الفهرس 
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Abstract
Summary
Introduction
Leprosy is a leading cause of disability and death worldwide, Leprosy is a chronic infection that remains endemic, particularly in third world countries (Walker, et al 2006).In Egypt, the risk factors governing the distribution of leprosy are unknown (Hegazy , et al 2002) caused by the acid-fast, rod-shaped bacillus Mycobacterium Leprae or the more recently discovered Mycobacterium Lepromatosis ( Han et al,2009).
Two of the most common and least-treated co-morbidities of leprosy are anxiety and depression. Increasing evidence suggests that anxiety and depression may have direct impacts on health status, hospitalization and exacerbation of leprosy, rather than being consequences or markers of disease severity. Thus, detecting depression or anxiety in patients with leprosy is of great importance.
The work consisted of two parts: theoretical and practical
I. The theoretical part
Review of literature
The theoretical part of this thesis involves the following chapters:
• Chapter One:
This chapter provides a brief introduction about leprosy It includes definition of leprosy, epidemiology, risk factors, pathology of the disease , assessment of leprosy severity, types of leprosy and prognosis .
• Chapter Two:
This chapter discusses women sexuality, female sexual function and its affection by leprosy disease .
• Chapter three:
This chapter emphasize on the psychiatric disorders associated with leprosy especially depression and anxiety. It explains the interaction between the psychiatric symptoms and leprosy symptoms. It also discusses the prevalence of each comorbid disorder in leprosy patients and its impact on the course of leprosy disease.
This chapter discusses the quality of life of leprosy patients including the relation between psychiatric co morbidity of leprosy and physical disability, the physical functioning, the social functioning and psychological well being.
This chapter also provides an up to date and evidence based approach to management of psychiatric disorders associated with leprosy. It provides the goals of management and the ways to achieve these goals. Treatment modalities include and psychological therapy based on the cognitive behavioral techniques in addition to Interpersonal psychotherapy, Self-management programs, Supportive therapy and Self-help groups.
Aim of the work:
• To assess depression and anxiety in patients with leprosy .
• To examine the impact of anxiety and depressive symptoms on psychological and physical functioning.
• To study the impact of psychiatric assessment and its severity on the quality of life of patients with leprosy .
• To study the impact of severity of leprosy on psychiatric state.
• To study the impact of severity of leprosy on female sexual function .
II. The practical part
Subjects:
Subjects included in the study are 50 female patients with leprosy (diagnosed by clinical examination) recruited from the of leprosy clinic in Beni Seuf and 50 healthy ones from dermatology outpatient clinic in benisuef university hospital.
Methodology:
The fifty patients of leprosy were established the diagnosis by a specialist from leprosy clinic.
All participants were subjected to the following:
1- History Taking .
2- International Index Of female sexual Function .
3- Beck Anxiety Scale .
4- Beck Depression Scale .
I. Beck anxiety inventory (BAI) (Beck et al., 1988) Arabic version
II. Beck depression inventory (BDI) (Beck et al., 1988) Arabic version.
Results
The age of the female patients was (20-45) mean (37.5±7.1) .
Duration of the disease was (Year) 0.2-20 mean (10.0±6.1) .
88%of patients showed anxiety disorders (16% mild, 14% moderate, 58% severe) .
56%of patients showed depressive disorders (38%mild, 14% moderate,4%severe).
The physical deformity ratio is approximately 60% of the patients .
There is statistical significance difference between patients and controlled as regarding no of off springs which is much higher in patients than controlled p value0,001 .
The results also show: There is statistical significant difference between patients and controlled as regarding Beck anxiety inventory and NO statistical significant difference as regarding Beck depression inventory.
There is statistical significance between patients and controlled in the pain as a parameter of sexual function which is more severe at patents than controlled p value0,001
There is statistical significance between anxiety and sexual function score as p value is 0,001 .
Conclusions
1- The theoretical part of this work highlights the fact that psychiatric co-morbidities (Anxiety and depression) are one of the important clinical manifestations of leprosy.
2- Findings of the study, as well as other studies reported in the literature indicates that there is high frequency of psychiatric co-morbidities in leprosy patients especially anxiety and depression which represents the most frequent psychiatric disorder in leprosy.
3- The presence of psychiatric co-morbidities increases the impairment in quality of life in leprosy patients.
4- Our findings show the importance of screening for depressive and anxious symptoms in patients with leprosy to provide adequate patient care.
5- Future classifications of leprosy severity might include those psychological aspects, as they are potentially treatable aspects of the disease.
Recommendations
1- There is a need for similar multi-centre studies on larger sample of leprosy patients aiming at the detection of the prevalence of psychiatric disorders in Egyptian population suffering from leprosy
2- Follow up studies is needed aiming at assessment of the course, prognosis and the impact of leprosy on quality of life especially in those who suffers from psychiatric co-morbidities with leprosy
3- There is a need for further researches to show the relation of leprosy and occurrence of other psychiatric disorders such as somatization and somatoform disorders.
4- Further studies are needed to elucidate the effectiveness of treating psychiatric distress in these patients, as well as the efficacy of screening to identify those who might benefit from specific therapy.
5- Try to study in depth the biological correlation between the aggravation of Leprosy severity and psychiatric disorders.