Ethics, culture and psychiatry.
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Culture↗
Biomedical subjects
A Okasha
Publications and source records attributed to A Okasha.
Egyptian contribution to the concept of mental health.
This paper provides an historical look at the Egyptian contribution to mental health from Pharaonic times through to the Islamic era and up to today. The current situation as regards mental health in Egypt is described.
Arab World↗
From the Hawaii Declaration to the Declaration of Madrid.
The Declaration of Hawaii, adopted by the World Psychiatric Association (WPA) in 1977, was a significant event. But the needs and new ethical dilemmas of the 1990s led WPA to develop new recommendations on the duties of psychiatrists resulting in the Declaration of Madrid, adopted by WPA in 1996. It outlines the framework of ethical conduct of psychiatrists, formulates seven general guidelines with an increased emphasis on research and resource allocation, and gives five specific guidelines on euthanasia, torture, the death penalty, selection of sex, and organ transplantation.
Capital Punishment↗
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.
Adult↗
Cognitive dysfunction in obsessive-compulsive disorder.
OBJECTIVE: Assessment of cognitive functions among obsessive-compulsive disorder (OCD) patients would help in understanding the neurobiology and brain areas involved in that disorder. The objective of this work was to study the cognitive dysfunction in OCD patients and to identify its correlation with both the clinical picture and the severity of the disorder. METHOD: Neuropsychological and electrophysiological event-related potentials were tested in 30 OCD patients and compared with 30 normal volunteers of a matched gender, age and education. RESULTS: Results showed a defective visuospatial recognition, which worsens with chronicity, deteriorated set-shifting abilities, overfocused attention to irrelevant stimuli and delayed selective attention to relevant tasks. Mild cases showed better selective attention than severe cases. Obsessive cases had a defective visual memory, while compulsive cases had delayed perception of task relevant stimuli. Mixed cases showed disturbed information-processing both early and late. CONCLUSION: OCD patients have a characteristic pattern of cognitive dysfunction that differs among patients of varied severity, chronicity and symptom type. We suggest a striatofrontoparietal neural pathophysiology. OCD seems to be a heterogeneous disorder, both clinically and pathophysiologically.
Adolescent↗
The impact of disease management on outcomes and cost of care: a study of low-income asthma patients.
An asthma disease management program designed specifically for low-income patients experiencing significant adverse events can improve health outcomes substantially, while lowering costs. The Virginia Health Outcomes Partnership aimed to help physicians in a fee-for-service primary care case management program manage asthma in Medicaid recipients. Approximately one-third of physicians treating asthma in an area designated as the intervention community volunteered to participate in training on disease management and communication skills. This large-scale study discovered that the rate of emergency visit claims for patients of participating physicians who received feedback reports dropped an average of 41% from the same quarter a year earlier, compared to only 18% for comparison community physicians. Although only a third of the intervention community physicians participated in the training, emergency visit rates for all intervention community physicians nonetheless declined by 6% relative to the comparison community among moderate-to-severe asthma patients when data for participating and nonparticipating physicians were combined. At the same time, the dispensing of some reliever drugs recommended for asthma increased 25% relative to the comparison community. A cost-effectiveness analysis projected direct savings to Medicaid of $3 to $4 for every incremental dollar spent providing disease management support to physicians. The results of this study demonstrate the potential this program offers, especially for Medicaid programs in other states that want to improve the care of their primary care case management networks and, at the same time, manage costs.
Anti-Asthmatic Agents↗
Mental health in the Middle East: an Egyptian perspective.
This article introduces the reader to mental health in the Middle East with an Egyptian perspective, from the Pharaonic era through the Islamic Renaissance, up until the current state. During Pharaonic times, mental illness was not known as such, as there was no separator between Soma and Psyche. Actually, mental disorders were described as symptoms of the heart and uterine diseases, as stated in Eber's and Kahoun's papyri. In spite of the mystical culture, mental disorders were attributed and treated on a somatic basis. In the Islamic era, mental patients were never subjected to any torture or maltreatment because of the inherited belief that they may be possessed by a good Moslem genie. The first mental hospital in Europe was located in Spain, following the Arab invasion, and from then on it propagated to other European countries. The 14th century Kalawoon Hospital in Cairo had four departments, including medicine, surgery, ophthalmology, and mental disorders. Six centuries earlier, psychiatry in general hospitals was recognized in Europe. The influence of Avicenna and Elrazi and their contributions to European medicine is well-known. This article discusses further the current state of the mental health services in Egypt and the transcultural studies of the prevalence and phenomenology of anxiety, schizophrenia, depression, suicide, conversion, and obsessive compulsive disorders. An outline of psychiatric disorders in children is discussed. The problem of drug abuse is also addressed, especially that in Egypt after 1983, where drugs like heroine replaced the common habit of hashish.
Child↗
Using data mining to build a customer-focused organization.
Data mining is a new buzz word in managed care. More than simply a method of unlocking a vault of useful information in MCO data banks and warehouses, the author believes that it can help steer an organization through the reengineering process, leading to the health system's transformation toward a customer-focused organization.
Algorithms↗
Comments on teaching psychiatry to undergraduates.
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Education, Medical, Undergraduate↗
Mental health services in the Arab world.
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Africa, Northern↗
Mental health services and research in the Arab world.
Although there are 22 Arab countries in the Arab League, the mental health services provided in those countries show several forms of variation. Economic, political, social and cultural factors seem to play a major role in determining the state of the psychiatric profession and the access of the service to citizens. The different needs expressed by Arab colleagues at times seem incompatible with the available allocated resources. Some Arab countries enjoy the highest income per capita, yet this is inconsistent with the quality of mental health services available there. The per capita mental health services, the availability of a Mental Health Act, and the space allocated for mental health in medical curricula are but a few of the concerns that have been expressed by colleagues from the different countries of the Arab region. The following review will attempt to draw up a profile of the situation for mental health services and research in the region, and to suggest some measures for intervention.
Delivery of Health Care↗
The future of medical education and teaching: a psychiatric perspective.
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Clinical Competence↗
Settings for learning: the community beyond.
The primary objective of medical education to medical students should not be the recruitment of specialists or to provide instructions about highly sophisticated clinic medicine. Our responsibility towards them is rather to enable them to learn about medical practice in its most prevalent context, which is the community medical practice, and to contribute to their general medical education and the health welfare of their community. The health needed by the nation cannot possibly be provided by specialists. It is a task for all doctors. If we agree that the ultimate goal of medical education is to secure health and proper care (whether primary, secondary or tertiary) for the population, medical curricula and learning settings should be open for any modifications that ensure a proper approach to our patients' practicalities, resources and needs. A major modification involved in that process would be for the educational setting to move from the hospital into the community and doctors to acquire the skills and conviction of working as part of a health team, in which they are not necessarily the leaders. The main social target of the World Health Organization and its member states, and in fact the main goal of humanity, is 'Health for All by the year 2000' through primary health care (HFA/PHC). Health systems of countries will have to be reoriented, so that they are based on the PHC approach. Health personnel are needed to service those health systems which are relevant to the needs of HFA/PHC, and hence whose education should be relevant to this major goal. This does not mean that by the year 2000 doctors and nurses will provide medical care for everybody or that sickness and disability will be eradicated. It does mean, however, that health begins at home, in schools and in factories, and that health care services should be available in those places and should respond to the needs expressed in those places. It is there, where people live and work, that health is made or broken. It does mean that essential health should be accessible to all individuals and families in an acceptable and affordable way, and with their full involvement. Health personnel should be trained according to the plans of integrated health services and health manpower development (HSMD), with a view of placing at the disposal of the system the right kind of manpower, in the right numbers, at the right time, in the right place (WHO 1979, 1985, 1987). Graduates of programmes based on problem-based, community-oriented tracks as opposed to the traditional track should certainly be able to: respond to the health needs and expressed demands of the community, work with the community, stimulate healthy lifestyles and self-care, educate the community as well as their co-workers, solve and stimulate the resolve of both individual and community health problems, orient their own as well as community efforts to health promotion, prevent disease, unnecessary suffering, disability and death, work in and with health teams, if necessary provide leadership to such teams, continue learning lifelong so as to keep competence up to date, and improve this competence as much as possible (Fülöp 1990). A limited literature is available comparing innovative and conventional medical curricula, where the innovative one is based on problem-solving learning with a community-oriented track geared towards community needs (Schmidt 1983). This approach showed that the outcome is better, if directed towards the health needs of the community.
Community Health Services↗
Expressed emotion, perceived criticism, and relapse in depression: a replication in an Egyptian community.
OBJECTIVE: The aims of this study were to determine the value of families' expressed emotion and patients' perception of family criticism in predicting relapse in Egyptian depressed patients and to evaluate transcultural differences in assessment of these measures. METHOD: The subjects were 32 consecutive depressed patients from psychiatric clinics in Cairo and Ismailia, Egypt, who fulfilled the DSM-III-R criteria for major depression or bipolar disorder. An Arabic version of the Camberwell Family Interview was administered to key relatives of the depressed patients. Rating of expressed emotion was performed blindly by a qualified rater to assess levels of criticism, hostility, emotional overinvolvement, warmth, and positive remarks. Patient perception of family criticism (perceived criticism) was also assessed. All patients were followed up for 9 months to assess relapse and compliance with treatment. RESULTS: The relation of family criticism to relapse was statistically significant. Although this result replicates previous findings, the criticism level that best differentiated relapsers and nonrelapsers was a score of 7, which is much higher than previously reported in Western studies. This relation was not observed for other expressed emotion components. Also, no association between perceived criticism and relapse was detected. CONCLUSIONS: Expressed emotion is a prognostic factor that should be assessed with consideration of the specific culture and intrafamilial patterns. The use of perceived criticism in the prediction of relapse in depression is questionable. There is a need for a simplified, less time-consuming assessment tool that takes cross-cultural differences and specificities into consideration.
Adolescent↗
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.
Adult↗
Diagnostic agreement in psychiatry. A comparative study between ICD-9, ICD-10 and DSM-III-R.
A random sample of 100 new patients referred consecutively to the psychiatric hospital was assessed using the Arabic translation of the PSE. An abstract form was designed to include all PSE scores as well as the necessary extra data to make ICD-9, ICD-10, and DSM-III-R diagnoses. Kappa correlation was calculated for inter-rater and intra-rater reliability. Overall reliability and reliability of each major psychiatric diagnosis were compared between the three systems. The use of the PSE helped in achieving good agreement between Arab psychiatrists for all the three systems, but ICD-10 was found to have the highest reliability figures both for three-digit and four-digit psychiatric diagnoses.
Female↗
Reliability of ICD-10 research criteria: an Arab perspective.
Within a broader World Health Organization (WHO) collaborative research around the ICD-10 diagnostic criteria for research, the Regional Office for the Eastern Mediterranean (EMRO) ICD-10 research coordinating center at the Ain Shams Institute of Psychiatry presented the data collected from 8 Arab centers, which investigated a total of 233 patients using the local psychiatric interview schedules and diagnosed according to ICD-10 criteria. Interrater reliability was found to range between an almost perfect (0.81-1) to substantial agreement (0.61-0.80) (using the kappa coefficient) in diagnosing organic mental disorders, substance use disorders, schizophrenic, schizotypal and delusional disorders, affective disorders and neurotic and stress-related disorders. The categories of psychological development and child and adolescent disorders were diagnosed less frequently and the agreement between raters was lower. Though no culture-bound syndromes were encountered in any of the centers, difficulties in diagnosis using the research criteria were identified in the domain of simple schizophrenia and dissociative versus conversion disorders. These difficulties are discussed in consideration of the experience of our psychiatrists.
Adolescent↗
Academic difficulty among male Egyptian university students. I. Association with psychiatric morbidity.
A survey was made of academic difficulties among undergraduate students at Ain Shams University, Cairo, during the academic year 1979-1980. Almost 6% of students dropped out before graduating and a further 8% required substantial extra time to complete their course of study: these figures were almost identical for both sexes. Psychiatric disorders were diagnosed in 42% of male students with academic problems (compared with 9% among the academically successful), with neuroses accounting for nearly half of the cases and schizophrenia for a quarter. Serious psychiatric illness was nearly four times as frequent among 3rd-year students as among 1st-year students.
Educational Measurement↗