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   Table of Contents - Current issue
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September-December 2018
Volume 39 | Issue 3
Page Nos. 95-149

Online since Thursday, October 11, 2018

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ORIGINAL ARTICLES  

Biopsychosocial profile of children with speech and language impairment p. 95
Rania A Hamed, Hala T Mohamed, Omnia A Azazi, Karima A Bahgat
DOI:10.4103/ejpsy.ejpsy_45_17  
Introduction Severe speech and language disorders in young children can negatively affect later educational achievement, even after intensive intervention unless early intervention is initiated. Aim The aim was to investigate speech and language impairment in a sample of children and its possible etiological factors and to assess electroencephalogram (EEG) and MRI findings in them. Participants and methods A total of 43 children with speech and language impairment referred to Psychiatry Department, Al Zahraa University hospital, during the period from April 2016 to January 2017 and 28 children with normal language development as control group, aged 3–6 years old, were subjected to clinical psychiatric assessment, Wechsler intelligence scale for children, EEG, and brain MRI. Results The total number of cases was 43 [30 male (69.8%) and 13 female (30.2%) patients]; there was a statistical significance regarding positive family history of illness, parental education, work of the mother, and delayed speech among siblings. The presence of antenatal medical problem, antenatal drug intake, and neonatal morbidity shows a statistical significance. Overall, 27.9% of cases had previous history of delayed milestones of growth and corporal punishment; verbal abuse is the method used to discipline them. Moreover, 25.6% of cases had separation trouble at early school experience and reported to be follower or isolated in their peer relationship. Intelligence quotient assessment showed that 34.9% of cases had borderline intellectual functioning. There was a statistically significant difference between cases and control regarding abnormal EEG findings. Overall, 9.4% of cases had abnormal MRI finding. Conclusion In the current study, we found that speech and language impairment is a multietiological disorder, and early recognition will permit early intervention.
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Case–control study of depression in mothers of children with attention deficit hyperactivity disorder p. 100
Ayman A Elhadad
DOI:10.4103/ejpsy.ejpsy_5_17  
Background Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood-onset psychiatric disorders. It is characterized by inattention, hyperactivity, and impulsivity. ADHD can affect the social, cognitive, and academic performance of the child. Mothers of ADHD children tend to experience more stress, social isolation, self-blame, and depression. Aim The aim of this study was to identify the spread of depression in a sample of mothers with children having ADHD who were being followed up at the outpatient clinic of Abha Psychiatric Hospital. Patients and methods Sixty biological mothers of children with ADHD were incluced in this study. Each mother was evaluated for the presence of a major depressive disorder using the Beck Depression Inventory scale. A control group of 60 mothers of children without any psychiatric disorder or chronic medical condition was also included. Results On the basis of the Diagnostic and Statistical Manual of Mental Disorders V criteria, about 41.6% of mothers with ADHD children were found to be depressed. Conclusion An overall 41.6% of mothers of ADHD children had major depressive disorder, suggesting that routine screening for maternal depression needs to be considered when children are diagnosed with ADHD.
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Screening for attention-deficit hyperactivity disorder among high-school graduates accepted for enrollment at Alexandria Faculty of Medicine: academic year 2016/2017 p. 105
Ayat Eltayar, Iman Diab, Heba Elweshahy, Hesham Sheshtawy, Abd Elrahman Sharaf
DOI:10.4103/ejpsy.ejpsy_31_17  
Background Attention-deficit hyperactivity disorder (ADHD) is a prevalent and underdetected disorder with problematic consequences. Aim of the work The aim of this study was to study the prevalence of ADHD in first-year medical students before their start of academic work. Participants and methods A comprehensive survey of all high school graduates accepted for enrollment at Alexandria Faculty of Medicine for the academic year 2016/2017 was conducted using validated Arabic version of Adult Self-Report Scale screener questionnaire. Results Response rate was ∼93% (779 students). Screening of enrolled students for ADHD using Adult Self-Report Scale showed that nearly one-fifth (21.8%) had symptoms highly suggestive and another fifth (20.3%) were borderline. No significant difference was present between males and female students regarding their scores. Positive screening was not related to sex difference, residency, or type of school. Conclusion ADHD is prevalent among first-year medical students even before starting their academic study. Positive screening was not related to sex difference, residency, or type of school. Further follow-up is needed to discover the effect of positive screening on academic achievement.
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Polymorphism of serotonin transporter gene (SLC6A4) and its relation to tramadol dependence p. 109
Heba Baz, Dina Mahmoud, Sara A Naser, Walaa Rabee, Nahla Fawzy, Ola El-Sissy, Samir A Magd, Dalia Enaba
DOI:10.4103/ejpsy.ejpsy_4_18  
Background Many genes have been proven to be linked to substance use disorder, on top were serotonin receptor and transporter genes. Aim The aim of this study was to determine the frequency of 5-HTTVNTR allele variants of the serotonin transporter gene and the presence of polymorphic serotonin receptor gene (5-HTR1A) in tramadol-dependent patients in comparison with controls and to explore the association between the groups of tramadol dependent with and without psychiatric comorbidity and 5-HTTVNTR allele variants. Patients and methods This was a cross-sectional case–control outpatient study. The study sample consisted of 90 patients, with 60 tramadol dependents (55 males and five females) and 30 healthy controls. All patients fulfilled the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Criteria for substance dependence (on tramadol). Genotyping of the 5-HTTVNTR gene and 5-HT1A receptor gene promoter was done employing real-time PCR and PCR/RFLP, respectively. Results A significant association was found between the 5-HTT gene 10 allele polymorphism and tramadol dependence. No significant association was observed with the 5-HT receptor gene polymorphism. Conclusion This study detected an association between the presence of 5-HTTVNTR less transcriptional-efficient genotypes and tramadol dependence, and these genotypes increase psychiatric comorbidity with tramadol dependence, which suggests that the modulation of the serotoninergic system might be implied in psychiatric problems in tramadol dependence.
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Assessment of anxiety and depression risks among mothers having children with nocturnal enuresis disorder p. 115
Mona ELsayed, Haydy Hassan, Omnyia Ibraheem
DOI:10.4103/ejpsy.ejpsy_47_17  
Background Enuresis is an important health problem among children between the ages of 5–16 years, and it affects the children and their parents psychosocially. Objective This study aimed to detect the prevalence of anxiety and depression among the mothers having children with nocturnal enuresis disorder attending the psychiatric outpatients clinics of Seuz canal University Hospital and to detect the risk factors of these disorders in such group of patients. Patients and methods A case–control study included 38 mothers having children with nocturnal enuresis disorder and 38 matched control group comparable regarding sociodemographic data. Both groups were subjected to clinical interview to collect demographic data, Beck depression inventory to assess depression, and Hamilton anxiety rating scale to assess anxiety. Results There is a statistically significant difference between the study group and the control group regarding the mean Beck depression scale score; the study group has more depressive symptoms compared with the control group. However, there was no statistically significant difference between both groups regarding Hamilton anxiety scale score. Although there was an obvious increase in the mean Hamilton anxiety. Duration of management of more than 3 years was associated with the greatest risk of anxiety. Conclusion Our finding suggested that mothers who have children with nocturnal enuresis show more depressive symptoms than the control group. Duration of management of more than 3 years was associated with the greatest risk of anxiety.
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Subclinical eating disorders in a sample of secondary school girls and comorbidity with depression in Sharkia Governorate, Egypt p. 119
Nagda M Elmasry, Dalia M Khali
DOI:10.4103/1110-1105.243024  
Background Eating disorders are complex psychiatric syndromes in which cognitive distortions related to food and body weight and disturbed eating patterns can lead to significant and potentially life-threatening medical and nutritional complications. Aim of the work The aim of this study was to evaluate the frequency of subclinical forms of eating disorders and the association between it and depression in school girls in Sharkia Governorate, Egypt. Patients and methods In this two-stage cross-sectional study, we screened 2000 secondary school girls using eating disorder test. Those scoring 30 or less (n=415) and a control group randomly selected from those scoring 30 or more (N=215) were assessed using the eating disorder module of the Structured Clinical Interview for Diagnostic and statistical manual of mental disorders, 4th ed. (DSM-IV) axis-I disorders (SCID-I). SCID-I positive patients from stage 2 were screened for depressive symptoms using Beck Depression Inventory and diagnosed as having major depressive disorder according to DSM-IV criteria. Results The prevalence of subclinical eating disorders was 25.5% (subthreshold anorexia 3.5%, subthreshold bulimia nervosa 3.0%, SWC 10.0%, and subthreshold binge-eating disorder 9.0%), and the prevalence of major depressive disorder in SEDS patients was 10.8%. Conclusion Subclinical eating disorders are more frequent than typical eating disorders. Subclinical forms of eating disorders may represent a high-risk group for developing serious eating disorders; identifying this group will give an opportunity of prevention. Depressive disorder is frequent in patients with subclinical eating disorders.
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Disordered eating behaviors among adolescent patients with type I diabetes mellitus p. 127
Azza A El-Bakry, Amany A.A Mahmoud, Akmal M Kamal, Nagwan M Madbouly, Doaa R Ayoub, Reham M Kamel
DOI:10.4103/ejpsy.ejpsy_41_17  
Background Clinical and subclinical eating disorders (EDs) are common in adolescents with type I diabetes. Diabetes is associated with a high prevalence of risk factors for EDs such as high BMI, depression, low self-esteem, and anxiety. Aim This work aimed to study the prevalence of abnormal eating behaviors in adolescent patients with type I diabetes mellitus, and its association with depressive and anxiety symptoms. Patients and methods Seventy-five patients were recruited from the Endocrinology and Diabetes Clinic at Kasr Al Ainy Hospital. Eating Disorders Examination Questionnaire and Diabetes Eating Problem Survey were used to screen for abnormal eating behaviors. The diagnosis was checked using the criteria for EDs according to the fifth ed. of the Diagnostic and Statistical Manual of Mental Disorders. Subsequent assessments for depression and anxiety were performed using the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale, respectively. Results Disordered eating behaviors (DEB) were found in 34.7% of the study group; all were diagnosed with EDs not otherwise specified. Fifty percent of the participants had depressive symptoms and 54% had anxiety symptoms. Conclusion DEBs were found in adolescent patients with type I diabetes. Depression and anxiety were found in nearly half of the patients with DEBs.
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Depression and unexplained somatic symptoms in multiple sclerosis: MRI and quality of life correlates p. 133
Yahia A.A.El Aziz, Wardaa Aboelez, Ashraf El-Mitwalli, Wafaa El Bahaey
DOI:10.4103/ejpsy.ejpsy_7_18  
Background Medically unexplained symptoms (MUSs) are considered a huge burden on both physicians and patients alike and can be regarded as a form of multiple sclerosis (MS) mimic, which should be carefully investigated together with other psychiatric comorbidity-like depression and anxiety in MS patients to overcome its negative influence on patients’ quality of life. Aim The aim of our thesis research was to determine the rate of comorbidity between MS, the unexplained somatic symptoms and depression, and correlation with MRI findings, and to study the impact of the unexplained somatic symptoms, depression and disabilities on quality of life in patients with MS. Patients and methods This study was conducted on 30 patients and 30 controls. All patients were evaluated by clinical assessment and radiological assessment using MRI of brain and spine. Both patients and controls were evaluated by Patient Health Questionnaire-15 for unexplained somatic symptoms, Beck Depression Inventory for depression and 36-item Short Form Health Survey for health-related quality of life. Conclusion MS patients had an increased incidence of medically unexplained somatic symptoms and depression versus the matched normal participants, which in turn was responsible for the decline of their quality of life. Most MUS in MS patients resulted from the burden of the primary disease. However, the probability of whether these MUS could be a relapse could not be confirmed or excluded.
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A study of psychiatric comorbidities in irritable bowel syndrome p. 140
Victor S Michael, Mohamed M El Hamady, Shewikar T El-Bakry, Mona M.S Awd
DOI:10.4103/ejpsy.ejpsy_9_18  
Background Irretable bowel syndrome (IBS) is a functional syndrome characterized by chronic abdominal pain accompanied by altered bowel habits. Stress often worsens the symptoms of patients with IBS. Psychiatric disorders and IBS appear to have bidirectional comorbidities. Objectives The aim of this study was to assess the psychiatric comorbidities in patients with IBS. Patients and methods The study included a total number of 150 patients complaining of IBS symptoms with at least one episode of abdominal pain or flatulence per week in association with a change in bowel habit. All patients in the study were subjected to a detailed history taking and complete general and local abdominal examination. Moreover, International Classification of Diseases-10th revision internal medicine criteria for diagnosis, International Classification of Diseases-10th revision symptom checklist for mental disorders, and social readjustment rating scale were estimated. Results Patients of all age groups visit the clinics when they complain from IBS, mostly those of ages ranging from 31 to 40 years, who represented 38% of the studied group. Females complained more than males (66 and 34%). The most frequent psychiatric comorbidity with IBS was the neurotic and behavioral syndromes (53.3%) followed by psychotic and affective syndromes (32%), then the organic mental and psychoactive substance use syndrome (8%), and lastly, the personality disorders (4%). There was a significant association between IBS type and depression, generalized anxiety disorder (GAD), panic disorder, obsessive compulsive disorder (OCD), and somatization. Moreover, there was a significant correlation between IBS type and bipolar disorder, depression, GAD, panic disorder, OCD, somatization, and nonorganic sleep disorder. Conclusion Most patients with IBS have associated psychiatric or somatic comorbidities or overlapping other functional gastrointenstinal disorder (FGIDs). Patients with IBS have significantly higher levels of psychiatric comorbidities than healthy ones and are more susceptible to stress-related disorders.
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