Adel Gabriel

Examining perceptions of academic stress and its sources among university students: The Perception of Academic Stress Scale

The development of a scale to measure perceived sources of academic stress among university students. Based on empirical evidence and recent literature review, we developed an 18-item scale to measure perceptions of academic stress and its sources. Experts (n = 12) participated in the content validation process of the instrument before it was administered to (n = 100) students. The developed instrument has internal consistency reliability of 0.7 (Cronbach’s alpha), there was evidence for content validity, and factor analysis resulted in four correlated and theoretically meaningful factors. We developed and tested a scale to measure academic stress and its sources. This scale takes 5 minutes to complete.

Adjunctive topiramate treatment in refractory obese bipolar patients: A descriptive open label study

OBJECTIVES: To examine efficacy and tolerability of topiramate as an adjunctive treatment for overweight refractory bipolar patients. METHOD: Patients (n=30) with Bipolar I or II, were provided with an open label treatment with topiramate as an add-on therapy. All patients deemed refractory to at least one mood stabilizer, were overweight, and were treated with topiramate as an adjuvant to existing medication for at least 12 weeks. The primary effectiveness measure was the Clinical Global Impression Scale (CGI). Other scales included the Young’s Mania Rating Scale (YMRS), and the Hamilton Depression scale (HAMD21). Measures prior to adding topiramate were compared to those repeated at 4, 8 and 12 weeks. Tolerance, and weight changes were monitored. RESULTS: There was significant reduction in both depressive and manic symptoms with adjunctive treatment. The mean BMI at 12 weeks of topiramate treatment dropped by 2 points (p<0.0001). CONCLUSION: Topiramate is an effective adjunctive treatment in bipolar refractory patients and the significant weight reduction effects may result in important medical risk reductions, and make topiramate attractive for some obese bipolar patients.

Gabapentin adjunctive to risperidone or olanzapine in partially responsive schizophrenia: an open-label pilot study

Background There is a great need in the treatment of schizophrenia for a drug, or drug combinations, to improve clinical response with fewer serious side effects. The objective of this study was to explore the therapeutic effects and tolerability of the anticonvulsant gabapentin as an adjunctive in the treatment of patients with partially responsive schizophrenia. Methods Ten consenting patients with a confirmed Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision diagnosis of schizophrenia were identified. All patients failed at least one 12-week treatment trial with risperidone or olanzapine. Gabapentin was added to ongoing antipsychotic treatment with olanzapine or risperidone for eight weeks. The primary outcome measure was the Positive and Negative Syndrome Scale (PANSS). Other scales included the Calgary Depression Scale (CDSS) and the Abnormal Involuntary Movement Scale (AIMS). Repeated-measures multivariate analysis of variance was utilized to examine changes in outcome measures over time with adjunctive treatment with gabapentin. Results There was a significant drop in the PANSS and CDSS scores at endpoint (week 8). There were no significant differences between the two treatment groups with regard to changes in all outcome measures or in AIMS score. The adjunctive treatments were well tolerated and side effects were transient. Conclusion Gabapentin could be used successfully as an adjunct to novel antipsychotics in partially responsive schizophrenia. However, large controlled studies are needed to examine the effectiveness of gabapentin in psychotic disorders.

Risperidone, quetiapine, and olanzapine adjunctive treatments in major depression with psychotic features: a comparative study

Objectives The purpose of this study was to compare the effectiveness of novel antipsychotics in the treatment of psychotic depression. Method Consecutive patients who were admitted (n = 51) with a confirmed diagnosis of major depression with psychotic features (delusions or hallucinations or both) participated in this open-label, naturalistic study. All patients were treated with selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (citalopram or venlafaxine extended release [XR]), and atypical antipsychotic agents were added, as tolerated, during the first week of initiating the citalopram or venlafaxine. There were patients (n = 16) who received risperidone, who received quetiapine (n = 20), and who received olanzapine (n = 15), as an adjunctive treatment to either citalopram or venlafaxine for at least 8 weeks. Outcome measures included the Clinical Global Impression-Severity subscale (CGI-S), as the primary outcome measure, as well as the Hamilton Rating Scale for Depression-21 item (HAM-D21) and the Brief Psychiatric Rating Scale (BPRS). Tolerance to treatments and weight changes were monitored over the period of the trial. Results All patients completed the trial with no drop outs. At 8 weeks, there was a statistically significant (P < 0.001) clinical improvement in all outcome measures for both the depressive and psychotic symptoms, for all three groups of atypical adjunctive treatments. Utilizing analysis of variance (ANOVA), there were no significant differences between the three adjunctive treatment groups in outcome measures. The three antipsychotic agents were equally tolerated. At 8 weeks there was slight increase in weight in the three treatment groups, which was statistically significant (P > .01) in the olanzapine group. Conclusion Quetiapine, risperidone, and olanzapine, given as adjunctive treatment with SSRIS or SNRIs can significantly and equally improve depressive and psychotic symptoms, in the short-term treatment of major depression with psychotic features. The author recommends that large controlled trials be conducted to examine the differences in long-term efficacy and tolerance between the atypical antipsychotic agents, in the treatment of major depression with or without psychotic features.

Serotonin reuptake inhibitor and fluvoxamine-induced severe hyponatremia in a 49-year-old man.

Objectives. To describe a case of fluvoxamine-induced severe hyponatremia, most likely due to abnormal antidiuretic hormone excretion (SIADH), and to discuss the implication for maintenance treatments for these patients. Clinical Observations. Although this syndrome had its incidence most commonly among the elderly, we report a case of severe hyponatremia (serum sodium <114 mmol/L), in a relatively young male. Treatment. Symptoms responded well to IV hyperosmolar sodium and to the discontinuation of fluvoxamine. This patient was maintained for treatment on an alternative Selective Serotonin Reuptake Inhibitor (SSRI), Citalopram, without developing recurrence of symptoms. Outcome and Conclusion. Protocols to monitor the maintenance treatments in high-risk patients may be needed to prevent recurrence of serious complications.

Problem-solving strategies in psychiatry: differences between experts and novices in diagnostic accuracy and reasoning

Background The purpose of this study was to examine and compare diagnostic success and its relationship with the diagnostic reasoning process between novices and experts in psychiatry. Methods Nine volunteers, comprising five expert psychiatrists and four clinical clerks, completed a think-aloud protocol while attempting to make a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnosis of a selected case with both Axis I and Axis III diagnoses. Results Expert psychiatrists made significantly more successful diagnoses for both the primary psychiatric and medical diagnoses than clinical clerks. Expert psychiatrists also gave fewer differential options. Analyzing the think-aloud protocols, expert psychiatrists were much more organized, made fewer mistakes, and utilized significantly less time to access their knowledge than clinical clerks. Both novices and experts seemed to use the hypothetic-deductive and scheme-inductive approaches to diagnosis. However, experts utilized hypothetic-deductive approaches significantly more often than novices. Conclusion The hypothetic-deductive diagnostic strategy was utilized more than the scheme-inductive approach by both expert psychiatrists and clinical clerks. However, a specific relationship between diagnostic reasoning and diagnostic success could not be identified in this small pilot study. The author recommends a larger study that would include a detailed analysis of the think-aloud protocols.

Psychoeducational methods for patients suffering from depression: the knowledge seeking instrument (KSI).

OBJECTIVE To develop and psychometrically assess a short instrument that can be easily used in clinical practice to measure knowledge-seeking behavior in patients suffering from depression. METHOD We developed the knowledge seeking instrument (KSI), a self-report scale of three items to assess the number of hours spent in knowledge seeking behavior such as reading written materials, surfing the internet, or watching audio-visual tools. Experts in mood disorders (n=12) participated in the formal validity assessment of the instrument, and the developed instrument was administered to outpatients who were attending psychiatry clinic (n=63). All patients also completed a multiple choice question instrument to measure knowledge of depression, a Likert self report questionnaire to assess attitudes towards depression and its treatment, and an adherence to antidepressants scale. RESULTS In addition to the empirical evidence for validity, there was 68% agreement among experts that the items were highly relevant in measuring behavior of knowledge seeking, providing evidence for content validity. There were significant correlations (p<0.05) between knowledge of psychological and biological treatments of depression and knowledge seeking reading scores. The internal consistency reliability (Cronbachs alpha) was 0.67 for the instrument. CONCLUSION AND SIGNIFICANCE The KSI takes 2 min to complete. There is evidence for reliability, content, and criterion based concurrent validities. The KSI can be utilized to assess knowledge seeking behavior in patients with depression.

Does seeking knowledge of depression make a difference? A randomized study to examine the efficacy of psychoeducational intervention with patients suffering from non-psychotic depressio

Aims: the primary objective of the study is to assess the efficacy of a systematic patient-centered psychoeducation program on knowledge seeking of depression and on the clinical outcomes, in patients with non-psychotic major depressive disorder. Method: 52 consenting patients with confirmed diagnosis of major depression were randomly assigned to a group (n = 32) who received systematized psychoeducation for depression, and to a waiting group (n = 20) who received standard care. the intervention group received systematic education consisting of (i) reading material, “depression manual”, and (ii) individual or groups educational sessions. the primary clinical outcome measures included the clinician rated quick inventory of depressive symptomatology (QIDs-c) and the self-rated quick inventory of depressive symptomatology (QIDs-sr). Patients in both groups completed QIDs-sr, and the knowledge seeking behavior instrument (KsI), at baseline, at 4th, 8th and 12th weeks. results: At 12th week, there was significant (p< 0.01) reduction in the (QIDs-cr) and the (QIDs-sr) scores in both the intervention