Although somatic symptoms may be florid among patients with depression, they have considerably less weight than core depressive symptoms in the diagnosis of depression. The emerging cognitive factor could be similar to that described by previous authors.

No abstract

Post-traumatic stress disorder, survivor guilt and substance use -a study of hospitalised Nigerian army veteransObjectives. To investigate the prevalence of post-traumatic stress disorder (PTSD) and survivor guilt in a sample of hospitalised soldiers evacuated from the Liberian and Sierra-Leonean wars in which Nigerians were involved as peace keepers. The relationships between PTSD, survivor guilt and substance use were also investigated.Design. A socio-demographic data questionnaire, the PTSD checklist and a validated World Health Organization substance use survey instrument were used to obtain data from the subjects.Setting. The study took place at the 68 Nigerian Army Reference Hospital, Lagos, Nigeria, which was the base hospital for all casualties from the Liberian and SierraLeonean operations.Subjects. All hospitalised patients from the military operations during a 4-year period (1990 -1994) who were physically capable of being assessed were included in the study.Results. The prevalence rate for PTSD was found to be 22% and survivor guilt was found in 38% of the responders.PTSD was significantly associated with long duration of stay in the mission area, current alcohol use, lifetime use of an alcohol/gunpowder mixture, and lifetime cannabis use.Survivor guilt was significantly associated with avoidance of trauma-related stimuli but not duration of combat exposure.Conclusions. Although the sample studied was specific, PTSD might be quite common and probably undetected G T Okulate, MB ChB, FWACP, FMCPsych O B E Jones, BSc (Psych), MSc (Psych)

Although auditory hallucinations are universal phenomena, they show cultural and ethnic variation. We set out to study some differences between auditory hallucinations in Nigerian patients and their foreign counterparts. We also investigated the usefulness of auditory hallucinations in distinguishing between schizophrenia and affective disorders. A semi-structured interview was used to obtain information from 89 patients with auditory hallucinations who met ICD-10 criteria for either schizophrenia or affective psychoses and 10 others with organic mental disorders. Responses were compared with respect to the frequency, form and content of the hallucinatory voices as well as the languages spoken. In this sample, voices speaking exclusively in a foreign language were uncommon. Voices commanding and those discussing patients in the third person were the commonest in schizophrenic patients but not as frequent as in a similar group of patients in the UK studied by other authors. In patients with schizophrenia, voices were more likely to discuss the patient, whereas in affective disorders, voices were more likely to evoke fear, and patients were more likely to carry out commands. In conclusion, only three features of auditory hallucinations distinguished between schizophrenic and affective psychoses patients. Auditory hallucinations may be less harassing in Nigerian schizophrenic patients than in their UK counterparts. These hallucinations are most often perceived in the individual's mother tongue, with or without additional use of English, even when the patients have been 'westernized' through education and religion.

Most Nigerian soldiers acknowledge the usefulness of condoms in HIV prevention, but few use them in sexual relationships. Identification of soldiers low in HIV-risk behaviours, particularly regular condom use, to function as peer educators appears desirable. We therefore sought to identify HIV-risk issues among a group of Nigerian soldiers. Male soldiers were more likely to be older, married and living alone than their female counterparts. Female soldiers had had better education than the males but, in spite of that, alcohol use and sexual relationships in the context of alcohol were widespread with no difference between the genders. However, alcohol abuse as detected in 22-27% of the soldiers was more likely to be a male problem. Having more than one sex partner did not distinguish the male soldiers from the females. Consistent condom use was uncommon, found in only 16-20%, with no difference between genders. Married persons (more likely to be males) were more guilty of no or inconsistent condom use. Although this study has failed to recognise who might be potential peer educators based on their non-risky behaviours, it has highlighted some important inadequacies in the Army health education campaign programme with respect to HIV/AIDS issues. Large-scale interventions, including more extensive condom promotion, training large numbers of peer educators, promoting ingenious ways of female self-protection from the highly dominant males and encouraging further research have been advocated.