Hanan Hussein

Characteristics of autism spectrum disorders in a sample of egyptian and saudi patients: transcultural cross sectional study

BackgroundAutism is a biological disorder with clearly defined phenomenology. Studies from the Middle East on this topic have been particularly rare. Little is known about the influence of culture on clinical features, presentations and management of autism. The current study was done to compare characteristics of autism in two groups of Egyptian as well as Saudi children.MethodsThe sample included 48 children with Autism Spectrum Disorder. They were recruited from the Okasha Institute of Psychiatry, Ain Shams University, Cairo, Egypt and Al-Amal Complex for Mental Health, Dammam, Kingdom of Saudi Arabia. They were grouped into an Egyptian group (n = 20) and a Saudi group (n = 28). They were assessed both clinically and psychometrically using the GARS, the Vineland adaptive behavioral scale, and the Stanford Binnet IQ test.ResultsTypical autism was more prevalent than atypical autism in both groups. There were no statistically significant differences in clinical variables like regression, hyperactivity, epilepsy or mental retardation. Delayed language development was significantly higher in the Egyptian group while delay in all developmental milestones was more significant in the Saudi group. The Vineland communication subscale showed more significant severe and profound communication defects in the Saudi group while the Gilliam developmental subscale showed significantly more average scores in the Egyptian group. Both groups differed significantly such that the age of noticing abnormality was younger in the Saudi group. The age at diagnosis and at the commencement of intervention was lower in the Egyptian group. The Saudi group showed a higher percentage of missing examinations, older birth order and significantly higher preference to drug treatment, while the Egyptian group showed a high preference to behavioral and phoniatric therapies, higher paternal and maternal education, higher employment among parents and higher family concern.ConclusionCultural context may significantly influence the age of noticing abnormality, the age of starting intervention, developmental and perinatal problems, family concerns about managing the problem as well as familial tendency for neurodevelopmental disorders, all of which have important impact on clinical symptomatology and severity of autism. Culture also influences significantly the ways of investigating and treating autism.

Impact of personality temperaments and characters on academic performance and specialty selection among a group of Egyptian medical graduates

Background: The relationship between personality temperaments, academic achievement and specialty interest is important because of its implications in career counseling. Aim: To assess the effect of personality on academic performance and career selection and to study the impact of some sociodemographic factors on academic achievement and career choice of medical graduates. Methodology: A total of 436 medical graduates of Ain Shams medical school were approached, out of which 331 participated. They were given a sociodemographic questionnaire, and the Temperament and Character Inventory–Revised (TCI-R; 240) for personality construct; they had to answer questions about academic achievement, ranking, scores and choice of medical specialty. Results: Novelty seeking (NS1, NS2 and NS3) and self-transcendence (ST1 and ST2) were correlated with graduation ranking, (r = .2, p = .00; r = .15, p = .009; r = .16, p = .005; r = .12, p = .003; r = .14, p = .02; r = .17, p = .004; r = .13, p = .03, respectively), that is, lower NS and ST had better academic outcome. Only high school score was associated with better achievement (p = .00). In specialty selection, females were significantly overrepresented in pediatrics and clinical pathology, whereas males were significantly predominating surgical specialties except for obstetrics and gynecology (p = .00). Students choosing patient-centered specialties had higher reward dependence (RD), persistence (PS) and cooperativeness (C); those choosing clinical pathology had highest harm avoidance (HA), whereas those choosing radiology had lowest HA and those choosing surgery had significantly higher self-directedness (SD3). Conclusion: Personality impacts academic achievement and specialty choice with other factors as gender and previous scholastic performance.

Autism spectrum disorders: a review of the literature from Arab countries

BackgroundIn the developing countries and specifically in the Arab world, the field of child psychiatry is relatively new. Autism became a subject of interest in the region only during the late 1990s. Tremendous effort is needed to raise the awareness of policy makers toward the need for implementation of services and research plans aiming to bridge the gap between the needs of and services provided for autism. AimThe aims of the study were to: (a) focus on the magnitude of the problem of autism in the Arab world; (b) highlight research conducted in this field; and (c) shed light on services provided for autistic patients and their families in the Arab world with special focus on cultural and economic characteristics of the region and its impact on autism. MethodsAll internationally published English language articles and their reference lists were reviewed using MEDLINE (1992–2012) and studies on autism spectrum disorder conducted in all Arab countries were selected. ResultsData from studies conducted by different Arab countries on various fields of autism research – genetic, autoimmune, oxidation stress, nutritional deficiencies, environmental toxins, errors of metabolism, mitochondrial dysfunction, clinical studies, imaging, treatment outcome, and available services for autistic patients – were collected and reviewed. Between 1992 and 2012 a total of 75 articles were published from Arab countries, most of which (n=55, 73.3%) were published in the last 4 years. Most of the articles discussed possible etiologies of the disorder (n=42, 56.6%). Autoimmune theory was the most commonly investigated in the Arab region (n=12, 16%). Review articles constituted 16% (n=12) of the published articles. The least addressed topic was treatment outcome (n=4, 5.3%). Most of the research came from Saudi Arabia (n=23, 30.6%) and Egypt (n=16, 21.3%). Lebanon came third (n=11, 14.7%) and had mostly review articles (n=6). Internationally published studies on the prevalence of autism in Arab countries showed inconsistent frequency. ConclusionThere is growing interest in autistic disorders in the Arab world, particularly in Egypt and Saudi Arabia, as evidenced by the increase in research in this field in the last few years. Research on autism in Arab countries is still in its infancy and needs organizational efforts to be fruitful. Further research is needed within Arab countries to determine the most effective and efficient means of improving diagnosis and service delivery in the context of the particular country, culture, and governmental structure.

Performance evaluation of Cognitive Radio Network Predictive MAC (P-MAC) access algorithm and its enhancement

Cognitive radio (CR) technology is envisaged to solve the problems in wireless networks resulting from the limited available spectrum resources and the inefficiency in the spectrum usage by exploiting the existing wireless spectrum opportunistically. In this paper, Predictive MAC (P-MAC) is the MAC protocol that we propose as a new one for Cognitive Radio Networks (CRN). This MAC protocol can be applied on centralized or distributed networks. It is based on a prediction model called Exponential Smoothing model (ESM) [6]. The ESM predicts the channel distribution behavior for an ON/OFF channel scenario with various distributions. The P-MAC has the ability to fill the channels vacancies as much as possible with less sensing time and RTS/CTS exchange. Therefore, the proposed model occupies the vacancies much better than the other ones. Also by using a simulation model we proved that it has higher throughput and less sensing overhead.

Female sexual dysfunction and body image dissatisfaction in Egyptian obese patients

BackgroundAlthough female sexual dysfunction (FSD) is a highly prevalent health problem, the information with regard to their prevalence is still scarce in international literatures. ObjectivesThe aim of this study was to determine the frequency of sexual dysfunctions among a sample of female patients seeking treatment for obesity, and to examine the correlation of sexual dysfunctions with BMI and body image concern. Patients and methodsA cross-sectional study based on a semistructured interview was conducted to assess 65 female patients seeking treatment at the obesity clinic and compared with 42 healthy controls matched with cases. The assessment tools included the following: structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM IV)-clinical version, Arabic version of the female sexual function index, and body image questionnaire. ResultsThe study revealed that the mean BMI of the case group was 34.7±6.5. Sexual dysfunction was prevalent in 75% of cases according to the structured clinical interview for DSM IV-clinical version and in 81.5% according to the FSD index, with a specific significance of orgasm, satisfaction, and pain as compared with controls. Dissatisfaction with body image was significantly associated with the presence of FSD in the case group. Body image questionnaire scores significantly positively correlated to the female sexual function index and did not correlate to BMI. ConclusionThe prevalence of sexual dysfunctions among overweight female patients seeking treatment for obesity is relatively high and significantly related to body image dissatisfaction and not with BMI.

Attention deficit hyperactivity disorder and maternal psychosomatic stress: a case–control study

Objectives This research aimed to assess the level of psychological and physiological stress in mothers of patients with attention deficit hyperactivity disorder (ADHD) and to explore social and child-related factors associated with self-reported maternal mental and physical health and level of proinflammatory biomarkers. Participants and methods A total of 30 mothers and their children with ADHD were compared with 18 mothers of healthy children. Children were assessed with the KSADS-PL psychiatric interview, Conner’s Parent Rating Scale, and Wechsler Intelligence Scale. Mothers were assessed with the Perceived Stress Scale, Interpersonal Support Evaluation Checklist, Pennebaker Inventory of Limbic Languidness, and Hospital Anxiety and Depression Scale. Their plasma levels of interleukin-6 and C-reactive protein were measured. Results Mothers of patients with ADHD had higher scores in almost all the scales; however, values of proinflammatory biomarkers showed no significant difference. There was a significant association between parenting a child with ADHD and the presence of high level of perceived stress, having depression or anxiety. Mothers of ADHD children with high Conner’s Parent Rating Scale oppositional subscale scores showed higher somatic complaints. Those with less perceived social support had less total sleeping hours. Development of anxiety and depression was correlated with low levels of perceived support and high levels of perceived stress. Conclusion Parenting a child with ADHD is associated with significant stress and lack of social support, which are significantly correlated to the development of psychological and physical morbidity, not necessarily associated with abnormal biomarkers. When treating a child with ADHD, measures to improve the mother’s state of well-being should be considered, including counseling and self-help groups.

The impact of substance abuse on the severity of manic relapse in bipolar disorder

BackgroundBoth bipolar I and bipolar II disorders are highly comorbid with substance use disorders (SUD), and this comorbidity is associated with a more severe illness course and early mortality. Individuals with both disorders have a more severe course of bipolar disorder, including earlier onset, more frequent episodes and more complications, including anxiety- and stress-related disorders, aggressive behavior, legal problems and suicide. ObjectivesTo recognize the impact of comorbid substance use on the severity of manic episodes in a sample of Egyptian bipolar I disorder (BD I) patients and their clinical outcomes. Participants and methodsIn the current cross-sectional study, a sample of 30 patients was selected with a diagnosis of BD I from the Inpatient Psychiatric Units of the Institute of Psychiatry, Ain Shams University. Patients in manic relapse according to Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV), irrespective of their sex, aged between 18 and 55 years and who could read and write to be able to undergo the needed assessments were selected. They were subdivided into two groups: group I included patients without comorbid SUD and group II included patients with comorbid SUD. They were assessed using (a) a structured Clinical Interview for DSM-IV, (b) the Young Mania Rating Scale (YMRS), and (c) the Anger, Irritability, and Assault Questionnaire (AIAQ). In addition, those with comorbid substance use were further assessed by (d) the Addiction Severity Index. ResultsStatistical analysis of the data was carried out. Results revealed the presence of a positive relation between AIAQ (indirect assault patient rating and direct assault caregiver rating) and YMRS scores. On examining the sociodemographic characteristics, no significant difference was found between both groups regarding their age, educational level, employment as well as their marital status. The age of onset was higher in group II; a positive family history and medication noncompliance as well as suicidal attempts were positive in group II with statistical significance. YMRS and AIAQ showed higher scores in group II in all domains with a highly statistically significant difference. ConclusionOur results showed impaired functioning and a worse general psychiatric outcome in patients with BD I and comorbid SUD. This has implications for current treatment programs and should lead to more research into the underlying psychopathological mechanisms.

Two years’ outcome of autism in a sample of Egyptian and Saudi children: a comparative prospective naturalistic study

BackgroundPrevious studies have shown marked variability in the outcome of autistic children and have reported different prognostic factors related to this issue. AimThe current study was carried out to (a) examine and compare the outcome of autism in a sample of Egyptian and Saudi patients from a comprehensive point of view over a period of 2 years and (b) identify factors and prognostic variables related to outcome. MethodsThe study included 48 children with autism. They were recruited from the Institute of Psychiatry, Ain Shams University, Cairo, Egypt, and the Al-Amal complex for Mental Health, Dammam, Kingdom of Saudi Arabia. The diagnosis was made according to Diagnostic and Statistical Manual of Mental Disorders, 4th ed. The sample included 20 Egyptian and 28 Saudi patients. They were assessed at baseline and at follow-up after 2 years. Assessment included clinical assessment, the Clinical Global Impression – Improvement Scale, the Childhood Autism Rating Scale, the Gilliam Autism Rating Scale, the Vineland Adaptive Behavioral Scale, and the Stanford Binet intelligence quotient test. ResultsGood outcome among the entire sample was significantly correlated with higher age of noticing abnormality, higher intelligence quotient, mild severity of autism, fairly high scores on the Vineland scale, and low stereotypy scores. There was a tendency toward a better outcome in the Egyptian group compared with the Saudi group. However, this tendency was not statistically significant. In the Egyptian group, there was a significant decrease in Gilliam subscales scores, indicating improvement in autism level, with no significant improvement in Vineland subscales. In the Saudi group, there was an improvement in the Gilliam stereotype subscale and worsening in the Vineland total and subscales. Good outcome among the entire sample was also significantly associated with having atypical autism, absence of seizures, or regression; normal milestones of development, high parental concern, having normal electroencephalography, taking no drugs or being stable on one drug therapy, early behavioral intervention, receiving phoniatric therapy, and improvement of more than two core deficits in response to drug therapy. ConclusionThe outcome of autism appears to be related to certain influential factors such as the severity of autism, familial and clinical factors, perinatal and developmental factors as well as method of dealing and intervening with autism. Specifically, initial severity of autism, parental concern, and early intervention with behavioral approaches appear to be the strongest predictors of the outcome of autism.

The extent and correlates of same class versus multiclass polypharmacy among Egyptian psychiatric inpatients: a cross-sectional study

ObjectiveTo examine the frequency and patterns of polypharmacy use among Egyptian psychiatric inpatients and to assess the influence of patients’ characteristics on polypharmacy prescription. MethodsA cross-sectional study conducted in the Institute of Psychiatry, Ain Shams University, during a period of 6 months. Medical records of patients were reviewed upon discharge. Demographic data, diagnosis, the duration of the illness, the number of episodes, psychotropic medications prescribed on discharge, and the duration of hospital stay were obtained. Polypharmacy was operationally defined as the concurrent use of two or more psychotropic medications in the same patient for treating symptoms of his/her illness. ResultsA total of 187 patients were included in the study, and 78.1% were discharged on polypharmacy. Diagnosis was the only significant factor associated with polypharmacy (P=0.003). The number of drugs prescribed was positively correlated to the number of episodes (P=0.001), the duration of hospital stay (P=0.04), and the duration of the illness (P=0.05). Multiple antipsychotics were prescribed to younger patients (P=0.008) with psychotic disorders (P=0.001) and with a longer duration of hospitalization (P=0.05). Multiple antidepressants were prescribed more to patients with depressive disorders (P=0.03) with a longer duration of the illness (P=0.05) and a higher number of episodes (P=0.01). ConclusionPolypharmacy is a common clinical practice in psychiatric inpatients influenced by a complex interplay of several factors. Clinical diagnosis seems to be the most consistent factor influencing polypharmacy prescription. There is a need for more pragmatic approaches to improve clinical practice and reduce the use of polypharmacy.