Psychiatry in Africa: an overview

Article Abstract:

Africa comprises 53 independent, multitribal nations with many diverse cultures. Nigeria alone has at least 240 different ethnic languages. Even so, all African nations share similar experiences in the political, social, economic, and cultural realms. Most Africans believe in some supernatural causation of disease, which may affect both their symptomatology and health-seeking behavior. Psychiatric illnesses, such as neurotic, psychotic and depressive disorders, are as common in Africa as in the western world, and have similar manifestations. Some differences in patient symptoms and the treatment services that are available are outlined. For example, a two-year pilot study on schizophrenia found that schizophrenic patients from the Third World had better outcomes that those from the developed nations, although health care was less available. This is in accord with the noted prevalence of acute short-lived psychotic states reported in Africa. The difference may be a result of the protective influence of the extended family and community systems, which are known to be more tolerant and less critical environments than those found in the West. Africans may also have more of a tendency to point to bodily symptoms of their depressive disorders, as may occur when their dialect does not accommodate depression as a concept. Traditional, informal healers are popular and common, and modern psychological treatment services are not usually available. Many people, especially the mentally ill, also throng to churches for healing. The typical health-seeking person starts with a traditional healer, then goes to a church, and finally to a hospital. Formal documentation of traditional medicine has been suggested for both cultural and therapeutic purposes. This resource should not be lost or underutilized, especially since other resources are sparse. There is a deficiency of trained psychiatric medical personnel, but this is currently being addressed by the universities. The practice of psychotherapy is very limited at this time, but drugs and electric shock treatment are commonly used in hospitals. Though the basic principles of psychiatry seem to be of universal application, in Africa research in this field has been minimal and requires further study. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychiatric services, Mental health services, Africa

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Defining and measuring stabilization of patients during 4 years of intensive community support

Article Abstract:

To define and measure the success rate of an intensive community support program, 196 patients were studied over a four-year period. These individuals previously had been unable to successfully integrate into society or to achieve stability and had high rates of hospitalization or incarceration. The patients had few close familial relationships in the community and past histories of frequent hospitalizations, and overall, were severely handicapped by their mental disorders. Researchers found that traditional methods of measuring the success of these patients were inadequate and devised a more accurate measurement system in the belief that if a better understanding of this group could be obtained, more effective management could be instituted to assist these individuals in improving their quality of life. Six hypotheses regarding the expected outcome were developed: frequency of "daily distress events" would decrease; billing would remain stable after showing an initial decrease; patient satisfaction (self-reported) would improve; hospitalizations would decrease; the decrease of hospitalization would be maintained; and incarceration would not increase. All of these six hypotheses were realized at the end of the four-year period. Although the goals of the program where achieved, some minor qualifications accompany these findings. The population did not remain constant - approximately 1.5 patients were discharged each month. Another limitation was that all measures of analysis were not applied to all patients over the entire four-year period. However, among those who did remain in the study, the majority felt that overall quality of life had improved.

Evaluation, Community psychiatric services, Community mental health services, Chronically ill

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Intensive community-focused treatment of veterans with dual diagnoses

Article Abstract:

The clinical case histories of two veterans who are both suffering from major psychiatric disorders and severe substance abuse illustrate the complex and difficult challenges in behavioral health care. The two patients made the transition from a five-year course of intensive outpatient care focused on repeated cycles of crisis and hospitalization to a community-centered treatment program. Their cases highlight the importance of evidence-based medicine that relies on empirical science to inform clinical decision making and promote greater accountability.

Case studies, Diseases, Substance abuse, Veterans, Ambulatory medical care, Ambulatory care, Substance abuse treatment, Critical care medicine

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