A retrospective study of the clinical outcome of bipolar disorders in a mental health facility in north-eastern Nigeria.

Abstract

The efficacy and cost effectiveness of mood stabilizers in bipolar affective disorders have been established. Addition of mood stabilizers to a treatment regimen increases cost 8 folds. However, in Africa how affordable an intervention is makes all the difference, as initiation of treatment and compliance depends on it. The prescription of mood stabilizers in our environment is complicated by economic considerations. Local evidence is required to justify ne of the most impoverished regions of Africa. Aims: To describe the patterns of treatment of bipolar illness in north-eastern Nigeria and to determine if there is any relation between use of mood stabilizers and a positive treatment/ prophylaxis outcome. Method: A 2-year case controlled retrospective study (2004-2006) of all bipolar disorder cases was conducted and comparison between patients treated with mood stabilizers plus antipsychotics and those on antipsychotics only was made. A total 225 of all diagnosed cases of bipolar affective disorder that met the inclusion criteria were included in the study. Results: The average age of presentation of our patients is 19.5 years, with an equal male to female ratio. Majority (70%, n= 157) were diagnosed as bipolar affective disorder current episode manic. Most of the patients (79%, n=166) were treated with typical antipsychotics only, while only (20%, n=45) had a combination of mood stabilizers and antipsychotic, less than 1%, (n=4) received atypical. The differences between the compared groups in terms of core symptoms relief and clinician's impression were statistically significant (x²=21.5,2df, p< 0.005; X² 9.8,2df, p< 0.005). While 43% of patients on mood stabilizers experienced no relapses in 2 years, all the patients on typical antipsychotic alone had at least one relapse. Conclusions: Bipolar patients do well clinically when placed on mood stabilizers, yet only a minority who are able to afford benefit from its inclusion into their treatment regimen, resulting in a generally poor outcome, increasing burden on family members, as well as stigmatization by the wider community. Clinicians practicing in underdeveloped countries should feel confident in prescribing mood stabilizers and governments should subsidize the cost of mental health care.