Validity of the Shahin Mixed Depression Scale: A Self-Rated Instrument Designed to Measure the Non-DSM Mixed Features in Depression.

BACKGROUND: The DSM5-defined mixed features in depression do not include psychomotor agitation, irritability or distractibility because they are considered overlapping symptoms. A growing number of modern psychiatrists have expressed dissatisfaction with this and proposed alternative sets of mixed symptoms that are much more common and clinically relevant. Among such alternative criteria were those proposed by Koukopoulos. He utilized the research diagnostic criteria of agitated depression (RDC-A) as a mixed depression subtype, and validated another form of mixed depression, the Koukopoulos criteria for mixed depression (K-DMX). PURPOSE: This study provides psychometric validation for the first self-rated scale designed to measure the most common mixed symptoms in depression as proposed by Koukopoulos. PATIENTS AND METHODS: We conducted a multicenter cross-sectional study of 170 patients with unipolar depression. They completed the Shahin Mixed Depression Scale (SMDS) and underwent expert interviews as a gold standard reference. SMDS' psychometric properties were assessed, including Cronbach's alpha, factor analysis, sensitivity, specificity, predictive value and accuracy. RESULTS: We found significant association and agreement between mixity according to SMDS and the gold standard (K-DMX and RDC-A according to expert interview) with good internal consistency (Cronbach's alpha=0.87), high sensitivity (=91.4%), specificity (=98.0%), positive predictive value (=96.9%), negative predictive value (= 94.2%) and accuracy (=95.2%). Factor analysis identified one factor for psychomotor agitation and another for mixity without psychomotor agitation. CONCLUSION: SMDS was a reliable and valid instrument for assessing the frequently encountered and clinically relevant mixed features in depression.

Free Testosterone and Prolactin Levels and Sperm Morphology and Function Among Male Patients With Tramadol Abuse: A Case-Control Study.

BACKGROUND/PURPOSE: Tramadol abuse has become a crisis in Egypt and many other Middle Eastern countries. Tramadol abuse is associated with sexual dysfunction and male infertility, according to recent animal and human studies. The objective of this study was to compare tramadol abuse patients and healthy controls regarding free testosterone and prolactin levels and semen analysis. METHODS: Sixty patients with opiate use disorders attributed to tramadol (OUD-T) based on Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) diagnostic criteria and 30 healthy controls were included in the study. Sociodemographic and clinical data and urine, blood, and semen samples were collected from patients and controls for assessment. RESULTS: Compared with controls, OUD-T patients had higher prolactin and lower free testosterone levels. Patients with OUD-T were more likely to have lower sperm count and higher abnormal motility and forms of sperms compared with controls. CONCLUSIONS: Patients with OUD-T were found to be more likely to have lower free testosterone levels and lower sperm counts and vitality, and higher prolactin levels and sperm abnormal forms compared with controls.

Opioid Use Disorders Attributed to Tramadol Among Egyptian University Students.

BACKGROUND: Tramadol use is an overwhelming problem in Egypt with tremendous medical and social consequences especially among youth. Use liability among Egyptian university students is underevaluated. This study aimed to estimate the prevalence and associated correlates of tramadol use among students from Zagazig University, Egypt. METHODS: A cross-sectional study included a total of 1135 undergraduate students, from 10 colleges in Zagazig University. Participants were randomly selected and assessed for tramadol use using The Drug Use Disorders Identification Test (DUDIT) and The Drug Use Disorders Identification Test-Extended (DUDIT-E). RESULTS: The prevalence of tramadol use was 12.3% among university students, with higher prevalence in male (20.2%) than female students (2.4%). The average age at onset of tramadol use was 17.6 ±â€Š2.1. Only 15% of the students with substance use were using tramadol alone whereas the rest (85%) were using at least 1 drug plus tramadol. One-fifth of these students started with tramadol as their first drug. Smoking, cannabis, and alcohol use predict tramadol use. About 60% of students who use tramadol had drug-related problems and 30% had dependence. Treatment readiness for tramadol use is negatively correlated with smoking and its duration. CONCLUSIONS: Tramadol use was common among university students, with higher prevalence among males. There is a considerable relationship between tramadol use, smoking, and use of other substances. Further population-based longitudinal studies need to investigate the causal relationship between tramadol use, smoking, and use of other substances.

Cognitive Impairment and Tramadol Dependence.

BACKGROUND AND OBJECTIVE: Cognitive impairment is one of the consequences of substance abuse. Tramadol abuse is a public health problem in Egypt. The objective of this study was to estimate the prevalence and correlates of cognitive impairment among tramadol-abuse patients and control subjects. METHODS: This study included 100 patients with tramadol abuse and 100 control subjects (matched for age, sex, and education) who were recruited from Zagazig University Hospital, Egypt. Patients were divided into 2 groups: patients who used tramadol only (tramadol-alone group) and patients who used tramadol and other substances (polysubstance group). The participants were interviewed using Montreal Cognitive Assessment test and had urine screening for drugs. RESULTS: Twenty-four percent of the cases used tramadol alone, whereas the remaining used tramadol and other substances, mainly cannabis (66%) and benzodiazepines (27%). Tramadol-abuse patients were about 3 times more likely to have cognitive impairment than control subjects (81% vs 28%). Tramadol-alone patients were more than 2 times more likely to have cognitive impairment than control subjects (67% vs 28%). Cognitive impairment was significantly associated with polysubstance abuse. There was no association between cognitive impairment and sociodemographic or clinical factors. CONCLUSIONS: Cognitive impairment occurs commonly among tramadol-abuse patients. Memory impairment is the most common cognitive domain to be affected. There is a significant association between cognitive impairment and polysubstance abuse.

Psychiatric Morbidity among a Sample of Orphanage Children in Cairo.

Objective. This study identifies the prevalence of emotional and behavioral problems and the associated factors in orphanage children. Methods. This cross-sectional study was conducted in three private orphanages in Cairo. Two hundred sixty-five children of ages ranging from 6 to 12 years living in three different orphanages care systems were included in the study. A sociodemographic information form and the Child Behavior Checklist (CBCL) were used. Children were clinically interviewed and psychiatric disorders were identified. Diagnoses were done according to the manual for diagnosis and statistics of mental disorder fourth version (DSMIV). A written formal consent from the director of social solidarity was obtained before inclusion in the study. Results. The prevalence of behavioral disturbances was 64.53% among those in institutional care and the most prominent psychiatric disorders were nocturnal enuresis (23.3%), attention deficit hyperkinetic disorder (ADHD) (19.62%), oppositional defiant disorder (17.36%). Age at first admission, causes of receiving institutional care, and moves 2 or more times between institutions were significantly associated with an increased risk of behavioral and emotional problems. Conclusion. Our study showed that children living in institutions are prone to suffer from psychiatric disorders. Stability of the caregiver acts as a protective variable.