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Acute non-anaphylactic reactions to procaine penicillin include fear of death, sensations of disintegration, perceived changes of body shape, and visual and auditory hallucinations. Fragments of the original reaction experience, or elaborations of it, feature prominently in a chronic syndrome which persists if the initial reaction is not supported emotionally or professionally. The cultural acceptance of the reality of 'mysterious' forces played a role in the syndrome. Compatible diagnostic labels were panic disorder, post-traumatic disorder, mixed phobic disorder, and depressive illness. The observed period prevalence rate is 5.9 per 1,000. [ABSTRACT FROM AUTHOR]

This paper reports the highlights of long-term dynamic psychotherapy with an African. The case is presented of a 34-year-old Nigerian ex-army officer with the onset of panic symptoms following the death of a neighbor. This event was found to symbolize the core of his conflicts. Therapy revealed ongoing conflict with his father, with peers at work and in his marriage. There were also violations of the incest taboos in his extended and polygamous family. The psychotherapeutic process is delineated with special reference to Oedipal components. The following variations are discussed: (i) the impact of a cultural setting which enforced infancy/early childhood domicile with mother, separate sleeping quarters for the father, and later separation of all males from mother; (ii) the dynamics of growing up in a home where father has multiple wives who may function as surrogate mothers in his lifetime or, at his death, as potential wives; (iii) the vicissitudes of the incest taboo in a complex extended family that is under siege by urbanization. The therapeutic experience contrasts sharply with the experience of western psychiatrists who practiced in Nigeria two decades before. [ABSTRACT FROM AUTHOR]

Efforts at medical psychotherapy in the Lagos University Teaching Hospital are appraised. Six popular generalisations that have tended to discourage attempts at medical psychotherapy in Africa are presented and illustrated by thirteen vignettes derived from our experience in psychotherapy among Nigerians in the last six years. The vignettes encourage reappraisal of these popular generalisations with a view to modifying them and stimulating more effort by others in the same direction. Methods used are discussed and relevant literature is reviewed. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about a case report on the occurrence of bulimia nervosa in Nigeria.

Background: To systematically evaluate the empirical evidence on the impact of community-based health insurance (CBHI) on healthcare utilization and financial risk protection in low- and middle-income countries (LMIC)., Methods: We searched PubMed, CINAHL, Cochrane CENTRAL, CNKI, PsycINFO, Scopus, WHO Global Index Medicus, and Web of Science including grey literature, Google Scholar®, and citation tracking for randomized controlled trials (RCTs), non-RCTs, and quasi-experimental studies that evaluated the impact of CBHI schemes on healthcare utilization and financial risk protection in LMICs. We assessed the risk of bias using Cochrane's Risk of Bias 2.0 and Risk of Bias in Non-randomized Studies of Interventions tools for RCTs and quasi/non-RCTs, respectively. We also performed a narrative synthesis of all included studies and meta-analyses of comparable studies using random-effects models. We pre-registered our study protocol on PROSPERO: CRD42022362796., Results: We identified 61 articles: 49 peer-reviewed publications, 10 working papers, 1 preprint, and 1 graduate dissertation covering a total of 221,568 households (1,012,542 persons) across 20 LMICs. Overall, CBHI schemes in LMICs substantially improved healthcare utilization, especially outpatient services, and improved financial risk protection in 24 out of 43 studies. Pooled estimates showed that insured households had higher odds of healthcare utilization (AOR = 1.60, 95% CI: 1.04-2.47), use of outpatient health services (AOR = 1.58, 95% CI: 1.22-2.05), and health facility delivery (AOR = 2.21, 95% CI: 1.61-3.02), but insignificant increase in inpatient hospitalization (AOR = 1.53, 95% CI: 0.74-3.14). The insured households had lower out-of-pocket health expenditure (AOR = 0.94, 95% CI: 0.92-0.97), lower incidence of catastrophic health expenditure at 10% total household expenditure (AOR = 0.69, 95% CI: 0.54-0.88), and 40% non-food expenditure (AOR = 0.72, 95% CI: 0.54-0.96). The main limitations of our study are the limited data available for meta-analyses and high heterogeneity persisted in subgroup and sensitivity analyses., Conclusions: Our study shows that CBHI generally improves healthcare utilization but inconsistently delivers financial protection from health expenditure shocks. With pragmatic context-specific policies and operational modifications, CBHI could be a promising mechanism for achieving universal health coverage (UHC) in LMICs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Eze et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In a setting in which somatic symptoms without obvious organic causes are prevalent and in which doctors do not have very convincing explanations to offer, people in prolonged contact with such patients may appear to develop similar symptoms but claim the original patient as the source of their symptoms. At times, it is the original patient that detects the similarity and raises the question of contagion. Based on a study of four Nigerian patients, the author proposes the possible existence of a shared somatic disorder, comparable in many ways to induced psychotic disorder (DSM-III-R) and reopens the discussion on the whole concept of sharing/communication of psychiatric symptoms.

A case of folie à deux in two sisters from Nigeria is presented. The illness arises in a setting of multiple object losses, and social isolation, which left the two sisters most vulnerable. The more passive sister picks up some of the symptoms of her previously ill sister and they join in destructive activity which brings them to the hospital. Transcultural aspects are emphasized.

A survey of 50 male and 50 female (N = 100) psychiatric outpatients of Lagos University Teaching Hospital was carried out. DSM III diagnoses of patients was determined from the case notes. Sociodemographic data were also recorded. Findings were analysed for inter-relationships of diagnoses, sociodemographic data and three belief categories (medical, psychosocial and supernatural). The expected predominance of supernatural beliefs was absent; psychosocial responses were greater than the supernatural. There was no relationship between psychoses and supernatural belief types.