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.

COVID-19-related stigmatization among a sample of Egyptian healthcare workers.

OBJECTIVES: To explore coronavirus disease 2019 (COVID-19)-related stigma and its associated factors among Egyptian physicians. METHODS: A cross-sectional study using an anonymous online questionnaire was conducted from 7 to 21 June 2020. The survey was distributed via social media and email to physicians working in Egypt through convenience sampling. RESULTS: 509 physicians participated in the study (mean age: 41.5±10.2). 138 (27.1%) participants were directly involved in the care of COVID-19 patients. 159 (31.2%) participants reported severe level of COVID-19-related stigma. Participants' mean overall COVID-19-related stigma score was 40.6±8.0. The mean subscale scores were: personalized stigma 26.0±5.7, disclosure concerns 9.3±2.2, negative self-image 6.9±1.6, and concern with public attitudes 24.4±4.9. In the multivariable regression analyses, the overall COVID-19-related stigma score was higher in participants with lower qualifications (ß = -0.19, 95% CI: 2.32, -0.64, p = 0.001), and in those working in a quarantine hospital (ß = 0.08, 95% CI: 0.01, 7.14, p = 0.050). CONCLUSIONS: A considerable proportion of Egyptian physicians in this exploratory study experienced COVID-19-related stigmatization. These preliminary findings highlight the need for specific research and targeted interventions particularly addressing COVID-19-related stigmatization among healthcare workers.

Screening of social phobia symptoms in a sample of Egyptian university students

Abstract Background Public speaking is a main requisite for academic achievement amongst university students. Epidemiological data on social phobia among University students in the Arab World are scarce. Objectives To screen for social phobia symptoms in a representative sample of Egyptian university students, and to highlight some putative risk factors associated with them. Methods Two thousand nine hundred and nineteen Egyptian university students participated in the study. They were screened for social phobia using Brief Social Phobia Scale (BSPS). Students total and subdomain scores on the BSPS were correlated with their demographic and scholastic variables. Results Social phobia symptoms were estimated to be prevalent among (44%) of the study sample. A significant (p < 0.05) negative correlation was found between students' age and avoidance scores on BSPS and between students' educational year and their scores on fear, avoidance and physiologic subdomains on the BSPS. Regression analysis pointed out to a number of predictive factors for the higher total BSPS scores such as female gender and being a medical student. Discussion Our study demonstrated a high rate of social phobia symptoms in university students. It also demonstrated a number of significant predictive factors associated with the domains of social phobia such as gender, BMI, scholastic year and faculty type.

Evaluating the effectiveness of a culturally adapted behavioral family psycho-educational program for Egyptian patients with schizophrenia.

Although a growing body of evidence supports the effectiveness of behavioral family therapies for patients with schizophrenia, few studies have been carried out on the effectiveness of such programs for Egyptian patients. The current study translated and culturally adapted the Behavioral Family Psycho-Education Program (BFPEP) and conducted a preliminary efficacy evaluation for outpatients suffering from schizophrenia. Thirty patients received 14 sessions of culturally adapted Program (CA-BFPEP) and 30 received treatment as usual; all were followed up for 6 months. Pre- and post-intervention assessment included primary outcome measures that assessed the clinical, social, quality of life and attitude towards medications. The CA-BFPEP group demonstrated significant treatment effects as they had greater reductions in psychotic symptoms (PANSS), improvement of social function (SFQ), quality of life (QoL), and attitude towards medications (DAI), compared to patients in the control group. These results demonstrate the feasibility of implementing family therapy interventions in different cultural settings with relatively minor modifications. These promising findings invite further efforts to maximize the benefits of family therapy interventions internationally and to encourage mental health policy makers to integrate this mode of therapy in routine care management plans for patients with schizophrenia.

Trait emotional intelligence in a sample of Egyptian children with attention deficit hyperactivity disorder.

BACKGROUND: The link between types and severity of attention deficit hyperactivity disorder (ADHD) symptoms and trait emotional intelligence (TEI) is still underinvestigated, especially in children. We aimed to examine the relationship between TEI and ADHD symptoms in a sample of Egyptian children. METHOD: The study included 50 children with ADHD, who were compared on the basis of their TEI and contrasted with 25 matched healthy controls. They were subjected to the Arabic version of the following scales: Connors scale 3rd edition, parent rating form, Kiddie-Schedule for affective disorders and Schizophrenia present and Lifetime Version (K-SADS-PL), Stanford Binet intelligence scale, 4th edition and Trait Emotional Intelligence Child form (TEI) and a semistructured clinical data sheet for sociodemographic data. RESULTS: Using TEI scale, the control group was shown to have higher scores in TEI than cases, there was a high significant difference with regards to eight of nine TEI facets together with the TEI global score. Moreover, the control group significantly outperformed ADHD children with mixed and hyperactive subtypes on TEI global score in all facets except for adaptability. Meanwhile, the inattentive group performed significantly poorer than those in the control group on TEI global score, adaptability, emotional expression, self-motivation and emotion regulation facets. Trait Emotional Intelligence was negatively correlated with four of ADHD symptom groups assessed by Connors test, namely; impulsivity, cognitive, social problem, and emotional liability symptoms. However, Impulsivity was negatively correlated with all the domains of TEI except for adaptability and emotional expression. On the other hand, oppositional symptoms did not show a significant correlation with any of the TEI facets. CONCLUSIONS: Trait emotional intelligence is highly impaired in children with ADHD and emotional deficits are corner stone features of that disorder, low impulsivity facet of TEI is highly correlated with social problems and poor peer relations.

Duration of untreated psychosis in an Egyptian sample: Sociodemographic and clinical variables.

BACKGROUND: Duration of untreated psychosis (DUP) has been considered as a poor prognostic factor for psychotic disorder. Several studies have been investigating different predictors of DUP in Western countries, while in Egypt only a few studies have examined various predictors of DUP. AIMS: To study DUP in Egyptian patients with psychotic disorders and to investigate how certain illnesses, patient, socio-cultural risk factors and help-seeking behaviour are correlated with prolonged DUP. METHOD: The sample included 100 patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) diagnosis of psychotic disorder were selected and interviewed to assess DUP. They were interviewed using the Structured Clinical Interview for DSM-IV axis I disorders (SCID-I), Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) scale. RESULTS: Mean (±standard deviation ( SD)) of DUP was found to be 36.93(±45.27) months. DUP was correlated with various sociodemographic and clinical variables. Following log transformation of DUP, correlation with PANSS scores was done and revealed highly significant statistical relation of DUP to PANSS negative and PANSS positive scores. In linear regression analysis, it was found that age of patients, the age of onset, residence, being illiterate, the insidious mode of onset, negative family history of psychiatric disorder and the severity of illness as indicated by PANSS are among DUP predictors. CONCLUSION: Longer DUP results from multiple patient- and illness-related factors. This has many implications in targeting early intervention with specific consideration to cultural factors.

Frequency of occurrence of specific reading disorder and associated psychiatric comorbidity in a sample of Egyptian primary school students.

BACKGROUND: Specific reading disorder (dyslexia) is common in primary school students. Data on prevalence rates in Egypt are needed along with better screening tools to guide future research. We aimed to estimate the frequency of dyslexia in a sample of fourth and fifth graders. METHOD: A cross-sectional study was conducted in Eastern Cairo through multistage random selection of students from three governmental primary schools. A total of 586 students were recruited. Only 567 students fulfilled the inclusion criteria; they were subjected to screening by Goodenough Draw-a-Man test for intellectual quotient (IQ), the Reading Disability Test of Nasra Gilgil (RDT) to identify dyslexic children, Wechsler Children Intelligence Scale for thorough detection of IQ, and the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL) to detect psychiatric comorbidity. RESULTS: The frequency of occurrence of specific reading disorder (dyslexia) was 11.3% among the studied sample of Egyptian primary school students. The gender ratio was nearly 1.3:1 boys to girls. Comorbidity with other psychiatric disorders was found in 57.8% of the sample. Attention deficit hyperactivity disorder (ADHD) was present in 33%, generalized anxiety disorder in 21.6%, and major depressive disorder in 16.2% of patients. CONCLUSION: Dyslexia was prevalent in fourth and fifth graders. A meaningful presence of ADHD, anxiety, and depressed mood was detected in students. There is a need for better screening and awareness for early intervention and service provision. The cross-sectional design, lack of collateral information, and records precluded inference of casualty. The lack of rural comparator and samples from other governorates limit generalization of results.

Polysomnographic characteristics of bipolar hypomanic patients: Comparison with unipolar depressed patients.

BACKGROUND: Sleep profile in bipolar disorder has received little attention in comparison to sleep studies in major depressive disorders. Specific sleep abnormalities especially in REM sleep parameters have been detected in depression. The current study aimed at investigating whether bipolar disorder shares the same polysomnographic (PSG) changes or not. METHODS: All night polysomnographic assessments were made for 20 patients diagnosed to have hypomania, in addition to 20 patients with major depression and 20 healthy matched controls. All participants were examined using Standardized Sleep Questionnaire, SCID-I for psychiatric diagnosis, based on DSM-IV criteria, YMRS (for hypomanic patients), HAMD (for major depression patients), and all-night polysomnography (for all subjects). RESULTS: The two patient groups differed significantly from controls in their sleep profile, especially regarding sleep continuity measures, Short REML (Rapid Eye Movement Latency), with increased REMD (Rapid Eye Movement sleep density). High similarity was found in EEG sleep profile of the two patient groups, though the changes were more robust in patients with depression LIMITATIONS: A relatively small sample size, the absence of follow up assessment, lack of consideration of other variables like body mass index, nicotine and caffeine intake. CONCLUSION: Similarity in EEG sleep profile between Bipolar disorder patients and patients with major depression suggests a common biological origin for both conditions, with the difference being "quantitative" rather than "qualitative". This quantitative difference in sleep efficiency and SWS (Slow wave sleep), being higher in hypomania, might explain the rather "refreshing" nature of sleep in hypomanic patients, compared to depression.

Role of Islam in the management of Psychiatric disorders.

With the significant growth of the Muslim population all over the world, there exists a corresponding increase in the need for mental health services that suit this group of patients. Research demonstrates the effectiveness of the integration of spirituality and religiosity into psychotherapy and how religious beliefs could affect the management plans. This article discusses the impact of various beliefs in the Islamic faith on the bio-psychosocial model for the management of different psychiatric disorders including focusing on the modification of psychotherapeutic techniques as cognitive restructuring. It also shows other types of therapies such as music therapy, meditation therapy, and aromatherapy. The main emphasis remains to ensure that Muslim psychiatric patients get ethical, acceptable, and effective 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.