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Background: The stigma of epilepsy is pervasive in developing country contexts and negatively affects the psychological and social wellbeing of its sufferers. The experience of stigma varies across settings and probably relate to disease severity and social characteristics. This study sought to describe the extent and correlates of perceived and enacted stigma among outpatients with epilepsy. Methods: The participants were consecutively presenting epilepsy outpatients in a tertiary facility that attended clinic regularly and had no overt medical or psychiatric co-morbidities. The patients were interviewed with a semi-structured questionnaire. Results: There were 93 participants with a mean age of 30.2 ± 10.3 years and 57.0% were males. The experience of stigma was reported by 46.2% and 67.7% of the participants for perceived and enacted stigma, respectively. Over one-third of the patients had suffered burns or a similar injury in the past. The correlates of perceived stigma were rural residence, lower levels of education, and longer duration of illness. Gender, age and frequency of seizures were not statistically significant determinants. The correlates of enacted stigma were being single, older age, rural residence, and longer duration of epilepsy. A past history of burns and disclosure of epilepsy to individuals outside the family added to the likelihood of experiencing stigma. Conclusion: The burden of epilepsy related social stigma is high in Nigeria. Cultural stereotypes and misconception add to this. There is need for appropriate culture-congruent educational interventions to provide the right information about epilepsy and debunk the misconceptions and myths associated with the condition. This will need to be coupled with astute clinical management of cases and active case finding. Both qualitative and longitudinal quantitative studies would be required to deepen our understanding of the How to cite this paper: Achor, J.U.,

Respiratory dyskinesia (RD) is a rarely-recognized side effect of antipsychotic medication. There are only few reports of respiratory dyskinesia in patients with tardive dyskinesia (TD), and almost all came from developed countries. Reported here is a case of a 58-year old lady who developed tardive dyskinesia while on typical antipsychotics and subsequently respiratory dyskinesia while on olanzapine. The diagnosis of respiratory dyskinesia was missed initially by the psychiatrists when the symptoms were mild and later by other specialists even when the presentation was classical. It is recommended that patients on antipsychotics, especially those with TD should be regularly examined for RD and when any clinician is managing a patient on an antipsychotic with respiratory problems, the possibility of RD should be considered.

Adverse cutaneous reactions are common, being associated with many prescribed drugs including psychotropic medications. Very few cutaneous reactions with olanzapine have been described in the literature but none of these reports came from Nigeria, a country where clinicians have joined the developed world in prescribing increasingly atypical antipsychotics such as olanzapine. We report a case of a 30-year old clergy with paranoid schizophrenia who developed acute angioedema with urticaria shortly after she was commenced on olanzapine. The lesion resolved on withdrawal of olanzapine but re-occurred following a re-challenge. Drug-related skin reactions are probably under-reported, may be because most are mild and self-limiting. Clinicians should know and educate their patients on antipsychotic-related skin lesions. Awareness of this rare side effect will lead to timely reporting, prompt management, and eventual better compliance with psychotropic medications.

Background: Cases of peripheral oedema associated with antipsychotic medication have been reported, especially with the atypical types of antipsychotics. The exact cause is not known. Aim: Our purpose is to bring to the medical world that though peripheral oedema is more reported with atypical antipsychotics than the typical counterparts, rarely it occurs following typical antipsychotic medication such as haloperidol. Presentation of Case: We report a case of pedal oedema following intramuscular injection of haloperidol to a 35-year old female doctor diagnosed with delusional disorder. Withdrawal of the drug led to immediate resolution of oedema but subsequent re-administration of the drug provoked a re-occurrence of oedema which again resolved quickly on the suspension of the haloperidol. Discussion: Every antipsychotic, especially the second-generation antipsychotics, has the potential to cause peripheral oedema. The cause of the oedema is not very certain but its occurrence can cause embarrassment to patients and family leading to fear, unnecessary investigations, and poor medication adherence. Conclusion: Clinicians are reminded that while peripheral oedema is known to be associated more Case Study