Decreased acylated and total ghrelin levels in bipolar disorder patients recovering from a manic episode.

BACKGROUND: To date, only few studies have investigated ghrelin levels in bipolar disorders, and all have exclusively measured acylated ghrelin, with none investigating total ghrelin (acylated and des-acylated). We aimed to investigate peripheral levels of acylated and total ghrelin in subjects experiencing a manic episode of bipolar disorder. METHODS: Peripheral levels of acylated and total ghrelin were measured in hospitalised medicated individuals recovering from a manic episode. Enzyme-linked immunosorbent assays (ELISA) were used to measure ghrelin levels in patients and compared with healthy controls. The relationship between ghrelin levels in bipolar disorder, self-reported hunger measures, demographic and clinical parameters was investigated with correlational analyses. RESULTS: Twenty-four subjects (15 males, 9 females) recovering from mania and 27 matched healthy controls (13 males, 14 females) were recruited for the study. Mean values of both acylated (187 vs.520 pg/mL) and total ghrelin (396 vs. 648 pg/mL) were significantly reduced in bipolar disorder (p = 0.001). Ghrelin levels correlated positively with markers of illness severity and negatively with prescribed mood stabilizers, second-generation antipsychotics, weight and body mass index. CONCLUSION: Peripheral measurements of acylated and total ghrelin were both reduced in bipolar disorder patients compared to healthy controls. Whilst illness severity promotes higher ghrelin levels, pharmacological treatment and weight gain exercise the opposite effect.

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.

Secondary association of PDLIM5 with paranoid schizophrenia in Emirati patients.

Schizophrenia is a clinically and genetically heterogeneous disorder of unknown etiology. PDLIM5 variants have been linked to schizophrenia and other related neuropsychiatric disorders and upregulated in the brain of schizophrenia patients suggesting a possible pathogenic role in disease progression. The aim of this study is to examine the potential association of schizophrenia in Emirati patients with previously reported variants in PDLIM5, PICK1, NRG3 or DISC1 genes. Consequently, we found a secondary association between PDLIM5 variants and the paranoid subtype of schizophrenia in Emirati Arabs suggesting that PDLIM5 may represent a determinate/marker for schizophrenia subtype specification. However, no associations were found with variants in PICK1, NRG3 or DISC1 genes.

Higher frequency of C.3435 of the ABCB1 gene in patients with tramadol dependence disorder.

BACKGROUND: Polymorphic variation at the ABCB1 gene has been shown to affect the pharmacodynamics and kinetics of various drugs. AIM: This study aimed to determine the frequency of occurrence of Single Nucleotide Polymorphism (SNP) in position A118G OPRM1 (rs1799971) gene and C.3435 (rs1045642) gene in tramadol users in comparison with normal controls. METHODS: This was a cross sectional case-control outpatient study. The study sample consisted of 127 subjects (74 tramadol-dependents and 50 healthy controls). All patients fulfilled the Diagnostic and Statistical Manual IV Criteria for substance dependence (on tramadol). Genotyping of the OPRM1 gene 118 SNP and ABCB1 genes C.3435 SNP was performed by PCR, followed by restriction fragment length polymorphism identification. RESULTS: A significant association was found between the ABCB1 gene T allele at the polymorphic site 3435 and tramadol dependence. No significant association was observed with the A118G OPRM1 gene. CONCLUSION: The high frequency of ABCB1 gene T allele present at the polymorphic site 3435 could provide a protective mechanism from tramadol dependence disorder. Further study, using a larger sample, would be useful in further evaluating the possible role of ABCB1 gene polymorphisms.

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.

Death anxiety (Thanatophobia) among drug dependents in an Arabic psychiatric hospital.

AIM: The primary aim of this study was, for the first time to our knowledge, to examine the level of death anxiety (thanatophobia) in drug dependents attending the outpatient clinic in a psychiatric hospital and to examine the relationship of demographic variables to death anxiety. METHOD: Eighty-five patients were recruited from outpatient psychiatric attendees at the psychiatric hospital, Kingdom of Bahrain. The death anxiety scale was administered to assess death anxiety, and a clinical psychiatric interview was used to assess psychopathology. RESULTS: The mean age of the sample was 36.8 years (SD = 8.8). All subjects who participated in the study were Arabic males; the majority of them were primary school (i.e. first 5 years of education or schooling) educated (n = 57; 67%) and single (n = 48; 56.5%). The total mean of death anxiety score of the drug abusers was high (3.52±.95). One-way ANOVA showed that there was no significant difference among the scores the drug dependents received on the death anxiety scale related to different groups of age, education, type of the drug used, or the number of times of taking drugs per day. However, there was a significant difference in the level of control of use, marital status, duration of use, cigarettes smoking, and level of religiosity. CONCLUSION: The results of this study indicate that the level of death anxiety is high, in general, among drug abusers and that being divorced, not actively practicing a religious faith, having at least 1-10 years or more than 20 years history of drug abuse, and smoking at least 20 or more cigarettes per day significantly increases the level of death anxiety.

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.

Pattern of attempted suicide in Babylon in the last 6 years of sanctions against Iraq.

Suicide among Muslims and in Muslim countries is rare (Hocaoglu et al, 2007). Although much of the research has comprised simple descriptive studies, and despite the possible underreporting of suicidal behaviour in countries where such behaviour is illegal, suicide rates do appear to be lower among Muslims than among the followers of other religions, even in countries which have populations belonging to several religious groups (Lester, 2006). However, rates of attempted suicide do not appear to be lower in Muslims than in non-Muslims (Pritchard & Amanullah, 2007), possibly because although there are strong religious sanctions against suicide, there are no clear principles regarding attempted suicide.

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.

Benzhexol-dependence resulting from self-medication for intermittent explosive disorder.

Objective. Recent observations in Iraq during the period of sanction suggest the existence of benzhexol prescribing linked to its calming effects on explosive behaviours. This inspired our group to research the existence of this practice and the characteristics of those involved in it. Method. All patients from the psychiatric service in Merjan Hospital, Al Hilla City, Babylon Governate, Iraq, who had a prescription for benzhexol between January 1991 and December 2000, were identified. All participants received their diagnosis based on the clinical criteria of the DSM-IV, after taking a comprehensive medical and psychiatric history, mental state examination and collateral information from family members. The patients were evaluated by the same qualified consultant psychiatrist at the initial assessment and all through the period of follow-up. Results. In the 10-year period under study, 354 patients were prescribed benzhexol. A total of 190 patients diagnosed as intermittent explosive disorder (IED) and 164 suffering from severe mental disorders or personality disorders were excluded from the study. The average age of the IED group was 29.5 years. On direct questioning, the main reason patients gave most frequently for using benzhexol was to control the aggressive outbursts (N=92, 48.4), to get high (N=49, 25.8), to relax (N=26, 13.7), to get rid of boredom (N=23, 12.1). In total, the whole group were prescribed benzhexol, at an average dose of 12.5 mg/day (range 2-20 mg/day). At the time of final assessment the mean dose of prescribed benzhexol had fallen slightly to 12 mg/day (2-20 mg/day), with 10 patients being benzhexol free. Of the 190, three patients had a diagnosis of obsessive compulsive disorders, 36 patients had a diagnosis of benzodiazepines dependence, and a further five had a diagnosis of alcohol dependency syndrome. Eighty percent felt satisfied with the effect of the drug and 95 were not motivated to stop it. Conclusions. There are a significant number of patients who are routinely prescribed benzhexol as a replacement therapy. The main original reason for starting it is to control outbursts and improves their reaction to stress situations. This growing issue raises the need for awareness, by both public and medical practitioners, of the potential adverse effects of benzhexol and its untoward consequences.

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.

Acontecimientos vitales y adicción: una revisión de la bibliografía / No disponible

La idea de que los acontecimientos vitales estresantes pueden contribuir al inicio y desarrollo de un trastorno por abuso de sustancias ha ganado aceptación, particularmente en la comunidad clínica. Se revisan aquí las investigaciones sobre acontecimientos vitales y su relación con los trastornos adictivos. Los acontecimientos adversos de la vida diaria se dividirán en acontecimientos predisponentes o de vulnerabilidad, precipitantes o desencadenantes, y factores mediadores. Se resumen los hallazgos de los estudios y se argumenta su relevancia para la metodología

La desorientación de la edad propia: una forma de síndrome de falsa identificación delirante o de deterioro intelectual / No disponible

Se presentan dos casos de pacientes con esquizofrenia y que habían infravalorado en 10 años su edad, que acuden por primera vez a consulta psiquiátrica. Uno de los pacientes presentados no toma neurolépticos y no está institucionalizado. También se presenta una revisión sobre la desorientación de la edad propia

Las consecuencias del consumo del Khat: Una revisión de la literatura

El Khat es un árbol de hoja perenne que crece en determinados lugares del Este de África y de la Península Arábiga. Las hojas del Khat contienen efectos estimulantes y se mastican con frecuencia en aquellos países en donde crece. Debido a la disponibilidad del transporte aéreo, esta droga se ha extendido a la Europa Occidental y a América. En este artículo revisaremos todos aquellos aspectos relacionados con las consecuencias del Khat, su uso y su abuso en los diferentes lugares del mundo (AU)

Modelo de consumo de drogas entre minorías étnicas en un ambiente comunitario de drogadicción

El objetivo de este estudio fue el de examinar el modelo de abuso de tóxicos que seguían ciertas minorías étnicas al compararlas con un grupo de personas de nacionalidad británica. A través de una recopilación retrospectiva nos encargamos de revisar a todos los pacientes que fueron valorados en un periodo de 3 años. 179 de ellos cumplieron los requisitos para ser incluidos en el estudio. Se examinó a 140 pacientes caucasianos, entre los que se encontraban 119 británicos, 18 irlandeses y otros 3 europeos; también participaron en el estudio 24 pacientes asiáticos y 15 afro-caribeños. El estilo de abuso de tóxicos evidentemente, era diferente cuando comparábamos cada minoría étnica en relación con el grupo británico. Se apreciaba mayor proporción de consumo de opio en la muestra asiática que en la británica. En cambio, el grupo de afro-caribeños era el mayor consumidor de cocaína. También se registraron importantes consumos de opio entre el grupo irlandés; además, comparado con el grupo británico, el 100 per cent de sus miembros compartía las jeringuillas. Estos hallazgos demuestran las diferentes formas de consumir tóxicos que tienen las minorías étnicas. Incluso entre los mismos grupos raciales, por ejemplo en los caucásicos, el modelo de consumo es diferente. Por todo ello son necesarios Servicios orientados hacia las diferencias que presentan las diversas etnias en lo que al abuso de tóxicos se refiere (AU)