Theses in Psychiatry http://adhlui.com.ui.edu.ng/jspui/handle/123456789/66 2026-02-25T10:16:33Z 2026-02-25T10:16:33Z OYEWUSI, GUREJE http://adhlui.com.ui.edu.ng/jspui/handle/123456789/677 2019-04-30T12:35:15Z 1993-01-01T00:00:00Z

Title: THE NOSOLOGICAL STATUS OF SCHIZOPHRENIA: A MULTIDIMENSIONAL VALIDITY STUDY Authors: OYEWUSI, GUREJE Abstract: In spite of many years of research, schizophrenia remains a medical puzzle. Even though modern classificatory systems have revolutionized its clinical diagnosis by improving reliability, its validity as a distinct disorder remains controversial. Schizophrenia has many characteristic signs and symptoms but no pathognomonic ones: it has clinical features which overlap those of a number of other disorders. Many workers have been unable to demonstrate a distinct bimodality between schizophrenia and affective psychoses when these disorders have been studied with regard to clinical phenomenology. A number of neurobiologic features have been associated with schizophrenia but most of these are non-specific as they have been demonstrated in patients with other disorders. The course of the iliness is unpredictable and varied. Given this array of unknown, it is no wonder that the Search for its aetiology remains largely exploratory. It is therefore now widely accepted that further significant progress in the study of schizophrenia. especially progress In the identification of aetiological factors and in the possible formulation of preventive measures, will only be made after the problems associated with the clinical heterogeneity of the disorder have been successfully addressed. Over the years, a number of investigators have suggested various ways of subdividing the iliness. These have shown different degrees of success. The challenge of the present time is to use various clinical and neurobiologic domains to determine the most empirically useful way to achieve this subdivision. This study was designed to determine the validity of schizophrenia in a sample of Nigerian patients and to explore which procedure for subdividing it has the potentials for defining broadly homogenous groups of patients. A multidimensional approach was employed such that aspects of the clinical phenomenology, historical and familial antecedents, and neurobiologic correlates of the subjects were Study 60 consecutively admitted patients with schizophrenia diagnosed according to the Research Diagnostic Criteria. Control groups consisted of 53 randomly selected normal subjects, 35 consecutively admitted patients with mania, and 11 with psychotic depression. Study subjects were identical to controls with respect to gender, age, social class, and educational attainments. Patient were made up of non-institutionalized young subject s with relatively short duration of illness. Using standardized procedures, the patient groups were evaluated for a history of perinatal and childhood head trauma, premorbid functioning, psychiatric disorder in first degree relatives, and clinical features of iliness . All the subject had neurobiologic assessment consisting of examination for the presence of neurologic soft signs, determination of cerebral dominance using a battery of sensor motor tests, and evaluation of performance on a number of neuropsychologic tests designed to reflect the functioning of specific brain areas. Assessment procedures anc measurement techniques were shown to be generally reliable. Analyses consisted of comparisons of study and control groups, and of putative subtypes of schizophrenia using univariate statistical methods such as the t-test, chi square, simple correlation, and analysis of variance as appropriate. Multivariate techniques such as various forms of multiple regression analysis were used to determine strengths of associations after potentially confounding factors had been controlled for. Family history data provided support for the view that schizophrenia was a heritable disease. While the first degree relatives of schizophrenics showed an elevated risk for the illness, there was no suggestion that. such relatives showed a similar risk for affective psychoses. Schizophrenics were significantly more likely to have experienced obstetric complications and childhood head injuries than patients with affective psychoses. On the other hand, no evidence was found for a more impaired premorbid functioning, a higher prevalence of neurologic soft signs, or deviant cerebral dominance among schizophrenics than among patients with affective psychoses. Compared with normal and non-schizophrenic controls, patients with schizophrenia showed a relatively consistent pattern of impaired performance on neuropsychological tests, especially on those tests requiring frontal lobe integrity. In a discriminant function analysis, 8 variables consisting of symptomatic features of illness, age at onset of illness, cumulative score of left-sided soft signs, and performance on the Similarities subtest of weschier Adult intelligence test correctly classified 81% of the schizophrenics and 76% of the patients with affective psychoses. Exploration of different subtyping schema revealed that even though the diagnosis of the traditional hebephrenic, catatonic, mixed (or undifferentiated), and paranoid subtypes could be made reliably, these classic subtypes of schizophrenia have little to support their validity in this sample of early onset schizophrenics. There was also no evidence to suggest that subdivisions based on putative aetiolgical factors of familiality or early brain insult have practical utility as only very few patients could be classified in these ways. On the other hand, characterizing patients with the use of positive and negative symptoms profile has empiric validity. However, using factor analytic techniques, a three- rather than a two level typology of syndromes best described the patients. The three syndromes could be termed negative, disorganized, and positive based on their constituent symptom configurations. The results suggested that while the negative syndrome may be characterized by its association with poor premorbid functioning, especially during adolescence, the disorganization syndrome was characterized by its association with widespread impairment of cognitive functioning, particularly of frontal lobe functioning. The positive syndrome generally showed no strong association with the assumed variables. This study has shown that while schizophrenia is a disorder that can be reliably and validly distinguished from normality and for affective psychoses, its clinical heterogeneity often blurs this distinction. Using a multidimensional approach, it was shown that the illness consists of three relatively independent but coexisting syndromes. These schizophrenia were shown to be valid by demonstrating that they bore differential association with historical and neurobiologic correlates. The validity of this approach at subdividing the illness suggests that future research into various aspects of schizophrenia, especially aspects of the aetiology and biological substrate of the illness, are more likely to be rewarding if the disorder is seen as consisting of these three overlapping syndromes. Description: A Thesis in the Department of Psychiatry, submitted to the Faculty of Clinical Sciences and Dentistry in partial fulfillment of the requirements for the degree of Doctor of Philosophy, University of Ibadan.

1993-01-01T00:00:00Z OHAERI, J. U. http://adhlui.com.ui.edu.ng/jspui/handle/123456789/528 2018-12-19T11:38:11Z 1995-05-01T00:00:00Z

Title: COMPUTERISED TOMOGRAPHIC BRAIN SCAN FINDINGS IN A COHORT OF NIGERIANS WITH SCHIZOPHRENIA AND MANIA Authors: OHAERI, J. U. Abstract: Computerised tomographic (CT) scan has become a useful and reliable non-invasive tool for investigating possible neuropathological conditions associated with psychiatric disorders. While earlier studies of the so called functional psychotic states focused on schizophrenia, some studies of affective disorder have shown that the findings may not be specific to schizophrenia. These studies have been carried out in the developed countries where schizophrenia is predominantly characterised by insidiuos onset and poor outcome (Type II). The need to replicate these findings in a developing country where schizophrenia is thought to be predominantly of acute/onset and relatively good outcome, has necessitated this study. With their consent, and those of their relations, the CT scan of 50 schizophrenic, 14 manic (in steady state) and 41 normal subjects, were compared. Clinical assessments were done independently of CT measures. The following CT measurements were done: the Bicaudate Ratio; the lateral ventricular - Brain Ratio; the Sylvian Fissure Area Ratio; densities of the Frontal and parietal areas; and visual ratings of Cortical Sulci and central (Subcortical) atrophy. Analysis of variance showed that across the groups, significant difference between the patients and normal subjects were noted for Sylvian Fissure Area. The Third Ventricle area of schizophrenics was significantly larger than that of normal subjects, while being closer to that of manic subjects. The tendency for patients to have larger lateral ventricle area than normal subjects just failed to reach acceptable significance ( 0.05). Schizophrenics with negative symptoms had significantly larger mean lateral ventricle area than normal subjects; those with poor outcome as well as those without negative symptoms had significantly larger mean third ventricle area and Sylvian Fissure area than normal subjects. Two-way ANOVA showed no significant interaction between outcome and negative symptoms. In multiple regression analysis, lateral ventricle area could be significantly predicted among schizophrenics by bicaudate ratio and third ventricle area, but not among manic subjects. Psychiatric patients had significantly higher prevalence of cortical sulci and subcortical atrophy; and higher mean frontal density than normal; while schzophrenics had significantly higher parietal density than other groups. CT measures did not significantly correlate with duration of illness. In analysis of co-variance, these findings were sustained. The findings are similar to those from developed countries in showing that the so called functional psychotic illness are most probably associated with non-specific neuropathology. The findings are discussed in the light of evidence from neuropathological studies, neuropsychological theories and Crow's hypothesis. Description: A Thesis submitted to the Department of Psychiatry, College of Medicine, University of Ibadan, in partial fulfillment of the requirements for the award of the Doctor of Medicine (MD) Degree in Psychiatry.

1995-05-01T00:00:00Z ODEJIDE, O.A. http://adhlui.com.ui.edu.ng/jspui/handle/123456789/79 2019-04-08T14:18:00Z 1985-03-01T00:00:00Z

Title: PSYCHO-SOCIAL FEATURES OF IN-PATIENTS IN LONG-STAY PSYCHIATRIC HOSPITALS: CROSS-CULTURAL STUDY Authors: ODEJIDE, O.A. Abstract: In a survey of 226 patients at the Lantoro annex of Aro Neuropsychiatric Hospital, Abeokute, Nigeria, schizophrenic patients. constituted the largest group 163 (72.1%), followed by organic brain syndrome 37 (16.4%), and affective disorders 20 (8.8%) (Table 6). Most of the schizophrenic patients were the chronic, undifferentiated subtypes while in 21 (56,8%) of the 37 patients clinically diagnosed as cases of organic psychoses, the disorder was adduced to their gross abuse of cannabis. One hundred and thirty-three (58.8%) of the patients were found to have spent more than six months in the hospital and were classified as long-stay patients. The factors found to be related such prolonged hospitalization were the diagnosis of chronic schizophrenics, single marital status, loss of contact with relatives and criminal behaviour. Fifty-three (39.9%) of the 133 long-stay patients committed criminal offences as a result of which the law enforcement agencies referred them to the institution for psychiatry opinion and/or treatment. The study highlighted the communication gap between the psychiatric institution and the judicial system culminating in the indefinite hospitalization of such patients. Pharmacological treatment and electroconvulsive therapy (ECT) were the main treatment modalities used at the centre. All the 133 long-stay patients except one were on psychotropic drugs and a1so 37 (27.6%) of them had ECT as adjunct to chemotherapy. Polypharmacy was frequently employed at the centre with different psychotropic drug combination . The diagnosis of chronic schizophrenics and epilepsy were found to have attracted a more frequent practice of polypharmacy. Persistent abnormal involuntary movement was an exclusive finding among the long-stay patients. It was prevalent among the females, in the middle aged adults and the old age group. Also it was found not to be related to the daily and neuroleptic dosage or the num,ber of previous hospitalization for psychiatric disorders. Among the 87 long stay-patients on whom the psychopathological symptom profile schedules (PSP) were completed. 80.5% were schizophrenic patients. These were 50 cases of chronic undifferentiates and 20 cases of paranoid schizophrenia. Symptoms of formal thought disorders were more prevalent among chronic undifferentiated schizophrenics while delusions featured more significantly among paranoid schizophrenic patients. In the comparison of the Lantoro long-stay patients and similar group of patients at the Middle Tennessee Mental Health Institute (MTMHI), close similarities were observed in the preponderance of schizophrenic patients, (Lantoro 80.5%; MTMHI 75%). Similarly, the psychopathologies found in the schizophrenic patients in both population were strikingly identical. Some of such symptoms were episodes of irregular recurrence of symptoms without remission and intermittent deterioration (thrusts), lack of insight, delusions, auditory hallucinations and formal though disorders. When the psycopathological symptom profiles of the chronic undifferentiated schizophrenics were compared with those of the paranoid schizophrenics in both populations, formal disorders of thinking occurred significantly more frequently among the chronic undifferentiated schizophrenics than among the paranoid schizophrenics. Cn the other hand, delusions, irritability and suspiciousness were the symptoms more prevalent among the paranoid schizophrenic patients. These findings tend to support the impression that even though both illnesses were under the same syndrome called schizophrenia, their symptom presentation and course of illness were different. The history of illness in paranoid schizophrenics, showed regular periodic recurrence of episoles with full remission (phases). On the other hand, the chronic undifferentiated schizophrenics had episodes of irregular recurrence without full remission and intermittent deterioration (thrust). Like the PSP findings in both centres, polypharmacy and psychotropic drug combinations were found to be the practice. Contrary to the common belief, the mean daily dose of the psychotropic drugs prescribed in Lantoro located in a developing country was not significantly different from that of MTMHI. However, the prevalence of abnormal involuntary movements was higher (43%) in the MTMHI long-stay population than in those at Lantoro. One important finding at the Lantoro survey was the lack of definite social rehabilitation programmes for the chronic patients. A chronic psychiatric disorder such as chronic undifferentiated schizophrenia, constitutes a major rehabilitation problem which requires urgent hospital and community based programmes. The planning and execution of such rehabilitation programmes will involve psychiatric social workers, occupational therapists, clinical psychologists, psychiatric nurses and psychiatrists. Further, increasing the number of mental health personnel especially psychiatric nurses and psychiatrists, will facilitate a regular clinical review of long-stay patients with its attendant prevention of prolonged hospitalization, polypharmacy and the development of persistent abnormal involuntary movements. Description: A THESIS IN THE DEPARTMENT OF PSYCHIATRIC SUBMITTED TO THE FACULTY OF MEDICINE IN PARTIAL FULFILLMENT OF THE REQUIREMENT OF DOCTOR OF PHILOSOPHY OF THE UNIVERSITY OF IBADAN, NIGERIA.

1985-03-01T00:00:00Z