Search

Objectives: To determine the prevalence and distribution of psychiatric morbidity among convicted male sex offenders and to establish factors associated with sexual offending., Design: A Cross-sectional descriptive survey., Setting: Kamiti Maximum Security Prison, Nairobi, Kenya., Subjects: Seventy six male convicts., Results: Forty seven (61.8%) had defilement-related convictions, 23 (30.3%) had rape-related, while six (7.9%) had other convictions. Twenty seven (35.5%) out of 76 had a DSM-IV Axis I disorder, majority of whom (71.1%) were dependent on or abused substances, and 26 (34.2%) had an Axis II disorder, most of whom had antisocial and impulsive personality disorders (46.2%). Of these 12 (15.8%) had an Axis I diagnosis alone, 11 (14.5%) had an Axis II diagnosis alone while 15 (19.7%) had both Axis I and II diagnoses, that is, co-morbidity. Exposure to erotica was statistically associated with both Axis I and II (p = 0.02 and p = 0.0003 respectively) and pre-occupation with thoughts about sex was associated with Axis II disorders (p = 0.01)., Conclusions: Most of those with psychiatric morbidity targeted children and had antisocial or impulsive personality disorder. Awareness campaigns to enlighten the public of the fact that children are the most common victims and research to determine ways of treating and rehabilitating sexual offenders could reduce the vice.

A descriptive study was carried out in pregnant women who were affected by the 1998 bomb blast in Nairobi, Kenya, and their babies who were in utero at the time of the blast. The psychological effects of the event on the exposed women were severe. After three years, the average score on the Impact of Event Scale - Revised was still higher than 29 for the three subscales combined, suggesting that most of the study group was still suffering from clinical post-traumatic stress disorder (PTSD). The scores on all Childhood Personality Scale (CPS) subscales were significantly higher in children of the study group than in controls. The mothers' PTSD symptom levels at one month after the blast correlated with the children's CPS profiles.

Following the death of 67 boys in a fire tragedy at Kyanguli School in rural Kenya, the level of traumatic grief was assessed in a sample of 164 parents and guardians whose sons died in the fire. The study was cross-sectional. Counseling services were offered to all the bereaved parents soon after the tragedy. The subjects were interviewed using the Traumatic Grief Scale. A group of 92 parents/guardians was interviewed 2 months after the event, while the other group of 72 was assessed 7 days later. The second group of bereaved parents also completed the Self Rating Questionnaire (SRQ) and the Ndetei-Othieno-Kathuku scale (NOK). Over 90% of parents from both groups had a yearning for the departed and found themselves searching for him quite often. There was no much difference in terms of symptoms profile or intensity between the two groups. It appears that the counseling offered had minimal impact on the levels of distress.

Objective: To estimate the prevalence and pattern of substance use among children and young persons appearing in the Nairobi Juvenile Court, Kenya., Design: A point prevalence survey., Setting: The Nairobi Juvenile Court, Kenya., Subjects: Ninety (sixty four males and twenty six females) children and young persons aged 8 to 18 years classified as criminal offenders, group I (60) and those for protection and discipline, group II (30), were selected., Method: Socio-demographic and substance use questionnaires were administered to the subject. International classification of diseases, 10th Edition (ICD-10) diagnostic criteria were used., Results: Crude rate for substance use in this study was found to be 39 out of the total sample of 90(43.3%), children and young persons. Of these thirty nine, 33 (85.8%) were males and six(14.2%) were females. Twenty nine (32.2%) used nicotine, 19(21.1%) used volatile hydrocarbons, 8(8.9%) used cannabis six (6.7%) used alcohol, five (5.6%) used khat and three (3.3%) used sedatives. Multiple substance use was also evident., Conclusion: This study has shown a high presence of substance use in children and young persons appearing in the Nairobi Juvenile Court.

Objectives: To estimate the prevalence and pattern of psychiatric disorders among children and young persons appearing in the Nairobi juvenile court, Kenya., Design: A point prevalence survey., Setting: The Nairobi Juvenile Court, Kenya., Subjects: Ninety (sixty-four males and twenty-six females) children and young persons aged 8 to 18 years classified as criminal offenders, group I (60), and those for protection and discipline, group II (30), were selected., Method: A socio-demographic questionnaire, reporting questionnaire for children (RQC), follow-up interview for children (FIC), present state examination (PSE) and clinical interview were administered to the subjects. International Classification of Diseases, 10th Edition (ICD-10) diagnostic criteria were used., Results: The crude psychiatric morbidity (CPM) rate was 44.4%. ICD-10 documented psychiatric disorders detected in those with CPM were conduct disorders 45%, mixed disorders of conduct and emotion 20%, emotional disorders with onset specific to childhood 20%, mood disorders 12.5% and hyperkinetic disorders 2.5%., Conclusion: This study has shown a high presence of psychiatric morbidity in children and young persons appearing in the Nairobi Juvenile Court. These juveniles need and would benefit from mental treatment as recommended in section 18 of Cap 141 of the laws of Kenya; The Children's and Young Persons Act.

Transcultural psychiatry, whose scientific founder Emil Kraepelin is considered as, in its 100 years of tradition has not only developed a varied range of methods but has also brought about a change in the respective scientific questions as well as in related research and clinical applications. Whereas transcultural research on the psychopathology of depression contributed to the further development of psychiatric nosology, transcultural psychiatry has recently been increasingly faced with issues concerning phenomena of social change and globalization. One region, where such conditions can be observed in particular is Africa, where the dissolving of traditional standards and support systems and growing economic insecurity causes a considerable burden especially on women. As an example, results from a cross-sectional study on East African women using a two step design as well as qualitative and quantitative, standardized psychiatric methods are discussed concerning the association of social change, psycho-social risk factors and the development of depressive disorders. Efficient clinical methods towards diagnosis and treatment of new risk groups will have to be developed, of which an important aspect will be crisis intervention.

Objectives: To estimate the prevalence and pattern of substance use among patients attending primary health centres in urban and rural areas of Kenya., Design: A descriptive cross-sectional prevalence survey., Setting: Urban health centres of Jericho and Kenyatta University (KU) and rural health centres in Muranga district., Subjects: One hundred and fifty adult patients (seventy eight males and seventy two females) were included in the study., Intervention: Semi-structured questionnaires and the DSM IV diagnostic criteria were used to record the socio-demographic data and to determine substance dependence or abuse., Results: The substances commonly used in descending order of frequency were alcohol, tobacco, khat and cannabis. Only alcohol and tobacco were extensively used. Lifetime prevalence rates of alcohol use for the two urban health centres were 54% and 62% compared to 54% for the rural health centres. For tobacco the lifetime prevalence rates were 30% for Jericho, 28% for KU and 38% for Muranga. The differences between the rural and urban samples were not statistically significant. More males than females had used alcohol (average lifetime use 80.8% for males compared to 30.6% for females: p<0.05) and tobacco (average lifetime use 56.4% for males compared to 5.6% for females p<0.05)., Conclusion: The rates of substance abuse were generally low with the exception of alcohol and tobacco. Socio-cultural factors might be responsible for the differences noted. It is suggested that preventive measures and education should be emphasised at the primary care level.

This was a study to compare the psychiatric consequences of closed head injury (CHI) in 37 patients with 39 demographically similar patients with fractured lower limb injury (FLLI), aged 16-55 years. The outcome measures were the Clinical Interview Schedule-Revised, the Bender Gestalt Test and the WHO AUDIT Core for alcohol abuse. The final diagnoses were made according to DSM-III-R diagnostic criteria. The findings indicated that CHI patients suffered more psychiatric consequences than FLLI controls (OR = 4.07; 95% CI = 1.30:13.14; p = 0.013). Depression and anxiety disorders were the most common problems encountered in these subjects.

The content of grandiose ideas and delusions in patients of various cultural groups admitted to a London psychiatric hospital were compared. There were no overall differences but certain trends were apparent. It was found that religion was the commonest content of grandiose symptoms in all the groups. Its frequency was higher in the African and Jamaican groups, an observation that can be understood from the cultural background of these groups. The other types of content, namely royals, identity and ability were less frequent in all groups.

In a study of the frequencies of hospital diagnoses of anxiety or related conditions and the Catego syndromes and diagnoses of anxiety and related conditions it was found that with the exception of the syndrome of tension, there were no overall cultural differences in the distribution of these syndromes across the nine cultural groups studied. However, the occurrence of these syndromes was barely reflected in the hospital diagnoses of anxiety and related conditions, even less so in the Catego diagnoses where one case of hysteria was found in the African group. All the symptoms of anxiety and related conditions are found in all the cultural groups notwithstanding other symptoms which may be culturally determined. It is argued that, at least in this hospital-based study, most or all of these symptoms were subordinate to other more predominant clinical or Catego diagnoses.

One hundred and forty patients seen in a suburban walk-in walk-out clinic over a period of 30 days were studied. Twenty-eight (20 per cent) of them were found to be primarily psychiatrically disabled, 83 (59.3 per cent) primarily physically disabled and the diagnosis of the rest (20.7 per cent) was uncertain. The psychiatric patients were found to be suffering from anxiety and depressive states. Their sex, age, education, economic status, symptomatology and duration of the illness were analysed. The findings suggest among other things that the prevalence of psychiatric disorders in the rural setting in Kenya is high and therefore calls for a proportionate provision of mental health care facilities. They also suggest that anxiety and depression in African patients are masked by somatic symptoms, often leading to unnecessary delays in diagnosis and management.

Some literature on the significance of culture on psychiatric phenomenology and also literature on psychiatric phenomenology in immigrants, particularly in Great Britain, are reviewed. It is pointed out that paranoid and religious phenomenology is particularly common in some immigrant groups and that this can be understood to some extent as a reflection of cultural factors. In order to elucidate more the role of culture in psychiatric phenomenology in immigrants to Great Britain the socio-cultural backgrounds of the immigrants and in particular the Africans, the West Indians and the Asians are discussed in some details. The phenomenology of psychiatric illness as recorded in a hospital based population of diverse cultural backgrounds in a London hospital was studied to see if any variations across the various cultural groups could be understood in terms of cultural factors. It was found that paranoid and religious phenomenology was more associated with African and West Indian groups for cultural reasons rather than their socio-environmental and racial status in Britain. Paranoia was directed to fellow immigrants rather than to the host population. It is concluded that paranoia and religious phenomenology do not necessarily have the same clinical significance in various cultural groups. It is also pointed out that hallucinations, and in particular auditory hallucinations and First Rank Symptoms of schizophrenia, which have assumed diagnostic significance in some cultures, may not necessarily have the same significance in other cultures.

The pattern of delusions in a cross-cultural hospital population was studied. It was found that there were cultural differences in persecutory, grandiose and religious, and sexual and fantastic delusions, accounted for mainly by the relatively higher frequencies in the African and West Indian cultural groups. These phenomena can be understood in terms of the cultural backgrounds of these groups. It is further argued that similarly defined persecutory delusions have a wide clinical significance that goes beyond schizophrenia in some cultural groups.

In a controlled study of life events in depressed patients in Kenya it was found that the rate of life events was higher in the depressed group in the 27 weeks preceding the onset of depression but with a sharp increase in the last 6-9 weeks before onset. It was also found that the depressed patients continued to experience independent life events after the onset of the depression. It is hypothesized that the continued occurrence of life events after the onset of depression is an incentive to seek help and, eventually, a psychiatric referral.

The Syndrome Check List (SCL) as detailed by Wing et al. (1) was used on patients belonging to various cultural groups admitted to a London hospital. On the basis of combined Catego diagnosis of schizophrenia and paranoid schizophrenia the frequency of patients with first rank symptoms (FRS) for each group was calculated. It was found that the frequencies of FRS showed cultural differences and that these differences were less when groups were relatively culturally similar. These findings are compared with findings elsewhere. The clinical dilemma presented by these findings is discussed.

The development of psychiatry in Kenya has passed through three stages with considerable overlap - primitive/non-scientific, humanistic and scientific. These stages are similar to those in the development of psychiatry in the Western societies. The prevalence of psychiatric illness amongst those seeking medical help is no less than 20%. There is a need for a full range of the various psychiatric services, but the problems involved are immense and constitute major differences between the practice of psychiatry in Kenya and in Western countries. There is, however, a clearly evident move to solve these problems.

In a study of Catego depressive syndromes, using the Syndrome Check List and the Catego programme, no significant differences in depression symptomatology frequencies were found in nine different cultural groups of patients admitted to a London hospital. There were some differences in the frequencies of the hospital diagnoses of depression, whereas the Catego diagnoses showed greater similarity. It is argued that symptoms characteristic of depression in the West are common to all cultures and will become apparent on enquiry in conjunction with other culturally determined symptoms.

The frequencies of auditory, visual and olfactory hallucinations as defined by Wing et al. were studied in schizophrenic patients of various groups treated in the same hospital. The diagnosis of schizophrenia was made by the use of the Syndrome Check List. It was found that there were some cultural differences in the frequencies of hallucinations, these being higher in the African, West Indian and Asian culture groups than in the English and other groups. The possible clinical significance of these variations are discussed.

Thirty Kenyan patients (15 consecutive first-ever referrals to the out-patient clinic and 15 consecutive first-ever admissions) of black African origin on chemotherapy for clinical depression (uncomplicated by organic or other psychotic illness) in Nairobi and 40 non-psychiatrically disturbed controls (controlled for race, sex and age) living in and around Nairobi were included in this study. Information was obtained from each subject using a structured questionnaire. It was found that in the consecutive first-ever admissions or referrals females were overrepresented in the patient group and that lack of regular income and being first born were associated with the depressed group as compared with the non-depressed group. These observations are discussed in the light of their socio-cultural context and compared with related observations in Western settings.

Case notes of patients from nine different cultural groups admitted to a London hospital were scrutinized for religious background and religious phenomenology. With the exception of preaching behaviour there were no statistically significant cultural differences, but certain trends were apparent. The pattern of religion in each cultural group could be understood in terms of the historical and geographical origins of these groups. Religious phenomenology was better explained in terms of deep-seated cultural factors rather than current religion.

Eighty 'psychotic' patients admitted to Mathare Psychiatric Hospital, Nairobi, were screened using the New Haven Schizophrenic Index (NHSI). Fifty-one (64%) of these were positive and the rest negative. Of those positive 73% had First Rank Symptoms (FRS) of schizophrenia as opposed to only 24% in the group negative for schizophrenia. This difference is highly significant (P less than 0.001). The commonest individual FRS were thought echo, thought insertion, delusional mood and auditory hallucinations in third person. The frequency distribution of FRS had no relation to sex or age. These results are compared and contrasted with the findings of similar studies in various cultures.

Thirty Kenyan patients of black African origin undergoing treatment for clinical depression in Nairobi, and 40 matched non-psychiatrically disturbed controls in the community were studies for life events using the Brown-Harris model. It was found that the depressed group had significantly more life events (P less than 0.001 with Yates correction for continuity) in the twelve months preceding the onset of their depression than the controls in the same period. These results are similar to those obtained by several workers in Western settings. Their implication for the practice of psychiatry in an African context is examined, and some myths about psychiatry in Africa re-examined.

Eighty 'psychotic' Kenyan patients of African origin were screened using the New Haven Schizophrenic Index (NHSI). Fifty-one of these (64%) were found positive. Delusions were found to be significantly more common (P less than 0.001) in the NHSI positive group than in the negative group. Sex and age had no effect on the distribution of delusions in general but level of education did. These findings are compared and contrasted with findings of similar investigations and some of their implications are discussed.

Eighty Kenyan 'psychotic' patients were screened using the New Haven Schizophrenic Index (NHSI) and were all studied for hallucinations using standardised definitions. Fifty-one of the patients were NHSI positive and the rest NHSI negative. Sixty-one percent of the NHSI positive had hallucinations in one or more modalities as compared with 31% of the NHSI negative group. Of the NHSI positive 51% had auditory hallucinations directly to the patient, 43% had visual hallucinations and 25% had olfactory hallucinations. These results are compared and contrasted with the very few similar observations made elsewhere.

At a London hospital the prevalence and types of recorded paranoid disorders, and their characteristics were extracted from the files of in-patients of various cultural groups. It was found that West Indians and Africans had more paranoid colouring in their psychiatric illness than any other group. Other immigrant groups had less paranoid features than the English group. The self or a family member was the commonest focus of intended harm in all the cultural groups. Supernatural modes of injury were common in the West Indians and Africans. It is argued that in immigrants paranoid disorder is not merely due to discrimination consequent on their migrant status, but that cultural factors inherent in the immigrants are also of etiological importance.

Eighty-three consecutive first-ever admissions to the general medical wards at the Kenyatta National Hospital ( KNH ), were screened for alcoholism using the Feighner's Research Diagnostic Criteria for Alcoholism ( FRDCA ) in their first week of admission. They were aged between 18-65 years and able to give informed consent and participate in an interview. 48% of the males, 13% of the females and 31% of the overall sample scored for definite alcoholism. Abnormal drinking behaviour and social pathology associated with drinking rather than the medical and psychiatric aspects of alcoholism were more associated with the alcoholism group. These findings are compared and contrasted with similar findings in Western settings.

Out of 100 first referrals to a newly started family/marital - sex therapy clinic in Nairobi, 52 cases were studied for sociodemographic characteristics, help-seeking pattern for their sexual problems, presentation of the sexual problems, factors that might sustain the sexual problems, types of sexual problems and the treatment approaches. There was a male preponderance. Both married and non-married patients were seen. The problems tended to occur in relatively young people, and for those who were married in relatively early years of their marriage. The patients attributed the causes of the sexual problems to physical rather than psychological factors, although objective assessment found relatively very few possible physical causes. Elementary rather than subtle psychological causes were frequent. These formed fertile grounds for intervention. The findings are discussed in the light of the social-cultural context in which they were obtained.

Following the method of Brown and Harris 30 Kenyan patients suffering from depression and 40 community non-psychiatrically-disturbed controls were studied for contextual and reported threat due to short-term and long-term life events. It was found that the patients did not over-rate threat due to events (in 'search for the meaning') nor did the controls under-rate the threat of life events. Some theoretical issues on the 'contextual threat' of life events are raised.