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TARDIVE DYSKINESIA AND INTERNALIZED (SELF) STIGMA AMONG OUTPATIENT CLINIC ATTENDEES WITH SCHIZOPHRENIA: PREVALENCE AND CORRELATES

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Supervisor: Dr (Mrs). T.A. Adamson
Faculty: PSYCHIATRY
Month: 05
Year: 2015

Abstract

Background: Tardive dyskinesia (TD), defined as repetitive abnormal involuntary movements of the face, trunk and limbs, can be an embarrassing sequela to the use of antipsychotic medicationsand may affect basic functions of daily living. The apparent physical manifestation of this condition as a side effect of medication therapy often adds to the stigma experienced by patients with mental illness.Stigma has been shown to be a major barrier to recovery in patients with mental illness, as it prevents early presentation to healthcare facilities and adherence to medication therapy. Aim: The study aimed to determine the prevalence and correlates of tardive dyskinesia and those of internalized (self) stigma, among patients with schizophrenia attending the outpatient clinic of the Neuropsychiatric Hospital Aro, Abeokuta. Methods: Patients with schizophrenia on remission attending the outpatient clinic of theNeuropsychiatric Hospital Aro, Abeokuta, were recruited for the study. Diagnosis of schizophrenia was confirmed using the Structured Clinical Interview for axis I DSM-IV disorders (SCID). Socio-demographic information such as age, education, gender and clinical variables such as onset of illness, type, duration of use and dosage of antipsychoticsamong others, were recorded using a questionnaire designed for the purpose. The patients were assessed for tardive dyskinesia using the Abnormal Involuntary Movement Scale (AIMS), while the Internalized Stigma of Mental Illness (ISMI) scale was administered for the assessment of self-stigma. Results: A total of three hundred and thirty-five (335) consenting respondents who met the eligibility criteria were interviewed. There were slightly more females than males, (50.7%), majority were unmarried (44.5%), mostly in the young age group (age range 18 – 39years) (57.6%) and with a mean age of 39.15 SD(±11.07) years. The prevalence of tardive dyskinesia and high internalized self-stigma among the respondents were 18.5% and 27.5% respectively. Advancing age was significantly correlated with tardive dyskinesia, while higher levels of self-stigma were found in those that were unmarriedand had greater number of years of education. The clinical parameter that correlated with tardive dyskinesia was the administration ofdepot and oral antipsychotic medications. Factors that correlated with self-stigma sub-scales of the internalized stigma of mental illness scale in the study were living with others, (discrimination experience which measures respondents’ perception of the way they currently tend to be treated by others, and stereotype endorsement which measures the degree to which a respondent agrees with the common stereotypes about people with mental illness), being in employment and having higher levels of education (stigma resistancewhich measures the experience of resisting internalized stigma). Significant association (p= 0.04) was found only between tardive dyskinesia and the stereotype endorsement sub-scale of the Internalized Stigma of Mental Illness Scale (ISMI). Conclusion: The results indicate that tardive dyskinesia is still prevalent among patients with schizophrenia on antipsychotic medications in the era of so-called atypical antipsychotic drugs. Tardive dyskinesia however was not found to positively correlate with stigma, neither was there significant relationship between it and the subscale domains of the internalized stigma of mental illness scale except for stereotype endorsement

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