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   Table of Contents - Current issue
September-December 2017
Volume 38 | Issue 3
Page Nos. 131-192

Online since Wednesday, October 25, 2017

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Assessment of risk for cardiovascular disease in a sample of schizophrenic patients Highly accessed article p. 131
Shereen M Abdel Mawella, Hoda A Hussein, Talal A Mohamed, Reda Roshdy, Mamdouh M ElGamal
Background Interest in cardiovascular diseases (CVD) in schizophrenic patients has grown recently because of documented increased mortality. Causes of this mortality are most probably somatic diseases, particularly CVD. We aim to assess the risk for developing CVD in schizophrenic patients using C-reactive protein (CRP) and lipid profile by applying the Framingham Risk Score and correlate this risk with the severity of symptoms of schizophrenia. Patients and methods This is a cross-sectional study consisting of 62 schizophrenic patients who were recruited from the Kuwait Center for Mental Health inpatient departments. The structured Clinical Interview for DSM4 Axis of Disorders (SCID-I) and positive and negative syndrome scale were administered on all patients. Laboratory investigations for serum level of CRP, total cholesterol level, and high-density lipoprotein level were carried out. Cardiac risk was assessed on the basis of Framingham Risk Score. Results Twenty-one percent of patients had a risk for developing CVD as per the Framingham Risk Score. All patients had intermediate to high risk of developing CVD on the basis of baseline CRP. There was sex-related difference in cardiovascular risk as women had no risk, whereas 25% of men had a risk for developing CVD. There was no significant correlation between risk for CVD and severity of symptoms of schizophrenia. Conclusion Our study points to the measurement of CRP and screening of lipid levels as an improved method for identifying schizophrenic patients at risk for cardiovascular events.
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A study of personality disorders among patients with somatization disorder p. 138
Hiam F Elsaied, Rania A Hamed, Yared Belay
Background The fact that there is a high association between personality disorders (PDs) and somatization disorder (SD) is widely accepted, to the extent that many expert clinicians find themselves compelled to manage personality traits in patients with SD to obtain good treatment outcomes. This study was conducted to identify the distribution of all Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision (DSM-IV-TR) PDs among patients with SD who were referred from primary care settings. Patients and methods This case–control study was conducted from September 2014 to April 2015 and was approved by the Ethics Committee at Al Amal Psychiatric Hospital, in Almadina Almonawara, KSA. Demographic data including sex, age, marital status, and education level of the cases and controls were collected. SD was diagnosed according to the DSM-IV-TR, whereas PDs were measured using the Diagnostic Checklist for Personality Disorders. Results The ages of cases ranged from 32 to 50 years (mean: 39.21±6.45 years); 55.8% of the group was male and 67.3% was married; 924.2% of the participants were educated. There was no significant difference in sociodemographic characteristics. The incidence of PDs in SD patients was 63.3%, compared with 10% in controls [odds ratio (OR)=18.5294; 95% confidence interval (95% CI)=5.6686–60.5687]. The highest OR for PDs in patients with SD, compared with that in controls, was for paranoid personality (OR=18.2063; 95% CI=4.9595–66.8357), followed by obsessive personality (OR=16.5000; 95% CI=5.8373–46.6399), and histrionic personality (OR=9.0444; 95% CI=2.4677–33.1489). Conclusion PDs in Saudi SD patients is very high. The results were comparable to that found in British and American studies, supporting the theory of Lillienfield that SD should be grouped under Axis II disorders of the DSM system and not under Axis I. Paranoid, obsessive, and histrionic personalities were the most common PD subtypes in SD patients as regards ORs.
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A study of dental diseases in psychiatric patients: is there a relationship? p. 143
Ayman A Elhadad
Background Oral health is an integral part of general health. There is evidence that patients suffering from mental illness are more vulnerable to dental neglect and poor oral health. Patients and methods All patients attended the dental clinic in the Abha Psychiatric Hospital from the inpatient departments or the out patient department (OPD) clinics for adult psychiatry, and child and adolescence psychiatry clinics are registered through the computer system and the data were collected for the Hijri year of 1437. Results Male patients were more in number compared with female patients (444 vs. 110). In addition, the age group between 25 and 45 years was more affected by dental problems than other groups. Also, the chronic psychiatric patients with a long stay at the psychiatric hospital were more affected than the newly admitted ones. Conclusion Better coordination between medical, dental, and psychiatric unit administration is required to serve the needs of this group of patients.
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Association of executive dysfunctions and symptoms in a sample of bipolar affective disorder patients p. 147
Magda Fahmy, Wafaa Hagagg, Khaled Abd El Moez, Mona Elsayed, Sabry Elsayes
Background Executive functions are defined as the higher-level cognitive functions that are necessary to plan and execute goal-directed behaviors and may include cognitive flexibility, creativity, planning ability, abstract thinking, concept formation, and response inhibition. Recently, it has been shown that those with schizophrenia, as well as those with bipolar disorder, exhibit deficits in executive functions relative to controls. Executive function capability is an important predictor of the treatment, prognosis, and functional outcomes of these disorders. Patients and methods This cross-sectional study was carried out in Suez Canal University Outpatient Psychiatric Clinic. It included 60 patients with bipolar disorder type 1 (male and female). All studied patients were subjected to assessment of the manic symptoms using the total scores of Young’s Mania Rating Scale and the depressive symptoms using the total scores of the Hamilton Depression Rating scale by researcher. Assessment of cognitive functions was carried out by an expert psychologist using the Wechsler Adult intelligence Scale, Wechsler Memory Scale-III-Revised Hayling Sentence Completion Test, Trail Making Test, and the Wisconsin Card-Sorting Test. Result The results showed worsening in the executive function associated with manic than with depressive symptoms. Conclusion Manic symptoms had a significant effect on cognitive functions.
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Patterns of psychiatric symptoms in geriatric persons living in care homes p. 154
Mohamed Shawky, Ibtihal M.A. Ibrahim, Eman El-Sheshtawy, Mohamed Elsayed, Mohamed E El-Hadidy
Background The aging population possesses sociological problems that are usually associated with medical problems. Elderly persons ‘living in old age homes’ are expanding in numbers; are people in such settings prone to psychological stress rather than those living in community? Aim To assess the extent of mental illness in old age group living in care homes, and to determine the level of social support. Participants and methods A case–control study was conducted on 116 elderly individuals, who were divided into two groups − group A included 56 individuals living in old-age homes, and group B included 60 individuals living with their families (control group). All of them were subjected to the following: assessment of sociodemographic status and clinical diagnoses using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders scale, the Brief Psychiatric Rating Scale, and the Multidimensional Scale of Perceived Social Support (MSPSS). Results There was no significant statistical differences between both groups regarding the presence of a possible psychiatric disorder (P<0.05). In the case group, we found significant differences for factor neurotic (t=2.894), factor positive (t=4.633), and factor negative (t=8.893) compared with the control group. Conclusion Special care should be provided for the elderly living in old-age homes as they are more prone to psychiatric illnesses and have a higher risk for depression, less social support, and more severe isolated psychiatric symptoms.
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Correlates of brain derived neurotrophic factor in children with attention deficit hyperactivity disorder: A case-control study p. 159
Hala Taha, Eman Elsheshtawy, Soheir Ibrahim Mohamed, Omnia Al-Azazzy, Mohamed Elsayed, Salah Al Sayed Ibrahim
Background Brain derived neurotrophic factor (BDNF) appears to intervene in the pathogenesis and treatment response in Attention deficit hyperactivity disorder (ADHD), based on the conceptualization of ADHD as a neurodevelopmental disorder and the importance of the BDNF for normal neural development. Aim To estimate the difference in the serum level of BDNF in children diagnosed with ADHD and normal control, find its clinical correlates and to search which factors could predict abnormal level of BDNF. Subjects and methods A case control study was done on 35 child newly diagnosed untreated ADHD, control group of 30 healthy children. All were subjected to IQ test (Stanford-Binet), Conner’s test to assess severity of different symptoms. Blood sample to determine the level of BDNF. Results Serum level BDNF was significantly higher in children with ADHD (0.1596±0.0909 ngm). BDNF was positively correlated with cognitive problems (r=0.345) and negatively correlated with age and IQ (r=−0.399, −0.383 respectively). Predictors for high level of BDNF were age (beta=−0.368), IQ (beta=−0.368) and inattention (beta=0.422). Conclusion High serum level of BDNF in children with ADHD could have a role in the etiology of ADHD, affecting cognition and intelligence. The presence of inattention and low intelligence can predict high level of BDNF.
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Autistic traits in the offspring of schizophrenic patients: a cross-sectional study p. 164
Ghada M Salah El-Deen, Rehab S Mahdy
Background Recent research shows that for every kid who receives an actual autism diagnosis, there is another who has autistic traits including repetitive behaviors and communication problems. Aim The aim of this study was to detect the existence of autistic traits among offspring of schizophrenic patients in the age group from 4 to 11 years, and its association with the sociodemographic data. Patients and methods Sixty-three offspring of schizophrenic patients (who were diagnosed using DSM-IV) from 4 to 11 years of age (based on a pilot study) were selected using a systematic random sampling technique. The Autism Spectrum Quotient-Children’s version (AQ-Child) questionnaire was applied and medical, neurological history and examination, and psychological assessment were carried out for each child. Results According to the AQ-Child, the normal insignificant score of autistic traits ranges from 0 to 45 and no child lied in this category. About 55.6 % of the children scored below the cutoff point (46–75) and 44.4% of the children scored above the cutoff point (76). Conclusion The frequency of autistic traits was markedly high in the children of schizophrenic patients. No statistically significant difference was found between above and below AQ score groups as regards sociodemographic and clinical factors, except for socioeconomic status.
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Qualitative versus quantitative study of distress in a sample of young age breast cancer survivors p. 172
Mahmoud A Batrawi, Hanaa A El Sayed, Hoda A Hussein, Sherine M Abdel Mawella, Nagwan M Madbouly, Shereen M Fawzi
Context Breast cancer survivors suffer from distress that extends along a continuum: from common normal feelings of vulnerability to disabling psychiatric symptoms. Aim The aim of this study is to describe the ‘lived’ experience of distress in a sample of young breast cancer survivors using a person-centered approach, determine the coping mechanisms used, and the prevalence of anxiety and depression in these patients. Patients and methods This is a cross-sectional descriptive study in which 30 Egyptian female breast cancer survivors diagnosed between the age of 20 and 40 years were selected among the patients attending the outpatient clinic of the Oncology Department, Cairo University Hospitals. The Hospital Anxiety and Depression Scale was used to assess the prevalence of anxiety and depression among a sample of survivors and the Coping Processes Scale was used to determine the coping processes that they use in the face of their distress. A person-centered approach was used to determine the extent of their distress and gain a better knowledge of each survivor’s experience with cancer. Results The prevalence of anxiety was 70.0% and that of depression was 63.3%. There was a statistically significant negative association between acceptance and depression and a negative association between seeking information and social support and anxiety. Conclusion Each patient had different experiences and different stress-related cancer effects and management. Each patient is unique in her experience so we must listen to each patient.
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Metabolic syndrome in psychiatric patients (comparative study) p. 179
Fatma A Mousa, Hani H Dessoki, Sarah M El Kateb, Ahmed A Ezzat, Mohamed R Soltan
Background It is generally estimated that metabolic syndrome (MetS) is especially common in patients with severe mental illness, with a high prevalence ranging from 30 to 60% for schizophrenic and bipolar disorders, which predispose them to further medical complications up to premature death. Objective The aim of this study was to compare the prevalence of MetS in patients with major depressive disorder (MDD), schizophrenic patients, and healthy general individuals, and to assess the relation between cortisol levels and presence of MetS. Patients and methods The study included 120 participants (40 patients with drug-naive MDD, 40 patients with drug-naive schizophrenia, and 40 healthy individuals who served as the control group). Full history was taken. Blood pressure and waist circumference (WC) were measured and BMI was calculated. Laboratory investigations were carried out, including fasting blood glucose (FBG), serum triglycerides, serum high-density lipoprotein, and a morning level of serum cortisol. Results The study revealed a similar prevalence of MetS in the MDD and the schizophrenic group (27.5%) compared with a prevalence of 22.5% in the control group. The WC and the BMI were significantly higher in the MetS patients of the MDD and the schizophrenic group compared with those of the control group. FBG was significantly higher among MetS patients in the MDD group as compared with those in the schizophrenic and the control group. Cortisol level was significantly higher in MetS patients in the MDD and the schizophrenic group as compared with those in the control group. Conclusion The prevalence of MetS is higher in MDD and schizophrenic patients than in the general population, and is related to high WC, BMI, FBG, and serum cortisol. Hence, screening of such patients for metabolic disturbances is recommended.
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Erratum: Assessment of personality traits in a sample of opioid-dependent patients in comparison with nondependent men p. 192

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