Cross-cultural differences through subjective cognition: illustration in translatology with the SSTIC-E in the UAE.

The development of appropriate and valid multicultural and multilingual instruments research is necessary due to a growing multicultural and multilingual society in the 21st century. We explored the use of a cognitive scale related to subjective complaints, focusing on the first step: a cross-cultural and semantic validation. This study presents the translation and cross-validation process of the "Subjective Scale to Investigate Cognition in Schizophrenia" (SSTICS) for the United Arab Emirates (UAE) region via different languages used in Dubaï/Abu Dhabi. This scale measures cognitive complaints and has been validated with psychosis and used in 20 clinical trials worldwide. It evaluates areas of the illness related to self-awareness focusing on memory dysfunction and deficits of attention, language, and praxis. We described the method of cross-cultural validation, with back-translation, semantic steps, and societal contexts. The use of the Subjective Scale to Investigate Cognition in Emirates (SSTIC-E) was explored with different samples of UAE Arabic-speaking subjects. First, a pilot sample mean SSTICS total score was 16.5 (SD:16.9); (p < 0.001). The SSTIC-E was then administered to 126 patients and 84 healthy control participants. The healthy group has a lower mean score of 22.55 (SD = 12.04) vs. 34.06 (SD = 15.19). The method was extended to nine other languages, namely, Pakistani/Urdu, Hindi, Marathi, Lithuanian, Serbian, German, Romanian, Sinhala, and Russian. The scales are provided in the article. The overall aim of the translation process should be to stay close to the original version of the instrument so that it is meaningful and easily understood by the target language population. However, for construct validity, some items must be adapted at the time of translation to ensure that the questioned cognitive domain is respected. For example, cooking, an executive function, does not have the same occurrence for an Emirati male, or remembering a prime minister's name, semantic memory, requires an electoral system to appoint the leader of a country. Translation methods and processes present many challenges but applying relevant and creative strategies to reduce errors is essential to achieve semantic validation. This study aims to measure personally experienced knowledge or attitudes; such language effects can be a thorny problem.

Metabolic syndrome and its relation to antipsychotic polypharmacy in schizophrenia, schizoaffective and bipolar disorders.

The risk of metabolic syndrome (MetS) has been attributed to antipsychotic use in psychiatric patients. To date, there is limited data on the relationship between antipsychotic polypharmacy and MetS in patients with schizophrenia, schizoaffective disorder and bipolar disorder. Therefore, we aimed to investigate the rate of MetS in patients with these disorders receiving antipsychotic monotherapy and polypharmacy. We conducted a cross-sectional study on patients seen between January 2017 and December 2020, collecting data on the class, type, route of administration and number of antipsychotics received. We used the American Association of Clinical Endocrinology criteria to diagnose MetS. We included 833 subjects of whom 573 (68.8%) received antipsychotic monotherapy and 260 (31.2%) received polypharmacy. Overall, 28.6% ( N  = 238) had MetS with no statistical difference between the two groups. Diastolic blood pressure and receiving olanzapine were significant predictors for developing MetS. In conclusion, our study found no significant difference in the rate of MetS between antipsychotic monotherapy and polypharmacy. A number of variables were significant predictors for MetS. Our findings were consistent with other studies and warrant the need for careful choice of antipsychotics and regular screening and management of abnormal metabolic parameters.

Prevalence and risk factors for metabolic syndrome in schizophrenia, schizoaffective, and bipolar disorder.

BACKGROUND: Metabolic Syndrome (MetS) is a risk for developing cardiovascular diseases and its prevalence is especially high in psychiatric patients. To date, there is limited data from the United Arab Emirates (UAE) on the prevalence of MetS. Therefore, we aimed to investigate its prevalence and possible risk factors in a large sample of psychiatric patients in the UAE. METHODS: A cross-sectional study was conducted at Al-Ain Hospital, in Al-Ain City, UAE. We collected demographic and clinical data on patients diagnosed with schizophrenia, schizoaffective, and bipolar affective disorder in the period between January 2017 and December 2020. This included their secondary diagnosis (psychiatric or medical), vital signs (heart rate, systolic and diastolic blood pressure, Body Mass Index [BMI]), metabolic parameters (fasting blood glucose, cholesterol, triglycerides, low-density lipoprotein, high-density lipoproteins), and prescribed medications. We used the American Association of Clinical Endocrinology (AACE) criteria to diagnose MetS. RESULTS: We included 889 subjects and of these, 79.8% (N = 709) had a BMI ≥25 kg/m2 and 9.8% (N = 87) had no abnormal metabolic parameters. Overall, 28.1% (N = 250) had MetS with no statistical difference between the three groups. Fasting blood glucose levels and abnormally elevated triglycerides were significant predictors for MetS. CONCLUSION: Our study found that around one in three patients had MetS irrespective of the three diagnoses. Some variables were significant predictors for MetS. Our findings were consistent with other studies and warrant the need for regular screening and management of abnormal metabolic parameters.

There is no statistical difference between schizophrenia, schizoaffective disorder, and bipolar disorder with regards to the prevalence of metabolic syndrome.Fasting blood glucose levels and abnormally elevated triglycerides were significant predictors of metabolic syndrome.Screening of metabolic parameters is important as well as the careful tailoring of the choice of antipsychotics.

Psychiatric disorders in inpatient Ethiopian migrant workers in the United Arab Emirates.

Migrant workers have higher rates of mental health problems than non-migrant workers, with Ethiopian migrant workers in the United Arab Emirates appearing to be overrepresented in the psychiatric inpatient population compared with their numbers in the general population. We sought to investigate the pattern of psychiatric inpatient admissions in Ethiopian migrant workers over a 10-year period (2011-2020) in order to highlight demographic and clinical characteristics, and to investigate factors predicting the length of hospital stay. We reported the mean and frequency of demographic and clinical data of Ethiopian psychiatric inpatients at one of the largest governmental hospitals in eastern Abu Dhabi between 2011 and 2020, and investigated factors predicting length of stay in hospital using linear regression. Our results show that Ethiopian expatriates made up 7.9% of all admissions over a 10-year period, had a mean length of hospital stay of almost 20 days, with 98.1% of them being female, 92.8% being domestic workers, 90.1% having a language barrier, 57.4% being single and 55.5.% having one or more recent stressors prior to admission. The most common diagnoses were acute stress reaction (31.6%), psychosis (29.3%), bipolar disorder (14.8%) and adjustment disorder (11.0%). Work-related stress, termination of employment and several clinical factors significantly predicted length of stay in hospital.

The Utility of CYP2D6 and CYP2C19 Variants to Guide Pharmacological Treatment in Complex Unipolar Major Depression: A Pilot Longitudinal Study.

Major depression is a frequent condition which variably responds to treatment. In view of its high prevalence, the presence of treatment resistance in major depression significantly impacts on quality of life. Tailoring pharmacological treatment based on genetic polymorphisms is a current trend to personalizing pharmacological treatment in patients with major depressive disorders. Current guidelines for the use of genetic tests in major depression issued by the Clinical Pharmacogenomics Implementation Consortium (CPIC) are based on CYP2D6 and CYP2C19 polymorphisms which constitute the strongest evidence for pharmacogenomic guided treatment. There is evidence of increased clinical response to pharmacological treatment in major depression although largely in non-treatment resistant patients from Western countries. In this study, well characterised participants (N = 15) with complex, largely treatment resistant unipolar major depression were investigated, and clinical improvement was measured at baseline and at week-8 after the pharmacogenomics-guided treatment with the Montgomery Åsberg Depression Rating Scale (MÅDRS). Results suggested a statistically significant improvement (p = 0.01) of 16% at endpoint in the whole group and a larger effect in case of changes in medication regime (28%, p = 0.004). This small but appreciable effect can be understood in the context of the level of treatment resistance in the group. To our knowledge, this is the first study from the Middle East demonstrating the feasibility of this approach in the treatment of complex major depressive disorders.

Use of endoscopic submucosal dissection or full-thickness resection device to treat residual colorectal neoplasia after endoscopic resection: a multicenter historical cohort study.

INTRODUCTION : Residual colorectal neoplasia (RCN) after previous endoscopic mucosal resection is a frequent challenge. Different management techniques are feasible including endoscopic full-thickness resection using the full-thickness resection device (FTRD) system and endoscopic submucosal dissection (ESD). We aimed to compare the efficacy and safety of these two techniques for the treatment of such lesions. METHODS : All consecutive patients with RCN treated either using the FTRD or by ESD were retrospectively included in this multicenter study. The primary outcome was the R0 resection rate, defined as an en bloc resection with histologically tumor-free lateral and deep margins. RESULTS : 275 patients (median age 70 years; 160 men) who underwent 177 ESD and 98 FTRD procedures for RCN were included. R0 resection was achieved in 83.3 % and 77.6 % for ESD and FTRD, respectively (P = 0.25). Lesions treated by ESD were however larger than those treated by FTRD (P < 0.001). The R0 rates for lesions of 20-30 mm were 83.9 % and 57.1 % in the ESD and FTRD groups, respectively, and for lesions of 30-40 mm were 93.6 % and 33.3 %, respectively. On multivariable analysis, ESD procedures were associated with statistically higher en bloc and R0 resection rates after adjustment for lesion size (P = 0.02 and P < 0.001, respectively). The adverse event rate was higher in the ESD group (16.3 % vs. 5.1 %), mostly owing to intraoperative perforations. CONCLUSION: ESD is effective in achieving R0 resection for RCN whatever the size and location of the lesions. When residual lesions are smaller than 20 mm, the FTRD is an effective alternative.

Can Cotard Syndrome Be Induced?: Illustration With a Rare Case of Potential Organ Transplant.

ABSTRACT: Cotard syndrome is a rare condition characterized by delusions ranging from a belief that one has lost organs to insisting that one has lost one's soul or is dead. This is the report a case of a 45-year-old man who was comatose after an attempted suicide. This was initially diagnosed as brain death and use of his organs for transplantation was actively considered. However, he awakened days later with new-onset Cotard syndrome. It remains difficult to know the link, unconscious or conscious, between this patient's delusions and the fleeting intention of doctors who intended to transplant his organs. This is the first description of a coincidence between delusional denial of an organ and the potential medico-surgical act of having an organ removed. This case is an opportunity to revisit the philosophical concepts of negation and nihilism. A multidisciplinary reflection is needed to give meaning to other clinical presentations.

Patterns and factors associated with consulting traditional healers on the care pathway of psychiatric patients in the United Arab Emirates.

BACKGROUND: Despite the availability of mental health services in the United Arab Emirates (UAE), reluctance in seeking a mental health professional is widely prevalent. In many countries, psychiatric patients consult Traditional Healers (THs) prior to seeing mental health professionals. Data from the UAE on the pattern of consulting THs is limited. AIMS: To investigate patterns and factors for visiting THs in psychiatric patients in Abu Dhabi, the capital of UAE. METHOD: We conducted a cross-sectional study of patients attending the adult psychiatry clinic, Maudsley Health, Abu Dhabi. We assessed 214 patients for the pattern and possible factors for contact with THs on their pathway to psychiatric care. RESULTS: There were 58 males and 156 females. Most (43.5%) had a depressive disorder. Prior to consulting a mental health professional, 28% had seen a TH, of whom 36.7% had only one visit and 60% had seen only one TH. Advice from a friend or family member was the commonest reason for consulting THs (81.7%). Envy was the commonest explanation given by THs for symptoms (26.7%). Female gender and having a high school education or less significantly predicted contact with THs. CONCLUSIONS: Almost a third of our sample consulted THs prior to seeking psychiatric care. Closer collaboration with THs could help bridge the gap with psychiatrists to avoid delays in patients accessing psychiatric care, however caution is needed to mitigate the possible negative effects of such a collaboration.

Beyond antipsychotics: the role of medication and nonmedication factors in female sexual dysfunctions in schizophrenia.

To date, few studies have investigated male sexual dysfunctions (FSDs) in schizophrenia in non-Western countries, with most studies focusing on the sexual side effects of antipsychotic medications. Therefore, we aimed to screen for FSD in a sample of Egyptian females with schizophrenia, compare them to controls and to investigate demographic and clinical parameters associated with FSD. We conducted a cross-sectional study of 72 medicated and unmedicated females with schizophrenia (27 unmedicated and 45 medicated) and 24 controls. They were assessed using the Female Sexual Function Index (FSFI) and data were collected for demographic and clinical parameters. We found that females with schizophrenia had significantly lower scores on the FSFI compared to controls and that 93.1% of females with schizophrenia reached the threshold for FSD (FSFI score ≤26), compared to 87.5% of controls. Medicated and unmedicated subjects did not differ significantly in most domains of the FSFI. Age, duration of illness, positive and negative syndrome Scale total, positive and negative symptom scores correlated significantly with the majority of domains of the FSFI. Rates of FSD are very high in both schizophrenia and controls and correlate in schizophrenia with a number of demographic and clinical parameters, suggesting that FSDs are not restricted to the side effects of medications. There is a need to screen for sexual function in routine practice, and for developing active strategies to tackle sexual dysfunctions.

Mental health, wellbeing and burnout among medical students in the United Arab Emirates.

BACKGROUND: Medical students tend to experience high levels of stress during their studies, that can result in mental health disorders and burnout, further affecting academic performance and later ability to practice. AIMS: To investigate previous and current mental health issues, significant sources of stress, burnout, and substance use among medical students in the United Arab Emirates (UAE). METHOD: We conducted an online survey to collect data on demographics, sources of stress, mental health problems, burnout, and substance use in 385 medical students from the UAE University. We used the Oldenburg Burnout Inventory (OLBI), the General Health Questionnaire 12 (GHQ-12), and the CAGE questionnaire. RESULTS: Our results indicated that 5.7% of participants had been diagnosed with a mental health condition prior to joining medical school, and that 21.6% of participants were diagnosed with a mental illness while in medical school. On the OLBI, 77.4% screened positive for burnout (81.3% for disengagement and 95.1% for exhaustion), with 74.5% screening positive for mental health difficulties on the GHQ-12 and <1% screening positive on the CAGE for problem drinking. There was a statistically significant positive correlation between scores on the OLBI and the GHQ-12. CONCLUSIONS: Our study indicated that high levels of stress, burnout and mental illness are experienced among medical students in the UAE.

Repetitive transcranial magnetic stimulation (rTMS) is associated with increased abstinence in substance use disorders and comorbid depression.

BACKGROUND: Substance use disorders (SUDs) are associated with high rates of comorbid depression. Finding effective treatments for many of the substances of abuse is still an area of developing research. Repetitive transcranial magnetic stimulation (rTMS) is an established treatment for depression, but its effects in SUDs are less conclusive. Therefore, we aimed to investigate the effect of rTMS in patients with SUDs and comorbid major depressive disorder (MDD). METHODS: We conducted a retrospective observational study of 55 patients with SUDs and comorbid MDD who were eligible for rTMS. Craving was measured using the Brief Substance Craving Scale (BSCS). Severity of MDD was measured using the Clinical Global Impression-Severity (CGI-S) scale. RESULTS: We found a statistically significant difference between baseline and posttreatment scores in patients receiving rTMS on both CGI-S scores and BSCS scores. The number of rTMS sessions significantly predicted increased days of abstinence in the community, even after controlling for confounders. CONCLUSIONS: Patients with SUDs and MDD who received rTMS significantly improved in the areas of severity of depression and craving. The number of rTMS sessions significantly predicted increased abstinence.

Frequency of illness anxiety (hypochondriasis) by proxy encountered by doctors in parents towards their children.

BACKGROUND: Illness anxiety disorder is a condition of having a persistent fear of having a serious or life-threatening illness despite few or no symptoms. Current classification systems assume that illness anxiety is experienced relative to one's own health, and not towards others ("by proxy"), yet it has been observed to occur in parents towards their children. This study was designed to survey doctors about how commonly they encounter illness anxiety by proxy (IAP). METHODS: We conducted a qualitative survey of 149 physicians who work with children (pediatricians, psychiatrists, and general practitioners) from the United Arab Emirates (UAE) and Egypt. The survey was administered via email and a paper-based form. In the UAE, 108 physicians were emailed the survey; 55 (50.1%) responded. For the email survey we used items from the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). An additional 100 physicians were surveyed in person; 94 (94%) responded. RESULTS: Nearly all respondents (98.7%) reported having encountered IAP in parents. Of these, 51 (34.2%) reported frequently encountering these types of health anxieties, and 50 (33.6%) reported that the parents' concern that their child had a serious disease persisted despite reassurance and appropriate medical evaluation. Seventy-eight (52.3%) respondents reported that exaggeration of actual existing symptoms was the most common reason for parents' fears; 72 (48.3%) reported that the concerned parent was more likely to be the mother; and 36 (24.2%) reported that most parents were not 100% certain of their own beliefs. CONCLUSIONS: IAP is frequently encountered by pediatricians, psychiatrists, and general practitioners. Practitioners who work with children and their parents need to be aware of this phenomenon to provide appropriate support and treatment. More research is needed to screen for the extent and severity of this phenomenon.

Decreased acylated and total ghrelin levels in bipolar disorder patients recovering from a manic episode.

BACKGROUND: To date, only few studies have investigated ghrelin levels in bipolar disorders, and all have exclusively measured acylated ghrelin, with none investigating total ghrelin (acylated and des-acylated). We aimed to investigate peripheral levels of acylated and total ghrelin in subjects experiencing a manic episode of bipolar disorder. METHODS: Peripheral levels of acylated and total ghrelin were measured in hospitalised medicated individuals recovering from a manic episode. Enzyme-linked immunosorbent assays (ELISA) were used to measure ghrelin levels in patients and compared with healthy controls. The relationship between ghrelin levels in bipolar disorder, self-reported hunger measures, demographic and clinical parameters was investigated with correlational analyses. RESULTS: Twenty-four subjects (15 males, 9 females) recovering from mania and 27 matched healthy controls (13 males, 14 females) were recruited for the study. Mean values of both acylated (187 vs.520 pg/mL) and total ghrelin (396 vs. 648 pg/mL) were significantly reduced in bipolar disorder (p = 0.001). Ghrelin levels correlated positively with markers of illness severity and negatively with prescribed mood stabilizers, second-generation antipsychotics, weight and body mass index. CONCLUSION: Peripheral measurements of acylated and total ghrelin were both reduced in bipolar disorder patients compared to healthy controls. Whilst illness severity promotes higher ghrelin levels, pharmacological treatment and weight gain exercise the opposite effect.

Transient Elastography Accurately Screens for Compensated Advanced Chronic Liver Disease in Patients With Ongoing or Recent Alcohol Withdrawal.

BACKGROUND & AIMS: Liver stiffness measurement by transient elastography (TE) is a promising method for staging fibrosis in alcohol-related liver disease, but uncertainties remain regarding the influence of alcohol consumption and thus the ideal timing for TE performance. We evaluated the performance of TE compared with liver biopsy to exclude compensated advanced chronic liver disease (cACLD) in patients hospitalized for alcohol detoxification. METHODS: Patients were recruited prospectively at 6 in-patient addiction centers in France. Eligible patients had increased aspartate aminotransferase levels, and no history or signs of overt cirrhosis. TE, histology, and biochemistry measurements were obtained within a median of 6 days after alcohol withdrawal. TE and biochemistry were repeated 1 and 2 months later. RESULTS: The study included 259 patients for per-protocol analysis, of whom 45 (17%) had cACLD. TE identified patients with high accuracy at inclusion and at the 1- and 2-month follow-up evaluation, with area under the curve values of 0.96 (95% CIs, 0.94-0.99), 0.96 (95% CIs, 0.92-0.99), and 0.93 (95% CIs, 0.85-1.00), respectively. In 84% of patients, cACLD was ruled out when liver stiffness was less than 10 kPa (negative predictive value, 99% (95% CIs, 98%-100%)) or ruled in when greater than 25 kPa (positive predictive value, 93% (95% CI, 83%-102%)). Algorithms based on aminotransferase levels and/or bilirubin did not add to the diagnostic performance of TE in this period. Among patients with initial liver stiffness of 10 to 25 kPa, more than half of those with no cACLD showed liver stiffness of less than 10 at 1- and 2-month follow-up testing. CONCLUSIONS: TE performed during the first 2 months after alcohol cessation is an excellent method for excluding alcohol-related cACLD. CLINICAL TRIAL NUMBER: NCT01789008.

More than just anti-NMDAR: the many facets of autoimmune encephalitis.

This editorial expands on a Praxis article published by Beattie and colleagues in the trainees' section of this journal. The authors describe an interesting case of anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis, outline the clinical presentation and make suggestions on ways to approach this rare disorder. Here we provide an overview of autoimmune conditions that result in the production of autoantibodies targeting central nervous system proteins mediating autoimmune encephalitis and offer a perspective on approaches to diagnosis and treatment.

Pattern of psychiatric in-patient admissions in Al Ain, United Arab Emirates.

An understanding of the current state of mental health services in the United Arab Emirates (UAE) from a clinical perspective is an important step in advising government and stakeholders on addressing the mental health needs of the fast-growing population. We conducted a retrospective study of data on all patients admitted to a regional psychiatric in-patient unit between June 2012 and May 2015. More Emiratis (UAE nationals) were admitted compared with expatriates. Emiratis were diagnosed more frequently with substance use disorders and expatriates with stress-related conditions. Psychotic and bipolar disorders were the most common causes for admission and had the longest in-patient stays; advancing age was associated with longer duration of in-patient stay.

Validation of the Mini-Addenbrooke's Cognitive Examination in Mild Cognitive Impairment in Arabic Speakers.

INTRODUCTION: Mild cognitive impairment (MCI) represents a target for early detection and intervention in dementia, yet there is a shortage of validated screening tools in Arabic to diagnose MCI. The mini-Addenbrooke's Cognitive Examination (m-ACE) is a brief cognitive battery that is scored out of 30 and can be administered in under 5 min providing a quick screening tool for assessment of cognition. OBJECTIVE: We aimed to validate the m-ACE in Arabic speakers in Egypt with MCI to provide cut-off scores. METHODS: We included 24 patients with MCI and 52 controls and administered the Arabic version of the m-ACE. RESULTS: There was a statistically significant difference (p < 0.0001) on the total m-ACE score between MCI patients (mean 18.54, SD 3.05) and controls (mean 24.54, SD 2.68). There was also a statistically significant difference between MCI patients and controls on the total score and the fluency, visuospatial, and memory recall sub-scores of the m-ACE (p < 0.05). Performance on the m-ACE significantly correlated with both the Mini-Mental State Examination (MMSE) and the Addenbrooke's Cognitive Examination-III (ACE-III). Using a receiver operator characteristic curve, the optimal cut-off score for MCI on the m-ACE total score was 21 out of 30 (87.5% sensitivity, 84.6% specificity, and 85.5% accuracy). CONCLUSIONS: We validated the Arabic m-ACE in Egyptian patients with MCI and provided objective validation of it as a screening tool for MCI, with good sensitivity, specificity, and accuracy that is comparable to other translated versions of the m-ACE in MCI.

Atomoxetine in Attention-Deficit/Hyperactivity Disorder in Children With and Without Comorbid Mood Disorders.

Objectives: Mood disorders are commonly associated with attention-deficit/hyperactivity disorder (ADHD), adding to the clinical complexity. Some symptoms associated with ADHD are often associated with an increase in emotional disorders and depression. Hence, the management of comorbid mood symptoms in the context of ADHD represents a particularly difficult clinical challenge. Few studies in literature, and probably none in the Arab world, have investigated the impact of individual common comorbid disorders on the efficacy of atomoxetine (a nonstimulant norepinephrine reuptake inhibitor) as a monotherapy for the treatment of these comorbid mood symptoms. Therefore, our aim was to investigate the effect of atomoxetine in a sample of drug-naive Egyptian children with ADHD, with and without comorbid mood disorders. Methods: A prospective, naturalistic, open-label study. Results: Atomoxetine is an effective treatment for the symptoms of ADHD in the presence of comorbid mood disorder, but with a slower rate of improvement than if applied in the absence of mood disorder; in addition, our study showed improvement regarding the depressive symptoms in the mood group after 1 month. Conclusions: The study highlighted that atomoxetine is an effective treatment for ADHD in the presence of comorbid mood disorder, and improves depressive symptoms in the mood group. It also predicts mild resistance to the effects of atomoxetine on ADHD with slower improvement than those with ADHD only.