Dr Cecilia Busari

Background: Agoraphobia diagnosis has largely remained unchanged, with its criteria based on persistent fear and avoidance of certain clusters of situations. The controversial diagnosis of Agoraphobia with or without a history of panic disorder has also been retained in classification systems; with the understanding that patients either generally have never fully met or meet the diagnostic criteria for panic attacks. Case report: A 49-year old female presented to an outpatient Psychiatric clinic with a 12-year history of fear of enclosed spaces which was precipitated by an unstable relationship with a male partner who frequently assaulted, abused, and neglected her because she refused to terminate an unplanned pregnancy, she had for him. According to ICD-11, she was diagnosed with Agoraphobia with panic attacks, she was treated with Tab. Fluoxetine 20mg daily and Cognitive Behavioural Therapy and in the past two years she improved significantly with appropriate consistency in her follow-up visits. Conclusion: This case report shines a beam of light on the very few reported cases of agoraphobia and its incapacitating course on those who suffer from it. In Nigeria, there is scanty literature on agoraphobia, for multiple reasons such as stigma, the embarrassing nature of the illness, and no disclosure of illness. Conclusion: The knowledge of febrile seizures among mothers in Calabar is fair, however, interventions with harmful traditional practices remains a challenge and community-based health

Background: Globally, psychoactive substance use and its resulting dependence are gradually attaining a menacing trend. Psychotherapeutic techniques like cue exposure therapy (CET), in combination with other treatment approaches, may potentially produce better outcomes. Objectives: This study aims to determine and compare the sociodemographic determinants, the relationship between sociodemographic characteristics and relapse, the distribution of psychoactive substances, the prevalence of relapse, and the mean duration to relapse among the cases (patients who received CET while on treatment) and control group (patients who did not receive CET while on treatment). Method: This is a retrospective cross-sectional interventional study. From the case notes of 75 cases and 75 controls, information concerning sociodemographic characteristics, number of relapses, different psychoactive substances used and duration before relapses (latency to relapse) were retrieved. Results: The results showed a significant association between the number of relapses and sociodemographic variables of age, marital status and occupation. A significant majority of patients used cannabis; patients who received CET had significantly fewer relapses and had a significantly longer duration before relapse (relapse latency period) in comparison with controls (patients who did not receive CET). Conclusion: CET, in combination with other evidence-based treatment modalities, produces better outcome measures in the management of patients with substance dependence.

Background: Depression is one of the commonest psychiatric disorders seen among Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS) individuals and these two conditions are significant public health issues. Also, lack of social support increases the risk of depression among them. Aim: To determine the extent and type of social support and correlates of depression among HIV/AIDS patients attending General Hospital in south-south, Nigeria. Setting: The research was conducted in the HIV/AIDS outpatient clinic of the General hospital in south-south, Nigeria. Methods: A cross-sectional study design was carried out on three hundred and twenty-three patients living with HIV/AIDS from June to October 2016. The instruments used were Socio-demographic questionnaire, Mini international neuropsychiatric interview M.I.N.I (A1-A6 module, English version 6.0), and OSLO-3 items social support scale. Results: Majority (95.7%) of the respondents received social support and more than half (53.6%) of the respondents have strong social support. There was a significant association between social support and depression (X2 =18.38, df =1, p=0.001). The majority (83.3%) of the respondents were females and depression was significantly associated with marital status (X2=7.36, df=2, p=0.03).Also, there was a significant association between monthly income and depression(X2=9.31, df=2, p=0.01). In multivariate regression, absence of social support (B=2.120, p=0.001, OR=8.327) was the most significant predictor for depression Conclusion: This finding implies that depression is one of the mental health issues that affect HIV/AIDS infected individuals in Nigeria and lack of social support increases the risk of depression among them.

Background: There is increasing evidence that patients with schizophrenia have high tendency to commit suicide. However, such an act is usually preceded by suicidal behaviours (or suicidality) such as suicidal ideations, suicidal intent, suicidal plans and suicidal attempt. If any of this suicidal behaviour spectrum is missed, then suicide results. In spite of the relevance of such behaviours in the management and prognosis of schizophrenia, there is a paucity of research on the patterns and correlates of suicidal behaviours amongst this population group in sub-Saharan Africa. Aim: This study assessed the prevalence and pattern of suicidality and its relationship with certain sociodemographic and clinical variables. Setting: The study was conducted at the outpatient psychiatric clinic of the Lagos University Teaching Hospital, Idi-Araba, Lagos State. Methods: Suicidal behaviours were assessed amongst 160 randomly selected patients with schizophrenia over a six-month period. The prevalence, pattern and correlates of suicidal behaviour amongst them were also assessed. Data were collated and processed with the eighteenth version of Statistical Package for Social Sciences (SPSS 18). Results: About 43.1% of the participants exhibited suicidal behaviour. Of these, 5.8% exhibited suicidal plans whilst 75.4% attempted suicide. In terms of severity, one tenth (10%) of those who expressed suicidal behaviour exhibited severe suicidal tendencies. Participants who earned lesser income were more likely to exhibit suicidal behaviour. The same pattern was observed for medication adherence viz a viz suicidal behaviour. Conclusions: The study brings to the fore the tendency of patients with schizophrenia to commit suicide, hence the need to screen for suicidal behaviour before suicide eventually occurs.

Background: Depression is one of the commonest psychiatric disorders seen among Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS) individuals. This study examined the potential relationship between depression and Cluster of differentiation (CD4) cell counts in patients with HIV/AIDS attending a General hospital in South-South, Nigeria. Methods: A descriptive cross-sectional study was conducted among 323 HIV-positive individuals attending the HIV clinic of the General hospital in South-south, Nigeria. Socio-demographic /Clinical questionnaire was designed to assess their sociodemographic/ Clinical characteristics, they had clinical interview with the Major depression episode module of Mini international neuropsychiatric interview which was used to diagnose for depression, the severity of depression was assessed using Beck’s depression inventory –II. Ethical Clearance to proceed with the study was sought and obtained from the ethical committee of the Cross River State Ministry of Health. Results: Displayed that about 12.7% of the respondents were diagnosed to be depressed, out of which 7.7% of them had recurrent depression. Majority (83.3%) of the respondents were females and depression was significantly associated with marital status (X =7.36, df=2, p=0.03). Also, there was a significant association between 2 monthly income and depression(X =9.31, df=2, p=0.01). The presence (t=1.352, df=321, p value=0.18) and 2 severity (F(3, 322)=1.157, p-value=0.33) of depression were not significantly associated with CD4 cell count. Conclusion: The implication of this finding is that depression is one of the mental health issues that affect HIV/AIDS infected individuals in Nigeria. Furthermore, this study showed that the presence and severity of depression were not significantly associated with CD4 cells count.

The aim of this study was to determine the relationship between use of antipsychotics and the occurrence of sexual dysfunction and hyperprolactinemia among patients. From a sample of 70 patients (43 males and 27 females) taking antipsychotics for at least 3 months and an equal number of psychotropic naïve controls matched for sex and age (±5 years), demographic, clinical, and medication information were collected. Sexual function was assessed using the International Index of Erectile Function and Female Sexual Function Index among male and female respondents, respectively. Serum prolactin level was also assayed. The mean daily dose of antipsychotics was 303.81 mg; mean prolactin level was 24.50 ng/ml and 12.66 ng/ml among the subjects and controls, respectively. The prevalence of hyperprolactinemia was 38.6% among the subjects and 1.4% among the controls (χ2 = 0.637, df = 1, p = 0.000). The prevalence of sexual dysfunction was higher among the subjects (67.2%) than the controls (40%) (χ2 = 0.173, df = 1, p = 0.796). The presence of hyperprolactinemia (χ2 = 12.904, df = 1, p = 0.000), use of antipsychotic combination (χ2 = 6.656, df = 1, p = 0.013), and daily dose of antipsychotics (t= -3.986, df = 65.229, p = 0.000) were found to be significantly associated with sexual dysfunction. Hyperprolactinemia was the strongest predictor of sexual dysfunction (Wald = 6.30, df = 1, OR = 1.131, 95% CI = 1.027 to 1.245, p = 0.016). Sexual dysfunction and hyperprolactinemia were more prevalent among subjects than controls. These findings should guide psychiatrists in antipsychotics prescription.

Controversies exist as to the existence of pornographic addiction and how it should be defined. Currently, the proposed ICD-11 classification classifies pornographic addiction under the impulse control disorder section as there is not enough evidence of its similarity with chemical addictions and behavioral addiction. In Nigeria, there is scant literature on pornographic addiction. However, with the steady rise in internet penetration in the nation, pornographic use is increasing and the country ranks high among those that search for pornography on the internet. Therefore, problematic pornographic use and pornography addiction may represent a hidden disorder with an unknown burden and magnitude. This paper presents a case report of a young male with pornography addiction with comorbid psychiatric disorder presenting to a tertiary hospital in Nigeria.

Objective was to determine the prevalence of galactorrhea among respondents, to determine the correlation between the dose of antipsychotic and the presence of galactorrhea, to determine the relationship between the duration of drug use and the prolactin level, to determine the relationship between class of antipsychotic and galactorrhea, and to determine the predictors of galactorrhea among the respondents. This is a cross-sectional study. From 81 consenting patients taking prescribed antipsychotic medications and all of whom have met the inclusion criteria, a sociodemographic interview schedule was administered. Next, the venous blood sample was collected for the estimation of the serum prolactin level. The prevalence of galactorrhea was 50.6%, there was a correlation between galactorrhea and chlorpromazine equivalent dose of antipsychotics (r = 0.356, p = 0.001), there is an association between galactorrhea and the use of typical antipsychotics, there was also an association between the duration of antipsychotic use and galactorrhea, and the greatest predictor of galactorrhea was found to be the duration of antipsychotic medication usage. Galactorrhea can result from the use of atypical or typical antipsychotics, and the duration of antipsychotic use was the greatest predictor of galactorrhea.

This report looks at some of the practical reasons why drug and alcohol services should engage with families to a greater extent than they may currently do. The recommendations reflect aspects of best practice which may already be employed in services as well as some more speculative areas for further work. The report examines the numbers of families affected and issues around their engagement with services. It then looks at the importance of working with families from the point of view of intergenerational substance use. Finally, the report provides a model for a pathway for working with families in drug and alcohol services. The latter two sections are written from a psychological perspective as it is as much the relationships in the family that need to be addressed as the clinical aspects of treatment.