Marwa Abdel Meguid

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.

Serum leptin level and its association with fatigue in patients with chronic hepatitis C virus infection

BACKGROUND AND STUDY AIM Fatigue is one of the most common presenting symptoms of chronic hepatitis C virus (HCV) infection. Its pathogenesis has been poorly investigated. Serum leptin levels are increased in cirrhosis and are suggested to have a role in the mediation of fatigue. This study was designed to assess possible association of serum leptin levels with fatigue and severity of liver disease in Egyptian patients with chronic hepatitis C infection. PATIENTS AND METHODS Seventy patients and 20 control subjects participated in the study. They were subjected to clinical and laboratory assessment, the determination of serum leptin level by ELISA and the assessment of fatigue using the multidimensional assessment of fatigue (MAF) scale. Respondents are asked to reflect on fatigue patterns for the past week. The MAF is a revision of the Piper Fatigue Scale. RESULTS Fatigue was present in all patients (100%) and 13 subjects of the control group (65%). There was a highly significant statistical difference between cases and controls regarding the presence and severity of fatigue. Serum leptin level was significantly higher in cases (24.9±28) in comparison to the control subjects (14.8±8). Serum leptin was not related to severity of liver disease as assessed by the Child Pugh classification. Serum leptin levels were directly correlated to the severity of fatigue (p<0.01) in patients but not in the control subjects. CONCLUSION Fatigue is highly prevalent in Egyptian patients with chronic HCV infection. Leptin might play a role in the mediation of fatigue in those patients drawing attention to biological basis of one of the most common symptoms facing clinician dealing with this problem.

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.

Studying late-onset schizophrenia and non schizophrenia psychosis in elderly Egyptian patients

BackgroundIn Egypt, the proportion of elderly people in the population is increasing markedly; cases of late-life psychoses are increasing at a rapid pace as the population of the world ages, and this will create a tremendous economic burden on the society because of the increasing rates of disability. AimThe aim of this work was to compare the sociodemographic and clinical characteristics, daily living functioning, and cognitive impairment between late-onset schizophrenia and other late-onset psychotic disorders. Patients and methodsA cross-sectional comparative study was conducted on 100 patients: 50 patients with schizophrenia with onset after the age of 50 years (group A) and 50 patients with nonschizophrenia late-onset psychoses (group B). All patients were interviewed using The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders Axis-I diagnosis were assessed using the Positive and Negative Syndrome Scale, the Functional Assessment of Activity of Daily Living scale, section B of the Cambridge Mental Disorders of the Elderly Examination, and the Wechsler Adult Intelligence Scale. ResultsPatients in group A were significantly younger – they were mainly women (72%), the majority were never married (54%), and 62% were living alone – compared with group B, who were mainly married (46%) and lived more often with their families. Among patients with late onset schizophrenia spectrum, 70% had paranoid subtype, 12% had delusional disorder and the rest had either undifferentiated or schizoaffective subtype. On the other hand, 70% of group B patients had psychotic symptoms due to dementia, 20% had mood disorder with psychotic symptoms; and the rest 10% had psychosis secondary to medical illnesses. (Group B) patients had significantly lower scores on items assessing positive symptoms and higher scores on general psychopathology than did (Group A) patients, the scores on negative symptoms, and also the total PANSS scores were almost similar in both groups and did not show any significant differences. Group A patients scored significantly better in daily living functioning, whereas a significant number of patients of group B needed partial and complete support. Cognitive assessment revealed that group A patients scored almost within norms, except for memory, apraxia, abstract, and perception items, compared with group B patients who scored significantly lower in all cognitive items. ConclusionPatients with late-onset schizophrenia compared with patients with other late-onset psychoses differ in a number of psychosocial and clinical variables, daily functioning, and cognitive abilities. The results of this study contribute to the development of a better understanding of the elderly patient population with different types of late-onset psychoses, which have been largely ignored in research.

Depressive symptoms and hopelessness among patients with cancer: role of religiosity

IntroductionPatients suffering from cancer may be more vulnerable to depressive symptoms and suicidality. These symptoms may be affected by the degree of religiosity and faith. AimThe objective of this study was to assess the depressive symptoms, hopelessness, and suicidality among patients suffering from cancer and to study the role of religiosity and how it affects depressive symptoms, hopelessness, and suicidality in this group of patients. Materials and methodsThis is a cross-sectional study among a sample of patients with cancer. They were subjected to sociodemographic sheets and self-report questionnaires (Beck Depression Inventory (BDI), Beck Hopelessness Scale, Religious Orientation Scale-Revised (internal–external religiosity). ResultsMost of the patients (97.5%) expressed depressive symptoms (BDI>10) with different severities: mild (10.3%), moderate (76.9%), and severe (12.5%). The highest severity was among patients suffering from breast cancer. The majority (77.9%) of patient scores in hopelessness were estimated to be mild. There was an indirect relationship between BDI scores and scores of external and internal religiosity. The study revealed an indirect relationship between hopelessness scores and external religiosity scores. However, the relationship was statistically nonsignificant. ConclusionThis study revealed that Egyptian patients who are suffering from cancer experience a high frequency of depressive symptoms. However, hopelessness and suicidality are expressed in low frequency.

Duration of untreated psychosis in an Egyptian sample: Sociodemographic and clinical variables.

Background: Duration of untreated psychosis (DUP) has been considered as a poor prognostic factor for psychotic disorder. Several studies have been investigating different predictors of DUP in Western countries, while in Egypt only a few studies have examined various predictors of DUP. Aims: To study DUP in Egyptian patients with psychotic disorders and to investigate how certain illnesses, patient, socio-cultural risk factors and help-seeking behaviour are correlated with prolonged DUP. Method: The sample included 100 patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) diagnosis of psychotic disorder were selected and interviewed to assess DUP. They were interviewed using the Structured Clinical Interview for DSM-IV axis I disorders (SCID-I), Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) scale. Results: Mean (±standard deviation (SD)) of DUP was found to be 36.93(±45.27) months. DUP was correlated with various sociodemographic and clinical variables. Following log transformation of DUP, correlation with PANSS scores was done and revealed highly significant statistical relation of DUP to PANSS negative and PANSS positive scores. In linear regression analysis, it was found that age of patients, the age of onset, residence, being illiterate, the insidious mode of onset, negative family history of psychiatric disorder and the severity of illness as indicated by PANSS are among DUP predictors. Conclusion: Longer DUP results from multiple patient- and illness-related factors. This has many implications in targeting early intervention with specific consideration to cultural factors.

Ethnic differences in the prevalence of catatonia among hospitalized psychiatric patients in Kuwait

IntroductionCulture and ethnicity may influence how catatonia manifests in relation to different psychiatric disorders. The presence of different ethnic groups in Kuwait and only one inpatient psychiatric service has contributed to the evolution and carrying out of this study idea. ObjectiveTo compare the prevalence of catatonia among different ethnic groups of hospitalized psychiatric patients in Kuwait. MethodologyRetrospectively, we reviewed the files of patients with first psychiatric presentation and hospitalization at the Psychological Medicine Hospital in Kuwait during 2008 who showed characteristics of catatonia. We compared demographics, dates of admission and discharge, duration of stay, number of hospitalizations, ICD-10 diagnosis, and psychiatric treatment. ResultsIn 2008, the percentage of first admissions was 37.3%. Of these patients: 6.2% had catatonic features; 52.5% were female, with a mean age of 28.5 years (SD=6.895); 52.5% were south Asians, 17.5% were black Africans, 12.5% were Kuwaitis, 15% belonged to other Asian communities, and 2.5% were non-Kuwaiti Arabs; 82.5% were admitted once, and the rest twice, of whom 2.5% showed signs of catatonia during both admissions; 40% had acute psychotic disorders, 27.5% had depressive disorders, 20% had schizophrenia, 7.5% had bipolar disorder, and 5% had organic mental disorder; 92.5% had mutism and 75% had negativism; 82.5% received conventional antipsychotics and 50% electroconvulsive therapy. LimitationLanguage barrier led to some limitations in diagnosis verification, besides lack of correlation with socioeconomic status because of the retrospective nature of the study. However, many of our findings matched those of other studies regarding ethnicity. ConclusionAmong hospitalized psychiatric patients in Kuwait, catatonia is more common among south Asians than among Arabs, other Asians, and black Africans.

Metabolic dysfunction related to typical and atypical antipsychotics in drug-naive patients with nonaffective psychosis: a prospective comparative study

Background Metabolic syndrome induced by antipsychotic (AP) drugs is commonly encountered in patients with nonaffective psychosis. Epidemiological studies report that 52% of patients with severe mental illness such as schizophrenia, schizoaffective disorder, bipolar disorder, and depression have metabolic syndrome compared with only 23–25% of the general population and thus have a markedly decreased life expectancy. Aim The study aimed to compare the effect of typical and atypical APs on different metabolic parameters in newly diagnosed drug-naive patients with psychotic disorders for a period of 12 weeks, which were divided into three follow-up visits, and clarify the associated risk factors. Patients and methods A convenient sample of 80 patients 18–50 years of age, of both sexes, from both inpatient and outpatient departments of the Institute of Psychiatry were screened for possible inclusion in the study. All patients were interviewed using SCID-I. Patients fulfilling the DSM-IV diagnostic criteria for schizophrenia, delusional disorder, brief psychotic disorder, and/or schizophreniform disorder, who had never been treated with psychotropic medication, and who had no comorbid medical conditions were included. Using computerized randomization, patients were assigned to two groups: group I received typical APs and group II received atypical APs. Demographic and clinical data were collected and anthropometric measurements were taken. Finally, laboratory analysis was performed for assessment of fasting blood glucose and lipid profile. Results The mean age of the patients was 26.03±6.53 years in group I and 28.48±6.29 years in group II. Group I patients were prescribed haloperidol, trifluoperazine, and flupenthixol, whereas group II patients were prescribed risperidone, olanzapine, and quetiapine. With regard to weight gain, patients in both groups were found to gain weight; however, it was more evident in patients given atypical APs, with a statistically significant difference across visits. Fasting blood glucose level increased significantly across visits in each group, but a comparison between the two groups did not show statistical significance. With regard to lipid profiles, cholesterol levels increased across visits and showed a statistically significant difference in visit 3; serum triglycerides and low-density lipoprotein increased as well but with no statistical significance; high-density lipoprotein decreased across visits but with no statistical significance. Conclusion AP medications, although providing a tremendous change in the lives of patients and giving them a better future, have imposed more of a burden on their metabolic profiles. This is especially true of atypical compounds.

Correlates of psychiatric morbidity in Egyptian renal transplant recipients

Background High rates of psychiatric morbidity have been reported after successful renal transplantation. Aim The aim of this study was to estimate the prevalence of psychiatric disorders among renal transplant recipients and to study their sociodemographic and medical correlates. Patients and methods A stratified random sample of 230 postrenal transplant recipients was selected from the nephrology clinics of Ain Shams University Specialized Hospital and from Nasser Institute Nephrology Clinics. All cases were subjected to a semistructured questionnaire for renal transplant recipients, the socioeconomic family scale, the Arabic version of the General Health Questionnaire-28, and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Axis I Disorders. Results The prevalence of psychiatric morbidity was 39.1%. Major depression was the most frequently encountered diagnosis (16.52%), followed by adjustment disorder with depressed mood (9.13%), dysthymia (8.26%), generalized anxiety disorder (4.35%), and post-traumatic stress disorder (0.87%). There was a statistically significant association between psychiatric morbidity and age, occupational level, and marital status. However, there was no significant association between psychiatric morbidity and sex, educational level, social class, side effects of drugs received after transplant, medical diseases other than renal impairment, duration of hemodialysis therapy before surgery, and type of donor. Conclusion The frequency of psychiatric morbidity is quite high in renal transplantation recipients, which necessitates thorough screening of the demographic and clinical variables. The involvement of mental health professionals with the team of renal transplantation can help and facilitate early detection and proper intervention to help patients suffering from psychiatric complications after the surgery.

SOCIODEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF VICTIMIZED VERSUS NON- VICTIMIZED PATIENTS WITH SCHIZOPHRENIA: AN EGYPTIAN STUDY

Persons with mental disorders living in the community are liable for victimization and are considered as a high-risk group. Objective of this study was to explore the sociodemographic variables and clinical characteristics related to victimization of patients with schizophrenia in comparison to their nonvictimized counterparts. One hundred patients were recruited from the inpatient wards and outpatient clinics of the Institute of Psychiatry, Ain Shams University. They were subjected to Structured Clinical Interview for DSM-IV Axis I diagnosis (Clinical Version); Positive and Negative Syndrome Scale (PANSS); Global Assessment of Functioning (GAF); Clinical Global Impression (CGI); designed extensive questionnaire to elicit demographic data; inquiry about drug compliance and Victimization Questionnaire. Results show that 70 patients of the studied sample were non-victimized and 30 patients were victimized. Victimized patients were significantly younger, living mainly in urban areas, had less frequent history of bullying at school. There were exposed significantly to higher frequency of family domestic violence and childhood abuse. They scored higher for all subscales and in total PANSS scores and they were less compliant on medication than did their non-victimized counterparts. Until now studies of victimization of mentally ill did not draw the attention of researchers and clinicians in Arab world. This study proves that victimization is not uncommon among patients with schizophrenia; Clinicians should include assessment for victimization of their patients as a routine work. The current study provides preliminary data for clinicians and policy makers to consider strategies to protect patients with various mental illnesses from being victimized.