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Abstract
the medical literature is vast and rapidly expanding. As clinical practice becomes busier and time for reading and reflection becomes even more precious, the ability effectively to peruse the medical literature and, in the future, to become familiar with a knowledge of best practice from modern communication systems will be essential skills for doctors. This explains the importance of understanding of the concept of ”evidence-based medicine”.
Evidence-based medicine” is the enhancement of a clinician’s traditional skills in diagnosis, treatment, prevention and related areas through the systematic framing of relevant and answerable questions and the use of mathematical estimates of probability and risk.
As mood disorders constitute a major public health problem, many Egyptian studies were interested in discussing mood disorders from many different aspects. These studies must open the door for new researches and their conclusions must direct our clinical practice.
This work was conducted in order to systematically review and appraise the Egyptian studies on mood disorders and hence recommendations for further studies are generated.
In the first chapter, a general idea about the concepts of systematic review and critical appraisal was given with describing the standard appraisal questions that should be answered for proper evaluation of researches. A list of the most commonly used research methods in practice was presented, the specific appraisal questions asked to evaluate each method were discussed in details in this chapter.
In the second chapter, the Egyptian studies discussing the epidemiology of mood disorders were presented with discussing their main findings. Abd-El Hamid (1989), found that the prevalence of major depressive disorder was 8,1-10,9 % and the prevalence of bipolar disorder was 1,4-2,6 %, Mohammed (1989), concluded that the prevalence of major depressive disorder among adolescents was 2,53% and the prevalence of dysthymia was 2,42 %.
Erfan (1995), found that the the prevalence of dysthymia among depressive patients was 23,5 %. Mahfouz et al. (1997), concluded that the prevalence of major depressive disorder was 22,8 %. El-Tantawy (1998), reported that the prevalence of major depressive disorder was 1,4 % and the prevalence of bipolar disorder was 1,3 %.
Abed El-Fattah et al. (1998), found that the prevalence of major depressive disorder was 1,37 % and the prevalence of bipolar disorder was ,45%. Ghanem et al. (1999), concluded that the prevalence of major depressive disorder was 5,2 % and the prevalence of dysthymia was 10,8 %. Ghanem et al. (2006), reported that the prevalence of major depressive disorder was 2,7 % and the prevalence of dysthymia was 1,03 %.
In the third chapter, the Egyptian studies discussing the etiology of mood disorders were presented. As regard the biochemical factors, El-Naggar (1989), found that norepinephrine is biochemically dysregulated in major depressive disorder. Mostafa et al. (1998), concluded that increase in dopamine levels is associated with improvement of major depression. Essawy et al. (2000), observed decreased serotonin level and increased cortisol level during depressive state. Regarding the immunological factors, Khalil et al. (1998), found that depression may negatively affect cellular immunity. El-Naggar (1996), reported that the total number of lymphocytes was significantly lower in depressed patients. Shalaby et al. (1997), found that monocytes may play a role in the acute phase of depression. El-Sayeh et al. (1998), observed decreased the absolute count and percentage of CD8-T lymphocytes in patients with major depression.
Few studies discussed the genetic factors of mood disorders, El-Moussely et al. (1995), found that polygenic inheritance is a major component in the etiology of mood disorders, Eissa (2001), observed that dopamine transporter gene plays a major role in the susceptibility for bipolar mood disorder. Regarding the psychosocial factors, Al-Sheikh (1993), found that work, economic and marital stresses were important psychosocial factors in the development of major depression. Abed El-Samei (1999), reported that events concerning the interpersonal relationships were the most frequent provocative events before the onset of depressive episode. Abed El-Meguid (2005), found that 40 % of patients with mood disorders had co-morbid personality disorders.
In the fourth chapter, the Egyptian studies discussing the clinical description of mood disorders were presented. Eissa (1995), found that the most frequent prodromal symptoms were mood changes, sleep disturbances and changed motive for life, on the other hand, Ramy (1998), reported that the most frequently reported symptoms before depressive episode were early insomnia, depersonalization and decreased appetite while decreased need for sleep, irritability and hypertalkativeness were the most frequently prodromal symptoms of manic episode.
As regard the cognitive dysfunction in mood disorders, El-Batrawy (2002); Sayyah (2003) and Rabie (2005), observed evidence of cognitive deterioration in patients with mood disorders. El-Tantawy (1998) and Abed El-Fattah et al. (1998), studied the symptomatology of depression. They found that the commonest presenting symptoms of depression are depressed mood, lack of energy and sleep disturbances. Ghanem et al. (1999) and El-Dod et al. (2000), studied the symptomatology of depression in old age. They found that elderly depressed patients were more liable to complain of hypochondriasis, somatic preoccupation and psychomotor retardation.
Abed El-Samei (1995), studied the sleep disturbances in depression. It was found that prolonged first rapid eye movement period and increased rapid eye movement density were specific sleep disturbances in depressed patients. Some Egyptian studies addressed the prevalence of depressive symptomatology in other medical conditions, Fawzy et al. (1998), found that 20 % of pregnant women had depression during the first trimester of pregnancy. Shama (1998), observed that 64,71% of patients with Parkinson’s disease had major depressive episode. El-Mahalawy and Gad-Allah (1996), reported that 15 % of diabetic patients had major depression. El-Mahalawy et al. (1991), found that 33 % of patients with renal failure on hemodialysis were depressed. Omar et al. (1998), concluded that 43 % of physically ill elderly patients had major depressive disorder.
In the fifth chapter, the Egyptian studies discussing the outcome of mood disorders were presented. Effat et al. (1997), found that 13,33 % of patients had mild impairment compared to 26,66 %- 56,66 %- 3,33 % of patients had moderate, severe, very severe impairment of quality of life respectively. Mansour (1999), found that 52,5 % of patients get syndromal recovery but 47,5 % of patients get symptomatic recovery and only 25 % of patients return back to baseline. Serag et al. (2005), found that 48 % of patients get syndromic recovery but 26 % of patients get symptomatic recovery and 24 % of patients get functional recovery.
In the sixth chapter, the Egyptian studies discussing the management of mood disorders were presented. Regarding the role of ECT, Okasha (1996) and Easa (1997), found that ECT leads to improvement of depression faster than pharmacotherpy but with transient cognitive deficits. Rafik et al. (1999), observed the fall in plasma noreadrenaline under the effect of ECT with improvement of melancholic and psychotic depression.
On the other hand, there were some studies discussing other approaches for management of mood disorders. Khalifa et al. (2005), reported that tricyclic antidepressants improve sleep continuity with increasing slow wave sleep and reducing rapid eye movement sleep in contrast to selective serotonin reuptake inhibitors that show disturbed sleep parameters with reducing slow wave sleep. Shaheen (1992), observed that electroacu-puncture causes clinical improvement in treatment of dysthymia similar to that obtained using tricyclic antidepressants but as regard major depression, electroacupuncture is less effective compared to tricyclic antidepressants.
In each chapter, critical appraisal of the related studies was done intending to shed light on the missed points in these studies to overcome them in the future.
Common missed points were found in these studies, some of these researches were missing a good description of the study design. Also, few studies were concerned with evaluating the reliability and validity of their measures and for justifying the sample size in order to meet their aims. Describing the statistical methods used, discussing the unwanted events occurred during the study and how they were dealt with, sources of bias and how they were eliminated were also common missed points in many Egyptian researches.