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ORIGINAL ARTICLES
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.
  4,669 81 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.
  2,712 0 2
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.
  2,110 133 -
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.
  1,878 48 -
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.
  1,234 188 -
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.
  1,224 172 -
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.
  1,285 92 -
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.
  407 925 -
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.

  950 73 1
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.

  802 124 -
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.
  773 126 -
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.
  778 82 1
Comparison of family burden, quality of life, and disability in obsessive compulsive disorder and schizophrenia in Zagazig University Hospitals
Mohamed G Negm, Rehab S Mahdy, Abd Alshafi M Khashaba, Rafik R Abd El-Latif
January-April 2014, 35(1):39-44
DOI:10.4103/1110-1105.127276  
Background Obsessive compulsive disorder (OCD) is a chronic psychiatric disorder and it is one of the 10 most disabling medical conditions worldwide. Patients with severe OCD may have comparable level of global functioning, family burden, quality of life (QoL), and disability as patients with schizophrenia. Patients and methods We selected 100 patients (50 with OCD, 50 with schizophrenia) from Zagazig University Hospitals, psychiatric outpatients' clinics. Some of these patients were admitted and became inpatients whereas the rest continued to attend follow-up as outpatients to assess family burden, QoL, and disability. Results Deleterious effects of illness on families, patients' QoL, and functioning occur not only in schizophrenic but also in OCD patients. Symptom severity and noncompliance on maintenance treatment are associated with greater disability and poor QoL. Conclusion Management should be planned with these considerations to enhance functioning and QoL and thus decrease disabilities.
  743 109 -
Psychoeducational program for breast cancer survivors, effect on cancer-related fatigue and quality of life
Mohamad Ezzat Amin Arafa, Mohamad Hassan
January-April 2013, 34(1):25-33
DOI:10.7123/01.EJP.0000415299.41177.69   
Objectives

To assess the efficacy of the psychoeducational program in alleviating cancer-related fatigue and mood symptoms, and improving quality of life of breast cancer survivors.

Methods

A prospective follow-up case–control study was carried out between June and December 2010. Eighty patients were randomly selected from among women who had recently completed their treatments for breast cancer at the outpatient clinic in the Department of Clinical Oncology, Cairo University (Egypt). They were divided into group A, which received the program, and group B, the waiting control group. Karnofsky Performance Scale was used to exclude physical disability. Assessment was carried out twice, at weeks 0 and 4, using Hospital Anxiety and Depression Scale (HADS), Health-Related Quality of Life-Short Form (HRQL-SF) 36, and Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF). The psychiatric diagnosis was made according to the Diagnostic and Statistical Manual of Psychiatric Disorders, 4th ed., Text Revised criteria.

Results

There was a nonsignificant difference between both groups in terms of sociodemographic or medical data, and the mean scores of HADS, HRQL-SF 36, and MFSI-SF at week 0. There was a significant difference between both the groups in terms of the mean scores of HADS, HRQL-SF 36, and MFSI-SF at week 4. There was a significant difference between the mean scores of HADS, HRQL-SF 36, and MFSI-SF in group A before and after the intervention.

Conclusion

Fatigue is a major problem in the majority of breast cancer patients after therapy. A psychoeducational program improves various aspects of patients’ physical, emotional, and quality of life.

  772 78 -
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.

  783 65 -
Some neuropsychiatric comorbidities of attention deficit hyperactivity disorder
Rizk M. Khodeir, Mohamed M. El-Hamady, Shwikar T. El-Bakry, Michael V.S. Mikhael
May-August 2014, 35(2):71-79
DOI:10.4103/1110-1105.134192  
Objectives The aim of the study was to find out the possible neurological and psychiatric comorbid disorders that might be associated with attention deficit hyperactivity disorder (ADHD) and to assess the intelligence quotient (IQ) in the diagnosed patients, and hence improve the accurate diagnosis of ADHD and its management. Patients and methods This study is a comparative cross-sectional study (the study group and the control group). Participants were recruited from the Neuropsychiatric and Pediatric Clinics in Benha University Hospital, in addition to some private clinics and centers. The sample size of this study was 74 (divided into two groups, the study and the control groups). Participants were chosen by nonrandom technique; all patients who fulfilled the inclusion criteria and accepted (their parents) to participate were included in the study. All case and control groups were subjected to a semistructured interview, complete neuropsychiatric clinical assessment, psychometric testing using Wechsler Intelligence Scale for Children, Conners Parent Rating Scale-revised, long version, and Revised Behavior Problem Checklist. Electroencephalography was performed for some cases and controls. Results The mean age of the ADHD children was 8.78 years old; it was more prevalent among boys. Perinatal problems were significantly prevailing among cases of ADHD. In all, 70.3% had ADHD combined type, 10.8% had ADHD predominantly hyperactive-impulsive, and 18.9% had ADHD predominantly inattentive type. The control group showed higher mean IQ of 105.4 ± 9.6 compared with the ADHD case group who showed mean IQ of 93.8 ± 10.7. There were several significant comorbidities such as delayed language development, delayed developmental milestones, oppositional defiant disorder, conduct disorder, depressive symptoms, sleep disturbance, nocturnal enuresis, and soft neurological signs. Conners scale showed that the ADHD children showed higher mean in all Conners test items than the control group. ADHD children had higher mean along all Revised Behavior Problem Checklist compared with the control group. With respect to correlations, the oppositional defiant disorder was significantly correlated to the combined type ADHD. There was statistical significant difference in the whole sample where children who did not have oppositional defiant disorder had higher IQ (101.5 ± 11.5) than those who did (95 ± 11.1). Conclusion ADHD is a disorder that carries several neuropsychiatric comorbidities. Assessment of children with ADHD should address these comorbidities, and management should focus on them to obtain best outcomes for the patients.
  732 71 -
Evaluation of psychiatric morbidity and quality of life in patients with acne vulgaris
Athar A Saker, Khaled A El-Moez, Roshdy W Mohammad, Nader A Ismail
September-December 2015, 36(3):144-149
DOI:10.4103/1110-1105.166357  
Background The influence of acne on body image is believed to be the main factor associated with psychological morbidity. As the face is almost always the site of involvement of acne, its presence can alter one's perception of body image. Psychiatric disorders can develop secondary to acne vulgaris. Aim of the work This work was carried out to evaluate the psychological morbidity and effects of acne vulgaris on quality of life. Patients and methods A total of 140 patients with acne vulgaris were assessed for severity of acne using the acne severity scale and for depressive and anxiety disorder using the Hamilton Rating Scale for Depression and Hamilton Anxiety Rating Scale. Quality of life was assessed using the Dermatology Life Quality Index (DLQI). Results There were a statistically significant relation between acne severity and severity of depression and anxiety on assessment scales. The relation between acne severity and DLQI was statistically significant. In most patients with mild acne severity, a minor effect on DLQI was present, whereas in most patients with severe acne, severe effects were present. Conclusion Treatment needs to address both the primary skin condition and the psychiatric manifestations.
  661 123 -
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.

  680 89 1
Effectiveness of combined methadone maintenance treatment and psychosocial treatment program for heroin-dependent patients ( an international experience)
Wageeh Abdel Nasser Hassan, Richard A. Rawson, Khaled A. Mohammed, Mansour M. Shawky
May-August 2012, 33(2):51-56
DOI:10.7123/01.EJP.0000412560.66206.66   
Objective

To evaluate the effectiveness of combined methadone maintenance treatment and psychosocial treatment program for heroin-addicted patients.

Participants and methods

Forty-eight heroin-dependent participants were interviewed using the Addiction Severity Index (ASI), 5th ed., and the Mini International Neuropsychiatric Interview during the first week of their admission to a methadone clinic in Los Angeles, California, for baseline assessment. A follow-up ASI assessment was made 6 months after their first interview.

Results

ASI revealed that 67% of participants reported chronic medical problems, 69% were unemployed, 94% had been incarcerated, and 71% had suffered from psychiatric symptoms in the past 30 days, the most common being anxiety and depression. Female participants reported significantly more severe medical, employment, and psychiatric problems than did male participants. The Mini International Neuropsychiatric Interview revealed that 63% met criteria for the presence of one or more current psychiatric disorders. By the time of follow-up investigation, 15 participants had dropped out of the study. Participants who were still in treatment showed significant improvement in their medical, drug, legal, family, and psychiatric problems compared with their baseline assessments.

Conclusion

Combined methadone treatment and psychosocial treatment worked well for most of the participants of both sexes with or without comorbid psychiatric disorders.

  717 51 -
Assessment of depression and anxiety in children on regular hemodialysis
Mohammed M. Abdel Salam, Mohammed Ali Abdo, Usama Mahmoud Yousef, Saber A. Mohamed
May-August 2014, 35(2):100-104
DOI:10.4103/1110-1105.134196  
Background Depression and anxiety are well established as prevalent mental health problem in end-stage renal disease patients treated with hemodialysis. However, these problems remain difficult to assess and are undertreated. Objectives The aim of the study was to estimate the prevalence of depression and anxiety and to evaluate their risk factors in children on regular hemodialysis. Materials and methods Forty pediatric patients with end-stage renal failure on regular hemodialysis and 20 healthy control children were studied. All participants were subjected to proper history taking, thorough medical and psychiatric examination, psychometric assessment by pediatric anxiety and children depression inventory scale, and laboratory investigations including serum urea, creatinine, serum albumin, serum iron, serum ferritin, serum calcium, serum phosphate, serum parathormone hormone, hemoglobin level, and PT and PTT levels. Results There was a high prevalence rate of anxiety and depression among hemodialysis patients compared with that in healthy control children. Hemoglobin and serum albumin were found to be negatively correlated with both anxiety and depression. Conclusion Majority of pediatric patients undergoing hemodialysis were severely depressed and anxious. Pediatric patients on regular hemodialysis with anemia and hypoalbuminemia have more psychiatric disturbance than others.
  661 98 -
Correlates of antenatal bonding ( an Egyptian Study)
Suaad Moussa, Osama Refaat, Maha Emad, Aref Khoweiled, Tamer Goueli, Mohammad Ezzat
September-December 2012, 33(3):126-134
DOI:10.7123/01.EJP.0000414132.30979.90   
Background

The relationship between mother and child develops and progresses throughout the pregnancy period. In recent times there has been increasing interest in antenatal maternal–foetal bonding and its relationship with different variables, as well as the impact of this bonding on the child’s mental health.

Objectives

To investigate the pattern of maternal–foetal relationship during pregnancy, and its relationship to maternal depression and to different sociodemographic and pregnancy-related factors, as well as to the perception of intimate relation with spouse.

Methods

One hundred expectant Egyptian mothers attending obstetric outpatient clinics for regular follow-up of their pregnancy were recruited into the study. They were asked to fill the Maternal–Fetal Attachment Scale (MFAS), the Intimate Bond Measure and the Edinburgh Postnatal Depression Scale.

Results

Maternal antenatal bonding was significantly higher on the MFAS in expectant mothers with longer gestational age. Women with assisted pregnancy had significantly higher scores on the MFAS total score and Role Taking and Attribution subscales. However, if the cause of infertility was unexplained or related to female-oriented factors, the aforementioned MFAS scores tended to be significantly lower than when infertility was related to male-oriented or both factors. Primiparous women had significantly higher scores on the MFAS total score and Role Taking and Differentiation subscales compared with multiparous women. Women who perceived themselves as being healthy had significantly higher scores on the Interaction subscale of MFAS. In this study the intimate relationship with the spouse, and not the marriage duration, showed significant differences in relation to maternal bonding. Expectant mothers who reported a positive attitude towards their marital relationship (Optimal Intimacy and Affectionate Constraint) had significant higher means on the total score of the MFAS and on the Interaction, Giving of Self and Role Taking subscales. The study showed that expectant women with previous loss of foetus and those with no depressive symptoms had better bonding despite the lack of significance.

Conclusion

Maternal antenatal bonding is associated with multiple factors including longer gestational age, parity, previous loss of foetus, assisted pregnancy, perceived good maternal health and intimacy with partner.

  652 80 1
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.
  622 98 -
The prevalence and characteristics of attention-deficit hyperactivity disorder among a sample of Egyptian substance-dependent inpatients
Ahmed Abdelkarim, Hoda Salama, Soha Ibrahim, Osama Abou El Magd
January-April 2015, 36(1):9-13
DOI:10.4103/1110-1105.153771  
Introduction Attention-deficit hyperactivity disorder (ADHD) affects not only children, but persists in up to 4.4% of the general population. Comorbidity is common among adults with ADHD, including substance abuse. To our knowledge, the relation between ADHD and substance-use disorder (SUD) has not been studied in Arab countries thoroughly. Aim of the work The aim of this study was to estimate the prevalence rate of adult ADHD among substance-use inpatients and to compare substance use in patients with and without adult ADHD with regard to the onset, the severity, and the type of substance of abuse. Participants and methods This cross-sectional comparative study was conducted at the Addiction Treatment Center at El Maamoura psychiatric hospital. One hundred and two adult male inpatients were recruited and assessed using a semistructured interview questionnaire to collect sociodemographic data, substance-use history, and medical and psychiatric history. The psychiatric interview was applied, and psychometric assessment was performed using the Arabic version of the Wender Utah Rating Scale, which examined retrospectively the symptoms of childhood ADHD, and the Arabic version of the Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist for screening for adult ADHD. Results Thirty-six (35.3%) patients were diagnosed as having adult ADHD according to DSM-IV-TR criteria. The presence of adult ADHD was associated with an earlier mean age of onset of SUD (15.58 vs. 13.22 years). It was also associated with a larger number of hospital admissions (6.83 vs. 3.39 times). Individuals with ADHD achieved a shorter mean period of abstinence (124.53 vs. 209.82 days). Conclusion This study confirmed the presence of adult ADHD among substance-use patients with a considerable prevalence rate. Also, the presence of adult ADHD was associated with a more complicated course of SUD.
  622 91 1
Sexual risk among substance users and its relation to personality profile
Momtaz Abd-Elwahab, Mohamed Ezzat Amin
September-December 2012, 33(3):135-141
DOI:10.7123/01.EJP.0000415088.97056.8a   
Objectives

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.

Participants and methods

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.

Results

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.

Conclusion

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.

  636 70 2
EDITORIAL
New concept of depression and its management
Ahmed Okasha
January-April 2012, 33(1):1-8
DOI:10.7123/01.EJP.0000412301.27206.f1   
  635 67 -