Psychiatry

Impulsivity, suicidality, and emotional dysregulation in women having borderline personality disorder with and without substance dependence Samir A Magd, Moustafa Rakhawy, Rania Mamdouh, Somaya Shaheen Egyptian Journal of Psychiatry 2019 40(2):59-63 Objective The objective of this article is to detect differences between women having borderline personality disorder (BPD) with and without substance dependence regarding impulsivity, suicide, and emotional dysregulation. Patients and methods A total of 40 women with BPD [diagnosed by structural clinical interview for DSM (SCID) II] were compared with 40 women diagnosed as having BPD with substance dependence (diagnosed by SCID I and SCID II) attending the outpatient clinic in our university hospital using BPD severity index, Barratt Impulsiveness Scale, and Difficulties in Emotional Regulation Scale. Results BPD with substance dependence women were more impulsive than those without substance dependence, but there were no difference between both groups regarding suicide and emotional dysregulation. Conclusion The findings of the study have clinical implications for management of women with BPD.

Psychiatric and social profile of recovering substance-dependent women Magd S Abol, Rania Mamdouh, Sherine El Mekawy, Sally El Sheikh Egyptian Journal of Psychiatry 2019 40(2):64-73 Objectives The objective of this article is to estimate the presence of psychiatric disorders among a group of recovering substance-dependents female patients and to assess the degree of social competence and support of the recovering substance-dependent women throughout the process of recovery. Patients and methods A total of 30 recovering substance-dependent women were selected as consecutive samples from private hospitals, private clinics, and private rehabilitation centers in Greater Cairo. Moreover, 30 controls were included who were nonsubstance-dependent volunteer women. All participants gave written consent and were subjected to the following interviews, assessments, and investigations: informed consent, Structured Clinical Interview for DSM axis I, Addiction Severity Index for cases, Social Support Questionnaire, Social Competence Scale, and urine sampling for cases. Results Most recovering substance-dependent women were single, mostly divorced, and unemployed. Benzodiazepines were the most common substance of abuse followed by opiates and alcohol. The period of sobriety was 6 months to 1 year in half of the cases. The addiction severity index revealed most cases had severe drug and alcohol use, severe psychiatric problems, and severe problems in their social relationships owing to drug dependence, and approximately half of the cases had severe medical and legal problems owing to drug dependence. Most of the recovering substance-dependent women showed low social competence and had limited to fair level of social support in their recovery. All recovering substance-dependent women had a psychiatric diagnosis. Major depressive disorder and posttraumatic stress disorder are the two most common psychiatric disorders found in recovering substance-dependent women. Conclusion There is a high prevalence of psychiatric disorders among recovering substance-dependent female patients. Their social competence is low, and they tend to have limited to fair social support throughout the process of recovery.

A preliminary study of stress and infertility among Egyptian female sample in Benha city Victor S Mikhael, Mohamed M El-Hamady, Shewikar T El-Bakry, Raghdaa A Abdel-Halem Egyptian Journal of Psychiatry 2019 40(2):74-85 Background To study infertility-related stress among women, as the experience of infertility can be extremely stressful and associated with a range of psychiatric problems in infertile women, to examine its relationship with their coping capability to stress and marital satisfaction, and to study some of the risk factors that may lead to psychiatric disorders. Objective In this study, we have analyzed the psychiatric problems of infertile women, their coping capability to stressful life events, and marital satisfaction among them. Patients and methods In a cross-sectional study, 30 infertile women (15 explained and 15 unexplained infertility) were randomly selected and advised to a clinical psychiatric assessment and to fill up Stressful Life Events Coping questionnaire and Marital Satisfaction Inventory. After obtaining their consents, psychiatric problems such as depressive disorders, anxiety disorders, panic, somatoform disorders, and personality profile were assessed. Moreover, their coping capability to stressful life events and marital satisfaction was studied. Results were analyzed and compared with the results from 10 fertile women. Results According to a clinical psychiatric assessment, Stressful Life Events Coping questionnaire, and Marital Satisfaction Inventory, major depression, anxiety disorders, comorbid anxiety and depression, and premenstrual dysphoric disorder were significantly more frequent in infertile women. Considering somatization and personality disorders, there was no significant difference between infertile and fertile women. Pathological coping capability to stress and marital dissatisfaction, on the contrary, was significantly higher among infertile women. Conclusion Infertility may be considered as one of the major casual factor in depression and anxiety disorders, has negative coping capability to stress, and shows marital dissatisfaction.

Effect of zinc supplementation in zinc-deficient children with attention-deficit hyperactivity disorder Azza El-Bakry, Amal M El Safty, Amany A Abdou, Omnia R Amin, Doaa R Ayoub, Dina Y Afifi Egyptian Journal of Psychiatry 2019 40(2):86-94 Background Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder increasing in prevalence. Although there is limited evidence to support treating ADHD with mineral supplements, research does exist showing that patients with ADHD may have reduced levels of zinc, ferritin, and magnesium. These nutrients have important roles in neurologic function, including involvement in neurotransmitter synthesis. In spite of the good response of many patients with ADHD to stimulant drugs, a substantial percent do not respond to or develop significant side effects from stimulants. For this reason, zinc treatment has been considered to show positive results on various symptoms in ADHD patients with zinc deficiency. Objectives The aim of this study is to elucidate the effect of zinc supplementation on ADHD symptoms in zinc-deficient ADHD children. Patients and methods Thirty zinc-deficient children diagnosed with ADHD and on a fixed dose of methylphenidate were enrolled in this study. They were assigned to zinc supplementation (30 mg/day) as gluconate in an open-label follow-up trial for 10 weeks. Results There was a statistically significant difference among zinc-deficient ADHD children before and after zinc supplementation on all working memory index subtest scores and all Conner’s subscale scores. This result points to the effect of zinc supplementation on ADHD symptom domains.

Zinc deficiency in children with attention-deficit hyperactivity disorder Azza El-Bakry, Amal M El Safty, Amany A Abdou, Omnia R Amin, Doaa R Ayoub, Dina Y Afifi Egyptian Journal of Psychiatry 2019 40(2):95-103 Background Attention-deficit hyperactivity disorder (ADHD) is a common behavioral disorder in children that may persist into adulthood. Insufficient nutritional supply and deficiency of trace elements and other components including various minerals have been suggested to play a role in the development of ADHD symptoms. Zinc in particular was found to be significantly deficient in patients with ADHD compared with healthy controls, so it was concluded that zinc deficiency might play a role in the etiopathogenesis of ADHD. Objectives The aim of the work is to investigate the association of serum zinc levels with ADHD diagnosis, its symptom domains, and severity. Patients and methods A total of 75 children aged from 6 to 14 years with Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) diagnosis of ADHD were enrolled in this study. All children were assessed using Colored Progressive Matrices IQ test, Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime version (K-SADS-PL), the Working Memory Index (WMI) of Wechsler Intelligence Scale for Children (WISC-III), and Conner’s Parent Rating Scale − Revised − Long version (CPRS-R-L). Serum zinc level was measured in all children using atomic absorption spectroscopy. Results Overall, 52% of children with ADHD (n=39) had forthright zinc deficiency with serum zinc levels less than 60 μg/dl. Five children only had marginal zinc levels, with serum zinc level ranging between 60 and 80 μg/dl. Serum zinc levels were lower in children living in rural areas. Zinc-deficient children showed lower IQ scores than non-zinc-deficient group.

The association between personality, coping, and depression in patients with chronic pain Reem Deif, Kate Ellis Egyptian Journal of Psychiatry 2019 40(2):104-113 Background As a rising concern in the medical and mental health fields, this study aims to examine predictors of depressive symptoms in a sample of Egyptian patients with chronic pain in terms of coping styles and personality traits. Patients with chronic pain are believed to experience different stressors, which include, but are not limited to, pain, disability, reduced productivity, and financial difficulties. Such factors, in addition to various psychosocial factors, constitute the disease burden of chronic pain. Objective This study examines the degree to which coping styles and personality traits can influence the disease outcome in terms of comorbid depressive symptoms. Patients and methods A total of 98 (50 patients with fibromyalgia and 48 patients with rheumatoid arthritis) patients were interviewed and were assessed in terms of their coping styles, personality profile, and severity of depressive symptoms. Results Findings show a high prevalence of depressive symptoms and suggest passive coping, high neuroticism, low extraversion, unmarried status, and more years of education to be moderate predictors of the severity of chronic pain. Conclusion Conclusion Findings of this study shed light on the significance of the psychological aspects of chronic pain conditions and may help in designing liaison interventions for the management of secondary and comorbid depressive symptoms.

Auditory P300 and neuropsychological cognitive functioning assessment of patients with chronic hepatitis B and C infection Tarek Desoky, Hameed Baddary, Mohammed A Moneim, Ahmed Ali Egyptian Journal of Psychiatry 2019 40(2):114-122 Background A growing body of interest was addressed to the concept of minimal rather than overt hepatic encephalopathy as a subclinical manifestation in chronic hepatitis B- and C-infected patients with normal liver function. This study aims to neuropsychologically and neurophysiologically assess those patients for minimal cognitive impairment and its correlates. Patients and methods Thorough neuropsychological evaluation including Wechsler Memory Scale-Revised, Wisconsin Card Sorting Test, Trail Making Test, Montreal Cognitive Assessment Test, and Beck Depression Inventory (BDI), and neurophysiological (P300-evoked potential) assessment were conducted on untreated blood donors with hepatitis C virus (n=24) and hepatitis B virus (n=16) infection and 40 healthy controls. Results All tools of assessment showed a significant difference between cases and controls that suggests higher incidence of depression and cognitive dysfunction among hepatitis patients with no difference between B and C types of infection apart from BDI, which showed higher scores (more depressive features) among hepatitis C rather than B. Among variables such as patient age, BMI, BDI, and viral load titer, only BDI showed a significant positive correlation with such impairments. Conclusion Neuropsychological- and neurophysiological-based evidence of cognitive impairment was proved to be significantly present among cases with chronic hepatitis B and C infection. The value of such evaluation in the management plan of such group of patients needs further future studies.

Pattern of referral to a consultation-liaison psychiatry service in an Egyptian cancer center Mahmoud A El Batrawi, May Gaber, Shahinaz I Mekheimar, Samy A Alsirafy Egyptian Journal of Psychiatry 2019 40(2):123-126 Aim/Objective/Background Integration of consultation-liaison(C-L) psychiatry services in palliative care units in oncology departments is very limited in Egypt. A new dedicated C-L psychiatry service was recently established within the premises of the palliative care clinic in Kasr al Ainy Center for Clinical Oncology and Nuclear Medicine (NEMROCK), Cairo, Egypt. The aim of this study was to examine the characteristics, diagnoses and follow up of patients referred to this new service in a year period. Methods The clinical and psychiatric characteristics of all consecutive oncology patients (n=44) referred to this new C-L psychiatric service in a year period were examined. Psychiatric diagnosis was made according to the Diagnostic and Statistical Manual of Psychiatric Disorders, 5th edition (DSM 5). Results A total number of 44 patients (12 males and 32 females) were referred to the C-L clinic during the study period. Half of the patients had breast cancer.The other half was a diverse group involving different sites. In the advanced stage of cancer, males were significantly more represented than the females. As regards psychiatric diagnosis, the most common category was adjustment disorder (22 patients) followed by major depression (11 patients). Six of the patients had non-psychiatric distress, two had a primary psychotic disorder, two had substance related disorder and one had a major cognitive disorder. Causes of suffering in the non-psychiatric distressed group included lack of adequate medical information, physical concerns, existential concerns and family concerns. Most patients received psychotropic medication. Conclusions The scope and severity of psychiatric morbidity and distress detected in the referred oncology patients reflects the need to integrate C-L psychiatric services within psycho-oncological and palliative care clinics.