EVALUATION OF THE MANAGEMENT OF ANXIETY DISORDERS AT AHMADU BELLO UNIVERSITY TEACHING HOSPITAL

(A CASE STUDY OF KADUNA, NIGERIA)

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Author

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Department of Medicine

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.