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   2013| May-August  | Volume 34 | Issue 2  
    Online since June 2, 2014

 
 
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ORIGINAL ARTICLES
Anxiety, depression, and strain among caregivers of terminally ill patients
Fadia Zyada, Mohamed sheta, Hanaa El Degwi, Rasha Saad
May-August 2013, 34(2):77-84
DOI:10.7123/01.EJP.0000419667.93575.14   
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.

  2,988 349 5
A survey on the significance of psychological and psychiatric assessment among qualified African football referees
Shewikar T El Bakry
May-August 2013, 34(2):85-92
DOI:10.7123/01.EJP.0000418693.73007.54   
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.

  1,665 189 4
Bone mineral density comparative pilot study in autistic children
Mona Reda, Marwa Abdel Meguid
May-August 2013, 34(2):93-97
DOI:10.7123/01.EJP.0000422071.27347.98   
Background

Bone mineral studies of children with autism are scanty.

Aim of the study

This cross sectional selective study aimed to compare bone mineral density (BMD) of autistic children to healthy children.

Subject and method

39 autistic children were recruited from outpatient clinics of Special Needs Center of Postgraduate Childhood Studies, Ain-Shams University. Using DSM-IV all diagnosed autistic children were assessed for severity by Childhood Autism Rating Scale, examined for anthropometric data and was subjected for Serum Complete Blood Picture, Serum Calcium and Phosphorus levels. Laboratory investigations were investigated. All data compared to normal children.

Results

showed highly statistical significant difference in total BMD Z-score with P-value=0.001 and no significant difference in spine BMD Z-score P-value=0.255.

Conclusion

The present study conclude that there is no relation between autism and BMD, for further evaluation of effect of diet restriction and drugs effect on BMD of autistic children.

  1,714 139 -
Central auditory processing and audio-vocal psycholinguistic abilities in children with attention deficit-hyperactivity disorder
Asmaa Abdel-Hamid, Rasha Safwat, Omnia Raafat, Hani Hamed, AyaAllah Farouk
May-August 2013, 34(2):98-103
DOI:10.7123/01.EJP.0000422007.47886.8b   
Objective

Central auditory processing disorders and attention deficit-hyperactivity disorders (ADHD) have become popular diagnostic entities for school-age children. P300 (P3) event-related potential (ERP) putatively reflects central auditory dysfunctions associated with ADHD.

Participants and methods

Forty children with a diagnosis of ADHD according to Diagnostic and Statistical Manual of Mental Disorders, 4th ed. and 39 normal children were included in the study and were subjected to P300 ERP, audio-vocal items of Illinois test of psycholinguistic abilities.

Results

This study found a significant difference in P300 latency, amplitude, and most of the audio-vocal subtests between the patients and the controls. This difference was obvious in older children for the Illinois test, but was not observed in P300 results.

Conclusion

There was a CAPD in ADHD children as indicated by decreased amplitude of P300 and prolonged latency in such children.

  1,658 195 2
Phenomenology and diagnostic outcome of first-episode psychosis
Maha M. Eltayebani, Mamdouh M. Elgamal, Osama Gado, Tarek Shoukry
May-August 2013, 34(2):115-127
DOI:10.7123/01.EJP.0000425501.15925.4a   
Background and objectives

The establishment of criteria for the definition of first-episode psychosis is complex. The literature on this topic is controversial in terms of the limits of duration of symptoms and the inclusion of prodromal symptoms, together with symptoms of the acute phase. Defining first-episode psychosis and determining the diagnostic outcome in the short term for early recognition and intervention might contribute significantly toward reducing later morbidity and chance of recovery. The aim of the current study is to examine the clinical presentation both at baseline and at short-term follow-up (2 years) with determination of the diagnostic outcome on the basis of systemic and structured instruments and frequent follow-up.

Methods

Ninety drug-naïve patients were recruited consecutively from among inpatients after the exclusion of patients with first-contact psychosis who had neurological or central nervous system problems, chronic medical conditions, a history of or current substance abuse or dependence and mental subnormality. Assessment at baseline and after 2 years by structured DSM-IV interviews (SCID), PANSS, HDRS, YMRS, and WAIS as well as WMS-III. Demographics and clinical characteristics were obtained, and a consensus diagnosis was made on the basis of structured instruments, medical records, collateral information, and face-to-face interviews.

Results

Patients with first-episode psychosis were divided into three diagnostic outcome groups: schizophrenia spectrum (n=49; 54.4%), bipolar psychosis (n=21; 23.3%), and depressive psychosis (n=20; 22.2%). Patients in the schizophrenia spectrum were predominantly men, single, and students with no educational differentiation and with no familial risk compared with patients with other two diagnoses. Younger age, early age of onset, long duration of untreated psychosis and short duration of untreated illness, and low rate of hospitalization, but with longer duration of stability and higher sensitivity for extrapyramidal side effects were reported more in the schizophrenia spectrum group than the affective spectrum group. Cognitive functions were better in bipolar and depressive psychosis both at baseline and at the short-term assessment (2 years later) compared with schizophrenia spectrum patients, who showed more improvement after 2 years of assessment on attention and executive function than effective ones. Higher severity of depression was recorded on depressive psychosis in both steps of assessment than that in patients with bipolar schizophrenia. The mean YMRS scores were higher in patients with bipolar psychoses, followed by schizophrenia patients than the depressive group. PANSS five-factor analysis showed that negative symptoms and cognitive disorganization were the highly significant differentiating aspect of the schizophrenia spectrum group than the affective spectrum patients.

Conclusion and recommendations

Overlap of symptoms and clinical presentation in patients of first-episode psychosis both at baseline and for short-term outcome is quite common. Interacting longitudinal and cross-sectional assessment may help to clarify this complexity of presentation at first-episode psychosis. Focus on the differentiation of primary and secondary symptoms in researches as well as biological findings is important to clarify this heterogeneity.

  1,454 144 -
A study on nonpsychiatric management of psychiatric patients in Minia governorate, Egypt
Ahmed M. Kamal, Mohamed A Abd Elhameed, Mohamed T. Siddik
May-August 2013, 34(2):128-133
DOI:10.7123/01.EJP.0000427172.96958.10   
Background

The world is suffering from an increasing burden of mental disorders and a widening gap in treatment. About 450 million people suffer from mental or behavioral disorders; yet, only a small minority receives even the most basic treatment.

Objectives

The objective of the study was to assess nonpsychiatric treatments and traditional and folklore management of psychiatric disorders and examine the nature of communication between psychiatric and nonpsychiatric care providers in Minia Governorate, Egypt.

Participants and methods

A total of 1134 patients [638 male (56.2%) and 496 female (43.8%)] were recruited from the outpatient psychiatric clinic of Minia University Hospital. They were interviewed using an unstructured open-ended technique to assess the previous methods by which their psychiatric illness was handled.

Results

The number of patients who reported that they had undergone nonpsychiatric medical and cultural traditional treatment methods was 985 (82% of the sample). Nonpsychiatric medical management techniques used by the patients (530, 53.8%) included medical treatment and investigations advised by general practitioners in primary healthcare units (231 patients, 43.5%), internal medicine (123, 23.2%), pediatric services (101, 19.1%), neurosurgery (25, 4.8%), and others including emergency room services (50, 9.4%). Nonpsychiatric cultural traditional interventions (455 patients, 46.2%) included following the Holy Koran (274 patients, 60.2%), using herbs and plants (91, 20%), Hegab (written words on a piece of paper, 55, 12.1%), Hegama (23, 5.4%), and physical interactions (12, 2.3%). The rate of referral of these patients from nonpsychiatric to psychiatric attention was limited (119 patients, 12%).

Conclusion

Our results highlighted the need to enhance communication between psychiatrists and providers of nonpsychiatric care to psychiatric patients.

  1,314 117 2
A study of cofactors implicated in response to electroconvulsive therapy in patients with psychotic disorders
Mohamed A. AbdelHameed, Maha A Hassan, Mohamed A Foly, Abd El-Raouf O Abd El-Bakey
May-August 2013, 34(2):134-141
DOI:10.7123/01.EJP.0000427173.24271.22   
Background

Electroconvulsive therapy (ECT) is an effective treatment for psychotic disorders with relatively few side effects and rapid onset of action. Factors that may predict patients’ responses to ECT need to be explored.

Objective

The aim of the study was to investigate the responses of an inpatient group of psychotic (schizophrenia and schizoaffective disorder) patients to ECT administration and the factors favoring better response.

Participants and methods

Eighty patients with schizophrenia and schizoaffective disorder indicated to receive ECT were selected from among the inpatients of El-Minia Psychiatry Hospital. Psychiatric examination by completion of a psychiatric sheet, full medical examination, and necessary investigations for anesthesia fitness were conducted for all patients. The Brief Psychiatry Rating Scale was used to assess patients’ symptoms before initiation of ECT, after undergoing three sessions, and after termination of the ECT course (6–8 sessions).

Results

Response to ECT was similar among different age groups in both male and female patients. Patients’ responses to treatment differed according to their specific diagnosis and according to the duration of the current episode or exacerbation of psychotic illness before ECT administration.

Conclusion

Age and gender of patients with schizophrenia and schizoaffective disorder do not play a role in determining their response to treatment with ECT. Patients’ specific diagnoses and the duration of the current episode or exacerbation of psychotic illness before ECT administration are important factors in determining the response of psychotic patients to ECT.

  1,234 135 2
Duration of no treatment ( impact on clinical picture and short-term outcome)
Maha AL Tayebani, Mamdoh ELGamal, Rasha Bassim, Soliman AL Khadary
May-August 2013, 34(2):104-114
DOI:10.7123/01.EJP.0000425499.31173.5a   
Background

The duration of untreated illness (DUI) represents a modifiable parameter, the reduction of which may positively influence the outcome and long-term course of related mental conditions. It has been suggested that a long duration of untreated psychosis (DUP) has a neurotoxic effect with expected consequent cognitive dysfunction.

Aim

The aim is to examine the clinical and cognitive effects of DUP and DUI on the 2-year clinical outcome of drug-naive patients having their first-episode psychosis.

Patients and methods

This prospective study was carried out at the Psychological Medicine Hospital, State of Kuwait, and consisted of two parts: (a) baseline assessment, in which all patients with first-contact psychosis were clinically and psychometrically assessed by DSM-I and SCID-I, Positive and Negative Syndrome Scale, Hamilton Depression Rating Scale, Young Mania Rating Scale, Subtests of Wechsler Memory Scale (3rd ed.), and Wechsler Adult Intelligence Scale (WAIS; 3rd ed.) and (b) end of a 2-year follow-up, in which patients who continued 2 years of follow-up were reassessed by all the clinical and psychometric studies used at baseline.

Results

Ninety patients were followed up, of whom 54.5% were nonaffective patients, 23.33% had bipolar psychosis, and 22.22% had depressive psychosis. In the schizophrenia spectrum, although improvement in neuropsychological and cognitive status was observed after treatment, persistent cognitive deficits and negative symptoms were still observed in clinically stable individuals. DUP was found to be related to current age, number of rehospitalizations, negative symptoms, and trail make A, and inversely related to memory subtest scores. In bipolar and depressive psychosis, DUI was significantly related to current age, rehospitalization, age at onset, and total positive symptoms. DUI also had a highly significant inverse relation to performance test and total WAIS (P=0.000 and 0.000) and a significant direct relation to speed and processing (trail make A) and with reasoning (trail make B) (P=0.006 and 0.006). After 2 years, DUI was significantly inversely related to the performance test of WAIS (P=0.026).

Conclusion

Long DUP is associated with lower levels of symptomatic and cognitive recovery. Therefore, early detection programs are required to decrease the period between illness onset, diagnosis, and treatment in first-episode psychotic patients, which could lead to improved therapeutic strategies and public health initiatives.

  1,163 99 -