Suaad Moussa

The history of group psychotherapy in Egypt dates back to the late 1960s. Group psychotherapy in Egypt has witnessed the application of different therapeutic approaches that were subject to cultural, individual and group transformations and evolutions. Despite these long years of practice, the current situation of this field is not well recognized by a great number of Egyptian mental health professionals. This work will draw attention to the present status of group psychotherapy in Egypt in light of the foundation of the Egyptian Association of Group Therapies (EAGT).

One of EAGT priorities was to gather the information pertaining to the history of group psychotherapy practices in Egypt. This was achieved through interviewing the pioneer Egyptian figures in this field including the two main founders and their followers. Selected verbal quotations revealing interviewees’ personal experiences, challenges or transformations will be presented. Future expectations and provisional plans for group psychotherapy in Egypt will finally be discussed with regards to EAGT effort in this field.
Conclusion:
Group psychotherapy in Egypt has passed through several stages. The current emphasis is towards paving the role for a more structured approach while preserving our genuinity, one of the main targets of EAGT.

Background
Depression in relation to child conception and birth is not limited to mothers. Recently,
there has been a growing interest in the study of depression in expectant fathers and in
fathers after birth of their children, its correlates and consequences. These studies are
relatively rare, especially in our culture.
Objectives
The aim of this study was to screen for depressive symptoms in expectant fathers and
to study their sociodemographic, pregnancy and marital correlates.
Methods
Eighty-five Egyptian expectant fathers, husbands of Egyptian wives attending private
Gynaecology and Obstetrics clinics for regular follow up of an unthreatened
pregnancy, were asked to fill the Edinburgh Postnatal Depression Scale and the
Intimate Bond Measure (I BM).
Results
A total of 31.8% (n = 27) of the expectant fathers scored at least 10 on the
Edinburgh Postnatal Depression Scale, indicating possible depression. High
percentages of anxiety were found in both depressed and nondepressed participants.
Depression did not correlate with sociodemographic variables. A significantly higher
percentage of depressed participants desired a boy (48.1 vs. 24.1%) and were
expecting a boy (40.1 vs. 24.1%). Other pregnancy variables were not associated
with depression. A significantly higher percentage of depressed participants
(35 vs.19.5%) perceived their marital relation as lacking intimacy, with only 5% rating
their relation as having optimum intimacy on the I BM. Depression correlated negatively
(r = – 0.269, P = 0.036) with the care subscale but not with the control subscale of
the I BM.
Conclusion
Fathers are probably at an increased risk of depression in the antenatal period, which
is related to their perception of marital intimacy. Delineation of specific cultural and
personal contributors needs further research.
Keywords:
antenatal depression, Edinburgh Postnatal Depression Scale, father, intimacy, paternal

BACKGROUND Adherence to treatment is a complex and poorly understood phenomenon. This study investigates the relationship between older depressed patients' adherence to antidepressants and their beliefs about and knowledge of the medication. METHODS Assessment was undertaken of 108 outpatients over the age of 55 years diagnosed with depressive disorder and treated for at least four weeks with antidepressants. Adherence was assessed using two self-report measures: the Medication Adherence Rating Scale (MARS) and a Global Adherence Measure (GAM). Potential predictors of adherence investigated included sociodemographic, medication and illness variables. In addition, 33 carers were interviewed regarding general medication beliefs. RESULTS 56% of patients reported 80% or higher adherence on the GAM. Sociodemographic variables were not associated with adherence on the MARS. Specific beliefs about medicines, such as "my health depends on antidepressants"(necessity) and being less worried about becoming dependant on antidepressants (concern) were highly correlated with adherence. General beliefs about medicines causing harm or being overprescribed, experiencing medication side-effects and severity of depression also correlated with poor adherence. Linear regression with the MARS as the dependent variable explained 44.3% of the variance and showed adherence to be higher in subjects with healthy specific beliefs who received more information about antidepressants and worse with depression severity and autonomic side-effects. CONCLUSIONS Our findings strongly support a role for specific beliefs about medicines in adherence. Challenging patients' beliefs, providing information about treatment and discussing side-effects could improve adherence. Poor response to treatment and medication side-effects can indicate poor adherence and should be considered before switching medications.
Key words: compliance, depression, elderly, side-effects, carers, education, cognition, concordance

Background: The relationship between mother and child develops and progresses throughout the pregnancy period. Recently there has been an increasing interest in the antenatal maternal-fetal bonding and its relation to different variables, as well as the impact of this bonding on the child's mental health.
Objectives: to investigate the pattern of maternal-fetal relationship during pregnancy, and its relation to maternal depression as well as to different sociodemographic and pregnancy-related factors, and perception of intimate relation with spouse. Methods: 100 Egyptian expecting mothers attending the Obstetric outpatient clinics for regular follow up of their pregnancy were recruited in the study. They were asked to fill the Maternal-Fetal Attachment Scale (MFAS), the Intimate Bond Measure (IBM) and the Edinburgh Postnatal Depression Scale (EPDS).
Results: Maternal antenatal bonding was significantly higher on the MFAS in expecting mothers with longer gestational age. Women with assisted pregnancy had significantly higher scores on MFAS total score and Role Taking and Attribution subscales. However, if the cause of infertility was unexplained or related to female factors, the aforementioned MFAS scores tend to be significantly lower than those with infertility related to male or both factors. Primiparous had significantly higher scores on the MFAS total score and Role Taking and Differentiation subscales than multiparous. Women who perceived themselves as being healthy were having significant higher score on the Interaction subscale of MFAS. In this study the intimate relation with the spouse, and not the marriage duration, was showing significant differences regarding maternal bonding. Expectant mothers that reported positive attitude toward their marital relation (Optimal Intimacy and Affectionate Constraint) had significant higher means on the total score of the MFAS as well as the Interaction, Giving of self and Role Taking subscales. The study showed that expectant women with previous loss of fetus and those with no depressive symptoms had better bonding despite the lack of significance.
Conclusions: Maternal antenatal bonding is associated with multiple factors including; longer gestational age, parity, previous loss of fetus, assisted pregnancy, perceived good maternal health, and intimacy with partner.

Abstract
Background: Recent literature has pointed out the importance of assessing the impact of child’s mental illness on both child and parent. The term ‘impairment’ refers to consequences of present psychiatric symptomatology for the children regarding their distress or functioning. In contrast, ‘burden’ reflects the problems for significant others, i.e. the parents and other family members. Objective: The objective of this study is to investigate the impact of the psychiatric illness on children and the caregivers along with factors contributing to it. Subjects &Methods: 350Children aged 4 to 16 attending Child & Adolescent outpatient clinics for the first time with presenting complaint. Children were diagnosed according to DSM-IV and parents were required to fill the Strengths & Difficulties Questionnaire (SDQ). Results: According to SDQ, 50.9% of the cases were in the abnormal range on Total Difficulties score, while 77.8% were in the abnormal range on the Impact score. 58.7% of parents perceived their children as having definite/severe difficulties, 83% reported difficulties for duration more than 12 months. Classroom impairment was the most frequently reported, 80% of caregivers were significantly burdened by their children’s difficulties but only 46.4% perceived these difficulties as distressing to the child. Factors that predicted significant difficulties were the extent of total psychopathology and its duration, and impairment. Scoring high on the prosocial scale negatively predicted the perceived difficulty. Moderate to severe burden was predicted by perceived difficulties and the impact of difficulties on the child’s life. Conclusion: Perceived burden was the main motive driving parents to seek help of psychiatric services. It is predicted by perceived difficulties and impairment of the child.
Key words: child, impact, impairment, burden, Strengths and Difficulties Questionnaire, SDQ

Epilepsy in childhood is a pervasive disorder that includes not only seizures but also significant effects on cognition, behavior and quality of life. Although behavior and emotional problems are common, the recognition of these problems is difficult. Method: This study assessed the psychiatric problems of epileptic children ,using the childhood behavioral checklist (CBCL) , covering the internalizing and externalizing behavior disturbances.100 epileptic children and 100 healthy children are included in two groups of age ranged from 6-13 years (mean age 8.69),60 boys ,and 40 girls ,in each group. Results: 70%of the epileptic group indicates severe affection of behavioral disturbance on the total CBCL results (within the clinical range of psychiatric disorders), compared to only 14%in the control group. Attention problem, anxiety/depression and social problems showed the highest significant difference, while withdrawal /depression, aggressive behavior, rule breaking behavior and somatic complaints showed lower significant difference. Behavioral disturbance is more significant in boys than girls, and more in younger children than elder. EEG changes that showed significant relation were the withdrawal /depression symptoms. Conclusion: Children with epilepsy showed more psychopathology than children from the general population .So medical care of epilepsy should go beyond seizure control; consultation liaison psychiatry has the characteristic body knowledge needed for an integrated "Biopsychosocial" approach.

This guidance details the needs of children, and the qualities of parenting that meet those needs. Parental mental disorders can damage the foetus during pregnancy through the action of drugs, prescribed or abused. Pregnancy and the puerperium can exacerbate or initiate mental illness in susceptible women. After their birth, the children may suffer from the social disadvantage associated with severe mental illness. The parents (depending on the disorder, its severity and its persistence) may have intermittent or prolonged difficulties with parenting, which may sometimes result in childhood psychological disturbance or child maltreatment. This guidance considers ways of preventing, minimizing and remedying these effects. Our recommendations include: education of psychiatrists and related professions about the effect of parental mental illness on children; revision of psychiatric training to increase awareness of patients as caregivers, and to incorporate relevant assessment and intervention into their treatment and rehabilitation; the optimum use of pharmacological treatment during pregnancy; pre-birth planning when women with severe mental illness become pregnant; development of specialist services for pregnant and puerperal women, with assessment of their efficacy; community support for parenting by mothers and fathers with severe mental disorders; standards
of good practice for the management of child maltreatment when parents suffer from mental illness; the importance of multi-disciplinary teamwork when helping these families, supporting their children and ensuring child protection; the development of child and adolescent mental health services worldwide.
Key words: Parenting, severe mental illness, mother-infant relationship, substance abuse, childhood mental disorders, child maltreatment, child and adolescent mental health services
(World Psychiatry 2011;10:93-102)
PMID: 21633678 [PubMed] Free PMC Article

There has been a decline in the mortality rate among infants and children under five years of age in the last decade in many developing countries. This has led to a shift in focus to look beyond survival to the prevention or reduction of impairment and promotion of children’s health. With the apparent rise in the prevalence of autism spectrum disorders (ASD) in the Arab countries the development of an Arabic tool for early diagnosis and intervention was sought as part of an effort to better understand the prevalence of this disorder. The Modified Checklist for Autism in Toddlers (M-CHAT) was chosen. The study was conducted in nine Arabic speaking countries. The final analysis included 228 children (122 screened positive for ASD). The sensitivity (0.86), the specificity (0.80) and positive predictive value (0.88) were very similar to Robins et al. study (2001). Maternal health problems during pregnancy and labour were found to be more significant for ASD mothers than their control. In addition, child health problems were more evident among ASD subjects as reported by their parents with significant differences from controls. The limitation of the study is that the sample size is not large enough to generalize the results to all countries of the region. The strength of the study is that it is the first known study where Arab countries undertook a collaborative mental health study using the same tool for screening for a specific disorder.
PMID: 18569180 [PubMed - indexed for MEDLINE]

Background. Current Psychiatric classification is guided by a specific methodological approach, the use of operationally defined diagnostic concepts to ensure adequate reliability, the latter being an initial step towards establishing valid diagnostic categories. This approach reflects a particular methodology and philosophy of science: logical empiricism. An alternative approach is the use of diagnostic concepts based on ideal types. Ideal types were originally introduced by Max Weber in the social sciences. Karl Jaspers acknowledged their potential clinical usefulness. More recently, ideal types were proposed as an alternative approach to classification in psychiatry.
This paper attempts to evaluate two different methodological approaches to classification: one that is empirically derived, based on operationally defined concepts, and another which is phenomenologically derived, based on ideal type concepts.
To achieve this purpose, the classification of subtypes of schizophrenia was compared, using the Diagnostic and Statistical Manual of Mental Disorders (third edition revised)(DSM-III-R) and a classification specifically designed to be based on ideal types.
To achieve this purpose, we investigated the reliability and validity of ideal types. Then we investigated the differences between the two approaches in other areas pertinent to classification such as coverage and patterns of discrimination between different subtypes within and across both classifications.
Method. The sample consisted of 94 male subjects from the services at the department of psychiatry, Cairo University. The subjects selected had an equivocal diagnosis of schizophrenia and represented as much as possible the different DSM- III-R subtypes of schizophrenia.
Tools. Each subject was rated by at least two raters. Each rater was provided with a manual describing the ideal types, which were designated types A, B and C, as well as guidelines for rating. The outcome measure for reliability was inter-rater reliability. Discriminant validity was used as an outcome measure of validity for both classifications.
Discriminant validity was assessed using components derived by factor analysis of scores on Positive and Negative Syndrome Scale. It was administered to each subject by an independent rater.
Statistical procedures included: kappa statistic for inter-rater reliability and
discriminant function analysis for discriminant validity. In addition, regression with a dummy dependent variable and analysis of variance were used to investigate further differences between the two classifications. Principle Component analysis was used to identify components and their variance order in the whole sample.
Results. Ideal types demonstrated adequate levels of reliability and validity.
Comparison between the two approaches showed differences in coverage and in the way in which corresponding types relate to the clinical profile of the whole sample.

Objectives: To assess coping strategies, strengths and difficulties of children with low vision enrolled in main stream education.
Methods: A cross sectional study of 26 children age 8 to 15 attending the outpatient clinic for low vision of the Memorial Institute for Ophthalmologic Research in Giza. A structured interview for psychiatric assessment in addition to Children Depression Scale (CDI), Coping Strategies Questionnaire and Strength & Difficulties Questionnaire (SDQ) were used. Results were analyzed using both the qualitative descriptive and quantitative approaches.
Results: The most frequent coping strategies used were spiritual & emotional expression. Academic, emotional (anxiety rather than depression) and peer problems were the most frequent. There was a very low agreement between parents and children's ratings regarding most domains.
Conclusion: Integration of low vision children in main steam education is recommended and few modifications would significantly improve their quality of life.

Thirty male patients suffering from poor scholastic performance were enrolled in this study. The study and matched control groups underwent full pediatric and psychiatric assessment as well as chromosomal analysis and cytogenetic fragile X site detection. They were all in schools and had an IQ above 75. Exclusion included major dysmorphic features, visual or hearing impairment, ADHD, pervasive developmental disorder, tic disorder, anxiety and mood disorders. In addition the control group had at least an average scholastic performance as reported by parents and school grades and no history of any psychiatric disorder.
Results: 43.33% (n=13) of the study group had reading disorder or reading disorder &/or disorder of written expression; 13.33% (n=4) had mathematics disorder another 13.33% (n=4) had difficulties with mathematics not amounting to disorder, and 30% (n=9) qualified for the DSM IV TM category of academic problem (V62.3) where they presented with failing grades and significant underachievement despite their relative adequate intellectual capacity and absence of learning disorder. Chromosomal analysis detected 11 cases (36.67%) with chromosomal variations. These were interstitial deletion in chromosome 2(p22-p24) in one case; paracentric inversion chromosome 6 (p23 – p24) in one patient; paracentric inversion chromosome 9 (p21 – p24) in two patients; interstitial deletion in chromosome 15 (q22 – q23) in one patient; Chromosome 15(p +) ( duplication of the short arm) in two patients; supernumerary small marker chromosome in one patient; deletion of the heterochromatine of Y chromosome Y (q12) in two patients and break at X(q27) in folate deficient media in two patients (one had an additional 15p+). None of the control group was found to have an abnormal cytogenetic study. Conclusion: Poor academic performance could be added to the various phenotypes predicting genetic (chromosomal) abnormality.