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Fahad D Alosaimi,1 Deemah A AlAteeq,2 Sarah I Bin Hussain,3 Riham S Alhenaki,4 Abdullah A Bin Salamah,5 Noor Adnan AlModihesh1 1Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia; 2College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; 3Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; 4Department of Pediatrics, King Abdullah Specialized Children’s Hospital, KAMC, MNGHA, Riyadh, Saudi Arabia; 5Department of Family and Community Medicine, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Deemah A AlAteeqCollege of Medicine, Princess Nourah Bint Abdulrahman University, P.O. Box 93949, Riyadh 11683, Saudi ArabiaEmail DAalateeq@pnu.edu.saObjectives: To examine public’s knowledge, beliefs, and attitudes toward bipolar disorder (BP) in Saudi Arabia (SA).Methods: A cross-sectional survey was performed in 2016 in Riyadh, SA. The survey included sociodemographic characteristics and BP awareness scale.Results: Of 416 participants, 49.5% had prior knowledge of BP, mainly from internet and social media, and 57% considered it to be common in SA. About half believed BP is caused by a neurophysiological or neurochemical imbalance and that it can be treated with psychiatric medications. Supernatural causes, weak faith, and weakness of character were considered causes of BP by 55%, 48%, and 40% of participants, respectively. Recreational activities and head bandaging by traditional therapists were considered viable treatment options by 55% and 41% of participants, respectively. Students and healthcare professionals scored significantly higher on awareness scale. Regarding attitude, a majority believed that persons with BP can work effectively ‎(86%)‎, have to pull themselves together to get over it (47%), and consider it a shame to mention that someone in a family is affected by BP (32%). Regarding relationships, 22% were not willing to maintain a friendship and 39.3% were not willing to marry someone with BP.Conclusions: This study revealed suboptimal public awareness towards BP in SA. It identified several misconceptions and negative attitudes toward patients with BP. Further studies are needed to investigate potential public interventions to improve literacy of BP.Keywords: bipolar disorder, awareness, literacy, attitudes, Saudi

Fahad D Alosaimi,1 Hossam S Alawad,2 Ayedh K Alamri,2 Abdullah I Saeed,2 Khalid A Aljuaydi,2 Alwaleed S Alotaibi,2 Khalid M Alotaibi,2 Eiad A Alfaris3 1Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia; 2Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia; 3King Saud University Chair for the Development of Medical Education, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia Background: Physicians experience several work-related stressors that have been mounting up in recent decades. This study aimed to examine perceived stress and its risk factors and consequences among consultant physicians in Saudi Arabia. Methods: A cross-sectional study was conducted from November 2014 to March 2015 among physicians who were assigned rank of consultant. The stress level was assessed using perceived stress scale (PSS).Results: A total of 582 consultants participated. The average age was 46.9±7.9 years, 71% were males, 56% were Saudi, 15% were smokers, and 68% slept ≤6 hours per night. The median PSS score was 17 (interquartile range of 14–21), which represented 44% of maximum possible PSS score. The upper tertile of PSS score (represents a high stress level) was significantly associated with being younger, female, and Saudi. The majority (85%) considered job environment to be stressful and ~50% attributed that to a high workload and a noncooperative administration. In the year preceding this study, half of consultants frequently contemplated or even worked toward changing their medical institutes or even moving to work outside Saudi Arabia because of perception of a stressful working environment. Over the previous year, encountering life stressors, considering job environment as stressful and experiencing passive suicidal ideation, were significantly associated with higher levels of stress. In multivariate analysis, the following factors were independently associated with stress: female gender (odds ratio [OR]=2.41, 95% CI 1.58–3.70) and perceived stressful working environment (OR=3.66, 95% CI 1.87–7.17).Conclusion: Consultant physicians in Saudi Arabia experience moderate to high levels of perceived stress that are relatively comparable to physicians worldwide. A significant association was found between stress levels and both female gender and perception of a stressful working environment. Further studies are required to assess physician-based interventions and organization-directed approaches to management of stress among physicians. Keywords: stress, Saudi Arabia, consultants, patterns, risk factors

Fahad D Alosaimi,1 Alaa AlMulhem,2 Hanan AlShalan,2 Mohammad Alqazlan,3 Abdulgader Aldaif,4 Matthew Kowgier,5 Janooshsheya Balasundaram,6 Sanjeev Sockalingam6,7 1Department of Psychiatry, 2College of Medicine, King Saud University, 3Department of Mental Health, King Faisal Specialist Hospital and Research Centre, 4Department of Neurology, King Saud University, Riyadh, Saudi Arabia; 5Dalla Lana School of Public Health, University of Toronto, 6Centre for Mental Health, University Health Network, 7Department of Psychiatry, University of Toronto, Toronto, ON, Canada Objectives: Our aim was to identify the impact of psychosocial predictors, specifically relationship style, depressive symptoms, anxiety symptoms, cognitive impairment, and culture-specific disease beliefs, on treatment adherence for multiple sclerosis (MS) patients.Methods: In this cross-sectional observational study, patients from two MS clinics in Saudi Arabia completed self-reported questionnaires focused on MS treatment adherence, physical symptom burden, relationship style, cultural beliefs, depressive symptoms, anxiety, and cognitive impairment.Results: A total of 163 MS patients participated, 81.6% of them were female, and the mean age of the patients was 31.6 years. Mean patient-reported adherence to their MS treatment regimen was 79.47%±25.26%. Multivariate linear regression analysis only identified patients’ belief that their MS was due to “supernatural” forces as being significantly negatively associated with MS medication adherence.Conclusion: This study demonstrates the importance of cultural interpretations to MS medication adherence in comparison to psychosocial factors. Education and family involvement in the treatment planning may address this issue and warrant further research. Keywords: multiple sclerosis, adherence, depression, attachment style, culture

Fahad Dakheel Alosaimi,1 Mohammed Asiri,2 Saleh Alsuwayt,2 Tariq Alotaibi,2 Mohammed Bin Mugren,2 Abdulmalik Almufarrih,2 Saad Almodameg,2 1Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia; 2College of Medicine, King Saud University, Riyadh, Saudi Arabia Background: A number of reports suggest a link between depression and nonadherence to recommended management for end-stage renal disease (ESRD) patients on maintenance dialysis. However, the relationship between nonadherence and other psychosocial factors have been inadequately examined. Objectives: To examine the prevalence of psychosocial factors including depression, anxiety, insecure attachment style, as well as cognitive impairment and their associations with adherence to recommended management of ESRD. Methods: A cross-sectional observational study was carried out from 2014 to 2015. Chronic dialysis patients were recruited conveniently from four major dialysis units in Riyadh, Saudi Arabia. Nonadherence was defined as decreased attendance in dialysis sessions, failure to take prescribed medications, and/or follow food/fluid restrictions and exercise recommendations. Results: A total of 234 patients (147 males and 87 females) were included in this analysis, with 45 patients (19.2%) considered as nonadherent (visual analog scale < 8). Approximately 17.9% of the patients had depression (Patient Health Questionnaire score ≥10), 13.2% had anxiety (Hospital Anxiety and Depression scale-anxiety >7), while 77.4% had cognitive impairment (Montreal Cognitive Assessment score

Fahad D Alosaimi,1 Feras A Alkharboush,2 Maram H Altuwariqi11Department of Psychiatry, King Saud University, Riyadh, Kingdom of Saudi Arabia; 2College of Medicine, King Saud University, Riyadh, Kingdom of Saudi ArabiaAbstract: Miliary tuberculosis (TB) is a serious infection with various presentations that can perplex even the most experienced clinicians. To our knowledge, there is a lack of published reports that link psychiatric symptoms directly with miliary TB (either alone or co-occurring with other medical symptoms). Mental health workers may, therefore, not consider, and consequently miss, this important diagnosis. Here we are reporting a case of cyclical anxiety occurring in a 67-year-old patient. For 3 years prior to admission, the patient failed to respond to multiple courses of different antianxiety medications. The patient required hospital admission as he deteriorated and had a reduced level of consciousness. A chest X-ray revealed bilateral nodules and a magnetic resonance imaging scan showed multiple enhancing tuberculous lesions in the cerebral white matter, brain stem, and cerebellum. A diagnosis of miliary TB was finally made. Several characteristics of this case suggest that the diagnosed anxiety disorder was due to miliary TB. However, we cannot exclude the possibility that generalized anxiety disorder preceded the onset of miliary TB or that both diseases were coincidental. The report serves as a reminder that organic causes for psychiatric symptoms always need to be considered, particularly if they follow an atypical pattern or fail to improve with usual psychiatric medications.Keywords: anxiety disorder, elderly, psychosomatic, case report, Saudi Arabia

Psychosomatic medicine has been known to play a pivotal role in the management of complex medical cases by providing a bridge between the physical disease and psychological distress. This case study focuses on a 42-year-old Saudi female diagnosed with breast cancer and generalized anxiety disorder. In addition to anxiety, the patient had a history of obsessive-compulsive personality traits, which contributed to her reluctance to undergo mastectomy. Significant challenges and noncompliance with treatment were caused by her unwillingness and inadequate interaction with the medical team. An integrated multidisciplinary strategy including psycho-oncological interventions was necessary because of the complexity of this case. Communication issues were addressed through the concerted efforts of the specialist teams. A comprehensive patient-practitioner understanding was established, which enabled the teams to persuade the patient to undergo surgical intervention. Overcoming her initial resistance, the patient eventually complied with the treatment plan, leading to a successful surgery. Postsurgical evaluations using the Hamilton Anxiety Scale indicated a significant reduction in anxiety levels. This case underscores the critical contribution of psychosomatic medicine to healthcare, especially in challenging situations that demand additional resource allocation, further highlighting the importance of an interdisciplinary approach, efficient communication, and patient-practitioner rapport in healthcare outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alatawi et al.)

Background: Psychological assessment after intensive care unit (ICU) discharge is increasingly used to assess patients' cognitive and psychological well-being. However, few studies have examined those who recovered from coronavirus disease 2019 (COVID-19). There is a paucity of data from the Middle East assessing the post-ICU discharge mental health status of patients who had COVID-19., Aim: To evaluate anxiety and depression among patients who had severe COVID-19., Methods: This is a prospective single-center follow-up questionnaire-based study of adults who were admitted to the ICU or under ICU consultation for > 24 h for COVID-19. Eligible patients were contacted via telephone. The patient's anxiety and depression six months after ICU discharge were assessed using the Hospital Anxiety and Depression Scale (HADS). The primary outcome was the mean HADS score. The secondary outcomes were risk factors of anxiety and/or depression., Results: Patients who were admitted to the ICU because of COVID-19 were screened ( n = 518). Of these, 48 completed the questionnaires. The mean age was 56.3 ± 17.2 years. Thirty patients (62.5%) were male. The main comorbidities were endocrine ( n = 24, 50%) and cardiovascular ( n = 21, 43.8%) diseases. The mean overall HADS score for anxiety and depression at 6 months post-ICU discharge was 11.4 (SD ± 8.5). A HADS score of > 7 for anxiety and depression was detected in 15 patients (30%) and 18 patients (36%), respectively. Results from the multivariable ordered logistic regression demonstrated that vasopressor use was associated with the development of anxiety and depression [odds ratio (OR) 39.06, 95% confidence interval: 1.309-1165.8; P < 0.05]., Conclusion: Six months after ICU discharge, 30% of patients who had COVID-19 demonstrated a HADS score that confirmed anxiety and depression. To compare the psychological status of patients following an ICU admission (with vs without COVID-19), further studies are warranted., Competing Interests: Conflict-of-interest statement: The author reports no conflicts of interest in this work., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background Cancer patients suffer from variable degrees of distress. The distress thermometer (DT) is a valuable tool for screening those patients for distress. Few studies have addressed the utility of DT in screening cancer patients in Saudi Arabia. We aimed to measure the distress level of adult cancer patients utilizing the DT and identify the appropriate measures and interventions required to improve this population's well-being. Methods This cross-sectional study was carried out at the oncology center of King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Enrollment criteria were Saudi adults (≥14 years old), with a diagnosis of cancer, who gave informed consent. They were screened for distress using the DT and its associated problem list (PL). A workflow for a psycho-oncology supportive program was suggested. Results Using DT at a cut-off score of ≥4, 22% of patients had significant distress. The most frequent problems reported were loss/change of physical activity, swelling/edema, change in eating, family health problems, and child care. The multivariable binary regression analysis showed that sadness, depression, worry/anxiety, fear, loss of interest, change in appearance, taking care of myself, swelling/edema, and memory/concentration problems were independent factors for significant distress in our cohort. The suggested workflow could effectively be implemented among cancer patients. Conclusion The current study's findings support previous reports concerning the utility of DT in screening cancer patients for distress. A considerable number of Saudi cancer patients suffered from significant distress, which was significantly related to the emotional, spiritual, social, and religious aspects of their problems. We suggested a workflow by which cancer centers can implement DT screening after developing a plan for timely distress evaluation, with further proper management and referrals accordingly. Additional studies are warranted., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Alghamdi et al.)

A patient's suicide or suicide attempt is a challenging experience for psychiatrists. This study aimed to explore the common coping strategies and habits developed by psychiatrists/trainees following such incidents. A self-administered questionnaire was distributed among participants in Saudi Arabia. The study enrolled 178 participants, of whom 38.8% experienced a patient's suicide, 12.9% experienced a patient's severe suicide attempt, and 48.3% did not encounter any suicidal events. The most frequently utilized sources of support were colleagues (48.9%), team discussions (41.3%), and supervisors (29.3%). Only 21.4% received formal education in coping with a patient's suicide. Approximately 94.9% reported a lack of support systems within their institution. The study highlighted the coping strategies most commonly employed by psychiatrists/trainees and revealed that the majority of participants reported no changes in their daily habits. The findings underscore the need for a structured support system and formal educational resources to address the existing deficit. Mental health organizations must take action to ensure adequate resources for healthcare providers., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Alawad et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Establishing a balanced diet is necessary for obtaining the required daily micronutrients and macronutrients. However, the importance of using dietary supplements to complement one's diet is a significant aspect to consider. While studies have reported the prevalence and patterns of dietary supplements in Saudi Arabia, most focused on university students, women in their reproductive life-particularly during pregnancy-or male athletes. Hence, the objective of this study is to estimate the prevalence and patterns of dietary supplement usage, along with the associated sociodemographic and psychiatric predictors among women attending fitness centers in Saudi Arabia., Methods: A cross-sectional design was utilized using a structured questionnaire to collect data on dietary intakes such as consumption, nutrition supplements, type of nutrition supplements, and reason for consuming dietary supplements. Data collection occurred in female fitness centers, with participants accessing the questionnaires through QR codes linked to online Google forms. The dietary usage was assessed using a structured questionnaire developed by the study authors, and depressive and anxiety symptoms were assessed using the PHQ-9 and the GAD-7 scales, respectively. SPSS 23.0 was utilized to analyze the data, and a multivariable logistic regression analysis was performed to determine the association between sociodemographic and psychiatric predictors and patterns of dietary supplement usage. The results were presented by reporting an unadjusted and adjusted odds ratio (AOR) with 95 % Confidence Intervals (CIs)., Results: The total number of participants in this study was 453 women. Half of the 453 women (46.1 %) consumed dietary supplements, and (84.0 %) reported taking proteins, caffeine, creatinine, mineral salts, fish oil, and/or amino acids or a combination of these dietary supplements. A considerable number of women (41.0 %) reported that a doctor, dietitian, or trainer motivated them to take the dietary supplement, and (38.0 %) of women self-prescribed dietary supplements. More than half (51 %) of the women consumed dietary supplements to compensate for nutrient deficiency, and 48 % used them to improve their health. Women who did not work to earn were 53 % less likely to consume dietary supplements (AOR = 0.47; [95 % CI: 0.30-0.72]) than women who reported working to earn either in the private or government sector. Depressed women were (42 %) less likely to consume dietary supplements than non-depressed women (AOR = 0.58; [95 % CI: 0.33-0.99]) after adjusting for sociodemographic variables and other medical conditions., Conclusion: It has been evident that a large proportion of women enrolled in the fitness center report consuming dietary supplements, mostly to compensate for energy and to improve overall health. The findings highlight that non-working and depressed women were less likely to use dietary supplements than their counterparts. By understanding these patterns, the community can tailor health interventions and policies to ensure equitable access to proper dietary support, especially for those facing challenges like depression and unemployment. Future research on a larger sample of women outside fitness centers is encouraged to explore further dietary supplement consumption and patterns among diverse population groups, and to ultimately develop health guidelines for the appropriate use of supplements., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Purpose: Smartphone addiction is prevalent among medical students, and there is a concern that the coronavirus disease 2019 (COVID-19) pandemic fueled a rise in smartphone addiction. Earlier studies suggest a link between excessive smartphone usage and negative outcomes such as depression, stress, and reduced academic achievement. However, there is a dearth of both local studies in Saudi Arabia and studies conducted during the COVID-19 pandemic exploring the prevalence of smartphone addiction and its association with academic performance, depression, and perceived stress, which is the purpose of the current study. Methods: In 2021, a cross-sectional research project took place among medical students at King Saud University and the Vision Colleges located in Riyadh, Saudi Arabia. An online self-administered questionnaire consisting of demographic variables, grade point average (GPA), the Patient Health Questionnaire-9 (PHQ-9), the Perceived Stress Scale-4 (PSS-4), and the Smartphone Addiction Scale-Short Version (SAS-SV) was deployed. Results: Three hundred and fifteen students participated. Around 47.9% of students reported smartphone addiction, and the mean SAS-SV score was 32.31 ± 12.01 points. Both PHQ-9 and PSS-4 scores showed a significant positive correlation with the SAS-SV score (r = 0.216, p < 0.001 and r = 247, p < 0.001, respectively), while GPA did not (r = -0.027, p = 0.639). An adjusted analysis showed that the PSS-4 score was positively associated with the SAS-SV score (odds ratio (OR) = 1.206, p < 0.001), while the PHQ-9 score was not (OR = 102, p = 0.285). Conclusions: Smartphone addiction is prevalent among medical students and associated with perceived stress. Additional research is required to gain a deeper comprehension of this issue and to assess the success of intervention initiatives aimed at encouraging healthy smartphone usage, particularly in times of crisis like the COVID-19 pandemic.

Background: Patient suicides are significant events that tremendously affect psychiatrists- personally and professionally. Very few studies have focused on studying the impact of both serious suicidal attempts and completed suicide on psychiatrists and psychiatry trainees., Aim: This study assessed the prevalence and impact of patient suicide and serious suicidal attempts on psychiatrists and psychiatry trainees in Saudi Arabia., Methods: This national cross-sectional study of psychiatrists and psychiatry trainees was conducted in Saudi Arabia. Participants completed an online self-administered questionnaire to assess emotional and professional impacts and the traumatic impact of patient suicide using the Impact of Event Scale-Revised (IES-R)., Results: 178 psychiatrists were enrolled in this study. The prevalence rate of patient suicide among participants was 38.8%, and they experienced adverse emotional reactions. Additionally, among those who were not exposed to patient suicide, 12.9% reported exposure to serious suicide attempts, and almost all of them experienced related negative emotions. The most frequently reported emotions were sadness (61.95%), shock (48.91%), and guilt (25%), and these emotions lasted longer in completed patient suicide cases than attempted suicide. Nearly 84% of participants who experienced suicide reported its impact on their profession. The most reported professional impacts were increased focus on suicide cues, attention to legal aspects, and a tendency to hospitalize. Of participants who experienced suicide, 75.4% reported that the overall impact of suicidal events on their professional practice had improved. Of the total number of respondents who experienced either suicide or serious suicidal attempts, 10.9% reported symptoms of PTSD., Conclusions: The study highlighted the emotional and professional burden that psychiatrists and psychiatry trainees experience due to patient's completed suicides and serious suicidal attempts. Additionally, it emphasized the need for further research to study the benefits of implementing preparatory and training programs to help trainees and psychiatrists in such instances., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Incidences of cancer are increasing at an unprecedented rate in Saudi Arabia, making it a major public health concern. Cancer patients are faced with physical, psychological, social, and economic challenges, all of which can impact quality of life (QoL)., Objectives: This study aims to explore the sociodemographic, psychological, clinical, cultural, and personal factors that could affect the overall QoL of cancer patients., Methods: A total of 276 cancer patients who attended the King Saud University Medical City's oncology outpatient clinics between January 2018 to December 2019 were included. QoL was assessed with the Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. Psychosocial factors were assessed with several validated scales., Results: QoL was poorer among patients who were female ( p = 0.001), have visited a psychiatrist ( p = 0.028); were taking psychiatric medications ( p = 0.022); and had experienced anxiety ( p < 0.001), depression ( p < 0.001), and distress ( p < 0.001). The most used method to self-treat was Islamic Ruqya (spiritual healing; 48.6%), and the most often perceived cause for developing cancer was evil eye or magic (28.6%). Good QoL outcomes were associated with biological treatment ( p = 0.034) and satisfaction with health care ( p = 0.001). A regression analysis showed that female sex, depression, and dissatisfaction with health care were independently associated with poor QoL., Conclusions: This study demonstrates that several factors could influence cancer patients' QoL. For instance, female sex, depression, and dissatisfaction with health care were all predictors of poor QoL. Our findings support the need for more programs and interventions to improve the social services for cancer patients, along with the need to explore the social difficulties oncology patients face and address such obstacles through improving social services by expanding the scope of social workers' contribution. Larger multicenter longitudinal studies are warranted to examine the generalizability of the results., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 AlJaffar, Enani, Almadani, Albuqami, Alsaleh and Alosaimi.)

Background: Medical professionalism reflects the commitment of physicians to their patients, society, themselves, and the profession. The study examined residents' attitudes towards professionalism and how these attitudes vary among the different demographic groups, namely gender, specialty, and year of residency., Methods: A proportionate random sampling strategy was used to select the study sample. Medical residents from six specialties at a large tertiary care teaching facility were invited to participate in an online survey. The survey used the modified Learners Attitude of Medical Professionalism Scale (LAMPS), which consists of five domains: respect, excellence, altruism, duty/accountability, and integrity. Chi-square, Student t-test, one-way ANOVA, factorial ANOVA, and post hoc analysis were used to examine the attitudinal differences towards professionalism among the different demographic factors., Results: The overall response rate was 82.7%. Overall, the residents' self-reported attitudes towards professionalism was positive. The highest score was for the "respect" domain (4.61), and the lowest was for "altruism" (3.67). No significant association was found between the mean scores and the three studied variables, namely, gender, specialty (surgical/nonsurgical), and level (senior/junior)., Conclusions: No significant differences were observed in the overall attitude towards professionalism among the residents regarding their year of residency, gender, and specialty. The low altruism score and absence of improvement of the total score regarding the residents' increasing experience in the profession are concerns that need remedial action. Therefore, we suggest that future research look for possible explanations by using multi-institutional surveys that explore not only the residents' attitudes, but also the trainers' attitudes and practice, work situations, the hidden curriculum, and culture. Key messagesAttitudes towards professionalism among different demographic groups of residents do not show similar variations as has been reported in the literature, albeit in different sociocultural contexts.The low altruism score and absence of improvement of the total score as the residents gained more experience in the profession are concerns that need remedial action.A longitudinal study involving more than one institution for both residents and their faculty members to compare faculty scores with those of residents, while controlling for specialty and gender, may help elucidate the factors affecting attitudes towards professionalism and suggest possible means of addressing unfavourable attitudes.

Purpose: Despite the effectiveness of androgen deprivation therapy in advanced prostate cancer, serious neuropsychiatric consequences in androgen deprivation therapy (ADT)-treated patients, mainly depression, have been concerning and gained more attention recently. This narrative review aims to shed light on the risk and pharmacological management of ADT-induced depression in PCa patients. Methods: We searched PubMed, Scopus and Google Scholar databases using MESH keywords "Prostate cancer OR prostate neoplasm" AND "Depression" AND "Androgen Deprivation Therapy" AND "antidepressants". Search was limited to English and studies conducted on humans. Studies' titles and abstracts were screened, and further information were obtained from the text, if necessary, to decide whether studies are to be included in this review. Results: Our review revealed 23 studies confirming the occurrence and worsening of depressive symptoms in ADT-treated patients, which frequently require pharmacological interventions; whereas 10 studies indicated otherwise. All studies were prospective, retrospective, cross-sectional or case reports. Based on the incidence of depression provided by the observational studies, the average among ADT-treated patients was 18.23% (range: 2.1-46.9%), while it was 8.42% (range: 1.4-23.3%) in the non-ADT patients. Although several treatments have been used for depression in cancer patients, current knowledge lacks observational and controlled studies as well as clinical guidelines that demonstrate efficacy and safety of antidepressants and guide clinicians to the appropriate treatment in these patients, respectively. On the other side, a few clinical studies have been published regarding the efficacy of selective serotonin reuptake inhibitors, selective serotonin and norepinephrine reuptake inhibitors and/or saftey on other ADT associated adverse effects. Conclusions: Our work supports the recent attention towards mood issues as an adverse effect of ADT, and that greater awareness of this is warranted among clinicians. Clinical studies published regarding the use of antidepressants for other ADT associated adverse effects established the foundation that can be adopted to examine these therapies on ADT-induced depression.

Objectives: Medical residents' direct contact with patients with COVID-19 places them at high risk of psychological disturbance. This study aimed to estimate the prevalence of depression and anxiety symptoms, and their relationship with the COVID-19 pandemic among medical residents in KSA., Methods: A cross-sectional study was conducted between January and March of 2021. The Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7) were used to screen for depressive disorders and generalized anxiety disorder, respectively., Results: A total of 533 medical residents participated in the study; 52% were men, and 58% were single. Most residents had direct contact with one or more patients with COVID-19. The prevalence of depression and anxiety symptoms was 65.8% and 58.3%, respectively. The study revealed that gender was a risk factor for diagnosis with COVID-19 among residents: male residents were diagnosed with COVID-19 to a greater extent than female residents. In addition, being a nonsmoker rather than a smoker was associated with a higher risk of COVID-19 diagnosis. A multivariate regression analysis revealed that gender (female) and residency level (R5) were independently associated with anxiety symptoms. Similarly, the independent correlates of depression symptoms were gender (female) and specialty (family medicine)., Conclusion: A high prevalence of depression and anxiety symptoms was found among medical residents trained in KSA. The rates were significantly higher among female than male residents., (© 2022 [The Author/The Authors].)

Purpose: Patient satisfaction with healthcare was recognized as an indispensable component of healthcare quality assurance programs for decades. Limited research has explored psychosocial variables impacting patient satisfaction with cancer care. The objective of our study was to identify the level of patient satisfaction with cancer care in Riyadh, Saudi Arabia and determine the psychosocial and clinical predictors of patient satisfaction., Methods: A cross-sectional observational study was carried out in 2018-2019 with patients with cancer at the Outpatient Oncology Clinic at King Saud University Medical City in Riyadh, Saudi Arabia. The questionnaire contained a visual analog scale (VAS) of satisfaction with cancer care, a VAS of satisfaction with social support, the Patient Health Questionnaire-9 Depression scale, and the Generalized Anxiety Disorder 7-item scale., Results: Out of the 400 patients approached, 280 agreed to participate in the study. Of the 280 patients participating in the study, 65% were satisfied with cancer care. Higher satisfaction was associated with being non-Saudi, being employed, having fewer household residents (≤4), being satisfied with social support, not receiving radiotherapy, and receiving hormonal or biological therapy. Having anxiety or depression was also associated with lower satisfaction. After adjustment for sociodemographic and clinical characteristics, being satisfied with social support, having ≤ 4 household residents, receiving hormonal therapy, and receiving biological therapy rather than radiotherapy were all independent predictors of higher satisfaction with cancer care., Conclusion: This study found an inadequate level of patient satisfaction with cancer care. Higher levels of satisfaction were associated with being satisfied with social support, using biological and hormonal therapy, while lower satisfaction was associated with a larger number of household residents (>4), depression, anxiety and using radiotherapy., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

Objectives: To identify the magnitude of treatment adherence among people with epilepsy (PWE) and the impact of sociodemographic, medical and psychosocial factors on treatment adherence., Methods: A quantitative cross-sectional observational study was performed based on data collected from adult patients attending the epilepsy clinic, King Saud University Medical City, Riyadh, Saudi Arabia. Patients completed paper-based questionnaires including a sociodemographic, cultural, psychiatric history and medical history sections. In addition to that we evaluated treatment adherence by visual-analogue scale (VAS), depressive symptoms by PHQ-9, anxiety symptoms by GAD7, physical symptoms by PHQ-15, attachment style by ECR16 and cognitive impairment by MOCA., Results: A total of 207 patients participated, with a mean age of 34 years;.53.6% were female. The mean patient-reported adherence to their treatment regimen was 81.6%±18.4%. Univariate analysis revealed statistically significant negative associations between depression, anxiety and physical symptoms and treatment adherence. However, multiple linear regression analysis only showed physical symptoms to be a significant predictor for epilepsy medication adherence., Conclusion: Somatic (physical) complaints could be important predictors of treatment adherence in (PWE). This study is one of the first to suggest the importance of targeting physical symptoms in screening and intervention approaches to improve Antiepileptic drugs (AEDs) adherence., (Copyright: © Neurosciences.)

In recent years, the global burden of diabetes distress has increased significantly worldwide, imposing mental health issues on patients and the healthcare system. Hence, this study aimed to estimate the prevalence of diabetes distress and determine its psychosocial predictors among Saudi adults with type 2 diabetes mellitus (T2DM). This cross-sectional, observational study was conducted at Diabetes Clinics, Tertiary Care Academic Medical Center, King Saud University Medical City, Riyadh, Saudi Arabia. The survey questionnaire was distributed to 423 participants. The sample size was 384, where the prevalence of diabetes distress was 48.5%. Based on 5% precision and a confidence interval of 95%, the response rate was 78.25% (334 respondents), among which 61.4% of respondents were females, the remaining 38.6% were males, and the mean age was 56.39 years. The mean scores for the Saudi Arabian Diabetes Distress Scale-17 (SADDS-17) subdomains including emotional burden, physician-related distress, regimen-related distress, and interpersonal distress were 2.63 ± 1.29, 2.31 ± 1.44, 2.48 ± 1.16, and 2.23 ± 1.24, respectively. Based on the World Health Organization Quality of Life Assessment Instrument, Short Version (WHOQOL-BREF) transformed scores, the quality of life was recorded as 62.7%. There was a statistically significant positive correlation between the Hospital Anxiety and Depression Scale (HADS) score ( r = 0.287, p < 0.01) and the total SADDS-17 scores. The Patient Health Questionaire (PHQ) 15 scores showed significant positive correlations with the total SADDS-17 scores ( r = 0.288, p < 0.01) and each of the four subdomains. Our present study revealed that diabetes distress prevalence is alarmingly high among patients in Saudi Arabia, Riyadh. Our findings provide evidence that physical symptoms, quality of life, depression, and anxiety are the notable predictors of diabetes distress., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Batais, Alfraiji, Alyahya, Aloofi, Almashouq, Alshehri, Almizel, Alotaibi and Alosaimi.)

Objectives: To estimate the prevalence of distress in patients with cancer in Saudi Arabia and to identify common psychosocial stressors in these patients. We also looked for associations between distress and psychological, sociodemographic, and medical factors., Methods: This cross-sectional study was performed in the oncology outpatient clinic at King Saud University Medical City, Riyadh, Saudi Arabia, from January 2018 to December 2019. It included 280 patients with breast cancer, colorectal cancer, or lymphoma. Sociodemographic information was collected using questionnaire, along with information on medical history and any psychiatric history. Distress was assessed using the Distress Thermometer and Problem List. Satisfaction with social support was rated using the visual analog scale. All patients were screened for depression using the Patient Health Questionnaire 9-item depression scale and anxiety using the Generalized Anxiety Disorder 7-item scale., Results: The prevalence of distress in our study population was found to be 46%. Distress was associated with several practical, family, emotional, and physical stressors in the problem list. Logistic regression identified predictors of distress to be anxiety (odds ratio [OR] 8.7, confidence interval [CI] 1.98-38.24, p =0.002) and receiving radiotherapy (OR 3.6, CI 1.33-9.99, p =0.009), while Saudi nationality (OR 0.22, CI 0.05-0.95, p =0.037) and stage I cancer (OR 0.18, CI 0.05-1.40, p =0.002) were associated with low distress., Conclusion: Approximately half of cancer patients were found to have distress. Anxiety, advanced cancer stage, and radiotherapy were independently associated with distress., (Copyright: © Saudi Medical Journal.)

Objectives: To translate, validate, and adapt the diabetes distress scale (DDS)-17 to a Saudi Arabian (SA) DDS (SADDS-17). Also, to evaluate the psychometric properties of the newly adapted SADDS-17., Methods: This was a cross-sectional study evaluating the psychometric properties of the DDS. The DDS was translated using the forward-backward translation from English to Arabic at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia, in January 2016. Statistical analyses included exploratory factor analysis, internal consistency, testretest reliability, and construct validity. Moreover, contingent validity was evaluated using hospital anxiety and depression scale, visual analogue scale, and the World Health Organization quality of life assessment instrument., Results: A total of 109 participants were included in this study. The exploratory factor analysis of our Arabic scale supported the original DDS with 4 sub-scales. Correlations ranged from 0.376 to 0.718 for items in regimen-related distress, 0.327 to 0.533 for items in emotional burden, 0.413 to 0.722 for items in physician-related distress, and 0.492 to 0.556 for items in interpersonal distress. The Cronbach's alpha value of the SADDS was 0.848 for the total scale. The test-retest reliability value was 0.78., Conclusion: Our SADDS is a valid and reliable instrument for detecting diabetes distress among Saudi Arabian patients with type 2 diabetes., (Copyright: © Saudi Medical Journal.)

Objective: Alterations in brain function in patients with schizophrenia (SCZ) and other neuropsychiatric disorders are evident not only during specific cognitive challenges, but also from functional MRI data obtained during a resting state. Patients with chronic SCZ have shown deficits in default mood network (DMN) and gray matter volume in resting-state functional magnetic resonance imaging (rs-fMRI). However, cortical thickness and surface area in first-episode schizophrenic patients have rarely been investigated., Patients and Methods: In the present study, we applied independent component analysis (ICA) to a series of rs-fMRIs of 15 SCZ patients and 15 matched healthy controls. The data were analyzed using MELODIC of FMRIB's Software Library (FSL version 5.9; www.fmrib.ox.ac.uk/fsl) to identify large-scale patterns of temporal signal-intensity coherence., Results: Patients with SCZ showed significantly higher functional connectivity in the DMN, auditory network, and cerebellum network (p=0.049, p=0.05, and p=0.007, respectively) than matched healthy controls. The patients also exhibited significantly less cortical thickness, primarily in the bilateral prefrontal and parietal cortex, and higher thickness in the bilateral anterior temporal lobes, left medial orbitofrontal cortex, and left cuneus than the matched healthy controls., Conclusions: These results indicate that significantly abnormal DMN connectivity and cortical thickness contribute to local functional pathology in patients with SCZ.

Aims: This study evaluated the psychometric characteristics of the Polish version of the PHQ-9 in detecting major depression (MDD) and 'MDD and/or dysthymia' in people with and without type 2 diabetes., Methods: Participants were randomly selected from a diabetes outpatient facility (N = 216) and from among patients admitted to a medical center and psychiatric hospital (N = 99). The participants completed the PHQ-9. The Hamilton Depression Rating Scale and the Mini International Neuropsychiatric Interview were used to identify the presence of psychiatric symptoms. The optimal cut-offs for PHQ-9 in people with and without type 2 diabetes were investigated based on two methods: 1) Youden's index which identifies cut-off points useful in scientific research; 2) a second method of two-stage screening for depressive disorders to provide guidance for clinical practice., Results: The Polish version of the PHQ-9 is a reliable and valid screening tool for depression in people with and without type 2 diabetes. An optimal cut-off of ≥ 7 was indicated by Youden's index and ≥ 5 by the two-stage method for screening for MDD and 'MDD and/or dysthymia' in the group with type 2 diabetes. A cut-off of ≥ 11 was optimal for screening for both MDD and 'MDD and/or dysthymia' among people without diabetes (Youden's index). The two-stage approach suggested a ≥ 10 score for screening for MDD and ≥ 9 for screening for 'MDD and/or dysthymia' in people without diabetes., Conclusions: A lower cut-off score of the PHQ-9 is recommended for people with type 2 diabetes as compared to the general population., Competing Interests: The authors have declared that no competing interests exist.

Objectives: To examine the association of several psychosocial disorders with quality of life (QoL) among chronic hemodialysis patients., Methods: A cross-sectional observational study was conducted in 2018 and recruited chronic hemodialysis patients from 3 major hemodialysis centers in Riyadh, Kingdom of Saudi Arabia (KSA). Quality of life was assessed using a previously validated Arabic version of the dialysis version-III of the QoL index., Results: A total of 101 patients (56 males and 45 females) were included. The mean age was 54.0±12.3 years. The overall mean of QoL was 88.8/100 points (out of 100). The family (95.0%) and psychological/spiritual (94.7%) domains had the highest scores. The prevalence of psychosocial disorders was 24.8% for depressive symptoms, 15.8% for anxiety symptoms, 88.1% for cognitive impairment, 76.8% for insecure attachment style, and 38.6% for medium/high severity of somatic symptoms. All psychosocial disorders and higher cognition level were negatively correlated with QoL (Spearman correlation r ranged between -0.228- -0.468). After adjusting for sociodemographic and clinical characteristics, anxiety symptoms and higher cognition level were independent predictors of poor QoL, while marital status (married) was an independent predictor of good QoL., Conclusion: We report higher QoL and relatively better psychosocial profiles among current chronic hemodialysis patients than reported before. Psychosocial disorders specially anxiety can negatively impact QoL. Patients who were not cognitively impaired were more negatively affected in QOL. The findings re-emphasize the importance of the early detection and management of psychosocial disorders to improve QoL in chronic hemodialysis patients.

Purpose: This case-control study assessed the prevalence of psychiatric disorders in Arab (Saudi) patients with narcolepsy using a structured clinical interview., Methods: The study included 74 adult patients with narcolepsy and 265 controls matched for age and sex. Narcolepsy diagnosis was made according to the International Classification of Sleep Disorders-Third Edition. Psychiatric disorders were diagnosed via using a validated Arabic version of the Mini International Neuropsychiatric Interview DSM-IV (MINI version 6). A multivariate logistic regression model was used to assess the potential influence of narcolepsy on the comorbidity of psychiatric disorders., Results: The mean age of the patients was 29.4 ± 10.2 years, and males accounted for 81% of the study sample. Forty-four patients (60%) were diagnosed with narcolepsy type-1 (NT1) and 30 (40%) with narcolepsy type-2 (NT2). Psychiatric disorders were diagnosed in 45% of patients with narcolepsy compared with 15% of the controls (p < 0.001). The multivariate logistic regression models demonstrated that compared with the controls, patients with narcolepsy were more likely to have major depressive disorders (OR, 4.3 [CI, 2.2-8.2]), and generalized anxiety disorders (OR, 9.5 [CI, 1.8-50.2]). No difference was detected between the prevalence of various psychiatric disorders in patients with NT1 and NT2., Conclusion: Comorbid psychiatric disorders are common among Arab (Saudi) patients with narcolepsy compared with the general population. Therefore, clinicians should be aware of the comorbidity of narcolepsy and psychiatric disorders, particularly depression.

Background: Patients with diabetic foot ulcers may have a lower quality of life. The objective was to compare the quality of life and its psychosocial determinants among patients with and without diabetic foot ulcers., Methods: A case-control study was conducted in 2017 among patients with (cases) and without (controls) diabetic foot ulcers. The study tools included the World Health Organization's Quality of Life scale (WHOQOL-BREF), the Hospital Anxiety and Depression (HAD) scale for anxiety and depression, the Patient Health Questionnaire Physical Symptoms (PHQ-15) for the severity of somatic symptoms, and the Summary of Diabetes Self-Care Activities (SDSCA) measure for self-management., Results: A total of 209 patients (45 cases and 164 controls) were included. The average age was 56.2 ± 11.7 years, and 55.5% were female. The average scores of WHOQOL-BREF, PHQ-15, and SDSCA were 74.4% ± 12.1% and 8.1 ± 6.1, and 30.4 ± 21.8, respectively. The prevalence of anxiety and depression were 19.6 and 24.9%, respectively. SDSCA was the only psychosocial determinants higher in cases than controls (mean difference = 15.0, 95% CI = -8.0-22.0). The correlation coefficients of WHOQOL-BREF scores with anxiety, depression, and PHQ-15 scores in all patients were - 0.559 ( p  < 0.001), - 0.582 ( p  < 0.001), and - 0.532 ( p  < 0.001), respectively, with similar numbers in both groups. In multivariate analysis, only the association between quality of life and depression was maintained., Conclusion: Quality of life and psychosocial determinants with the exception of self-management were not associated with diabetic foot ulcers. Depressive symptoms were independent determinant of poor quality of life, irrespective of the status of diabetic foot ulcers., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s). 2019.)

Background: Lack of recognition of labeled drug-drug interactions (DDIs) is a type of medication error of particular relevance to the treatment of psychiatric patients. Pharmacists are in a position to detect and address potential DDIs., Objective: This study aimed to explore pharmacists' role in the identification and management of DDIs among psychiatric patients in psychiatric outpatient clinics of a university-affiliated tertiary care hospital in Riyadh, Saudi Arabia., Method: This study was a retrospective, cross-sectional medical chart review of patients visiting outpatient psychiatric clinics. It utilized medical records of patients who were taking any psychotropic medications and were prescribed at least one additional drug. The hospital Computerized Physician Order Entry system was used to identify DDIs and determine the pharmacists' interventions. The Beers criteria were applied to detect inappropriate prescribing among older patients., Results: On average, the pharmacists intervened in 12 out of 213 (5.6%) cases of major or moderate DDIs. Older age, higher number of prescription medications, the severity of DDIs, and the utilization of lithium and anticoagulants were positively associated with the pharmacist undertaking an action., Conclusion: Future studies should explore the prevalence rate of harmful DDIs among psychiatric patients on a large scale and examine the effectiveness of different pharmacy policies in the detection and management of DDIs.

Background: Multiple scales in different languages were developed to measure patient-reported side effects of antineoplastics. However, these scales vary in their coverage of antineoplastics' side effects, and none of them address both the severity and impact of antineoplastics' side effects on patient quality of life. Hence, there is a need to develop a comprehensive, concise, and general scale to assess patients' perceptions of both severity and impact of the commonly reported side effects of antineoplastics on patients' activities of daily living and make it available in Arabic., Objectives: To develop and validate a new scale in Arabic to assess patient-reported antineoplastics' side-effects among Arabic-speaking patients undergoing chemotherapy., Methods: A new scale was developed in Arabic that addresses 40 different emotional, cognitive, and physical side-effects of antineoplastics. The Antineoplastic Side effects Scale (ASES) contained three subscales focused on the side effects frequency, severity, and interference with patients' activities of daily living. Seventy-eight patients with different cancer types were recruited from the oncology clinics of a university-affiliated tertiary care hospital in Riyadh, Saudi Arabia. The reliability of the questionnaire was examined using Cronbach's alpha method. The construct validity was examined using principal component analysis with varimax rotation. The association between the scores of ASES subscales and various patient medical and sociodemographic characteristics were also examined., Results: The mean age of participants was 53.8 (12.5) years and most of them were female (65.3%) and married (84.6%). The ASES demonstrated good internal consistency (Cronbach's alpha = 0.91). The severity of the perceived side effects and their impact on activities of daily living were positively associated with female gender., Conclusion: The newly developed ASES demonstrated good validity and reliability. This tool will hopefully help healthcare providers and patients to identify commonly reported antineoplastic side effects.

Background: Anxiety disorder, one of the highly disabling, prevalent and common mental disorders, is known to be more prevalent in persons with type 2 diabetes mellitus (T2DM) than the general population, and the comorbid presence of anxiety disorders is known to have an impact on the diabetes outcome and the quality of life. However, the information on the type of anxiety disorder and its prevalence in persons with T2DM is limited., Aims: To assess the prevalence and correlates of anxiety disorder in people with type 2 diabetes in different countries., Methods: People aged 18-65 years with diabetes and treated in outpatient settings were recruited in 15 countries and underwent a psychiatric interview with the Mini-International Neuropsychiatric Interview. Demographic and medical record data were collected., Results: A total of 3170 people with type 2 diabetes (56.2% women; with mean (SD) duration of diabetes 10.01 (7.0) years) participated. The overall prevalence of anxiety disorders in type 2 diabetic persons was 18%; however, 2.8% of the study population had more than one type of anxiety disorder. The most prevalent anxiety disorders were generalised anxiety disorder (8.1%) and panic disorder (5.1%). Female gender, presence of diabetic complications, longer duration of diabetes and poorer glycaemic control (HbA1c levels) were significantly associated with comorbid anxiety disorder. A higher prevalence of anxiety disorders was observed in Ukraine, Saudi Arabia and Argentina with a lower prevalence in Bangladesh and India., Conclusions: Our international study shows that people with type 2 diabetes have a high prevalence of anxiety disorders, especially women, those with diabetic complications, those with a longer duration of diabetes and poorer glycaemic control. Early identification and appropriate timely care of psychiatric problems of people with type 2 diabetes is warranted., Competing Interests: Competing interests: AB has received a research grant from Abbott, and fees for lectures from Lundbeck. CL has received travel expenses paid by unrestricted grants from Eli Lily and Sanofi to attend the World Diabetes Congress and the American Psychiatric Association conference. The Association for the Improvement of Mental Health Programs, which sponsored this programme and financially supported tasks related to its management and data analysis, received unrestricted grants from Eli Lilly and Sanofi. NS received travel support and fees from Janssen, Cilag, Lundbeck International Neuroscience Foundation, Servier: all outside the activities related to work on this study or on this paper. WW has received personal fees from Roche Pharma, outside the submitted work.

Objectives: To examine the knowledge and attitude towards dentist-industry relationship including accepting gifts, influence on decisions, and accuracy of given information among dentists working in Saudi Arabia. In addition, to examine the association of such knowledge and attitude of dentists' behavior with industry, including sorts of interaction and accepting industrial gifts., Methods: A cross-sectional study was conducted among dental practitioners working in the private and governmental hospitals located in the various regions of Saudi Arabia. A self-administrated questionnaire was developed and distributed to all participants. Fourteen questions assessed the socio-demographic, economic, and occupational characteristics of the participants including age, gender, nationality, monthly revenue, income satisfaction, hospital setting, job rank, specialty, and patients' socio- economic status. Seventeen questions assessed the interaction with DSRs, acceptance and characteristics of gifts and opinion of dentists regarding gift acceptance in dental practice. One-Way ANOVA and t -test was used to examine differences in transformed scores by socio-demographic, occupations and outcome characteristics. All P-values were two-tailed. P-value < 0.05 was considered as significant., Results: Total of 672 participants responded to general questions related to the knowledge and attitude. The mean of the overall knowledge and attitude score was 64.3 ± 7.2, general questions score was 63.1 ± 8.6 and interaction questions score was 66.9 ± 8.0. Approximately, 40% of participants disagreed that accepting industrial gifts can affect their own decisions but slightly lower proportion (25%) disagreed that accepting industrial gifts can affect decisions of other dentists. Only 25% of participants thought it is ethical to accept industrial gifts and even fewer proportions (20%) believed that dental supply representatives (DSRs) always provide accurate information about their new materials. Almost two-thirds of participants trusted information from other sources than from DSRs. On the other hand, 40% of the participants were against banning industrial gifts to dentists and approximately 50% were against informing the patients about the industrial gifts given to their dentist by dental companies., Conclusions: There was insufficient knowledge and an overall positive attitude towards the dental industry among the sample of dentists in Saudi Arabia. Well-designed ethical education programs should be implemented to enhance knowledge and attitudes about the interactions with dental industry.

Objective: Investigation of brain structure in disease has been enhanced by developments in shape analysis methods that can identify subtle regional surface distortions. High-resolution magnetic resonance (MR) imaging was used to compare volumetric and shape analysis in schizophrenia (SCZ) patients and healthy controls (CON)., Methods: T1-weighted, 1-mm thick MR images were acquired for 15 patients with SCZ and 15 age-matched healthy controls using subcortical volume and shape analysis, which we believe to be complimentary to volumetric measures., Results: SCZ patients showed significant shape differences compared to healthy controls in the right hippocampus ( P < 0.005), left and right putamen ( P < 0.044 and P < 0.031), left caudate ( P < 0.029), right pallidum ( P < 0.019), and left thalamus ( P < 0.033)., Conclusion: Our results provide evidence for subcortical neuroanatomical changes in patients with SCZ. Hence, shape analysis may aid in the identification of structural biomarkers for identifying individuals of SCZ., Competing Interests: There are no conflicts of interest.

Background: The distress thermometer (DT) has been studied and validated as an effective screening instrument for identifying distress among cancer patients worldwide. This study aims to evaluate the validity of the Arabic version of the DT in Saudi cancer patients, to define the optimal cutoff point of the Arabic DT for detecting clinically significant distress and to determine whether there is any correlation between clinically significant distress and other demographic and Problem List variables., Methods: The original form of the DT was translated to Arabic using a forward and backward translation method. Then, a group of 247 cancer patients who were followed up at the Outpatient Oncology Clinic at King Saud Medical City in Riyadh, Saudi Arabia, completed a socio-demographic and clinical status questionnaire, the DT and the Problem List scale, and the Hospital Anxiety and Depression Scale (HADS)., Results: Receiver operating characteristic (ROC) curve analyses picked out an area under the curve of 0.76 when compared with a HADS cutoff score of 15. The DT had the best sensitivity (0.70) and specificity (0.63) with cutoff score of 4. A DT score of 4 or more was found to have a statistically significant correlation with female gender, advanced cancer stages and most of the Problem List items, including child care, work or school, treatment decision, dealing with children and partners, depression, fears, nervousness, sadness, loss of interest in usual activity, religious concerns, appearance, bathing/dressing, breathing, diarrhea, fatigue, feeling swollen, fever, getting around, indigestion, memory and concentration, nausea, dry nose, pain, and sexual problems. In contrast, a multivariate regression analysis confirmed only advanced cancer stages, treatment decision, depression, fear, sadness, worry, breathing, feeling swollen, fever, indigestion, memory and concentration, dry nose and congestion, pain and sleep as independent factors associated with distress in cancer patients., Conclusions: We found the Arabic version of the DT to be a valid instrument for screening distress in Saudi patients with cancer. Our study proposes using a cutoff score of 4 as an indicator of clinically significant distress in this population., Competing Interests: The authors have declared that no competing interests exist.

Background: The Stanford Proxy Test for Delirium (S-PTD) is a tool developed to be completed by nurses at the end of their shift. It was designed to use the knowledge acquired during a full shift of nurse-patient interaction. The objective of our study was to validate the S-PTD among a mixed sample of patients in both the intensive care unit (ICU) and non-ICU settings., Methods: A cross-sectional study was conducted in an ICU and three general medical wards in a tertiary care hospital. Patients were independently and blindly assessed for delirium by (1) the patients' primary nurses using the S-PTD at the end of their shift, and (2) a Consultation liaison psychiatrist who conducted a neuropsychiatric evaluation based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)., Results: A total 288 patients were included in current analysis. Using the S-PTD, delirium was identified in 72 (25.0%), while an expert neuropsychiatric examination, based on DSM-5 identified delirium in 75 (26.0%) patients. This study demonstrated that the S-PTD has very strong discriminative ability (area under the curve= 0.946, p<0.001). An S-PTD cut-off score ≥3 was associated with an 82.7% sensitivity, an 95.3% specificity, an 86.1% positive predictive value, a 94.0% negative predictive value, and a 92.0% overall diagnostic accuracy. These results were similar in both ICU and general ward patients., Conclusion: The S-PTD has excellent sensitivity and specificity in detecting delirium in both ICU and ward patients, even when compared with the gold-standard, a DSM-based neuropsychiatric examination., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: Hyperprolactinemia is a common adverse event associated with psychotropic medications (mainly antipsychotics) used in the management of schizophrenia and bipolar disorders. The aim of this study was to estimate the prevalence of hyperprolactinemia in psychiatric patients and to evaluate its association with various psychiatric diagnoses and the use of various psychotropic medications., Methods: A cross-sectional observational study was conducted between July 2012 and June 2014. Patients were recruited from a number of hospitals located in the five regions of Saudi Arabia. Hyperprolactinemia was defined as blood prolactin levels >25 ng/mL in females and >20 ng/mL in males, regardless of the presence of symptoms., Results: A total of 997 patients (553 males and 444 females) were included in the current analysis. The average blood prolactin level was 32.6 ± 44.1 ng/mL, with higher levels among females than males (42.9 ± 61.3 versus 24.4 ± 18.6, p < .001). The prevalence of hyperprolactinemia was 44.3%, with no significant gender difference (41.9% in females versus 46.3% in males, p = .164) but with huge variability according to individual antipsychotic and other psychotropic medications. In the multivariate analysis adjusted for demographic and clinical characteristics, hyperprolactinemia was independently and positively associated with using antipsychotic medications (OR = 2.08, 1.26-3.42, p = .004). Additionally, previous hospitalisation, diabetes and hypothyroidism were positively associated, whereas having primary depressive disorders was negatively associated., Conclusions: We report a high prevalence of hyperprolactinemia among a large sample of psychiatric patients in Saudi Arabia, which was linked to the use of antipsychotic medications. Routine measurement of blood prolactin levels for all patients maintained on antipsychotic agents is recommended, regardless of symptoms.

Background: In view of a constant increase in the number of patients treated with antipsychotic medications, the problem of nonadherence to the prescribed treatment becomes particularly relevant. Since one of the major contributors to the nonadherence is the presence of side effects of the drugs being used, the availability of tools for assessment of adverse reactions is of great importance., Objective: The objective of the present work was to develop an Arabic language version of the Glasgow Antipsychotic Side-effect Scale (GASS)., Methods: After confirming the accuracy of translation, the questionnaire was given to 100 patients in two psychiatric centers in Saudi Arabia., Results: The Cronbach's alpha (0.793) indicated a good reliability of the survey. The mean GASS score was 19.09, indicating absent or mild side effects of antipsychotics, but 46% of patients experienced moderate, and 25% experienced severe side effects. An analysis of the correlation between patients' characteristics and side effects revealed the presence of a positive relationship between the side effects and health literacy., Conclusions: It is expected that the Arabic-GASS will benefit Arabic-speaking psychiatric patients by helping them to express their concerns about side effects of antipsychotics. The collected results also document the importance of patients' health literacy in achieving high-quality healthcare., Competing Interests: The authors have declared that no competing interests exist.

Background: The higher prevalence of smoking among psychiatric patients is well established. However, gender-specific associations have rarely been the focus of studies among patients with various psychiatric disorders. The aim of this study was to estimate the gender-specific prevalence of current smoking by psychiatric patients and its association with various psychiatric disorders and the use of psychotropic medications., Methods: A cross-sectional observational study was performed between July 2012 and June 2014. Patients were recruited from six hospitals located in the five regions of Saudi Arabia., Results: Of the 1193 patients, 402 (33.7%) were current smokers. The incidence of current smoking was much higher among males than females (58.3% versus 6.7%, p  < 0.001). In one or both genders, current smoking was associated with marital status, education, family income, residence, obesity, physical activity, substance abuse, inpatient status, previous psychiatric hospitalization, and age at onset of psychiatric illness. In both gender, smoking was higher in patients who had a secondary psychiatric disorder (66.7% versus 37.5%, respectively), those who had a primary psychotic disorder (63.7% versus 12.3%), and those taking antipsychotic medication (64.1% versus 8.3%) but lower in patients who had a primary depressive disorder (40.3% versus 4.3%), those who had a primary anxiety disorder (45.8% versus 0.0%), and those taking antidepressant medications (53.7% versus 3.6%). In a multivariate analysis adjusted for demographic/clinical characteristics and psychiatric disorders, current smoking was independently associated with primary psychotic disorders in females (OR = 3.47, 1.45-8.27, p  = 0.005) but not in males. In a multivariate analysis adjusted for demographic/clinical characteristics and psychotropic medications, current smoking was independently associated with antipsychotic medication use in males (OR = 1.79, 1.10-2.93, p  = 0.020). Current smoking was strongly associated with substance abuse in both univariate and multivariate analyses., Conclusion: The prevalence of current smoking is high with marked gender difference in a large sample of mixed psychiatric patients in Saudi Arabia. Smoking-cessation programs may be urgently needed for these vulnerable patients.

Background: Exposure to stressful working conditions without adequate stress-coping strategies may lead to stress and even psychiatric morbidity. There are a dearth of studies on stress-coping strategies among consultant physicians in the Arabian Gulf., Objectives: Determine stress-coping strategies among consultants in Saudi Arabia and the relationship of strategies to level of stress., Design: Analytical cross-sectional study., Settings: Conducted between November 2014 and March 2015 among physician consultants registered at the Saudi Commission for Health Specialties., Subjects and Methods: Text messages were used to directly ask consultants to complete an online questionnaire., Main Outcome Measures: The 28-item Brief COPE inventory and the Perceived Stress Scale., Sample Size: 582., Results: The consultants were largely males (71%) and Saudi (56%), and their mean age was 46.9 (7.9) years. Adaptive stress-coping strategies were more frequently used than maladaptive stress-coping strategies (68% versus 49%). Stress levels were positively correlated with maladaptive stress-coping strategies (r=0.41, P less than .001) and negatively correlated with adaptive stress-coping strategies (r=-0.09, P=.026). Religion was the most frequently reported stress-coping strategy (79.6%) while alcohol drinking or substance use was the least frequently reported stress-coping strategy (28.0%). Females used both adaptive and maladaptive stress-coping strategies more than males (P=.002 and P less than .001, respectively). Stress management education/training was positively associated with frequent use of adaptive stress-coping strategies., Conclusions: Physician consultants generally cope well with work stressors. Nevertheless, there is still a critical need for stress management programs targeting consultants in order to further improve coping strategies., Limitations: The low response rate may negatively impact the validity and the generalizability of the current findings. The cross-sectional study design precluded the finding of any causal association., Conflict of Interest: None.

Objectives: To estimate prevalence of physical activity and its associations with various psychiatric disorders and the use of psychotropic medications., Methods: A cross-sectional observational study was carried out between July 2012 and June 2014. Patients were enrolled from a number of hospitals located in 5 regions of the Kingdom of Saudi Arabia., Results: A total of 1185 patients were included in current analysis: 796 were outpatients, and 389 were inpatients. Out of 1,185 patients, 153 (12.9%) were physically active. Much higher rates of physical activity were reported among males than females (15.9% versus 9.6%, p less than 0.001). According to the univariate analysis, higher rates of physical activity were positively correlated with primary bipolar disorders, the use of antianxiety medications and, to a lesser extent, use of antipsychotic medications, but they were negatively correlated with primary anxiety disorders, use of antidepressant medications, and use of multiple psychotropic medications. The associations between physical activity and primary bipolar disorders (odds ratio [OR]=2.47, p=0.002), use of antianxiety medications (OR=3.58, p=0.003), and use of multiple psychotropic medications (OR=0.33, p less than 0.001) remained significant after adjusting for demographic and clinical characteristics., Conclusion: We report a variable but generally low prevalence of physical activity among a large, mixed sample of psychiatric patients in Saudi Arabia. These findings may highlight the importance of assessing physical activity status of psychiatric patients and the critical need for physical activity promotion programs among this group of disadvantaged patients.

The objective of the study was to evaluate the differences in psychosocial distress and coping mechanisms among infertile men and women in Saudi Arabia (SA). We performed a cross-sectional study of infertile patients (206 women and 200 men) attending infertility clinics in three referral hospitals in Riyadh, SA. A semi-structured questionnaire was developed to assess socio-demographic, clinical and psychosocial variables. Infertility-related psychosocial pressures were reported in 79 (39.7%) male and 97 (47.3%) female participants (p = 0.123). Males suffered more from intrusive questions and pressure to conceive, remarry or get divorced, while females were stressed more from psychological and emotional exhaustion, marital discord, attitudes of mothers-in-law or society, and persistent desire by the husband to have children. To cope with infertility, females engaged more in religious activities (p < 0.001) and spoke more to someone regarding their problems (p < 0.001). To solve their infertility problems, 50% tried to find solutions via the internet, and 38.5% of males and 51% of females reported using alternative medicines (p = 0.012). The patients with infertility in SA face multiple psychosocial stressors related to their infertility, and cope differently based on the gender and culture-specific knowledge of infertility. The female participants were significantly more affected from psychosocial stressors and the persistent desire by their spouse to have children.

Objectives: To evaluate the prevalence and clinical correlates of metabolic syndrome (MetS) and its components among patients with psychiatric disorders., Methods: A cross-sectional study was conducted among adult patients with psychiatric disorders at major hospitals in Saudi Arabia. After measurements were recorded for all MetS components, demographic and clinical information was obtained mainly by reviewing the patients' medical charts., Results: The prevalence rate of MetS among the 992 study participants was 41.2%, high triglycerides was 32.8%, large waist circumference was 42.2%, high blood pressure was 42.5%, high fasting blood sugar was 47.8%, and low HDL cholesterol was 52.5%. Participants with MetS were more likely to be older, illiterate, divorced or widowed, have a higher number of children, older age of onset of psychiatric illness, longer duration of psychiatric disease, no previous psychiatric hospitalization, and have a history of diabetes and hypertension. After adjusting for significant demographic and clinical characteristics, none of the psychiatric diagnoses and treatments was independently associated with MetS, except the use of mirtazapine and venlafaxine., Conclusions: The prevalence of MetS and its components among patients with psychiatric disorders is alarming irrespective of their diagnoses. Thus, metabolic screening especially among high risk groups is critical., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Depression literacy in general population constitutes an ability to understand depression, with knowledge of disease, its risk factors and symptoms. High levels of depression literacy promote early intervention, potentially reducing related disability., Aim: This study investigated the depression literacy in women visitors to clinics of a tertiary care hospital in Riyadh, Saudi Arabia., Methods: Women of 18 and more years were surveyed during their visit to primary and other healthcare clinics of a public hospital in Riyadh. Knowledge on depression symptoms, causes and management approaches identified depression literate women scoring more than 30 points on a 42-item tool., Results: Of the 409 participants, 65.5% were depression literate, 50% educated as college and above, 64.3% married, 50.7% housewives, 62.4% reported use of multiple information sources (range, 0-8) and had a mean age of 34.9 (standard deviation ( SD), 12.4) years. In a logistic regression model, participants scoring less than 30 for depression literacy were significantly associated with women having less than college-level education, divorced marital status and use of decreasing number of learning resources., Conclusion: Women with low education divorced; using fewer information sources need specific considerations by healthcare providers for assessment of depressive disorders in this setting.

Introduction: Multiple sclerosis (MS) is a common disorder in some regions of the world, with over 2.3 million people diagnosed worldwide. Cognitive impairment is one of the earliest symptoms to present in the course of the disease and can cause significant morbidity. We proposed a study to explore the psychosocial predictors of cognitive impairment in MS patients in Saudi Arabia, a previously unexplored patient population., Methods: Demographic data, depression scale (PHQ9), symptom burden (PHQ15), anxiety (GAD7), disease duration, and Montreal Cognitive Assessment (MOCA) scores were collected from 195 patients in a neurology clinic in Ryiadh, Saudi Arabia. Univariate and multiple regression analyses were conducted to identify variables that are significantly associated with cognitive impairment., Results: Variables that were identified to be significantly associated with cognition, p < 0.05, were education level, disease duration, and family history., Discussion: Both education level and disease duration were variables identified in previous studies. We showed family history to be a significant variable, and no association was found with depression or anxiety, which is unique to our study population., Conclusions: We identified several psychosocial predictors that are associated with cognition in our patient population. It was also noted that a difference exists between patient populations, highlighting the need for further studies in specific geographical regions.

Objective: To explore the possible causes behind adults seeking psychotropic medications without a prescription; identify the most commonly used psychotropic medications without a prescription; and determine the prevalence of depression and anxiety disorders among adults who used psychotropic medications without a prescription in Riyadh, Kingdom of Saudi Arabia., Methods: A cross-sectional study was conducted from November 2014 to August 2015. A convenience sample was taken by distributing a self-administered questionnaire among participants who had obtained psychotropic medications without a prescription from retail pharmacies during the 4 weeks prior to study intake in Riyadh, Kingdom of Saudi Arabia. In addition to the study questionnaire, the 9-item Patient Health Questionnaire was used to screen for major depressive disorder, and the 7-item Generalized Anxiety Disorder Scale was used to screen for general anxiety disorders., Results: Of the 302 subjects, 42.4% attributed their use of psychotropic medications without a prescription to the non-seriousness of their symptoms and 28.5% to the high cost of psychiatric services. Escitalopram was the most commonly used medication (31.8%), and 3 atypical antipsychotics were used by more than one-fifth of the study participants. The prevalence for major depressive disorder was 46.0% and 41.7% for generalized anxiety disorder., Conclusion: Most of the participants were able to easily obtain psychotropic medications without a prescription. We recommend implementing strong policies to prevent retail pharmacies from dispensing psychotropic medications without a prescription.

Objectives: To investigate the prevalence and correlates of smartphone addiction among university students in Saudi Arabia., Methods: This cross-sectional study was conducted in King Saud University, Riyadh, Kingdom of Saudi Arabia between September 2014 and March 2015. An electronic self administered questionnaire and the problematic use of mobile phones (PUMP) Scale were used. , Results: Out of 2367 study subjects, 27.2% stated that they spent more than 8 hours per day using their smartphones. Seventy-five percent used at least 4 applications per day, primarily for social networking and watching news. As a consequence of using the smartphones, at least 43% had decrease sleeping hours, and experienced a lack of energy the next day, 30% had a more unhealthy lifestyle  (ate more fast food, gained weight, and exercised less), and 25% reported that their academic achievement been adversely affected. There are statistically significant positive relationships among the 4 study variables, consequences of smartphone use (negative lifestyle, poor academic achievement), number of hours per day spent using smartphones, years of study, and number of applications used, and the outcome variable score on the PUMP. The mean values of the PUMP scale were 60.8 with a median of 60. , Conclusion: University students in Saudi Arabia are at risk of addiction to smartphones; a phenomenon that is associated with negative effects on sleep, levels of energy, eating habits, weight, exercise, and academic performance.

Tardive dyskinesia (TD) is one of the most serious and disturbing side-effects of dopamine receptor antagonists. It affects 20-50% of patients on long-term antipsychotic therapy. The pathophysiology of TD remains poorly understood, and treatment is often challenging. Here, we present a 32-year-old woman presenting with a 9-month history of TD occurring after risperidone withdrawal, and characterized almost exclusively by tongue protrusion. After being seen by different specialties and undergoing multiple investigations, she was eventually correctly diagnosed with TD by a specialist team and successfully treated with amantadine. Vigilance and awareness of this condition and its risk factors are required to make the correct diagnosis, especially in cases with unusual presentations caused by atypical antipsychotics, and treatment can be challenging.

Background and Objectives: No study has assessed psychiatric disorders among infertile men and women seeking fertility treatment in Saudi Arabia. Therefore, we sought to measure the rate of psychiatric disorders in this population., Design and Setting: This was a cross-sectional observational study among patients attending infertility clinics at three referral hospitals in Riyadh, Saudi Arabia, between January 2013 and September 2014., Patients and Methods: 406 patients (206 women and 200 men) participated in the study. The approved Arabic version of the MINI tool was used to assess 18 common psychiatric illnesses., Results: The response rate was 81%. Of the men surveyed, only 4.5% self-reported having a psychiatric disorder. Of the women surveyed, only 10.2% reported having a psychiatric disorder. However, using the MINI scale, psychiatric illness was documented in 30% of males and 36.9% of females. The most common diagnoses for both genders were depression (21.7%) and anxiety (21.2%). Significantly more females than males exhibited suicidality and depression. In contrast, significantly more males than females had bipolar disorders and substance-related disorders. A low monthly income among male and female participants and polygamy among female participants were significantly associated with psychiatric disorders., Conclusions: This study shows that a higher prevalence of psychiatric disorders, particularly depression and anxiety, among infertile men and women in Saudi Arabia is associated with lower income and polygamy. This study highlights the importance of integrated care for alleviating the psychological burden of this unfortunate population and improving outcomes and quality of life. This study also encourages follow-up studies that aim to further understand the complex relationship between fertility and psychological well-being.

Objectives: To examine perceived stress among residents in Saudi Arabia and its associated risk factors., Methods: A cross-sectional study of all residents registered at the Saudi Commission for Health Specialties, Riyadh, Saudi Arabia, was conducted between May and October 2012. We assessed the likelihood of stress using the perceived stress scale (PSS)., Results: Out of the 4000 residents contacted, 1035 responded and 938 were included. The mean (±standard deviation) PSS score was 22.0±5.1 (median 22 and inter-quartile range of 18-25). With the exception of gender and nationality, no significant associations were found between stress and socio-demographic or behavioral factors. Stress was associated with higher workload, sleep deprivation, dissatisfaction with colleagues and the program, and harmful ideations. Stressors included work-related, academic, and homesickness stressors. In multivariate analysis, the following were independently associated with stress: Saudi nationality, facing homesick stressor, facing work-related stressor, dissatisfaction with relationships with colleagues, and frequent thoughts of quitting the medical profession., Conclusion: Residents in Saudi Arabia are at comparable or slightly higher risk of perceived stress than that reported among residents worldwide. Unfortunately, most of the participants never received stress management, which highlights the need for stress management programs during residency.

The relationship between physicians and the pharmaceutical industry has ethical implications for patient care. This study examined knowledge and attitudes towards the pharmaceutical industry, and associations with actual behaviour, among physicians working in Saudi Arabia. In a cross-sectional study in 2012, a 100-point score was created from 17 5-point Likert-scale questions to assess knowledge and attitudes. The overall score of 659 participants was 63.1 (SD 8.5), with a majority holding a generally positive attitude. Higher (i.e. better) scores were significantly associated with a lack of interactions with the pharmaceutical industry and with refusal of gifts but not with education about ethics. In multivariate analysis, refusing gifts, additional income and Saudi nationality remained independently associated with higher scores. Overall, there was suboptimal knowledge and a generally positive attitude towards the pharmaceutical industry among the sample of physicians in Saudi Arabia.

Background: In this study, we compared the prevalence of psychiatric disorders and the characteristics of those who either use or do not use faith healers (FHs) services. We also assessed the independent factors of study subjects associated with using FHs., Methods: This cross-sectional study compared those who use FHs (n = 383) with a control group of those who do not use them (i.e., shopping mall visitors, n = 424) using a survey of sociodemographic characteristics and a validated Arabic version of the Mini International Neuropsychiatric Interview (MINI 6.0)., Results: Participants who ranked higher among FH users included males, people who were either married, divorced, or widowed, those with less education, and those with lower income. They were more likely to report past medical and psychiatric history. Those with diagnosable psychiatric disorders were more likely to visit FHs, especially if the diagnosis was of psychotic and bipolar disorders. The prevalence of psychiatric disorders was higher among FH users, and depressive and anxiety disorders were the most prevalent., Conclusions: The study showed that having past psychiatric history and a current psychiatric disorder are risk factors for using FHs. Also, a high percentage of FH users had a diagnosable psychiatric disorder. Further research should assess how to facilitate their access to the mental health system.