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.

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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.

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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.

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Introduction Recent studies have begun to examine sex differences in first-episode psychosis in an attempt to explain the heterogeneity of the illness. The aim of the current study was to examine sex differences with respect to sociodemographics and clinical presentations, including cognitive, affective, and psychotic aspects, in both nonaffective and affective groups at their first episode of psychosis. Materials and methods Sixty-one men and 29 women, 18 years of age or older, were recruited, admitted in the psychological medicine hospital, state of Kuwait, from January 2007 up to December 2009 for treatment of first-episode psychosis. All patients were divided according to the consensus clinical diagnoses on the basis of a structured clinical interview of DSM-IV into two groups: patients with nonaffective psychosis (n = 49, 39 men and 10 women) and patients with affective psychosis (n = 41, 22 men and 19 women). Psychometric assessment was carried out using Hamilton Depression Rating Scale, Young Mania Rating Scale, Positive and Negative Syndrome Scales, Wechsler Adult Intelligence Scale, and (Wechsler Memory Scale - 3rd ed.) subtests including measures for verbal, visual and working memory, attention, and executive functions as well as the trail-making test. Assessment of neurological side effects was carried out using the Simpson-Angus Scale. The assessment was carried out at baseline and after 2 years of follow-up. Results Men in the nonaffective psychosis group (schizophrenia, schizoaffective, and delusional disorder) were significantly younger, had an early age at onset (3-5 years), higher level of education, and intact occupational function compared with women who had a more stable marital life. Men required a longer period for improvement in symptoms and were more sensitive to neurological side effects than women. Sociodemographics were comparable in both sexes in the affective psychosis group (bipolar psychosis and depressive psychosis). In terms of symptom presentation, there was no statistically significant impact of sex on different cognitive, affective, and psychotic aspects of presentation in both diagnostic groups at baseline and after 2 years of follow-up. Men had more severe affective symptoms, and more positive and low negative scores compared with women in the nonaffective psychosis group. Although nonsignificant, the affective group had higher cognitive functions and a faster rate of improvement compared with the nonaffective group. Conclusion and recommendation Study of sex differences in first-episode psychosis is still a challenging and a controversial issue in the short term, especially in clinical presentation. Longitudinal studies and long-term follow-up where biological and psychosocial variables are interacting are highly recommended.

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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.

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Background Low vitamin D levels are associated with schizophrenia, depression, and seasonal affective disorder in adults. The relationship between vitamin D and depression in pediatric population is little investigated. Aim of the study The aim of the study was to determine the association between depression severity and serum levels of 25-OH cholecalciferol in children and adolescents. Patients and methods A total of 82 depressed children and adolescents and 21 age-matched and sex-matched healthy controls were enrolled in the study. All participants were subjected to sociodemographic variables, medical and psychiatric examination, psychometric evaluation by the semistructured clinical interview and Hamilton Depression Rating Scale, routine laboratory investigations, and serum 25-OH cholecalciferol levels measurement. Results There was no significant difference between the groups with respect to age, sex distribution, BMI, family income, and residency. Children of joint paternal family type and with positive psychiatric family history have statistically significant increase in the severity of depression compared with those of other family types and with negative psychiatric family history. Vitamin D levels and severity of depression were inversely correlated; the more severe the depression was, the lower was the level of vitamin D. Conclusion 25-OH cholecalciferol deficiency is more prevalent in depressed children and adolescent patients than in normal children. Vitamin D supplementation in depressed children might be further investigated in the future.

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Background Enlarged ventricles and reduced hippocampal volume are consistently found in patients with first-episode psychosis. Many studies examining brain structure changes in antipsychotic-naive patients have generally focused on the striatum. In this study, we examined whether reduction in hippocampal volume is a morphological trait in such a group of patients in an attempt to find its clinical and cognitive correlates for patients with different diagnoses of first-episode psychosis both at their first contact and at short-term follow-up. Patients and methods We obtained high-resolution three-dimensional T-weighed MRI scans of the hippocampus for 90 patients with first-episode psychosis (49 patients with schizophrenia, 21 patients with bipolar psychoses, and 20 patients with depressive psychosis) as well as 23 healthy controls both at the baseline and after 2 years of assessment. Assessment of the clinical picture was carried out using the structured SCID interviews, HDRS, YMRS, and PANSS. Cognitive function and intellectual abilities were examined using WMS-III, the Trail Making Test, and WAIS. Results A greater reduction in hippocampal volume was evident in the schizophrenia group than the bipolar and depressive psychosis groups compared with the healthy controls both at baseline and after 2 years, indicative of being a morphological trait for such patients. Negative symptoms were related to hippocampal volume reduction in the schizophrenia group. The initial assessment of untreated patients revealed reduction in their hippocampus volume which correlated with the longer duration of untreatment. After 2 years of follow-up, recurrent hospitalization was found to be related to further volume reduction. Impaired working memory, verbal memory, and baseline intellectual abilities were related positively to structural hippocampal changes. Cognitive and clinical correlation with a reduction in hippocampal size was less evident in the bipolar psychosis group, which may highlight different structural changes in other areas in the striatum. Conclusion and recommendation Hippocampal volume reduction may be considered as morphological traits for some patients with first-episode psychosis, and linked to some clinical and cognitive impairment. Study of the shape, localized regions of the hippocampus as well as other brain areas may help to clarify the circuits shared in the pathophysiology of psychoses of different types. Early detection of structural changes with the study of high-risk patients may aid effective treatment and improve outcomes.

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