A pilot study investigating the in vitro efficacy of sucralfate against common veterinary cutaneous pathogens.

OBJECTIVE: To determine whether Cicalfate® (Avene), a commercially available skin cream, or its active ingredient - sucralfate - demonstrate in vitro antimicrobial effect against common veterinary cutaneous pathogens. MATERIALS AND METHODS: Prospective study assessing in vitro susceptibility of standardised and clinical strains of common veterinary cutaneous pathogens to titrated concentrations of sucralfate in either saline solution (range 0∙2 to 200 mg/mL) or in Cicalfate® restorative cream solubilised in DMSO (range 0∙002 to 1 mg/mL). Minimum inhibitory concentrations were determined by broth dilution in accordance with Clinical and Laboratory Standards Institute guidelines. RESULTS: Both solutions demonstrated in vitro inhibitory effects against strains of Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus pseudintermedius, Escherichia coli and Enterococcus faecalis. Minimum inhibitory concentration ranges for susceptible bacteria tested in Cicalfate® solution and sucralfate solution were 0∙06 to 0∙25 mg/mL and 25 to 50 mg/mL, respectively. Sucralfate solution did not demonstrate antimicrobial effects against laboratory strains of S. aureus and E. faecalis and neither solution demonstrated antimicrobial effects against the clinical strain of P. aeruginosa. For organisms inhibited by sucralfate, Cicalfate® solution inhibited growth at lower sucralfate concentrations than sucralfate solution. CLINICAL SIGNIFICANCE: The results of this pilot study suggest that Cicalfate® and sucralfate demonstrate in vitro antibacterial activity. Further in vitro and clinical studies are warranted to confirm these observations and determine their clinical utility in the treatment of superficial pyoderma.

Familial predictors of childhood shyness: a study of the United Arab Emirates population.

OBJECTIVES: Phobic anxiety disorders generally breed true. In this regard, family studies have suggested an association between childhood shyness and maternal social phobia. In this study, the relationship between childhood shyness and maternal social anxiety was examined. SUBJECTS AND METHODS: 203 5-year-old children from an Arabian Gulf community and their mothers were evaluated. The children were assessed in stage 1 using the shyness scale of Stevenson-Hinde and Glover and the Preschool Behavior Checklist (PBCL), while mothers completed the Liebowitz Social Anxiety Scale. In the second stage, blind clinical interviews were carried out to ascertain the diagnosis of psychiatric diagnoses, if any, using DSM-IV criteria. RESULTS: 27% of the children were identified as shy using the shyness scale of Stevenson-Hinde and Glover and 19% scored above the cutoff for behavioral disturbance on the PBCL. Child shyness was associated with female gender and maternal social anxiety as indicated by scores on the Liebowitz Social Anxiety Scale, while an inverse relationship was noted with behavioral disturbance. The odds of the child having a high shyness score was increased if the mother had social anxiety (odds ratio = 2.14) and the child lived in a family that was 'not socially active' (odds ratio = 1.42). CONCLUSION: Our initial findings suggest that there may be a complex interaction between maternal social anxiety and family sociability in childhood shyness. Prospective longitudinal work is indicated.

Evaluation of adrenal function in small-breed dogs receiving otic glucocorticoids.

The objectives of this study were to evaluate adrenal function after otic glucocorticoid [Tresaderm (dexamethasone) and Otomax (betamethasone)] therapy in small-breed dogs without evidence of otitis and to evaluate the length of time needed for resolution of adrenal suppression after discontinuation of treatment. Fourteen clinically healthy, privately owned, small-breed dogs with normal ears and normal adrenocorticotropin (ACTH) stimulation tests were assigned to one of two treatment groups, receiving one of the medications at the manufacturer's recommended dosage twice daily for 2 weeks. All of the dogs in the betamethasone treatment group had normal ACTH stimulation tests after 2 weeks of treatment. In contrast, 5/7 (71.43%) in the dexamethasone group, had suppressed adrenocortical responses to exogenous ACTH. Three of these five dogs (42%) returned to normal values 1 week after ceasing the medication and two (28.57%) returned to normal values 2 weeks after ceasing the medication. In conclusion, it appears that adrenal function can be suppressed for up to 2 weeks in dogs receiving otic dexamethasone. A follow-up study repeating this work in dogs with inflamed ears is needed before further clinical recommendations can be made.

Personality profile among primary care patients: experimenting with the Arabic IPDE ICD-10.

OBJECTIVE: To estimate the prevalence of personality disorder (PD) among primary health care (PHC) patients, and to investigate the characteristic features of the International Personality Disorder Examination, the ICD-10 module (IPDE ICD-10). METHOD: A sample (n = 158) PHC patients in Al Ain, United Arab Emirates (UAE) were interviewed by general practitioners (GPs) using the Arabic version of the IPDE ICD-10. RESULTS: Patients interviewed were 82 males and 76 females. Definite PD was identified in 12.7%. Prevalence rates among males and females were 9.8 and 15.8% consecutively. Commonest personality disorders were the schizoid (5.1%), anankastic (4.4%) and the emotionally unstable, borderline type (3.8%). Comorbidity of PD was manifested by 30% of definite PD patients. The mean dimensional scores of definite and probable PD patients were 5.6 and 4.3 consecutively. CONCLUSION: The IPDE-ICD-10 is useful but relatively time consuming with repetition and need of rephrasing in some items. Dimensional measurement proved essential.

Reliability, validity, and factor structure of the Arabic version of the 12-item General Health Questionnaire.

The aim was to examine the psychometric properties of the Arabic 12-item General Health Questionnaire in a sample of university students. A sample of 157 university students was screened using this questionnaire and the Hopkins Symptom Checklist-90. A standardized clinical interview using SCID was conducted on a subset of screened students. Reliability, validity, and factor analysis of the questionnaire were evaluated. Using factor score discrimination between cases and noncases was also evaluated. The Arabic version of the GHQ-12 proved to be reliable as indicated by Cronbach alpha of .86. The best balance between sensitivity and specificity was found at the General Health Questionnaire cut-off point of 15/16: at this threshold, sensitivity was .88 and was paired with a specificity of .84. Principal component analysis with varimax rotation identified three factors, namely, Factor A (general dysphoria), Factor B (lack of enjoyment), and Factor C (social dysfunction). Factors A and C discriminated between clinically distressed and clinically nondistressed subjects. The General Health Questionnaire-12 as a whole is a reliable and valid screening tool in university settings.

A comparison of the validity of two psychiatric screening questionnaires: the Arabic General Health Questionnaire (AGHQ) and Self-Reporting Questionnaire (SRQ-20) in UAE, using Receiver Operating Characteristic (ROC) analysis.

This study compared the ability of the Arabic General Health questionnaire (AGHQ) and Self-Reporting Questionnaire (SRQ-20) to screen ICD-10 psychiatric disorders in an Arab community in Al Ain, United Arab Emirates. Standardised psychiatric assessments of subjects using the Composite International Diagnostic Interview (CIDI) were carried out. The Receiver Operating Characteristic (ROC) analysis was used to determine validity indices for the AGHQ and SRQ-20. For the AGHQ, sensitivity, specificity and area under the curve (AUC) were 86, 85 and 93% respectively, while for the SRQ-20, validity indices were 83, 83 and 90% respectively. Overall performance of the AGHQ was significantly better than the SRQ-20, especially in males and those under the age of 30 years. We conclude that both questionnaires are valid screening instruments in an Arab community in the UAE.

A1 Ain Community Psychiatric Survey. I. Prevalence and socio-demographic correlates.

BACKGROUND: Psychiatric community studies are essential for the planning and development of psychiatric services, as well as being helpful in examining the socio-demographic correlates of mental disorders in a given community. Few such studies have been carried out to date in the Arabian peninsula. This paper forms part of a multipurpose community psychiatric survey conducted in A1 Ain in the United Arab Emirates. The findings regarding lifetime prevalence and psychiatric morbidity are reported. METHODS: A total of 1394 (n = 1394) adults systematically sampled from Al Ain community were assessed with a modified version of the Composite International Diagnostic Interview (CIDI) as well with other instruments: the new screening psychiatric instrument, Self-Reporting Questionnaire (SRQ-20), and the Structured Clinical Interview for DSM-IV Axis 1 disorders (SCID) screening module. Lifetime prevalence and 1-week prevalence rates of mental distress as measured by screening instruments were estimated as well as the lifetime prevalence rate of CIDI ICD-10 psychiatric disorders. The sensitivity of the CIDI interview to correctly pick up distressed subjects, as well as those who had undergone previous treatment for a psychiatric disorder, was also calculated. Associations between socio-demographic risk factors and ICD-10 psychiatric disorder as well as with mental distress were also examined by bivariate and multivariate analyses. RESULTS: Overall lifetime prevalence of ICD-10 psychiatric disorder was found to be 8.2% (95% CI: 6.7-9.7), while the 1-week prevalence rate of mental distress as measured by the SRQ-20 was 15.6% (95% CI: 11.8-19.5) and the lifetime prevalence rate of mental distress as measured by the new screening instrument was 18.9% (95% CI: 11.5-25.9). The CIDI interview correctly picked up 42% of subjects who had received previous psychiatric treatment and 51% of the distressed. Mood disorders and anxiety (neurotic) disorders were more common in women and alcohol and substance use disorders were exclusively confined to men. Female sex, young age, quality of marital relationship, life events over past year, chronic life difficulties, physical illness, family history of psychiatric disorders and past history of psychiatric treatment were found to be significantly associated with ICD-10 psychiatric disorder. Multivariate analysis revealed that age, sex, exposure to chronic difficulties and past history of psychiatric treatment were the most significant predictors of ICD-10 psychiatric disorders, and exposure to chronic difficulties, past history of psychiatric treatment and educational attainment were the significant predictors of lifetime ever and current mental distress. CONCLUSION: The pattern and trend of psychiatric morbidity found in this survey is in line with those reported by other surveys that utilized similar assessment instruments. Differences in rates are explained by different methodologies used.

Al-Ain community psychiatric survey IV: socio-cultural changes (traditionality-liberalism) and prevalence of psychiatric disorders.

UNLABELLED: BACKGROUND This study was set to explore the relationship between socio-cultural change and psychopathology. METHOD: A representative sample (n = 1,394) of Al-Ain adult population had their psychopathology assessed with the Composite International Diagnostic Interview and other self-reported questionnaires, while the socio-cultural change was assessed with the modified version of the Socio-cultural Change Questionnaire (ScCQ). The reliability and construct validity of the modified ScCQ were assessed. The overall Tradition Index, attitudinal and behavioural indices of the sample were estimated. Association between socio-cultural change and psychopathology was also evaluated. RESULT: The reliability of the modified ScCQ was found to be moderate (alpha Cronbach 0.66) and the hypothesis regarding its construct validity was confirmed. Mean traditional index was found to be 0.61 +/- 0.14.Young, highly educated, skilled, and female subjects were found to be significantly less conservative and their scores on traditional index deviated significantly from overall mean. Less traditional people were also found to have a significantly increased rate of ICD-10 psychiatric disorder and higher scores on psychopathology measures especially among females. Although females showed significantly more modern attitude, there were no significant sex differences in the expressed behaviour as measured by the behavioural Tradition Index. CONCLUSION: The findings of this study suggest that the prevalence of psychiatric disorder varies significantly according to the extent to which subjects adhere to traditional values.

The performance of the Center for Epidemiologic Study Depression Scale (CES-D) in an Arab female community.

BACKGROUND: The purpose of this study was to investigate the psychometric properties of the Arabic version of the CES-D. METHODS: Three samples of young Arab females were chosen from different young female populations (n =450). The translated version of the CES-D, sociodemographic and risk factors questionnaires were applied to the above three samples. A subsample was selected (n = 30) to re-rate the scale items and the same sample was interviewed by the SCID. The internal consistency and test-re-test reliability were estimated as well as the factor structure of the Arabic CES-D. The discriminative and criterion validity of the scale was also investigated using the ROC analysis. RESULTS: Seventy five percent (n = 350) of the subjects completed the scale. Alpha coefficient was found to be 0.88 and the split-half reliability was 0.83. The average re-test reliability (ICC = 0.59). Factor analysis yielded three factors: interpersonal problems, mixed affective/somatic factor and the positive affect factor. There was significant differences in mean total score between depressed and non-depressed subjects as classified by SCID as well as by self-perception of depression and the need for treatment. ROC analysis revealed that a cut-off point of 21 discriminated best between depressed and non-depressed subjects (sensitivity= 82%, specificity = 83% with AUC of 84%). CONCLUSION: The Arabic CES-D was found to possess reasonable reliability and reasonable discriminative and criterion validity.

Al Ain Community Survey of Psychiatric Morbidity III. The natural history of psychopathology and the utilization rate of psychiatric services in Al Ain.

BACKGROUND: We evaluated the natural history of psychopathology in a stratified sample (n = 245) comprising subjects with no DSM-III-R psychiatric disorder, subthreshold disorder and threshold (DSM-III-R) psychiatric disorder, respectively, over a 12-months period, using the Structured Clinical Interview for DSM-III-R mental disorders (SCID) as an assessment tool. METHODS: A representative sample categorized 1 year earlier into DSM-III-R psychiatric disorder, subthreshold disorder and no DSM-III-R psychiatric disorder were reassessed with SCID 1 year on. The incidence, recovery rates and the percentage of subthreshold disorders which become DSM-III-R disorders were calculated. The utilization rate of psychiatric services was also assessed. RESULTS: The incidence rate of new cases was 10.4%. The recovery (remission) rate was 41.5%, and approximately 20% of subthreshold disorders became definitive disorders (DSM-III-R) after 1 year. Anxiety disorders tend to have a higher magnitude of temporal stability in comparison with depressive disorders. Male sex and contact with psychiatric services were found to affect the recovery rate. Approximately 13% of the sample had made contact with psychiatric services with no gender differences, but men were significantly more often hospitalized than women. CONCLUSION: Our findings indicate that mental disorders are relatively common. The high incidence rate found in this study is attributed in part to the high negative rate at baseline assessment. Approximately 60% of psychiatric disorders in the community are persistent, and patients with emotional disorder under-utilize existing services.

The role of pterins and related factors in the biology of early postpartum depression.

Plasma tryptophan and other putative amino acids, cortisol, folate and vitamin B12 and urinary biopterin (B) and neopterins (N) were measured in three groups of women: 62 women in the early postpartum period, 23 pregnant and 38 non-gravid controls. Sixty-two postpartum women were screened for depression by the Edinburgh postnatal depression scale (EPDS) on day 7 after delivery. Postpartum women had significantly lower tryptophan, vitamin B12 and significantly greater levels of cortisol, folate, neopterins and biopterins than controls. Comparisons between women who were classified on the EPDS as cases and non-cases revealed only a statistically significant difference for lower N:B (P<0.01) and lower folate (P<0.01) ratio in cases than non-cases. Multiple regression analysis showed a significant contribution for low tryptophan to increased EPDS which also showed significant correlations with low methionine, low tyrosine, low N:B ratio and high vitamin B12.

The rationale, development and reliability of a new screening psychiatric instrument.

BACKGROUND: This paper describes the rationale, development, reliability and validity of a new screening psychiatric instrument. METHOD: The instrument comprises 26 items that tap the cardinal features of main psychiatric categories as defined by ICD-10 and DSM-IV. These items were adapted from various structured and semi-structured diagnostic interviews that yield ICD-10 and DSM-IV psychiatric diagnoses. After a training course, 12 trainees and the trainer rated blindly the 26 items on 45 subjects (22 with psychopathology and 23 without). Inter-rater reliability coefficient (Kappa) was estimated between trainees and the trainer on each item of the instrument. The total score on the new instrument was then correlated with the total score on the Arabic Self Reporting Questionnaire (SRQ-20) and the Arabic version of the General Health Questionnaire (GHQ) in a random sample from the general population (n = 365). Logistic regression was utilised to estimate the power of the total score on the new instrument in discriminating between cases and non-cases as classified by the SRQ-20. RESULTS: Excellent levels of agreement (Kappa > 0.80) were found for all items except for obsession (Kappa = 0.65) and for depressed mood (Kappa = 0.70). Moderate correlations were found between the total score on the new instrument and total score on SRQ-20 (r = 0.69) and the total score on the Arabic GHQ (r = 0.7). The new instrument correctly classified 89% of subjects into cases and non-cases. CONCLUSIONS: The results of this study indicate that the new instrument is a highly reliable and valid screening instrument. The authors are now investigating its test-retest reliability and its procedural validity.

Hormonal aspects of postpartum depression.

Plasma cortisol, prolactin, oestrogen, progesterone, thyroxine, thyrotrophin (TSH) were collected from 23 pregnant, 70 postpartum women at 7 days postpartum, and 38 non-gravid controls. Sixty two postpartum women were screened for depression by the Edinburgh Postnatal Depression Scale (EPDS) on day 7 after delivery and 34 of them were assessed by the Present State Examination (PSE) at 8 +/- 2 weeks after delivery. Postpartum women had a significantly greater level of cortisol, prolactin, thyroxine and oestrogen than non-puerperal women. Postpartum women with current depression (EPDS > or = 11) had significantly lower plasma prolactin levels than those without depression and those who developed depression within 6-10 weeks after delivery (PSE level > or = 5) had significantly lower plasma prolactin and significantly greater progesterone levels than those who were not depressed. There were significant correlations between age and plasma cortisol and prolactin levels. Higher thyroxine levels predicted greater severity of concurrent symptoms of depression (total EPDS score) whilst higher progesterone and lower prolactin levels predicted the occurrence of depression (total PSE score) 6-10 weeks after delivery. Women who breastfed had significantly lower EPDS and total PSE scores and higher plasma prolactin levels than those who did not breastfed their infants whilst women who had previous episodes of depression had significantly greater EPDS and PSE scores, lower prolactin and higher TSH levels than those who had not suffered from previous episodes of depression.

The Dubai Community Psychiatric Survey. IV. Life events, chronic difficulties and psychiatric morbidity.

The relationship between life events, chronic social difficulties and psychiatric morbidity was investigated in 297 women selected at random as part of the Dubai Community Psychiatric Survey. The PSE-ID-CATEGO system was used to identify psychiatric cases, based on an Index of Definition level of 5 or more. Life events in the 6-month period prior to illness or interview were elicited through the Life Events and Difficulties Schedule. Chronic difficulties were explored through direct questioning based on a list of possible problems. The study demonstrates a significant excess of marked and moderately threatening life events in acute cases of psychiatric disorder (50%) compared to chronic cases (16.7%) and non-cases (27.9%). The association was particularly marked for events in the 3-month period before the onset. Around 33% of psychiatric morbidity may be attributed to marked and moderately threatening life events. Rates for mild events were similar in the three groups of subjects. Subjects experiencing chronic social difficulties included a significantly higher proportion of cases (33.3%) than those who did not experience such difficulties (9.1%). The effect of chronic social difficulties was more pronounced than, and independent of, the effects of life events. There were no interactions between life events and vulnerability factors in their effect on psychiatric morbidity, although numbers were small. The results suggest that the overall influence of life events and chronic difficulties on psychiatric morbidity is commensurate with that in Western societies, despite the different coping traditions of Islam.

The validity of the Arabic Edinburgh Postnatal Depression Scale.

For the purpose of this study, a consecutive sample of 95 postpartum women were assessed at 1 week postpartum with the (EPDS) and at 8 +/- 2 weeks postpartum using the Present State Examination (PSE). A moderate correlation between PSE total score and EPDS score was found (r = 0.57). A moderate agreement between EPDS and Catego diagnosis of depression was also found (Kappa = 0.52). Using a cut-off score of 12 on EPDS and Catego diagnosis as a criterion variable, the sensitivity and specificity of the scale were 73% and 90%, respectively. However, using a cut-off score of 10, the sensitivity of the scale rose to 91% without much fall in its specificity (84%). The internal reliability of the scale was 0.84 (alpha Cronbach). We conclude that the Arabic version of the EPDS is a reliable and valid screening tool for depression in postpartum women.

Postpartum psychiatric illness in Arab culture: prevalence and psychosocial correlates.

BACKGROUND: There have been numerous studies of the prevalence of postpartum depression and its putative risk factors in Western Europe and North America, but very few studies in developing countries including the Arab world. METHOD: Ninety-five women admitted to the New Dubai Hospital in Dubai, United Arab Emirates, for childbirth were studied. All subjects were assessed in the postpartum period using clinical and socio-cultural instruments: the Self Report Questionnaire (SRQ) at day 2, the Edinburgh Postnatal Depression Scale (EPDS) at day 7, and the Present State Examination (PSE) at week 8 +/- 2 and week 30 +/- 2 after delivery. RESULTS: The prevalence rate of psychiatric morbidity was 24.5% by the SRQ, 17.8% by the EPDS, and 15.8% by the PSE. A number of psychosocial factors emerged as putative risk factors for postpartum depression. CONCLUSIONS: The prevalence rates of postpartum psychiatric morbidity and its risk factors in this Arab culture are similar to the results obtained in numerous previous studies in industrialised countries. These findings have implications for the early detection and care of women at risk for postpartum depression.

The prevalence of early postpartum psychiatric morbidity in Dubai: a transcultural perspective.

There have been numerous studies of the prevalence of postpartum psychiatric illness and its putative risk factors in Western Europe and North America, but very few studies have been undertaken in developing countries, including the Arab world. A total of 95 women admitted to the New Dubai Hospital in Dubai, United Arab Emirates, for childbirth were studied. All subjects were assessed in the postpartum period using clinical and socio-cultural instruments, namely the Self-Reporting Questionnaire (SRQ) on day 2 and the Edinburgh Postnatal Depression Scale (EPDS) on day 7 after delivery. The prevalence of psychiatric morbidity was 24% according to the SRQ and 18% according to the EPDS. A number of psychosocial factors emerged as putative risk factors for postpartum psychiatric disturbance, including depressive illness. It is concluded that the prevalence of postpartum psychiatric morbidity and its risk factors in this Arab culture are similar to the results obtained in numerous previous studies conducted in industrialized countries. These findings have implications for the early detection and care of women at risk for postpartum psychiatric illness.

The diagnostic stability of ICD-10 psychiatric diagnoses in clinical practice.

This study examines the stability of ICD-10 diagnoses of patients admitted to Al Ain (United Arab Emirates) inpatients psychiatric unit during the period from November 1993 to August 1995. Diagnostic stability is a measure of the degree to which diagnoses remained unchanged at a later hospital admission. One hundred and seven patients were admitted more than once during this period, accounting for 168 readmissions. High levels of diagnostic stability were found for ICD-10 Fl-psychiatric disorders (100%), F2-schizophrenia (87%), F3-bipolar disorders (87%) and F3-depressive disorders (73%). A poor level of stability was found for patients with neurotic, stress related and adjustment disorders (F4), ranging from zero for somatoform disorders to 50% for generalized anxiety and panic disorders. Poor levels of stability were also found for other psychoses (excluding schizophrenia and affective psychoses) and personality disorders. We conclude that the introduction of ICD-10 as a formal diagnostic system has greatly improved the temporal stability of the most commonly encountered psychiatric disorders (ICD-10 Fl to F3 disorders), confirming the construct validity of those psychiatric disorders. Further investigations are required to evaluate the diagnostic stability of neurotic and other psychotic disorders.

The Dubai Community Psychiatric Survey: acculturation and the prevalence of psychiatric disorder.

Dubai, an Emirate in the Gulf region, has experienced spectacular social change as a result of the exploitation of its oil reserves. The Dubai Community Psychiatric Survey was designed to study the effects of this social change on the mental health of female nationals. In this paper, we approach the problem by quantifying social change in two main ways: the first focused on social change at the individual level as measured by the Socio-cultural Change Questionnaire (Bebbington et al. 1993). The second examined the effect of social change at the community level by identifying areas of residence at different levels of development. We hypothesized that attitudes and behaviours markedly at odds with traditional prescriptions would be associated with high rates of psychiatric morbidity. On the individual level, the association between psychiatric morbidity and the amount of social change reflected in the behaviours and views of the subjects was not significant. However, there was a significant association between morbidity and between social attitudes and behaviours. At the community level, in contrast, the relationship between psychiatric morbidity and social change was significant: there was more psychiatric morbidity in areas at the extremes of the social change continuum. The hypothesis put forward in this study must be modified accordingly.