.V, 2020) Esan, O. B.; Oladele, O.; Adediran, K. I.; Abiona, T. O.Background: Neurocognitive impairments (NCI) are common in patients with bipolar I disorder. However, reports about the affected domains, outcomes and magnitude have been inconsistent. The aim of this study was to compare the magnitude (severity) and specificity (domains), of (NCI) in euthymic Bipolar I Disorder (BD) patients with a demographically and educationally matched sample of patients with schizophrenia in remission (SC) and healthy controls (HC). Methods: The Screen for Cognitive Impairment in Psychiatry (SCIP) was applied in this cross-sectional study, to all consecutive and consenting euthymic outpatients with bipolar I disorder (BD) (n = 76), remitted patients with schizophrenia (n = 130) and age and gender-matched healthy controls (HC) (n = 100). The cognitive tests done included Verbal List Learning-Immediate (VLT-I), Working Memory Test (WMT), Verbal Fluency Test (VFT), Verbal Learning Test-Delayed (VLT-D) and Processing Speed Test (PST). Within the bipolar group, the association between NCI and functioning was assessed. Results: There was a significant difference in the proportions of participants that had cognitive impairment from the 3 groups (37% (HC) vs. 71.1% (BD) vs. 91.5%(SC) (p=0.001) The BD group in comparison to the HCs did worse on all domains of the SCIP except WMT and PST. The BD group was not significantly different from the SC group in all neuropsychological domains of the SCIP except WMT. BD group significantly functions better than the SC group. The severity of depressive symptomatology and VLT-I were independent predictors of functioning in the BD group. Conclusion: Cognitive impairment affects almost all the neurocognitive domains of the BD group. The difference in NCI between euthymic BD patients and SC in remission are quantitative rather than qualitative.Item Modeling psychological function in patients with schizophrenia with the PANSS: an international multi-center study(Cambridge University Press, 2021) Fountoulakis, K. N.; Dragioti, E.; Theofilidis, A. T.; Wiklund, T.; Atmatzidis, X.; Nimatoudis, I.; Thys, E.; Wampers, M.; Hranov, L.; Hristova, T.; Aptalidis, D.; Milev, R.; Iftene, F.; Spaniel, F.; Knytl, P.; Furstova, P.; From, T.; Karlsson, H.; Walta, M.; Esan, O. B.; Oladele, O.; Osunbote, C.; Rybakowski, J. K.; Wojciak P.Background: The aim of the current study was to explore the changing interrelationships among clinical variables through the stages of schizophrenia in order to assemble a comprehensive and meaningful disease model. Methods: Twenty-nine centers from 25 countries participated and included 2358 patients aged 37.21 11.87 years with schizophrenia. Multiple linear regression analysis and visual inspection of plots were performed. Results: The results suggest that with progression stages, there are changing correlations among Positive and Negative Syndrome Scale factors at each stage and each factor correlates with all the others in that particular stage, in which this factor is dominant. This internal structure further supports the validity of an already proposed four stages model, with positive symptoms dominating the first stage, excitement/hostility the second, depression the third, and neurocognitive decline the last stage. Conclusions: The current study investigated the mental organization and functioning in patients with schizophrenia in relation to different stages of illness progression. It revealed two distinct “cores” of schizophrenia, the “Positive” and the “Negative,” while neurocognitive decline escalates during the later stages. Future research should focus on the therapeutic implications of such a model. Stopping the progress of the illness could demand to stop the succession of stages. This could be achieved not only by both halting the triggering effect of positive and negative symptoms, but also by stopping the sensitization effect on the neural pathways responsible for the development of hostility, excitement, anxiety, and depression as well as the deleterious effect on neural networks responsible for neurocognition.Item Staging of schizophrenia with the use of PANSS: an international multi-center study(Oxford University Press, 2021) Fountoulakis, K.N.; Dragioti, E.; Theofilidis, A.T.; Wikilund, T.; Atmatzidis, X.; Nimatudis, I; Thys, E.; Wampers, M.; Hranov, L.; Hristova, T.; Aptalidis, D.; Milev, R.; Iftene, F.; Esan, O.B.; Oladele, O.B.; Osunbote, C.Introduction: A specific clinically relevant staging model for schizophrenia has not yet been developed. The aim of the current study was to evaluate the factor structure of the PANSS and develop such a staging method. Methods: Twenty-nine centers from 25 countries contributed 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Analysis of covariance, Exploratory Factor Analysis, Discriminant Function Analysis, and inspection of resultant plots were performed. Results: Exploratory Factor Analysis returned 5 factors explaining 59% of the variance (positive, negative, excitement/hostility, depression/anxiety, and neurocognition). The staging model included 4 main stages with substages that were predominantly characterized by a single domain of symptoms (stage 1: positive; stages 2a and 2b: excitement/hostility; stage 3a and 3b: depression/anxiety; stage 4a and 4b: neurocognition). There were no differences between sexes. The Discriminant Function Analysis developed an algorithm that correctly classified >85% of patients. Discussion: This study elaborates a 5-factor solution and a clinical staging method for patients with schizophrenia. It is the largest study to address these issues among patients who are more likely to remain affiliated with mental health services for prolonged periods of time.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 Bipolar I disorder in remission vs. schizophrenia in remission: Is there a difference in burden?(Elsevier, 2017) Esan, O.B.; Osunbote, C.; Oladele, O.; Fakunle, S.; Ehindero, C.; Fountoulakis, K.N.Introduction: Bipolar disorder (BD) is considered to have a better outcome in comparison to schizophrenia. However, recent data dispute this notion. The current study aimed to compare the burden of patients with BD type I (BD-I) in remission with similar patients with schizophrenia (SZ) in remission. Material and Methods: Patients with schizophrenia (n=75) and BD-I (n=54) aged 18-64 years were included in the study. The diagnosis was made with the SCID-I/P. Patients were assessed for sociodemographic variables, stigma, quality of life, disability, suicidality and current symptomatology. The statistical analysis included Analysis of Covariance (ANCOVA) and chi-square test. Results: ANCOVA with age at onset as a covariate and marital status and diagnosis as grouping variables returned no significant difference. Discussion: The results of the current study suggest that when in remission, BD-I patients do not differ from patients with schizophrenia with regards to stigma, quality of life, disability level and suicidality. Also, when in remission, they do not differ regarding the severity of their psychopathology.Item 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.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 Comparison of the profile of patients with acute and transient psychotic disorder and schizophrenia in a Nigerian teaching hospital(American Psychiatric Assicaition Publishing, 2013) Esan, O.B.; Fawole, O.I.Acute and transient psychotic disorders (ATPD) are different from schizophrenia; however, very little research has been done on this disorder in low-income countries, where the incidence is as high as 10 times the incidence in the more developed countries. The authors sought to identify/ characterize the sociodemographic and clinical differences between the two disorders by performing a retrospective review of the records of patients with untreated first episode of ATPD and schizophrenia seen at the University College Hospital, Ibadan, between January 1, 2006 and December 31, 2010, extracting sociodemographic and clinical data. A group of 243 patients with schizophrenia and 124 subjects with ATPD met the inclusion criteria. Patients with ATPD were more likely to present below the age of 25 years. Excitement was more common in ATPD than in schizophrenia; suspiciousness was more common in subjects with schizophrenia than ATPD. Also, anxiety and uncooperativeness were significantly more likely to occur in ATPD. Poor orientation, disturbance of volition, and preoccupation were more common in schizophrenia. The mean age at onset was similar between patients with schizophrenia and ATPD. In keeping with findings in Europe and North America, there are clinical and sociodemographic differences between ATPD and schizophrenia; however, a different set of features differentiate between the two conditions in Nigerians.