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   2020| January-April  | Volume 41 | Issue 1  
    Online since January 22, 2020

 
 
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ORIGINAL ARTICLES
Cognitive impairment and pregabalin dependence
Abouzed Mohamed, Emam M
January-April 2020, 41(1):14-18
DOI:10.4103/ejpsy.ejpsy_34_19  
Background One of the major consequences of substance misuse is its effect on patient cognition. Pregabalin is a new-generation antiepileptic which is believed to have an addictive effect. Objective This cross-sectional study is aimed to estimate the prevalence of cognition impairment among patients with pregabalin misuse. This study includes 300 patients and 100 controls with matched age, sex, and education. The drug abuse patients were divided into two groups: the first group patients used pregabalin alone and the second was a polysubstance group; each group was formed of 150 patients matched in sex, age, and educational level to the pregabalin group. For the diagnosis we used urine screening for drugs. We used the Montreal cognitive assessment test in Arabic edition to evaluate the cognitive function of the patient. Result Cognitive impairment was more in pregabalin misuse patients (M=25.4, SD=3.3) than in the control group (M=27.5, SD=3.7) according to the Montreal cognitive assessment test, P value less than 0.001. The most affected domains were visuoconstruction, digit span, verbal fluency, and recall, with dose (M=625, SD=400). There was no association between cognitive impairment and dose of pregabalin or duration of substance abuse. Conclusion This study concluded that pregabalin misuse patients were likely to have cognitive impairment due to the drug effect and their cognitive impairment was less than the polysubstance misuse group.
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Brain electrical activity mapping in the diagnosis of attention-deficit hyperactivity disorder
Osama A Elmagd Elkholy, Hussein H Abdeldayem, Asmaa O Badawy
January-April 2020, 41(1):7-13
DOI:10.4103/ejpsy.ejpsy_18_19  
Background Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder of childhood. It affects approximately 4% of all children, although estimates vary widely from 3% to 11% or more. Neuroimaging and neurophysiological tests have been increasingly used to understand the relation between brain functionality and ADHD symptoms. QEEG provides a method that can measure the neurophysiological mechanisms underlying neurodevelopmental disorders. By using spectral analysis is able to find abnormalities of brain functionality and connectivity linked to abnormal ADHD behaviors. The objective of the current work was to study and compare the efficacy & accuracy of QEEG for diagnosis of ADHD children, to assess the spectral characteristic of QEEG findings within cases of ADHD, to detect the presence of specific EEG findings that might help in diagnosis. Methodology The current study was conducted on 60 school aged children range from 6-15 years (60 ADHD children matching DSM-5 criteria) and 20 typically developing children. All cases were subjected to thorough history taking and clinical examination with special attention to neurological examination. Both cases and controls were subjected to QEEG analysis and interpretation. All studied children had undergone assessment with Arabic form of Conners’ Parent Rating Scale short form, IQ test, Arabic version of DSM-5. The present study revealed that: Increased levels of slow waves (predominantly theta) , decreased levels of relative Beta LF activity, and increased levels of Theta/Beta LF ratio, in QEEG of ADHD when compared to QEEGs of normal controls. The present study revealed significant differences between ADHD cases & control at all regions of brain; according to average amplitude of power spectrum of all bands (Theta, Beta LF&HF) and Theta/Beta LF ratio. From this study we concluded that children with ADHD have QEEG dysfunctions that underlie their symptomatology. QEEG average of power spectral analysis (theta, beta LF and theta/beta LF ratio) can differentiate between ADHD cases (abnormal power) & normal population (normal power).
  1,036 149 -
Cognitive impairment and depression in patients with diabetic retinopathy
Marwa Ahmed, Mohamad Gad, Mohamad Al-Adlany
January-April 2020, 41(1):1-6
DOI:10.4103/ejpsy.ejpsy_13_19  
Background Several reports have shown that cognitive impairment risk is increased in diabetes mellitus by about 40%. Abnormalities in the retinal vascular cytoarchitecture resulting from diabetes might be responsible for cognitive impairment as the blood-brain and blood-retinal barriers are similar Such potential relationship between abnormalities in the retinal vascular structure and cognitive impairment is highly valuable in predicting the risk for cognitive impairment in diabetes. Aim of the work This study aims to examine the association between diabetic retinopathy and cognitive impairment in diabetic patients both type 1 and type 2. Patients and methods A total of 200 patients with diabetes were selected (120 diabetic patients with retinopathy, 46 diabetic nonretinopathy patients, and 34 newly diagnosed diabetic patients). All patients were assessed using retinal photography, Hamilton depression rating scale, mini-mental state examination, and trail making test. Results Cognitive impairment was significantly higher in individuals with diabetic retinopathy when compared with individuals without retinopathy and newly diagnosed diabetes mellitus. Patients with diabetic retinopathy were significantly more severely depressed relative to other groups of patients. Conclusion Our results revealed that diabetic retinopathy was associated with cognitive impairment. However, the degree of retinopathy did not appear to have significant correlation with the degree of cognitive impairment.
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Depressive and anxiety symptoms in relation to sexual dysfunction in female patients with psoriasis
Ahmed M Hassanin, Nashaat N Ismail, Amr N Kaddah, Asmaa A.E Ebrahiem, Mohamed R. Soltan, Ahmed A.E Ezzat Abd Elhakim
January-April 2020, 41(1):25-32
DOI:10.4103/ejpsy.ejpsy_36_19  
Background Psoriasis is a chronic, inflammatory cutaneous disease with worldwide estimated prevalence ranging from 0.9 to 8.5%. Psoriasis has been associated with psychological problems, including low self-esteem, depression, anxiety, sexual dysfunction, or suicidal ideation. Objectives To assess depressive and anxiety manifestation in relation to sexual functions in female patients with psoriasis compared with healthy controls. Patients and methods One hundred female patients with psoriasis were recruited from the dermatology outpatient clinic of the medical faculty of Beni-Suef University, and 80 female participants were included as a control group. The study was conducted after obtaining the approval of the ethical committee of the Faculty of Medicine, Beni-Suef University. All participants were subjected to the following: Beck Depression Inventory, Beck Anxiety Inventory, and Female Sexual Function Index. Results Patients with psoriasis showed a highly significant depressive and anxiety symptoms and scores on Beck Depression Inventory and Beck Anxiety Inventory, respectively, compared with control group (65 vs. 26.1% and 74 vs. 66.1%, respectively). Psoriasis cases exhibited a statistically significant decrease in all domains of Female Sexual Function Index compared with control group, except satisfaction. Cases with sexual dysfunction showed significantly higher anxiety symptoms and scores (but not depression) than cases with normal sexual dysfunction. Conclusion Patients with psoriasis showed more depressive and anxiety symptoms. Moreover, they showed more sexual dysfunction, particularly on the desire, arousal, lubrication, and orgasm components of sexual function in female patients. Sexual dysfunction is associated with anxiety but not with depression in female patients with psoriasis.
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Cytokine profile among a sample of bipolar and schizophrenic patients: a comparative study
Shaimaa M Arafa, Shaimaa Abdelhafeez
January-April 2020, 41(1):41-50
DOI:10.4103/ejpsy.ejpsy_38_19  
Background Bipolar disorder (BD) and schizophrenia are serious forms of mental illness which are considered to be complex and multisystemic conditions. Several lines of evidence point to the key role of immune dysfunction in both disorders, with recent reports citing abnormal blood levels of cytokines where the most obvious mechanism is a dysregulation of the balance of proinflammatory and anti-inflammatory cytokines. Objective The aim was to explore the presence of immune dysfunction in BD in comparison with schizophrenia and to compare them to apparently healthy control persons. Participants and methods This study was a cross-sectional study on 90 individuals (30 diagnosed as BD, 30 as schizophrenic, and 30 apparently healthy controls). Age matched and sex matched. They were assessed by general medical and neurological examination. Semistructured clinical interview for DSM-IV (SCIDI), positive and negative schizophrenia scale (PANSS) for the schizophrenia group, Yearsania rating scale (YMRS) for the bipolar group, and laboratory investigations include: serum interleukin (IL)1B level and serum IL6 level for the three groups. Result The mean serum IL1B level was found to be higher in the bipolar group than that of the control group and schizophrenia group .The mean serum IL1B level in the schizophrenia group was higher than that of the control group. The mean serum IL6 level was higher in the bipolar and schizophrenia groups than that of the control group. It was also found that serum IL1B showed a highly significant correlation with the duration of illness in the bipolar group, while serum IL6 showed a significance with the duration of illness in the bipolar and schizophrenia groups. In the bipolar group, significant correlation was found between IL6 and number of episodes, while in the schizophrenia group, a significant correlation was found between IL6 and age at onset of illness and number of episodes. Conclusion There is mounting evidence of increased immune markers, particularly proinflammatory cytokines in BD and schizophrenia patients. So, identifying the biomarkers could represent new tools which could help to improve diagnosis and find prognostic markers which offers great promises toward a better understanding of the etio-pathological mechanisms involved in BD and schizophrenia, and for the development of prevention and personalized treatments.
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Child characteristics associated with comorbidities among children diagnosed with attention-deficit hyperactivity disorder
Abdallah S Ibrahem, Ghada M Salah-Eldeen, Haitham M.Abo Hashem, Omnia A Aiad
January-April 2020, 41(1):19-24
DOI:10.4103/ejpsy.ejpsy_35_19  
Background More than half of children who are diagnosed with attention-deficit hyperactivity disorder (ADHD) were reported to have one or more comorbid psychiatric disorder. Our aim is to assess different comorbidities in children diagnosed with ADHD and to explore the association between the presence of such comorbidities and the characteristics of both the child and the family. Patients and methods The study included 48 children with ADHD who fulfilled the inclusion criteria. The diagnosis of ADHD was made by semistructured clinical interview for both parents and child according to psychiatric sheet of Psychiatry Department of Zagazig University hospitals. Confirmation of diagnosis, severity, and subtype was done by revision and evaluation of child’s presentation according to DSM-5 criteria and the Conner’s Comprehensive Behavior Rating Scales (parent’s version). Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) was used to assess psychiatric comorbidities among children with ADHD. Results Approximately 77.1% of children with ADHD had at least one psychiatric comorbidity. Overall, 41.7% of the population of this study had externalizing disorders (disruptive behavior disorders), whereas 52.1% had internalizing disorder, including mood disorders (25%) and anxiety disorders (29.1%). In addition, neurodevelopmental disorders were comorbid in 27.1% of the population sample. Statistically significant differences between different groups of comorbidities regarding academic performance and ADHD subtype and severity were found. Conclusion Most children with ADHD have one or more comorbid psychiatric disorders. Children with ADHD and comorbidities are more prone to low academic performance and increased severity of ADHD.
  718 83 -
Associating personality disorders in fathers with substance-related disorder and their index child behavioral problems: a cross-sectional study
Samah H Rabei, Mohamed H El-Din
January-April 2020, 41(1):51-56
DOI:10.4103/ejpsy.ejpsy_25_19  
Background Paternal comorbid personality disorder among fathers with substance-related disorder may directly throw its effect on child monitoring and disciplinary practices or indirectly through its impact on the interparental relationship on their children and adolescents. Objective The objective of this study was to illustrate the pattern of behavioral problems of children and adolescents of substance-related disorder fathers with comorbid personality disorder, and to explore the association between these behavioral problems of children and adolescents. Patients and methods One hundred patients were recruited from the inpatient wards and outpatient clinics of the Institute of Psychiatry, Ain Shams University. They were subjected to a structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders-IV Axis I diagnosis (clinical version), SCID-II and child behavior checklist. Results and conclusion Depressive, paranoid, passive aggressive, narcissistic, and antisocial personality disorders in fathers with substance-related disorder have the worst impact on child behavioral problems..
  622 85 -
Risk factors of cognitive dysfunction among patients with chronic obstructive pulmonary disease
Amgad A.M Gabr, Mahmoud El Saeed Abd El Raoof, Sally S Abd-Elhamed, Ibrahim H Elbanaa
January-April 2020, 41(1):33-40
DOI:10.4103/ejpsy.ejpsy_37_19  
Background Cognitive dysfunction is one of the most common comorbidities related to chronic obstructive pulmonary disease (COPD), with ∼70% of patients developing such condition. Besides, cognitive dysfunction has been established to be a potential predictor of mortality and morbidity. Aim This study was conducted to assess the possible causes of cognitive dysfunction among patients with COPD. Patients and methods Patients with COPD aged more than 40 years were included in the current study. Patients were further assorted into two groups based on the assessment of cognition state using Mini Mental State Examination: patients who had COPD without cognitive dysfunction (control group) and patients who had COPD with cognitive dysfunction (case group). Results A total of 120 participants were included in the study. Of them, 60 patients experienced COPD without cognitive dysfunction (control group) whereas 60 patients experienced COPD with cognitive dysfunction (case group). There was a statistically significant difference between both groups regarding the education level (P=0.038), intelligence quotient levels (P=0.004), duration of symptoms (P=0.042), and Modified Cumulative Illness Rating Scale (MCIRS) (P=0.001). The results of regression model showed that patient’s age (P=0.01), MCIRS (P=0.041), duration of symptoms (P=0.03), and education state (P=0.029) were statically significant predictors of Mini Mental State Examination score. Conclusion The findings of our investigation increase the awareness that despite the controlled COPD, elderly obese patients with high MCIRS score and long duration of symptoms were more susceptible to develop cognitive dysfunction.
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