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Abdulrazak Abyad MD, MPH, MBA, AGSF, AFCHSE

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Volume 2, December 2018

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Editorial

This is the second issue this year with papers from Muscat, Egypt, Turkey and Scotland.

In the two papers from Egypt the author dealt with depression issues. In the first paper the author assessed the prevalence and predictors of depression among the elderly residing in residential homes in Delta District (Dakahlia, Damietta and El-Gharbia governorates). It was a cross-sectional descriptive study included the 110 institutionalized elderly in all residential homes in Delta District. Data collection tools included a structured interview questionnaire for personal data, Geriatric Depression Scale short form (GDS-15), Berlin Social Support Scale (BSSS) and Katz and Akpom Activity of daily living scale (ADL). The findings of the study indicate that the prevalence of depression in the study population (n=110) was 60 %, of which 19.1 % had severe depression. Prevalence of depression was found to be significantly higher among those with impairment in ADL(P? 0.000), socially isolated (P? 0.000), loneliness (P? 0.000), lack of support system, dissatisfied with ageing process (P? 0.000) and not practices religious activity regularly (P? 0.000). The findings suggest that depression is highly prevalent among the institutionalized elderly. In addition to, loneliness, impairment in ADL, lack of social interaction and support system, dissatisfaction with ageing process, lack of social and spiritual activities are associated with experience of depression among the elderly residing in residential homes.


The second paper assess the effect of family psycho-education intervention on depressive symptoms in patients with depression in conjunction with their antidepressants medication. The study was carried out on 95 patients at the inpatient and outpatient Psychiatric department Mansoura University Hospital, Egypt. Pre-tests and post-tests (n = 95), and 3-months after intervention were eighty eight (n = 88). The findings of the study indicate that the performance of the ADL, depressive symptoms improved after implementation of family intervention. The author concluded that ADL, and depressive symptoms in patients with depression improved after implementation of family intervention in conjunction with antidepressant drugs. This conclusion leads to accept the hypothesis of the study that family intervention along with antidepressants drugs that improve the depressive symptoms among the depressed patients.

Amusaidi A et al; presented a a case from Muscat who had developed catatonic features for the first time in late perinatal period. Her presentation was accompanied by new onset hypertension and proteinuria. This case highlights the importance of careful monitoring during prenatal period of women with psychotic mental illness and the necessity and importance of communication between psychiatry and other medical specialties as well as the unique medical and psychiatric complications they face. Confounding factors such as mutism and a psychotic appearance may further complicate the clinical picture in such cases. The authors stressed that Preeclampsia and eclampsia can have neuropsychiatric manifestations due to acute brain injury which has been well recognized. There is developing evidence for association between preeclampsia / eclampsia and mental health problems. Psychiatric disorders and preeclampsia / eclampsia are commonly seen clinical problems during pregnancy, and untreated cases can have serious outcomes.
Helvaci,M.R et al; tried to understand whether or not there are some significant relationships between irritable bowel syndrome (IBS) and parameters of the metabolic syndrome. The study included 331 patients with the IBS and 334 control cases. The mean age of the IBS patients was 41.8 years. Interestingly, 65.2% of the IBS patients were female. Prevalence of smoking was significantly higher in patients with the IBS (37.7% versus 20.6%, p<0.001). Mean values of body mass index were similar in both groups (27.6 versus 27.7 kg/m2, p>0.05). As an important component of the metabolic syndrome, prevalence of white coat hypertension was significantly lower among the IBS patients (26.5% versus 31.7%, p<0.05). The authors concluded that IBS may be a low-grade inflammatory process being initiated with infections, inflammations, psychological disturbances-like stresses, and eventually terminated with dysfunctions of the gastrointestinal and genitourinary tracts, and many other systems of the body. Although there may be a direct relationship between IBS and smoking, there may be some inverse relationships between IBS and parameters of the metabolic syndrome with some unknown mechanisms yet.

Erskine W., looked at caring for those who care for others concentrating on Arabic culture who care for demented patients. She discussed the predicted estimates for dementia prevalence with population trends for ageing across the Arab states. As some states show rapid population ageing, the priority is to embrace research methods and the practical application of care implementation for people. This should be approached through communities and national strategies in ways that only Arab tradition finds suitable. To this end those influencing health and social policy must plan resources and training to offer the maximum support. This will require education to be responsive and sensitive in the training of professionals as well as across primary, secondary and tertiary levels of health services. It is essential that these training initiatives include a focus upon the creation of multidisciplinary teams both in appropriate settings with home-based services at the centre. Such needs and developments represent huge challenges to national and community-based health services across Arab states. Whilst many Middle Eastern countries have incorporated international influences and agencies to coordinate care, it should not be assumed that future care needs will be implanted with external or international ambitions for health and social care provision. The response should utilise only, where appropriate, international input where it benefits the region and as an overarching priority structure its own culturally embedded community dementia care and family carer support.

Dr Abulrazak Abyad
Chief Editor
Email: aabyad@cyberia.net.lb

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