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.

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Background Culture plays a major role in healthcare delivery. The majority of mentally ill patients prefer to attend nonmedical practitioners such as traditional healers. Practical clinical application of the research in cultural competency can enable physicians to decide whether folk traditional healing practices are harmful or benign. Like other cultures, the Arab culture transmits a number of beliefs, which are locally shared, although considered unlikely or even objectively disprovable by others outside the culture. Aim In this paper, we examine the view of mood disorders as seen by the patients and the role of faith healers in the treatment of such disorders with regard to urban versus rural areas. Patients and methods We assessed 416 United Arab Emirates national patients with Bipolar Affective Disorder (BAD) (279 urban and 137 rural) after confirmation of diagnosis with Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revised. These patients underwent Mini International Neuropsychiatric Interview, Help-Seeking Pattern, and Experience Questionnaire, which stressed on the attitude of the patient toward psychiatric illness, belief in healer management, line and result of traditional management, and the frequency of seeking traditional healers. Results The current study showed that about 60% of patients of both populations had visited faith healers before seeking medical services. Rural population usually shows no commitment to treatment and resorts to traditional therapy more often compared with the urban population (24 vs. 17.5% and 33.7 vs. 19%, respectively). Rural patients were more credulous toward faith management compared with urban patients (35.1 and 18.4%, respectively), whereas a merge of the two beliefs, psychiatric and faith management, was more common in the urban population than in the rural population (31.6% compared with 9.6%, respectively). An overall 39.5% of the families of urban cases and 9.6% of the families of rural cases considered mental illness a real disease as any other organic disease. In faith healing, different diagnoses, which included touch, evil eye, witchcraft, and jinn possession, were evenly distributed among patients with varying percentages among rural and urban populations. Conclusion This study shows that the majority of patients suffering from mental illness, especially in rural populations, prefer to approach faith healers first, which may delay entry to psychiatric care and thereby negatively impact the prognosis of BAD. Therefore, we should improve the orientation of the general practitioners (GPs) and broaden the destigmatization program about psychiatric disorders, especially mood disorders. This highlights the importance of mental health education, developing a positive collaborative relationship with traditional healers, and highlighting the role of cultural beliefs in both the evaluation and the management of mental disorders.

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Background School aggression has become an increasing concern to public health professionals, clinicians, policy makers, educators, and the general public. It is a multifaceted problem with biological, psychological, social, and environmental roots. Aim The aim of this study was to examine the prevalence and the influence of social, family, and school environments on the development of school aggression. Patients and methods A multistage stratified sample of 574 students of both sexes aged 13–18 years was selected from the preparatory and secondary schools chosen from Zagazig Center through the academic year 2014–2015. Sociodemographic characteristics of the students were evaluated using a self-reporting questionnaire. Aggressive behavior was assessed using the Aggressive behavior and hostility scale for adolescents (the parts of physical and verbal aggression). Results Physical aggression was severe in 0.7% of the sample, moderate in 8.5%, mild in 39.2%, and minimal in 51.7%. As regards verbal aggression, it was severe in 0.5% of the sample, moderate in 8.0%, mild in 40.5%, and minimal in 51.1% of the sample. Risk factors for aggression were male sex, age greater than 15 years, unfavorable school atmosphere, practicing sports, smoking, watching action movies, personal history of physical abuse, being second-born child of the family, attending urban schools, and a history of dropping class. Conclusion School aggression is a frequent and a serious problem among school adolescents. It is necessary to evaluate the level of seriousness and attempt to find effective preventing measures.

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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.

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Objective This study was conducted to find out knowledge and attitudes toward epilepsy among a sample of people living in Ismailia governorate in Egypt. Patients and methods A cross-sectional survey was conducted by using a face-to-face interview; 840 respondents were included, among whom 420 were from an urban area − Sheikh Zayed district − and 420 were from a rural area − Abu-Sultan village. The survey instrument was a 26-item questionnaire in Arabic form that was designed to evaluate knowledge and attitudes with respect to epilepsy. Results Of the 840 respondents, 91.2% had heard of or read about epilepsy, 24.8% knew someone with epilepsy, and 30.7% had witnessed a seizure. According to the respondents, the main cause of epilepsy was psychological disease (63.7%), followed by evil spirits (Jinn) (49.5%) and a form of insanity (47.4%). Approximately 70% of the respondents (70.7%) agreed that the intelligence of an epileptic patient is below average. About three-quarters of the respondents (74.6%) believed that epilepsy cannot be cured. More than 50% of the respondents believed that an epileptic patient could not get married (57.5%), nor have a child (58.7%). About 80% of the respondents refused to marry an epileptic patient (77.7%) or to marry their child to an epileptic patient (83.0%). Fifty-nine percent of the respondents would not offer a job to a person with epilepsy, and 41.1% refused working with an epileptic patients. The negative attitudes toward an epileptic person were more common among rural, female, less-educated, and elderly respondents. Conclusion Public perception of epilepsy is lacked and needs attention. The study revealed that practices and knowledge toward epilepsy were limited, especially with respect to epilepsy’s cause, manifestation, and management. Continuing effective educational interventions would be needed to improve the appropriate understanding of epilepsy, and to ameliorate the social discrimination and misconceptions against epilepsy.

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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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Background Child abuse − a form of family violence − is one of the major public health issues with far-reaching effects and costs and have many implications on health policy and prevention strategies. Objective The aim of the study was to assess risk factors of child physical abuse among school-aged children in the child’s background and family characteristics and to estimate its psychiatric sequelae. Patients and methods The study was conducted in Maternity and Children Hospital, Al Medina (Al Monawara), Kingdom of Saudi Arabia, on school-aged children referred from the committee protection program from September 2012 to April 2015 using such some psychometric tests as the Child Maltreatment Questionnaire, the Mini International Neuropsychiatric Interview for children and adolescents (for major depressive episodes), Revised Behavior Problem Checklist, and Copper Smith Self-Esteem Inventory. Results Out of 186 students (age range between 12 and 16 years) 49.4% were the youngest children, mainly boys (58%), 94% had good health, 70% were from large-sized families, and 51% of whose mothers and 54% of fathers were illiterate, and all these variables showed a significant difference in both mild/moderate and severe child abuse. There were significant associations between physical abuse and low self-esteem, major depressive episode, conduct disorder, anxiety withdrawal, attention deficit hyperactivity disorder, and socialized aggression, mainly with severe physical abuse. Conclusion Physical abuse is found in a significant proportion of children, mostly living in large-sized families, of illiterate unemployed parents. Furthermore, physical abuse is commonly associated with low self-esteem, major depression episodes, conduct disorder, attention deficit hyperactivity disorder, and socialized aggression.

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Background It has been recently shown that electroencephalogram (EEG) paroxysmal abnormalities are frequently recorded in patients with autism despite the absence of seizures. Objective On the basis of the increasing evidence of EEG abnormalities in autism, the aim of this study was to detect the EEG abnormalities in relation to the degree of severity of autism. Patients and methods EEG was measured in 40 autistic children aged 2–12 years, in comparison with 40 typically developing matched children. The severity of autism was assessed using the Childhood Autism Rating Scale. Results We found that 50% of the autistic children had abnormal EEG findings. There was a statistically significant relation between the EEG abnormalities and the severity of autism. Moreover, there was a statistically significant relation between the site of the wave abnormalities and the severity of autism. Conclusion Our study suggests that the use of neurological investigative techniques such as EEG be considered routinely during the evaluation of autistic children.

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Background It is generally estimated that metabolic syndrome (MetS) is especially common in patients with severe mental illness, with a high prevalence ranging from 30 to 60% for schizophrenic and bipolar disorders, which predispose them to further medical complications up to premature death. Objective The aim of this study was to compare the prevalence of MetS in patients with major depressive disorder (MDD), schizophrenic patients, and healthy general individuals, and to assess the relation between cortisol levels and presence of MetS. Patients and methods The study included 120 participants (40 patients with drug-naive MDD, 40 patients with drug-naive schizophrenia, and 40 healthy individuals who served as the control group). Full history was taken. Blood pressure and waist circumference (WC) were measured and BMI was calculated. Laboratory investigations were carried out, including fasting blood glucose (FBG), serum triglycerides, serum high-density lipoprotein, and a morning level of serum cortisol. Results The study revealed a similar prevalence of MetS in the MDD and the schizophrenic group (27.5%) compared with a prevalence of 22.5% in the control group. The WC and the BMI were significantly higher in the MetS patients of the MDD and the schizophrenic group compared with those of the control group. FBG was significantly higher among MetS patients in the MDD group as compared with those in the schizophrenic and the control group. Cortisol level was significantly higher in MetS patients in the MDD and the schizophrenic group as compared with those in the control group. Conclusion The prevalence of MetS is higher in MDD and schizophrenic patients than in the general population, and is related to high WC, BMI, FBG, and serum cortisol. Hence, screening of such patients for metabolic disturbances is recommended.

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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.

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Background The relationship between mental health and obesity has been studied in different types of research studies as it is considered very important. A lot of research studies have proposed several theories and mechanisms on how the two are linked, which should be reviewed and considered in the management plan of psychiatric disorders. Objectives The aim of this study was to find out the prevalence and correlates of obesity and overweight in a sample of psychiatric patients (inpatients and outpatients) with no history of pharmacological treatment in Al-Hussein University Hospital. Patients and methods This cross-sectional study was conducted during a 6-month-period on 130 psychiatric patients who were subjected to a semistructured clinical interview according to DSM-IV-TR criteria to diagnose psychiatric disorders. Obesity assessment was carried out by measuring the weight (kg) using a scale and measuring the height (m) to calculate the BMI, which is based on the BMI equation Wt (kg)/Ht² (m²). Results The prevalence of obesity and overweight in psychiatric patients was 66.93% (22.31% were obese, and 44.62% were overweight). The prevalence of obesity was highest in bipolar disorder (41.38%), followed by depression (37.93%), schizophrenia (10.34%), anxiety disorder (6.9%), and finally substance abuse disorder (3.45%), but the difference was not statistically significant. There was a significant correlation between sociodemographic characteristics of patients and obesity and the distribution of psychiatric disorders. Conclusion The prevalence of obesity and overweight in psychiatric patients was relatively high, and this can occur with most psychiatric disorders, especially mood disorders, and were supposed to be due to other several mechanisms and risk factors other than the effect of psychotropic medications on the weight of psychiatric patients. Moreover, there are some demographic and social factors that may moderate or mediate the association between obesity and psychiatric disorders; thus, identification of overweight and obesity, associated risk factors, and efforts to prevent weight gain should begin at the initiation of mental health treatment.

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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.

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Background An understanding of the interplay between mental illnesses and metabolic disorders is crucial. At present, in Nigeria, studies on coexistence of these conditions are scarce. Therefore, this study was carried out to determine the prevalence of obesity, metabolically healthy obesity (MHO) and metabolic syndrome (MS) in adults with major mental illnesses. Materials and methods One hundred and twenty four patients with schizophrenia, depression and bipolar disorder were recruited into this cross-sectional study. Blood pressure and anthropometric indices were obtained using standard methods. After an overnight fast, plasma glucose levels and lipid profile were determined. MS was diagnosed using the Joint Interim Statement. MHO was defined as overweight/obesity with less than or equal to one MS risk factor, whereas metabolically unhealthy obesity (MUO) was defined as overweight/obesity with greater than or equal to two MS risk factors. Results More than half (55.6%) of the patients had normal body weight. The prevalence of overweight, obesity and MS was 25.8, 18.5 and 20.2%, respectively. Similarly, the prevalence of MHO and MUO among the overweight/obese patients was 21.8 and 78.2%, respectively. MUO was more prevalent in patients with schizophrenia compared with patients with depression and bipolar disorder. Low HDL and central obesity were the most common components of MS in the study participants. Conclusion It could be concluded from this study that metabolic disorders are not uncommon in Nigerians with major mental illness. Therefore, early identification of patients with metabolic alteration and introduction of preventive measures might forestall further cardiometabolic deterioration, especially in patients with schizophrenia.

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Background

Clinical studies have shown greater sex differences in symptoms of schizophrenia, with men having more negative symptoms than women, which may be related to the action of the reproductive hormones.

Objective

The aim of this study was to determine the relationship between negative symptoms and the plasma levels of testosterone and dehydroepiandrosterone sulfate (DHEAS) in male patients with schizophrenia.

Participants and methods

The participants were 50 male patients with chronic schizophrenia. The psychopathology of the patients was assessed using the Positive and Negative Syndrome Scale (PANSS). The Calgary Depression Scale for Schizophrenia (CDSS) and the Drug-induced Extrapyramidal Symptoms Scale (DIEPSS) were also used to exclude the effects of depression or drug-induced extrapyramidal symptoms.

Results

The PANSS negative scores showed a significant inverse correlation with the serum testosterone levels without a correlation with serum DHEAS.

Conclusion

This study indicates that testosterone but not DHEAS may play an important role in the severity of negative symptoms in male patients with schizophrenia.

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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.

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Background The prevalence of opioid dependence is increasing in the world and in Egypt among university students, which because of many false concepts being adopted. Objectives This study was conducted to detect the prevalence and the effects of opioid dependence among a sample of Mansoura University students. Participants and methods The study was carried out on 700 male students, aged 18–25 years. All students were assessed using semistructured interview and urine drug screening. Students were divided into three groups: the first group comprised 300 students who were not drug users, the second group comprised 300 polysubstance users, and the third group comprised 100 solitary opioid users. The first and third groups were subjected to psychometric assessment using Mini Neuropsychiatric Interview for substance dependence, Arabic version. Psychometric assessment was performed with the following tools: Wisconsin Card Sorting Test, Hamilton rating scale for depression, and PANSS positive and negative symptom scale; laboratory investigations included liver function tests and kidney function test. Results We found that out of 100 students who were opioid users, 88 students used tramadol and 12 used heroin. Liver and renal functions were nearly normal in cases, with a high statistically significant difference between cases and controls regarding serum glutamic oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT), and creatinine. Higher scores for Hamilton scale for depression and trail A and B mean values were found in cases compared with controls. Conclusion The prevalence of tramadol dependence among Mansoura University students is higher than heroin dependence. In addition, opioid dependence has a negative biological and psychiatric sequelae, which is contrast to the false concepts of opioid dependence.

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Purpose

The present study was carried out to investigate why psychiatric and psychological examinations are neglected during periodical medical examinations for football referees.

Patients and methods

A total of 42 certified male referees were randomly selected from the Sports Medicine Specialized Center situated at Nasr City, Cairo Governorate, Egypt. All participants were registered at the African Confederation of Football. Male adult referees with ages ranging from 29 to 43 years were included in the study. Questionnaires related to the demographic personal characteristics, anxiety, physical health, stress, burnout, and depression were filled out by the participants.

Results

The mean age of the participants was 40±3.35 years. Of the participants, 34 were unmarried and eight were married; 32 participants did not have children and 10 did. A total of 36 participants had recieved higher education and six recieved only high school education. Participants were under moderate training schedules of 5 sessions/week of 1½–2 h each and had moderate years of experience (30–50 matches/year). With regard to the Burnout Anxiety Inventory, 63.3% of the participating referees showed no signs of anxiety, 18.4% were at borderline, 15.9% showed mild signs, and 1% presented with moderate records. With regard to the mind over mood depression scores, 35 participants showed no signs, whereas only two showed low signs. The Beck Depression Inventory scores of all participants was in the range of 0–7, that is, they had normal levels of depression. The physical wellness scores of 31 participants were recorded as excellent, whereas five recorded only average scores. With respect to the life stress scores, 67% of participants had normal life stress scores compared with 33% who were more prone to suffer or experience illnesses or accidents from life stress incidents. The Burnout Inventory scale revealed that 47.05% of participants had little signs and 52.95% showed low signs of burnout, with none being at risk. The Maslach results were also in concordance, according to which only one referee suffered from a burnout.

Conclusion

Thus, it may be deduced that, although the present levels of burnout may not be high, there is always potential for it to increase. Thus, programs on burnout are suggested to be included in training courses for referees to prevent the start of symptoms. It is therefore recommended that physical checkup be supplemented with psychiatric and psychological examinations in the periodical assessments of physical health for football referees.

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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 Although attention deficit hyperactivity disorder (ADHD) is one of the best-researched disorders in medicine, to our knowledge, there are no existing clinical studies on ADHD in Kuwait. This is the first study on ADHD in the state of Kuwait. Aim of the work The main aim of this study was to describe the clinical profile, frequency, sociodemographics, and impairments seen in patients with ADHD subtypes in a clinic-referred sample of school-aged children with ADHD in Kuwait. Patients and methods The sample consisted of 70 patients recruited from the child psychiatric outpatient clinic of the Kuwait Centre of Mental Health. The included patients had to fulfill the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. - text revision criteria - for ADHD and were between the ages of 6 and 15 years; patients of both sexes, Kuwaitis or expats, from all socioeconomic and educational backgrounds were included. All participants were initially screened using the Vanderbilt ADHD parent and teacher diagnostic rating scale and then subjected to a semistructured interview to verify the diagnosis of ADHD and apply the exclusion criteria. Wechsler Intelligence scale III was applied to rule out cases of intellectual disability (IQ score ≤70). The Mini International Neuropsychiatric Interview (MINI-KID) was performed to rule out cases with autism spectrum disorders and psychosis. Results This study showed that 71.4% of patients were male and 28.6% were female. The mean age of the patients was 10.2 (΁2.6) years. The most prevalent ADHD subtype was the ADHD-combined subtype (65.7%), followed by the ADHD-predominantly inattentive subtype (20%) and the ADHD-hyperactive impulsive subtype (14.3%). The ADHD-inattentive subtype was significantly more common among female patients and adolescents. The ADHD-hyperactive impulsive subtype was significantly more common among male patients and younger children. The ADHD-inattentive subtype showed a significantly older age of onset and presentation compared with the other two subtypes. In all, 51.4% of patients had a history of perinatal problems and 70% had a family history of ADHD. Patients in the sample were highly impaired functioning at both home and school; 90% failed to complete their homework, 68.6% disrupted classrooms, 12.9% were on probation or had been dismissed from school, 25.7% repeated a school grade, and 72.9% of patients had problematic relations with family members or peers. Conclusion The ADHD-combined type is the most prevalent subtype. The older mean age at presentation to the clinic compared with the mean age in similar studies may point to the critical lack of public awareness regarding ADHD or reluctance to refer children to the only psychiatric hospital in Kuwait. They suffer from impairments in many aspects of their lives that warrant attention in screening, management, and planning for service delivery as well.

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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.

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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.

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Introduction Autistic spectrum disorders (ASDs) prevalence varies widely by sex and the racial/ethnic group. The male-to-female ratio ranged from 3 to 4 : 1. Some consider ASD to be an autoimmune disorder, in which the autoimmune response to the developing brain myelin may impair anatomical development of neural pathways in autistic children; this affects the speed of impulse transmission. Interleukin-12 (IL-12) is an interleukin that is naturally produced by dendritic cells and macrophages in response to antigenic stimulation; it plays an important role in the activities of natural killer cells and T lymphocytes involved in the immune system. Aim of the work The present study was conducted to compare the level of serum IL-12 between children with autistic disorder (AD) and healthy control children, and also to study the relation of serum IL-12 with the severity of autistic symptoms. Participants and methods A cross-sectional study was conducted on two groups; group I included 20 patients with AD and group II included 20 normal children matched for age and sex, recruited from the Child and Adolescent Outpatients Clinic at Al Hadra University Hospital. All children were subjected to a complete psychiatric history, physical and neurological examination, psychometric assessment by Childhood Autistic Rating Scale, and estimation of serum IL-12 using the enzyme-linked immunosorbent assay method. Results The mean serum level of IL-12 was significantly higher in AD children than in controls and was related to a younger age, male sex, a positive family history and ante/natal/postnatal history, nondevelopment of spoken language, the presence of comorbidities, and higher Childhood Autistic Rating Scale mean scores. Conclusion The study pointed out an immunological impairment in the form of an elevated serum level of IL-12 in autistic children and its positive relation to autistic symptom severity. This supports the immunological etiology of ASD.

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Introduction Premenstrual dysphoric disorder (PMDD) is a severe and disabling form of premenstrual syndrome affecting 3–8% of menstruating women. The relationship between PMDD and psychiatric disorders is still unclear. Aim The aim of this study was to assess the prevalence and symptoms of PMDD in a sample of psychiatric patients. Patients and methods A sample of psychiatric outpatients and inpatients who attended for treatment was clinically diagnosed according to Diagnostic and Statistical Manual of Mental Disorders-5 by clinical interview and by applying the premenstrual symptoms screening tool for diagnosis of PMDD. Results The prevalence of PMDD among cases and controls was 40.5 and 7.6%, respectively. PMDD was most prevalent among depressed patients (96.4%) followed by those with bipolar diseases (38.5%) and was less frequent among anxiety and psychotic patients (4.5 and 1.8%, respectively). Conclusion PMDD is highly related to psychiatric disorders especially depression and bipolar disorder.

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Introduction Negative symptomatology has been demonstrated to be the most relevant predictor of increased future socio-occupational dysfunction and poorer quality of life. Negative symptoms and functional outcomes have consistently been linked, with several studies reporting worse functional outcomes in individuals with more prominent negative symptoms. Folate deficiency has been identified as a risk factor for schizophrenia and its negative symptoms. Aim The aim of this study was to assess the serum levels of folate and vitamin B₁₂ in a sample of schizophrenic patients and their relation to negative symptoms in these patients. Patients and methods It is a cross-sectional study aiming to assess the serum level of folate and vitamin B₁₂ in schizophrenic patients. All patients were recruited from the Kuwait Center for Mental Health after taking approval from the scientific and ethics committee of the hospital. The study was conducted in the period from January 2016 to April 2016; the total number of patients was 41 after applying the inclusion and exclusion criteria. We applied the Positive and Negative Syndrome Scale and the Scale for the Assessment of Negative Symptoms; serum levels of vitamin B₁₂ and folate were measured by radioimmunoassay technique. Results About 41.5% of the patients have low folate level and about 39% of the patients have low B₁₂ level. There are significant positive correlations between severity of negative symptoms and duration of illness and number of hospital admissions. Also there are significant positive correlations between serum levels of vitamin B₁₂ and folate. There are significant negative correlations between serum levels of vitamin B₁₂. All negative symptoms were assessed by the Scale for the Assessment of Negative Symptoms (affective flattening, alogia, attention, aviolation, and anhedonia). We cannot find a significant correlation between serum levels of folic acid and negative symptoms. Conclusion Folate and vitamin B₁₂ deficiency may be a risk factor for schizophrenia and negative symptoms; so we suggest to evaluate the serum vitamin B₁₂ and folate levels for schizophrenic patients followed by dietary supplementation for patients with low vitamin B₁₂ or folate.

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Background The 20th century ended with the conviction that drug abuse was a global problem, and thus global solutions were required. Adolescence represents a critical time to prevent alcohol and other drug use. Early initiation and regular use is often associated with negative consequences. Research on adolescents focuses increasingly on features of the family in predicting and preventing substance use, such as parenting style, parental monitoring, and parental substance use. Although there is an increasingly alarming phenomenon of drug abuse demonstrated in the Egyptian community, there has been no study that estimated the prevalence and risk factors of substance abuse in adolescents in Egypt recently. Aim of the work The current study aimed at exploring the effect of various familial risk factors on the development and severity of substance use in adolescent Egyptians. Participants and methods The current study included two groups: the patient group, which included 100 adolescents (92 male and eight female) from Mansoura, Egypt, between 10 and 19 years of age who were diagnosed as being substance abusers or substance dependants according to the DSM-IV-TR criteria; and the control group, which included 100 (86 male and 14 female) age and sex matched participants with no current psychiatric or neurological disorders. Tools of assessment used were as follows: Mini International Neuropsychiatric Interview for children and adolescents (MINI KID), the Teen Addiction Severity Index (T-ASI) scale, and a scale for measuring family socioeconomic status for health research in Egypt. Familial assessment was carried out with Parental Monitoring Questionnaire and parenting style questionnaire. Results The incidence of substance use was higher in male (92%) than in female (8%) adolescents. The most commonly abused substances were tramadol (97%), followed by cannabis (94%) and sedatives and hypnotics (38%), and the least commonly abused substance was anticholinergic (12%). The majority of the studied addicts were abusing more than one drug (92%). The results of the study indicated a highly significant difference between substance users and controls on all familial risk variables. Conclusion The substance use disorders are a major health problem among youth, and it is more prevalent in male sex in Egyptian population. Tramadol dependency is at the top of all substances abused in Egypt, followed by polysubstances. The findings highlight how family influences subsequent adolescent substance use.

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