Biomedical subjects

M T Abou-Saleh

Publications and source records attributed to M T Abou-Saleh.

At least 19 recordsLinked to original sources

PubMed2003

Older community residents with depression: long-term treatment with sertraline. Randomised, double-blind, placebo-controlled study.

BACKGROUND: Despite a growing use of selective serotonin reuptake inhibitors in older people, only one trial has examined their prophylactic efficacy in people aged 65 years and over. AIMS: To examine the efficacy of sertraline in preventing the recurrence of depression in older people living in the community. METHOD: Participants were openly treated with sertraline and then randomised into a double-blind, placebo-controlled continuation/maintenance study of about 2 years duration. Drug dosage was maintained at levels that achieved remission. RESULTS: No significant difference between the sertraline and placebo groups was found in the proportion of recurrences (-7.9%; 95% CI -28.06 to 12.23). Increased age and minor residual symptoms during the continuation phase were associated with recurrence. CONCLUSIONS: Sertraline at therapeutic dosage does not provide significant protection against recurrence.

Age Factors↗

PubMed2001

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.

Adult↗

PubMed2001

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.

Adult↗

PubMed2001

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.

Adult↗

PubMed2000

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.

Adult↗

PubMed1999

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.

Adolescent↗

PubMed1999

Single photon emission tomography with 99m Tc-HMPAO in Arab patients with depression.

BACKGROUND: This study investigates the rate of cerebral blood flow (rCBF) in Arab patients wth depression. METHODS: Forty-four patients with DSM-III-R major depressive disorders were studied at rest using single photon emission computerized tomography (SPECT) with 99m Tc-HMPAO in comparison with 20 normal controls. All patients were assessed using the Hamilton Rating Scale for Depression (HRSD). RESULTS: The depressed group showed greater rCBF in left and right posterior frontal and parietal cortical regions than normal controls. Within the depressed group, patients with the least severe illness (HRSD < 20) had significantly lower rCBF than normal controls, whilst those with moderately severe (HRSD 20-29) and severe (HRSD > 30) had significantly greater rCBF in most cortical regions than normal controls. Symptom scores, derived from the HRSD were predicted by rCBF principally increased rCBF in the left frontal cortex. CONCLUSIONS: These results suggest a generalized cerebral activation principally in the frontal cortex which is in contrast to the results of most previous studies but more in line with the results of studies of induced affect and some studies of depression subsyndromes.

Adult↗

PubMed1999

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.

Adult↗

PubMed1999

School mental health screening: a model for developing countries.

Using the experience derived from a screening programme of all school-going children in the Al Ain District, United Arab Emirates, this article reports on a cost-effective model that can be used in other developing countries. The need for training child health and school professionals in identifying mental and developmental disorders is discussed.

Child↗

PubMed1998

Anorexia nervosa in an Arab culture.

The available literature indicates that anorexia nervosa is rare in Arab culture. We report 5 cases of anorexia nervosa: 3 female and 2 male patients. Two are UAE nationals, 2 are Omanis, and 1 is Sudanese. The occurrence of these cases is discussed in the context of sociocultural changes and the increasing westernization of the UAE society.

Adolescent↗

PubMed1998

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.

Adult↗

PubMed1997

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.

Adult↗

PubMed1997

Problems in validating endogenous depression in the Arab culture by contemporary diagnostic criteria.

This study highlights the difficulties that may be encountered in attempting to apply the clinical construct of endogenous depression derived from western studies to depressed Arab patients. The agreement between 4 operational systems on the diagnosis of endogenous (melancholic) depression is explored in 100 patients with primary depressive disorder in Al-Ain, United Arab Emirates. The symptom characteristics of the 61 patients in whom all diagnostic systems agreed are then described quantitatively and qualitatively. Subjects were evaluated by the Newcastle scale, Hamilton's 21 item depression scale, global assessment of functioning scale, and the operational criteria of the diagnostic systems used. Diagnosis of endogenicity was derived by computer according to the respective criteria. The agreement between DSM-IV, ICD-10, and RDC criteria is moderately high (0.72). When the Newcastle Index is included, it is only moderate (0.58). Disagreements are related to differences in diagnostic criteria. Small differences affect concordance appreciably. DSM-IV agreed with a majority of external validators, differentiating a more homogeneous groups of patients. In the present study, endogenous depression identified by western criteria, was less likely to manifest by guilt feelings, a distinct quality of mood, and loss of libido. The descriptions of patients reveal that the mood component of depression is expressed differently, somatic metaphors are used frequently to express distress, religious elements influence the expression of symptoms, and depression may manifest in behaviours not directly indicative of the disorder. Endogenous depression may be identified in the Arab culture, but considerable variation in its component symptom frequencies and mode of expression needs to be taken in consideration for defining it in terms appropriate to the culture.

Adult↗

PubMed1997

The primary care anxiety and depression (PCAD) scale: a culture-oriented screening scale.

The construction of a screening scale for states of anxiety and depression among primary health care (PHC) patients is described. Most of the scale items were selected from a pool of items chosen from two international screening scales which were validated locally, namely the Self-Reporting Questionnaire (SRQ-20) and the Hospital Anxiety and Depression (HAD) Scale. A validity study of a new sample of PHC patients indicated that the scale provided a valid measure of anxiety and depressive states, and was closely correlated with the psychiatrist's clinical judgement. The scale correlated more strongly with the psychiatrist's clinical judgement than the general practitioners' assessments. Two cut-off points were established, one of which is more appropriate for clinical use and the other for prevalence estimation. The former threshold of the scale could be used to alert the busy general practitioner to the possibility that clinically significant anxiety or depression may be present.

Adolescent↗

PubMed1997

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.

Adult↗

PubMed1997

Performance of the Hamilton Depression Rating Scale in depressed patients in the United Arab Emirates.

Cross-cultural variation in the frequencies and modes of expression of depressive symptoms may influence the validity of depression rating scales. The most widely used instrument for this purpose, namely Hamilton's Depression Rating Scale (HDRS), has not been systematically evaluated in Arab countries. This study evaluates the face validity of the HDRS-21 by studying symptom frequencies, factor structure and symptom clusters in 100 UAE depressed patients. Concurrent validity is tested by comparing total HDRS scores with global estimates of severity made by clinicians, admission status, impairment of social and occupational functioning, and the endogenicity score of the Newcastle (NC) Diagnostic Index. Total HDRS scores show highly significant agreement with three independent measures of severity of depression. Rank orders of the most and least frequent symptoms are consistent with studies of similar design. Marked differences lie in more retardation and somatization and fewer cognitive components in the present study. Principal-component analysis confirmed the heterogeneous structure of the scale, separating a group of core depressive symptoms, and endogenous, somatization, anxiety and psychotic symptom components. The internal consistency (reliability) of the whole scale is moderate, and improves in the core symptom factor. The main conclusion is that the HDRS is sensitive to severity of depression in the UAE culture. However, it measures heterogeneous aspects, and its internal consistency suffers as a result. High levels of retardation and somatization contribute significantly to the total score in socially developing communities.

Adolescent↗

PubMed1997

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.

Adult↗

PubMed1995

Predictors of response to amine-specific antidepressants.

Discriminant function analysis of data from a double-blind comparative trial of lofepramine (a noradrenaline-specific reuptake inhibitor) and fluoxetine (a serotonin-specific reuptake inhibitor), involving 183 patients was used to identify predictors of response. Psychic anxiety significantly predicted a positive response to antidepressant medication, whereas psychomotor retardation, observed sadness, subjective lassitude and somatic complaints were significant predictors of nonresponse. Age, gender, endogenicity, duration of illness and number of previous episodes were not predictive of response. Significant differences were found between predictors of response to fluoxetine and lofepramine (P < 0.001 all groups). Predictors of response to lofepramine were similar to overall predictors, i.e., psychic anxiety predicted responders whilst observed sadness, psychomotor retardation, lassitude, inability to feel and somatic complaints predicted nonresponders. In contrast, baseline weight loss predicted response to fluoxetine, whereas anxiety, reduced insight and a tendency to blame others significantly predicted nonresponse. Such findings have practical implications for the management of depressive illness.

Adult↗