Abdullahi Fido

Toxic trace elements in the hair of children with autism

Excess or deficiency of natural trace elements has been implicated in the etiology of autism. This study explores whether concentration levels of toxic metals in the hair of children with autism significantly differ from those of age- and sex-matched healthy controls. In-hair concentration levels of antimony, uranium, arsenic, beryllium, mercury, cadmium, lead and aluminum from 40 boys with autism and 40 healthy boys were determined by Perkin-Elmer mass spectrometry. The children with autism had significantly (p < 0.001) higher in-hair concentration levels of lead, mercury and uranium. There was no significant difference between the two groups in the other five toxic elements. The ratio between nutritional elements and toxic metals among children with autism was within the normal range. The possible sources of the toxic metals are discussed. Such testing is informative but at present the practical implications in terms of diagnosis and clinical management are limited.

Serum lipid concentrations in patients with major depressive disorder

This study compared the serum lipid concentrations in 100 patients with major depressive disorder (MDD) with those from 100 matched healthy controls. It was found that the serum total cholesterol concentration in patients with MDD (5.27 +/- 1.18 mmol/L) was significantly lower than the value (6.63 +/- 1.32 mmol/L) in sex-, age-, and weight-matched healthy controls. This significant decrease in serum cholesterol in patients with MDD was noted in both sexes and in all age groups. Patients with MDD, however, had significantly higher HDL cholesterol than matched controls. There were no statistically significant differences in serum concentrations of triglycerides, apolipoprotein (Apo) A1, Apo B, transferrin, and albumin between patients and controls. Clinical recovery of patients with MDD was accompanied by a significant increase in serum total cholesterol from 5.27 +/- 1.18 mmol/L to 6.12 +/- 1.2 mmol/L. These results suggest an association between low serum total cholesterol and depression in both sexes and at all age groups.

The opinion of caregivers on aspects of schizophrenia and major affective disorders in a Nigerian setting.

Background In Nigeria the burden of caring for persons with severe mental disorders rests largely on families whose attitudes to these conditions have not been explored. Objectives To assess the opinion of relatives of 75 schizophrenics and 20 major affective disorder cases on aspects of the disease and compare with the responses of relatives of cancer, infertility and sickle cell disease (SCD) cases. Method Caregivers were assessed using a burden questionnaire that contained items on etiological beliefs and attitudes to illness. Results The responses of relatives of the two psychiatric illness groups were similar. The single most important etiological factors were that “it is Satans work” (35.8 %) and “it is a natural illness“ (23.2 %). Other factors were “genetic” (9.5 %), “witchcraft” (10.5 %) and “curse by enemies” (10.5 %). This was similar to the opinion of cancer and infertility caregivers; but different from SCD where the most important causative factors were “genetic” (41.5 %) and “natural” (21.5 %). Psychiatric caregivers had higher frequency of anger and stigma. Over two-thirds of psychiatric caregivers felt glad caring for the patient and would not like the patient institutionalized. Most families were thought to be supportive and there was an impression that caring had made family emotional ties closer. Conclusions These families were tolerant and would cooperate with health authorities. Causative models are influenced by available knowledge and practices in the culture. To actualize the potential of families to play useful community psychosocial roles, there is a need for public mental health literacy and welfare support.

Coping with Infertility among Kuwaiti Women: Cultural Perspectives

Backgrounds: Although previous studies conducted in western countries have reported that psychological factors are part of the experience of infertility, no study has assessed this relationship in Arab women. Aims: To examine psychological distress among Kuwaiti women with infertility problems and explore the perceived causes of infertility. Methods: An Arabic version of the Hospital Anxiety and Depression Scale (HADS) was used to examine the psychological status of 120 Kuwaiti infertile women and an age-matched sample of 125 healthy pregnant women as a control group. Results: Compared with age-matched pregnant control sample. The infertile women exhibited a significant higher psychopathology in all HADS parameters in the form of tension, hostility, anxiety, depression, self-blame and suicidal ideation. The illiterate group attributed the causes of their infertility to supernatural causes such as evil spirits, witchcraft and God’s retribution, while the educated group blamed nutritional, marital and psychosexual factors for their infertility. Faith and traditional healers were considered as the first treatment choice among illiterate women, while the educated women opted for an infertility clinic for treatment. Childlessness results in social stigmatization for infertile women and places them at risk of serious social and emotional consequences. Conclusions: The prevalence and severity of psychological distress in this sample of infertile Kuwaiti women indicates the appropriateness of referring these patients for psychological evaluation. Successful programmes in dealing with infertility in Kuwait need to include the establishment of a community based intervention strategy to educate people about infertility and to give guidelines for treatment options.

Detrimental effects of variable work shifts on quality of sleep, general health and work performance.

Objectives: The aim of this study was to explore the detrimental effects of working a varying pattern of 8-hour shifts on quality of sleep, general health and work performance. Subjects and Methods: The Arabic version of the Pittsburgh Sleep Quality Index (PSQI)and 2 self-administered questionnaires were used to assess quality of sleep, work performance and general health in a sample of 200 males on a schedule of varying 8-hour shifts at the Kuwait Oil Company. A matched sample of an equal number of workers on a fixed daytime shift as a control group was enrolled in the study. Results: Compared with men working on a straight daytime shift schedule, those working on 8-hour variable shifts exhibited higher rates of heavy smoking (p < 0.003), coffee/tea consumption (p < 0.0001), constipation (p < 0.002), job stress (p < 0.0001) and poor sexual performance (p < 0.0001). Variable-shift workers reported persistent sleep disturbances in 3 dimensions of the global score of the PSQI (p < 0.0001). They also had significantly more complaints of fatigue (p < 0.005), poor level of work performance (p < 0.005) and loss of concentration (p < 0.005). Shift workers were significantly more prone to making errors and having accidents at work, and were more likely to report absence from work than the controls (p < 0.0001 and p < 0.005, respectively). Conclusion: These results suggest that the majority of workers on an 8-hour variable-shift schedule experienced various health problems, poor quality of sleep and an increased risk for errors and accidents at work as compared with those workers on a straight daytime shift schedule. There is a need to compare potential benefits of an alternative work shift schedule.

Olanzapine in the Treatment of Behavioral Problems Associated with Autism: An Open-Label Trial in Kuwait

Objectives: To study the efficacy and safety of olanzapine for the treatment of children with autism associated with disruptive behavior problems. Subjects and Methods: A prospective open-label trial was conducted on 40 male children (mean age 12.2 ± 2.2 years, range 7–17 years) meeting Diagnostic Statistical Manual IV criteria for autism. After a washout period from previous medications (2–14 days), patients received olanzapine (5–10 mg/day) for a 13-week treatment period. The primary efficacy measures were Aberrant Behavior Checklist (ABC) and Clinical Global Impressions-Severity (CGI-S) done at baseline and end of treatment. At the beginning and end of treatment, patients underwent laboratory and physical investigations: ECG, chest X-ray, urinalysis, serum chemistry, blood glucose and lipid profile, hematology and hepatitis B serology. Results: Paired comparison of baseline and 13-week endpoint scores showed significant reductions in ABC subscale scores for irritability (p < 0.0001), lethargy (p < 0.0001), stereotyped behavior (p < 0.005), hyperactivity (p < 0.0001) and inappropriate speech (p < 0.005). Of 40 patients, 12 (30%) were considered as ‘improved’ on CGI-S scores compared to baseline, a statistically significant difference (p < 0.05). No liver enzyme elevation or any other serum biochemical changes resulted from treatment, which was not associated with significant body weight changes or any other treatment-emergent side effects. Conclusions: The study shows that olanzapine treatment can be beneficial in alleviating some behavioral symptoms (irritability, hyperactivity/noncompliance and lethargy/withdrawal) associated with autism. The short period of this trial limits inferences about adverse effects such as body weight increase and tardive dyskinesia. Further long-term placebo-controlled studies of olanzapine are required.

Risperidone-induced increase of plasma norepinephrine is not correlated with symptom improvement in chronic schizophrenia

BACKGROUND Previous studies have shown an increase in plasma levels of norepinephrine (NE) after clozapine treatment of schizophrenia. This effect has been suggested to relate to improvement in symptoms. METHODS To test whether other novel antipsychotic drugs have such an effect, the present experiment examined schizophrenic symptoms and plasma levels of NE before and after 5 weeks of treatment with risperidone or haloperidol. RESULTS Risperidone, but not haloperidol, significantly increased plasma NE; however, there was no correlation of this effect with clinical improvement on any symptom scale. CONCLUSIONS This finding suggests that risperidone shares similar properties with clozapine in enhancing peripheral NE, but that these changes in plasma NE may not be a consistent indicator of atypical antipsychotic drug efficacy.

Psychiatric Morbidity among Housemaids in Kuwait a. Prevalence of Psychiatric Disorders in the Hospitalized Group of Housemaids

Objectives: To determine the first hospital admission rates and the nature of psychiatric disorders among housemaids and compare them with the Kuwaiti female patients. Subjects and Methods: Based on the International Classification of Diseases (10th revision; ICD-10) symptom checklist, a semi-structured interview was administered to all the housemaids and the Kuwaiti female patients hospitalized during the 2-year study period. Results: The hospital admission rates were 1.86 times higher in housemaids than in the Kuwaiti female patients and the nature of psychiatric disorders was also different in the two groups. The stress-related disorders were more common among housemaids while schizophrenia was the commonest disorder among Kuwaiti patients. Duration of hospital stay was significantly shorter for housemaids, and four fifths of them were repatriated on mental health grounds. Conclusions: The psychiatric morbidity is higher among housemaids than Kuwaiti females and a substantial number of them are prematurely repatriated on health grounds. Further studies are needed to explore the possible pre-immigration risk, and post-immigration precipitating factors, to prevent this ‘expatriate failure’.

Psychiatric morbidity among housemaids in Kuwait III: Vulnerability factors

Background: Housemaids are a relatively homogenous immigrant subgroup in terms of their gender; ethnic origin; and socio-cultural, educational and occupational background. Psychiatric morbidity among housemaids is two to five times higher than the native female population. Aims: To determine the possible pre-immigration risk factors for prospective psychiatric breakdown among the housemaids. Methods: The sample consisted of all the housemaids (N = 197) hospitalised during the two-year study period. The controls comprised all the newly arrived housemaids (N = 502). The measures obtained included demographic characteristics and previous history of physical illness, psychiatric illness, hospitalisation and family history of psychiatric disorder. Results: More than a quarter of the hospitalised group broke down within one month of their arrival. The hospitalised group had a significant excess of Sri Lankan housemaids; non-Muslims; those with less than four years of education and those with a previous history of physical illness, psychiatric illness or hospitalisation. Conclusions: A number of potential risk factors results in premature repatriation of housemaids on mental health grounds. Preventive measures involving recruitment procedures and pre-departure orientation courses are needed to minimise the expatriate failure among the housemaids.

Effective Method of Teaching Psychiatry to Undergraduate Medical Students: The Student Perspective

Objectives: A search of the literature revealed that there are no studies of the effectiveness of teaching strategies from the medical students’ perspective. This study aims to explore medical students’ views on various teaching methods in psychiatry. Materials and Methods: A questionnaire describing several learning methods including clinical or bedside teaching, independent study, lectures, teaching aids, verbal/nonverbal behavior, and small-group teaching was administered to sixth-year medical students of the Faculty of Medicine, Health Sciences Center, Kuwait University. Results: Eighty-three percent of the students surveyed thought that well-delivered lectures were the most preferable learning method. Fifty-five percent agreed that live patient presentations were the most effective teaching aid. Independent study and small-group teaching were negatively viewed by 75% of the students. Slides/overheads and video presentations were evaluated by students as the last useful teaching methods. Factors cited as helpful in teaching included an enthusiastic interactive lecturer, a clear, audible voice, and visual teaching materials. Conclusion: This finding suggests that medical students are able to differentiate between effective and ineffective teaching methods in psychiatry and because of this they remain among the keenest critics of the education they receive.