Marwa El Missiry

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.

Factors correlated with the emergence of depressive symptoms in Egyptian donors after living donor liver transplantation

IntroductionLiving donor liver transplantation has recently emerged as an effective therapeutic alternative for patients with end-stage liver disease. Little is known about psychosocial outcome and psychiatric complications after living donor liver transplantation. Aim of the studyThe aim of the study was to investigate the rate of depressive symptoms in Egyptian liver donors postdonation and to assess the risk factors associated with the development of such depressive symptoms. Patients and methodsThe present study evaluated 33 donor candidates who were introduced to donate after all medical and psychological tests being free. All participants were interviewed using designed questionnaire for personal history, relationship to recipient, and satisfaction about donation, Beck Depression Inventory, Eysenck Personality Questionnaire, and D-scale of Guilford Inventory of Personality Factors. ResultsAt the first visit, 12.1% had depressive symptoms on Beck Depression Inventory; on follow-up, the rate of depressive symptoms had increased to 27.3% at the second visit. However, in the subsequent visits, the rates of depressive symptoms declined again to 15.2% at the third and to 15.1% at the fourth visits. Female sex, low educational level, managerial job, related as sib to the recipient, presence of depressive personality traits, and high scores in the Eysenck Personality Questionnaire psychoticism were found to be independent risk factors correlated with the development of depressive symptoms in liver donors. ConclusionWith careful preoperative psychiatric assessment and postoperative monitoring of liver donors, the development of depression could be identified and treated. Moreover, identifying risk factors correlated with the development of depression could aid in the selection of donors.

Screening for ADHD in a Sample of Egyptian Adolescent School Students.

Objective: To screen for ADHD in a sample of Egyptian adolescent students, and study the distribution of different subtypes of ADHD, associated comorbidities, and sociodemographic correlates. Method: A total of 925 adolescents were randomly selected and screened by the Conners-Wells’ Adolescent Self-Report Scale–Short form (CASS:S), and potential cases were further assessed by the Kiddie Schedule for Affective Disorders and Schizophrenia–Present and Lifetime versions (K-SADS-PL). Results: A total of 87 students (9.4%) had potential ADHD diagnosis with evident preponderance in boys (13.8%, n = 58) than in girls (5.8%, n = 29) with a ratio of 2:1 (p = .000, χ2 = 17.328). The hyperactive-impulsive subtype comprised the majority of cases (54.7%, n = 41). Psychiatric comorbidity was invariably present (85.1%, n = 74). Nearly half the cases had poor academic achievement (43.7%, n = 34). Positive correlates included family history of psychiatric disorders, the order of birth, and parental disharmony. Conclusion: ADHD is prevalent in Egyptian adolescents and is associated with high psychiatric comorbidity and a pronounced effect on academic performance.

Addiction Stigma Among Mental Health Professionals and Medical Students in Egypt

Objectives:The stigma toward substance use disorders is different from other health conditions, it complicates efforts for social acceptance of patients. Health care providers may hold negative beliefs about addiction patients, that is, that they overuse system resources, fail to adhere to recommended care, abuse the system through drug-seeking and diversion. Therefore, this study was set to compare addiction stigma among psychiatrists, psychiatric nurses, and medical students, and to test whether stigma varies according to the abused substance (alcohol, cannabinoids, heroin, and tramadol). Materials and Methods:A cross-sectional study was conducted on 467 subjects (351 graduating medical students, 65 psychiatric nurses, and 51 psychiatrists). Mental health professionals worked in the Department of Neuropsychiatry in the University Hospital, or Ministry of Health Hospital, or Mental Health and Addiction Treatment Centre. All consenting participants were subjected to questionnaires to assess stigma: Level of Familiarity, Perceived Dangerousness, Fear, and Social Distance with substance use disorder patients. Results:It was found that stigma was significantly lower (P<0.05) toward cannabinoids, whereas it was significantly higher toward heroin (P<0.01). Stigma was significantly higher (P<0.01) among medical students, whereas it was significantly lower (P<0.01) among psychiatrists and nurses working in Mental Health and Addiction Treatment Center and significantly (P<0.01) decreased with more years of experience. Conclusions:Interventions aimed at reducing stigma related to substance use disorders should be started from medical school. Contact-based training and education programs targeting medical students, psychiatrists, and other members of the treatment team including nurses, psychologists, and rehabilitation specialists are imperative.

Evaluating the effectiveness of a culturally adapted behavioral family psycho-educational program for Egyptian patients with schizophrenia

Although a growing body of evidence supports the effectiveness of behavioral family therapies for patients with schizophrenia, few studies have been carried out on the effectiveness of such programs for Egyptian patients. The current study translated and culturally adapted the Behavioral Family Psycho-Education Program (BFPEP) and conducted a preliminary efficacy evaluation for outpatients suffering from schizophrenia. Thirty patients received 14 sessions of culturally adapted Program (CA-BFPEP) and 30 received treatment as usual; all were followed up for 6 months. Pre- and post-intervention assessment included primary outcome measures that assessed the clinical, social, quality of life and attitude towards medications. The CA-BFPEP group demonstrated significant treatment effects as they had greater reductions in psychotic symptoms (PANSS), improvement of social function (SFQ), quality of life (QoL), and attitude towards medications (DAI), compared to patients in the control group. These results demonstrate the feasibility of implementing family therapy interventions in different cultural settings with relatively minor modifications. These promising findings invite further efforts to maximize the benefits of family therapy interventions internationally and to encourage mental health policy makers to integrate this mode of therapy in routine care management plans for patients with schizophrenia.

Risk factors influencing severity of attention deficit hyperactivity disorder in a sample of preparatory school students in Cairo

Background: Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders. Severity of symptoms is associated with more behavioral problems, poor academic performance, and persistence of symptoms into adulthood. Methods: To examine the clinical and social correlates that may be identified as risk factors associated with ADHD severity in a sample of adolescent ADHD school students. A total of 925 students were recruited from two public and two private schools from eastern Cairo. They were interviewed using Conners-Wells Adolescent Self-Report—short version (CASS-S); students scoring more than 65 were further interviewed with Kiddie Schedule for Affective Disorders and Schizophrenia—present and lifetime version (K-SADS-PL) to confirm the diagnosis, then Conners-Wells Adolescent Self-Report—long version (CASS-L) to assess severity and Wechsler Intelligence Scale for Children (WISC) to ascertain intellectual ability. Results: About 10.3% of cases were severe, 5.7% were moderate, and 83.9% were mild. Severity was significantly associated with female gender, psychiatric comorbidity, family problems, conduct symptoms, and poor anger management. Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV) hyperactive–impulsive type was the only predictive factor of ADHD severity. Conclusions: The diagnosis of hyperactive–impulsive subtype may predict the severity of ADHD symptoms.

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.

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.