M. T. Abou-Saleh

Who responds to prophylactic lithium

Response to prophylactic lithium was studied in relation to clinical and psychological characteristics in a large series of patients with recurrent affective disorders. The findings were that bipolar patients with a family history of mania or depression had more favourable responses than those with no family history of affective disorders. Unipolar patients with more endogenous illnesses and those with pure familial depressive disease had more favourable responses than those with less endogenous illnesses and those with sporadic and depression spectrum diseases. Good responders showed generally less personality disturbance on a variety of measures than fair-to-poor responders. Response to lithium over 6 months in unipolar illness and over the first year in bipolar illness was strongly associated with long-term response.

Al Ain Community Psychiatric Survey. I. Prevalence and socio-demographic correlates

Abstract  Background: Psychiatric community stud- ies are essential for the planning and development of psychiatric services, as well as being helpful in examining the socio-demographic correlates of mental disorders in a given community. Few such studies have been carried out to date in the Arabian peninsula. This paper forms part of a multipurpose community psychiatric survey conducted in A1 Ain in the United Arab Emirates. The findings regarding lifetime prevalence and psychiatric morbidity are reported. Methods: A total of 1394 (n= 1394) adults systematically sampled from Al Ain community were assessed with a modified version of the Composite International Diagnostic Interview (CIDI) as well with other instruments: the new screening psychiatric instrument, Self-Reporting Questionnaire (SRQ-20), and the Structured Clinical Interview for DSM-IV Axis 1 disorders (SCID) screening module. Lifetime prevalence and 1-week prevalence rates of mental distress as measured by screening instruments were estimated as well as the lifetime prevalence rate of CIDI ICD-10 psychiatric disorders. The sensitivity of the CIDI interview to correctly pick up distressed subjects, as well as those who had undergone previous treatment for a psychiatric disorder, was also calculated. Associations between socio-demographic risk factors and ICD-10 psychiatric disorder as well as with mental distress were also examined by bivariate and multivariate analyses. Results: Overall lifetime prevalence of ICD-10 psychiatric disorder was found to be 8.2% (95% CI: 6.7–9.7), while the 1-week prevalence rate of mental distress as measured by the SRQ-20 was 15.6% (95% CI: 11.8–19.5) and the lifetime prevalence rate of mental distress as measured by the new screening instrument was 18.9% (95% CI: 11.5–25.9). The CIDI interview correctly picked up 42% of subjects who had received previous psychiatric treatment and 51% of the distressed. Mood disorders and anxiety (neurotic) disorders were more common in women and alcohol and substance use disorders were exclusively confined to men. Female sex, young age, quality of marital relationship, life events over past year, chronic life difficulties, physical illness, family history of psychiatric disorders and past history of psychiatric treatment were found to be significantly associated with ICD-10 psychiatric disorder. Multivariate analysis revealed that age, sex, exposure to chronic difficulties and past history of psychiatric treatment were the most significant predictors of ICD-10 psychiatric disorders, and exposure to chronic difficulties, past history of psychiatric treatment and educational attainment were the significant predictors of lifetime ever and current mental distress. Conclusion: The pattern and trend of psychiatric morbidity found in this survey is in line with those reported by other surveys that utilized similar assessment instruments. Differences in rates are explained by different methodologies used.

Low level alcohol consumption and the fetus

Abstinence from alcohol is the only safe message in pregnancy R ecently the media in the United Kingdom highlighted the messages presented by one of us (RASM) and researchers from other industrialised countries, that the only safe communication about alcohol consumption in pregnancy is that of abstinence. Unfortunately the scientific basis for this recommendation was not clarified in the media. We provide here examples of the evidence that has led the United States, Canada, Australia, and other countries to adopt the abstinence message. Fetal alcohol syndrome was first reported in the international literature by Smith and Jones in 1973.1 Before that, Lemoine published a series of 127 cases in France, highlighting the phenotypic presentation of people exposed to alcohol while pregnant.2 The full syndrome is characterised by a combination of short stature, neurocognitive deficits, and a specific triad of facial dysmorphology (short palpebral fissures, flat philtrum, and thin upper lip vermilion). Fetal alcohol spectrum disorder is an overarching term encompassing the behavioural diagnoses occur …

Al Ain community survey of psychiatric morbidity II. Sex differences in the prevalence of depressive disorders.

AIM To examine sex differences in the prevalence of depressive disorders in an Arab community. METHODS One thousand three hundred and ninety-four subjects (n=1394) were systematically sampled from the general population in Al-Ain city, United Arab Emirates. All subjects were interviewed and assessed with the modified version of the Composite International Diagnostic Interview (CIDI) and a specially designed socio-demographic questionnaire. The lifetime male and female prevalence rates were estimated. Multivariate logistic regression of various socio-demographic variables was carried out to assess independent risk factors for depression. Statistical significance of sex differences in rates of depression by various socio-demographic groups were also assessed. RESULTS The lifetime rates in males and females were 2.8 and 10.3%, respectively. F:M ratio found in this study is highest reported ratio in the literature. Sex, life events, chronic difficulties and to a certain extent age were found to be risk factors for depression in the studied community. The prevalence rates of depression were higher in females in all above categories but such differences reached statistical significance in age category before 55, regardless of marital status, when the number of children is four or more and among those exposed to recent life events and chronic difficulties. Females were found to to be more exposed to chronic life difficulties but only depressed females were significantly more subjected to recent life events. CONCLUSION Sex differences in depression is a robust finding but more studies are needed to explain the high F:M ratio found in this survey.

The epidemiology of substance misuse and comorbid psychiatric disorders

The common co-occurrence of substance misuse and other psychiatric disorders and their intricate relationships have led to major community-based epidemiological studies in the US which showed high rates of current and lifetime comorbidity. Moreover, studies of clinical populations conducted in North America, Europe and Australia, showed even higher rates of comorbidity. The aetology of this comorbidity has also been investigated and important models have emerged with findings that inform its assessment and treatment. Future epidemiological studies should focus on the study of concurrent conditions rather than lifetime ones using research diagnostic instruments with high reliability providing information on a number of key outcomes.

The British experience of dual diagnosis in the national health service

The co-occurrence of substance misuse and other psychiatric disorder (dual diagnosis) has been increasingly recognized in the UK. Clinical studies of patients with severe mental disorders showed high rates of substance misuse with poor clinical and social outcome. These patients often fall ‘between the cracks’ of the separate general psychiatric and addiction services. This has necessitated the development of a national policy advocating the provision of integrated care within mainstream psychiatric services. There are emergent models of good practice that require evaluation of effectiveness and cost effectiveness.

Al-Ain community psychiatric survey IV: socio-cultural changes (traditionality-liberalism) and prevalence of psychiatric disorders

Background This study was set to explore the relationship between socio-cultural change and psychopathology. Method A representative sample (n = 1394) of Al-Ain adult population had their psychopathology assessed with the Composite International Diagnostic Interview and other self-reported questionnaires, while the socio-cultural change was assessed with the modified version of the Socio-cultural Change Questionnaire (ScCQ). The reliability and construct validity of the modified ScCQ were assessed. The overall Tradition Index, attitudinal and behavioural indices of the sample were estimated. Association between socio-cultural change and psychopathology was also evaluated. Result The reliability of the modified ScCQ was found to be moderate (alpha Cronbach 0.66) and the hypothesis regarding its construct validity was confirmed. Mean traditional index was found to be 0.61 ± 0.14. Young, highly educated, skilled, and female subjects were found to be significantly less conservative and their scores on traditional index deviated significantly from overall mean. Less traditional people were also found to have a significantly increased rate of ICD-10 psychiatric disorder and higher scores on psychopathology measures especially among females. Although females showed significantly more modern attitude, there were no significant sex differences in the expressed behaviour as measured by the behavioural Tradition Index. Conclusion The findings of this study suggest that the prevalence of psychiatric disorder varies significantly according to the extent to which subjects adhere to traditional values.

Al Ain Community Survey of Psychiatric Morbidity III. The natural history of psychopathology and the utilization rate of psychiatric services in Al Ain

Background: We evaluated the natural history of psychopathology in a stratified sample (n = 245) comprising subjects with no DSM-III-R psychiatric disorder, subthreshold disorder and threshold (DSM-III-R) psychiatric disorder, respectively, over a 12-months period, using the Structured Clinical Interview for DSM-III-R mental disorders (SCID) as an assessment tool. Methods: A representative sample categorized 1 year earlier into DSM-III-R psychiatric disorder, subthreshold disorder and no DSM-III-R psychiatric disorder were reassessed with SCID 1 year on. The incidence, recovery rates and the percentage of subthreshold disorders which become DSM-III-R disorders were calculated. The utilization rate of psychiatric services was also assessed. Results: The incidence rate of new cases was 10.4%. The recovery (remission) rate was 41.5%, and approximately 20% of subthreshold disorders became definitive disorders (DSM-III-R) after 1 year. Anxiety disorders tend to have a higher magnitude of temporal stability in comparison with depressive disorders. Male sex and contact with psychiatric services were found to affect the recovery rate. Approximately 13% of the sample had made contact with psychiatric services with no gender differences, but men were significantly more often hospitalized than women. Conclusion: Our findings indicate that mental disorders are relatively common. The high incidence rate found in this study is attributed in part to the high negative rate at baseline assessment. Approximately 60% of psychiatric disorders in the community are persistent, and patients with emotional disorder under-utilize existing services.

Dual diagnosis of substance misuse and psychiatric disorders: a U.S.–U.K. perspective

Correspondence: Mohammed T. Abou-Saleh, MPhil, PhD, FRCPsych, Reader & Honorary Consultant in Addiction Psychiatry, St George’s Hospital Medical School, University of London, Clinical Director – Addiction Services, Director of Research and Development, South-west London and St George’s NHS Trust, Cranmer Terrace, London, SW17 0RE, UK. Tel: þ44 (0)20 87250368; Fax: þ44 (0)20 87252914; E-mail: mabousal@sghms.ac.uk

Cerebral blood flow in alcohol withdrawal: relation to severity of dependence and cognitive impairment.

Background: Alcohol dependence affects cerebral function in complex, still unsettled ways. Methods: Thirty exclusively alcohol-dependent patients in various stages of withdrawal and 25 matched controls were examined for regional uptake of 99mTc-HMPAO in nine homologous regions of the cerebral cortex by single photon emission tomography (SPET). Image analysis reports regional uptake/uptake in homologous hemisphere. Results: Alcohol dependence is associated with diminished perfusion in the anterior, and middle frontal regions, and increased perfusion in the posterior temporal regions. Frontal hypoperfusion is related to alcohol withdrawal because it disappears with longer time between imaging, last intake and correlates with a composite index of cognitive impairment at the time. Temporal hyperperfusion persists for longer periods. Severe dependence correlates with both frontal, and temporal altered perfusion. Discussion: Alcohol withdrawal leads to redistribution of blood flow favouring the temporal, and more posterior regions of the cortex at the expense of frontal flow.