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   Table of Contents - Current issue
Coverpage
May-August 2020
Volume 41 | Issue 2
Page Nos. 57-124

Online since Thursday, May 21, 2020

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REVIEW ARTICLE  

Review of the New Zealand adult attention-deficit hyperactivity disorder work by Moffitt et al. (2015) p. 57
Jeffrey C Marck
DOI:10.4103/ejpsy.ejpsy_32_19  
Despite a prevailing assumption that attention-deficit hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental disorder, no prospective-longitudinal study has described the childhoods of the adult ADHD population. Unexpectedly, the adult ADHD group did not show tested neurophysiological deficits in childhood or adulthood nor did they show polygenetic risk for childhood ADHD. Findings raise the possibility that adults presenting with the ADHD symptom picture may not have a childhood-onset neurodevelopmental disorder; thus, the disorder’s place in the classification system must be reconsidered, and research must investigate the etiology of adult ADHD.
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ORIGINAL ARTICLES Top

Comparative study of victimized Egyptian patients with schizophrenia, bipolar disorder, and major depression p. 61
Ahmed El Missiry, Eman Shorub, Doha El Serafi, Heba Fakher, Ramy Ali, Ahmed Adel Abdelgawad
DOI:10.4103/ejpsy.ejpsy_7_19  
Background Patients with severe mental disorders living in the community are liable to victimization and are considered a high-risk group. However, there is a lack of identification of victimization rate and factors associated with its occurrence among mentally ill patients. Objectives To explore the sociodemographic variables and clinical characteristics related to victimization of patients with schizophrenia, bipolar disorder, and depression. Patients and methods This was a cross-sectional comparative study that included 300 patients (100 patients for each disorder) who were recruited from the inpatient wards and outpatient clinics of the Institute of Psychiatry, Ain Shams University. They were subjected to the following: a designed questionnaire to obtain demographic data, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Axis I diagnosis (SCID I-CV), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI), and the Victimization Questionnaire (VQ). Results Overall, 43.3% of our sample reported being victimized in the past 12 months, with high victimization rate among depressed patients. It was found that all victimized patients were subjected to emotional victimization; however, patients with schizophrenia were exposed to higher rates of physical victimization (93.3%) and miscellaneous victimization (73.3%) in comparison with other groups. It was also found that 33% of patients with bipolar disorder and schizophrenia had been victimized by their parents, whereas 77% of depressed patients had been victimized by their spouses. Depressed women were the most likely to be victimized followed by male patients with bipolar disorder and patients with schizophrenia. Pattern of victimization was different among the study groups. Depressed patients were mainly perpetrated by their spouses, whereas patients with schizophrenia and bipolar disorder were mainly victimized by their parents. None of the patients reported the victimization events to police, friends, family members, or their physicians. Conclusion Our findings suggest that victimization is common among patients with severe mental illness, with high rates in depressed patients through their spouses. The clinicians should inquire about victimization during their routine assessment and should follow strategy to minimize revictimization of their patients.
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Psychosocial background of female and male convicted of Intimate Partner Homicide p. 71
Reda Ismail, Taghreed El Shafei, Shaimaa M Arafa, Fatema Aboalanwar
DOI:10.4103/ejpsy.ejpsy_42_19  
Background Homicide is an important cause of premature mortality globally, but evidence for the magnitude of homicides by intimate partners is scarce and hampered by the large amount of missing information about the victim–offender relationship. Intimate partner violence is a serious, preventable public health problem that affects millions of Americans. Violence between intimate partners ranges from verbal abuse to physical violence, with lethal outcome at the far end of the spectrum. The term ‘intimate partner violence’ describes physical, sexual, or psychological harm by a current or former partner or spouse. Partner homicide differs from other form of mass murder in that the murder kills a family member who is a loved one rather than an anonymous person. Aim To identify sociodemographic and criminological characteristics in perpetrators of intimate partner homicide (IPH); to identify personality traits of those who commit IPH; to identify to what extent IPH experienced mental illness and mental disorder, before or in connection to the offense; and to investigate the associated risk factors to commit homicide of an intimate partner, such as substance use. Patient recruitment After taking a written approval from Al-Azhar University Faculty of Medicine Ethical Committee and from Ministry of Health General Secretariat of Mental Health Training Department and an oral consent from the offenders, a sample was taken of all male (35) and female (two) individuals, aged 18 years or older, who were convicted of homicide of their intimate partner. These were new admitted cases who were evaluated after being referred from public prosecutor to check for the mental state of the offenders. Methods Each offender was subjected to the following: (a) clinical psychiatric assessment, (b) Homicide Questionnaire, (c) standardized psychiatric assessment by Mini International Neuropsychiatric Interview PLUS, and (d) standardized psychological assessment by Eysenck Personality Questionnaire-Revised, Wechsler adult intelligence scale, and the Alcohol, Smoking, and Substance Involvement Screening Test. Results The result revealed that sex is a risk factor for partner homicide, as of 37 offenders, only two were females compared with 35 males. Abusive parent and violence within the family were the most common risk factors inside the families. Overall, 51.4% of IPH offenders were highly educated, with significant relation between educational level and the crime, and most of them were employed at the time of crime. Of the sample, 32.4% were diagnosed as having antisocial personality disorder, 67.6% schizophrenia, and 32.4% mood disorders. Moreover, 29.7% had a past history of previous admission in a psychiatric hospital, and 40.5% were taking psychiatric medication. All offenders are tobacco smokers, and the most common substances used were cannabis, then opioid and sedative, and the least was alcohol beverages. Sharp instruments were the most common weapon used by the offenders, and the crime usually was done at night.
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Acceptance and action questionnaire − substance abuse: translation into arabic, content validity and reliability p. 82
Ibrahem H Rashed Elkalla, Abdel-Hady El-Gilany, Mohammed El Wasify
DOI:10.4103/ejpsy.ejpsy_46_19  
Background Substance abuse is a chronic illness with complex and intervening treatment process. It is important to have measurement scale to help in the follow-up of individuals throughout the therapeutic and rehabilitation process. It helps to make patients confident in treatment phases and assist health professionals to track their clients’ progress, measuring acceptance and action towards therapeutic process, and its effect on commitment to treatment plan is essential for patients with substance use disorder. Objective The aim was to validate the Arabic version of acceptance and action questionnaire − substance abuse (AAQ-SA) and assess reliability of this questionnaire and translation into Arabic. Patients and methods AAQ-SA has been translated into Arabic. Methodological design was used to investigate content validity index (CVI) reported by eleven expert jurors. Judgment was done by eight psychiatry professors, one psychiatry assistant professor, one psychiatry consultant and an assistant lecturer of psychology, and then, the Arabic version was distributed among 45 substance abuse patients in recovery. Among them, six patients did not attend the second interview. A total of 39 rehabilitated substance abuse patients with remission period from 3 weeks to 28 months completed their interviews. Intraclass correlation coefficient ICC (inter-rater and intrarater agreement) and Cronbach’s α reliability coefficients were addressed to investigate reliability. Results The I-CVI Item CVI for relevance ranged from 0.717 to 1.0 and for clarity from 0.636 to 1.0. The S-CVI Scale CVI was 0.873 for both relevance and clarity. On the contrary, the e-CVI expert CVI ranged from 0.667 to 1.0 for relevance and from 0.778 to 0.944 for clarity. All inter- rater and intrarater correlation coefficients are positive and significant and ranges from 0.48 to 0.92 for inter-rater and from 0.44 to 0.9 for intrarater. The inter-rater and intrarater correlation coefficients of the total score were 0.83 and 0.85, respectively. The total Cronbach’s α of the total scale was 0.92. Cronbach’s α for value commitment and defused acceptance are 0.92 and 0.91, respectively. The mean total scores of pretest rater 1, pretest rater 2, and post-test rater 1 were 68.6±15.7, 70.7±17.9, and 70.6±17.1, respectively, with no statistically significant differences. Conclusion In conclusion, AAQ-SA Arabic version based on the results is valid, reliable, and stable, and its translation is convenient to the culture. More research studies should be done in the field of therapy and rehabilitation for patients with addiction problems in Egypt and the Arabic world.
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Comparing cognitive dysfunction in euthymic patients with first episode and recurrent episodes of major depression p. 89
Hanan M.E Azzam, Ahmed A El Missiry, Nesreen M Mohsen, Karim A Aziz, Heba F Hendawy, Abdel Gawad Khalifa, Amina A.M Negm
DOI:10.4103/ejpsy.ejpsy_47_19  
Background Euthymic patients with major depressive disorder demonstrate cognitive deficits in executive function, attention, and memory, but to date, limited amount of work has compared patients with first-episode depression (FED) with patients with recurrent episodes of depression (RED), and no studies have been conducted in the Egyptian population. Aim The aim was to compare cognitive functions between euthymic patients after FED and patients with RED. Participants and methods A total of 60 euthymic participants (30 with FED and 30 with RED) were administered a battery of cognitive tasks, including the Wechsler Adult Intelligence Scale, Wechsler Memory Scale, and Wisconsin Card Sorting Test. Results Patients with RED performed significantly poorly than patients with FED on tasks measuring abstract thinking, verbal memory, working memory, verbal immediate recall, and executive functions (which included tasks for conceptualization, cognitive flexibility, shifting, planning, and sustained attention). Conclusion There are significant differences in performance on cognitive functions between euthymic patients with FED and RED across memory tasks and executive functions but with relative sparing of tasks of general intelligence. Poorer cognitive functions may possibly be associated with recurrent episodes.
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Prevalence of obsessive compulsive spectrum disorder in patients seeking dermatological consultation p. 97
Samar S Motawa, Hassan Abd El Raheem Fayed, Abeer Abdelaziz, Nisrin Elsaadouni, Mahmoud Elwasify
DOI:10.4103/ejpsy.ejpsy_49_19  
Background Previous studies have reported the relation between some dermatological presentations and obsessive compulsive disorder (OCD). The aim of this study is to estimate the prevalence of OCD in patients with dermatological disorders attending Mansoura University Hospital, as well as describe the different dermatological presentation of the OCD and possible association between dermatological lesions and the severity OCD. Patients and methods The study was conducted on 500 patients at the Dermatology Outpatient Clinic of Mansoura University. The patients were assessed by Diagnostic and statistical manual of mental disorder V OCD criteria and the Yale Brown Obsessive Compulsive Scale, Arabic version for assessment the severity. Results Among 500 patients, 55 (10.6%) were diagnosed as having OCD spectrum, comprising two (3.8%) with skin excoriations, 14 (26.4%) with trichotillomania, two (3.8%) with body dysmorphic disorder, 0 (0.0) with hoarding disorder, and 37 (69.9) with OCD. Conclusion There was an increased prevalence of OCD spectrum disorders among patients with dermatological disorders. Detection and diagnosis of comorbid psychiatric problems with skin disease is critical to the optimal management of psychodermatological disorders.
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Prevalence and determinants of suicidality among medical students in Oman p. 103
Mohamed El-Sayed, Miriam A Simon, Zaid Al-Khabouri, Narjis Al-Mandhari, Ahmed M El Shamy
DOI:10.4103/ejpsy.ejpsy_1_20  
Objective The aim was to explore the stress sources and determine the prevalence of suicidal ideation among medical students and its association with demographic characteristics and stress factors. Patients and methods A cross-sectional study was conducted on Oman Medical College students of preclinical and clinical years. Data were collected using a semistructured questionnaire with sections on sociodemographic factors, stress factors, and assessment of suicidality. Prevalence of suicidal ideation and behavior in the past was assessed with the help of questions in the General Health Questionnaire pertaining to suicide. Results A total of 314 medical students participated in the study. The average age of the participants was 22.13 years. Most students who participated in the study were females (76.4%). Regarding the year of study, 66.6% of students belonged to the preclinical years, whereas 33.4% of participants were currently undergoing clinical training. The higher level of stress was associated with problems related to nutrition, poor sleep, emotional problems, and difficulties in the study courses. Overall, 33.4% of medical students had a lifetime prevalence of suicidal ideation. It was also seen that the rates of making a suicidal plan (8%) or attempting suicide (4.5%) were lower. Results also indicate that the prevalence of suicidal ideation is higher among students in the preclinical years when compared with students in clinical training. Conclusion The prevalence of suicidal ideation and attempts among medical students was in the higher range in international comparison. Medical students are future doctors who are in need to be protected from avoidable causes of morbidity and mortality including suicide. There is a necessity for further investigations to identify the core sources of emotional distress and academic burden in this population and then propose strategies consequently.
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The prevalence of depression, anxiety, and stress among a sample of first-year medical students p. 111
Safaa M Hammouda, Taghreed M El Shafie, Eman El Shennawy
DOI:10.4103/ejpsy.ejpsy_3_20  
Background Stress in medical education has become a global phenomenon. The excessive working hours, competitive academic environment, lack of recreational activities, lack of peer support, staying away from home, and financial problems are common reasons of depression, anxiety, and stress in medical schools. The objective of this study is to examine the prevalence of depression, anxiety, and stress among a group of Egyptian medical school students from the Faculty of Medicine, Pharmacy, and Dentistry (100 students from each). Patients and methods A structured self-generated questionnaire was used for identifying demographic and social characteristics and risk factors of psychological illness among those students, and also the Arabic short version of the standardized Depression Anxiety Stress Scale 42 was applied. Results The students of Faculty of Medicine showed the highest percent of depression (96%), anxiety (98%), and stress (76%), whereas the students of faculty of pharmacy showed lower percent of depression (70%), anxiety (81%), and stress (59%). Most medical students (medicine 42%, pharmacy 33%, and dentistry 41%) had moderate depressive symptoms, whereas 34% of students of Faculty of Medicine had severe depressive symptoms and 45% of them had extreme anxiety. Most of the students came from rural areas and lived outside home away from their families. Conclusions The high prevalence of depression, anxiety, and stress symptoms among medical students is alarming. This shows the need for primary and secondary prevention measures, with the development of adequate and appropriate support services for this group.
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Sleep disorder among shift work nurses and its impact on their quality of life at Al Ahrar Governmental Hospital, Zagazig City, Egypt p. 117
Amani S Ahmed, Rania A Hamed
DOI:10.4103/ejpsy.ejpsy_6_20  
Background Shift work sleep disorder is a crucial occupational health problem for nurses that not only causes health problems for them but also affects patient’s safety and job performance. Objective The aim was to assess the magnitude of sleep disorders among shift working nurses at Al Ahrar Governmental Hospital and to determine the associations between sleep disorders and work characteristics and their impact on quality of life. Materials and methods A comparative cross-sectional study was conducted among 180 nurses. Data collection was done by using Pittsburgh Sleep Quality Index to measure the quality of sleep, insomnia severity index to measure self-perception of insomnia symptoms, Epworth sleepiness scale to measure daytime sleepiness symptoms, and functional outcome of sleep questionnaire to measure the quality of life. Results It has been estimated that 73% of shift work nurses are suffering from poor subjective sleep quality compared with the morning shift group (20%) and 60% of shift work nurses had sleep disturbances compared with 36.7% among the morning shift group with a significant difference (<0.01). Of the shift work group 31.1% was suffering from daytime sleepiness and 11.1% of them was suffering from moderate severity insomnia compared with 8.9% of the day working group (P<0.001). The overall average score of functional outcomes of sleep quality was higher among the day working group (17.62±1.07) compared with (16.23±1.4) of the shift work group (P<0.001). Conclusion Shift work sleep disorders are prevalent and important health concerns among nurses. Nurses’ sleep disorders can affect the patient’s safety by affecting the nurse’s performance and care quality. Therefore, planning for improving work shift schedules by hospital administration can be helpful and the use of day rest after night shift work can improve the sleep quality of nurses.
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