Mahmoud Elhabiby

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.

Characterization of Substance Abuse Patients Presenting for Treatment at a University Psychiatric Hospital in Cairo, Egypt

ObjectivesThis study was designed to assess the patterns and severity of drug and alcohol problems of a group of patients presenting for treatment at a substance abuse treatment program in Egypt. MethodsA total of 268 patients with drug/alcohol problems were interviewed at the Ain Shams Institute of Psychiatry in Cairo over a period of 1 year (2005 to 2006) using the Arabic version of the Addiction Severity Index, 5th edition. One hundred sixty patients were interviewed during the intake session and the other 108 were interviewed within the first week of their admission to the treatment program. ResultsIn the past 30 days before admission to the treatment program, 30% of the patients reported medical problems, 38% reported employment problems, 9% reported illegal activities, 62% reported serious conflicts with their families, 37% reported serious conflicts with other people, and 64% reported one or more psychiatric symptoms. The major drug problem was heroin for 52% of the patients, other opiates for 23%, and other drugs, including alcohol, for the remaining 25% of the patients. ConclusionsOpiates were the major drug problem for most of our patients, representing 75% of cases, whereas barbiturates, stimulants, hallucinogens, and inhalants were rarely found to be the major drug problem for patients. Injection was a significant problem for heroin users that needs to be addressed in treatment programs.

Psychiatric disorders among a sample of internally displaced persons in South Darfur

Background: The violent armed conflict in Darfur has been ongoing for years getting the attention of human rights activists and mental health professionals. Aim: The aim of this study was to assess psychiatric disorders in a sample of internally displaced persons (IDPs) in South Darfur. Method: A cross-sectional observational study, as a part of the ‘Darfur Campaign’ organized by Arab Federation of Psychiatrists, assessing psychiatric disorders in a sample of internally displaced women using the Structured Clinical Interview for DSM-IV (SCID-I) (clinical version). Results: Up to 25.7% of participants had lost a close family member or more in the violent clashes. Psychiatric diagnoses were found in 62.2% of the participants. The most frequently reported was post-traumatic stress disorder (PTSD) reaching 14.9%, followed by depression 13.5% (among which 2.7% with psychotic features), while comorbid PTSD and depression reached 8.1% of participants. Patients with psychiatric diagnoses had an older age (36.6 years) (p = .024). Suffering from a psychiatric disorder was found to be associated with losing a family member in the conflict (p = .015), being 35.6% in patients with psychiatric diagnoses compared to 10.3% in those without losing a family member in the conflict (odds ratio (OR) = 4.7, 95% confidence interval (CI) = 1.25–18.28). Conclusions: This study used a standardized tool for diagnosing psychiatric morbidity among refugees in Darfur to give as much as possible an actual description of the problems and psychiatric morbidity caused by human-made disasters. This study can help to lead to a more detailed and specific mental health service program much needed by this population.

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.

Negative symptoms and functioning in institutionalized versus outpatient schizophrenic patients

BackgroundSchizophrenia is among the top 10 disabling conditions worldwide among young adults. Negative symptoms contribute more toward poor functional outcome and quality of life for individuals with schizophrenia than positive symptoms. Many studies have suggested that institutionalization affects social functioning and quality of life significantly; yet, there is still ongoing debate on the optimal duration of hospital stay as a rapid and early discharge can lead to higher rates of relapse and rehospitalization. ObjectivesThis study aimed to examine the phenomenology of institutionalized schizophrenic patients and assess the impact of institutionalization on negative symptoms and overall functioning. Patients and methodsTwo groups of schizophrenic patients between 30 and 60 years of age and who had schizophrenia for at least 2 years were studied. Group I included 20 institutionalized schizophrenic patients in Al Abbassia Mental Hospital and group II included 20 outpatient schizophrenic patients. The diagnosis was confirmed by ICD10 in all patients, followed by assessment with a positive and negative symptom scale, the global assessment of functioning (GAF) scale, and the Wechsler adult intelligence scale. ResultsPositive and negative symptoms scale showed a statistically significant difference in delusions and hallucinatory behavior (P=0.05), passive social withdrawal, and total negative symptoms score (P=0.05) in institutionalized patients, and also in disorientation and lack of judgment and insight (P=0.05); on GAF, in group II, the scores were statistically significantly worse (P=0.00). ConclusionNegative symptoms on positive and negative symptoms scale are worse in outpatients and GAF is better in outpatient schizophrenics, confirming that institutionalization can have a negative impact on schizophrenic patients and their ability to return to community life.

Would placing pictorial health warnings on waterpipe devices reduce waterpipe tobacco smoking? A qualitative exploration of Egyptian waterpipe smokers' and non-smokers' responses.

Background Although Egypt places four generic pictorial health warnings (PHWs) on the front and back half of waterpipe tobacco packs (WTPs), waterpipe tobacco smoking (WTS) rates have continued to rise. It has been suggested that PHWs would be more salient if placed on the waterpipe device itself. This qualitative study explored how participants perceived the effects placing PHWs on waterpipe devices would have on warning salience and uptake or quitting of WTS. Methods We conducted 10 focus groups and 10 in-depth interviews with 90 adult waterpipe smokers and non-smokers, men and women, who lived in rural, semi-urban and urban regions of Egypt. We presented participants with four novel PHWs of different sizes positioned randomly at four locations on a waterpipe device (the glass body, metal holder, mouthpiece or hose), one at a time. At each session, participants viewed a PHW on all four locations. Novel warnings were shown on plain labels with a dark uniform background and featured pictures, text and the quitline number. Transcripts were analysed using thematic analysis. Results Participants thought placing PHWs on waterpipe devices might increase salience, prevent WTS initiation or trigger quit attempts; they favoured placing PHWs on the glass body, mouthpiece or waterpipe hose. Both waterpipe smoker and non-smoker participants thought these potential effects would affect non-smokers or non-established smokers more than established waterpipe users. Conclusions Our exploratory study suggests that PHWs featured prominently on waterpipe devices could potentially deter experimentation with waterpipe tobacco products and promote cessation, especially among non-established users.

Sleep profile in anorexia and bulimia nervosa female patients

OBJECTIVE Sleep wake cycle and eating patterns undergo major changes throughout life and have been proved to be very correlated. Eating disorder prevalence is increasing and sleep problems are very common among them. The current study is concerned with investigating the sleep pattern in anorexia and bulimia female patients using both subjective and objective assessment tools. METHODS A cross sectional study of sleep patterns using structured sleep disorder questionnaire and full night polysomnography in 23 female patients with bulimia and anorexia, patients aged 18-45 years not on any treatment for a month at least, compared to a sex and age matched control group (20 participants), all cases were collected from the Institute of Psychiatry, Ain Shams University over 18 months interval. RESULTS Significant affection of most domains of sleep measured by subjective and objective assessment tools in patients compared with the control group. DISCUSSION Sleep is equally affected in bulimia and anorexia patients, confirming that sleep and eating disorders are highly correlated. Sleep may be a clinical marker in eating disorders.

Plain packaging of waterpipe tobacco? A qualitative analysis exploring waterpipe smokers’ and non-smokers’ responses to enhanced versus existing pictorial health warnings in Egypt

Objective Despite the global increase in waterpipe tobacco smoking (WTS) including in Egypt, few studies have assessed the effectiveness of waterpipe tobacco (WT) health warnings. Egypt has used pictorial health warnings (PHWs) on waterpipe tobacco packs (WTPs) and has rotated these every two years since 2008. We explored in this qualitative study how participants perceived existing PHWs on WTPs, assessed how they interpreted novel plain packaging of WT featuring enhanced PHWs, and probed perceptions of how existing and novel sets would affect uptake or cessation of WTS. Design We conducted ten qualitative focus groups and ten in-depth interviews. We explored participants’ views of the four existing PHWs (occupied 50% of the front and back of WTPs, displayed cancers, and featured colourful fruits and flavors) and four novel PHWs (occupied 80% of the front and back of WTPs, displayed different topical content, with plain packaging). Transcripts were analyzed using thematic analysis. Setting Rural Menoufia, urban and semi-urban Cairo, Egypt. Participants 90 waterpipe smokers and non-smokers, men and women, aged 18 years or older. Outcomes Perceived potential effect on WTS uptake or cessation, probing factors related to PHW content and WTP design. Results Participants in focus groups and in-depth interviews thought existing WT PHWs elicited affective responses, but found them unclear or unrealistic and thought the colourful packaging detracted from the warnings. In contrast, they thought novel and larger WT PHWs presented in plain packaging might prevent WTS initiation or trigger quit attempts. Participants regarded warnings featuring proximal health risks as most likely to be acceptable. Conclusions Our exploratory study suggests larger WT PHWs featuring proximal risks and presented on plain WTPs could potentially deter experimentation with WT products among non-users and promote cessation among existing users.

Motivational interviewing for smoking cessation in patients with cardiac diseases

Background Motivational therapy for smoking cessation given to patients with cardiac disease has a reinforcing role that decreases smoking related precedent heath, social and financial burdens. Aim The aim of this study was to assess the therapeutic effect of motivational interviewing sessions on the smoking course and quitting success rates in cardiac patients compared with patients who did not receive the sessions. Patients and methods Our study was carried out on 120 smokers with cardiac diseases at the rehabilitation clinic; patients were divided into an experimental group of 60 patients who received motivational interviewing sessions while monitoring their smoking severity in the pre, post and follow-up sessions and another 60 matched controls who received a single advice on cessation treatment; both groups were assessed in the pre, post and follow-up session periods. A sociodemographic sheet, the Decisional Balance Scale, the Fagerström Test for Nicotine Dependence, the Readiness to Change Questionnaire, the Stress Test Questionnaire, and the Stress Management technique Questionnaire were used. Results Heart attack episodes were decreased in the experimental group by 50% after intervention with higher ‘high motivation’ to quit (98.33 and 91.66% in post and follow-up, respectively) compared with the preintervention period (1.67%). In the pre and follow-up periods, very low nicotine dependence was reported in 86.67 and 91.67% of the experimental group, respectively, compared with 8.33% in preintervention period. Also, 91.67% of the experimental group stopped smoking successfully in the follow-up period compared with 45% of the control group. Conclusion Using motivational techniques can encourage patients to quit smoking with less stress and can increase self-efficacy of patients.

Cognitive dysfunction in β-thalassemia major and intermedia patients and its clinical correlates

BackgroundIn Egypt, thalassemia is considered one of the most common genetically determined hemolytic diseases. Its high prevalence causes a significant burden on health resources. Few studies conducted on thalassemia patients have shown a heightened risk for cognitive function affection, and hence affects the patient’s quality of life. ObjectiveThe aim of this study was to assess the cognitive functions and its clinical correlates in &bgr;-thalassemia major and &bgr;-thalassemia intermedia patients in comparison with healthy controls. Patients and methodsThis study included 40 &bgr;-thalassemia patients who were divided into two groups: 20 &bgr;-thalassemia major patients and 20 &bgr;-thalassemia intermedia patients. 20 controls matched for age and sex participated in the study. Cases were collected from the Hematology Outpatient Clinic, Internal Medicine Department of Ain Shams University. All participants were subjected to a full neuropsychological battery. ResultsCompared with controls, both &bgr;-thalassemia patient groups were equally and significantly impaired on most of the neuropsychological battery domains. Serum hemoglobin, serum iron, heart abnormalities, and liver functions were nonsignificant correlates, and hepatitis C virus infection and vaccination history were significant correlates. ConclusionOur findings suggest that both thalassemia types are equally affected as regards multiple cognitive domains, with no correlation with blood transfusion or serum iron levels, questioning any role for hemosiderosis as a cause for cognitive impairment.