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.

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.

Relations between nutrition and cognitive performance in Egyptian toddlers.

PIP: Two relatively unexplored questions--which specific components of chronic mild child malnutrition are associated with specific behavioral and cognitive deficits and do psychosocial child rearing factors moderate the nutrition-development relationship?--were investigated in a longitudinal study involving 153 toddlers from the Egyptian village of Kalama. Beginning at study entry at age 18 months and continuing until 30 months, food intake information was obtained for 2 consecutive days each month. During the same period, researchers visited the homes twice a month to observe both toddler behavior and caregiver styles. Finally, standardized infant development tests were administered at 24 months and 30 minutes and the capacity for exploratory, symbolic play was assessed. Specific components of nutritional intake at 18-23 months of age were confirmed to be uniquely related to specific developmental outcomes at 24 months of age. Changes in toddler intake from 18-30 months also predicted 30-month cognitive performance. At 24 months, general mental competence was associated positively with fat intake, total kilocalories, and total protein intake while symbolic play capacity was related only to total protein intake. Significant increases in predictive variance occurred when the model was expanded to encompass caregiver behaviors as well as nutritional factors. For example, when nonverbal response to child vocalizations was used as the environmental measure, there was evidence of both coactive and synergistic interactions for comparisons involving cognitive development indicators. For symbolic play, an increase in predictive variance was found when the model included the multiplicative interaction of animal kilocalories by nonverbal response to vocalizations. Also observed was a buffering effect against poor psychosocial rearing conditions given the presence of adequate nutritional intake. These findings suggest the feasibility of multidimensional risk profiles, the provision of specific nutrients targeted at specific deficits, and multidisciplinary interventions.^ieng

Relation of rearing environment to adaptive behavior of Egyptian toddlers.

2 questions were explored: (1) Do observed relations found in Western cultures between specific psychosocial environmental factors and toddlers adaptive behavior resemble the pattern of relations found in a non-Western setting? (2) Does the specificity of relations between environment and performance found in Western cultures also operate in a non-Western culture? Subjects were 153 Egyptian toddlers, 18-30 months of age, and their caregivers. Twice a month between 18 and 30 months toddlers were observed in naturalistic interactions with their caregivers, and measures of caregiver behavior and toddler functioning were coded. Replicating previous results from Western cultures, canonical analysis indicated that caregiver vocal stimulation was positively related to indices of toddler behavioral competence, while nonverbal response to vocalization and physical contact stimulation were negatively related. The salience of sib caregivers was also noted. Particularly for the age period between 24 and 29 months, results indicated specificity of environmental action such that measures of caregiver vocal stimulation were uniquely related to measures of toddler vocalization, while caregiver response to distress was uniquely related to toddler emotionality. The present pattern of results suggests at least some degree of cross-cultural generalizability of environment-development relations and of the specificity model of environmental action.

Diet during lactation associated with infant behavior and caregiver-infant interaction in a semirural Egyptian village.

Potential processes through which nutritional and non-nutritional factors can relate to infant state and behavior and mother-infant interactions were examined in 41 mother-infant pairs from semirural Egyptian households. All infants were breast-fed, and breast milk was the main source of their nutrient intake. Median birth weight was close to reference median; however, most infants showed growth faltering when they were 3-6 mo of age. Among the infant behavioral and state variables, only drowsiness (a proxy for activity and alertness) was significantly associated with the nutritional and non-nutritional factors examined. Among these factors, mothers' intakes of animal source foods and certain B vitamins were the strongest predictors of drowsiness. The nature of the association between maternal diet and drowsiness, examined by multiple regression analysis, showed clearly that inadequate diet of the mother was the major risk factor. Alertness of infants was further compromised when there were several children in the households. The small, less vocal and less alert infants received less vocalization from their mothers. In this environment, infants of undernourished mothers may not receive the extra care and stimulation needed and are at risk for subsequent developmental disabilities.

PIP: Each week physicians visited the households of 41 mother-infant pairs living in Kalama, Egypt, to examine infant behavior and caregiver-infant interactions from 3 to 6 months of age, as they relate to various factors, e.g., maternal nutrition and health and socioeconomic status. All the mothers breast fed their infants. Liquids which are inferior sources of energy and nutrients were the most customary food supplements during the first 6 months. Even though the median birth weight tended to equal that of the WHO international reference, most infants experienced faltering growth by 3 months. At 6 months, 75% were below the 25th percentile and 20% were in the 5th percentile. Growth faltering was linked with increased diarrhea (p .05). Even though the mothers' diets contained sufficient niacin, thiamin, folate, and vitamin C, the diets did not supply mothers enough riboflavin, vitamin B-6, vitamin A, calcium, and zinc. Breast milk did not have adequate amounts of vitamin B-6 and, perhaps, not even enough riboflavin and vitamin A. It did contain adequate amounts of calcium, however. Drowsiness was significantly related to maternal diet during lactation but not during pregnancy (especially energy intake from animal sources, p = .0001; energy intake from plant sources, p = .03); number of siblings (p = .009); crowding (p = .06); vocalization from mothers (p = .08); and low socioeconomic status (p = .07). Maternal diet was the best predictor of drowsiness followed by number of siblings. Without remediation in maternal nutrition, infants of undernourished mothers appeared not to receive appropriate care and stimulation, therefore placing them at risk of subsequent development disabilities. Intervention studies should be done to examine this main effect of maternal undernutrition and the importance of covarying environmental risk factors, e.g., crowding.

Determinants of pregnancy outcome and newborn behavior of a semirural Egyptian population.

Several potential determinants of birth weight and neonatal behavioral organization, ie, maternal anthropometry, food intake (energy, protein, and plant- and animal-source foods), morbidity, and household socioeconomic status, were followed systematically in a semirural Egyptian population during greater than or equal to 6 mo of pregnancy. In early pregnancy mothers were generally normal weight to moderately overweight. Their mean energy intake, largely from plant sources, was approximately 8.37 MJ/d (2000 kcal/d) during trimesters 2 and 3. Early (3 mo) pregnancy weight and weight gain during trimesters 2 and 3 were significantly positively related to birth weight Z scores. The best predictor model examined for birth weight included early pregnancy weight, weight gain, and length of gestation (R2 = 0.45). Early pregnancy weight and maternal intake of animal-source foods were significant positive predictors of the newborn's orientation and habituation behavior, respectively. Habituation and orientation measures assess the infant's early ability to process information.

Vitamin B-6 status of Egyptian mothers: relation to infant behavior and maternal-infant interactions.

Functional consequences of marginal maternal vitamin B-6 status for behavior of the neonate and for mother-infant interactions at age 3-6 mo were assessed by a double-blind procedure. In 27 of 70 Egyptian village women studied, vitamin B-6 concentration of their milk was considered indicative of poor maternal vitamin B-6 nutriture. Neonatal behavior, quantified by the Brazelton Neonatal Behavioral Assessment Scale, showed that consolability, appropriate build-up to a crying state, and response to aversive stimuli were significantly correlated with maternal vitamin B-6 nutriture. Naturalistic observational procedures, used twice monthly with infants aged 3-6 mo, indicated that mothers assessed as having marginal vitamin B-6 status were less responsive to their infants' vocalizations, showed less effective intervention to infant distress, and were more likely to use older siblings as care-givers than were mothers of better vitamin status. We conclude that vitamin B-6 was a factor influencing both the behavior of the mother and her infant.

Academic difficulty among male Egyptian university students. II. Associations with demographic and psychological factors.

We compared 178 students with academic problems with 77 academically successful students. Academic difficulty showed highly significant associations with low socio-economic status, over-crowded housing, paternal behaviour problems and a poor relationship between the parents; also significant associations with family history of psychiatric disorder and living away from home. Academic achievement at school was no guide to university performance. Failed students had fewer friendships, especially with women, and more limited recreational activities. They also scored significantly lower on tests of verbal and non-verbal IQ, and worse on the Bender Gestalt and trail-making tests. EPQ results suggested that university students, particularly those with academic difficulties, are more neurotic and introverted than the general Egyptian population.

A psychosocial study of accidental poisoning in Egyptian children.

One hundred and twenty-seven accidentally poisoned children from the emergency room of the Islamic Girls College, Cairo, were compared with an equal number of controls. The highest age incidence for both sexes in poisoned children was 36 months. Males outnumbered females at a ratio of 3:2. Behavioural problems such as hyperactivity, temper tantrums, aggression, stubbornness, nocturnal enuresis and impulsiveness occurred more often in poisoned children than in controls and more often in those (24 patients) referred with accidental poisoning on more than one occasion. The families of poisoned children differed significantly from the controls in their large size, low level of education, disturbed home atmosphere and the accessibility to the child of the poisonous substance.