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ORIGINAL ARTICLES
Psychosocial characteristic of female victims of domestic violence
Khaled Abd El Moez, Mona Elsyed, Ismail Yousef, Amany Waheed Eldeen, Wafa Ellithy
May-August 2014, 35(2):105-113
DOI:10.4103/1110-1105.134197  
Background Domestic violence against women is prevalent in every country, cutting across boundaries of culture, class, education, income, ethnicity, and age. Domestic violence against women results in far-reaching physically and psychological consequences. Although the impact of physical abuse may be more visible, psychological scarring is harder to define and report. Women who remained in violent relationships were considered to have morbid characteristics, which included the need to be hurt and punished. Objective This work was carried out to determine the psychosocial characteristics of women exposed to domestic violence. Materials and methods The current study is a cross-sectional controlled study. In this study, psychological characteristics, using the Minnesota multiphasic personality inventory scale (MMPI) personality inventory scale, of 44 women (who presented to the Emergency Unit of Suez Canal University Hospital) complaining of physical abuse of domestic origin were evaluated after taking their consent, and were compared with 22 women with no history of domestic violence. Results The psychological assessment to 44 female victims of domestic violence according to the MMPI personality inventory scale showed a significant difference between the study and the control group in depressive traits, psychopath traits, and psychotic traits. Conclusion Our finding suggested that the study group showed more depressive, psychotic, and psychopathic manifestations than the control group and more studies need to identify whether this results were related to abuse or character logical traits in those women.
  6,086 288 -
Dynamic aspects of obesity in a sample of Egyptian women
Magdy M Arafa, Hoda A Hussein, Wafaa A Fahmy, Shereen M Abd El Mawella, Shimaa M Nassar
January-April 2014, 35(1):14-21
DOI:10.4103/1110-1105.127265  
Introduction Obesity is actually conceptualized as a complex, multifactorial disorder, in which genetic, psychological, physiological, environmental, and socioeconomic factors play a major role. The nature of the relationship between obesity and psychological distress continues to be debated by researchers and clinicians. Some studies have suggested a relationship between being overweight and having increased psychiatric symptoms, and an association between obesity and several lifetime psychiatric disorders, whereas other studies have found no association at all. Aim It is hypothesized that there are differences between obese and normal-weight women in different dynamic aspects; therefore, here, we compare them in terms of defense mechanisms, self-esteem, and body image. Also, we attempt to explore the association between the degree of obesity and the severity of psychopathology. Patients and methods This was a case-control cross-sectional study, in which a group of 40 obese women seeking treatment for obesity were recruited from the National Nutrition Institute (BMI ≥ 30), and a group of 40 healthy normal-weight women were recruited from among the general population (control sample). They were subjected to the following psychometric procedures: Symptom Check List-90-R (SCL-90-R), Body Image Questionnaire (BIQ), Rosenberg Self-Esteem Scale (RSES), and Defense Style Questionnaire (DSQ-40). Results In terms of SCL-90-R, there was a significant difference between the two groups in the somatization, hostility, and paranoid ideation subscales; the scores for these on SCL-90-R were higher in the obese group. For BIQ, there was a statistically highly significant difference between the two groups; obese individuals had a disturbed body image compared with those in the control group. For DSQ-40, the obese women showed excessive use of immature defenses (displacement) and the control group showed frequent usage of neurotic defenses (reaction formation); there was a significant difference between the two groups in the two defenses. There was no significant difference in self-esteem. There was a positive correlation between BMI and the somatization subscale, BMI and the phobia subscale, and BMI and the Global Severity Index subscale of SCL-90-R in the obese group. There was a positive correlation between BMI and the depression subscale and BMI and the interpersonal sensitivity subscale of SCL-90-R in the control group. There was a negative correlation between BMI and mature defense styles in the obese group, whereas in the control group, there was a positive correlation between BMI and immature defense styles. There were no significant correlations between BMI and both BIQ and RSES. Conclusion Obese women have more disturbed body image, immature defense mechanisms, and psychopathology than the control group.
  5,842 149 1
Prevalence of substance abuse among adolescent school students in Zagazig
Mohamed G Negm, Amira A Fouad
September-December 2014, 35(3):161-166
DOI:10.4103/1110-1105.144344  
Introduction The 20th century ended with the conviction that drug abuse was a global problem and thus global solutions were required. This is a cross-sectional study that was carried out in Zagazig Center, Sharkia governorate, in the year of 2013 (September to October). Participants and methods The study included 204 preparatory and secondary school students. The mean age of the participants was15.26 ± 1.59 years. The school students were met in their classrooms, in the presence of their teachers, and assessed for substance abuse using the Drug Use Disorders Identification Test (DUDIT) and the Drug Use Disorders Identification Test-Extended (DUDIT-E); urine samples were then collected for all participants during the interviews using the multidrug one-step test. Results The prevalence of smoking and substance abuse among school students were 8.3 and 8.8%, respectively, and the majority of them used substances once a month or less. The most common substances used by the students included tramadol, cannabis, and alcohol (83.3, 27.8, and 16.7%, respectively), with a mean age of onset of smoking of 16.06 ± 1.39 years and a mean age of onset of substance abuse of 16.5 ± 1.098 years. Conclusion Substance abuse and smoking were common among adolescents, and the age at onset was almost the same for both. DUDIT and DUDIT-E may significantly contribute to more effective screening of drug problems in research and clinical settings with groups at risk and it may be useful for mapping drug use among different groups in public health contexts.
  5,606 0 3
Catechol-O-methyltransferase gene polymorphisms in Saudi cases with schizophrenia
Ashraf Tantawy, Abduhamid Al-Yahia, Yasser Raya, Abdurrahman Al-Mohaimeed, Ahmad Settin
September-December 2015, 36(3):118-123
Background This work was conducted to test for the association of genetic polymorphisms of catechol-O-methyltransferase (COMT) with the susceptibility and clinical patterns of schizophrenia among Saudi patients. Participants and methods This is a case-control study involving 79 patients fulfilling the ICD-10 criteria of schizophrenia and 82 healthy controls. Patients were interviewed by different tools, which included the Diagnostic Interview for Genetic Studies (DIGS/V4.0), the Positive and Negative Symptoms Scale (PANSS), and the World Health Organization Disability Assessment Schedule (version 2.0) (WHO/DAS II). All patients and controls were screened for COMT G >A gene polymorphisms using the real-time PCR technique. Results Frequencies of all genetic variants of COMT G >A [V158M] did not show a significant difference on comparing cases with controls (P > 0.05). Comparing the frequencies of genetic variants in cases having positive parental consanguinity and a family history of schizophrenia or other mental illnesses with those without a history also showed nonsignificant results (P > 0.05). A stratified analysis related to severity scores and associated clinical illnesses also showed a nonsignificant difference (P > 0.05). Conclusion Polymorphism related to COMT G >A was not associated with the susceptibility and the severity of schizophrenia among Saudi cases.
  1,127 3,092 -
Functional outcome in childhood-onset schizophrenia in Nigeria: a 3-year longitudinal study
Musa U Umar, Shehu Sale
September-December 2016, 37(3):118-124
DOI:10.4103/1110-1105.195549  
Background The outcome of childhood-onset schizophrenia (COS) is generally regarded as poor. Few prospective studies have been reported from developing countries. Aim The aim of the present study was to assess the functional outcome in COS and the factors associated with poor outcome. Methods This 3-year prospective study included 19 patients with COS. Diagnosis was based on the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., criteria using the Kiddie-Schedule for Affective Disorders and Schizophrenia − Present and Lifetime Version; severity was assessed through the Positive and Negative Symptoms Scale, whereas the measure of outcome used was Children’s Global Assessment Scale. Results The mean duration of follow-up was 39.53 (SD ±5.37) months. The mean age of onset of COS was 10.47 (SD ±0.91) years. At the end of the study, 31.6% of the participants had good outcome, 42.1% had moderate outcome, and 26.3% had poor outcome. Factors associated with poor outcome included history of perinatal complication, more negative symptoms, and longer duration of untreated psychosis. Conclusion More than a third of the sample showed good outcome over the few years of follow-up. On the basis of the findings of this study, we recommend an early intervention.
  1,170 2,583 -
The impact of anxiety and depression during pregnancy on fetal growth and the birth outcome
Youmna Sabri, Hanan Nabel
May-August 2015, 36(2):95-100
DOI:10.4103/1110-1105.158117  
Background Maternal depressive and anxiety symptoms during pregnancy have been reported in some, but not all, studies to be associated with an increased risk of preterm birth and intrauterine growth restriction (IUGR). Objectives The aim of this study was to estimate the risk of preterm birth and IUGR associated with antenatal anxiety and depression during early pregnancy and to evaluate their impact on fetal growth and the birth outcome. Patients and methods The following measures were applied to 54 pregnant mothers: the Edinburgh Postnatal Depressive Scale (EPDS), the Beck Anxiety Inventory (BAI), and fetal biometric data and behavior were recorded during ultrasound examination at 24-36 weeks of gestation and the placental blood perfusion was measured by Doppler assessment of the systolic/diastolic ratio (S/D ratio) of the umbilical artery in the third trimester. Results This study revealed that women with depressive and anxiety symptoms in the third trimester of pregnancy exhibit an increased likelihood of having oligohydramnios, IUGR, diminished placental perfusion, and preterm labor. Conclusion This study provides evidence that maternal depressive and anxiety symptoms during pregnancy are associated with various fetal developmental problems.
  3,171 361 -
EDITORIAL
Revolution and mental health
Mohammed Elmahdy
September-December 2012, 33(3):111-116
DOI:10.7123/01.EJP.0000415781.93483.75   
  915 2,424 -
ORIGINAL ARTICLES
Physical and verbal aggression among adolescent school students in Sharkia, Egypt: prevalence and risk factors
Nagda M Elmasry, Amira A Fouad, Dalia M Khalil, Khalid S Sherra
September-December 2016, 37(3):166-173
DOI:10.4103/1110-1105.195547  
Background School aggression has become an increasing concern to public health professionals, clinicians, policy makers, educators, and the general public. It is a multifaceted problem with biological, psychological, social, and environmental roots. Aim The aim of this study was to examine the prevalence and the influence of social, family, and school environments on the development of school aggression. Patients and methods A multistage stratified sample of 574 students of both sexes aged 13–18 years was selected from the preparatory and secondary schools chosen from Zagazig Center through the academic year 2014–2015. Sociodemographic characteristics of the students were evaluated using a self-reporting questionnaire. Aggressive behavior was assessed using the Aggressive behavior and hostility scale for adolescents (the parts of physical and verbal aggression). Results Physical aggression was severe in 0.7% of the sample, moderate in 8.5%, mild in 39.2%, and minimal in 51.7%. As regards verbal aggression, it was severe in 0.5% of the sample, moderate in 8.0%, mild in 40.5%, and minimal in 51.1% of the sample. Risk factors for aggression were male sex, age greater than 15 years, unfavorable school atmosphere, practicing sports, smoking, watching action movies, personal history of physical abuse, being second-born child of the family, attending urban schools, and a history of dropping class. Conclusion School aggression is a frequent and a serious problem among school adolescents. It is necessary to evaluate the level of seriousness and attempt to find effective preventing measures.
  2,848 296 2
Sex differences in cognitive dysfunction among bipolar disorder patients
Heba Aly, Hoda Salama, Soha Ibrahim, Hesham El-Shestawy
January-April 2015, 36(1):1-8
DOI:10.4103/1110-1105.153766  
Introduction Studies have proposed that cognitive deficits are present in a variety of mood states in bipolar disorder (BD). In addition, a few studies have pointed to the presence of sex-related differences in cognitive dysfunction in BD. Aim of the work This comparative study aimed to study the cognitive functioning of BD patients in different episodes, and detect any sex-related differences in cognitive functioning in the studied sample. Patients and methods The recruited sample consisted of 150 patients selected at random from El Maamoura Mental Hospital over 6 months. Four groups were formed: group I, comprising 38 (19 male and 19 female) BD patients having manic episodes; group II, comprising 26 (12 male and 14 female) BD patients having depressive episodes; group III, comprising 36 (20 male and 16 female) patients in remission (euthymic); and group IV, comprising 50 controls matched for age, sex, and education. Clinical and psychiatric evaluations were carried out and psychometric assessment was performed using the 17-item Hamilton Depressive Scale and the Young Mania Rating Scale, as well as cognitive assessments using three tests: Wisconsin's Card Sorting Test (WCST), the digit span subtest of the WAIS-R and DSST (the digit symbol subtest of the WAIS-R). Results The BD patients in the three groups having BD showed significant cognitive deficits compared with controls. Manic and depressive patients showed impairment in attention, working memory, and executive functions. Euthymic patients showed significant impairment in working memory and executive functions. Only euthymic patients revealed a statistically significant sex-related difference in terms of short-term memory, attention, and working memory, with women being worse than men. Interestingly, in the control group a difference in executive functions was reported wherein healthy control women performed significantly better than control men on the WCST-128 (completed significantly more number of categories and committed significantly fewer perseverative errors). Conclusion Cognitive dysfunction should be regarded as a core feature of BD as it was present across all mood states in our sample. In addition, discrepancy has been found between male and female euthymic patients regarding cognitive functions, suggesting a sex-related difference in the clinical expression of BD.
  2,948 174 1
EMDR-based mental health services for the Arab spring
Walid Abdul-Hamid, Jamel Turkey, Jamie Hacker Hughes
September-December 2013, 34(3):143-147
DOI:10.7123/01.EJP.0000430560.07880.56  
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[ABSTRACT]   Full text not available  [PDF]
  507 2,554 -
Caudate nucleus volume in schizophrenia, bipolar, and depressive psychosis
Maha ELTayebani, Mamdoh ElGamal, Osama Gado, Mohamed Samer Abdelaal
January-April 2014, 35(1):1-13
DOI:10.4103/1110-1105.127264  
Introduction The caudate nucleus (CN) is a crucial component of the ventral striatum and part of the striatal-thalamic circuits that is modulated by limbic structure to subserve emotional processing. MRI studies examining the CN have yielded equivocal, mixed results. We aimed to examine the CN size and its clinical, cognitive correlates in drug-naive patients with first-episode psychosis. Materials and methods (i) The CN was manually traced on MRI scans from 49 schizophrenic patients, 21 bipolar patients, and 20 patients with depressive psychosis as well as 23 healthy control individuals both at baseline and after 2 years. (ii) Structured SCID interviews of DSM-IV, HDRS, YMRS as well as PANSS were conducted. (iii) WMS-III and WAIS were used to test cognitive function and finally, the Simpson-Angus Scale for extrapyramidal Parkinson features. Results (i) CN size was significantly more reduced in bipolar patients than in healthy controls with a magnitude of around 18.5%. (ii) Schizophrenic and depressive patients showed a modest volume reduction in CN (8.5 and 12.5%, respectively). (iii) Only bipolar patients showed cognitive dysfunction associated with a 1% progressive reduction in CN size after 2 years of follow-up. Clinical importance was unclear for depressive and schizophrenia patients. Conclusion and recommendation CN volume reduction in bipolar psychotic patients may reflect part of the pathophysiology of the illness, but it is unclear whether it is primary or secondary to other structural changes. Study of the shape, functional changes in CN as well as areas connected to it may uncover the primary mechanisms of bipolar psychosis.
  2,719 114 -
Schizophrenia resistance ( is there a difference?)
Mamdoh ElGamal, Maha ElTayebani, Seham Fathi
January-April 2013, 34(1):51-60
DOI:10.7123/01.EJP.0000415775.84252.a9   
Background

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.

Aim and objectives

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.

Methods

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.

Results

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.

Conclusion and recommendation

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.

  2,696 137 -
Impairment in working memory in multiple sclerosis
Osama Abourelmaged El-Kholy, Mohamed Ramadan, Mahmoud El-Sheikh, Moataz Ali
September-December 2012, 33(3):117-125
DOI:10.7123/01.EJP.0000414294.51794.7d   
Aim

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.

Participants and methods

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.

Results

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.

Conclusion

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.

  1,442 1,291 2
The impact of attention-deficit hyperactivity disorder across the lifespan on substance use disorders
Hoda Salama, Soha Ibrahim, Osama Abou El Magd, Ahmed Abdel Kerim
May-August 2015, 36(2):66-72
DOI:10.4103/1110-1105.158113  
Introduction Attention-deficit hyperactivity disorder (ADHD) affects not only children, but persists into adulthood with a prevalence rate up to 4.4% in the general population. The association between ADHD and substance use disorders (SUDs) is getting more into the scientific focus. However, the impact of ADHD on SUD regarding the economic system and healthcare is still underestimated. Aim of the work The aim of this study was to analyze the impact of childhood and adult ADHD on SUD by comparing the SUD clinical outcome between a group of SUD inpatients having a history of childhood ADHD and another group of SUD inpatients having concurrent adult ADHD. Participants and methods A cross-sectional comparative study was conducted at the Addiction Treatment Center at El Maamoura Mental Hospital. In all, 102 adult male patients were assessed using a clinical psychiatric interview and psychometric assessment using the Arabic version of Wender Utah Rating Scale for retrospective assessment of symptoms of childhood ADHD. Also, the Arabic version of the Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist was used to screen for adult ADHD. Results Sixty-four patients out of the total studied sample had a history of childhood ADHD. Of them, only 36 patients fulfilled the DSM-IV-TR criteria for adult ADHD. The presence of adult ADHD was associated with an earlier mean age of onset of SUD (13.22 vs. 14.86 years), a larger number of hospital admissions (4.21 vs. 6.83 times), and a shorter mean period of abstinence (124.53 vs. 271.50 days) than patients with a history of childhood ADHD. Conclusion In comparison with childhood ADHD, the presence of adult ADHD among patients with SUD was associated with a more complicated course of SUDs and a poorer clinical outcome.
  2,328 281 2
Perimenopausal psychiatric aspects in urban versus rural Egyptian women in Menoufiya
Nabil R Mohamed, Lamiaa G El-Hamrawy, Afaf Z Rajab, Mohamed S El Bahy, Eman G Saleh
January-April 2015, 36(1):21-39
DOI:10.4103/1110-1105.153774  
Background The perimenopause marks a major life transition for women, an end to the childbearing years and cessation of menses. Women frequently face a number of major life stressors during the years leading up to menopause. Aim This study aimed to explore the biopsychosocial aspects of perimenopause, to study the distribution of menopausal symptoms in an urban versus a rural community, and to study the psychosocial profile of women with psychiatric disorders during the perimenopausal period and their impact on quality of life to evaluate their attitude toward menopause and its relation to the psychiatric disorders, and to focus on the possible relationship between estradiol level and psychiatric disorders in perimenopausal women. Patients and methods This study enrolled 50 perimenopausal women and 20 premenopausal women as a control group. Tools of the study We used the following tools: Structured Clinical Interview of DSM-IV, Stressful Life Events Scale, the Arabic version of Greene Climacteric Scale and Menopausal Symptom Checklist, the Quality of Life Scale for Menopausal Women, Attitude Towards Menopause, the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Sleep Questionnaire, and laboratory investigations including determination of follicle stimulating hormone serum level and serum estradiol level. Results In this study, the perimenopausal group had significantly (P < 0.001) greater stressful life events than premenopausal women (66% of perimenopausal women were at a definite risk for illness and 34% were at a moderate risk for illness). Perimenopausal women with psychiatric disorders had significantly greater stressful life events than those without psychiatric disorders. We also found that 36 (72%) perimenopausal women had significantly (P < 0.01) positive attitude compared with five (25%) premenopausal women. Perimenopausal women with psychiatric disorders had greater severity of menopausal symptoms (highly significant in hot flushes). Perimenopausal women with psychiatric disorders had poor quality of life and marked psychological limitations. In the present study, risk factors for patients with major depressive disorder were a family history of mood disorder, vasomotor symptoms, and stressful life events. Risk factors for generalized anxiety disorder were a family history of generalized anxiety disorder (GAD) and vasomotor symptoms. Conclusion It is important to assess the psychosocial profile, women's attitude toward menopause, menopausal symptoms, and screening for psychiatric disorders for better quality of life and better outcome.
  2,377 174 1
Thyroid dysfunction in attention-deficit hyperactivity disorder and effect of comorbidity
Samia Abd El Rahman, Shereen M. Abd El Mawella, Hoda A. Hussein, Mohamed El Mosalmy
May-August 2014, 35(2):89-94
DOI:10.4103/1110-1105.134194  
Introduction Attention-deficit hyperactivity disorder (ADHD) is considered to have a biologic basis, but the precise cause is unknown. It is one of the neurodevelopmental abnormalities observed frequently in children with generalized resistance to thyroid hormone, suggesting that thyroid abnormalities may be related to ADHD. Aim To assess thyroid dysfunction in children with ADHD and to detect the most common comorbidity. Participants and methods This was a case-control cross sectional study, in which 30 ADHD children were recruited from the Kasr Aini Pediatric Hospital (Abu-El Rish) outpatient psychiatry clinic and compared with 14 healthy control children, siblings of the patient group who participated in this research. Psychometric procedure The Stanford Binet Intelligence Scale, the Arabic version of Conners' Parent Rating Scale-Revised-Long version, and social score were used to calculate social standards of families. Laboratories assessment Serum total T3, total T4, and thyroid-stimulating hormone were assessed using the enzyme-linked immunosorbent assay. Results About 80% of the participants were males and 20% were females. Diagnosis according to the Diagnostic and statistical manual of mental disorders, 4th ed. (DSM-IV) showed that 29 (96.7%) of the patients were diagnosed with ADHD combined type by DSM-IV and only one patient (3.3%) had ADHD inattentive type. Forty percent of the patients were from low socioeconomic class, followed by 26.7% from moderate socioeconomic, and a very low socioeconomic class; however, 6.6% were from a high socioeconomic class. There was a statistically significant difference between cases and control groups in all components of Conners' Parent Rating Scale; all cases had higher means than the control group (P = 0.001). There was no significant difference between both the study group and their siblings in serum total T3, thyroid-stimulating hormone, T4 (P > 0.05). Fifty percent of the patients had no or only one comorbidity and 15 (50%) had two or more comorbidities. On comparing the two subgroups (group with no or one comorbidity and the other group with two or more comorbidities), we found that there were no statistically significant differences between the two groups in the IQ components test. There were only statistically significant differences between two subgroups in the social problem subscale of Conners' scale, which showed higher scores in the subgroup of patients with two or more comorbidities. Also, there were no statistically significant differences in the thyroid profile of the two subgroups and the thyroid functions were within normal. Conclusion Oppositional defiant disorder was the most common comorbidity. Social problems are common in children with ADHD with comorbidity. Children with ADHD have no thyroid dysfunction.
  2,280 163 1
Gender differences in executive functions and reading abilities in children with attention deficit hyperactivity disorder
Rim Roufael, Azza El-Bakry, Dalal Amer, Osama Refaat, Maha Emad-Eldin
May-August 2012, 33(2):63-73
DOI:10.7123/01.EJP.0000413587.34899.c5   
Background

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.

Aim

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.

Methods

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.

Results

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.

Conclusion

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.

  2,202 158 2
Sleep disorders and sleep quality among patients with anxiety or depressive disorders in relation to their quality of life
Ashraf M.A. El-Tantawy, Abdulhameed Al-Yahya, Yasser M Raya, Saber A Mohamed
January-April 2014, 35(1):56-64
DOI:10.4103/1110-1105.127284  
Background Sleep is essential in our lives and is related to the physical, mental and psychological state of the individual. Sleep problems are prevalent among psychiatric patients with common anxiety or depressive disorders. Patients and methods In 200 patients with anxiety or depressive disorders, diagnosis of specific sleep disorders was carried out according to the Diagnostic and statistical manual of mental disorders, 4th ed., text revision criteria using a semistructured psychiatric interview. Comorbidity was assessed using the Charlson Comorbidity Index. The quality of sleep was measured using the Pittsburgh Sleep Quality Index (PSQI); the negative emotional states of depression, anxiety and stress were measured using the Depression Anxiety Stress Scales and the quality of life was measured using the Short Form 36-item (SF-36). Results Overall, 36% of the patients showed sleep disorders: 43% of them had anxiety disorders and 29% of them had depressive disorders. Primary insomnia has a higher statistically significant difference among patients with anxiety or depressive disorders (27.5%) than the control group (4.0%) (P < 0.05). Patients with anxiety or depressive disorders who have sleep disorders have higher PSQI scores (P < 0.01) and lower SF-36 scores (P < 0.01) than patients with anxiety or depressive disorders who do not have sleep disorders. There was a correlation between the Depression Anxiety Stress Scales score with PSQI and SF-36 scores regarding both patients with anxiety disorders and patients with depressive disorders. Conclusion Sleep disorders and poor sleep quality would have a negative impact on important aspects of health-related quality of life of patients with anxiety or depressive disorders. Understanding of the prevalence, correlates and implications of sleep disturbances and sleep quality for healthcare utilization in this patient population could provide useful guidance for the design of services and targeted treatments that improve the quality of life of these patients. Clinicians should routinely screen for sleep problems in patients with anxiety or depressive disorders.
  1,958 218 -
Depression among school aged epileptic children and their siblings
Marwa Abd El-Maksoud, Hamdy Bedair, Hanan Azouz, Heba Abou El-Wafa
September-December 2015, 36(3):124-131
DOI:10.4103/1110-1105.166349  
Introduction Researches on children and adolescents with epilepsy have revealed a high incidence of psychological and behavioral difficulties. For a longtime, patients and physicians tended to focus solely on the control of epileptic seizures, while disregarding the presence of comorbid psychiatric symptoms and disorders. Recognition of their negative impact in the life of patients with epilepsy in recent years has highlighted the need for the early identification of psychiatric symptoms. Aim of the work The work aimed to study the prevalence of depression in school aged epileptic children and their siblings and to study the possible risk factors of depressive disorders in those children with epilepsy and their siblings. Patients and methods The study included 150 school children divided into three groups: epileptic children, their siblings, and a healthy control group. They have been all subjected to history taking, neurological examination, psychiatric interview, electroencephalography, and psychometric assessment using Children's Depression Inventory, Arabic form. Results We found a significant relationship between the prevalence of depression and focal seizures (P < 0.001) especially frontal and temporal lobe epilepsy; however, we did not find a statistically significant relationship between depression and other seizures related risk factors. There was a significantly (P = 0.002) poor school performance among epileptic children (42%) compared with their siblings (16%) and the control children (12%), and also there was a significant relationship between poor school performance in epileptic children and high prevalence of depression (P = 0.025) among these children. Conclusion There is no great impact of epilepsy on the social or psychological life of the siblings especially among young children. Despite the high prevalence of depression among young epileptic children, it was not statistically significant compared with the control children. Moreover, there is a significant relationship between focal seizures and depression especially temporal and frontal lobe epilepsy. Depression as a comorbidity in epileptic children further compromises their school performance.
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A study of child physical abuse
Hiame F Elsaied, Abdallha A Alsehly
May-August 2017, 38(2):120-126
DOI:10.4103/1110-1105.209674  
Background Child abuse − a form of family violence − is one of the major public health issues with far-reaching effects and costs and have many implications on health policy and prevention strategies. Objective The aim of the study was to assess risk factors of child physical abuse among school-aged children in the child’s background and family characteristics and to estimate its psychiatric sequelae. Patients and methods The study was conducted in Maternity and Children Hospital, Al Medina (Al Monawara), Kingdom of Saudi Arabia, on school-aged children referred from the committee protection program from September 2012 to April 2015 using such some psychometric tests as the Child Maltreatment Questionnaire, the Mini International Neuropsychiatric Interview for children and adolescents (for major depressive episodes), Revised Behavior Problem Checklist, and Copper Smith Self-Esteem Inventory. Results Out of 186 students (age range between 12 and 16 years) 49.4% were the youngest children, mainly boys (58%), 94% had good health, 70% were from large-sized families, and 51% of whose mothers and 54% of fathers were illiterate, and all these variables showed a significant difference in both mild/moderate and severe child abuse. There were significant associations between physical abuse and low self-esteem, major depressive episode, conduct disorder, anxiety withdrawal, attention deficit hyperactivity disorder, and socialized aggression, mainly with severe physical abuse. Conclusion Physical abuse is found in a significant proportion of children, mostly living in large-sized families, of illiterate unemployed parents. Furthermore, physical abuse is commonly associated with low self-esteem, major depression episodes, conduct disorder, attention deficit hyperactivity disorder, and socialized aggression.
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Suicide risk and personality traits among Egyptian patients with substance use disorders
Mostafa Shahin, Ashraf A Fouad, Alia A Saleh, Aliaa Magdy
January-April 2018, 39(1):15-22
DOI:10.4103/ejpsy.ejpsy_23_17  
Background The magnitude of the problem of substance use in Egypt has been growing lately. Substance use disorders (SUDs) have been associated with depression and suicide, as well as impulsivity and specific personality traits. Aim and Objectives This study aimed at evaluating suicide risk and its correlates in a sample of 40 substance users and 40 control subjects. Methods The severity of the addiction problem among substance users was assessed using Addiction Severity Index (ASI). Beck Suicide Inventory (BSI), DSM-5 Brief Personality Inventory (PID-5 BF) and Barrat’s Impulsivity Scale-11 were applied to both groups. Results The study showed that patients with SUDs had a higher suicide risk when compared with controls (P<0.05). They also showed higher impulsivity scores (P<0.05) and personality trait disorders (P<0.001) when compared with controls, particularly in antagonism (P<0.001), disinhibition (P<0.001), negative affect (P<0.05) and psychoticism (P<0.05). Conclusions Pathological personality traits may be associated with increased risk of suicide in patients with SUDs.
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EDITORIAL
Egyptian children with autism spectrum disorders: risk factors and comorbidity in relation to disease severity
Wafaa A Elbahaaey, Magda H Elkholy, Salwa S Tobar, Haitham El-Boraie
May-August 2016, 37(2):59-69
DOI:10.4103/1110-1105.193023  
Background Autism spectrum disorders (ASDs) represent a group of neurodevelopmental disorders characterized by impaired reciprocal socialization and communication, often accompanied with stereotyped ritualistic behavior. To date, no clear data could explain the dramatic worldwide increase in the incidence of ASD during the last two decades. It is suggested that some environmental factors besides a genetic predisposition leads to the disease. In addition, the disease is known to be associated with other psychiatric comorbidities. Aim The current study aimed to assess the incidence of psychiatric comorbidity present in those children and to relate the findings to the severity of the disease. Patients and methods The current study included 40 children (27 boys and 13 girls), with ages ranging from 3 to 11 years, and diagnosed with ASDs on the basis of the DSM-IV-TR criteria. Patients were divided to three groups according to their score on Gilliam Autism Rating Scale: mild ASD (10 cases); moderate ASD (11 cases), and severe ASD (19 cases). Data were collected through clinical psychiatric interview, Mini International Neuropsychiatric Interview for children and adolescent (M.I.N.I. KID), the Gilliam Autism Rating Scale, Vineland Adaptive Behavior Scales, and a scale for measuring family socioeconomic status for health research in Egypt. Results The present study demonstrated that 72.5% of the cases presented in families with middle socioeconomic status, which are highly educated, the majority (80%) of parents of studied cases lacked consanguinity degree, while only 20% from them had consanguinity from first degree; the vast majorities (92.5%) of the cases were not presented with family history of autism. As regards comorbidity, 90% of the cases were associated with one or more comorbid conditions and the presence of more than one comorbidity usually associated with male sex and severe type of autism, 72.5% of studied cases suffered from comorbid tics (40% occurs in severe autism), 25% of cases presented with associated attention-deficit/hyperactivity disorder, 20% of cases suffered from oppositional defiant disorder (ODD) as comorbid conditions, 37.5% of studied cases had comorbid obsessive compulsive disorder (OCD), and 5% of cases suffered from comorbid general anxiety disorder. Conclusion From the current study it was concluded that boys, high and moderate socioeconomic states, consanguinity, positive family history represented conditions that are associated with an increased risk for autism and ASDs in Egyptian population. Presence of one or more of those risk factors in children with autism is usually associated with severe type of the disease and more associated comorbidities. Determining the contribution of these risk factors may improve detection, earlier treatment, and better prevention of the disease. Comorbid tics, attention-deficit/hyperactivity disorder, ODD, and OCD are most presented among boys, whereas comorbid general anxiety disorder is more presented in girls with autism. The most occurring coincidence of comorbidity is comorbid tics and OCD, followed by comorbid OCD and ODD. Those coincidences were associated with severe autism and male sex. We suggest future studies using large samples to confirm the finding of the present work.
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ORIGINAL ARTICLES
Neurological soft signs and insight in obsessive–compulsive disorder
Nagda M Elmasry, Amira M Youssef, Amany E Mohamed, Waleed R Ashour
September-December 2016, 37(3):125-131
DOI:10.4103/1110-1105.195543  
Background Obsessive–compulsive disorder (OCD) is an anxiety disorder characterized by the presence of obsessions and compulsions that interfere with the patient’s life. It has been shown that patients with OCD have increased rates of neurological soft signs (NSS) when compared with healthy controls. NSS are minor abnormalities like poor motor coordination, sensory and perceptual difficulties, and difficulties in sequencing of complex motor tasks. It has been suggested that OCD patients with poor insight are at the most severe end of this spectrum. Aim of the work The aim of this study was to determine the frequency pattern of symptoms (obsessions and compulsions) in OCD patients, to examine NSS in patients compared with healthy individuals, and find any correlation between NSS scores and the severity of OCDs [total Yale Brown Obsessive Compulsive Scale (YBOCS) score] and the degree of insight. Participants and methods The study included two groups: 30 OCD patients and 30 healthy individuals as controls. Both groups were subjected to psychiatric and neurological examination using the Cambridge Neurological Inventory (Part 2), the YBOCS checklist to detect types of obsessions and compulsions, and the Overvalued Ideas Scale to assess the degree of insight in OCD patients. Results The most common types of obsessions and compulsions among the patients were religious (70%), contamination (77%), and cleaning compulsions (77%). OCD patients recorded significantly higher total scores of NSS and domain scores (motor coordination, sensory integration, and primitive reflexes) compared with the control group (P<0.05). A positive correlation was found between NSS scores and total YBOCS scores and Overvalued Ideas Scale scores. Conclusion We conclude that OCD patients have higher scores for NSS compared with controls, particularly for motor coordination signs. NSS positively correlated with the severity of disease. There was a positive correlation between NSS scores and OVIS scores, which measures the degree of insight.
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Psychiatric morbidity of chronic institutionalized patients with schizophrenia ( implications for future community care)
Mamdoh ElGamal, Maha ElTayebani, Rasha Bassim
September-December 2012, 33(3):158-170
DOI:10.7123/01.EJP.0000415664.74117.93   
Background

In many western countries, deinstitutionalization of chronically mentally ill patients was established after the mass introduction of neuroleptics in the late 1960s and the early 1970s. Deinstitutionalization was proven to be successful when there were strong ideological or humanitarian motives and when psychiatric reform was a priority and was completed with a comprehensive system of community. However, its long-term effects should be examined and questioned in terms of improving quality of life and functional abilities.

Aim and objectives

The research aimed at studying the morbidity profile and impact of schizophrenia on chronic institutionalized mentally ill patients as baseline data for planning of deinstitutionalization and a Community care program.

Methods

Data on sociodemographics, course of illness, treatment history, rate of admission, duration of hospital stay, and medical condition were collected retrospectively, followed by a cross-sectional study of a total of 95 patients with a schizophrenia spectrum using psychopathological rating scales such as PANSS, MMSE, CGI-S. Diagnosis according to DSM-IV and an interview using SCID were carried out by two different psychiatrists for high inter-rater reliability. The sample was recruited from among long-stay hospital patients.

Results

The mean age of onset of schizophrenia among the patients was 48.9±10.3 and 21.2±5.7 years. The mean duration of illness was 27.5±9.3 years, whereas the mean duration of repeated admission was 19.07±12.5 years. With respect to the median percentage of total hospital stay, 30% could be attributed to the patients’ median age and 55% to illness duration, whereas with respect to chronic hospitalization 20% could be attributed to the patients’ median age and 35% to illness duration. Of the patients, 85% were men; 70% were single and unemployed with a low socioeconomic status; 25% lacked private housing; 30% had diabetes mellitus and/or hypertension; 80% were obese and overweight; and 50% were on antilipid drugs. Delusion, hallucination, and conceptual disorganization were the highest-scoring positive symptoms in 50% of cases. Negative symptoms also scored higher (7.4) on all items in 60% of cases. Eighty percent had compromised cognitive deficits. Early age of onset of schizophrenia and being older were powerful predictors for repeated admission, a long duration of illness, and chronic hospitalizations. Severity of illness is also a powerful predictor for long hospital stay.

Conclusion

Schizophrenia is a chronic devastating illness that impacts function and cognitive abilities, and is characterized by a high rate of admission, chronic course of illness as well as chronic institutionalization. For continuity of care and a favorable prognosis, early comprehensive, multidisciplinary, and multimodel programs are required for patients with mental illness from the date of first hospital contact.

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Anxiety, depression, and strain among caregivers of terminally ill patients
Fadia Zyada, Mohamed sheta, Hanaa El Degwi, Rasha Saad
May-August 2013, 34(2):77-84
DOI:10.7123/01.EJP.0000419667.93575.14   
Aim

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.

Participants and methods

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.

Results

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.

Conclusion

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.

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