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The prevalence of akathisia is variably reported in the literature and its psychiatric impact is little studied. The aim of this study was to establish the prevalence, the associated factors, and the psychiatric impact of akathisia among patients undergoing antipsychotic treatment.A cross-sectional descriptive study was carried out at the Department of Psychiatry A, at Razi Hospital, in Tunis. It included patients with psychosis, undergoing antipsychotic treatment, from June 2016 to February 2017. Akathisia was diagnosed according to the Barnes Akathisia Scale.The prevalence of akathisia was 19.5% (n = 24, schizophrenia/schizoaffective disorder, n = 20; bipolar disorder, n = 4). The delay between the diagnosis of the disease and the onset of akathisia was 7.1 ± 8.8 years. Among the sample of patients with akathisia, 20/24 were on monotherapy of which 14 on conventional antipsychotics and six on atypical antipsychotics. Patients with akathisia were on atypical (8/24), low-potency conventional (4/24), or high-potency conventional (17/24) antipsychotics. The average dose of antipsychotics in chlorpromazine equivalent was 2294.5 ± 3037.7 mg. After adjusting for confounders, the only factor significantly positively associated with the diagnosis of akathisia was the dose of antipsychotics prescribed ( P = 0.01). The following psychiatric manifestations were reported by patients with akathisia: dysphoria/irritability (16/23), anxiety (18/24), sadness (15/24), suicidal thoughts (11/24), heteroaggressivity (8/23), sleep disturbances (16/24), and suicidal attempts (9/24).Despite the high psychiatric and social burden of akathisia, it remains largely underdiagnosed and undertreated, because in part of its subjective component.

As the global vaccination mass campaign against COVID-19 extended to children aged 5 to 11 years, some parents remained hesitant about their children being administered the vaccine despite data supporting its safety. Parent vaccine hesitancy (PVH) may have predisposed certain groups of children, particularly those with autism spectrum disorder (ASD), to COVID-19 when other neurotypical children would have been vaccinated. We investigated the current PVH in 243 parents of children with ASD and 245 controls using the Parent Attitudes about Childhood Vaccines (PACV) scale. The study was conducted in Qatar from May to October 2022. Overall, 15.0% [95% CI 11.7%; 18.3%] of parents were vaccine-hesitant, with no difference (p = 0.054) between groups (ASD children [18.2%] vs. controls [11.7%]). The only sociodemographic factor associated with higher vaccine hesitancy was being a mother (as compared to being a father). The COVID-19 vaccine receipt rate at the time of the study did not differ between ASD (24.3%) and non-ASD groups (27.8%). Around two-thirds of parents of children with ASD refused or were unsure about vaccinating their children against COVID-19. We found that the intent to vaccinate against COVID-19 was higher in parents who were married and in those with a lower PACV total score. Continued public health efforts are needed to address vaccine hesitancy among parents.

Background Suicide is a serious public health problem. Aims To investigate the sociodemographic and clinical features of callers (patients) classed by the Qatar National Mental Health Helpline (NMHH) as moderate to high priority based on the risk of self-harm or suicide during the COVID-19 pandemic. Method The study design was a retrospective chart review of patients who contacted the helpline in the first 12 months, starting 1 April 2020. Data of those classed as moderate to high priority based on risk to self were collected using a specifically designed form. Absolute and relative frequencies for each of the studied categorical variables were determined. Results Four hundred and ninety-eight patients were included. More than half were female. The mean age was 32 years (range 8–85 years). Two-thirds of patients were from Arab countries and more than half of all patients had contacted mental health services for the first time. The most common symptoms elicited included suicidal thoughts, depressed mood and disturbed sleep. The most common psychiatric disorders were depression and generalised anxiety disorder. Most patients were seen within 4 h and received psychiatric interventions. Virtually all patients received non-pharmacological interventions; only 38.5% received pharmacological interventions. The majority had follow-up appointments arranged with mental health services. Conclusions People from the Indian subcontinent and males proportionally approached services less, which may reflect stigma. The NMHH improved access to care for patients considered at risk to self and prevented hospital admissions. The NMHH offers a valuable additional choice to patients and assists in prevention and management of suicidal behaviour and other mental health difficulties.

Background The policies on resident supervision in the psychiatry training program at Hamad Medical Corporation (HMC), Qatar, meet the requirements of the Accreditation Council of Graduate Medical Education-International (ACGME-I). The psychiatry department has mandated one-hour weekly supervision of residents. Unlike clinical supervision, little is known about how residents perceive individual supervision and its impact on their training. The purpose of this study was to explore psychiatry residents’ feedback on weekly individual supervision, focusing on frequency, content, and perceived quality. Results We conducted an anonymous survey among all residents in the psychiatry department of HMC, exploring the number and content of individual supervision sessions received during the previous six months, and their satisfaction with supervision provided. Out of 25 residents, 20 responded to the survey. The results showed that 95% (n=19) of those who responded had received some form of supervision during the previous six-month period, 15% (n=3) had it consistently on a weekly basis, and only 5% (n=1) received no supervision at all. “Topics selected by the resident and/or the supervisor” was the most frequently provided response by the residents to highlight the content of supervision. The percentage of residents satisfied was proportional to the number of individual supervision sessions received. Conclusions Action must be taken to improve the standard of individual supervision to include training of faculty, time protection during supervision, and ongoing support from program leadership.

The present study examined performance in Theory of Mind (ToM) in a group of 31 Arabic-speaking verbal children (7–12 years-old) with autism spectrum disorder (ASD), in comparison with neurotypical controls (NT) matched for age and for cognitive abilities. An innovative task in a digital format named “The Tunisian Social Situations Instrument” (TSSI) was used and allowed us to study four different subdomains of ToM: attribution of intention and epistemic ToM (cognitive ToM), affective ToM, and detection of faux pas (advanced ToM). Our study showed impairments in ToM in children with ASD, similar to those reported in the literature. Our findings additionally suggested that affective and advanced ToM, specifically the detection of faux pas, might be more challenging for ASD children than other components of ToM. Future studies with larger number of children may lead us to specify which subdomains are the most impaired in order to develop specific tools targeting these specific impairments.

Neuropsychiatric symptoms are important treatment targets in the management of dementia and can be present at very early clinical stages of neurodegenerative diseases. Increased cortisol has been reported in Alzheimer's disease (AD) and has been associated with faster cognitive decline. Elevated cortisol output has been observed in relation to perceived stress, depression, and anxiety. Dehydroepiandrosterone sulfate (DHEAS) has known anti-glucocorticoid effects and may counter the effects of cortisol.We aimed to examine whether CSF cortisol and DHEAS levels were associated with (1) neuropsychiatric symptoms at baseline, (2) changes in neuropsychiatric symptoms over 3 years, and (3) whether these associations were related to or independent of AD pathology.One hundred and eighteen participants on a prospective study in a memory clinic setting, including patients with cognitive impairment (n = 78), i.e., mild cognitive impairment or mild dementia, and volunteers with normal cognition (n = 40), were included. Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory Questionnaire (NPI-Q). CSF cortisol and DHEAS, as well as CSF AD biomarkers, were obtained at baseline. Neuropsychiatric symptoms were re-assessed at follow-up visits 18 and 36 months from baseline. We constructed linear regression models to examine the links between baseline neuropsychiatric symptoms, the presence of AD pathology as indicated by CSF biomarkers, and CSF cortisol and DHEAS. We used repeated-measures mixed ANCOVA models to examine the associations between the neuropsychiatric symptoms' changes over time, baseline CSF cortisol and DHEAS, and AD pathology.Higher CSF cortisol was associated with higher NPI-Q severity scores at baseline after controlling for covariates including AD pathology status (B = 0.085 [0.027; 0.144], p = 0.027; r = 0.277). In particular, higher CSF cortisol was associated with higher baseline scores of depression/dysphoria, anxiety, and apathy/indifference. Elevated CSF cortisol was also associated with more marked increase in NPI-Q scores over time regardless of AD status (p = 0.036, ηHigher CSF cortisol may reflect or contribute to more severe neuropsychiatric symptoms at baseline, as well as more pronounced worsening over 3 years, independently of the presence of AD pathology. Our findings also suggest that interventions targeting the HPA axis may be helpful to treat neuropsychiatric symptoms in patients with dementia.

Older individuals are more vulnerable to severe coronavirus disease 2019 and medical complications. Vaccination stands as an efficient and safe vanguard against infection. However, negative attitudes and perceptions pertaining to available vaccines might hinder community inoculation. The aim of this study was to assess vaccine hesitancy and its psychosocial determinants among the elderly in Qatar. We conducted a cross-sectional study between October 15 and November 15, 2020, using a composite online survey including the Vaccine Attitudes Examination Scale in addition to questions on sociodemographic correlates and the role of healthcare professionals. The vaccine hesitancy rate was 19.5%. The main reasons for willingness to vaccinate included understanding the nature of disease and role of vaccination, in addition to information provided by physicians. Fears mainly centered around vaccine safety. Vaccine hesitators were more likely to be non-Qatari and having received the influenza vaccine at least once. Gender, marital status, socioeconomic status, educational level, and having completed childhood vaccinations were not associated with vaccine hesitancy. Efforts should be directed toward raising awareness of vaccine efficacy and safety profiles. Physicians should additionally be educated about their pivotal role in advocating vaccine acceptance. We recommend reassessing vaccine hesitancy and its associated factors following a year of campaigning and vaccine administration to identify and target vulnerable groups.

SUMMARYNeuroleptic malignant syndrome (NMS) is a rare and potentially fatal adverse reaction to drugs. In psychiatric practice, it is mainly associated with antipsychotics. The classic presentation is that of hyperpyrexia, muscle rigidity, mental state changes and autonomic instability. Subtle forms are difficult to recognise owing to symptom overlap with other conditions. This article discusses the clinical presentation of the syndrome, its differential diagnosis and use of supportive care, medication and electroconvulsive therapy in its treatment. It also explores prevention of NMS and reinstatement of treatment after an episode. It is stressed that all but the mildest forms of NMS should be considered a medical emergency that is properly managed in an acute hospital.

Autism spectrum disorders (ASDs) are a group of neurodevelopmental disorders defined by a deficit in social interactions and the presence of restricted and stereotypical behaviors or interests. The etiologies of autism remain mostly unknown. Many genetic and environmental factors have been suspected. Among these environmental factors, exposure to several chemical elements has been previously studied. The purpose of this study was to compare the levels of trace elements in the blood plasma of children with ASD with typically developed children (TDC). The participants in this study consisted of 89 children with ASD (14 girls and 74 boys) and 70 TD children (29 girls and 41 boys). The levels of 33 chemical elements have been analyzed by inductively coupled plasma spectrometry (ICP-MS). We detected significant differences in the levels of eight elements between the two groups, among which there were three rare earth elements (REEs): Eu, Pr, and Sc (p = 0.000, p = 0.023, and p

Background Pathologic changes in cerebral and retinal structures governing the pupillary light reflex occur in Alzheimer's disease (AD). Analysis of pupillary responses originating from different retinal cells may allow for non-invasive detection of cerebral AD pathology. Objective This study aimed to quantify the pupil light reflex using a portable chromatic pupillometer in patients with early stage AD and compare their responses to those of a healthy control group. Methods Participants in this case-control pilot study were recruited from a well-characterized cohort of elderly people participating in a larger prospective study on early AD. Cognitive testing, volumetric brain imaging, and lumbar puncture were performed in all participants to define two groups: early AD, i.e., cognitively impaired subjects with biomarker-confirmed AD pathology, and control group of subjects with normal cognition and normal CSF biomarker profile. Pupil responses to red and blue light stimuli intended to activate cone photoreceptors and melanopsin ganglion cells were recorded under photopic conditions. Results Sixteen patients with AD (mean age 77 years) and sixteen controls (mean age 71 years) were tested. Baseline pupil size was significantly smaller in AD patients. Pupillary contraction amplitude to all red and blue lights was also smaller in AD patients but did not reach statistical significance. The post-illumination pupillary response was the same between the two groups. Conclusion Compared to healthy controls, we found only a smaller resting size of the pupil in patients with early AD. The pupillary dynamics to light stimulation remained relatively preserved.

Reducing stigma among mental health and health professionals has been an ultimate priority in many countries worldwide. This study aimed to evaluate the effectiveness of a four-session educational intervention for reducing stigma of mental illness targeting family medicine trainees in Tunisia. A quasi-experimental design was adopted with an intervention group (N = 51) and a control group (N = 56). Pre-intervention data were collected using an online survey. A four-session seminar series was implemented and organized. Post-intervention data were collected immediately after the end of the intervention then 2 months thereafter. Instruments included Attribution Questionnaire (AQ-27), Self-Determination Scale (SDS), Empowerment Scale (ES), and Recovery Scale (RS). Repeated measures analysis of covariance and multiple analysis of covariance tests were carried out. Results revealed that the intervention had moderate effects on the AQ-27 score and on six of its stigma factors including factors of the dangerousness model. The intervention improved SDS score, but not ES or RS scores. Positive effects were observed immediately after the intervention and 2 months thereafter. Regular implementation of educational programs in clinical practice would be beneficial. Developing other anti-stigma methods is needed to address the concepts of recovery and responsibility of patients with mental illness.

BackgroundSchizophrenia (SZ) and bipolar disorder (BD) share many features: overlap in mood and psychotic symptoms, common genetic predisposition, treatment with antipsychotics (APs), and similar metabolic comorbidities. The pathophysiology of both is still not well defined, and no biomarkers can be used clinically for diagnosis and management. This study aimed to assess the plasma proteomics profile of patients with SZ and BD maintained on APs compared to those who had been off APs for 6 months and to healthy controls (HCs).MethodsWe analyzed the data using functional enrichment, random forest modeling to identify potential biomarkers, and multivariate regression for the associations with metabolic abnormalities.ResultsWe identified several proteins known to play roles in the differentiation of the nervous system like NTRK2, CNTN1, ROBO2, and PLXNC1, which were downregulated in AP-free SZ and BD patients but were “normalized” in those on APs. Other proteins (like NCAM1 and TNFRSF17) were “normal” in AP-free patients but downregulated in patients on APs, suggesting that these changes are related to medication's effects. We found significant enrichment of proteins involved in neuronal plasticity, mainly in SZ patients on APs. Most of the proteins associated with metabolic abnormalities were more related to APs use than having SZ or BD. The biomarkers identification showed specific and sensitive results for schizophrenia, where two proteins (PRL and MRC2) produced adequate results.ConclusionsOur results confirmed the utility of blood samples to identify protein signatures and mechanisms involved in the pathophysiology and treatment of SZ and BD.

Objectives Infection control measures during the Covid-19 pandemic have focused on limiting physical contact and decontamination by observing cleaning and hygiene rituals. Breastfeeding requires close physical contact and observance of hygienic measures like handwashing. Worries around contamination increase during the perinatal period and can be expressed as increase in obsessive compulsive symptoms. These symptoms have shown to impact breastfeeding rates. This study attempts to explore any relationship between the Covid-19 pandemic and perinatal obsessive–compulsive symptomatology and whether the Covid-19 pandemic has any impact on intent to breastfeed. Methods A cross sectional survey of perinatal women attending largest maternity centre in Qatar was carried out during the months of October to December 2020. Socio-demographic information, intent to breastfeed and information around obsessive compulsive thoughts around Covid-19 pandemic were collected using validated tools. Results 15.7% respondents report intent to not breastfeed. 21.4% respondents reported obsessive–compulsive symptoms. 77.3% respondents believed the biggest source of infection was from others while as only 12% of the respondents believed that the source of infection was through breastfeeding and 15.7% believed the vertical transmission as the main source of risk of transmission. Conclusions The rates of Obsessive–compulsive symptoms were increased and the rates of intent to breastfeed were decreased when compared with pre pandemic rates. The obsessive–compulsive symptoms and the intent to not breastfeed were significantly associated with fear of infection to the new-born. Obsessive–compulsive symptoms were not significantly correlated with intent to breastfeed and can be seen as adaptive strategies utilized by women to continue breastfeeding in the context of fear of infection.

Background: The coronavirus disease-2019 (COVID-19) pandemic has imposed an unprecedented strain on healthcare systems worldwide. In response, psychiatrist trainees were redeployed from their training sites to help manage patients with COVID-19. This study aimed to examine the attitude of psychiatrist trainees toward redeployment to COVID-19 sites and their perceived preparedness for managing physical health conditions during redeployment. Methods: A cross-sectional researcher-developed online survey was administered among psychiatrist trainees in May 2020 at the Department of Psychiatry, Hamad Medical Corporation, Qatar. Results: Of the 45 psychiatrist trainees, 40 (88.9%) responded to the survey. Most trainees reported being comfortable dealing with chronic medical conditions, but less so with acute life-threatening medical conditions. Half reported feeling anxious about redeployment, and most felt the need for additional training. We found that trainees’ perceived redeployment preparedness was significantly associated with their level of postgraduate training and the time since and duration of their last medical or surgical training. Conclusion: Adequate preparation and training of psychiatrist trainees is important before redeployment to COVID-19 sites to ensure that they can effectively and safely manage patients with COVID-19.

Background: Many studies have shown a high prevalence of depression, anxiety, and stress symptoms in COVID-19 patients and the general population. However, very few studies directly examined the potential impact on the health-related quality of life (HRQoL), and none compared HRQoL in COVID-19 patients to the general population amid the pandemic.Methods: We carried out a cross-sectional study comparing HRQoL (as measured using the RAND Short Form 36 or SF-36 Health Survey) in randomly selected individuals from three different groups: hospitalized COVID-19 patients, quarantined COVID-19 patients, and controls from the general population in Qatar. We constructed a multivariate analysis of covariance (MANCOVA) to compare the SF-36 scores between the three groups and control for various covariates.Results: Our sample consisted of 141 COVID-19 inpatients, 99 COVID-19 quarantined patients, and 285 healthy controls. Surprisingly, we found that HRQoL was higher in COVID-19 hospitalized than in COVID-19 non-hospitalized patients than in controls. The main components where COVID-patients scored higher than controls were physical functioning and role limitations due to emotional problems. In COVID-19 patients, the female gender, older age, and past psychiatric history were associated with lower HRQoL.Conclusions: It seems that COVID-19 patient's HRQoL might be better than expected. Our results can be explained by social support from family and friends, easy access to mental health screening and care, and a possible change of perspectives after recovery from COVID-19, resulting in psychological growth and enhanced resilience.

Recent advances in information technology (IT) provided us with novel teaching solutions, with the potential of a new enhanced learning experience, that is, more adapted to the needs and preferences of the younger generations of psychiatric trainees. These tools include the use of online/virtual whiteboards, live surveys/polls, live quizzes, virtual classrooms, and virtual reality. In the present paper, we describe the implementation of modern technology in psychiatric training in Tunisia, a North-African middle-income country. We discuss the potential benefits arising from this implementation, and we report the challenges and difficulties. Overall, the implementation of these modern technology-based tools in psychiatric training has been successful, with a very few obstacles. It seems that the integration of these novel approaches is possible even in middle and low-income countries without much hassle. These tools can enhance trainees' participation, motivation, and engagement, thereby potentially improving learning outcomes. Most disadvantages are related to potential technical glitches, and are likely to improve as technology progresses. Teaching is the art of tailoring the educational tools to the learning objectives and to the learners' characteristics and preferences. To achieve optimal learning outcomes, it is often needed to use a mixture of different "modern" and "less modern" techniques.

Background: Facial expressions transmit information about emotional state, facilitating communication and regulation in interpersonal relationships. Their acute recognition is essential in social adaptation and lacks among children suffering from autism spectrum disorders. The aim of our study was to validate the “Recognition of Facial Emotions: Tunisian Test for Children” among Tunisian children in order to assess facial emotion recognition in children with autism spectrum disorders (ASD).Methods: We conducted a cross-sectional study among neurotypical children from the general population. The final version of or test consisted of a static subtest of 114 photographs and a dynamic subtest of 36 videos expressing the six basic emotions (happiness, anger, sadness, disgust, fear and surprise), presented by actors of different ages and genders. The test items were coded according to Ekman’s “Facial Action Coding System” method. The validation study focused on the validity of the content, the validity of the construct and the reliability.Results: We included 116 neurotypical children, from 7 to 12 years old. Our population was made up of 54 boys and 62 girls. The reliability’s study showed good internal consistency for each subtest: the Cronbach coefficient was 0.88 for the static subtest and 0.85 for the dynamic subtest. The study of the internal structure through the exploratory factor analysis of the items of emotions and those of intensity showed that the distribution of the items in sub-domains was similar to their theoretical distribution. Age was significantly correlated to the mean of the overall score for both subtests (p < 10–3). Gender was no significantly correlated to the overall score (p = 0.15). High intensity photographs were better recognized. The emotion of happiness was the most recognized in both subtests. A significant difference between the overall score of the static and dynamic subtest, in favor of the dynamic one, was identified (p < 10–3).Conclusion: This work provides clinicians with a reliable tool to assess recognition of facial emotions in typically developing children.

Background The mental health burden of COVID-19 has been examined in different settings. Existing research has relied on the latent variable model in assessing COVID-19-related distress. Network theory provides an alternative framework wherein symptoms are conceptualised as causal, interconnected constituents rather than outcomes of mental disorders. Aims To assess networks of self-reported anxiety and depressive symptoms among quarantined individuals. Method Consenting individuals in different quarantine centres in Qatar completed the Patient Health Questionnaire Anxiety and Depression Scale. We used partial correlation network methods to illustrate interactions of self-reported psychopathology. Results Participants with COVID-19 were significantly older and had a significantly higher proportion of males. The most central node was COVID-19, followed by thoughts of self-harm. COVID-19 status was strongly positively connected to thoughts of self-harm, which was positively connected to psychomotor changes, which were connected to decreased concentration. COVID-19 status was also positively connected to feeling anxious, which was strongly connected to inability to concentrate, which was connected to feeling afraid. Conclusions COVID-19 was the most influential factor, with the highest number and strength of connections to psychopathology in a network of anxiety and depressive symptoms in a quarantine setting. Beyond the resolution of the infection, therapeutic interventions targeting psychomotor changes might prove beneficial in reducing suicidality among quarantined individuals with COVID-19. Follow-up with mental health services after COVID-19 infection is needed to restore psychological well-being. Further research is needed to understand the short- and long-term psychological effects of COVID-19, and the outcomes of different therapeutic interventions.

Objective Pivotal clinical trials revealed good clinical efficiency of ocrelizumab while having a good safety profile in the management of multiple sclerosis (MS). However, real-world data of ocrelizumab in daily clinical practice remain scarce. The aim of this study was to evaluate the preliminary safety profile and effectiveness of ocrelizumab treatment for MS in an Arab population in a real-world clinical setting. Methods In this retrospective single-center observational study in Qatar, we reviewed the medical records and analyzed the clinical and MRI data of all patients with relapsing-remitting MS (RRMS) and active secondary progressive MS (aSPMS)—between October 2017 through December 2020—who had received at least one infusion of ocrelizumab (Q-OCRE). Results A total of 60 MS patients were included (57 with RRMS, three SPMS). The Median follow-up period was 19 months (range, 1–32). The most common reason for switching to ocrelizumab was increased disease activity and three-quarters of the patients were on a previous disease-modifying drug (DMD). No evidence of disease activity (NEDA) status at year 1 was achieved in 73% of the cohort. Mild infusion-related reactions (IRR) and infections were reported (mainly upper respiratory tract infections followed by urinary tract infection) with a declining percentage over the follow-up applications. No severe side effects were observed. Conclusion Our real-world experience confirms good efficacy, tolerability, and safety of ocrelizumab in our Arab population.

Thyroid abnormalities are documented consequences of quetiapine treatment. This may have clinical implications as changes in thyroid hormones may deteriorate a person's affective state. Yet less is known about the clinical factors and underlying mechanisms associated with thyroid hormones on quetiapine therapy. We therefore systematically reviewed the published literature of evidence of quetiapine-induced thyroid abnormalities. We searched MEDLINE, PsycINFO, Google Scholar, and EMBASE for articles in which individuals developed biochemically confirmed thyroid abnormalities (with or without clinical symptoms) while on quetiapine treatment. We included case reports, case series, observational, and experimental studies. We included 32 studies, 20 of which were observational and experimental studies. There were 10 case reports and 1 case series. All the research designs suggested an association between quetiapine and hypothyroidism. However, these findings were limited by the quality of the included studies and the general lack of either a clear temporal relationship or dose response. Quetiapine has been associated with thyroid abnormalities, mainly with hypothyroidism. Drug imputability in these abnormalities is not always clear, and the underlying pathophysiology may include immunological and nonimmunological mechanisms. Large prospective studies are required to clarify this association and to further inform the management of patients treated with quetiapine where hypothyroidism occurs.

BackgroundThe ongoing pandemic has led to a global surge in coronavirus disease 2019 (COVID-19)-related mental health research. However, most related publications come from Western countries or China, and their findings cannot always be extrapolated to Arab countries.AimsThis study provides a quantitative and qualitative analysis of mental health research pertaining to Arab countries' response to the COVID-19 pandemic.MethodsA scoping review of the World Health Organization (WHO) COVID-19 database for publications on mental health was conducted by authors affiliated with Arab institutions, including articles from inception to 24 October 2020. The included publications were evaluated for their national distribution, international collaboration, publication type, and main research themes. Methodological quality analysis of the included research studies was performed using the original and modified versions of the Newcastle–Ottawa Scale.ResultsIn total, 102 articles were included in this study, averaging 4.6 articles per Arab country. Most of the articles emerged from the Kingdom of Saudi Arabia, Jordan, and Egypt. A majority of publications demonstrated international collaboration. Most of the publications were original research studies and cross-sectional in design. The predominant research theme was examining the pandemic’s mental health effects on the general population and healthcare workers. Only 28.0% of the studies were of high methodological quality, whereas 41.5% were moderate and 30.5% were low in quality.ConclusionsMental health research in response to the COVID-19 pandemic in the Arab region has quantitative and qualitative shortfalls. Arab institutions need to respond to the pandemic promptly in order to address the delineated research gap and to generate higher-quality research output.

A multitude of research on facial emotion recognition (FER) in Autism Spectrum Disorders (ASD) have been published since several years. However, these studies have mainly used static high intensity stimuli, including adult and/or children facial emotions. This current study investigated FER in children with ASD using an innovative task, composed of a combination of static (114 pictures) and dynamic (36 videos) subtests, including children, adolescent, and adult male and female faces, with high, medium, and low intensity of basic facial emotions, and neutral expression. The ASD group consisted of 45 Tunisian verbal children, and the control group consisted of 117 tunisian typically developing children. Both groups were aged 7–12 years. After adjusting for sex, age, mental age, and school grade, the ASD group scored lower than controls on all tests except for the recognition of happiness and fear in the static subtest, and the recognition of happiness, fear, and sadness in the dynamic subtest (p ≥ 0.05). In the ASD group, the total score of both the static and the dynamic subtest were positively correlated with the school grade (p < 0.001), but not with age, or mental age. Children with ASD performed better in recognizing facial emotions in children than in adults and adolescents on videos and photos (p < 0.001). Impairments in FER would have negative impact on the child's social development. Thus, the creation of new intervention instruments aiming to improve emotion recognition strategies at an early stage to individuals with ASD seems fundamental.

Background The COVID-19 outbreak has caused challenges for healthcare systems worldwide. Recent data indicates that the psychological impact has differed with respect to occupation. In many countries, medical residents have been on the front line of this pandemic. However, data on the psychological impact of infectious disease outbreaks, and COVID-19 in particular, on medical residents are relatively lacking. Aims The aim of our study was to assess the psychological impact of the COVID-19 pandemic on medical residents working on the front and second line. Method An electronic survey was sent to all medical residents in Qatar. Depression, anxiety and stress were assessed by the Depression, Anxiety and Stress Scale – 21 Items. Professional quality of life was measured by the Professional Quality of Life measure. Results Of the 640 medical residents contacted, 127 (20%) responded. A considerable proportion of residents reported symptoms of depression (42.5%), anxiety (41.7%) and stress (30.7%). Multivariate analysis of variance showed significant effects of seniority in residency, with junior residents having poorer outcomes. In addition, there was a statistically significant interaction effect with moderate effect sizes between gender and working on the front line, as well as gender, working on the front line and seniority, on mental health outcomes. Conclusions The COVID-19 pandemic may have a negative impact on junior residents’ mental health. Preventive measures to reduce stress levels and easy access to professional mental health services are crucial.

For frontline healthcare workers (FHW) who are working with Coronavirus Disease-19 (COVID-19) patients, PPE is currently considered as one of the most discussed topics. Recommendation from international organizations concerning the use of PPE are broadly consistent but equipment use is not. No previous studies examined the use of PPE in Tunisia.Evaluate the availability of personal protective equipment(PPE) in addition to the reality and perception regarding personal safety in workplace.We carried out a cross-sectional survey from 15th April to 5th May 2020 across public and private institutions in Tunisia. A 33-item structured questionnaire was developed and administered to FHWs.We received 723 responses. We found that there was a likely overuse of PPE in addition to a high rate of side effects caused by PPE.Additional training in PPE use might be useful, and sessional work should be considered to decrease the side effects associated with PPE use.

Background: Major Depressive Disorder (MDD) requires therapeutic interventions during the initial month after being diagnosed for better disease outcomes. International guidelines recommend a duration of 4-12 weeks for an initial antidepressant (IAD) trial at an optimized dose to get a response. If depressive symptoms persist after this duration, guidelines recommend switching, augmenting, or combining strategies as the next step. Premature discontinuation of IAD due to ineffectiveness can cause unfavorable consequences. Hence, we aimed to determine the prevalence and the patterns of strategies applied after an IAD was changed because of a suboptimal response as a primary outcome. Secondary outcomes included the median survival time on IAD before any change; and the factors that were associated with IAD change.Methods: This was a retrospective study conducted in Mental Health Services in Qatar. A dataset between January 1, 2018, and December 31, 2019, was extracted from the electronic health records. Inclusion and exclusion criteria were defined and applied. The sample size was calculated to be at least 379 patients. Descriptive statistics were reported as frequencies and percentages, in addition, to mean and standard deviation. The median time of IAD to any change strategy was calculated using survival analysis. Associated factors were examined using three cox regression models.Results: A total of 487 patients met the inclusion criteria of the study, 431 (88%) of them had an occurrence of IAD change to any strategy before end of the study. Almost half of the sample (212 (49%); 95% CI [44% - 53%]) had their IAD changed within less than or equal to 30 days. The median time to IAD change was 43 days with 95% CI [33.2 – 52.7]. Cox regression analysis showed three statistically significant factors were associated with our secondary outcome: age, un-optimization of the dose, and absence of comorbid anxiety.Conclusions: Our findings suggest that clinicians resorted to IAD change within a median time of six weeks. However, this change often occurred without optimization of the IAD dose and might be too late. Future prospective studies with adequate randomization can better investigate the median survival time on IAD and other associated factors.

BackgroundPatients with schizophrenia are at least twice as likely to develop diabetes mellitus compared to the general population. This is of significance in Qatar given the high prevalence of obesity and diabetes. Furthermore, the lifespan of people with schizophrenia and diabetes is shortened by approximately15 years due to long-term microvascular and macrovascular complications. High quality diabetes care can significantly reduce morbidity and mortality. We assessed the level of diabetes care delivered to patients with schizophrenia and diabetes compared to those with diabetes alone.MethodsWe performed a retrospective chart review of patients with diabetes mellitus with (n=73) and without (n=73) schizophrenia. Demographic information and electronic medical records were reviewed for 6-month and 1-year American Diabetic Association standards of diabetes care. Optimal diabetes care was defined as having completed glycated hemoglobin (HbA1c), lipid profile and retinal examination within 12 months. ResultsOptimal diabetes care was significantly lower in patients with schizophrenia and diabetes compared to diabetes alone [26.0% (n=19/73) vs 52.1% (n=38/73), p=0.002]. Patients with diabetes and schizophrenia were also significantly less likely to have had body mass index recorded within six months (p=0.008) and HbA1c (p=0.006), lipid profile (p=0.015), estimated glomerular filtration rate (eGFR) (p=0.001) and order for retinal screening (p=0.004) over 12 months. After adjusting for multiple comparisons, only assessment of eGFR (p=0.01) and order for retinal screening (p=0.04) remained significant. ConclusionPatients with schizophrenia and diabetes in Qatar receive sub-optimal diabetes care compared to those with diabetes alone.

Autism is a multifactorial disease with multiple etiologic hypotheses. Some studies suggest changes in brain GABA mediated inhibition in autism, and a higher intracellular chlorine levels in autistic children. Given these data, clinical trials are conducted to test the efficacy of diuretics in improving clinical symptoms in autism.The aim of our study was to evaluate the effectiveness of Bumetanide in autistic children.This is an experimental study of cross-type. We included children older than 5 years, with autistic disorder according to the diagnostic criteria of DSM- IV (Diagnostic and Statistical Manual of Mental Disorders, IV) and ADI-R (Autism Diagnostic Interview Revised), followed by the child psychiatry consultation Razi hospital. The subjects underwent assessment using the ADI-R, the behavioral scale CARS (Childhood autistic rating scale) and CGI (Clinical Global printing) prior to take diuretic (Bumetanide). In the protocol, the children received checks to day7, day14, day30, day60, day90 comprising: a clinical evaluation (weight gain, blood pressure, general examination for potential adverse effects); biological evaluation; and evaluations by scales (CARS and CGI) after every 3 months of evolution to objectively assess effectiveness.Twenty-nine children were included in our study. The average age was 7.9 years.Initiation of medication was carried out with a dose of 1 mg / day, in all children. The average duration of the protocol was 12 months. Sixteen children were excluded from the study for the following reasons: appearance of hypokalemia, poor tolerance of treatment, insufficient efficacy as estimated by parents. Measuring the effectiveness of diuretic, by studying correlations in the CARS showed an efficacy of this treatment at 3 months (p˂10-3), 6 months (p˂10-3), at 9 months (p = 0.010) and 12 months (p = 0.04), and this compared to the initial assessment. Significant improvement (p˂10-3) was found between the 3rd and 6th month.While our results seem to be promising. A larger sample and a medium and long-term evaluation after the end of treatment are needed.

Introduction: Corona Virus Disease 2019 (COVID-19) quarantine has been associated with depression, anxiety, and stress symptoms. We hypothesize these symptoms might even be more pronounced in the elderly, who may be particularly sensitive to social isolation. However, certain individuals might be more resilient than others due to their coping mechanisms, including religious coping. Objectives: We aimed to examine the levels of perceived stress, depressive, and anxiety symptoms in older adults under COVID-19 quarantine in Qatar; and to identify the sociodemographic, psychological, and clinical factors associated with mental health outcomes, with a focus on the role of resilience, and religiosity. Methods: A cross-sectional study assessing depressive, anxiety, and stress symptoms as well as resilience, and religiosity through a phone survey in adults aged 60 years or more under COVID-19 quarantine in the State of Qatar, in comparison to age and gender-matched controls. Results: The prevalence of depressive, anxiety, and stress symptoms in elderly subjects under COVID-19 quarantine in Qatar was not significantly different from the prevalence in gender and age-matched controls. In the quarantined group, higher depressive, anxiety, and stress scores were associated with the female gender and with lower resilience scores but were not linked to age, psychiatric history, medical history, duration of quarantine, or religiosity. Conclusion: The elderly population does not seem to develop significant COVID-19 quarantine-related psychological distress, possibly thanks to high resilience and effective coping strategies developed through the years.

Background: CANMAT 2018 guidelines identify two phases of Major depressive disorder (MDD) treatment: an acute phase (getting to symptomatic remission), and a maintenance phase (preventing relapse and recurrence). CANMAT recommends increasing the antidepressant dose for non-improvers at 2 to 4 weeks if the medication is well- tolerated. If a poor response to initial Antidepressant (IAD) after 4 weeks, clinicians may opt to step 2 in treatment algorithms such as switching, augmentation, combination strategies,etc. There is substantial evidence from our practice that many patients receive inadequate duration of treatment trial (less than 4 weeks before going to step 2 in treatment). The clinician should then consider treatment issues that may affect the clinical response. Primary outcome: To evaluatetime (in Days) between initiation of antidepressant monotherapy and any change strategy such asswitching, combinationand/or augmentation of pharmacotherapy as a result of suboptimal response to initial therapy at physicians documentation. Method: A 12- month audit was initiated in a mental health hospital, HMC, Qatar. Data were collected retrospectively for the 12 months preceded the approval of the audit. Patients were eligible to be included if they werefemale or male aged between 18 and 65 years (inpatients and outpatients) diagnosed with an episode of major depression as diagnosed under (ICD-10, Version 2010) initially treated with a single antidepressant (using a flexible dosage regimen if required) and for whom initial treatment changed/ modified because of a suboptimal response at physicians documentation, which is clearly documented in the patients medical chart. Exclusion criteria were patients who had depression with psychotic features, or if they were pregnant women. Descriptive statistics were applied to the primary and secondary outcomes. Results: A total of 70 patients were included in this study. 60% were females and 40% were males. Median time to any change strategy was 50.5 days. 44.3% (n=31) of the sample has at least one change strategy of their initial antidepressant that occurred Less than 4 weeks.The main change in pharmacological management after a suboptimal response was switching (47%) followed by augmentation (27%). The most prevalent pharmacological classes that used for augmentation were antipsychotics (52%) then antidepressants (29%). Quetiapine and olanzapine were on thetop medications used. Conclusion: Changing treatment in less than 4 weekswas observed in 44% of the sample, which represents rather poor compliance to the international guidelines. Higher sample size is required to avoid variability and increase reliability of the results. Our future plan is to present the results in CME series of lectures focusing on MDD to highlight the gap between the current practice and the international guidelines. The project sponsor will share the results with policymakers to develop facility guidelines for MDD treatment.

Elevated cortisol levels have been associated with poorer cognitive performance in cross-sectional studies; this may be both a factor contributing to neurodegeneration and cognitive decline and a result of developing brain pathologies. However, it is still unclear (1) whether cortisol measures predict later cognitive decline and (2) whether cortisol changes over the years might be associated with cognitive changes. We analyzed data from CoLaus/PsyCoLaus, a prospective population-based study. Salivary cortisol (4 different measures on 1 day) and neuropsychological assessments were performed at a first visit and a follow-up visit 5 years later in 625 dementia-free participants aged ≥65 years. Salivary cortisol levels at waking and 30 minutes after waking, as well as longitudinal changes in cortisol 30 minutes after waking, cortisol awakening response, and cortisol AM-PM difference were associated with decline in global cognition. After controlling for potential confounders, only longitudinal changes in cortisol 30 minutes after waking remained associated with cognitive decline. These mostly negative findings indicate absent or subtle association between salivary cortisol and cognitive decline.

Objective Even though all guidelines recommend generally against antipsychotic polypharmacy, antipsychotic polypharmacy appears to be a very common practice across the globe. This study aimed to examine the prescription patterns of antipsychotics in Qatar, in comparison with the international guidelines, and to scrutinize the sociodemographic and clinical features associated with antipsychotic polypharmacy. Methods All the medical records of all the inpatients and outpatients treated by antipsychotics at the Department of Psychiatry–Hamad Medical Corporation (HMC) in Doha, Qatar (between October 2012 and April 2014) were retrospectively analyzed. We retrieved the available sociodemographic data, psychiatric features, and details on the medication history. Results Our sample consisted of 537 individuals on antipsychotics (2/3 were male; mean age 33.8±10.2 years), prescribed for a psychotic disorder in 57%, a mood disorder in 9.3%, and various other diagnoses in 33.7%. About 55.9% received one antipsychotic, 29.6% received two antipsychotics, and 14.5% received more than two antipsychotics. Polypharmacy was associated with younger age (p = 0.025), being single (p Conclusions Antipsychotic polypharmacy appears to be quite common in Qatar, as it is the case in many other countries, in contrast with most international recommendations. Studies are needed to explore the reasons behind this disparity.

Catatonia is one of the most severe psychiatric syndromes that might be caused by many medical as well as psychiatric conditions. Catatonia in adolescents is rare and largely understudied.This papers aims to examine cases of catatonia among adolescent psychiatric inpatients, and to scrutinize both the etiologies and the management options.A retrospective descriptive study involving all cases of catatonia among adolescents admitted to the Department of Child and Adolescent Psychiatry in Razi Hospital - Manouba - Tunisia between January 2006 and December 2013. Catatonia was confirmed by Bush-Francis Catatonia Rating Scale. Medical records were examined for gender, age, clinical presentation, medical or psychiatric diagnosis as well as management. Psychiatric diagnoses were made according to the DSM-IV criteria.Our series consisted of 12 cases, aged between 12 and 16 with a sex ratio male/female of 0.5. Catatonia was due to a medical condition in three cases and to a psychiatric disorder in the other nine cases. Psychiatric diagnoses included: manic episode (n=3), major depressive episode (n=2), schizophrenia (n=2), pervasive developmental disorder (n=1) and conversion disorder (n=1).Catatonia is rare yet life-threatening. Careful and thorough examination is needed to determine the etiological disorder, on which depend both treatment and prognosis.

BackgroundOlder people are particularly exposed to stressful events, known to activate the hypothalamus-pituitary-adrenal axis. Many studies highlighted the possible deleterious effects of elevated cortisol on cognition, assuming a likely role of stressful events. Yet, very few studies actually examined these assumed links between life events, cortisol and cognition.ObjectiveTo examine associations between salivary cortisol, cognition and life events in a population of non-demented old individuals.MethodsA cross-sectional analysis was conducted using data from Colaus/PsyColaus, a longitudinal population-based study involving 6733 Lausanne residents. Salivary cortisol samples (upon waking, 30 minutes after waking, at 11 am and at 8 pm) were obtained from 799 non-demented participants aged at least 60.Life events, activities of daily life along with depressive symptoms were assessed using a standardized questionnaire. A comprehensive neuropsychological test battery was used to determine the Clinical Dementia Rating (CDR).For multiple comparisons, P values were adjusted (P′) according to Holm-Bonferroni's method.ResultsCortisol at 11 am and cortisol area under the curve (AUC) were positively correlated with CDR sum of boxes (CDRSOB) scores (P′ = 0.035; Rho = 0.097 and P′ = 0.024; Rho = 0.110, respectively). The association between cortisol AUC and CDRSOB remained significant after controlling for age, sex, body mass index, education, smoking and depression (P = 0.001; β = 0.001; R2 change = 0.016).The number and the total impact of life events were associated neither with cortisol nor with CDRSOB.ConclusionsElevated cortisol was associated with poorer cognitive functioning yet independently of life events. This suggests that the increased cortisol associated with poorer cognition might be not a mere reflection of stressful events but rather explained by other factors, yet to be elucidated.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ObjectiveBenefits of statins in the long term follow-up of ST elevation myocardial infarction (STEMI) have been established, but the short term benefits of early statins prescription remain unproven, especially according to the reperfusion result.Aim of the studyTo assess the benefit of early statins prescription in in-hospital outcome of STEMI patients.MethodsBetween January 1995 and November 2011, 1388 patients admitted for STEMI have been included in the MIRAMI (MonastIR Acute Myocardial Infarction) registry. During this period, statins were introduced in early management of STEMI patients. This enabled us subdivide patients, after excluding those with missing treatment data, into 2 groups: early prescribed statins group (n=561) versus no statins prescribed group (n=804). We compared in-hospital outcome between these two groups and among the subgroups of successful or failure reperfusion therapy.ResultsIn the early statins prescription group, there was a significant reduction of in-hospital mortality (12.1% vs 5.3%, p

Background Despite significant progress made in diagnostic and therapeutic modalities, infective endocarditis (IE) remains a serious affection associated with considerable mortality and morbidity. Aim To describe the epidemiological and clinical aspects of native valve infective endocarditis (IE) in a Tunisian high-volume tertiary care center and to identify the predictors of outcome. Methods and results Demographic, clinical, laboratory, and echocardiographic characteristics were examined in 176 patients who fulfilled the modified Duke criteria for native valve IE between January 1993 and December 2008. Logistic regression analysis was used to identify prognostic factors for death. Mean age was 36.1±7.5 years. Diagnosis was definite in 85% of cases. Median time to diagnosis was 19 days. Rheumatic heart disease (RHD) was the predominant (47%) underlying heart condition. Mitral valve location was the most frequent seat of IE (37.7%). One or more vegetations were detected in more than 86.8% of cases. The median size of vegetation was >15 mm in 26% of cases. In 84 cases (48.5%), cultures remained negative. Serology was positive in 16 cases, and in 4 cases leaflet culture identified the agent. Causative microorganisms were mainly Staphylococci (n=42 (24.2%), including 8 coagulase-negative Staphylococcus), and Streptococci (n=32). Overall mortality was 18.6%. On multivariate analysis, congestive heart failure (hazard ratio = 5.62, 95% CI 1.32 to 12.54, p=0.008) and large vegetations (>15 mm; hazard ratio = 4.28, 95% CI 1.91 to 11.69, p=0.004) and neurological complications (hazard ratio = 3.27, 95% CI 1.84 to 9.11, p=0.002) were predictive of in-hospital mortality. Conclusion IE remains a serious disease affecting a young population in Tunisia, with RHD as still the most common underlying heart disease, and it is associated with a high mortality.

Background Hyperglycemia has been shown to be a powerful predictor of worse outcome after ST segment-elevation myocardial infarction (STEMI). The aim of this study was to investigate the relation between acute hyperglycemia and angiographic and clinical outcome after primary or rescue angioplasty for STEMI. Methods We prospectively included 383 patients who underwent revascularization for STEMI: 332 primary angioplasty and 51 rescue angioplasty, Plasma glucose was measured at hospital admission. Acute hyperglycemia (HG) was defined as plasma glucose of 11 mmol/L, regardless of the diabetic status. Results Among the 383 patients with STEMI included in the study, 158 (41.2%) patients had acute hyperglycemia. There was no difference among the two groups with regard to clinical characteristics, cardiovascular risk factors and hemodynamic parameters. Angioplasty success, TIMI 3 flow and ST segment resolution were significantly lower in acute HG group. On multivariate regression, HG wasn’t found to be an independant predictor of angioplasty success (p=0.08; OR=0.9; 95%IC [0.92–1]) or of ST resolution, however diabetes was independently associated with ST segment resolution after achieving TIMI 3 flow (OR= 3.2; 95% CI [1.02 – 8.1]; p=0.014). Acute hyperglycemia (OR: 3.8; p=0.005) was found to be an independent predictor of in-hospital mortality in multivariate analysis. Among the HG patients, mortality predictors were: glycemia level (OR=1.13; 95%CI [1.03–1.23]; p=0.005), Killip class (OR: 2.14; 95% CI [1.36 – 3.35]; p=0.001), blood hemoglobin level (OR: 0.69; 95%CI [0.53 – 0.9]; p=0.007), and angioplasty success (OR: 0.25; 95%CI [0.08–0.82]; p=0.022). Conclusion Acute hyperglycemia in patients with STEMI is an important predictor of mortality with an increasing mortality risk even beyond 11 mmol/L but diabetes is a better predictor of ST resolution after TIMI 3 restoring. This suggests the usefulness of assessment of glycemic metabolism in the setting of reperfusion for acute myocardial infarction and the beneficial effect of strict glycemic control.