In-hospital psychoeducation for family caregivers of Nigerian children with cancer (The RESCUE Study).

OBJECTIVES: High levels of caregiver burden (CB) are experienced by informal caregivers of pediatric patients with cancer. There is increasing evidence highlighting the extent of CB across sub-Saharan African countries, although there remains lack of interventions that target improvements in their experience. This study aimed to determine the impact of a structured psychoeducation program on caregivers' outcomes relating to preparedness to provide care, burden of caregiving, and quality of life (QoL). METHODS: This quasi-experimental (pre-and-posttest) design, involved family caregivers of children on admission for cancer treatment in 4 Nigerian tertiary hospitals. Eligible participants received 2 structured, psychoeducational training sessions delivered by a multidisciplinary oncology team, focusing on the management of patients' condition, spiritual care, self-care, and support. RESULTS: Subjects were mainly female (79.5%) and mostly mothers to children undergoing cancer treatment (74.7%). Commonest cancer type was acute lymphoblastic leukemia (23.9%) with evidence of metastatic disease found in 9.6% of children. Significant improvements were observed between pre- and posttest for unmet needs (z = -9.3; p < 0.001), preparedness for caregiving in palliative care (PCPC) (z = -7.0; p < 0.001), and overall QoL (z = -7.3; p < 0.001). A significant reduction in CB was also reported (z = -8.7; p < 0.001). SIGNIFICANCE OF RESULTS: This psychoeducational intervention (PEI) resulted in significant improvements in unmet needs, CB and significant improvements in PCPC. However, a reduction in QoL of the family caregivers was also observed. Findings from this study should encourage the use of well-crafted PEIs, delivered within hospital settings to promote improvements in outcomes for informal caregivers of hospitalized children suffering from cancer, in an African context. Further intervention development is required to better understand intervention components influencing changes in outcomes, while exploring feasibility testing and adaptation to similar settings in Nigeria and within Africa.

Family, twin and adoption studies of severe mental disorders in sub-Saharan Africa: a scoping review.

PURPOSE: The traditional genetic epidemiological studies are necessary to improve accurate risk communication to service users and their families. This scoping review aimed to describe the volume and scope of existing research evidence on family, twin and adoption studies of severe mental disorders (SMDs) in SSA. This is with a view to identifying gaps in the literature and the adequacy of data for a systematic review and meta-analysis. METHODS: Literature search was done for all original peer-reviewed research articles on the topic in SSA using PubMed and MEDLINE. Publications included were peer-reviewed original articles, irrespective of their quality, carried out in the region from the 1970s till 9th March, 2022, which were available in English or translated to English. Case reports, abstracts, and studies among populations living outside the region were excluded. RESULTS: A total of five studies that met the inclusion criteria across the 46 countries in the region were identified. Of the three thematic areas of focus, only family studies on SMDs had research work in SSA. These studies provided evidence of familial clustering of SMDs in SSA. There were no twin and adoption studies on SMDs in the region. However, the review noted the establishment of two twin registries in Guinea-Bissau and Nigeria. A huge gap exists in the area of twin and adoption studies on SMDs in SSA. CONCLUSION: The volume of research evidence on traditional family genetic studies of SMDs is grossly inadequate to consider a systematic review in SSA. We have suggested studies to remedy the situation.

Neurological soft signs in first episode psychosis among psychiatric hospital patients and its relationship with dimensions of psychopathology: A comparative study.

Background: Neurological soft signs (NSS), as subtle, nonlocalising neurological abnormalities, are considered as the potential markers of psychosis. However, comparative studies of antipsychotic-naïve patients with first-episode psychosis (FEP) and first degree relatives (FDRs) are uncommon. We compared the prevalence and pattern of NSS in FEPs, their healthy FDRs and a healthy non-relatives' control group (HC), highlighted the relationship between NSS and psychopathology and proposed cut-off scores for prevalence studies. Materials and Methods: Two hundred and two participants per group were recruited. The FEPs were consecutive attendees; FDRs were accompanying caregivers; while the HC were from hospital staff. The Brief Psychiatric Rating Scale and the Neurological Evaluation Scale were used to assess psychopathology dimensions and NSS, respectively. Results: Using an item score of two ('substantial impairment'), the prevalence of at least one NSS was: 91.5% (95% confidence interval [CI]: 86.7%-94.9%), 16.8% (95% CI: 11.8%-22.7%) and 6.5% (95% CI: 3.5%-10.9%), respectively, for FEP, FDRs and HC. FEPs were impaired in a broad range of signs. The noteworthy relationships were as follows: (i) a significant correlation between the negative symptoms' dimension versus number of NSS (r = 0.4), and NSS total score (r = 0.3), (ii) the anxiety/depression dimension correlated negatively with number of NSS (r = -0.3) and (iii) NSS cut across psychosis categories. We propose a cut-off score of ≥ 4 for the number of signs signifying probable impairment. Conclusion: The findings indicate that, subject to further studies, NSS could be regarded as a broader phenotype of neurologic dysfunction associated with psychosis proness.

The effects of cannabidiol on behavioural and oxidative stress parameters induced by prolonged haloperidol administration.

OBJECTIVES: We investigated the influence of oral cannabidiol (CBD) on vacuous chewing movements (VCM) and oxidative stress parameters induced by short- and long-term administration of haloperidol in a rat model of tardive dyskinesia (TD). METHODS: Haloperidol was administered either sub-chronically via the intraperitoneal (IP) route or chronically via the intramuscular (IM) route to six experimental groups only or in combination with CBD. VCM and oxidative stress parameters were assessed at different time points after the last dose of medication. RESULTS: Oral CBD (5 mg/kg) attenuated the VCM produced by sub-chronic administration of haloperidol (5 mg/kg) but had minimal effects on the VCM produced by chronic administration of haloperidol (50 mg/kg). In both sub-chronic and chronic haloperidol groups, there were significant changes in brain antioxidant parameters compared with CBD only and the control groups. The sub-chronic haloperidol-only group had lower glutathione activity compared with sub-chronic haloperidol before CBD and the control groups; also, superoxide dismutase, catalase, and 2,2-diphenyl-1-picrylhydrazyl activities were increased in the sub-chronic (IP) haloperidol only group compared with the CBD only and control groups. Nitric oxide activity was increased in sub-chronic haloperidol-only group compared to the other groups; however, the chronic haloperidol group had increased malondialdehyde activity compared to the other groups. CONCLUSIONS: Our findings indicate that CBD ameliorated VCM in the sub-chronic haloperidol group before CBD, but marginally in the chronic haloperidol group before CBD. There was increased antioxidant activity in the sub-chronic group compared to the chronic group.

A comparative study of perceived burden in parent caregivers of adolescents with epilepsy in a resource-restricted setting: Investigating the explanatory factors of perceived burden.

OBJECTIVE: Parent caregivers often play vital roles in the care of adolescents with epilepsy (AWE) in resource-restricted settings; however, little is known about the burden borne by these parents. This study investigated the burden perceived by parents of AWE and described the explanatory factors. METHODS: An equal number (n = 121) of age- and gender-matched parent caregivers of AWE (cases) and parents of adolescents with sickle cell disease (comparison group) were interviewed with the Parent Illness Intrusiveness Rating Scale to assess disruptions in their relationships and lifestyle. Parents of AWE were assessed for psychological distress with the 12-item General Health Questionnaire, and AWE were interviewed with the Hospital Depression-Anxiety Scale. RESULTS: The majority of the cases and the comparison group were mothers (76%), with mean (SD) ages of 44.11 (SD = 6.92) versus 43.59 (SD = 6.39) years, respectively. The prevalence rate of psychological distress in cases was 38%, and depressive-anxiety symptom was prevalent in 39.7% of AWE. The level of perceived burden was significant in all parent caregivers, albeit higher in cases relative to the comparison group across multiple domains, including relationship/personal development, intimacy, instrumental and global. A high level of burden in parents of AWE was predicted by a poor family financial and material support to the adolescents, increased contact hours with adolescents, psychological distress in the parent caregivers, and anxiety-depressive symptoms in AWE after controlling for cofounders. CONCLUSION: The study findings underscore the need for psychosocial support to bolster resilience and adaptive coping styles in parents of AWE, particularly in resource-restricted settings. A culturally sensitive interdisciplinary blueprint of locally viable actions model for psychosocial support for parent caregivers of AWE is strongly suggested. Future studies are indicated to shed more light on the modifiable risks of perceived burden, and the effectiveness of psychosocial interventions in parents of AWE.

Naturalistic clinical and psychosocial outcome of incident cases of schizophrenia in Enugu Federal Psychiatric Hospital: A preliminary report at 4-month follow-up.

INTRODUCTION: Longitudinal outcome studies based on incident and predominantly neuroleptic-naïve cases of schizophrenia are uncommon in the modern literature. AIMS: To determine the proportion of persons with schizophrenia with different levels of clinical and functional outcome at monthly intervals of naturalistic treatment follow-up for 4 months: response, remission and recovery; and to examine the predictors of outcome. SUBJECTS AND METHODS: Consecutive incident cases that fulfilled stringent criteria for schizophrenia were recruited into the study. After a baseline assessment, 160 incident cases of schizophrenia were followed up 4-weekly for indicators of symptomatic and functional outcome for 16 weeks. Standard rating scales were used to assess clinical and functional outcome. Sociodemographic and clinical variables were evaluated as predictors of outcome using multiple regression analysis. RESULTS: The attrition rate at week 16 was 29.4%; hence, 113 subjects (out of 160) were available for assessment at the end of follow-up. Of the 113, 66.4%, by Brief Psychiatric Rating Scale (BPRS), met criteria for response (i.e., >50% reduction), while 20.3% could be judged to be clinically non-responsive to treatment (i.e., <20% decrease). Also, 60.2%, by BPRS, met the criteria for remission, while 44.5% met the criteria for recovery. The most important predictor, at week 16, of clinical and psychosocial outcome was social support (48.7%-51.8% of variance). CONCLUSION: Although as a preliminary report, the present findings are hypothesis-generating, the implication of the results is that, as a group, over a 4-month period of modern hospital treatment, schizophrenia patients who were incident cases progressively experienced significant reduction in psychopathology. The findings, therefore, support earlier international cross-cultural reports of relatively good clinical outcome from developing countries, thereby encouraging the idea of treatment optimism in schizophrenia in Africa.

Mental and physical comorbidity in an Arab primary health care setting.

BACKGROUND: There are no published studies on the comorbidity of common mental conditions (anxiety, depression, and somatization) and physical illnesses in the Arab world. Our aim was to estimate the prevalence of common mental conditions comorbid with physical illnesses among primary care attenders in Kuwait, and the sociodemographic characteristics associated with this comorbidity. METHODS: The Patient Health Questionnaires for somatization, anxiety and depression (PHQ-SAD) were administered to a representative sample of 1046 attenders (M: F = 429: 617; mean age 37.6, SD 12.7) seen in primary care clinics in Kuwait. Based on well-established cut-off scores, the presence and severity of three mental conditions -depression, anxiety, and somatization-was ascertained; physical diagnoses were ascertained by the attending physicians. RESULTS: Of 1046 respondents, 442 (42.3%) had at least one mental condition and 670 (64.1%) had a physical illness diagnosis, viz.: diabetes mellitus (248/670 = 37.0%), hypertension (229/670 = 34.2%), asthma (82/670 = 12.2%), non-chronic physical illnesses (63/670 = 9.4%), or heart disease (48/670 = 7.2%), with 34.4% (360/1046) having mental-physical comorbidity. Male: female ratio for the 670 subjects was 287: 383. The unadjusted odds ratio (OR) for having a mental condition in those with a physical illness vs. those without a physical illness was 4.16 (95% C.I. = 3.12, 5.55). Comorbidity was associated with older age, being divorced or widowed, a lower level of education, and poorer living conditions. Regardless of the physical illness, the most frequent comorbid mental disorder was somatization. The prevalence and severity of mental conditions were associated with the number of physical illnesses. CONCLUSION: As has been reported in other parts of the world, somatization, anxiety, and depression are highly prevalent among primary care attenders in Kuwait and they are typically comorbid with physical illness. Strategies for their prevention and treatment need to take into consideration their association with physical illness and social disadvantage.

Familial aggregation of mood disorders among relatives of schizophrenia probands admitted in a hospital in South-Eastern Nigeria: A family comparative study.

INTRODUCTION: The debate on the current nosological status of schizophrenia and mood disorders as distinct entities is very active among scholars. There is a paucity of genetic epidemiological data to contribute an African perspective to this debate. AIM: This study aimed to assess the morbid risk of mood disorders in the relatives of schizophrenia probands, in comparison with the families of a sample of healthy controls. SUBJECTS AND METHODS: This study elicited the information on the morbid risk of mood disorders among 5259 relatives of schizophrenia probands (n = 138) and 6734 relatives of healthy controls (n = 138) through direct interview of patients, available relatives of patients and the comparison group. The family history approach using the Family Interview for Genetic Studies was utilised to obtain information on the morbid risk of all relatives that could be recalled. The diagnosis of available relatives was confirmed using the Diagnostic Interview for Genetic Studies. Morbid risk estimates were calculated using the Weinberg shorter method for age correction. RESULTS: Morbid risk for mood disorders in the first-, second- and third-degree relatives of schizophrenia probands were 1.39% (95% confidence interval [CI] = 1.23-1.55), 0.86% (95% CI = 0.80-0.92) and 0.55% (95% CI = 0.53-0.57), respectively, compared with 0.45% (95% CI = 0.39-0.51), 0.11% (95% CI = 0.07-0.51) and 0.08% (95% CI = 0.06-0.09), respectively, for the healthy comparison group. CONCLUSION: This result supports the impression that familial risk for mood disorders is significantly higher among relatives of schizophrenia patients, compared with healthy controls and that there could be familial relationship between the predisposition to schizophrenia and mood disorders.

Morbid risk of schizophrenia amongst relatives of schizophrenia probands: A family-controlled study.

INTRODUCTION: There is a dearth of data on heritability of schizophrenia in Africa. The few African studies that addressed familial psychiatric morbidity in schizophrenia involved relatively small sample sizes and addressed psychiatric morbidity only in first-degree relatives. The present study sought to improve upon the methodology of previous African studies, and widen the scope to second- and third-degree relatives with a view to enriching the field of genetic epidemiology in Africa. METHODS: This study elicited information on the morbid risk of schizophrenia amongst 5259 relatives of schizophrenia probands (n = 138) and 6734 relatives of healthy controls (n = 138) through direct interview of patients, available relatives of patients and controls. Diagnosis of probands was confirmed using Mini International Neuropsychiatric Interview. Through a direct interview of 138 patients and their available relatives, a family history approach using the Family Interview for Genetic Studies was utilised to obtain information on the morbid risk for all relatives that could be recalled. The same approach was utilised for the interview of the controls (aged 45 years and above) and their relatives. Morbid risk estimates were calculated using the Weinberg shorter method. RESULTS: Morbid risk for schizophrenia in the first-, second- and third-degree relatives of schizophrenia probands was 10.9% (95% confidence interval [CI] = 10.6-11.2), 4.2% (95% CI = 4.1-4.3) and 3.9% (95% CI = 3.6-4.2), respectively, compared with 2.6% (95% CI = 2.5-2.7), 1.6% (95% CI = 1.5-1.7) and 1.5% (95% CI = 1.4-1.6), respectively, of the healthy control group. CONCLUSION: The findings support the widely noted impression that schizophrenia significantly aggregates in families of schizophrenia probands more than healthy controls.

RELATIONSHIP OF PERSONALITY TRAITS WITH ANXIETY, DEPRESSIVE AND PTSD SYMPTOMATOLOGY AND ACADEMIC PERFORMANCE. Experience with an Arab college student sample.

BACKGROUND: The objective was to highlight the profile of Eysenck Personality Questionnaire traits of a sample of Arab college students, and assess the relationship of trait scores with gender, age and symptoms of anxiety, depression, PTSD and grade point average (GPA) score. Similar reports from the Arab world were restricted to neuroticism/extraversion and rarely involved traumatic experience and psychosocial performance. METHODS: Participants (N = 624) were Kuwaiti national college students who completed, in class, the EPQ- 90, Hopkins Symptoms Checklist, and the PTSD Checklist. RESULTS: Men had higher psychoticism (p < 0.004) and extra- version (p <0.03) scores, while women had higher neuroticism (p < 0.001) and lie scale scores (p < 0.001). Students with the lowest GPA had the highest scores for psychoticism (p< 0.01). Psychoticism and neuroticism were significantly correlated with each other, but negatively with extraversion and lie scale. The correlations of psychopathology were strongest with neu- roticism and psychoticism; and negative with extraversion and the lie scale. In regression analyses, the dominant predictor of psychopathology was neuroticism. With neuroticism as covari- ate, the sex difference in depression scores was no longer sig- nificant. CONCLUSIONS: Our findings support the usefulness of neuroticism as reflecting characteristic level of distress; and a combination of high neuroticism and low extraversion as vul- nerability marker for psychopathology. Psychoticism needs further study as a marker of psychosocial underachievement.

Integrating mental health screening into routine community maternal and child health activity: experience from Prevention of Mother-to-child HIV transmission (PMTCT) trial in Nigeria.

PURPOSE: Although the prevalence of mental health disorders in Nigeria is comparable to most developed countries, access to mental health care in Nigeria is limited. Improving access to care requires innovative approaches that deliver mental health interventions at the community level. The aim of this study was to determine the feasibility and acceptability of integrating mental health screening into an existing community-based program for prevention of mother-to-child transmission of HIV targeted at pregnant women and their male partners. METHODS: Pregnant women and their male partners from 117 churches enrolled in the healthy beginning initiative (HBI) in southeast Nigeria participated in the mental health screening project. Two members from each church were trained as church-based health advisors to administer the 12-item general health questionnaire. RESULTS: Ninety-three percent of the pregnant women and their male partners agreed to participate and fully completed the questionnaire. Overall, 21.7 % of the respondents scored above the threshold of 11 indicating significant psychological distress, with women having significantly higher scores than men. CONCLUSION: Mental health screening is feasible and well accepted among a cohort of pregnant women and their male partners. Church members can be trained as health advisors to administer mental health screening. Mental health interventions can be developed on the framework of the HBI.

Characteristics of subjects with comorbidity of symptoms of generalized anxiety and major depressive disorders and the corresponding threshold and subthreshold conditions in an Arab general population sample.

BACKGROUND: There is controversy about differential meaningfulness between comorbid generalized anxiety disorder (GAD)/ major depressive disorder (MDD), the corresponding "pure" disorders and subthreshold conditions. We compared subjects who met DSM-IVTR criteria of symptoms and functional impairment for comorbid GAD/MDD, versus those with GAD, MDD, subthreshold conditions, and without significant symptoms. The comparison measures were socio-demographics, clinical severity, and quality of life (QOL). MATERIAL/METHOD: Participants (N=3155: 55.1% female, aged 16-87 yrs) were a general population sample of Kuwaitis who self-completed DSM-IVTR criteria-based questionnaires and the WHOQOL-BREF in 2006/7. We scrutinized the questionnaires and classified them into categories. RESULTS: Of the 273 GAD and 210 MDD cases, the prevalence of comorbidity among cases with GAD was 30.8%, and 40% among MDD. Of the 398 subthreshold GAD and 194 subthreshold MDD cases, 58 had subthreshold anxiety/depression comorbidity. Comorbid threshold GAD/MDD cases were significantly older, and more likely to be women, divorced and unemployed, compared with GAD and MDD. In all measures, the threshold GAD/MDD comorbidity was the severest condition. There was a monotonic decrease in QOL with increasing anxiety-depression symptoms. For the predictors of subjective QOL, the GAD/MDD comorbidity group differed markedly from the others. CONCLUSIONS: The high prevalence of comorbidity and subthreshold conditions supports the recommendation to assess them routinely, regardless of the primary reason for consultation. Our findings support a dimensional model with comorbid GAD/MDD at the higher end of a continuum, and differing from the "pure" conditions by a later onset and predictors of subjective wellbeing.

Prevalence of physical, psychological, and sexual abuse among a nationwide sample of Arab high school students: association with family characteristics, anxiety, depression, self-esteem, and quality of life.

OBJECTIVES: The objectives were first, to assess the lifetime and 12-month prevalence of physical, psychological, and sexual abuse among a stratified random sample of Kuwaiti high school students and second, to explore the association of child abuse with parental characteristics, subjective quality of life (QOL), self-esteem, anxiety, and depression. METHOD: We assessed the students for experience of abuse by their mothers, fathers, and others, using standard scales on psychological, physical and sexual abuse. They also completed the short version of the World Health Organization's QOL Instrument; the Rosenberg self-esteem scale, and a scale for anxiety and depression. RESULTS: We obtained responses from 4,467 students (49% boys), mean age 16.9 years. About 18, 15, and 18%, indicated that for at least six times in the past 12 months, they experienced psychological abuse by their mothers, fathers and others, respectively. The corresponding figures for lifetime experience were similar. The respective figures for experience of physical abuse during the past 12 months were 4.3, 5.8, and 6.4%. For lifetime experience, the corresponding figures were 3.4, 5.3, and 5.8%. The girls had significantly higher physical/psychological abuse scores. There were no significant gender differences in the prevalence of sexual attacks (8.6%) and someone threatening the subjects with sex (5.9%). The prevalence of someone sexually exposing themselves to the students (15.3%) and unwanted touching of sexual parts (17.4%) was significantly higher among the boys. Over one-third of those abused had experienced multiple abuses. Child abuse was significantly associated with parental divorce, diminished QOL and self-esteem, high scores on anxiety/depression, and difficulty with studies, and social relationships. In the regression analysis involving only the abuse indices, psychological abuse by mothers was the most important predictor of depression, anxiety, and self-esteem (11.5-19.7% of variance). Good quality of parental relationship seemed protective. CONCLUSION: The findings support the impression that, despite the conservative culture, child abuse is being experienced by a significant number of children in the Arab world. Preventive education in this culture should include limits on child disciplinary measures, the vulnerable groups identified, the impact on psychosocial functioning, and the protective effect of parental harmony.

Effects of cannabidiol on vacuous chewing movements, plasma glucose and oxidative stress indices in rats administered high dose risperidone.

Atypical antipsychotics, despite their rapid dissociation from dopamine receptors and reduced tendency to induce oxidative stress, have been associated with difficult-to-manage movement disorders, including tardive dyskinesia (TD). The study set out to investigate the effects of cannabidiol (CBD), a potent antioxidant, on risperidone-induced behavioural and motor disturbances; namely vacuous chewing movements (VCM), and oxidative stress markers (e.g. superoxide dismutase (SOD), catalase (CAT), reduced glutathione (GSH), malondialdehyde (MDA), Nitric oxide (NO), and DPPH (2,2-diphenyl-1-picrylhydrazyl)). Oral risperidone (10 mg/kg) or oral CBD (5 mg/kg) were administered to six experimental groups. While risperidone alone was administered for 28 days, CBD concomitantly or in sequential order with risperidone, was administered for 28 days; and CBD alone was administered for 21 days. Behavioural, motor, and specific biochemical parameters, which included VCM, muscle tone, fasting blood sugar (FBS), and oxidative stress markers were assessed at different time points after the last dose of medication. Oral CBD (5 mg/kg) significantly reduced risperidone-induced elevated FBS when given after the administration of risperidone. Oral CBD also had effects on VCM when administered before risperidone and similarly, attenuated risperidone-induced increased muscle tone. It was also established that concomitant or sequential administration of CBD and risperidone did not have any adverse effects on cognition or locomotion. Both CBD and risperidone increased the activity of antioxidant enzymes and decreased the activity of pro-oxidant enzymes. This study suggests CBD could mitigate metabolic dysregulation and extrapyramidal side effects associated with risperidone without producing cognitive impairments.

Effects of cannabidiol on weight and fasting blood sugar with chronic and subchronic haloperidol administration.

OBJECTIVES: The duration of administration (e.g., subchronic or chronic) of haloperidol may influence its adverse effects. We studied the effects of duration of administration of haloperidol on body weight and fasting blood sugar (FBS). In addition, we examined whether orally administered cannabidiol (CBD) had any putative mitigating influence on haloperidol-induced body weight changes and FBS elevation. METHODS: Haloperidol (5 mg/kg/day) was administered for 21 days (subchronic administration), via the intraperitoneal (IP) route, or monthly (50 mg/kg monthly) for 3 months (chronic administration), via the intramuscular (IM) route, either alone or before CBD (5 mg/kg/day). Oral CBD (5 mg/kg/day) alone and distilled water alone were administered for 21 days. Weight and FBS were measured before administration of pharmacological agents (distilled water in the control group) and post-administration. RESULTS: Group differences in average weight across time were significant. Pairwise comparisons showed that mean weight of the subchronic (IP) haloperidol alone group (Group A) and the chronic (IM) haloperidol before CBD group (Group F) increased significantly over time. Post medications, there was a significant increase in mean FBS in the subchronic (IP) haloperidol group compared to the subchronic (IP) haloperidol before CBD group. There was also a significant reduction in mean FBS from the baseline for the control group only. CONCLUSION: We demonstrated that the duration of administration of haloperidol influenced weight and FBS in rats, suggesting that metabolic side effects, may be influenced by duration of administration. CBD ameliorated the increase in weight and FBS observed in the subchronic (IP) haloperidol groups.

Profile of subjective quality of life and its correlates in a nation-wide sample of high school students in an Arab setting using the WHOQOL-Bref.

BACKGROUND: The upsurge of interest in the quality of life (QOL) of children is in line with the 1989 Convention on the Rights of the Child, which stressed the child's right to adequate circumstances for physical, mental, and social development. The study's objectives were to: (i) highlight how satisfied Kuwaiti high school students were with life circumstances as in the WHOQOL-Bref; (ii) assess the prevalence of at risk status for impaired QOL and establish the QOL domain normative values; and (iii) examine the relationship of QOL with personal, parental, and socio-environmental factors. METHOD: A nation-wide sample of students in senior classes in government high schools (N = 4467, 48.6% boys; aged 14-23 years) completed questionnaires that included the WHOQOL-Bref. RESULTS: Using Cummins' norm of 70% - 80%, we found that, as a group, they barely achieved the well-being threshold score for physical health (70%), social relations (72.8%), environment (70.8%) and general facet (70.2%), but not for psychological health (61.9%). These scores were lower than those reported from other countries. Using the recommended cut-off of <1SD of population mean, the prevalence of at risk status for impaired QOL was 12.9% - 18.8% (population age-adjusted: 15.9% - 21.1%). In all domains, boys had significantly higher QOL than girls, mediated by anxiety/depression; while the younger ones had significantly higher QOL (p < 0.001), mediated by difficulty with studies and social relations. Although poorer QOL was significantly associated with parental divorce and father's low socio-economic status, the most important predictors of poorer QOL were perception of poor emotional relationship between the parents, poor self-esteem and difficulty with studies. CONCLUSION: Poorer QOL seemed to reflect a circumstance of social disadvantage and poor psychosocial well-being in which girls fared worse than boys. The findings indicate that programs that address parental harmony and school programs that promote study-friendly atmospheres could help to improve psychosocial well-being. The application of QOL as a school population health measure may facilitate risk assessment and the tracking of health status.

Relationship between symptoms of anxiety and depression in a sample of Arab college students using the Hopkins Symptom Checklist 25.

BACKGROUND: The controversy over the relationship between symptoms of anxiety and depression is an enduring issue. Various models have been proposed to explain this relationship. We explored the following research questions. First, using exploratory factor analysis (EFA), will the symptoms that define anxiety and depression (as in the Hopkins Symptom Checklist 25, HSCL-25) appear together in 1 factor, or are they separable into the hypothesized dimensions of the disorders? Second, using confirmatory factor analysis, how will the structural integrity of the resulting factors compare with those of the various models that have been proposed to explain the relationship between the symptoms of anxiety and depression? This issue has not been investigated in an Arab setting. METHOD: Participants (n = 624) were Kuwaiti national college students, who completed the HSCL-25 in class. EFA was done by principal axis factoring. Seven models were generated for comparison in confirmatory factor analysis, using 8 'fit' indices in Analysis of Moment Structures, version 16. RESULTS: The 5 factors from EFA were similar in construct to the subscales of the Mood and Anxiety Symptom Questionnaire, on which the tripartite model of anxiety and depression was validated ('core anxiety', 'core depression', 'general distress mixed', 'general distress anxiety', 'general distress depression'). The hierarchical bifactor model and the dimensional model characterized by the correlation of these factors were best at meeting the fit indices, followed by the correlated 2-factor anxiety/depression model. In line with theory, the correlation between the specific anxiety/depression factors was lower than that between each of them and the general distress mixed factor; and there was no significant gender difference in the summed score for core depression. CONCLUSION: The findings support the impression that, although the core symptoms of anxiety are separable from the core symptoms of depression, there is an overlapping set of symptoms which contribute to the experience of comorbidity. The relationship between symptoms of anxiety and depression probably has dimensional and hierarchical elements. The findings broaden the evidence base of the cross-cultural validity of the tripartite model.

Introducing the Objective Structured Clinical Examination (OSCE) in the undergraduate psychiatric curriculum: evaluation after one year.

OBJECTIVE: The Objective Structured Clinical Examination (OSCE) was introduced in undergraduate psychiatry clerkship in 2008. The authors studied the effect of OSCE on the students' performance. METHODS: The ″short case″ (SC) and ″oral examination″ (OE), two of the five components of the previous assessment format, were replaced with the OSCE. Results were compared with those of the 2007 students. RESULTS: The introduction of the OSCE had little impact on the overall scores, but the 2007 students had significantly higher scores on the essay examination and long case, whereas the 2008 group had significantly higher scores on the OSCE (versus the OE for the 2007 group). In comparing the top 10 scoring students from the two classes, the 2007-year students had significantly higher overall scores, both on end-of-course tests and the annual examinations. In particular, the scores for the OSCE exams for the 2008 class were significantly lower than the scores for the OE in the 2007 class. CONCLUSION: The higher scores on OSCE in Year 2008 suggest that students performed better on clinical skills and professional development than recall on the factual-knowledge domains. Since the changes were introduced in the year 2008, the comparison can best be regarded as qualitative, and it is probably too early to judge the impact of the OSCE. Further studies to determine validity of the OSCE are needed.

Emotional distress among parent caregivers of adolescents with sickle cell disease: Association with patients and caregivers variables.

Evidence suggests that impairment in caregiver wellbeing can alter the quality of care in children with sickle cell disease. We examined 121 parent caregivers of adolescents with sickle cell disease for emotional distress and disruptions to caregiver lifestyle and interests. Participants were predominantly mothers 92(76%) with mean age, 43.59 (SD = 6.39) years. Four in every ten caregivers had emotional distress, and this was predicted by frequent hospital attendance and disruptions in caregiver lifestyle, relationships, and interests. Psychosocial support to promote resilience and adaptive coping-styles to deal with the stress from unforeseen crises, frequent hospital visits, and lifestyle disruptions are indicated to improve caregiver wellbeing.

Relationship of family caregiver burden with quality of care and psychopathology in a sample of Arab subjects with schizophrenia.

BACKGROUND: Although the burden experienced by families of people with schizophrenia has long been recognized as one of the most important consequences of the disorder, there are no reports from the Arab world. Following the example of the five-nation European (EPSILON) study, we explored the following research question: How does the relationship between domains of caregiving (as in the Involvement Evaluation Questionnaire--IEQ-EU) and caregiver psychic distress on the one hand, and caregiver's/patient's socio-demographics, clinical features and indices of quality of care, on the other hand, compare with the pattern in the literature? METHOD: Consecutive family caregivers of outpatients with schizophrenia were interviewed with the IEQ-EU. Patients were interviewed with measures of needs for care, service satisfaction, quality of life (QOL) and psychopathology. RESULTS: There were 121 caregivers (66.1% men, aged 39.8). The IEQ domain scores (total: 46.9; tension: 13.4; supervision: 7.9; worrying: 12.9; and urging: 16.4) were in the middle of the range for the EU data. In regression analyses, higher burden subscale scores were variously associated with caregiver lower level of education, patient's female gender and younger age, as well as patient's lower subjective QOL and needs for hospital care, and not involving the patient in outdoor activities. Disruptive behavior was the greatest determinant of global rating of burden. CONCLUSION: Our results indicate that, despite differences in service set-up and culture, the IEQ-EU can be used in Kuwait as it has been used in the western world, to describe the pattern of scores on the dimensions of caregiving. Differences with the international data reflect peculiarities of culture and type of service. Despite generous national social welfare provisions, experience of burden was the norm and was significantly associated with patient's disruptive behavior. The results underscore the need for provision of community-based programs and continued intervention with the families in order to improve the quality of care.