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THE ARAB JOURNAL OF PSYCHIATRY

Vol. 6, N° 2, November (1995)

 E.mail: takriti@nol.com.jo

 

 

q        CONTENTS / SOMMAIRE /  فهرس الموضوعات

 

q       Research Papers      

§          Group Psychotherapy With Arab Patients  / H. AI-Mutlaq    K. AI-Chaleby

§          Community Care  ... Examining The Trend / M. Nasser

§          The Pros and Cons of Community Psychiatric Care: Review from the British Experience / Walid Abdulhamid

§          Psychiatry in Jordan; Past, Present and Future / M. Kamai

§          Hidden and Conspicuous Psychiatric Morbidity in   Saudi Primary Health Care (A Pïlot Study) / E.Al-Fares, A. AI-Hamad & S. AI-Shammari

§          Psychological Aspect of Primary Fibromyalgia Syndrome  / A. Doughan, M.Bino, J. Kawar & T. Ahmed

§          Psycho-Social Adaptation of Saudi Students and  Spouses in Canada / A. AI-Sabiae, V. F DiNicola

§          A Study on Psychiatric Aspects of Migraine / M. El-Senosy & A. Mobarak        

§          Detection of Nicotine Dependence and  Smoking Profiles in Smokers in Kuwait  / A. Lotfy, H. Jazzaf & K. AI-Saieh

§          Benzodiazepines in Developing Countries: Not for  Domination Yet / A. Osman & S. Ibrahim

 

q       SUMMARY / RESUMES / ملخصات 

 

q       Research Papers      

§         Group Psychotherapy With Arab Patients  / H. AI-Mutlaq    K. AI-Chaleby

ABSTRACT : Group  psychotherapy is a modality of treatment in which some patients who are especially selected are placed into a group guided by a trained therapist, in order to help affect behavioral change and personality modification. This is achieved by using a variety of technical maneuvers and theoretical frameworks. The leader of the group, uses group member's interactions in order to produce the desired change of goal. The early experiences of Arab participation within a group has received many disappointments and has therefore resulted in some therapists discontinuing the practice of this form of psychotherapy, and relying mainly on individual approaches, instead. Using the non-directive approach and the permissive attitude of having emotions expressed freely in the group led to cpnflicts within the patient and between patients in the group. These were difficult to resolve and ended many times in an angry withdrawal of some patients and a few divorces within the patient groups. It is important to identify those aspects that might have a detrimental effect on the interaction, and thus have a negative effect on group therapy. Techniques need to be modified in the light of the culture in order to get an optimum outcome of therapy. The purpose of this presentation is to identify those characteristics and to delineate the favourable ones and utilize them in order to achieve the best results possible.

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§         Community Care  ... Examining The Trend / M. Nasser

ABSTRACT :  The concept of community psychiatric care emerged in recent years as a revolutionary idea aiming at the closure of the large isolated mental institutions and the transfer of care to a locally based accessible and humane environment. The paper reviews the ideological background to this concept with particular reference to the impact of the antipsychiatric movement on modern psychiatric practice and the role of economical and political factors in determining the style of delivery of psychiatric care. The author describes and attempts to critically evaluate some of the community programs in this respect drawing on the Italian, American and British experiences. 

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§         The Pros and Cons of Community Psychiatric Care: Review from the British Experience / Walid Abdulhamid

ABSTRACT : Since the 1950s, community care has been a Government health policy in Britain. The overall aim of this policy was to enable the mentally ill to be treated in the community near where they live. This aims to preserve  their social and occupational skills and keep them in touch with their social network of friends and relatives. In spite of these humanitarian aims, community care is facing more and more criticism from psychiatrists and researchers in the field. This paper aims to introduce a balanced argument about the research evidence for and against the wider implementation of community care policies. This is written with the implications for the mental health services in the Arab World in mind.    

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§         Psychiatry in Jordan; Past, Present and Future / M. Kamai

  

§         Hidden and Conspicuous Psychiatric Morbidity in   Saudi Primary Health Care (A Pïlot Study) / E.Al-Fares, A. AI-Hamad & S. AI-Shammari

ABSTRACT : OBJECTIVE : To estimate the rate of hidden psychiatric morbidity (HPM) among the study population and to compare the assessment of the primary health care (PHC) physician with that of the psychiatrist.

     DESIGN:  All patients seen on two weekly sessions were rated by a PHC physician according to a pre-designed 5-point severity rating scale and diagnostic classification. One third of them, selected on the basis of systematic random sampling, were interviewed by a psychiatrist using the clinical interview schedule (CIS). The same diagnostic and severity rating scales were filled by the psychiatrist.

     SETTING: A primary care center in Riyadh, the capital of Saudi Arabia. Participants-114 patients seen by the PHC physician and 38 of them interviewed by the psychiatrist.

 RESULTS : The hidden psychiatric morbidity (HPM) is high (31%), representing 67% of the total psychiatric morbidity (46%). This is due to the low identification index of the physician (33%). The higher the severity of the illness as rated by the PHC physician, the more likely to be a clinically significant psychiatric case. On the other hand, the specificity (95%) and predictive value (86%) are high, i.e. he is likely to be correct when he makes a positive diagnosis.

     There is a significant difference in the ratings of the psychiatrist and the physician, (McNamar’s test, P< 0,01 ) and the agreement is low, (Cohen’s Kappa = 0,26).

      Psychiatric illness with somatic symptoms constituted the largest proportion of diagnostic categories as judged by the psychiatrist (31%. 6%). Patients labeled by the PC physician to have physical illness in a neurotic personality were usually missed psychiatric cases.

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§         Psychological Aspect of Primary Fibromyalgia Syndrome  / A. Doughan, M.Bino, J. Kawar & T. Ahmed

ABSTRACT : This study was designed to identify the presence of psychological disturbances in fibromyalgia patients and to explore the relationship between stress and other psychological disorders in fibromyalgia patients. Thirty female patients with Primary Fibromyalgia Syndrome (PFS) and thirty matched normal female controls (NC), were assessed by using four psychological questionnaires, using the Arabic Versions of Beck Depression Inventory (BDI), the Spielberger State-Trait Anxiety Inventory (STAT), the Stress Scale and the Whitly Index (WI) Hypochondriasis Scale. Results showed that patients with fibromyalgia were significantly higher in their psychological profiles. This indicates that those patients  were psychologically more disturbed than the normal controls and they suffer from neurotic traits such as: anxiety, depression and hypochondriasis symptoms. Results also revealed a significant relationship between stress and depression and between stress , and anxiety symptoms among fibromyalgia patients.

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§         Psycho-Social Adaptation of Saudi Students and  Spouses in Canada / A. AI-Sabiae, V. F DiNicola

ABSTRACT :  Cultural change is a stressful process that is associated with higher risk of both mental and physical illnesses. These associations vary among people where refugees have a higher risk than immigrants who in turn have a higher risk than sojourners. In this study we investigated the psychosocial adaptation of Saudi students and their spouses in Canada. There were (368) potential subjects who received a mailed out questionnaire that includes questions on demographic data and mode of adaptation and the (SCL-90-R) to measure psychological disturbances. Response rate was 55,7%. More male subjects  were involved in formal training and were able to the speak English language compared to female subjects. About third of the subjects had some relationship to Canadians while almost all had maintained close contact with other Saudis. There was reduction in religious observance but not personal habits and behaviors. Again one third fulfilled the criteria for caseness on the (SCL-90-R). Differences between males and females were discussed along with other findings in cultural context. 

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§         A Study on Psychiatric Aspects of Migraine / M. El-Senosy & A. Mobarak        

ABSTRACT : This study was conducted on 40 migraine patients and a 40 healthy control group : aiming to study the psychiatric aspects of migraine. Both groups were subjected to :

  A/ Clinical neuropsychiatric examination ;

  B/ Psychometric testing using Bender Gestalt (BG) ; Trail Making  ™ and Eysenck Personality Questionnaire (EPQ) tests.

 RESULTS :

(A) The Clinical evaluation showed that :

1. Emotional stress, menses, exhaustion and hunger were the commonest precipitating factors for migraine attacks.

2. The obsessive, independent and alert were the commonest personality traits of patients.

3. The commonest psychiatric symptoms were depression, irritability, retarded thinking and anxiety.

4. Significant relationship was found between severity of migraine and depression and irritability ; depression being more significant in migraine, with typical aura familial hemiplegic migraine.

(B) Psychometric studies showed :

1. The score of patients were significantly lower in patients than the control group with regard to BG and TM.

2. Patients showed higher neuroticism and lower extroversism than the control group on EPQ.

    From this study we can confirm the importance of psychiatric examination  for migraine patients. Also, the result of this study showed that stresses are the main cause for precipitation of an attack. So future studies on the biochemical relation between migraine and stress will help in more understanding of the mechanism of this disorder.

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§         Detection of Nicotine Dependence and  Smoking Profiles in Smokers in Kuwait  / A. Lotfy, H. Jazzaf & K. AI-Saieh

ABSTRACT : A sample of 100  smokers in Kuwait was studied for smoking profiles and nicotine dependence. A 15-item American questionnaire was applied to the sample cases for detection of smoking cessation. A score   indicative  of nicotine dependence has been recorded by the great majority of smokers. Almost all the sample members expressed their wish to quit smoking and admitted that they stopped smoking or tried to do so in the past. The smokers concerns about quitting and the methods they thought of to help them quit were assessed. Responses of smokers could serve in predicting physiological discomfort which might accompany quitting. Moreover, their responses could serve as a cue for discussing with them how to quit smoking, and at the same time be a predictor as to their ability to success in quitting. The need to take this information into consideration while planning for smoking control strategies was then emphasized.

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§         Benzodiazepines in Developing Countries: Not for  Domination Yet / A. Osman & S. Ibrahim

ABSTRACT : Since their introduction in the 1960s, benzodiazepines (BZDs), have readily gained a wide popularity and become one of the most widely prescribed psychiatric drugs. However, they have recently come under a critical reappraisal, on account of their potential harm if abused, or dependence with long term use. Consequently, many psychiatrists have become over reluctant to prescribe these drugs, to the extent that many patients, even those severely anxious, who will never live normally without BZDs, or a similar substitute have been refused them. We studied 400 case notes of patients diagnosed as suffering from anxiety or a related disorder in two different hospitals  to find out the pattern of BZD prescriptions in Saudi Arabia. We found that the pattern is inconsistent and varies significantly between the two hospitals and not necessarily for medical reasons. We highlight the danger of such attitudes , and the place of BZDs in developing countries.

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