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   2012| September-December  | Volume 33 | Issue 3  
    Online since June 4, 2014

 
 
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EDITORIAL
Revolution and mental health
Mohammed Elmahdy
September-December 2012, 33(3):111-116
DOI:10.7123/01.EJP.0000415781.93483.75   
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ORIGINAL ARTICLES
Impairment in working memory in multiple sclerosis
Osama Abourelmaged El-Kholy, Mohamed Ramadan, Mahmoud El-Sheikh, Moataz Ali
September-December 2012, 33(3):117-125
DOI:10.7123/01.EJP.0000414294.51794.7d   
Aim

The aim of the current study was to assess the relation between working memory dysfunction and clinical and MRI findings in relapsing remitting multiple sclerosis.

Participants and methods

This study was conducted on 50 patients with clinically definite relapsing remitting multiple sclerosis, they were recruited from the Outpatient Clinic of Alexandria University Hospitals; and 25 healthy controls matched for age, sex, and educational level. All participants were subjected to neuropsychological assessment that included: digit span, visual span, N-nack task, and Wisconsin card sorting test. The patient group was further subjected to: Expanded disability status scale (EDSS) and brain MRI.

Results

Clinically, the present study found no statistically significant correlations between working memory dysfunction and age, age at onset, sex, number of relapses, affected functional system, or EDSS status. Alternatively, there were statistically significant positive correlations between working memory dysfunction and the duration of illness.

Conclusion

This study suggests that according to the resources utilized by cognitive tasks, working memory tasks may be classified into high-demanding working memory tasks (2-back task and WCST) and low-demanding working memory tasks (1-back task and digit and visual span), and in relapsing remitting multiple sclerosis working memory dysfunction includes mainly high-demanding working memory tasks.

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Psychiatric morbidity of chronic institutionalized patients with schizophrenia ( implications for future community care)
Mamdoh ElGamal, Maha ElTayebani, Rasha Bassim
September-December 2012, 33(3):158-170
DOI:10.7123/01.EJP.0000415664.74117.93   
Background

In many western countries, deinstitutionalization of chronically mentally ill patients was established after the mass introduction of neuroleptics in the late 1960s and the early 1970s. Deinstitutionalization was proven to be successful when there were strong ideological or humanitarian motives and when psychiatric reform was a priority and was completed with a comprehensive system of community. However, its long-term effects should be examined and questioned in terms of improving quality of life and functional abilities.

Aim and objectives

The research aimed at studying the morbidity profile and impact of schizophrenia on chronic institutionalized mentally ill patients as baseline data for planning of deinstitutionalization and a Community care program.

Methods

Data on sociodemographics, course of illness, treatment history, rate of admission, duration of hospital stay, and medical condition were collected retrospectively, followed by a cross-sectional study of a total of 95 patients with a schizophrenia spectrum using psychopathological rating scales such as PANSS, MMSE, CGI-S. Diagnosis according to DSM-IV and an interview using SCID were carried out by two different psychiatrists for high inter-rater reliability. The sample was recruited from among long-stay hospital patients.

Results

The mean age of onset of schizophrenia among the patients was 48.9±10.3 and 21.2±5.7 years. The mean duration of illness was 27.5±9.3 years, whereas the mean duration of repeated admission was 19.07±12.5 years. With respect to the median percentage of total hospital stay, 30% could be attributed to the patients’ median age and 55% to illness duration, whereas with respect to chronic hospitalization 20% could be attributed to the patients’ median age and 35% to illness duration. Of the patients, 85% were men; 70% were single and unemployed with a low socioeconomic status; 25% lacked private housing; 30% had diabetes mellitus and/or hypertension; 80% were obese and overweight; and 50% were on antilipid drugs. Delusion, hallucination, and conceptual disorganization were the highest-scoring positive symptoms in 50% of cases. Negative symptoms also scored higher (7.4) on all items in 60% of cases. Eighty percent had compromised cognitive deficits. Early age of onset of schizophrenia and being older were powerful predictors for repeated admission, a long duration of illness, and chronic hospitalizations. Severity of illness is also a powerful predictor for long hospital stay.

Conclusion

Schizophrenia is a chronic devastating illness that impacts function and cognitive abilities, and is characterized by a high rate of admission, chronic course of illness as well as chronic institutionalization. For continuity of care and a favorable prognosis, early comprehensive, multidisciplinary, and multimodel programs are required for patients with mental illness from the date of first hospital contact.

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Sexual risk among substance users and its relation to personality profile
Momtaz Abd-Elwahab, Mohamed Ezzat Amin
September-December 2012, 33(3):135-141
DOI:10.7123/01.EJP.0000415088.97056.8a   
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.

  2,114 185 3
Correlates of antenatal bonding ( an Egyptian Study)
Suaad Moussa, Osama Refaat, Maha Emad, Aref Khoweiled, Tamer Goueli, Mohammad Ezzat
September-December 2012, 33(3):126-134
DOI:10.7123/01.EJP.0000414132.30979.90   
Background

The relationship between mother and child develops and progresses throughout the pregnancy period. In recent times there has been increasing interest in antenatal maternal–foetal bonding and its relationship with different variables, as well as the impact of this bonding on the child’s mental health.

Objectives

To investigate the pattern of maternal–foetal relationship during pregnancy, and its relationship to maternal depression and to different sociodemographic and pregnancy-related factors, as well as to the perception of intimate relation with spouse.

Methods

One hundred expectant Egyptian mothers attending obstetric outpatient clinics for regular follow-up of their pregnancy were recruited into the study. They were asked to fill the Maternal–Fetal Attachment Scale (MFAS), the Intimate Bond Measure and the Edinburgh Postnatal Depression Scale.

Results

Maternal antenatal bonding was significantly higher on the MFAS in expectant mothers with longer gestational age. Women with assisted pregnancy had significantly higher scores on the MFAS total score and Role Taking and Attribution subscales. However, if the cause of infertility was unexplained or related to female-oriented factors, the aforementioned MFAS scores tended to be significantly lower than when infertility was related to male-oriented or both factors. Primiparous women had significantly higher scores on the MFAS total score and Role Taking and Differentiation subscales compared with multiparous women. Women who perceived themselves as being healthy had significantly higher scores on the Interaction subscale of MFAS. In this study the intimate relationship with the spouse, and not the marriage duration, showed significant differences in relation to maternal bonding. Expectant mothers who reported a positive attitude towards their marital relationship (Optimal Intimacy and Affectionate Constraint) had significant higher means on the total score of the MFAS and on the Interaction, Giving of Self and Role Taking subscales. The study showed that expectant women with previous loss of foetus and those with no depressive symptoms had better bonding despite the lack of significance.

Conclusion

Maternal antenatal bonding is associated with multiple factors including longer gestational age, parity, previous loss of foetus, assisted pregnancy, perceived good maternal health and intimacy with partner.

  1,918 217 2
Emotional involvement and burden in caregivers of patients with Alzheimer’s disease
Hanan El-Shinnawy, Tamer Goueli, Mohamed Nasr
September-December 2012, 33(3):149-157
DOI:10.7123/01.EJP.0000415860.50861.b6   
Background

There has been relatively little research on caregivers of patients with Alzheimer’s disease and those with cognitive disorders for long durations.

Aim

To examine the psychological dimensions, defensive styles strategies, and distress in caregivers of Alzheimer’s patients.

Methods

Caregivers of 40 patients with Alzheimer’s disease were interviewed and compared with a group of caregivers of diabetic patients on the experience of caregiving, emotional stress, and burden. Caregivers of patients with Alzheimer’s disease were assessed using the Defense-Style Questionnaire and the Involvement Evaluation Questionnaire.

Results

Caregivers of patients with Alzheimer’s disease used mature, neurotic, and immature defensive strategies to cope with the patient’s symptoms and difficult behavior, and experienced more worry about these problems and led to increased supervision.

There were sex differences among caregivers; female caregivers were more prone to worry and overinvolvement than male caregivers.

Conclusion

Caregivers of patients with Alzheimer’s disease have to cope with a wide range of problems and develop coping defensive strategies. Caregivers worried most about the difficult behavior and symptoms of patients with Alzheimer’s disease. The increased levels of worry, tension, negative feelings, and overuse of mature defenses in caregivers are associated with personal and sociodemographic variables, rather than variables related to the illness itself.

  1,840 181 -
Assessment of controlled substances, dependence on them, and their management by pharmacists
Mazen El-Sakka, Wafa Kanan
September-December 2012, 33(3):142-148
DOI:10.7123/01.EJP.0000414242.39563.41   
Introduction

Substance abuse is more than just a health problem; it is a formidable moral, social, and economic challenge of pandemic proportions. Palestine is not an exception to this problem, and the trend of use is increasing. Healthcare providers, primary care physicians, pharmacists, patients themselves, and their families, can all play a role in identifying and preventing prescription drug abuse.

Methodology

The study population included 205 public pharmacies distributed across the Gaza Strip governorates. Data was collected by means of an interview questionnaire administered to pharmacists working in the pharmacies.

Study objectives

The aim of the study was to identify and verify several variables and attributes affecting drug abuse, including the knowledge, attitudes, and practices of pharmacists, and to study and analyze the drug abuse situation in the Gaza Strip.

Results

The majority of pharmacists (90.2%) acknowledged drug addiction as an existing phenomenon in the Gaza Strip society, and 32.2% of pharmacists believed that the physician, the pharmacist, and the inspection department all shared the responsibility for its existence. Most pharmacists believed that the increased anxiety and tension in the community was the most common reason for this increase in demand for drugs. Approximately 50.2% of pharmacists did not believe that their colleagues dispensed any of the controlled drugs without a doctor’s prescription. Approximately 89.8% of pharmacists were convinced of the need for a medical prescription to dispense any of the drugs listed, and of these 89.8%, 84.8% did not dispense any of the controlled drugs to a person they suspected of being dependent on drugs, even if that person had a medical prescription. Hence, the study showed no significant relationship.

Conclusion

The study showed that drug abuse is an existing phenomenon in the Gaza Strip and there is a lack of attention to reduce its spread and impact on society. There are similarities between female and male pharmacists in the Gaza Strip with regard to knowledge about drug abuse; however, there are differences in practice and attitude among them.

Recommendation

Physicians, pharmacists, and the inspection department should assume their respective responsibilities toward prevention of drug abuse as a shared responsibility in order to ensure a safe future for the entire community.

  1,333 102 -
Dehydroepiandrosterone sulfate and testosterone levels correlate with negative symptoms in male patients with schizophrenia
Haitham M. Hashim, Mohmed G. Negm
September-December 2012, 33(3):181-185
DOI:10.7123/01.EJP.0000416070.97156.25   
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.

  1,181 162 3
Metabolic syndrome and type 2 diabetes in chronic institutionalized patients with schizophrenia
Mamdoh Elgamal, Maha Eltayebani, Seham Fathy
September-December 2012, 33(3):171-180
DOI:10.7123/01.EJP.0000415707.23330.ab   
Introduction

Schizophrenia is a life-threatening illness with a mortality rate that is twice as high as that of the general population. Over 60% of deaths in schizophrenic patients are due to natural causes such as cardiovascular illness. Patients with schizophrenia and schizoaffective or bipolar disorder may have a predisposition to metabolic syndrome that is exacerbated by a sedentary life, poor dietary habits, possible limited access to care, and antipsychotic drug-induced adverse effects. It has been found that the prevalence rate of metabolic syndrome among schizophrenic patients ranges from 32 to 51%, with a two- to three-fold higher mortality rate due to heart attack compared with those without metabolic syndrome.

Aim and objectives

The current study aimed at detecting the prevalence and patterns of metabolic syndrome in chronic institutionalized patients with schizophrenia, comparing patients with metabolic syndrome - defined by different criteria- and lastly trying to find the predictor factors for metabolic syndrome and for diabetes mellitus.

Methods

Ninety-five patients with schizophrenia and schizoaffective disorder were recruited from long-stay hospital wards, were interviewed using structured clinical interview, and were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, 4th ed. They were subjected to a cross-sectional assessment by psychopathological rating scales including positive and negative syndrome scale, mini mental state examination, and clinical global impression – severity index scale and also to anthropometric measurement taking (BMI and waist circumference). Sociodemographic and clinical characteristics as well as treatment history were collected from data files. Cases were classified into four groups according to the International Diabetes Federation criteria: definite cases with metabolic syndrome (IDF criteria); the high-risk group (lacking one criterion); risky cases with risk for central obesity; and patients with no apparent risk. Data were collected and statistically analyzed.

Results

Twenty-two patients (23.15%) had definite metabolic syndrome according to IDF criteria, 47 patients (49.4%) had high risk, 17 patients (17.8%) had risk factors of metabolic syndrome, and only nine cases (9.4%) had no apparent risk for metabolic syndrome. Sociodemographic and clinical characteristics and psychopathological rating scores were not predictors for metabolic syndrome, nor for diabetes mellitus. BMI and waist circumference had the highest sensitivity, predictive value, and diagnostic accuracy for metabolic syndrome compared with the presence of diabetes, hypertension, or dyslipidemia. Diabetes mellitus occurred earlier and was of longer duration compared with other metabolic disturbances.

Conclusion

(1) The high risk of MS among patients with chronic schizophrenia mandates careful monitoring and elimination of risk factors. (2) BMI and WC as well as blood sugar and lipid profile are considered simple measures for detecting risk factors. (3) Attempts towards toward eliminating risk factors such as poor lifestyle, obesity, and metabolic disturbances is vital for long stay hospitalised patients.

  1,042 111 1