Heba Fathy

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.

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.

Stigma, self-esteem, and depression in adolescent patients with epilepsy

Introduction Epilepsy affects close to 1% of adolescents. Adolescents with epilepsy (AWE) experience comorbid psychiatric disorders, the most common of which is depression. Epilepsy in adolescents is associated with a perceived stigma of epilepsy and with low self-esteem. Objective This study aims to evaluate depression, perceived illness stigma of epilepsy, and self-esteem in a sample of AWE, and to evaluate the association between depression and the latter two variables in these patients. Patients and methods This is a cross-sectional case–control study. Adolescents (14–22 years of age) with idiopathic epilepsy in Kasr Al Ainy outpatient epilepsy clinic were interviewed using Structured Clinical Interview for DSM-IV Axis-I Disorders to assess the presence of depressive disorders. A total of 30 AWE with depression and 30 AWE without depression (as controls) were recruited, using convenient purposive sampling. The Internalized Stigma of Mental Illness Scale was used to assess perceived illness stigma of epilepsy and the Rosenberg Self-Esteem Scale was used to assess self-esteem in both cases and controls. Patients with depression were also interviewed by Beck Depression Inventory. Results Perceived internalized stigma of epilepsy was significantly higher and self-esteem was lower in the AWE with depression compared with patients without depression. Conclusion Perceived illness stigma of epilepsy and self-esteem are associated with depression in AWE.

Assessment of serum level of total glutathione in a sample of schizophrenic patients versus bipolar patients

IntroductionThere is strong evidence that oxygen-free radicals may play an important role in the pathophysiology of major mental illnesses such as schizophrenia and bipolar disorders. Aim of the studyThe aim of the study was to detect the difference in the level of total glutathione (GSH) in serum samples of schizophrenic patients compared with bipolar patients and healthy controls, and assess any significant correlation between the level of GSH and clinical findings. Patients and methodsThis is a case–control cross-sectional study that included a sample of 30 schizophrenic patients and 30 patients with bipolar I disorder (manic, depressive, mixed episode) who were compared with 30 healthy controls well matched for age, sex, educational level, and marital state. All patients were recruited from the Kasr Al Aini psychiatric outpatient clinic and inpatient department.This was a cross-sectional case–control study. Psychometric procedureThe Young Mania Rating Scale, the Hamilton Depression Rating Scale, and the Positive and Negative Syndrome Scale were used. Serum samples were evaluated for level of GSH. ResultsThere were statistically significant differences between controls and both patients with schizophrenia and those with bipolar I disorder in terms of serum level of total GSH, but no significant differences between the two patient groups. There was significant negative correlation between GSH and both negative symptoms and number of hospital admissions in the schizophrenic group. There was significant negative correlation between GSH level and both aging and duration of illness in the bipolar disorder group, and significant positive correlation between GSH and manic-mixed episode in the bipolar group. There was significant positive correlation between smoking and GSH in the control group but no significant correlation between the level of GSH and smoking in the schizophrenic group or bipolar group. ConclusionThis preliminary study detects low levels of serum GSH in both schizophrenic and bipolar patients compared with controls. Thus, total GSH seems to play a role in the pathophysiology of these disorders and it may be considered an important indirect biomarker for the oxidative stress theory in these patients for further studies and investigation in a large group sample.

Event-related potentials in bipolar disorder with comorbid anxiety disorder

IntroductionHigh comorbidity with anxiety disorders has been reported in bipolar disorder (BPD). The presence of comorbid anxiety often complicates the presentation and the course of BPD. Bipolar I disorder is associated with abnormal filtering of sensory information at an early, preattentive level as shown by diminished gating of the auditory-evoked P50 potential assessed by a paired-click paradigm. ObjectiveThis study aims to compare patients with BPD and anxiety disorder, patients with BPD without anxiety disorder, and controls in terms of the auditory-evoked potential. Participants and methodsThis was a cross-sectional and case–control study with a convenient sampling. After obtaining consent from the ethical committee in Kasr Al-Ainy hospital, the population of this study was divided into three groups. The first group included 30 patients with bipolar I disorder and comorbid anxiety disorder according to the Diagnostic and Statistical Manual Classification of Mental Disorder, 4th ed. (DSM-IV). The second group included 30 patients with bipolar I disorder with no other comorbid axis I diagnosis. The patients in the two groups were of both sexes and ranged in age from 20 to 50 years. We excluded those with other psychiatric comorbidities and major medical diseases. They were selected consecutively from among outpatients and inpatients of Kasr Al-Ainy Psychiatry and Addiction Hospital of Cairo University. The third group included 30 individuals (healthy volunteers) matched for age, sex, and socioeconomic status, with no history for any psychiatric disorders. All patients were subjected to the Structured Clinical Interview for DSM-IV Axis I Disorders, the Hamilton Anxiety Rating Scale, and the paired-click paradigm. ResultsPatients with BPD showed higher suppression in P50, N100, and P200 waves than BPD patients with comorbid anxiety, which is also higher than that among the controls. ConclusionImpaired sensory gating in BPD patients was marked by suppression in P50, N100, and P200 waves of the auditory-evoked potential (paired-click paradigm). Comorbid anxiety disorders lead to a higher suppression in the P50, N100, and P200.

Evaluation of serum brain-derived neurotrophic factor to assess the association between psoriasis and depression

BackgroundPsoriasis patients usually experience problems pertaining to body image, low self-esteem, anxiety, and depression. Brain-derived neurotrophic factor (BDNF) has been used as a marker of depression. ObjectiveTo assess the association between depression and psoriasis objectively by analysis of serum BDNF levels. Patients and methodsNinety participants were divided into three equal groups: the psoriasis group, the depression group, and the healthy control group. The psoriasis area severity index was assessed in psoriatic patients. The 30 patients with depression were diagnosed according to the Diagnostic and statistical manual of mental disorders. All participants were assessed by the Beck depression inventory scale and the life stress inventory scale. BDNF serum level was measured in all participants using the quantitative sandwich enzyme immunoassay technique. ResultsPsoriasis patients presented with different degrees of severity. In the psoriasis group, the mean BDNF level was significantly lower in depressed patients than in those who were not suffering from depression (P<0001). BDNF levels were significantly lower in both psoriasis patients with depression (P<0.0001) and depressed patients (P<0.001) compared with the control group. A significant correlation was found between BDNF levels and both the life stress and Beck scale (P<0.001) and the duration of psoriasis (P<0.01). In contrast, the severity of psoriasis had no impact on BDNF levels. ConclusionThe serum BDNF levels decreased in depressed patients and in psoriasis patients compared with normal healthy individuals. Evaluation of BDNF levels could be used as an objective measure of depression in psoriatic patients.

Cognitive impairment in depressed students of Cairo University Hospital

Introduction Major depression may affect the ability to think, concentrate, make decisions, formulate ideas, reason, and remember. Patients with major depression also often show neurocognitive deficits consistent with frontal lobe dysfunction. The co-occurrence of depressive symptoms and cognitive impairment plays a role in determining disability in individuals. Aim of the study To assess the presence of cognitive deficits in depressed undergraduate university students and then to assess the correlation between severity of depression and cognitive impairment in these students. Patients and methods After obtaining consent from the ethical committee in Kasr El Aini Hospital, 50 patients with the diagnosis of Major Depressive Disorder according to the DSM-IV criteria were recruited from the psychiatric outpatient clinic of Cairo University Student Hospital, with no sex preference. Fifty control participants of similar age, sex, and educational backgrounds were recruited as volunteers. Psychometric procedures: Beck Depression Inventory for severity of depression, selected subtests of Wechsler Adult Intelligence Scale (WAIS), and Wechsler Memory Scale-Revised (WMS-R). Results Medical and paramedical students recruited from six faculties constituted 40% of the entire sample. Forty percent of the cases were diagnosed with moderate depression, whereas 60% of them were diagnosed with severe depression. All the scores of the subtests of WAIS and WMS-R used were higher in the control group. The scores of the Beck Depression Inventory were correlated positively with the digit symbol and digit span subtests of WAIS and to figural memory and visual memory span subtests of WMS-R. Conclusion Depressed undergraduate university students had more cognitive deficits than nondepressed students. The severity of depression was correlated positively with some of these cognitive deficits.

Neurological soft signs with respect to type of symptoms in patients with schizophrenia

Introduction Neurological soft signs have been documented to occur in up to 60% of patients with schizophrenia and have been found even in neuroleptic-naive patients. Aims The aims of the study were to illustrate the presence of neurological soft signs among patients with schizophrenia and to show any relationship between neurological soft signs and type of symptoms. Patients and methods One hundred patients with schizophrenia were selected consecutively in a cross-sectional study. The patients were assessed using the Structured Clinical Interview for Diagnostic and statistical manual of mental disorders (DSM) Axis of Disorders, Positive and Negative Syndrome Scale, complete neurological examination, and Cambridge Neurological Inventory for soft sign examinations (primitive reflexes, repetitive movement, sensory integration), and Trail Making Test. Results The main finding in this study indicates that the patients with schizophrenia have neurological impairment. There are positive correlations between soft neurological signs and positive symptoms in paranoid type, other types, and with the total; these indicate that neurological soft signs are more prominent in patients with positive symptoms than in those with negative symptoms. Conclusion Neurological Soft Signs (NSS) occur in a majority of the schizophrenia patient population and are largely distinct from symptomatic and cognitive features of the illness. Neurological signs in patients with schizophrenia are associated with prominent negative symptoms, relatively poor psychosocial performance, and significantly more cognitive impairment.