Background Borderline personality disorder (BPD) is one of the main challenges of psychiatric care with severe morbidity, high social costs, and substantial prevalence. Despite developing interest in early identification of BPD in children and adolescents, few, if any, diagnostic tools are available in Arabic. Methods The current study aims to assess the psychometric properties and convergent validity of the borderline personality features scale for children and parents (BPFSC and BPFSP) and the childhood interview for DSM-IV/5 borderline personality disorder (CI-BPD) in the diagnosis of the borderline personality disorder (BPD) in an inpatient sample of Egyptian adolescents. This descriptive cross-sectional study included 60 convenience sample of adolescents admitted to the inpatient child and adolescent Psychiatry unit in Tanta Psychiatry and Neurology Centre, Tanta University Hospitals. Results The psychometric tools in interest were translated to Arabic by the first and second authors after appropriate permissions. Arabic adaptation of CI-BPD demonstrated excellent internal consistency, Cronbach’s α = .79. Test–retest reliability was high, r = .82, p < .001. The Arabic version of the BPFSC and BPFSP demonstrated good internal consistency for the total score (Cronbach’s α = .78 and .75 respectively). In a pilot sample (n = 60), internal consistency remained acceptable for both versions of the scale (α = .79 and .77 respectively). Conclusions The adapted tools demonstrated good internal consistency, high inter-rater reliability and strong convergent validity.

Parenting plays a significant role in shaping a child’s behavior. Parent Management Training (PMT) is a well-established treatment for children with disruptive behavior disorders. No controlled studies have assessed PMT’s efficacy in the Arab region. Eighty-seven families with children displaying oppositional and disruptive behaviors were recruited. Fifty-two completed an Arabic-adapted PMT program, while 35 participated in treatment as usual, consisting of child-centered behavioral therapy, over 8 weeks. Both groups were then followed every 4 weeks for 16 weeks. Families completed validated Arabic versions of the Child Behavior Checklist (6–18) (CBCL 6–18) and the Conflict Tactic Scale - Parent Child Version (CTS-PC) scales at intake, 12 weeks, and 24 weeks. Both groups matched on age, sex, socioeconomic status, and psychoactive medication use. The PMT group showed greater, ongoing improvement in CBCL 6–18 internalizing and externalizing scores. This pattern did not differ by age group, medication use, or trainer. After therapy, both groups reported using less non-violent discipline and psychological aggression in dealing with their children. Culturally adapted PMT could be more effective than the child-centered behavior modification commonly used in Egypt. It may help to reduce disruptive behavior, support psychological well-being, and improve parent-child relationships.

BACKGROUND:Neurofibromatosis Type 1 (NF1) is a multisystem genetic disorder that may impact psychological well-being in children. This study aimed to assess behavioral problems and functional competence in children with NF1 and examine the associations of these problems with disease severity and lesion visibility. METHODS:A case-control study was conducted with 38 children diagnosed with NF1 and 38 ageand sex-matched healthy controls. All participants underwent an assessment using the Arabic version of the Child Behavior Checklist (CBCL). Clinical severity and lesion visibility were rated using the Modified Ablon Scale. RESULTS:Children with NF1 showed significantly higher scores in anxiety, attention problems, and social difficulties scales of the CBCL (p < 0.001), along with greater scores on the internalizing and externalizing problem scales. Total competence scores, including school performance, social adaptation, and activities, were significantly lower in the NF1 group. Visibility and severity of physical lesions were positively correlated with behavioral problems and negatively correlated with competence. DSM-oriented scales revealed a higher prevalence of ADHD, affective symptoms, and PTSD-related complaints in the NF1 group. CONCLUSION:These findings highlight the need for early psychological evaluation and multidisciplinary care strategies to support mental health and quality of life in this vulnerable group. IMPACT:This study provides the first controlled data on emotional and behavioral problems in Egyptian children with NF1 using a validated Arabic CBCL tool. Children with NF1 showed more frequent internalizing, externalizing, and DSM-oriented psychiatric symptoms compared with healthy peers. Greater clinical visibility and severity of NF1 were associated with increased behavioral difficulties. Routine psychological screening and multidisciplinary management are mandated in children with NF1.

Self-regulation is a core phenomenon in child psychology. The Dysregulation Profile (DP), a composite scale that results from adding up three scores of the Child Behavior Checklist (CBCL 6–18), has emerged during the last two decades as a transdiagnostic construct in child and adolescent psychiatry that reflects serious difficulties in self-regulation, including emotional and behavioral dysregulation. This work aimed to investigate the prevalence of DP in a clinical sample compared to a community sample of Egyptian youth and to explore the potential demographic and clinical correlates of this phenomenon. The electronic scoring records of the previously validated Arabic version of the CBCL 6–18 were reviewed for a large clinical sample of convenience (n = 3642, age range 6–18) and another community sample (n = 595) previously recruited by our group with the same age range. The prevalence and the clinical correlates of the Dysregulation Profile (DP) of the CBCL were investigated. Almost one-third of the clinical sample (33.1

Attention deficit hyperactivity disorder (ADHD) symptoms vary significantly through adolescence. Adolescents with ADHD face a heightened risk of developing substance use disorder, with this progression occurring more rapidly than in the general population. Both substance use disorder and mental health disorders pose significant public health challenges, especially when they co-occur. The study aims to highlight potential distinctions between the two groups, adolescents with ADHD without substance use disorder and adolescents with ADHD with substance use disorder, this aims to contribute to a better understanding of the complex relationship between ADHD and substance use disorder in adolescents. A total of 30 adolescents diagnosed with ADHD aged from 13 to 21 years who attended the outpatient clinic of the child and adolescent psychiatry unit at Neuropsychiatry Department, Psychiatry, Neurology and Neurosurgery Center in Tanta University Hospitals. All participants were subjected to the following: history taking, general and neurological examination, Socioeconomic status scale, The Stanford-Binet Intelligence Test 5th edition, A urine screening for substances of abuse (for the group with substance use), Addiction Severity Index 5th edition (for the group with substance use) and Conners’ Parent Rating Scale. Adolescents with ADHD and comorbid substance use disorder were predominantly males older than 17 years old, with no significant difference in terms of residence and intelligence quotient. Social status and family history were the most dimensions affected, severe types of ADHD and poly substance abuse especially cannabinoids were key features in adolescents.

Attention-deficit hyperactivity disorder (ADHD) has a high comorbidity with substance use disorders (SUDs). The overlap between ADHD and SUD in both adolescents and adults is one of the areas of increasing clinical and public health interest. The current study aimed to investigate the demographic and clinical characteristics of individuals with ADHD and comorbid SUDs during the adolescence period in comparison with those with ADHD without SUDs. Thirty adolescents aged 13–21 with ADHD, half of them with comorbid SUD, were interviewed using the Kiddie Schedule of affective disorders and schizophrenia. The Arabic version of Conners’Parent Rating Scale, urine screening for substances of abuse and the electronic version of the Continuous performance test-3 (X-version) (CPT3-X) were used to evaluate the adolescents. Subjects with ADHD and SUD were more likely to be males (86.7

Stigma and discrimination linked to mental illness profoundly impact patients as well as their families, who typically experience social withdrawal and increased hesitancy to access help services. This can lead to mental health underuse and escalating caregiver psychological distress. In this study, we aimed to assess stigma attitudes in family members of patients with psychiatric disorders and the consequences both for their psychological well-being and for patients. This is a cross-sectional, multicenter study including 633 relatives of patients diagnosed with psychiatric disorders attending clinics in four governorates of the Delta region in Egypt. A sociodemographic and clinical data sheet was prepared for both patients and their relatives. Stigma was assessed using the Perceived Devaluation-Discrimination Scale to assess patient-focused and family-focused stigma. Patient-focused stigma was reported by 64

Background: Recently, there has been tremendous progress in the treatment of this malady with various techniques of psychotherapy that were shown to be effective in RCTs. One of these techniques is System Training for Emotional Predictability and Problem Solving (STEPPS), which is a group psychotherapy approach developed in the 1990s at the University of Iowa in the US. Our study’s objective was to assess the effectiveness of STEPPS in treatment of patients with borderline personality disorder in Egyptian Arabic speaking community and to evaluate the association between baseline clinical characteristics, treatment response, and early treatment cessation to understand which patients’ characteristics make them suitable or not for this new treatment. Methods: This research was performed in Neuropsychiatry Department of Tanta University Hospitals. Fifty-six patients were collected from the inpatient and outpatient departments. The study, however, was conducted as an outpatient program in the above-mentioned settings during the period from April 2019 to December 2020. Patients with BPD were assigned at their convenience or according to immediate availability of treatment slot either to Group-I receiving STEPPS (n=27, with only 20 subjects completing the course) or Group-II receiving usual treatment ―TAU‖ (n=29 of which 20 patients remaining till the end of the trial). Results: STEPPS patients showed better improvement of BEST in comparison to TAU with significantly lower mean of total score of BEST that retained its significant lower values at the 6 months follow-up after treatment period. The decrease in the mean of BEST scores in the Experimental group in comparison to TAU was also significant for the mean values of all BEST subscales, significant variations was maintained at 6 months follow up between Experimental and TAU cases among all BEST subscales. STEPPS patients had better improvement of emotion regulation in comparison to TAU wih significant lower mean of total score of DERS that retained its significantly lower values at the 6 months follow-up after treatment period. The decrease in mean of DERS scores was significant for the mean value of all DERS subscales in the STEPPS group in comparison to TAU. Again, the outcomes obtained at the end of treatment year were all maintained at 6 months follow up with statistically significant differences between STEPPS and TAU patients among all DERS subscales. STEPPS patients showed better improvement of quality of life in comparison to TAU as shown in the statistically significant higher mean of total score of quality of life that retained its statistically significant higher values at the 6 month follow up following treatment year. The STEPPS group had significantly increased mean quality-of-life scores in comparison to TAU in the mean values of all quality-of-life subscales. Again, the outcomes obtained at the end of treatment year were all maintained at 6 months follow up with statistically significant differences between STEPPS and TAU patients among all quality-of-life subscales. Although STEPPS patients showed definitive improvement on the Filter Questionnaire in post-test in comparison to baseline test, the differences were not statistically significant in most of the filters. Conclusions: STEPPS as a sole (not add-on) intervention proved superior efficacy in comparison to TAU (cognitive behaviour therapy) for treating patients suffering from borderline personality disorder in Tanta University Hospital, as evidenced by the lower attrition rate of borderline patients who received STEPPS therapy in comparison to those who were managed by TAU. Patients in the STEPPS group had better improvement of emotion regulation, borderline symptoms and quality of life in comparison to TAU as demonstrated in the significantly lower mean of total score of DERS scale, BEST scale and the significantly higher mean of total score of WHO quality of life scale, both at the end of the treatment period after 6 months of follow up. Improvement in schema questionnaire in STEPPS group was limited as schema is rigid and need more duration to be changed.

Background The Achenbach System of Empirically Based Assessment (ASEBA) forms are among the most studied instruments for assessing behavioral, emotional, social, and thought problems in children and adolescents worldwide. Although ASEBA instruments have been translated into Arabic, fewer studies have investigated their psychometric properties and norms in Arabic speaking societies than in other societies. Methods Revisions were made to the Modern Standard Arabic (MSA) translations of the Child Behavior Checklist for Ages 6–18 (CBCL/6–18), the Teacher’s Report Form (TRF), and the Youth Self-Report (YSR). Parents of 6–18-year-olds who came to the general pediatric clinic in Tanta University Hospital during a 2-year period for routine check-ups were invited to fill out the CBCL/6–18 ( N = 595), while 11–18-year-olds were invited to fill out the YSR ( N = 409). TRFs were filled out by teachers ( N = 329). Results Confirmatory factor analyses supported the previously reported eight-factor syndrome structure of the forms with good psychometric properties and moderate cross-informant correlations. The mean CBCL/6–18 and YSR Total Problem scores qualified for the previously established ASEBA Multicultural Norm Group 2, while the mean TRF Total Problem score qualified for group 3. Conclusions The good psychometric properties and the identification of Multicultural Norm Groups for scores obtained with the Arabic translations of ASEBA forms in Egyptian society support use of the ASEBA for assessment and outcome evaluations of behavioral, emotional, social, and thought problems among Egyptian youth.

Objective of the study: To assess the cognitive impairment among diabetic patients and explore the potential alterations in various areas of the brain in a sample of diabetic patients in comparison to normal control subjects. Study Design: Cross-sectional study. Place and Duration of Study: Neuropsychiatry Department, Tanta University and Centre of Psychiatry, Neurology and Neurosurgery-Tanta University, at the Diabetes& endocrinology unit in the department of internal Medicine, Tanta University Hospitals and at the radiology department, Tanta University Hospitals during the interval from September 2018 to September 2019. This study was conducted on two groups Group A (60) diabetic patients compared to Group B (20) normal healthy individuals free from any cognitive impairment matched age and sex using psychometric scales e.g. Structured Clinical Interview (SCID) (American psychiatric association, 1994), Stanford-Binet Intelligence quotient (I.Q) fourth edition, Mini mental state examination (MMSE) or Folstein test, The Montreal Cognitive Assessment (MOCA) test, Trail making test (Part A& part B)& Stroop color_word test (Computerized version).and diffusion tensor imaging. All subjects aged from (18-65) years old. Results: patients with cognitive impairment represented 53.3% of the diabetic patients. Most of them presented with MCI (45%), while (8.3%) of them presented with dementia. The most affected executive functions in diabetic patients with impaired cognitive functions are delayed recall, attention, naming and language as assessed by MMSE& MOCA scales. There was negative correlation between HBA1C levels and fractional anisotropy in most of areas of interest of statistically significant value. Conclusion: The higher HBA1C levels (uncontrolled diabetes mellitus), the more cognitive deficits recorded through psychometric tests& DTI.

Background: Epilepsy is a common neurological condition that can have a detrimental impact on social, emotional, and cognitive functioning. Psychiatric and cognitive problems in children with epilepsy and antiepileptic drugs can affect quality of life. Long-term follow-up studies reveal that epilepsy that develops in childhood is more common than epilepsy that develops later in life. Has a marked impact on adult life even when the epilepsy is not complicated by intellectual disability or other neurological impairments. The aim of this study was to study cognitive and behavioral impacts of idiopathic epilepsy and antiepileptic drugs in children and adolescents compared to normal ones. Methods: This prospective, case control study was conducted on 60 children or adolescents suffering from idiopathic epilepsy aged 6-16 years. Children were classified into four equal groups and were examined after 6 months from diagnosis: Group A subjected to valproic acid at a dose of 10-60 mg/kg/day, group B subjected to Carbamazepine at a dose of 10-30 mg/kg/day, group C subjected to levetiracetam at a dose of 10-60 mg/kg/day and group D subjected to Oxcarbazepine at a dose of 20-30 mg/kg/day. Thirty healthy children or adolescents of matched age and sex served as a control group who attended Pediatric General Outpatient Clinic of Tanta University Hospitals. The following was done to all of the patients: full history taking, complete physical examination, routine laboratory investigations, electroencephalography, brain magnetic resonance imaging, specific tests for behavior and executive functions including the Child Behavior Checklist – school age, Stanford-Binet Intelligence Scales (fifth version), Wisconsin Card Sorting Test and Continuous Performance Test. Thirty healthy children or adolescents of matched age and sex served as a control group. Results: Children with epilepsy who were treated with AEDs showed higher behavioral problems scales, lower mean IQ and lower executive functions as compared to controls. LEV and VPA had a more negative effect on behavior than CBZ and OXC while VPA and CBZ had a more negative effect on mean IQ and executive functions than LEV and OXC. Conclusion: Antiepileptic drugs (AEDs) may be one of the causes of epilepsy-related cognitive and behavioral issues in children.

Background Conduct disorder (CD) is a serious and common psychiatric disorder affecting children and adolescents. “Callous-unemotional traits” is a new specifier added to the diagnosis of CD in the DSM-5. The new specifier is thought to be associated with more severity and higher genetic load. Oxytocin is known to be related to interpersonal sympathy and social affection, and so its deficiency might be related to unemotionality. This work aims to explore the levels of serum oxytocin in adolescents with CD associated with callous-unemotional (CU) traits as compared to healthy control subjects. Twenty patients aged 12–18 years and 20 controls of the same age range were recruited. An Arabic-translated and validated version of Mini International Neuropsychiatric Interview for kids (MINI-kid) was used to confirm the diagnosis. The Youth Psychopathic Inventory-short version (YPI-short version) and the Inventory of Callous-Unemotional Traits (ICU), both parent and self-reports, were all translated into Arabic and validated by the authors and used to evaluate the sample. Evaluation of serum oxytocin level using ELISA technique was done. Results After statistical adjustment for differences in socioeconomic status, an adolescent with CD associated with CU traits showed low levels of serum oxytocin level as compared with the control group. Serum oxytocin levels were negatively correlated in a statistically significant degree with the unemotional, the callousness, and the uncaring subscores of ICU—self-report. Conclusions Low levels of serum oxytocin might play a potential role as a biomarker for CU traits and CD severity in adolescents with CD.

Aims: To evaluate SD in depressed married premenopausal women and to study mood in married women with primary sexual complain. Study Design: Cross-sectional case control research. Place and Duration of Study: Neuropsychiatry and Obstetrics and Gynecology departments at Tanta University Hospital. The study was conducted from April 2019 to the end of March 2020. Methodology: This research involved 300 females. Subjects were allocated into three equal groups: group 1(females with major depressive disorders who met DSM-5 diagnostic criteria for Major depressive disorders and were drug naïve, group 2: females with primary sexual complain and/or disorders and group 3: normal healthy female did not have history of medical or psychiatric diseases. All cases were subjected to psychiatric interview by Arabic version of MINI, Arabic version of the female sexual index, Hamilton depression scale, Hamilton anxiety scale, quality of life (QOL) assessment and modified Fahmy and Sherbini scale for socioeconomic study. Results: There was positive significant correlations between female sexual index and Hamilton depression and anxiety score (p <0.001, p=0.012 respectively). There were negative significant correlations between female sexual index and physical, Psychological, social domains and total score of modified Fahmy& Sherbiny scale (p=0.073, 0.039, 0.003, 0.009) respectively. Conclusion: Severity of depression is correlated to severity of SD among female cases with major depressive disorder. QOL is affected significantly by depression and by presence of sexual complaints and/or disorders among women as high incidence of SD in women with probable depression and is linked with significantly worse QOL.

BACKGROUND To our knowledge, this is the first study that aims to investigate the demographic and clinical correlates of admission into a specialized inpatient psychiatric unit for children and adolescents in Egypt and the Arab world. METHODS The files of all service users who presented for care in the outpatient service for children and adolescents in xxxx University between July 2017 and December 2019 were reviewed. Of the 1195 files reviewed, 100 patients were admitted to the inpatient unit for 133 admission episodes with an average duration of 18.5 days per episode. RESULTS The most common diagnosis among admitted children and adolescents was disruptive behavior disorder. Having a diagnosis of bipolar disorder, eating disorder, or trauma related disorders powerfully predicted admission. Both physical and sexual abuse also predicted admission, readmission and longer duration of admission. CONCLUSIONS The need for admission into specialized psychiatric inpatient units for children and adolescents is comparable to that in other parts of the world. There is an urgent necessity to develop such therapeutic units across the entire Arab world with subsequent need to establish suitable training programs for mental health workers to deal with children and adolescents diagnosed with sever psychiatric disorders in inpatient setting.

Background: Obesity is becoming an important issue for health promotion. The World Health Organization estimated that around 1.5 billion adults were overweight (body mass index (BMI) 25 kg/m2) and about 500 million people were obese (BMI 30 kg/m2) in 2008. The relationship between obesity and mental health is also considered important. In a community-based study, obesity was positively associated with several mental disorders, especially mood disorders and anxiety disorders. The aim of the study is the assessment of current and lifetime psychiatric disorders among morbidly obese patients. Methods: This case control study was conducted on 60 participants from outpatient clinic of GIT surgery unit and community. All participants were subjected to: Body weight and body mass index, Psychiatric interview for diagnosis of psychiatric disorders by Arabic version of MINI, Scale for diagnosis of Bulimia nervosa by Shokeer, Scale for diagnosis of Anorexia Nervosa by Shokeer, Binge Eating Disorder Screener-7, Eating attitude test, Hamilton Depressions Rating Scale and Hamilton anxiety scale. Results: There was a significant increase in anxiety in patients with morbid obesity compared to control group. There was a significant difference between both groups showing the high prevalence of depression in patients with morbid obesity. Based on EAT test, there was a significant prevalence of abnormal eating behaviors in patients group compared to none of control group. A screening test for the presence of Binge eating symptoms revealed significant increase of symptoms in patients’ group. Conclusions: Psychiatric disorders are prevalent in morbidly obese patients and are associated with significantly worse quality of life. In addition, morbidly obese patients had significantly worse physical and mental health relative to control group from general population. High rates of psychiatric disorders among morbidly obese patients seem to be the rule rather than an exception.

Chronic kidney disease (CKD) is defined by the Kidney Disease and Outcome Quality Initiative as a child who has kidney damage lasting for at least three months with or without decreased glomerular filtration rate. Hemodialysis (HD) means removal of waste products and extra fluid directly from the blood when the kidneys do not work properly. Studies aimed at investigating neurocognitive impairment in children with CKD have identified a wide range of delays in cognitive development. The aim of this study was to assess the cognitive functions and adaptive behavior in children with end-stage renal disease (ESRD) on regular HD. This case-controlled study was conducted on 30 children suffering from ESRD who were on treatment at the Pediatric Nephrology Unit of Tanta University Hospital. Thirty apparently healthy children served as a control group, in the period from January 2017 to January 2018. All children were subjected to full history taking, careful physical and neurological examination, specific investigations including assessment of intelligence quotient (IQ) using Stanford Binet test 5th edition; assessment of adaptive behavior, assessment of executive functions by using Wisconsin Card Sorting Test; and continuous performance test. This study showed that mean values of IQ and the Vineland test were significantly lower among patients than controls. The study suggests that children with ESRD had lower IQ, adaptive behavior and executive functions than healthy control children.

Background and Purpose: Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurodevelopmental disorder in children. The purpose of this study is to explore the rate of psychiatric comorbidities among children with ADHD and investigating the impact of comorbidities on function of children. Subjects and Methods: Sixty-four children of both genders who fulfilled DSM-5 criteria for ADHD were included. All subjects were subjected to IQ assessment, Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), Conners Rating Scale, and Child Behavior Check List (CBCL). Results: Combined subtype was the commonest (50%) followed by hyperactive-impulsive (31.25%), then inattentive (18.75%). Psychiatric comorbid disorder among pediatric cases with ADHD was ODD (31.25%), followed by nocturnal enuresis (23.44%), conduct disorders (18.75%), motor tic disorders (15.63%), anxiety disorders (12.50%), depressive disorders (10.94%), substance abuse disorders (9.38%), autism spectrum disorders (7.81%), vocal tic disorders (1.56%). There was a statistically significant difference between gender and conduct disorder and SUDs (P <0.05). There was no significant difference in the distribution of comorbidities among subtypes except for conduct disorder (P<0.05). There was a significant difference between comorbidities and severity of ADHD, according to the Conners scale (P<0.05). There was a significant difference between comorbidities number and different CBCL parameters (P<0.05). There was a significant negative correlation between the number of comorbidities and total competence and positive correlation with the total problem (P<0.05). Conclusions: The presence of comorbid disorders among pediatric cases with ADHD is the rule rather than the exception. Oppositional defiant disorder, followed by nocturnal enuresis, are the most common comorbid diseases. Comorbidities number is negatively correlated with total competence and positively correlated with the total problem.

Background Conduct disorder (CD) is a prevalent psychiatric disorder in youth with heterogeneous presentations and hazardous outcomes on family and society. Identifying potential biological markers may help in better understanding and management of the problem. This work aims to explore the potential volumetric brain abnormalities in an Arab-Egyptian sample of conduct disordered youth with and without comorbid ADHD. A total of 27 subjects with conduct disorder, 14 of which also fulfilled the criteria of ADHD, in addition to twenty healthy subjects were recruited. A validated Arabic version of the Mini International Neuropsychiatric Interview for Children and Adolescents “M.I.N.I-Kid” was carried out. MRI acquisition was performed on 1.5 T Toshiba MRI scanner. Cortical reconstruction and automatic volumetric segmentation were performed with the Freesurfer image analysis suite. Results Youth with CD, with and without ADHD, showed significantly lower cortical thicknesses and smaller subcortical volumes in most of the hemispheric areas. When the two patient groups were compared, youth with CD + ADHD had significantly greater cortical thicknesses but smaller subcortical volumes as compared to youth with CD only. Conclusions Conduct disorder, comorbid with ADHD, might prove to be a distinct phenotypic entity with different biological substrates, and hence different needed management, from CD without comorbid ADHD.