Prevalence and risk factors for metabolic syndrome in schizophrenia, schizoaffective, and bipolar disorder.

BACKGROUND: Metabolic Syndrome (MetS) is a risk for developing cardiovascular diseases and its prevalence is especially high in psychiatric patients. To date, there is limited data from the United Arab Emirates (UAE) on the prevalence of MetS. Therefore, we aimed to investigate its prevalence and possible risk factors in a large sample of psychiatric patients in the UAE. METHODS: A cross-sectional study was conducted at Al-Ain Hospital, in Al-Ain City, UAE. We collected demographic and clinical data on patients diagnosed with schizophrenia, schizoaffective, and bipolar affective disorder in the period between January 2017 and December 2020. This included their secondary diagnosis (psychiatric or medical), vital signs (heart rate, systolic and diastolic blood pressure, Body Mass Index [BMI]), metabolic parameters (fasting blood glucose, cholesterol, triglycerides, low-density lipoprotein, high-density lipoproteins), and prescribed medications. We used the American Association of Clinical Endocrinology (AACE) criteria to diagnose MetS. RESULTS: We included 889 subjects and of these, 79.8% (N = 709) had a BMI ≥25 kg/m2 and 9.8% (N = 87) had no abnormal metabolic parameters. Overall, 28.1% (N = 250) had MetS with no statistical difference between the three groups. Fasting blood glucose levels and abnormally elevated triglycerides were significant predictors for MetS. CONCLUSION: Our study found that around one in three patients had MetS irrespective of the three diagnoses. Some variables were significant predictors for MetS. Our findings were consistent with other studies and warrant the need for regular screening and management of abnormal metabolic parameters.

There is no statistical difference between schizophrenia, schizoaffective disorder, and bipolar disorder with regards to the prevalence of metabolic syndrome.Fasting blood glucose levels and abnormally elevated triglycerides were significant predictors of metabolic syndrome.Screening of metabolic parameters is important as well as the careful tailoring of the choice of antipsychotics.

Use of endoscopic submucosal dissection or full-thickness resection device to treat residual colorectal neoplasia after endoscopic resection: a multicenter historical cohort study.

INTRODUCTION : Residual colorectal neoplasia (RCN) after previous endoscopic mucosal resection is a frequent challenge. Different management techniques are feasible including endoscopic full-thickness resection using the full-thickness resection device (FTRD) system and endoscopic submucosal dissection (ESD). We aimed to compare the efficacy and safety of these two techniques for the treatment of such lesions. METHODS : All consecutive patients with RCN treated either using the FTRD or by ESD were retrospectively included in this multicenter study. The primary outcome was the R0 resection rate, defined as an en bloc resection with histologically tumor-free lateral and deep margins. RESULTS : 275 patients (median age 70 years; 160 men) who underwent 177 ESD and 98 FTRD procedures for RCN were included. R0 resection was achieved in 83.3 % and 77.6 % for ESD and FTRD, respectively (P = 0.25). Lesions treated by ESD were however larger than those treated by FTRD (P < 0.001). The R0 rates for lesions of 20-30 mm were 83.9 % and 57.1 % in the ESD and FTRD groups, respectively, and for lesions of 30-40 mm were 93.6 % and 33.3 %, respectively. On multivariable analysis, ESD procedures were associated with statistically higher en bloc and R0 resection rates after adjustment for lesion size (P = 0.02 and P < 0.001, respectively). The adverse event rate was higher in the ESD group (16.3 % vs. 5.1 %), mostly owing to intraoperative perforations. CONCLUSION: ESD is effective in achieving R0 resection for RCN whatever the size and location of the lesions. When residual lesions are smaller than 20 mm, the FTRD is an effective alternative.

Repetitive transcranial magnetic stimulation (rTMS) is associated with increased abstinence in substance use disorders and comorbid depression.

BACKGROUND: Substance use disorders (SUDs) are associated with high rates of comorbid depression. Finding effective treatments for many of the substances of abuse is still an area of developing research. Repetitive transcranial magnetic stimulation (rTMS) is an established treatment for depression, but its effects in SUDs are less conclusive. Therefore, we aimed to investigate the effect of rTMS in patients with SUDs and comorbid major depressive disorder (MDD). METHODS: We conducted a retrospective observational study of 55 patients with SUDs and comorbid MDD who were eligible for rTMS. Craving was measured using the Brief Substance Craving Scale (BSCS). Severity of MDD was measured using the Clinical Global Impression-Severity (CGI-S) scale. RESULTS: We found a statistically significant difference between baseline and posttreatment scores in patients receiving rTMS on both CGI-S scores and BSCS scores. The number of rTMS sessions significantly predicted increased days of abstinence in the community, even after controlling for confounders. CONCLUSIONS: Patients with SUDs and MDD who received rTMS significantly improved in the areas of severity of depression and craving. The number of rTMS sessions significantly predicted increased abstinence.

Can Cotard Syndrome Be Induced?: Illustration With a Rare Case of Potential Organ Transplant.

ABSTRACT: Cotard syndrome is a rare condition characterized by delusions ranging from a belief that one has lost organs to insisting that one has lost one's soul or is dead. This is the report a case of a 45-year-old man who was comatose after an attempted suicide. This was initially diagnosed as brain death and use of his organs for transplantation was actively considered. However, he awakened days later with new-onset Cotard syndrome. It remains difficult to know the link, unconscious or conscious, between this patient's delusions and the fleeting intention of doctors who intended to transplant his organs. This is the first description of a coincidence between delusional denial of an organ and the potential medico-surgical act of having an organ removed. This case is an opportunity to revisit the philosophical concepts of negation and nihilism. A multidisciplinary reflection is needed to give meaning to other clinical presentations.

The Utility of CYP2D6 and CYP2C19 Variants to Guide Pharmacological Treatment in Complex Unipolar Major Depression: A Pilot Longitudinal Study.

Major depression is a frequent condition which variably responds to treatment. In view of its high prevalence, the presence of treatment resistance in major depression significantly impacts on quality of life. Tailoring pharmacological treatment based on genetic polymorphisms is a current trend to personalizing pharmacological treatment in patients with major depressive disorders. Current guidelines for the use of genetic tests in major depression issued by the Clinical Pharmacogenomics Implementation Consortium (CPIC) are based on CYP2D6 and CYP2C19 polymorphisms which constitute the strongest evidence for pharmacogenomic guided treatment. There is evidence of increased clinical response to pharmacological treatment in major depression although largely in non-treatment resistant patients from Western countries. In this study, well characterised participants (N = 15) with complex, largely treatment resistant unipolar major depression were investigated, and clinical improvement was measured at baseline and at week-8 after the pharmacogenomics-guided treatment with the Montgomery Åsberg Depression Rating Scale (MÅDRS). Results suggested a statistically significant improvement (p = 0.01) of 16% at endpoint in the whole group and a larger effect in case of changes in medication regime (28%, p = 0.004). This small but appreciable effect can be understood in the context of the level of treatment resistance in the group. To our knowledge, this is the first study from the Middle East demonstrating the feasibility of this approach in the treatment of complex major depressive disorders.

Transient Elastography Accurately Screens for Compensated Advanced Chronic Liver Disease in Patients With Ongoing or Recent Alcohol Withdrawal.

BACKGROUND & AIMS: Liver stiffness measurement by transient elastography (TE) is a promising method for staging fibrosis in alcohol-related liver disease, but uncertainties remain regarding the influence of alcohol consumption and thus the ideal timing for TE performance. We evaluated the performance of TE compared with liver biopsy to exclude compensated advanced chronic liver disease (cACLD) in patients hospitalized for alcohol detoxification. METHODS: Patients were recruited prospectively at 6 in-patient addiction centers in France. Eligible patients had increased aspartate aminotransferase levels, and no history or signs of overt cirrhosis. TE, histology, and biochemistry measurements were obtained within a median of 6 days after alcohol withdrawal. TE and biochemistry were repeated 1 and 2 months later. RESULTS: The study included 259 patients for per-protocol analysis, of whom 45 (17%) had cACLD. TE identified patients with high accuracy at inclusion and at the 1- and 2-month follow-up evaluation, with area under the curve values of 0.96 (95% CIs, 0.94-0.99), 0.96 (95% CIs, 0.92-0.99), and 0.93 (95% CIs, 0.85-1.00), respectively. In 84% of patients, cACLD was ruled out when liver stiffness was less than 10 kPa (negative predictive value, 99% (95% CIs, 98%-100%)) or ruled in when greater than 25 kPa (positive predictive value, 93% (95% CI, 83%-102%)). Algorithms based on aminotransferase levels and/or bilirubin did not add to the diagnostic performance of TE in this period. Among patients with initial liver stiffness of 10 to 25 kPa, more than half of those with no cACLD showed liver stiffness of less than 10 at 1- and 2-month follow-up testing. CONCLUSIONS: TE performed during the first 2 months after alcohol cessation is an excellent method for excluding alcohol-related cACLD. CLINICAL TRIAL NUMBER: NCT01789008.

Frequency of illness anxiety (hypochondriasis) by proxy encountered by doctors in parents towards their children.

BACKGROUND: Illness anxiety disorder is a condition of having a persistent fear of having a serious or life-threatening illness despite few or no symptoms. Current classification systems assume that illness anxiety is experienced relative to one's own health, and not towards others ("by proxy"), yet it has been observed to occur in parents towards their children. This study was designed to survey doctors about how commonly they encounter illness anxiety by proxy (IAP). METHODS: We conducted a qualitative survey of 149 physicians who work with children (pediatricians, psychiatrists, and general practitioners) from the United Arab Emirates (UAE) and Egypt. The survey was administered via email and a paper-based form. In the UAE, 108 physicians were emailed the survey; 55 (50.1%) responded. For the email survey we used items from the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). An additional 100 physicians were surveyed in person; 94 (94%) responded. RESULTS: Nearly all respondents (98.7%) reported having encountered IAP in parents. Of these, 51 (34.2%) reported frequently encountering these types of health anxieties, and 50 (33.6%) reported that the parents' concern that their child had a serious disease persisted despite reassurance and appropriate medical evaluation. Seventy-eight (52.3%) respondents reported that exaggeration of actual existing symptoms was the most common reason for parents' fears; 72 (48.3%) reported that the concerned parent was more likely to be the mother; and 36 (24.2%) reported that most parents were not 100% certain of their own beliefs. CONCLUSIONS: IAP is frequently encountered by pediatricians, psychiatrists, and general practitioners. Practitioners who work with children and their parents need to be aware of this phenomenon to provide appropriate support and treatment. More research is needed to screen for the extent and severity of this phenomenon.

Decreased acylated and total ghrelin levels in bipolar disorder patients recovering from a manic episode.

BACKGROUND: To date, only few studies have investigated ghrelin levels in bipolar disorders, and all have exclusively measured acylated ghrelin, with none investigating total ghrelin (acylated and des-acylated). We aimed to investigate peripheral levels of acylated and total ghrelin in subjects experiencing a manic episode of bipolar disorder. METHODS: Peripheral levels of acylated and total ghrelin were measured in hospitalised medicated individuals recovering from a manic episode. Enzyme-linked immunosorbent assays (ELISA) were used to measure ghrelin levels in patients and compared with healthy controls. The relationship between ghrelin levels in bipolar disorder, self-reported hunger measures, demographic and clinical parameters was investigated with correlational analyses. RESULTS: Twenty-four subjects (15 males, 9 females) recovering from mania and 27 matched healthy controls (13 males, 14 females) were recruited for the study. Mean values of both acylated (187 vs.520 pg/mL) and total ghrelin (396 vs. 648 pg/mL) were significantly reduced in bipolar disorder (p = 0.001). Ghrelin levels correlated positively with markers of illness severity and negatively with prescribed mood stabilizers, second-generation antipsychotics, weight and body mass index. CONCLUSION: Peripheral measurements of acylated and total ghrelin were both reduced in bipolar disorder patients compared to healthy controls. Whilst illness severity promotes higher ghrelin levels, pharmacological treatment and weight gain exercise the opposite effect.

Validation of the Mini-Addenbrooke's Cognitive Examination in Mild Cognitive Impairment in Arabic Speakers.

INTRODUCTION: Mild cognitive impairment (MCI) represents a target for early detection and intervention in dementia, yet there is a shortage of validated screening tools in Arabic to diagnose MCI. The mini-Addenbrooke's Cognitive Examination (m-ACE) is a brief cognitive battery that is scored out of 30 and can be administered in under 5 min providing a quick screening tool for assessment of cognition. OBJECTIVE: We aimed to validate the m-ACE in Arabic speakers in Egypt with MCI to provide cut-off scores. METHODS: We included 24 patients with MCI and 52 controls and administered the Arabic version of the m-ACE. RESULTS: There was a statistically significant difference (p < 0.0001) on the total m-ACE score between MCI patients (mean 18.54, SD 3.05) and controls (mean 24.54, SD 2.68). There was also a statistically significant difference between MCI patients and controls on the total score and the fluency, visuospatial, and memory recall sub-scores of the m-ACE (p < 0.05). Performance on the m-ACE significantly correlated with both the Mini-Mental State Examination (MMSE) and the Addenbrooke's Cognitive Examination-III (ACE-III). Using a receiver operator characteristic curve, the optimal cut-off score for MCI on the m-ACE total score was 21 out of 30 (87.5% sensitivity, 84.6% specificity, and 85.5% accuracy). CONCLUSIONS: We validated the Arabic m-ACE in Egyptian patients with MCI and provided objective validation of it as a screening tool for MCI, with good sensitivity, specificity, and accuracy that is comparable to other translated versions of the m-ACE in MCI.

Validation of the Egyptian-Arabic Version of the Addenbrooke's Cognitive Examination III (ACE-III) in Diagnosing Dementia.

INTRODUCTION: The Addenbrooke's Cognitive Examination III (ACE-III) (2012) is a brief cognitive battery that assesses five sub-domains of cognition (attention and orientation, memory, verbal fluency, language, and visuospatial abilities) which are commonly impaired in dementia. OBJECTIVE: We aimed to validate the Egyptian-Arabic ACE-III in dementia patients, and to provide cut-off scores for the ACE-III in diagnosing dementia in Egyptian-Arabic speakers. METHODS: We included 37 patients with dementia (Alzheimer's disease, n = 25, vascular dementia, n = 8, and dementia with Lewy bodies, n = 4) and 43 controls. RESULTS: There was a statistically significant difference (p < 0.001) in the total ACE-III score between dementia patients (mean 49.81 ± 18.58) and controls (mean 84.84 ± 6.36). There was also a statistically significant difference between dementia patients and controls in all sub-score domains of the ACE-III (p < 0.001). Using a receiver operator characteristic curve, the optimal cut-off score for dementia on the ACE-III total score was 72, (89% sensitivity, 95% specificity, 92% accuracy). CONCLUSIONS: The results of this study provide objective validation of the Egyptian-Arabic version of the ACE-III as a screening tool for dementia, with high sensitivity, specificity, and accuracy comparable to other translated versions of the ACE-III.

Adaptation and Validation of the Mini-Addenbrooke's Cognitive Examination in Dementia in Arabic Speakers in Egypt.

BACKGROUND: The mini-Addenbrooke's Cognitive Examination (m-ACE) is a brief cognitive battery that assesses 5 subdomains of cognition (attention, memory, verbal fluency, visuospatial abilities, and memory recall). It is scored out of 30 and can be administered in under 5 min providing a quick screening tool for assessment of cognition. OBJECTIVES: We aimed to adapt the m-ACE in Arabic speakers in Egypt and to validate it in dementia patients to provide cutoff scores. METHODS: We included 37 patients with dementia (Alzheimer's disease [n = 25], vascular dementia [n = 8], and dementia with Lewy body [n = 4]) and 43 controls. RESULTS: There was a statistically significant difference (p < 0.001) on the total m-ACE score between dementia patients (mean 10.54 and standard deviation [SD] 5.83) and controls (mean 24.02 and SD 2.75). There was also a statistically significant difference between dementia patients and controls on all sub-score domains of the m-ACE (p < 0.05). Performance on the m-ACE significantly correlated with both the Mini-Mental State Examination (MMSE) and the Addenbrooke's Cognitive Examination-III (ACE-III). Using a receiver operator characteristic curve, the optimal cutoff score for dementia on the m-ACE total score was found to be 18 (92% sensitivity, 95% specificity, and 94% accuracy). CONCLUSIONS: We adapted the m-ACE in Arabic speakers in Egypt and provided objective validation of it as a screening tool for dementia, with high sensitivity, specificity, and accuracy.

Validation of the Addenbrooke's Cognitive Examination-III in Mild Cognitive Impairment in Arabic Speakers in Egypt.

BACKGROUND AND AIMS: Mild cognitive impairment (MCI) represents an important point on the pathway to developing dementia and a target for early detection and intervention. There is a shortage of validated cognitive screening tools in Arabic to diagnose MCI. The aim of this study was to validate Addenbrooke's Cognitive Examination-III (ACE-III) (Egyptian-Arabic version) in a sample of patients with MCI, to provide cut-off scores in Egyptian-Arabic speakers. METHODS: A total of 24 patients with MCI and 54 controls were included in the study and were administered the Egyptian-Arabic version of the ACE-III. RESULTS: There was a statistically significant difference (p < 0.001) in the total ACE-III score between MCI patients (mean 75.83, standard deviation (SD) 8.1) and controls (mean 86.26, SD 6.74). There was also a statistically significant difference between MCI patients and controls in the memory, fluency, and visuospatial sub-scores of the ACE-III (p < 0.05) but not in attention and language sub-scores. Using a receiver operator characteristic curve, the optimal cut-off score for diagnosing MCI on the ACE-III total score was 81, with 75% sensitivity, 82% specificity, and 80% accuracy. CONCLUSIONS: The results of this study provide objective validation of the Egyptian-Arabic version of the ACE-III as a screening tool for MCI, with good sensitivity, specificity, and accuracy that are comparable to other translated versions of the ACE-III in MCI.

Impact of a culturally adapted behavioural family psychoeducational programme in patients with schizophrenia in Egypt.

OBJECTIVE: To study the effect of a culturally adapted, structured family intervention on symptom severity, medication attitudes and knowledge, social functioning and quality of life in patients with schizophrenia. METHODS: Thirty subjects with schizophrenia were selected to receive 14 sessions of a culturally adapted behavioural family psychoeducational programme (BFPEP). Another 30 subjects received standard treatment as usual (STU) for 6 months. Pre- and post-intervention outcomes were assessed using the Positive and Negative Syndrome Scale (PANSS), Drug Attitude Inventory 10-item scale (DAI-10), Quality of Life Scale (QLS) and Social Functioning Questionnaire (SFQ). RESULTS: There was a no significant difference between BFPEP and STU at baseline on all measures. There was a significant difference (p < .05) between pre- and post-treatment scores for BFPEP on all measures, a significant difference (p < .05) between pre- and post-treatment scores for STU on all measures (favouring pre-treatment scores) and a significant difference (p < .05) favouring BFPEP over STU on all measures post-treatment. CONCLUSIONS: These results demonstrate the feasibility and effectiveness of implementing family therapy psychoeducational interventions in different cultural settings, with relatively minor modifications. This may have implications for mental health policy makers to make available such programmes for patients and mental health professionals.

Antipsychotic Polypharmacy and Its Relation to Metabolic Syndrome in Patients With Schizophrenia: An Egyptian Study.

PURPOSE/BACKGROUND: Few studies have examined the relationship between antipsychotic polypharmacy and metabolic syndrome in schizophrenia. Some studies suggest that antipsychotic polypharmacy may be associated with greater metabolic risk, whereas other studies suggest that this is uncertain. To date, there have been no studies in Egypt or the Arab world that have investigated this relationship. We sought to compare subjects with schizophrenia receiving antipsychotic polypharmacy and monotherapy as regards metabolic outcomes and to investigate medication-related factors associated with metabolic syndrome. METHODS/PROCEDURES: We recruited 118 subjects with schizophrenia and compared between those receiving antipsychotic polypharmacy (86 subjects) and monotherapy (32 subjects) as regards demographic, clinical, metabolic, and antipsychotic medication characteristics. We examined the effect of antipsychotic-related factors an outcome of metabolic syndrome. FINDINGS/RESULTS: The prevalence of metabolic syndrome in our sample was 38.1%. Except for gender, there was no statistically significant difference as regards demographic and clinical characteristics, rates of metabolic syndrome, or for individual metabolic parameters. We found a statistically significant difference (P < 0.05) between the 2 groups as regards the number, dose, and duration of intake and for the number of subjects receiving typical antipsychotics (oral and depot) and a number of individual antipsychotic medications. Using logistic regression, receiving haloperidol depot was the only antipsychotic-related factor predictive for metabolic syndrome. IMPLICATIONS/CONCLUSIONS: The prevalence of metabolic syndrome does not differ in schizophrenia whether patients are receiving polypharmacy and monotherapy nor do they differ for individual metabolic parameters. Most antipsychotic-related characteristics did not predict for metabolic syndrome.

The Periscreen Strip Is Highly Efficient for the Exclusion of Spontaneous Bacterial Peritonitis in Cirrhotic Outpatients.

OBJECTIVES: We aimed to assess the performance of a new strip (Periscreen) for the rapid diagnosis of spontaneous bacterial peritonitis (SBP). METHODS: Ascitic fluid (AF) of cirrhotic patients hospitalized between March 2014 and August 2015 was independently tested by two readers using the new strip, which has four colorimetric graduations (negative, trace, small, and large). SBP was diagnosed on neutrophils in ascites>250/mm3. Ascites not related to portal hypertension were excluded. RESULTS: Overall, 649 patients from 21 French centers were included and 1,402 AF (803 AF samples from 315 outpatients and 599 samples from 334 inpatients) were assessed. Eighty-four AF samples (17 AF in 9 outpatients and 67 AF in 31 inpatients) were diagnosed as SBP. The prevalence of SBP was 6% (2.1% in outpatients vs. 11.2% in inpatients; P<0.001) and 7.2% in patients with symptoms suggestive of SBP (3% in outpatients vs. 11.3% in inpatients; P<0.001). The κ value for inter-reader agreement was 0.81 (95% confidence interval: 0.77-0.84) when using the "trace" threshold. Considering discordant results (n=131) as positive to interpret the diagnostic performance of the strip at the "trace" threshold, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 91.7, 57.1, 12.0, and 99.1%, respectively. At this "trace" threshold, sensitivity and NPV were both 100% in outpatients, and 89.5 and 97.9% in inpatients, respectively. At the "small" threshold, sensitivity, specificity, PPV and NPV were 81.0, 85.9, 25.9 and 98.7%, respectively. CONCLUSIONS: The Periscreen strip is a rapid and highly efficient tool for excluding SBP in the outpatient setting.

Metabolic syndrome and its relation to antipsychotic polypharmacy in schizophrenia, schizoaffective and bipolar disorders.

The risk of metabolic syndrome (MetS) has been attributed to antipsychotic use in psychiatric patients. To date, there is limited data on the relationship between antipsychotic polypharmacy and MetS in patients with schizophrenia, schizoaffective disorder and bipolar disorder. Therefore, we aimed to investigate the rate of MetS in patients with these disorders receiving antipsychotic monotherapy and polypharmacy. We conducted a cross-sectional study on patients seen between January 2017 and December 2020, collecting data on the class, type, route of administration and number of antipsychotics received. We used the American Association of Clinical Endocrinology criteria to diagnose MetS. We included 833 subjects of whom 573 (68.8%) received antipsychotic monotherapy and 260 (31.2%) received polypharmacy. Overall, 28.6% ( N  = 238) had MetS with no statistical difference between the two groups. Diastolic blood pressure and receiving olanzapine were significant predictors for developing MetS. In conclusion, our study found no significant difference in the rate of MetS between antipsychotic monotherapy and polypharmacy. A number of variables were significant predictors for MetS. Our findings were consistent with other studies and warrant the need for careful choice of antipsychotics and regular screening and management of abnormal metabolic parameters.

Clinical Reasoning in the Use of Long-acting Aripiprazole in Psychosis in Bilateral Nephrectomy on Hemodialysis.

Psychiatric disorders are common in patients on hemodialysis. To the best of our knowledge there are no reported cases of psychosis developing in hemodialysis patients in the context of nephrectomy, and there is limited data on the use of long-acting antipsychotics in hemodialysis, which are generally not recommended in chronic kidney disease. We present the case of a 40-year-old lady with bilateral nephrectomy receiving hemodialysis who developed psychosis that resulted in her refusing to continue hemodialysis and was irregularly compliant with oral antipsychotics, necessitating the use of a long-acting injection. We report on the approach to clinical reasoning in the choice of aripiprazole and the need for a long-acting injection. Based on its pharmacological and pharmacokinetic properties oral aripiprazole 20 mg was commenced and after establishing tolerability and response, the patient was switched to long-acting aripiprazole 400 mg monthly achieving full remission of psychotic symptoms after 6 months with maintained improvement after 12 months. Based on its properties, aripiprazole may be a reasonable option in the treatment of psychosis in patients on hemodialysis with nephrectomy and can be considered even as a long-acting injection in these patients.

Cross-cultural differences through subjective cognition: illustration in translatology with the SSTIC-E in the UAE.

The development of appropriate and valid multicultural and multilingual instruments research is necessary due to a growing multicultural and multilingual society in the 21st century. We explored the use of a cognitive scale related to subjective complaints, focusing on the first step: a cross-cultural and semantic validation. This study presents the translation and cross-validation process of the "Subjective Scale to Investigate Cognition in Schizophrenia" (SSTICS) for the United Arab Emirates (UAE) region via different languages used in Dubaï/Abu Dhabi. This scale measures cognitive complaints and has been validated with psychosis and used in 20 clinical trials worldwide. It evaluates areas of the illness related to self-awareness focusing on memory dysfunction and deficits of attention, language, and praxis. We described the method of cross-cultural validation, with back-translation, semantic steps, and societal contexts. The use of the Subjective Scale to Investigate Cognition in Emirates (SSTIC-E) was explored with different samples of UAE Arabic-speaking subjects. First, a pilot sample mean SSTICS total score was 16.5 (SD:16.9); (p < 0.001). The SSTIC-E was then administered to 126 patients and 84 healthy control participants. The healthy group has a lower mean score of 22.55 (SD = 12.04) vs. 34.06 (SD = 15.19). The method was extended to nine other languages, namely, Pakistani/Urdu, Hindi, Marathi, Lithuanian, Serbian, German, Romanian, Sinhala, and Russian. The scales are provided in the article. The overall aim of the translation process should be to stay close to the original version of the instrument so that it is meaningful and easily understood by the target language population. However, for construct validity, some items must be adapted at the time of translation to ensure that the questioned cognitive domain is respected. For example, cooking, an executive function, does not have the same occurrence for an Emirati male, or remembering a prime minister's name, semantic memory, requires an electoral system to appoint the leader of a country. Translation methods and processes present many challenges but applying relevant and creative strategies to reduce errors is essential to achieve semantic validation. This study aims to measure personally experienced knowledge or attitudes; such language effects can be a thorny problem.

Patterns and factors associated with consulting traditional healers on the care pathway of psychiatric patients in the United Arab Emirates.

BACKGROUND: Despite the availability of mental health services in the United Arab Emirates (UAE), reluctance in seeking a mental health professional is widely prevalent. In many countries, psychiatric patients consult Traditional Healers (THs) prior to seeing mental health professionals. Data from the UAE on the pattern of consulting THs is limited. AIMS: To investigate patterns and factors for visiting THs in psychiatric patients in Abu Dhabi, the capital of UAE. METHOD: We conducted a cross-sectional study of patients attending the adult psychiatry clinic, Maudsley Health, Abu Dhabi. We assessed 214 patients for the pattern and possible factors for contact with THs on their pathway to psychiatric care. RESULTS: There were 58 males and 156 females. Most (43.5%) had a depressive disorder. Prior to consulting a mental health professional, 28% had seen a TH, of whom 36.7% had only one visit and 60% had seen only one TH. Advice from a friend or family member was the commonest reason for consulting THs (81.7%). Envy was the commonest explanation given by THs for symptoms (26.7%). Female gender and having a high school education or less significantly predicted contact with THs. CONCLUSIONS: Almost a third of our sample consulted THs prior to seeking psychiatric care. Closer collaboration with THs could help bridge the gap with psychiatrists to avoid delays in patients accessing psychiatric care, however caution is needed to mitigate the possible negative effects of such a collaboration.