Background: Chronic Spontaneous Urticaria (CSU) is an allergic auto-immune disease with more than... more Background: Chronic Spontaneous Urticaria (CSU) is an allergic auto-immune disease with more than 6 weeks of continuous symptoms, it is known to trigger allergic wheal formations and angioedema. Vitamin D at optimal levels plays an important role in adjusting innate immunity thus People who has deficient or insufficient levels of serum vitamin D suffer from disturbance in immune system. Accordingly, studies have been established to explore the effect of vitamin D on CSU. Aim of the Study: To determine the effect of 12 weeks daily oral vitamin D supplementation [ high (4,000 IU/d) versus low (600 IU/d) dose of orally administered vitamin D3] on Urticaria activity score (UAS-7), quality of life (QOL) and medication burden in patients with chronic spontaneous urticaria, and to assess the relationship between vitamin D levels and CRP in these patients. Patients and methods: This single blind randomized prospective study conducted to 50 patients with CSU, admitted to Ain shams hospital, 50 patients were divided into 2 groups according to the dose of vitamin D orally administrated to these subjects, the first was group A , patients have received vitamin D orally in High dose 4000 IU/Day compared to group B , which included 25 cases received oral vitamin D in a low dose concentration 600 IU/d , Patients has been followed up in 3 times at baseline (0 week) , 6 weeks and 12 weeks intervals. Results: Serum vitamin D levels in Group were higher than Group B (44.48 12.86 vs 34.45 5.43). Medication consumption was higher in group A compared to group B, thus favors orally low dose administration of vitamin D at first 6 weeks in the beginning of treatment course. UAS7 score in group A was better than Group B from baseline) to 6 weeks (P=0.009 vs 0.239) and from 6 weeks to 12 weeks. (P= 0.011 vs <0.0011). There was no significant difference in serum CRP between group A and group B as regards to CRP, furthermore there was no statistically correlation between 3 times intervals in group A and group B separately (12.71 1.47 vs 13.11 1.45). Conclusion: Improvement of both quality of life, and UAS7 score after receiving of High dose 4000 IU/d vitamin D orally in Group A, could benefit patients with CSU and decrease the complication of this disease. It was also found Serum Vitamin D level has no significant relation with C Reactive protein level, thus we couldn't relay on evaluation the chronicity of urticarial by measuring its value in serum blood with patients suffering from chronic spontaneous idiopathic urticaria.
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.
Given that achievement in learning mathematics at school correlates with work and social achievem... more Given that achievement in learning mathematics at school correlates with work and social achievements, it is important to understand the cognitive processes underlying abilities to learn mathematics efficiently as well as reasons underlying the occurrence of mathematics anxiety (i.e. feelings of tension and fear upon facing mathematical problems or numbers) among certain individuals. Over the last two decades, many studies have shown that learning mathematical and numerical concepts relies on many cognitive processes, including working memory, spatial skills, and linguistic abilities. In this review, we discuss the relationship between mathematical learning and cognitive processes as well as the neural substrates underlying successful mathematical learning and problem solving. More importantly, we also discuss the relationship between these cognitive processes, mathematics anxiety, and mathematics learning disabilities (dyscalculia). Our review shows that mathematical cognition relies on a complex brain network, and dysfunction to different segments of this network leads to varying manifestations of mathematical learning disabilities.
European Annals of Allergy and Clinical Immunology, 2018
Attention deficit hyperactivity disorder (ADHD) has gained importance lately, because it has beco... more Attention deficit hyperactivity disorder (ADHD) has gained importance lately, because it has become common and has caused serious implication to those affected. DSM-IV-TR defined ADHD by symptoms of inattention, hyperactivity and impulsivity (1). Studies estimated that 4% to 8% of children worldwide have ADHD, which is more prevalent in boys than girls by three folds (2). In Egypt, the prevalence raised to 9.4% (3). There are many speculations about the possible relationship between ADHD and allergy, owing to the fact that ADHD children had allergic disorders. It is putative that ADHD might be a complication of allergy, as it was found that allergic reactions led to a sequence of imbalanced cholinergic/adrenergic activity in the central nervous system (4). On the other hand, ADHD can occur secondary to side effects of antiallergic drugs (5). The pathogenesis of allergy and ADHD both rely on gene-environment interaction, which is complex in nature (6). Surprisingly, ADHD and allergy share the hypersensitivity phenomenon. When exposed to certain stimuli which are tolerated by normal subjects, a sequence of symptoms occur. As inhalants like mite or ingestants like milk can trigger an allergic reaction, certain foods and pollens can activate ADHD symptoms (7). Due to this hypersensitivity concept in pathogenesis of both allergic disease and ADHD, integrated evaluation, proper diagnosis, prevention and management should be revised and put in consideration to improve quality of care of these patients (5). Therefore, the aim of this work was to investigate the percentage of allergic conditions among clinically diagnosed children with ADHD, and to study the effect of allergy on symptom patterns, severity and its association with demographic variables in ADHD children. Secondary outcomes were to detect the most common allergens in ADHD children with concurrent allergic disorders.
Previous studies have shown that high total homocysteine levels are associated with Alzheimer's d... more Previous studies have shown that high total homocysteine levels are associated with Alzheimer's disease (AD) and mild cognitive impairment (MCI). In this study, we test the relationship between cognitive function and total homocysteine levels in healthy subjects (Global Dementia Rating, CDR = 0) and individuals with MCI (CDR = 0.5). We have used a cognitive task that tests learning and generalization of rules, processes that have been previously shown to rely on the integrity of the striatal and hippocampal regions, respectively. We found that total homocysteine levels are higher in MCI individuals than in healthy controls. Unlike what we expected, we found no difference between MCI subjects and healthy controls in learning and generalization. We conducted further analysis after diving MCI subjects in two groups, depending on their Global Deterioration Scale (GDS) scores: individuals with very mild cognitive decline (vMCD, GDS = 2) and mild cognitive decline (MCD, GDS = 3). There was no difference among the two MCI and healthy control groups in learning performance. However, we found that individuals with MCD make more generalization errors than healthy controls and individuals with vMCD. We found no difference in the number of generalization errors between healthy controls and MCI individuals with vMCD. In addition, interestingly, we found that total homocysteine levels correlate positively with generalization errors, but not with learning errors. Our results are in agreement with prior results showing a link between hippocampal function, generalization performance, and total homocysteine levels. Importantly, our study is perhaps among the first to test the relationship between learning (and generalization) of rules and homocysteine levels in healthy controls and individuals with MCI.
Although homocysteine (Hcy) has been widely implicated in the etiology of various physical health... more Although homocysteine (Hcy) has been widely implicated in the etiology of various physical health impairments, especially cardiovascular diseases, overwhelming evidence indicates that Hcy is also involved in the pathophysiology of schizophrenia and affective disorders. There are several mechanisms linking Hcy to biological underpinnings of psychiatric disorders. It has been found that Hcy interacts with NMDA receptors, initiates oxidative stress, induces apoptosis, triggers mitochondrial dysfunction and leads to vascular damage. Elevated Hcy levels might also contribute to cognitive impairment that is widely observed among patients with affective disorders and schizophrenia. Supplementation of vitamins B and folic acid has been proved to be effective in lowering Hcy levels. There are also studies showing that this supplementation strategy might be beneficial for schizophrenia patients with respect to alleviating negative symptoms. However, there are no studies addressing the influence of add-on therapies with folate and vitamins B on cognitive performance of patients with schizophrenia and affective disorders. In this article, we provide an overview of Hcy metabolism in psychiatric disorders focusing on cognitive correlates and indicating future directions and perspectives.
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.
Background Bipolar disorder has been identified as the sixth cause of disability among all medica... more Background Bipolar disorder has been identified as the sixth cause of disability among all medical illnesses, as it had been widely accepted that patients recovered completely and remain free in-between episodes. However, recent studies have shown that euthymic bipolar patients continue to have psychosocial difficulties and have reduced ability to regain premorbid levels of social and vocational functioning even after episodes of remission, suggesting that a gap exists between syndromal recovery and functional recovery, and this gap may be because of cognitive impairments. Cognitive deficits, most notably in attention, verbal learning, and executive function, can be observed across multiple phases of bipolar disorder. Aim of the study To show the range of neuropsychological deficits in the various cognitive domains in euthymic bipolar I patients depending on the previous clinical state and to correlate these cognitive deficits with illness characteristics and profile. Participants and methods This was a case-control study that included 60 patients divided into two major groups: a stratified random sample of 30 patients in the euthymic phase of bipolar I disorders and a control group. The patient group was diagnosed using Structured Clinical Interview for DSM-IV (SCID-I) and the euthymic state was determined using the Young Mania Rating Scale (YMRS) and the Hamilton Rating Scale for Depression (HRSD); we used Wechsler Adult Intelligence Scale (WAIS) and Wechsler Memory Scale-Revised (WMSR) for cognitive assessment. Results Euthymic patients with bipolar I performed poorer than controls on tests of intelligence, attention, memory, and executive functions. Performance on most domains of Wechsler Adult Intelligence Scale (WAIS) was associated with age of onset of illness and the number of depressive episodes. These differences were statistically significant, with residual symptoms not reaching clinical significance. Conclusion We conclude that cognitive deficits associated with euthymia in bipolar disorder can be considered both a consequence of the disorder and a determinant of outcome in recovery for bipolar I disorder.
Psychosis and hallucinations occur in 20-30% of patients with Parkinson&amp;amp;amp;amp;amp;a... more Psychosis and hallucinations occur in 20-30% of patients with Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;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.
Frontiers in Behavioral Neuroscience, Nov 28, 2014
Comparisons of cognitive impairments between schizophrenia (SZ) and bipolar disorder (BPD) have p... more Comparisons of cognitive impairments between schizophrenia (SZ) and bipolar disorder (BPD) have produced mixed results. We applied different working memory (WM) measures (Digit Span Forward and Backward, Short-delay and Long-delay CPT-AX, N-back) to patients with SZ (n = 23), psychotic BPD (n = 19) and non-psychotic BPD (n = 24), as well as to healthy controls (HC) (n = 18) in order to compare the level of WM impairments across the groups. With respect to the less demanding WM measures (Digit Span Forward and Backward, Short-delay CPT-AX), there were no between group differences in cognitive performance; however, with respect to the more demanding WM measures (Long-delay CPT-AX, N-back), we observed that the groups with psychosis (SZ, psychotic BPD) did not differ from one another, but performed poorer than the group without a history of psychosis (non-psychotic BPD). A history of psychotic symptoms may influence cognitive performance with respect to WM delay and load effects as measured by Long-delay CPT-AX and N-back tests, respectively. We observed a positive correlation of WM performance with antipsychotic treatment and a negative correlation with depressive symptoms in BPD and with negative symptoms in SZ subgroup. Our study suggests that WM dysfunctions are more closely related to a history of psychosis than to the diagnostic categories of SZ and BPD described by psychiatric classification systems.
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
The cerebellum has been considered for a long time to play a role solely in motor coordination. H... more The cerebellum has been considered for a long time to play a role solely in motor coordination. However, studies over the past two decades have shown that the cerebellum also plays a key role in many motor, cognitive, and emotional processes. In addition, studies have also shown that the cerebellum is implicated in many psychiatric disorders including attention deficit hyperactivity disorder, autism spectrum disorders, schizophrenia, bipolar disorder, major depressive disorder, and anxiety disorders. In this review, we discuss existing studies reporting cerebellar dysfunction in various psychiatric disorders. We will also discuss future directions for studies linking the cerebellum to psychiatric disorders.
Background: Chronic Spontaneous Urticaria (CSU) is an allergic auto-immune disease with more than... more Background: Chronic Spontaneous Urticaria (CSU) is an allergic auto-immune disease with more than 6 weeks of continuous symptoms, it is known to trigger allergic wheal formations and angioedema. Vitamin D at optimal levels plays an important role in adjusting innate immunity thus People who has deficient or insufficient levels of serum vitamin D suffer from disturbance in immune system. Accordingly, studies have been established to explore the effect of vitamin D on CSU. Aim of the Study: To determine the effect of 12 weeks daily oral vitamin D supplementation [ high (4,000 IU/d) versus low (600 IU/d) dose of orally administered vitamin D3] on Urticaria activity score (UAS-7), quality of life (QOL) and medication burden in patients with chronic spontaneous urticaria, and to assess the relationship between vitamin D levels and CRP in these patients. Patients and methods: This single blind randomized prospective study conducted to 50 patients with CSU, admitted to Ain shams hospital, 50 patients were divided into 2 groups according to the dose of vitamin D orally administrated to these subjects, the first was group A , patients have received vitamin D orally in High dose 4000 IU/Day compared to group B , which included 25 cases received oral vitamin D in a low dose concentration 600 IU/d , Patients has been followed up in 3 times at baseline (0 week) , 6 weeks and 12 weeks intervals. Results: Serum vitamin D levels in Group were higher than Group B (44.48 12.86 vs 34.45 5.43). Medication consumption was higher in group A compared to group B, thus favors orally low dose administration of vitamin D at first 6 weeks in the beginning of treatment course. UAS7 score in group A was better than Group B from baseline) to 6 weeks (P=0.009 vs 0.239) and from 6 weeks to 12 weeks. (P= 0.011 vs <0.0011). There was no significant difference in serum CRP between group A and group B as regards to CRP, furthermore there was no statistically correlation between 3 times intervals in group A and group B separately (12.71 1.47 vs 13.11 1.45). Conclusion: Improvement of both quality of life, and UAS7 score after receiving of High dose 4000 IU/d vitamin D orally in Group A, could benefit patients with CSU and decrease the complication of this disease. It was also found Serum Vitamin D level has no significant relation with C Reactive protein level, thus we couldn't relay on evaluation the chronicity of urticarial by measuring its value in serum blood with patients suffering from chronic spontaneous idiopathic urticaria.
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.
Given that achievement in learning mathematics at school correlates with work and social achievem... more Given that achievement in learning mathematics at school correlates with work and social achievements, it is important to understand the cognitive processes underlying abilities to learn mathematics efficiently as well as reasons underlying the occurrence of mathematics anxiety (i.e. feelings of tension and fear upon facing mathematical problems or numbers) among certain individuals. Over the last two decades, many studies have shown that learning mathematical and numerical concepts relies on many cognitive processes, including working memory, spatial skills, and linguistic abilities. In this review, we discuss the relationship between mathematical learning and cognitive processes as well as the neural substrates underlying successful mathematical learning and problem solving. More importantly, we also discuss the relationship between these cognitive processes, mathematics anxiety, and mathematics learning disabilities (dyscalculia). Our review shows that mathematical cognition relies on a complex brain network, and dysfunction to different segments of this network leads to varying manifestations of mathematical learning disabilities.
European Annals of Allergy and Clinical Immunology, 2018
Attention deficit hyperactivity disorder (ADHD) has gained importance lately, because it has beco... more Attention deficit hyperactivity disorder (ADHD) has gained importance lately, because it has become common and has caused serious implication to those affected. DSM-IV-TR defined ADHD by symptoms of inattention, hyperactivity and impulsivity (1). Studies estimated that 4% to 8% of children worldwide have ADHD, which is more prevalent in boys than girls by three folds (2). In Egypt, the prevalence raised to 9.4% (3). There are many speculations about the possible relationship between ADHD and allergy, owing to the fact that ADHD children had allergic disorders. It is putative that ADHD might be a complication of allergy, as it was found that allergic reactions led to a sequence of imbalanced cholinergic/adrenergic activity in the central nervous system (4). On the other hand, ADHD can occur secondary to side effects of antiallergic drugs (5). The pathogenesis of allergy and ADHD both rely on gene-environment interaction, which is complex in nature (6). Surprisingly, ADHD and allergy share the hypersensitivity phenomenon. When exposed to certain stimuli which are tolerated by normal subjects, a sequence of symptoms occur. As inhalants like mite or ingestants like milk can trigger an allergic reaction, certain foods and pollens can activate ADHD symptoms (7). Due to this hypersensitivity concept in pathogenesis of both allergic disease and ADHD, integrated evaluation, proper diagnosis, prevention and management should be revised and put in consideration to improve quality of care of these patients (5). Therefore, the aim of this work was to investigate the percentage of allergic conditions among clinically diagnosed children with ADHD, and to study the effect of allergy on symptom patterns, severity and its association with demographic variables in ADHD children. Secondary outcomes were to detect the most common allergens in ADHD children with concurrent allergic disorders.
Previous studies have shown that high total homocysteine levels are associated with Alzheimer's d... more Previous studies have shown that high total homocysteine levels are associated with Alzheimer's disease (AD) and mild cognitive impairment (MCI). In this study, we test the relationship between cognitive function and total homocysteine levels in healthy subjects (Global Dementia Rating, CDR = 0) and individuals with MCI (CDR = 0.5). We have used a cognitive task that tests learning and generalization of rules, processes that have been previously shown to rely on the integrity of the striatal and hippocampal regions, respectively. We found that total homocysteine levels are higher in MCI individuals than in healthy controls. Unlike what we expected, we found no difference between MCI subjects and healthy controls in learning and generalization. We conducted further analysis after diving MCI subjects in two groups, depending on their Global Deterioration Scale (GDS) scores: individuals with very mild cognitive decline (vMCD, GDS = 2) and mild cognitive decline (MCD, GDS = 3). There was no difference among the two MCI and healthy control groups in learning performance. However, we found that individuals with MCD make more generalization errors than healthy controls and individuals with vMCD. We found no difference in the number of generalization errors between healthy controls and MCI individuals with vMCD. In addition, interestingly, we found that total homocysteine levels correlate positively with generalization errors, but not with learning errors. Our results are in agreement with prior results showing a link between hippocampal function, generalization performance, and total homocysteine levels. Importantly, our study is perhaps among the first to test the relationship between learning (and generalization) of rules and homocysteine levels in healthy controls and individuals with MCI.
Although homocysteine (Hcy) has been widely implicated in the etiology of various physical health... more Although homocysteine (Hcy) has been widely implicated in the etiology of various physical health impairments, especially cardiovascular diseases, overwhelming evidence indicates that Hcy is also involved in the pathophysiology of schizophrenia and affective disorders. There are several mechanisms linking Hcy to biological underpinnings of psychiatric disorders. It has been found that Hcy interacts with NMDA receptors, initiates oxidative stress, induces apoptosis, triggers mitochondrial dysfunction and leads to vascular damage. Elevated Hcy levels might also contribute to cognitive impairment that is widely observed among patients with affective disorders and schizophrenia. Supplementation of vitamins B and folic acid has been proved to be effective in lowering Hcy levels. There are also studies showing that this supplementation strategy might be beneficial for schizophrenia patients with respect to alleviating negative symptoms. However, there are no studies addressing the influence of add-on therapies with folate and vitamins B on cognitive performance of patients with schizophrenia and affective disorders. In this article, we provide an overview of Hcy metabolism in psychiatric disorders focusing on cognitive correlates and indicating future directions and perspectives.
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.
Background Bipolar disorder has been identified as the sixth cause of disability among all medica... more Background Bipolar disorder has been identified as the sixth cause of disability among all medical illnesses, as it had been widely accepted that patients recovered completely and remain free in-between episodes. However, recent studies have shown that euthymic bipolar patients continue to have psychosocial difficulties and have reduced ability to regain premorbid levels of social and vocational functioning even after episodes of remission, suggesting that a gap exists between syndromal recovery and functional recovery, and this gap may be because of cognitive impairments. Cognitive deficits, most notably in attention, verbal learning, and executive function, can be observed across multiple phases of bipolar disorder. Aim of the study To show the range of neuropsychological deficits in the various cognitive domains in euthymic bipolar I patients depending on the previous clinical state and to correlate these cognitive deficits with illness characteristics and profile. Participants and methods This was a case-control study that included 60 patients divided into two major groups: a stratified random sample of 30 patients in the euthymic phase of bipolar I disorders and a control group. The patient group was diagnosed using Structured Clinical Interview for DSM-IV (SCID-I) and the euthymic state was determined using the Young Mania Rating Scale (YMRS) and the Hamilton Rating Scale for Depression (HRSD); we used Wechsler Adult Intelligence Scale (WAIS) and Wechsler Memory Scale-Revised (WMSR) for cognitive assessment. Results Euthymic patients with bipolar I performed poorer than controls on tests of intelligence, attention, memory, and executive functions. Performance on most domains of Wechsler Adult Intelligence Scale (WAIS) was associated with age of onset of illness and the number of depressive episodes. These differences were statistically significant, with residual symptoms not reaching clinical significance. Conclusion We conclude that cognitive deficits associated with euthymia in bipolar disorder can be considered both a consequence of the disorder and a determinant of outcome in recovery for bipolar I disorder.
Psychosis and hallucinations occur in 20-30% of patients with Parkinson&amp;amp;amp;amp;amp;a... more Psychosis and hallucinations occur in 20-30% of patients with Parkinson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;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.
Frontiers in Behavioral Neuroscience, Nov 28, 2014
Comparisons of cognitive impairments between schizophrenia (SZ) and bipolar disorder (BPD) have p... more Comparisons of cognitive impairments between schizophrenia (SZ) and bipolar disorder (BPD) have produced mixed results. We applied different working memory (WM) measures (Digit Span Forward and Backward, Short-delay and Long-delay CPT-AX, N-back) to patients with SZ (n = 23), psychotic BPD (n = 19) and non-psychotic BPD (n = 24), as well as to healthy controls (HC) (n = 18) in order to compare the level of WM impairments across the groups. With respect to the less demanding WM measures (Digit Span Forward and Backward, Short-delay CPT-AX), there were no between group differences in cognitive performance; however, with respect to the more demanding WM measures (Long-delay CPT-AX, N-back), we observed that the groups with psychosis (SZ, psychotic BPD) did not differ from one another, but performed poorer than the group without a history of psychosis (non-psychotic BPD). A history of psychotic symptoms may influence cognitive performance with respect to WM delay and load effects as measured by Long-delay CPT-AX and N-back tests, respectively. We observed a positive correlation of WM performance with antipsychotic treatment and a negative correlation with depressive symptoms in BPD and with negative symptoms in SZ subgroup. Our study suggests that WM dysfunctions are more closely related to a history of psychosis than to the diagnostic categories of SZ and BPD described by psychiatric classification systems.
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
The cerebellum has been considered for a long time to play a role solely in motor coordination. H... more The cerebellum has been considered for a long time to play a role solely in motor coordination. However, studies over the past two decades have shown that the cerebellum also plays a key role in many motor, cognitive, and emotional processes. In addition, studies have also shown that the cerebellum is implicated in many psychiatric disorders including attention deficit hyperactivity disorder, autism spectrum disorders, schizophrenia, bipolar disorder, major depressive disorder, and anxiety disorders. In this review, we discuss existing studies reporting cerebellar dysfunction in various psychiatric disorders. We will also discuss future directions for studies linking the cerebellum to psychiatric disorders.
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Papers by Abeer Eissa