Genome-wide copy number variant screening of Saudi schizophrenia patients reveals larger deletions in cases versus controls.

Introduction: Genome-wide association studies have discovered common polymorphisms in regions associated with schizophrenia. No genome-wide analyses have been performed in Saudi schizophrenia subjects. Methods: Genome-wide genotyping data from 136 Saudi schizophrenia cases and 97 Saudi controls in addition to 4,625 American were examined for copy number variants (CNVs). A hidden Markov model approach was used to call CNVs. Results: CNVs in schizophrenia cases were twice as large on average than CNVs in controls (p = 0.04). The analyses focused on extremely large >250 kilobases CNVs or homozygous deletions of any size. One extremely large deletion was noted in a single case (16.5 megabases on chromosome 10). Two cases had an 814 kb duplication of chromosome 7 spanning a cluster of genes, including circadian-related loci, and two other cases had 277 kb deletions of chromosome 9 encompassing an olfactory receptors gene family. CNVs were also seen in loci previously associated with schizophrenia, namely a 16p11 proximal duplication and two 22q11.2 deletions. Discussion: Runs of homozygosity (ROHs) were analyzed across the genome to investigate correlation with schizophrenia risk. While rates and sizes of these ROHs were similar in cases and controls, we identified 10 regions where multiple cases had ROHs and controls did not.

Suicidal Ideation Among Medical Students in Dammam, Saudi Arabia.

Background: Medical students are at high risk of suicidal ideation. Aim: We aimed to obtain information on suicidal ideation among medical students in Dammam located in the Eastern Province of Saudi Arabia. Method: This cross-sectional study was conducted at the College of Medicine affiliated with Imam Abdulrahman Bin Faisal University in the Eastern Province of Saudi Arabia. Suicidal ideation in the past 12 months was assessed based on responses to four questions in the depression subscale of the General Health Questionnaire 28 (GHQ-28). In addition, data were collected to examine the association of suicidal ideation with various factors. Results: We found that 1 in 3 medical students in the study had suicidal ideation in the past 12 months, while around 40% had lifetime suicidal ideation. Suicidal ideation was associated with feelings of parental neglect, history of physical abuse, and dissatisfaction with academic performance. Limitations: The cross-sectional nature of this study limits its ability to determine causality regarding suicidal ideation. Conclusion: These rates are considerably high when compared with rates from studies in other countries around the world. This study provides a reference in the field of suicidology for this region of Saudi Arabia.

Mental health research in the Kingdom of Saudi Arabia: A review of trend and visibility over four decades.

In the last few decades, there has been significant advancement in higher education and research in the Kingdom of Saudi Arabia (KSA) However, no research has quantified the studies on mental health in Saudi Arabia. The aim of this review was to review literature on mental health in KSA over the last four decades and compare it with studies done in other medical and surgical specialties. This narrative review is based on research published in the global scientific database of Web of Science, Scopus and Medline/PubMed. Mental Health Research of Saudi Arabia published since 1975 was retrieved. Publications related to other medical specialties such as surgery, internal medicine and pharmacology were also retrieved for comparison. A total of 159,796 studies related to medical and non-medical specialties were conducted in Saudi Arabia. A total of 52,699 related to medical specialties, 670 of which were on mental health and 52,029 on other medical specialties. At the beginning of the last decade there was a sharp increase in medical research (including mental health) publications from Saudi Arabia. Mental health research does not differ from research in other medical specialties in its output. In spite of the huge strides made in research in KSA, the provision of support for mental health research in the Kingdom is inadequate. Possible challenges and recommendations have been identified.

The function of patient-centered care in mitigating the effect of nursing shortage on the outcomes of care.

BACKGROUND: The shortage of nursing staff is a national and international issue. Inadequate number of hospital nurse staff leads to poor health care services. Yet the effects of patient-centeredness between the relationships of nursing shortage on the quality of care (QC) and patient safety (PS) have not been explored. The aim of this study was to examine the mediating effects of patient-centeredness on the relationship of nursing shortage on the QC and PS in the Medical and Surgical Wards, in Malaysian private hospitals. METHOD: A descriptive, cross-sectional study was carried out on 12 private hospitals. Data was gathered, through a self- administered questionnaire, from 652 nurses, with a 61.8% response rate. Stratified simple random sampling was used to allow all nurses to participate in the study. Hayes PROCESS macro-regression analyses were conducted to explore the mediating effects of patient-centeredness on the relationships of hospital nurse staffing on the QC and PS. RESULTS: Patient-centeredness mediated the relationships of hospital nurse staffing on both the QC (F = 52.73 and P = 0.000) and PS (F = 31.56 and P = 0.000). CONCLUSION: Patient-centeredness helps to mitigate the negative associations of nursing shortage on the outcomes of care. The study provides a guide for hospital managers, leaders, decision-makers, risk managers, and policymakers to maintain adequate staffing level and instill the culture of patient-centeredness in order to deliver high quality and safer care.

Academic job satisfaction questionnaire: Construction and validation in Saudi Arabia.

BACKGROUND: Colleges and universities are becoming increasingly accountable for teaching outcomes in order to meet rigorous accreditation standards. Job satisfaction (JS) seems more difficult to measure in the academic field in view of the complexity of roles, duties and responsibilities. OBJECTIVES: To compile and determine the psychometric properties of a proposed Academic Job Satisfaction Questionnaire (AJSQ) suitable for university faculty, and amenable to future upgrading. MATERIALS AND METHODS: A 46-item five-option Likert-type draft questionnaire on JS was distributed for anonymous self-reporting by all the academic staff of five colleges in University of Dammam (n=340). The outcome measures were (1) factor analysis of the questionnaire items, (2) intra-factor α-Coefficient of Internal Consistency Reliability, (3) inter-factor correlations, (4) comparison of psychometric properties in separately analyzed main faculty subgroups. RESULTS: The response rate was 72.9 percent. Factor analysis extracted eight factors which conjointly explained 60.3 percent of the variance in JS. These factors, in descending order of eigenvalue, were labeled "Authority", "Supervision", "Policies and Facilities", "My Work Itself", "Interpersonal Relationships", "Commitment", "Salary" and "Workload". Cronbach's-α ranged from 0.90 in Supervision to 0.63 in Salary and Workload. All inter-factor correlations were positive and significant, ranging from 0.65 to 0.23. The psychometric properties of the instrument in separately analyzed subgroups divided by sex, nationality, college and clinical duties produced fairly comparable findings. CONCLUSION: The AJSQ demonstrated good overall psychometric properties in terms of construct validity and internal consistency reliability in both the overall sample and its separately analyzed subgroups. RECOMMENDATION: To replicate these findings in larger multicenter samples of academic staff.

Job satisfaction among the academic staff of a saudi university: an evaluative study.

BACKGROUND: Job satisfaction is a major determinant of job performance, manpower retention and employee well-being. OBJECTIVES: To explore the state of job satisfaction among the academic staff of King Faisal University - Dammam (KFU-D), and detect the areas and groups at a higher risk of being dissatisfied. METHOD: A fully-structured 5-option Likert-type Job Satisfaction Questionnaire (JSQ) composed of an evaluative item and eleven domains making a total of 46 items was used. It was distributed by internal mail to all the 340 academic staff, 248 of whom returned completed questionnaires (response rate = 72.9 %). FINDINGS: The overall mean Job Satisfaction Rate (JSR) was 73.6 %. The highest JSR's were found in three domains ("Supervision", "Responsibility", and "Interpersonal Relationships"), and the lowest in four others ("Salary", "My Work Itself", "Working Conditions", and "Advancement"). The JSR was significantly lower among Saudi nationals, females, those below age 40, those from clinical medical and Dentistry departments. Multiple Regression identified six independent variables which conjointly explained 25 % of the variance in job satisfaction (p < 0.0001). These were: being an expatriate, above the age of 50, serving the university for less than one or more than ten years, and, not from a clinical department of Medicine or Dentistry. CONCLUSIONS: Most staff were satisfied with many aspects of their jobs, but there was significant dissatisfaction with several job-related aspects and demographic features. Appropriate interventions are indicated. Further studies are needed to confirm the present findings and to monitor future trends.

Two decades of treatment seeking for substance use disorders in Saudi Arabia: trends and patterns in a rehabilitation facility in Dammam.

BACKGROUND: Treatment provision and treatment seeking for substance use disorders is a relatively new phenomenon in the Middle East. The present study aims to study these trends among first admissions to the specialized addiction treatment Amal Hospital of Dammam over its first two decades (1986-2006). The main outcome measures were: annual inception number (AIN), relative frequency of substances (RFS), relative frequency of drug combinations (RFDC), mean number of substances (MNS), and sociodemographic changes. RESULTS: A total of 12,743 patients were admitted between 1986 and 2006. The majority were aged 20-39 years (83%), never married (60%), and with low education (81%). In the second decade, subjects were significantly older and less unemployed than in the first decade (28.9 years versus 30.2 years; 27% versus 19%). The mean AIN rose from 509 in the first decade to 765 in the second decade. In the same periods, the RFS increased for amphetamines and cannabis (from 12.1 and 17.5% to 48.1 and 46.5%, respectively), decreased for heroin, sedatives and volatile substances (from 51.1, 15.1, and 6.1% to 22.5, 7.3, and 2.5%, respectively), and remained stable for alcohol (from 27.1 to 26.7%). The overall RFDC increased from 25.5 to 43.2% with significant pair-wise increases of cannabis/amphetamine, alcohol/cannabis and alcohol/amphetamine, and heroin/alcohol. The mean number of substances per subject increased from 1.32 to 1.56%. CONCLUSIONS: Significant shifts have occurred in the types and patterns substances use among treatment-seeking subjects. These findings underscore the need for community-based epidemiologic studies and for the establishment of a comprehensive drug information system in Saudi Arabia.

Obstructive sleep apnea syndrome among a snoring community.

OBJECTIVE: To evaluate the relation between snoring and the presence of obstructive sleep apnea (OSA) in terms of relevant health parameters and questionnaire responses. METHODS: Selective random sampling within a household survey in the cities of Al-Khobar and Dammam, Kingdom of Saudi Arabia over a 3 month period during the year 2000, was carried out. One hundred and fifty-two persons, aged 17-62 years, with a positive history of snoring as determined by the spouse or other members of the family were selected. RESULTS: The presence of OSA was determined using the Epworth sleepiness scale (ESS). The predictors included age, gender and body mass index. Snoring was found to be more associated with OSA as suggested by ESS in the study sample. The severity of snoring and its pattern are more associated with apneic patients. CONCLUSION: Snoring is common and may be a serious medical problem. This study revealed that snoring is associated with symptoms suggesting OSA syndrome as detected by ESS. The family doctor and his team should be aware of the condition, using simple screening test such as ESS, improves the patient care, and finding of suspected cases.

Depressive disorders in psychiatric outpatient clinic attendees in eastern saudi arabia.

BACKGROUND: Depressive disorders are common in Psychiatry Outpatient Clinics. PATIENTS: All new patients attending the Psychiatry Clinics at King Fahd Hospital of the University (KFHU), in the Eastern Province were included in the study. AIM: To investigate the frequency and pattern of depressive disorders among Psychiatric Out-patients attendees in the KFHU. METHODS: A semi-structured psychiatric interview and clinical mental state examination were used in the assessment of all consecutive new patients attending the clinic during the study period. The Psychiatric diagnoses were made according to the 10(th) Edition of International Classification of Mental and Behavioral Disorders (ICD-10). RESULTS: The frequency of depressive disorders was 19.3%. The majority of the patients were between 20-49 years of age and females predominated in the ratio of 1.7:1. Almost 70% were formally unemployed (including 66 housewives). Depressive disorder of the moderate nature was the commonest. CONCLUSION: Depressive disorders are common in Psychiatry outpatients. The socio-demographic characteristics of depressive disorder in the Kingdom of Saudi Arabia are similar to those abroad in many respects.

Can a short-term training course improve the primary-care physicians' attitudes toward mental health problems?

OBJECTIVE: To measure changes in the attitude of Primary Health Care (PHC) physicians towards mental illnesses after a short-term training course. In addition, to ascertain if this change would persist 6 months after the training course. METHOD: This is an intervention type study. Out of 296 PHC physicians working in Eastern Saudi Arabia, 191 were randomly selected and divided randomly into two groups. The Study groups were tested for pre and post exposure (immediate and 6months later), to the psychiatric training course. The Control group was not involved in the intervention. The course was run over a 4-day period in June 1999. A 26-item self-administered questionnaire to assess the PHC physicians' attitudes was used. RESULTS: The study group consisted of 45 trainees, 24 (53%) of whom were men. The control group, 121 out of 166 physicians, responded to the questionnaire, with an 83% response rate, men forming 49%. The data analysis indicated a significant improvement in the PHC physicians' attitude after the course (P<0.0001). Six months later, as compared with their immediate post-test, the positive attitudes persisted within the study group (p-value=0.274). Multiple regressions indicated that the duration of undergraduate psychiatric training was the only contributor factor. CONCLUSION: This training course resulted in a positive change in the trainees' attitudes. Besides, it showed that the undergraduate psychiatric training had a favourable effect on the PHC physicians' attitude. Therefore, there should be frequent mental health training programs for PHC physicians. Moreover, physicians who spent longer period in undergraduate psychiatric training should be given the priority to work in PHC settings.

Cerebral palsy in Saudi children.

OBJECTIVE: To describe the clinical profile, and identify its risk factors, of cerebral palsy (CP) as seen in a cohort of consecutive Saudi children aged between one and 3 years of age prospectively over a one-year period. METHODS: Saudi children aged 1-3 years with CP (diagnosis based on specified criteria) were selected from children presenting to the Neurology service at the King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia with delayed milestones, seizures, mental retardation and difficulty with walking and evaluated at 3-monthly intervals for one year from January to December 2000. Information on gestation duration, labor and delivery, birth weight and the medical history of the mothers was obtained. Cranial computerized tomography and electroencephalography were carried out in addition to baseline investigations (toxoplasmosis, other, rubella, cytomegalovirus, and herpes simplex virus serology, serum lactate, pyruvate, amino acid screen, thyroid function tests, and chromosome analysis). Somatosensory, molecular genetics and muscle biopsy for histopathologic and histochemical studies were not performed in any of the patients. RESULTS: One hundred and eighty-seven children with CP were seen during the study period: 109 males (mean age 20.3 +/- 8.69 months); 78 females (mean age 20.6 +/- 8.55 months). Seventy-three had microcephaly (<5th percentile) with a mean head circumference of 44.5 +/- 3.69 cms for males and 43.0 +/- 4.16 for females. The main symptoms were inability to walk independently (54%), delayed speech (52%) and seizures (45%). The main neurologic features were motor weakness (85%), spasticity (60%), language dysfunction (42%), mental retardation (31%) and head lag (30%). A history of previous CP in the family was obtained in 8 patients (4%) but none of them had other features of hereditary spastic paraplegia. Electroencephalography abnormalities, present in 113 (73%) were more frequent in those without seizures than with seizures. Cranial computerized tomography abnormalities were mainly cerebral atrophy (60%) and hydrocephalus (53.7%). Twenty-five percent were from twin pregnancies; 56 (34%) were of low birth weight, 20% were pre-term deliveries, birth asphyxia was present in 165 and breech presentation was encountered in 8%. CONCLUSION: The main risk factors identified were twin pregnancy, pre-term delivery, prolonged labor, low birth weight and a history of previous CP in the family. Our findings suggest that improved maternal and childcare particularly in the ante and perinatal periods may reduce the incidence of CP in this environment.

Newly diagnosed seizures in adults.

OBJECTIVE: To study the clinical, electroencephalographic (EEG) and computed tomography (CT) profile in a hospital population of over 18-years adult patients with newly diagnosed recurrent seizures. METHODS: The clinical profiles obtained from history including detailed description of the seizures, examination, EEG and CT findings were recorded prospectively for all over-18 patients who were referred to the electrodiagnostic service at King Fahd Hospital of the University, Al-Khobar, Eastern Province, Kingdom of Saudi Arabia from January 1, 1996 to December 31, 1997. The data was entered into a standard database file and analyzed using a personal computer. RESULTS: Seventy-three patients (43 males, 30 females, mean age 32.3 years) with newly diagnosed recurrent seizures were studied. A positive family history of seizures was found in 12.3%. The main seizure types were partial in 27 (37%), partial with secondary generalization in 22 (30.1%) and generalized in 24 (32.9%). The types of epileptic syndromes included localization-related 34 (46.6%), generalized 24 (32.9%) and undetermined 15 (20.5%). The EEG was abnormal in 45 (61.6%) with epileptiform activity, focal in 22 (48.9%), generalized in 11 (24.4%) and non-epileptiform activity in 12 (26.7%). The cranial CT findings were normal in 44 patients (60.3%) and abnormal in 29 (39.7%) patients, with focal lesions in 19 (65.5%) and generalized cerebral atrophy in 10 (34.5%). CONCLUSION: Our results showed that partial and partial with secondary generalization seizures are the most frequent seizure type and the most common epileptic syndrome was the localization-related type in this age group. These results are comparable to previous population- and hospital-based western reports.

Comparative evaluation of multiple choice question formats. Introducing a knowledge score.

OBJECTIVE: Over the last 6 years different multiple choice question (MCQ) formats have been used in postgraduate examinations for trainees in psychiatry. In phase 1 - K-type True/False (T/F) items with negative marking; in phase 2 combined T/F and type-A one-best answer (OBA) questions without negative marking; in phase 3 exclusively OBA without negative marking. The study compares the gross scores (GS) obtained with different MCQ formats, and introduces knowledge score (KS). METHODS: The study was conducted in the Saudi Council for Health Specialties, Riyadh, Kingdom of Saudi Arabia from 1996 to 2002. The mean percentile scores obtained by all postgraduate trainees sitting any Part I or Part II Saudi Board Examination in Psychiatry were subjected to a comparative analysis. RESULTS: A total of 110 candidates sat 18 examinations returning 143 papers containing a total of 32,375 MCQ options. Phase 1 generated lowest overall mean GS (47.8%), phase 3 occupied an intermediate position (53.1%) and phase 2 produced the highest score (68.3%). The KS, to the contrary, generated strikingly similar results for all the 3 phases (47.8, 50.5 and 49.5%) indicating that the marked differences in the GS were probably related to benefits obtained from guessing in the absence of negative marking. In this respect, the OBA produced considerably higher KS scores than the T/F, presumably due to its facilitating extra benefits from cueing, partial knowledge and judgement. CONCLUSION: Different MCQ formats generate dissimilar quantitative results. The OBA format seems superior to the T/F format in crediting judgement and application of knowledge. In non-negatively marked MCQ tests, the suggested KS provides results comparable to those of negatively marked tests. Pass marks in MCQ tests should be calibrated according to the used format.

Mental health training in primary care. Impact on physicians knowledge.

OBJECTIVE: The objective of this study was to measure changes in the Primary Health Care (PHC) physicians` knowledge towards mental illnesses after a short-term training course. METHODS: The interventive study consisted of a sample of 31 PHC physicians randomly selected from different PHC centers in Eastern Saudi Arabia. The physicians were exposed to a 4-day intensive training course in mental illnesses in June 1999. They were assessed using multiple choice questions testing before (pre-test) and after (post-test) to assess their knowledge regarding mental illnesses. RESULTS: The analysis of the accumulated data indicated that there was a significant improvement in the PHC physicians` knowledge of mental illnesses after the course (p<0.0001). The effect of recall bias was excluded in the post-test evaluation. In addition, multiple regression analysis indicated that the undergraduate psychiatric training courses had a positive contribution in both pre- and post-tests. CONCLUSION: The authors surmised that a mental training course could improve the knowledge base of PHC physicians. Furthermore, by giving substantial weight to the undergraduate and internship psychiatric training might improve the delivery of mental health services at the PHC level.

Research and research activities in a university in Eastern Saudi Arabia.

OBJECTIVES: The purpose of the present study was to obtain the views of faculty members regarding various aspects of scientific research, which is one of the essential functions of a University. METHODS: A cross-sectional study was conducted in the College of Medicine, King Faisal University, Dammam, Kingdom of Saudi Arabia, between January and June 2001, using a standardized questionnaire to obtain the views of faculty members in both basic and clinical departments on issues related to scientific research. The questionnaire consisted of 41 items and the responses were assessed on a 5 point scale. The variables included specified objectives for research by administration, quality of research, process of application for funding, available facilities for research, constraints to meaningful scientific research and mechanisms that would enhance its quality. RESULTS: The response rate was 67% (74 of the total available 110): Professors 22, Associate Professors 27, Assistant Professors 23 and Lecturers 2 in 24 departments (6 basic sciences, 18 clinical sciences). The number of completed research projects was judged inadequately by 50 (68%), and 31 (42%) thought the quality could be improved upon. The process of the application for funding was cumbersome. The major identified constraints were inadequate infrastructure, additional administrative duties (89%) and teaching schedule overload (82%). The major strategies suggested to enhance the quality of research included simplifying the process for application for research (approval and funding), provision of defined quality time for faculty members to engage in research and the establishment of adequate support and infrastructure facilities. CONCLUSIONS: Most faculty members aspire for a higher quality of biomedical research. The following were identified strategies to improve research goals and quality: Provision of starting seedling packages for new faculty members, simplifying research application processes, establishing efficient and adequate infrastructures, and providing protected research time.

Psychiatric admission in a general hospital. Patients profile and patterns of service utilization over a decade.

OBJECTIVE: To analyze the socio-demographic and clinical characteristics of admitted patients and the patterns of their service utilization over a decade from March 1988 to March 1998. METHODS: Prospective data compilation using a structured questionnaire, hospital records and follow-up observations at King Fahd Hospital of the University in Al-Khobar, Kingdom of Saudi Arabia. RESULTS: A total of 1366 patients (683 of each sex) had 2217 admissions in 10 years. By the International Classification of Diseases, 10th edition criteria, 19.5% had schizophrenia, 15.2% bipolar disorder, 9.9% depressive episodes, 8.6% acute and transient psychotic disorders, 7.7% adjustment disorders and 7.6% dissociative disorders. Males were more frequently admitted for schizophrenia and females for mood and anxiety disorders. Most non-Arab expatriates were diagnosed as acute and transient psychotic, stress-related or dissociative disorders. Re-hospitalizations constituted 28% of all admissions. The mean length of stay was 25 days per admission and 41 days per patient. The overall bed occupancy rate was 84.9%. A subgroup of 16.9% of patients, mostly with schizophrenia or bipolar disorder, consumed 62.3% of the bed occupancy. CONCLUSION: Gender and immigration were the main determinants of variance in patient characteristics, nosological distribution and pattern of service use. More beds are needed. Psycho-educational programs should be intensified to reduce the social stigma and societal intolerance to mental patients. Active family involvement improves compliance and might reduce re-hospitalization rates. Heavy service consumers should be transferred to long-stay facilities.

Psychiatric admission in a general hospital: Patients profile and patterns of service utilization over a decade.

OBJECTIVE: To analyze the socio-demographic and clinical characteristics of admitted patients and the patterns of their service utilization over a decade from March 1988 to March 1998. METHODS: Prospective data compilation using a structured questionnaire, hospital records and follow-up observations at King Fahd Hospital of the University in Al-Khobar, Kingdom of Saudi Arabia. RESULTS: A total of 1366 patients (683 of each sex) had 2217 admissions in 10 years. By the International Classification of Diseases, 10th edition criteria, 19.5% had schizophrenia, 15.2% bipolar disorder, 9.9% depressive episodes, 8.6% acute and transient psychotic disorders, 7.7% adjustment disorders and 7.6% dissociative disorders. Males were more frequently admitted for schizophrenia and females for mood and anxiety disorders. Most non-Arab expatriates were diagnosed as acute and transient psychotic, stress-related or dissociative disorders. Re-hospitalizations constituted 28% of all admissions. The mean length of stay was 25 days per admission and 41 days per patient. The overall bed occupancy rate was 84.9%. A subgroup of 16.9% of patients, mostly with schizophrenia or bipolar disorder, consumed 62.3% of the bed occupancy. CONCLUSION: Gender and immigration were the main determinants of variance in patient characteristics, nosological distribution and pattern of service use. More beds are needed. Psycho-educational programs should be intensified to reduce the social stigma and societal intolerance to mental patients. Active family involvement improves compliance and might reduce re-hospitalization rates. Heavy service consumers should be transferred to long-stay facilities.