Clinical Profile of Early Onset Psychosis in a Nigerian Sample

Aims: This study assesses the clinical profile of children and adolescents with psychotic disorders presenting to a psychiatric facility in Lagos, Nigeria.

Study Design: The study design was a retrospective chart review.

Place and Duration of Study: The study was conducted at the largest child psychiatric facility in Nigeria, the Child and Adolescent center of the Federal Neuro-Psychiatric Hospital, Yaba, Lagos, from October to December 2011.

Methodology: Patients (n=168) with early onset psychotic disorder presenting to the facility within a two year period (September 2009 to August 2011) were reviewed. Using a pro-forma containing variables of interest derived from a literature review of the research subject, the case notes of all children and adolescents with psychotic disorder presenting to the facility were reviewed to determine their presentation, clinical characteristics and diagnostic subtypes. Diagnoses were according to the ICD-10 criteria.

Results: Males (56.5%) out-numbered females and the mean age of the sample was 15.3 (±3.6) years. The age at onset of psychotic disorder ranged from 6 to 18 years with a mean age of 14.2 (±2.6) years. Onset of psychosis was described as gradual/insidious by 47% and abrupt/acute by 53%. About one out of five (20.8%) had history of birth complications while 19% had delayed attainment of developmental milestones. Insomnia (49.4%), auditory hallucination (48.8%), irrational speech (40.5%) and aggressive behavior (33.3%) were the most prevalent symptoms. The most common axis I diagnoses was schizophrenia (36.9%), followed by organic psychosis (25%) and acute psychotic disorder (19.6%).

Conclusion: Our findings indicate the need for early intervention in psychosis and planning of services to meet the needs of young people with psychotic disorders in Nigeria. The relative preponderance of obstetric complication and organic psychosis highlights an unmet need for improved obstetric care with consequent reduction in psychosis