An investigation of knowledge and attitudes towards antidepressants: a cross-sectional survey of Jordan's six medical schools.

OBJECTIVE: Depression is Jordan's most ravaging mental illness. Despite the growth of antidepressant use, only a handful of studies examine the factors affecting antidepressant knowledge among healthcare workers or medical students. Therefore, we aimed to explore the knowledge and attitudes towards antidepressants across Jordan's six medical schools. METHODS: Using a cross-sectional design, we investigated the knowledge and attitudes towards antidepressants through the Drug Attitude Inventory and a literature-validated knowledge domain. Clinical students from Jordan's six medical schools were recruited. Differences in knowledge and attitudes scores were examined by year of study, medical school among other factors. A multivariate linear regression model was utilized to assess predictors of knowledge. RESULTS: We included a total of 1,234 participants representing Jordan's six major schools of medicine. About 14.9% of participants had a personal history of antidepressant use while 20.5% reported family history of psychiatric disease. The majority of students demonstrated favorable attitudes towards antidepressants (74.1%). Students demonstrated an average understanding of antidepressants' mechanism of action, side effects, but not indications in special populations. Senior medical students, higher GPA, higher family income, personal history of antidepressants, and family history of psychiatric illnesses were associated with significantly higher knowledge scores (all p-values < 0.001). In addition to attitudes scores, the aforementioned were positive predictors of knowledge scores in the multivariate model. CONCLUSION: Medical students' knowledge towards antidepressants leaves room for significant improvement. Yet, it is evident that significant differences for both attitudes and knowledge exist across medical schools which may indicate a gap in either training or teaching methodology.

Prevalence of anxiety and depressive symptoms in ulcerative colitis patients in Jordan and its relationship to patient-reported disease activity.

Inflammatory bowel disease is associated with higher rates of anxiety and depression compared to the general population. We aimed to determine the prevalence of anxiety and depressive symptoms among patients with ulcerative colitis and correlation to disease activity. In this cross-sectional study, we collected data from 70 consecutive ulcerative colitis patients over one year at our inflammatory bowel disease outpatient clinic through an interview and a questionnaire containing patient demographics and disease characteristics. Anxiety and depressive symptoms were characterized using the Generalized Anxiety Disorder-7 questionnaire and Patient Health Questionnaire-9, respectively, with ulcerative colitis disease severity assessed by the Partial Mayo scoring system. The majority of our patients were females (68.6%) and the mean age was 39.3 years. Rates of anxiety and depressive symptoms among ulcerative colitis patients were 65.7% and 58.6%, respectively. Depressive symptoms were significantly associated with patient-reported disease activity (r = 0.361; p = 0.010). Significant percentages of ulcerative colitis patients were appreciated to have anxiety and depressive symptoms, and there was a correlation between patient-reported disease activity and depressive symptoms. At this high rate of prevalence, it is justified to screen patients for the presence of psychiatric comorbidities.

The Effect of Antipsychotics and Their Combinations with Other Psychotropic Drugs on Electrocardiogram Intervals Other Than QTc among Jordanian Adult Outpatients.

The ECG changes produced by antipsychotics and other psychotropic medications are studied mostly regarding QTc interval prolongation. This study aimed to investigate ECG changes beyond long QTc interval produced by psychotropic medications. A cross-sectional study was conducted to assess the effect of these agents on RR, PR, TpTe intervals and TpTe/QT ratio among Jordanian outpatients. The RR interval was significantly shorter among patients on TCAs versus those not receiving TCAs and among patients on polytherapy versus those on monotherapy (p < 0.05 for both comparisons), when adjusted for age, gender, BMI, caffeine intake, smoking, presence of diabetes mellitus, cardiovascular disease and medications known to produce heart rate changes. Positive correlations were found between the PR interval and age in patients treated with SGAs, SSRIs, citalopram, polytherapy and in the total sample (p < 0.01 for all). Inverse correlations were found between the RR interval and the number of psychotropic medications among patients treated with SSRIs and in the whole study sample (p < 0.01 for both). In conclusion, various ECG changes beyond QTc interval prolongation are observed in patients on antipsychotics and other psychotropic medications, in those on polytherapy. It is recommended to obtain an ECG before starting patients on psychotropic drugs known to produce electrocardiographic changes and their combinations.

The Effect of Psychotropic Medications and Their Combinations on the QTc Interval Among Jordanian Outpatients: A Cross-Sectional Study.

Objective: To investigate the effect of psychotropic drugs and their combinations on the QTc interval as well as the prevalence of long QTc (LQTc) among ambulatory patients with psychiatric illness in Jordan. Methods: A cross-sectional study that included patients treated in an outpatient psychiatric clinic was conducted. The QTc duration was calculated using a combined QT correction (Bazett's formula for heart rate 60-100 and the Framingham formula for extremes of HR). Results: Among 307 patients, about 60% received multiple psychotropic drugs. The LQTc frequency was 1.2%. QTc interval prolongation was observed in patients receiving selective serotonin reuptake inhibitors (SSRIs) (P = .011), tricyclic antidepressants (TCAs) (P = .033), citalopram (P = .044), or psychotropic polytherapy (P = .005). The addition of SSRIs to second-generation antipsychotics (SGAs) also lengthened the QTc interval (P = .029). There was a correlation between the number of psychotropic medications and the QTc length (P = .018). All patients with LQTc carried at least one risk factor for it other than the use of psychotropic medication(s), 3 of 4 patients had a combination therapy, all patients were prescribed SSRIs, and 2 of them had comorbid conditions. Conclusion: There is a high prevalence of psychotropic drugs polytherapy, and it is clearly associated with LQTc. Citalopram, SSRIs, and TCAs prolong QTc interval. It is recommended to assess non-pharmacological factors for LQTc and, if necessary, to obtain an electrocardiogram before starting patients on psychotropic drugs known to prolong the QTc interval.

Sleep Quality in Patients With Type 2 Diabetes Mellitus.

BACKGROUND: This study aims to evaluate the sleep quality in patients with type 2 diabetes mellitus (T2DM), and to assess the relevance of other factors to sleep quality. METHODS: A cross-sectional study was carried out at the National Center for Diabetes, Endocrinology and Genetics (NCDEG) in Amman, Jordan, during the period from October 1, 2015 to December 31, 2015. A total of 1,211 (540 male and 671 female) patients with T2DM were recruited. Data were collected using the Pittsburgh sleep quality index (PSQI) to assess the sleep quality with a cutoff point of PSQI ≥ 8. Participants' demographic background data were also recorded. Statistical analysis was conducted using SPSS version 22. RESULTS: The mean age of our patients was 58.8 ± 9.74 years. Mean body mass index (BMI) was 32.67 ± 6.1 kg/m2, and mean duration of diabetes was 10.3 ± 7.38 years. The mean PSQI score was 10.2 ± 3.10. In the present study, poor sleep quality was reported in 81% of participants. Multivariate logistic regression analysis revealed that poor sleep quality was significantly associated with high HbA1c, female gender, smoking, unemployment, and insulin use. The study showed that subjective sleep quality and quantity, night sleep disturbance, and daytime dysfunction were risk factors for poor glycemic control. CONCLUSIONS: In our series, patients with T2DM (81%) have poor sleep quality. Females, smokers, unemployed individuals, insulin users and patients with uncontrolled diabetes seem to be significantly at higher risk of poor sleep quality.

An ethnographic-feminist study of Jordanian women's experiences of domestic violence and process of resolution.

We interviewed 12 Jordanian women who had experienced domestic violence (DV) and were receiving assistance at the Jordanian Women's Union (JWU). Our aim was to explore the history and factors supporting attainment of freedom from DV. Narratives revealed themes of DV toward girls; forced marriage; physical, psychological, or sexual abuse before and during marriage; and escalation and enduring DV. Escaping from DV required family and JWU support. In the context of a strongly patriarchal, religious society, we observed a process of resolution by shifting cultural values and themes of empowerment, with an undercurrent of suffering blamed on inequalities in the legal process.

Evaluating the mental health of Jordanian women in relationships with intimate partner abuse.

This study evaluated the mental health consequences of abuse among Jordanian women and tested the effectiveness of using cognitive behavioral interventions to change the level of depression and level of stress among Jordanian women experiencing intimate partner abuse (IPA). A mixed methods design using phenomenology and quasi-experimental research data collection and analysis was implemented. The most commonly reported form of abuse was psychological abuse. Prior to cognitive behavioral intervention, participants demonstrated moderate to severe levels of depression, low levels of perceived social support, moderate to high levels of self-efficacy, and used approach coping skills more frequently than avoidance coping. Cognitive behavioral interventions resulted in decreased depression (p = .003) and decreased stress levels, although this finding did not reach significance (p > .05). Cognitive behavioral interventions are effective interventions when working with women experiencing IPA.