الفهرس Only 14 pages are availabe for public view
 |  | from | 162 |  |  |
| | | from | 162 | | |
Abstract
Current state of Egyptian psychiatric research; lack of teamwork, lack of cumulative nature of research, bad registration of research data & inability to implement the research results and recommendations, putting us in front of an obvious fact that we are in need to reviewing our Egyptian psychiatric researches on substance use disorders in a systematic way to appraise its results across the time & place in an Egyptian perspective in order illustrate points of power & weakness to generate recommendations which may help us in constructing guidelines in our next researches on this important topic.
In order to achieve this goal different databases were explored; 1- Library of faculty of medicine – Ain Shams University. 2- Library of faculty of medicine – Al Azhar University. 3- Library of faculty of medicine – Cairo University. 4- Databases of (Egyptian Journal of Psychiatry), (Current Psychiatry) and (Medline) for Egyptian studies. After exploring these databases, a list of 65 Egyptian psychiatric researches on substance use disorder was generated
After reviewing this material, they were categorized in the following categories; I-Epidemiology, II-Etiology, III-Clinical Description, IV-Suicidality in substance abuse disorders, V-Management, VI-Outcome. Researches which were used in the review were critically appraised.
Regarding the epidemiology of substance use; it was found that; surprisingly alcohol exposure was the most prevalent substance among Cairo preparatory & secondary schools students, Abd El-Baky, et al (1994), Hashem (2002) and Adel (2005). The problem of substance use Egypt is related to poly-substance use rather than single substance, Kamel, et al (1995), Abd El-Azim (2001) and Hatata (2004). Initiation of substance use (gate way drugs; especially smoking cigarettes) at early age is alarming sign for development of substance use disorders Fahmy (1989) & Ismail (1993). Although the prevalence of substance abuse among females is low in clinical studies of Okasha & Raafat (1988), Hatata (2004), Abd El-Azim (2001) and Kamel, et al (1995), yet substance exposure among females is more prevalent in survey studies among Cairo preparatory & secondary schools female students, Abd El-Baky, et al (1994), Hashem (2002) and Adel (2005). This represents an alarming sign as more efforts are needed to prevent such exposure.
Regarding etiology of substance use disorders it was found that the etiological risk factors for development of substance use disorders were: 1- Parent absence. 2- Bad relationship with the father. 3- Bad relationship with the mother. 4- Negative mothers’ image. 5- Bad parental relationship. 6- Cold home atmosphere. 7- Family history of personality traits/disorders. 8- Family history of substance abuse. 9- Having Bad Peers. 10-Being a member of substance abusers group. 11- History of childhood conduct disorder. 12- History of childhood (or early adolescence) poor social adaptation. 13- History of child abuse. 14- Exposure to Substance. 15- Above average pocket money. 16- Poor religious believes & attitudes. Imam (1984), Fahmy (1989), Metwally (1990), Abd El-Baky, et al (1994), Abd El-Azim (2001), Dsokky (2001), Hashem (2002). Also it was found that the studies on biological etiological factors were missed.
Regarding clinical description of substance use in Egypt it was found that the problem of substance abuse is poly-dimensional as it is associated with other psychiatric & medical comorbidities, Kamel, et al (1995), Abd El-Azim (2001), Hatata (2004), so more studies are needed to be conducted in this field in order to establish guidelines for effective management of such comorbidities.
Regarding suicidality in substance use there is a strong correlation between clinically defined substance dependence and abuse and suicidal behaviors. Despite this, researchers have not established that substance use and abuse have a causal effect on suicidal behaviors. Substance use and abuse often are correlated with other, sometimes hard to measure, causal factors. Despite controlling psychiatric comorbidities, the estimates provided by the available studies may be still be confounded by other unobservable factors Mrkowitz et al (2002), so further researches addressing this subject are needed to avoid confounding factors.
Regarding management of substance use disorders it is obvious that many important issues about management of substance use disorders were not discussed. More information is needed about the selection of treatment modality according to; unique needs of each individual, nature of each disorder, efficacy, cost effectiveness. Certain areas need more studies such as treatment of intoxication & withdrawal, the new pharmacotherapies and psychosocial therapy. Also there is great need to discuss the concept of harm reduction & and its appropriateness to our community features. Lastly integrative approaches needs more research due to associated comorbidities with substance use disorders.
Regarding outcome of substance use disorders; it was found that the relapse predictors among substance users were: low education level, unemployment, low socio-economic status, positive family history of substance abuse and other psychiatric disorders & high scores of ASI. While, high internal religiosity was found to be associated with low relapse rate EL-Ghonemy (2005). No other available studies discussing the prospective outcome (cohort studies) of substance abusers.
After reviewing the appraisal of the studies which were used in the review it was found that there was great development over the last 22 years regarding design of the studies, methodology, selection of cases, statistics, results presentation, discussion, limitation of the study, critical appraisal and recommendations. Two common criticisms were found among the available studies; the 1st, the study design was not mentioned clearly in some studies and the 2nd, Statistical measuring of the size of the sample (power of the study) was not mentioned in most of the available studies.
Finally summary of clinical M.D. thesis and M.Sc thesis on substance abuse disorders done in Ain Shams University – Neuropsychiatry Department was generated in order to evaluate our present state to aid the next researcher to identify new targets in their researches, (see the appendix).