Psychiatry in Africa: Special Problems and Unique Features

Ilechukwu, S.T.C.

doi:10.1177/136346159102800301

Cited by 19 publications

(9 citation statements)

References 98 publications

(97 reference statements)

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“…This is in keeping with Ilechukwu's study which showed that somatic symptoms were common amongst patients with mild depression as those with severe depression tended to have more of psychomotor retardation (Ilechukwu, 1991).…”

Section: Discussionsupporting

confidence: 88%

Psychiatric Diagnoses of Patients Presenting with Functional Somatic Symptoms in a Primary Care Clinic at a University Teaching Hospital in Nigeria

Okafor¹,

Udofia²,

Ekpe³

2015

OJD

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Background: A number of patients that attend primary care medical settings present with distressing bodily complaints which are not attributable to organic (physical) pathology. The difficulties in diagnosing and treating such patients have been observed by many Health Care Practitioners. This study assesses the presence of psychological conditions and attempts to make psychiatric diagnoses (using a standardized diagnostic instrument) in patients presenting with Functional Somatic Symptoms (FSS) in a primary care clinic at the University of Calabar Teaching Hospital. Method: The study was carried out at the General Out Patients Clinic (GOPC) of the University of Calabar Teaching Hospital (UCTH). It was a cross-sectional study of a convenience sample of 100 randomly selected patients presenting with Functional Somatic Symptoms. Those who consented filled the modified version of the Enugu Somatization Scale and were interviewed with the Schedule for Clinical Assessments in Neuropsychiatry (SCAN) for possible psychiatric diagnoses. Results: While 41 of the selected patients were males, 59 were females. Their mean age was 38.5 (SD = 12.2). Frequent headaches and body heat (internal heat) were the most prevalent symptoms in the patients. ICD-10 psychiatry diagnoses using the SCAN were made in 79% of the patients studied. Depressive disorders (diagnosed in 48% of the patients) and anxiety disorders (in 21%) were the most common diagnoses. Older patients were mainly diagnosed of depressive disorders (p = 0.016) whereas younger patients tended to receive diagnoses of anxiety disorders (p = 0.039). Conclusion: Patients presenting with FSS may have diagnosable psychiatric disorders which if not recognized would go untreated. Psychiatric referral may therefore reduce the sufferings of the patients.

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Section: Discussionsupporting

confidence: 88%

Psychiatric Diagnoses of Patients Presenting with Functional Somatic Symptoms in a Primary Care Clinic at a University Teaching Hospital in Nigeria

Okafor¹,

Udofia²,

Ekpe³

2015

OJD

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“…Somatic symptoms are commonly expressed by Nigerian patients with depression [20–24]. Ilechukwu [20] found that somatic symptoms were more common in mild and moderate depression than severe depression in a Nigerian clinical population. However, to the best of our knowledge, these somatic symptoms have not been previously shown to be predictive of either PMD or NMD among Africans.…”

Section: Discussionmentioning

confidence: 99%

“…Depressive symptoms were regarded as present (positive) only if the response items were rated as 3. In addition to the symptom profile elicited with the SCID, we also included the item “other somatic symptoms” in order to capture certain somatic symptoms (such as heat or peppery sensations in the head or body; heaviness or tension in the head; emptiness or feelings of fluid in the head; and crawling sensations) which have been shown by previous authors to be common or uniquely expressed among Africans [20–24]. In view of the fact that the expression of these symptoms may be related to the cultural idioms of distress or the use of somatic metaphors [25], “other somatic symptoms” were painstakingly probed clinically to ascertain their nature, quality, and frequency.…”

Section: Methodsmentioning

confidence: 99%

Symptom Profile and Severity in a Sample of Nigerians with Psychotic versus Nonpsychotic Major Depression

Adeosun

Jeje

2013

Depression Research and Treatment

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The therapeutic strategies in managing patients with psychotic major depression (PMD) differ from those with non-psychotic major depression (NMD), because of differences in clinical profile and outcome. However, there is underrecognition of psychotic symptoms in depressed patients. Previous studies in Western population suggest that certain symptom patterns, apart from psychosis which may be concealed, can facilitate the discrimination of PMD from NMD. These studies may have limited applicability to sub-Saharan Africa due to cross-cultural differences in the phenomenology of depression. This study compared the rates and severity of depressive symptoms in outpatients with PMD (n = 129) and NMD (n = 117) using the Structured Clinical Interview for Depression (SCID) and Hamilton Depression Rating Scale (HAM-D). Patients with PMD had statistically significantly higher rates of suicidal ideation, suicidal attempt, psychomotor agitation, insomnia, and reduced appetite. Patients with NMD were more likely to manifest psychomotor retardation and somatic symptoms. PMD was associated with greater symptom severity. On logistic regression analysis, suicidal ideation, psychomotor disturbances, insomnia, and somatic symptoms were predictive of diagnostic status. The presence of these symptoms clusters may increase the suspicion of occult psychosis in patients with depression, thereby informing appropriate intervention strategies.

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“…Guilt was thought to be very infrequent among Africans with depression, 5 but more recent studies 6,7 have shown that it is being more frequently encountered in clinical practice. In the literature, survivor guilt is usually mentioned as a feature of PTSD.…”

Section: That 99% Ofmentioning

confidence: 99%

Post-traumatic stress disoder, survivor guilt and substance use - a study of hospitalised Nigerian army veterans

Okulate¹,

Jones²

2006

S. Afr. J. Psych.

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Post-traumatic stress disorder, survivor guilt and substance use -a study of hospitalised Nigerian army veteransObjectives. To investigate the prevalence of post-traumatic stress disorder (PTSD) and survivor guilt in a sample of hospitalised soldiers evacuated from the Liberian and Sierra-Leonean wars in which Nigerians were involved as peace keepers. The relationships between PTSD, survivor guilt and substance use were also investigated.Design. A socio-demographic data questionnaire, the PTSD checklist and a validated World Health Organization substance use survey instrument were used to obtain data from the subjects.Setting. The study took place at the 68 Nigerian Army Reference Hospital, Lagos, Nigeria, which was the base hospital for all casualties from the Liberian and SierraLeonean operations.Subjects. All hospitalised patients from the military operations during a 4-year period (1990 -1994) who were physically capable of being assessed were included in the study.Results. The prevalence rate for PTSD was found to be 22% and survivor guilt was found in 38% of the responders.PTSD was significantly associated with long duration of stay in the mission area, current alcohol use, lifetime use of an alcohol/gunpowder mixture, and lifetime cannabis use.Survivor guilt was significantly associated with avoidance of trauma-related stimuli but not duration of combat exposure.Conclusions. Although the sample studied was specific, PTSD might be quite common and probably undetected G T Okulate, MB ChB, FWACP, FMCPsych O B E Jones, BSc (Psych), MSc (Psych)

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Psychiatry in Africa: Special Problems and Unique Features

Cited by 19 publications

References 98 publications

Psychiatric Diagnoses of Patients Presenting with Functional Somatic Symptoms in a Primary Care Clinic at a University Teaching Hospital in Nigeria

Psychiatric Diagnoses of Patients Presenting with Functional Somatic Symptoms in a Primary Care Clinic at a University Teaching Hospital in Nigeria

Symptom Profile and Severity in a Sample of Nigerians with Psychotic versus Nonpsychotic Major Depression

Post-traumatic stress disoder, survivor guilt and substance use - a study of hospitalised Nigerian army veterans

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