Case report: Avoidant/restrictive food intake disorder after tonsillectomy.

Background: Avoidant Restrictive Food Intake Disorder (ARFID) is a newly classified eating disorder that requires further understanding of its presentation. There is no previous report of ARFID in a child post-tonsillectomy. ARFID may be a potential negative outcome for children following oropharyngeal surgery. Case presentation: A female child aged 10 years and 2 months presented with ARFID associated with depression, anxiety and nutritional deficiency following tonsillectomy. She had more difficulty in swallowing solids than fluids and had repeated vomiting and spitting food after chewing it. She became dehydrated and malnourished with a BMI of 10.5 and was misdiagnosed with myasthenic gravis. Conclusions: To our knowledge, this is the first case report of ARFID in a child post-tonsillectomy. We discuss the pathophysiology of ARFID, which remains elusive, and recommend psychiatric assessment when evaluating children post operative tonsillectomy.

Impact of Magnesium and Ferritin Deficiency on Depression Among Adolescent Students.

BACKGROUND: Depression is considered the fourth-leading cause of health problems. It is the fourth-leading cause of health problems and disability, which causes 16% of the worldwide burden of disease and injury among adolescents. OBJECTIVE: The aim of the present study was to evaluate the possible association of magnesium (Mg) and ferritin deficiency with depression in adolescent students. PATIENTS AND METHODS: This case control study in secondary schools at Al-Ghanayem discrete. The total number included was 358 students. All were screened for depression by the Arabic version of the Beck questionnaire. The students who had positive score was selected as cases 86 and a matched same number of students with negative score was selected as controls. Serum level of ferritin and magnesium was measured in the 2 groups. RESULTS: There was statistically significant difference between the studied groups when comparing depression grade with each of ferritin and Mg Depressed group cases had lower mean values of ferritin and Mg. The ferritin cut-off level for the prediction of depression was (35.5 µg/dL, which had a sensitivity of 74.4% and a specificity of 75.6%. The magnesium cut-off levels for the prediction of depression were1.95 mg/dL and 104.5 ng/dL which had a sensitivity of 70% and 64%, respectively. CONCLUSION: There was a statistically significant negative correlation between depression severity and each of socio-economic status ferritin and Mg. Each of ferritin and Mg were predictors for depression.

A double blind randomized clinical trial of the effectiveness of low frequency rTMS over right DLPFC or OFC for treatment of obsessive-compulsive disorder.

We compared the effectiveness of low frequency repetitive transcranial magnetic stimulation over right dorsolateral prefrontal cortex (DLPFC), right orbitofrontal cortex (OFC) and sham for treatment of obsessive-compulsive disorder (OCD) and sought to determine possible predictors of effective treatment. Sixty OCD patients participated and were randomly allocated to one of the 3 treatment groups. Treatment was administered daily for 10 days. Assessments were made at the beginning and end of therapy as well as three months later using the Yale-Brown obsessive compulsive scale (Y-BOCS), Hamilton Anxiety Rating Scale (HAM-A), Beck Depression Inventory (BDI), and Clinical Global Impression - Severity scale (CGI-S). There were no significant demographic or clinical differences between the groups at baseline. One-way repeated measures ANOVA showed that participants in all 3 groups improved their scores on all rating scales following treatment. A two-way repeated measures ANOVA revealed a significant time and group interaction due to the fact that both active treatment groups outperformed the sham group, although there was no significant difference between the two. Percent improvement had significant negative correlations with the following factors: duration of illness, baseline Y-BOCS, HAM-A, and BDI. We conclude that rTMS over either right DLPFC or OFC has a therapeutic effect on OCD symptoms. Patients with lower Y-BOCS and fewer comorbidities responded best to rTMS.

Prevalence of school bullying and its relationship with attention deficit-hyperactivity disorder and conduct disorder: a cross-sectional study.

Background: School bullying is the most widespread form of violence among adolescents. It has been identified as a critical problem for students and has evolved into a public health issue and global crisis. The study aims to assess the prevalence of school bullying among primary school students and its relationship with attention deficit hyperactive disorder (ADHD) and conduct disorders. Among the 280 primary school students those aged 10-12 years were recruited. All participants were assessed by parent interview, the Arabic version of the bullying behavior scale for children and adolescents and the Arabic version of the Conners' Teacher Rating Scale-28. Results: We found that the prevalence rate of bullying behavior was 12.5% among students. In bullying students' group, males were higher percentage (15.8%) than females (9%). Also, they had the highest mean scores regarding verbal bullying and social bullying, followed by psychological and physical bullying. Regarding Conners', the higher mean scores of conduct problem, passive-inattentive, and hyperactivity index were associated with bullying students in compared to students without bullying. Conclusions: The prevalence of school bullying among primary school students was 12.5%. Also, there was significant association between bullying students and having attention deficit hyperactive disorder (ADHD) and/or conduct disorder.

Correlation between psychiatric impact of COVID-19 during pregnancy and fetal outcomes in Egyptian women.

The prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) was examined in 238 pregnant women with (n = 146) and without (n = 92) coronavirus disease 2019 (COVID-19) using the State-Trait Anxiety Inventory (STAI), Edinburgh Postnatal Depression Scale (EPDS), and PTSD Checklist for DSM-5 (PCL-5). Fetal outcomes in the same groups were evaluated using the Apgar score. Anxiety and depression scores were significantly higher in women with COVID-19 but PTSD scores were similar in both groups. Infection with COVID-19 was associated with a higher number of fetal deaths or an Apgar score <7. During the COVID-19 pandemic, approximately 46.6% of pregnant women had depression, 5.5% had PTSD, 64.3% had state anxiety, and 60.9% had trait anxiety. Except for PTSD, psychiatric problems and poor fetal outcomes were higher in women with COVID-19 than in those without COVID-19. Lastly, women with COVID-19 were more prone to have a fetus who died or had an Apgar score of <7.

Case Report: Catatonia Associated With Post-traumatic Stress Disorder.

We report here about a 12-year-old female patient who had two life-threatening accidents that led to post-traumatic stress disorder associated with catatonia. She had closed eyes, had urinary and fecal incontinence, and had been in an abnormal position for one and half month. Moreover, she had complications such as dehydration, malunion of the fractured arm, and deformities in hand and foot. After detailed psychiatric examination, neurological assessment, and laboratory investigation, the patient received successful treatment in the form of benzodiazepine injections, intravenous fluid, oral antidepressants, and six sessions of electroconvulsive therapy (ECT). We discuss the pathophysiology of catatonia, which remains elusive, and recommend evaluating catatonic children for any possible trauma during psychiatry assessment.

Prevalence and predictors of postpartum depression in Upper Egypt: A multicenter primary health care study.

BACKGROUND: Postpartum depression (PPD) is highly prevalent with a major impact on the mother and child health. We aimed to determine the prevalence of PPD in primary health care centres which provide vaccinations services to infants in Assiut city and to evaluate the possible risk factors associated with PPD. METHODS: In this multicentre study, 257 mothers attended three primary health care centres for immunization of their babies were recruited from January 2019 to January 2020. All participants were evaluated for socio-demographic features, Family affluence scale (FAS), Edinburgh Postnatal Depression Scale (EPDS) and associated risk factors. RESULTS: The mean age of the participants was 27.98 ± 4.7. About half of the mothers and their husbands had low education level. Most of the families (89%) have low socioeconomic scale (SES). About (33.5%) women were found to have possible PPD. In the logistic regression analysis, SES, history of depression, history of PPD, history of stressful conditions, familial support, unwanted pregnancy, and male preference were significant statistical in PPD (p < 0.05). LIMITATIONS: We did not investigate the medical and psychological problems during antenatal care. Also, we did not assess relation of the type of delivery and medical problems during delivery on the postnatal care. CONCLUSIONS: PPD was prevalent in 33.5% The possible risk factors of PPD were low SES, history of depression, history of PPD, history of stressful conditions, familial support, unwanted pregnancy, and male preference.

Repetitive transcranial magnetic stimulation in the treatment of obsessive-compulsive disorders: Double blind randomized clinical trial.

Repetitive transcranial magnetic stimulation (rTMS) has become widely used as a therapeutic tool in psychiatric research. The aim of this study was to evaluate the impact of different frequencies of rTMS over right dorsolateral prefrontal cortex (DLPFC) in OCD. Forty five patients with OCD participated in the study. Patients were evaluated using: Yale-Brown obsessive compulsive scale (Y-BOCS), Hamilton Anxiety Rating Scale (HAM-A), and Clinical Global Impression-Severity scale (CGI-S). They were randomly classified into three groups: 1st group received 1Hz rTMS; 2nd group received 10Hz rTMS; and 3rd group received sham stimulation all at 100% of the resting motor threshold for 10 sessions. They were followed up after the last treatment session and 3 months later. There was a significant "time"×"group" interaction for 1Hz versus Sham but not for 10Hz versus Sham. 1Hz versus 10Hz groups showed a significant interaction for Y-BOCS and HAM-A (P=0.001 and 0.0001 respectively). 1Hz rTMS has a greater clinical benefit than 10Hz or Sham. There was also a significantly larger percentage change in GCI-S in the 1Hz group versus either 10Hz or sham. We conclude that 1Hz-rTMS, targeting right DLPFC is a promising tool for treatment of OCD.

Motor cortical excitability in obsessive-compulsive disorder: Transcranial magnetic stimulation study.

OBJECTIVES: Transcranial magnetic stimulation is a non-invasive method of stimulating the brain that is increasingly being used in neuropsychiatric research. Previous work has suggested that the pathophysiology of obsessive-compulsive disorder (OCD) may involve dysfunction of excitatory and/or inhibitory brain function. This study aimed to extend those findings. METHODS: The study included 45 OCD patients and 15 age- and sex-matched healthy volunteers. Clinical evaluation was conducted using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Anxiety Rating Scale (HAM-A), and Clinical Global Impression rating scale (CGI). Physiological measures were resting and active motor thresholds (RMT and AMT), motor evoked potential (MEP) amplitude, cortical silent period (CSP) and transcallosal inhibition (TCI) durations, short-interval intracortical inhibition (SICI), and intracortical facilitation. RESULTS: RMT and AMT were significantly lower in patients than in the control group. The mean duration of the CSP and TCI were also significantly shorter. Obsessive trait was associated with significant reduction of TCI duration compared to compulsive trait. There was significant reduction in SICI in OCD patients compared to controls. There were no significant correlations between the Y-BOCS, HAM-A and CGI scores and the cortical excitability parameters. CONCLUSION: These results provide further evidence for inhibitory deficits or increased facilitation in cortical circuits of patients with OCD.

A double-blind randomized clinical trial on the efficacy of magnetic sacral root stimulation for the treatment of Monosymptomatic Nocturnal Enuresis.

PURPOSE: Purpose of this study was to evaluate the long term efficacy of repetitive sacral root magnetic stimulation (rSMS) in patients with monosymptomatic nocturnal enuresis (MNE). METHODS: Forty four patients were randomized to receive either sham or real repetitive sacral root magnetic stimulation (rSMS; 15 Hz with a total of 1500 pulses/session) for 10 sessions. Evaluation was performed before starting treatment, immediately after the 5th and 10th treatment session, and 1 month later, using frequency of enuresis/week, visual analogue scale (VAS) and quality of life as outcome measures. Resting and active motor thresholds of gastrocnemius muscles were measured before and after the end of sessions. RESULTS: Both treatment and control groups were comparable for baseline measures of frequency of enuresis, and VAS. The mean number of wet nights/week was significantly reduced in patients who received real rSMS. This improvement was maintained 1 month after the end of treatment. Patients receiving real-rSMS also reported an improvement in VAS ratings and quality of life. A significant reduction of resting motor threshold was recorded after rSMS in the real group while no such changes were observed in the sham group. CONCLUSION: These findings suggest that rSMS has potential as an adjuvant treatment for MNE and deserves further study.