EVALUATION OF THE MANAGEMENT OF ANXIETY DISORDERS AT AHMADU BELLO UNIVERSITY TEACHING HOSPITAL, KADUNA, NIGERIA
EVALUATION OF THE MANAGEMENT OF ANXIETY DISORDERS AT AHMADU BELLO UNIVERSITY TEACHING HOSPITAL, KADUNA, NIGERIA
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Date
2006-05
Authors
AIMOLA, Edward Kehinde
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Abstract
Anxiety disorders are mental disorders that share extreme or pathological anxiety as the
principal disturbance of mood or emotional tone. This study involved a retrospective
analysis of data obtained from hospital records of patients attending clinic at the
psychiatry unit of Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria for a
two year period spanning January 1st, 2003 to December 31st, 2004. The study population
of 875 patients consisted of only patients who attended clinic six times or more within the
period under study. This study was carried out to describe prevalence, comorbidity,
management and burden of anxiety disorders among patients.
Average clinic attendance in 2004 (72.5) increased as against 2003 (64.6). With respect
to relative occurrence, anxiety disorders (8.0%), ranked lower than schizophrenia
(46.6%), depression (13.7%) and seizure disorders (12.1%). Majority of anxiety disorders
patients were male (62.3%), married (70.5%), Hausa (34.4%) from Kaduna state (41.0%)
and of the Muslim faith (57.4%). Most were in their twenties (26.2%) and thirties
(32.8%) and had been attending clinics for five years or less. The mean age of patients
(36.3 years) diagnosed as having anxiety disorders (n=61) was higher than that for the
study population (29.2 years) of mental disorders (n=875). Half of anxiety disorders
patients were employed (50.8%) and very few had tertiary education (1.6%). Generalised
anxiety disorder (80.3%) was the most prevalent subtype of anxiety disorder. Anxiety
depressive disorder (16.4%), obsessive compulsive disorder (1.6%) and panic disorder
(1.6%) were other subtypes of anxiety disorders identified. Only 11.5% of patients had
records showing family history of mental disorders.
Majority of anxiety disorder patients (62.8%) had another comorbid diagnosis. Non
psychiatric comorbid diagnoses (50.8%) were more prevalent while psychiatric comorbid
diagnoses were present in 14.7% of anxiety disorder patients. Hypertension (36.1%) was
the most prevalent non psychiatric comorbid diagnosis, while somatization disorder
(6.6%) and depressive disorders (4.9%) were the most prevalent psychiatric comorbid
diagnosis. The mean age for patients with comorbid disorders was significantly higher
than for patient who had no comorbid disorders (P<0.01). Comorbid disorders were
found to have no association with sex or marital status; however, average frequency of
clinic visits increased significantly in the presence of non psychiatric comorbid disorders
(P<0.05).
Signs and symptoms varied and they included somatoform complaints (which were the
most prevalent), insomnia and sleep disorders, cardiovascular complaints, anxious mood,
gastrointestinal symptoms and tension. Hematological investigations (31.1% of patients),
serum / urea / electrolyte / creatinine (26.2%), and stool microscopy (13.1%) were the
most frequently requested laboratory investigations. Management of anxiety disorders
involved the use of pharmacotherapy (67.2%) or a combination of psychotherapy and
pharmacotherapy. Drugs employed include; amitriptyline (used in 83.6% of patients),
imipramine (16.4%), nitrazepam (13.0%), bromazepam (11.5%) and diazepam (6.6%).
Antipsychotics employed included; trifluperazine (77.0%), chlorpromazine (9.8%) and
thioridazine (8.2%). Antihypertensives employed included; propranalol (23.0%),
nifedepine (14.8%), bendrofluazide (11.5%) and amiloride-hydrochlorothiazide (9.8%).
Other drugs encountered include vitamin B complex (70.5%), benzhexol (57.4%), and
carbamazepine (4.9%). Non pharmacological approaches included; psychotherapy
(54.1% of times), counseling (insight counseling and counseling with family members)
(41.7%), and relaxation therapy (4.2%). Mean frequency of clinic visit did not differ
significantly in patients that received either pharmacotherapy only or a combination of
psychotherapy and pharmacotherapy. However, one-way analysis of variance show that
with increase in years since registration there was significant decrease in cost of
treatment (P<0.05). Neither accessibility nor employment status was found to affect
adherence with clinic visits. Drug use was accompanied by side effects in significant
number of patients (82.0%). Predominant side effects included; insomnia (in 7.4% of
patients), weakness (4.5%), headaches (4.1%), dizziness (2.5%) and excessive sleep
(2.0%). Use of other drugs (38.0% of times), reduction of drug dose (23.0%), taking of
drugs at a different time of the day (11.5%), counseling (11.5%), drug discontinuation
(7.7%) and increase drug dose (e.g. increase dose of amitriptyline when insomnia was the
complain) (7.7%) were methods employed in management of side effects.
Calculated annual drug cost (N276,750:84) far outweighed cost of laboratory
investigations (N32,530:00) and cost of hospitalization (N14,500:00). The average cost
of treatment per patient per month was N1,200:00 while the average cost of laboratory
investigations per patient per month was N 403:91. Average of percentage number of
times patients were accompanied to clinic was 17.76%. Travel time and waiting were
sources of loss in productive time identified.
In conclusion, anxiety disorders are common and their course can be complicated by the
presence of comorbid disorders, however, early diagnosis and proper management can
help improve health care outcomes.
Description
A THESIS SUBMITTED TO THE POST GRADUATE SCHOOL AHMADU
BELLO UNIVERSITY INFACIAL FULLFILLMENT OF THE REQUIRMENTS
FOR THE AWARD OF MASTER OF PHARMACOLOGY
DEPARTMENT OF PHARMACOLOGY AND CLINICAL PHARMACY
FACULTY OF MEDICINE
AHMADU BELLO UNIVERSITY
ZARIA, NIGERIA
Keywords
EVALUATION,, MANAGEMENT,, ANXIETY DISORDERS,, AHMADU BELLO UNIVERSITY TEACHING HOSPITAL,, KADUNA,, NIGERIA.