الفهرس 
History and Nosological Consideration to Major DepressionOnly 14 pages are availabe for public view
 |  | from | 330 |  |  |
| | | from | 330 | | |
Abstract
Inspite Major Efforts had been expended in recent decades, still designation of psychotic
depression as a distinct disorder (from depressive spectrum) is a controversial issue and more
investigations are needed.
-many convincing evidences had been estimated as regard etiology, clinical
picture, course, prognosis and response to treatment which characterize psychotic depression but
it is still better classified under a broader rubric of affective disorder
- Presentations of psychotic depression differ from culture to culture but the main core of illness
is still similar.
Aim of the study
Test the following hypotheses.
HYPOTHESIS 1: major depression with psychotic features could be a distinct entity in comparison
with major depression without psychotic features.
These two types may be different in regards:
!-Prodromal phase 2-Full episode
3-Post episode (Residual symptoms, rate of recovery and rate of recurrence) HYPOTHESIS 2: major
depressive disorder with and without psychotic features could differ from culture to
culture. (Universality of illness or one continuum colored with effect of culture)
HYPOTHESIS 3: the expected discriminating differences which can separate between major depression
with and without psychotic features inside one culture could differ from culture to culture. So we
tried in this work to explore the differences between psychotic and non psychotic depression across
two different cultures with stress on positive psychotic features which represent the hallmark
distinguishing psychotic from nonpsychotic depression
Component of the study
A) Theoretical part:
A review of literature regarding the following
-Chapter I: which gives a general idea about history and nosological consideration to Major
Depression with stress on Arab Diagnosis and Classification of Depression?
-Chapter II: incidence and prevalence especially in the Arab Culture
-Chapter III: different Courses and Outcomes of Major Depression.
-Chapter VI: we had discussed the Personality Profile and its relation to Major Depression
especially psychotic type
-Chapter VII: effect of Culture on presentation and how culture could color the illness
-Chapter VIII: This mam bulk reviewed a lot of paper analyzing and emphasizing in
details psychotic depression in its different aspects.
B) Practical part:
*It is formed of
I. A comparative descriptive study between psychotic depression and nonpsychotic depression
inside the same culture (inside both Egyptian and Kuwaiti cultures).
2. A comparative descriptive study of psychotic depression across both cultures (Universality of
illness or one continuum colored with effect of culture). *It includes
I- Socio demographic data
II- History and Longitudinal Course characteristics III- Examination characteristics
IV- Psychometric studies
V- Rate of Recovery and Recurrence
Subject and methods: Sample
The study involved two main groups of patients (Egyptian group and Kuwaiti group). Each of
them included 60 severe major depressive patients, 30 of major
depression with psychotic features (study group). And 30 of major depression without psychotic
features (control group). All of them were inpatients of both sex (Age range from 20-60 Yrs) in a
big governmental hospital and diagnosed by senior specialist psychiatrists of master degree
qualification and more than 12 years experience and under supervision of consultant psychiatry.
Method
Both groups (Egyptian and Kuwaiti, Psychotic depression and non psychotic depression) will
be subjected to the following:
1) Full medical and neurological examination
2) Psychiatric examination: clinical sheet (Leon eta!. 1989).
3) Hamilton Depression Rating Scale (HDRS).
4) Scale for Assessment of Positive Psychotic symptoms (SAPS).
5) Beck Scale for Suicidal Ideation (BSS).
6) All items of Personality Assessment Scale (PAS).
7) The prodromes of recurrence and relapse questionnaire (patient and family forms), (Mahfouz,
1993).
8) Follow up for 9 months to assess rate of recurrence which is indicated by need for admission
*The design of the study: will be comparative, clinical and prospective (except for the data about
the Prodromal phase will be retrospective).
1-Prodromal phase 2-Full episode
3-Post episode (Residual symptoms, rate of recovery and rate of recurrence)
Results:
1- Results of Sociodemographical Data:
1) Age:
Inside culture, Egyptian non psychotic patients have greater and significant (p<0.05) mean age
(32.93+7.15 for psychotics and 38.26+8.87 for non psychotics) and they are similar to Kuwaiti non
psychotic patients who have also
a greater and significant (p<0.05) mean age (29.76+7.57 for psychotics and 35.00+8.63 for non
psychotics).
Across cultures, both psychotics and non psychotic patients show no significant
for mean age.
2) Gender Distribution:
Females are more represented in both samples and in both diagnoses but the differences are not
significant
3) Marital Status:
Marital problems are higher in psychotic patients and Kuwaiti in general but the differences are
not significant across and inside cultures, so in Egyptian psychotic patients there are (4=13.33%
for single; 6=20% for divorced and 4=13.33% for separated) while in Kuwaiti psychotic there are
(5=16.66% for single; 10=33.33% for divorced and 5=16.66% for separated).
4) Job distribution:
Unemployed are more represented in Kuwaiti patients (20=33.33% for psychotics and 16=53.33% for
non psychotics) while professionals were more represented in Egyptian patients (6=20% for
psychotics and 14=46.6% for non psychotics).
5) Educational level:
Nearly no difference between categories, no significance inside both Egyptian and Kuwaiti cultures
and also, on comparison across cultures the differences were not significant.
II- Results of History and Longitudinal Course characteristics:
1) Age of onset of 1st episode
it is clear that Kuwaiti patients have early onset (24.60+3.74 for psychotics and
28.70±4.87 for non psychotic) than Egyptian patients (29.07+3.75 for psychotics
and 34.03±6.68 for non psychotic) and the differences across two cultures are markedly significant
(P<O.OO 1) for total age of onset.
2) Duration of episode and between episodes
Psychotic depression especially in Kuwaiti patients show longer duration of episodes and longer
durations between episodes (Duration of 1st episode= 13.2±1.23; of 2nd episode =13.12±1.26; current
episode= 13.53+1.24; duration between 1’t and 2nd =14.47±2.41 and between others=14.47+2.41) than
that of Egyptian psychotics (Duration of 1st episode= 11.96+1.10; of 2nd episode
=12.00±1.26; current episode= 12.02+1.37; duration between 1st and 2nd
=14.37±1.99 and between others=14.43+1.91).the differences inside cultures are markedly
significance (P<O.OO I) while across two cultures is markedly significant for duration of episodes
only.
3) Seasonality
The differences inside cultures and across cultures are of no significant value
4) Precipitating Factors
The difference inside cultures and across cultures are clear where Kuwaiti patients have more
precipitating factors 12patients (40%) for psychotics and 20 patients (66.7%) for non psychotics
while Egyptian patients have 8 patients (26.7%) for psychotics and 16 patients (53.3%) for non
psychotics. these differences are significant (P<0.05) inside culture but not significant across
cultures.
5) Prodromal manifestations
-the most important findings are consistency of prodroma in all samples (no significant
difference). Total number of psychotic episodes with Prodromes is nearly similar across cultures
(58/86 for Egyptian and 60/84 for Kuwaiti and of no significant difference) while non psychotic
episodes with Prodromes are more represented in Kuwaiti culture. Most of Egyptian psychotic
episodes (36/86)