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Background: Diabetes mellitus and depression are serious common diseases, and the number of people with both conditions is rising steadily. Depression in people with diabetes mellitus results in poorer prognosis through different mechanisms. On the other hand, the presence of diabetes in individuals with depression increases functional impairment that is associated with depression. Aims: The study aimed to assess the prevalence and factors associated with depression among adults with type 2 diabetes mellitus attending a diabetes clinic in Cairo, Egypt. Methods: A cross-sectional study was conducted among adult patients with diabetes type 2 attending a diabetes clinic in the endocrinology department in Ain Shams University Teaching Hospital, Cairo, Egypt. Data were collected through face-to-face interviews by trained psychiatrists and from patients' records. Results: The prevalence of depression among diabetic patients was 21.8% (95% CI [15.6%, 29.1%]). Depression was more common among younger age groups and those with a higher level of education. There was no significant difference between those with lifetime depression compared to those without depression regarding physical health complications. Conclusions: The prevalence of depression among patients with type 2 diabetes is high. Given the impact of co-morbid diabetes and depression, diabetic patients should be routinely screened for the latter condition. [ABSTRACT FROM AUTHOR]

Background: Repetitive transcranial magnetic stimulation showed some evidence for improving symptoms of ADHD along with its relative safety, thus could serve as a treatment strategy or an alternative to stimulant medication. Accordingly, 60 children with ADHD were assessed, and 30 participants were allocated to the rTMS group and received 15 sessions of rTMS over the right dorsolateral prefrontal cortex combined with Atomoxetine 1.2 mg/kg/day. The other 30 participants were allocated to the Sham group and received 15 sessions of sham rTMS and atomoxetine 1.2 mg/kg/day. Clinical assessments of ADHD symptoms and severity were done and compared at 3 points, before treatment, after receiving 15 sessions of rTMS and follow-up 1 month after the last rTMS session, using Conner's Parent Rating Scale-Revised-Long form, Children's Global Assessment Scale, and Clinical Global Impression. Results: The two groups show significant improvement in the T scores of all CPRS subscales, CGI and CGAS. However, the rTMS group had a significantly more improvement than the sham group in inattention, total ADHD severity, CGI, and CGAS after rTMS and continued to the follow-up after 1 month. Conclusions: rTMS is an efficacious intervention for treating ADHD, and combined rTMS and atomoxetine is superior to atomoxetine alone in improving attention deficit symptoms and total ADHD symptoms severity. Trial registration: PACTR, PACTR202110558451583. Registered 25 June 2021. Approved 29 October 2021- Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=15968. [ABSTRACT FROM AUTHOR]

Background: Internet addiction is a global phenomenon that has been a topic of great interest to researchers, clinicians, teachers, parents, and community groups. The study aims in determination of the rate of problematic Internet use among a sample of Egyptian adolescent students, relations of problematic Internet use with socio-demographic data, risk factors, and comorbid psychiatric disorders. A sample of 248 Egyptian adolescent school students aged 11 to 18 years old were assessed using the Young's Internet Addiction Test (IAT), Internet Gaming Disorder (IGD) Scale, Social Media Disorder (SMD) Scale, Youth Self-Report (YSR), and The Mini International Neuropsychiatric Interview for children and adolescents (Mini KID). Results: Among the study sample, 42.3% of the students suffered from mild Internet addiction, 35.1% suffered from moderate Internet addiction, and 3.6% suffered from severe addiction. 31.5% were risky gamers and 10.5% were disordered gamers; 34.3% had problematic social media disorder and the highest observed psychiatric disorders were major depressive episodes 9.3%, generalized anxiety disorder 7.7%, alcohol dependence 4.4%, attention-deficit hyperactivity disorder 4.4%, social phobia 4%, and a higher percentage of psychiatric disorders among severe Internet addiction 88.9% and among moderate addiction 70.6%, disordered gamers 92.3%, problematic social media users 60%, and a higher mean of hours spent online per day of 6.8 h per day. Conclusions: Problematic Internet use has a negative impact on Egyptian adolescent students in international schools in study sample and adds to the existing literature regarding the magnitude of Internet addiction and its relationship with different psychiatric disorders. [ABSTRACT FROM AUTHOR]

Background: Problematic internet use has been identified in the last decade as a rising problem due to growing availability and impact of Internet use through social media, mobiles, and laptops are now a must in life, adolescents are most vulnerable for the misuse and its impacts. Aim: To assess the prevalence of problematic internet use, Facebook, and gaming addiction among Egyptian adolescents and its impact. Methods: The study assessed 700 adolescents aged from 14 to 18 years, both sexes, using Young internet addiction test, Internet gaming disorder scale, the Bergen Facebook addiction scale, the MINI international neuropsychiatry interview for children and adolescents and the socioeconomic status scale. Results: A total of 584 students continued the study to the end with response rate more than 75%, the mean age was 16.1 = 1.2, 65.6% were having internet addiction, 61.3% were gaming addicts, and 92.8% Facebook addicts. Depression, dysthymia, suicide, social anxiety panic, and phobias were common comorbidities in addicted adolescents. Conclusion: This study shows that a significant percentage of adolescents are having different patterns of problematic internet use which is negatively impacting their mental health. [ABSTRACT FROM AUTHOR]

Background: World Health Organization (WHO) declared Coronavirus disease 2019 (COVID-19) as a pandemic in March 2020. Such widespread outbreaks are associated with adverse mental health consequences. Aims: To evaluate mental health outcomes among Egyptian healthcare workers (HCW) treating patients with confirmed or suspected Coronavirus Disease 2019 (COVID-19) to direct the promotion of mental wellbeing, by screening for symptoms of anxiety, insomnia, depression and stress, and analyzing potential risk factors. Methods: This cross-sectional, hospital-based survey study collected demographic data and mental health measurements from 502 HCW dealing with COVID-19. HCW were surveyed in 20 hospitals (Fever, Chest, and Quarantine hospitals) in different parts of Egypt, in April and May 2020. Results: Among the 502 HCW surveyed; 60.0% were physicians, 16.1% were specialized nurses, and 23.9% were non-specialized nurses. About 35.3% worked in chest hospitals, 17.5% in fever hospitals, and 47.2% in quarantine hospitals. A considerable proportion of HCW had symptoms of anxiety, insomnia, depression, and stress. Females were at higher risk of experiencing symptoms of severe anxiety (odds ratio [OR], 1.85; 95% CI, 1.12–3.05; p =.016), severe depression (OR, 2.013; 95% CI, 1.17–3.4; p =.011), and severe stress (OR, 2.68; 95% CI, 1.5–4.6; p <.001). Fever hospital workers were at higher risk of severe depression (OR, 1.52; 95% CI, 1.11–2.09; p <.01), compared to Quarantine hospital workers. Conclusion: Ensuring proper mental health support for HCW is an important component of public health measures for addressing the COVID-19 epidemic and safeguarding the continuity of appropriate medical service. [ABSTRACT FROM AUTHOR]

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Undergraduate psychiatric education is essential for the training of medical students and for their recruitment into psychiatry. A significant shortage of graduates choosing a career in psychiatry has been recently documented, and this trend might have many causes. When medical students have positive experiences of teaching, elective placements and exposure to psychiatric patients, their attitudes towards psychiatry are significantly better. Therefore, there is a need to improve the quality of undergraduate training courses in psychiatry. Innovative teaching strategies are suggested, including the use of movies, virtual reality, simulated patients and multiprofessional training wards. [ABSTRACT FROM AUTHOR]

Introduction: Alexithymia is characterized by difficulties in describing feelings. Many studies have shown that there is a relation between alexithymia and different types of addictions. Nowadays, smartphone addiction is proposed to be a global problem. The current study focuses on the rates of alexithymia and its association with smartphone addiction in an Egyptian university. Materials and Methods: This is a cross-sectional study that was conducted in Ain Shams University. A sample of 200 university students was surveyed using Toronto Alexithymia Scale (TAS) and Smartphone Addiction Scale – Short Version (SAS-SV). Results: The results showed that 44 students (22%) had alexithymia. It was also found that around one third of the sample (N=65, 32.5%) met the criteria of smartphone addiction. There was a strong association between alexithymia and smartphone addiction (OR=4.33, 95% CI 2.15–8.74, p= < 0.001). Conclusion: This study supports existing literature indicating the strong association between alexithymia and smartphone addiction. [ABSTRACT FROM AUTHOR]

Background: Poor adherence to treatment is one of the main challenges to symptom control and preventing recurrence in bipolar disorder (BD). Numerous studies have established an association between patients' poor adherence and an increased risk of recurrence, relapse of the symptoms and admission to hospital. Aim: To study the socio-demographic and clinical factors associated with medication nonadherence in patients with BD who were admitted to the hospital. Setting: The study was conducted at the Institute of Psychiatry, Ain Shams University. Methods: A 1-year longitudinal prospective study of 110 patients, aged 18-60 years, with BD-I. Young Mania Rating Scale, Clinical Global Impression, Global Assessment of Functioning, Sheehan Disability Scale and Insight and Treatment Attitude Questionnaire were applied before and 6 months after discharge. Adherence was measured using the Morisky 8-Item Medication Adherence Scale. Sociodemographic data and level of functioning were studied in relation to adherence. Results: Higher adherence was noticed in female, married and older patients and those with a higher level of education. However, low adherence was more common in male, nonmarried and less educated patients. Follow-up after 6 months revealed that the high adherence group scored the lowest in terms of disability. Meanwhile, the low adherence group scored the highest scores in disability. Conclusion: Several socio-demographic and clinical variables were found to be associated with a low adherence rate to the prescribed medication in patients with BD-I. Age and impaired insight were found to be significant predictive factors for non-adherence. [ABSTRACT FROM AUTHOR]

Background: Patients with major mental illness have an increased risk of victimization. Nevertheless, this topic was not thoroughly studied in Egyptian patients with major mental illness. Objectives: The objectives of this study are to investigate the rates of victimization and understand its profile, psycho-demographic and clinical correlates among a sample of Egyptian patients with major mental illness. Participants and Methods: A total of 300 patients (100 patients with schizophrenia, 100 with bipolar and 100 with major depression) were recruited from the inpatient wards and outpatient clinics at Ain Shams University. They were subjected to a demographic questionnaire, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI) and a Victimization Questionnaire (VQ). Results: In our study population, 130 (43.3%) of patients were victimized, of them 52 (40%) were diagnosed with major depressive disorder, 48 (36.9%) with bipolar disorder and 30 (23.1%) with schizophrenia. Victimization was more in female, married, unemployed individuals and those living in rural areas. Patients exposed to domestic violence or abuse during childhood had higher rates of victimization. All victimized patients were subjected to emotional victimization, 64.6% were physically victimized and 53.8% were subjected to miscellaneous types of victimization. Patients were victimized mainly by acquaintance followed by family members. The majority of patients did not report their victimization and considered it as a personal issue or not important enough to be reported. Conclusion: Patients with major mental illness are susceptible to significant victimization. Clinicians should explore possible history of abuse or victimization in their patients, empower and support the victimized ones. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Addiction is a chronic yet treatable disorder. Patterns of addiction, whether substance related or behavioural, vary among countries and regions. Addiction medicine practice and approaches used in management are not only different from one country to another but are influenced by other factors, including environmental ones. The COVID-19 pandemic is one of the major environmental changes that had an impact on addiction. In this editorial, light will be shed on three articles covering recent updates in addiction medicine, ranging from types of substances and service provision to inclusion of gaming disorder in ICD-11. [ABSTRACT FROM AUTHOR]

Training and education must be frequently reviewed and developed to match the pace of rapid advances in psychiatry, preparing current and future psychiatrists to cope with the increasing amount of knowledge and skill required. In this, there is a need to ensure that training delivered internationally meets a common standard. This is essential not only to provide equivalent quality of care worldwide, but also to eliminate one of the obstacles faced by international medical graduates working abroad. Having the basic skills to publish work and viewpoints is essential in this era of rapid development and technological advancement to ensure sharing of knowledge and expertise. [ABSTRACT FROM AUTHOR]

The family is the basic unit of any society and culture. The concept, structure, and function of the family unit vary considerably across different cultures; however, its role continues to be imperative to the development of individuals and their psychological make-up. All societies have a concept of 'family', its relative importance, structure, and functions; however, this varies according to the particular culture. In the Arabic culture, as well as other collectivistic cultures, the extended family is often regarded as the basic unit. The family is the foundational and basic social unit that fosters the stability, well-being and sustainability of society. The quality of family relationships shapes and influences the social, psychological, and biological development and functioning of its members. This may be especially relevant to individuals with mental health problems. The people of ancient Egypt valued family life highly, and this is the case even now. They treasured children and regarded them as a great blessing. If a couple had no children, they would pray to the gods and goddesses for help. They would also place letters at the tombs of dead relatives asking them to use their influence with the gods. The importance of family has not changed dramatically even though the structures are beginning to. In this paper we highlight changes in family set-up and the state of family therapy in Egypt. [ABSTRACT FROM AUTHOR]

Background: Although much attention has been drawn to trends in smoking and smoking related diseases in the general population, increasing evidence suggests that patients with mental illness are at a high risk for tobacco use and nicotine addiction. Cigarette smokers usually state the antidepressant and anxiolytic effects of smoking, but evidence reports that cigarette smoking may promote negative effect, so that the causal direction of this association still mysterious. It was reported that there is a cause effect relationship between cigarette smoking and depression as multiple studies mentioned that tobacco use increases the risk of symptoms of depression. The relationship between smoking and depression was attributed to genetic predisposition, low level of dopamine, low self-esteem, and coping styles. Aim of the Work: The current study aimed to study the pattern of tobacco use among patients with depression, to study the degree of motivation to quit in patients with depression, and to assess severity of suicidal behavior among patients with depression using tobacco. Patients and Methods: This is a case control study conducted in patients with the diagnosis of depression attending the outpatient clinic or inpatient of the institute of psychiatry Ain Shams University Hospitals during the academic year 2018-2019. The sample size was consisted of 100 patients and the patients were selected randomly. The relationship between tobacco use and depression between Egyptian patients was assessed using Socioeconomic status scale (SES), Hamilton Rating scale for Depression (HRSD), FagerströmTest for Nicotine Dependence (FTND), Lebanon Waterpipe Dependence Scale-11 (LWDS-11), Reason for quitting scale (RFQ), Columbia–Suicide Severity Rating Scale (C-SSRS), and ICD-10 symptom checklist for mental disorders. Results: The present study showed a statistical significant association between the following scales; Fagerstrom Test for Nicotine Dependence (FTND) and Hamilton depression rating scale (HDRS), Difference score of Reason for quitting scale (RFQ) and Hamilton depression rating scale (HDRS), and Fagerstrom Test for Nicotine Dependence (FTND) and Columbia–Suicide Severity Rating Scale (CSSRS). Conclusion: Compared to non-depressive persons, the results showed that depressive groups were less desired for quitting smoking. [ABSTRACT FROM AUTHOR]

Background: The four-dimensional symptom questionnaire (4DSQ) is a Dutch self-administered screening tool that has been developed in primary care to differentiate non pathologic general distress from depression, anxiety and somatization. It has been validated in the English language as well as other languages yet it has not been validated in Arabic. For the sake of developing the appropriate Arabic version, linguistic validation has been sought with the guidance of cross cultural adaptation guidelines. Objective: To design the appropriate Arabic version of the 4DSQ that has linguistic and conceptual equivalence to its validated English version and that is appropriate for administration to Egyptian primary care attendees. Methods: The validated English version of the 4DSQ was translated by 5 translators (including specialist psychiatrist, internists and English language specialist) into Arabic (Egyptian spoken dialect) without mutual consultation. An expert committee that consisted of 2 professors of public health and family medicine and an associate professor of neuropsychiatry was formed. The consensus version was created after expert committee modification and approval of each questionnaire item using DELPHI method. After that the back translation to English was carried out by two independent bilingual physicians whose English is their mother tongue. A pilot study was carried out on 17 bilingual participants after answering the questionnaire in both languages to test its equivalence. The consensus Arabic version was updated based on the pilot study and the final version was developed. The final version was then tested on 278 Egyptian primary care attendees. Results: After the course of forward and back translation, expert committee’s review and developer’s comments, the final version of Arabic 4DSQ was developed for assessment of distress, depression, anxiety and somatization. There was no significant difference between results of Arabic and English questionnaire using paired T test. Final testing showed very good internal consistency of each of the 4 scales of the questionnaire. Conclusion: The Arabic 4DSQ linguistically and conceptually corresponds to the validated English 4DSQ. It has good structural validity and internal consistency reliability and thus could be used in primary care after further psychometric validation. [ABSTRACT FROM AUTHOR]