BackgroundSymptoms of attention-deficit hyperactivity disorder (ADHD) are known to persist into a... more BackgroundSymptoms of attention-deficit hyperactivity disorder (ADHD) are known to persist into adulthood in the majority of cases.AimsTo determine the prevalence of methylphenidate, dexamfetamine and atomoxetine prescribing and treatment discontinuation in adolescents and young adults.MethodA descriptive cohort study using the UK General Practice Research Database included patients aged 15–21 years from 1999 to 2006 with a prescription for a study drug.ResultsPrevalence of prescribing averaged across all ages increased 6.23-fold over the study period. Overall, prevalence decreased with age: in 2006, prevalence in males dropped 95% from 12.77 per 1000 in 15-year-olds to 0.64 per 1000 in 21-year-olds. A longitudinal analysis of a cohort of 44 patients aged 15 years in 1999 demonstrated that no patient received treatment after the age of 21 years.ConclusionsThe prevalence of prescribing by general practitioners to patients with ADHD drops significantly from age 15 to age 21 years. The...
Abstract Background: Drug abuse is considered one of the most serious public health problems, esp... more Abstract Background: Drug abuse is considered one of the most serious public health problems, especially among young people at working ages. In this study, we assessed clinical characteristics of patients presenting with drug abuse who were referred to the addiction treatment clinics of Al-Mamoura mental hospital (Alexandria, Egypt), including sociodemographic variables, clinical symptoms, physical complications and psychiatric co-morbidities in comparison to other substance abuse. Methods: A descriptive cross sectional and comparative study was conducted on 516 patients attending outpatient addiction treatment clinics in 2013–14 on the Structured Clinical Interview for DSM-IV (SCID-I and SCID-II) as well as social and addiction scales. Results: in our sample, drug addiction was more common in males than females. Importantly, among many potential factors, it was found that peer pressure (friends) was the most common cause for drug abuse. Second, it was also found that psychiatric symptoms were more common among patients with substance abuse than legal or financial problems. Conclusions: Future behavioral treatments should take into account the role played by friends that lead to drug abuse and the maintenance of such habits. Further, pharmacological and behavioral therapies should consider psychiatric aspects of drug abuse as these are very common and may impact effective recovery.
Background Alzheimer’s disease (AD) is a progressive neurodegenerative disease. The potential eff... more Background Alzheimer’s disease (AD) is a progressive neurodegenerative disease. The potential effect of nutrition on development of AD has become a topic of increasing scientific and public interest. High intakes of saturated and trans -unsaturated (hydrogenated) fats were positively associated with increased risk for AD, whereas intakes of polyunsaturated and monounsaturated fats were protective against cognitive decline in the elderly. Would foods rich in these fatty acids delay cognitive decline in elderly people who are vulnerable to AD? Objectives The aim of this study was to measure the concentration of plasma fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) in patients with AD and study the relationship between foods rich in these fatty acids and severity of cognitive decline. Methods A total of 62 individuals were screened for cognitive decline using the mini-mental status examination test and were diagnosed with AD using the Diagnostic and Statistical Manual of Mental Disorders , 4th ed., diagnostic criteria. Data on nutrition were obtained and blood samples were withdrawn to determine the plasma levels of the fatty acids EPA and DHA. Results Patients with late-onset AD have significantly higher intake of food and food supplements containing both fatty acids. Conclusion High intake of food and food supplements rich in EPA and DHA fatty acids may delay the onset of AD.
Psychosis and hallucinations occur in 20-30% of patients with Parkinson&a... more Psychosis and hallucinations occur in 20-30% of patients with Parkinson's disease (PD). In the current study, we investigate cognitive functions in relation to the occurrence of psychosis in PD patients. We tested three groups of subjects - PD with psychosis, PD without psychosis and healthy controls - on working memory, learning and transitive inference tasks, which are known to assess prefrontal, basal ganglia and hippocampal functions. In the working memory task, results show that patients with and without psychosis were more impaired than the healthy control group. In the transitive inference task, we did not find any difference among the groups in the learning phase performance. Importantly, PD patients with psychosis were more impaired than both PD patients without psychosis and controls at transitive inference. We also found that the severity of psychotic symptoms in PD patients [as measured by the Unified Parkinson Disease Rating Scale Thought Disorder (UPDRS TD) item] is directly associated with the severity of cognitive impairment [as measured by the mini-mental status exam (MMSE)], sleep disturbance [as measured by the Scales for Outcome in Parkinson Disease (SCOPA) sleep scale] and transitive inference (although the latter did not reach significance). Although hypothetical, our data may suggest that the hippocampus is a neural substrate underlying the occurrence of psychosis, sleep disturbance and cognitive impairment in PD patients.
BackgroundAbout 20% of individuals older than 60 years of age suffer from a mental illness, the m... more BackgroundAbout 20% of individuals older than 60 years of age suffer from a mental illness, the most common among them being depressive, cognitive, and anxiety disorders. The prevalence of these disorders and their sociodemographic correlates should be further explored, especially in underdeveloped countries. ObjectivesThe aim of this study was to examine for depressive and anxiety disorders in a group of medically ill elderly patients. In addition, this study aimed to describe the sociodemographic background of patients and its correlation with psychiatric symptoms. Patients and methodsA total of 273 medical patients older than 60 years of age were recruited from the internal medicine outpatient clinic. Psychiatric assessment was carried out using Structured Clinical Interview for DSM-IV (SCID-I) and the diagnosis was made according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria. Furthermore, cognitive assessment was performed using Mini Mental State Examination (MMSE) and social classification using Fahmy and El-Sherbini’s Scale. Results44.7% of the study sample had one of the depressive or anxiety disorders, the prevalence of which was higher in patients with more than one medical problem. In addition, the highest prevalence of depression and anxiety was found in patients with heart disease, followed by patients with liver disease, although this was not statistically significant. Finally, there was a significant relationship between female sex and depression and also a highly significant relationship between depression and low socioeconomic status. ConclusionDepression and anxiety disorders are common among medically ill patients and these may worsen the medical condition and quality of life of these patients. Therefore, psychiatric screening of all medically ill patients with a routine follow-up is highly recommended.
BackgroundBehavioral symptoms of dementia are noncognitive symptoms that occur commonly with Alzh... more BackgroundBehavioral symptoms of dementia are noncognitive symptoms that occur commonly with Alzheimer’s disease (AD). The characterization of the clinical profile of AD patients may help to better understand disease evolution and to improve diagnosis and treatment. Thus, the aim of our study is to describe the clinical profile of AD patients and to correlate the presence of behavioral symptoms with other variables of the disease. MethodsAssessments of behavioral symptoms measured by the Revised Memory and Behavior Problems Checklist, the Mini Mental State Examination, the Clinical Dementia Rating, and the Disability Assessment for Dementia were performed for 40 AD patients. ResultsThe Revised Memory and Behavior Problems Checklist scores were significantly increased in severe cases in comparison with mild cases. There were significant positive correlations between the Revised Memory and Behavior Problems Checklist with the Clinical Dementia Rating, and the Disability Assessment for Dementia. There was a significant negative correlation between the Revised Memory and Behavior Problems Checklist and the Mini Mental State Examination. ConclusionOur study shows that patients with AD have a high prevalence of behavioral and psychological symptoms measured by the Revised Memory and Behavior problems Checklist and that behavioral symptoms, cognitive impairment, and disease severity are correlated. Therefore, the Revised Memory and Behavior problems Checklist is a useful tool for evaluation in patients with AD.
ABSTRACT Background: Schizophrenia is a diverse disorder. One facet of its diversity is the age a... more ABSTRACT Background: Schizophrenia is a diverse disorder. One facet of its diversity is the age at onset. About 23% of people with schizophrenia experience their first episode after the age of 40. Cognitive deficits in schizophrenia are the core features of the illness. They are the strongest predictors of function and are considered potential targets for treatment. Although some studies have reported an association between earlier age at onset and more severe cognitive deficits, others have failed to find differences between the cognitive profiles of individuals with early-onset schizophrenia (EOS) and those with late-onset schizophrenia (LOS). Thus, LOS may constitute a subtype of schizophrenia with a specific pattern of cognitive dysfunction. Objectives: This study aimed at describing and comparing cognitive profiles of LOS with those of EOS. Subjects and methods: This is a cross-sectional comparative study between a group of 50 patients with LOS (onset above 50 years) and a group of 50 healthy volunteers who were age-matched and sex-matched with the first group to determine deficits. The LOS patients were also compared with another group of 50 patients with EOS (onset before 30 years). All patients were interviewed using The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders. Severity of symptoms was assessed using the Positive and Negative Syndrome Scale. Cognitive and functional assessments were made using the Wechsler Adult Intelligence Scale, Cambridge Cognitive Examination Scale, and Functional Assessment of Activity of Daily Living Scale, section B of the Cambridge Mental Disorders of the Elderly Examination. Results: There were marked significant difference between old schizophrenic patients and the control group with regard to cognitive function, with more impairment in the schizophrenic group. In addition, LOS patients had more cognitive impairment than EOS patients. There was a specific pattern of cognitive deficits in LOS, which include immediate memory, visuospatial ability, some of the motor (apraxia) function, and executive functions (abstraction and perception). Conclusion: Although LOS may constitute a less severe form of schizophrenia, the effect of serious cognitive impairment together with aging may cause similar functional impairment; hence, cognitive rehabilitation and control of other factors that may worsens cognitive impairment are strongly recommended.
Homocysteine (Hcy) is a sulphur-containing amino acid synthesized in one-carbon metabolic cycle. ... more Homocysteine (Hcy) is a sulphur-containing amino acid synthesized in one-carbon metabolic cycle. It is metabolized either by transsulfuration to cysteine or by remethylation to methionine. Plasma Hcy levels are often measured by collecting blood samples using the Hcy enzyme immunoassay (EIA) method. Several factors are known to increase hcy level including male gender, older age, higher body weight, lower folic acid and vitamin B dietary intake, cigarette smoking, alcohol abuse, chronic renal disease, as well as certain medications such as diuretics and fibrates. Interindividual differences in Hcy levels might be also attributed to certain genetic risk factors that influence the activity of one-carbon metabolism. Two single nucleotide polymorphisms in the methylenetetrahydrofolate reductase gene (MTHFR) –C677T and AI298C—are among the most important genetic predictors of Hcy level and have been widely studied in numerous diseases that might be linked to alterations in one-carbon metabolism. Primarily, high Hcy levels have been exclusively regarded as a risk factor for cardiovascular diseases. Indeed, it has been found that Hcy may lead to endothelial injury triggering a cascade of processes resulting in atherosclerosis
BackgroundSymptoms of attention-deficit hyperactivity disorder (ADHD) are known to persist into a... more BackgroundSymptoms of attention-deficit hyperactivity disorder (ADHD) are known to persist into adulthood in the majority of cases.AimsTo determine the prevalence of methylphenidate, dexamfetamine and atomoxetine prescribing and treatment discontinuation in adolescents and young adults.MethodA descriptive cohort study using the UK General Practice Research Database included patients aged 15–21 years from 1999 to 2006 with a prescription for a study drug.ResultsPrevalence of prescribing averaged across all ages increased 6.23-fold over the study period. Overall, prevalence decreased with age: in 2006, prevalence in males dropped 95% from 12.77 per 1000 in 15-year-olds to 0.64 per 1000 in 21-year-olds. A longitudinal analysis of a cohort of 44 patients aged 15 years in 1999 demonstrated that no patient received treatment after the age of 21 years.ConclusionsThe prevalence of prescribing by general practitioners to patients with ADHD drops significantly from age 15 to age 21 years. The...
Abstract Background: Drug abuse is considered one of the most serious public health problems, esp... more Abstract Background: Drug abuse is considered one of the most serious public health problems, especially among young people at working ages. In this study, we assessed clinical characteristics of patients presenting with drug abuse who were referred to the addiction treatment clinics of Al-Mamoura mental hospital (Alexandria, Egypt), including sociodemographic variables, clinical symptoms, physical complications and psychiatric co-morbidities in comparison to other substance abuse. Methods: A descriptive cross sectional and comparative study was conducted on 516 patients attending outpatient addiction treatment clinics in 2013–14 on the Structured Clinical Interview for DSM-IV (SCID-I and SCID-II) as well as social and addiction scales. Results: in our sample, drug addiction was more common in males than females. Importantly, among many potential factors, it was found that peer pressure (friends) was the most common cause for drug abuse. Second, it was also found that psychiatric symptoms were more common among patients with substance abuse than legal or financial problems. Conclusions: Future behavioral treatments should take into account the role played by friends that lead to drug abuse and the maintenance of such habits. Further, pharmacological and behavioral therapies should consider psychiatric aspects of drug abuse as these are very common and may impact effective recovery.
Background Alzheimer’s disease (AD) is a progressive neurodegenerative disease. The potential eff... more Background Alzheimer’s disease (AD) is a progressive neurodegenerative disease. The potential effect of nutrition on development of AD has become a topic of increasing scientific and public interest. High intakes of saturated and trans -unsaturated (hydrogenated) fats were positively associated with increased risk for AD, whereas intakes of polyunsaturated and monounsaturated fats were protective against cognitive decline in the elderly. Would foods rich in these fatty acids delay cognitive decline in elderly people who are vulnerable to AD? Objectives The aim of this study was to measure the concentration of plasma fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) in patients with AD and study the relationship between foods rich in these fatty acids and severity of cognitive decline. Methods A total of 62 individuals were screened for cognitive decline using the mini-mental status examination test and were diagnosed with AD using the Diagnostic and Statistical Manual of Mental Disorders , 4th ed., diagnostic criteria. Data on nutrition were obtained and blood samples were withdrawn to determine the plasma levels of the fatty acids EPA and DHA. Results Patients with late-onset AD have significantly higher intake of food and food supplements containing both fatty acids. Conclusion High intake of food and food supplements rich in EPA and DHA fatty acids may delay the onset of AD.
Psychosis and hallucinations occur in 20-30% of patients with Parkinson&a... more Psychosis and hallucinations occur in 20-30% of patients with Parkinson's disease (PD). In the current study, we investigate cognitive functions in relation to the occurrence of psychosis in PD patients. We tested three groups of subjects - PD with psychosis, PD without psychosis and healthy controls - on working memory, learning and transitive inference tasks, which are known to assess prefrontal, basal ganglia and hippocampal functions. In the working memory task, results show that patients with and without psychosis were more impaired than the healthy control group. In the transitive inference task, we did not find any difference among the groups in the learning phase performance. Importantly, PD patients with psychosis were more impaired than both PD patients without psychosis and controls at transitive inference. We also found that the severity of psychotic symptoms in PD patients [as measured by the Unified Parkinson Disease Rating Scale Thought Disorder (UPDRS TD) item] is directly associated with the severity of cognitive impairment [as measured by the mini-mental status exam (MMSE)], sleep disturbance [as measured by the Scales for Outcome in Parkinson Disease (SCOPA) sleep scale] and transitive inference (although the latter did not reach significance). Although hypothetical, our data may suggest that the hippocampus is a neural substrate underlying the occurrence of psychosis, sleep disturbance and cognitive impairment in PD patients.
BackgroundAbout 20% of individuals older than 60 years of age suffer from a mental illness, the m... more BackgroundAbout 20% of individuals older than 60 years of age suffer from a mental illness, the most common among them being depressive, cognitive, and anxiety disorders. The prevalence of these disorders and their sociodemographic correlates should be further explored, especially in underdeveloped countries. ObjectivesThe aim of this study was to examine for depressive and anxiety disorders in a group of medically ill elderly patients. In addition, this study aimed to describe the sociodemographic background of patients and its correlation with psychiatric symptoms. Patients and methodsA total of 273 medical patients older than 60 years of age were recruited from the internal medicine outpatient clinic. Psychiatric assessment was carried out using Structured Clinical Interview for DSM-IV (SCID-I) and the diagnosis was made according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria. Furthermore, cognitive assessment was performed using Mini Mental State Examination (MMSE) and social classification using Fahmy and El-Sherbini’s Scale. Results44.7% of the study sample had one of the depressive or anxiety disorders, the prevalence of which was higher in patients with more than one medical problem. In addition, the highest prevalence of depression and anxiety was found in patients with heart disease, followed by patients with liver disease, although this was not statistically significant. Finally, there was a significant relationship between female sex and depression and also a highly significant relationship between depression and low socioeconomic status. ConclusionDepression and anxiety disorders are common among medically ill patients and these may worsen the medical condition and quality of life of these patients. Therefore, psychiatric screening of all medically ill patients with a routine follow-up is highly recommended.
BackgroundBehavioral symptoms of dementia are noncognitive symptoms that occur commonly with Alzh... more BackgroundBehavioral symptoms of dementia are noncognitive symptoms that occur commonly with Alzheimer’s disease (AD). The characterization of the clinical profile of AD patients may help to better understand disease evolution and to improve diagnosis and treatment. Thus, the aim of our study is to describe the clinical profile of AD patients and to correlate the presence of behavioral symptoms with other variables of the disease. MethodsAssessments of behavioral symptoms measured by the Revised Memory and Behavior Problems Checklist, the Mini Mental State Examination, the Clinical Dementia Rating, and the Disability Assessment for Dementia were performed for 40 AD patients. ResultsThe Revised Memory and Behavior Problems Checklist scores were significantly increased in severe cases in comparison with mild cases. There were significant positive correlations between the Revised Memory and Behavior Problems Checklist with the Clinical Dementia Rating, and the Disability Assessment for Dementia. There was a significant negative correlation between the Revised Memory and Behavior Problems Checklist and the Mini Mental State Examination. ConclusionOur study shows that patients with AD have a high prevalence of behavioral and psychological symptoms measured by the Revised Memory and Behavior problems Checklist and that behavioral symptoms, cognitive impairment, and disease severity are correlated. Therefore, the Revised Memory and Behavior problems Checklist is a useful tool for evaluation in patients with AD.
ABSTRACT Background: Schizophrenia is a diverse disorder. One facet of its diversity is the age a... more ABSTRACT Background: Schizophrenia is a diverse disorder. One facet of its diversity is the age at onset. About 23% of people with schizophrenia experience their first episode after the age of 40. Cognitive deficits in schizophrenia are the core features of the illness. They are the strongest predictors of function and are considered potential targets for treatment. Although some studies have reported an association between earlier age at onset and more severe cognitive deficits, others have failed to find differences between the cognitive profiles of individuals with early-onset schizophrenia (EOS) and those with late-onset schizophrenia (LOS). Thus, LOS may constitute a subtype of schizophrenia with a specific pattern of cognitive dysfunction. Objectives: This study aimed at describing and comparing cognitive profiles of LOS with those of EOS. Subjects and methods: This is a cross-sectional comparative study between a group of 50 patients with LOS (onset above 50 years) and a group of 50 healthy volunteers who were age-matched and sex-matched with the first group to determine deficits. The LOS patients were also compared with another group of 50 patients with EOS (onset before 30 years). All patients were interviewed using The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders. Severity of symptoms was assessed using the Positive and Negative Syndrome Scale. Cognitive and functional assessments were made using the Wechsler Adult Intelligence Scale, Cambridge Cognitive Examination Scale, and Functional Assessment of Activity of Daily Living Scale, section B of the Cambridge Mental Disorders of the Elderly Examination. Results: There were marked significant difference between old schizophrenic patients and the control group with regard to cognitive function, with more impairment in the schizophrenic group. In addition, LOS patients had more cognitive impairment than EOS patients. There was a specific pattern of cognitive deficits in LOS, which include immediate memory, visuospatial ability, some of the motor (apraxia) function, and executive functions (abstraction and perception). Conclusion: Although LOS may constitute a less severe form of schizophrenia, the effect of serious cognitive impairment together with aging may cause similar functional impairment; hence, cognitive rehabilitation and control of other factors that may worsens cognitive impairment are strongly recommended.
Homocysteine (Hcy) is a sulphur-containing amino acid synthesized in one-carbon metabolic cycle. ... more Homocysteine (Hcy) is a sulphur-containing amino acid synthesized in one-carbon metabolic cycle. It is metabolized either by transsulfuration to cysteine or by remethylation to methionine. Plasma Hcy levels are often measured by collecting blood samples using the Hcy enzyme immunoassay (EIA) method. Several factors are known to increase hcy level including male gender, older age, higher body weight, lower folic acid and vitamin B dietary intake, cigarette smoking, alcohol abuse, chronic renal disease, as well as certain medications such as diuretics and fibrates. Interindividual differences in Hcy levels might be also attributed to certain genetic risk factors that influence the activity of one-carbon metabolism. Two single nucleotide polymorphisms in the methylenetetrahydrofolate reductase gene (MTHFR) –C677T and AI298C—are among the most important genetic predictors of Hcy level and have been widely studied in numerous diseases that might be linked to alterations in one-carbon metabolism. Primarily, high Hcy levels have been exclusively regarded as a risk factor for cardiovascular diseases. Indeed, it has been found that Hcy may lead to endothelial injury triggering a cascade of processes resulting in atherosclerosis
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