impact of Arab culture on psychiatric ethics

The belief of the universality of implementing similar ethical codes in all cultures and societies is a mirage. Informed consent, involuntary admission and confidentiality are not so empowering in some traditional and Eastern societies, representing two thirds of the World population. Autonomy versus family centered decision is one of the main connectors of differences between Western and Eastern Societies. The influence of managed care and the third party in mental health services have changed not only Doctor-patient relationship, but also the disclosure of information. Informed consent in therapeutic alliances and research became a basic human right and has been emphasized in the WPA declaration of Madrid and its specific guidelines.. In what ways does acculturation change the beliefs of patients of various ethnicities? Whether we like it or not, the encounters between psychiatry and law keep bringing us back to our conflicting conceptions of the value of health on the one hand and the value of liberty, integrity and autonomy on the other. In traditional cultures, social integration is emphasized more than autonomy; that is, the family, not the individual, is the unit of society. Dependence is more natural and infirmity is less alien in these cultures. When affiliation is more important than achievement, how one appears to others becomes vital an shame. How can we practice without showing disrespect or disregard for local values? On the other hand, how can we ensure that respect for the local culture does not become a pretext for bypassing ethical guidelines, to the detriment of the patients' rights?

State of the art in the management of bipolar disorder

In this paper there is a revision of the classification and prevalence of mood disorders, with the emphasis on the higher rates of prevalence of Bipolar Disorders in recent studies. The clinical phenomenology is updated with some discussion of the misunderstood classification and inconsistent diagnosis and treatment worldwide. The managements in psychiatry generally and in Bipolar disorder in particular has been discussed. The pharmacotherapy of Bipolar Disorder is reviewed. Lithium, Novel antipsychotics and the management of acute mania or mixed episodes as well as acute depression and rapid cycling also maintenance treatment is clarified, without forgetting the importance of psychosocial intervention. The conclusion calls for more research in the field

biology of obsessive compulsive disorder: an evidence from topographic EEG

The authors review the history of obsessive compulsive disorder, over the last 6 centuries with emphasis on the biological aspects. The study on thirty patients with primary obsessional disorder, showed abnormal E.E.G. in 90% of the cases, the results of this study are discussed in the light of other studies about the biology of this disorder, the authors hypothesized that the possible biological basis of OCD, is that latent behavioural patterns stored in the basal ganglia are somehow triggered by abnormally functioning inferior frontal lobes

Obsessive compulsive disorder in different cultures an Egyptian perspective

Obsessive illness represents 2.6% of the total population of psychiatric out-patients in Egypt [Okasha, 1968]. Eight four Egyptian obsessionals were studied and followed-up for period of five years. Males were predominant [54] with an earliar age of onset than females but the majority started to present themselves between 20-29 years. Marital status and education showed an even distribution with obsessionals but varied in presentation. There was a positive family history of similar disease in 31% of cases. Precipitating factors were evident in 69% of cases. The symptomatology varied according to culture with ideas, ruminations and fears commoner in urban populations and rituals and impulse predominating in patients coming from countryside. The study seems to support the view that obsessionals have received a strict and puritanical up-bringing with much insistence on onedience and cleanliness. Religious impulses and cleaning rituals were prevalent among our patients and the reasons were discussed. The outcome was rather similar to other studies in Western and non-Western countries with cure in 15%, improvement in 56%, no change in 21% and psychosis in 8%. Transcultural comparison between obsessive thoughts in Egypt, India and Jerusalem was made. This required retrospective analysis of the symptomatology for compatible analysis. The cultural aspect was discussed in the symptom formation of OCD. There is a claim of specific pharmacological treatment for obsessional illness but the present data of prognosis bear no relationship to the line of management. At attempt to explain the physiological basis of the disease was made. The sudden onset, spontaneous recovery, family history, rhythmic nature and its association with organic cerebral lesions and similar outcome in different parts of the world regardless of the line of treatment may give a clue to its biological nature as evidenced by brain imaging studies

Psychological understanding of Egyptian heroin users

The most recent evidence of drug abuse in Egypt shows a sharp upswing in heroin use since 1983, this remarkable change in the addict population directs our attention to study the psychological aspects of the problem. We studied 78 male Egyptian Heroin users admitted to two private mental hospitals at great Cairo, and we compared them regarding different variables with a controlled matched group with on history of narcotic abuse. They were subjected to semistructured psychiatric interview and assessment of psychological functions using a battery of psychometric tests. Results revealed that the mean score of users was higher than controls in psychoticism, neuroticism, and criminality on applying the Eysenck personality questionnaire. Users had moderate degree of anxiety and depression and they showed significant cognitive deficits which were more pronounced during early detoxification period. According to the DSM-III it was found that there is no specific personality type or disorder for heroin users

Neurophysiological substrate of obsessive compulsive disorder: an evidence from topographic EEG

Obsessive-compulsive disorder has recently been found to be associated with various biochemical markers; this has revived interest in its biological basis. Most of the work to data has emphasized on the role of neurotransmitters involved and neurophysiological arousal. In this presentation, evidence from electrophysiological study: Topographic EEG mapping has focused on a possible left hemispheric dysfunction associated with this disorder. Thirty patients diagnosed as primary obsessional disorder according to DSM-III R, were examined by a topographic EEG. Their age ranged between 16-45 years, with a mean of 32. 1 years; 19 were males and 11 females. 50% of our patients [15 cases] showed evidence of left hemispheric dysfunction where two had hyperactive foci in the temporal region. 20% [6 cases] showed evidence of right hemispheric involvement; 4 had a right hemispheric dysfunction and two had right hemispheric hyperarousal. 10% [3 cases] had normal records; 13.3% [4 cases] showed generalized cerebral dysfunction and 6.7% [2 cases] had borderline records. Our results indicate a more significant association between the left hemisphere and the obsessional symptomatology

Psychiatric morbidity in a mental retardation unit

This study is an attempt to classify mental disorders in mentally retarded patients within the existing psychiatric diagnostic framework. Prevalence of psychiatric disorders was estimated to be 58% among 31 patients in a private hospital for mentally handicapped in Cairo. Depression, schizophrenia and early childhood autism were present in 3 cases, while neurotic disorders, behaviour disorders, hyperkinetic syndrome and hypomania presented themselves in 2 patients. Organic catatonia was detected in 1 case. Epilepsy showed itself in 11 retarded patients [35.5%], chiefly of grand mal type [63.6%]. Aggression was a common symptom found especially in epileptic retarded patients, particularly in females and those with severe retardation. A plea is made for further studies on psychiatric morbidity of mentally retarded patients

social readjustment ratimng questionnaire: a study of Egyptians

The life events approach to the study of social stress, has been the focus of increasing critical attention. The aim of this work is to develop a questionnaire to quantify the degree of adaptation required by diverse life events. This work allowed us also to make cross-cultural comparisons between the "Egyptian Sample" and the "American Subjects" in rating of life events that require social readjustment