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   2012| May-August  | Volume 33 | Issue 2  
    Online since June 6, 2014

 
 
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ORIGINAL ARTICLES
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.

  3,405 227 3
The Egyptian law 71/2009 ‘Care of mentally ill patients’ ( knowledge and opinions of service providers, relatives, and patients with substance abuse)
Aref Khoweiled, Dalal Amer, Manal Abed, Osama Refaat, Tamer Goueli, Emad Hamdi
May-August 2012, 33(2):74-82
DOI:10.7123/01.EJP.0000413117.68566.8e   
Background

The new Egyptian law for the care of the mentally ill has set strict criteria specifying the circumstances under which a person can be involuntarily detained in mental health institutions. The New Law does not specify whether addiction, as a psychiatric disorder, should be treated differently from other psychiatric disorders. Since the law was decreed by Parliament, the number of admissions of patients with drug addiction has reportedly declined.

Objectives

To explore the knowledge and attitude toward the New Law ‘Law for the Care of the Mentally Ill Patient’ (71/2009) among service providers, patients, and patients’ relatives and how it is perceived to have affected the service to addiction patients.

Participants and methods

A total of 505 patients with substance misuse, 213 relatives, and 172 substance misuse healthcare workers (providers) were assessed using specially designed questionnaires.

Results

More than 90% of service providers had heard about the new mental health law in Egypt. More than 50% of substance users and their relatives were not aware of it. About two-thirds of the patients agreed with provisions of the New Law as they relate to addiction, whereas more than two-thirds of service providers did not. Attribution of illness affected patients’ agreement with involuntary admission. More patients who agree to enforcing treatment view addiction as an illness (72 vs. 60%, &khgr;2=6.79, P=0.009). There is a dominant perception that the law does not allow involuntary admission of addiction patients for treatment (about 80% of service providers and 87% of relatives). Sixty-four percent of patients in this sample agreed on involuntary treatment for a period of time until patients can make rational decisions about their treatment and 69% of the patients’ relatives believed that the law needs to be modified to allow involuntary admission for addiction patients.

Conclusion

There are considerable ambiguities about the regulations of commitment for treatment as well as the duration of treatment and discharge for patients with addiction problems under the new mental health law (71/2009). This is only matched by an overall negative attitude of the studied stakeholders, especially service providers, which may be attributed in the latter case to a large gap in training.

  1,686 150 2
Neuropsychiatric complications after liver transplantation
Mohamad Ezzat Amin, Faisal Abd El-Wahab Atta
May-August 2012, 33(2):57-62
DOI:10.7123/01.EJP.0000413631.81234.45   
Objective

The aim of this retrospective study was to evaluate the incidence of neuropsychiatric complications (NPCs) after living donor liver transplantation.

Methods

Between May 2001 and April 2005, 110 recipients were admitted to the ICU after liver transplantation (LT) and were evaluated by full general, psychiatric, and neurological examinations, electroencephalography, and brain computed tomography and/or MRI. Diagnosis of psychiatric disorders was made according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision criteria, and the presence or absence of paradoxical psychiatric syndrome (PPS) was evaluated on the basis of the diagnostic criteria for PPS. Patients were observed after LT for 1 year.

Results

Of the patients who underwent transplantation, 50.9% developed NPCs and these patients’ stay in the ICU was much longer than that of all admitted patients. Neurological complications were observed in 32.7% of patients and psychiatric disorders in 43.6%, of which 62.5% developed PPS. The survival rate after LT of patients with NPCs was similar to that of patients without NPCs. The incidence of neuropsychiatric symptoms was found to be similar between patients treated with cyclosporine and those treated with tacrolimus. Finally, no correlation was observed between the primary cause of liver disease and the NPCs reported.

Conclusion

There was a high incidence of NPCs after LT, prolonging the patients’ stay in intensive care significantly. Careful preoperative and postoperative neuropsychiatric evaluations are important for early diagnosis of NPCs.

  1,583 103 -
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.

  1,458 98 -
Antenatal depression in expectant fathers ( an Egyptian study)
Suaad Moussa, Maha Emad, Aref Khoweiled, Dalal Amer, Osama Refaat, Tamer Goueli
May-August 2012, 33(2):90-96
DOI:10.7123/01.EJP.0000413118.03956.0b   
Background

Depression in relation to child conception and birth is not limited to mothers. Recently, there has been a growing interest in the study of depression in expectant fathers and in fathers after birth of their children, its correlates and consequences. These studies are relatively rare, especially in our culture.

Objectives

The aim of this study was to screen for depressive symptoms in expectant fathers and to study their sociodemographic, pregnancy and marital correlates.

Methods

Eighty-five Egyptian expectant fathers, husbands of Egyptian wives attending private Gynaecology and Obstetrics clinics for regular follow up of an unthreatened pregnancy, were asked to fill the Edinburgh Postnatal Depression Scale and the Intimate Bond Measure (IBM).

Results

A total of 31.8% (n=27) of the expectant fathers scored at least 10 on the Edinburgh Postnatal Depression Scale, indicating possible depression. High percentages of anxiety were found in both depressed and nondepressed participants. Depression did not correlate with sociodemographic variables. A significantly higher percentage of depressed participants desired a boy (48.1 vs. 24.1%) and were expecting a boy (40.1 vs. 24.1%). Other pregnancy variables were not associated with depression. A significantly higher percentage of depressed participants (35 vs.19.5%) perceived their marital relation as lacking intimacy, with only 5% rating their relation as having optimum intimacy on the IBM. Depression correlated negatively (r=−0.269, P=0.036) with the care subscale but not with the control subscale of the IBM.

Conclusion

Fathers are probably at an increased risk of depression in the antenatal period, which is related to their perception of marital intimacy. Delineation of specific cultural and personal contributors needs further research.

  1,067 108 1
Eating disorders in a sample of Egyptian women with bipolar I disorder
Shereen Mohamed Abdel Mawella, Hoda Abdou Hussein, Mohamad Ezzat
May-August 2012, 33(2):97-101
DOI:10.7123/01.EJP.0000413120.27143.53   
Introduction

Eating disorders are relatively common among patients with bipolar disorder. Overweight, obesity, and extreme obesity are common in this patient group. Eating disorders in these patients not only increase the risk for further episodes but also have a detrimental effect on the body and may eventually prove fatal if left untreated.

Aim of the study

To assess eating disorders in female bipolar patients and the relation between eating disorders and both obesity and disturbed body image in these patients.

Participants and methods

A case–control cross-sectional study, in which 60 female bipolar patients were recruited from the Psychiatric Department and clinic of Kasr al Aini Hospital and compared with 30 female healthy controls.

Psychometric procedure

The Hamilton Depression Rating Scale, the Young Mania Rating Scale, the Eating Disorder Test, and the Body Image Scale were used and BMI was determined.

Results

There was a statistically significant difference between the case and the control group in terms of eating disorders as 80% of the cases had eating disorders compared with only 16.1% of the control group (P=0.000). The eating disorders were most frequent during a manic episode (100%), followed by a mixed episode (92.9), a depressive episode (90.9%), and finally euthymia (41.4%). There was also a statistically significant difference between the case and the control group in terms of disturbed body image as cases reported more disturbed body image (P=0.000). There was no statistically significant difference between the case and the control group in terms of obesity, but we found a positive correlation between obesity and disturbed body image in the case group.

Conclusion

Eating disorders are more frequent in female bipolar disorder patients, especially during a manic episode; also, obesity is common among these patients, especially those who take atypical antipsychotics, and these obese patients have a more disturbed body image.

  1,078 78 -
Homocysteine level and depression in patients with ischaemic heart disease
Mohamed Nashaat, Emad Hamdi, Shereen Mohamed Abdel Mawella, Dalal Amer, Aref Khoweiled, Hoda Abdou, Amal Abdou
May-August 2012, 33(2):83-89
DOI:10.7123/01.EJP.0000413550.34072.a4   
Background

High levels of homocysteine are associated with vascular disease, changes in the levels of monoamine neurotransmitters and depression. A plausible hypothesis for these associations is that high homocysteine levels are implicated in vascular disease and neurotransmitter deficiency, which are in turn linked to depression.

Aim

To investigate the association between elevated homocysteine levels and depressive symptoms in patients with ischaemic heart disease (IHD).

Participants and methods

Eighty patients with a confirmed diagnosis of IHD were consecutively selected in a cross-sectional study from the inpatient and outpatient cardiology department of Kasr-Al-Ainy hospital. All IHD patients were diagnosed according to the criteria of the American College of Cardiology. Depression was evaluated using the Present State Examination-10 Short English–Arabic Version and the Beck Depressive Inventory. The serum level of homocysteine was determined using the chemiluminescent technique.

Results

Thirty-six ischaemic heart patients (45%) had depressive disorders. Depressed patients were older and had a longer duration of the IHD. The level of homocysteine was higher in depressed patients (P=0.098). Positive correlations were found between age and the serum level of homocysteine (P=0.028) but no correlations were found between the serum level of homocysteine and the severity of depression. Sleep disturbances correlated significantly with homocysteine levels irrespective of age.

Conclusion

Depressive symptoms are common in IHD patients, especially patients with prolonged duration of the disease. They are more apparent in IHD patients at times of emergency and intervention. In IHD patients, the serum level of homocysteine is associated with the occurrence of vegetative depressive symptoms.

  897 120 2
The impact of paediatric psychiatric morbidity as perceived by parents attending outpatient services
Suaad Moussa, Maha Emad, Dalal Amer, Aref Khoweiled, Tamer Goueli, Osama Refaat
May-August 2012, 33(2):102-110
DOI:10.7123/01.EJP.0000413183.73506.fb   
Background

Recent literature has pointed out the importance of assessing the impact of a child’s mental illness on both the child and the parents. The term ‘impairment’ refers to the consequences of present psychiatric symptomatology for the children regarding their distress or functioning. In contrast, ‘burden’ reflects the problems for significant others, that is, the parents and other family members.

Objective

The objective of this study is to investigate the impact of psychiatric illness on children and the caregivers, along with the factors contributing to it.

Participants and methods

A total of 350 Children aged 4–16 years attending Child and Adolescent Outpatient Clinics for the first time with presenting complaints. Children were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., and parents were required to fill the Strengths and Difficulties Questionnaire (SDQ).

Results

According to SDQ, 50.9% of the cases were in the abnormal range on the total difficulties score, whereas 77.8% were in the abnormal range on the impact score. Of the parents, 58.7% perceived their children as having definite/severe difficulties and 83% reported difficulties for a duration of more than 12 months. Classroom impairment was the most frequently reported; 80% of caregivers were significantly burdened by their children’s difficulties but only 46.4% perceived these difficulties as distressing to the child. The factors that predicted significant difficulties were the extent of total psychopathology and its duration and impairment. Scoring high on the prosocial scale negatively predicted the perceived difficulty. Moderate-to-severe burden was predicted by perceived difficulties and the impact of difficulties on the child’s life.

Conclusion

Perceived burden was the main motive driving parents to seek psychiatric services. It is predicted by perceived difficulties and impairment of the child.

  776 80 -