Alzheimer's Behavioral and Psychiatric Burden in Saudi Arabia: Validation of the Saudi Version of the Neuropsychiatric Inventory.

BACKGROUND: The burden of behavioral and psychiatric symptoms in dementia (BPSD) has not been characterized in Saudi patients with Alzheimer disease (AD). Moreover, the Saudi version of the Neuropsychiatric Inventory (SNPI) has not been validated. OBJECTIVES: The purpose of this study was to validate the SNPI and describe frequency and determinants of BPSD in Saudi AD patients. METHODS: The SNPI and BEHAVE-AD instruments were administered to community-dwelling Saudi AD patients and their caregivers. RESULTS: The sample size was 192. The first 59 constituted the validation cohort. Cronbach alpha of the SNPI and BEHAVE-AD were 0.91 and 0.79, respectively. There were significant correlations between: (1) the total SNPI and BEHAVE-AD scores ( r =0.84, P <0.001); (2) analogous SNPI and BEHAVE-AD symptom subscores ( P <0.05); (3) SNPI and BEHAVE-AD caregiver distress ( F =22.6, P <0.001). Inter-rater reliability of the SNPI was excellent (kappa=0.74). Ninety percent of patients experienced 4 SNPI symptoms or more. Patients with stroke and prior psychiatric history were most likely to experience BPSDs. The most common symptom was apathy (82%). Caregiver distress was determined by the total NPI score and impulsiveness subscale score. CONCLUSIONS: The SNPI is valid and reliable for assessing BPSD in Saudi AD patients. Longitudinal studies of BPSDs in Saudi specialized dementia clinics are needed.

Mind-Body dualism and medical student attitudes toward mental illness in Saudi Arabia.

BACKGROUND: Philosophical beliefs regarding the origin of mental illness may underlie resistance to psychiatric treatment and affect attitudes toward the mentally ill. AIM: The present study sought to: (1) identify characteristics of medical students who hold mind-brain dualism (MBD) beliefs and (2) determine relationships between MBD beliefs and perceptions of mental illnesses. METHODS: This was a cross-sectional study that asked medical students questions about mind-brain beliefs and religiosity. Three fictitious vignettes (schizophrenia, antisocial personality disorder [APD], and depression) were presented and then students asked about how much participants felt the patients in these scenarios bore responsibility for their illness. A MBD score was calculated to measure MBD beliefs, and a total responsibility score (RS) was used to measure patient blameworthiness. Mediation analysis was used to examine whether MBD beliefs explained the relationship between religiosity and perceived patient responsibility for their illness, and whether this was moderated by gender. RESULTS: The questionnaire was completed by 106 Saudi medical students. The average RS was highest for the APD scenario and lowest for schizophrenia, whereas depression fell intermediate between those two (ANOVA F (1.82, 219.83) = 27.21, P < .001). Religiosity was positively correlated with RS, a relationship that was mediated by MBD in all three vignettes. CONCLUSION: Mind-brain dualism beliefs among medical students in Saudi Arabia were associated with greater perceptions of self-infliction, preventability, controllability, and blameworthiness for patients with mental illness, moderated by gender. Greater emphasis on the neurobiological aspects of psychiatric disorders might help to change this attitude.

Determinants of Health-Related Quality of Life of Epilepsy Patients in Jeddah, Saudi Arabia.

Background Epilepsy puts an enormous burden on the physical and mental health of patients and can negatively impact their Health-Related Quality of Life (HRQoL). Previous studies have identified multiple factors impacting patients' HRQoL; however, a consensus has not been reached, as these factors vary among different populations. This has not been sufficiently investigated in Saudi Arabia. Thus, this study aims to assess the HRQoL of epilepsy patients, as measured by the Quality Of Life In Epilepsy-31 (QOLIE-31) questionnaire, to determine the effects of demographics, disease characteristics, and antiepileptic drugs (AEDs) on patients in Jeddah, Saudi Arabia. Methods This was a cross-sectional, questionnaire-based study of adult epilepsy patients receiving AEDs who followed up at the epilepsy clinic at King Abdulaziz University Hospital between April 2018 and June 2018. Recruited individuals participated by phone interview. Results A total of 200 participants fulfilled our inclusion criteria and consented to participate; 57.4% were males. The average age was 32.8 years. The total average score on the QOLIE-31 was 61.56 (±17.52). QOLIE-31 scores correlated inversely with seizure frequency (p<.000) while the class of medication used, and the number of drugs administered did not correlate with HRQoL. Conclusion Whereas previous work has suggested a better quality of life when using newer generation AEDs, our study found no significant difference between the class of medication and whether monotherapy or polytherapy is used. Our findings suggest that efforts to improve HRQoL should be directed toward proper control of seizures regardless of medication class, as the frequency of attacks has the most detrimental effect on patients' quality of life.

The diagnostic yield of the routine EEG at a tertiary care center in Saudi Arabia: A retrospective study.

BACKGROUND: The Routine Electroencephalography (REEG) records cerebral electrical activity to aid in the diagnosis and classification of Epilepsy. Indiscriminate use of the REEG may lower its clinical yield. The pretest clinical variables contributing to the yield of the REEG outcome have not been well-established in the context of developing healthcare systems where REEG utilization may differ from well-established centers. The aim of this study is to determine the yield of the REEG and the pretest clinical variables predicting the yield of the REEG at a single center in the context of the developing healthcare system in Saudi Arabia. MATERIALS AND METHODS: We reviewed REEG reports at a single center in Jeddah, Saudi Arabia between 2015 and 2018. We collected demographic and clinical data from the patients' electronic files. Patients of age ≥18-year-old were included. We collected age, gender, nationality, the indication for the REEG, co-morbidities, antiseizure medicines (ASMs), and details related to the yield of the REEG (normal or abnormal, epileptiform or non-epileptiform, focality, and the presence of rhythmic or periodic patterns or seizures). RESULTS: We included 500 records. Fifty-nine percent were females. The mean age was 39 ±â€¯17 years. Of the recorded REEGs, 42.4% were abnormal, 14.6% of them showing definite epileptiform discharges and 85.4% showing only slowing. Half of the REEGs of individuals previously diagnosed with epilepsy revealed abnormal findings. ASM use was associated with slowing in the REEG (p < .05). Using logistic regression, history of a previous stroke and use of carbamazepine or lamotrigine were predictors of the presence of abnormalities in the REEG, while use of ≥2 ASMs predicted the presence of epileptiform discharges. Stroke also predicted abnormal slowing alongside increased age. CONCLUSION: The clinical yield of the REEG in this sample of patients from a single institution in the context of a developing healthcare system was relatively low. History of stroke and being on more than one ASM may predict that the REEG will show relevant abnormalities.