A statistical study of factors associated with psychosis at Mathari Hospital, Nairobi

Although there are known factors associated with increased risk of developing psychosis, the exact etiology remains elusive. Psychosocial and biological factors are known to interact in their development. Factors such as obstetric complications, season of birth, drug abuse, migration and ethnicity, urbanicity, social adversity, and trauma in childhood have been found to be related to psychosis. Unfortunately, studies done in Kenya only look at these factors as secondary to other inquiries. This study sought to identify the determinants of psychosis as presented by patients admitted at Mathari Hospital. Mathari Hospital is Kenya's sole National Referral and Teaching psychiatric Hospital with a capacity of 700 beds. This was a cross-sectional study of patients being discharged from Mathari Hospital at the time. A questionnaire was designed to help in collecting information from the patients, after obtaining permission from the Kenyatta National Hospital/ University of Nairobi Ethics and Research Committee. First patient was randomly selected, from a list of patients admitted at the time, after which every odd number patient being discharged was approached for interview. The patient included was to be able to respond to questionnaire items. Agitated patients were excluded. Clinical notes at admission were incorporated for clinical history, as well as primary caregiver accounts. Data analysis was performed in R 3.0. 2 Software. Data obtained was analysed in terms of descriptive statistics, and later logistic regression was used to determine the important factors that affect psychosis and establish any associations that are unique to the Kenyan scenario. Multiple linear regression was used to establish factors that determine length of DUP. One-way ANOVA was used to test the effect of social and biological factors on DUP and age at onset of psychosis. Simple linear regression was done to model the relationship between age at onset 'of psychosis and duration, in years, of drug abuse. A total of 145 patients completed the interviews. Majority of the respondents were male patients (55.17%, n=80, N=145). 53.79% (n=78, N=145) of the respondents had a working diagnosis of psychosis. The mean age at onset of psychosis was 26.03±7.67 SD (n=67, N=145), the mean Duration of Untreated Psychosis (DUP), in weeks, was 10.19±8.47 SD (n=67, N=145). It was established that family history of psychosis and residence were significant in predicting the probability of a patient having psychosis. Drug abuse and residence were significant in determining the length of DUP. CHAPTER ONE INTRODUCTION 1.1 Background Psychosis is classified according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-IV), as a component of certain serious mental disorders in which a person loses touch with reality; principal signs include hallucinations, delusions and impaired insight (American Psychiatric Association, 2000). The psychotic states include: Schizophrenia, Schizophreniform disorder, Schizo-affective disorder, Delusional disorder, Brief psychotic disorder, Shared psychotic disorder, Psychotic disorder due to a general medical condition, Substance-induced psychotic disorder, and Psychotic disorder not otherwise specified. There are a number of known factors that increase the risk of developing psychotic states such as schizophrenia. As in many other diseases, genetic and environmental factors interact in their development. Psychosocial and environmental factors shown to be related to psychosis and schizophrenia are: obstetric complications, season of birth, drug abuse, migration and ethnicity, urbanicity, social adversity and trauma in childhood (Mattson et al., 2008). Although family history is the strongest risk factor for schizophrenia; environmental factors related to urbanicity may contribute to a substantial proportion of the population (Casten and Preben, 2001). The lifetime prevalence of bipolar disease is approximately 1%. Adoption studies have demonstrated that biological relatives of bipolar patients are more likely to have the disorder than are adoptive relatives (Taylor et al., 2002). Heavy