Telephone-based telepsychiatry consultations: a qualitative exploration of psychiatrists' experiences in Oman.

OBJECTIVES: The utilisation of tele-mental health services has the potential to address challenges in mental health services within the Eastern Mediterranean Region. However, the adoption of tele-mental health in Oman remains limited. Therefore, this study aimed to explore the experiences of psychiatrists with telephone consultations, offering valuable insights to advance the field of telepsychiatry. DESIGN: This is a qualitative exploratory study. The analysis of the data involved the application of manifest content analysis. SETTING: The semi-structured interviews were conducted with the psychiatrists at Al Masarra Hospital. PARTICIPANTS: A total of 10 semi-structured interviews were conducted. RESULTS: The study reveals that psychiatrists encounter communication challenges in telephone consultations, such as the absence of visual cues, confirming patient identity, conducting comprehensive assessments and effectively communicating with younger patients who may lack developed social skills or patients with specific health conditions. Infrastructure limitations, such as outdated medical records, lack of electronic prescriptions and limited availability of child/adolescent psychiatric medications, further restrict the effectiveness of telepsychiatry consultations. In contrast, telephone appointments offer convenience and flexibility for psychiatrists, allowing them to manage non-clinical responsibilities and provide focused consultations tailored to individual needs. In addition, it benefits patients by improving appointment adherence, diminishing stigma and financial savings compared with in-person consultations. CONCLUSIONS: Tele-mental health has emerged as a promising avenue for enhancing mental healthcare services in Oman. Addressing psychiatrists' challenges is crucial to further developing and strengthening these services.

Dexmedetomidine in the Treatment of Depression: An Up-to-date Narrative Review.

Depressive disorders (DD) are common, and their prevalence is expected to rise over the next decade. Depressive disorders are linked to significant morbidity and mortality. The clinical conundrum of depressive disorders lies in the heterogeneity of their phenomenology and etiology. Further, the currently available antidepressants have several limitations, including a delayed onset of action, limited efficacy, and an unfavorable side effect profile. In this review, Dexmedetomidine (DEX), a highly selective and potent α2-adrenergic receptor (α2-AR) agonist, is proposed as a potentially novel antidepressant with multiple mechanisms of action targeting various depression pathophysiological processes. These mechanisms include modulation of the noradrenergic system, regulation of neuroinflammation and oxidative stress, influence on the Brain-Derived Neurotrophic Factor (BDNF) levels, and modulation of neurotransmitter systems, such as glutamate. The review begins with an introduction before moving on to a discussion of DEX's pharmacological features. The pathophysiological and phenomenological targets of DD are also explored, along with the review of the existing preclinical and clinical evidence for DEX's putative anti-depressant effects. Finally, the review ends by presenting the pertinent conclusions and future directions.

The differential mediating roles of resilience in the relationship between meaningful living and stress among college students during the COVID-19 pandemic.

The current literature, mostly Euro-American based, indicates that the presence of meaning in life (MIL) improves resilience and lowers stress. However, the differential mediating roles of resilience in the relationship between the search for and presence of MIL, and stress have not been explored. This study aimed to investigate the differential mediating roles of resilience in the relationship between the presence of and search for MIL, and stress among Omani college students amid the COVID-19 pandemic. This cross-sectional study consisted of the Brief Resilience Scale, Perceived Stress Scale 4, and Meaning in Life Questionnaire, as well as socio-demographic questions. A path analysis model was used to examine the hypothesis. A total of 970 Omani college students responded to the questionnaire. Findings indicate that searching for MIL was significantly associated with a high level of stress directly (ß = 0.023; p < 0.001) and indirectly, through a negative effect on resilience (ß = 0.006; p < 0.001). Conversely, the presence of MIL was significantly associated with a decreased level of stress directly (ß = - 0.045; p < 0.001) and indirectly via a positive effect on resilience (ß = - 0.151; p < 0.001). In keeping with the proposed hypothesis, this study contributes to the current knowledge, by extrapolating the effect of searching for MIL on resilience and stress, and culturally re-contextualizing MIL research. University counseling centers could adopt meaning-based strategies to mitigate stress by promoting meaningful living and resilience.

Parental Attitude Towards the Prescription of Psychotropic Medications for Mental Disorders in Children in a Tertiary Care University Hospital in Oman.

Objectives: This study aimed to investigate parental attitude towards psychotropic drugs' use for children's mental disorders. Methods: This cross-sectional study was conducted from December 2020 to March 2021 at the Department of Behavioural Medicine, Sultan Qaboos University Hospital, Muscat, Oman. A questionnaire was used to determine parents' opinions and attitudes about use of psychotropic medications on their children and, in a small proportion, other caregivers if the child attended with them. Risk factors associated with parents who preferred to consult a folk healer (FH) for children with mental disorders were identified by the logistic regression model. Results: A total of 299 parents participating in the study (response rate: 95.2%). Most (n = 244, 81.6%) agreed to give their child psychotropic medications if necessary, but 25.4% (n = 76) would consult an FH before a psychiatrist. Married parents were 14.5 times (P = 0.011) more likely than separated or divorced parents to consult an FH. Caregivers with a monthly income below 500 OMR and between 500 and 1,000 OMR were 2.5 (P = 0.016) and 3.2 times (P <0.001), respectively, more likely than those with more than 1,000 OMR to consult an FH. Parents who disagreed with giving their children psychotropic medications were 3.8 times (P <0.001) more likely to consult an FH than parents who agreed to give them if necessary. Conclusion: Most parents agreed to give their children psychotropic medications if necessary. However, a proportion of parents and caregivers preferred to consult an FH before accessing mental health services.

Psychogenic hiccups in an older adult: A case report and literature review.

Hiccups are typically benign and self-limiting. However, persistent or intractable hiccups can be debilitating, and may indicate the presence of an underlying physiological or psychological disorder. A 63-year-old man presented to the behavioral medicine clinic at a tertiary care hospital in Muscat, Oman, with a 4-year history of intractable hiccups. After exclusion of all organic causes of intractable hiccups, a diagnosis of psychogenic hiccups was made. Psychogenic hiccups are very rare, and only seven case series and reports have been published to date, according to PubMed and Google Scholar. This report includes a comprehensive review of the literature on all reported cases of psychogenic hiccups published to date, according to these two databases, to thoroughly investigate the effectiveness of various therapies for this condition. Psychogenic hiccups are very rare, and diagnosis should be made after exclusion of organic causes. Management can be challenging because of the lack of evidence-based interventions.

Parental consanguinity and ovarian reserve: A retrospective cohort study.

Background: Infertility affects around 10-15% of couples worldwide and is both a social and medical problem. Parental consanguinity is considered to reduce fertility reserve. Consanguineous marriages, especially first cousin marriages, are very common in Oman according to the Oman National Health Survey data. Objective: This study aimed to determine whether women born to consanguineous parents have reduced ovarian reserve. Materials and Methods: This cohort study was conducted on 414 women aged ≤ 39, treated for infertility at Sultan Qaboos University hospital and Royal hospital, Muscat, Oman from January 2019-December 2020. Each participant was interviewed and a complete history, including parental consanguinity and physical examination, were recorded. On day 2 of the menstrual cycle, serum concentration of the following was performed: follicle-stimulating hormone (FSH), luteinizing hormone, estradiol, prolactin, thyroid stimulating hormone, and anti-Müllerian hormone (AMH). AMH was done, if necessary, on other days of the cycle. Antral follicle count (AFC) was done on day 2 and 3 of the menstrual cycle. Results: Of the 414 women, parental consanguinity was present in 40.2% of couples. In women with low AFC, parental consanguinity was present in 15.3% compared to 13.0% in the non-consanguineous group. About 15% of women with low AMH had consanguineous parents, compared to 20.2% from the non-consanguineous group. High levels of FSH were present in 6.5% and 4.2% of the consanguineous and non-consanguineous groups, respectively. No significant difference was observed in AFC with reference to body mass index. Conclusion: The results from this study showed no statistically significant difference in low ovarian reserves (AFC, AMH, and FSH) in women whose parents had a consanguineous marriage.

A promising future for tele-mental health in Oman: A qualitative exploration of clients and therapists' experiences.

Objectives: Tele-mental health services can play an important role in overcoming barriers in mental health services in the Eastern Mediterranean Region. However, despite its potential, tele-mental health has not been widely adopted in Oman. This study is an exploratory investigation into the experiences of therapists and their clients in utilizing video-based tele-mental health care during the COVID-19 pandemic. Methods: A total of 19 semistructured qualitative interviews were individually conducted, it included 13 adult clients with mental health conditions who received video-based tele-mental health care and six clinical psychologists who provided video-based tele-mental health care during the COVID-19 pandemic. Results: The clients reported favorable experiences using tele-mental health, with the primary benefits being convenience, easy accessibility to subspecialized care, reduced absenteeism from work with commuting costs, and alleviated mental health stigma. The therapists also expressed experiencing benefits from tele-mental health, such as reduced risk of intrahospital infection, reduced healthcare costs, and the achievement of work-life balance. Primary concerns were related to the lack of public tele-mental health services, lack of specified tele-mental health guidelines, shortage of trained therapists, limited access to high-speed Internet, electronic devices, privacy, and concerns toward the security of telehealth systems in general. Conclusion: Clients and therapists report that tele-mental health offers new opportunities to improve the quality of mental healthcare services in Oman, and that the challenges could be resolved by establishing governmental tele-mental health services along with developing tele-mental health guidelines and implementing local postgraduate clinical psychology programs in universities in Oman.

Effectiveness and Adverse Effects of Risperidone in Children with Autism Spectrum Disorder in a Naturalistic Clinical Setting at a University Hospital in Oman.

OBJECTIVE: This study aimed at examining the effectiveness of treating children with autism spectrum disorder (ASD) who present with irritability, aggression, and disruptive behavior at the Sultan Qaboos University Hospital (SQUH) in Muscat, Oman, with risperidone, and to note any sex-based differences among this cohort. METHOD: This was a retrospective study conducted at the Department of Behavioral Medicine at SQUH over two years from January 2017 to December 2018. This study included all children aged 3 to 18 years attending the Child and Adolescent Mental Health Service (CAMHS) outpatient clinic with a diagnosis of ASD, based on the DSM-5 criteria, and comorbid disruptive behavior, who had been prescribed risperidone. RESULT: This study identified 95 ASD patients (72 males). Male patients' BMI score after 12 months of risperidone treatment showed an increase by 0.62 (1.57 SD; P=0.001); however, there was no significant change among female patients. Somnolence was noted in 69.6% of female patients as compared to 34.7% of males (P=0.003). Among those with a family history of ASD, 5 out of 17 patients had treatment success (29.4%), whereas 70 out of 78 patients (90.0%) who did not have a similar history had successful treatment. CONCLUSION: In conclusion, low-dose risperidone monotherapy is effective and well tolerated among some children with ASD who present with disruptive behavior in a naturalistic clinical setting. However, we found that some of the side effects, such as weight gain and somnolence, were concerning.

Self-Inflicted Total Amputation of the External Genitalia as a Psychological Repercussion of the COVID-19 Pandemic: A Case Report.

During the coronavirus disease 2019 (COVID-19) pandemic, mandatory quarantine has interrupted everyday social life, leaving many individuals feeling confined and lonely, with increased rates of suicide and suicidal behavior. Genital self-mutilation (GSM) is a rare phenomenon that typically occurs in the context of severe mental illness. The following case report describes the first case of total self-inflicted genital amputation in a healthy man who had no prior history of mental or medical conditions. This case poses challenges for psychiatric diagnosis and treatment. We report a case of a 52-year-old male with no significant medical and psychiatric history who was admitted to a tertiary care hospital after attempting suicide by self-inflecting a total amputation of his external genitalia due to fear of COVID-19 infection. The diathesis-stress linked with the tribulations of the current pandemic was highlighted as well as other possible contributory factors and psychopathology behind his clinical presentation.

Crippling Side Effects Induced by Paliperidone Palmitate Treatment: A Case Report.

In this report, we present the case of a 20-year-old woman with schizophrenia, who had been treated with a once-monthly dosage of long-acting paliperidone palmitate due to poor adherence to oral antipsychotics. She presented to the emergency department of the Sultan Qaboos University Hospital (SQUH), Muscat, Oman, with tachycardia, difficulty in breathing, difficulty in swallowing, choking, excessive production of saliva, drooling, urinary incontinence, blurry vision, a shuffling gait, slowness of movement, stooped posture, muscle rigidity, tremor, and hyperprolactinemia. The paliperidone palmitate injections were discontinued and the patient underwent a treatment course with procyclidine, and she subsequently achieved full recovery within seven days. It appears that even though the long-acting paliperidone palmitate prescription had improved her psychotic symptoms, it also induced several potentially life-threatening conditions. This case report highlights the diagnostic challenge represented by the overlapping features of the neuroleptic malignant syndrome (NMS) and extrapyramidal side effects (EPS).

Efficacy of a Six-Week-Long Therapist-Guided Online Therapy Versus Self-help Internet-Based Therapy for COVID-19-Induced Anxiety and Depression: Open-label, Pragmatic, Randomized Controlled Trial.

BACKGROUND: The COVID-19 pandemic has led to a notable increase in psychological distress, globally. Oman is no exception to this, with several studies indicating high levels of anxiety and depression among the Omani public. There is a need for adaptive and effective interventions that aim to improve the elevated levels of psychological distress due to the COVID-19 pandemic. OBJECTIVE: This study aimed to comparatively assess the efficacy of therapist-guided online therapy with that of self-help, internet-based therapy focusing on COVID-19-induced symptoms of anxiety and depression among individuals living in Oman during the COVID-19 pandemic. METHODS: This was a 6-week-long pragmatic randomized controlled trial involving 60 participants who were recruited from a study sample surveyed for symptoms of anxiety or depression among the Omani public amid the COVID-19 pandemic. Participants in the intervention group were allocated to receive 1 online session per week for 6 weeks from certified psychotherapists in Oman; these sessions were conducted in Arabic or English. The psychotherapists utilized cognitive behavioral therapy and acceptance and commitment therapy interventions. Participants in the control group received an automatic weekly newsletter via email containing self-help information and tips to cope with distress associated with COVID-19. The information mainly consisted of behavioral tips revolving around the principles of cognitive behavioral therapy and acceptance and commitment therapy. The primary outcome was measured by comparing the change in the mean scores of Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) scale from the baseline to the end of the study (ie, after 6 sessions) between the two groups. The secondary outcome was to compare the proportions of participants with depression and anxiety between the two groups. RESULTS: Data from 46 participants were analyzed (intervention group n=22, control group n=24). There was no statistical difference in the baseline characteristics between both groups. Analysis of covariance indicated a significant reduction in the GAD-7 scores (F1,43=7.307; P=.01) between the two groups after adjusting for baseline scores. GAD-7 scores of participants in the intervention group were considerably more reduced than those of participants in the control group (ß=-3.27; P=.01). Moreover, a greater reduction in mean PHQ-9 scores was observed among participants in the intervention group (F1,43=8.298; P=.006) than those in the control group (ß=-4.311; P=.006). Although the levels of anxiety and depression reduced in both study groups, the reduction was higher in the intervention group (P=.049) than in the control group (P=.02). CONCLUSIONS: This study provides preliminary evidence to support the efficacy of online therapy for improving the symptoms of anxiety and depression during the COVID-19 crisis in Oman. Therapist-guided online therapy was found to be superior to self-help, internet-based therapy; however, both therapies could be considered as viable options. TRIAL REGISTRATION: ClinicalTrials.gov NCT04378257; https://clinicaltrials.gov/ct2/show/NCT04378257.

Predictors of psychological distress among the public in Oman amid coronavirus disease 2019 pandemic: a cross-sectional analytical study.

Coronavirus disease 2019 (COVID-19) is a global, virulent pandemic disease that emerged in December 2019, with both short- and long-term psychological repercussions being inevitable. This study aimed to investigate the prevalence and predictors of psychological distress, defined by the presence of either depression or anxiety, among the public in Oman during the COVID-19 pandemic. This was a web-based, cross-sectional study conducted using governmental and private institutional e-mail systems and social media platforms. Anxiety and depression were assessed using both the Generalized Anxiety Disorder-7 Scale and the Patient Health Questionnaire-9. Logistic regression analysis was used to assess the independent predictors. There were a total of 1538 participants in this study (75% female). The prevalence of psychological distress was 30%. Being female, having financial instability, being treated for mental illness and self-medication for coping with stress were independent predictors of psychological distress among the study sample (Odds ratio [OR] = 1.69, confidence interval [CI] = 1.24-2.29; OR = 2.05, CI = 1.54-2.74; OR = 5.35, CI = 3.50-8.18; OR = 7.23, CI = 3.06-17.09, respectively). The results from this study will help public health officials in Oman to plan for and mitigate psychological repercussions of the current and future pandemics.

Solitary Fibrous Tumor Revealed by Worsening Clinical Depression: A Case Report from Oman.

Brain tumors are serious pathologies that can lead to significant morbidity and mortality, and early detection and diagnosis may result in favorable outcomes for patients. We present the case of a 27-year-old male who was referred to the Department of Behavioural Medicine of the Sultan Qaboos University Hospital (SQUH), Muscat, Oman, in 2019, due to worsening of his depressive symptoms. Depression was the only initial symptom of the patient's solitary fibrous tumor, and surgical resection of the tumor followed by radiotherapy resulted in the complete remission of his psychiatric symptoms.

Cyclic Vomiting Syndrome: A Case Report and Mini Literature Review.

A 27-year-old man presented to the emergency department with nausea, vomiting, and abdominal pain. He had been having similar episodes for the last seven years, and all of the previous workups had been unremarkable. After excluding all organic causes of his presentation, the patient was diagnosed with cyclic vomiting syndrome (CVS) and managed accordingly. He has shown remarkable improvement and no further attack has been reported for almost five months since the diagnosis was made. This case report highlights the diagnostic challenge represented by CVS. Also, it summarizes the main aspects of management to achieve and maintain the remission of the condition.