العربيةMrs. N. Kobty – Counsellor in Dubai
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Profile
Dubai Counsellor
Noora is an Arab American raised in Abu Dhabi, UAE. Upon completion of her secondary education at the Choueifat International School- Abu Dhabi, she relocated to the United States to continue her studies at the Michigan State University College of Social Sciences, where she earned a Bachelor of Science degree in Psychology. Noora then completed her Post Graduate studies at Western Michigan University, where she was awarded a Masters degree in Counseling Psychology. Noora is dually licensed in the United States as both a Counselor and Psychologist by the State of Michigan and has several years of professional experience working in the United States providing a full range of Psychological Services.
She has experience working with a variety of clinical diagnosis, with a broad range of issues, from anxiety to depression to eating disorders to family issues, across all age groups from young children to elderly adults.
Noora has always had an interest in working with children. In 2010, when Noora returned to the UAE she took on a job as a School Counselor at the Glenelg School of Abu Dhabi, compassionately assisting children from 10-18 years old with various issues such as attention deficit disorder (ADD &ADHD), learning disabilities, anxiety, depression, eating disorders, family divorce, low self-esteem, peer pressure and adjustment issues. In addition, her duties involved helping children with career and academic development, as well as life skills planning. Noora is also qualified & trained to treat children through play therapy.
As a Cognitive Behavioral Therapist (CBT), who is fluent in both English & Arabic, Noora’s areas of interest working with adults include depression, anxiety, obsessive compulsive disorders, couples therapy, family dynamics, social phobia, eating disorders, paranoid thoughts, low self-esteem and adjustment difficulties.
Noora also performs various neuropsychological testing for children and adults, which include testing to determine any learning disabilities or ADHD, Personality testing and Wechsler Intelligence Scale.
© GNC, German Neuroscience Center Dubai (Neurology, Psychiatry, Psychology, Counseling, Dubai, UAE)
Articles
Workplace Stress in Dubai – Psychologist, Dr. Harry, Speaks to Gulf News
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Dr Carl Ramberg, neurologist, German Neuroscience Center, Dubai, offers advice on the debate between sitting and standing work culture. […] How much is too much standing? That is Individual, he says. “Young, fit guard soldiers may stand for a long time, but even they need to take regular short walks. Older unfit people with diseasesRead more© GNC, German Neuroscience Center Dubai (Neurology, Psychiatry, Psychology, Counseling, Dubai, UAE)
Diseases treated
Acute reaction to Stress
Extreme life events may produce individual patterns of reaction. Such events might be the death of a partner, war, experiences, separation, accidents, experience of violence, traumata or abuse. To some people this might be the case even with simple things like attendance of school, a move or likewise. Of course it is only natural for a person confronted with a stressful event to feel sad, shocked or unable to understand what is happening.
However, if this reaction takes too long or does not stop at all or the reaction in itself is inadequate to the event thus leading to an increased impairment of the person concerned, this person needs professional help.
The reactions to life events can be manifold producing for instance restricted consciousness, decreased attention, disorientation, amnesia or depression, desperation, anxiety or aggression but also bodily symptoms like sweating, heart throbbing and blushing are common.If the reaction occurs immediately after the event and disappears fairly rapidly, this is called acute reaction to stress. This is a normal reaction. However, depending on the severity of the symptoms professional help may be needed for a short time.
Adjustment Disorder
Adjustment Disorder means that a normal reaction to stress starts as late as a month after the event and will continue up to six months. This still would be considered a normal reaction although also in these cases therapeutic help might be necessary.
Anxiety, Phobia, Panic Attacks
Fear is a feeling that everybody knows as being an entirely normal feeling. Fear usually is a reaction to a frightening situation such as a bank robbery or any other dangerous situation.
Normal fear turns into anxiety disorders or phobia when a fearful reaction occurs that does not correspond to the actual event, i.e. a situation that the majority of people would rate as not frightening at all, or if the anxiety reaction is so abnormally strong that the patient has the impression he is going to vomit, to faint, to die or to go insane.
Depression
Depression is a mental disease which may express itself by
1. subdued spirit
2. loss of interest
3. social retreat
4. feeling of guilt
5. reduced self-esteem
6. attention deficit disorders
7. sleeping disordersbut also by bodily symptoms like pain or paraesthesia. Depression shows various clinical pictures which makes it very difficult to come to quick conclusions. Whereas in former times depression was simply considered to be ill humour, over the last decades depression has become recognized as a very common and serious illness.
Dissociative Disorder (Conversions)
Traumatic events or seemingly unsolvable problems can lead to a psychic reaction known as conversion. The unsolvable problem is deferred resulting in disturbances which the person concerned can no longer trace back to the basic event.
The problem may be deferred to the following scopes:
- Psyche: this path may lead to amnesia, flight (fugue), stupor, trance, obsession, loss of identity
- Motor system: may lead to weakness, palsy, dystonia, disturbances in coordination and loss of hold
- Sensibility: may lead to paraesthesia, prickling and physical numbness
- Brain: may lead to epileptic-like fits
Eating Disorders
Eating disorders are conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual’s physical and mental health. Bulimia nervosa and anorexia nervosa are the most common specific forms of eating disorders. Other types of eating disorders include and OSFED. Bulimia nervosa is a disorder characterized by binge eating and purging. Purging can include self-induced vomiting, over-exercising, and the usage of diuretics, enemas, and laxatives. Anorexia nervosa is characterized by extreme food restriction to the point of self-starvation and excessive weight loss
PTSD – Post Traumatic Stress Disorder
PTSD – Post Traumatic Stress Disorder may remain for as long as six months after a traumatic event and may be prolonged for years. Typical criteria are:
- The recollection and reliving of the event, also in dreams.
- Avoidance of anything that might call back the event. This may lead to total social withdrawal.
- The feeling of mental numbness. Affects will diminish.
- Amnesia.
- General arousal, irritability, disturbance of concentration, anxious alertness, scariness, sleeping disorders.
PTSD – Post Traumatic Stress Disorder
Schizophrenia
The prevalence of schizophrenia is 0.7%. However, of the 24,000,000 sick people worldwide only about 50% are treated adequately. The majority of the maltreated patients live in developing nations. There are two kinds of symptoms – early symptoms which may exist years before the actual outbreak of schizophrenia – and main symptoms.
About 70% of the patients show early symptoms like alteration of experience and conspicuousness in conduct although to a small extent that it will not easily be brought into connection with early signs of schizophrenia.
Sleep Disorders
Sleep disorders are becoming a global problem these days. More and more patients come to our GNC Center in Dubai Healthcare City complaining “I can’t sleep!” “I’m always feeling tired”. Our neurologists at GNC know how to deal with these problems.
Sleep Disorder Definition
Sleep studies are of essential importance for all those (even children) suffering from sleep disorders (problems with initiating and maintaining sleep, snoring, sleeplessness, disturbed rhythm of sleep, somnambulism, etc.), since the various forms of sleep disorders may indicate some serious illness such as narcolepsy, an epilepsy related disease or respiratory failures during sleep such as sleep apnea. On the other hand, stress related or other psychiatric disturbances may cause sleep disorders or vice versa, just as inappropriate bedding.
For all these reasons it is of the utmost importance to analyze sleep and sleeping customs thoroughly in order to determine by aid of the neurologist the individually correct diagnosis and ensuing possibilities of treatment.
The sole application of sleeping drugs does not represent an ideal solution but may even be dangerous because it could lead to dependencies as unwanted side-effect.
Other methods, such as relaxation techniques or Cognitive Behavioural Therapy (CBT) will lead to sustained changes of habit and improvement of the sleep.
Close cooperation with ENT-Clinics even enables us to diagnose potentially life-threatening cases and together find the suitable kind of therapy such as CPAP (Continuous Positive Airway Pressure) or oxygen application.
Sleep Disorder Diagnostics (Polysomnography )
Thanks to modern technology, Polysomnography was discovered and is considered to be a powerful tool to diagnose sleep disorders. Polysomnography is a comprehensive recording of physiological changes that occur during sleep such as brain waves, oxygen level in the blood, heart rate and breathing rate as well as eye and leg movement. It is used to diagnose or rule out many types of sleep disorders, including Narcolepsy, Restless legs movements, REM behavior, Parasomnias and sleep apnea. This procedure is often requested or ordered for patients with frequent complaints of excessive daytime fatigue .nd severe sleepiness that may be caused by interrupted sleep.
How to Prepare for the Sleep Disorder Test
There are no major preparations necessary. The patient is advised not to take any sleep medicine or drink alcohol or caffeinated beverages prior to this test.
Risk factors of the Sleep Disorder Test
Polysomnography is a non invasive procedure. There is no risk, except maybe some skin irritation caused by the adhesive used to attach the sensors to the skin. It is therefore a fabulous procedure for children too.
Mechanism of the Sleep Disorder Test
Physiologic sensor leads are placed on the patient in order to record the following:
1. EEG (Electroencephalogram)
2. EOG (Electro-Occulogram)
3. EMG (Electromyogram)
4. ECG (Electrocardiogram)
5. Airflow (thermistor or thermocouple sensor)
6. Respiratory Effort (piezo crystal effort sensor)
7. Oxygen saturation (Pulse oximeter)
Procedure of the Sleep Disorder Test
1. AT A SLEEP LABORATORY OR HOSPITAL
For the standard test, the patient comes to a sleep lab in the early evening, and over the next 1–2 hours is introduced to the setting and “wiring up” so that multiple channels of data can be recorded when he/she falls asleep. The sleep lab may be in a hospital, or in a center. A sleep technician should always be in attendance and is responsible for attaching the electrodes to the patient and monitoring the patient during the study. She must explain to the patient about the procedure to keep the patient relaxed throughout the night.
The sleep laboratory should be equipped with video cameras in the patient’s room, so that the patient can be recorded while sleeping. This allows the technician to review the tape at any time during the test and verify whether strange looking waveforms were caused by an actual arousal, a period of wake, or normal patient movements in bed.
2. AT HOME
Nowadays, neurologists may carry out home studies to enhance patient comfort and reduce expenses, which is in the best interest of any patient. The patient is given thorough instructions as to how the screening tool is used. He will then use the equipment at home in his usual sleep surroundings and return it the next day.
Most screening tools consist of an airflow measuring device (thermistor) and a blood oxygen monitoring device (pulse oximeter). They are small and easy to handle and produce excellent graphs and other results.
At the German Neuroscience Center our neurologists follow this new path and provide patients with a tool they can easily apply at home rather than putting the patient into an awkward situation at the clinic because they realize that especially in Arabic countries with prayer times and similar rules to follow, it might be difficult for the patient to carry out a sleep study outside their homes.
The patient will sleep with the screening device for at least one up to several nights, and then return the device to the neurologist.
The neurologist will retrieve data from the device and can make assumptions based on the information given, for example, a series of drastic blood oxygen desaturations during night periods may indicate some form of respiratory event (apnea). At a minimum, the equipment will monitor the oxygen saturation.
Sleep Disorder Test Summary
Polysomnography (PSG) has proved to be a convincing tool for enhancing our understanding of sleep and its disorders. It is an essential diagnostic procedure to clarify the causes of sleep disorders thus enabling the neurologist to determine an appropriate form of treatment.
Ideally, and in accordance with international guidelines, sleep studies will be carried out by neurologists in close cooperation with an ENT specialist in such cases where first results point at a serious disease, as is standard at the German Neuroscience Center GNC.
Evaluation of sleep disorders must be made more readily available to the hundreds of thousands of patients with sleep disorders who still lack diagnosis and treatment. Lack of sleep or permanently disturbed sleep will lead to reduced concentration and failing personal efficiency. This will not only gravely affect the patients’ private lives but also their daily working capacity.
Sleep disorders, if not analyzed and left untreated, may lead to dangerous, even fatal, situations and social decline by, for instance, losing one’s job. Today, thanks to Polysomnography, nobody has to take such risks, since our neurologists, psychiatrists and psychologists at the German Neuroscience Center know of many ways how to treat sleep disorders adequately after having analyzed and diagnosed the causes thoroughly.
Soraya Waradij, B.Sc.
Neurophysiologist
German Neuroscience Center, DHCC, Dubai
References:
1. Collop NA, Anderson WM, Boehlecke B, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med . 2007;3:737-747.
2. Personal communication: Michael E. Garrison RSPGT, Supervisor Sleep Disorders Center KUMC.
3. Rechtschaffen, Allan. Kales, Anthony. A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. Brain Information Service/Brain Research Institute. UCLA Los Angeles, CA. 1986.
4. McDonough, James T. Stedman’s Concise Medical Dictionary. 2nd edition. Williams and Wilkins Publishers. Baltimore, MD. 1994.
5.Sheldon SH, Spire J-P, Levy HB. Pediatric Sleep Medicine. W.B. Saunders, Co. Philadelphia, PA. 1992.
6. G. Hayak E. Ruther, Insomnie Schalffosigkeit, 1995
Somatoform disorder
It happens every so often that patients complaining about bodily symptoms consult numerous doctors and specialists without getting a sufficient explanation for their problems nor remedies. Such patients are definitely ill, they will have pains, functional disorders or likewise and yet the highly developed modern medicine seems unable to help them.
Trying to find release, such patients will consult doctors at frequent intervals which is called “doctor hopping”. Or, after years of looking for medical professional help without any result, they will turn to alternative medicine. This kind of behaviour expresses the enormous pressure these patients are under.
The problem, however, lies in the logical deduction that in case of physical symptoms or pain the solution must be bodily. If one is suffering from diarrhoea or pain in the feet, of course the obvious choice would be a specialist for diarrhoea or pain in the feet.
© GNC, German Neuroscience Center Dubai (Neurology, Psychiatry, Psychology, Counseling, Dubai, UAE)
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