Psychiatry

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A Psychotropic Medication Prescription Pattern in Children and Adolescents at the Psychiatry Outpatient Clinics of Yekatit12 Hospital Medical College (HMC), Addis Ababa, Ethiopia. A Retrospective Chart Review
(Addis Ababa University, 2022-06) Tadele, Senait; Girma, Fikirte
Introduction - Mental disorders account for a growing proportion of the worldwide burden of diseases. The prevalence of mental disorders in Children and Adolescents ranges from 17% to 22% and contributes to 15% of children and adolescents. In Ethiopia, there are not that many studies on the prevalence of childhood and adolescent psychiatric disorders which range from 3.5% to 25.2%. The practice of prescription of psychotropic medications is different in different settings but there are no studies on the prescription pattern of children and adolescents in Ethiopia. This study tries to see the pattern of psychotropic medication prescription in one of the two governmental children and adolescent Yekatit, psychiatry clinics in Addis Ababa. Objective: -To assess the Psychotropic medication prescription pattern in children at psychiatry outpatient clinics of Yekatit12 Hospital Medical College, Addis Ababa Methods – A retrospective chart review, an outpatient department of Yekatit Hospital in children and adolescents <19 and seen from January – to December 2019. Result: -In the present study, antipsychotic drugs were the most prescribed psychotropic drug, followed by antidepressant drugs. There is also moderate use of mood stabilizers and antiepileptic drugs. Risperidone was the most frequently prescribed drug among second-generation antipsychotics. Fluoxetine was the most prescribed class of antidepressants. Conclusion and recommendation: -Improving medical record completeness services is an important war ford improving the quality of healthcare. It is also very important to follow state us and for monitoring adverse drug
Teratogenic Risk Awareness and Practice of Contraceptive use among Reproductive Age Women with Bipolar Disorder Attending Amanuel Specialized Mental Hospital, Facility based Cross Sectional Study
(Addis Ababa University, 2021-11) Hailiye, Tigist; Fekadu, Abebaw
Background Treatment of bipolar disorder in female patients pauses great difficulty because medications that are being used have risk of causing congenital malformations and neurodevelopmental problems in babies born to mothers who took the drugs during their pregnancy and also women with bipolar disorder have higher risk of untended pregnancies and birth related complications than the general population. So female patients who are in the reproductive age group should be aware of these risks and should be able to take necessary precautions which include pregnancy planning, effective contraceptive use and folate supplementation. Objective To assess awareness of teratogenic risk and practice of contraceptive use among reproductive age women with bipolar disorder Methods A hospital-based cross-sectional quantitative study was conducted at Amanuel Specialized mental Hospital. Samples of 384 consecutive outpatients with bipolar disorder diagnosis were enrolled. Data was collected using structured questionnaire which was administered by psychiatry nurses. Data was analyzed using the Statistical Package for the Social Sciences (SPSS), Version - 21. Results – 384 participants who had follow up at Amanuel specialized mental hospital outpatient clinic participated in the study. About 40% of participants reported that they have awareness about teratogenic risk of mood stabilizer treatment. 38.28% reported current use of contraceptive methods. Among the participants who were taking mood stabilizers 223(60.6) did not use contraceptive11111111111111111 Conclusions -In this study, the majority of women with bipolar disorder did not have awareness about teratogenic risk and majority of them reported that they were not using contraceptive methods. Psychoeducation about teratogenic risk and the need for contraceptive use for women with bipolar disorder attending psychiatric outpatient clinic should be strengthened. Key words: bipolar disorder, women, contraceptive, teratogen, Amanuel specialized mental hospital, Ethiopia
Prevalence of Depressive Symptoms among HearingImpaired Students of Addis Ababa University: A Cross- sectional Study
(Addis Ababa University, 2022-03) Damtew, Rekik; Dr. Getachew, Meron(Consultant psychiatrist ); Prof.Araya, Mesfin(Consultant psychiatrist )
Introduction: Being Deaf or Hard of Hearing (DHH) has been linked withincreased social isolation, negative self-concept, low perceived competence and stigma, higher prevalence of physical and sexual abuse among DHH youth andchildren.(Knutson, Johnson, and Sullivan 2004)(Mekonnen et al. 2016). This alcan predispose DHH individuals to depressive disorders. Furthermore, thcommunication barriers create a challenge in the evaluation and treatment omental health conditions of DHH individuals. Objective: The study aims to study the prevalence of depressive symptomamong hearing impaired students in AAU. Methods: An institution based cross-sectional study was done to assess thprevalence of depressive symptoms in all DHH students of Addis Abab University (AAU) from August 9- October 11, 2021 using the Patient HealthQuestionnaire-9 (PHQ-9). Data cleaning and analysis with descriptive statisticwere done using SPSS version 26. Results; 138 out of 142 students responded to the study. The prevalence odepressive symptoms was found to be 42%. The severity level of depression based on the PHQ-9 scoring was found to be 1.4%, 26.8%, 9.4% and 4.3% fominimal, mild, moderate and severe depressive symptoms Conclusion; The prevalence of depressive symptoms is higher than thresults of hearing students done at Addis Ababa, Debrebirhan, Haramaya and Jimma Universities. This study calls for having further studies to know more about the mental health service needs of DHH individuals.
Perspective of Teachers on Substance Abuse among High School Students at Tikur Anbessa Secondary School, Addis Ababa, Ethiopia: A Qualitative Study.
(Addis Ababa University, 2022-01) Eshetu, Wudasie; Dr.Alemayehu, Biruh(MD, Assistant Professor of Psychiatry ); Prof.Teferra, Solomon(MD, PhD, Addiction Psychiatrist )
Background Substance abuse is a patterned, harmful and hazardous use of psychoactive substance (drug) including alcohol and illicit drugs in which the user consumes the substance in amounts or with methods which are harmful to them or others. Globally, drugs and substance abuse continue to bechallenge, especially among the youth in school and out of school. It negatively impacts the academic, social, psychological and physical development among the abusers. Schools may will be able to influence drug use behavior and the primary role of the school is to teach skills, to impartknowledge and establish a sound value base in relation to health and drug use. Objectives The objective of this study is to explore the perspective of teachers on substance abuse among TikurAnbessa secondary school students. Method A qualitative research design was used. Target population of this study were teachers in Tikur Anbessa Secondary school. Participants were recruited using purposive sampling technique. Sampling continued until theoretical saturation was achieved and twelve in depth interviews weredone. The interviews were audio recorded, transcribed in Amharic and translated into English. Tdata were coded using Open code software 4.03. Thematic analysis was used to identify key theme Results This study showed teachers had good understanding about adolescent substance use. The study identified respondents had knowledge on the possible factors that led to substance use. All of the teachers mentioned the possible consequences of drug use on the student’s life. The teachers mentioned themselves as responsible on mitigation of drug besides other responsible bodies like families, other school community, neighbors, governmental and non-governmental bodies and religious institutions; they also said prevention of drug use is everyone’s responsibility, but still some teachers mentioned having knowledge gap on drugs. Recommendation Schools are the best places to teach students about the harms associated with substance misuse. If the Ethiopian Ministry of Education applies organized school-based prevention programs, it will prevent harm associated with using substance. It is recommended this school-based prevention program includes providing adequate training to teachers, integration into curriculum, involvement of parents and collaboration with other stakeholders. Regulating school environment and its surroundings is also recommended to limit access to substances. Punitive measures such as expulsion of students who are found using substances from school shoulbe done in a less psychologically traumatic way.
Prevalence and Associated Factors of Functional Neurologic Symptom Disorder among Patients Attending Psychiatric Outpatient Clinic at TASH from Hamle 1/2011 – Hamle 30/2013 E.C: a Retrospective Electro Medical Record Review
(Addis Ababa University, 2022-01) Mengiste, Selamawit; Tsigebrhan, Ruth(M.D., Consultant Psychiatrist); Belay, Getahun (M.D., Consultant psychiatrist)
Background: Functional neurologic symptom disorder is one of the somatic symptom disorders characterized by different subtypes of presentations. Its prevalence and associated factors vary in between the developed and developing countries including the subtypes too. Study objective: To determine the prevalence and associated factors of functional neurologic symptom disorder in patients attending psychiatric clinic at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Method: A retrospective electronic medical record review was done. The study participants were selected from the registry of the outpatient psychiatric clinic in the duration of Hamle 1/2011 – Hamle 30/2013 E.C. Data was collected by means of data extraction sheet. The Collected data was entered and analysed using SPSS version 20. A descriptive analysis was conducted. Univariable then multiple logistic regression was done to determine the factors associated with FNSD. Results: In this study, there were a total of 2089 patients seen from the time of from Hamle 1/2011 – Hamle 30/2013 E.C. From the total seen patients 105 were diagnosed with conversion disorder making its prevalence 5.02% and incidence 2.20%. Most patients (63.8%) were below the age of 20, with mean age of presentation of 20 years and SD of 10 years. The mean duration of presentation was less than three months (45.7%). The commonest subtype of functional neurological symptom disorder was found to be attack or seizure (68.6%). The commonest psychiatric comorbidities were found to be mood spectrum disorders. Significant association was seen between age younger 20 years, female gender and urban area of residency and diagnosis of FNSD. Conclusion: The sociodemographic characteristics results from our study are comparable to other studies form a similar setup, and so are the clinical characteristics.
Factors Associated with Successful 'Insanity ' Defense and Characteristics of Defendants Pleading ‘insanity’ in Ethiopia: Facility-based Retrospective Report Review.
(Addis Ababa University, 2022-02) Rediet Dribsa; Dr.Limenhe, Asnake(MD, Forensic Psychiatrist ); Dr.Haile, Tsegereda(MD, Assistant Professor of Psychiatry)
Introduction: Forensic psychiatry operates at the interface of two disparate disciplines: Law and psychiatry. Forensic psychiatry is a subspecialty of psychiatry in which scientiﬁc and clinical expertise are applied to legal issues legal contexts Amanuel Mental Specialized Hospital is one of the largest and oldest psychiatric hospital in Ethiopia; it is also the only hospital that gives inpatient forensic psychiatry service at this time. To our knowledge, the clinical & criminal justice characteristics of the 'insane' have never been a subject of study in Ethiopia. We are very hopeful that this study will be beneficial for the improvement of the forensic service training of mental health professionals and ultimately benefit those affected by the limitations of information and scarcity of research to pinpoint issues we can work on to better the care provided to forensic psychiatry patients. Objective: To describe cases and explain the reason for their acquittal due to being "criminally irresponsible" in the forensic inpatient service at Amanuel Mental Specialized Hospital in a span of 6.5 years (between 01/01/2015 and 08/01/ 2021 GC). Methods: A retrospective facility-based study was conducted in Amanuel mental specialized hospital for a study period of 6.5 years from January 2015-August 2021. Forensic reports were used as a source of data, a data extraction sheet was used to collect data, and SPSS version 24 was used to analyze the data. Descriptive statistics are displayed in text, tables, and figures. Variables that showed association with the outcome variable using binary logistic regression were subjected to multivariate logistic regression. Statistical significance was declared at p-value < 0.05. Result: A total of 205 forensic reports of defendants were identified in the study period. Of this, 15 (7.3 %) cases did not have a conclusive forensic opinion regarding criminal responsibility; these cases were excluded from the analysis. The mean age of the defendants was 33.13 years with a standard deviation of 10.6 years. This study also showed that the magnitude of insane defendants among patients who had forensic mental health assessment at Amanuel mental health specialized hospital was found to be 39.5 %. The study revealed from the cases who have neuropsychiatric diagnoses 62.2 % were found to be "criminally irresponsible." Conclusion & recommendation: The number of insane defendants among patients who had forensic mental health assessment at Amanuel mental health specialized hospital was relatively high. Factors that had an association with insane defendants include psychiatric diagnosis of schizophrenia spectrum disorder, bipolar І disorder, and disordered psychiatric condition during the time of assessment. Creating awareness about severe mental illness and early detection and initiation of treatment may contribute to the prevention of the offenses as a society and improve the quality of life for the clients.
Prevalence and Psychological Impact of Sexual Harassment against Female Medical Students and Residents at Addis Ababa University, College of Health Sciences
(Addis Ababa University, 2021-11) Seifu, Nardos; Dr. Hanlon, Charlotte (Psychiatrist); Dr. Asaminew, Azeb (Psychiatrist)
Background: Gender based violence and sexual harassment remains a substantial issue facing women and girls around the world. Professional women are not exempted, including women who join medical school. Study objective: The objective of this study was to investigate the prevalence and types of gender-based violence (GBV) and sexual harassment and associated psychological distress in female medical students and residents at Addis Ababa University, College of Health Sciences (AAU CHS). Method: The study design was a cross-sectional survey. Study participants include female clinical year medical students and residents at AAU CHS. The sampling technique that was employed was total population sampling with initial target sample size of 340, subsequently changed to 436 after inclusion of first year residents and new clinical year-1 students. The Sexual Experience Questionnaire was used to measure gender-based violence and sexual harassment. Depressive symptoms were measured using the Patient Health Questionnaire 9-item version (PHQ-9). Traumatic stress symptoms were measured using the PC-PTSD scale and anxiety symptoms were measured using the GAD-2. Open-ended questions were used to ask about reporting the incidents, any help obtained, unmet needs and preferences for sources of help. The questionnaires were administered as an anonymous self-administered questionnaire. Data were analyzed using descriptive frequencies and negative binomial regression to look at the association between GBV/sexual harassment and depressive symptoms, traumatic stress and anxiety symptoms. Results: Even though the questionnaire included sensitive questions, the response rate appeared to be representative of the population. A total of 368 women participated; 65.7% were clinical students and 32.5% were residents. Over one quarter (26.2%) self-identified as having been sexually harassed at the university. Based on systematic screening with the SEQ, the prevalence of sexual harassment among female medical students and residents was substantially higher (81.8%); with 77.2% experiencing gender harassment, 70.6% experiencing unwanted sexual attention and 36.6% experiencing sexual coercion. Of those who were sexually harassed, only 3.2% reported the incident. After reporting, 99.3% did not receive any support frommedical school and 97.9% did not receive any help from other institutions. From the women who had received help, 100% of them reported that it was inadequate. 11.1% of the respondents indicated to have moderate depression while 4.1 % of the participants indicated moderately severe and severe depression (each). 38 respondents (10.3%) responded ‘’yes’’ for 4 out of the 5 questions on the PC-PTSD screening tool indicating possible PTSD. 14.1% of the respondents scored 3 points (the cutoff point) on the GAD-2 indicating a possible anxiety disorder. Total sexual harassment score and subscales were strongly associated with depression, traumatic stress and anxiety scores. The top three recommendations the women forwarded were to take appropriate actions against the perpetrators, to empower women and increase awareness about the problem. Conclusions: The study signifies the presence of high prevalence of sexual harassment within the institution. Despite the high figure, there seems to be low perception of sexual harassment, under reporting and inadequate response. One apparent impact is on women’s mental health. Participating women identified key actions that need to be taken so that harassment can be reduced and women who experience harassment can be better supported.
Exploring the Care-receiving Experiences of People with Severe Mental Illness, Amanuel Mental Specialized Hospital, Addis Ababa,Ethiopia:A Qualitative Study.
(Addis Ababa University, 2022-01) Legesse, Gizachew; Abera, Selam(MD, Assistant professor of Psychiatry); Girma, Engida(MD, Assistant professor of Psychiatry); Worku, Beniam (MD, Assistant professor of Psychiatry)
Background: - An understanding of the experience of individuals living with severe mental illness cared by mental health professionals and caregivers promote better understanding of the patient. This may in turn promote enhancement of the therapeutic relationship, engagement of people living with severe mental illness in their care and finally improvement of clinical outcomes. Objective: - To explore the care-receiving experience of people with severe mental illness receiving care at Ammanuel Mental Specialized Hospital. Method: - a qualitative study design was used. Nine in-depth interviews were conducted using semi-structured questions. The in-depth interviews were audio recorded, transcribed and translated into English. Data was coded by using open code 4.03 software package and thematic analysis was used to identify key themes. Results: - There appear five overarching themes with underlying subthemes: firstly, the meaning to illness and care received. Most participants mentioned that it is very difficult to accept mental illness and they tend to accept it gradually and mentioned the care received was lifesaving and mean a lot for their survival. Secondly, Positive experiences of care received, most had positive experiences regarding the care they received. They mentioned variety of positive expectations and hopes about what the care they received would lead to in terms of improvement in their current and future situations. Thirdly, negative experiences of care received, their negative care receiving experiences emanated from different problems they encountered and stigma they faced while receiving care. Fourthly, relationships with care provider in which most experienced good relationships while few experienced bad relationships and finally coping mechanisms. Conclusion: - The study revealed the positive and negative experiences of people with severe mental illness regarding the care received. It is paramount importance to continue positive aspect of the care provided and to devise ways to tackle negative aspect of care voiced by care receivers to improve care provisions that enhance patients’ recovery.
Common Symptoms of Depression among Patients with Depressive Disorders Receiving Outpatient Care in Tertiary Hospitals in A.A., Ethiopia:A Cross Sectional Study
(Addis Ababa University, 2022-01) Solomon, Eyerusalem; Milkias, Barkot(Assistant professor of Psychiatry); Yared, Mahlet (Assistant professor of Psychiatry); Medhin, Girmay(Associate Professor of Epidemiology and Biostatistics)
Background The major assessment tool that is of use in Ethiopia to diagnose and treat depressive disorders is DSM 5. However, DSM -5 might not represent the diverse symptomatology of depression in a country with diverse ethnic and cultural background. Having a clear knowledge of the type of common presentations or complaints of patients with depression coming to outpatient services in tertiary hospitals has significant implication for clinicians to provide appropriate patient care. Objective To identify the common presenting symptoms of depressive disorders among patients who came to receive outpatient care for depressive disorders in tertiary hospitals in Addis Ababa. Another objective is to identify common symptoms along the domains and to investigate its association with sociodemographic factors of the study participants. Method A cross sectional facility-based study design was used. The study participants included patients who visited outpatient psychiatric services in 3 tertiary hospitals in Addis Ababa in the past 2 years, by mainly focusing on patients who are currently visiting the OPDs and going back up to 2 years until the sample size was reached. Potentially eligible patients were selected by filtering those who have been diagnosed with depressive disorders. Then, using the inclusion and exclusion criteria samples were identified until the sample size which was needed reached starting from the most recently recorded patient (consecutive sampling). Consecutive patients were recruited starting from those currently on follow up to until about those who were seen in the past 2 years at least once. Study participants were interviewed through Face to Face interview. Descriptive statistical methods were used to summarize the collected data and to help us understand the collected information. The most distressing symptom domains were analyzed. Cross tabulation was done to see association between sociodemographic and symptom domains. Results- Feeling down, depressed or hopeless were the most frequently endorsed symptoms occurring in >90% of the patients. All items were rated with fainting spells being the lowest rated occurring in only 10.9% of the patients. At least one symptom was seen in 98.8% of them from somatic domain, 96.4% from affective, 93.3% from other and 78.2% from cognitive domains. From the patients who reported most distressing symptoms, around 58(35.2%) of them mentioned symptoms from the affective domain as their most distressing symptom, 46(27.8%) mentioned symptoms from somatic domain, 21(12.7%) mentioned two or more symptom combinations from different domains, 12(7.2%) from cognitive and 1(0.6%) from other domain. Conclusion- Above 90 % of the study participants reported to have symptoms from the 3 domains of depression which are affective, somatic, and other. Around 78% of the patients also reported to have one or more symptoms from cognitive domain of depression. When expressing symptoms which are most distressing to them, significant proportion of the patients reported symptoms which are combinations from all the 4 domains of depression. Symptoms which are not included in DSM criteria and screening tools being used in clinical setup are shown to be reported in high frequency and also as most distressing in this study.
Subjective Experiences of Clients who have Attended Psychotherapy at Tikur Anebessa Specialized Hospital and Zewditu Memorial Hospital, Ethiopia 2021: A Qualitative Study
(Addis Ababa University, 2021-11) Tumiso, Eshetu; Dr.Mengesha, Filmon; Dr.Birhanu, Ribka
Background Psychotherapy, traditionally known as talk therapy is one of the main management modalities used in mental health. It is used to help clients with claimed psychosocial problems to overcome their symptoms and to improve their well being and mental health by applying psychosocial methods. Clients are the reasons why all the psychotherapies are made for and understanding their subjective experiences of the psychotherapies helps us the understanding them, to make psychotherapy meaningful and to design contextual modalities of intervention compatible to a given psychosocial context. This study focuses on assessing the subjective experiences of clients who have attended psychotherapy at TASH and ZMH. Objective To explore and understand the subjective experiences of clients who have attended psychotherapy at TASH and ZMH, so that we would learn from how psychotherapy appears for the clients from their perspective. Method Qualitative study was conducted on clients who have attended psychotherapy at TASH and ZMH by using in-depth semi-structured interview questions that was prepared after referring different articles on the topic. Participants were recruited using non-probabilistic heterogeneous purposive sampling technique from the hospitals referred above. Participants were those who have attended psychotherapy at least for four sessions, consented to take part, speak Amharic language fluently and on stable mental condition. Sampling proceeded until theoretical saturation was achieved. Eight in-depth interviews were conducted and all were included in the results. The in-depth interviews were audio recorded, transcribed and translated into English. Thematic analysis was used to identify key themes. Findings The subjective experiences of clients who have attended psychotherapy were summarized in to four major themes with subordinate subthemes. Firstly, how clients perceived psychotherapy and all of them have defined it as a means of discharging out impacted emotions. They have also differentiated talk therapy from other routine advices based on their experiences and they have had different types of goals set by collaborating with the clinicians. The second theme was their positive experiences and except one all of the participants had helpful experiences which were categorized under how it has impacted their self concept, their social life and their understanding of factors that had contributed to their illnesses. Clients have also described mechanisms at which how psychotherapy has healed them. In the healing process is attributed to clinicians’ factors such as empathic listening and clients’ factors such as willingness to be healed and their belief on the therapy. The third theme was the negative experiences of clients. They have experienced it due to different factors like the therapist, the society and the therapy itself. How they had experienced relationships were the fourth theme identified. Conclusion Clients have experienced psychotherapy as beneficial in most cases and harmful in some cases. What mattered most for the clients were; an empathic listening, unconditional acceptance and their connection with the therapist who is emotional sensitive and focusing on them as a person not on their problems as priority. Therapists’ being not persistent and sensitive had a counterproductive effect on the therapeutic alliance and contributed to the worsening of symptoms. Clients were not comfortable with frequent turnover of clients, being evaluated in front multiple people and long waiting time they spent. Most of the concepts mentioned as healing mechanisms and negative impacts were mainly described in the contexts of identity of clients, interpersonal relationships and social life.
Clinical Care of Patients with Anxiety Disorders Receiving Care at Psychiatric Outpatient Clinic at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Retrospective Chart Review
(Addis Ababa University, 2022-02) Asrat, Emmanuael; Baheretebeb, Yonas(MD, Associate Professor and Consultant Child Psychiatrist); Milkias, Barkot(MD, Assistant Professor and Consultant Psychiatrist)
Introduction: Anxiety Disorders are a group of disorders that have a core symptom of excessive fear and anxiety and associated behavioral symptoms. It is a condition that can be experienced by anyone but it needs intervention when symptoms become excessively distressing or disabling, or reduce quality of life. Background: Anxiety Disorders constitute the leading prevalent mental disorders in the world. Globally, there are around 45.82 million incidences of anxiety disorders and 301.39 million prevalence rate of Anxiety Disorders. The DALYs as estimated by the GBD in 2019 was estimated to be around 28 million years. In Ethiopia, it is estimated that the lifetime prevalence of anxiety disorders is around 7.5 % in a study done in Addis Ababa. National Institute for Clinical Excellence (NICE) guidelines recommend the use of psychological interventions in anxiety spectrum disorders. The most evidence is for Cognitive Behavioral Therapy (CBT) which has the highest empirical evidence whereas the most evidence for pharmacotherapy is the use of Antidepressant medications. The treatment gap for mental illness throughout the world is universally large. Despite the enormous burden Anxiety disorders pose to our health care system there hasn’t been much evaluation done regarding the quality of care mental health services. Objective: the objective of the study was to evaluate the types of care patients with anxiety received including the psychological and pharmacological treatment provided to them. This study also aims to determine the level of patient engagement to treatment and to determine the associated factors. Method: A Retrospective chart (EMR) review was done to explore the socio-demographic characteristics, Clinical Evaluation, Treatment modalities offered and Treatment Engagement of patients with Anxiety disorders in psychiatric outpatient department of Tikur Anbessa specialized hospital patients that visited the OPD from Hamle 1, 2010 E.C to Hamle 30, 2013 EC. Once the data was obtained it was exported to Excel spreadsheet and it was cleaned and checked for errors and missing variables, and then it was exported to SPSS version 26 and descriptive analysis was done. Result: This study found the commonest diagnosis to be GAD (58.5%) and the second commonest diagnosis was Panic Disorder (32.7%). The study found that there is a high psychiatric comorbidity of anxiety disorders with MDD and other anxiety disorders accounting for 33.3% and 28.3% respectively. Out of the other anxiety disorders, a higher co-occurrence between panic disorders and generalized anxiety disorders was seen. From the 98 cases that were in the study 32 (32.6%) were offered only medications while 18 (18.4%) of patients were offered only psychotherapy. Both of these modalities were offered in combination in 25 (25.5%) of the cases. Neither medication nor psychotherapy was offered for 23(23.5%) of the cases in the study. Psychoeducation, psychotherapy referral and prescription of medication were found to increase the likelihood of treatment engagement in the study.
Psychological Distress and Coping Mechanisms of Adolcents Living with HIV in Black lion Hospital ART Clinic, Phenomenological Study.
(Addis Ababa University, 2022-02) H/Michael, Bezawit; Hailu, Henok; Ahmed, Ikram
Introduction HIV targets immune system and weakens people’s defence against many infections. Adolescent age looked as a transitional period between childhood and adulthood and pass through deferent periods during this time of transition. Thus, as they are passing through this phase of development they faced different challenges as a result of being diagnosed as having HIV. Method The phenomenological design from qualitative approach was used in order to get the information. Ten respondents participated in the current study. Data was collected by using semi structured interview and analyzed by applying thematic analysis. Result Ten participants involved in the study. Five of them were male and the rest of the participants were female. Respondents age range from 15-18 years. The result showed that most prominently, fear of stigma leads majority of respondents to keep quiet about their health condition and this in return help them to mitigate the psychological distressed. Other than this, the finding also involved on showing different associated factors, social support and ways of coping related to their health. Conclusion People have fear of disclosure about their HIV status as a result of fear of stigma. Furthermore, limited social awareness and ongoing drug adherence routine are also associated factors that add to the psychological distress.
Pathway of Patient to Amanuel Specialized Mental Health Hospital: A Facility based Cross Sectional Study
(Addis Ababa University, 2021-11) Abdela, Tofik; Alem, Atalay(MD, PHD, Professor of Psychiatry, AAU, CHS, SOM, Department of Psychiatry)
Introduction:-Pathway to care is a process in which a patient with mental illness goes through before seeking help from mental health professional. According to the Goldberg-Huxley model of the pathway psychiatric care in order to get visit to psychiatrists it should have to pass three filters starting from community setting. Back ground:- The Pathway the patient influenced by many one of them is distribution of psychiatric care facility. In developed country the first focal point in pathway is General practitioner which looks identical to the Goldberg and Huxley model. In low- and middle-income countries (LMICs) most of the patients with mental illness seek treatment from the traditional and religious modality of treatment. A meta-analysis of pathway studies in sub-Saharan Africa indicates approximately equal initial choice of biomedical (49.2%) and alternative (48.1%) mental healthcare pathways. A study done on 2003 at ASMH also showed that less than half of mental illness patients directly contacted a mental hospital, and the median delay between onset of illness and arrival at the psychiatric hospital was 38 weeks. Other two studies done in Northern and South west Ethiopia showed than the median delay was 52 weeks. Objective:- The objective of the study was to measure time of delay to reach Amanuel hospital from the onset of symptom to getting care. The effect of sociodemographic factors on the pathway to way care. It also tried to assess the associated factors which affect the delay to seeking modern psychiatric care. Generally it used to see the change that occurred in the past 18 years after implementation of different intervention on development of psychiatric care. Method:- Directly data was collected from patient or attendant of patient who visited Amanuel Emergency and outpatient OPD for the first time from16th, 2021 –July 31st2021 with WHO encounter form. Once the data was collected it was exported to Excel spreadsheet and cleaned and checked for error and missing variable and, then it was exported to SPSS version 26 and descriptive analysis was done. Result:-The study found the median delay to get psychiatric care at AMSH was 20 week where as in any modern institution who gave psychiatric service was 14 weeks. The study also found that young or old Age, being married or divorced , elementary or secondary school level of education, first point of care to traditional healer or religious treatment were predictors of delay to get psychiatric care.
Developing Service User and Caregiver Involvement in Mental Health System Strengthening in Ethiopia
(Addis Abeba University, 2021-05) Abayneh, Sisay(Phd); Dr.Hanlon, Charlotte; Dr.Lempp, Heidi
Background: Service user and caregiver involvement has become an expectation in all aspects of the mental health system, including in policy, planning, service delivery, quality improvement, research and education around the world. Service user involvement is particularly promoted as a strategy to scale-up quality mental healthcare service in low-and-middle-income countries (LMICs). However, little is known about actual involvement experiences and how best to involve service users and caregiversin mental health systems. No study of involvement has been conducted in Ethiopia. Hence, this study aimed to achieve the following objectives. General objective: To develop, pilot and evaluate a model of service user/caregiver involvement in mental health system strengthening in Ethiopia The specific objectives of the study were to:  explore the experiences, perceived barriers and facilitators regarding service user and caregiver involvement in mental health system strengthening.  develop an acceptable, sustainable and feasible Theory of Change model of service user and caregiver involvement in the expanding mental health system.  equip service users and health professionals for greater involvement in mental health system strengthening.  pilot the feasibility and acceptability of a co-developed model of service user and caregiver involvement in mental health system strengthening. Methods: A predominantly qualitative approach was used, which was conducted in three phases. The study was situated within participatory approaches informed by a critical social theoretical perspectives and social-ecological system theory. The thesis consists of 5 articles, which have been published or are about to be submitted for publication. Phase 1 provides the context for the thesis, which was a formative qualitative study conducted to explore the experiences of involvement, barriers to, facilitators and capacity building needs for greater involvement from the perspective of key stakeholders (Paper 1). In the study, 39 semistructured interviews were carried out with purposively selected service users (n=13), caregivers (n=10), heads of primary care facilities (n=8) and policy makers/planners/service developers (n=8). Thematic analysis was applied. In Phase 2, a Theory of Change(ToC) model was developed in iterative participatory workshops conducted in (i) Addis Ababa with purposively selected psychiatrists (n=4) and multidisciplinary researchers (n=3), and (ii) a rural district in south-central Ethiopia (Sodo) with community stakeholders (n=24). Information from the workshops (provisional ToC maps, minutes, audio recordings), and inputs from Paper1 were triangulated to develop the detailed ToC map. This ToC map was further refined with written feedback and further consultative meetings with the research team (n=6) and community stakeholders (n=35) (Paper 2). Based on findings from paper 1 and 2, an empowerment training programme was developed, delivered and evaluated for acceptability, feasibility and preliminary impacts using a mixed-methods design in Paper 3 (Chapter 7). The training was delivered separately for service users (n=12) and caregivers (n=12), and health professionals (n=18). The quantitative data consisted of process data, satisfaction questionnaires, and a retrospective pre-test survey. Qualitative data included exit and follow-up in-depth interviews with service users and caregivers. Descriptive statistics were performed for quantitative data, and qualitative data were analysed using a thematic analysis approach. The findings were integrated through triangulation for convergent themes following analysis. Phase 3 involved Participatory Action Research (PAR) implementation strategy development, piloting the ToC model and a case study of the piloting process and participants‘ experiences of involvement. Accordingly, a PAR protocol was developed to guide the ToC model implementation process (Paper 4) and the ToC model was piloted using PAR in three stages, each with iterative activities of plan, act, observe and reflect. Two stakeholder groups, a Research Advisory Group (RAG) and Research Participant Group (RPG), were established and collaborated in all stages of the PAR process. Data collection involved process documentation of meetings and activities: attendances, workshop minutes, discussion outputs, and reflective notes, participatory observation of sessions, and in-depth interviews with service users (n=6), caregivers (n=4) and health professionals (n=2) involved throughout the PAR process. Descriptive analysis was used for process data, and thematic analysis was used for qualitative data. Triangulation and synthesis of findings was carried out to develop the case study (Paper 5Chapter 8). Results: The formative qualitative study showed that the concept of service user involvement is new within the Ethiopian mental health system and that service user participants had little direct involvement in mental health systems strengthening. Several potential benefits were identified, included were improved appropriateness and quality of services, and greater protection against mistreatment and promotion of respect for service users. This study identified key multilevel barriers and facilitators to effective involvement, and many areas of capacity building needs for greater involvement. Stigma was considered to be a pervasive barrier, operating within the health system, the local community and individuals. Low recognition of the potential contribution of service users seemed linked to limited empowerment and mobilization of service users. There was a strong need for awareness-raising and training to equip service users, caregivers, service providers and local community for involvement. The participatory ToC model co-produced described the causal pathways for greater service user involvement with key components (community, health organisation, service user and caregiver), interventions, preconditions, assumptions and indicators for each component along the pathway to the long-term outcomes and impact. The participatory nature of ToC process raised awareness of the possibilities for servicer user and caregiver involvement, promoted co-working and stimulated immediate commitments to mobilise support for a grass roots service user organization. The empowerment training content, delivery process and standard of the training program met participants‘ expectations, improved positive gains in understanding about metal illness, stigma, service-user involvement, and human rights. The training had positive impacts, including increased self-confidence, sense of empowerment, social benefits, and perceived therapeutic benefits. Through active collaboration and involvement the stakeholder groups identified their top research priorities considered as significant problems in their specific settings (particularly the need for public awareness-raising and addressing stigma and discrimination) and developed intervention programmes, action plans and initiated actions that could resolve some of these problems. Key mechanisms used for inclusive participation included capacity building and bringing together diverse stakeholders, anchoring the study in established strong community involvement structures, and making use of participatory strategies and activities during the PAR process. The case study about participants‘ experiences of involvement in PAR identified and explained about: (i) expectations and motivation, (ii) experiences of the dynamics of the PAR process, (iii) perceived impacts of involvement in the PAR process, and (iv) implementation challenges and future directions. Conclusions: Service user and caregiver involvement in mental health system strengthening is a complex process, which is affected by multilevel factors that demands interventions that recognize this complexity.This thesis shows that effective involvement could be achieved by empowering key stakeholders for greater involvement. PAR can be a feasible and acceptable approach for empowerment and collaborative engagement of a range of stakeholders in mental health system strengthening. Combining ToC with a PAR approach can provide a more inclusive active involvement model of stakeholders including service users and caregivers. Embedding effective service user and caregiver involvement can be hindered with lack of strategic enabling regulatory infrastructure within the mental health system. Implications: The findings of this thesis can be of practical relevance to researchers and those working in health care settings to develop service user and caregiver involvement in mental health system strengthening. It contributes theoretical understanding for future research and provides practical knowledge for application of participatory action oriented approaches about how to develop participatory models and actively involve key stakeholders in the contexts of low resource setting.
The Lived Experience of Pregnancy-related Anxiety among Women with a History of Pregnancy Loss in the Case of Zewditu and Gandhi Memorial Hospitals, Addis Ababa.
(Addis Abeba University, 2021-08) Zewdie, Seyoum; Getaneh, Fiker; Tebebu, Getahun
Background: During pregnancy, a woman's body undergoes significant physiological change and it is a very vulnerable time in a woman's life which may be understood as a part of a woman's transition to motherhood as being with child', a paradox of joy and suffering due to the coming of a newborn child and unexpected fetal loss and related complications. Thus, during a period of transition interpersonal and emotional support as well as time for personal reflection are needed. Objective: To gain a better understanding of lived experiences of pregnancy-related anxiety among women having a history of pregnancy loss. Methods: A descriptive phenomenological technique was utilized to describe the experiences of women about pregnancy-related anxiety with pregnant mothers having a history of pregnancy loss. Participants were recruited from Zewditu and Gandhi Memorial Hospitals in Addis Ababa, the capital of Ethiopia. The purposive sampling (criterion) technique was employed to choose participants from the chosen venues. Face-to-face indepth interviews and participant observation were used to obtain data. After making sense of all of the data by reading it repeatedly, the data was broken down into intelligible units or themes. Following the progression of themes of the study, the complete data set was reorganized, and a detailed account of the lived experiences was documented. Result: Eight pregnant women, each in a different background, took part in the study. The study's main focus was on the pregnancy-related anxiety that women with a history of pregnancy loss experienced during the current pregnancy period. The circumstances of fetal loss are beyond an individual's control, as well as the obstacles and challenges faced by women who have experienced it, as well as the incidence changing the individual lives and families as a whole. In general, the researcher was found four themes 'that are emerged in the data. Conclusion& Recommendation: According to the study, Pregnancy-related anxiety was confirmed to be an emotional experience for women with a history of fetal loss, resulting in unpleasant recollections of pregnancy-related experiences for which they were not ready, or expect such incidence to happen to their life. As a result, women who have emotional difficulties or experiences throughout the data collection period were given psychological assistance, and psychoeducation is provided on times and locations of treatment that are accessible to them.
Outcomes of Clozapine Treatment in Ethiopia: A Retrospective Study
(Addis Abeba University, 2020-10) Kebede, Mekitew; Dr.Getachew, Meron(M.D., Psychiatrist,AAU); Dr.Girma, Engida(MD, Psychiatrist, AAU)
Background:- Clozapine is a second-generation antipsychotic drug which was introduced in 1961. It has wide clinical utility particularly for patients with treatment-resistant schizophrenia. Prescription of clozapine shows a considerable variation across countries. There is a general delay in its initiation partly because of its adverse effects, unavailability of clozapine and psychiatrist attitudes towards the medication. Many studies have investigated clinical characteristics, adverse effect profile and treatment outcomes over time internationally. However, to the best of our knowledge, there is only one institution based study in Ethiopian. Objective: To assess the outcomes of clozapine treatment in five health facilities in Ethiopia. Method: A retrospective chart review was conducted from May to October, 2020 on patients who have been treated with clozapine between 2017 to 2020. Data extraction sheet was used to extract secondary data to assess indications, adverse effects and treatment outcomes of patients treated with clozapine . SPSS version 25 was used for data entry and analysis. Results: A total of 84 patients treated with clozapine were recruited and the main indications were treatment resistant schizophrenia(TRS) n=60 (71%), treatment resistant schizophrenia with tardive dyskinesia (TD) n=13(15.5%) and tardive dyskinesia n=10(11.9%). Seventy two (85.7%) patients had improvement of admission complaints upon discharge. The main improved symptoms were positive psychotic symptoms n=67(79.8%), negative symptoms n=52(61.9%), aggression n=33(39.3%), suicidal behavior n= 11(13.1%), depressive symptoms n=20(23.8%) and improvement of cognitive function n= 22(26. 2%). In case of TD patients, a mean AIMS score of 17.3 at admission reduced to 5.5 upon discharge. The most common side effects were sedation n=46(54.8%),sialorrhea n=31(36.9),constipation n=24(28.6%),weight gain n=18(21.4%) and transient hematological abnormalities n=14(16.7%). Serious side effect found were seizure n= 4(4.8%), persistent tachycardia n= 2(2.3%) and myocarditis n= 1(1.2%) Conclusion and Recommendation: Clozapine was indicated for treatment of TRS and TD, which resulted in improvement of admission complaints. Most of the side effects were tolerable and manageable. The main identified reason for discontinuation of the medication was unavailability. Having seen the indications, tolerable adverse effects and better treatment outcomes of clozapine, we recommend that patients with TRS and TD to be enrolled in clozapine treatment as soon as treatment-resistance is confirmed.
The Psychological Experience of Covid-19 tested Positive People in Eka Kotebe Hospital, Addis Ababa, Ethiopia: Coping and Resilience: A qualitative study.
(Addis Abeba University, 2020-10) Alemu, Dagim; Teferra, Solomon( MD, PhD, Associate Professor of Psychiatry); Alemayehu, Biruh( MD, Assistant Professor of Psychiatry)
Introduction: It has been seven and half months since the first Novel Corona Virus case was reported in Ethiopia. The number of infected people has been rapidly expanding globally and nationally. In Ethiopia, as of October 26, 2020, it has reached to 93,343 infected and 1,426 deaths. There are few studies that have explored the lived experiences of previous epidemic outbreaks of emerging infectious diseases including Ebola, Severe acute respiratory syndrome (SARS), Influenza A (H1N1) and Middle East respiratory syndrome (MERS). Except one Study from China, there is a dearth of research on the psychological experience of COVID-19 hospitalized patients and there is no such study conducted in Ethiopia. Objective To explore and describe the psychological experience and the coping and resilience of COVID-19 hospitalized patients in Eka Kotebe hospital Addis Ababa, Ethiopia. Method A phenomenological qualitative study design was used. Participants were recruited using non- probabilistic heterogeneous purposive sampling technique from the hospital referred above. Participants were those who are confirmed cases of COVID-19 infection, consented to take part, speak Amharic language fluently and on stable medical condition. Sampling proceeded until theoretical saturation was achieved. Eleven in-depth telephone interviews were conducted and seven were included in the results. The in-depth interviews were audio recorded, transcribed and translated into English. Thematic analysis was used to identify key themes. Results There major themes were identified describing the initial emotional reaction, daily life in hospital and stressors as well as resilience and ways of coping. Initial response towards the disease included fright, denial and anger during the early stages, which dissolved into acceptance in the later stages and mix of positive and negative emotions towards the end of hospitalization. The primary sources of stress were the inadequacy of information about the disease, health and economical stability of family, concern about long term sequela of the disease and stigma. Despite these, all the study subjects displayed strong resilience and coping mechanisms whereby they engaged themselves in some form of coping mechanisms which included taking advantage of the social support by engaging themselves in group and pair conversations and practicing spiritual rituals together. Different contributing factors were considered for their resilience which encompasses the role of having a cognitive capability to understanding the disease, lessons learned from wisdom of their role models in life or adverse experiences during early life and most importantly having a faith. Finally, most participants expressed the moral lessons gained from their experience with COVID- 19 and reflected on their positive outlooks. Conclusion The COVID-19 pandemic has caused emotional distress among the patients. The findings in this study also have some unique elements of the perceived stressors and coping strategies. The main features centered upon the stigma and discrimination, safety of family, economic stability, role of culture, religious believe and ritual practices. These results promote understanding of the language and behavior of patients, enhance communication, inspire to denote interventions targets and pave the way for future researches studying the long-term psychological experience from COVID-19.
A Qualitative Study on Clinicians’ Perspectives on the Mental Health Needs of People with Cancer inTikurAnbessa Specialized Referral Hospital, Oncology Follow-Up Clinic, In Addis Ababa, Ethiopia
(Addis Abeba University, 2018-11) Mekasha, Bethelhem; Hanlon, Charlotte(BM, BS, MRCPsych, Msc, Phd); Worku, Benyam (MD, Assistant professor of Psychiatry); Abrha, Aynalem (MD, Internist, Oncologist, Palliative care advisor); Ayers, Nicola(RN, BSc, MSc, PhD, Palliative care advisor)
Background: Significant numbers of people with cancer develop mental health problems at different stages of the disease.Psychological/psychiatric treatment is part of palliative care that is given to people with cancer to make them be able to deal with their problem individually and as a family. The Oncology unit atTASRHis known to be the only cancer referral center in the country. Published data done in Ethiopia were not found on how health care professionals in the oncology units understandassess or address mental health needs of people with cancer and the obstacles they encounter. Objective: This study aims to explore the clinicians‟ perspective of mental health needs of people with advanced cancer and the strategies clinicians use to assess and address those needs in TASRHOncology follow-up clinic. Method: An exploratory qualitative research design was employed and participants were selected purposively based on years of experience. Data was collected, transcribed in Amharic, translated to English and then analyzed through thematic analysis. The study was conducted at TASRH, October 2018. Results: Majority of the participants reported to notice some mental health problems in patients with cancer but have some difficulty to identify symptoms and provide first line treatments. All participants stated that it is advantageous for patients to know about their illness. Participants also suggest the disadvantages patients from knowing about their illness is mainly due to the ways of information delivery. The increased number of patients visiting the clinic on daily basis was a major obstacle. Conclusion:Timely and accurate diagnosis of co morbid mental disorders and addressing psychosocial factors is required to increase quality of life of people with cancer.
Non-adherence to Antidepressant Treatment and its Predictors among Outpatients with Depressive Disorders, a Hospital-based Ccross-sectional Study in Addis Ababa, Ethiopia
(Addis Abeba University, 2020-10) Mulugeta, Selam; Prof.Araya, Mesfin(MD, Ph.D, Professor of Psychiatry, Department of Psychiatry, AAU); Dr.Milkias, Barkot (MD, Assistant Professor of Psychiatry, Department of Psychiatry, AAU)
BACKGROUND: In Ethiopia, there is inadequate information on non-adherence to antidepressant treatment in patients with depressive disorders. Having awareness of the pattern of adherence is important in future prognosis, quality of life and functionality in these patients. This study will be conducted to assess the prevalence of Non-Adherence to Antidepressant treatment and its predictors among Psychiatry Outpatients with Depressive Disorders. METHODS: A hospital-based cross-sectional quantitative study was conducted at the psychiatry clinic of Tikur Anbessa Specialized Hospital. A sample of 216 consecutive outpatients with Depressive disorders who visited the Psychiatry clinic since June 2019 and who had at least two visits prior to their last visit were enrolled. Data was collected using questionnaires through inperson and phone call interviews. The eight-item Morisky scale, a scale extensively used in the Ethiopian setting, was used to assess the pattern of medication adherence. Other specially developed tools were used to obtain sociodemographic and clinical information from electronic medical records and patient interviews. Data was analyzed using the Statistical Package for the Social Sciences (SPSS), Version - 25. Univariate and multivariable analyses were carried out to assess factors associated with non-adherence. RESULTS: Ninety percent of the participants who were taking antidepressant medication were found to have a primary diagnosis of Major Depressive Disorder. Based on the 8-item Morisky Medication Adherence Scale, the prevalence of non-adherence was found to be 84.7%. Living distance between 11 to 50 kms from hospital (AOR= 11, 95% CI (29,46.6)), post-secondary level of education (AOR= 8.3, 95% CI (1, 64.4)), taking multiple medications (AOR= 6.1, 95% CI (1, 34.9)) were found to have significantly increased odds of non-adherence. CONCLUSION: The prevalence of non-adherence is very high among patients with depressive disorders. Non-adherence was significantly associated with factors such as increased living distance from the hospital, relatively higher educational level, and polypharmacy. Proper and patent centered psychoeducation to patients, addressing the communication gap between patients and doctors, clinicians’ adherence to prescribing guidelines, avoiding polypharmacy unless indicated, and working on accessibility of treatment for common mental disorders is essential to decrease non-adherence. Larger analytical studies to further establish causal relationships to nonadherence and its impact on depression treatment outcomes are recommended.
Descriptive Analysis of Cases Seen At Psychiatric Outpatient Department Of Tikur Anbessa Specialized Hospital from Sep 11, 2019 - Mar 9, 2020:A retrospective crossectional study in Addis Ababa, Ethiopia
(Addis Abeba University, 2020-10) Abebe, Tesfanesh; Dr.Birhanu, Ribka; Dr.Bahiretibeb, Yonas
Background In mental health descriptive studies on the socio-demographic variables provides data regarding study participants and it is necessary for the determination of whether the individuals in a particular study are a representative sample of the target population for the generalizability purpose. It helps to Identify and address differences in care for specific population and for the development of additional patient centered services. Among the study done in Ethiopia, there is an existing inpatient visit study at Amanuel mental specialized hospital. At TASH there is a lack of organized data regarding socio-demographic characteristics, diagnosis, and frequency of psychiatric illnesses. Objective To identify the socio-demographic characteristics, diagnosis, and frequency of psychiatric illness at TASH outpatient department of psychiatry. Method Descriptive study was conducted. The study material was 981 charts of patients, which was assessed from electro-medical recording system, by using a convenient non-probability sampling method to explore the socio-demographics of the patients and their diagnosis. Data was collected by a means of data extraction sheet from electro-medical recording system at TASH. The collected data was analyzed by using SPSS version 25, in the analysis process frequency distribution of variables was calculated. Results The result of this research has shown that the mean age of patients to care is 30.5, 54.5% were male in gender. 18.1 % have a higher-level education, 42.7% are employed, and 43.5% single. 21.9% had a diagnosis of depressive disorder, 20.7 % had schizophrenia spectrum and other psychotic disorder and 17.2 % have neurodevelopmental disorders. 71.5% are treated with only medication and 23.3% are treated with psychotherapy. Conclusion The present study point to the need for further research and attention to lack of completeness of the records seen on the socio-demographic and diagnosis variables which could be detrimental to the quality of healthcare service and the need for child and adolescent clinic that is found to hold significantly high number compare to the service provide currently.

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