Late Onset First Episode Psychosis Emerging as Delusional Misidentification of Familiar Sacred Places During a Holy Pilgrimage: A Case Report and Literature Review.

BACKGROUND: The delusional misidentification syndromes (DMS) include a myriad of discrete but related syndromes, which have wide spectrum anomalies of familiarity. Several misidentification syndromes have been described in the psychiatric literature, the most common of these delusions are: the Capgras syndrome; the Fregoli syndrome; the syndrome of inter-metamorphosis; reduplicative paramnesia; and environmental reduplication. CASE PRESENTATION: The reported case highlights the emergence of late onset first episode psychosis in a Middle Eastern 65-year-old female who has no previous psychiatric history. The nature of psychosis was mainly delusions of misidentification and persecution. DISCUSSION: DMS are relatively rare and occur predominantly in association with schizophrenia and affective psychosis. Between 25 and 40% are associated with organic conditions such as dementia, head injuries, brain tumors, and epilepsy. Only three cases of misidentification of sacred places have been reported previously in the literature. This case report is the first to present a DMS, emerging as a late onset first episode psychosis during the sacred journey of Hajj. CLINICAL IMPLICATIONS: The reported case highlights the importance of early recognition and treatment of mental health conditions that may appear de novo during the Hajj sacred journey. Readily available psychiatric resources, psychotropic medications, and psycho-education may be pivotal in ensuring mental well-being of pilgrims, which is fundamental to maintain the mental capacity required for completing these journeys.

Association between Depression and Factors Affecting Career Choice among Jordanian Nursing Students.

BACKGROUND: Although stress reaction is high among nursing staff and nursing students in the Middle East and its effect on life is known, there are scant studies reporting on these clinical and social features. In addition, there are no studies reporting on factors that influence career choice among this group. AIM: This study aimed to investigate factors that influence career choice among nursing students and their possible association with depressive symptoms. METHOD: Participants were 150 (84.7% response rate) nursing students randomly selected from each academic year at the Nursing College/Jordan University of Science and Technology. Participants consented and completed the socio-demographic data collection sheet. The Arabic version of the Beck Depression Inventory-II Scale was used to assess participants with respect to depressive symptoms. A modified list of factors influencing career choice and a Likert scale to assess the level of sadness and the degree of religiosity were used as well. RESULTS: Students ranked the most important three factors influencing their career selection as family decision, religious factors, and the desire to care for others. The prevalence of depression among the sample was 26%. Students who had a desire to care for others were less likely to suffer from depression and those who chose nursing as their career due to religious factors were significantly less depressed than those who did not. Meanwhile, students who chose nursing under family pressure or because of a lack of alternative opportunities were more depressed. The odds ratio for depressive symptoms was 0.24 when students chose nursing because of religious factors, whereas it was 4.92 when the family strongly influenced the student's career decision and 3.61 when a nursing career was the only perceived opportunity available. CONCLUSION: The main factors associated with depression among this sample of nursing students were pressure from their family to choose a nursing career and having no other career or employment opportunities. Religiosity was negatively associated with depression and may act as a protective factor; however, future studies using longitudinal designs will need to confirm this hypothesis.

Schizophrenia: Impact of psychopathology, faith healers and psycho-education on adherence to medications.

BACKGROUND: Many patients suffering from psychosis are nonadherent to their medications. Nonadherence can range from treatment refusal to irregular use or partial change in daily medication doses. AIM: To investigate whether symptom dimensions, post-discharge care plans and being involved with faith healer affect the adherence to treatment in patients with schizophrenia. METHOD: A total of 121 patients with schizophrenia were examined 6 weeks post-discharge from the inpatient unit and assessed for full, partial or nonadherence to medication. RESULTS: There was a significant association between family involvement and partial adherence and between community team involvement post-discharge and full adherence to medications. Psycho-education was a predictor for adherence to medications, persecutory delusions and lack of insight predicted partial adherence, while being involved with faith healers predicted nonadherence. CONCLUSION: Adherence to medications and socio-demographic variables are independent. This study demonstrated that nonadherence or partial adherence to medications is associated with lack of insight and persecutory delusions. Psycho-education could improve the adherence to medication compliances.

Impact of political violence on the mental health of school children in Egypt.

BACKGROUND: Since the beginning of the Egyptian political conflict, Tahrir Square has been the epicentre of intense political violence. Students attending schools located near this square witnessed and/or directly experienced the consequences of a series of violent events. AIM: This study will investigate the presence of psychiatric symptoms in children attending these schools to explore patterns of responses according to their perceptions of the revolution on their lives, adjusted for, gender and socio-economic status. METHOD: A descriptive cross-sectional study conducted with 515 Egyptian school children attending government, experimental, and private language schools located within 1 km of Tahrir Square. To assess psychiatric symptoms in these children, a specially designed questionnaire was used to detect, depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms and impairments. RESULTS: Children attending schools near Tahrir Square showed high rates of depression, PTSD and anxiety symptoms. The risk factors identified for developing psychiatric symptoms were a negative perception of the effect of the revolution, knowing someone exposed to trauma during the events, female gender and low socio-economic class. DISCUSSION: These results highlight the need for large-scale studies to explore the consequences of ongoing political violence on children and to establish baseline data on the mental health of Egyptian children.

A specific, accurate, and sensitive measure of total plasma malondialdehyde by HPLC.

Malondialdehyde (MDA) is one of the most commonly reported biomarkers of lipid peroxidation in clinical studies. The reaction of thiobarbituric acid (TBA) with MDA to yield a pink chromogen attributable to an MDA-TBA2 adduct is a common assay approach with products being quantified by ultraviolet-Vis assay as nonspecific TBA-reactive substances (TBARS) or chromatographically as MDA. The specificity of the TBARS assay was compared with both chromatographic assays for total plasma MDA. The levels of total plasma MDA were significantly lower than the plasma TBARS in each of the samples examined, and interestingly, the interindividual variation apparent in the level of plasma MDA was not evident in the plasma TBARS assay. Each of the four online chromatographic detectors yielded a precise, sensitive, and accurate determination of total plasma MDA, and selected-ion monitoring was the most-accurate assay (101.3%, n = 4). The online diode array detectors provided good assay specificity (peak purity index of 999), sensitivity, precision, and accuracy. This research demonstrates the inaccuracy that is inherent in plasma TBARS assays, which claim to quantify MDA, and it is proposed that the TBARS approach may limit the likelihood of detecting true differences in the level of lipid peroxidation in clinical studies.

Impact of self-reported life events on the profile of opioid dependence syndrome.

AIM: The aim of this work was to investigate the impact of life events on the profile of opioid dependent patients. METHOD: Recruitment was achieved through outpatient drug treatment clinic in Birmingham, UK, and data were collected through semistructured interviews. One-hundred and twenty subjects with opioid dependence syndrome were interviewed, and 100 controls of non-drug-using family members and friends. RESULT: The mean age of the opioid group was 33.3 years, SD = 8.8. The majority individuals of the sample were White British (80.8%), unemployed (69.2%), and male (75%). The mean severity of dependence as measured by two scales indicated severe level of dependence according to the authors of each scale. The mean number of traumatic events for the opioid dependence group was 4.8, SD = 3.57 vs. 3.55; SD = 3.65 in control group with significant difference (t = 2.56, df = 218, p = .01). Significant predictors of severe opioid dependency were age of second exposure to events, change of residence, break-up with boy/girlfriend, and conflict with father. CONCLUSION: The data presented indicate that a significant group of opioid dependent patients experience adverse life events in both childhood and adulthood. It is by attending to and addressing these issues that health care workers can alleviate ongoing distress and promote confidence.

Subjective life satisfaction and mental disorders among older adults in UAE in general population.

BACKGROUND: Life satisfaction is widely considered to be a central aspect of human welfare. Many have identified happiness with it, and some maintain that well-being consists largely or wholly in being satisfied with one's life. Empirical research on well-being relies heavily on life satisfaction studies. AIMS: The aim of this study was to examine the relationships of psychiatric disorders and physical disorders on life satisfaction among Arab older adults in general population. METHODS: Face-to-face interviews with Geriatric Mental State Interview (GMS-A3) were conducted with a nationwide sample of 2000 household in 2001. Total samples of 610 elders (above 60 years) were interviewed. RESULTS: There were 347 males (56.9%) and 263 females (43.1%). The mean age was 68.6 years (SD = 8.3). The commonest diagnoses were depression (20.2%), anxiety (5.6%), hypochondriasis (4.4%), and organic brain syndrome with or without dementia (3.6%). The findings suggest that having depressive disorder was significantly associated with less life satisfaction in the whole sample of older adults' people. In addition, anxiety, hypochondriacal disorders, and organic brain syndrome were significantly associated with low life satisfaction. Meanwhile, other psychiatric disorders e.g., phobia, Obsessive Compulsive disorder (OCD), schizophrenia were not significantly associated with life satisfaction. No significant relationship was found with any physical disorders alone. The data further reveal that low level of life satisfaction was especially significant in the age group above 85 years and people who live alone or only with wife/husband. CONCLUSIONS: The strong influence of psychiatric disorders e.g., depression, anxiety, organic brain syndrome, and hypochondriasis rather than physical disorders suggests that a lack of meaning and worries are more detrimental to life satisfaction than physical frailty. The findings underscore the need to develop interventions that help older people deal more effectively with psychiatric disorders and its comorbidities. Moreover, the results suggest that providing family support, by not allowing older adults to live alone, may be especially helpful for older adults.

Referrals to psychiatric service in United arab emirates: an analysis of the content of referral letters.

OBJECTIVES: To study all psychiatric referrals by General Practitioners (GPs) to the psychiatric service at Al-Ain Hospital for 7 years starting from July 1997 till December 2003. The study examined the appropriateness of referrals and the quality of information presented in the referral document. Also, it studied the outcome of this referral including the response of the psychiatrist. METHOD: The case notes of all patients referred from the Primary Health Centres to the psychiatric service of Al-Ain Hospital for the period specified were studied. The data related to the GP referral were obtained from the copy of the referral letter, in the case notes. The information included: identifying data, reason for referral, symptomatology, relevant medical history and investigations, provisional diagnosis, recommended action, and the response of the psychiatrist. The diagnosis in the referral letter was compared to the International Classification of Diseases, 10th edition, Primary Health Care version [ICD-10 (PHC)], and to the final diagnosis in the case notes for agreement. RESULTS: among the whole sample of 503 GP referrals there were 309 males (61.4%) and 179 (35.6%) females and 15 (3%) missing data. The mean age was 32.8 years (SD=13.7), with mean age for UAE nationals 31.4 years (SD=15.58) and expatriates as 34.3 years (SD=11.32) with significant difference between the two groups (t=2.253, p=0.03), 74.2% expatriates males with significant difference, and 15 missing data. Analysis of the referral letters showed that Diagnosis was clearly indicated in 380 (77.2%), was not mentioned in 112 (22.8%) of the referral letters, with 11 missed data. Psychiatrists agreed with the GP diagnosis in 205 of them (41.7%), but considered diagnosis inaccurate in 175 (35.6%) of these cases. All the referred patients had been seen by psychiatrists. However, replies of the psychiatrists to the GPs referrals were made only in 29 patients (5.9%); 4 of these replies were written and the 2 copies of the letter were kept in the file. No reply was written in 460 cases and 14 missing data. Also physical examination and investigations were not mentioned in the majority of referrals. CONCLUSION: There is poor quality of GP referral letters and obvious poor response rate of psychiatrists to the GPs. This is an indication for urgent need for intensive training to GPs advising them to include particular items of information in future referrals.

Psychogenic Psychosis Revisited: A Follow up Study.

BACKGROUND: Although brief and acute psychoses are usually dramatic in presentation, they usually have benign course. Studies investigating clinical features and changes in diagnosis between psychotic episodes have differed in design. However, some consistent findings have emerged. This study seeks to clarify and extend these features by describing and comparing clinical diagnostic stability in a group of subjects with first episode psychosis diagnosed as acute psychotic disorder (psychogenic psychosis) followed up for 6 years. METHODS: The study comprises a retrospective evaluation of case records of 161 patients admitted for the first time with first episode psychosis. Among this group a subgroup of 69 psychogenic psychoses were followed up with special reference to stability of diagnosis within a period of 6 years. RESULTS: Forty-six patients (67.6%) were male, 22 (32.4%) were female and data were missing in one case-record. There was no significant statistical difference between gender and diagnosis. The mean age was 27.5 years (13-45 years). There were criteria, which distinguish acute psychotic disorder (psychogenic psychosis). These criteria include acute onset with short duration of untreated psychosis, precipitating factors, adjusted pre-morbid personality, no family history of mental disorder, short duration of admission, full recovery in most of cases, with no further admission. Nearly 80% of the patients have never been admitted again in 6 years time. CONCLUSIONS: Our findings show a high level of agreement with the original concept of psychogenic psychosis; however, these bear little relationship to the DSM-IV (1994) and ICD-10 (WHO, 1993) criteria for brief or acute psychotic disorder.