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   2016| May-August  | Volume 37 | Issue 2  
    Online since November 2, 2016

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Egyptian children with autism spectrum disorders: risk factors and comorbidity in relation to disease severity
Wafaa A Elbahaaey, Magda H Elkholy, Salwa S Tobar, Haitham El-Boraie
May-August 2016, 37(2):59-69
Background Autism spectrum disorders (ASDs) represent a group of neurodevelopmental disorders characterized by impaired reciprocal socialization and communication, often accompanied with stereotyped ritualistic behavior. To date, no clear data could explain the dramatic worldwide increase in the incidence of ASD during the last two decades. It is suggested that some environmental factors besides a genetic predisposition leads to the disease. In addition, the disease is known to be associated with other psychiatric comorbidities. Aim The current study aimed to assess the incidence of psychiatric comorbidity present in those children and to relate the findings to the severity of the disease. Patients and methods The current study included 40 children (27 boys and 13 girls), with ages ranging from 3 to 11 years, and diagnosed with ASDs on the basis of the DSM-IV-TR criteria. Patients were divided to three groups according to their score on Gilliam Autism Rating Scale: mild ASD (10 cases); moderate ASD (11 cases), and severe ASD (19 cases). Data were collected through clinical psychiatric interview, Mini International Neuropsychiatric Interview for children and adolescent (M.I.N.I. KID), the Gilliam Autism Rating Scale, Vineland Adaptive Behavior Scales, and a scale for measuring family socioeconomic status for health research in Egypt. Results The present study demonstrated that 72.5% of the cases presented in families with middle socioeconomic status, which are highly educated, the majority (80%) of parents of studied cases lacked consanguinity degree, while only 20% from them had consanguinity from first degree; the vast majorities (92.5%) of the cases were not presented with family history of autism. As regards comorbidity, 90% of the cases were associated with one or more comorbid conditions and the presence of more than one comorbidity usually associated with male sex and severe type of autism, 72.5% of studied cases suffered from comorbid tics (40% occurs in severe autism), 25% of cases presented with associated attention-deficit/hyperactivity disorder, 20% of cases suffered from oppositional defiant disorder (ODD) as comorbid conditions, 37.5% of studied cases had comorbid obsessive compulsive disorder (OCD), and 5% of cases suffered from comorbid general anxiety disorder. Conclusion From the current study it was concluded that boys, high and moderate socioeconomic states, consanguinity, positive family history represented conditions that are associated with an increased risk for autism and ASDs in Egyptian population. Presence of one or more of those risk factors in children with autism is usually associated with severe type of the disease and more associated comorbidities. Determining the contribution of these risk factors may improve detection, earlier treatment, and better prevention of the disease. Comorbid tics, attention-deficit/hyperactivity disorder, ODD, and OCD are most presented among boys, whereas comorbid general anxiety disorder is more presented in girls with autism. The most occurring coincidence of comorbidity is comorbid tics and OCD, followed by comorbid OCD and ODD. Those coincidences were associated with severe autism and male sex. We suggest future studies using large samples to confirm the finding of the present work.
  7,671 511 2
Causal attributions and executive functions of academic procrastination in Mansoura University students
Youmna Sabri, Ibrahim Hamdy, Mahmoud El-Wasify, Mohamed El-Wasify, El-Sayed Saleh
May-August 2016, 37(2):70-78
Background Academic procrastination is the irrational delay in the beginning or completion of an academic task within the desired time frame. It has many negative consequences on students, for example, wasting time, loss of opportunities, decreased productivity, and lack of success in addition to serious emotional and health problems. Aim The purpose of this study was to assess procrastination among a sample of college students in different academic areas, identify the possible reasons of this behavior, and examine the role of causal attributions and various executive functions (EFs) of students in academic procrastination. Participants and methods Eighty college students from Mansoura University participated in this study and were diagnosed by the staff members of the Committee of Postponing Exams in the Department of Psychiatry using Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision. After being diagnosed, they were asked to complete three questionnaires; the Procrastination Assessment Scale-Students, Executive Skills Questionnaire, and the Causal Dimension Scale II. Results The results show that the age of the procrastinating students ranges between 18 and 32 years. The men (n= 48) represent 60% of the procrastinators. Most of the students procrastinate during the second and third years of their college study (30 and 32.5%, respectively). Students from the Faculty of Engineering represent 25% of the procrastinators. The commonest psychiatric diagnosis among the procrastinating students is obsessive compulsive disorder (27.5%), followed by malingering (17.5%), and generalized anxiety disorder (12.5%). Reasons of procrastination, for example, aversiveness of the task and low frustration tolerance, tendency to feel overwhelmed and poor time management, and peer influence, have significant positive correlation (P ≤ 0.01) with procrastination among students. Several EFs have a significant negative correlation (P ≤ 0.001) with presence of procrastination among students, for example, working memory, organization, time management, emotional control, task initiation, and sustained attention and flexibility. Finally, locus of causality and stability have a significant positive correlation (P ≤ 0.001) with procrastination among students, whereas personal control has a highly significant negative correlation (P ≤ 0.001), with the presence of procrastination among students. There are 11 significant predictors of procrastination, for example, difficulty in making decision, dependency and help seeking, laziness, anxiety, rebellion against control, fear of success, response inhibition, sustained attention, metacognition, goal-directed persistence, and external control. Conclusion and recommendations Procrastination is more common among male students with obsessive compulsive disorder. Several EFs, for example, working memory, organization, time management, emotional control, task initiation, and flexibility as well as locus of causality, stability, and personal control are impaired among procrastinating students and significantly correlated with the occurrence of procrastination. Finally, many variables can be considered as predictors of procrastination among students, for example, difficulty in making decision, dependency and help seeking, laziness, anxiety, rebellion against control, fear of success, response inhibition, sustained attention, metacognition, goal-directed persistence, and external control. All previous data represent cues for the development of strategies among students to prevent the aggravation of this problem.
  4,960 434 2
Study of effectiveness of brief cognitive behavioral therapy for auditory hallucinations in schizophrenia
Dalia Nagui Rizk, Hoda Salama, Tarek Molohkia, Layla Kassem
May-August 2016, 37(2):53-58
Introduction A growing body of evidence supports the use of cognitive behavioral therapy (CBT) for the treatment of schizophrenia. Auditory hallucinations are a common feature in schizophrenia that persists as a distressing symptom even after adequate pharmacotherapy regimen. Combining pharmacotherapy with brief CBT may reduce the severity of symptoms through decreasing the distress caused by the hallucinations. Aim The aim of this study was to evaluate the effectiveness of brief individual CBT for auditory hallucinations combined with treatment as usual (TAU) compared with TAU only in a sample of Egyptian schizophrenic patients referred to the Outpatient Clinic of El Hadara University Hospital. Patients and methods A total of 40 patients diagnosed with schizophrenia referred to the outpatient clinic of El Hadara University Hospital were randomly assigned into two groups: group I received brief CBT for auditory hallucinations combined with TAU, and group II received TAU only. Brief CBT for auditory hallucinations was delivered on eight sessions of 45 min each with a frequency of once per week. Positive and Negative Syndrome Scale (PANSS) was assessed before and after therapy in both groups and outcome was compared. Results On comparing the pre-assessment scores with the post-assessment scores of group I after 8 weeks of brief CBT for auditory hallucinations, a significant symptom reduction was observed for the PANSS positive (−18.31%, P < 0.001), negative (−16.67%, P < 0.001), general symptoms (−16.53%, P < 0.001), and total (−16.53%, P < 0.001) scores. Moreover, on comparing group I with group II after 8 weeks of brief CBT for auditory hallucinations, a significant symptom reduction was observed for the PANSS positive (P < 0.001), negative (P = 0.008), general symptoms (P < 0.001), and total (P < 0.001) scores. Conclusion Brief CBT for auditory hallucinations was found to be effective in reducing symptom severity in schizophrenia
  4,229 373 1
Public attitudes and knowledge toward epilepsy in ismailia governorate
Ahmed Osama, Mohammed Abd El Fatah El Smahy, Mona El sayed, Sabry Moawad
May-August 2016, 37(2):104-110
Objective This study was conducted to find out knowledge and attitudes toward epilepsy among a sample of people living in Ismailia governorate in Egypt. Patients and methods A cross-sectional survey was conducted by using a face-to-face interview; 840 respondents were included, among whom 420 were from an urban area − Sheikh Zayed district − and 420 were from a rural area − Abu-Sultan village. The survey instrument was a 26-item questionnaire in Arabic form that was designed to evaluate knowledge and attitudes with respect to epilepsy. Results Of the 840 respondents, 91.2% had heard of or read about epilepsy, 24.8% knew someone with epilepsy, and 30.7% had witnessed a seizure. According to the respondents, the main cause of epilepsy was psychological disease (63.7%), followed by evil spirits (Jinn) (49.5%) and a form of insanity (47.4%). Approximately 70% of the respondents (70.7%) agreed that the intelligence of an epileptic patient is below average. About three-quarters of the respondents (74.6%) believed that epilepsy cannot be cured. More than 50% of the respondents believed that an epileptic patient could not get married (57.5%), nor have a child (58.7%). About 80% of the respondents refused to marry an epileptic patient (77.7%) or to marry their child to an epileptic patient (83.0%). Fifty-nine percent of the respondents would not offer a job to a person with epilepsy, and 41.1% refused working with an epileptic patients. The negative attitudes toward an epileptic person were more common among rural, female, less-educated, and elderly respondents. Conclusion Public perception of epilepsy is lacked and needs attention. The study revealed that practices and knowledge toward epilepsy were limited, especially with respect to epilepsy’s cause, manifestation, and management. Continuing effective educational interventions would be needed to improve the appropriate understanding of epilepsy, and to ameliorate the social discrimination and misconceptions against epilepsy.
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Galantamine therapy for alzheimer’s disease by introducing nanodrug delivery systems
Walaa A Mostapha, Shewikar T El-Bakry
May-August 2016, 37(2):86-96
Introduction The major cause of dementia, a major public health problem, is Alzheimer’s disease (AD). A reliable method for the diagnosis and follow up of AD is needed together with a specific biological marker. Galantamine (Gal), an acetylcholinesterase inhibitor for AD therapy, has several reported side effects. Aim of the Work One approach to reduce dosing amounts, frequency of administration, and adverse side effects while maintaining the drug efficiency is the development of drug delivery systems using nanoparticles. Material and Methods Presently, Galantamine with either cerium/calcium hydroxyapatite (Ce/Ca-HAp) or carboxymethyl chitosan/ceria/calcium hydroxyapatite (CMCS/Ce/Ca-HAp) was intraperitoneally injected at a dose of 2.5 mg/kg body weight for 2 and 4 weeks. A total of 86 female adult albino Wistar rats (189–200 g weight) were used. AD was induced in ovariectomized rats with aluminum chloride oral treatment at doses of 17 mg/kg body weight daily for 2 months. The rats were divided into six groups: group 1, which included normal control rats; group 2, which included rats treated with Gal injected intraperitoneally at a dose of 2.5 mg/kg body weight; group 3, which included rats with AD; group 4, which included AD-induced rats treated intraperitoneally with Gal; group 5, which included AD-induced rats treated with Gal coated with Ce/Ca-HAp; group 6, which included AD-induced rats treated with Gal coated with CMCS/Ce/Ca-HAp for 2 and 4 weeks. Results In the current study, AD-induced histological alterations manifested as amyloid plaque formation of different sizes, congestion with perivascular edema, degenerated neurons with diffused gliosis, loss of pyramidal cells, separation of cortical tissue, and formation of fibrous glial scar. Several tests may be cumulatively used for early detection as decreased acetylcholine, B-cell lymphoma 2, tissue thromboplastin, GSH, superoxide dismutase, CAT, and cytochrome P450 and increased amyloid β, Chol, brain-type fatty acid binding protein, nitric oxide, MDA, and GSSH. Treatment with Gal coated with Ce/Ca-HAp imposed a highly significant improvement to near-to-normal levels in both histological and biochemical parameters. Gal coated with CMCS/Ce/Ca-HAp failed to encounter obvious ameliorations. Conclusion In conclusion, brain markers (acetylcholine, B-cell lymphoma 2, amyloid β, tissue thromboplastin, Chol, brain-type fatty acid binding protein, nitric oxide, and MDA) together with brain antioxidants (GSH, superoxide dismutase, CAT, and cytochrome P450) may be used in progressive laboratory testing method besides well-known imaging techniques. Gal therapy may impose limited improvements; thus, drug delivery systems using Gal coated with Ce/Ca-HAp may aid in minimizing dosing amounts, frequency of administration, and adverse side effects of drug while increasing its therapeutic efficacy.
  3,038 230 1
Child abuse experiences in adolescents with externalizing disorders
Rania H El-Baz, Warda F Abo-El-Ezz, Mohammed A.E. El-Hadidy, Hala A El-Boraie
May-August 2016, 37(2):46-52
Objectives The purpose of this study was to explore the effect of experiencing childhood abuse on externalizing disorders in a sample of adolescents from Mansoura Adolescents Unit. Patients and methods A total of 300 adolescents were included in the study; of them 100 were diagnosed as having externalizing disorders, whereas the other 200 were control adolescents from the outpatient clinic of Dermatology Department and Pediatric Hospital of Mansura University. The Mini International Neuropsychiatric Interview for Children and Adolescents was used for diagnosis, and a questionnaire on child abuse experiences was administered for assessment of parental abuse (physical and psychological) and sexual abuse. Finally, the modified Global assessment of functioning scale was used to assess the outcome of externalizing disorders. Results Paternal psychological abuse is significantly associated with attention deficit hyperactivity disorder (combined type), conduct disorder (CD), and substance use disorders (SUDs), whereas paternal physical abuse is significantly associated with CD and SUDs. Maternal physical abuse is associated with CD and oppositional defiant disorder, whereas maternal psychological abuse and sexual abuse are significantly associated with CD and SUDs. Therefore, paternal physical abuse is considered the only predictor of externalizing disorders. Conclusion This study has implications for the assessment of effect of childhood abuse on externalizing disorders during adolescence. Children physically abused, especially by the father in the sample, appeared to be at a greater risk for externalizing disorders. However, all types of child abuse were associated with externalizing disorders.
  3,015 222 1
Metabolically healthy obesity and metabolic syndrome in Nigerian adults with major mental illness
Kehinde S Akinlade, Olawumi O Satope, Victor O Lasebikan, Sheu K Rahamon
May-August 2016, 37(2):97-103
Background An understanding of the interplay between mental illnesses and metabolic disorders is crucial. At present, in Nigeria, studies on coexistence of these conditions are scarce. Therefore, this study was carried out to determine the prevalence of obesity, metabolically healthy obesity (MHO) and metabolic syndrome (MS) in adults with major mental illnesses. Materials and methods One hundred and twenty four patients with schizophrenia, depression and bipolar disorder were recruited into this cross-sectional study. Blood pressure and anthropometric indices were obtained using standard methods. After an overnight fast, plasma glucose levels and lipid profile were determined. MS was diagnosed using the Joint Interim Statement. MHO was defined as overweight/obesity with less than or equal to one MS risk factor, whereas metabolically unhealthy obesity (MUO) was defined as overweight/obesity with greater than or equal to two MS risk factors. Results More than half (55.6%) of the patients had normal body weight. The prevalence of overweight, obesity and MS was 25.8, 18.5 and 20.2%, respectively. Similarly, the prevalence of MHO and MUO among the overweight/obese patients was 21.8 and 78.2%, respectively. MUO was more prevalent in patients with schizophrenia compared with patients with depression and bipolar disorder. Low HDL and central obesity were the most common components of MS in the study participants. Conclusion It could be concluded from this study that metabolic disorders are not uncommon in Nigerians with major mental illness. Therefore, early identification of patients with metabolic alteration and introduction of preventive measures might forestall further cardiometabolic deterioration, especially in patients with schizophrenia.
  2,663 179 4
Assessment of serum cortisol, thoughts of death, and loss of pleasure in patients with schizophrenia: a correlative study
May-August 2016, 37(2):79-85
Context The hypothalamic–pituitary–adrenal (HPA) axis seems dysregulated in schizophrenic patients, but the underlying mechanisms are unknown; yet recent evidence indicates that systemic cortisol metabolism influences blood cortisol levels and HPA axis functioning. There has been a recent increase in interest in anhedonia research. Linkages to schizophrenia and the underlying neurobiology are still not well understood. There is clear evidence that the activity of certain neurobiological systems has a role in the pathophysiology of suicidal behavior and this includes hyperactivity of the HPA axis. Objectives The objectives of this work were to examine whether there is an increased activity of HPA axis in schizophrenic patients, and to detect the presence of an association between the level of plasma cortisol and thoughts of death and anhedonia in the disorder. Setting and design Twenty patients diagnosed with schizophrenia were studied in comparison with 20 controls. Patients and methods All patients were assessed through Present State Examination, 10th revision. The Snaith Hamilton Pleasure Scale was used to assess anhedonia, and Beck’s Suicidal Ideation Scale was used to quantify suicidal intention. In addition, The Positive and Negative Syndrome Scale was also used. Blood samples were collected from all patients to assess plasma cortisol level in the morning and evening. Statistical analysis Collected data in this study were analyzed using the statistical package for the social sciences (version 15). Results There were increased levels of morning and evening cortisol in schizophrenic patients. Thoughts of death were positively associated with elevated morning cortisol. Conclusion Schizophrenic patients have higher cortisol levels in comparison with controls, suggesting hyperactivity of the HPA axis in the disorder. Anhedonia predicts suicidal tendencies in schizophrenia; the higher the anhedonia, the higher the suicidal ideations.
  2,372 147 -
Consultation–liaison psychiatric services in Dubai, UAE: a descriptive analysis study
Mohamed Shahda, Khaled S Sherra, El Hassanen M Mahmoud, Osman Elsaid
May-August 2016, 37(2):111-116
Introduction Liaison psychiatry refers to the interface between psychiatry and general hospital patients. It involves psychiatrist’s intervention in the care of medically ill patients who present with psychiatric symptoms while in a general hospital setting. It may also involve the assessment of patients who have pre-existing psychiatric illness or those who develop psychiatric symptoms because of their medical or surgical illness. It is estimated that nearly 26.5–60% of the general medical inpatients suffer psychiatric comorbidity. Aim of the study The aim of this study was to evaluate the pattern and the characteristics of liaison referral to the psychiatric department from other general medical and surgical departments at Al Rashid Hospital, Dubai, and its association with clinical and diagnostic factors, and to study the quality and appropriateness of information presented in the referral letters to the psychiatric department. Patients and methods The patients included in the study were recruited from individuals who had been consecutively assessed and treated by the liaison psychiatric team at Rashid Hospital, Dubai, UAE, during the period of 6 months from 1 November 2012 to 30 April 2013. A specially designed data sheet was developed and a pilot analysis on 20 patients was undertaken using the designed data sheet to assess the applicability of data collection and tool arrangement of items, and to estimate the time needed and the feasibility of the study. The data sheet included demographic data, data of patterns of descriptive psychopathology, either physical or mental, before presentation, a mental state examination and cognitive assessment through the Mini Mental State Scale. We identified the following parameters to evaluate the referred letters from GP and other medical or surgical specialists or consultants: the degree of urgency − reason of referral, symptom-relevant life events or stresses, family history of psychiatric disorder, medical history, psychiatric history, treatment given, physical examination and any investigations that have been performed, mental state examination and psychiatric diagnosis. Results The number of referrals over the indicated period was 60 patients (6 months). Suicidal behaviour was the highest among the reasons for referral. The main comorbid physical disorders included 13 (21.7%) endocrine disorders, 11 (18.3%) gastrointestinal tract disorders, 10 (16.7%) central nervous system disorders, seven (11.7%) musculoskeletal system disorders, six (10%) respiratory system disorders, five (8.3%) coronary artery diseases, five (8.3%) urogenital disorders and three (5%) sensory deprivation. The medical history was not mentioned in 46 (76.7%) of the referral letters The action taken by the psychiatrist after assessments were admission to the psychiatric ward for 21 patients (35%), outpatient appointments for 24 (40%) and discharge from psychiatric service for 15 patients (25%). Psychiatrists agreed with the GP diagnosis in 15 cases (25%), but considered the diagnosis inaccurate in 27 (45%) of these cases. Replies of the psychiatrists to the GP referrals were made only in 18 patients (30%); no reply was written in 42 (70%) cases. Conclusion Future research is needed to understand how liaison service can be utilized and sustained most effectively as part of general hospital care. A comprehensive consultation–liaison unit that comprises a sufficient number of multidisciplinary mental health professionals (psychiatrist, psychologist, social worker) is vital in general hospital settings to address the unmet needs.
  2,307 176 1
Erratum: Axis-I psychiatric morbidity in a sample of Egyptian competitive athletes

May-August 2016, 37(2):117-117
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