Mahmoud Elwasify

Cranial electrotherapy stimulation for the treatment of chronically symptomatic bipolar patients.

Objective The aim of this study was to determine if cranial electrotherapy stimulation (CES) is beneficial in chronically symptomatic bipolar (CSBP) subjects. Methods A retrospective chart review of all consecutive CSBP subjects who were prescribed CES collected demographic and clinical information. Results The Clinical Global Impression improved significantly [mean (SD), 2.7 (0.6) at baseline vs 2.0 (0.0), t = 0, P < 0.001], but mood symptoms change minimally. There were very few adverse effects of CES. Conclusions Patients with CSBP continue to experience symptoms with CES but also are modestly improved.

P-468 - Prevalence and correlates of depression and anxiety among high school students in eastern region, saudi arabia

Background Mental health among high school students represents an important and growing public health problem in developing countries particularly in Saudi Arabia. Objectives The objectives of this study were to estimate the prevalence of mental health problems among high school students at Al-Hassa, Saudi Arabia and to determine the possible correlates of these disorders among them. Methods A self administered anonymous survey was administered to a multistage random sample of high school students. A total sample of 1652 were selected by multistage proportionate sampling method. Information about socio-demographics, presence of chronic disease conditions and other potential correlates as financial, personal, family problems were collected. Depressive and anxiety disorders were assessed using the Patient Health Questionnaire (PHQ). Results The estimated prevalence of any depressive or anxiety disorder was 21.9%. Major depressive disorders have been encountered in 9.9%, other depression of 19.4% and any depression of 24.4%. Panic disorder was found in 4.0% and generalized anxiety disorders in 14.0%. Suicidal ideation in the past four weeks was reported by 1.1% of students. Mental health problems were more prevalent among students of scientific department. Major depression and depression and anxiety disorders were significantly higher among girls. Logistic regression revealed that the type of department, female gender, chronic disease condition, the presence of financial and personal problems were the significant predictors for major depressive disorders. Conclusion These findings highlight the need to address mental health in adolescent population, particularly among those of lower socioeconomic status.

Causal attributions and executive functions of academic procrastination in Mansoura University students

Background Academic procrastination is the irrational delay in the beginning or completion of an academic task within the desired time frame. It has many negative consequences on students, for example, wasting time, loss of opportunities, decreased productivity, and lack of success in addition to serious emotional and health problems. Aim The purpose of this study was to assess procrastination among a sample of college students in different academic areas, identify the possible reasons of this behavior, and examine the role of causal attributions and various executive functions (EFs) of students in academic procrastination. Participants and methods Eighty college students from Mansoura University participated in this study and were diagnosed by the staff members of the Committee of Postponing Exams in the Department of Psychiatry using Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision. After being diagnosed, they were asked to complete three questionnaires; the Procrastination Assessment Scale-Students, Executive Skills Questionnaire, and the Causal Dimension Scale II. Results The results show that the age of the procrastinating students ranges between 18 and 32 years. The men (n = 48) represent 60% of the procrastinators. Most of the students procrastinate during the second and third years of their college study (30 and 32.5%, respectively). Students from the Faculty of Engineering represent 25% of the procrastinators. The commonest psychiatric diagnosis among the procrastinating students is obsessive compulsive disorder (27.5%), followed by malingering (17.5%), and generalized anxiety disorder (12.5%). Reasons of procrastination, for example, aversiveness of the task and low frustration tolerance, tendency to feel overwhelmed and poor time management, and peer influence, have significant positive correlation (P ≤ 0.01) with procrastination among students. Several EFs have a significant negative correlation (P ≤ 0.001) with presence of procrastination among students, for example, working memory, organization, time management, emotional control, task initiation, and sustained attention and flexibility. Finally, locus of causality and stability have a significant positive correlation (P ≤ 0.001) with procrastination among students, whereas personal control has a highly significant negative correlation (P ≤ 0.001), with the presence of procrastination among students. There are 11 significant predictors of procrastination, for example, difficulty in making decision, dependency and help seeking, laziness, anxiety, rebellion against control, fear of success, response inhibition, sustained attention, metacognition, goal-directed persistence, and external control. Conclusion and recommendations Procrastination is more common among male students with obsessive compulsive disorder. Several EFs, for example, working memory, organization, time management, emotional control, task initiation, and flexibility as well as locus of causality, stability, and personal control are impaired among procrastinating students and significantly correlated with the occurrence of procrastination. Finally, many variables can be considered as predictors of procrastination among students, for example, difficulty in making decision, dependency and help seeking, laziness, anxiety, rebellion against control, fear of success, response inhibition, sustained attention, metacognition, goal-directed persistence, and external control. All previous data represent cues for the development of strategies among students to prevent the aggravation of this problem.

The association of BDNF gene polymorphism with cognitive impairment in insomnia patients

Background Reductions in BDNF activity have shown associations with depressed mood. Other evidence has demonstrated that the BDNF Val66Met polymorphism (rs6265) appears to reduce neural plasticity. A limited number of studies have investigated the influence of these genetic polymorphisms in insomnia. The present study sought to confirm the presence of associations between BDNF Val66Met polymorphism (rs6265) occurrence in normal sleepers and those with insomnia. Method The study subjects consisted of a patient group (n = 199) complaining of insomnia and a control group (n = 51). Each subject was clinically interviewed using questions taken from the Brief Insomnia Questionnaire. After the interview, the subjects were asked to complete the Insomnia Severity Index, The Hamilton Depression Rating Scale, and the Montreal Cognitive Assessment Test. An overnight polysomnography test was also administered. Blood samples were collected for genetic study. Results The insomnia patients showed a greater prevalence of heterozygous (A/G) VAL/MET polymorphism than the normal controls (p = ≤ 0.0001). This finding confirmed that this genetic polymorphism, which impairs BDNF activity, is an important correlate of disturbed sleep. Further, the finding of significantly greater (p = ≤ 0.0001) depression scores among the insomnia group suggested that BDNF is an important factor in the development of depressive symptoms. Clinical Implications The results of the present study indicate that BDNF gene polymorphism plays a prominent role in the variation of symptoms among insomnia patients and, further, that this polymorphism is strongly related to the severity of depression. HighlightsGenetic factors are important contributors to sleep processes, sleep disorders and cognitive functioning.Insomnia is one of the commonest sleep disorders and there is a lack of satisfactory objective testing instruments for assessing cognitive deficits in insomnia patients.Genetic polymorphisms which impair BDNF function was found in patients with insomnia and were significantly greater than in normal control subjectsAssociations between the BDNF polymorphism and poor performance on the cognitive tests, polysomnograhic parameters, and severity of insomnia and depression were detected.

Screening for obstructive sleep apnoea in tramadol users: a case–control study

Background Although opioids are known to cause sleep apnoea, to date, the risk for obstructive sleep apnoea (OSA) in individuals abusing tramadol has not been investigated. Therefore, we aimed to investigate the risk for OSA in individuals abusing tramadol. Patients and methods We conducted a case–control study comparing 100 patients with tramadol addiction with 100 healthy controls, assessing them for risk for OSA with the STOP-Bang questionnaire and for risk for daytime sleepiness with the Epworth Sleepiness Scale (ESS). We correlated between Severity of Dependence Scale, STOP-bang and ESS scores. Results Individuals abusing tramadol had significantly higher scores (P<0.001) on both STOP-bang and ESS compared with healthy controls. However, both the patient and control groups scored less than 3 on the STOP-bang, indicating that neither group reached the threshold for being high risk for OSA. Correlation of Severity of Dependence Scale scores with STOP-bang and ESS scores showed a statistically significant negative correlation (P<0.001 for both). Correlation between STOP-bang scores and ESS scores showed a statistically significant positive correlation (P<0.001). Conclusion Our study was the first to specifically examine the risk for OSA in individuals abusing tramadol. We found a significantly higher risk for OSA and more daytime sleepiness compared with healthy controls. However, OSA risk in both the patient and control groups did not reach the threshold for being high risk for OSA. We also found a significant negative correlation for dependence severity with OSA risk and daytime sleepiness, and a significant positive correlation between OSA risk and daytime sleepiness.

Relation between insomnia and stress, anxiety, and depression among Egyptian medical students

BackgroundThere has been a growing attention paid to depression, anxiety, and stress among college students. Only few studies have assessed these topics among medical students, and fewer still have been conducted in Arab countries. Furthermore, the relation of depression, anxiety, and stress to insomnia has not been thoroughly investigated. Participants and methodsThis cross-sectional, questionnaire-based observational study explored the prevalence of stress, anxiety, and depression and their relationship to insomnia among 980 undergraduate medical students of Mansoura University. The data were gathered using a demographic questionnaire, the Insomnia Severity Index, and the Depression Anxiety Stress Scale. ResultsThe prevalence of symptoms of stress, anxiety, and depression was 63.7, 66.9, and 59.2%, respectively. There were significant associations with multiple demographic variables. There was a significant positive correlation between Insomnia Severity Index score and stress, anxiety, and depression scores. Different stressors were identified by the students, including residence, working while being educated, studying more than 4 h a day, difficulty studying in English, problems communicating with the teaching staff, fear of failure in the future, death of a family member, chronic illness of a family member, physical health problems, and problems due to coping with academic demands. ConclusionStress, anxiety, and depression are common among medical students in Egypt, and are correlated with insomnia.

Help-seeking patterns in an Egyptian sample of substance use disorder patients

BackgroundSubstance use disorder is a major problem worldwide. The increased number of addicts is not matched by an equal effort to increase awareness of the available services provided to them in their community. Patterns of seeking help and sources of advice and referral to specialized and professional help are not clear and quiet related to the cultural and demographical environment, something that had never been properly investigated in the Egyptian community. AimThis study explored the most frequent patterns of help-seeking behaviors among patients with substance use disorders and the referral sources to professional services. Participants and methodsThis cross-sectional, questionnaire-based observational study was conducted among 40 patients aged above 18 years who were diagnosed with substance use disorder according to DSM-IV and who presented at the substance treatment program with male residential and outpatient services at the Institute of Psychiatry of Ain Shams University Hospitals over a period of 6 months. Exclusion criteria were limited mental competency, intoxication, or the inability to provide informed written consent. The data were gathered using Fahmy and El-Sherbini’s Social Classification Scale, Addiction Severity Index, and a Researcher-Designed Questionnaire and were analyzed using SPSS software. ResultsThe primarily abused drug was tramadol, a seen in 70% of the sample, followed by heroin in 20% and other substances including alcohol in 12.5%. Family was the most frequent source of referral to professional help among cases attending the clinic, and emergency services was the least common. The mean severity profile scores measuring problems and functional impairment using Addiction Severity Index were higher in the ‘employment’ domain (0.66±0.32), whereas legal (0.00±0.00), alcohol (0.01±0.07), and psychiatry (0.01±0.06) domains had lower scores. Our study concluded that patients who presented late for help (>1 year) were mostly divorced, living in slum areas, and were middle class. We also found that they first approached their friends for consultation, and source of referral was emergency room or friends with the same problem. ConclusionHelp-seeking through family was the most common pattern in our study.

P-255 - Health related quality of life among mothers of egyptian children with autistic spectrum disorders

Background Little is known about the Quality of Life (QoL) in mothers of Arab children with Autism Spectrum Disorders (ASD): The aim of the present study was to assess QOL among mothers with children affected with ASD: Methods Socio-demographic variables and ASD history were assessed using personal interview with a structured questionnaire. HRQoL domains were assessed using SF-36 questionnaire, while maternal mental health was assessed using Mini-International Neuropsychaitric interview (MINI-Arabic Version). Results Mothers of children with ASD group showed significant deterioration along the physical and social domains of HRQoL compared to mothers of apparently healthy children. Deterioration in HRQoL showed a positive correlation with the level of severity of the childrens symptoms and to coexisting behavioral problems and lower socio-demographic profile. Conclusion Results of this study provide preliminary evidence that mothers of children in need of social support and clinical interventions which are family centered, rather than child focused.

P01-148 - Social anxiety disorder (SAD) among outpatients attending a tertiary care psychiatric service in eastern nile delta

Thirty patients suffering from generalized social anxiety disorder (SAD) and diagnosed according to DSM-IV criteria attending the psychiatric outpatient clinic of a University hospital in Egypt 2009–2010 were assessed by the Liebowitz Social Anxiety Scale to estimate the severity of symptoms.Anxiety and depressive symptoms were also assessed by Hamilton anxiety rating Scale and Montgomery-Asberg Depression Rating Scale (MADRS). The Global assessment of functioning was completed following the appointment. Forty-seven percent of the patients were males, and 53% were females. The mean age of the sample was 22.5 years, with a mean duration of SAD of 5.6 years. Forty percent of patients had a positive family history for SAD. Forty percent of patients presented with co-morbid depressive disorder, whereas 24% presented with anxiety disorder and 31% with other disorders. The age of patients was found to correlate positively with total LSAS score, but it correlated negatively with the total depressive score. The severity of social anxiety symptoms was significantly greater in patients with co-morbid diagnoses and in depressive disorders than in anxiety disorders. High Correlations between MADRS and LSAS scores were observed in depressive disorders. Limitations Small size of convenience sample undergoing varying treatments within a single specialist tertiary referral centre. Early recognition and treatment of SAD, may ameliorate the occurrence of depression. Follow up studies are needed to investigate the risk factors that may lead to depression in SAD.

P03-413 - Stress in first-year Egyptian and Saudi female medical students: a cross cultural comparison

Introduction College students, especially freshmen, are particularly prone to stress due to the transitional nature of college life. However most of studies in this context were conducted in Western Europe and North America with only few recent studies conducted in the Arab world. This study sought to determine whether there was a difference in perceived stress levels of female medical students at Mansoura University, Egypt, and King Faisal University, Saudi Arabia. Methods The sample consisted of first year female medical students. The self-reported questionnaire covered four categories, including 13 items, of sources of stress (stressors).Perceived stress scale and Hospital Anxiety and Depression Scale were used to measure stress, anxiety and depression. Results There is no significant difference between the two groups regarding number of stressors. However, Saudi students were more likely to cite emotional problems, excessive workload and fear of future. The most common items in Egyptian students were financial and environmental problems. Prevalence of stress and clinical anxiety was higher in the Saudi sample. Logistic regression analyses of independent predictors of high level of stress among both groups combined were Saudi nationality, larger family size, clinical depression and clinical anxiety. Conclusions Perceived stress and anxiety are frequent among Saudi students. This information could be useful in designing preventive mental health programs that should be an integral part of the routine clinical facilities caring for medical students to help them to cope with the increasing demands of medical education.