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   Table of Contents - Current issue
Coverpage
September-December 2021
Volume 42 | Issue 3
Page Nos. 115-179

Online since Tuesday, September 28, 2021

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ORIGINAL ARTICLES  

Profile of egyptian patients with borderline personality disorder with and without comorbidity p. 115
Reem El Ghamry, Abdel N Omar, Nivert Zaki, Heba Elshahawi, Dina Naoom, Reem Hashim, Mahmoud Morsy
DOI:10.4103/ejpsy.ejpsy_4_21  
Background Borderline personality disorder (BPD) is a complex psychiatric disorder associated with a wide range of psychopathology, including unstable mood, impulsive behavior, and suicidality, which is a defining feature of borderline, as well as high rates of axis I comorbidity. Aim To identify the profile of psychiatric comorbidity among patients with BPD and to compare them with a group of patients with BPD without comorbidity regarding some demographic variables, suicidal behavior, impulsivity, and functioning. Methods Structural Clinical Interviewing was done for DSM-IV axis I and axis II diagnoses. We recruited 30 patients with BPD, without axis I comorbidity (group I) and other 31 patients with BPD with comorbidity (group II). We compared both groups regarding different demographic variables, family circumstances impulsivity, suicidality, and functioning using suicide behavior questionnaire − revised, Barratt impulsiveness scale II, and global assessment of function. Results Patients with BPD in group II had one additional diagnosis, mainly major depression (35.5%), substance-related disorder (35.5%), anxiety disorder (16.1%), whereas bipolar disorder and eating disorders were equally rated (6.5% each). Group II patients scored significantly higher in the total suicidality scores using suicide behavior questionnaire − revised than group I, yet the two groups did not differ significantly in impulsivity scores. Meanwhile, the former group was significantly younger (P=0.05), and they started their illness and seeked treatment at a younger age with more history of previous hospitalization than did group I. In addition, their global assessment of function is significantly impaired (P=0.002). Conclusion Comorbidities in patients with BPD are high, mainly major depression and substance-related disorders, which are associated with increased suicidality behavior, hospital admission, and impaired functioning. Data obtained conveys the need to give high priority to recognize the comorbidities that pose risk on the lives of patients with BPD.
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Burnout in Egyptian mental health professionals and its relation to their psychosocial and vocational characteristics p. 123
Eman Shorub, Ahmed Saad, Tarek El Sehrawy, Mahmoud Monzem, Samah Rabei
DOI:10.4103/ejpsy.ejpsy_5_21  
Background Worldwide studies showed that mental health professionals have high rates of burnout. To date, no studies have looked at burnout in Egyptian mental health professionals, so investigating burnout in this population would be important as it may affect their performance. A total of 156 mental health professionals from three psychiatric hospitals in Cairo (Ain Shams University Hospitals, Abbassyia Mental Hospital, and Psychological Mental Hospital) were investigated for sociodemographic and vocational data using the Structured Clinical Interview for DSM-IV-Clinician Version (SCID-CV) and burnout assessment tool: the Maslach Burnout Inventory in this study. Results Overall, 57.7% of participants had high emotional exhaustion, 21.5% had high depersonalization, and 47.8% had high personal accomplishment on the Maslach Burnout Inventory. The number of working hours/week was positively correlated with emotional exhaustion and depersonalization. The number of night shift/month was positively correlated with depersonalization. Conclusion There was high burnout syndrome among mental health professionals in Egypt.
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The relation between pattern of feeding and behavior & mental health disorders among children p. 128
Enas A.M Abdurrahman, Tayseer M Elzayat, Rania A Hamed, Amira H Hassan
DOI:10.4103/ejpsy.ejpsy_7_21  
Introduction The benefits of breastfeeding are innumerable, such as a reduction in the risk of acute otitis media, gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, childhood leukemia, additionally may reduce the risk of psychological and behavioral disorders among children. Aim To evaluate the effect of breastfeeding on behavioral and mental health disorders of school-age children. Patients and methods This case–control comparative study was carried out on a group of children aged from 6 to 12 years, who were divided into two groups: the patient group included 50 children who were diagnosed with behavioral and mental health disorders according to DSM 5 criteria of diagnosis and were recruited from the outpatient psychiatry clinic of Al-Zahraa Hospital University during the period from March 2020 to September 2020 and a control group with apparently healthy children with no history of psychological manifestations matched in number, age, and sex with the patient group. Result The mean age was 8.4±2.2 years. There were 15 (30.0%) female and 35 (70.0%) male patients, with the highest percentage having attention-deficit hyperactive disorder (ADHD) (72.0%), followed by obsessive-compulsive disorder (OCD) (24.0%), learning disorder (10.0%), and conduct disorder (2.0%). The majority of the cases (29) were mixed fed (58.0%), 11 (22.0%) were artificially fed, and 10 (20.0%) were breastfed. There was a highly statistically significant difference between artificial (bottle) feeding and mixed feeding regarding behavioral disease as ADHD and OCD were highly significant, with P value more than 0.001. Moreover, there was a highly statistically significant difference between the duration of breastfeeding less than or equal to 6 months and ADHD and OCD. Conclusions Breastfeeding has been demonstrated that is inversely associated to behavioral and mental health disorders as increase the duration of breastfeeding associated with decrease the incidence of psychological and behavioral disorders.
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Electrophysiological and psychophysical testing in children with attention-deficit hyperactivity disorder p. 139
Shereen D. Abo Hammer, Reham M Lasheen, Mona A Kotait, Reham A Amer
DOI:10.4103/ejpsy.ejpsy_12_21  
Background Multiple techniques are used for understanding, determining the real pathophysiological process, and treating attention-deficit hyperactivity disorder (ADHD). The aim of this study was to assess cortical auditory evoked potentials (CAEP) as well as P300 in children with ADHD, and its correlation with neurocognitive tests [Wisconsin card sorting test (WCST), digit span (DS), and Stroop test (ST)]. Patients and methods A prospective cross-sectional study was performed on 103 children, who were divided into two groups: 53 children newly diagnosed with ADHD (according to Diagnostic and statistical manual of mental disorders, 5th ed.), who were drug naïve, and 50 normal control matched for age, sex, educational and social level, and intelligence quotient. All participants had detailed psychiatric history, intelligence quotient Wechsler intelligence scale for children (WICS), Conners’ parent/teacher rating scale abbreviated form for ADHD, neuropsychological tests (WCST and Stroop), pure tone audiometry, speech audiometry using GSI 61 audiometer, immittance test using interacoustic, and sustained attention test using auditory continuous performance test (ACPT) P300. Results Children with ADHD had more perseverative responses, more preservative errors, and more failure to maintain set (FMS) than controls in WCST, with a significant difference among study groups. ADHD group was impaired in digit span backward and ST than control group. P300 amplitude and latency were significantly different between the study groups. In comparison with the control group, statistical delayed latencies of significance were observed in ADHD between all CAEP components. A significant difference for P1-N1 amplitude was observed among different components of CAEP, and no significance was observed regarding P2-N2 amplitude. ACPT showed a significant difference between both groups, with higher percentage in control group. Positive correlations were observed between P300 amplitude and WCST (perseverative error), P300 amplitude and ST results, and N2 latency and DS backward. Conclusion Assessment of CAEPs and P300 in children with ADHD, as well as their correlation with neurocognitive tests (WCST, DS, and ST), is crucial in diagnosis and management.
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The effect of age on the degree of improvement of pragmatics in delayed language developed children p. 148
Riham El Maghraby, Walaa El Sayed, Heba E.A.El Wafa
DOI:10.4103/ejpsy.ejpsy_14_21  
Background The study of actual language use is called “pragmatics.” The literal meaning of an utterance is necessary, but not sufficient for the partner to reconstruct the meaning conveyed by the actor. The interventions of pragmatic impairments depend mainly on improving the four important aspects for any effective social communication contexts that are social interactions, social cognition, language processing, and pragmatic skills. Aim The paper aims to study the effect of age on pragmatic intervention to decide what age is more appropriate to give the better response of pragmatic impaired children. Patients and methods This study was conducted on 20 children with pragmatic impairments attending the Unit of Phoniatrics, in the outpatient clinic of Alexandria Main University Hospital. The children of the study were divided into two groups: group A: 10 children with pragmatic skill impairments aged (5–<6.5) years old and group B: 10 children with pragmatic skills impairments aged (6.5–8) years old. First, Initial assessment: (A) elementary diagnostic procedures: history taking, general examination. (B) Clinical diagnostic aids: psychometric evaluation, Arabic language test, and pragmatic language skills evaluation by using the Arabic version of Test of Pragmatic Language second edition, which is a subtest of Comprehensive Arabic language test. Second, Intervention: the program was applied to all children in groups of 2–3 children, one session per week, each session ranging from 45 to 60 min. Two types of interventions were applied which were: (a) direct intervention: typically delivered by speech-language pathologist and (b) indirect interventions: typically consisted of advices and instructions to the parents or to support the generalization of social communication skills in the child’s environment. “Say and Do Positive Pragmatic Fun Sheets” program helps children learn to use appropriate social communication skills in everyday situations. The fun sheets target a variety of social communication skills in the following areas: giving information, persuasion, requesting, problem solving, feelings, appropriate interaction, greetings/politeness, and topic maintenance. The duration of therapy was about 3–6 months. Third, Reevaluation: after a period of 3–6 months of therapy using the protocol of initial assessment. Results A statistically highly significant increase in the scores of the cases of the school-age studied groups A and B was seen when comparing between pre- and posttherapy, and no statistically significant difference when comparing posttherapy scores between the two studied groups. Conclusion There is no difference in improvement degree of pragmatics in the two age groups so starting therapy can be done at any age to improve the pragmatic skills of children.
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Impact of familial and perinatal risk factors in children with attention deficit hyperactivity disorders: an Egyptian sample p. 158
Manal Omar, Dina Y ElAlfy, Michael Sobhi
DOI:10.4103/ejpsy.ejpsy_19_21  
Introduction Attention-deficit hyperactivity disorders (ADHD) are reported in children who have a higher risk of perinatal complications, reaching up to 35–50% of children born with low birth weight, or preterm, and other natal and neonatal complications. Objective To study the patterns and extent of familial and perinatal risk factors in children with ADHD. Patients and methods The sample was 456 ADHD cases out of 3152 children who were attending a Neurodevelopmental Child Psychiatry Clinic in Cairo, Egypt, from April 2010 to October 2018. The control group was 274 apparently normal children attending the Neurodevelopmental Child Psychiatry Clinic for parental consultations and counseling. Results The most prominent significant risk factors were the existence of attacks of skin allergy and cerclage prenatally, while asphyxia and neonatal ICU admission were significant risk factors postnatally. There was a significant correlation between the cerclage and in-vitro fertilization with no significant correlation with previous abortion. There is a significant correlation with threatened abortion, using drug treatment for threatened abortion, infection, and inflammation during pregnancy, also the placenta was not nutritive, kidney, lung, cardiac problems postnatally, and cesarean section were significantly correlated with cerclage as a risk factor. Conclusions There was a complex interaction of familial and other antenatal risk factors of ADHD, the role of an inadequate maternal and child healthcare delivery system was also evident.
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Anxiety, depression, and stress risk among medical staff during COVID-19 pandemic: a single-center experience p. 166
Mohamed R Soltan, Shaimaa S Soliman, Mariam E Dawoud
DOI:10.4103/ejpsy.ejpsy_17_21  
Background The widespread pandemic of coronavirus disease 2019 (COVID-19) virus has caused major psychological effects, especially among health care workers who are exposed to high viral load. The aim was to investigate the psychological effects of COVID-19 on health care workers and factors affecting them. The study was carried out with an online questionnaire distributed through Google Forms for medical staff at Faculty of Medicine, Fayoum University, Egypt. The questionnaire included sociodemographic questions; validated psychometric tools for the assessment of depression, anxiety, and stress (Depression Anxiety Stress Scales-21); and the Impact of Event Stress Scale-Revised (IES-R). Results The total number of the participants was 115 respondents. IES-R showed that 28.7% had high posttraumatic stress disorder. By Depression-Anxiety-Stress Scale, 13% had severe, 26.1% had extremely severe depression, 10.4% had severe, and 13.9% had extremely severe anxiety, and stress level was severe in 16.5% and very severe in 13.9%. The factor ‘work-years less than 5 years’ was significantly associated with the presence of stress. Personal psychiatric history of anxiety was significantly associated with abnormal IES and depression. Conclusions During the COVID-19 outbreak, medical health workers had psychosocial problems and risk factors for developing them. They were in need of attention and recovery programs.
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CASE REPORT Top

A case report of Kluver–Bucy syndrome following herpes simplex encephalitis p. 174
Sripathi S Goud, Vishal Indla, Indla R Reddy
DOI:10.4103/ejpsy.ejpsy_20_21  
Kluver–Bucy syndrome (KBS) is a rare syndrome seen after lesions of temporal lobes of the brain. Herpes simplex virus 1 is the most common infectious agent causing KBS owing to predilection of the virus to selectively affecting the temporal lobes. In this paper, we present a rare case of KBS that developed after herpes simplex encephalitis.
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COMMENTARY Top

Psychological impact of a volcano eruption − Mount Nyiragongo p. 176
Harpreet S Dhillon, Shibu Sasidharan
DOI:10.4103/ejpsy.ejpsy_27_21  
The volcanic eruption is a rather uncommon type of natural disaster and is restricted to certain geographical regions. The psychological distress studied among the evacuees of a volcano in many countries revealed symptoms of anxiety, insomnia, anergia, social dysfunction, and anhedonia persisting even after six months of eruption. A study after a volcanic eruption in Iceland revealed higher incidence of mental distress and post-traumatic stress disorder (PTSD) in exposed versus the non-exposed groups. Insomnia, psychological morbidity, and possible long-term psychological morbidity were reported as the most common symptoms in the high-exposure group (based on the volcano-ash fall). Studies also show the involvement of children’s mental health. DRC, being a low-income country lacks the research and does not have strongly researched data regarding the prevalence of psychological morbidity post the volcano eruption. However, the psychological maladjustments after the Mount Nyiragongo eruption in 2002 were reported as the major health consequence as per WHO. This paper analyses the various psychological aspects during and after a volcanic eruption.
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