Menan A. Rabie

Cognitive functions among euthymic bipolar I patients after a single manic episode versus recurrent episodes.

BACKGROUND There is a growing consensus that persistent cognitive deficits are common in patients with bipolar disorders even when they are euthymic. AIM The aim was to assess objectively the presence of cognitive deficits in bipolar patients in remission, and to correlate these deficits with the recurrence of the disease. METHODS Cognitive functions (executive function, memory, intelligence, attention and concentration) of a group of euthymic bipolar patients after a single manic episode were compared to cognitive functions of patients who experienced recurrent episodes, both groups were assessed during remission. The results were compared with a control group, using SPSS. RESULTS Euthymic bipolar patients assessed after a single manic episode showed impairment in attention, executive functions and total memory score in comparison to healthy control subjects. While they performed better than Euthymic bipolar patients assessed after recurrent bipolar episodes as regards attention and executive function. CONCLUSION Bipolar disorder is associated with attention, memory and executive dysfunction. Attention and executive dysfunction is deteriorated by the recurrence of bipolar episodes.

Prevalence and correlates of depressive disorders in elderly with type 2 diabetes in primary health care settings

OBJECTIVE Depression is associated with poor glycemic control and complications in people with type 2 diabetes. We assessed the prevalence of depressive symptoms and antidepressant medication use among elderly with and without type 2 diabetes and the association between depression and diabetes complications. RESEARCH DESIGN AND METHODS In 2004-2006, the Primary Health Care research in Type 2 Diabetes Study applied the Beck Depression Inventory II (BDI-II) to 458 participants with type 2 diabetes (47% male, aged 65 + or -8.9 years, type 2 diabetes duration 19 + or - 8.7 years) and 546 participants without diabetes (non diabetic group) (51% male, aged 59 + or - 8.7 years). Use of antidepressant medication was self-reported. Depressive disorder was defined as a BDI-II score >14 and/or use of antidepressant medication. Occurrence of diabetes complications (retinopathy, blindness, neuropathy, diabetes-related amputation, and kidney or pancreas transplantation) was self-reported. RESULTS Mean BDI-II score, adjusted for age and sex, was significantly higher in participants with type 2 diabetes than in non diabetic participants (least-squares mean + or - SE: 7.4 + or - 0.3 vs. 5.0 + or - 0.3; P<0.0001). The prevalence of depressive disorder (as defined by BDI-II>14 and/or antidepressant use) in participants with type 2 diabetes was significantly higher than that of age- and sex-adjusted non diabetic participants (32.1 vs. 16.0%, P<0.0001). Type 2 diabetic participants reported using more antidepressant medications (20.7 vs. 12.1%, P = 0.0003). More type 2 diabetic than non diabetic participants were classified as depressed by BDI-II cut score (17.5 vs. 5.7%, P<0.0001) or by either BDI-II cut score or antidepressant use (32.1 vs. 16.0%, P<0.0001). Participants reporting diabetes complications (n = 209) had higher mean BDI-II scores than those without complications (10.7 + or - 9.3 vs. 6.4 + or - 6.3, P<0.0001). CONCLUSIONS Depression is highly prevalent in type 2 diabetes and requires further study on assessment and treatment.

Clinical characteristics of depression among adolescent females: a cross-sectional study.

BackgroundAdolescents rarely seek psychiatric help; they even hesitate to disclose their feelings to their parents. However; the adolescents especially the females experience depressive symptoms more frequently than general population. Do they experience classic depressive symptoms? Are there symptoms specific to this subpopulation?Aim of the studyThrough this study, the authors aimed to estimate the prevalence of depressive disorders in Egyptian adolescent female students. They also expected a characteristic profile of symptoms for the adolescent females. However available literature provides no guidance in the description of this profile of symptoms.MethodsA number of 602 adolescent females were interviewed, and subjected to General Health Questionnaire (GHQ); Children Depression Inventory (CDI), Structured Clinical Interview for DSM-IV Axis-I Disorders (SCID-I), then Hamilton Rating Scale for Depression (Ham-D). Results were analyzed by the use of SPSS-15.ResultsThe study revealed the prevalence of depression in the sample of the study to be 15.3% (measured by CDI), and 13.3% (measured by SCID-I). Fatigue was the most common presenting depressive symptom (81.3%), in addition to other emotional, cognitive and physiological symptoms. Suicidal ideations were the most common suicidal symptoms in depressed adolescent females (20%), with 2.5% serious suicidal attempts.ConclusionsThe somatic symptoms were by far the most common presenting symptom for female adolescents suffering from depressive disorders. Depressive phenomena including unexplained fatigue, decreased energy, psychomotor changes, lack of concentration, weight changes and suicidal ideations may be the presenting complaints instead of the classic sad mood.

Serum level of brain derived neurotrophic factor (BDNF) among patients with bipolar disorder

BACKGROUND There is a growing body of evidence that serum brain derived neurotrophic factor (BDNF) is altered during the episodes of bipolar disorder. The aim of this study was to investigate serum BDNF levels in bipolar disorder patients during manic and depressive episodes and its clinical utility in bipolar disorder compared to other psychiatric disorders. METHODS The study was conducted on 80 Egyptian patients, who were classified into 4 groups: group Ia (25 patients with depressive episodes), group Ib (25 patients with manic episodes), group II (15 patients having Schizophrenia) as pathological controls and group III (15 healthy subjects) as controls. All subjects were diagnosed according to DSM-IV, assessed using the Hamilton Rating Scale for depression (HAM-D), and the Young Mania Rating Scale (YMRS). sBDNF concentrations were measured using the quantitative sandwich enzyme immunoassay technique. RESULTS sBDNF showed significantly lower levels in patients with depressive episodes or manic episodes. The best cut-off for sBDNF in discriminating depressed patient from healthy control was ≤33,000pg/ml (AUC=0.891, sensitivity of 84%, and specificity of 80%). Moreover, the best cut-off for sBDNF in discriminating mania patients׳ group from healthy control was ≤29,500pg/ml, (AUC=0.984, asensitivity of 96%, and specificity of 86.7%). LIMITATIONS Only a small sample size was considered which included only drug free patients. BDNF was measured in serum not in CSF or brain tissue. CONCLUSIONS Low sBDNF levels are strongly associated with active phases of bipolar disorder, in depressive and manic episodes.

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.

Sleep behavior and sleep problems among a medical student sample in relation to academic performance: a cross-sectional questionnaire-based study

BackgroundMedical students are exposed to high academic demands, which may affect their sleep pattern. Insufficient sleep quantity and quality with excessive daytime sleepiness can affect their mental ability needed for proper academic performance. ObjectiveThe aim of the study was to examine the sleep pattern and the common sleep disorders among medical students and possible associations with academic performance and evaluation. Materials and methodsA cross-sectional survey was carried out on a sample of students at the Faculty of Medicine, Ain Shams University, during the academic year 2009–2010, using a self-report sheet including the following: (i) a designed questionnaire meant to collect data about sleeping behavior and possible factors that may affect it and possible association with the academic performance. (ii) The Insomnia Severity Scale to assess the presence of insomnia and its severity. (iii) The Epworth Sleepiness Scale to assess them for daytime sleepiness in different situations. (iv) A General Health Questionnaire to exclude other significant mental health problem in participants. ResultsThis study was carried out on 435 medical students (51.5% female), with a mean age±SD of 21.4±1.88. They were selected from all academic groups of the faculty studying in the first to the sixth year. A total of 125 (28.7%) students scored 10 or more on Epworth Sleepiness Scale, suggesting excessive daytime sleepiness. The academic achievements reflected by their last year’s evaluation degrees were distributed among the sample as follows: fair (40.6%), good (69.3%), very good (74%), and excellent (73%). Insomnia during the month preceding data collection was reported as occurring frequently in 32.6% and occasionally in 36.3% of the students and was evident among 62.5, 67.9, 70.9, and 69.7% of the fair, good, very good, and excellent students, respectively. Different parasomnias were prevalent between medical students. ConclusionA high prevalence of sleep disorder was found in this group of students. Students scoring good and very good for their academic performance had the more severe form of sleep disorders. Poor sleep quality and chronic partial sleep deprivation affected some of the students’ learning skills needed, but did not affect the whole learning process. These findings should be considered when working for programs to improve academic performance in medical students keeping in mind different sleep habits and possible sleep problems of students.

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.

Personality profile of obese children and adolescents: relation to body mass index and metabolic complications

Background Personality traits can affect eating behaviors, the development of obesity, and obesity treatment failure. Because of the scarcity of research on the relationship between personality traits and childhood obesity and its importance in obesity treatment outcome, the current study aimed to assess the personality profile of obese children and adolescents, investigate the relationship between patterns of temperament and character as well as psychopathology in obese youths and explore the relationship between personality traits and severity of childhood obesity and its metabolic complications independent of the impact of psychopathology. Methods After exclusion of children with comorbid psychiatric disorders, 40 obese children were enrolled from the Pediatrics Obesity Clinic, Ain Shams University. They were compared with a matched control group of nonobese children (n=20). The Junior Temperament and Character Inventory was used to assess the personality profile, and Child Behavioral Checklist was used to assess psychopathology. Results Obese children were found to have significantly higher novelty seeking and harm avoidance behavior compared with nonobese controls. Among obese children, high novelty seeking was associated with externalizing problems, and low self-transcendence was associated with internalizing problems. Higher BMI was associated with higher novelty seeking and lower persistence. Personality traits related to metabolic complications of obesity were persistence, self-transcendence, and self-directedness. Conclusion Personality traits may contribute to health outcome through their association with obesity and its progression. These data underscore the future potential usefulness of personality assessment in obesity management and suggest the use of cognitive behavioral therapy targeting these personality traits to achieve better treatment outcome.

Clinical profile and functioning in late-onset versus early-onset schizophrenia: a comparative study

BackgroundPsychotic symptoms arising de novo among older adults are not uncommon. Their distinctive features and phenomenology are of increasing clinical interest. Their comparison with early-onset psychosis can provide better insight into this complex phenomenon. AimThe aim of this study was to compare the clinical picture and functioning of 50 patients presenting with late-onset schizophrenia (LOS) (>50 years) with a similar number of patients with early onset (<50 years). Patients and methodsThe recruited patients were interviewed using the Structured Clinical Interview for DSM Axis-I Disorders (SCID-I). Those fulfilling the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. diagnostic criteria for schizophrenia and other psychotic disorders underwent further clinical evaluation of the psychopathology using the Positive and Negative Syndrome Scale. The functioning was estimated using activities of daily living and instrumental activities of daily living. ResultsPatients with LOS were mainly women, unmarried or divorced, living alone, had less familial psychiatric history, higher education and better premorbid functioning compared with their earlier-onset counterparts. Their psychotic symptoms occurred mainly in conjunction with a number of chronic medical illnesses and sensory deficits, with less impairment in daily living function in contrast to the earlier-onset group. Clinically, the delayed development of psychosis was associated with a relative lack of negative symptoms, affective blunting, formal thought disorder and the absence of conceptual disorganization. Nonetheless, it was associated with prominent systematized delusion and multimodal hallucinations. Our study showed that paranoid schizophrenia was by far the most frequent diagnostic type of schizophrenia encountered in the LOS group, whereas the disorganized and undifferentiated schizophrenia subtypes were the most common diagnoses in the early-onset schizophrenia group. ConclusionOur data support the finding of differences in the phenomenology, psychosocial variables and functioning between patients with LOS and early-onset schizophrenia. Hence, a critical re-evaluation of the current diagnostic systems in the light of this awareness is very important. Schizophrenia symptoms arising de novo at an older age is better designated in the classification as a subtype of schizophrenia. This remains a nosological caveat that requires further evaluations.