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   2015| January-April  | Volume 36 | Issue 1  
    Online since March 23, 2015

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Sex differences in cognitive dysfunction among bipolar disorder patients
Heba Aly, Hoda Salama, Soha Ibrahim, Hesham El-Shestawy
January-April 2015, 36(1):1-8
Introduction Studies have proposed that cognitive deficits are present in a variety of mood states in bipolar disorder (BD). In addition, a few studies have pointed to the presence of sex-related differences in cognitive dysfunction in BD. Aim of the work This comparative study aimed to study the cognitive functioning of BD patients in different episodes, and detect any sex-related differences in cognitive functioning in the studied sample. Patients and methods The recruited sample consisted of 150 patients selected at random from El Maamoura Mental Hospital over 6 months. Four groups were formed: group I, comprising 38 (19 male and 19 female) BD patients having manic episodes; group II, comprising 26 (12 male and 14 female) BD patients having depressive episodes; group III, comprising 36 (20 male and 16 female) patients in remission (euthymic); and group IV, comprising 50 controls matched for age, sex, and education. Clinical and psychiatric evaluations were carried out and psychometric assessment was performed using the 17-item Hamilton Depressive Scale and the Young Mania Rating Scale, as well as cognitive assessments using three tests: Wisconsin's Card Sorting Test (WCST), the digit span subtest of the WAIS-R and DSST (the digit symbol subtest of the WAIS-R). Results The BD patients in the three groups having BD showed significant cognitive deficits compared with controls. Manic and depressive patients showed impairment in attention, working memory, and executive functions. Euthymic patients showed significant impairment in working memory and executive functions. Only euthymic patients revealed a statistically significant sex-related difference in terms of short-term memory, attention, and working memory, with women being worse than men. Interestingly, in the control group a difference in executive functions was reported wherein healthy control women performed significantly better than control men on the WCST-128 (completed significantly more number of categories and committed significantly fewer perseverative errors). Conclusion Cognitive dysfunction should be regarded as a core feature of BD as it was present across all mood states in our sample. In addition, discrepancy has been found between male and female euthymic patients regarding cognitive functions, suggesting a sex-related difference in the clinical expression of BD.
  6,551 301 2
Perimenopausal psychiatric aspects in urban versus rural Egyptian women in Menoufiya
Nabil R Mohamed, Lamiaa G El-Hamrawy, Afaf Z Rajab, Mohamed S El Bahy, Eman G Saleh
January-April 2015, 36(1):21-39
Background The perimenopause marks a major life transition for women, an end to the childbearing years and cessation of menses. Women frequently face a number of major life stressors during the years leading up to menopause. Aim This study aimed to explore the biopsychosocial aspects of perimenopause, to study the distribution of menopausal symptoms in an urban versus a rural community, and to study the psychosocial profile of women with psychiatric disorders during the perimenopausal period and their impact on quality of life to evaluate their attitude toward menopause and its relation to the psychiatric disorders, and to focus on the possible relationship between estradiol level and psychiatric disorders in perimenopausal women. Patients and methods This study enrolled 50 perimenopausal women and 20 premenopausal women as a control group. Tools of the study We used the following tools: Structured Clinical Interview of DSM-IV, Stressful Life Events Scale, the Arabic version of Greene Climacteric Scale and Menopausal Symptom Checklist, the Quality of Life Scale for Menopausal Women, Attitude Towards Menopause, the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Sleep Questionnaire, and laboratory investigations including determination of follicle stimulating hormone serum level and serum estradiol level. Results In this study, the perimenopausal group had significantly (P < 0.001) greater stressful life events than premenopausal women (66% of perimenopausal women were at a definite risk for illness and 34% were at a moderate risk for illness). Perimenopausal women with psychiatric disorders had significantly greater stressful life events than those without psychiatric disorders. We also found that 36 (72%) perimenopausal women had significantly (P < 0.01) positive attitude compared with five (25%) premenopausal women. Perimenopausal women with psychiatric disorders had greater severity of menopausal symptoms (highly significant in hot flushes). Perimenopausal women with psychiatric disorders had poor quality of life and marked psychological limitations. In the present study, risk factors for patients with major depressive disorder were a family history of mood disorder, vasomotor symptoms, and stressful life events. Risk factors for generalized anxiety disorder were a family history of generalized anxiety disorder (GAD) and vasomotor symptoms. Conclusion It is important to assess the psychosocial profile, women's attitude toward menopause, menopausal symptoms, and screening for psychiatric disorders for better quality of life and better outcome.
  4,830 299 1
The prevalence and characteristics of attention-deficit hyperactivity disorder among a sample of Egyptian substance-dependent inpatients
Ahmed Abdelkarim, Hoda Salama, Soha Ibrahim, Osama Abou El Magd
January-April 2015, 36(1):9-13
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.
  3,724 396 3
Dissociative phenomena in attempted suicide
Hala Fakhry
January-April 2015, 36(1):45-53
Background Dissociation may play a role in forgetting the events during self-inflicted behaviors and suicidal trials. Objective A trial was conducted to investigate the presence of dissociative phenomena among people attempting suicide. Participants and methods A convenient sample of 77 suicide attempters who joined the study (Group 1) was admitted to 'Sharjah Kuwaiti Hospital' in 2007 under police supervision. These patients reported forgetting the details of the suicidal trial, and hence they were referred for psychiatric consultation. Only fully conscious patients with clear sensorium who gave consent were included. Clinical assessment of Group1 included SCID to diagnose patients according to Diagnostic and Statistical Manual of Mental Disorders. 4 th ed (DSM-IV). Psychometric assessment for patients was performed using the Questionnaire of Experience of Dissociation (QED) and the Dissociative Experience Scale (DES) for dissociative phenomena, the analysis of their response to a direct question about suicidal ideation in item 9 of the Beck Depression Inventory as the suicidal index and the assessment of the degree of hopelessness using the Hopelessness Scale (HS). A matching control group of 50 volunteers with 'no psychiatric disorder' from the general population (Group 2) was included in the study for comparison. Results Although 29 (37.66%) of the suicidal attempters in Group 1 had no psychiatric diagnosis, 48 (62.34%) had psychiatric diagnosis and three of them had both Axis I and Axis II DSM-IV diagnoses. MDD was the most prevalent diagnosis among these diagnoses [22 (59.46%)]. Results showed significantly high scores (P = 0.0001) of QED, DES, and HS in the study group (Group 1) compared with the control group (Group 2). A highly significant difference was found in the mean score of dissociative scales, QED (P = 0.0040) and DES (P < 0.0001), between attempters with and without psychiatric diagnosis, but not in the mean scores of HS (P = 0.7640). A statistically significant difference was found between the method used in the suicidal attempt and the mean scores of HS (P = 0.0060) and DES (P = 0.0001), but not QED (P = 0.4755). Conclusion Suicidal attempters have a high prevalence of dissociative phenomena. The presence of psychiatric diagnosis and not the method used in suicide may play a role in increasing the suicidal intent.
  3,585 182 2
Cognitive impairment in depressed students of Cairo University Hospital
Zeinab Sarhan, Heba Fathy, Nagwan Madbouly
January-April 2015, 36(1):54-59
Introduction Major depression may affect the ability to think, concentrate, make decisions, formulate ideas, reason, and remember. Patients with major depression also often show neurocognitive deficits consistent with frontal lobe dysfunction. The co-occurrence of depressive symptoms and cognitive impairment plays a role in determining disability in individuals. Aim of the study To assess the presence of cognitive deficits in depressed undergraduate university students and then to assess the correlation between severity of depression and cognitive impairment in these students. Patients and methods After obtaining consent from the ethical committee in Kasr El Aini Hospital, 50 patients with the diagnosis of Major Depressive Disorder according to the DSM-IV criteria were recruited from the psychiatric outpatient clinic of Cairo University Student Hospital, with no sex preference. Fifty control participants of similar age, sex, and educational backgrounds were recruited as volunteers. Psychometric procedures: Beck Depression Inventory for severity of depression, selected subtests of Wechsler Adult Intelligence Scale (WAIS), and Wechsler Memory Scale-Revised (WMS-R). Results Medical and paramedical students recruited from six faculties constituted 40% of the entire sample. Forty percent of the cases were diagnosed with moderate depression, whereas 60% of them were diagnosed with severe depression. All the scores of the subtests of WAIS and WMS-R used were higher in the control group. The scores of the Beck Depression Inventory were correlated positively with the digit symbol and digit span subtests of WAIS and to figural memory and visual memory span subtests of WMS-R. Conclusion Depressed undergraduate university students had more cognitive deficits than nondepressed students. The severity of depression was correlated positively with some of these cognitive deficits.
  2,775 223 1
Psychological insulin resistance in patients with type 2 diabetes mellitus
Maha M El Shafei, Hala El Said Sayyah, Rania Hussein
January-April 2015, 36(1):60-65
Aim Our study was conducted to review factors responsible for psychological insulin resistance among patients with type 2 diabetes mellitus. Patients and methods In our study on 100 patients with type 2 diabetes mellitus enrolled from an outpatient clinic of diabetes, all patients were noncompliant to diet and exercise, with high HbA1c, and all planned to be converted to insulin therapy. Results The results showed that a large number of factors account for psychological insulin resistance in patients; the main categories were emotional, cognitive, social, cultural, and interaction with health providers. Conclusion We concluded that there is a significant need of evidence-based interventions that help remove psychological barriers about insulin use in patients.
  2,589 281 3
Prevalence and risk factors of erectile dysfunction among chronic hepatitis C male patients treated with pegylated interferon-α and ribavirin
Nagy Fawzy, Hesham A Atia, Sherif M Galal, Jihan A Shawky
January-April 2015, 36(1):40-44
Aim The aim of the study was to determine the prevalence and risk factors of erectile dysfunction (ED) among chronic hepatitis C male patients treated with pegylated interferon-α and ribavirin. Patients and methods The sample consisted of 85 male patients treated with pegylated interferon-α2a and ribavirin for 12 months, recruited from Tropical and Internal Medicine outpatients of Zagazig University Hospitals. ED was prospectively studied by International Index of Erectile Function questionnaire, depression was assessed by Hospital Anxiety and Depression Scale, and routine laboratory investigations in addition to serum total and free testosterone were evaluated before, during, and 6 months after treatment. Results Prevalence of ED among chronic hepatitis C male patients was 40% (34 patients). There was significant deterioration of International Index of Erectile Function scores and Hospital Anxiety and Depression Scale with respect to basal values and a significant decrease in total and free testosterone with gradual improvement toward the end of treatment period. Emotional state and physical profiles were the most significant risk factors for sexual dysfunction. Conclusion ED is common among hepatitis C virus patients treated with pegylated interferon-α and ribavirin and it is multifactorial.
  2,261 201 3
Cognitive decline in different delirium subtypes and the associated change in the biomarker S100B serum level
Nabil R Mohamed, Lamiaa G El Hamrawy, Ayman K Abdel-Hamid, Afaf Z Ragab, Mohamed S Abdel-Shafy
January-April 2015, 36(1):14-20
Objectives This study was designed to assess the cognitive decline in different delirium subtypes and the change in the level of serum S100B, with determination of the outcome of delirium. Background Delirium involves a wide range of cognitive disturbances across its different subtypes. The serum S100B level is high in delirious patients and plays a role in the process of learning and memory. The outcome of delirium differs according to delirium subtypes. Participants and methods This study enrolled 35 delirious patients (group A) and two control groups. Group B comprised 10 patients with disease but without delirium. Group C comprised 10 normal healthy individuals. All participants were subjected to the Delirium Symptom Interview scale, the Cognitive Test for Delirium, the Delirium Motor Subtype Scale, and the Trail Making Test parts A and B, and the level of serum S100B was measured. About 17 delirious patients were followed up after 1 month to assess the cognitive decline and the mortality rate. Results The level of cognitive dysfunction in delirious patients was significantly higher than that in the two control groups (group B and group C). The level of cognitive dysfunction was not significantly different among the four delirium subtypes. Attention impairment occurred in 96% of the patients, and the less affected cognitive domain was comprehension, which occurred in 77% of the patients. The level of serum S100B was significantly higher in delirious patients compared with the two control groups, but it was not significantly different among the delirium subtypes. After 1 month, the hypoactive subtype was associated with more cognitive dysfunction and a high mortality rate. Conclusion Cognitive decline occurs in delirious patients, but this decline was not significantly different among the delirium subtypes. The most affected cognitive domain was attention and the least affected one was comprehension. Delirium was associated with a high level of serum S100B, but this level was not significantly different among the delirium subtypes. The hypoactive subtype was associated with a poor outcome.
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