Tarek Asaad

Melatonin and Sleep-Related Problems in Children With Intractable Epilepsy

Children with epilepsy have high rates of sleep problems. Melatonin has been advocated in treatment of sleep disorders, and its beneficial effect has been confirmed in insomnia. The aim of this study was to assess melatonin levels in children with intractable epilepsy and its relation to pattern of sleep and characteristics of seizure disorder, as well as the effect of melatonin therapy on those parameters. The study was conducted on 23 children with intractable epilepsy and 14 children with controlled seizures. Patients were evaluated by psychometric sleep assessment and assay of diurnal and nocturnal melatonin levels. Children with intractable epilepsy received oral melatonin before bedtime. They were reassessed after 3 months. Children with intractable epilepsy had higher scores for each category of sleep walking, forcible teeth grinding, and sleep apnea. At the end of therapeutic trial, patients with intractable epilepsy exhibited significant improvement in bedtime resistance, sleep duration, sleep latency, frequent nocturnal arousals, sleep walking, excessive daytime sleepiness, nocturnal enuresis, forcible teeth grinding, sleep apnea, and Epworth sleepiness scores. There was also significant reduction in seizure severity. Thus, use of melatonin in patients with intractable seizures was associated with improvement of both many sleep-related phenomena and the severity of seizures.

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.

Substance Abuse in a Sample of Egyptian Schizophrenic Patients

One hundred schizophrenic patients followed up in the outpatient department of Ain Shams University Psychiatric Institute (Cairo, Egypt) were studied for the problem of substance abuse. Twenty six percent of those patients were found to fulfill DSM-IV criteria for substance abuse. The most commonly abused substances were anti-parkinsonian drugs followed by cannabinoids, opioids, and benzodiazepines. Significant risk factors for abuse included male gender, high level of depression, smoking, and premorbid personality, with no significant association regarding schizophrenia subtype or neuroleptic drug dosage. More focusing and search for substance abuse is recommended as an important step in evaluating schizophrenic patients.

Sleep in Ancient Egypt

The ancient Egyptian civilization is one of the oldest and most fascinating in history. The contribution of ancient Egypt to the field of sleep medicine is quite evident. The concept of sleep had been linked to death, and the Egyptians were the first to describe similarity between dreams and awakenings. Dream interpretation and analysis had been extensively practiced for thousands of years before the modern psychoanalytic theories. Sleep was also used as a method of healing in special sleep temples, designed for dream incubation. Early mentioning of sleep disorders and their treatment could be found in the few survived papyri dealing with the ancient Egyptian medicine. The first hypnotic medication in history was prescribed by the Egyptians, who used poppy seeds (opium) to treat insomnia, headache, and as an anesthetic.

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.

Sleep profile in bipolar affective disorders

BackgroundThe relationship between sleep and mood disorders is bidirectional. MethodsThis review is throwing light on sleep changes associating bipolar disorders (BDs) with special emphasis on the type II BD cases. ResultsSleep disturbance in BD can be both a risk factor and a symptom of mood episodes. ConclusionSleep disturbance could be a trait marker of BD, although longitudinal assessments are warranted to assess the potential causal relations and the long-term implications of sleep disturbance in BD.

Sleep profile in a sample of Egyptian school-aged children with depression

BackgroundChildren with major depressive disorder often complain of subjective sleep disturbances. Studies that assessed the prevalence and nature of subjective sleep complaints in children and adolescents with depression showed controversial findings. Many polysomnographic (PSG) studies have failed to find objective evidence of these disturbances. AimThe aim of this study was to find out the following: (i) differences in sleep profile between children with depression and healthy control; (ii) the relationship between sleep profile disturbance and the severity of depression; (iii) the role of sex in sleep profile disturbance of depressed children; (iv) the relationship between family history of psychiatric disorders and sleep profile disturbance of depressed children. Patients and methodsParticipants were randomly selected according to certain inclusion and exclusion criteria from the Child Psychiatry Clinic in the Institute of Psychiatry, Ain Shams University Hospitals. Cases and controls were subjected to psychiatric institute sheet, MINI Kid (Arabic version), IQ test, Children’s Sleep Habits Questionnaire (CSHQ) (Arabic version), Children’s Depression Inventory Questionnaire and PSG. ResultsThe study sample consisted of 30 children: 20 cases and 10 controls. A total of 60% were boys and 40% were girls (for both cases and controls), with an age range of 8–12 years (mean 9.95 years) for cases and 8–10 years (mean 10.3 years) for controls. There were significant differences in many sleep parameters in cases compared with controls including increased sleep latency, decreased sleep efficiency, increased stages NI and NII, decreased stage NIII (deep sleep), decreased rapid eye movement (REM) latency, increased bedtime resistance, increased time to sleep, decreased sleep period and marked increase in sleep-related anxiety, with relevant increased disorders of excessive somnolence (with no significance to age, sex, REM sleep or REM density). Children’s Depression Inventory Questionnaire severity scores were correlated with most of the CSHQ and PSG parameters. ConclusionDepressed children showed a significant distinct profile of sleep disturbance compared with healthy normal controls. This profile is apparent both in clinical parameters such as CSHQ and in PSG parameters. Specifically, bedtime resistance and sleep period are strongly related to the severity of depression.