الفهرس | Only 14 pages are availabe for public view |
Abstract Reaching peaceful f~ontiers, after an exhaustivo oxcursion, digging f~r f.acts and scientific logical deductions about the sit1.’_.J.~oifonmental - ill - health in both rural and urban cOlilDlunities in Egypt, it is noV! ripe to condense ~l1efacts upon which the forth comming recoillmendatioliswill be founded. A systematic sample of 200 patients extracted from University Hospital out-patient clinics was exploited in that study, which Dlcluded 103 urban and 97 rural patients from both Alexandria and Dakahlia Governorates. Rural and urban stratification was the main theBe for investigation and discussion. However, an exll2.UE:tivreeview of literature was presented includinG a classification of mental disorders and the popular concepts about these diseases. A historical review was important to be incLuded, as well as a survey of the ecological factors of mental illness (1. e, biological, psychological and sociological). Psychiatric ther2·PY - being one of the - 234 - prinary J.ines of prophyla..xis - was outliLled ’Nith the purpose of being comprehensive. The statistical situation o:c mental health se:L’vices in Egypt Vias given due cOI13ideration. Analysis of the field study l’.elS yielded vi’cal demo~raphic data: males constituted 54.5 % of the total grou:’ l.n_vestigateu, 54.3 IC- of urban patients and 54.6 ;)0 of rural patients. Hemales constituted the remainder. The average age of the total group was 31.7 + 1L1-.78 years. ’I’he average age for urban patients was 33.98 ~ 7.47 years, where-as that of rural patients was 28.86 :t 6.14 anel the difference Vias found to be statistically si&~ificant. Patients less than 15 years of aoe cO;Jstituted 10 ~0of the total sample, 60 ~0-J±’ whomwere males, as \ielJ. as 60 (0 were rural patients. ’I’he age g:coup 15 _ 2:) years had the highest frequency i.e 28 % of the total sample, 57.1 % of whomwere males and 51.8 >, were rLlral patients. The age group 25 - 35 years constituted 24.5 % where-as the age group 35 - 45 years -_.. -------- - -------------------------- - 235 - constituted 14.5 ;0 The ase group 45 - 55 y. constituted 16 ~’c’ and the a=,8 group 55 -t- constituted 7 10. lt was found that the majority of the investi- Sated sample were below 45 years of abe (77 ~,,). The group of patients below legdl age of marriaGe aDlOunted to 25 patients, 20 of whom suffered f’r-ora orGanie brain lesions and mental deficiency. Hifteen of these were rural patients. The married group constituted 35.4 ;j of the total sample, 53. 2 ;~,of whom were urban patien’cS. ’:l:wenty-eie;mhatrried patients (45.1 70) were psyehoneurotie, the majority of whom came from urban areas (71.4 fo ). Psychoses affected 22.6 ;0 of the married patients, the majority of whom were rural victDlls (71.4 %). The ”Single” group attained the highest frequency in the srunple (37.1 %), most of whom came from ur- Ocill lucalities (55.4 ~:~,). nSL”’1.g1e\i psychoneurotics consti”cuteu (36.9 %) of that group. In this and in more than one item of analysis, the hypothesis that urbanization paves the way for psychoneurosis is further documented. The ”Single” psychotics as well as the mental deficients --_.--- --- -- ------ ----- - 236 - exceed those 1,resent in other marital stiJ,tes. ’:l:h8”Divorc.ed-” [jI’oup in the sample amounted to 21.7 ~b of the total. ,’lOst of the divo.rced were psychoneurotics (34.5 510) and the ],lo.J01- ity of psychoneurotics came from urbal1 localities (69.7 50). Ps~’chotics constituted (26.3 10) and the majority came from rural locaHties (60 ~,,). The ”Vlidowed-”group constitute(l, 6.99 jo, most of ’.1homcame from rural localities (66.6 rn. Fifty percent of this group were rural patients affected with psychoneurosis and orgal1ic brain lesions. The masculule modal age for ill8.rriaGe in rural areas was 19.5 years where-as it is 25.4- years L”1 ur-bari areas. The feminine modal age for marriage in rural are::lB was 14- years, where-as it is 18.75 years in urban areaB. Investigation of the educational level revea. lcd that illiteracy is wide - spread in both rural arid urban patients. It amoun.ts to 4-9.4- ~:-in rural - ------ - 237 - victims and 36.9 ~”in urban ones. These rates differed significantly from genera.l rates of illiteracy. Psychotics constituted 27 50of illiterate rural patients, whereas Psyc::loneurosis stand at the top of the list in urban localities (36.8 %). A aizec.ble seGmentof r-ura.Lj1atiEmts ”who can read and w’rite” were affected with organic brain lesions (40.7 i’i). Rural psychotics ”who can read and write” constituted 37 ~” of the total for that group. Psychoneurotj_ cs constituted 18.5 1:’ of that educiitional level. Rural }latients who attained primary education amounted to 13.6 ~o of the total. Urban patients of the same educational level constituted 25.2 roo It was evident that psychoneurosis stands high in this educational level in both urban and rural residences. This arouses the attention that education c~~ be similar to urbanisation, as educated rural patients have similar proneness to that disease. A finding which fortifies this assumption i.s the distribution of rural patients amongother fw:ther levels of education, where it is found that those whopassed to secondry schools and higher education ”fall under’ the category of ”psychoneurosis”. - 238 - The reflections of Occupation on mental health 1;Jerevaried. In the sample investi[;atod 12 industrial workers who lived in rural localities constituted 6 % of the total sample. It is observed that 41.7 ~o of these workers were affected with psychoneurosis as a manifestation of the city jobs practised by many of them. The urban industrial psychoneurotics constitutecl ~;I.9 ’/0 of urban L’1.dustrial workers. AgricUltural wo:cLe1’samounted to 31.9 ’}’o in rural patients, 61.3 70 of ”hoillhad psychosis and organic brain lesions. Only 4 (12,.7 %) had psychoneurosis. ’rwo-thirds of the agricultural worlcers in the sample living in urban areas were a.Lfected with psychoneurosis. A sizeable segment (45.4 %) of rural patients who)ractised aQ~llListrative jobs were psychoneurotics. Psychbnour.oticSo·constituted two-thirds of all urban adrrill1istrators. This denotes that the job of administrati. on predisposes to pSYChOl18urosisnt both :I.’esidences: urban and rural. It was fOllild that 71.9 % of urban sales workers were psychotics, where-as 23 % of rural sales workers --- ------------ - 239 - suffered from trhe aane syndrome. Hifty percent of urban ”housewives and others” succumb to psycheneurosis. Mental deficiency st2illds high (44.4 %) in the group of snude.o.t s referred frOB schools, which appeared in the sample. Study of SOl~ces of referral of psychiatric patients, showed that general practitioners referred 7.2 ;’” rural patients, and IO.7 )b urban ones amounting to 9 ~’) of all psychiatric individuals in the sample. The Group referred by relatives amounted to 35 yo of the total, 42.3 ;tu of whomwere rural victims. The most proIlinent diagnosis for rural patients referred by relatives were psychosis and organic brain lesions. Urban patients referred by relatives constituted 28.I ~o of all urban patients ~~d the most promDlent diagnoses fox’ those patients were psychosis and pschoneurosis. Forty-two percent of urban pationts soek psychiatric advice by themselves probably being aware of nodLca.l. problems and. facilities, the majorioY of whom were psychoneurotics. Police - referred cases amounted to 7.:5 Yo, two-thirds of whomwere rural patients. The ..•. 21;0 - most yrominent diagnosis for police - referred cases was ps;ychoses. School - referred cases were mostly diae;noE:edas mentally deficient who amount to 72.4 70 of all students referred by school. Rural, mentally deficiEmt, school-referred patients constitute 57 % of the total for that source of referral. Stratific,.::-tion of psychiatric syndromes with respect to residence has revealed that psychoneurosis constitutes the most prGvalent diagnosis in the total sample investigatGd having a rate of 35.5 ;!Q. More thDll two-thirds of these (69.1 %) were urbDll patients. Rural psychoneurotics constituted less than one-third of the total (30.9 1’0), Psychoneuro tics constituted ’+7.6 ;’ of total urban patients and 22.7 10 of rural patients. Psychoses affected 20.5 5o:Jf the sample. Rural I,sychotics dominated urban psychotics having the following rates respectively: 58.5 % and 41.5 %. This showed that psychoneurosis is mostly an urban disease where-as psychosis puts itself as a rural one. Rural psychotics and. urban psychotics constituted 24.7 5/0 and - 241 - 16.5 ~u respectively. Rur&l p~tients affected with orGanic brain lesions constituted 24.7 % from total rural patients, whereas ur-bun victims constituted 11.7 %of all urban pa ti.ent s, lVientallydeficient patients constituted 13.5 >,0 of the slliuple,51.8 of whom wero rural patients and 48.2 % were urban. Stratification of psychiatric syndromes with respects to age, has sho’vu that patients below I5 years of age wore exclusively affected with mental deficiency and orGanic brain lesions. Study of rural patients of the age group I5-25 years, has shown that 34.5 % of that ago group were psychoneurotics. Organic brain lesions had the same rating. Rural ;)sychotics of that age group constituted I7.2 ~/o, whore-as hent8.1 deficiency affected I3.8 50 of that group. Two-thirds of the urban patients of that age gro~J were psychoneurotics. llientaldeficienay affected 25.9~. Psychoneurosis affected a total of 50 ~ of both residences of that age group and therefore stands high - 242 - as Cl prominent disease of that age. The most frequent diagnosis of the age 25-45 years was psychoneurosis in urban patients (53.2 50 and psychosis in rural patients 00.3 70)’ ’I’he age gro’:,,: 45 .;. still shows that psychosiS (34 ;70) remains the dominant diagnosis in rural areas, where-as psychoneurosis (30.4 ~) and psychosis (26 %) are the most frequent di~Snosis in urban victims. Organic brain lesions were evident i.n those over 55 yeers of age (42.8 %). Strcttification of psychi2.tric syndro’;l8s Ylith respect to sex has shoYmthat females are highly prone to psychoneurosis at all levels, rural, urban and total. psychoneurotic rural females constituted 59 ;1” of all rural jhtien’Gs affected with psychoneurosis and 14.4 % of all rural patients in the sample. -,”’romall rural females they constituted 31.8 %. Psychoneurotic urban females constituted 55.1 :/,. of all urban pCltients affected with psychoneurosis and 25.2 50 of all urban patients in the sample and 57.4 )” from all urban females. Forty-five percent of all fomaloB in the investigated sample were psychoneurotics. ------- - 243 - Psychotic rural females exceeded rural males nav ing the same disease (45.I %). Psychotic urban females exceeded (52.9 %) urban males having the salliedisease. The percentabe frequency of psychotic females was found to be 24.1 ;c from total fe,nales in the aamp Lc and tt.isgives the second position as a ’isychiatric hazard for females, psychoneurosis being, the first. Organic brain lesions were the most prominent diagnosis for rural males and amounted to 24.5 to for all rural maleS. Psychosis ~~d mental deficiency have a r-at o of 20.7 ;0 for each fron rural males. Psychoneurosis i8 not a significant hazard for rural males, as it oLfected only 15 ’/e of rural males. However urban males differ from rural males in the fact that psychoneurosis is their most prominent diagnosis, followed by organic brain lesio~s. Urban psychoneurotics constituted 39.3 ’/0 of all urban males. Urban patients having organic brain lesions amounted to 17.8 jb from all c~ban males. Psychotic urban males and those affected with mental deficiency have the same rate (14.~;%) from all urban l!Jales. - 244 - Stratification of psychL,tric syndromes with reS)8ct to symptauatalagy hc’csshoi.n tt:.;tt r;omost fI’erluon t symptoms were those of affectivity di,’;c:’iers, for the total sillnpleffildfor rural patients. Th( second category of symptoms in frequency were sler;p disorders with respect to the total group and for urbffilpatients. The third complaint as regards frequency of occurrence, is memory disorder at all levels: total, rural ffildurban. O,rientation disorders have got the least frequency for all levels. The most frequent symptoms in the age group ( - 15 years ) was found to be memory disorders accou.~ted for by mental deficiency and orgffilic brain lesions as dominffiltsyndromes of that age group. The most frequent symptoms in the age group 15 - 25 years were affectivity ffildsleep disorders. In the ,:\30ijroup 25 - 45 years a.lee: , affectivity and thouD1t disorders predominated. Sex disorders progress in a linear fashion to attain a peak during 45 - 55 yea~s of age. Durinb the (55 + years) age gr’oup, the mo st prominent disorders were those of memory and affectivity. - 24-5 - In a broad consideration of the leading symptOlilSin psychiatric syndromes it was fOillluthat porceptio: l disorders were more prevalent in psychoses and organic brain lesions and is of negligible importance in psychoneurosis. It was fOillldthat 63.4- % of psychotics have perception disorders a..’ltdhet 50 ’/0 of those affected with organic brain lesions have the Sa;}8 symptoms. Thought disorders predominate in mental deficielcy, psychosis and organic brain lesions and is of ~egligible significffilce in psychcneurosis~ It was found that 88.8 % of all those affected with mental deficiency, 78 ’/0 of psychotics and 58.3 ’/0 of those affocted with organic brclin lesions have thought disorders. Affectivity disorders prevail in psychoneurosis, psychosis and organic brain lesions, as it affects 87.3 ~ of psychoneurotics, 80.5 % of psychotics and 77.7 % of those having organic brain lesions. Sex disorders prevail in psychotics to a rate of 56.1 ’/”. Sleep disorders are widespread but predominate ------- ----- ---------- -------------.’ - -- ---- - ----- - -- - -- -- - - - --------- - |