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BackgroundMisconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base.MethodsWe reviewed studies with more than 2000 participants or meta-analyses from five or more studies or 2000 or more participants. We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required comparison adjusted funnel plots. We excluded treatment studies with waiting-list or treatment as usual controls. From this literature, we extracted evidence-based assertions about the disorder.ResultsWe generated 208 empirically supported statements about ADHD. The status of the included statements as empirically supported is approved by 80 authors from 27 countries and 6 continents. The contents of the manuscript are endorsed by 366 people who have read this document and agree with its contents.ConclusionsMany findings in ADHD are supported by meta-analysis. These allow for firm statements about the nature, course, outcome causes, and treatments for disorders that are useful for reducing misconceptions and stigma.

Abstract Objective to compare the pre and post hysterectomy mental ill health (MIH) status and also, to determine whether there is any association with the surgical indication. Methodology An observational study, conducted among women scheduled for hysterectomy at the University College Hospital, Ibadan from January till June 2005. The MIH morbidities were assessed using a validated general health questionnaire (GHQ) before and after the surgery by trained research assistant. The score of 4 and above was used as the cut off. Cross tabulations were performed to detect any association and also to compare pre and post hysterectomy mental health status. The level of statistical significance was set at P < 0.05. Results Of the 50 women recruited, 45 participated in the study. The age range of the participants was 35 to 63 years with a mean of 48.6 (SD = 0.6) years. Anxiety related disorder was present in 20 (44.4%), and depression in 3 (6.7%) before hysterectomy. Post surgery, there was significant increase in those with anxiety by 6.8% and a reduction in the proportion of depressive illness by 2.3%. Uterine fibroid as a preoperative diagnosis, had significant association among those with anxiety related disorder (68.4%) and depression (10.5%). Conclusion This study suggests that mental ill health may complicates hysterectomy for benign uterine pathology among Nigerian women, and that anxiety related disorders increases after operation with the highest proportion in those with clinical diagnosis of Uterine Fibroid. We recommend adequate preoperative counseling using properly trained psychologists when affordable to minimize these morbidities.

Abstract Background Pediatric liaison services attending to the psychological health needs of children with chronic physical illness are limited or virtually non-existent in Nigeria and most sub-Saharan African countries, and psychological problems complicate chronic physical illness in these children and their mothers. There exist needs to bring into focus the public health importance of developing liaison services to meet the psychological health needs of children who suffer from chronic physical illness in this environment. Sickle cell disease (SCD) and juvenile diabetes mellitus (JDM) are among the most common chronic physical health conditions in Nigerian children. This study compared the prevalence and pattern of emotional disorders and suicidal behavior among Nigerian children with SCD, JDM and a group of healthy children. Psychological distress in the mothers of these children that suffer chronic physical illness was also compared with psychological distress in mothers of healthy control children. Methods Forty-five children aged 9 to 17 years were selected for each group of SCD, JDM and controls. The SCD and JDM groups were selected by consecutive clinic attendance and the healthy children who met the inclusion criteria were selected from neighboring schools. The Youth version of the Computerized Diagnostic Interview Schedule for Children, version IV (C- DISC- IV) was used to assess for diagnosis of emotional disorders in these children. Twelve-item General Health Questionnaire (GHQ – 12) was used to assess for psychological distress in mothers of these children and healthy control children. Results Children with JDM were significantly more likely to experience DSM – IV emotional disorders than children with SCD and the healthy group (p = 0.005), while children with JDM and SCD were more likely to have 'intermediate diagnoses' of emotional disorders (p = 0.0024). Children with SCD and JDM had higher rates of suicidal ideation when compared to healthy control children and a higher prevalence of maternal psychological distress was found in their mothers when compared to the mothers of healthy children (p = 0.035). Conclusion The higher prevalence of emotional disorders and suicidal ideation among children with SCD and JDM points to a need for development of liaison services in pediatric facilities caring for children with chronic physical illness to ensure holistic approach to their care. The proposed liaison services would also be able to provide family support interventions that would address the psychological distress experienced by the mothers of these children.

Background: The presence of psychiatric morbidity in the child and adolescent age group is demonstrable in various studies conducted in various settings in Kenya. This study set out to determine the psychiatric morbidity and socio-demographic profile of patients who eventually present for care at a tertiary specialist child and adolescent mental health clinic in Kenya. Knowledge of the patterns of presentation of disorders is crucial for planning of service scale up as well as serving as a useful training guide. Methods: This was a cross sectional descriptive study of 166 patients and their guardians presenting to the child and adolescent mental health clinics at a tertiary referral hospital in Nairobi, Kenya. Data was collected using a researcher designed socio-demographic questionnaire and the Kiddie-schedule for affective disorders and schizophrenia-present and lifetime (KSADS-PL 2009 Working Draft) and analysed using Statistical Package for Social Scientists. Results: There were more males (56%) than females in this study and the participant's mean age was 13.6 years. Substance abuse disorders were the most prevalent presentation (30.1%) followed by depressive disorders (13.9%), with most referrals to the clinic coming from medical practitioners and teachers. The mean time to accessing care at the clinic after the onset of symptoms was 16.6 months, with the longest time taken to specialist care being 183 months. Conclusions: The findings from this study will go a long way to support the establishment of programs that improve timely child and adolescent mental health service delivery. The involvement of various stakeholders such as the education sector and the community is key in the development of these programs. [ABSTRACT FROM AUTHOR]

Background: Psychosocial issues and interventions play a very important role in the aetiology, course and prognosis of several child psychiatric disorders. Psychosocial problems in a child and adolescent psychiatric clinic population in Nigeria were documented as a preliminary step towards the planning and development of this new facility.Methods: A standardised assessment procedure was integrated into the routine at the clinic when services commenced. Psychosocial stressors and life events were measured using the interview method so that in-depth information could be obtained.Results: Over the 3-year period of study, 79 (62.2%) of the 127 new referrals to the clinic had significant psychosocial stressors in the year preceding presentation. Problems with primary support, such as separation from parents to live with relatives, disruption of the family, abandonment by mother, psychiatric illness in a parent and sexual/physical abuse, occurred in 50 (39.4%) of the subjects. Problems with social environment occurred in 11 (8.7 %), 39 (30.7 %) had educational problems, 5 (3.9%) had economic problems and 15 (11.8%) of the children had "other" psychosocial stressors. Significantly more children and adolescents with disruptive behaviour disorders and disorders like enuresis, separation anxiety and suicidal behaviour had psychosocial stressors when compared to children with psychotic conditions, autistic disorder and epilepsy (chi(2) = 9.6; p = 0.048).Conclusions: The importance of the psychosocial diagnostic dimension in routine practice is illustrated in this study. Some psychosocial factors identified are cultural practices. The effects of these practices on child mental health require further study. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor suggesting that child mental health services in the developed countries establish partnerships with a similar group in developing countries.

BACKGROUND: Although effective treatment modalities for mental health problems currently exist in Nigeria, they remain irrelevant to the 70% of Nigeria's 120 million people who have no access to modern mental health care services. The nation's Health Ministry has adopted mental health as the 9th component of Primary Health Care (PHC) but ten years later, very little has been done to put this policy into practice. Mental Health is part of the training curriculum of PHC workers, but this appears to be money down the drain. AIMS OF THE STUDY: To review the weaknesses and problems with existing mode of mental health training for PHC workers with a view to developing a cost-effective model for integration. METHODS: A review and analysis of current training methods and their impact on the provision of mental health services in PHC in a rural and an urban local government area in Nigeria were done. An analysis of tested approaches for integrating mental health into PHC was carried out and a cost-effective model for the Nigerian situation based on these approaches and the local circumstances was derived. RESULTS: Virtually no mental health services are being provided at the PHC levels in the two local government areas studied. Current training is not effective and virtually none of what was learnt appears to be used by PHC workers in the field. Two models for integrating mental health into PHC emerged from the literature. Enhancement, which refers to the training of PHC personnel to carry out mental health care independently is not effective on its own and needs to be accompanied by supervision of PHC staff. Linkage, which occurs when mental health professionals leave their hospital bases to provide mental health care in PHC settings, requires a large number of skilled staff who are unavailable in Nigeria. In view of past experiences in Nigeria and other countries, a mixed enhancement-linkage model for mental health in PHC appears to be the most cost-effective approach for these Nigerian communities. DISCUSSION: Nigeria is currently experiencing a 'double epidemic', and with high infant and maternal mortality rates, the burden of mental health problems is still invisible to policy makers. Meagre resources allocated to mental health need to be utilised maximally with cost-effective interventions. This mixed enhancement-linkage model draws on the strengths of both models, while taking into account their limitations. Concrete conclusions cannot be drawn until the model developed is fully tested. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: This model has the potential of making mental health services available, accessible and acceptable in these communities. This should reduce the burden of suffering for the mentally ill by providing treatment and restorative care, promoting mental health and preventing mental illness in the populace. IMPLICATIONS FOR HEALTH POLICY FORMULATION: The current mental health policy for Nigeria focuses on enhancement as the mode in which mental health can be successfully integrated into PHC and so far this has not been successful. Results emerging from this model can be presented to policy makers thereby supporting replication in other parts of the country. This could ultimately lead to a change in the mental health policy on training for mental health at the PHC level. IMPLICATIONS FOR FURTHER RESEARCH: Mental health services and mental health economics research are still at the stage of infancy in Nigeria. This study provides baseline information and should stimulate further research in these two vital areas.