To describe the characteristics of informal caregivers of terminally ill (hepatic, cardiac, and renal failure) patients and their care recipients and to examine the relationship between depression, anxiety, and burden among informal caregivers.
This was a cross-sectional study, in which 51 caregivers of terminally ill (hepatic, cardiac, and renal failure) patients were recruited from among inpatients of Internal Medicine Department, Kasr Al Aini, Faculty of Medicine, from September 2011 to April 2012. The patients were subjected to a Caregiver Questionnaire, Hamilton Anxiety Rating Scales, and Hamilton Depression Rating Scales, and the Modified Caregiver Strain Index was determined.
Most of the caregivers experienced high levels of burden, severe anxiety, and mild depression. Several factors showed a statistically significant correlation with caregiver burden, anxiety, and depression including the care recipient’s functional status, personality changes, mental functioning, the presence of comorbidity, the Palliative Prognostic Score, being the main caregiver, duration of caregiving, the caregiver’s employment status, perceived health, and impact on social activities. Caregiver burden, anxiety, and depression were significantly correlated.
Caregivers of terminal organ failure (hepatic, cardiac, and renal) patients experience high levels of burden, severe anxiety, and mild depression. Predictors of anxiety, depression, and burden include being the main caregiver, duration of caregiving, the caregiver’s employment status, perceived health, and impact on social activities.
Executive function (EF) develops throughout childhood and adolescence. Up to half of youth with attention deficit hyperactivity disorder (ADHD) show executive dysfunction. Reading disability has a comorbidity with ADHD of 20–40%. Adequate reading comprehension depends on higher cognitive skills beyond word decoding.
The aim of this study was to investigate EFs and reading abilities in a group of primary school children with ADHD [intelligence quotient (IQ)≥85] and whether they differ with sex.
A total of 30 Egyptian boys and 30 girls aged 8–12 years diagnosed with ADHD were compared with 40 healthy matched controls in terms of clinical assessment of reading skills, comorbidites, IQ, ADHD symptoms using Conners’ Parent Rating Scale-Revised-Long version (CPRS-R-L), EFs using the Wisconsin Card Sorting Test (WCST), and metacognitive reading using the Metacognitive Reading Comprehension Scale.
In total, 50% of ADHD cases showed the combined type, 31.7% the predominantly inattentive, and 18.3% the predominantly hyperactive type, with a significant gender difference (P=0.007). Patients had significantly higher scores in all CPRS-R-L scales, except for the anxious–shy subscale. Boys had higher means in the ‘hyperactivity’, whereas girls had higher means in the ‘cognitive problems/inattention’ scale. Male and female patients did not differ in comorbid learning disabilities but differed in conduct disorder and depression. Patients scored significantly lower on all WCST indices, except the first trials (P<0.001). Girls with ADHD made more errors, P=0.050, and completed less number of categories than boys, P=0.024. EF did not correlate with the hyperactivity subscale of CPRS-R-L. It correlated with the cognitive problems/inattention subscale in male and female patients. The Metacognitive Reading Comprehension scores differed significantly between the children with ADHD and the controls (P<0.001). None of the WCST indices predicted the Metacognitive Reading Comprehension total score. The total score was predicted only by the CPRS-R-L N scale (DSM-IV total), but not by its other subscales, IQ scales, sex, or age.
Children with ADHD have lower EF and reading abilities than controls. Executive dysfunction is related to inattention and not to hyperactivity. No robust differences in EF can be attributed solely to sex. Reading and metacognitive reading dysfunctions showed no gender difference.
Clinical studies have shown greater sex differences in symptoms of schizophrenia, with men having more negative symptoms than women, which may be related to the action of the reproductive hormones.
The aim of this study was to determine the relationship between negative symptoms and the plasma levels of testosterone and dehydroepiandrosterone sulfate (DHEAS) in male patients with schizophrenia.
The participants were 50 male patients with chronic schizophrenia. The psychopathology of the patients was assessed using the Positive and Negative Syndrome Scale (PANSS). The Calgary Depression Scale for Schizophrenia (CDSS) and the Drug-induced Extrapyramidal Symptoms Scale (DIEPSS) were also used to exclude the effects of depression or drug-induced extrapyramidal symptoms.
The PANSS negative scores showed a significant inverse correlation with the serum testosterone levels without a correlation with serum DHEAS.
This study indicates that testosterone but not DHEAS may play an important role in the severity of negative symptoms in male patients with schizophrenia.
Electroconvulsive therapy (ECT) is an effective treatment for psychotic disorders with relatively few side effects and rapid onset of action. Factors that may predict patients’ responses to ECT need to be explored.
The aim of the study was to investigate the responses of an inpatient group of psychotic (schizophrenia and schizoaffective disorder) patients to ECT administration and the factors favoring better response.
Eighty patients with schizophrenia and schizoaffective disorder indicated to receive ECT were selected from among the inpatients of El-Minia Psychiatry Hospital. Psychiatric examination by completion of a psychiatric sheet, full medical examination, and necessary investigations for anesthesia fitness were conducted for all patients. The Brief Psychiatry Rating Scale was used to assess patients’ symptoms before initiation of ECT, after undergoing three sessions, and after termination of the ECT course (6–8 sessions).
Response to ECT was similar among different age groups in both male and female patients. Patients’ responses to treatment differed according to their specific diagnosis and according to the duration of the current episode or exacerbation of psychotic illness before ECT administration.
Age and gender of patients with schizophrenia and schizoaffective disorder do not play a role in determining their response to treatment with ECT. Patients’ specific diagnoses and the duration of the current episode or exacerbation of psychotic illness before ECT administration are important factors in determining the response of psychotic patients to ECT.
Egypt experienced its first nationally televised antistigma campaign in 2007. This independent study aims at a scientific evaluation of the potential benefits of this campaign.
Two educational clips lasting 1 or 2 min each were aired daily on prime time television between 1 and 31 October 2007. Five messages were relayed as the clip rolled on. A specially designed questionnaire covering six areas was used; these included demographics, identifying those who have seen the clips, memory and opinion about each message, stigma-related attitudes, and behavior toward the mentally ill persons. Twenty mental health workers with experience in field work ranging in training from 1 to 13 years received two training sessions. The questionnaire was piloted on 82 participants and subsequently modified. A total of 3000 participants who consented to being interviewed were selected to participate. The data of 2274 participants from the Greater Cairo region are reported in this study (75.8%).
The study sample is more representative of the younger, as only 21% of the sample were above 46 years, educated, as only 18% were illiterate, married, as 55% of the sample were married, and employed sections of the population. A total of 55% reported that daily life stressors were the cause of mental illness. Only 17% of the study sample actually acknowledged seeing the antistigma adverts (campaign exposed, CE) and 83% were campaign unexposed. There were no statistically significant demographic differences between both groups. Among those who saw the campaign adverts, a significant proportion reported a number of positive effects on attitude and behavior. However, when CE and campaign unexposed participants were compared, no statistically significant differences emerged. A total of 50% of the participants remembered that mental illness is curable. The question that psychiatric patients are dangerous to self or others showed a statistically significant difference between participants who were CE and those who were not exposed.
The public were willing to express their opinions as they showed significant cooperativeness and validity of their answers, especially those exposed to the campaign. The television is the medium of choice that the public prefer is the evidence stated in the paper. The antistigma media campaign leads to changes in the attitude of participants who are exposed to mental illness. Positive messages influenced attitude change more.
Bipolar disorder in adolescents is often referred to as juvenile bipolar disorder. A peak in the prevalence of bipolar disorder has been documented between the ages of 15 and 19 years. Wide-ranging neuropsychological deficits have been found in many studies of juvenile bipolar disorder. Persistent neuropsychological deficits present in the euthymic state suggest that such deficits could be vulnerability trait markers of the illness.
To identify and assess cognitive functioning in euthymic adolescents diagnosed with bipolar disorder.
A case–control cross sectional study, in which 30 euthymic bipolar adolescents were recruited from the psychiatric adolescent clinic of Kasr al Ainy and compared with 30 healthy controls.
The Hamilton Rating Scale of Depression, the Young Mania Rating Scale, the letter cancellation test, the digit span and digit symbol/coding tests, the Bender gestalt test and the Wisconsin card sorting test were used.
Cases had significantly higher mean scores than controls in the letter cancellation test and its omission errors as well as in the perseverative errors of the Wisconsin card sorting test, and lower mean scores in the digit span, digit symbol coding and the Bender gestalt tests. There was a significant positive correlation between the number of omission errors on the letter cancellation test and both of the number of manic episodes and the age of onset of the illness.
There are neuropsychological deficits in the areas of sustained attention, set shifting, processing speed and visual and auditory short-term memory in euthymic bipolar adolescent patients, type I. There is a significant correlation between the number of manic episodes as well as age of illness onset and sustained attention.
The new Egyptian law for the care of the mentally ill has set strict criteria specifying the circumstances under which a person can be involuntarily detained in mental health institutions. The New Law does not specify whether addiction, as a psychiatric disorder, should be treated differently from other psychiatric disorders. Since the law was decreed by Parliament, the number of admissions of patients with drug addiction has reportedly declined.
To explore the knowledge and attitude toward the New Law ‘Law for the Care of the Mentally Ill Patient’ (71/2009) among service providers, patients, and patients’ relatives and how it is perceived to have affected the service to addiction patients.
A total of 505 patients with substance misuse, 213 relatives, and 172 substance misuse healthcare workers (providers) were assessed using specially designed questionnaires.
More than 90% of service providers had heard about the new mental health law in Egypt. More than 50% of substance users and their relatives were not aware of it. About two-thirds of the patients agreed with provisions of the New Law as they relate to addiction, whereas more than two-thirds of service providers did not. Attribution of illness affected patients’ agreement with involuntary admission. More patients who agree to enforcing treatment view addiction as an illness (72 vs. 60%, &khgr;2=6.79, P=0.009). There is a dominant perception that the law does not allow involuntary admission of addiction patients for treatment (about 80% of service providers and 87% of relatives). Sixty-four percent of patients in this sample agreed on involuntary treatment for a period of time until patients can make rational decisions about their treatment and 69% of the patients’ relatives believed that the law needs to be modified to allow involuntary admission for addiction patients.
There are considerable ambiguities about the regulations of commitment for treatment as well as the duration of treatment and discharge for patients with addiction problems under the new mental health law (71/2009). This is only matched by an overall negative attitude of the studied stakeholders, especially service providers, which may be attributed in the latter case to a large gap in training.
High levels of homocysteine are associated with vascular disease, changes in the levels of monoamine neurotransmitters and depression. A plausible hypothesis for these associations is that high homocysteine levels are implicated in vascular disease and neurotransmitter deficiency, which are in turn linked to depression.
To investigate the association between elevated homocysteine levels and depressive symptoms in patients with ischaemic heart disease (IHD).
Eighty patients with a confirmed diagnosis of IHD were consecutively selected in a cross-sectional study from the inpatient and outpatient cardiology department of Kasr-Al-Ainy hospital. All IHD patients were diagnosed according to the criteria of the American College of Cardiology. Depression was evaluated using the Present State Examination-10 Short English–Arabic Version and the Beck Depressive Inventory. The serum level of homocysteine was determined using the chemiluminescent technique.
Thirty-six ischaemic heart patients (45%) had depressive disorders. Depressed patients were older and had a longer duration of the IHD. The level of homocysteine was higher in depressed patients (P=0.098). Positive correlations were found between age and the serum level of homocysteine (P=0.028) but no correlations were found between the serum level of homocysteine and the severity of depression. Sleep disturbances correlated significantly with homocysteine levels irrespective of age.
Depressive symptoms are common in IHD patients, especially patients with prolonged duration of the disease. They are more apparent in IHD patients at times of emergency and intervention. In IHD patients, the serum level of homocysteine is associated with the occurrence of vegetative depressive symptoms.
The aim of the current study was to assess the relation between working memory dysfunction and clinical and MRI findings in relapsing remitting multiple sclerosis.
This study was conducted on 50 patients with clinically definite relapsing remitting multiple sclerosis, they were recruited from the Outpatient Clinic of Alexandria University Hospitals; and 25 healthy controls matched for age, sex, and educational level. All participants were subjected to neuropsychological assessment that included: digit span, visual span, N-nack task, and Wisconsin card sorting test. The patient group was further subjected to: Expanded disability status scale (EDSS) and brain MRI.
Clinically, the present study found no statistically significant correlations between working memory dysfunction and age, age at onset, sex, number of relapses, affected functional system, or EDSS status. Alternatively, there were statistically significant positive correlations between working memory dysfunction and the duration of illness.
This study suggests that according to the resources utilized by cognitive tasks, working memory tasks may be classified into high-demanding working memory tasks (2-back task and WCST) and low-demanding working memory tasks (1-back task and digit and visual span), and in relapsing remitting multiple sclerosis working memory dysfunction includes mainly high-demanding working memory tasks.
To study sexual behavior among substance users, to find an association between substance use and risky sexual behaviors, and to determine whether there is an association between personality traits and risky sexual behaviors among substance users.
Our participants (100) were divided into two groups: group 1 (cases) included 50 individuals (diagnosed with substance abuse according to the DSM-VI criteria) recruited from the Kasr El Aini psychiatric inpatient ward and group 2 (controls) included 50 normal control individuals, matched for age, sex, and socioeconomic status. All patients were men, ranging age from 18 to 40 years, were taking substances for at least 6 months, and all of them could read and write. Those with a comorbid axis I diagnosis were excluded from the study. Both groups were subjected to a full psychiatric sheet, risk assessment battery (RAB), and the Eysenck personality questionnaire. The Addiction Severity Index was determined for cases, urine sampling was carried out using drug screening strips, and a laboratory test was performed for HIV and hepatitis C virus detection.
Both groups showed nonsignificant differences in terms of age, education, employment, education, and social status. The most prevalent substance used was tramadol (96%), followed by cannabis (72%) and heroin (58%). Hepatitis C virus infection was detected in (16%); none of the patients had HIV (AIDS). There were statistically significant differences in extroversion and neuroticism between the cases and the controls. There was a statistically significant difference between the cases and the controls in terms of the sexual subscale of RAB. There was a significant correlation between psychoticism and criminality subscales in Eysenck Personality Questionnaire and the RAB in the case group.
Patients with substance abuse have more sexual risk than normal controls. Sexual risk is not related to the severity of addiction, but to psychoticism and criminal behavior of personality.
Central auditory processing disorders and attention deficit-hyperactivity disorders (ADHD) have become popular diagnostic entities for school-age children. P300 (P3) event-related potential (ERP) putatively reflects central auditory dysfunctions associated with ADHD.
Forty children with a diagnosis of ADHD according to Diagnostic and Statistical Manual of Mental Disorders, 4th ed. and 39 normal children were included in the study and were subjected to P300 ERP, audio-vocal items of Illinois test of psycholinguistic abilities.
This study found a significant difference in P300 latency, amplitude, and most of the audio-vocal subtests between the patients and the controls. This difference was obvious in older children for the Illinois test, but was not observed in P300 results.
There was a CAPD in ADHD children as indicated by decreased amplitude of P300 and prolonged latency in such children.
The present study was carried out to investigate why psychiatric and psychological examinations are neglected during periodical medical examinations for football referees.
A total of 42 certified male referees were randomly selected from the Sports Medicine Specialized Center situated at Nasr City, Cairo Governorate, Egypt. All participants were registered at the African Confederation of Football. Male adult referees with ages ranging from 29 to 43 years were included in the study. Questionnaires related to the demographic personal characteristics, anxiety, physical health, stress, burnout, and depression were filled out by the participants.
The mean age of the participants was 40±3.35 years. Of the participants, 34 were unmarried and eight were married; 32 participants did not have children and 10 did. A total of 36 participants had recieved higher education and six recieved only high school education. Participants were under moderate training schedules of 5 sessions/week of 1½–2 h each and had moderate years of experience (30–50 matches/year). With regard to the Burnout Anxiety Inventory, 63.3% of the participating referees showed no signs of anxiety, 18.4% were at borderline, 15.9% showed mild signs, and 1% presented with moderate records. With regard to the mind over mood depression scores, 35 participants showed no signs, whereas only two showed low signs. The Beck Depression Inventory scores of all participants was in the range of 0–7, that is, they had normal levels of depression. The physical wellness scores of 31 participants were recorded as excellent, whereas five recorded only average scores. With respect to the life stress scores, 67% of participants had normal life stress scores compared with 33% who were more prone to suffer or experience illnesses or accidents from life stress incidents. The Burnout Inventory scale revealed that 47.05% of participants had little signs and 52.95% showed low signs of burnout, with none being at risk. The Maslach results were also in concordance, according to which only one referee suffered from a burnout.
Thus, it may be deduced that, although the present levels of burnout may not be high, there is always potential for it to increase. Thus, programs on burnout are suggested to be included in training courses for referees to prevent the start of symptoms. It is therefore recommended that physical checkup be supplemented with psychiatric and psychological examinations in the periodical assessments of physical health for football referees.
Schizophrenia is a chronic disease of the body and mind that affects 1% of the population. About one-fifth to one-third of all patients with schizophrenia do not respond adequately to drug treatment and that have been consistent over time. Definitions of this group have long been hampered by a lack of consistency with confusion with chronicity. Clozapine has shown superior efficacy and this has been replicated consistently.
Because of the high prevalence, importance, and inconsistency of schizophrenia resistance, the current study aimed to (a) examine the differences between resistant and nonresistant schizophrenic groups in chronic long-stay patients, (b) study the clinical profile of the clozapine-resistant group in comparison with others, and finally (c) determine the predictors of resistant schizophrenia.
This was a retrospective and cross-sectional study of 95 patients with chronic schizophrenia or schizoaffective disorder, admitted in long-stay hospital wards at the Psychological Medicine Hospital (Kuwait). They were interviewed by Structured Clinical Interview for DSM-IV and diagnosed according to the Diagnostic and Statistical Manual of Mental Illness, 4th ed. criteria. Patients were assessed by the Brief Psychiatric Rating Scale (BPRS), Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Severity (CGIS) scale, and Mini-Mental State Examination. Sociodemographics, clinical characteristics, and the history of treatment were determined. Schizophrenia resistance was formulated according to modified Kane’s criteria, which include the following: BPRS score of at least 45; two or more of positive symptoms score of at least 4 (suspiciousness, hallucinatory behavior, conceptual disorganization, and unusual thoughts); CGIS score of at least 4 (moderate to extremely ill); previous failure on two antipsychotic trials of different categories of the full therapeutic range (≥1000 mg of chlorpromazine equivalent) and for at least 3–6 months’ duration; and finally, no preceding good function for at least 2.5 years in the last 5 years.
Thirty-six patients fulfilled the criteria of schizophrenia resistance (37.8%). There was a significant shift in the drug regimen prescribed, with the prescription of more atypical antipsychotics, especially clozapine, with repeated failure of previous drug trials. The only significant difference between the resistant and the nonresistant group was in the psychopathological severity, indicated by higher scores on PANSS, and CGIS scores. Age younger than 40 years and early onset age of schizophrenia (<20 years) were powerful predictors for schizophrenia resistance; other sociodemographic and clinical characteristics lacked significant predictive value.
Younger age and early-onset schizophrenia are considered poor prognostic factors. Early aggressive management of schizophrenia may help eliminate chronicity as well as resistance. Research on the biological predisposition for schizophrenia resistance including the clozapine resistance group is required.
Alzheimer’s disease (AD) is a progressive neurodegenerative disease. The potential effect of nutrition on development of AD has become a topic of increasing scientific and public interest. High intakes of saturated and trans-unsaturated (hydrogenated) fats were positively associated with increased risk for AD, whereas intakes of polyunsaturated and monounsaturated fats were protective against cognitive decline in the elderly. Would foods rich in these fatty acids delay cognitive decline in elderly people who are vulnerable to AD?
The aim of this study was to measure the concentration of plasma fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) in patients with AD and study the relationship between foods rich in these fatty acids and severity of cognitive decline.
A total of 62 individuals were screened for cognitive decline using the mini-mental status examination test and were diagnosed with AD using the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., diagnostic criteria. Data on nutrition were obtained and blood samples were withdrawn to determine the plasma levels of the fatty acids EPA and DHA.
Patients with late-onset AD have significantly higher intake of food and food supplements containing both fatty acids.
High intake of food and food supplements rich in EPA and DHA fatty acids may delay the onset of AD.