Focus on psychiatry in Egypt

Characterization of Some "Hashish" Samples in the Egyptian Illicit Trafficking Market Using a Thermal Separation Probe and Gas Chromatography-Mass Spectrometry

Drugs that are illegal have long been a part of Egyptian society. The most widely misused form of narcotic is marijuana, also known as "bango", and other cannabis-related products like "hashish". The chemical profile of some available "hashish" in the local Egyptian illegal market and its possible country of origin are investigated using a gas chromatography-mass spectrometry technique in conjunction with a thermal separation probe (TSP/GC/MS). The TSP/GC/MS method reveals the presence of 23 different terpenes, of which caryophylla-4(12),8(13)-dien-5α-ol, isoaromadendrene epoxide, caryophyllene, and alloaromadendrene oxide-(1) are detected in high relative proportions. Ten cannabinoid components are also detected. These are cannabiorcochromene (CBC-C1), tetrahydrocannabivarin (THCV), delta-8-tetrahydrocannabinol (delta-8-THC), exo-THC, cannabichromene, cannabidiol (CBD), cannabielsoin (CBE), dronabinol (delta-9-THC), cannabigerol (CBG), and cannabinol (CBN). Phenotypic index (THC % + CBN %)/CBD %) is measured for the test samples to identify both the nature of the samples (fiber- or drug-type cannabis) and the country of origin.

Integrating Cognitive Behavioural and Islamic Principles in Psychology and Psychotherapy: A Narrative Review

Standardisation of knowledge has become a by-product of globalisation, and western-based models are often seen as the ultimate answer to expertise and development. In light of this, some professionals have debated the feasibility of employing cognitive behavioural therapy (CBT) with Muslim communities. Debates have focused on CBT's secular roots and its compatibility with a world where Islam permeates most aspects of life. This article highlights some of the theoretical dilemmas of integration and suggests ways to bridge the existing gap between secular and Islamic literature and avoid alienating those individuals who might feel uncomfortable with secular CBT teachings.

Knowledge, stigma, and beliefs toward mental illnesses among schoolteachers in Damascus

BACKGROUND

Teachers have an important role in promoting the mental wellbeing of their students, hence their knowledge and attitudes toward mental health disorders should be assessed. A very few studies regarding this topic were conducted in Syria, but due to the recent events which have had occurred the country, it is essential to deal with students who suffer from mental illnesses professionally especially that such disorders may be stigmatized by the society.

AIMS

This paper aims to investigate knowledge, beliefs, and attitudes toward mental disorders in a sample of Syrian schoolteachers.

METHOD

A cross-sectional study using self-administered questionnaire was conducted in Damascus and Refdimashq, involving 400 teachers from 16 schools.

RESULTS

The results showed that the prevalence of stigmatizing positions toward psychiatric illnesses was low among teachers. The contributors did not state a correlation between spiritual beliefs and psychological disorders. It was also found that teachers were neutral in their knowledge about mental illnesses and psychiatric treatment or interventions along with their mental health resources. However, 42.5% of the participants use the internet for such purposes.

CONCLUSION

In general, teachers of Damascus and its Refdimashq had a reasonable degree of awareness about mental disorders and treatments. Furthermore, neither stigma nor the relation between religious thoughts and mental disorders had been ascertained.

Community Mental Health Services in Egypt

As far back as the 14th Century, Egypt had already developed mental health care in a community-based sense in Kalaoon Hospital in Cairo, 600 years before similar institutions were founded across the globe. By 2001, an Egyptian-Finnish bilateral comprehensive reform program was incorporated. A few years later, in 2007, the Minister of Health and Population initiated a proper appraisal of the mental health services in Egypt, which was aimed at achieving better integration and coordination in the mental health sector, as well as supervision and training on the national, governmental, and primary care levels. By 2009, the Mental Health Act of 2009 (Law 71) brought basic conceptual changes to the care of people with a mental illness in Egyptian institutions, replacing the outdated 1944 law that had been used in Egypt for decades. However, despite all of the important steps Egypt is taking to move toward more integrated mental health services, more effort and resources are still needed to fight against stigma and to develop a comprehensive multidisciplinary approach that is approachable and effective to all those who need it.

Enhancing “Health-Promoting Schools” through Implementing Mental Health Program

BACKGROUND: The implementation of social and emotional learning program Social Emotional Learning (SEL) program is considered to be a low cost, simple method, and efficient intervention that shows a promise in promoting students’ mental health (MH). AIM: We aimed to enhance “The Health-Promoting Schools” initiative through the implementation of a MH promotion program. METHODS: The study is a school-based non-randomized controlled trial, in purposively selected schools. It included 460 students with a mean age of 11 (± 0.7) years old, all are boys, and were divided into two groups; intervention group (n = 230) and control group (n = 230). The ten components of the health-promoting school were assessed in the intervention school using the CDC tool “The School Health Index,” which enables the school team to identify the strengths and weaknesses of their school’s policies and programs. As a result, a tailored SEL program was developed fitting the Egyptian culture and students’ needs, along with the recommendations and trends. RESULTS: The baseline assessment results for the intervention school were in the medium range percentages (20–80%). The social and emotional part had not been a major concern given for our students. The students who participated in the SEL program evidenced significant improvements in grit, growth mindset, self-management, social awareness, and school safety compared to the control group. According to the teachers’ perception scale, 70% of the teachers reported that the learning strategies of students have been improved. CONCLUSION: The findings suggest that a relatively simple-to-administer SEL curriculum added to the regular school curriculum for a period of only 2–3 months can yield promising results as regard to positive behavioral and cognitive changes in students.

Assessment of addiction management program and predictors of relapse among inpatients of the Psychiatric Institute at Ain Shams University Hospital

Background

Rehabilitation programs targeted to patients with substance use disorder (SUD) following successful detoxification constitute a global public health concern. This study aimed to examine the effectiveness of a combined pharmacotherapy/cognitive behavior therapy (CBT) model through assessing abstinence/relapse rate and quality of life (QOL) in a sample of patients with SUD. Indeed, we aimed to identify the relapse predictors.

Results

The relapse rate in the inpatient group was 45.33%, compared to 56% in the outpatient group. Multivariate analysis revealed that patients with educational levels less than secondary school, rural residency, being single or divorced, having cravings lasting for 6 weeks from detoxification, legal history, presence of borderline, antisocial and multiple personality disorder could predict relapse in patients with SUD. Moreover, there was a statistically significant difference between the legal, substance, and social domains of ASI (X²= 12.525, p=0.014; X²= 12.525, p=0.023; and X²= 6.335, p=0.042 respectively) and the majority of QOL domains and relapse.

Conclusions

Socio-demographic data, legal history, craving, and presence of co-morbid personality disorders along with, legal, substance, and social domains of ASI might be implicated in relapse, suggesting that addiction rehabilitation programs targeting these topics would reduce the risk of relapse.

Help-Seeking Patterns Among the General Population in Singapore: Results from the Singapore Mental Health Study 2016

This study aimed to establish lifetime mental health service utilisation among the general population of Singapore. The sociodemographic correlates of those seeking help from different service provider groups and changes in lifetime mental health service utilisation between 2010 and 2016 among those with mental disorders were also explored. A population-based cross-sectional epidemiological household survey of the Singapore resident population aged 18 years and above was conducted from 2016 to 2018, using the World Mental Health Composite International Diagnostic Interview (CIDI) version 3.0. Data from two cross-sectional population-based studies were used for comparison of lifetime mental health service utilisation in 2010 (n = 6616) and 2016 (n = 6126). Chi square test and multiple logistic regression were used to analyse the data. A total of 6126 respondents completed the study in 2016. Overall 9.3% of the total sample, 32.0% of those with mental disorders, and 5.7% of those not meeting criteria for mental disorders, ever sought help for their mental health issues in their lifetime, from any treatment service sectors. Several sociodemographic characteristics were found to be correlated with different service provider groups. There was no change in mental health service utilisation between 2010 and 2016 for all mental disorders included in this study, with the exception of a significant increase in help sought from professionals in social services, among those with alcohol abuse. Even though the overall help-seeking rates are low, it is encouraging that those seeking help did so from mental health professionals and professionals working in the social services.

Characteristics and outcomes of patients admitted to the first psychiatric intensive care unit in Egypt

Background

Psychiatric intensive care units (PICU) have become an essential part of psychiatric hospital design worldwide, there are few published data about their effectiveness.

Aim

In this study, the characteristics and outcomes of 50 Egyptian patients admitted to the first PICU in the Middle East region between April 2015 and October 2018 were retrospectively examined.

Setting

The study was conducted at the Institute of Psychiatry, Ain Shams University.

Methods

Data on patients in PICU at the Institute of Psychiatry, Ain Shams University, were collected retrospectively and analysed and included information on previous psychiatric contact, diagnoses, causes of admission and outcomes. Continuous and categorical variables were subjected to statistical analyses.

Results

The majority of patients in PICU were of female gender, having a diagnosis of schizophrenia. The most common reason for admission to the PICU is the management of delirium, followed by catatonia. The average length of patients’ stays in PICU ranged from half a day to 16 days. Immediate outcome differed where the majority of patients (47 patients, 94%) were discharged to the inpatient psychiatric ward.

Conclusion

This study reviewed practice in the first PICU in Cairo, Egypt, over 3 years, showing the importance of ongoing evaluations of patient populations in providing the best clinical practice; the typical PICU patient is likely to be: female, suffering from schizophrenia or bipolar affective disorder (BAD). The most common reason for PICU admission is for the management of delirium followed by catatonia.

Setting Up a Cognitive Training Service for Egyptian Older Adults

BACKGROUND

With greying of nations, dementia becomes a public health priority. The rising dementia prevalence escalates both health care expenses and burden, placing the entire healthcare system and caregivers under huge stress. Cognition-oriented interventions have been shown to enhance the overall cognitive performance among healthy and cognitively impaired older adults.

OBJECTIVE

This article is assumed to be a steppingstone for the introduction and establishment of cognition- oriented interventions in Egypt. In addition, it aims to offer provisional guidance for health care providers in Arab speaking countries in a stepwise approach in order to establish cognition-oriented intervention services and help them to evaluate and monitor their efficacy.

METHODS

Aconsortium of Egyptian and Greek specialists developed a protocol for the operations of the Ain Shams Cognitive Training Lab and the provision of cognition-oriented interventions. This protocol is based on a previous successful protocol that has been implemented in Greece for more than 10 years and is co-designed to fit the needs of older adults in Arabic speaking countries.

RESULTS

The types of services offered, their objectives, recruitment of participants, delivery of interventions, measurement of outcomes and privacy policy are all outlined in the policy.

CONCLUSION

Establishing the appropriate framework in which cognitive training strategies can be adapted and implemented in Arabic population, constitutes an inevitable achievement in healthy ageing and can be also assumed as a dementia prevention strategy. Moreover, setting up the first cognitive laboratory in Egypt older adults, can be a model of good practice across the Arabic countries.

Knowledge, attitude and health-seeking behavior among family caregivers of mentally ill patients at Assiut University Hospitals: a cross-sectional study

Background

Mental illness is associated with misunderstanding and unfavorable attitude worldwide. The belief in its spiritual nature made traditional healers the main service consultants for mentally ill patients. The present study is a cross-sectional study conducted among 425 main family caregivers of mentally ill patients at Assiut University Hospital. The objective of the study was to assess the caregivers’ knowledge and attitude towards mental illness as well as their health-seeking behavior for their mentally ill relatives.

Results

The studied caregivers had low scores of knowledge and attitude towards mental illness. Age of the caregivers, their education, and the type of first consulted care and aggressive behavior of the mentally ill relatives were the significant predictors of caregivers’ knowledge and attitude towards mental illness. The majority of caregivers (80.2%) sought advice for the first time from traditional healers. Traditional healers referred only 16.4% of caregivers’ mentally ill relatives to psychiatric care.

Conclusion

The studied caregivers had poor knowledge and a negative attitude towards mental illness. Traditional healers were the main consulted care. So, increasing awareness of mental illness is highly recommended.

A clinical study of suicide in patients admitted in psychiatry unit in Assiut University

Background

This study was performed for clinical study of suicide including risk factors in psychiatric patients admitted in psychiatric unit of Assiut University Hospital (AUH).

Results

We found that frequency of suicidal attempts is more in MDD (major depressive disorder), bipolar disorders followed by schizophrenia. And frequency of suicidal attempts in patients with multiple previous attempts before this one was higher in patients with mood disorders (53.8%) than psychotic and substance-induced disorders (32.3%, 13.8% respectively), with statistically significant difference in patients with MDD as well as there was significant treatment outcome on suicidal behavior.

Conclusion

The frequency of suicidal attempts is more in MDD (major depressive disorder), bipolar disorders followed by schizophrenia. There was significant severity of suicidal behavior in patients with psychotic disorders in comparison to patients with substance-induced disorder or mood disorders.

Prevalence of Mental Disorders, Cognitive Impairment, and Dementia Among Older Adults in Egypt: Protocol for a Systematic Review

Background

In Egypt, the population of older adults is rapidly growing. The last census in 2017 indicated that older adults numbered 94.8 million, which is a 2.56% increase from the 2006 census. There is growing evidence that the older population is at greater risk for some forms of mental disorders such as depression, dementia, and many more.

Objective

This study aims to review the current evidence regarding the prevalence of mental disorders among older adults in Egypt. This will be achieved by estimating the current prevalence of mental disorders and identifying any sociodemographic correlations with mental disorders.

Methods

An electronic search of 5 key databases (MEDLINE, PsycINFO, EMBASE, AMED, and PubMed) from their date of inception was conducted. In addition, scans of reference lists and searches of key journals, citations, and relevant internet resources were conducted. Studies were included if they were published in English, point prevalence studies, conducted with older Egyptians aged ≥60 years, and conducted using a validated diagnostic tool to ascertain mental disorders. Studies that did not meet any of these criteria were excluded.

Results

This systematic review started in November 2018. The literature search of the 5 databases revealed 343 papers. After screening titles and abstracts, scanning citations and reference lists, and searching internet sources, a total of 38 full-text articles were accessed, of which 16 studies met the eligibility criteria and were included. We are currently in the process of data extraction and synthesis.

Conclusions

This research will help bring the scale of mental disorders among older adults in Egypt to the forefront. This may help ensure evidence-based initiatives are established and that priority is given to resource allocation for geriatric mental health in Egypt.

Trial Registration

PROSPERO International Prospective Register of Systematic Review CRD42018114831; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=114831

International Registered Report Identifier (IRRID)

DERR1-10.2196/14637

The practice and research of cognitive behavioural therapy in Egypt: a review of the current status

Cognitive behavioural therapy (CBT) is generally defined as a short-term, problem-oriented psychotherapy that focuses on modifying dysfunctional emotions, thoughts and actions. In clinical practice, CBT consists of a number of cognitive and behavioural techniques that aim to help patients suffering from psychological disorders. The practice of CBT is well established in Western countries. In non-Western countries, CBT is still in the process of being established as the evidence-based psychotherapy. Despite being the heart of the Arab world, the development and practice of psychotherapy in Egypt in general, and CBT specifically, is still emerging. The training and practice of CBT has received a mixed response in Egypt. In practical settings, evidence-based CBT is subject to individual and cultural variations and adaptations. Many local studies examining the efficacy of CBT in psychiatric disorders among different population groups in Egypt have been conducted. Unfortunately, many of these studies have not been published and therefore have missed the opportunity for international recognition. The current review aims to explore the practice of CBT with a specific focus on national research of efficacy and adaptability of CBT for different populations in Egypt.

Key learning aims

(1)

Age dependent association of inbreeding with risk for schizophrenia in Egypt

BACKGROUND

Self-reported consanguinity is associated with risk for schizophrenia (SZ) in several inbred populations, but estimates using DNA-based coefficients of inbreeding are unavailable. Further, it is not known whether recessively inherited risk mutations can be identified through homozygosity by descent (HBD) mapping.

METHODS

We studied self-reported and DNA-based estimates of inbreeding among Egyptian patients with SZ (n = 421, DSM IV criteria) and adult controls without psychosis (n = 301), who were evaluated using semi-structured diagnostic interview schedules and genotyped using the Illumina Infinium PsychArray. Following quality control checks, coefficients of inbreeding (F) and regions of homozygosity (ROH) were estimated using PLINK software for HBD analysis. Exome sequencing was conducted in selected cases.

RESULTS

Inbreeding was associated with schizophrenia based on self-reported consanguinity (χ2 = 4.506, 1 df, p = 0.034) and DNA-based estimates for inbreeding (F); the latter with a significant F × age interaction (β = 32.34, p = 0.0047). The association was most notable among patients older than age 40 years. Eleven ROH were over-represented in cases on chromosomes 1, 3, 6, 11, and 14; all but one region is novel for schizophrenia risk. Exome sequencing identified six recessively-acting genes in ROH with loss-of-function variants; one of which causes primary hereditary microcephaly.

CONCLUSIONS

We propose consanguinity as an age-dependent risk factor for SZ in Egypt. HBD mapping is feasible for SZ in adequately powered samples.

Frequency of use of the International Classification of Diseases ICD-10 diagnostic categories for mental and behavioural disorders across world regions

AIMS

The study aimed to examine variations in the use of International Classification of Diseases, Tenth Edition (ICD-10) diagnostic categories for mental and behavioural disorders across countries, regions and income levels using data from the online World Psychiatric Association (WPA)-World Health Organization (WHO) Global Survey that examined the attitudes of psychiatrists towards the classification of mental disorders.

METHODS

A survey was sent to 46 psychiatric societies which are members of WPA. A total of 4887 psychiatrists participated in the survey, which asked about their use of classification, their preferred system and the categories that were used most frequently.

RESULTS

The majority (70.1%) of participating psychiatrists (out of 4887 psychiatrists) reported using the ICD-10 the most and using at least one diagnostic category once a week. Nine out of 44 diagnostic categories were considerably variable in terms of frequency of use across countries. These were: emotionally unstable personality disorder, borderline type; dissociative (conversion) disorder; somatoform disorders; obsessive-compulsive disorder (OCD); mental and behavioural disorders due to the use of alcohol; adjustment disorder; mental and behavioural disorders due to the use of cannabinoids; dementia in Alzheimer's disease; and acute and transient psychotic disorder. The frequency of use for these nine categories was examined across WHO regions and income levels. The most striking differences across WHO regions were found for five out of these nine categories. For dissociative (conversion) disorder, use was highest for the WHO Eastern Mediterranean Region (EMRO) and non-existent for the WHO African Region. For mental and behavioural disorders due to the use of alcohol, use was lowest for EMRO. For mental and behavioural disorders due to the use of cannabinoids, use was lowest for the WHO European Region and the WHO Western Pacific Region. For OCD and somatoform disorders, use was lowest for EMRO and the WHO Southeast Asian Region. Differences in the frequency of use across income levels were statistically significant for all categories except for mental and behavioural disorders due to the use of alcohol. The most striking variations were found for acute and transient psychotic disorder, which was reported to be more commonly used among psychiatrists from countries with lower income levels.

CONCLUSIONS

The differences in frequency of use reported in the current study show that cross-cultural variations in psychiatric practice exist. However, whether these differences are due to the variations in prevalence, treatment-seeking behaviour and other factors, such as psychiatrist and patient characteristics as a result of culture, cannot be determined based on the findings of the study. Further research is needed to examine whether these variations are culturally determined and how that would affect the cross-cultural applicability of ICD-10 diagnostic categories.

Integrating Egyptian mental health services into primary care: the policy maker's perspective

Egypt has a population of roughly 80 million, served by about 9000 psychiatric beds, 1000 psychiatrists (one psychiatrist per 80 000 citizens), 1900 psychiatric nurses and about 200 clinical psychologists (Okasha, 2004). Service providers fall into three main sectors: public, private, and not-for-profit non-governmental organisations (NGOs). The public sector is managed essentially by the Ministry of Health and bears the brunt of service provision.

Risk factors for non-fatal occupational injuries among construction workers: A case–control study

Background:

Substance abuse is a serious problem, because it affects both workers and young people. Prevalence and consequences of cannabis abuse among construction workers in particular are not well studied in Egypt.

Objectives:

To determine the association between non-fatal occupational injuries among construction workers and their demographic and occupational factors and to assess the frequency of cannabis abuse and its relationship to injury severity and workdays lost.

Subjects and methods:

A case–control study was conducted at Mansoura Emergency Hospital. Cases were 100 acutely injured male workers. A control group of 90 healthy age-matched workers was selected from 8 construction sites. Workers were interviewed, and a questionnaire was completed that included socio-demographic data, full occupational history, and causes and type of injury. Injury outcome measures included lost workdays and the injury severity score (ISS). Cannabis abuse in injured workers was monitored by preliminary testing of urine and confirmatory testing of blood.

Results:

Logistic regression analysis revealed that the independent predictors of occupational injuries were rural residence, being a carpenter or painter and past history of injuries. The most common accidents were slipping falls (62%). Confirmed cannabis test was positive in 51.1% of the injured workers. Median days away from work were greater among cannabis users than non-users. The ISS was significantly higher among users compared to non-users ( p < 0.05).

Conclusion:

Cannabis abuse can increase injury severity and prolong workdays lost. Drug testing is recommended for at-risk construction workers with inadequate safety measures.

Islamist suicide terrorism and erich fromm’s social psychology of modern times

Mainstream social science has struggled to explain the appeal of suicide terrorism to so many Muslim youths, relying as it does on standard socio-economic indicators and research meant to identify suicidal tendencies. The existential emphasis is missing. This commentary is inspired by the work of clinical psychologist Erich Fromm (1900-1980) and his investigation of the social psychology of modernity, as well as how this intermingles with existential fears related to mortality (death-related fears) and the passage of time (the end of the world or apocalypse). Modernity, explained Fromm, makes one feel small, insignificant and isolated in the larger scheme of things. This demands a violent response, often involving self-sacrifice, to reassert the balance, which allows Islamists to take advantage of death-related anxieties and exaggerate the sense of confrontation with the world through apocalyptic prophecies. Current psychological research on death and studies of terrorism and religious extremism both confirm many of Fromm’s findings and expand on them. In this commentary I argue that the religion of Islam, far from being a source of suicide terrorism, has historically restrained both suicidal tendencies and political violence directed at civilians, but it is the slow yet sure encroachment of modernity that has eroded these theological and communitarian defences. Other problems, such as household politics, gender roles, and theological teachings concerning death likewise feed this process, as documented by Arabic researchers in contexts other than political violence.

Duration of untreated psychosis and pathway to care in Riyadh, Saudi Arabia

AIM

Recent studies of 'duration of untreated psychosis' (DUP) indicate that some patients remain untreated in the community for some time. Considerable emphasis has been placed on reducing the DUP. However, most studies investigating DUP have been conducted in Western countries, where well-developed primary care systems are available. This study aims to describe DUP and its association with both demographic factors and pathways to care in Riyadh, Saudi Arabia.

METHODS

A retrospective study of 421 new case records of all Saudi schizophrenia patients over a 2-year period in six governmental hospitals in Riyadh, Saudi Arabia.

RESULTS

The median DUP was 1.41 years (interquartile range 0.35-2.81 years). The longest time to contact was 9.86 years but 90% had a DUP shorter than 5 years. Older age at onset, single marital status and higher educational level were associated with shorter DUP. Long DUP was associated with help seeking from traditional healers.

CONCLUSION

In Saudi Arabia, it usually takes longer for patients to seek help from psychiatric services after their first psychosis onset than it does in Western countries. The results suggest that the DUP is influenced by both demographic factors and pathways to care.

Pathophysiology of refractory obsessive-compulsive disorder: A study of visual search combined with overactive performance monitoring

Based on both functional and structural studies of excessive activity, fronto-striatal-thalamic-cortical and cortico-striatal circuits have been hypothesized to underlie the pathophysiology of obsessive-compulsive disorder (OCD). However, the neurobiological underpinnings of OCD refractory to medication and therapy remain controversial. This study aimed to evaluate neuroanatomical abnormalities of the whole brain and to evaluate visual processing in patients with refractory OCD.This study was comprised of 2 experiments. The neuroanatomical abnormalities of the whole brain were evaluated using a visual search in combination with overactive performance monitoring (Experiment I), and visual processing was evaluated using event-related potentials recorded from subjects during performance of a visual search task. We also examined the amplitudes and latency of the error-related negativity (ERN) using a modified flanker task (Experiment II). Standard low-resolution electromagnetic tomography analysis was applied to determine the special areas.Patients with refractory OCD had a significantly greater number of saccades and prolonged latencies relative to the healthy controls. Scalp map topography confirmed that visual cognitive and executive dysfunction was localized to the fusiform gyrus. Furthermore, we found that during a modified flanker task, ERNs had a greater amplitude and a prolonged latency relative to those of the healthy controls. Further data analysis suggested that cognitive dysfunction and compulsive behavior in OCD patients were linked to abnormalities within the dorsolateral prefrontal cortex (DLPFC).We identified abnormal activities within the fusiform gyrus and DLPFC that likely play important roles in the pathophysiology of OCD.

Forensic analysis of suicidal ideation among medical students of Egypt: A crosssectional study

Suicide is one of the major causes of death in the world. In this study a total of 612 students from two public universities in Cairo were assessed using an online survey that included 19 items from the self administered version of Beck's Suicidal Ideation scale in addition to three questions to assist in forensic analysis of the suicide. 12.75% of respondents scored above 24 in the 19 items from the suicidal ideation scale. Females showed a slightly higher score of suicidal ideation (Mean 18.1, SD 12.22) and year 1 students tended to score higher than pre-clinical and clinical phase students (Mean 15.1, SD 10.1, P value 0.042). Most of the suicide plans were to be executed at home with the use of available medications for overdose. This study shed light on the importance of support systems for medical students with a high stress on family support.

Neuropsychological performance of Finnish and Egyptian children with autism spectrum disorder

Background

Previous studies investigating neuropsychological functioning of children with autism spectrum disorder (ASD) have only analysed certain abilities, such as executive functions or language. While comprehensive assessment of the neuropsychological profile of children with ASD has been the focus of recent research, most of the published evidence originates from single centres. Though studies on differences in neuropsychological features of children with ASD across countries are essential for identifying different phenotypes of ASD, such studies have not been conducted.

Objective

Our goal was to assess the neuropsychological abilities of children with ASD in northern Finland and Egypt and to examine the effect of age and intelligence quotient (IQ) on these abilities.

Design

Selected verbal and non-verbal subtests of the neuropsychological assessment NEPSY were used to examine 88 children with ASD in northern Finland (n=54, age M=11.2, IQ M=117.1) and Egypt (n=34, age M=8.4, IQ M=96.6).

Results

Finnish ASD children scored significantly higher than their Egyptian counterparts on the verbal NEPSY subtests Comprehension of Instructions (p<0.001), Comprehension of Sentence Structure (p<0.01), Narrative Memory (p<0.001) and Verbal Fluency (p<0.05) and on the non-verbal NEPSY subtest Design Fluency (p<0.01). Finnish and Egyptian ASD children did not differ on the subtests Memory for Faces, Object Recognition and Object Memory. In addition, we found that age and verbal IQ can have significant influence on neuropsychological performance.

Conclusions

Our results suggest a possible cultural impact on verbal and visuomotor fluency. However, the ability to recognize and memorize objects and the disability to remember faces appear to be typical for ASD and culturally independent.

A Comparative Study of Nurses as Case Manager and Telephone Follow-up on Clinical Outcomes of Patients with Severe Mental Illness

BACKGROUND

Providing community-based mental health services is crucial and is an agreed plan between the Iranian Mental Health Office and the Regional Committee for the Eastern Mediterranean (affiliated with WHO). The aim of this study was to determine the effectiveness of home-visit clinical case-management services on the hospitalization rate and other clinical outcomes in patients with severe mental illness.

METHODS

A total of 182 patients were randomly allocated into three groups, namely, home-visit (n=60), telephone follow-up (n=61) and as-usual care (n=61) groups. Trained nurses as clinical case-managers provided home-visit services and the telephone follow-up tasks. Hospitalization rate as a measure of recurrence, as well as burden, knowledge, general health condition of caregivers with positive/negative symptoms, satisfaction, quality of life, and social skills of the consumers were assessed as the main and secondary outcomes, respectively.

RESULTS

Most clinical variables were improved in both intervention groups compared with the control group. During the one year follow-up, the rate of rehospitalization for the telephone follow-up and as-usual groups were respectively 1.5 and 2.5 times higher than the home-visit group.

CONCLUSION

Trained clinical case-managers are capable of providing continuous care services to patients with severe mental illness. The telephone follow-up services could also have beneficiary outcome for the consumers, their caregivers, and the health system network.

Study of depression and quality of life among hemodialysis patients: an Egyptian experience

PURPOSE

Depression is common among hemodialysis patients. Even in developed countries, the prevalence of depression and its relation to health-related quality of life (HRQOL) in dialysis patients has only been poorly investigated. Furthermore, similar reports from many developing countries such as Egypt are scarce. This might be due to cultural and social concerns. This study is intended to address this important issue.

METHODS

This cross-sectional study was conducted at the dialysis unit of the Urology and Nephrology Center, Mansoura University, Egypt. Data of 76 chronic hemodialysis patients (mean age 43.2 ± 15 years; 54 males and 22 females) were retrieved. Psychiatric interview and psychometric assessment of depression and HRQOL (using an Arabic-adapted Beck Depression Inventory II and Short Form scale, respectively) were performed.

RESULTS

Depression was diagnosed in 58 patients (76.3 %). Of them, 18 (23.7 %), 15 (19.7 %) and 25 patients (32.9 %) were suffering from mild, moderate and severe depression, respectively. Depressed dialysis patients group was comparable to the non-depressed group except for a higher prevalence of peripheral neuropathy (46.7 vs. 11.5 %; p = 0.034) and a less frequent use of iron therapy (52.7 vs. 86.7 %; p = 0.017). Except for role limitation due to physical problems, all HRQOL aspects were significantly worse among the whole group of depressed patients compared to the non-depressed group.

CONCLUSION

Depression is common among our Egyptian hemodialysis patients. It seems to adversely affect almost all aspects of HRQOL. Therefore, a regular combined nephrology/psychiatry approach should be central to the medical care of hemodialysis patients in order to accurately assess for depression among them. Moreover, large national studies to delineate the prevalence and impact of depression among Egyptian hemodialysis patients are needed.

Clinical characteristics of autism spectrum disorder in Israel: impact of ethnic and social diversities

Despite the increased global prevalence and recognition of autistic spectrum disorder (ASD), it is still scarcely reported in the Arab world. Though Israel has a higher prevalence of ASD, a previous national survey of patients diagnosed between 1972 and 2004, demonstrated that 98% of them were of Jewish ancestry. The disproportional low number of Arab children with ASD in Israel is unclear but may reflect lower awareness and cultural bias. In the present study we collected clinical and demographic characteristics of 200 children with ASD from Arab and Jewish sectors in Israel that were evaluated in two child development centers. We compared the incidence and the medical comorbidity of autism between these two ethnics groups. The medical and psychiatric comorbidity profile in these children was similar to the worldwide published studies. In the present study the prevalence of autism in the Arab sector in Israel was similar to that of the Jewish sector. The Arab patients presented with more severe autistic manifestations and higher incidence of mental retardation, familial members with autism, and consanguinity (P < 0.05), while in the Jewish sector milder forms (such as Asperger syndrome and PDD-NOS) were more frequent. This discrepancy might be explained by both genetic and cultural factors.

Medical and Psychiatric Effects of Long-Term Dependence on High Dose of tramadol

BACKGROUND

Tramadol dependence has been studied recently after large-scale exposure. Although tramadol dependence has increased rapidly in Egypt since 2004, no studies have evaluated the effect of high dose long-term tramadol dependence.

OBJECTIVES

To address the chronic sequel of tramadol dependence over at least 5 years duration with a large dose (more than 675 mg/day, three tablets or more, each tablet of 225 mg). The study was aimed to check the physical and psychiatric status during tramadol dependence and 3 months after complete treatment.

METHODS

The present study was applied on 79 patients with single tramadol-dependence dose of 675 mg or more for 5 years or more. We examined the physical and psychological impact of tramadol abuse before and after 3 months of stoppage of the drug.

RESULTS

The blood chemistry was nearly within normal parameters, although slight nonsignificant rise in liver enzymes was reported in some cases. Patients during tramadol dependence period were angry, hostile, and aggressive. On the other hand, after treatment the main problem observed was the significant increase in comorbid anxiety, depressive, and obsessive-compulsive symptoms, but no increase was found in psychotic symptoms. Tramadol-dependence dose was more important than duration of use in psychiatric illness.

CONCLUSIONS

Tramadol dependence on high dose could be physically safe to some limit, but psychiatrically it has many side effects.

The bidirectional relation between psychiatric disorders with selected cardiovascular and endocrinal diseases: an Egyptian perspective

Cardiovascular and endocrine diseases may act as burdens for individuals suffering from one of these medical illnesses, and whether through the ensuing psychological distress, or some biological mechanisms, these medical diseases can eventually lead to the development of psychiatric morbidities. Moreover, psychiatric morbidities negatively affect the prognosis of both cardiovascular and endocrine diseases. Despite transcultural differences, Egyptian patients with ischemic heart diseases (ISHD), heart failure (HF), diabetes mellitus (DM), or thyroid diseases (TD) endure the same psychological distress as their Western counterparts. Psychiatric assessment and evaluation should be regularly repeated among patients with cardiovascular and endocrinal diseases, and patients who are at risk should be closely followed up.

Patterns of disease presentation and management in Egyptian primary care: findings from a survey of 2458 primary care patient consultations

Background

The Egyptian government is considering embarking on a new wave of health sector reform. Although primary care is seen as central to the anticipated reforms, little is known about the current morbidity and utilization patterns in Egyptian publicly funded primary care. We conducted this survey study of patient encounters to describe the demographic characteristics of patients attending publicly-funded primary care practices, the relative frequency of conditions encountered in these practices, and the rates of drug prescription, investigation and referral.

Method

Cross-sectional survey of twelve primary care practices and 2458 patient consultations. Additional secondary data were collected from five of the twelve practices for preventive services provided at these practices i.e. immunizations, family planning and ante-natal care.

Results

54% of the attendances were for people below the age of twenty, of which 54% were females. In patients above the age of twenty, women accounted for 73% of consultations. Upper respiratory tract infection was the most common reason for encounter, accounting for 24% of the presentations, followed by gastroenteritis (10%), intestinal parasites (5%), and lower respiratory tract infections (5%). Over 97% of patients were prescribed at least one drug, whereas investigation and referral rates were low (15% and 5% respectively). When the analysis was repeated for practices where data on both curative and preventive services were available (5 practices and 2146 consultations), substantial proportions of patients were found to seek care for immunizations (25%), family planning (12%), and ante-natal care (11%).

Conclusion

Most patients utilizing primary care practices in Egypt seek care for minor and preventive services with relatively few consultations for more serious conditions. There is also a pattern of prescribing drugs to most primary care patients which may reflect over-prescribing by primary care doctors.

Impact of religion and culture on mental disorders among Egyptians

This review looks at the long-established customs and religious beliefs, as well as social and family structures, affecting the symptoms of psychiatric disorders among Egyptian people. It considers reactions to emotional distress and dysfunctionality. Some light is also shed on the healthcare system.

Psychiatric Morbidity among a Sample of Orphanage Children in Cairo

Objective. This study identifies the prevalence of emotional and behavioral problems and the associated factors in orphanage children. Methods. This cross-sectional study was conducted in three private orphanages in Cairo. Two hundred sixty-five children of ages ranging from 6 to 12 years living in three different orphanages care systems were included in the study. A sociodemographic information form and the Child Behavior Checklist (CBCL) were used. Children were clinically interviewed and psychiatric disorders were identified. Diagnoses were done according to the manual for diagnosis and statistics of mental disorder fourth version (DSMIV). A written formal consent from the director of social solidarity was obtained before inclusion in the study. Results. The prevalence of behavioral disturbances was 64.53% among those in institutional care and the most prominent psychiatric disorders were nocturnal enuresis (23.3%), attention deficit hyperkinetic disorder (ADHD) (19.62%), oppositional defiant disorder (17.36%). Age at first admission, causes of receiving institutional care, and moves 2 or more times between institutions were significantly associated with an increased risk of behavioral and emotional problems. Conclusion. Our study showed that children living in institutions are prone to suffer from psychiatric disorders. Stability of the caregiver acts as a protective variable.

Overview of the family structure in Egypt and its relation to psychiatry

The family is the basic unit of any society and culture. The concept, structure, and function of the family unit vary considerably across different cultures; however, its role continues to be imperative to the development of individuals and their psychological make-up. All societies have a concept of 'family', its relative importance, structure, and functions; however, this varies according to the particular culture. In the Arabic culture, as well as other collectivistic cultures, the extended family is often regarded as the basic unit. The family is the foundational and basic social unit that fosters the stability, well-being and sustainability of society. The quality of family relationships shapes and influences the social, psychological, and biological development and functioning of its members. This may be especially relevant to individuals with mental health problems. The people of ancient Egypt valued family life highly, and this is the case even now. They treasured children and regarded them as a great blessing. If a couple had no children, they would pray to the gods and goddesses for help. They would also place letters at the tombs of dead relatives asking them to use their influence with the gods. The importance of family has not changed dramatically even though the structures are beginning to. In this paper we highlight changes in family set-up and the state of family therapy in Egypt.

Sociodemographic and Clinical Characteristics of Patients attending Psychotherapy in a Tertiary Care Hospital in Oman

OBJECTIVES

There is significant evidence that psychotherapy is a pivotal treatment for persons diagnosed with Axis I clinical psychiatric conditions; however, a psychotherapy service has only recently been established in the Omani health care system. This study aimed to investigate the sociodemographic and clinical characteristics of attendees at a psychotherapy clinic at a tertiary care hospital.

METHODS

An analysis was carried out of 133 new referrals to the Psychotherapy Service at Sultan Qaboos University Hospital, a tertiary care hospital.

RESULTS

The majority of referrals were females (59%), aged 18-34 years, employed (38%), had ≤12 years of formal education (51%), and were single (54%). A total of 43% were treated for anxiety disorders (including obsessive compulsive disorder), while 22% were treated for depression. A total of 65% were prescribed psychotropic medications. The utilisation of the Psychotherapy Service and its user characteristics are discussed within the context of a culturally diverse Omani community which has unique personal belief systems such as in supernatural powers (Jinn), contemptuous envy (Hassad), evil eye (Ain) and sorcery (Sihr) which are often used to explain the aetiology of mental illness and influence personal decisions on utilising medical and psychological treatments.

CONCLUSION

Despite the low number of referrals to the Psychotherapy Service, there is reason to believe that psychotherapy would be an essential tool to come to grips with the increasing number of mental disorders in Oman.

Menopause and work--the experience of middle-aged female teaching staff in an Egyptian governmental faculty of medicine

OBJECTIVES

There is a global trend of increasing numbers of older women in the workforce. However, limited information is available regarding the relationship between the menopause transition and work, especially in developing countries. The objectives of this study were to investigate the relationship between experience of the menopause transition and work and to examine the factors affecting how women cope, including the extent to which women disclosed their menopausal status.

METHODS

Using a cross-sectional single group design, 131 middle-aged female medical teaching staff working in Zagazig Faculty of Medicine completed questionnaires and semi-structured interviews.

RESULTS

Participants, particularly those who were postmenopausal, reported high average scores on depressed mood, memory/concentration, sleep problems, vasomotor symptoms, and sexual behavior subscales of the Women's Health Questionnaire (WHQ). Women reported that poor working environment and work policies and conditions, functioning as sources of work stress, aggravated their menopausal symptoms. Disclosure of their menopausal status was uncommon; limited time and socio-cultural barriers were the most commonly reported reasons for non-disclosure.

CONCLUSION

It could be concluded that the menopause transition is an important occupational health issue especially for women in developing countries. Implementing health promotion programs, improving working environment and work policies, and raising awareness of menopause are recommended to help women to cope with the menopause transition and to maintain well-being and productivity at work.

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

BACKGROUND

Adolescents 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 STUDY

Through 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.

METHODS

A 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.

RESULTS

The 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.

CONCLUSIONS

The 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.

Acculturation and polysubstance abuse in Arab-American treatment clients

Acculturation to U.S. culture by Latinos and Asian Americans has been associated with increased prevalence of substance abuse. However, little is known about the association between acculturation and substance use among Arab Americans, or more specifically, among Arab-American treatment clients. In 156 Arab-American male treatment clients, we found that higher levels of U.S. acculturation were positively associated with increased prevalence of polysubstance abuse. This first report on a large series of Arab-American clients also found considerable within-group variability. These results can be used to develop treatment plans and work-force training on the importance of U.S. acculturation and variability within Arab Americans.

Case-management for patients with schizophrenia in Iran: a comparative study of the clinical outcomes of Mental Health Workers and Consumers' Family Members as case managers

The objective of this study was to evaluate the effectiveness of case-management services and the feasibility of considering the Consumers' Family Members (CFM) as service providers in Iran as a developing country. Three trained case-managers were allocated into each group (Mental Health Worker-MHW and CFM), providing 12 months of home-visit services for 129 individuals with schizophrenia. Burden, knowledge, quality of life and the general health condition of the caregivers, as well as positive/negative symptoms and social skills of the consumers were evaluated. Most clinical variables were improved without significant differences between groups. The hospitalization rate was reduced by 67%.

Health services utilization by school going Omani adolescents and youths with DSM IV mental disorders and barriers to service use

BACKGROUND

Recent corpus of research suggests that psychiatric disorders amongst adolescents and youths are an emerging global challenge, but there is paucity of studies exploring health services utilization by this age group in Arab region.

AIM

This study focus on the health services utilization and the barriers among school going adolescents and youths with DSM IV disorders in the country Oman, whose population is predominantly youthful.

METHODS

Representative sample of secondary school Omani adolescents and youths were concurrently interviewed for the (i) presence of DSM IV mental disorders using the face-to-face interview, World Mental Health-Composite International Diagnostic Interview (WMH-CIDI), (ii) tendency for health care utilization and (iii) predictors of utilization with clinical and demographic background.

RESULTS

The proportions of lifetime cases having ever made treatment contact are low, being 5.2% for any anxiety disorder and 13.2% for any mood disorder category. None of these anxiety cases made treatment contact in the year of onset of the disorder, and the median delay when they eventually made treatment contact is about 14 years. In any mood disorders category only 3.6% made contact within the 1st year of onset with the median delay in initial treatment contact is two years for the Bipolar disorder (broad), four years for Any Mood disorder and nine years for the Major Depressive Disorder group. Male gender is significantly associated with less likelihood of making treatment contact when suffering from Social phobia (p = 0.000), Major Depressive Disorder (p = 0.000) and Bipolar Disorder (p = 0.000). The younger cohorts of 14-16 years and 17-18 years of Social phobic made significantly less lifetime any treatment contact (p = 0.000). The 14-16 year olds were significantly less likely to make lifetime any treatment contact for Bipolar Mood disorder (p = 0.000), while the 17-18 group were 1.5 times more likely to do so. Over past 12 months only between 6 to 12% of those having some form of mental disorder avail of any treatment facility with utilization pattern nearly equal between the any healthcare and any non healthcare facilities. In the any healthcare services, more of those with anxiety disorders seek help from general medical doctors while those with Major Depressive Disorder and any Mood disorders are comparatively treated more by non allopathic services. Females were 13.5 times more likely to avail treatment(chi sq 7.1) as also those cases with increased severity of illness were 7 times more likely(chi sq 9.6). In the any treatment category for any 12 month disorder in general, the younger cohort of 14-16 years is 2.2 times more likely to receive any treatment over past 12 months (p = 0.042) while the situation shows marked reversal in the 17-18 age groups. Having any mood disorder is a significant predictor for the same (p = 0.040).

DISCUSSION

Present findings confer with other studies from elsewhere suggesting under utilization of health care services for those with mental illness. Since cultural teaching and traditional coping with mental illness are contributing significantly in furnishing mental health need for many in Oman, the findings are discussed within social-cultural context that forms the basis of the complex health care utilization in Oman. This could foster policies that help bridge the gap between allopathic and non-allopathic care services.

Prevalence of emotional and behavioural problems among 6-12 year old children in Egypt

Epidemiological information about prevalence of child mental health problems is essential to inform policy and public health practice. This information is weak in many developing countries and those in developmental transition. There have been few such studies in Arab countries and none in Egypt. We conducted a population prevalence study of emotional and behavioural disorders among 1186 6-12 year old children in Minia, Egypt. Data was collected from teachers and parents using the Strengths and Difficulties Questionnaire with a 98 and 91% response respectively. Prevalence of abnormal symptom scores is reported for both parents and teachers. Prevalence of probable psychiatric diagnoses was measured using the SDQ multi-informant algorithm. These prevalences have then been compared to published UK data. The prevalence of emotional and behavioural symptoms was high as reported by both parents and teachers (Abnormal total difficulties: teachers 34.7% (95% CI 32.0-37.5), parents 20.6% (18.2-23.2). Abnormal prosocial scores: teachers 24.9% (22.5-27.5), parents 11.8% (9.9-13.9)) but prevalence of probable psychiatric diagnoses was much lower (Any psychiatric diagnosis 8.5% (6.9-10.5); Emotional disorder 2.0% (1.2-3.0); Conduct disorder 6.6% (5.1-8.3); Hyperactivity disorder 0.7% (0.3-1.4)). Comparison with UK data showed higher rates of symptoms but similar rates of probable disorders. Despite public, professional and political underestimation of child mental health problems in Egypt, rates of symptoms are higher than in developed countries, and rates of disorders are comparable. These findings support greater investment in community and primary care prevention and treatment initiatives.

Psychiatry in the land of the Sphinx: is an overseas elective justified?

OBJECTIVE

The aim of this paper is to provide a descriptive account of a 6-month sabbatical in Egypt to highlight the diversity of benefits in incorporating such activities within psychiatric training programs.

CONCLUSIONS

An overseas elective offers an exciting practical opportunity to broaden one's experience of transcultural psychiatry and obtain a perspective on mental illness and its cultural variations. It also promotes an understanding of health service management in low and middle income countries and offers the opportunity to contribute to their healthcare at minimal cost. However, the elective needs to be undertaken at an optimal period of a psychiatrist's career and with minimal disruption to local services. Training schemes and employers could provide more opportunities for interested trainees, with specified projects and aims in mind, to undertake such electives so that they can begin to develop expertise in treating a particular cultural group. In turn, this would go a long way to producing culturally capable psychiatrists for the wide range of ethnic minorities in Australia.