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   2014| September-December  | Volume 35 | Issue 3  
    Online since November 11, 2014

 
 
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ORIGINAL ARTICLES
Prevalence of substance abuse among adolescent school students in Zagazig
Mohamed G Negm, Amira A Fouad
September-December 2014, 35(3):161-166
DOI:10.4103/1110-1105.144344  
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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Attention deficit hyperactivity disorder in a referred sample of school-aged children in Kuwait: sociodemographics, frequency, clinical presentations and impairments
Hosam A Salem, MT Fahmy, IM Youssef, WE Haggag, AG Muhamed, DN Radwan, S Alkhadhari
September-December 2014, 35(3):115-126
DOI:10.4103/1110-1105.144323  
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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Neurological soft signs with respect to type of symptoms in patients with schizophrenia
Heba Fathy, Mohamed A Khalil
September-December 2014, 35(3):167-172
DOI:10.4103/1110-1105.144346  
Introduction Neurological soft signs have been documented to occur in up to 60% of patients with schizophrenia and have been found even in neuroleptic-naive patients. Aims The aims of the study were to illustrate the presence of neurological soft signs among patients with schizophrenia and to show any relationship between neurological soft signs and type of symptoms. Patients and methods One hundred patients with schizophrenia were selected consecutively in a cross-sectional study. The patients were assessed using the Structured Clinical Interview for Diagnostic and statistical manual of mental disorders (DSM) Axis of Disorders, Positive and Negative Syndrome Scale, complete neurological examination, and Cambridge Neurological Inventory for soft sign examinations (primitive reflexes, repetitive movement, sensory integration), and Trail Making Test. Results The main finding in this study indicates that the patients with schizophrenia have neurological impairment. There are positive correlations between soft neurological signs and positive symptoms in paranoid type, other types, and with the total; these indicate that neurological soft signs are more prominent in patients with positive symptoms than in those with negative symptoms. Conclusion Neurological Soft Signs (NSS) occur in a majority of the schizophrenia patient population and are largely distinct from symptomatic and cognitive features of the illness. Neurological signs in patients with schizophrenia are associated with prominent negative symptoms, relatively poor psychosocial performance, and significantly more cognitive impairment.
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Depression in chronic hepatitis C patients and the role of cognitive behavioral therapy in its treatment
Eman R Elsafy, Wael Abu-Hendy, Haitham M Abouhashim, Heba A Fouad
September-December 2014, 35(3):179-186
DOI:10.4103/1110-1105.144351  
Background Hepatitis C is a major health problem in Egypt and worldwide. Hepatitis C is associated with an increased prevalence of psychiatric disorders, particularly depression. In addition, depression is one of the neuropsychiatric side effects of interferon (IFN) therapy. Although antidepressants have been proven to be effective in the treatment of depression in this patient population, the risk of hepatotoxicity and toxicity warrants the search for other treatment alternatives for depression, such as cognitive behavioral therapy (CBT). Patients and methods A sample of 100 hepatitis C-seropositive patients was divided into two groups: 50 IFN-treated patients and 50 patients not undergoing IFN treatment. All the patients were subjected to an assessment of detailed history and a physical examination and were evaluated for the presence of depression using the Structured Clinical Interview for DSM-IV axis I disorder (SCID-I), the Hamilton Rating Scale for Depression (HAM-D), and the Zagazig Depression Scale (ZDS). The patients who were diagnosed with depression received a course of CBT, and were tested using the same scales after completing the CBT and after 3 months of completing the therapy. Results Our data confirm the high rate of major depressive disorders among the population of patients with hepatitis C, with the prevalence of depression being higher in the group undergoing treatment with IFN (40%) than the untreated group (28%). Depression scores on both HAM-D and ZDS were higher in the IFN-receiving group. CBT intervention resulted in a marked decrease in ZDS and HAM-D scores over time in both the groups. Conclusion We concluded that a huge percentage of chronic hepatitis C patients develop depression, both those who undergo IFN treatment and those who did not receive any HCV treatment. CBT has been found to be an efficacious treatment for this adverse effect.
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Quality of life and self-esteem of children and adolescents with diabetes type 1
Youmna Sabri, Ashraf Sharkawy, Shwikar Farrag, Hala El Boraie
September-December 2014, 35(3):173-178
DOI:10.4103/1110-1105.144348  
Background Diabetes mellitus (DM) is one of the most common chronic diseases in children and adolescents and requires special self-care behaviors throughout life. Living with the requirements related to glycemic control, insulin therapy, diet plan, and physical activity may have a significant impact on the psychological functioning of not only the patients, but also their families. Aim The present study had the purpose of evaluating the health-related quality of life (HRQoL) and self-esteem (SE) of children and adolescents with type 1 diabetes mellitus (T1DM), analyzing the relationship between these constructs in this population and comparing these results with those of nondiabetic ones, and finding if there is association between metabolic control (HbA1c) and these psychosocial correlates (HRQoL and SE). Materials and methods Study participants included parents and their children/adolescents with type 1 diabetes who were 10-18 years old. The participants have had T1DM for more than 2 years. The control group consisted of 42 healthy children who were 10-18 years old. PedsQL 4.0 Generic Core Scales were designed to measure the core health dimensions in both healthy and patient populations. PedsQL 3.0 diabetic module (DM) was developed to measure diabetes-specific HRQoL, for youths with T1DM. Hare Area-Specific Self-Esteem Scale measures adolescents' feelings about their worth and importance among peers, as students, and as family members. Results The mean total HRQoL scale scores (child self-report and parent proxy-reports) were 75.42 and 72.37 for diabetic patients and 94.80 and 96.83 for healthy ones, with significant difference (P < 0.001). In addition, diabetic patients showed lower SE (2.31) than healthy ones (2.05), as higher scores indicate lower SE. However, there were significant negative correlations between PedsQL 4.0 Generic Core Scale - both child and parent report - and SE scale scores in diabetic patients, whereas [Table 5] shows positive correlation between HbA1c levels and SE scores and insignificant negative correlation between HbA1c levels and school function scores in PedsQL among diabetic patients. Conclusion Diabetic patients have lower quality of life than healthy ones in the physical, emotional, and social domains. The SE and quality of life concepts are related, that is, the better the quality of life of diabetic patients, the higher the SE. Uncontrolled diabetes (increased level of HbA1c, 8.4%) did not affect PedsQL except for school function domain, but with insignificant statistical level. However, this suboptimal metabolic control affects the SE of children and adolescents.
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Study of olfactory identification and EEG in a sample of schizophrenic patients and their first-degree relatives as an endophenotype for schizophrenia
Hoda M Salama, Soliman A Tahon, Tarek K Molokhia, Nada A Mohamed
September-December 2014, 35(3):127-132
DOI:10.4103/1110-1105.144327  
Objective Investigations of the genetic basis for mental disorders have recently focused on Endophenotypes as alternative phenotypes reflecting internal phenomena of organisms that define elements of mental disorders proximal to effects of genes. Olfactory deficits and abnormal resting state electroencephalogram (EEG) are among endophenotypes that have been reported in patients with schizophrenia. This study assessed olfactory function and resting state EEG abnormalities in patients (first episode and chronic schizophrenic patients) and again in the healthy first degree family members of schizophrenic patients to determine genetic liability for the disorder. Method The University Of Pennsylvania Smell Identification Test (UPSIT) was administered birhinally to three groups of subjects aged less than 65 years: 30 schizophrenic patients, 30 healthy first degree family members and 30 age- and sex-matched healthy volunteers. Resting EEG data were also collected from the study groups. Result A high percentage of schizophrenic patients (both first episodes and chronic patients) were microsmic compared with control subject (P = 0,000*). However there was no significant statistical difference between first episode patients and family group (P = 0.915). The family group showed significantly statistical difference in UPSIT score compared to control subjects (P = 0,001*).These group differences could not be accounted for by age, sex, medication exposure, education or smoking habit. Schizophrenic patients had no significantly statistical difference (on the augmented low frequency-delta component than did normal control subjects P = 0.167), and there was no significant difference in scores on the delta component between first episode and chronic schizophrenic patients (P = 713). In the family group no significant difference on the augmented low frequency-delta component than did normal control subjects (P = 176). Conclusions Impairment in olfactory identification ability was present from the onset of psychotic illness which suggests central causes. Olfactory identification deficit aggregates in healthy first-degree family members which may serve as a strong endophenotypic vulnerability marker. The findings of Resting state EEG collected from the study groups suggest that there is EEG abnormalities in schizophrenia patients and their first degree healthy family members, but because small sample size the data wasn't' conclusive and needs to be repeated on larger sample size.
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Neuropsychological cognitive dysfunctions in psychotic bipolar disorders
Nagy Fawzy, Usama M Youssef, Amira A Fouad
September-December 2014, 35(3):133-137
DOI:10.4103/1110-1105.144331  
Objectives The aim of this study was to determine neuropsychological cognitive dysfunctions in psychotic bipolar disorders and compare the results with a control group. Participants and methods The sample included two groups: group I included 20 psychotic bipolar patients recruited from psychiatric outpatient clinics of Zagazig University Hospitals. Group II included 20 participants selected randomly from Zagazig University Hospitals visitors. Patients were subjected to a semistructured psychiatric interview using the DSM-IV criteria for psychotic bipolar diagnosis, detection of mania by Young mania rating scale for the study group, and detection of neuropsychological cognitive function, where executive functions were assessed using the Wisconsin card sorting tests and memory was assessed using the Wechsler memory scale. Results The results of the current study indicated a highly significant difference between psychotic bipolar patients and the control group in executive functions, logic memory, digit span forward, digit span backward, associative learning, and total memory, and a reversible highly significant correlation between the number of hospitalizations and cognitive functions in psychotic bipolar patients for block design. Conclusion The current study concluded that neuropsychological cognitive dysfunctions are highly prevalent in psychotic bipolar disorders and it is strongly inter-related with sociodemographic and clinical characteristics.
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Prevalence and relationship of religiosity level and suicidal ideation in depressed patients
Nagy Fawzy, Nagda Elmasry, Amira A Fouad, Usama M Youssef, Wa-il Abohendy
September-December 2014, 35(3):138-142
DOI:10.4103/1110-1105.144333  
Objective The aim of this study was to determination the prevalence and relationship of religiosity level and suicidal ideation in depressed patients. Patients The sample included 100 patients recruited from psychiatric outpatient clinics of Zagazig University Hospitals. The patients included fulfilled the Diagnostic and statistical manual of mental disorders, 4th ed., text revision, criteria for depression, were between 18 and 60 years of age, of both sexes, and were from all socioeconomic and educational classes. Patients and methods All participants were subjected to a psychiatric assessment for depressive symptoms using the Arabic version of Beck Depression Scale, suicidal ideation using the Arabic version of the Beck Suicide Ideation Scale, and religiosity using the Scale of Islamic Religiosity Attitude. Results The results of the current study showed that the prevalence of suicidal ideations was 18 and 10% in those with low religiosity level among depressed patients. There was a statistically significant difference between religiosity and suicide in depressed patients. Conclusion The current study concluded that suicidal ideations are a highly prevalent phenomenon, and suicidal ideation was more prevalent in less religious patients than highly religious patients.
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Psychiatric profile of physically ill pediatric patients
Hani H Dessoki, Hala Fakhry, Mohamed A Khalil, Maged A Gomaa, Sherif M Gohar, Mohamed Meebid, Tareq Abu Elkhair
September-December 2014, 35(3):143-150
DOI:10.4103/1110-1105.144336  
Background Mental health is an important component of overall health and mental disorders that can cause suffering, disability, and, rarely, even death. Pediatric-psychiatric liaison programs have evolved to enable the staff pediatricians to receive adequate training to assess emotional, behavioral, and family problems that may be an integral part of the patient's symptoms. Objectives The aim of the current study is to assess the prevalence of psychiatric symptoms among physically ill children ranging in age from 16 to 18 years attending the pediatric outpatient clinic in Beni Suef University Hospital and to compare the differences in psychiatric symptoms in relation to sex and the nature of physical illness among these patients. Participants and methods This survey study is a cross-sectional, observational, and comparative study. The study was carried out in the Pediatric outpatient clinic of Beni Suef University Hospital. A random sample of 300 Egyptian children with acute and chronic illness aged between 6 and 18 years, fulfilling the inclusion and exclusion criteria, participated in this study over an 8-month duration starting from May 2011 to December 2011. All participants of the study, both patients and informants, were subjected to a screening test using 'the Child Behavior Checklist for ages 6-18,' and intelligence quotient (IQ) was assessed for all sharing patients using the 'Stanford-Binet Intelligence Scale.' Results One hundred and seventy (56.7%) of the 300 selected patients were females and 130 (43.3%) were males; 260 of these patients attended regular schools. Out of the total number of patients, 155 (51.67%) presented with acute illness, whereas 145 (48.33%) had chronic illnesses. The mean IQ score was 79.8 ± 15.2 and only 22.3% of the sample (67 patients) had an 'average' IQ. Sex-based comparison of IQ results showed that female patients had significantly higher IQ scores (82.2 ± 13.6 with P = 0.035). However, Child Behavior Checklist 6-18 scores showed that 223 out of 300 patients had diagnosable Internalizing disorders with internalizing T-scores above 70; 118 (52.9%) of these were females compared with 105(47.1%) males, with a statistically significant difference (P = 0.026). Meanwhile, 203 patients had diagnosable externalizing disorders with externalizing T-scores above 70; 104 (51.2%) of these were females. IQ scores differed significantly, being higher in acute illnesses (82.3 ± 13.6 vs. 77.8 ± 15.9 and P = 0.025). Another significant difference between patients with acute illnesses and those with chronic illnesses was clear in the internalizing T-score and the externalizing T-score (higher in acute illnesses, P = 0.028 and 0.034, respectively). Conclusion The current status of psychiatric problems in pediatric physically ill patients calls for mandatory cooperation in pediatric consultation-liaison services in the Beni Suef Governorate.
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Demographic and personality assessment in relation to suicidal ideation in depressive disorders
Amany E Mohamed, Nelly R Abdel Fattah, Nagda M El Masry
September-December 2014, 35(3):151-160
DOI:10.4103/1110-1105.144341  
Background Suicidal ideation is common in depressive disorders, but only moderately related to depression severity. To prevent suicidal behavior, it is important to better understand the personality traits associated with suicidal ideation because prediction and assessment of suicidal ideation in depressed patients is an essential factor for proper management. Objective We aimed to assess some demographic profile and personality traits in relation to suicidal ideation in depressive disorders. Patients and methods A cross-sectional study was conducted in the Inpatient Ward and the Outpatient Clinic of the Psychiatry Department, Zagazig University Hospitals, Sharkia, Egypt, during the period from January 2013 to June 2014. Seventy patients (46 female and 24 male), age from 18 to 60 years, with depressive disorders diagnosed according to the Diagnostic and statistical manual of mental disorders, 4th ed. (DSM-IV) were subjected to a screening using the Modified Scale for Suicidal Ideation and the Eysenck's Personality Questionnaire (Arabic version). Results 65.7% of the patients included in the study had suicidal ideation during the course of their illness. Female patients, patients who were divorced, widowed, or married, and those with more than 6 years of education had high rates of suicidal ideation. Also, there was a statistically significant relation between suicidal ideation and Psychoticism and Neuroticism personality domains. Conclusion Suicide ideations are common among patients with depressive disorders and are associated with neurotic and psychotic personality traits.
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