Attitude towards mental help-seeking, motivation, and economic resources in connection with positive, negative, and general psychopathological symptoms of schizophrenia: a pilot study of a psychoeducation program.

Introduction: Schizophrenia is typically treated with medication as the first approach, but additional strategies are necessary to enhance the effectiveness of this treatment for better outcomes. However, it is crucial to explore methods, alongside medication, that promote a positive attitude towards seeking mental health support and alleviate symptom severity among non-institutionalized individuals of different age groups in Pakistan. Thus, this pilot study aimed to utilize a psychoeducation program to enhance patients' motivation and attitudes toward seeking treatment, decrease symptom severity, and investigate the role of financial factors in their illness journey. Methods: In this preliminary investigation, our focus was on individuals who had been diagnosed with schizophrenia and were receiving treatment from various hospitals and primary care clinics. Following a thorough screening process, 255 participants met the eligibility criteria, and 220 completed the psychoeducation program. The study included both male and female participants, with 143 (56.08%) being men and 112 (43.82%) being women. Regarding marital status, 123 (48.24%) were single, 98 (38.43%) were married, and 34 (13.33%) were divorced widowers or widows. The age range of the respondents varied from 18 to 52 years, with a mean age of 35.45 and a standard deviation of 10.27. Results: The results indicated a decrease in symptom severity following a 16-week psychoeducation program. The psychoeducation program significantly reduced the positive symptoms, negative symptoms, and general psychopathological symptoms among patients. Similarly, significant improvement was observed in patients' motivation toward treatment and they actively participated in treatment after getting psychoeducation about the treatment. Similarly, after the psychoeducation program significant improvement was seen in patients' attitudes towards help-seeking and perceived mental health functioning. Conclusion: In summary, the findings suggest that our psychoeducation program has the potential to positively impact the motivation and help-seeking attitudes of schizophrenia patients towards treatment. Moreover, there is a need for further exploration of psychoeducation programs for schizophrenia, particularly in countries facing economic challenges. This study paves the way for the development of an indigenous psychoeducation program tailored to Pakistani schizophrenia patients, with potential applicability for Urdu-speaking individuals. Clinical Trial Registration: https://www.thaiclinicaltrials.org/show/TCTR20210208003, identifier TCTR20210208003.

Predictors of postpartum depression and its association with sleep quality among mothers in Qassim, Saudi Arabia: A descriptive cross-sectional study.

OBJECTIVE: This cross-sectional study aims to examine the prevalence of postpartum depression (PPD) and sleep problems, their relationship, and the characteristics associated with depression/insomnia in Qassim, Saudi Arabia. METHODS: An online survey was administered to a convenience sample of 395 mothers who had given birth within the preceding year. The survey comprised demographic characteristics, pregnancy and childbirth characteristics, depression (via the Edinburgh Postnatal Depression Scale; EPDS), and sleep quality (via the Pittsburgh Sleep Quality Index; PSQI). RESULTS: Nearly two-thirds of respondents (62.3%) had PPD, while 92.2% experienced poor sleep quality. Both scales demonstrated a statistically significant positive correlation. Participants with previous PPD, peripartum depression, a personal or family history of other depression, those bottle-feeding their infants, or who had a change in sleep pattern scored significantly higher on the EPDS and had poorer PSQI scores. Respondents with a history of mental illness, pregnancy or delivery complications, those who lacked support, or gave birth to unhealthy newborns also had significantly higher EPDS scores. CONCLUSIONS: PPD and poor sleep quality were highly prevalent among mothers living in the Qassim region of Saudi Arabia. Not surprisingly, PPD was strongly correlated with poor sleep quality. Postpartum counseling for mothers during the first year after delivery is necessary to decrease the risk of developing depressive symptoms and poor sleep quality. Screening for sleep-related difficulties and depression in prenatal and postnatal programs may help prevent the development of depressive disorder among postpartum women in this region of Saudi Arabia (or other areas of the Middle East).

Brief cognitive behavior therapy for stigmatization, depression, quality of life, social support and adherence to treatment among patients with HIV/AIDS: a randomized control trial.

OBJECTIVE: Individuals living with HIV/AIDs are at a high risk of many problems like depression, stigma, quality of life, decreased adherence to treatment, and lack of social support. The present study aimed to investigate the impact of brief-cognitive behavior therapy (B-CBT) on reducing depression and stigma and improving treatment adherence, quality of life, and social support among patients with HIV/AIDS attending antiretroviral therapy (ART). MATERIALS AND METHODS: This randomized clinical trial was conducted at ART Clinic in the Tehsil Headquarters Hospital Shahkot Nankana Sahib from July 2021 to October 2021. After baseline screening, 126 patients met the eligibility criteria and 63 were allocated to the experimental group (EXPg = 63) and 63 to waitlist-control group (WLCg = 63). Participants' age range was from 20 to 55 years. Participants who were taking ART treatment were enrolled for the CBT treatment. Before this, all the participants completed a baseline assessment to ensure a level of severity and diagnosis. A total of eight CBT based therapeutic sessions were conducted individually with EXPg. To assess the outcomes among patients receiving ART, we used Demographic form, Patient health questionnaire, HIV stigma scale, General medication adherence scale, Multidimensional scale of perceived social support, and WHOQOL BREF scale. RESULTS: Findings suggest that B-CBT significantly reduced the level of depression (i.e. F (1, 78) = 101.38, p < .000, η2 = .599), and social stigma (i.e. F (1, 78) = 208.47, p < .000, η2 = .787) among patients with HIV/AIDS. Furthermore, CBT substantially improved the level of adherence to treatment (i.e. F(1,78) = 24.75, p < .000, η2 = .503), social support (i.e. F (1, 78) = 128.33, p < .000, η2 = .606), and quality of life (i.e. F (1, 78) = 373.39, p < .000, η2 = .837) among patients with HIV/AIDS. Significant mean difference M(SD) on PHQ at post-analysis in the EXPg vs. WLCg was seen 1.22(0.47) vs. 2.30(0.68) and similarly, on MPSS at a post-analysis in the EXPg vs. WLCg 2.85(0.36) vs. 1.70(0.51) which indicates sound therapeutic outcomes. CONCLUSIONS: Cognitive behavioral therapy effectively decreases the level of depression and stigma and enhances the level of social support, quality of life, and adherence to treatment among HIV/AIDS patients. It is concluded that cognitive behavior therapy is an effective treatment approach for patients with HIV/AIDS. TRIAL REGISTRATION: Thai clinical trial registry (i.e. TCTR = TCTR20210702002 ).

Reliability and validity estimation of Urdu version of Children Emotion Management Scales (CEMS) in Pakistan.

Introduction: The present study aimed to translate and validate Children's Emotion Management Scales into Urdu, the national language of Pakistan. Method: The current study comprised three different phases, i.e., phase I: Cross-language validation over a sample of (N = 169) school children, estimated at a 1-week interval. Results: The results indicate a significant correlation (r = 0.846-0.891) at p < 0.01. In phase II, the internal consistency reliability (r = 0.808-0.904) and split-half reliability (r = 0.737-0.898) of the scale were assessed (N = 683) at p < 0.01. Furthermore, significant results for test-retest reliability analysis (N = 168) were obtained (r = 0.736-0.917 at p < 0.01), following the confirmatory factor analysis (CFA) (N = 1,083). Exploratory factor analysis (EFA) was conducted on the same sample chosen for CFA. EFA resulted in the retention of original inhibition (INH), dysregulated expression (DYS), and emotional coping (EMO) factors. CFA findings suggest a good model fit. In phase III, convergent validity and divergent validity were checked (N = 385, 255, and 213). Convergent validity of INH and DYS subscales and divergent validity of EMO subscales were established, with SBI (r = 0.217-0.609; 0.210-0.445; -0.026 to -0.553), SHS (r = 0.417-0.441; 0.480-0.546; -0.338 to -0.582), and suppression subscale of ERQ (r = 0.430-0.480; 0.468-0.522; -0.245 to -0.369) at p < 0.01. For divergent validity of INH and DYS subscales and convergent validity of EMO subscales, their scores were correlated with the SPS (r = -0.204 to -0.350; -0.318 to -0.459; 0.191-0.531), RSE Scale (r = -0.226 to -0.351; -0.279 to -0.352; 0.255-0.507), DTS (-0.290 to -0.617; -0.369 to -0.456; 0.246-0.680), and reappraisal subscale of ERQ (r = -0.456 to -0.541; -0.329 to -0.544; 0.446-0.601) at p < 0.01. Discussion: It is concluded that the scale is reliable and valid with sound psychometric properties.

Fluoxetine for the treatment of onychotillomania associated with obsessive-compulsive disorder: a case report.

BACKGROUND: Obsessive-compulsive disorder is a condition in which patients experience an obsession and/or a compulsion. It has a high impact on the quality of life, and is associated with an increased prevalence of psychiatric comorbidities in patients. Onychotillomania is an underestimated psychodermatosis caused by repeated self-inflicted damage to the nail unit. In patients, it is characterized by an obsessive or irrepressible impulse to repeatedly damage their own nails, resulting in their destruction. It is a chronic condition that is difficult to manage, largely because of its psychocutaneous character, as well as its high tendency to interact with underlying neuropsychiatric diseases or other behavioral disorders. Only a few studies have reported an association between obsessive-compulsive disorder and onychotillomania, which typically presents with therapeutic challenges. Cognitive behavioral therapy, physical-barrier approaches, and pharmaceutical treatments have been reported to be beneficial in the management of onychotillomania; however, no major clinical studies have investigated the effectiveness of these therapies. Onychotillomania remains a clinical and therapeutic issue owing to the lack of evidence-based treatment techniques. CASE PRESENTATION: We report a case of an 18-year-old, middle-eastern female patient who developed onychotillomania when she was being treated with paroxetine for obsessive-compulsive disorder and was showing partial improvement. The patient developed side effects from paroxetine, and was switched to fluoxetine. Thereafter, improvement in her obsessive-compulsive disorder was observed, which relapsed when treatment was discontinued. However, the onychotillomania symptoms did not reemerge. CONCLUSION: Onychotillomania typically presents both diagnostic and therapeutic challenges. Fluoxetine plays an important role in the treatment of onychotillomania and other psychiatric disorders. However, large-scale studies should be conducted before these outcomes can be generalized.

Escitalopram-induced epistaxis: A case report.

Selective serotonin reuptake inhibitors (SSRIs) are a group of drugs used to treat various psychiatric disorders such as major depression, generalised anxiety, and obsessive-compulsive syndrome. Although generally safe, SSRIs can lead to various adverse effects, including an increased risk of bleeding due to their effect on platelet activation and aggregation. Unexpected bleeding can occur at different sites, in people of different age groups, and in combination with other medications. The commonly reported risk factors associated with medication-induced bleeding in patients with mental disorders include co-administration of other drugs and liver cirrhosis or failure. We report a relatively less common adverse effect of SSRIs. This is the case of a Middle Eastern man, known to have seasonal allergic rhinitis, who developed self-limiting epistaxis following the use of escitalopram for a depressive disorder. Since a history of seasonal allergy can precipitate bleeding when using SSRIs, risk factors for bleeding associated with SSRIs, excluding the common causes, should be explored for better management and prevention.

Scope, quality and inclusivity of international clinical guidelines on mental health and substance abuse in relation to dual diagnosis, social and community outcomes: a systematic review.

OBJECTIVE: It is estimated that up to 75% of patients with severe mental illness (SMI) also have substance use disorder (SUD). The aim of this systematic review was to explore the scope, quality and inclusivity of international clinical guidelines on mental health and/or substance abuse in relation to diagnosis and treatment of co-existing disorders and considerations for wider social and contextual factors in treatment recommendations. METHOD: A protocol (PROSPERO CRD42020187094) driven systematic review was conducted. A systematic search was undertaken using six databases including MEDLINE, Cochrane Library, EMBASE, PsychInfo from 2010 till June 2020; and webpages of guideline bodies and professional societies. Guideline quality was assessed based on 'Appraisal of Guidelines for Research & Evaluation II' (AGREE II) tool. Data was extracted using a pre-piloted structured data extraction form and synthesized narratively. Reporting was based on PRISMA guideline. RESULT: A total of 12,644 records were identified. Of these, 21 guidelines were included in this review. Three of the included guidelines were related to coexisting disorders, 11 related to SMI, and 7 guidelines were related to SUD. Seven (out of 18) single disorder guidelines did not adequately recommend the importance of diagnosis or treatment of concurrent disorders despite their high co-prevalence. The majority of the guidelines (n = 15) lacked recommendations for medicines optimisation in accordance with concurrent disorders (SMI or SUD) such as in the context of drug interactions. Social cause and consequence of dual diagnosis such as homelessness and safeguarding and associated referral pathways were sparsely mentioned. CONCLUSION: Despite very high co-prevalence, clinical guidelines for SUD or SMI tend to have limited considerations for coexisting disorders in diagnosis, treatment and management. There is a need to improve the scope, quality and inclusivity of guidelines to offer person-centred and integrated care.

Mental health among healthcare providers during coronavirus disease (COVID-19) outbreak in Saudi Arabia.

BACKGROUND: The novel coronavirus (COVID-19) was recently declared a pandemic by the World Health Organization (WHO). The first confirmed case in Saudi Arabia was announced on March 2, 2020. Several psychiatric manifestations may appear during pandemics, especially among frontline healthcare providers. OBJECTIVES: This study sought to explore depression and anxiety levels among healthcare providers during the COVID-19 outbreak in Saudi Arabia. METHODS: This was a cross-sectional study of a convenience sample of 502 healthcare providers in the Ministry of Health. Depression and anxiety were assessed via the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder 7 (GAD-7) questionnaires, respectively. RESULTS: The respondents represented various healthcare occupations: administrators (28.49%), nurses (26.29%), physicians (22.11%), non-physician specialists (13.94%), technicians (6.77%), and pharmacists (2.30%). The majority of them were male (68.1%). More than half of them had depressive disorder (55.2%), which ranged from mild (24.9%), moderate (14.5%), and moderately severe (10%) to severe (5.8%). Half of the sample had generalized anxiety disorder (51.4%), which ranged from mild (25.1%) and moderate (11%) to severe (15.3%). Multivariate analysis showed that males were significantly less predicted to have anxiety (Beta=-0.22, P-value <0.04), 30-39 years age group were significantly more predicted to have depression and anxiety group (Beta=0.204, P-value <0.001 and beta=0.521, P-value <0.003 respectively), and nurses had significantly higher mean score of anxiety (Beta=0.445, P-value <0.026). CONCLUSIONS: This study revealed that depression and anxiety are prevailing conditions among healthcare providers. Although efforts were accelerated to support their psychological well-being, more attention should be paid to the mental health of female, 30-39 age group and nursing staff. Promoting healthcare service as a humanitarian and national duty may contribute to making it a more meaningful experience in addition to advocating for solidarity, altruism, and social inclusion. Longitudinal research studies need to be conducted to follow up on healthcare providers' mental health symptoms and develop evidence-based interventions.

Perceived stress among students in virtual classrooms during the COVID-19 outbreak in KSA.

OBJECTIVES: COVID-19 is a newly discovered infectious Coronavirus that became pandemic. Since disease outbreaks can have mental health consequences, this study explored the perceived stress level among students during the Coronavirus Disease Outbreak and suspension of in-person teaching in Saudi Arabia. METHODS: A cross-sectional survey of a sample consisting of 367 students living in Saudi Arabia assessed socio-demographic characteristics, Perceived Stress Scale (PSS) and their emotions and concerns during the outbreak. RESULTS: Most participants were female (74.7%) and secondary school (79.8%) students. More than half of the participants showed moderate levels of stress (55%), while 30.2% registered high levels. Females and university students showed a significant association with stress level (p-value = 0.003 and 0.049, respectively). CONCLUSIONS: There was a moderate to high level of stress among students in KSA at the start of the COVID-19 outbreak. This study found a significant correlation between a high level of stress and female university students. The integration of online counselling and stress management programs would help mitigate the stress of students during distance learning.