Nivert Zaki

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.

Cognitive functions in euthymic patients with bipolar II disorder and their correlation with the clinical profile

Background Deficits in neurocognitive functions can hinder the functional recovery and the quality of life of psychiatric patients, especially those with bipolar disorder. Numerous reports consistently demonstrated cognitive deficits in euthymic patients with bipolar disorder; however, their relation to the clinical profile remains unclear. The aim of this study was to demonstrate the range of neuropsychological deficits in euthymic patients with bipolar II disorder and to correlate these neuropsychological deficits with their illness characteristics. Patients and methods Thirty bipolar affective disorder type II patients in their euthymic state were assessed by the Structured Clinical Interview for DSM-IV, the Hamilton Rating Scale for Depression, the Young Mania Rating Scale, the Wechsler Adult Intelligence Scale, the Wechsler Memory Scale, the Continuous Performance Test, and the Wisconsin Card Sorting Test. Patients’ cognitive functions were compared with a matched control group. Results The performance on most domains of the Wechsler Adult Intelligence Scale was associated with the total number of episodes, the number of depressive episodes, the age of onset, and the average duration of an episode in months. The performance on the Wechsler Memory Scale was significantly associated across most domains with the total number of episodes, the number of depressive episodes, the age in years, the average duration of an episode in months, and the average duration of illness in years. The performance deficits on the Wisconsin Card Sorting Test were significantly associated with the total number of episodes, the number of depressive episodes, family history, and the average duration of illness in years. Conclusion Bipolar II euthymic patients showed persistent cognitive deficits in some aspects of general intellectual capacity, executive and memory functions, and the ability for sustained attention, which are correlated with some clinical variables. Bipolar II patients should be routinely assessed for deficits in cognitive functions to enable early intervention and rehabilitation.

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.

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.

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.

Metabolic profile and indices in a sample of drug-naive patients with schizophrenia and bipolar disorder

BackgroundPatients with mental illnesses such as schizophrenia and bipolar disorder have an increased prevalence of metabolic syndrome (MetS) and its components, risk factors for cardiovascular disease, and type 2 diabetes. Although the prevalence of obesity and other risk factors such as hyperglycemia are increasing in the general population, patients with major mental illnesses have an increased prevalence of overweight and obesity, hyperglycemia, dyslipidemia, hypertension, and smoking, and considerably greater mortality compared with the general population. ObjectivesThe main objective of this study is to determine the development of MetS in a sample of drug-naive patients with schizophrenia and bipolar affective disorders compared with a matched control group and to identify the significant criteria and risk factors of developing MetS. Patients and methodsThis was a cross-sectional case–control study in which 60 participants were recruited, 40 with the diagnosis of schizophrenia and bipolar affective disorders and 20 matched control ones selected from inpatient units and outpatient psychiatric clinics at the Institute of Psychiatry, Ain Shams University, over a period of 6 months. The recruited samples were assessed by a semistructured interview on the basis of the interview (questionnaire) sheet of the Institute of Psychiatry, Ain Shams University Hospital, and the diagnosis was made on the basis of the International Classification of Diseases-10 symptom checklist with an established diagnosis of acute psychosis. They were also assessed by the following measurements: blood pressure, body weight, circumference, laboratory investigations including assessment of fasting blood glucose level, using oral glucose tolerance test, lipid profile including assessment of triglyceride, cholesterol, and high-density lipoprotein level. ResultsThe results for the clinical and laboratory profile of the three participant groups showed a highly significant correlation between fulfillment of the criteria of MetS and the pathology of psychotic and bipolar affective disorders. Moreover, the presence of positive risk factors for development of MetS was found to be significantly high among the two patient groups compared with the control one. ConclusionSchizophrenic and bipolar drug-naive patients are more likely to develop metabolic changes; our results support the need for close monitoring of metabolic abnormalities and preferential use of metabolic neutral agents in this population as the first-line treatment option. Further research focusing on elucidation of the complicated relationship between metabolic disorders and psychiatric conditions may enable the development of earlier effective interventions.

Study of temperament and character in pregnant and lactating women: a cross-sectional study

BackgroundPersonality is the dynamic organization within an individual of those psychophysical systems that determine his or her unique adjustment to the environment; it has a direct effect on mental disorders either etiological or phenomenological or prognostic. AimThis study aims to determine the presence of clinically significant psychiatric morbidity among pregnant and lactating women and to explore the effects and impacts of their temperament and characters on these outcomes. Participants and methodsOne hundred and five women attending the obstetric outpatient clinic at Ain Shams University Hospitals were recruited into this study. They were assessed by The Mini International Neuropsychiatric Interview, the Beck Depression Inventory, and Temperament and Character Inventory-Revised. ResultsThe results showed that axis-I diagnosis was present, the most prevalent of which was adjustment disorder, mixed type (13 patients, 33.3% of psychiatric morbidity). Statistically significant lower eagerness of effort, more inactivity, lower ambition, more underachieving, lower perfectionism, lower purposefulness, more lack of goal-direction and higher compassion was found among females with psychiatric morbidity. Depressed patients showed statistically significantly higher scores on shyness with strangers, fatigability and asthenia, and total harm avoidance scores in comparison with nondepressed patients.

A comparative study between patients with Alzheimer’s disease with and without diabetes mellitus in an Egyptian sample

ObjectivesTo assess the clinical differences between patients with Alzheimer’s disease (AD) with diabetes mellitus (DM) and those without DM. MethodsSixty patients with AD were divided into two groups: the patients in group A had DM and the patients in group B did not have DM; the severity of dementia was assessed using the Clinical Dementia Rating Scale, behavioral and psychological symptoms were assessed by the Neuropsychiatric Inventory in addition to the Mini-Mental State Examination. Vascular complications were excluded using computed tomography brain imaging and the diabetic condition was assessed by the blood glucose level. ResultsThe prevalence of severe dementia was significantly higher in AD patients with DM than in AD patients without DM, severe cognitive deterioration was significantly higher in AD patients with DM than in AD patients without DM, and behavioral and psychological symptoms were significantly more prevalent in the first group, especially depression. Patients with uncontrolled diabetes had more severe dementia than patients with controlled diabetes. ConclusionDiabetes is a risk factor for AD and adds to the severity of dementia; in addition, it is associated with more cognitive deterioration and more behavioral and psychological symptoms, especially depression, even in the absence of vascular complications.