Marwa Elmissiry

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.

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.

Are there differences in pattern and magnitude of cognitive deficits between euthymic patients with bipolar I and bipolar II disorder

BackgroundRecent preliminarily evidence suggests that types and severity of cognitive dysfunctions may differ between bipolar disorder I and II (BD-I and BD-II). However, available data are scarce and inconsistent. AimWe aimed to investigate the differences in cognitive deficits between BD-I and BD-II patients. Patients and methodsThe study included 60 euthymic patients with BD (30 BD-I and 30 BD-II) from a large ongoing project on Egyptian patients with BD; they were compared on the basis of their neuropsychological variables (e.g. executive function, attention, verbal, and visual memory) and compared with 30 healthy controls on cognitive performance. They were subjected to full neuropsychological battery. ResultsCompared with the healthy controls, patients with BD-I and BD-II showed significant impairment in the majority of cognitive tasks including working memory (digit span backwards, P=0.000), verbal memory (verbal paired association I and II, P=0.000), sustained attention (total errors of omission, P=0.028), and overall executive functions (categories completed, P=0.000). Post-hoc analysis showed the patients with BD-II having an intermediate level of performance in cognitive functions, between patients with type I disorder and healthy participants, and almost preserved executive functions compared with BD-I patients. ConclusionThis study showed differences in severity and pattern of cognitive deficits between BD subtypes, and so the difference is not merely quantitative as confirmed by most of the previous studies. However, there were also qualitative differences in the pattern of executive function deficits, being more extensive in BD-I, which may indicate different biological or genetic etiology between the two BD subgroups. Future researches are needed to support this hypothesis.

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.

Sexual dysfunction related to typical and atypical antipsychotics in drug naive psychotic patients

IntroductionSexual dysfunction is one of the bothersome adverse drug effects that is profoundly underestimated and infrequently addressed in practice. Studies have shown that 25–60% of patients with schizophrenia treated with antipsychotics report sexual dysfunction. Some studies reported that atypical antipsychotics cause less sexual dysfunction compared with typical antipsychotics, whereas other studies have reported otherwise.The aim of this study was to compare the effect of typical and atypical antipsychotics on sexual functions using the Changes in Sexual Functioning Questionnaire (CSFQ-14). Patients and methodsEighty patients were selected from the Institute of Psychiatry, Ain Shams University (Cairo, Egypt). Patients fulfilling the diagnostic criteria of psychotic disorders according to the Diagnostic and statistical manual of mental disorder IV criteria were included in the study. The patients were divided into two groups. Group I comprised patients who received first generation antipsychotics; three brands were used: haloperidol, trifluoperazine, and flupenthixol. Group II comprised patients who received second generation antipsychotics; three brands were used: olanzapine, risperidone, and quetiapine. Sexual dysfunction was assessed using the CSFQ-14 initially and after 12 weeks from starting the antipsychotic medication. ResultsThis prospective cohort study indicated that the rate of sexual dysfunction after 12 weeks of using antipsychotics was 61.25%. Group II patients showed the highest prevalence of sexual adverse effects compared with group I. The highest decline was reported with risperidone, and the lowest negative impact on sexual functioning was reported with haloperidol. ConclusionThe rate of antipsychotics-induced sexual dysfunction is high; however, it is profoundly neglected and infrequently addressed in psychiatric practice. Thus, this problem should be routinely revised and properly managed to prevent its possible sequelae on adherence issues and quality of life.

Effectiveness of a behavioral family psychoeducational program for Egyptian patients with bipolar disorder and their caregivers

BackgroundPharmacological strategies and psychological interventions are increasingly being recognized as an essential component in the treatment of patients with bipolar disorder. Psychoeducation for patients and their families may be beneficial in improving the outcome of the disorder. AimThe aim of this study was to assess the outcome of bipolar disorder in Egyptian patients who received patient/family psychoeducation therapy. Patients and methodsHundred and eleven patients with a diagnosis of bipolar disorder and their relatives were recruited and followed up for 12 months; the final sample included 99 patients, yielding a defaulter rate of 10.8%. These participants were divided into two groups: group I that received a behavioral family psychoeducational program (n=67 patients and their caregivers) and group II that received supportive psychotherapy (n=32 patients and their caregivers). We used the following parameters for assessment: the Young Mania Rating Scale, the Hamilton Depression Rating Scale, the Wisconsin Quality of Life Index Client Questionnaire, and the Social Functioning Questionnaire. The caregivers were assessed using the Family Burden subscales from the Social Behavior Assessment Schedule. ResultsOur data showed a significant reduction over time in the Hamilton Depression Rating Scale and Young Mania Rating Scale scores and a significant increase in the Social Functioning Questionnaire and Wisconsin Quality of Life Index Client Questionnaire scores for group I compared with group II. Moreover, there was a significant increase in the scores of Social Behavior Assessment Schedule in group I compared with group II. ConclusionThe behavioral family psychoeducational program proved to be beneficial in the management of bipolar disorder patients and had a positive impact on their caregivers in terms of reducing caregivers’ burden.

Risk factors for attention deficit hyperactivity disorder in a sample of Egyptian adolescents: a case–control study

BackgroundAttention deficit hyperactivity disorder (ADHD) is a commonly diagnosed behavioral disorder of childhood and adolescence that represents a public health problem with long-term adverse effects on academic, vocational and social development. ObjectivesThe aim of this study was to assess some putative risk factors that may be associated with ADHD in Egyptian adolescents compared to matched healthy controls. Methods925 preparatory school students were randomly selected from private and public schools in Eastern Cairo. We used the Conners-Wells’ Adolescent Self report Scale Short form (CASS: S), as a screener for ADHD students. Those scoring >65 were considered potential ADHD cases, and were assessed by the kiddie Schedule for Affective Disorders and Schizophrenia present and lifetime version (K-SADS-PL) for establishing a diagnosis then were further evaluated by: Wechsler Intelligence Scale (WISC) to assess intellectual abilities. School performances prepared by teachers were recorded. Students were asked to complete a Designed Questionnaire fulfilling data including family background. A local scale for social class classification was administered. We finally compared the ADHD group with a matched healthy control group. Results9.4% (N=87) of the selected sample had ADHD. The diagnosis of ADHD was significantly associated with low socioeconomic state (8.0%), first sib order (42.5%), quarrelsome home atmosphere (21.8%). One third of the ADHD sample was exposed to cold family relations and criticism with a highly significant association (P<0.001); a similar percentage was exposed to parental aggression and abuse but displayed significant statistical association P<0.05. Students with ADHD were significantly exposed to postnatal complications (23%), and had more joint (20.7%) and chest (26.4%) diseases; their school performance and IQ scores displayed very highly significant lower values than the control group. Risk factors associated with ADHD were family history of psychiatric illness, history of head trauma, first sib order, delayed sphincter control, epilepsy and parental disharmony. ConclusionOur findings highlighted important differences between ADHD subjects and healthy students in several aspects as psychosocial adversities and physical health and delineated significant associations between ADHD and some putative risk factors. These findings would serve as a useful guidance tip for early management of ADHD adolescents and their families who display those risk factors.

Myasthenia gravis and psychiatric comorbidities

BackgroundMyasthenia gravis (MG) is a chronic, autoimmune disease involving neuromuscular junctions frequently associated with psychiatric morbidity in terms of depression and anxiety. The interaction between MG and psychiatric disorders needs to be appreciated, especially in the primary care setting, as the symptoms may overlap. The main objective of this study was to recognize the rate of occurrence of psychiatric morbidity among MG patients and to assess the demographic variations of patients and its relevance. Participants and methodsA descriptive cross-sectional study was conducted during the period between June 2011 and December 2013 at the Neurology Department, Nasser Institute Hospital. Thirty MG patients from outpatients’ clinics/inpatients’ wards of Nasser Institute Hospital between 18 and 50 years of age and both sexes were included. The patients were subjected to clinical interview according to the protocol followed at the neuropsychiatry department of Ain Shams Faculty of Medicine, the quantitative myasthenia gravis test, and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th ed. ResultsThe results showed that 27 (90%) patients had psychiatric comorbidity. Major depressive disorder (MDD) was found in 13 (43.3%) patients and dysthymic disorder was seen in only 7 (23.3%) patients. Anxiety disorders were found in 10 (33.3%) patients; adjustment disorders were found in two patients and mixed anxiety depressive disorder was found in two patients (6.7% for each). The most frequent anxiety disorder was generalized anxiety disorder (16.7%), followed by obsessive–compulsive disorder and social phobia (10% each), and panic disorder (PD) and agoraphobia (6.7% each). There was a significant correlation between the myasthenia severity index of the patient and his chance to have MDD of moderate severity. In addition, there was a significant association between MDD of mild severity and number of hospitalizations (P=0.047), number of ICU admissions (P=0.034), and number of myasthenic crisis (P=0.038).There was a statistically significant association between severe MDD and number of plasmapharesis settings (P=0.04). Moreover, there was also a statistically significant association between PD and number of myasthenic crisis (P=0.042) and between agoraphobia without history of PD and number of hospitalizations (P=0.048). ConclusionA high association of psychiatric comorbidities with MG of up to 90% was seen in the current study. The most common psychiatric comorbidities are depressive disorders and anxiety disorders. The disease characteristics for MG are the most common variables to have a significant correlation with the rate of psychiatric comorbidities, especially disease duration and severity.

A study of brain single-photon emission computed tomography in a sample of Egyptian autistic male versus female children: cross sectional (comparative study)

BackgroundAutism is a neurodevelopmental disorder that affects boys more commonly than girls, with a range of heterogeneous presentations of clinical picture. There are several theories to explain these differences. These theories involve both genetic factors and phenotypic differences in how each sex manifests symptoms. AimThis study aimed to examine and compare the functional neuroanatomical changes and differences between male and female children with autism using brain single-photon emission computed tomography. Participants and methodsThirty children with autism spectrum disorder (10 girls and 20 boys) were assessed through brain imaging using 99mTc hexamethyl propylene amine oxime. The findings of males were compared with the findings of females using an independent Student’s t-test. ResultsThe frontal lobe was the most common area affected in both groups and showed high significant hypoperfusion, but the second common affected area differed; in males, it was the basal ganglia but in females it was the cerebellum. ConclusionFunctional techniques used in the assessment of this neurodevelopmental disorder are useful in explaining the difference in the presentations of autistic disorders among both males and females. Moreover, these findings may be helpful in the future for the management of these disorders.