الفهرس 
classification of mental disordersOnly 14 pages are availabe for public view
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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
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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
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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
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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 -
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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”.
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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
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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
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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
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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
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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.
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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.
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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.
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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
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