PSYCHOACTIVE SUBSTANCE USE AMONG PSYCHIATRIC OUTPATIENTS OF A TERTIARY HOSPITAL IN NIGERIA


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TABLE OF CONTENTS

Title page
Abstract
Table of contents
Glossaries of symbols

CHAPTER ONE (INTRODUCTION)
1.1       Statement of the problem
1.2       Significance of the study
1.3       Aim of the study
1.4       Specific objectives of the study
1.5       Research Questions
1.6       Hypothesis

CHAPTER TWO (LITERATURE REVIEW)
2.1       History of psychoactive substances
2.2       Global Psychoactive Substance Use Statistics
2.3       Burden of Disease and Prevalence
2.4       Classification of Psychoactive Substances
2.5       The mechanistic classification of psychoactive substances
2.6       Psychoactive Substance Use Disorders
2.7       Neurobiology, Neuropharmacological and Bio-behavioural basis of psychoactive substance use
2.8       Psychoactive substance use and mental illness
2.8.1 Psychoactive substance use and mental illness sharing similar neurobiological Basis
2.8.2 Psychoactive substance use and mental illness: Self medication hypothesis
2.9       Medication adherence
2.10 Under-diagnosis of psychoactive substance use
2.11 Treatment of Psychoactive Substance Use Disorders

CHAPTER THREE (METHODS)
3.1       Description of the study area
3.2       Study population
3.3       Study design
3.4       Sample size estimation
3.5       Respondents
3.6       Eligibility
3.7.1 Socio-Demographic and Drug Use Questionnaire
3.7.2 Schedule for Clinical Assessment in Neuropsychiatry (SCAN)
3.7.3 Translation of the instruments
3.8       Research assistant
3.9       Approval
3.10 Ethical Consideration
3.11 Pilot Test of Instruments
3.12.1 Procedure
3.13 Data Analysis
3.14 Data presentation

CHAPTER FOUR (RESULTS)
4.1       Socio-demographic characteristics of respondents
4.2       Socio-demographic profile of respondents with and without substance use
4.2.1 Age
4.2.2 Sex
4.2.3 Marital status
4.2.4 Religion
4.2.5 Highest level of education attained
4.2.6 Occupational status
4.3       Socio-demographic risk factors for psychoactive substance use
4.4       Non substance use psychiatric diagnoses of the respondents
4.5       Psychoactive substance use and the psychotropic drugs respondents were Receiving
4.6       Medication adherence
4.7       Underdiagnosis of substance use in the respondents

CHAPTER FIVE (DISCUSSION)
5.1       Socio-demographic profile of the respondents
5.1.1 Age
5.1.2 Sex
5.1.3 Marital status
5.1.4 Religion
5.1.5 Highest level of education
5.1.6 Occupational status
5.2       Socio-demographic predictors of psychoactive substance use
5.3       Home living arrangement
5.4       The non-substance use psychiatric diagnosis
5.5       Psychoactive substance use distribution
5.6       Prevalence of psychoactive substance use
5.7       Medication adherence
5.8       Underdiagnosis of substance use in the patients

CHAPTER SIX (SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
6.1 Summary
6.2 Conclusion
6.3 Limitations
6.4 Recommendations
REFERENCES
APPENDICES



ABSTRACT

Psychoactive substances and mental illness is a common comorbidity with poor treatment outcome on patients in some parts of the world. In Nigeria, there is dearth of information on the use of psychoactive substance in mentally-ill patients and their effects. This study investigated the influence of socio-demographic factors, prevalence and types of psychoactive substance use and the effect of these substances on adherence to prescribed medication among psychiatric out-patients of the Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Nigeria. For this descriptive cross-sectional study, all adult patients (18 years and above) who had previously attended the clinic at least1 year prior to the data collection period of 4 months were used. A sample size of 207 obtained from an estimated population of 450 regular attendees expected to visit the clinic was calculated. From the routine clinic follow-up, each consecutive 4th patient eligible for the study was interviewed until the sample size was attained. The selected respondents were made to complete a socio-demographic and drug use questionnaires and were then administered the Schedule for Clinical Assessment in Neuropsychiatry (SCAN). The data generated from these instruments was analysed by means of descriptive statistics using the statistical package for social sciences (SPSS), version 16. Chi square and t-tests were used to test for differences in proportion for categorical and continuous variables respectively. A total of 208 respondents were interviewed (52.9% males and 47.1% females). Although respondents in the age bracket of 21 to 40 used the substances more, this difference was not statistically significant (p=0.83). The sex, marital status, highest level of education and occupation of the respondents were found to be significant predictors of substance use. From this study, males, those who were married, those with higher level of education and the unemployed were found to use psychoactive substances more. The prevalence for the use of at least one psychoactive substance was 29.3%, while that for the use of multiple substances was 17.7%.
The most commonly used substances were alcohol, cannabis and tobacco and they were also the ones used in combination with one or the other. Other substances used to a lesser extent included anxiolytics, solvents and opioids. The SCAN identified 10.1% of the respondents with psychoactive substance use disorder of one type or the other. No statistically significant relationship between substance use and adherence. This use of psychoactive substance is common among psychiatric outpatients of the ABUTH and adherence behaviour is influenced by substance use. Further studies using larger sample size are therefore needed to evaluate the relationship between substance use and medication adherence and other effects such as poor response to medication in mentally-ill patients.

CHAPTER ONE

INTRODUCTION

1.1 Statement of the Problem

Mental disorders includes a heterogeneous group of conditions which have been traditionally put into groups as organic brain disorders, psychotic disorders, affective disorders, neurotic disorders, behavioral disorder, childhood disorders etc. These conditions essentially affect thought, emotional, behavioral and perceptual processes, often resulting in an enduring pattern of deviation from what is considered normal. Mental disorders are known to afflict humans from childhood to adulthood. However, some of these disorders are more common to some age group and sex. In addition, some mental illnesses show some sub-culturally based modification and expression of symptoms. The psychotic disorder which is one of the most severe and dramatic form of the mental disorders can often be a persistent illness. A common type is schizophrenia which according to current thinking arises from a hypothetical hyperdopaminergic activity in the limbic system. Schizophrenia exerts a great deal of loss and damage to the sufferer and has the capacity to interfere with his or her life expectations.

It can result in deterioration of the individual‘s overall life achievements and performance especially if it goes untreated or coexist with psychoactive substance use.


The use of psychoactive substances dates back as far as 10, 000 years ago (Merlin, 2003) and indeed have become popular such that the symbolic attachment on them in the socio-cultural lives of people will most likely continue. Psychoactive substances affect mental processes (WHO, 2011), similar to those affected by mental illness. Mentally-ill patients may resort to the use of substances to relieve symptoms, but these substances also tend to bring about changes in consciousness (such as increased alertness) and mood (such as euphoria) to warrant their continuous use despite risks and consequences. The use of alcohol and other

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