Psychiatric Comorbidity in Patients with Psoriasis, Vitiligo, Acne, Eczema and Group of Patients with Miscellaneous Dermatological Diagnoses

Background: Dermatological conditions can be associated with high psychiatric comorbidity. Several studies reported high rates of depression and anxiety particularly for specific dermatological disorders such as psoriasis and acne. Aim: The aim of this study was to compare the rates of psychiatric symptoms in patients with psoriasis, acne, vitiligo, and eczema versus patients who had other dermatological conditions;and to compare each dermatological group versus healthy control subjects. Methods: This prospective cross-sectional study was conducted in dermatology outpatient clinics in Khartoum. Hospital Anxiety and Depression Scale (HADS) was used to assess symptoms of anxiety (HADS-A) and depression (HADS-D). ICD-10 criteria were used for clinical psychiatric diagnosis. Tabulated results were analyzed using Chi-square test. Significance was set at P < 0.05. Results: HADS-D scores above the cut off points were significantly higher in patients with psoriasis (P = 0.0062), vitiligo (P = 0.0054), acne (P = 0.0103) and eczema (P = 0.0359) compared with healthy subjects. Similarly, HADS-A scores above the cut off points were significantly higher in patients with psoriasis (P < 0. 0.0001), vitiligo (P = 0.0001), acne (P = 0.0143) and eczema (P = 0.0281) compared with healthy subjects. No significant difference between the control group and patients with other dermatologic conditions regarding both HADS-D and HADS-A scores. Using ICD-10 criteria for clinical psychiatric diagnoses indicated that 52.3% of dermatology patients had an associated ICD-10 diagnosis;most commonly anxiety disorders (28.6%), and depression (21.9%). ICD-10 diagnoses of anxiety disorders included: OCD (13.3%) generalized anxiety disorder (5.7%), panic disorder (4.8%), phobic anxiety disorder (3.8%) and post-traumatic stress disorder (0.95%). Conclusion: Dermatological conditions are associated with high rates of psychiatric comorbidity. Screening for anxiety and depressive symptoms may be helpful for early diagnosis and management of associated psychiatric symptoms.

Barriers and challenges affecting parents’use of adrenaline autoinjector in children with anaphylaxis

BACKGROUND Anaphylaxis is a life-threatening condition that develops as a reaction to exposure to an allergen which can be found in common foods such as cow's milk,egg,fish,and nuts in children.The use of an intramuscular adrenaline auto-injector(AAI)is considered the most essential treatment in these situations and parents and caregivers are always encouraged to carry this device for use in an emergency which commonly takes place in public places such as restaurants,schools,and parks,where medical staff are not guaranteed to be available.However,previous studies,in different settings,have reported underuse of the AAI by parents.AIM To explore the reasons for underutilisation of the AAI in our community.METHODS A cohort of parents attending the paediatric allergy clinic at Al Ain Hospital in the United Arab Emirates completed a questionnaire survey aimed at assessing their understanding and knowledge of their child's allergy management,including their aptitude with the use of the AAI,as well as their competence and comfort in providing this treatment in an emergency.RESULTS Of 47 parents participating in the study,39 were Emirati parents(83%and most parents who completed the survey were mothers(66%).As expected,food was the main cause of allergic reactions requiring prescription of the auto-injector device.Tree nuts and peanuts were noted to be the most common offending food in these children(62%and 38%,respectively).A doctor provided demonstrations and training on using the auto-injector device to 94%of the parents.More than two-thirds of the parents and caregivers(79%)were deemed knowledgeable on the indication for use of the device.Reluctance to administer the device was expressed by many of the parents,despite their satisfaction with the coaching they received on using the device in the study.CONCLUSION Ongoing coaching and teaching of parents on use of the AAI is paramount.However,this should be carried out together with psychological support to aid the parents to eliminate their hesitancy and acquire sufficient confidence in using the device when needed.Group teaching and sharing experiences is an excellent educational technique in a non-formal setting.Paediatric clinic play therapists can also have a role in needle phobia desensitisation for parents and children.More research is needed to explore the lack of empowerment and other reasons behind their fear and anxiety in using the device to plan effective interventions.

Improving Adherence to Prescribed Antidiabetics and Cardiovascular Medications in Primary Health Care Centers in Nyala City, South Darfur State-Sudan

Aims: Prospective pharmacist’s interventions aimed to improve patient’s knowledge and behaviors to adhere to medications in patients with type 2 diabetes with or without cardiovascular medical conditions in primary health care (PHCs) centers in Nyala city, South Darfur State, Sudan. Methodology and Materials: 300 patients were enrolled for assessing adherence with the Brief Medication Questionnaire (BMQ) in ten PHCs in Nyala city. We assessed patients’ responses to BMQ pre-and post-interventions plan by: complex interventions, humanitarianism and disease outcomes determined by health-related outcomes (SF-36), glycosylated hemoglobin (HbA1c) and blood pressure. Results: BMQ scores have improved significantly in four screens (pre-and post-interventions): regimen [4.6 ± 0.2 to 1.8 ± 0.1;P = 0.001], belief [1.6 ± 0.3 to 0.3 ± 0.3;P = 0.007], recall [1.7 ± 0.2 to 0.6 ± 0.2;P = 0.043] and access screens [1.8 ± 0.1 to 0.4 ± 0.1;P = 0.005];which have indicated an improved patients’ adherence to medications. Percentage of subjects reaching target of post prandial blood glucose (PPBG) have increased from 28.0% to 49.3%;[P = 0.02] post interventions. PPBG mean values have decreased significantly from [11.1 ± 0.6 mmol/L to 8.1 ± 0.8 mmol/L;<span

Epidemiology of isolated hand injuries in the United Arab Emirates

AIM To provide suggestions for hand injury prevention by study the demography and risk factors of casualties suffering from isolated hand injuries.METHODS All trauma patients with isolated hand injuries who were admitted to Al Ain Hospital for more than 24 h during a period of 3 years were studied. Patient demographics,location, mechanism/time of injury, and length of hospital stay were all analyzed.RESULTS Two hundred and ten patients were studied. Their mean age was 29.7 years. Males constituted 92%. Sixty-five point one percent of all cases were from the Indian subcontinent. The workplace was the most common location of injury(67.1%), followed by the home(17.1%)and road(6.2%). Machinery caused 36.2% of all injuries,followed by heavy object(20.5%) and fall(11%). Cases injured at home were young(P < 0.0001) with an associated higher incidence of females(P < 0.0001).CONCLUSION Male workers in Al Ain city are at greater risk of sustaining hand injuries, predominantly from machinery. Safety education, personal protection, and the enforcement of safety standards are essential to the prevention and avoidance of hand injury.

Psychiatric Complications of Obesity and Its Treatment: A Brief Review

Obesity—defined as a body mass index (BMI) of 30 kg/m2 or more—is associated with a wide range of medical and psychiatric complications. Physical co-morbidities include: insulin resistance, type 2 diabetes mellitus, dyslipidemia, asthma, hypertension, coronary heart disease, osteoarthritis of the knee and polycystic ovary syndrome. Mental health problems are particularly more common among individuals presenting for treatment of obesity than those in the community. They have higher rates of depression, anxiety, increased substance abuse and an increased prevalence in eating disorders. It has been estimated that up to 60% of extremely obese individuals have been suffering from an Axis I psychiatric disorder;most commonly mood and anxiety disorders. Obstructive sleep apnea (OSA) can occur with obesity and can also lead to sleep disorders and psychiatric complications. Up to 40% of patients with sleep apnea were found to have affective disorder or alcohol abuse. Weight loss medications and surgery may add to the problem of psychological complications of obesity. For example, in 2008, rimonabant development was discontinued by manufacturer as it has been associated with an increased risk of adverse psychiatric events including suicidal ideation and suicidal behavior. On the other hand, the prevalence of obesity is also high among patents with psychiatric illness, which can be caused by the effects of psychotropic medications which can lead to increased appetite, weight gain, sedation and psychomotor retardation. Obesity is reported in more than 60% of patients with schizophrenia and bipolar disorder. Food intake is regulated by several neurotransmitters, peptides and amino acids. Antipsychotics which block dopamine D2 receptors increase appetite and result in significant weight gain, while drugs that increase brain dopamine concentration are anorexigenic.

Psychiatric Aspects of Infectious Diseases

Psychiatric symptoms can be associated with several systemic and central nervous system infections and they can be the initial presenting symptoms, occurring in the absence of neurological symptoms in some disorders as in some cases of viral encephalitis. They could also be part of the clinical picture in other cases such as psychosis or mood symptoms secondary to brucellosis or toxoplasmosis. Late-onset neuropsychiatric complications may also occur several years following the infection such as in the case of subacute sclerosing panencephalitis due to measles. Some Infectious diseases may have possible etiological role for major psychiatric disorders, based on yet unconfirmed reports for viral infectious diseases (e.g. Influenza virus and HSV-1) which are thought to have risk for developing schizophrenia and psychosis. Neuropsychiatric adverse effects can occur due to drugs (e.g. mefloquine, interferon-alpha) that are used for treatment of infectious diseases. Psychiatric symptoms can also be reactivated resulting from chronic, complicated and serious infections such as HIV that can lead to depression, anxiety or adjustment disorders, although CNS involvement can also be a possible etiological factor. Patients suffering from primary and severe psychiatric disorders are at increased risk of contracting infection;that is mainly related to high risk behaviors in patients with mania or schizophrenia. It is also important to consider that the co-occurrence of psychiatric symptoms and infection can be incidental (i.e. infectious diseases can occur in psychiatric patients regardless of the above mentioned factors). Early identification of the underlying etiology for organic/secondary psychiatric symptoms is essential for appropriate intervention and early treatment of the primary condition that could be the etiology of psychiatric symptoms so as to avoid unnecessary long-term psychiatric treatment and to avoid complications of possible misdiagnosis or delayed diagnosis of the primary condition.