Misdiagnosis of psychotic disorders occurred with patients of all ethnocultural backgrounds. PTSD and adjustment disorder were misidentified as psychosis among immigrants and refugees from South Asia. Studies are needed that compare clinical outcomes of use of cultural consultation with outcomes from use of other cultural competence models.

In low-income countries, clinicians must seek strategies to improve treatment adherence that are non-resource intensive and easily integrated into existing treatment structures. We conducted a prospective observational cohort study to investigate the relationship of family engagement in treatment during hospitalisation with post-discharge appointment and medication adherence in 81 patients from a Nigerian psychiatric hospital. After controlling for gender, diagnosis, mental state at discharge, and marital status, family involvement was significantly associated with appointment (P=0.047) but not medication adherence (P=0.590). Studies are needed to determine whether interventions based on engaging families in treatment can improve post-discharge adherence in this setting.

Objective: To describe and analyze patterns of polypharmacy among psychiatric outpatients in northern Nigeria and identify predictors of psychotropic polypharmacy. Method: A cross-sectional study, using chart review of new patients at outpatient clinics of two regional psychiatric hospitals in northern Nigeria, measuring rates, patterns and predictors of psychotropic polypharmacy. Results: A total of 278 patients were seen, of whom 92% were given two or more psychotropic agents. The pattern of psychotropic polypharmacy revealed that total, multi-class and adjunctive polypharmacy rates were high, while augmentation and same class polypharmacy rates were low. Age of respondent and diagnosis were the factors associated with total polypharmacy. Conclusion: The complex interplay of factors influencing physician prescription practices requires that a more pragmatic approach be adopted in efforts to curtail polypharmacy practice, rather than a wholesale, absolute condemnation of the practice.

This chapter examines the social and cultural roots and implications of current concepts of recovery. Consistent with biomedical notions of illness and disease, psychiatry has tended to frame “recovery” largely in terms of outcomes, as “recovery from illness”. However, during the last decade the term “recovery” has come to refer to a social movement promoting a reorientation in psychiatric care, toward ensuring that individuals can live a full life in their communities. Along with this reorientation, recovery is increasingly conceived of as a process, rather than an outcome, with individuals described as “being in recovery” rather than as “recovering from” an affliction. The new recovery “movement”, with its roots in civil rights and independent living movements, arose in part as a reaction to perceived attitudes of pessimism and paternalism inherent in conventional psychiatric care. It envisions for individuals with mental illness a reassertion of their rights to a dignified and meaningful life in the community and a renewed sense of agency, with an active say in the direction of their own healthcare. Although sometimes framed in the universalistic language of human rights, recovery is rooted in specific cultural concepts of self and personhood. The consumer-oriented recovery model, which is popular in the USA, builds on a Euro-American individualistic and egocentric concept of the person. However, in other cultures, sociocentric, ecocentric, or cosmocentric conceptions of personhood may have more salience. These differing cultural concepts of the person influence the trajectories of illness, modes of adaptation, response to interventions, and definitions of positive outcome. In particular, cultural notions of the person's connection to family, community, and spirituality play a key role in local notions of recovery. This will be illustrated with examples from qualitative research with African-Americans in the USA, indigenous peoples in Canada, and patients in Nigeria. Understanding the cultural and historical roots of recovery provides a framework for considering the relevance of recovery for diverse cultural groups, both within North American and European societies and in other parts of the world.

In Nigeria, outpatient care forms the bulk of the psychiatric service. While there are no published data, empirical observations indicate that default may be high and exerting a huge toll on the cost of care. The aims were to determine the first-appointment default rate among newly seen outpatients in a psychiatric clinic and to identify factors associated with it. The study was a survey of all newly seen patients from 1 January 2006 to 31 January 2006, and who were given a follow-up appointment. A total of 223 new patients were seen. Of these, 151 (67.7%) turned up for their appointment, 61 (27.4%) defaulted, and 11 (4.9%) were referred. Defaulters were more likely to be Christians, younger in age, and in employment. On using correlation statistics, respondents' religion and occupational status demonstrated a linear relationship and a significant association with followup attendance/non-attendance. The rate of non-attendance at first follow-up is of clinical concern, and the possible contribution of religion to this may be enormous. Clinicians and health policy makers need to be sensitive to this. The introduction of community psychiatric services and collaboration between orthodox and traditional/religious practitioners may help reduce default rates.