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.

Clinical Guidelines of the Egyptian Psychiatric Association for the Management of Treatment-Resistant Unipolar Depression in Egypt.

Background: Major depressive disorder (MDD) is a public health burden that creates a strain not only on individuals, but also on the economy. Treatment-resistant depression in the course of major depressive disorder represents a clinically challenging condition that is defined as insufficient response to two or more antidepressant trails with antidepressants of the same or different classes that were administered at adequate daily doses for at least 4 weeks. Objective/Hypothesis: To develop a treatment guideline for Treatment Resistant Depression (TRD). Methodology: Experts in the field gathered and reviewed the available evidence about the subject. Then, a series of meetings were held to create recommendations that can be utilized by Egyptian psychiatrists. Results: The guidelines provide recommendations in various clinical settings. It evaluates different situations, such as patients at risk of resistance, those with resistance and recommends strategies to resolve the clinical case. Conclusion: The consensus guidelines will improve the outcomes of patients, as they provide recommendations across various domains that are of concern for the practicing psychiatrist.

Cognitive functions in children and adolescents with early-onset diabetes mellitus in Egypt.

The objective of this study was to investigate performance on memory, intelligence, and executive functions in children and adolescents with type 1 diabetes mellitus (T1DM) and to investigate the role of glycemic control, hypoglycemic attacks and diabetic ketoacidosis. We compared 50 subjects with T1DM with 30 healthy controls (ages between 7 and 16 years) using Benton Visual Retention Test (BVRT), the Arabic version of the Wechsler Intelligence Scale for Children (WISC), and Wisconsin Card Sorting Test (WCST). We also compared good versus poor glycemic control in T1DM subjects. RESULTS: T1DM subjects had significantly poorer performance than controls on all subtests of the BVRT, on all subscales of the WISC (verbal, performance and total IQ) and on most subtests of WCST (p < 0.05). T1DM subjects with good glycemic control performed significantly better than subjects with poor glycemic control on all subtests of the BVRT and on all subscales of the WISC (p < 0.05), but there was no difference on the WCST. T1DM subjects differed from controls on memory, intelligence, and executive functions. They also differed according to good or poor glycemic control (except on the WCST). Cognitive performance significantly correlated with a number of demographic and clinical variables.

Serum level of brain derived neurotrophic factor (BDNF) among patients with bipolar disorder.

BACKGROUND: There is a growing body of evidence that serum brain derived neurotrophic factor (BDNF) is altered during the episodes of bipolar disorder. The aim of this study was to investigate serum BDNF levels in bipolar disorder patients during manic and depressive episodes and its clinical utility in bipolar disorder compared to other psychiatric disorders. METHODS: The study was conducted on 80 Egyptian patients, who were classified into 4 groups: group Ia (25 patients with depressive episodes), group Ib (25 patients with manic episodes), group II (15 patients having Schizophrenia) as pathological controls and group III (15 healthy subjects) as controls. All subjects were diagnosed according to DSM-IV, assessed using the Hamilton Rating Scale for depression (HAM-D), and the Young Mania Rating Scale (YMRS). sBDNF concentrations were measured using the quantitative sandwich enzyme immunoassay technique. RESULTS: sBDNF showed significantly lower levels in patients with depressive episodes or manic episodes. The best cut-off for sBDNF in discriminating depressed patient from healthy control was ≤33,000pg/ml (AUC=0.891, sensitivity of 84%, and specificity of 80%). Moreover, the best cut-off for sBDNF in discriminating mania patients׳ group from healthy control was ≤29,500pg/ml, (AUC=0.984, asensitivity of 96%, and specificity of 86.7%). LIMITATIONS: Only a small sample size was considered which included only drug free patients. BDNF was measured in serum not in CSF or brain tissue. CONCLUSIONS: Low sBDNF levels are strongly associated with active phases of bipolar disorder, in depressive and manic episodes.

Cognitive functions among euthymic bipolar I patients after a single manic episode versus recurrent episodes.

BACKGROUND: There is a growing consensus that persistent cognitive deficits are common in patients with bipolar disorders even when they are euthymic. AIM: The aim was to assess objectively the presence of cognitive deficits in bipolar patients in remission, and to correlate these deficits with the recurrence of the disease. METHODS: Cognitive functions (executive function, memory, intelligence, attention and concentration) of a group of euthymic bipolar patients after a single manic episode were compared to cognitive functions of patients who experienced recurrent episodes, both groups were assessed during remission. The results were compared with a control group, using SPSS. RESULTS: Euthymic bipolar patients assessed after a single manic episode showed impairment in attention, executive functions and total memory score in comparison to healthy control subjects. While they performed better than Euthymic bipolar patients assessed after recurrent bipolar episodes as regards attention and executive function. CONCLUSION: Bipolar disorder is associated with attention, memory and executive dysfunction. Attention and executive dysfunction is deteriorated by the recurrence of bipolar episodes.

Prevalence and correlates of depressive disorders in elderly with type 2 diabetes in primary health care settings.

OBJECTIVE: Depression is associated with poor glycemic control and complications in people with type 2 diabetes. We assessed the prevalence of depressive symptoms and antidepressant medication use among elderly with and without type 2 diabetes and the association between depression and diabetes complications. RESEARCH DESIGN AND METHODS: In 2004-2006, the Primary Health Care research in Type 2 Diabetes Study applied the Beck Depression Inventory II (BDI-II) to 458 participants with type 2 diabetes (47% male, aged 65 + or -8.9 years, type 2 diabetes duration 19 + or - 8.7 years) and 546 participants without diabetes (non diabetic group) (51% male, aged 59 + or - 8.7 years). Use of antidepressant medication was self-reported. Depressive disorder was defined as a BDI-II score >14 and/or use of antidepressant medication. Occurrence of diabetes complications (retinopathy, blindness, neuropathy, diabetes-related amputation, and kidney or pancreas transplantation) was self-reported. RESULTS: Mean BDI-II score, adjusted for age and sex, was significantly higher in participants with type 2 diabetes than in non diabetic participants (least-squares mean + or - SE: 7.4 + or - 0.3 vs. 5.0 + or - 0.3; P<0.0001). The prevalence of depressive disorder (as defined by BDI-II>14 and/or antidepressant use) in participants with type 2 diabetes was significantly higher than that of age- and sex-adjusted non diabetic participants (32.1 vs. 16.0%, P<0.0001). Type 2 diabetic participants reported using more antidepressant medications (20.7 vs. 12.1%, P = 0.0003). More type 2 diabetic than non diabetic participants were classified as depressed by BDI-II cut score (17.5 vs. 5.7%, P<0.0001) or by either BDI-II cut score or antidepressant use (32.1 vs. 16.0%, P<0.0001). Participants reporting diabetes complications (n = 209) had higher mean BDI-II scores than those without complications (10.7 + or - 9.3 vs. 6.4 + or - 6.3, P<0.0001). CONCLUSIONS: Depression is highly prevalent in type 2 diabetes and requires further study on assessment and treatment.

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.