Policy and legislation for the treatment of mental health and substance use disorders in Qatar.

There is a marked paucity of publications on the policy and legislation of mental health, and substance use disorders in the public domain in Qatar. Qatar National Vision provides a framework for national strategies and the State of Qatar has developed policies and legislation dedicated to mental health and substance use. In doing so, Qatar has adopted international guidance to shape its mental health services and relevant policy and legislation. This article is a narrative description of the evolution of the mental health and substance use policy and legislation in Qatar.

Impact of COVID-19 on ECT Practice in Qatar.

There is paucity of Electroconvulsive therapy (ECT) utilization surveys from the Arabian Gulf region and none available from Qatar. There is no literature available on impact of Coronavirus Disease 2019 (COVID-19) pandemic on ECT provision. ECT is a lifesaving treatment in psychiatric practice requiring anesthetic support and there were concerns that redeployment of anesthetists due to COVID-19 pandemic might have comparatively bigger impact on the provision of ECT. These concerns stem from the fact that psychiatric patients often get discriminated against in health care systems; largely due to stigma and the belief among healthcare providers that psychiatric illness is somehow not as serious as other types of medical or surgical illness. In this brief report we present pre-COVID ECT utilization from Qatar. We also report findings on ECT utilization during COVID-19 and compare changes with other elective and non-elective surgeries. ECT provision was down by 40% during March to August 2020 in our setting. The decline in ECT provision was comparable to other elective and non-elective surgeries.

Chronic neuropsychiatric sequelae of SARS-CoV-2: Protocol and methods from the Alzheimer's Association Global Consortium.

Introduction: Coronavirus disease 2019 (COVID-19) has caused >3.5 million deaths worldwide and affected >160 million people. At least twice as many have been infected but remained asymptomatic or minimally symptomatic. COVID-19 includes central nervous system manifestations mediated by inflammation and cerebrovascular, anoxic, and/or viral neurotoxicity mechanisms. More than one third of patients with COVID-19 develop neurologic problems during the acute phase of the illness, including loss of sense of smell or taste, seizures, and stroke. Damage or functional changes to the brain may result in chronic sequelae. The risk of incident cognitive and neuropsychiatric complications appears independent from the severity of the original pulmonary illness. It behooves the scientific and medical community to attempt to understand the molecular and/or systemic factors linking COVID-19 to neurologic illness, both short and long term. Methods: This article describes what is known so far in terms of links among COVID-19, the brain, neurological symptoms, and Alzheimer's disease (AD) and related dementias. We focus on risk factors and possible molecular, inflammatory, and viral mechanisms underlying neurological injury. We also provide a comprehensive description of the Alzheimer's Association Consortium on Chronic Neuropsychiatric Sequelae of SARS-CoV-2 infection (CNS SC2) harmonized methodology to address these questions using a worldwide network of researchers and institutions. Results: Successful harmonization of designs and methods was achieved through a consensus process initially fragmented by specific interest groups (epidemiology, clinical assessments, cognitive evaluation, biomarkers, and neuroimaging). Conclusions from subcommittees were presented to the whole group and discussed extensively. Presently data collection is ongoing at 19 sites in 12 countries representing Asia, Africa, the Americas, and Europe. Discussion: The Alzheimer's Association Global Consortium harmonized methodology is proposed as a model to study long-term neurocognitive sequelae of SARS-CoV-2 infection. Key Points: The following review describes what is known so far in terms of molecular and epidemiological links among COVID-19, the brain, neurological symptoms, and AD and related dementias (ADRD)The primary objective of this large-scale collaboration is to clarify the pathogenesis of ADRD and to advance our understanding of the impact of a neurotropic virus on the long-term risk of cognitive decline and other CNS sequelae. No available evidence supports the notion that cognitive impairment after SARS-CoV-2 infection is a form of dementia (ADRD or otherwise). The longitudinal methodologies espoused by the consortium are intended to provide data to answer this question as clearly as possible controlling for possible confounders. Our specific hypothesis is that SARS-CoV-2 triggers ADRD-like pathology following the extended olfactory cortical network (EOCN) in older individuals with specific genetic susceptibility.The proposed harmonization strategies and flexible study designs offer the possibility to include large samples of under-represented racial and ethnic groups, creating a rich set of harmonized cohorts for future studies of the pathophysiology, determinants, long-term consequences, and trends in cognitive aging, ADRD, and vascular disease.We provide a framework for current and future studies to be carried out within the Consortium. and offers a "green paper" to the research community with a very broad, global base of support, on tools suitable for low- and middle-income countries aimed to compare and combine future longitudinal data on the topic.The Consortium proposes a combination of design and statistical methods as a means of approaching causal inference of the COVID-19 neuropsychiatric sequelae. We expect that deep phenotyping of neuropsychiatric sequelae may provide a series of candidate syndromes with phenomenological and biological characterization that can be further explored. By generating high-quality harmonized data across sites we aim to capture both descriptive and, where possible, causal associations.

Characteristics of 100 consecutive patients with COVID-19 referred to consultation-liaison psychiatry services in Qatar: A comparison of patients with delirium versus other psychiatric diagnoses.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) can present with various neuropsychiatric manifestations. This study reports on patients with COVID-19 who were referred to the consultation-liaison (CL) psychiatry services in Qatar and compares the clinical and sociodemographic characteristics of those diagnosed with delirium versus other psychiatric diagnoses. METHODS: This is a retrospective review of the first 100 consecutive patients with COVID-19 who were referred to the CL services. RESULTS: Within the total cohort (n=100), most patients (92%) were male, and the mean age was 46 years. About 27% of patients had asymptomatic COVID-19, 35% had a past psychiatric history, and 48% reported pandemic related psychosocial stress. Delirium was the most common psychiatric diagnosis (n=29), followed by acute stress reaction/adjustment disorder, depression, mania, anxiety, non-affective psychosis, and dementia. Among patients with delirium, agitation was the most common symptom (76%), 86% were treated with psychotropic medications, and 17% died. Higher age, longer hospital stays, lower oxygen saturation, lower lymphocytic count, and higher C-reactive protein (CRP) values were significantly associated with delirium versus other psychiatric diagnoses. Higher age and lower oxygen saturations predicted delirium. CONCLUSION: Delirium was associated with a range of clinical variables and had significant mortality, despite the relatively young age of the patients. COVID-19 should be considered in patients presenting with delirium. Finally, early identification and management of delirium should be integral to COVID-19 protocols.

Clozapine prescribing practice and trends in Qatar: First national observational study.

BACKGROUND: Clozapine is the gold standard in the management of treatment-resistant schizophrenia. Despite its clinically proven efficacy clozapine utilization is variable globally and published evidence is suggestive of its underutilization. Research from the Arab region on clozapine utilization is limited. The aim of our descriptive observational study was to evaluate the prescribing practice of clozapine and its sociodemographic and clinical corelates in the State of Qatar. METHODS: The study is a retrospective case-note review of all patients maintained on clozapine, in the calendar year 2020. Data were collected on sociodemographic characteristics of the patients; antipsychotic trials before initiating clozapine; and clinical characteristics of the patients, including their diagnoses leading to prescription of clozapine, duration of illness, psychiatric hospitalizations, and co-morbidities. RESULTS: During the study period, 100 patients were maintained on clozapine. Patients were mostly Qatari and non-Qatari Arab males. Prescription rates were significantly different for Qatari patients when compared to non-Qatari patients. Most patients had a chronic illness with the age of onset of illness in early adulthood and were diagnosed with schizophrenia or schizoaffective disorder. The mean daily dose of clozapine was 325 mg. Eighty percent of the patients received two or more antipsychotic trials before initiating clozapine. Sixty-eight percent of the patients had more than two antipsychotic trials before initiating Clozapine. One third of patients had no history of psychiatric hospitalizations, and one quarter had five or more previous psychiatric hospitalizations. Of the psychiatric comorbidities, mood and substance use disorders were common. Of medical comorbidities, endocrine and metabolic disorders were common. CONCLUSION: Despite apparent underutilization, the Clozapine prescribing rates in Qatar are comparable to countries with plasma monitoring systems when framed within Qatar's unique demographic context. However, there still is a significant delay in Clozapine initiation despite its clinical superiority. STRENGTHS AND LIMITATIONS OF THIS STUDY: First study on Clozapine utilization from the Middle-East and North-Africa region. This study examined prescribing of clozapine in a national cohort of patients in Qatar. Provides insight into sociodemographic and clinical correlates of clozapine prescribing in a country with 90% migrants. Limited by the completeness of the information contained in the patients' medical charts.

The Impact of COVID-19 Pandemic on Individuals With Pre-existing Obsessive-Compulsive Disorder in the State of Qatar: An Exploratory Cross-Sectional Study.

Background: Published evidence about the impact of the COVID-19 pandemic on Obsessive-Compulsive Disorder (OCD) is conflicting. Most studies suggest an increase in the severity of OCD in people with pre-existing OCD, whereas some do not. Aim: Given the conflicting evidence globally and lack of data from the Arab world, we aimed to explore the impact of the pandemic on obsessive-compulsive symptoms in adults with pre-existing OCD. Methods: A telephonic questionnaire-based cross-sectional study among adults with pre-existing OCD and specifically with fear of contamination and washing compulsions being major symptom dimensions of OCD. The severity of OCD during the pandemic was compared with their pre-pandemic scores. The severity of OCD was assessed using the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Results: Those with the duration of diagnosis of OCD of<10 years showed a statistically significant increase in the mean YBOCS score of 5.54 from pre-pandemic to during pandemic, which was significant at p = 0.006. This significance was maintained across the Compulsive and Obsessive subsets of the scale. Conclusion: Adults with pre-existing OCD with fear of contamination reported a statistically significant increase in severity of obsessive-compulsive symptoms only if the duration of their OCD diagnosis was relatively shorter (<10 years). In the context of the conflicting evidence regarding the worsening of OCD symptoms due to the unique infection control measures of this pandemic, this study highlights the importance of the impact of the duration of the disorder and the subtype of the disorder. Such classification might help public health resources to be directed better at those most at risk and also help us understand the very nature of this disorder better.

Transitional Care Initiative within Mental Health Services in Qatar: Description and Evaluation of an Innovative Care Model.

The importance of effective health care transitioning of young people from adolescent to adult health services is well established in general and within mental health services in particular. There is no previous literature focusing on the implementation of the transitional care model within mental health services in the Arabian Gulf region. We outline details of how the international best practice of effective transitioning of young people from Child and Adolescent to Adult mental health services was adopted and implemented in the State of Qatar. The impact of this crucial initiative on patient care and service delivery is also explained.

Mental health research in the Arab region in response to the COVID-19 pandemic: a scoping review.

Background: The ongoing pandemic has led to a global surge in coronavirus disease 2019 (COVID-19)-related mental health research. However, most related publications come from Western countries or China, and their findings cannot always be extrapolated to Arab countries. Aims: This study provides a quantitative and qualitative analysis of mental health research pertaining to Arab countries' response to the COVID-19 pandemic. Methods: A scoping review of the World Health Organization (WHO) COVID-19 database for publications on mental health was conducted by authors affiliated with Arab institutions, including articles from inception to 24 October 2020. The included publications were evaluated for their national distribution, international collaboration, publication type, and main research themes. Methodological quality analysis of the included research studies was performed using the original and modified versions of the Newcastle-Ottawa Scale. Results: In total, 102 articles were included in this study, averaging 4.6 articles per Arab country. Most of the articles emerged from the Kingdom of Saudi Arabia, Jordan, and Egypt. A majority of publications demonstrated international collaboration. Most of the publications were original research studies and cross-sectional in design. The predominant research theme was examining the pandemic's mental health effects on the general population and healthcare workers. Only 28.0% of the studies were of high methodological quality, whereas 41.5% were moderate and 30.5% were low in quality. Conclusions: Mental health research in response to the COVID-19 pandemic in the Arab region has quantitative and qualitative shortfalls. Arab institutions need to respond to the pandemic promptly in order to address the delineated research gap and to generate higher-quality research output.

Why mental health service delivery needs to align alongside mainstream medical services.

There is significant individual human suffering and economic burden because of untreated mental health and substance use disorders. There is high psychiatric morbidity in primary and secondary medical care. At least one-fifth of patients attending primary care services in western countries pertain to mental health and one-third of patients attending general hospitals have a comorbid mental disorder. Patients with mental disorders have lower life expectancy than the general population due to various medical conditions and reduced access to physical healthcare. There is a suicide every 40 seconds and the vast majority of those who die by suicide have a diagnosable mental disorder. Despite this, most countries spend less than 2% of their health budgets on mental health. Effective treatments exist for mental disorders, however underfunding, poor integration of services, lack of trained health care professionals and stigma often prevent access to effective treatments. Stigma is a significant barrier to seeking help and receiving treatment. Geographical separation of mental health services from general hospital settings may be perpetuating the stigma of mental illness among the population. In this article, we review the key reasons why mental health services globally need to align with mainstream healthcare services and the longstanding reasons that necessitate the need to make mental health a public health priority.

Redeployment of psychiatrist trainees during the COVID-19 pandemic: evaluation of attitude and preparedness.

Background: The coronavirus disease-2019 (COVID-19) pandemic has imposed an unprecedented strain on healthcare systems worldwide. In response, psychiatrist trainees were redeployed from their training sites to help manage patients with COVID-19. This study aimed to examine the attitude of psychiatrist trainees toward redeployment to COVID-19 sites and their perceived preparedness for managing physical health conditions during redeployment. Methods: A cross-sectional researcher-developed online survey was administered among psychiatrist trainees in May 2020 at the Department of Psychiatry, Hamad Medical Corporation, Qatar. Results: Of the 45 psychiatrist trainees, 40 (88.9%) responded to the survey. Most trainees reported being comfortable dealing with chronic medical conditions, but less so with acute life-threatening medical conditions. Half reported feeling anxious about redeployment, and most felt the need for additional training. We found that trainees' perceived redeployment preparedness was significantly associated with their level of postgraduate training and the time since and duration of their last medical or surgical training. Conclusion: Adequate preparation and training of psychiatrist trainees is important before redeployment to COVID-19 sites to ensure that they can effectively and safely manage patients with COVID-19.

Mania and hypomania associated with COVID-19: a series of 15 cases seen by the consultation-liaison psychiatry service in Qatar.

BACKGROUND: A range of neuropsychiatric diagnoses have been reported in association with coronavirus disease 2019 (COVID-19). However, only sporadic cases of mania or hypomania have been reported in patients with COVID-19. This study aimed to report clinical characteristics of 15 consecutive cases of COVID-19-associated mania or hypomania seen in three general hospitals in Qatar in the early months of the pandemic in 2020. METHODS: This study is a retrospective case-note review of 15 cases of COVID-19-associated mania or hypomania (confirmed by polymerase chain reaction test), seen as inpatient consultations out of the first 100 consecutive patients managed by consultation-liaison psychiatric teams in Qatar between 2 March 2020 and 7 July 2020. RESULTS: The mean age of the 15 patients was 40 years. Twelve patients had mania, and three had hypomania. Regarding the physical severity of COVID-19, 10 patients were asymptomatic, two had upper respiratory tract symptoms alone and three had pneumonia. None of the patients were intubated. Potential risk factors for mania/hypomania included pandemic-related psychosocial stress before admission (n = 9), past history of mania/bipolar disorder (n = 6) or psychosis (n = 2), raised inflammatory markers (n = 7) and steroid use (n = 3). None had a history of recent substance misuse. Other than one patient with advanced cancer, none had comorbidity regarded as likely to have caused mania or hypomania. Three patients had mild white matter ischaemic changes on brain imaging. Standard pharmacological treatment for mania (i.e. antipsychotic medication supplemented by prn benzodiazepines) was effective. Ten patients were discharged home from the COVID-19 facility where they presented, but five required transfer to Qatar's psychiatric hospital for further treatment of mania. CONCLUSION: The association of mania or hypomania with COVID-19 may be spurious (e.g. representing an initial presentation of bipolar disorder) or causal. The reported cases illustrate a range of potential aetiological mechanisms by which COVID-19 could cause mania or hypomania. Cohort studies are necessary to determine the incidence, aetiology and prognosis of COVID-19-associated mania/hypomania.

The COVID-19 pandemic: an opportunity to make mental health a higher public health priority.

Coronavirus disease 2019 (COVID-19) was first recognised in December 2019. The subsequent pandemic has caused 4.3 million deaths and affected the lives of billions. It has increased psychosocial risk factors for mental illness including fear, social isolation and financial insecurity and is likely to lead to an economic recession. COVID-19 is associated with a high rate of neuropsychiatric sequelae. The long-term effects of the pandemic on mental health remain uncertain but could be marked, with some predicting an increased demand for psychiatric services for years to come. COVID-19 has turned a spotlight on mental health for politicians, policy makers and the public and provides an opportunity to make mental health a higher public health priority. We review longstanding reasons for prioritising mental health and the urgency brought by the COVID-19 pandemic, and highlight strategies to improve mental health and reduce the psychiatric fallout of the pandemic.

Improving referrals from primary care to secondary mental health services through an educational intervention: experience from Qatar.

Primary care is geared to manage patients with mild to moderate presentations of common mental disorders and to refer patients with more severe mental disorders to specialist mental health services. With growing demand for specialty care, the quality of the referral is increasingly important to ensure efficient patient flow across the primary/secondary care interface and appropriate use of secondary services. We report on an initiative in a Qatari mental health clinic to improve the quality of referrals from primary care to specialist mental health services through an educational intervention for family physicians. We highlight the problem, the intervention and the outcome of our initiative, which was the first of its kind in the region. The number of inappropriate referrals fell by 93%, and the number of referrals with inadequate clinical information declined from 15 (January 2019) to 1 (September 2019). Feedback was very positive; respondents reported feeling supported, with better understanding of care pathways, the scope of primary care and mental health services.

Primary care mental health services in Qatar.

With rapid growth and development in recent decades, the State of Qatar has been redefining strategies and policies towards building a world-class healthcare system. Mental health has emerged as a priority area for development. As a result, mental health services in the region are being redefined and expanded, and this was realised with the launching of the ambitious National Mental Health Strategy in 2013. Traditionally, mental healthcare in Qatar had been considered to be the remit of psychiatrists within secondary care. The new strategy supported the transition towards community-based care. It outlined a plan to design and build a comprehensive and integrated mental health system, offering treatment in a range of settings. In this article, we provide an overview of the advent of primary care mental health services in Qatar. We discuss the historical aspects of psychiatric care and development of primary care mental health services in Qatar.

Newspaper depiction of mental and physical health in Qatar.

This study provides an overview of the extent, nature and quality of reporting on mental health compared with physical health in Qatari newspapers. We analysed 1274 news reports from daily newspapers in Qatar. The majority of the articles provided general information and were either positive or neutral in tone, reporting purely on physical health matters. A small proportion made associations with violence or reported on suicide or substance use. Our results highlight the underrepresentation of mental health in Qatari newspapers. A collaboration between media and health professionals is recommended to improve reporting on mental health.

Development of mental health services for lower-skilled migrant workers in Qatar.

The largest group of migrants in Gulf Cooperation Council (GCC) countries are lower-skilled migrant workers. GCC countries have witnessed significant healthcare infrastructure investments over recent decades. Despite this, they are lagging to mainstream the mental health needs of lower-skilled migrants into national health policy frameworks. Qatar is one of the GCC countries where lower-skilled migrants constitute 50 per cent of population. In this article,we provide an overview of the development of specialist mental health service for lower-skilled migrants' and discuss the challenges, and measures taken by the State of Qatar to mainstream their health needs into national health policy framework.