Dalia Enaba

Correlates of psychiatric co-morbidity in a sample of Egyptian patients with bipolar disorder

BACKGROUND AND OBJECTIVES Bipolar disorder (BD) is a complex, chronic mood disorder involving repeated episodes of depression and mania/hypomania. Two thirds of patients with bipolar disorder have a comorbid psychiatric condition. This study aims to assess the prevalence of Axis I diagnosis with its socio-demographic and clinical correlates among a sample of Egyptian patients with bipolar disorder. METHODS Out of the 400 patients who were enrolled in the study from number of governmental and private psychiatric hospitals in Cairo, Egypt, 350 patients diagnosed with bipolar affective disorders (157 females and 193 males) with age ranging from 18 to 55years were selected. Patients were assessed using the Structured Clinical Interview for DSM-IV Axis I disorder (Research Version) (SCID-I). RESULTS Prevalence of psychiatric comorbidity among BD patients was 20.3% (71 patients) among which 63 patients (18%) had comorbid substance abuse and 8 patients (2.3%) had comorbid anxiety disorders. LIMITATIONS The study was limited by its cross sectional design with some patients having florid symptoms during assessment, not having a well representative community sample. This might have decreased the reliability and prevalence of lifetime psychiatric comorbidity due to uncooperativeness or memory bias. The study group was composed of bipolar patients attending tertiary care service which limits the possibility of generalizing these results on different treatment settings. CONCLUSIONS Substance abuse followed by anxiety disorders was found to be the most common psychiatric comorbidity. Family history of psychiatric disorders and substance abuse as well as current psychotic features were highly correlated with comorbidity.

Impact of political violence on the mental health of school children in Egypt

Abstract Background: Since the beginning of the Egyptian political conflict, Tahrir Square has been the epicentre of intense political violence. Students attending schools located near this square witnessed and/or directly experienced the consequences of a series of violent events. Aim: This study will investigate the presence of psychiatric symptoms in children attending these schools to explore patterns of responses according to their perceptions of the revolution on their lives, adjusted for, gender and socio-economic status. Method: A descriptive cross-sectional study conducted with 515 Egyptian school children attending government, experimental, and private language schools located within 1 km of Tahrir Square. To assess psychiatric symptoms in these children, a specially designed questionnaire was used to detect, depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms and impairments. Results: Children attending schools near Tahrir Square showed high rates of depression, PTSD and anxiety symptoms. The risk factors identified for developing psychiatric symptoms were a negative perception of the effect of the revolution, knowing someone exposed to trauma during the events, female gender and low socio-economic class. Discussion: These results highlight the need for large-scale studies to explore the consequences of ongoing political violence on children and to establish baseline data on the mental health of Egyptian children.

Role of traditional healers in the pathway to care of patients with bipolar disorder in Egypt.

Background: A large number of mentally ill patients prefer to visit non-medical practitioners such as traditional healers because of the confidence in the system, affordability and accessibility of the service. This may lead to delay in seeking psychiatric services and has prognostic impact. Aim: To assess the rate of bipolar affective disorder (BAD) patients seeking traditional healers, the sociodemographic and clinical correlates of those patients. Methods: We assessed 350 patients with BAD after confirmation of diagnosis with Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I) research version and assessment of functioning with Global Assessment of Functioning scale. They were assessed for percent, rate and timing of seeking traditional healers. Results: In all, 40.8% sought traditional healers, with 34.9% more than four times. Of those, 62.2% were before seeking psychiatric services and 37.8% after. Lower educational level, less impairment of functioning and presence of hallucinations were significant correlates. Conclusion: This study shows that most of the patients suffering from mental illness prefer to approach faith healers first, which may delay entry to psychiatric care and thereby negatively impact the prognosis of BAD. This highlights the importance of mental health education and developing a positive collaborative relationship with traditional healers.

Impact of Depression on Pathologic Internet Use Among Intern Doctors of Cairo University Hospital (Kasr Al-Ainy)

Introduction:The growth of the internet has impacted almost every facet of life in the world. In most cases, utilization of the internet has improved people’s lives. However, in some cases excessive use of the internet has been linked to significant impairment in critical areas of functioning. Aim of the Work:To determine the prevalence of pathologic use of the internet and verify whether there is a relation between this problem and the depressive disorders among Intern doctors working in Cairo University hospital. Subjects and Methods:A total of 300 Intern doctors of Cairo University hospitals were included. The Internet Addiction Test was used to measure pathologic intent use. Present State Examination-10 was used for screening of depressive symptoms and Beck Depression Inventory to determine the severity of depression. The Internet Application Checklist was used to determine internet usage patterns of the subjects. Results:More than half of the sample (54.0%) consisted of pathologic internet users. Only 12.3% comprised moderate/severe pathologic internet users. Severe forms of pathologic internet use were more prevalent in male individuals than in female individuals. Pathologic internet users were more associated with depressive symptoms and depressive disorders than nonpathologic internet users. Conclusions:There were significant positive correlations among internet addiction, depressive symptoms, and depressive disorders in fresh graduate Cairo University Intern doctors. As there is a potential harmful behavior among new graduate doctors, health professionals need to be aware of measures and procedures for the assessment of internet addiction and depression.

Polymorphism of serotonin transporter gene (SLC6A4) and its relation to tramadol dependence

Background Many genes have been proven to be linked to substance use disorder, on top were serotonin receptor and transporter genes. Aim The aim of this study was to determine the frequency of 5-HTTVNTR allele variants of the serotonin transporter gene and the presence of polymorphic serotonin receptor gene (5-HTR1A) in tramadol-dependent patients in comparison with controls and to explore the association between the groups of tramadol dependent with and without psychiatric comorbidity and 5-HTTVNTR allele variants. Patients and methods This was a cross-sectional case–control outpatient study. The study sample consisted of 90 patients, with 60 tramadol dependents (55 males and five females) and 30 healthy controls. All patients fulfilled the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Criteria for substance dependence (on tramadol). Genotyping of the 5-HTTVNTR gene and 5-HT1A receptor gene promoter was done employing real-time PCR and PCR/RFLP, respectively. Results A significant association was found between the 5-HTT gene 10 allele polymorphism and tramadol dependence. No significant association was observed with the 5-HT receptor gene polymorphism. Conclusion This study detected an association between the presence of 5-HTTVNTR less transcriptional-efficient genotypes and tramadol dependence, and these genotypes increase psychiatric comorbidity with tramadol dependence, which suggests that the modulation of the serotoninergic system might be implied in psychiatric problems in tramadol dependence.

Psychiatric and functional neuroimaging abnormalities in chronic hepatitis C virus patients: Is vasculitis a contributing factor?

BACKGROUND AND STUDY AIMS Central nervous system (CNS) involvement in hepatitis C virus (HCV) infection has different facets such as anxiety, depression, cognitive impairment and vasculitis. We were interested in detecting subclinical CNS involvement in chronic HCV infected subjects with and without systemic vasculitis. PATIENTS AND METHODS Nineteen patients (15 females and 4 males) with chronic HCV infection (mean age 46.5 ± 7 and mean duration since diagnosis of HCV infection 4.7 ± 4 years, including 6 (32%) Child-Pugh class A cirrhotic patients) and 30 age, sex and education matched healthy control subjects were studied. Thirteen patients had associated vasculitis. Patients and control subjects were assessed using the block design and comprehension subtests of Wechsler Bellevue Adult Intelligence Scale, Wechsler Memory scale (WMS), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). Brain HMPAO Single Photon Emission Computed Tomography (SPECT) was performed for HCV patients. RESULTS Patients with HCV had lower scores on the block design test compared to control subjects (8.37 ± 1.89 versus 10.37 ± 1.47, p < 0.001), lower total WMS scores (43.15 ± 10.49 versus 60.27 ± 8.08, p < 0.001) and higher anxiety and depression scores (16.94 ± 10.46 and 37.17 ± 10.38 versus 10.3 ± 4.67 and 28.9 ± 5.99, p = 0.004 and 0.001, respectively). Total WMS were lower in HCV patients with vasculitis compared to those without vasculitis (39.14 ± 9.3 versus 51.17 ± 8.3, p = 0.019) while the block design and comprehension tests, BAI and BDI were not significantly different between both groups. The block design and comprehension tests, WMS, BAI and BDI were not significantly different between cirrhotic and non-cirrhotic patients. Seven patients had different patterns of cerebral hypoperfusion on SPECT, and all of them had associated vasculitis. Abnormal SPECT was associated with lower total WMS scores (35.87 ± 10.8 versus 46.79 ± 8.6 in those with normal SPECT, p = 0.049). CONCLUSIONS Vasculitis may contribute to the development of neuropsychiatric involvement in HCV patients.

The assessment of sexuality and sex hormone levels in a group of synthetic opioid-dependent patients

Background Sexual dysfunctions are noted in chronic opiate addicts, which include reduced libido and sexual performance, erectile dysfunction, and delayed ejaculation in male population. Plasma testosterone levels have been shown to be consistently lower in opiate addicts as compared with non-substance-dependent male population. Aim The aim of this study was to assess the effect of synthetic opioid dependence on sexual functions of dependent patients as well as its effect on the level of sex hormone and to compare the sexuality and level of sex hormones of synthetic opioid-dependent male population with non-substance-dependent male population. Patients and methods Groups I and II were selected consecutively and were recruited from Kasr El-Ainy Hospital as well as private hospitals in greater Cairo during the period from November 2012 to March 2013. Group 1 included 30 substance-dependent male participants and group 2 included 30 non-substance-dependent male participants who were subjected to sexuality scale, international index of erectile function, and sex hormone levels. The addiction severity index was applied to group I only. Results The sociodemographic findings of the study found that 80.0% of group I participants were not working and only 20% worked, in comparison with group II in which 90% of participants were working and only 10% were not working. An overall 66.7% of group I participants were divorced and only 26.7% were married compared with group II in which no one was divorced and 86.7% of participants were married. As regards the sexuality scale, 56.6% of participants, which was more than half of group I, had intermediate level of sexual esteem, 23.3% of the group had low level of sexual esteem, and only 20% of the group had high level of sexual esteem. An overall 50%, which was half of group I had low sexual preoccupation, 30% had intermediate sexual preoccupation, and only 20% of the group had high sexual preoccupation. As regards the international index of erectile function, 26.6% had no erectile dysfunction, 36.6% had mild dysfunction, and 3.33% of men in group I had severe erectile dysfunction. An overall 6.6% of the group had no sexual desire dysfunction, 16.6% of the group had mild dysfunction, 26.6% of the group had moderate dysfunction, and 20% of group I had severe sexual desire dysfunction. An overall 10% of group I had no orgasmic dysfunction, 33.3% had mild orgasmic dysfunction, 46.6%, which was almost half of group I, had mild-to-moderate orgasmic dysfunction. According to sex hormone levels, 30% had low levels of testosterone, 50%, which was half of group I, had high prolactin levels, 3.3% had low levels, and 46.6% of the group had normal levels of prolactin, 30% of group I had high levels of luteinizing hormone, and 70% had normal levels of luteinizing hormone. Conclusion According to our study, it was shown that there was an effect of synthetic opioid dependency not only on the sexual functions of dependent men, including their erectile function, sexual orgasm, and desire, and their level of sexual esteem in which they experience low sexual esteem and low sexual preoccupation and high sexual depression compared with nondependent men but also on the level of their testosterone levels especially and high prolactin, which inhibit their sexual desire compared with nondependent men.

The Influence of a118g Single Nucleotide Polymorphism of Human Mu Opioid Receptor Gene and the mdr1 Gene in Egyptian Patients With Tramadol-induced Seizure

Objectives: Although seizures have been reported with tramadol use, the exact mechanism is not yet confirmed. An individual genetic susceptibility may have a role in developing seizures. The purpose of this study was to investigate the frequency of mutant allele of the OPRM A118G and MDR1 C3534T in tramadol users with seizures. Methods: After investigators obtained informed consent and when other causes of seizures were excluded, 74 Egyptian tramadol users, with and without seizures, were assessed clinically, radiologically, and by electroencephalogram. Their blood samples were genotyped for the µ-opioid receptor gene and the multidrug resistant (MDR1) genes. Results: Thirty-seven subjects had seizures. A history of head trauma and more opioid use were reported by the group with seizures. Family history of epilepsy was present in 2 subjects with seizures. There was no significant difference between the 2 groups with regard to the frequency of occurrence of the SNP A118G of the mu opioid receptor gene or the SNP C3435T of the MDR1 gene. Conclusions: This study could not illustrate a potential genetic background in the studied point mutations that could explain the development of tramadol-induced seizures.

Panic attacks and suicidality in bipolar patients

BackgroundBipolar disorders are among the most common life-threatening psychiatric illnesses due to suicide. Anxiety is the forgotten problem of bipolar disorder. AimThe aim of the study was to assess suicide and panic attacks in bipolar I patients and to assess the relationship between comorbid panic attacks and bipolar I disorder (manic, depressive, and mixed) and suicide. Patients and methodsApproval from the ethical and research committees of the Department of Psychiatry, Kasr Al Aini Hospital was obtained. One hundred patients diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., as bipolar patients were divided into three groups: 55 bipolar manic patients with a mean age of 29.51±7.603, 26 bipolar depressive patients with a mean age of 31.58±8.051, and 19 bipolar mixed patients with a mean age of 32.31±9.151. They were recruited from Kasr Al Aini Psychiatric Hospital (inpatients and outpatients) during the active phase of the illness. Psychiatric examination was applied using the semistructured interview, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Axis I Disorders, Young Mania Rating Scale, Hamilton Depression Rating Scale, and Suicide Probability Scale. ResultsMost of the female patients showing subclinical suicide probability were bipolar manic patients (87.5%), whereas most of the bipolar mixed female patients and the bipolar depressive female patients showed moderate and severe suicide probability on Suicide Probability Scale (27.3 and 33.3%, respectively). Female patients in the bipolar mixed and depressive groups showed significantly higher mean scores on the hopelessness and suicidal ideation subscales compared with the manic group patients. Male patients showed significant difference on the four subscales of Suicide Probability Scale. Male patients of the bipolar mixed and depressive groups showed significantly higher mean scores on the hopelessness, suicidal ideation, and hostility subscales compared with patients of the manic groups. There was a significant difference between the three patient groups regarding the presence of panic attacks, regarding the presence of panic disorder, and regarding the presence of psychotic features. There was significant positive correlation between the suicide probability and past history of suicide, family history of psychosis of the manic group; past history of suicide, family history of suicide, family history of mood disorder, the presence of panic attacks/panic disorders during the mixed episode; and past history of suicide, family history of suicide, panic attacks/panic disorders during the depressive episode. ConclusionSuicide probability is more related depressive aspect of the bipolar disorder. As for male patients of the manic group, the vast majority showed subclinical suicide probability. There is high frequency of comorbidity between bipolar disorder and panic symptoms that frequently reach the threshold of a comorbid panic disorder with increased suicide probability.