role of plasma homocysteine and lipoprotein [a] in coronary artery disease

Objective: to study the possible role of homocysteine and lipoprotein [a] as risk factors for premature coronary artery disease [CAD], and to assess their relationship to conventional risk factors

Subjects and Methods: 45 subjects were divided into 3 groups, 15 premature CAD patients without traditional cardiovascular risk factors, 15 premature CAD patients with one or more traditional cardiovascular risk factors [hypertension, diabetes mellitus, cigarette smoking, or dyslipidemia] and 15 healthy normal subjects matched for age and sex [controls]. All were subjected lo estimation of plasma homocysteine [Hcys], plasminogen activator inhibitor-1 [PAI-1] by ELISA, plasma folic acid by radioimmunoassay, plasma lipoproteine a [Lp[a]] by turbidimetry and plasma lipids by colorimetry

Results : this study showed a significant elevated Hcys and low folate levels in premature CAD patients. Significant correlations found between elevated level of PAI-1 and CAE in the two patient groups. There were significant positive correlations between plasma Hcys and that of PAI-I and LDL-C and significant negative correlations between plasma Hcys and that of folate and HDL-c in the patient groups. Plasma Lp[a] was only significantly elevated in premature CAD patients with traditional risk factors

Conclusion : Hcys, folic acid and PAI-1 might serve as independent risk factors for premature CAD in patients with and without traditional coronary risk factors. However. Lp[a] might confer an additional coronary risk factor only in the presence of traditional risk factors

Comorbidity of anxiety and depressive disorders in psychiatric outpatients

In 50 subjects presenting with anxiety or depression, co-morbidity of criteria based diagnoses was estimated at 72%. Pure forms of depression were found in 20% of cases, and pure anxiety in only 8%. The clinic psychiatrist gave more than one diagnosis in 24% of cases. This confirms the original prediction. In most of the cases, the additional diagnosis was more frequently an anxiety disorder or major depression. When studied retrospectively, it was more common to find cases of anxiety evolving into depression [42%] rather than the other way round [19%]. The overall conclusion derived from the study is that cases with concurrent anxiety and depressive disorders are more common in a cohort of psychiatric out-patients than cases with a single diagnosis. Assessment of these cases necessitates awareness of the possibility of comorbidity. The relationship between anxiety and depression is more than just coincidental presence of 2 prevalent conditions

Thought processes in paranoid and non paranoid schizophrenia

The distinction between paranoid and nonparanoid schizophrenia may serve as a basis for better understanding of aetiology of the disorder. There are several indicators that the distinction is clinically valid. This study deals with the possible differences between the two groups in terms of abstraction ability, and intellectual performance. Following the Tsuang-Winokur criteria, 15 paranoid schizophrenic subjects, 15 nonparanoid schizophrenics and 20 age and education matched controls were compared on the Egyptian Colloqual Proverb Test [CPT] and the Wechsler Adult Intelligence Scale [WAIS]. Nonparanoid schizophrenics performed poorly on the majority of dimensions of both tests. Paranoid schizophrenic subjects were less impaired but performed worse than controls. The results indicate a continuum of general dysfunction in abstraction and intellectual performance rather than discrete abnormalities that distinguish these two types of schizophrenia from normals. They therefore support a process approach to conceptualizing schizophrenia in which the paranoid type is regarded as a more integrated form of the same disorder rather than a distinct diagnostic entity

comparison of hospital and community cases of psychiatric disorder: I-clinical pattern and Sociodemographic characteristics

This study re-examines the pattern and sociodemographic associations of psychiatric disorder of the Dubai Community Psychiatric Survey [Ghubash et al., 1991]. The exact instruments and the same inclusion criteria were applied by the author to 42 consecutive outpatient female referrals. The findings of the community survey are largely replicated. In female citizens of the UAE, psychiatric morbidity is mainly comprised of depressive disorders [52%] followed by anxiety disorders [21.5%]. Severer forms of these disorders are met with in the hospital cases. Psychiatric morbidity in this population is not associated with a particular age group, level of education, employment, social class, having children, number of children, living in extended versus a nuclear family, or loss of either parent before the age of 15 years. Among the elements of the vulnerability model of Brown and Harris [1978], the protective effect of having confiding relationships has been substantiated in the hospital sample. Psychiatric morbidity was significantly associated with a post marital status, approached significance in polygamously married subjects, and is significantly associated with being a citizen of non-Arab ethnic origin. The latter finding probably reflects disadvantaged social status

Vulnerability to alcoholism: the role of parental absence and psychiatric distress

Parental absence during critical developmental years and antecedent psychiatric disorder may be important vulnerability factors for the development of alcoholism. To explore these possibilities 52 male and one female acohol dependent patients diagnosed according to the DSM-IIIR criteria were compared with 20 male controls matched for age, marital status, and employment type. Parental absence through death, separation, divorce, working abroad, and gross neglect or abuse was studied for the first 15 years of the subject's life. Absence of the father was found to be significantly associated with the later development of alcoholism. It was detected in 50.9% of alcohol dependent subjects compared to 15% of controls. Psychiatric morbidity was evaluated through individual administration of the Revised Self-Report Symptom Inventory, SCL-90-R [Derogatis, 1975]. Alcoholics were found to experience significantly higher levels of psychiatric symptoms than controls. Significant reducations in psychopathology, and improvement in adaptive functioning take place after participation in Alcoholics Anonymous [AA] group therapy. The favourable influence resulting from AA involvement may be direct on core symptoms or indirect through the promotion and maintenance of the abstinent state

Cardiac arrhythmias during closed mitral commissurotomy

The study included 20 patients with rheumatic mitral stenosis; 12 females and 8 males. The patients were subjected to full clinical evaluation and laboratory investigations. Several types of arrhythmias were recorded during each step in the operation. There were six main types of relevant arrhythmias: Supraventricular tachycardia occurred in 35%, junctional rhythm in 5%, premature ventricular contractions in 20%, couplets in 5%, multiplets in 20% and ventricular tachycardia in 50% of patients. It was evident that among the significant premonitoring data that make one suspect the occurrence of serious arrhythmias are atrial fibrillation and criteria of right ventricular overload. Ventricular hyperirritability, evident from frequent premature ventricular contractions, couplets, multiplets and ventricular tachycardia was seen more often in patients who have taken digitalis and diuretics for a long time and are likely to have a subnormal total body content of potassium

Study of systolic time intervals in diabetes mellitus before and after exercise

The study included 20 diabetic patients, six of them had insulin-dependent diabetes mellitus and 14 had non-insulin-dependent diabetes mellitus. Ten normal subjects were taken as a control group. All the subjects included in the study were chosen to be free from any cardiopulmonary disease with normal electrocardiogram and normal X-ray chest and heart. Systolic time intervals were recorded at rest and after exercise. Abnormal systolic time intervals were detected in diabetic patients at rest. This was considered as an indication of early left ventricular dysfunction. Such patients could be at high risk of developing cardiovascular complications. After exercise, PEP/LVET ratio showed improvement in the complications. After exercise, PEP/LVET ratio showed improvement, in the diabetic patients, as in the controls. This might suggest the presence of myocardial reserve to myocardial reserve to correct the resting abnormality on adequate stimulation

Body constitution associated with different rheumatic valvular lesions

This study included 70 cases with chronic valvular lesions; 35 having isolated mitral lesions, 25 having mitral and aortic valve lesions and 10 having isolated aortic valve lesion. For all patients the following were done: Clinical history of rheumatic activity and last attack of it, and clinical examination including general examination with stress on the presence or absence of arched palate, lax joints, kyphoscoliosis or any other musculoskeletal abnormalities, cardiac examination with evaluation of affected valves and presence of complications. Body measurements should be done. It was found that the incidence of skeletal anomalies was relatively higher in patients with isolated aortic valve

Diastolic function of the left ventricle in hypertension

This echocardiographic study aimed at evaluating the diastolic function of the left ventricle in 15 hypertensive patients. Left ventricular hypertrophy was detected in all the patients by ECHO only. The compliance of the left ventricle was reduced as shown by decreased EF slope, the maximum diastolic endocardial velocity and the prolonged isovolumic phase of relaxation; such changes were not closely related to the duration or severity of hypertension

Study of serum hydroxyproline in myocardial infarction

Healing of myocardial infarction is accompanied by an increased accumulation of collagen in the heart muscle. The amino acid hydroxyproline, an index of collagen metabolism, was measured in the serum of 20 patients with myocardial infarction and 10 healthy subjects. Determination were carried out on the 1st, 10th and 15th days following the infarction due to increased collagen biosynthesis during the healing process

kindling phenomenon: an introduction and preliminary application

The kindling phenomenon has attracted the attention of neuropsychiatrists in recent years. It is a direct demonstration of neural plasticity, and a model through which the process of epileptogenesis can be studied. Kindling is an experimental model of epilepsy that can be used appropriately to screen for potential anticonvulsant drugs. In this article the literature relevant to the development and technique of kindling, its basic mechanisms and potential theoretical and practical implications for psychiatry are reviewed. The technique used for amygdala kindling in the rat is described in detail, as well as methods on scoring and interpretation of seizure variables. The results of screening for the anticonvulsant properties of betaine, glutamate diethyl ester and cystine ethyl ester in kindled seizures have demonstrated no better effect than saline controls. These results are discussed in the light of methodological problems and recent findings

Some minerals and trace elements in acute myocardial infarction

The serum level of magnesium, zinc, copper, sodium and potassium was studied in forty patients with acute myocardial infarction. Serum for detection of these minerals and trace elements was obtained on the first day of hospital admission and after seven days. Significant hypomag-nesaemia was detected in patients with ventricular arrhythmia, cardiogenic shock and pulmonary oedema. Some patients with uncomplicated myocardial infarction showed hypomagnesaemia. A significantly subnormal zinc concentration was observed, but the lowest values, being observed in patients with serious complications. The serum copper level was elevated, but the elevation was not statistically significant. Ventricular ectopic beats and ventricular tachycardia were seen more frequently in hypokalaemic patients

brief psychiatric rating scale: interrater reliability

The application of psychiatric rating scales in follow-up and research should be preceded, among other prerequisites, by a study of interrater reliability. The Brief Psychiatric Rating Scale [B.P.R.S.] has been used extensively in research settings. This study attempted to establish interrater reliability for the B.P.R.S. in an Egyptian sample of psychiatric patients. Seventy one in-patients were selected at random and subjected to assessment of their symptoms by the B.P.R.S. They were assessed independently by four teams of raters, each team composed of two raters. Interrater reliability was studied for the 23 symptoms areas of the B.P.R.S. using the Pearson Product Moment Correlation Coefficient. Among the four teams, adequate interrater reliability was established for 17 items [range 0.50 to 0.97]. Moderate correlation [range 0.38 to 0.49] was found in one or two teams of raters in 6 items. A poor or negative correlation was found in one or two teams of raters in hallucinatory behaviour, uncooperativeness and mannerisms. Poor correlations were traced to minimal appearance of these symptoms leading to a statistical bias, as well as discrepancies in the knowledge of the raters about the patient's behavior outside the interview. In general reliability tends to be high whenever the item under consideration relies upon the patient's verbal reports rather than upon the opinion of the rater

Brief communication: milieu therapy, an Egyptian experience

The impact of a given hospital milieu upon the patients depends upon so many variables. The aim of this brief communication is to give an idea about a nine-year trial at creating a therapeutic milieu in an Egyptian private mental hospital. The theory and hypotheses underlying the proposed milieu, the administrative and therapeutic arrangements and the preliminary results of the experience are briefly discussed. Finally, the difficulties and frustrations encountered during the trial are mentioned

Clinical assessment of the state of consciousness during the experience of hallucination

A trial was made to assess clinically the state of consciousness during hallucinations. 50 hallucinating patients were selected at random and exposed to newly formalized clinical measures using the criteria of situational set: sensory inhibition and degree of active attention. Depending on these clinical criteria: we classified the clinical grades of consciousness into 3 grades. We reached the conclusion that the state of consciousness can be assessed clinically through assessing one of the phenomena that occur in its matrix. We found that organic and most of the schizophrenic hallucinations fall in grade I consciousness, while all the hallucinations of paranoid states as well as most of hallucinations of affective disorders fall in grade III. Lastly, hysterical hallucinations fall in grade III

Patterns of anxiety in criminal schizophrenic patients

Twenty-five schizophrenic patients were randomly chosen for the assessment of the presences of anxiety. Judging from the Khanka Mental Hospital files, twenty of these presented manifestation of anxiety at one time of their history. The twenty patients were clinically and psychometrically assessed for the presence of anxiety. The various manifestations of anxiety, the patterns, and the relation to particular situations were studied. Discussion of the results shows ambiguity in the use of the term, and the viscissitudes of anxiety in a psychotic population