Prodromal symptoms of relapse in a sample of Egyptian schizophrenic patients.

BACKGROUND: Schizophrenic patients and family members often retrospectively report having observed a number of nonpsychotic symptoms and/or certain alterations in behavior that they believe preceded any psychotic symptoms and behavior. The identification of possible relapse before its actual occurrence and the timely intervention in management are expected to spare both patient and family the suffering and pain of a full schizophrenic episode. The aim of this study was to determine if prodromal symptoms could be used as valid predictors of relapse in schizophrenic disorders and the relative diagnostic values of these symptoms in a sample of Egyptian schizophrenic patients. METHOD: One hundred Egyptian patients with schizophrenic disorders (DSM-III-R criteria) that had recently relapsed were retrospectively assessed for prodromal symptoms in the month preceding relapse. They were compared with 2 control groups, 50 Egyptian nonrelapsing schizophrenic patients and 50 healthy Egyptian individuals. RESULTS: Nonpsychotic symptoms were the most common prodromal symptoms occurring in relapsing patients. A significant difference in frequency of prodromal symptoms was found for relapsing patients versus nonrelapsing patients (p < .001) and healthy controls (p < .05). Prodromal symptoms appear to have a relatively specific value for predicting subsequent psychotic symptoms in those subjects who previously experienced such symptoms. CONCLUSION: Clusters of nonspecific prodromal symptoms exist that significantly differentiate between relapsing, nonrelapsing, and healthy controls. Fine-tuning of the identification of these symptoms could be a plausible clinical tool to be used by psychiatrists and general practitioners alike to predict a possibility of an impending relapse.

Cognitive dysfunction in obsessive-compulsive disorder.

OBJECTIVE: Assessment of cognitive functions among obsessive-compulsive disorder (OCD) patients would help in understanding the neurobiology and brain areas involved in that disorder. The objective of this work was to study the cognitive dysfunction in OCD patients and to identify its correlation with both the clinical picture and the severity of the disorder. METHOD: Neuropsychological and electrophysiological event-related potentials were tested in 30 OCD patients and compared with 30 normal volunteers of a matched gender, age and education. RESULTS: Results showed a defective visuospatial recognition, which worsens with chronicity, deteriorated set-shifting abilities, overfocused attention to irrelevant stimuli and delayed selective attention to relevant tasks. Mild cases showed better selective attention than severe cases. Obsessive cases had a defective visual memory, while compulsive cases had delayed perception of task relevant stimuli. Mixed cases showed disturbed information-processing both early and late. CONCLUSION: OCD patients have a characteristic pattern of cognitive dysfunction that differs among patients of varied severity, chronicity and symptom type. We suggest a striatofrontoparietal neural pathophysiology. OCD seems to be a heterogeneous disorder, both clinically and pathophysiologically.

Reproductive rights of Egyptian women: issues for debate.

Because the definitions of reproductive health and reproductive rights are so broad, it has been possible in Egypt and elsewhere for one or other issue on the reproductive health agenda to be prioritised to the detriment or exclusion of others, and a comprehensive approach avoided. Reproductive health and rights language was introduced in Egypt around the time of the International Conference on Population and Development in Cairo in 1994. From the moment these concepts were translated into Arabic, activists, scholars and women themselves discussed and debated their meanings and questioned whether Egyptian culture permitted a rights approach of this kind and whether reproductive rights were actually perceived as such by Egyptian women. This paper discusses the language of reproductive rights in relation to cultural specificity in the Egyptian context, Egyptian women's perceptions of reproductive rights, the role of tradition and religion, and the ways in which reproductive rights are taken up under Egyptian law. It analyses some of the arguments used against reproductive rights on these grounds.

Expressed emotion, perceived criticism, and relapse in depression: a replication in an Egyptian community.

OBJECTIVE: The aims of this study were to determine the value of families' expressed emotion and patients' perception of family criticism in predicting relapse in Egyptian depressed patients and to evaluate transcultural differences in assessment of these measures. METHOD: The subjects were 32 consecutive depressed patients from psychiatric clinics in Cairo and Ismailia, Egypt, who fulfilled the DSM-III-R criteria for major depression or bipolar disorder. An Arabic version of the Camberwell Family Interview was administered to key relatives of the depressed patients. Rating of expressed emotion was performed blindly by a qualified rater to assess levels of criticism, hostility, emotional overinvolvement, warmth, and positive remarks. Patient perception of family criticism (perceived criticism) was also assessed. All patients were followed up for 9 months to assess relapse and compliance with treatment. RESULTS: The relation of family criticism to relapse was statistically significant. Although this result replicates previous findings, the criticism level that best differentiated relapsers and nonrelapsers was a score of 7, which is much higher than previously reported in Western studies. This relation was not observed for other expressed emotion components. Also, no association between perceived criticism and relapse was detected. CONCLUSIONS: Expressed emotion is a prognostic factor that should be assessed with consideration of the specific culture and intrafamilial patterns. The use of perceived criticism in the prediction of relapse in depression is questionable. There is a need for a simplified, less time-consuming assessment tool that takes cross-cultural differences and specificities into consideration.

Panic disorder. An overlapping or independent entity?

We compared three groups of patients with panic disorder, generalised anxiety disorder and major depressive episode with a control group. Methods of comparison included a clinical profile of the patients, assessed by the Arabic version of the Present State Examination (PSE), a psychological battery of tests measuring personality traits and depressive and anxiety states, and the dexamethasone suppression test (DST) as a biological marker. Our data showed that psychological assessment and DST did not significantly differentiate between the three disorders. Despite a symptom overlap between the disorders, however, some symptoms were associated significantly more often with one disorder than another. Patients with panic disorder differed from patients with major depressive episode in showing more situational, avoidance and free floating anxiety, and more anxious foreboding. They showed less self-negligence, ideas of guilt, early awakening and social withdrawal. Compared with patients with generalised anxiety disorder, patients with panic disorder showed more loss of interest and muscle tension and less anxious foreboding, restlessness, inefficient thinking, social withdrawal and delayed sleep. Our conclusion is that the clinical course and the symptom profile of panic disorder justifies its existence as an independent diagnostic category.

Phenomenology of obsessive-compulsive disorder: a transcultural study.

Ninety patients suffering from obsessive-compulsive disorder (OCD) and diagnosed according to International Classification of Diseases (10th edition [ICD-10]) criteria attending the outpatient clinic of the Institute of Psychiatry in Cairo in 1991-1992 were assessed by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) for symptomatology and severity of symptoms. Sixty-nine percent of the patients were males, and 32% were females. The mean age of the sample was 23.7 years, with a mean duration of OCD of 3.2 years. Twenty percent of patients had a positive family history for OCD. Forty percent of patients presented with a mixture of obsessions and compulsions, whereas 29% presented with obsessions and 31% with compulsions. The most commonly occurring obsessions were religious and contamination obsessions (60%) and somatic obsessions (49%), and the most commonly occurring compulsions were repeating rituals (68%), cleaning and washing compulsions (63%), and checking compulsions (58%). Seventy-one percent of patients were rated severe on the Y-BOCS, and all of them had impaired insight; 9% were insightless. The age of patients was found to correlate positively with the total compulsive score and the total Yale BOCS score, but it correlated negatively with the total obsessive score. One third of patients had a comorbid depressive disorder. Regarding premorbid personality disorders, 14% had obsessive personality disorder, 34% had paranoid, anxious, or emotionally labile personality disorder, and 52% had no premorbid personality disorder. The role of religious upbringing has been evident in the phenomenology of OCD in Egypt, which is similar to the outcomes of studies in Jerusalem and different from results in India and Britain.(ABSTRACT TRUNCATED AT 250 WORDS)

Presentation of acute psychosis in an Egyptian sample: a transcultural comparison.

The symptomatological and diagnostic differentiations and outcome of acute psychosis were studied in 50 Egyptian patients using the Schedule of Clinical Assessment of Acute Psychotic States (SCAAPS). The prevailing symptoms were delusions, worry, irritability, mood changes, and disturbed behavior. Sixty-four percent of the patients were symptom-free at 1-year follow-up assessment. Various factors that affect clinical and social outcome were discussed. The problem of diagnostic terms was also studied comparing SCAAPS terms with those of DSM-III-R and ICD-10. The most frequent diagnosis was psychogenic psychosis or brief reactive psychosis corresponding to the previously mentioned first and second systems, respectively. The inclusion of acute and transient polymorphic psychotic disorders with or without stress in ICD-10 will encompass those clinical syndromes in different cultures. A comparative study with a matched Indian sample was also conducted, the results of which are discussed in detail.