Rasha E. Bassim

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.

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.

Behavior disturbance and psychiatric morbidity in a sample of abused Egyptian children

IntroductionConsequences related to child abuse represent a major public health problem with significant economic and human costs including health, social, behavioral and mental health problems for both children and adults. AimTo identify socio-demographic factors, behavioral disturbance as well as psychiatric morbidity in a sample of abused Egyptian children. Methodology1) General history with special focus on socio-demographic data and medical history, as well as current medical status, parental medical history and previous psychiatric illness. 2) Physical examination of children with inspection of regional injuries and required investigations when abuse is suspected. 3) Assessment using: A- The Mini International Neuropsychiatric Interview for Children (MINI-KID)- Arabic version. B- The Child Abuse and Negligence Scale to screen for child abuse. C- Child Behavior Symptoms Scale to subjectively assess child’s ability to adjust. D- Socio-economic level Scale for Family. E- General Health Questionnaire (GHQ) for the care givers to screen for psychiatric morbidity. ResultsThe abused children included 156 male (62.4%) and 94 female (37.6%) of which 161 (64.4%) were rural children (64.4%) and 89 (35.6%) were urban. Risk factors included earlier order of birth, abused parents with lower levels of education, lower grades of occupation, lower income, divorce, single parents, higher incidence of psychiatric illness, and substance abuse. Abused children had more pain and neurological complaints for a longer duration, wound scars often on the extremities (25 cases; 10%), psychiatric morbidities (53 cases; 21%), and more behavioral disturbance than non abused children (w 2=8.41, P=0.001). ConclusionAn earlier birth order, rural children, male sex, parents with low educational and income level, single parents, a history of psychiatric illness, and substance abuse are the risk factors of abuse. Psychiatric morbidities and behavioral disturbance are also higher in abused children.

Schizophrenia-negative symptoms: a real, lasting challenge. Retrospective and cross-sectional study

BackgroundNegative symptoms of schizophrenia, account vastly for its functional disability and often persist despite pharmacological treatment. AimThe aim of the study was to detect cases of resistant negative schizophrenia in institutionalized patients, compare between groups of resistant and nonresistant cases, formulate comprehensive criteria for resistant schizophrenia with different positive and negative symptoms, and find predictors of resistance. Patients and methodsAccording to DSMIV-SCID, 95 chronic schizophrenia patients were examined by BPRS, PANSS, CGIS, and MMSE. Clinical data, treatment history, and medical state were collected. Operational definition for negative resistant schizophrenia was acquired from PANSS and CGIS scores, and Modified Kane’s criteria for resistant schizophrenia. Cases were divided into four groups: resistant schizophrenia with predominant negative symptoms (n=26), resistant schizophrenia (modified Kane’s criteria) (n=25), overlapped resistant cases (n=11), and nonresistant cases (n=33). ResultsResistant schizophrenia patients and cases with predominant negative symptoms scored significantly higher (P=37.19±7.3) on mean negative scores (P=0.000), as well as all resistant groups (n=62) compared to nonresistant cases (n=33) (P=0.000, mean 34.08±8.9). Resistant negative schizophrenia group scored significantly lower on MMSE (P=0.05). The most powerful predictors for resistant negative schizophrenia were cognitive deficits presented by low score in MMSE, high score on disorientation and lack of attention items. ConclusionPresence of subgroup of patients with predominant negative symptoms, and not included in the definition of resistant schizophrenia, indicates that the available diagnostic criteria need to be reviewed. Cognitive dysfunction linked to negative schizophrenia suggests a bidirectional effect and possibility of a biological predisposition behind resistance other than social or environmental factors.

Cognitive and clinical correlates of hippocampus volume, an MRI 2-year follow-up study

Background Enlarged ventricles and reduced hippocampal volume are consistently found in patients with first-episode psychosis. Many studies examining brain structure changes in antipsychotic-naive patients have generally focused on the striatum. In this study, we examined whether reduction in hippocampal volume is a morphological trait in such a group of patients in an attempt to find its clinical and cognitive correlates for patients with different diagnoses of first-episode psychosis both at their first contact and at short-term follow-up. Patients and methods We obtained high-resolution three-dimensional T-weighed MRI scans of the hippocampus for 90 patients with first-episode psychosis (49 patients with schizophrenia, 21 patients with bipolar psychoses, and 20 patients with depressive psychosis) as well as 23 healthy controls both at the baseline and after 2 years of assessment. Assessment of the clinical picture was carried out using the structured SCID interviews, HDRS, YMRS, and PANSS. Cognitive function and intellectual abilities were examined using WMS-III, the Trail Making Test, and WAIS. Results A greater reduction in hippocampal volume was evident in the schizophrenia group than the bipolar and depressive psychosis groups compared with the healthy controls both at baseline and after 2 years, indicative of being a morphological trait for such patients. Negative symptoms were related to hippocampal volume reduction in the schizophrenia group. The initial assessment of untreated patients revealed reduction in their hippocampus volume which correlated with the longer duration of untreatment. After 2 years of follow-up, recurrent hospitalization was found to be related to further volume reduction. Impaired working memory, verbal memory, and baseline intellectual abilities were related positively to structural hippocampal changes. Cognitive and clinical correlation with a reduction in hippocampal size was less evident in the bipolar psychosis group, which may highlight different structural changes in other areas in the striatum. Conclusion and recommendation Hippocampal volume reduction may be considered as morphological traits for some patients with first-episode psychosis, and linked to some clinical and cognitive impairment. Study of the shape, localized regions of the hippocampus as well as other brain areas may help to clarify the circuits shared in the pathophysiology of psychoses of different types. Early detection of structural changes with the study of high-risk patients may aid effective treatment and improve outcomes.

Antipsychotic combinations: benefits versus risks, a focus on metabolic consequences

BackgroundDespite the controversy and doubts about positive and negative impacts, antipsychotic combination is an increasingly encountered clinical scenario nowadays. Aim and objectiveThis research was designed to study the differential benefits, and metabolic consequences of different drug combinations in chronic schizophrenia patients having moderate to severe psychopathology. Subjects and methods95 chronic schizophrenia patients were recruited from the Psychological Medicine Hospital in Kuwait. Combinations were made in two stages; stage I: conventional and atypical antipsychotics (n=83) and stage II: another atypical antipsychotic (Qutiapine or Aripiprazole) (n=54), in patients with moderate to severe psychopathology determined by the Clinical Global Impression-S (CGI-S). Metabolic consequences were assessed by monitoring blood sugar, HbA1C, cholesterol and triglyceride levels and Body Mass Index (BMI). Beneficial effects were assessed by changes on Brief Psychiatric Rating State (BPRS), Positive and Negative Syndrome Scale (PANSS), and (CGI-S) over the two stages. ResultsThere was no statistical significant differential effect for any drug combination in both stages on the metabolic measures. The mean scores were lowered by (32.15%, 23.20% and 24.12%) for positive, negative and general psychopathology scores in both stages, respectively. Positive psychopathology scores of PANSS were significantly lowered in cases of Haldol and Olanzapine combination in stage I, and cases where Qutiapine was added to any combination in the stage II. ConclusionDrug combinations can be safely used in chronic schizophrenia patients with moderate to severe psychopathology. However, benefits over risks need more verification, especially long term consequences and other adverse effects.

Clinical and psychodemographic profile of victimized versus nonvictimized Egyptian patients with bipolar mood disorder

BackgroundVictimization among individuals with severe mental illness is a common phenomenon. Individuals with bipolar disorder show unique symptoms that may make them vulnerable to victimization. ObjectivesTo explore the psychodemographic variables and clinical characteristics related to victimized patients with bipolar mood disorders in comparison to nonvictimized patients. Participants and methodsA total of 100 patients were recruited from the inpatient wards and outpatient clinics of the Institute of Psychiatry, Ain Shams University. They were subjected to the following: an extensive questionnaire to obtain demographic data, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Axis I diagnosis (Clinical Version), the Young Mania Rating Scale, the Mood Disorder Questionnaire, Global Assessment of Functioning, Clinical Global Impression, and the Victimization Questionnaire. ResultsIn total, 52 patients of the sample studied were nonvictimized and 48 patients were victimized. Parental separation, domestic violence, and child abuse were associated with victimization. Victimized patients scored higher on Young Mania Rating Scale and Mood Disorder Questionnaire. They were considerably more ill than nonvictimized patients. In terms of psychiatric comorbidity, 41.7% had comorbid psychiatric conditions; in addition, 16.7% were involved in substance abuse and 8.3% were dependent on psychoactive substances. It was found that all victimized patients were subjected to emotional victimization, 66.7% were subjected to miscellaneous victimization, and 58.3% were subjected to physical victimization. Patients were subjected to victimization mainly by family members. Moreover, none of the patients had reported these acts, considering it as being a personal issue or not important enough to be reported. ConclusionPatients with bipolar mood disorder are vulnerable to victimization. The severity of symptoms during episodes was found to be a triggering factor for victimization by guardians. This study drew the attention of clinicians toward investigation of the exposure of their patients to different types of victimization and finding possible solutions for the management and prevention of such acts.