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شبكة العلوم النفسية العربية



Vol. 12, No. 2, November  (2001)



q        CONTENTS / SOMMAIRE /  فهرس الموضوعات

q       Editorial

§          Bridging theory and practice: The use of critical incidents in addiction education for drug and alcohol specialists / G. Hussein Rassool


q       Review Article

§          Diagnosis and management of Vitamin B12 deficiency among elderly patients / Abdulrazak Abyad  


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  

§          Psychological sequelae of emotional abuse in institutionalized children / Tayseer F.E. Ahmad, Nasser Shuriquie

§          Psychological, social and cultural aspects of unconsummated marriage / Rafat S.Bayer, Walid M. Shunaigat  

§          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   

§          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  


q       SUMMARY / RESUMES / ملخصات 

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.

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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.  

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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.

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§         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.

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§         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.

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§         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.

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Letter to the Editor / The second Intifida : A Psychological Profile

                                       Walid Sarhan,M.D.& Jamal Al-Khatib,M.D. / e-mail: sarhan @


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.

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 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.

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§         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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