Brain Fag Syndrome and Stimulant Use Among Undergraduate

BRAIN FAG SYNDROME AND STIMULANT USE AMONG UNDERGRADUATE STUDENTS AT THE UNIVERSITY OF BENIN A DISSERTATION SUBMITTED TO THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PART FULFILLMENT OF THE REQUIREMENTS FOR THE FELLOWSHIP OF THE COLLEGE IN THE FACULTY OF PSYCHIATRY FMC PSYCH. (NIG). BY Dr. Ehigiator Okokhue Adayonfo M.B.B.S (UNIVERSITY OF BENIN) 2000. DEPARTMENT OF MENTAL HEALTH UNIVERSITY OF BENIN TEACHING HOSPITAL BENIN CITY, EDO STATE NIGERIA. NOVEMBER 2012 i ii DEDICATION This study is dedicated to the Almighty God. iii ACKNOWLEDGEMENT I express profound gratitude to Prof. O. Morakinyo, Dr. K. O. Akhigbe (My Supervisor and 2nd Supervisor respectively), Dr. E. Uwadiae (My Head of Department, Department of Mental Health, University of Benin Teaching Hospital, Benin City), Dr. S.O. Osasona (Postgraduate Training Co-ordinator, Department of Mental Health, University of Benin Teaching Hospital, Benin City) and Mr. O. Onofigho. My thanks also go to Dr. V. Asemota and Dr. I. Aina, all resident doctors and indeed all staff of the Department of Mental Health, University of Benin Teaching Hospital, and all authors whose work were cited in this study. I am also grateful to Dr. B.O. James, Mr. G.N. Okungbowa and Mr. I. Enang; the authorities of the University of Benin and the undergraduate students used for this study cooperated immensely, for which I am grateful. I am also very grateful to my wife, children, parents and siblings for their support and understanding. Finally, to God be the glory! iv SUMMARY Brain Fag Syndrome (BFS) which was first described by Raymond Prince in Nigeria in 1960, has continued to be studied. It is a culture bound syndrome found in Africans who are engaged in intellectual activities. It constitutes an impediment to the goal of studentship as it may lead to student wastage and or school dropout. Some theories have been put forward to explain the aetiology of BFS. Prince put forward the Forbidden Knowledge and the Ego Energy theories while Morakinyo Olufemi propounded the Psychophysiological or Circular Theory which links BFS to stimulant use. Most appealing is the Psychophysiological Theory, which could be subjected to empirical study. However, there is a dearth of study to link BFS to stimulant use. The aims of this cross-sectional study were; to determine the prevalence of BFS and stimulant use among undergraduate students at the University of Benin, determine any association between the two, to know the socio-demographic factors associated with BFS and to identify factors that may contribute to BFS among students who use stimulants. Multistage sampling technique was used to select five hundred, 300-level students from 7 of the 13 Faculties in the University, but 482 questionnaires were analysed due to attrition. Prevalence of BFS and past 30 days general stimulant use among the respondents were high (42.9% and 39.4% respectively). There was a statistically significant association between BFS and use of stimulants by the respondents. The study supported the Psychophysiological theory because BFS was common among the respondents that used stimulants. There was no significant difference between the socio-demographic characteristics of students who had BFS and those who did not. The study showed a significant positive v correlation between general psychiatric morbidity and BFS, in that BFS was significantly common among the respondents who were GHQ positive. Gender and general psychiatric morbidity were significantly associated with the respondents who used stimulants and came down with BFS. BFS was commoner among females than males who used stimulants, and among the students who used stimulants that were positive on the GHQ. Consequent upon the earlier mentioned findings, Nigerian undergraduate students may mind the use of stimulants during studies to forestall their coming down with BFS. Undergraduate students in Nigeria may learn the right study habits that would not need the use of stimulants to stay awake. In addition, mental health service provision as a part of the University health services rendered to the University community, for early detection and treatment of such problems as BFS among the undergraduate students. This could minimize BFS and the rate of dropout among the students, for the good of the Nigerian society. vi CONTENTS Declaration --------------------------------------------------------------------------------- i Certification--------------------------------------------------------------------------------- ii Dedication----------------------------------------------------------------------------------- iii Acknowledgement------------------------------------------------------------------------- iv Summary------------------------------------------------------------------------------------ v Table of Contents-------------------------------------------------------------------------- vii Introduction and Relevance of the study----------------------------------------------- 1 Literature Review------------------------------------------------------------------------- 5 Aims, Objectives and Hypothesis------------------------------------------------------- 21 Methodology------------------------------------------------------------------------------- 23 Results-------------------------------------------------------------------------------------- 34 Discussion---------------------------------------------------------------------------------- 65 Conclusion--------------------------------------------------------------------------------- 75 Limitations of the study------------------------------------------------------------------ 76 Recommendations------------------------------------------------------------------------ 77 References--------------------------------------------------------------------------------- 78 Appendices-------------------------------------------------------------------------------- 89 vii Chapter One INTRODUCTION Prince classified Brain Fag Syndrome (BFS) as a culture-bound syndrome (Prince, 1985; DSM-IV, 1994; Aina and Morakinyo, 2011). It was first described by him in Nigeria in 1960 (Prince, 1960), and it occurs commonly among African people involved in intellectual activities, such as students. Prince (1962) described the features of the syndrome as: (1) Intellectual impairment manifesting as inability to grasp the meaning of materials read, poor retention and recall, and difficulty with concentrating while reading. (2) Unpleasant sensations like heat or burning , pains, aches, and peppery feeling around the head and neck that are associated with study; either coming on when a student attempts academic activity or may be continuously present but becoming exacerbated when studying. Other sensory disturbances include blurring of vision or just seeing blank. (3) Fatigue and sleepiness in spite of adequate rest. (4) Affective disturbances may or may not be present, or volunteered by the student but may take the form of fear, anxiety and/or depression if present. Prince called the syndrome, “Brain fag” (BFS) since this was the phrase used by the students to describe the illness, which they believed was the result of brain fatigue. BFS was observed among students in other parts of Africa or in students of African origin studying abroad. On the contrary, the syndrome is rare among Caucasians (German, Assael, Muhangi, 1970; Wintrob, 1971; Lehmann, 1972; Thebaud and Rigamer, 1976; Minde, 1974). There are contentions about BFS been a separate nosological entity. Various researchers classified it as a depressive disorder, somatisation disorder, and an anxiety disorder or an anxiety depressive equivalent. Neki and Marinho (1968), and Guinness (1992b) classified 1 BFS as either a depressive disorder or an anxiety state; Jegede (1983), and Anumonye (1983); Peltzer, Cherian and Cherian (1988) opined that it was an anxiety-depression equivalent; while Mbanefo (1966), Ayorinde (1977), Ebigbo and Ihezue (1981), Nwezie (1982) and Ezeilo (1982) classified BFS as a somatisation disorder. Fatoye and Morakinyo (2003), regard BFS as a distinct syndrome which incorporates features of somatisation, obsession and depressive disorders. Ola, Morakinyo and Adewuya claimed that BFS was real and not a myth (Ola, Morakinyo and Adewuya, 2009). “The confusion about the nosological status of BFS seems to result from speculative opinions, failure to define the syndrome properly by authors, lack of biological markers to complement the clinical phenotype of the condition and the fact that most studies did not use the brain fag syndrome scale which is based on the definition of the syndrome” (Ola, Morakinyo and Adewuya, 2009). Nevertheless, the components of the syndrome draw a line of demarcation between it and other related ones, hence the reason for BFS as a distinct diagnostic entity. In addition, this could be one of the reasons the International Classification of Diseases (ICD-10) grouped it under “Neurotic, Stress Related and Somatoform Disorder, F48.8 (WHO, 1992), while the Diagnostic and Statistical Manual (DSM-IV) regards it as a Culture-Bound Syndrome (“Appendix I; Outline for Cultural Formulation and Glossary of Culture-Bound Syndromes”) (DSM-IV, 1994)). A few reports may indicate that Brain fag syndrome is common. Prince reported an average prevalence of 54 % among secondary school students in Ibadan, Nigeria (Prince, 1962). Peltzer, Cherian and Cherian reported a prevalence of 25% among secondary school students in South Africa (Peltzer, Cherian and Cherian, 1998), Fatoye reported

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