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Objective: This study explored in detail the association between tic symptomatology, related clinical variables, and psychopathology in 91 consecutive adult TS subjects from a UK clinic., Methods: Consecutive patients from a specialized Tourette clinic who met the DSM-III criteria for TS were evaluated using standardized rating scales for Tourette syndrome and other psychopathology., Results: The male female ratio in our cohort was 1.8:1. Significantly more males had an earlier age at onset of TS and history of birth complications. Obsessive compulsive behaviors in the patient was positively correlated with presence of attention deficit hyperactivity disorder and self-injurious behaviors. With regard to adult psychopathology, principal components factor analysis yielded two factors, 'obsessionality' and 'anxiety/depression', which accounted for 72% of the variance., Conclusion: Our results support the high occurrence of anxiety, depression and obsessionality in adult TS subjects.

Parental attitudes, religious beliefs, and other sociocultural factors have all been recognized to influence help-seeking patterns in relation to child psychiatric morbidity. But few systematic studies have addressed this issue in the Arab region. In this study, we investigated the help-seeking preferences for mental health problems in a community sample. 325 parents contacted as part of a community-based study of child psychiatric disorders were surveyed using a semistructured interview schedule. Only 38% of those surveyed indicated they would seek help from mental health specialists in the event of psychiatric problems developing in a family member, including their children. Main reasons given for nonconsultation were reluctance to acknowledge that a member of their family has a mental illness, stigma attached to attending mental health services, and the skepticism about the usefulness of mental health services. Willingness to utilize psychiatric services was associated with better parental education, occupation, and socioeconomic status. Our results suggest that sociocultural factors and parental perceptions may have a major effect on whether children with psychiatric disturbance receive professional help.

Objective: The prevalence of child psychiatric morbidity in the community is unknown in most developing countries, including those in the Arab region., Method: An epidemiologic study was carried out to estimate the prevalence of psychiatric morbidity and to determine the sociodemographic correlates in a sample of children in the community, aged 6 to 18 years, in A1 Ain, United Arab Emirates (UAE)., Results: We obtained a prevalence rate of 22.2% for overall morbidity, as classified in the DSM-1V, and 14.3% for those with significant dysfunction, with the most common diagnosis being mood disorders. Female sex, large family size, chronic life difficulties, family history of psychiatric disorder, and alcohol-related problems in a family member were significantly associated with DSM-IV diagnosis., Conclusion: Although the prevalence and symptomatology in this Middle East community are similar to those in Western studies, none of these children had received professional help, suggesting serious deficiencies in mental health care services in the country.

To study the psychosocial factors and illness variables associated with children's and parents' perceptions of and ways of coping with cancer, in 38 childhood cancer patients aged 5-15 years, coping was studied in relation to sociodemographic variables and self-perception in terms of competence, behaviour and self-worth. Less optimal coping was found to be associated with poor family communications and lack of sharing/expression of emotions ( P=0.005), presence of behavioural and emotional problems in the child ( P=0.008) and parental lack of hope ( P=0.001). No association was found with gender, parental education or occupation, socioeconomic status, or child's self-perception including global estimation of self-worth. Furthermore, none of the illness variables was found to be associated with coping. Awareness about health-related issues was found to be strongly associated with parental education ( P=0.000). Our findings suggest that parental hope and both social and family communication are integral to helping patients and families cope with the illness experience.

Objectives: To study the occurrence, associated factors, nature and prognosis of seizures in children with cerebral palsy (CP)., Design: A prospective, descriptive, hospital-based, case-control study., Setting: Tertiary level University Teaching Hospitals in the Al Ain Medical District, United Arab Emirates., Patients: Fifty-six children with CP and seizures seen in the neurodevelopmental clinics at Al Ain and Tawam University Hospitals during the period of 1997-1999 were studied (group 1). Two control groups of 35 children with CP without seizures (group 2) and 50 children with seizures but no CP (group 3) were also studied., Results: Spastic tetraplegia was the commonest type of CP associated with seizures whereas spastic diplegia was the commonest variety of CP in group 2. Most children with CP had an early onset of seizures within the first year of life as against those without CP. The children in group 1 had a higher incidence of neonatal seizures (42.9% vs. 29.4% in group 2 and 0% in group 3), presence of significant developmental delay (98.2% vs. 20.0% in group 3), occurrence of significant abnormalities on brain imaging (94.6% vs. 19.6% in group 3) and a need for use of more than 1 antiepileptic drug (66.1% vs. 30.0% in group 3). Over half of children in the study group presented with generalized tonic clonic seizures; the electroencephalogram (EEG) showed focal epileptic discharges with or without secondary generalization in 39.3%. The overall outcome of seizures in children with CP was poor needing prolonged course of anticonvulsant medications, polytherapy and higher incidence of refractory seizures and admissions for status epilepticus compared to the control group., Conclusions: Cerebral palsy is associated with a higher incidence of seizure disorders, which, in a majority, has its onset in the neonatal period; brain imaging showed abnormal pathology in most affected children, which possibly accounts for the tendency to more refractory seizures in these children.

Objective: To determine the prevalence, socio-demographic correlates and associated psychopathology in children with enuresis., Methods: A community survey of a stratified sample of 400 6-16 year old school children was carried out in the Al-Ain City, United Arab Emirates. Psychiatric disturbance, if any, was ascertained using the Rutter Parent Scale., Results: Thirty-two out of the 400 children (8%) surveyed, reported wetting the bed at least once per week. More boys were affected than girls, and 90% of those with enuresis were aged 6-11 years. Presence of enuresis was found to be associated with psychosocial stress in the family; large family size; a positive family history, poorer scholastic performance and presence of psychiatric disturbance as indicated by the Rutter parent score., Conclusion: Our findings suggest that bed-wetting is a common problem among school children and that they need to be carefully screened for associated psychopathology.

Tourette syndrome (TS) is characterised by multiple motor and one or more vocal tics. There have been no controlled studies using standardised instruments of depressive symptoms and obsessive compulsive symptomatology (OCS) in young people with TS. We completed a study of phenomenology and psychopathology in children with TS, including a controlled evaluation of the association between depressive symptoms, OCS, and TS. 57 people aged 15 or under with TS were recruited. Phenomenology and psychopathology were assessed using standardised instruments. The association between TS, depressive symptoms and obsessionality was investigated using 75 age- and gender-matched controls. There were high levels of depressive symptomatology and OCS in the TS group. Twenty-three (40 %) had carried out self-injurious behaviours and 34 (60 %) met criteria for Attention Deficit Hyperactivity Disorder (ADHD). Depressive symptoms and obsessionality were higher in the TS cohort compared with the control group; this excess persisted after adjustment for the effects of age, gender and comorbidity between depression and obsessionality. This study demonstrates high levels of psychopathology in children with TS, including ADHD, OCS and depressive symptoms. The findings illustrate the potentially complex, challenging combination of difficulties encountered by children with TS and those who care for them.

We report on 8 patients with adult-onset motor tics and vocalisations. Three had compulsive tendencies in childhood and 3 had a family history of tics or obsessive-compulsive behaviour. In comparison with DSM-classified, younger-onset Gilles de la Tourette syndrome, adult-onset tic disorders are more often associated with severe symptoms, greater social morbidity, a potential trigger event, increased sensitivity, and poorer response to neuroleptic medication., (Copyright 2002 Movement Disorder Society)

Objective: Given the widely recognized genetic basis for Gilles de la Tourette syndrome (TS) and the suggestion that the putative TS gene(s) may be expressed as or associated with a variety of psychiatric illnesses, this study was undertaken to assess the prevalence of tics and TS in a psychiatric inpatient population., Design: Cross-sectional study., Setting and Patients: 200 consecutive adult patients who were admitted to the psychiatric wards of University College London Teaching Hospitals., Outcome Measures: TS and related behaviours, as assessed by the comprehensive semi-structured National Hospital Interview Schedule., Results: None of the 200 patients had definite TS, but 2 were observed to have motor tics; 10 had a history of tics (present for less than a year), and 7 reported a family history of tics. Thus, 19 (9.5%) inpatients qualified for inclusion in a broadly defined TS diathesis. These rates are significantly lower than those reported in a similar community based epidemiological study of adolescents (p = 0.018)., Conclusions: Our findings do not support the theory that TS and related behaviours are over-represented among adult inpatients with psychiatric illnesses.

Background: Harterâs Self-Perception Profile for children (SPPC) is a self-reporting inventory for ascertaining childrenâs perception of themselves in various specific domains of their life, as well as their sense of global selfworth. A few studies have examined the psychometric properties of this instrument in the Western setting, but none have investigated this in an Arabic culture., Patients and Method: Psychometric properties of the SPPC were examined, using a sample of 100 schoolchildren aged 8 to 16 years in the United Arab Emirates., Results: The internal consistency reliability was found to be excellent with Chronbachâs alpha, ranging from 0.86 to 0.92. Significant age and gender differences were found with the internal consistency reliability scores, being higher in children aged 13 to 16 years (0.88 to 0.93) when compared to younger children, especially boys aged 8 to 12 years (0.54 to 0.66), suggesting a need to exercise caution while using this scale in young boys in this culture. Behavioral conduct subscale was found to have the highest reliability score and the strongest correlation to global self-worth (r=0.54) for both younger and older children in our sample. This is in contrast to findings from similar studies carried out on American and Dutch samples, where this subscale was found to have the lowest reliability score and the weakest correlation with oneâs global self-worth., Conclusion: The findings indicate that the SPPC is a reliable and internally valid instrument for use in the Arab culture.

Self-perception about competence, behaviour, and self-worth were examined in 30 children (8 to 14 years) recently diagnosed as having cancer and were compared with that of their parents' perception. The poor agreement between parents' and children's ratings on physical appearance and social acceptance is noteworthy in that these two domains are particularly vulnerable in children with cancer, given the effect of chemotherapy on physical appearance and children's tendency to view themselves as socially undesirable or a burden to others. This finding, if replicated, can have implications for therapeutic intervention since the discrepancy score could be used to challenge children's negative views in the context of cognitive therapy to improve their self-esteem.

Objective: To examine child psychiatric morbidity in an Arab culture., Method: Emotional and behavioral problems were investigated in 3,278 schoolchildren aged 6 to 15 years using a two-stage epidemiological study in Al Ain District, United Arab Emirates. Children were screened using standardized questionnaires completed by parents and school physicians in the first stage, and a stratified random sample were interviewed by a child psychiatrist in the second stage., Results: 23.9% of children were reported to have a mental health problem by either the parent or the school health physician. Boys were more often reported to be having problems than girls (1.8:1). Using the Rutter A2 scale for parents, the prevalence estimate for behavioral disorders was 16.5%. The weighted prevalence for DSM-IV disorders was 10.4% for the entire population. The presence of certain culture-specific risk factors such as male gender, number of children in the household, polygamy, and low socioeconomic status were identified for psychiatric disorders. A positive family history and consanguinity were the most significant factors associated with learning disorders., Conclusions: The prevalence rates of child psychiatric disorders and the symptomatology observed in this Middle East community are similar to those reported in Western studies.

The aim of this study was to ascertain accurately the prevalence of Tourette syndrome (TS) in a mainstream school population. All year 9 pupils (aged 13 to 14 years) in a mainstream secondary school were investigated using a two-stage procedure. Standardized questionnaires were completed by parents, teachers, and pupils. Class observations were also carried out to identify tics. Those pupils identified as having tics underwent a semistructured interview to determine whether they had TS according to DSM-III-R criteria. Data were available from at least one source (parent, teacher, or self-reports) on 166 of the 167 pupils in the year. Five subjects were identified as having TS according to DSM-III-R criteria, yielding a prevalence estimate of 299 per 10,000 pupils in this age group. The results of this study suggest that TS in the community as a whole is more common and milder than those prevalence estimates and descriptions of the disorder based on TS encountered in secondary or tertiary health-care service settings.

We present a case report illustrating the complexity encountered in the diagnosis and treatment of patients with multiple diagnoses. The clinical presentation in Tourette syndrome, and the behavioural manifestations in some cases of complex partial seizures can both be misunderstood and misdiagnosed. The paper, within the framework of a case, emphasises the need for a multidisciplinary approach in the assessment and management of such cases.

In this report we describe the circumstances surrounding an outbreak of mass hysteria among first year female university students. The outbreak was precipitated by a state of panic over the possibility of a fire which turned out to be harmless fumes from a locally used burning perfume. Twenty-three cases presented to the emergency room with symptoms of respiratory distress associated with marked emotional reactions. The outbreak was controlled by separating the patients, and the lack of media coverage facilitated this process. Cases with persistent and severe symptoms were those having physical and psychological problems prior to the occurrence of the outbreak. Individual vulnerability factors deserve special consideration in the management of mass hysteria since they are likely to influence the response to treatment.

A 53-year-old gentleman is described, who presented with acute onset of anxiety and obsessional symptoms. The clinical picture was complicated by the presence of mild alcohol withdrawal symptoms and history of excessive drinking for 20 years. A month later, he developed right hemiparesis. CT scan revealed a left frontal tumour, and on histology this was found to be Grade 4 astrocytoma.

Allele and genotype frequencies for three tetrameric short tandem repeat (STR) loci: HUMTHO1, TPOX, and CSFIPO, were determined in a United Arab Emirates (UAE) national population sample (n = 119). The loci were amplified simultaneously and the PCR products were separated in polyacrylamide DNA sequencing gels. Detection of the DNA fragments was accomplished using silver staining. Allele designations were determined by comparison to an allelic ladder. One allele at each locus was sequenced to confirm the nature of the repeats and their number. Alleles at the HUMTHO1 and TPOX loci were distributed bimodally, while CSF1PO showed unimodal distribution. The observed heterozygosities were 76% for HUMTHO1, 64% for TPOX, and 71% for CSF1PO. No deviation from the Hardy-Weinberg expectations was observed in the genotype distribution for the loci TPOX and CSF1PO, but the HUMTHO1 locus did depart from HWE based on the likelihood ratio and the exact test. No correlation was detected between the alleles at any of the three pairs of loci. The allelic frequency data of these three loci in the UAE population sample can thus be used in human identity testing.

The distribution of obsessive compulsive symptoms was compared in 16 individuals with primary obsessive compulsive disorder (OCD) and 16 individuals with Gilles de la Tourette syndrome (GTS) and associated obsessive compulsive behaviors (OCB). The two groups showed significant differences in the distribution of OC symptomatology. Furthermore, those OCD probands who shared a similar symptom profile with GTS individuals all had a positive family history of OCD. All of the other OCD probands were isolated cases. Implications of this finding on the etiology and pathogenesis of the two disorders are discussed.

In order to determine the prevalence of tic disorders in children with severe school problems requiring a residential facility and comparison groups of children in regular day schools, we performed direct clinical examinations for the presence of tics and Gilles de la Tourette's syndrome (GTS) in 20 children from a residential school for emotional and behavioral difficulties (EBD); 25 children from a residential school for learning disabilities; 17 "problem" children (PC) (identified by teachers as having academic or behaviour problems) and 19 normal children (NC) selected at random (using random numbers) from a regular school. Of the EBD students, 65% were judged to have definite tics as compared with 24% of students with learning difficulties (P < 0.05), 6% of PC (P < 0.003) and none of the NC (P < 0.0006) group. Most of the affected students met diagnostic criteria for GTS. Our findings suggest that GTS is commonly associated with the need for special education and that this association is particularly robust for children with severe school problems. In these children, the presence of tics may be an indicator of an underlying dysfunction of neurological development.

Background: Gilles de la Tourette's syndrome (GTS) is a familial neuropsychiatric disorder characterized by tics and obsessive-compulsive behaviours (OCB). Previous HMPAO SPET studies of subjects with GTS have shown hypoperfusion of striatal and frontal areas. Studies of patients with primary obsessive-compulsive disorder have shown, in contrast, hyperperfusion of similar areas., Methods: Twenty subjects from five families affected by GTS, including individuals with OCB but no tics, were examined using HMPAO SPET., Results: There were abnormalities of regional cerebral perfusion in individuals with GTS, OCB and tics. Hypoperfusion was in striatal, frontal and temporal areas. There was no hyperperfusion., Conclusions: Regional cerebral blood flow patterns in individuals with OCB in families affected by GTS are comparable to their relatives with GTS and differ from individuals with primary OCD in the absence of a family history of tic disorders.

Nineteen patients with Tourette syndrome (TS) were treated with risperidone, at a mean daily dose of 1.5 mg. Of those, 41% responded positively, 35% felt that it had made no difference, while it made 24% worse. Although 53% of the patients experienced side-effects, none had extrapyramidal side-effects. At follow-up, 8 to 11 months later, only two of 19 (11 %) patients were still taking risperidone. We suggest that risperidone does have a role in a minority of TS sufferers but it is not suggested as the first line treatment. More placebo-controlled studies using risperidone are clearly indicated.

Childhood sexual abuse may have a significant impact on psychological well being in later life. In this report, we describe 5 women who had a variety of psychological symptoms that were related to childhood sexual trauma. These factors were explored during psychotherapy. Persistent feeling of depression, anxiety and problems in socio-sexual functioning, were prominent. Therapy varied from counselling and ventilation, to prolonged dynamically oriented therapy.

The controversy of the use of stimulants in Gilles de la Tourette's syndrome (GTS) can only be understood by examining the relationship between GTS and attention deficit-hyperactivity disorder (ADHD), because the relationship between the two disorders is complex, and stimulants are used in the one (ADHD) and may be contraindicated in the other (GTS). This relationship therefore has to be viewed from several perspectives, including clinical, genetic, neurobiochemical, neurophysiological, and treatment strategies, to highlight the complexities involved, and reasons for controversy. The present review will examine these relationships, and thus the evidence for and against the treatment of GTS with stimulants.

An analysis of 383 cases of attempted suicide presented to the Accident and Emergency Department during 12 complete lunar cycles (one year) gave no support for an association between attempted suicide and the lunar cycle, especially the full moon. No control for weekends or holidays was made.

Forty six subjects infected with the human immunodeficiency virus (HIV) were followed up, for recording psychiatric morbidity if any, before and after the information regarding their HIV status was revealed to them. Among these, four patients had the AIDS syndrome, while 42 individuals were HIV carriers. The pre-information morbidity in the AIDS group included two individuals who presented with delirium and one with an adjustment disorder. The psychiatric diagnosis among the HIV carriers revealed one patient with major depression, four with adjustment disorders and four with alcohol dependence syndrome. The additional morbidity after the diagnoses was revealed included major depression and adjustment disorders which could be managed by psychological intervention and counselling in most cases. The individual who developed major depression later, committed suicide. The study though preliminary in nature, suggests that it may be beneficial to include psychiatric management as part of the general care of individuals with HIV infection.