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THE
ARAB JOURNAL OF PSYCHIATRY
Vol. 12,
No. 2, November (2001) E.mail: takriti@nol.com.jo |
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q
CONTENTS / SOMMAIRE /
فهرس
الموضوعات |
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q
Editorial q
Review Article
§
Diagnosis and management of Vitamin B12
deficiency among elderly patients / Abdulrazak Abyad q
Papers
§
Letter to the Editor : The
second Intifida : A Psychological Profile (Full Text) §
Psychiatric clues with historical routes in Iraq /
Maha S. Yonnis §
Stigma and mental disorders / Abd-Ul-Amir K.
Al-Ganimee |
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q
SUMMARY / RESUMES /
ملخصات |
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q
Editorial §
Bridging theory and practice: The use of critical incidents in addiction
education for drug and alcohol specialists / G. Hussein Rassool
ABSTRACT : The problems that
practitioners face in working with drug and alcohol misusers are rarely
straightforward and clear. Dealing with ambiguity and uncertainty are part of
the practitioner's role in working with substance misusers. The traditional
method of teaching and learning, to overcome the dichotomy between theory and
practice, is somewhat limited. There is a need to look beyond the traditional
approaches of teaching and learning activities. This paper describes an
attempt to provide a kind of learning strategy, using the critical incident
technique, to make meaningful links between theory and work practice in the
addiction field. q
Review
Article
§
Diagnosis and management of Vitamin B12 deficiency among elderly
patients / Abdulrazak Abyad
ABSTRACT: Vitamin B 12 deficiency is a multifaceted, multisystem
disorder that became more common with advancing age. insufficient absorption
seems to be the pathology mechanism underlying most cases of B12 deficiency
in the elderly. It is associated with an increased morbidity if it goes
undetected as often happens. Its diagnosis can be enhanced if the clinician
recognizes the nonspecific symptoms, glossitis, dermatological and
neuropsychiatry abnormalities. It is highly important to realize the nature
of Vit BI 2 deficiency in the elderly. It is a continuum from negative BI2
balance to frank deficiency, which can be detected by low serum B 12 levels
long before changes occur in hemoglobin levels. Since, signs and symptoms of
this complaint can be ill defined, the clinician should be concerned about
occult B12 deficiency in older subjects with baffling weakness, fatigue,
unusual neurology findings or cognitive dysfunction. A greatly discussed
issue is the relationship between B 12 deficiency and dementia. Many
investigators think that is has not been established as a cause of reversible
dementia current findings in the literature propose that treatment may
prevent significant neurologic and/or hematologic disease.
q
Papers
§
Deliberate self-harm in a Saudi University
Hospital: A Case Series Over Six Years (1994-2000) / Mahdi S. AbuMadini,
Sheikli I. Abdel Rahim
ABSTRACT:
Background:
A considerable number of predominantly young people are received at our
Accident and Emergency (A&E) department following episodes of deliberate
self-harm (DSH). Objective: To study the sociodemographic, clinical and behavioural characteristics of these subjects, and to discuss these features in a trans-cultural perspective.
Method:
Data were prospectively collected from consecutive DSH cases attending
A&E at King Fahed Hospital of the University (KFHU) over a period of six
years (1994-2000), using detailed structured questionnaires and add-on
information on subsequent encounters.
Results:
DSH constituted 10.2 percent of A&E referrals to psychiatrists. A total
of 362 subjects were studied. The male:femaleratio was l:I.8. The mean age
was 26 years, median - 24 and mode 21 years; 74.3 % of all subjects were
below 30 years. Nearly two thirds of the subjects received a diagnosis of
either personality or adjustment disorder. The most frequent method was drug
overdose (71.5 %) followed by self-cutting in 16.3%. Paracetamol was the most
frequently ingested substance. Only 12.7% genuinely wished to die; the bulk
were resorting to the act for other personal or interpersonal ends.
Conclusion: DSH is fairly frequent in this culture. Like elsewhere,
it seems, in most cases, to be a form of non-verbal communication of anger,
discontent or agony in maladaptive personalities characterized by poor affect
regulation, inadequate problem-solving skills and unhealthy background
socio-environmental interactions. Controlled studies are needed to support
these findings. §
Psychological sequelae of emotional abuse in
institutionalized children / Tayseer F.E. Ahmad, Nasser Shuriquie
ABSTRACT: Objectives: The purpose of this study is to
investigate the psychological consequences of emotional abuse in a group of
children. Those abused, were compared with a group of non-abused children. Methodology: Fifty institutionalized children suffering from emotional abuse were compared with a similar number of non-abused non-institutionalized children. Their age range was from 9.6 to 15.6 years old.
All children were interviewed
and assessed using three scales. These scales were the Arabic versions of the
depression scale, the anxiety scale for children and the self-concept scale.
The self-concept scale assesses eight dimensions which are social values,
self-confidence, sociability, intelligence, physical wellbeing, emotional
stability, vigor and aggression.
Results:
A comparison of the two groups using t-test showed that the abused
children scored significantly lower (p<0.001) in the social values,
self-confidence, sociability, intelligence, and emotional stability
dimensions on the self-concept scale. They scored significantly higher on the
anxiety and depression scales for children.
Conclusion: The results of this study confirm the hypothesis that
abused institutionalized children suffer more from psychological disorders
compared to non-abused non- institutionalized children, therefore they are at
greater need for psychological care and support. §
Psychological,
social and cultural aspects of unconsummated marriage /
Rafat S.Bayer, Walid M. Shunaigat
ABSTRACT: Objective: To clarify the psychological, social
and cultural factors associated with unconsummated marriages in Jordan. Patients and method: The study was conducted at the Prince Rashid Ben AI-Hassan Hospital between January 1999 and December 2000, which included all the patients presented to the psychiatry out-patient clinic with the chief complaint being unconsummated marriage, and in whom organic causes had been ruled out. One hundred and sixteen couples were studied and compared with a control group of normal couples. Results: The commonest age group affected were between 20-29 years (78%) with a mean age of 25.42 years, SD=4.48 (males) and 23.13 years, SD=4.38(females), most of whom were educated below secondary school education. The delay in presentation was between 3-12 months in about 60% of cases and the majority had misconceptions about the cause of their problems; 63.7% of patients attributing their problem to magic and 17.24% to Jinn possession.
The primary diagnosis of sexual
dysfunction in men, were premature ejaculation (25.86%) and erectile
dysfunction (22.41%), while in women was vaginismus (65.51%) and in about
(13.8%) of cases both partners were affected. The commonest fear among men
was fear of failure (66%), and in women fear of pain (47%) and fear of
bleeding (34%). Most marriages were traditionally arranged
(63.8%) (51.7% control group), and
most couples had little contact during engagement (58%)149% control
group),both of which did not reach a statistical significance. The majority
(76.7%) 162.9% control group, P=.022) of patients had spent their wedding
night at their primary family home, (27.6%) {37.1% control, P= 1231 of
patients had experience of foreplay before sexual intercourse, (56.9%) of
'the brides had to move to a different town which was higher than in the
control group (47.4%)but did not reach a statistical significance (P=. 148).
In about (28.4%) (17.2% control group, P=.0421of patients an immediate
confirmation of consummation was required by the family. Only (10.34%) of
patients revealed history of past sexual experience(all were males),which was
slightly lower than among the control group. (12.9%)(all were males) and
about(38.8%)of patients previous history of medical treatment for their
problem; in contrast (83.6%) previous history of contact with healers.
Conclusions: unconsummated marriage is a serious problem, which has
adverse marital and social consequences, the causes of which include
interaction of multiple factors, mainly psychological, social and cultural, which
emphasizes the need for better education and awareness concerning this issue
at both family and social levels.
§
An analysis of
psychiatric referrais, Saudi Arabia. / Naseem A.
Qureshi, Tariq A. AI-Habeeb, Yasser S. AI-Ghamdy, Dr.Mohi El-din M.
AI-Magzoub, Dr.Henk G. Schmidt, Dr.Henk van der Molen, Mohamed K.
Mohamed
ABSTRACT: Objective: The implementation of referral system
in Saudi Arabia has resulted both in streamlining of and substantial
improvement in the delivery of health services at all levels. This research
seeks to study the adequacy of information in the psychiatric referral
letters that were originated from primary health care centers [PHCCs] and
general hospitals [GHs) to a regional mental health hospital facility. Settings: Buraidah Mental Health Hospital, AI-Qassim health province. Method: The sample is comprised of randomly selected 540 photocopied psychiatric referrals [PHCCs=402, GHs=138] of patients who were referred for psychiatric consultation. Results: The analysis of data showed that the noted age and gender of referred patients were not significantly associated with two main sources of referral. Although PHCCs letters were quantitatively deficient in clinical information, the completeness of letters between the two referral sources did not differ significantly. GH referrals as compared to primary care referrals revealed statistically significant clinical findings and physical comorbid conditions. A proportion of diagnoses noted in overall GH referrals as compared to PHCC referrals was significantly matching with final diagnoses made by referred psychiatrists. Conclusion: Overall, psychiatric referrals both from PHCCs and GHs need further improvements in quantity and quality of data notation in referral letters. Moreover, general practitioners [GPs] including GH physicians need a condensed course on clinical psychiatry in general but psychiatric referral system in particular.
Keywords:
Psychiatric referral letters, primary health care centers, general hospitals,
clinical psychiatry, training, psychiatry referral system. Letter to the Editor / The second Intifida : A Psychological Profile
Walid Sarhan,M.D.& Jamal Al-Khatib,M.D. / e-mail:
sarhan @ joinnet.com.jo
Intifada is a term used to describe
the Palestinian uprising against the Israeli occupation, was first used in
1987 when children threw stones on the Israeli soldiers, who fired back and
bombed the civilians.
The first Intifada was stopped by
the Oslo peace agreement, that the Palestinians accepted, but the Israelis
never withdrew as agreed.
Last September, after several years
of negotiations, Mr. Sharon the opposition Leukud leader walked into Al-Aqssa
mosque, guarded by the army and police, in a test of the reaction of the
Palestinian people, after the failure of Camp David talks. As a popular
reaction of the people of Palestine after long winded peace talk efforts and
feeling of despair, and the Israelis have proved they are against any
peaceful settlement and indications that the Palestinians will not get back
any rights, as previously promised by the international community over the
years.
The second Palestinian Intifada
(September 2001) is different from the first one (1987-1993) in many aspects.
But two very important aspects are 1- the extensive satellite coverage of
Intifada and 2- the presence of the leadership in the ground of Israeli
aggressive missions (battlefield). The medias' instant broadcast has exerted
great influence on public opinion everywhere. The scene of the cold blooded
murder of child Mohamad Al-Durrah by an Israeli soldier who is still on the
loose, and despite trial of
wrapping up the event by some TV channels, poses one example of this
effect.
The scenario of 'security', which
the Israeli election campaigns had repeatedly emphasized, had recently
culminated in the election of a war criminal to lead the political
establishment in this military oriented state. Psychologically speaking,
security is
the
main worry of inflowing immigrants during the past 50 years, whereby many
previous pacts have not ensured secure borders for those who habituated the
land of Palestine.
In the current Intifada, the
Israelis imagine that every Palestinian Arab is a potential bomb, through
their own military mindedness perpetrated by continued drilling and training
of young and middle aged men and women in Israeli military camps, as a result
of which they harvest in their souls severe anxiety and fear through day and
night. Accordingly, a very high percentage of the Israeli population is on
Anxiolytics, not as treatment of anxiety disorders only, but also for the
treatment of ideological, existential and situational disturbances.
Martyristic or suicidal operations
against Israeli targets has broken all security barriers and challenged all
bombings, armed insurgents from fortified Jewish settlements and tank sweeps
overrunning Palestinian lives, possessions, olive trees and buildings. The
dilemma that is facing the Israeli mentality revolves around the question:
"How could one face an 'enemy' who does not care about death?". The
question becomes burdensome when the Israeli hear about young men rushing to
enlist for such operations. All this continues despite an existent great
disparity between a high-tech Israeli armament and a relatively armless
Palestinian people.
With regard to current world
affairs, as portrayed by communication media at large, we find that people in
general believe in the way they perceive facts rather than in the facts
themselves, spiting the truth if it ever appears later. This phenomenon is
highlighted by events in the current Intifada by the Palestinians.
We observe how certain publicity
media manipulate events, censor words and montage scenarios with creation of
perverted accounts of what had happened in reality. Falsification of events
also involves an industry of packaging and marketing manipulated news and
views, for instance, turning and Israeli army with a highly sophisticated
weaponry, which maintains and unprecedented siege of a whole population in
their own cities, towns and villages for many months, into a picture of a
defense organ which is attempting to maintain security against the
'aggressor' Palestinians, who in turn do not even possess the equivalent or
even simple defensive tools. Moreover, while fully trained Jewish settlers
rave through towns and villages of Palestinians, haphazardly shooting,
killing and wrecking Palestinian property, those very people appear on some
information media as crying women and children at a set-back after any
retaliation event by the Palestinians. All the aforesaid efforts, toward
manipulation of facts, comes in the direction of the masses, and falls under
the blanket of what has been called psychological warfare. The latter is a
weapon which has been strongly used by the Israeli authorities ever since
this second Intifada began, albeit all times prior to that. Psychological
warfare aims at invading and affecting the mind rather anything else, under
the pretext that eventually, winning or losing is a mental state. This weapon
has been used in wars to convince the 'enemy' that whatever they will do
cannot work, with
the
hope of implanting fear in both fighters in the battlefield and workers in
diplomatic corps as much as in the targeted population, the ultimate aim of
which is surrender. The common method used in psychological warfare is a direct
attack on the mind with manipulation of input in order to deceive senses and
perception, thereby recruiting illusive concepts and attitudes. For example,
the term ' occupied territories' (to say the least) is expressed by warring
psychologists as 'disputed territories' , or even just 'the territories'.
This very example highlight the allusiveness and creation of vagueness about
fairness and justice. On the one hand, when a Palestinian infant like
"Aya Hijjo" is murdered in her own cot by Israeli rockets fired at
civilian quarters, this is portrayed as accidental. On the other hand, when a
42-year-old Israeli Moshe is killed, he is portrayed as a farmer and a father
of two children. But the killed Palestinian, whoever is, remains a number. In
a different tune, statement are made
such as: "The Palestinians launch a terrorist
attack and the Israelis retaliate or fire back". So, who started it all?
How all this started becomes a matter of public rhetoric rather than a matter
of humanity, discrimination and occupation.
What is more illusive or even
delusional comes into light when the Israelis justify many months of a tight
siege with impoverishment of hundreds of thousands of people, including
children, adult and elderly, justify all this as an act of self defense. The
most important psychological mission of the Israelis and their allies and
corresponding media appears to concentrate on how to embrace facts,
manipulate and pack them, then insert them into the minds of many good people
with creation of delusional ideas about mutual violence and terrorism rather
than admit the Palestinian plight in their current Intifada as an attempt for
liberation against foreign occupation and colonialism in the form of Zionism. Psychiatric clues with
historical routes in Iraq / Maha S. Yonnis
ABSTRACT: Iraq had witnessed many early civilizations, and the
first farming village, a lot has been discovered in the last 3 centuries. The
treatment of psychiatric problems was mainly done by the priest. The cause
was thought to be the evil spirits mainly and for many problems treatment
used like opium, olive oil, juice of dates, hot and cold baths, Enema was one
of the tools, that time carried an ethical code with punishment for
physicians when they fail to do their job. A call for more research in the
heritage is in place. §
Stigma and mental disorders / Abd-Ul-Amir K.
Al-Ganimee
ABSTRACT: The word stigma recognized from Greek, who marked abnormal people to be organized by others. Kuffman introduced this word to sociology with 3 aspects and he graded it in severity, explanation of the stigma in mental illness was discussed thoroughly, as well as improving pubic awareness for to reduce the stigma. |
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