Evaluation of Sickle Cell Module for Quality of Life in Egyptian Children and Adolescents Patients: Impact of Psychiatric and Disease Specific Variables.

Sickle cell disease (SCD) impacts the physical, emotional, and psychological aspects of life. We aimed to study the quality of life (QoL) in Egyptian children and adolescents with SCD using the sickle cell module in relations to social, psychological and disease variables. A cross sectional study included 40 patients with SCD between 5 and 18 years. Details of diagnosis, SCD related complications, socioeconomic status were revised. Psychological assessment was done using children depression inventory, revised Children's Manifest anxiety scale and Health related QoL for both patients and parents using a validated Arabic age specific version of sickle cell module. Significant better scores for communication problems in mothers with college degree was found compared with other academic levels with no significant difference in QoL in relation to father education and significant higher communication problems with high rate of hospitalization (P = .021). Pain score was higher in 8-13 years compared with 13-18 years age groups. Significant worse scores for worrying was found in females, P = 0.033; Depression was found in 90% of studied patients. The main determinants of QoL in patients with SCD were maternal education and frequency of hospitalization. Depression is of alarming frequency for intervention.

Reducing the stigma of mental health disorders with a focus on low- and middle-income countries.

Mental health disorders are a burgeoning global public health challenge, and disproportionately affect the poor. Low- and middle-income countries (LMICs) bear 80 % of the mental health disease burden. Stigma associated with mental health results in delayed help seeking, reduced access to health services, suboptimal treatment, poor outcomes and an increased risk of individuals' human rights violations. Moreover, widespread co-occurrence of physical comorbidities such as noncommunicable diseases with mental health disorders makes the treatment of both conditions challenging and worsens prognosis. This paper explores various aspects of stigma towards mental health with a focus on LMICs and assesses measures to increase help-seeking and access to and uptake of mental health services. Stigma impacts persons living with mental illness, their families and caregivers and healthcare professionals (mental health professionals, non-psychiatric specialists and general practitioners) imparting mental health care. Cultural, socio-economic and religious factors determine various aspects of mental health in LMICs, ranging from perceptions of health and illness, health seeking behavior, attitudes of the individuals and health practitioners and mental health systems. Addressing stigma requires comprehensive and inclusive mental health policies and legislations; sustainable and culturally-adapted awareness programs; capacity building of mental health workforce through task-shifting and interprofessional approaches; and improved access to mental health services by integration with primary healthcare and utilizing existing pathways of care. Future strategies targeting stigma reduction must consider the enormous physical comorbidity burden associated with mental health, prioritize workplace interventions and importantly, address the deterioration of population mental health from the COVID-19 pandemic.

Electronic Mental Health as an Option for Egyptian Psychiatry: Cross-Sectional Study.

BACKGROUND: Egypt is a country of nearly 100 million citizens, and there are less than 1000 registered psychiatrists. The mental health care system is under resourced and nearly inaccessible for the majority of the population. In addition, youth under the age of 25 years represent 50% of Egyptian citizens; however, there are no specific services addressing their unique needs. How can the needs of the largest population in the Middle East be effectively addressed? Is a web-based framework an option for Egyptian psychiatrists to serve the population? OBJECTIVE: The aims of this study were to better understand the opinions of psychiatrists on the current state of mental health care services in Egypt and their current knowledge on electronic mental health (EMH); assess the attitudes of Egyptian psychiatrists toward web-based interventions and telemedicine for mental health; and identify perceived advantages and barriers of EMH development in Egypt. METHODS: A cross-sectional survey was conducted online among 640 Egyptian psychiatrists. It included a total of 36 items within a set of 16 questions asking about EMH literacy, integrating EMH into the mental health care system, and the perceived priorities and barriers of EMH. The sampling was supported by Tanta University, a large academic institution close to Cairo. Statistical analysis was performed using SPSS 25 (IBM Corp). Descriptive statistics, the chi-square test, the independent sample t test, and analysis of variance were applied. RESULTS: A total of 188 participants responded (response rate of 29.4%), of which 54.2% (102/188) were female and 54.3% (102/188) were between 30 and 45 years old. Less than half of the participants thought that the current health care system was efficient for adults (69/155, 44.4%), and even less thought it was efficient for youth (44/155, 28.3%). Almost all participants agreed that EMH would be beneficial for patient care (147/155, 94.8%) and that integrating EMH into the current health care system would be a good idea (118/155, 76.2%). The highest rated utility of web-based solutions was documentation, followed by psychoeducation and communication with professionals. The main advantages were to improve access to care in rural areas of the country and its convenience. CONCLUSIONS: There is scarcity of mental health resources in Egypt. Egyptian psychiatrists are interested in EMH and believe web-based platforms can become part of the solution for the Egyptian mental health care system.

Impact of a culturally adapted behavioural family psychoeducational programme in patients with schizophrenia in Egypt.

OBJECTIVE: To study the effect of a culturally adapted, structured family intervention on symptom severity, medication attitudes and knowledge, social functioning and quality of life in patients with schizophrenia. METHODS: Thirty subjects with schizophrenia were selected to receive 14 sessions of a culturally adapted behavioural family psychoeducational programme (BFPEP). Another 30 subjects received standard treatment as usual (STU) for 6 months. Pre- and post-intervention outcomes were assessed using the Positive and Negative Syndrome Scale (PANSS), Drug Attitude Inventory 10-item scale (DAI-10), Quality of Life Scale (QLS) and Social Functioning Questionnaire (SFQ). RESULTS: There was a no significant difference between BFPEP and STU at baseline on all measures. There was a significant difference (p < .05) between pre- and post-treatment scores for BFPEP on all measures, a significant difference (p < .05) between pre- and post-treatment scores for STU on all measures (favouring pre-treatment scores) and a significant difference (p < .05) favouring BFPEP over STU on all measures post-treatment. CONCLUSIONS: These results demonstrate the feasibility and effectiveness of implementing family therapy psychoeducational interventions in different cultural settings, with relatively minor modifications. This may have implications for mental health policy makers to make available such programmes for patients and mental health professionals.

Risk factors influencing severity of attention deficit hyperactivity disorder in a sample of preparatory school students in Cairo.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders. Severity of symptoms is associated with more behavioral problems, poor academic performance, and persistence of symptoms into adulthood. METHODS: To examine the clinical and social correlates that may be identified as risk factors associated with ADHD severity in a sample of adolescent ADHD school students. A total of 925 students were recruited from two public and two private schools from eastern Cairo. They were interviewed using Conners-Wells Adolescent Self-Report-short version (CASS-S); students scoring more than 65 were further interviewed with Kiddie Schedule for Affective Disorders and Schizophrenia-present and lifetime version (K-SADS-PL) to confirm the diagnosis, then Conners-Wells Adolescent Self-Report-long version (CASS-L) to assess severity and Wechsler Intelligence Scale for Children (WISC) to ascertain intellectual ability. RESULTS: About 10.3% of cases were severe, 5.7% were moderate, and 83.9% were mild. Severity was significantly associated with female gender, psychiatric comorbidity, family problems, conduct symptoms, and poor anger management. Diagnostic and Statistical Manual of Mental Disorders (4th ed.) ( DSM-IV) hyperactive-impulsive type was the only predictive factor of ADHD severity. CONCLUSIONS: The diagnosis of hyperactive-impulsive subtype may predict the severity of ADHD symptoms.

Screening for ADHD in a Sample of Egyptian Adolescent School Students.

OBJECTIVE: To screen for ADHD in a sample of Egyptian adolescent students, and study the distribution of different subtypes of ADHD, associated comorbidities, and sociodemographic correlates. METHOD: A total of 925 adolescents were randomly selected and screened by the Conners-Wells' Adolescent Self-Report Scale-Short form (CASS:S), and potential cases were further assessed by the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime versions (K-SADS-PL). RESULTS: A total of 87 students (9.4%) had potential ADHD diagnosis with evident preponderance in boys (13.8%, n = 58) than in girls (5.8%, n = 29) with a ratio of 2:1 ( p = .000, χ2 = 17.328). The hyperactive-impulsive subtype comprised the majority of cases (54.7%, n = 41). Psychiatric comorbidity was invariably present (85.1%, n = 74). Nearly half the cases had poor academic achievement (43.7%, n = 34). Positive correlates included family history of psychiatric disorders, the order of birth, and parental disharmony. CONCLUSION: ADHD is prevalent in Egyptian adolescents and is associated with high psychiatric comorbidity and a pronounced effect on academic performance.

Use of second-generation antipsychotics in the acute inpatient management of schizophrenia in the Middle East.

BACKGROUND: Management of acute psychotic episodes in schizophrenic patients remains a significant challenge for clinicians. Despite treatment guidelines recommending that second-generation antipsychotics (SGAs) should be used as monotherapy, first-generation antipsychotics, polypharmacy, and lower than recommended doses are frequently administered in clinical practice. Minimal data exist regarding the use of SGAs in the Middle East. The objective of this study was to examine the discrepancies between current clinical practice and guideline recommendations in the region. METHODS: RECONNECT-S Beta was a multicenter, noninterventional study conducted in Egypt, Kuwait, Saudi Arabia, and the United Arab Emirates to observe the management of schizophrenic patients who were hospitalized due to an acute psychotic episode. Patients underwent one visit on the day of discharge. Demographic and medical history, together with data on antipsychotic treatment and concomitant medication during the hospitalization period and medication recommendations at discharge were recorded. RESULTS: Of the 1,057 patients, 180 (17.0%) and 692 (65.5%) received SGAs as monotherapy and in combination therapy, respectively. Overall, the most frequently administered medications were given orally, and included risperidone (40.3%), olanzapine (32.5%), and quetiapine (24.6%); the doses administered varied between countries and deviated from the recommended guidelines. Upon discharge, 93.9% of patients were prescribed SGAs as maintenance therapy, and 84.8% were prescribed the same medication(s) as during hospitalization. CONCLUSION: Current clinical practice in the Middle East differs from guideline recommendations. Patients frequently received antipsychotics in combination therapy, by various methods of administration, and at doses above and below the recommended guidelines for the management of their acute psychotic episodes.

Role of traditional healers in the pathway to care of patients with bipolar disorder in Egypt.

BACKGROUND: A large number of mentally ill patients prefer to visit non-medical practitioners such as traditional healers because of the confidence in the system, affordability and accessibility of the service. This may lead to delay in seeking psychiatric services and has prognostic impact. AIM: To assess the rate of bipolar affective disorder (BAD) patients seeking traditional healers, the sociodemographic and clinical correlates of those patients. METHODS: We assessed 350 patients with BAD after confirmation of diagnosis with Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I) research version and assessment of functioning with Global Assessment of Functioning scale. They were assessed for percent, rate and timing of seeking traditional healers. RESULTS: In all, 40.8% sought traditional healers, with 34.9% more than four times. Of those, 62.2% were before seeking psychiatric services and 37.8% after. Lower educational level, less impairment of functioning and presence of hallucinations were significant correlates. CONCLUSION: This study shows that most of the patients suffering from mental illness prefer to approach faith healers first, which may delay entry to psychiatric care and thereby negatively impact the prognosis of BAD. This highlights the importance of mental health education and developing a positive collaborative relationship with traditional healers.

Correlates of psychiatric co-morbidity in a sample of Egyptian patients with bipolar disorder.

BACKGROUND AND OBJECTIVES: Bipolar disorder (BD) is a complex, chronic mood disorder involving repeated episodes of depression and mania/hypomania. Two thirds of patients with bipolar disorder have a comorbid psychiatric condition. This study aims to assess the prevalence of Axis I diagnosis with its socio-demographic and clinical correlates among a sample of Egyptian patients with bipolar disorder. METHODS: Out of the 400 patients who were enrolled in the study from number of governmental and private psychiatric hospitals in Cairo, Egypt, 350 patients diagnosed with bipolar affective disorders (157 females and 193 males) with age ranging from 18 to 55years were selected. Patients were assessed using the Structured Clinical Interview for DSM-IV Axis I disorder (Research Version) (SCID-I). RESULTS: Prevalence of psychiatric comorbidity among BD patients was 20.3% (71 patients) among which 63 patients (18%) had comorbid substance abuse and 8 patients (2.3%) had comorbid anxiety disorders. LIMITATIONS: The study was limited by its cross sectional design with some patients having florid symptoms during assessment, not having a well representative community sample. This might have decreased the reliability and prevalence of lifetime psychiatric comorbidity due to uncooperativeness or memory bias. The study group was composed of bipolar patients attending tertiary care service which limits the possibility of generalizing these results on different treatment settings. CONCLUSIONS: Substance abuse followed by anxiety disorders was found to be the most common psychiatric comorbidity. Family history of psychiatric disorders and substance abuse as well as current psychotic features were highly correlated with comorbidity.

Impact of personality temperaments and characters on academic performance and specialty selection among a group of Egyptian medical graduates.

BACKGROUND: The relationship between personality temperaments, academic achievement and specialty interest is important because of its implications in career counseling. AIM: To assess the effect of personality on academic performance and career selection and to study the impact of some sociodemographic factors on academic achievement and career choice of medical graduates. METHODOLOGY: A total of 436 medical graduates of Ain Shams medical school were approached, out of which 331 participated. They were given a sociodemographic questionnaire, and the Temperament and Character Inventory-Revised (TCI-R; 240) for personality construct; they had to answer questions about academic achievement, ranking, scores and choice of medical specialty. RESULTS: Novelty seeking (NS1, NS2 and NS3) and self-transcendence (ST1 and ST2) were correlated with graduation ranking, (r = .2, p = .00; r = .15, p = .009; r = .16, p = .005; r = .12, p = .003; r = .14, p = .02; r = .17, p = .004; r = .13, p = .03, respectively), that is, lower NS and ST had better academic outcome. Only high school score was associated with better achievement (p = .00). In specialty selection, females were significantly overrepresented in pediatrics and clinical pathology, whereas males were significantly predominating surgical specialties except for obstetrics and gynecology (p = .00). Students choosing patient-centered specialties had higher reward dependence (RD), persistence (PS) and cooperativeness (C); those choosing clinical pathology had highest harm avoidance (HA), whereas those choosing radiology had lowest HA and those choosing surgery had significantly higher self-directedness (SD3). CONCLUSION: Personality impacts academic achievement and specialty choice with other factors as gender and previous scholastic performance.

Pathways to child mental health services among patients in an urban clinical setting in Egypt.

OBJECTIVE: Of the 82.6 million people living in Egypt, 31% are children under age 15. Until recently, identification and treatment of child mental health problems have not been a high priority in Middle East countries. This study examined referral patterns of children who visited a government- operated, urban, outpatient mental health clinic in Cairo and the duration of illness before psychiatric consultation was obtained. METHODS: A total of 123 patients were recruited from a child psychiatry outpatient clinic at the Institute of Psychiatry of Ain Shams University hospitals. Diagnoses were made with the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version, the Gilliam Autism Rating Scale, and the Stanford-Binet Intelligence Scale. RESULTS: For 63% of children, the most distressing symptom reported was behavioral problems. The mean ± SD duration of illness before psychiatric consultation was 3.4 ± 3.1 years. Autism, mental retardation, and nocturnal enuresis were significantly associated with delays in obtaining psychiatric consultation, as was belonging to the middle or low social class. For most patients (67%), the first contact was with either a pediatrician or a psychiatrist. For a smaller proportion (5%), the first contact was a traditional healer. Most patients were referred to the clinic by relatives (30%), followed by pediatricians (21%), school teachers (12%), and traditional healers (5%). CONCLUSIONS: Most parents first sought the advice of pediatricians for their child's mental health problem, and a substantial number consulted traditional healers. Awareness programs targeting pediatricians and elementary school teachers are urgently needed in Egypt to shorten the duration of undiagnosed illness among children.

Immunological changes in patients with mania: changes in cell mediated immunity in a sample from Egyptian patients.

The immune system and its relation to psychiatric disorders has attracted many investigators, but there is still great controversy about the extent of immunological changes associated with different psychiatric disorders. Bipolar disorder is the least studied among the three major psychiatric disorders: schizophrenia, major depression and bipolar disorder. The current study was conducted on 20 patients with mania in comparison to 20 healthy controls, to evaluate changes in percentage of lymphocytes, active T-lymphocytes and natural killer (NK) cells. We found a significant decrease in the percentage of lymphocytes in mania patients as compared to controls. Assessment of Active T. lymphocyte (HLADR+) and NK cell (CD56+) by flowcytometry using a battery of paired (FITC and PE) monoclonal antibodies, revealed significant decrease in NK cells (P < 0.001), while no significant difference was found between patients and controls as regards percentage of active T lymphocytes. It is concluded that the immune response is altered in manic patients. However, further studies on large number of cases using various immunological parameters related to CMI are needed to confirm these findings.