Long-Term Effects of Low-Level Blast Exposure and High-Caliber Weapons Use in Military Special Operators.

Chronic low-level blast exposure has been linked with neurological alterations and traumatic brain injury (TBI) biomarkers. Impaired smooth-pursuit eye movements (SPEM) are often associated with TBI. The purpose of this study was to determine whether long-term operators of low-level blast exposure or high-caliber weapons use displayed oculomotor behaviors that differed from controls. Twenty-six members of an elite military unit performed a computerized oculomotor testing task using an eye tracker and completed a concussion assessment questionnaire. The participants were split into a blast exposure group and control group. The blast exposure group had a history of exposure to low-level blasts or high-caliber weapon use. The results revealed significant differences in SPEM, saccades, and fixations between the blast exposure group and control group. The blast exposure group's eye movements were slower, stopped at more frequent points when following a target, traveled further from the target in terms of both speed and direction, and showed higher rates of variation and inefficiency. Poor oculomotor behavior correlated with a higher symptom severity on the concussion assessment questionnaire. Military special operators exposed to long-term low-level blasts or high-caliber weapons usage displayed an impaired oculomotor behavior in comparison to controls. These findings further our understanding of the impact of long-term low-level blast exposure on the oculomotor behavior of military special operators and may inform practical implications for military training.

Brain Vital Signs in Elite Ice Hockey: Towards Characterizing Objective and Specific Neurophysiological Reference Values for Concussion Management.

Background: Prior concussion studies have shown that objective neurophysiological measures are sensitive to detecting concussive and subconcussive impairments in youth ice-hockey. These studies monitored brain vital signs at rink-side using a within-subjects design to demonstrate significant changes from pre-season baseline scans. However, practical clinical implementation must overcome inherent challenges related to any dependence on a baseline. This requires establishing the start of normative reference data sets. Methods: The current study collected specific reference data for N = 58 elite, youth, male ice-hockey players and compared these with a general reference dataset from N = 135 of males and females across the lifespan. The elite hockey players were recruited to a select training camp through CAA Hockey, a management agency for players drafted to leagues such as the National Hockey League (NHL). The statistical analysis included a test-retest comparison to establish reliability, and a multivariate analysis of covariance to evaluate differences in brain vital signs between groups with age as a covariate. Findings: Test-retest assessments for brain vital signs evoked potentials showed moderate-to-good reliability (Cronbach's Alpha > 0.7, Intraclass correlation coefficient > 0.5) in five out of six measures. The multivariate analysis of covariance showed no overall effect for group (p = 0.105), and a significant effect of age as a covariate was observed (p < 0.001). Adjusting for the effect of age, a significant difference was observed in the measure of N100 latency (p = 0.022) between elite hockey players and the heterogeneous control group. Interpretation: The findings support the concept that normative physiological data can be used in brain vital signs evaluation in athletes, and should additionally be stratified for age, skill level, and experience. These can be combined with general norms and/or individual baseline assessments where appropriate and/or possible. The current results allow for brain vital sign evaluation independent of baseline assessment, therefore enabling objective neurophysiological evaluation of concussion management and cognitive performance optimization in ice-hockey.

Reducing Mental Health Stigma in Medical Students and Doctors towards their Peers with Mental Health Difficulties: A Protocol.

Mental health problems are over-represented in doctors and medical students. However, stigma and 'a culture of shame' are formidable barriers to mental health services and consequently many doctors and medical students with mental health difficulties continue to suffer in silence despite the availability of effective treatment. Indeed, a recent study on over 2100 female physicians who met the diagnostic criteria for a mental disorder revealed that 50% were reluctant to seek professional help due to fear of exposure to stigma. Left untreated or undertreated, mental health problems in doctors can result in impairment of occupational functioning, compromise patient safety and place considerable strain on the economy (by increasing the amount of sick leave taken). Moreover, the consequences of mental health stigma in the medical profession can be fatal. Dr Daksha Emson, a psychiatrist with bipolar affective disorder, tragically killed herself and her baby daughter during a psychotic episode. An independent inquiry into Dr Emson's death concluded that she was the victim of stigma in the National Health Service. The mental health of medical students and doctors, in all of its aspects, must therefore be addressed with the urgency that it demands. Stephanie Knaak and colleagues conducted a data synthesis of evaluative studies on anti-stigma programmes for healthcare providers and identified six key ingredients one of which was a personal testimony from a trained speaker who has lived experience of mental illness. In this paper we outline a study protocol with the aim of answering the following research question, 'Does attending an anti-stigma programme comprised of a medic with first-hand experience of a mental health condition cause immediate and sustained reductions in mental health stigma from medical students and doctors towards their peers with mental health difficulties?'

Vertical smooth pursuit as a diagnostic marker of traumatic brain injury.

AIM: Neural deficits were measured via the eye tracking of vertical smooth pursuit (VSP) as markers of traumatic brain injury (TBI). The present study evaluated the ability of the eye tracking tests to differentiate between different levels of TBI severity and healthy controls. METHODOLOGY: Ninety-two individuals divided into four groups (those with mild, moderate or severe TBI and healthy controls) participated in a computerized test of VSP eye movement using a remote eye tracker. RESULTS: The VSP eye tracking test was able to distinguish between severe and moderate levels of TBI but unable to detect differences in the performance of participants with mild TBI and healthy controls. CONCLUSION: The eye-tracking technology used to measure VSP eye movements is able to provide a timely and objective method of differentiating between individuals with moderate and severe levels of TBI.

Association between knowledge, awareness, and practice of patients with type 2 diabetes with socio-economic status, adherence to medication and disease complications.

AIMS: Diabetes is a self-managed condition; knowledge, attitudes, and practices about the condition can influence the overall treatment outcomes and complications of the disease. The aim of this study was to assess the knowledge, attitude, and practice toward diabetes among T2DM patients in the UAE, a highly prevalent country with diabetes. METHODS: We used the revised Michigan Diabetes Knowledge Scale on T2DM patients. The awareness on diabetes was then assessed based on socio-demographic characteristics, illness perceptions, medication adherence, diabetic self-care, and T2DM complications. RESULTS: Overall assessment of T2DM patients on their knowledge, and attitude toward their diabetes were good in the majority of participants (544, 76%; 570, 76% respectively). However, adherence to diabetic self-care practices was fair in the mainstream (437, 57%). The compliance to medication (527, 70%) and eye care practice (475, 63%), were quite high; yet regular checking blood sugar at home 330 (44%) and the foot care practice 336 (45%) were not satisfying. CONCLUSION: Our results demonstrate that the intensive education service being given and time the physician spends with the T2DM patients is highly associated with better practice and outcome of the disease. There is a need for the establishment of better DM education programs in PHC clinics and the development of more campaigns and enlightening programs, both for health care providers and public on T2DM self-care, complications, and nature of the disease. We suggest that new policies be established with a focus on increasing community awareness of diabetes and preventive measures in UAE.

Using Experts by Personal and Professional Experience (EPPE) to increase interest in Psychiatry as a Career at Sixth-Form Level.

BACKGROUND: Psychiatrists play a multifaceted and critical role in improving the lives of people with mental illness. However, despite how rewarding, important and thrilling a career in mental health is, there continues to remain a shortage of psychiatrists in Low-, Middle- and High-Income Countries. There has been resurgence in interest in improving the image of psychiatry over recent years and several initiatives have been launched to increase recruitment into the specialty at Sixth Form level in the UK. DESIGN: We conducted a single-arm, pre-post, comparison study with Sixth Form students at an inner-city school in London. Students were invited to complete a survey before and after exposure to an assembly on mental health that was delivered by an Expert by Personal and Professional Experience (EPPE). Our aims were to detect and measure if there were any changes in perceptions of psychiatry and if there was an increase in interest in pursuing this profession as a career in this group. RESULTS: 63 out of 123 participants completed the before and after survey (51% response rate). Following exposure to the assembly, there were statistically significant improvements between the pre- and post- intervention means for, "Psychiatry has a positive impact on peoples' lives" (p value <0.0001), "People with mental illness can achieve success and be the best at what they do" (p value <0.0001) and, "I would consider psychiatry as a career" (p value <0.0001). CONCLUSION: Notwithstanding the limitations of this pilot study, our findings suggest that an assembly on mental health delivered by an EPPE (i.e. 'Wounded Healer') might be effective at increasing interest in psychiatry as a career at Sixth Form level. We suggest that assemblies on mental health and psychiatry be delivered by 'Wounded Healers' in schools and colleges nationwide to help drive recruitment into psychiatry.

Hajj and the Mental Health of Muslim Pilgrims: A review.

Mass gatherings occur in different situations and settings around the world. A mass gathering can range in size from thousands to millions and in nature from recreation (i.e. concerts) to religious festivals (i.e. the Hajj pilgrimage). Such mass gatherings can result in high rates of morbidity and mortality from communicable and non-communicable diseases, 'accidents' and, over recent years, terror attacks. Disproportionately lower consideration has been given to the mental health and wellbeing of people during mass gatherings compared to that given to physical health during such events. Hajj is a religious pilgrimage to Mecca in Saudi Arabia that all Muslims are Islamically obliged to fulfil at least once in their lifetime. With up to 3 million pilgrims attending Hajj annually, it has been described as, 'The largest and longest-standing mass gathering event on Earth'. Although Hajj is a spiritual experience that is considered enlightening by many pilgrims, it can also be highly stressful which can have adverse effects on both physical and mental health. Few studies have been published hitherto on the impact that Hajj has on the mental health of pilgrims. This review article provides a narrative summary of studies conducted on Hajj and the relationship that this mass gathering has with the mental health of pilgrims.

A King's College London Global Health Society Event discussing Global Mental Health to increase interest in Psychiatry as a Career: A Pilot Study.

INTRODUCTION: Despite the launching of multiple initiatives to increase recruitment into psychiatry, the profession continues to remain undersubscribed. Studies have shown that teaching on global mental health can improve attitudes toward psychiatry in medical students. To the best of our knowledge, no studies have been published hitherto that evaluate if a brief teaching session (i.e. 60 minutes in duration) on global mental health improves perceptions of psychiatry and increases interest in this specialty as a career. SUBJECTS AND METHODS: We conducted a single-arm, pre- post- comparison study on participants who attended a King's College London Global Health Society event on Global Mental Health. Participants completed a survey before and after exposure to the event. Our aims were to detect and measure if there were any changes in perceptions of psychiatry and if a brief teaching session on global mental health would increase interest in pursuing psychiatry as a career. RESULTS: 71 out of 90 participants responded (77.8% response rate). Following exposure to the event, there were statistically significant improvements in the scores for, "Psychiatry is interesting" (pre-event score 4.41, post-event score 4.66 p value <0.001), "I would talk positively about psychiatry to other people" (pre-event score 4.02, post-event score 4.48 p value <0.00001), and, "I would consider psychiatry as a career" (pre-event score 3.24, post-event score 3.72 p value <0.001). CONCLUSION: The results of our pilot study suggest that a brief lecture on global mental health may improve perceptions of psychiatry and increase interest in this specialty as a career. We recommend that global mental health be introduced into the medical school curriculum since this may help to increase recruitment into psychiatry.

The prevalence of Lyme disease and associated co-infections in people with a chronic post-concussive syndrome.

INTRODUCTION: There is increasing awareness that Lyme borreliosis (LB) and traumatic brain injury (TBI) may cause mental health symptoms. TBI and Lyme disease compromise the health and activities of millions of patients per year. The chronic symptoms and disability of TBI and Lyme disease share a similar clinical presentation. We have identified an alarming number of individuals suffering from post-concussion syndrome (PCS) that are refractory to care and that have serologically tested positive for Lyme disease. SUBJECTS AND METHODS: A single-center retrospective review of patient charts that were symptomatic a minimum of one year after a TBI that were tested for Lyme disease to ascertain if there was a relationship. RESULTS: 217 PCS patient records (93 females with a mean age of 34 years, 120 males with a mean age of 40 years and 4 individuals with unknown gender) were included in the review. 38% had a positive Western Blot Igenex IgM. There was a statistically significant relationship of a positive Western Blot Igenex IGM predicting chronic PCS Pearson χ2(1)=6.8866, P=0.009, Fisher's exact score p=0.015 and φ=0.2813 representing a moderate effect size. CONCLUSIONS: Long term PCS over one year's duration is associated with undiagnosed Lyme disease. There was statistical and substantive significance between individuals with chronic PCS having a positive Western Blot Igenex IgM. Males were more likely to have a positive Western Blot Igenex IgM than females.

Leveraging Digital Technology to Challenge Mental Health Stigma in West Bengal: A Protocol.

Mental health related stigma is a pernicious phenomenon that permeates and pervades our world. As stigma continues to evolve so too must our approach to reduce it. This paper outlines a protocol that leverages the power of virtual contact and digital technology to challenge mental health related stigma in West Bengal, India.

The Federation of Student Islamic Societies Programme to Challenge Mental Health Stigma in Muslim communities in Scotland: The FOSIS Glasgow Study.

INTRODUCTION: A recent study commissioned by the Scottish Government on the prevalence of mental disorders in Muslims in Scotland revealed that over 50% of the sample met the diagnostic criteria for a mental illness. Stigma is a major barrier to mental health services and despite the availability of effective treatment, many Muslims in Scotland with mental health difficulties continue to suffer in silence. The Federation of Student Islamic Societies (FOSIS) Scotland branch organized a mental health conference in Glasgow to improve Mental Health Literacy and challenge mental health related stigma in the Scottish Muslim community. The conference was comprised of: A counsellor with a background of Islamic psychology, a psychiatrist and an Imam (a Muslim religious leader). DESIGN: We conducted a single-arm, pre- post- comparison study on Muslims who attended the FOSIS mental health conference in Glasgow, Scotland. Validated psychometric stigma scales measuring knowledge (Mental Health Knowledge Schedule (MAKS)), attitudes (Community Attitudes towards the Mentally Ill (CAMI)) and behaviours (Reported and Intended Behaviour Scale (RIBS)) were administered on participants before and immediately after exposure to the programme. RESULTS: 34 out of the 55 participants who attended the conference responded (response rate 62%). 34/34 (100%) of the respondents were Muslim and the mean age was 22.7 years (Std. Dev. 6.04, min. 18, max. 49). There were no statistically significant changes in stigma across the domains of knowledge, attitude and behaviour in respondents following exposure to the event. CONCLUSION: Previous FOSIS anti-stigma conferences in England and Ireland featuring an Expert by Lived Experience were associated with statistically significant reductions in mental health related stigma. The results of the FOSIS Glasgow study supports the, 'Power of contact' with an Expert by Lived Experience at reducing mental health related stigma in the Muslim community. More robust research in this area is urgently required.

Improvement of Saccadic Eye Movements after Head-Eye Vestibular Motion (HEVM) Therapy and Neuro-Psychiatric Considerations.

INTRODUCTION: Eye movement pathology can assist in the identification, diagnosis and treatment of mental health disorders. Eye-tracking paradigms have been utilized to provide greater ecological validity, and directly capture the detailed sequence of processes in perception and attention, while quantifying classifiers in mood, anxiety, and psychotic disorders. Saccadic eye movements serve as an endophenotype for various mental health disorders. SUBJECTS AND METHODS: Patients suffering from post-concussive syndrome and mental health concerns performed saccadic eye movements that were quantified for amplitude, velocity, latency and accuracy before and after Head-Eye Vestibular Motion therapy (HEVM). RESULTS: HEVM therapy is associated with statistical and substantive significant improvements in mental health and in saccadic metrics. CONCLUSIONS: Oculomotor dysfunction is related to the symptom dimensions of mental health disorders that may be treated with physical rehabilitation modalities. We feel it reasonable to suggest that psychiatrists and others involved in the treatment of mental health disorders quantify eye movements and use them as biomarkers in the evaluation of the outcomes of varied therapies.

Metrological Performance of Instruments used in Clinical Evaluation of Balance.

Clinical assessment of a patient, monitoring the progress of a condition, and/or titration of a therapy is dependent on the metrological characteristics of diagnostic equipment. While metrological performance of instruments is commonly assessed in research, it is not so often done in clinical practice. Physical rehabilitation applications may benefit individuals with mental health concerns and are associated with an accurate analysis of balance and gait. There is a paucity of published data regarding the metrological characteristics of commonly used clinical instruments used in posturographic measurements. We desired to assess the accuracy, trueness, precision and resolution of four posturography systems that we use clinically in practice: a Bertec BP-5050, a Vestibular Technologies CAPS® Professional and a Vestibular Technologies CAPS® Lite threecomponent balance platforms, and a NeuroCom® Balance Manager SMART EquiTest®. Metrological performance by posturography instruments was recommended in 2013 by the International Standardization Committee for Clinical Stabilometry of the International Society for Posture and Gait Research (ISPGR). Clinical and research findings may be erroneous, or at the least misleading, if the instruments used to make clinical decisions are associated with significant error. We suggest that there is a strong need for posturographic instrumentation with appropriate metrological characteristics used in clinical applications. The ISPRG recommendations appear to be reasonable and appropriate, and our results show they are obtainable. Physical measurements and functional testing used to correlate and design mental health and physical based rehabilitation strategies are often dependent upon the accuracy and metrological integrity of diagnostic instruments used in posturography.

Exploring Obstetrical Interventions and Stratified Cesarean Section Rates Using the Robson Classification in Tertiary Care Hospitals in the United Arab Emirates.

OBJECTIVE: The objective of the present study was to explore obstetric management in relation to clinical, maternal and child health outcomes by using the Robson classification system. METHODS: Data was collected from obstetrics registries in tertiary care hospitals in Dubai, United Arab Emirates (UAE). RESULTS: The analysis of > 5,400 deliveries (60% of all the deliveries in 2016) in major maternity hospitals in Dubai showed that groups 5, 8 and 9 of Robson's classification were the largest contributors to the overall cesarean section (CS) rate and accounted for 30% of the total CS rate. The results indicate that labor was spontaneous in 2,221 (45%) of the women and was augmented or induced in almost 1,634 cases (33%). The birth indication rate was of 64% for normal vaginal delivery, of 24% for emergency CS, and of 9% for elective CS. The rate of vaginal birth after cesarean was 261 (6%), the rate of external cephalic version was 28 (0.7%), and the rate of induction was 1,168 (21.4%). The prevalence of the overall Cesarean section was 33%; with majority (53.5%) of it being repeated Cesarean section. CONCLUSION: The CS rate in the United Arab Emirates (UAE) is higher than the global average rate and than the average rate in Asia, which highlights the need for more education of pregnant women and of their physicians in order to promote vaginal birth. A proper planning is needed to reduce the number of CSs in nulliparous women in order to prevent repeated CSs in the future. Monitoring both CS rates and outcomes is essential to ensure that policies, practices, and actions for the optimization of the utilization of CS lead to improved maternal and infant outcomes.

Exploring obstetrical interventions and stratified cesarean section rates using the Robson classification in tertiary Care hospitals in the united arab emirates

Abstract Objective The objective of the present study was to explore obstetric management in relation to clinical, maternal and child health outcomes by using the Robson classification system. Methods Data was collected from obstetrics registries in tertiary care hospitals in Dubai, United Arab Emirates (UAE). Results The analysis of > 5,400 deliveries (60% of all the deliveries in 2016) in major maternity hospitals in Dubai showed that groups 5, 8 and 9 of Robson's classification were the largest contributors to the overall cesarean section (CS) rate and accounted for 30% of the total CS rate. The results indicate that labor was spontaneous in 2,221 (45%) of the women and was augmented or induced in almost 1,634 cases (33%). The birth indication rate was of 64% for normal vaginal delivery, of 24% for emergency CS, and of 9% for elective CS.The rate of vaginal birth after cesarean was 261(6%), the rate of external cephalic version was 28 (0.7%), and the rate of induction was 1,168 (21.4%). The prevalence of the overall Cesarean section was 33%; with majority (53.5%) of it being repeated Cesarean section. Conclusion The CS rate in the United Arab Emirates (UAE) is higher than the global average rate and than the average rate in Asia, which highlights the need for more education of pregnant women and of their physicians in order to promote vaginal birth. A proper planning is needed to reduce the number of CSs in nulliparous women in order to prevent repeated CSs in the future. Monitoring both CS rates and outcomes is essential to ensure that policies, practices, and actions for the optimization of the utilization of CS lead to improved maternal and infant outcomes.

The Treatment of Autism Spectrum Disorder With Auditory Neurofeedback: A Randomized Placebo Controlled Trial Using the Mente Autism Device.

Introduction: Children affected by autism spectrum disorder (ASD) often have impairment of social interaction and demonstrate difficulty with emotional communication, display of posture and facial expression, with recognized relationships between postural control mechanisms and cognitive functions. Beside standard biomedical interventions and psychopharmacological treatments, there is increasing interest in the use of alternative non-invasive treatments such as neurofeedback (NFB) that could potentially modulate brain activity resulting in behavioral modification. Methods: Eighty-three ASD subjects were randomized to an Active group receiving NFB using the Mente device and a Control group using a Sham device. Both groups used the device each morning for 45 minutes over a 12 week home based trial without any other clinical interventions. Pre and Post standard ASD questionnaires, qEEG and posturography were used to measure the effectiveness of the treatment. Results: Thirty-four subjects (17 Active and 17 Control) completed the study. Statistically and substantively significant changes were found in several outcome measures for subjects that received the treatment. Similar changes were not detected in the Control group. Conclusions: Our results show that a short 12 week course of NFB using the Mente Autism device can lead to significant changes in brain activity (qEEG), sensorimotor behavior (posturography), and behavior (standardized questionnaires) in ASD children.

Part I: Muslims, social inclusion and the West. Exploring challenges faced by stigmatized groups.

The rise of radicalisation, the 'demonization' of Muslims in the media and the immigration crisis in Europe have all contributed and colluded to heightened levels of Islamophobia in the West. The stigmatisation of Muslims can and has resulted in negative outcomes in this group such as elevated levels of psychological distress and an increase in hate crime and terrorist attacks perpetrated against Muslims from members of the far right. There are 1.6 billion Muslims on the planet and Islam is the fastest growing religion in the world. Now, more than ever it seems, is a critical time to learn about what the true message of Islam is and who the blessed prophet Muhammad peace be upon him (PBUH) was from reliable and authentic sources. This paper aims to challenge the stigma attached to Muslims through the following means: 1. It contains information to educate people about Islam, debunk myths and challenge negative stereotypes; 2. It utilizes the power of 'story-telling' to engage readers and to equip them with facts and the necessary skills to combat Islamophobia. Part I includes a brief introduction of Islam and concludes with a concise description and evaluation of an anti-Islamophobia programme that was piloted in Cambridge University (UK) and delivered as a Keynote Address at the Carrick Institute for Graduate Studies International Symposium of Clinical Neuroscience in Orlando, (USA). Our hope is that through this initiative we can create a critical mass and inspire and empower people, Muslims and non-Muslims alike to stand in solidarity and collectively challenge extremism in any of its many forms. Our hypothesis is that this will result in better outcomes such as reductions in radicalization and Islamophobia.

Part II: Muslims perceptions of British cobat troops.

BACKGROUND: On the 22nd May 2017, suicide bomber Salman Abedi detonated an improvised explosive device (IED) in the Manchester Arena killing 22 people and injuring 116 others. Following the 'massacre in Manchester', the leader of the Labour Party, Jeremy Corbyn, linked UK foreign policy with terrorism on British soil. Controversial and contentious though Corbyn's claims may be, the terrorists themselves have also reported that what motivates them to carry out their abominable atrocities are British military operations in Muslim majority countries. Indeed, on the 22nd May 2013, British serviceman, Lee Rigby, was brutally attacked and killed by Michael Adebolajo and Michael Adebowale near the Royal Artillery Barracks in Woolwich, southeast London. The perpetrators of this heinous act told passers-by at the scene that they wanted to avenge the killing of Muslims by the British Armed Forces. METHODS: We conducted a cross-sectional, mixed-methods study on Muslim perceptions of British combat troops and UK foreign policy. Participants were selected by purposive sampling. We crafted a survey that explored Muslim perceptions of the British military and the government's foreign policy. Response items were on a Likert-scale and there was white space for free text comments which were subjected to thematic analyses. RESULTS: 75/75 (100%) of the participants recruited responded. (75/75 (100%) Muslim participants, 43/75 (57.3%) female participants, 32/75 (42.7%) male participants, mean age 20.5 years, (Std. Dev. ±2.5)). 66/75 (88%) of respondents either agreed or strongly agreed that British military operations in Muslim majority countries have negatively influenced perceptions towards combat troops. 42/75 (56%) of respondents either agreed or strongly agreed that contact with a combat troops or veterans would positively influence their perceptions towards them. Themes of free text comments included the role that the media plays in demonising Muslims, the transcendental bond that Muslims around the world have for each other and 'the brainwashing' of British combat troops by the Government. DISCUSSION: The fact that many of the participants in our sample agreed or strongly agreed that social contact with service personnel or veterans would positively influence perceptions towards them is encouraging. The results of our survey lend support for future intervention studies investigating whether contact between Muslims residing in the UK and British combat troops would promote unity and community cohesion.

The performing arts and psychological well-being.

Although psychotropic drugs have been hailed as, 'One of the success stories of modern psychiatry' the prescribing of these medicines has not been without commotion, concern and controversy. Moreover, the President of the World Psychiatry Association Professor Dinesh Bhugra and colleagues, after conducting a recent large-scale study (n=25,522) on psychiatric morbidity in the UK, collectively issued the clarion call that, 'The mental health of the nation was unlikely to be improved by treatment with psychotropic medication alone'. The provision of mental healthcare services may likely benefit from a holistic approach that includes a variety of treatment options that prioritizes patient safety and preference. The performing arts is gaining popularity among service users as an adjunctive form of treatment for mental illness. There is a growing body of evidence that provisionally supports the claim that art therapy, 'Possesses the power to heal psychological wounds'. The North American Drama Therapy Association defines drama therapy as, 'The intentional use of drama and/or theatre processes to achieve therapeutic goals' and that it is 'active and experiential'. This review article discusses and describes the merits of dramatherapy and how this treatment modality can contribute to a patient's recovery from psychological distress.

The Federation of Student Islamic Societies programme to challenge mental health Stigma in Muslim communities in Ireland: The FOSIS Dublin study.

BACKGROUND: Mental health problems are common in Muslim communities however due to fear of exposure to stigmatization many people in this group continue to suffer in silence despite the availability of effective treatment. The Federation of Student Islamic Societies (FOSIS) organized the first ever Muslim mental health conference in Ireland to challenge the stigma attached to mental health problems in Muslims and to encourage care seeking in this group. As far as the authors are aware there are no intervention studies on mental health stigma in Muslim communities reported in the literature. DESIGN: We conducted a single arm, pre-post comparison study on Muslims who attended the FOSIS mental health conference in University College Dublin, Ireland. Validated stigma scales measuring knowledge (Mental Health Knowledge Schedule (MAKS)), attitudes (Community Attitudes towards the Mentally Ill (CAMI)) and behaviour (Reported and Intended Behaviour Scale (RIBS)) were administered on participants before exposure to the programme and immediately afterwards. RESULTS: 18/150 (12%) of participants completed the pre-post RIBS scale and pre-post MAKS scale and 16/150 (10.5%) of participants completed the pre-post CAMI scale. There were statistically significant differences in the pre-RIBS score compared to the post-RIBS score (p=0.0262) and the pre-MAKS score compared to the post-MAKS score (p=0.0003) but not in the pre-CAMI score compared to the post-CAMI score (p=0.6214). DISCUSSION: To the best of our knowledge, the FOSIS Dublin Study is the first intervention study on mental health stigma in Muslim communities to be published. The results of our study provide provisional support that a 'bespoke' Muslim mental health conference comprised of talks and workshops by experts in mental health, scholars in Islam and a lecture delivered by a Muslim with first-hand experience of a mental health problem are associated with reductions in stigma. More robust research with a longitudinal study design, larger sample sizes and a control group are needed to determine if such events can cause a sustained reduction in mental health stigma in Muslim communities.