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  Citation statistics : Table of Contents
   2014| May-August  | Volume 35 | Issue 2  
    Online since June 11, 2014

 
 
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ORIGINAL ARTICLES
Thyroid dysfunction in attention-deficit hyperactivity disorder and effect of comorbidity
Samia Abd El Rahman, Shereen M. Abd El Mawella, Hoda A. Hussein, Mohamed El Mosalmy
May-August 2014, 35(2):89-94
DOI:10.4103/1110-1105.134194  
Introduction Attention-deficit hyperactivity disorder (ADHD) is considered to have a biologic basis, but the precise cause is unknown. It is one of the neurodevelopmental abnormalities observed frequently in children with generalized resistance to thyroid hormone, suggesting that thyroid abnormalities may be related to ADHD. Aim To assess thyroid dysfunction in children with ADHD and to detect the most common comorbidity. Participants and methods This was a case-control cross sectional study, in which 30 ADHD children were recruited from the Kasr Aini Pediatric Hospital (Abu-El Rish) outpatient psychiatry clinic and compared with 14 healthy control children, siblings of the patient group who participated in this research. Psychometric procedure The Stanford Binet Intelligence Scale, the Arabic version of Conners' Parent Rating Scale-Revised-Long version, and social score were used to calculate social standards of families. Laboratories assessment Serum total T3, total T4, and thyroid-stimulating hormone were assessed using the enzyme-linked immunosorbent assay. Results About 80% of the participants were males and 20% were females. Diagnosis according to the Diagnostic and statistical manual of mental disorders, 4th ed. (DSM-IV) showed that 29 (96.7%) of the patients were diagnosed with ADHD combined type by DSM-IV and only one patient (3.3%) had ADHD inattentive type. Forty percent of the patients were from low socioeconomic class, followed by 26.7% from moderate socioeconomic, and a very low socioeconomic class; however, 6.6% were from a high socioeconomic class. There was a statistically significant difference between cases and control groups in all components of Conners' Parent Rating Scale; all cases had higher means than the control group (P = 0.001). There was no significant difference between both the study group and their siblings in serum total T3, thyroid-stimulating hormone, T4 (P > 0.05). Fifty percent of the patients had no or only one comorbidity and 15 (50%) had two or more comorbidities. On comparing the two subgroups (group with no or one comorbidity and the other group with two or more comorbidities), we found that there were no statistically significant differences between the two groups in the IQ components test. There were only statistically significant differences between two subgroups in the social problem subscale of Conners' scale, which showed higher scores in the subgroup of patients with two or more comorbidities. Also, there were no statistically significant differences in the thyroid profile of the two subgroups and the thyroid functions were within normal. Conclusion Oppositional defiant disorder was the most common comorbidity. Social problems are common in children with ADHD with comorbidity. Children with ADHD have no thyroid dysfunction.
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Assessment of depression and anxiety in children on regular hemodialysis
Mohammed M. Abdel Salam, Mohammed Ali Abdo, Usama Mahmoud Yousef, Saber A. Mohamed
May-August 2014, 35(2):100-104
DOI:10.4103/1110-1105.134196  
Background Depression and anxiety are well established as prevalent mental health problem in end-stage renal disease patients treated with hemodialysis. However, these problems remain difficult to assess and are undertreated. Objectives The aim of the study was to estimate the prevalence of depression and anxiety and to evaluate their risk factors in children on regular hemodialysis. Materials and methods Forty pediatric patients with end-stage renal failure on regular hemodialysis and 20 healthy control children were studied. All participants were subjected to proper history taking, thorough medical and psychiatric examination, psychometric assessment by pediatric anxiety and children depression inventory scale, and laboratory investigations including serum urea, creatinine, serum albumin, serum iron, serum ferritin, serum calcium, serum phosphate, serum parathormone hormone, hemoglobin level, and PT and PTT levels. Results There was a high prevalence rate of anxiety and depression among hemodialysis patients compared with that in healthy control children. Hemoglobin and serum albumin were found to be negatively correlated with both anxiety and depression. Conclusion Majority of pediatric patients undergoing hemodialysis were severely depressed and anxious. Pediatric patients on regular hemodialysis with anemia and hypoalbuminemia have more psychiatric disturbance than others.
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Some neuropsychiatric comorbidities of attention deficit hyperactivity disorder
Rizk M. Khodeir, Mohamed M. El-Hamady, Shwikar T. El-Bakry, Michael V.S. Mikhael
May-August 2014, 35(2):71-79
DOI:10.4103/1110-1105.134192  
Objectives The aim of the study was to find out the possible neurological and psychiatric comorbid disorders that might be associated with attention deficit hyperactivity disorder (ADHD) and to assess the intelligence quotient (IQ) in the diagnosed patients, and hence improve the accurate diagnosis of ADHD and its management. Patients and methods This study is a comparative cross-sectional study (the study group and the control group). Participants were recruited from the Neuropsychiatric and Pediatric Clinics in Benha University Hospital, in addition to some private clinics and centers. The sample size of this study was 74 (divided into two groups, the study and the control groups). Participants were chosen by nonrandom technique; all patients who fulfilled the inclusion criteria and accepted (their parents) to participate were included in the study. All case and control groups were subjected to a semistructured interview, complete neuropsychiatric clinical assessment, psychometric testing using Wechsler Intelligence Scale for Children, Conners Parent Rating Scale-revised, long version, and Revised Behavior Problem Checklist. Electroencephalography was performed for some cases and controls. Results The mean age of the ADHD children was 8.78 years old; it was more prevalent among boys. Perinatal problems were significantly prevailing among cases of ADHD. In all, 70.3% had ADHD combined type, 10.8% had ADHD predominantly hyperactive-impulsive, and 18.9% had ADHD predominantly inattentive type. The control group showed higher mean IQ of 105.4 ± 9.6 compared with the ADHD case group who showed mean IQ of 93.8 ± 10.7. There were several significant comorbidities such as delayed language development, delayed developmental milestones, oppositional defiant disorder, conduct disorder, depressive symptoms, sleep disturbance, nocturnal enuresis, and soft neurological signs. Conners scale showed that the ADHD children showed higher mean in all Conners test items than the control group. ADHD children had higher mean along all Revised Behavior Problem Checklist compared with the control group. With respect to correlations, the oppositional defiant disorder was significantly correlated to the combined type ADHD. There was statistical significant difference in the whole sample where children who did not have oppositional defiant disorder had higher IQ (101.5 ± 11.5) than those who did (95 ± 11.1). Conclusion ADHD is a disorder that carries several neuropsychiatric comorbidities. Assessment of children with ADHD should address these comorbidities, and management should focus on them to obtain best outcomes for the patients.
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Psychiatric morbidity and lifestyle of patients with coronary artery disease in Nile delta
Maha Borham, Mohamed El-Atrouny, Mohamed Abo El-Hoda, El-Sayed Saleh, Nevin Zaki, Gamal Gomaa
May-August 2014, 35(2):80-88
DOI:10.4103/1110-1105.134193  
Objectives This study aimed to (i) estimate the clinical variables in anxious and depressive patients with coronary artery disease (CAD), (ii) correlate the severity of anxiety and depression with the severity of CAD measured by coronary arteriography, and (iii) predict the psychopathology leading to the severity of CAD. Study design A total of 264 patients satisfied the inclusion and exclusion criteria and were enrolled in the study. This study consisted of two parts. (i) The first part included: (a) semistructured clinical psychiatric interview and (b) psychometric assessment such as scale to assess the personality type D, Anxiety-Depression Inventory, and Life Event Scale. (ii) The second part of the interview was concerned with CAD description. The following were performed to assess the cardiac problem such as history of the cardiac complaint, clinical examination, coronary angiography, and assessment of health-related risk markers such as diabetes mellitus and hypertension. Results This study was conducted on 264 patients of both sexes; 67.4% were male patients and 32.6% were female patients, with age ranging from 30 to 70 years. Hypertension was more in coronary artery affected patients, with highly significant statistical difference (P < 0.001), whereas diabetes mellitus occurred with no significant difference. Health-related risk markers such as exercise, smoking, adherence to medication, and regular doctor visits were higher in coronary artery affected patients, with high statistically significant difference (P < 0.001). In addition, personality type D, anxiety disorders, depression, and stressful life events were more in coronary artery affected patients (P < 0.001). There was positive correlation between the severity of CAD and age (r = 0.182, P < 0.01), total score of Dl4, social inhibition of Dl4, negative affectivity of Dl4, the severity of depression and anxiety, social introversion, and life events (P < 0.001). Stepwise linear regression indicated that the severity of coronary arteries affection could be significantly predicted by adherence to medication, social introversion, sex, family history of mood disorder, and age. Conclusion More than risk factor, for example, anxiety and depression, smoking, personality type D, severity of social introversion, stressful life events, lifestyle such as exercise, adherence to medication, and regular doctor visits when ill are positively correlated with the severity of CAD. These findings suggest that clinicians should assess patients for both anxiety and depression and continue to monitor these symptoms on a regular basis.
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Psychosocial characteristic of female victims of domestic violence
Khaled Abd El Moez, Mona Elsyed, Ismail Yousef, Amany Waheed Eldeen, Wafa Ellithy
May-August 2014, 35(2):105-113
DOI:10.4103/1110-1105.134197  
Background Domestic violence against women is prevalent in every country, cutting across boundaries of culture, class, education, income, ethnicity, and age. Domestic violence against women results in far-reaching physically and psychological consequences. Although the impact of physical abuse may be more visible, psychological scarring is harder to define and report. Women who remained in violent relationships were considered to have morbid characteristics, which included the need to be hurt and punished. Objective This work was carried out to determine the psychosocial characteristics of women exposed to domestic violence. Materials and methods The current study is a cross-sectional controlled study. In this study, psychological characteristics, using the Minnesota multiphasic personality inventory scale (MMPI) personality inventory scale, of 44 women (who presented to the Emergency Unit of Suez Canal University Hospital) complaining of physical abuse of domestic origin were evaluated after taking their consent, and were compared with 22 women with no history of domestic violence. Results The psychological assessment to 44 female victims of domestic violence according to the MMPI personality inventory scale showed a significant difference between the study and the control group in depressive traits, psychopath traits, and psychotic traits. Conclusion Our finding suggested that the study group showed more depressive, psychotic, and psychopathic manifestations than the control group and more studies need to identify whether this results were related to abuse or character logical traits in those women.
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Impact of mothers with depression, schizophrenia or epilepsy on family functioning
Khaled AbdEl-Moez, Mona ELsayed, Magda T. Fahmy, Wafaa E. Haggag
May-August 2014, 35(2):66-70
DOI:10.4103/1110-1105.134191  
Objective To evaluate and compare the impact of mothers with depression, schizophrenia or epilepsy on the family function. Background Family is the most important context of an individual. The primary function of a family unit is to provide a setting for the development and maintenance of family members on the social, psychological and biological levels. Methods After approval of our ethics committee, this cross-sectional study was conducted among a total of 153 families of mothers with depression, schizophrenia and epilepsy (51 families for each group) who attended the Suez Canal University outpatient clinic. All patients were subjected to clinical interview for the diagnosis of major depressive disorder and schizophrenia according to Diagnostic and Statistical Manual of Mental Disorders, 4th ed. criteria and Family Assessment Device (Arabic version). Results There was significant unhealthy family function of mother with depression compared with healthy functioning regarding problem solving (88.2%), communication (84.3%), roles (68.6%), affective responsiveness (62.7%) and behavior control domains (86.3%). There was a significantly higher unhealthy functioning in all domains [problem solving (88.2%), communication (96.1%), roles (76.5%), affective responsiveness (70.6%) and involvement (76.5%), behavior control (94.1%), and general functioning (72.5%)] in mothers with schizophrenia compared with healthy functioning. There was a significantly higher unhealthy functioning in all domains [problem solving (86.3%), communication (86.3%), roles (94.1%), affective responsiveness (72.5%) and involvement (72.5%), behavior control (92.2%), and general functioning (66.7%)] in mothers with epilepsy compared with healthy functioning. There were no statistically significant differences of unhealthy functioning in most of the domains in mothers with depression, schizophrenia, and epilepsy, except in the roles domain. Conclusion There was an increased unhealthy functioning in most of the domains in mothers with depression, schizophrenia and epilepsy compared with healthy functioning. There were no differences of unhealthy functioning in most of the domains in the mothers with depression, schizophrenia, and epilepsy, except in the roles domain.
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Metabolic syndrome in a sample of patients with bipolar disorder in Sharkia governorate
Mohamed G. Negm, Mohab M. Fawzi, Rafik R. Abd-El Latif
May-August 2014, 35(2):95-99
DOI:10.4103/1110-1105.134195  
Introduction Metabolic syndrome (MetS) is a group of metabolic abnormalities that include abnormal glucose metabolism, central obesity, dyslipidemia, reduced high-density lipoprotein-cholesterol, and hypertension. Patients and methods A random sample consisted of 50 bipolar patients recruited from psychiatric outpatient's clinics of Zagazig University Hospitals, whether or not would be admitted to the inpatients wards. The following scales were administered: Young Mania Rating Scale, Positive and Negative Syndrome Scale, and Zagazig Depression Scale. Results Our cross-sectional observation confirms that MetS is highly prevalent in patients with bipolar disorder. We found a prevalence of MetS of 64% among patients with bipolar disorder, which is approximately double (30%) the rate reported in our general population sample. Conclusion There is a need for psychoeducational programs including healthier eating habits and lifestyle advice in patients with bipolar disorder. Clinicians should be aware of the metabolic issues when treating these patients.
  - 1,555 103